The Peter Attia Drive - Qualy #102 - Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance?

Episode Date: January 29, 2020

Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.   The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

Welcome to a special bonus episode of the Peter Atia Qualies, a member exclusive podcast. The Qualies is just a shorthand slang for Qualification Round, which is something you do prior to the race, just much quicker. The Qualies highlight the best of the questions, topics and tactics that are discussed in previous episodes of the drive. So if you enjoy the quality, you can access dozens more of them through our membership program. Without further delay, I hope you enjoy today's quality. And currently the food industry says, I mean, I haven't really paid much attention to this, to be honest with you in the last few years, but is the food industry says, I mean, I haven't really paid much attention to this

to be honest with you in the last few years, but is the food industry basically still saying that while a can of Coke is not ever deemed even by Coca-Cola to be as nutritious as a carrot, in the end are they basically saying that all calories contribute equally to adiposity and insulin resistance? Yes, they are all saying it's about obesity and therefore it's about energy balance, therefore it's about calories, therefore all calories are the same.

That's what they say. It is absolutely not true. And we have all the reasons in the world to show why it's not true. We have empiric data, we have mechanistic data, we have plausibility data, we have hard data. That show that is just not the case. And if you want, I'll give you examples of it. All right, let's start. Yeah. Let's talk about fiber. You need 160 calories in almonds.

How many do you absorb? Two thirds. 130. Yeah, I mean 75%. Okay. Well, what happened to the other 30? Presumably it's going to drag some stuff out in your colon. Well, no. What happens is the soluble and insoluble fiber in the almonds forms a gel on the inside of the intestine. You can actually see it on electron microscopy, a whitish gel. That's going to act as a secondary barrier, preventing absorption of some of those almond

calories early on. Well, if they don't get absorbed in the duodenum, where they go next? Jijunum. Well, what's in the jijunum? That's not in the duodenum, the microbiome. Yeah. The duodenum is essentially sterile.

It's got a pH of one. Only H. Pylori can live there. You have to get the bicarbonate. When you're saying that that lining is formed in the duodenum. Duodenum, yeah. Exactly. To prevent your liver from getting the whole dose because anything that's absorbed in

the duodenum was straight to the liver. So how much fiber is in an apple? A lot. I mean, I can't give you a- But I'm just- But quite much. I mean, I'm making this number up. But let's say there's how many grams of fructose in an apple?

20. There's 30 calories in a standard apple, half of which would be fructose of 15. That seems low. An apple like a sweet apple. This will last for just a couple of months. Well, I mean, not a big, you know, mother apple, but, you know, like an apple apple. But so based on that, you're saying only half the fructose that you would eat in a piece of fruit might actually get to the liver.

Yeah, or less. Most of it's going to end up in the jujuneum. And once it goes to the jujuneum, it's a free-for-all. Do you absorb it or do the bacteria digest it and metabolize it for their own use? Remember, you have 10 trillion cells in your body, but you have 100 trillion bacteria in your intestine. Every one of us is just a big bag of bacteria with legs. Those bacteria have to survive. If the fructose gets absorbed at the level of the junom, in other words, if the gut out competes the bacteria, can it still get back to the liver?

Oh, yeah. Yeah. But the area in the curve will be wider, which means the insulin response will be lower, which is what you want, because it took longer. But a lot of it won't get absorbed. It'll be digested. It doesn't come out in the stool. It gets digested by the gut bacteria who use it for their own purposes. Now here's the thing that I only learned about a month and a half ago, which is absolutely essential. If you don't consume fiber, that means that your gut bacteria are not getting the food they need because you're absorbing it whole early. Well, they still have to survive. So what do they do? They protealize and lipoize the mucin layer. So auto digest. They auto digest the mucin layer that sits on the surface of your intestinal epithelial cells, protecting them. And you can actually see on electro microscopy an increased

opposition of the bacteria with the intestinal epithelial cell, which likely causes damage, possibly a leaky gut, and possibly GI disease like colitis and even maybe Crohn's. So the idea is to feed your bacteria or your bacteria will digest you. And what sources of fiber do you think? I mean, people talk about using Sillium husk and all these other things to sort of augment fiber. You think that's necessary? Do you think you can get enough of it just from... Well, so Sillium is soluble fiber. It's not insoluble fiber. You need both. Fiber has soluble insoluble like pectins,

like what holds jelly together. Insoluble fiber like cellulose, string stuff and celery. You need both to make that gel. So the insoluble fiber forms the lattice work like the net. Let's say you put a layer of petroleum jelly on a strainer. You would have an impenetrable water barrier, right? Yeah, so the insoluble is like the strainer and the soluble becomes the thing that fills

in the lattice. That's right. Exactly. So when you have both, it works. And there's data that shows that if you have either one or the other, it doesn't work. You need both. Well, you get both in real food. And this is why the food industry

keeps adding soluble fiber like sodium husk to food like fiber one bars doesn't make a damn bit of difference. They have insoluble fiber in things like certain breakfast cereals. But if you don't have the soluble fiber, also doesn't work. You need both. Real food has both. The point is, So the fiber fortified stuff is the easy way to do it is to add soluble fiber. That doesn't work. Okay, and that's what the food industry keeps doing

and keeps telling us that it's good because it's got extra fiber. Wrong doesn't have functional fiber. Doesn't have the fiber. That does what you want it to do. That's the reason a calorie is not a calorie all by itself. Hope you enjoyed today's special bonus episode of the quality. New episodes of the qualities are released Tuesday That's the reason a calorie is not a calorie all by itself. peteratiaemd.com forward slash subscribe. This podcast is for general informational purposes only, and does not constitute the practice of medicine, nursing,

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