The Dr. Hyman Show - The Real Reason For America’s Obesity Crisis And Chronic Disease Epidemic with Dr. David Kessler

Episode Date: April 1, 2020

Only about 12% of Americans are considered “metabolically healthy.” That means the other 88% of us aren’t meeting basic medical guidelines for things like blood pressure, blood glucose, cholesterol, and other markers of metabolic health. Which percentage do you fall into? When it comes to answering that question, one common factor is how many fast carbs you’re consuming. These are the carbohydrates that have been processed—yes, that includes sugar—but it also means starches like refined flours and other processed grains. Whole wheat bread is indeed a fast carb.  This week on The Doctor’s Farmacy I sat down with Dr. David Kessler to break down the differences between fast and slow carbs, how they affect our health, how our diet became so inundated with fast carbs and what we can do to regain metabolic strength. Dr. Kessler served as commissioner of the U.S. Food and Drug Administration under presidents George H. W. Bush and Bill Clinton. He is the author of A Question of Intent and The End of Overeating, a New York Times bestseller. He is a pediatrician and has been the dean of the medical schools at Yale and the University of California, San Francisco. Dr. Kessler is a graduate of Amherst College, the University of Chicago Law School, and Harvard Medical School. This episode is sponsored by AirDoctor and AquaTru. We need clean water and clean air not only to live but to create vibrant health and protect ourselves and loved ones from toxin exposure and disease. That’s why I’m teaming up with AquaTru and AirDoctor to offer you the AquaTru Water Purification System and AirDoctor Professional Air Purifier systems at a special price. Learn more at www.drhyman.com/filter. Here are more of the details from our interview:  Why 87% of Americans are metabolically unhealthy (7:03) What are fast carbs and how do processed carbohydrates affect us? (12:38) The glycemic index of bread is higher than that of table sugar (18:41) How processed carbs made from grains, corn, and wheat became the foundation of our diet (19:34) The food industry’s resistance to clear ingredient lists and labels on food (23:20) What are slow carbs? (26:02) Why we should all be able to get behind the idea of limiting fast carbs (32:00) Dr. Kessler’s own struggle with his weight, our tendency to turn to comfort foods in stressful time, and why it’s so difficult to break the vicious cycle that results from eating fast carb (33:29) The need for additional reform to the government’s dietary guidelines and how regulation differs in its oversight of the food industry vs the tobacco industry (41:08) Industry will follow the consumer (57:39) Dr. David Kessler’s new book is, Fast Carbs, Slow Carbs: The Simple Truth About Food, Weight, and Disease

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Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an F, a place for conversation that matters. And if you care about what's happening to chronic disease in America today, to the incredible struggle that people have with weight, to the challenges of our food supply and how we got here, you're going to love this conversation because it's with one of my idols, Dr. David Kessler, who's a physician, was the commissioner of the U.S. Food and Drug Administration under both Presidents George H.W. Bush and Bill Clinton. He's the author of a number of books, including A Question of Intent and The End of Overeating, which was a New York Times bestseller and was very influential in my understanding of the hyper-palatability of

foods and the way foods are designed to be addictive. He's a pediatrician. He's been the Dean of Medical Schools at Yale and the University of California, San Francisco. He's a graduate of Amherst College where my sister went, but I think he went there a little earlier than her. And he also got a law degree from the University of Chicago Law School and a graduate from Harvard Medical School. So he's been a long time mentor. And even though I've never met him, I've followed his work. I've been inspired by him and how he really calls out some of the challenges of what's happening with our food supply. In his new book, Fast Carbs, Slow Carbs, The Simple Truth About Food, Weight, and Disease

is out now, available everywhere you get your books, on Amazon or your local bookstores, although I imagine those might not be open today in the age of COVID. So welcome, Dr. Kessler. Thanks for having me. A pleasure to be with you. And thanks for the kind introduction. Of course. Well, you're an icon in this field for me. I think you've been able to call out things which I think most people in your position haven't. And you've had the courage to tell the truth about what's really happening in our food supply. And you've witnessed throughout your career, and I certainly have, you're a few years older than I am, the incredible explosion of obesity and heart disease and diabetes and chronic disease globally. And it's staggering. You know, when I graduated from medical school, actually when I was born, the obesity rate in this country

in 1960 was 5%. When I graduated from medical school in 1987, there wasn't a single state that had an obesity rate over 20%. And now most are 40% and the average obesity rate in America is 42%. So how did this happen? And how did our government and the food industry create this national health crisis? Well, I think you've hit the nail on the head. When you look at the data, the fact is only 12.2% of us are metabolically healthy. And that means that some 87% of us don't meet basic medical guidelines for weight, blood glucose, blood lipids, blood pressure. I mean, our bodies are in essence in metabolic chaos. And I think when you really dig deep, you find that for most of us,

the biochemical processes that convert what we eat and drink into energy, that is the real culprit. They put our bodies into metabolic chaos. So what you just said, I have to stop because it's sort of staggering. 12% of Americans are metabolically healthy. That's insane. I mean, how does this happen? How do we go from, you know, when I remember growing up in the 60s and 70s, you know, there wasn't this problem. I mean, I look at pictures of Woodstock, right? I saw this movie with Aretha Franklin called Amazing Grace, which was in an African-American church in Oakland in 1970. And like no one was overweight. I mean, it's just staggering. So weight, I think, is at the center, certainly carrying around excess energy. As much as I'd like to reassure people that you could be healthy at any weight,

the fact is as we age, that excess energy, that weight is problematic. Certainly, I've struggled over my lifetime. I've gained and lost my body weight multiple times. I have suits in every size. And, you know, I think the question is, how did we get here? And if you look at government guidelines, go back to the McGovern Committee, you know, in the 1970s, it focused initially on hunger and then on obesity. And if you look at those guidelines and the guidelines that came out in the 70s and then in 88, and even the guidelines that came out in 1990, the fact is they were to reduce fat intake, reduce saturated fat intake to limit simple sugars. But then they had this line

that said, increase complex carbohydrates. And so the concern was heart disease and fat, and we can talk about that. But the fact is that those government policies said increase carbohydrate consumption. And if you look at the bottom of the food pyramid, what's there? There's fruits and vegetables, but there's also grains. Well, it's what was at the bottom of the food pyramid, right? Six to 11 servings of bread, rice, serum, pasta a day for a healthy diet, which is stunning when you look back at it. So let me give you a food label. Let me give you, you know, the nutrition facts panel on all processed food. Your listeners know that. We worked on that and developed that in the 1990s. Let me describe a food label and tell me what you think the food is. So single serving.

I have a feeling it's a trick question. Okay. Here's, here's what's on that label, right? So it has 300 calories per serving. It has zero fat, 0% total fat, 0% saturated fat. And you look under total sugar, it says sugar's 0%. Has some salt in it, has some protein in it. The vast majority of the product, the total carbohydrates say 30%. No fat, no sugar, right? Meets all the, um, the guidance, right? What do you think that food is? Give me a guess.

A bagel. You got it. You get the prize. I, that's the answer. I was just guessing. That is the label on a bagel. So here's the, and you look at that label and it says total carbohydrates, 30%, right? And zero fat, zero sugar. So you go,

that bagel is good for me. Right. Yeah. See, see the thing is people get confused because most doctors still talk about complex carbs and even nutritionists talk about complex carbs. But you point out that it's not so clear as complex or simple, that it's much more complicated and has to do with fast versus slow carbs. Exactly. That's why, I mean, I call, I was thinking of calling the book metabolic chaos,

but most people probably want to understand what I was specifically referring to. So the, the key is first of all, let's discuss what are fast carbs. Okay. So fast carbs include sugar, of course, but it includes starch. And what's in that bagel? That bagel is all starch. And over the past half century, Americans and the world have having greatly increased their average intake of fast carbs. Let me just go back 200 years. You go down to Mount Vernon. You look in George Washington's home. You look at the ceiling in the main room.

You look at what's carved on that ceiling, and you see that it's sheaves of wheat. Washington, when he wrote to Lafayette 200 years ago, said he had hoped America would become the granary to the world. These fertile grasslands, the soil, it was ideal for growing grains. And we built this infrastructure. The soil, it was ideal for growing grains, right? And we built this infrastructure. So we did become the granary for the world. But let's just go into, let's look at that stalk of wheat, right?

So you go up that stalk of wheat and at the top, you have the wheat berry, the kernel. And, you know, going back to biology, when you look at that kernel, it has outer layers. It has the bran. It has the germ, the embryo at the base. But the real gold is the energy, the endosperm, the starch, right? And so you have these layers around that weak kernel. You have barriers, and there's about four or five barriers. And if you look under the electron microscope, if you look very closely at starch granules, you will see how the starch is tightly packed and really encompassed within these outer shells. And in fact, no doubt, you know, in order

to eat that wheat berry, you have to mill it, you have to take out the outer shells. But what I didn't fully understand was the effects of food processing. So is the grain milled? But then it goes into, and there are multiple different processing techniques, one being called extrusion cooking. And you then take that wheat, that starch granule, that intact starch granule, and you subject it to intense heat and intense shear forces so that the starches have that, their intact structure of that natural grain pummeled out of them. So what that extrusion cooking does, it takes that wheat, that starch, and it makes it into different shapes and different solids

and into thousands of different products throughout the supermarket aisle. But the fact is that starch, I mean, in that packaged food, I mean, it has been so pummeled and so dispersed and so destroyed that structure that that starch is in essence pre-digested. So that starch, when you eat these processed carbohydrates, what I call fast carbs, is that altered structure of processed food makes it rapidly absorbed. And no one ever asked, certainly in medical school, no one ever asked, what are the consequences of flooding our bodies constantly with this rapidly absorbable glucose? Because that's the result of this starch. And we never asked that. When I was in med school,

I thought that, you know, the GI tract was a tube. We now know that there are different hormones, there's different sensors in different parts of the GI tract, and by processing and eating these foods and getting rapidly absorbed, you know, we're stimulating certain hormones and not others. Insulin, right? right. The early hormones are the ones that stimulate insulin, but the food doesn't even get down to the lower GI tract. So it doesn't stimulate other hormones, such as the GLP hormones that give you satiety and fullness, and it never gets down to the microbiome. And, you know, it just never, you know, nutritionists, I don't think anyone really asked, what are the consequences of destroying the structure of food, taking all this starch, making it into this rapidly absorbable glucose and flooding bodies with it?

And I think we're seeing the consequence. Yeah, for sure. What's interesting is on George Washington's ceiling, the wheat that was on there was probably quite different in its ability to provide one nourishment, to have less starch, to probably have way more nutrient density. And when you look at the wheat we're eating now, it's quite different. You know, Norman Borlaug developed dwarf wheat, which was a great advance in producing a drought and weather-resistant crop that produced large amounts of starch in the granule. And from what I've learned, it has high levels of something called amylopectin A, which is a super starch. And so it wasn't intended to actually drive diabetes or obesity, but that was the unintended consequence. And it actually, when you look at the glycemic index of bread, it's actually

higher than table sugar. So we think, oh, bread is a complex carb and sugar is a simple carb. But in fact, the complex carb is worse for your blood sugar than the simple carb, and most people don't realize that. That bagel that we talked about, that bagel, which is starch, I mean, it can raise blood glucose to the equivalent. There's no sugar in that bagel, right? But when that bagel is eaten, that bagel can raise blood sugar the equivalent to some 20 teaspoons of pure sugar. So clearly this wasn't George Washington's fault. So there's been some legislation like the Farm Bill that's really made processed carbs our main source of food, growing large amounts of wheat and corn. And then the food processing giants began creating these ultra-processed grains, like these starchy fast carbs that you call them, bagels, pizza, packaged foods,

and they're everywhere. How did these grains, corn, wheat, rice, become the foundations of our diet? What were the kind of policies that were set up that started this trajectory? We built a massive infrastructure for which grains are the major staple, in part because of our fertile grasslands and our soil. But it's not just the growing. It's the milling, the transportation, the production of starch, the changing starch into modified starch so it can be used in thousands of products. This modified starch has become 60% of processed foods or so, I mean, are starch. And we used to think, no, it's sugar, it's fat. Those are the culprits.

But this vast majority of our diet, this starch, I mean, it's as if we're eating processed poison. So, you know, you were the commissioner of the FDA for seven years or more under two presidents, and you got to see up close and personal, you know, how the food industry acts in this regard. And, you know, we're trying to regulate an industry that doesn't want to be regulated. And the intent is to try to allow it to continue to market and sell unencumbered a whole array of foods that are driving our country into ruin through the chronic disease epidemic and the economic impact of that. And what the food industry often says is, well, we're just giving our customers what they want. And I often, I reply to that, well, if they were selling $2 bags of cocaine on every corner store, then they probably want that too. So talk about the business of big food and how the food

industry tries to manipulate our behavior, our appetites. And how do you think we deal with this? I mean, as a former government leader in the food drug administration, how can these food industries be held to account, financially accountable or through regulation or legislation? How do we address this? Because this obesity epidemic is scaling at a rate that is terrifying. We look at the COVID epidemic and you see this hockey stick of increasing cases. We say the same thing in obesity and diabetes and chronic disease. It's just played out over 40 years. It's still a hockey stick and it's getting worse.

Starch is the carrier. What the industry figured out is not only to use starch as the core staple in the vast majority of processed foods, but starch is the carrier for fat, sugar, and salt. I mean, starch, remember in kindergarten and first grade, I mean, starch, you know, you add water, you can make a paste out of it. That's not very palatable. But by the way, though, into that starch. But the vast majority of calories are certainly in that starch. When we did the food label, the industry fought us tooth and nail. I mean, strongly opposed putting that nutrition facts panel, you know, but we did it based on the best science back in 1990. But you look today, I think that science is advanced and a line that simply says total carbohydrates,

when the vast majority of those type of total carbohydrates are fast carbs, we need to be able to educate people and let them know what's really in that box that they're buying in the supermarket. So if you're, you're today, you're the commissioner of the FDA again, and maybe you will be, who knows, and you want to change this and put on the label fast carb, slow carb, what are the obstacles to doing that? What are the obstacles to making labels clear? Because in my book, Food Fix, I describe how food labels are deliberately confusing, how ingredient lists are confusing. You know, you look at other countries, they put the percent of the ingredient in order on the label. Here, you don't know if the second ingredient is 10% or 30%. If it says sugar on the second ingredient, you don't know how much of the food

is sugar. And then they also, there's loopholes where if you have five different kinds of sugar, you don't have to list it as the first ingredient, even though it's the most prominent ingredient. And you have a lack of clarity, for example, around the, the quality of the food on the label. Like you said, it doesn't say with a carbohydrate, if it's a carbohydrate, that's a nutrient dense, uh, youdense whole grain or bean, it just says carbohydrate. So how would you attack that today if you were a commissioner again? So we're talking about two different parts to the food label. First of all, there's the ingredient list and the facts label, right? And there's the ingredient list.

You're 100% right. I mean, no one really has looked at that ingredient list and improving that, you know, there's not a bright line. Let's just make sure all your listeners, I mean, fully understand what are fast carbs and what are slow carbs. Slow carbs are vegetables. They're legumes, they are high fiber foods, they're intact whole grains, they're foods that have their structure intact. Now, fast carbs are foods that have been processed and have, in essence, been pre-digested, and that starch gets rapidly absorbed. Now, there are some measures. Your listeners will have heard of glycemic index and glycemic load, and those measures

are pretty good. Now, there are some limitations of those measures, but I think it's fair to say anything that's a high glycemic index food is going to be a fast carb. Now, there's some scientific nuances. Just because it's low glycemic index doesn't mean that it's not a fast carb. And the industry says, well, there's no bright dividing line. But look, if you the real key is, you know, is there structure to the food? I mean, that vegetable, that legume, that intact whole grain has the natural structure intact.

It is high in fiber. The starch has not been destroyed to such an extent that the surface area becomes so increased that it gets so rapidly absorbed. So I think certainly high GI index or certainly glycemic index foods should be called out for them because those are fast carbs. There may be better measures and there's there's index of what the starch absorption that are being developed. But, you know, nothing's going to replace the the very simple test. Look at the food. Is the structure such that, I mean, does this look like food or does it look like processed food? I mean, that's the ultimate test. If it's been processed, if it doesn't look like something that exists in nature, then it's going to be a fast carb. And look, I think we have to be, when you look at the science,

we have to say, well, we're learning a lot. I think the fact is that I think we should agree that for certainly those of us who are metabolically vulnerable, those of us who struggle with our weight, the vast majority of us who struggle with our weight, the vast majority of us, adding fast carbs to our diet is adding fuel to the fire. Now, there may be a small percentage of the population, I don't know, 10, 15 percent, for whom they are not as metabolically challenged. But I think that bottom line, really encouraging food that has its structure intact is the key. And I think the reason why vegetables and legumes may be so good for us is in fact, because they're low in starch, they're low in fast carbs, and they're

high in fiber. And they're good not only for metabolic disorders, but also colon cancer and others. There's a strong association between fiber and less rapidly absorbable glucose in those foods and colon cancer. So it's pretty simple. It's just, you know, eat real food is what you're saying. And the challenges of our confusion about carbohydrate has to do with what we mean. And I think I often say that, you know, probably 75% of the population is carbohydrate intolerant. And what I mean by that is they're intolerant to starches and sugars, which is why 75% of us are overweight. But on the other hand, I also say that carbohydrates are the single most important food for long-term health and longevity. Why? Because vegetables are carbohydrates,

beans are carbohydrates, fruit is carbohydrates. And so are whole grains and those are fine. And I think most people don't understand that it's not carbohydrate or no carbohydrate. It's what carbohydrate. And I think that's what's so clear in your book, Fast Carbs, Slow Carbs, that you really help people understand that this epidemic of obesity is really driven by the good intentions of trying to provide a lot of abundant starch calories for a hungry population, a hungry world, but it's really backfired on us. I think it's at the root of metabolic disorders, weight, certainly diabetes and pre-diabetes.

You know, I tried to, it was a lot of different, you and I know a lot of our colleagues, you know, a lot of different diets out there, a lot of different theories out there. Should I go paleo or vegan or keto or Mediterranean? And, you know, I stood up at the American Heart Association and there was a panel with somebody representing each of those viewpoints. And I said, can we all agree that if we can eliminate fast carbs from our diet, that that would be a very important step? And everybody acknowledged yes. Absolutely. important step and everybody acknowledged yes absolutely I I think that's the basic message here right I mean I mean there are going to be uh individual preferences that certain things

are going to work better and and others uh but if we can all focus on this basic principle to eliminate fast carbs. And it's not just sugar. No, it's sugar and starch. And that's the definition of processed foods. If we can do that, you know, there's a lot of noise out there. You know, I don't know what you think. You know, a lot of different diets. But I think if we can just get behind this basic fact of limiting these rapidly absorbable, these fast carbs, we can dramatically affect our health. Yeah, I completely agree. I say, you know, every one of these dietary philosophies, whether it's paleo or vegan or low fat, high fat, whatever. If you look at what they have in common compared to the standard American diet, they have far more in common with each other than they do with the processed American diet. And we should sort of stop fighting with each other and start really talking about the real issues, which is our processed food diet. Bingo. I think we can do a great service to the public health if we can all recognize that

the real problem are these fast carbs. And we let that get out of control. And the problem is they're not so easy to stop, right? You struggle yourself over the years with weight and with your metabolism. And you speak of this not just as a scientist and academic, but also as a person who's learned this the hard way. So tell us a little bit about how these foods do not just affect our blood sugar and weight, but how they affect our brain chemistry, which you wrote about in the end of overeating, how addictive they are and how this has been a struggle for you as well. If you want any example that food, these highly palatable foods are a drug that can affect not only these metabolic pathways, which are the subject of this book, but the reward pathways, I mean, of the brain.

I mean, just look at what's going on now. I mean, we're all trying to shelter in our homes. Everyone, you know, I wish everyone well and to be safe. But the stress, the anxiety, I can tell you, I mean, and I've written books on this. You know, you take fat, sugar, and salt, you know, fat and sugar, fat and salt, fat, sugar, and salt. You put it on starch. And that palatability, you know, activates my reward circuits. I eat that food. I'm in momentary bliss.

And for a second, I feel better. Now, you know, five minutes later, I go, why did I do that? I can't believe I had the whole thing. Stress me. And, you know, the last thing I want to be doing is certainly at this time when the anxiety and fear, I mean, is palpable, right? I mean, comfort is very important. So I don't want to, you know, take away that comfort. But, you know, when we get through this, and we will get through this, I mean, we're going to want to be healthy. So, I mean, my reward pathway say, you know, I want this highly palatable fat, sugar, and salt. It's going to, I mean, that's the nature

of addiction. I want, I want, I want, it's going to make me feel better. Why did I do it? You term this, you had this term hyper palatable. It's an incredible term because it's not just that it's palatable, which is what your food should be and should be yummy and delicious and savory, but it's hyper palatable, which then hijacks your brain chemistry and makes it very difficult to stop. It's no different than a drug hit, right? I mean, it zones me out. It makes me feel better. And that's how it hijacks those circuits, but it's also hijacking the metabolic circuits. And you look at the different models. You know, we always thought that excess intake of calories, you know, we all know that leads to obesity, you know, and our endocrinologist friends have said that that obesity leads to insulin resistance

and hyperinsulinemia, and then go on to prediabetes and diabetes. So, you know, this model of excess calorie to obesity to hyperinsulinemia. But it's the other way around. Well, I mean, I think there is, you know, certainly increasing evidence that the excess intake of carbohydrates can lead to hyperinsulinemia and hyperinsulinemia can have an effect on obesity. Now, whichever model works, the fact is you get caught in this vicious cycle of hyper insulinemia insulin resistance once you're into that cycle that's caused by these uh this excess intake of these fast carbohydrates it's almost i mean it's impossible to lose weight

yeah i mean i think that's right. I think, you know, just to sort of break it down for people, when you eat a fast carb, your blood sugar goes up faster, which means your insulin spikes higher. And when that happens, there's a cascade of metabolic effects that really messes you up. One, the fat goes right into your fat cells. So you store fat in your belly fat, which is a dangerous fat that's inflammatory, that drives all chronic disease from heart disease, diabetes, cancer, even dementia. Two, it slows your metabolism. Three, it makes you hungry and want more. And so you've got this perfect storm that puts you in a vicious cycle of hunger and weight gain,

hunger, weight gain. And it's very difficult to break unless you really detox, literally detox from the addictive hyperpalatable starch and sugar that people are consuming every day. You look at the data. You know, Frank Gannon and Mary Nuttall did work back a decade or so ago, and they fed people high-starch diets, and they measured over weeks of eating this starch. They measure the blood glucose, and it's markedly elevated. And then if you take away that starch, you feed a low starch diet, you see after, you know, just five, six weeks, you see a dramatic drop in blood glucose. Now, these were mild diabetics. But, I mean, as a therapy, I'm certainly, you know, insulin drugs are very important for people. But the fact

is that reducing the consumption of fast carbs can have a very important therapeutic benefit. And rapid. One of my patients, she did quote my 10-day detox diet. She said, you should call it the three-day detox. I said, why? She says, well, my blood sugar went from 200 to 100 in three days. I'm like, wow, that's impressive because these foods do drive so much metabolic chaos. And I think that's a good word for it. So given this is true, and given that we, I think the science is pretty clear. And for those who want to learn more about what Dr. Kessler is talking about, check out his book, Fast Carbs, Slow Carbs. There's also an article by a friend of ours, I think you know him, David Lidwig, called the Carbohydrate Insulin

Hypothesis, where he postulates that it's not overeating that makes us fat. It's the fact that we're eating refined starches that actually causes us to being hungry, which makes us overeat, which makes us gain weight. So it's a very different framing of the conversation. I think it's important because it sort of takes the blame off the victim. It's like, oh, yeah, you get fat because you overeat. It's like, no, you overeat because you've got this belly fat that's making you overeat that's driven by the sugar and starch. So I think that's a very important reframing. But given that we know this scientifically now,

given that the food industry's tactics, and you lay this a little bit out in your book, and we want to get into that, are to sort of prevent change. How can the government play a role in addressing this science and protecting the public from the unintended consequences of the food system that we created, which now are no longer invisible, but are pretty clear, and we have to sort of backtrack and deal with these. So how do we do that? Well, you just, you look at the dietary guidelines and the dietary guidelines still say, you know, the number of servings of grains

and only half, you know, should be whole grains. But even the whole grains that they're talking about, many of those are really non-intact whole grains. They just process flour with the bran and germ added back. And you're adding bran back to a fast carb, and it still has the effect of being a fast carb. Wait, wait, wait. So you're saying whole wheat bread is still bad because it's processed and then they add back some bran and they add back some fiber, but it's still a fast carb.

It's still a fast carb. The bran may slow it down a little, the absorption, but understand, I mean, when nobody's eating wheat berries, right? Well, I mean, muesli, I mean, you know, I, it was interesting. I, the society for the study of ingestive behavior was in Utrecht in the Netherlands this last year. And inside the convention, everybody is saying privately that obesity, they can't get people to keep weight off. There is no way to do that. You walk outside the convention center, everyone is bicycling. You go into the supermarket. The American cereals are on the bottom of the shelf, barely visible. And what

you see are many intact cereals that are true whole grains, muesli, again, it would take an adaptation, but they're not anywhere as processed as the American counterparts. No, it's so true. So one of the things you talk about in the book is how you got a copy of the Food Industry Playbook and how they laid out some of its messaging strategies that they understand and manipulate the public skepticism and confusion about nutrition. And they use different terms, like in the industry's own words, like trying to reset or reframe the conversation.

So what are the tricks that the food industry is using to confuse consumers about this? Well, they talk about eating foods in moderation. That's a code word for all calories are the same. Exactly. And the fact is, we need to just level with the American public that the vast majority of what's in those central supermarket aisles are processed carbohydrates rapidly absorbed. And if you struggle with your weight, if you have certain metabolic vulnerability, if you're on the pathway to pre-diabetes or diabetes, these processed carbohydrates are, you know, are very, very problematic. But the whole industry the wheat, the corn, that is the American agricultural complex is built on in a significant way on those commodities uh and the processing uh took that uh that wheat kernel i mean and and you know added fat sugar and salt made it highly palatable and that's uh walk into uh you know when we're

back flying and we're in the new standard we're rushing and you go in and you try to find a snack, those are just processed carbohydrates. Those are fast carbs. So we're going to need a dramatic change in how we view foods. And how does the government help with this? You see a pathway there? I think that it starts with the dietary guidelines. I think it has to have a recognition of the damage that these processed carbohydrates have had. We need to change the view, change how we view these foods. Let me give you a comparison. And I just want to be careful. I'm not saying they're the same. But remember, certainly I had the privilege of being involved in the investigation and the regulation of tobacco,

and I am not, not saying that these things are comparable. But what I did learn was, yes, there are regulations and legislation on tobacco, but the fundamental difference that we made in this country, certainly during our lifetime, compared to my parents, my grandparents' generation, they used to view the cigarette as something that was adventurous, something that they wanted. Sexy. Sexy, et cetera.

We changed how we view the product. Today, it's a deadly, addictive, disgusting product. We had that critical perceptual shift. Thank you for helping with that. You're welcome. And again, I want to be careful in the comparison, but we need a perceptual shift. Yes, we can improve the food label. Yes,

we should improve the ingredient part of the label. Yes, we have to tell people, you know, we can't hide behind this line called total carbohydrates. We have to disclose, you know, what the percentage of fast carbs are on the label. But, go so far, what we have to do is change the perception of what we're eating. And if we're eating processed carbohydrates, the industry takes the position that processed food is no different than food that has its structure intact. And that is just not the case. And that's why I wrote the book. Yeah. I mean, it's so, it's so true. And, you know, part of the, part of the challenge is as we look at the tobacco example, the perceptions changed when there was litigation and the exposure of the tactics, the lying, the casting of doubt, the scientific manipulation of the tobacco industry that got people to see that they were pushing a product they knew was harmful and hurting the public. That's not the case for the food we're eating now.

People just don't understand the way in which the food industry acts across the spectrum of public health, government policies, social advocacy groups, front groups, science, academic institutions to really mold and manipulate public opinion to create an environment of doubt that prevents these kinds of clear distinctions that, yes, these starch and sugar calories are different than other carbohydrate calories. And that if we got a handle on this, we can then change our food production, the way we grow food, the way we produce it, the way we distribute it, market it. All these things have to happen for us to really change. So pushing back a little bit, I think the public perception is shaped in large part by the food industry's

messaging and by their control over federal policy through billions and billions of dollars of lobbying. So how do we break through that? I mean, it happened with tobacco, with litigation. Do we need to do that? And how could that make sense? So I think there's a more fundamental step first. I, and I'm, you know, I'm going to upset certain of my colleagues by saying this, but I think the nutrition community, I don't think we've done service to the American public, in part because we're arguing among ourselves about fine points of mechanism and science,

this insulin hypothesis, you know, we've not come together as a scientific community and set at the root of weight, metabolic disorders, much of cardiovascular disease, that these fast carbs are driving the problem. I mean, I think that that's the first step. If the nutrition and scientific community can get behind that simple message, and if people can agree on that, people will have different views of exactly how harmful it is. Is it the whole problem? But I know no one who's willing to say that this constant flood of our bodies with this never ending supply of fast carbs of this rapidly turn into rapidly absorbable glucose?

I mean, is has any benefit? Yeah. Now, one caveat. OK, one asterisk. I mean, in an environment where, you know, 100 years ago or even 50 years ago, when people were not in a positive energy balance, where people were not getting hungry food, right, where people were not, you know know were hungry and starving i would agree in that case right um if you're in a negative energy balance what i'm saying doesn't apply but in an environment the the reality of our environment today right where we're the vast majority of us are in a positive energy balance, meaning that we have more food than we can possibly ever burn. Fast carbs are the problem. Yeah. And we need to be able to agree on what the problem is. I think policymakers and the industry will follow,

but there's still such wide debate. Is it sugar? Is it fat? What is it that is driving this epidemic of metabolic disease? I think we have an obligation ourselves to answer that because it's not been clear. I mean, certainly not been clear to the average consumer who's been listening. No, but it is clear for anybody who's paying attention to the science. I mean, you look at the recent global burden of disease study of 195 countries and ultra processed food and the lack of protective foods kills 11 million people a year. I mean, that's a staggering amount of people

that's caused by a totally preventable factor, which is our ultra processed diet. And you know, the translation of that is mostly fast carbs. But some of our colleagues focus on, you know, different elements, right? They focus on it's sugar, right? Or they say, you know, fat is good for you or whatever. I think we have to clearly identify what the problem is. And I think it comes down to these fast carbs. And it's not just sugar. Sugar is certainly problematic. Don't get me wrong. And it's equally problematic as the starch. But the vast bulk of our diet,

I mean, are these processed carbohydrates. For sure. So, you know, one of the things that can help people is labeling. And, you know, in Chile, there was a sweeping set of laws that changed food labeling, that put warning labels on the front of food that had various ingredients that were deemed to be harmful, and that they could argue about whether that's true or not, whether it was salt, sugar, and saturated fat. And it led to a dramatic reduction in consumption and education for the public. The nutrition labels here are so confusing. And we did increase the, I think the quality of the labels by putting added sugars on, but it still doesn't really help people that much. And I was in a meeting recently where a woman who worked at the FDA was asked by me, why can't you put teaspoons of sugar as opposed to grams of sugar?

And her answer was, well, different forms of sugar equate to different levels of grams, so we can't do it. And I thought that was a nonsense answer because I'm sure there's a way to create some teaspoon equivalent for whatever sugar you're putting on there. And I think if it were to say instead of 39 grams of sugar on a can of soda, 10 teaspoons, people might go, oh, maybe that's not such a good idea. So how do we address the food label? Go back to that bagel. How many teaspoons of sugar in that bagel? Well, it'd be probably eight. But there's no sugar in that bagel? Well, it'd be pi-eight.

But there's no sugar in the bagel itself, right? Which sugar equivalents? It's its effect on blood glucose. You know, that large bagel has some 20, you know, teaspoons of sugar. As it affects the blood glucose, there's no sugar in the bagel. So we just have to be able to recognize that it's not just sugar, it affects the blood glucose. There's no sugar in the bagel. So we just have to be able to recognize that it's not just sugar, it's sugar and starch, right? So look, FDA is always going to want to make sure that it gets the science perfect. It's never going to want to be out there in front, especially when there are such disparate views. So we really do need

to come together. How to do it? There are a whole host of options. But to me, the issue is, how much does this food, I mean, how much is it going to affect the amount of blood glucose and that rise? Again, it's not a perfect test in all instances. And FDA and everybody goes, well, there's this limitation. And in this case, it's really not accurate. But we're missing, you know, we're not seeing the bigger picture here. That's right. And which is basically this food is a fast is just the vast majority. This is a fast carb. Don't eat it. Yeah.

And I would give you all the breakdown, you know. But in essence, you look at that, that food and it doesn't look like food. And that has its origins. And the number one ingredient is wheat or corn. You could be sure that in the vast majority of cases, that's going to be a fast carb. So how do we retool our entire food system to stop producing this? Because it seems like we've built a whole industrial food system and entire industry from the seed companies to the fertilizer companies, to the agrochemical companies, to the industrial farming system, to the processing and manufacturing

of these products. I mean, it just seems like a big giant mess that we have to get through to solve this. How do we get through that? You've just identified it. It's even bigger than what you've just stated. The transportation, the milling, the mechanized harvesting in the fields. It is the backbone of the agricultural superpower that we have become. Look, the industry will follow what consumers want. We change how consumers perceive what is healthy and what is not. We make that clear. The industry will change. They'll follow the consumer. But first, we have to come together, you know, as scientists and physicians and say, what's causing all this

diabetes and obesity? And we can't just tell people, you know, to eat less and exercise more. I mean, that has been obscuring what is really at the root. I mean, yes, there's some truth to those statements, but if it were true and I could do it and follow it, I mean, we wouldn't be in the circumstances that we're in. Of course, I want to eat less and exercise more. But, you know, you add to that, to our diet, these processed carbohydrates, we get caught in this vicious cycle that it's very hard to get out of. They're just telling me to eat less and exercise more. Once I'm insulin resistance or on the way to being there, it's just, you know, awfully difficult. The industry will retool me. The industry will give us more whole foods, more certainly vegetables, legumes and fruit, more food that looks like food, but they will deliver that. And I think there is a shift certainly at, you know, when we get back to restaurants, I mean, eating healthy,

I think we're getting a sense of it. We just have not clearly exposed the culprit until recently. That's true. And I think, you know, people find that it's often, you know, hard to eat unprocessed whole foods, that it takes time to cook and it's expensive and that it's difficult to do. You know, I think there are some challenges with that framework, although I think that is the industry's preference is to all have us believe that it takes too much time, that it costs too much, it's too difficult to eat real food. And during this lockdown, because of COVID-19, I've been cooking a lot. And so many Americans and making really delicious, simple foods that are really inexpensive, but highly

nutrient-dense and nourishing. And we've just been taught that that's not something that we can do. So how do we help people shift over to that perspective? And how do we get the government to help Americans? What kind of regulations need to change? And what can we do as consumers? We need to change the food label. We need to change the ingredient label. We need to change agricultural policy. We need to continue the good work that's been done on school meals. We need to be very careful on what we subsidize indirectly, what products. And most importantly, we have to change what consumers want. Because what we want,

if we want that hyper-reparability, that momentary bliss that processed foods offer, we're never going to get out of this situation we're in. We're going to have to change what consumers want. Yeah. And that's tough because the food industry that's producing the food that most of us eat has designed it to be, like you said, hyperpalatable and it's very difficult to get people off of that. And once they get stuck in that cycle, you know, I remember reading this paper by Dr. David Ludwig from Harvard who talked about when you actually start to consume these fast carbs, it stimulates this insulin production. And the cascade of that is it, one, it makes you store fat, but it also puts your body into a state of perceived starvation so that you want to exercise less and eat more. So the eating more and exercising less is actually a consequence

of eating the fast carbs, not a result of it, which is, I mean, not the cause of it, which is interesting. Look, I think the science is going to continue to evolve. The exact mechanism by which these fast carbs wreck have it, is it the fact that they are so in a whoosh, that our eating rate increases? Is it because they are the carrier of fat, sugar, and salt? Is it the fact that they're rapidly absorbed? Is it the fact that 100% of those calories get absorbed higher up in the GI tract and never get down to the microbiome? Is it the fact that GLP-1 is not secreted as much as GIP hormones, and therefore we don't have the satiety? Is it the various insulin mechanisms? Is it the brain reward mechanisms? We can leave that to the science. That will be sorted out in much more detail over the next number of years. And just because we don't have the exact

mechanism doesn't mean that we don't know the culprit. I mean, to the best you can, reduce or eliminate fast carbs from the diet, and we can change America's health. I mean, in a way, it seems, you it seems almost too simple, but I think you're actually right, which is if everybody just focused in on this one principle, that it's starch and sugar, fast carbs, as you call them, that are driving this global epidemic of chronic disease that's burdening our healthcare system. I mean, the fact is today we're seeing the consequence of having a very sick population in America, that people who get sick or die from COVID-19 are often those who are overweight or have a chronic disease that's caused by these ultra processed foods such as heart disease, diabetes and so forth. And if you're obese, you're three, almost three times as likely to die from COVID-19. So now is the time not to succumb to the hyperpalatable foods and to just comfort yourself with junk food, but to actually take the time that we have at home to start cooking real whole foods and get off this fast carb merry-go-round that's making us all sick and fast.

I think you've said it very well. Well, Dr. Kessler, it's been a real pleasure to talk to you. I've looked up to you for years. I'm so happy to have this chance to talk about your new book, Fast Carbs, Slow Carbs, Simple Truth About Food, Weight, and Disease. You can get it everywhere you get your books, on Amazon, hopefully a local bookstore if they're open. And thank you for this incredible contribution. I hope you get picked again to have a position to be the food policies are in a new government one day, because I think that would help us move down the road to a healthier nation, both physically and economically. So thank you so much for all the work you've done over the years to serve our country and

to bring the truth of what we should be eating to all of us. Many thanks. A pleasure being with you. Of course. Thank you for listening to The Doctor's Pharmacy. If you've loved this podcast, please share it with your friends and family on social media. Leave a comment.

We'd love to hear from you. Subscribe wherever you get your podcasts. Stay safe. And we'll see you next week on The Doctor's Pharmacy. Hey, it's Dr. Hyman. Do you have FLC? Well, it's a problem that so many people suffer from and often have no idea that it's not normal or that you can fix it. So what's FLC? Well, it's when you feel like crap. And you know the feeling. It's when you're super sluggish and achy and tired. Your digestion's off. You can't think clearly. You have brain fog or you just feel kind of run down. Can you relate? I know most people can't. In my experience as a practicing physician over the last 30 years,

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Now, FLC is a diagnosis. It's not a medical condition. It's just something we fall into when life gets busy or when we indulge a little too much around the holidays or don't listen to our body's messages. It's our body out of balance. Now, everyone gets off track here and there, and the 10-day reset was designed to help you get back on track. Now, it's not a magic bullet. It's not a quick fix. It's a system that works. If you want to learn more and get your health back on track, just visit GetPharmacy.com. That's Get Pharmacy with an F, F-A-R-M-A-C-Y.com. is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit

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