Talking To Teens: Expert Tips for Parenting Teenagers

Andy: This is pretty exciting. You think a lot about processed food and the effects of processed food. Why is that? Why are you so interested in that, and why do you spend so much time and energy thinking and writing about it?

Robert: Well, I didn't start out being an anti-processed food warrior, right? Basically started out taking care of short kids. I'm a pediatric endocrinologist. Short kids got fat on me. And everyone was saying, well, you eat too much, exercise too little. And I believed that for a period of time because that's what everyone told me-

Andy: Simple equation.

Robert: … that is what I learned in medical school, et cetera. But then I started doing research on the issue. And in 1995, I joined a whole stable, a whole cadre of about 40 children who had survived their brain tumors from surgery, radiation, et cetera. They were normal weight when they developed their tumor, but after their therapy, they became massively obese.

Robert: Now, the faculty at St. Jude Children's Research Hospital in Memphis, Tennessee, Pediatric Cancer Hospital, and there they had years earlier, George Bray, the father of obesity research in this country. Took eight of these kids, which they're called hypothalamic obesity because of damage to the hypothalamus. He took eight hypothalamic obesity patients, admitted them to his unit at UCLA Harbor Medical Center. Locked them up, threw away the key, and gave them 500 calories a day for a month. What do you think their weight did? It went up.

Robert: It went up 500 calories a day. That's the paradox. How can you gain weight on 500 calories a day? And the answer is because these kids would rather store it than burn it. These kids couldn't see the hormone in their blood leptin. Now, leptin took 20 more years to be discovered, but at that point in time, Bray knew that their signals for satiety, their signals for energy sufficiency were not reaching the brain and so the brain was ratcheting down the energy expenditure. They were actually burning less. So even on 500 calories a day, these kids were gaining weight. And I was faced with an entire clinic full of these kids. What am I going to do to help them? Now, in the literature well, that's kind of hard to do.

Andy: Try and eat 400 calories a day.

Robert: Not exactly. In the literature, there is an experimental condition for animals, for rats, that's very similar. Where you take an electrode and you put it in the hypothalamus and you buzz, you cause electrolytic lesion.

Andy: And that reduces their appetite-

Robert: No, it increases their appetite. And they burn less and they eat more.

Andy: Okay, interesting.

Robert: So, what had been shown in the animals was that there was a connection between that hypothalamus and the pancreas. And if you cut that connection, which is the vagus nerve, the nerve that runs the entire length of your abdomen from the brain all the way through your abdomen. If you cut that vagus nerve, then they didn't gain weight and their insulin levels, which were the driver of the weight gain, didn't go up. So I can't cut a vagus nerve. I'm not a surgeon. What we did do was we gave them a drug that blocked insulin release similar to what cutting the vagus nerve would do.

Robert: So, we gave them a drug that suppressed their insulin down to normal and low and behold, what happened was these kids started losing weight. A lot of weight. But what was more remarkable even than that was that these kids started exercising spontaneously. These were all kids who sat on the couch, ate Doritos and slept, and now, they're active. One kid became a competitive swimmer. Two kids started lifting weights at home. One kid became the manager of his high school basketball team running around collecting all the basketballs. These were kids who had lost all interest in life, and now they're returning to the world of the living.

Robert: And the parents would say, "My kid is back." And the kid would say, "This is the first time my head hasn't been in the clouds since the tumor." This was really remarkable. So we ended up doing the double blind placebo control trial. Not telling the kids what we were looking at, but we ended up measuring their intake and expenditure and their activity and their quality of life. And sure enough, if we got the insulin down with this drug, not only did they lose weight, but their quality of life improved because their energy expenditure improved. These kids became more physically active.

Robert: So, what this proved to me was that the two behaviors that we associate with obesity, gluttony and sloth, are really actually biochemical being driven by hormones. And the problem was high insulin. Now, you asked me, how does this relate to ultra-processed food and why do I think about that? Well, because these kids with the brain tumors, they're pretty rare, but everybody else has high insulin levels too. They have a phenomenon called insulin resistance. Their insulin levels are sky high also without a brain tumor. And the question was, why is that?

Andy: I see.

Robert: And so, my next set of research over the course of the 2000s, demonstrated that sugar, dietary sugar, the crystals, the stuff you put in your coffee, sucrose, fructose corn syrup, maple syrup from the agave, it caused that insulin problem. So it was the driver of the high insulin and when we got the sugar out of kids' diets, they started losing weight. They started being more spontaneously active also. So anything that makes your insulin go up, makes you a glutton and a sloth. And anything that brings your insulin down brings you back to normal.

Robert: Well, sugar is the primary ingredient in ultra-processed foods. And it has now been shown in many different studies in many different countries that ultra-processed food is the driver of chronic metabolic disease. Type two diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, polycystic ovarian disease. That's 75% of all healthcare costs in the world, not just in America, but in the world. And sugar is the marker and ultra-processed food is the vehicle. And so this is why ultra-processed food is the problem. And this is why I spend a lot of time writing about it and railing against it.

Andy: The sugar spikes the insulin and the insulin leads to the metabolic diseases and you started noticing this link or this trend. What was interesting to me reading through your book, because I always thought insulin is good. We want the insulin 'cause that brings down the blood sugar and helps kind of normalize or stabilize. I always thought of insulin as being kind of the good guy. You want to encourage that insulin. I thought that was kind of the issue with diabetes was not having enough, you need more insulin. Is that taking enough of that stuff?

Robert: So, insulin is a good news bad news hormone.

Andy: Okay. Interesting.

Robert: You absolutely need insulin. If you don't have insulin, you have type one diabetes and that is very dangerous and very problematic. I took care of loads of kids with type one diabetes over my career as a pediatric endocrinologist. I have loads of type one diabetics who had to be on insulin, and there was no option. And even until this day, there's still no option. They have to be on insulin. And I agree with that. The question is, how much insulin? Now, in the old days, which was just three years ago-

Andy: Way back.

Robert: … the standard mantra from the American Diabetes Association was, eat anything you want, just take enough insulin to cover it. This was a disaster. So complete note of disasters. One of the reasons why diabetics get all the complications that they get with the retinopathy and the neuropathy and the nephropathy and the cardiovascular disease and everything else and plus-

Andy: Your kind of just monitor and if your blood sugars get a little too high, you take a little more insulin. If it's low, then you drink some soda.

Robert: Well, the point is to not let the blood glucose go up in the first place so you don't have to give the insulin. So this is the problem. The problem is that you need your glucose down, but you also need your insulin down. The glucose causes what we call microvascular disease. Small vessel disease like retinopathy, neuropathy, nephropathy, eye disease, nervous system disease, kidney disease. That's true. But the insulin is what causes the cardiovascular disease, the cancer, and the dementia. So, you need both-

Robert: … to keep the insulin down. And the problem is that the American Diabetes Association continues even today to say that the problem is just a glucose problem. They don't recognize that the problem is also an insulin problem. So I've been trying very hard to impress upon my colleagues, the societies I belong to, my patients, how important it is to keep the insulin down. The only way to do that is by changing the diet.

Andy: Well, can't you just exercise a lot?

Robert: No, exercise is not enough. Exercise is valuable. I'm not going to argue that. Exercise is perhaps the second most important thing you can do for yourself. First being the diet. First being, fix the diet. Now, in my book, Metabolical, I list eight, count them, eight separate subcellular pathologies that contribute to chronic disease and aging, okay? And I'm just going to name them real quick for your audience. Glycation, oxidative stress, mitochondrial dysfunction, insulin resistance, membrane instability, inflammation, methylation, and autophagy.

Robert: Now, these are processes that go on inside everybody's cells every single day. But they can work right or they can work wrong. Now, if they're working right, you'll live to be 110 playing tennis. If they're working wrong, you'll be in a wheelchair with two stumps on dialysis waiting for your next stroke. And everything in between depending on how those eight pathologies are being managed. Now, exercise will fix four of those pathologies. That's good.

Andy: That's pretty good.

Robert: Nothing wrong with exercise. Exercise is good. But there are four pathologies that exercise won't fix. It won't fix the glycation. It won't fix the oxidative stress. It won't fix the membrane instability, and it won't fix the methylation, Okay? Yes, it will fix the mitochondrial dysfunction. It will fix the insulin. It will fix the inflammation, and it will fix the autophagy. So exercise is good. I'm not saying it's bad. It's good. But it's not enough. Necessary, but not sufficient. You cannot outrun a bad diet.

Andy: How many of those eight can nutrition improve?

Robert: All of them? All eight.

Andy: That's pretty good.

Robert: And more importantly, those eight are not drug-able. There's no medicine for any of those eight. But they're all suitable. You can fix those with food. And that's the point is if you understand why what you put in your mouth is so important in terms of your general health, your longevity, your cognition, your capabilities, your mental health, then people will start gravitating toward the stuff that's healthy. Right now, they're gravitating toward the stuff that makes them feel good short term. That's giving them pleasure. That's giving them a dopamine hit. Sugar, caffeine, alcohol, street drugs. Bottom line is, we are a dopamine society and that's sort of the antithesis of metabolic health.

Andy: What's the deal with fiber? You talk a lot about it and kind of make me think about it in a different way in your book, why it's so important.

Robert: So, fiber is the nutrient you don't absorb. Now, you would say to me, wait a second. If you don't absorb it, how can it be a nutrient? Because it's not a nutrient for you. It's a nutrient for your bacteria. It's a nutrient for your microbiome. Each of us is 10 trillion cells, except we have a 100 trillion bacteria in our intestine. Our bacteria outnumber us 10 to one. Each of us is really just a big bag of bacteria. Those bacteria have to eat something. Well, what do they eat? No, they eat what you eat. Question is, how much did you get versus how much did they get?

Robert: If you do not feed your bacteria, your bacteria will feed on you of mucin layer right off your intestinal epithelial cells leading to irritable bowel syndrome, inflammatory bowel disease, leaky gut, transport of bad proteins like cytokines and lipopolysaccharides, which are inflammatory across from the intestine into your bloodstream driving systemic inflammation, insulin resistance, and all those chronic metabolic diseases I talked about. So keeping your microbiome happy is job one. You have to feed your gut. And that's what half the book is about. Is explaining why you have to feed your gut.

Robert: Well, what does the gut eat? It eats fiber. Those bacteria can chew up fiber. We can't. In addition, those bacteria will make short chain fatty acids out of the fiber and short chain fatty acids, butyrate, propionate are anti-inflammatory. They actually keep our inflammation down, which is good for longevity and good for metabolic functioning. And the fiber sets up a gel on the inside of your intestine. When you swallow food with fiber like fruit, it has sugar, but it also has way more fiber. That fiber, and there are two kinds soluble and insoluble. You need both.

Robert: The soluble fiber is like pectins, what holds jelly together. The insoluble fiber is like cellulose. The stringy stuff in celery. Fruit has both. Almonds have both. Vegetables have both. Pretty much anything that comes out of the ground has both. That's why you have to eat what comes out of the ground is to get that fiber. The point is that the insoluble fiber, the cellulose, the stringy stuff in celery, will act like a lattice work, like a fishnet on the inside of your intestine. The soluble fiber, they're globular. They're like spheres. They plug the holes in the fishnet and together they form this impenetrable secondary barrier in your intestine that prevents glucose, fructose, simple starches from getting into the blood stream.

Robert: In doing so, you keep your blood glucose down and therefore you keep your insulin down, and that's the goal. Keep the insulin down. Fiber is the best way to keep your insulin down.

Andy: So it's like a time release coding for your-

Robert: Yeah. It's sort of like a tiny time release pill thing. That's right. And here's the best news. If you don't absorb it early, because the fiber's there, that means the food will go further down the intestine into the next part called the. And what's there? The bacteria and the bacteria will chew it up for its purposes. So you've ended up feeding your gut without feeding you. So even though you ate it, even though it registered as calories passing your lips, if you didn't absorb it, it wasn't for you.

Andy: … too much good.

Robert: Okay. So fiber is the nutrient you don't absorb. Fiber is the nutrient that's not for you. But it's a nutrient, but it's not for you, it's for your bacteria. But you have to feed your bacteria. So we throw the fiber in the garbage. We juice the fruit, throw the fiber in the waste basket. That is the single worst thing we can do. We're taking something positive and we're getting rid of it. And we're allowing the thing in the juice that's negative, the sugar, free reign, free access to raise our blood glucose, raise our fructose, raise our insulin, cause chronic metabolic disease and we die early.