The explosive growth in the use of weight-loss drugs is a supreme irony within a food system that creates the very chronic diseases that lead to obesity and a medical system that “manages” those conditions with no intention of actually curing them. In fact, “manage” is too kind of word for this setup for the truth is, medical treatment of chronic conditions more often than not just perpetuates these conditions and sometimes makes them worse.

I rarely do book reviews, but I believe Metabolical may be the most important contemporary account of the nexus between modern diets, chronic illness and ecological ruin. So, I’m going to give you a taste of what’s in it (pun intended).

According to Dr. Robert Lustig, author of Metabolical, thanks to the food and medical industries, the American public has come to believe the following things:

1. Gaining weight (sometimes lots of it) as we age is normal.
2. Developing chronic conditions such as diabetes, high blood pressure, and heart disease is inevitable for many people.
3. Once a person has a chronic condition, it cannot be reversed and must be managed primarily through medication and sometimes surgery.
4. Cancer strikes mostly randomly.
5. Exercise can prevent at least some of these conditions or even reverse them.

Okay, I know you are already expecting me to tell you that none of these is true. But, you’re probably saying to yourself, “Wait a minute! Exercise must be able to prevent some of these conditions or even reverse them.” You would be right in assuming that exercise is very helpful.

But the food industry intentionally deceives the public by telling us that lack of exercise alone is responsible for poor health. The sugar industry, for instance, has a web of willing “think tanks” and other nonprofits that have put out reports claiming that lack of exercise and not excess calories are the cause of the obesity epidemic. And also, by the way, they say, sugar consumption isn’t a cause of diabetes. (Lustig informs us that it is the tobacco industry that got its playbook from the sugar industry, not the other way around.)

According to Lustig, “You can’t outrun a bad diet.” Lustig tells the story of an amateur Finnish triathlete (and tech billionaire) who after selling his companies had the time to spend five hours a day exercising for years:

Nevertheless, by age thirty-eight, his performance was down. His glucose tolerance test revealed that he was prediabetic. He didn’t get it—how can a triathlete be prediabetic? He consulted UC Davis professor and low-carb physician Dr. Stephen Phinney, who had the answer: it was sports drinks. Caffeine has its own effect on insulin resistance separate from from fructose, and together they can cause their own brand of insulin resistance and glucose intolerance, ratcheting down some of the beneficial effects of exercise.

It turns out that the only way to fix health problems caused by eating processed food is to eat what Lustig calls Real Food (always capitalized in his book). As he often repeats: It’s not what’s in the food; it’s what’s been done to the food. By that he means the processing which often 1) eliminates much of the fiber (essential for feeding the microbiome and regulating the rate at which food is absorbed), 2) destroys many of the nutrients and 3) then adds sweeteners—mostly in the form of sugars—and also salt and so-called “natural flavors.”

Why is the food industry serving us mostly processed food? Because it is wildly profitable and consistently profitable because it is addictive. It plays to our evolutionarily designed cravings for that which is relatively scarce in nature: concentrated salt and sugar.  Processed food injects large amounts of these and other deleterious substances into the body all at once (thanks to lack of fiber) leading to the eight subcellular pathologies detailed in the book. Only five out those eight can even be mitigated by exercise.

So why should anyone listen to Lustig? First, he’s done important pioneering research on the link between diet and chronic disease as a professor of pediatrics and a member of the Institute for Health Policy Studies at the University of California at San Francisco, an institution devoted entirely to health sciences.

Second, he was a practicing pediatric neuroendocrinologist for 40 years, seeing firsthand the havoc the modern American diet has been wreaking on young people. Third, he devised treatment, mostly diet-based, that helped these young people recover from the metabolic dysfunction that was ruining their lives. Fourth, he relies not only on his own clinical experience and research, but the broad body of research on the relationship between diet and chronic illnesses which he says are not really illnesses, but symptoms of underlying metabolic dysfunction.

So, let’s return to statements 1 through 4 above which I haven’t yet addressed and which you will no longer believe once you read Metabolical:

1. Gaining weight (sometimes lots of it) as we age is normal.

It turns out that weight gain is almost always a symptom of underlying metabolic dysfunction which can be corrected by eating—you guessed it—Real Food. And being overweight in itself is not the cause of the dysfunction as about 20 percent of overweight people do NOT suffer from metabolic dysfunction. (Another thing you’ll learn in the book is that, contrary to what the food industry wants you to believe, not all calories are equal. It matters which foods you get them from.)

2. Developing chronic conditions such as diabetes, high blood pressure, and heart disease is inevitable for many people.

Same answer as 1 except substitute “chronic conditions” for “weight gain.”

3. Once a person has a chronic condition, it cannot be reversed and must be managed primarily through medication and sometimes surgery.

Same answer as 1 except substitute “chronic condition” for “weight gain.”

4. Cancer strikes mostly randomly.

The answer here is a little trickier. Cancer loves sugar. So if you want to die quickly after you get cancer, eat lots and lots of sugar. Also, metabolic dysfunction undermines immune function. Normal healthy humans have bodies which recognize malformed cancerous cells and get rid of them.

Naturally, you may be wondering if there is an easier way out. Can’t we just take pills to counteract what processed food does to us? No, not even natural dietary supplements will work because the primary problem is that you are getting too much of certain things which the body handles in ways that degrade your health. You have to get rid of those (or at least cut them way down) and substitute Real Food. It’s the only way, Lustig says.

Now, this has to be more expensive because fresh whole foods (organic is preferred) are more expensive than processed foods. But as Lustig points out (and he has the figures to prove it), 88 percent of all Americans are suffering from metabolic dysfunction at some level and 75 percent of all patients are suffering from chronic diseases related to that dysfunction. The lost work and medical costs alone swamp the increased food costs. My comment: Of course, people with low incomes would need help affording Real Food. But, a small part of the huge resources now devoted to treating those sick because of processed foods could be redirected—once those sick people start getting well—to those of modest means so that they may have access to Real Food.

Finally, I mentioned the ecological toll of the American diet. Rather than detail that here, imagine if the American agricultural and food system were to transition to regenerating soil while following organic methods and producing Real Food as close to the markets for those foods as feasible. That should give you some idea about how the ecological toll might be considerably lessened and possibly even reversed.

It would be a very tall order to turn around the American (and increasingly the world) food and medical systems. But as Lustig points out, we have no other rational choice. Either, we move society toward consuming Real Food or we bankrupt the medical system and further destroy the health and longevity of the entire population.

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P.S. For those using drugs called statins to reduce cholesterol, Lustig explains that 1) statins do not even target the type of cholesterol implicated in cardiovascular disease, 2) the research shows that they do nothing to reduce the risk of a first heart attack, and 3) they have ominous side-effects: muscle breakdown and the risk of developing kidney failure and type 2 diabetes. Statins are generally only useful in certain rare cases. In fact, even industry-sponsored research shows that heart disease patients—who seem like the best candidates for statins—have a median gain in life expectancy over five years of exactly four days! Taking statins is simply not worth the risk, Lustig says, when there is a good alternative: Real Food and exercise.

P.P.S. If you think Lustig is on to something and that you need to act, don’t be paralyzed by fear that you won’t ever again be able to salt your food. Healthy people, he tells us, generally do NOT have difficulty excreting excess salt. It is metabolic dysfunction that causes the difficulty in getting rid of excess salt. The easiest and best way to lower salt (and sugar) intake—and I know this is getting boring—is to stop eating processed foods that have a lot of both added to them and eat Real Food instead.

Organic home-grown tomatoes arranged in a circle. Christchurch, New Zealand.(2020) by Michal Klajban via Wikimedia Commons