Rules of Reduction

Rules of Reduction

Robert’s Rules of Reduction (of processed food, that is)

I’ve spent the last 25 years investigating the causes and treatments of chronic disease

(obesity, diabetes, fatty liver disease) in children and adults. I can sum up my research career in three simple precepts:

  1. It’s the insulin, stupid.
  2. It’s the sugar, stupid.
  3. It’s the lack of fiber, stupid.

All of this has led me to determine that our processed food diet is the primary culprit. It is high-sugar, low-fiber, toxic, addictive, ubiquitous, and detrimental to society. Therefore, I’ve dedicated my efforts to reduce its impact on people and the environment.

I’ve also determined that processed food is not going away, no matter how I may want it to. Partly because it’s cheap, partly because it’s convenient, and partly because it’s addictive.

I’m for fixing the problem any way I can. Society can do this in two ways:

  1. Reduce the availability of processed food.
  2. Reduce the harm of processed food.

Reducing availability is problematic, as the industry keeps pushing it, the public keeps demanding it, and the government keeps ignoring it. I’m doing what I can, most recently publishing a white paper to provide a roadmap for processed food reduction. 

But reducing harm may be a bit easier. To help sick people get better, I’ve teamed up with a group of materials science engineers to develop a proprietary fiber that will absorb sugars in the intestine, thus protecting the liver and feeding the gut, thus mitigating some of the toxic effects of processed food. The company is called BioLumen Technologies. It is very exciting and has generated interest within the processed food industry, most recently PepsiCo.

Some may question this strategy, as it would seem to be the antithesis of my message, and it looks on the surface like a “get out of jail free” card to patients, a “carte blanche” to the industry, and like I am “selling out”. Not true. You can’t let the perfect be the enemy of the good. People are hurting, people are dying, and COVID is making it worse. To stick to “principle” is to turn my back on these people. I’ve never taken a dime from the food industry, and I’m not starting now. I derive no salary from BioLumen, and I am not on Pepsi’s payroll. I’m just trying to fix the problem any way I can, using my research, knowledge, and expertise.

This fits well within my Hippocratic Oath and my oath to you, the public. Fix the problem. But you can’t fix a problem if you don’t know what the problem is. Everything I have learned so far in this amazing journey tells me that I do. If the processed food and beverage industry can figure it out too, then all to the better.


Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine, by Robert H. Lustig.

To be released May 4, 2021

Pre-orders being taken on Amazon. 

The New York Times bestselling author of Fat Chance explains the eight pathologies that underlie all chronic disease, documents how processed food has impacted them to ruin our health, economy, and environment over the past 50 years, and proposes an urgent manifesto and strategy to cure both us and the planet.

Dr. Lustig, a pediatric neuroendocrinologist who has long been on the cutting edge of medicine and science, challenges our current healthcare paradigm which has gone off the rails under the influence of Big Food, Big Pharma, and Big Government.

You can’t solve a problem if you don’t know what the problem is. One of Lustig’s singular gifts as a communicator is his ability to “connect the dots” for the general reader, in order to unpack the scientific data and concepts behind his arguments, as he tells the “real story of food” and “the story of real food”.

Metabolical will weave the interconnected strands of nutrition, health/disease, medicine, environment, and society into a completely new fabric by proving on a scientific basis a series of iconoclastic revelations, among them: 

  • Medicine for chronic disease treats symptoms, not the disease itself
  • You can diagnose your own biochemical profile
  • Chronic diseases are not ‘druggable’, but they are ‘foodable’ 
  • Processed food isn’t just toxic, it’s addictive
  • The war between vegan and keto is a false war — the combatants are on the same side
  • Big Food, Big Pharma, and Big Government are on the other side

Making the case that food is the only lever we have to effect biochemical change to improve our health, Lustig explains what to eat based on two novel criteria: protect the liver, and feed the gut. He insists that if we do not fix our food and change the way we eat, we will continue to court chronic disease, bankrupt healthcare, and threaten the planet. But there is hope: this book explains what’s needed to fix all three.

Food is Health

On September 30th, I will be a Keynote Speaker at the Crusonia on the Delta #FoodIsHealth Digital Forum. Crusonia has made Registration for the Forum FREE and encourages anyone passionate about the importance of healthy food to participate. You will be able to watch my conversation titled “FOOD IS HEALTH” live by registering here. I look forward to seeing you (digitally) at the Forum

Double Dose of Sugar

A double dose of sugar!

The Nature Metabolism paper explains why some people who eat high sugar diets get fatty liver and some don’t.

It has to do with “leaky gut”; those with leaky gut get NAFLD. Except that chronic fructose causes NAFLD!

The Cell Metabolism paper shows why fructose causes both liver fat AND oxidative stress.

Normally these are in different liver pathways. It turns out the cell has a switch called triose kinase, which directs fructose metabolites down one pathway or the other.

These two papers, taken together, drive home the assertion that fructose is the primary, and the most modifiable driver of fatty liver, insulin resistance, and metabolic syndrome.

It’s the processed food, D’oh!!

Fructose stimulated de novo lipogenesis is promoted by inflammation, Nature Metabolism

Triose Kinase Controls the Lipogenic Potential of Fructose and Dietary Tolerance, Cell Metabolism

Schematic summary from “Fructose stimulated de novo lipogenesis is promoted by inflammation.” In IEC, dietary fructose is converted to F1P by KHK. F1P inhibits protein N-glycosylation, triggering ER stress and intestinal inflammation to downregulate TJPs and trigger barrier deterioration and endotoxaemia. Endotoxin (LPS) reaches the liver via the portal vein and engages TLR4 on macrophages to activate nuclear factor kappa B (NF-κB) via the adaptor protein MyD88 and induce TNF expression and secretion. TNF engages TNFR1 on hepatocytes to induce caspase-2 (CASP2) mRNA, whose translation is stimulated by ER-stress-activated IRE-1. CASP2 activates SREBP1 to induce ACC1 and FAS, thereby priming the liver to convert KHK-generated F1P to FA (C:16, C:18), giving rise to hepatosteatosis. *P< 0.05; **P< 0.01; ***P< 0.001.


Wellness Bingo

Celebrate August being National Wellness Month!

Join the UCSF office of Wellness and Community in a UCSF Wellness Bingo Challenge to prioritize your wellbeing and self-care.

Throughout the month of August, pick and complete at least five of the activities in the Wellness Bingo Grid in any order. No need to actually stick to a diagonal or the same row or column – wellness is about being flexible too.

Submit your results in the Qualtrics link on the Bingo Grid and be entered in a drawing for a chance to win a $25 gift card. 10 winners will be selected!

Wellness Bingo Grid:

Qualtrics Submission Form:

Click on the image below for the interactive (hyperlinked) PDF:

Myths Of Chronic Metabolic Disease

Join us for a FREE live webinar on Tuesday, August 11th at 3:00 pm EDT!

Two Myths Of Chronic Metabolic Disease: The Real Problem and the Simplex Solution


Simplex Health Medical Advisor Robert Lustig M.D., M.S.L. endocrinologist, best-selling author, and an Emeritus Professor of Pediatric Endocrinology at the University of California will dispel two common obesity myths and reveal what’s really responsible for fueling the chronic disease in our country today. Co-hosted by Simplex Health’s Chief Medical Officer and Medical Director, Avrahom Gurwitz M.D. MPH FAAP CPH IFM and Clinical Director of Diabetes Prevention & Reversal and Director of Protocol Research & Development Stephanie Biggs, RD LDN CDE, will discuss dietary strategies that target this problem for the purpose of preventing and reversing disease.



I’m very happy to recommend Michael Goran and Elsie Ventura’s new book “Sugarproof” for two reasons. First, it’s yet another piece lifted out of the Jenga that the sugar industry compiled in the 1970’s, and the structure is finally tumbling down. Second, earlier in his career, Michael researched exercise. But he switched to sugar, because he realized no matter how we try otherwise, we can’t outrun a bad diet, and not even our kids can. Diet is the #1 problem. And sugar is public enemy #1.

Please join us for a live discussion with Sugarproof authors Drs. Goran & Ventura at How sugar disrupts growth and development and how to empower families to consume less.

Covid-19 Risk Factors

Obesity, type 2 diabetes and a cluster of risk factors all linked to poor diet is the root cause behind increased death rates from coronavirus.

  • Obesity, type 2 diabetes and metabolic syndrome associated with an up to 10-fold increase risk in death from COVID-19
  • Ultra-processed food which makes up half of British diet blamed as primary culprit
  • Only 1 in 8 adults are metabolically healthy
  • Dietary changes can rapidly reduce risk of health complications and can potentially send type 2 diabetes into remission within weeks.
  • International experts in medicine, dietetics and nutrition call for immediate update on public health messaging to eat whole nutritious food to rapidly reduce risk of COVID-19 complications and potentially save hundreds and thousands of lives.

Obesity, type 2 diabetes and a cluster of risk factors all linked to poor diet is the root cause behind increased mortality from COVID -19.

An article in European Scientist entitled “Covid 19 and the elephant in the room” by Dr. Aseem Malhotra, NHS Consultant Cardiologist and Professor of Evidence Based Medicine, calls on public health messaging to be urgently updated in the light of COVID -19 to ensure people are eating nutritious whole foods in an attempt to reduce risk and subsequent death rates from the virus.

Drawing on UK data Dr. Malhotra notes that 72.7% of patients admitted to ICU are overweight or obese and that those with the related metabolic syndrome have a tenfold increase in mortality from the virus. Referring to US data where obesity levels are similar to the UK, Dr. Malhotra notes that only 1 in 8 people are metabolically healthy including less than 1 in 3 of “normal” weight.

Brits during lockdown are stocking up on ready made meals. Dr. Malhotra says “Urgent changes must be made nationally to rapidly change public health outcomes.”

Dr. Malhotra, who has long campaigned against sugary and ultra-processed foods, says his findings are backed up by leading doctors and nutritionists and that data coming in from every country affected by the Covid-19 outbreak can no longer be ignored. He continues: “Looking at all the data, it is irrefutable that metabolic disease is the leading cause of mortality from Covid-19. This covers much of what we are already being told, that outcomes for patients suffering from type 2 diabetes, heart disease and high blood pressure are far worse than in otherwise healthy adults. What is not being spelled out is that poor diet and obesity is behind this.”

Dr. Malhotra says that key changes to the way we eat can have significant effects within weeks, reducing blood pressure and even reversing type 2 diabetes: “By immediately cutting out sugar and ultra-processed food and preparing fresh meals, the impact on health can be seen in just a matter of weeks. We have been far too cautious in the UK in terms of rolling out a massive public health campaign to get people to eat properly when we have known for over a decade that obesity-related illness is the biggest factor behind poor health and hospital admissions in the UK.”

Dr. Malhotra continues: “Now we find ourselves in a public health crisis brought on by Covid-19, and can see clearly obesity and diet related disease is behind a significant increase in the risk of hospitalization and death. With people at home catering for themselves every single night while this virus rampages through the country, the message is not just clear enough. The general public need to be told immediately by official sources to cut out sugar, refined carbohydrates and junk food and switch to a whole food diet abundant in vegetables, fruits, nuts, seeds, dairy and plenty of protein from pulses, fish, meat, and eggs, to improve their health within weeks to help protect themselves in case they contract the novel coronavirus.”

In the European Scientist article “Covid 19 and the elephant in the room,” Dr. Malhotra states: “Given the speed at which health markers for metabolic disease improve from dietary interventions, an equally strong if not more significant population health message should now be to “eat real food, protect the NHS and save lives. Such implementation backed by policy changes may not just save hundreds and potentially thousands of lives around the world in the coming months but given the high likelihood of another international viral pandemic in the next decade a healthier population and a subsequently more manageable health service will be much better equipped to handle what would then be a smaller mortality peak on the next occasion. Hopefully if and when that occurs a lockdown will not be required.  

Experts Comment

“Obesity and poor diet is emerging as one of the biggest risk factors for a severe response to Covid-19 infection that can no longer be ignored.”
– Tim Spector, Professor of genetic epidemiology, King’s College, London and author of the Diet Myth.

“I’ve heard COVID-19 referred to a beast, because it doesn’t distinguish. In point of fact, it doesn’t distinguish who it infects. But it does distinguish who it kills. Other than the elderly, it’s those who are Black, obese, and/or have pre-existing conditions. What distinguished these three demographics? Ultra- Processed food. Because ultra -processed food sets you up for inflammation, which COVID-19 is happy to exploit. Just another way processed food kills. Time to rethink your menu.”
– Dr. Robert Lustig, Professor emeritus of Pediatrics, Division of Endocrinology at the University of California, San Francisco (UCSF)

“In my opinion, Aseem Malhotra again conveys a powerful and important message, not only in the context of the current health crisis, but for the benefit of general (public) health as well. Avoiding junk and eating whole nutritious food is fundamental to reversing the staggering prevalence of chronic metabolic disease, and there’s no better time to start than now.”
– Hanno Pijl, Professor of Diabetes at the University of Leiden, The Netherlands.

“Dr. Aseem Malhotra sheds light on the real elephant in the room with COVID-19 and that is the people who are most susceptible to this virus, besides the elderly, are those individuals who are overweight or obese. Not only does being overweight increase the risk of dying from viruses but it also increases the risk of heart disease. He should be applauded for bringing this topic to light and the healthcare system should take notice of this important point of view. The evidence clearly reveals dietary changes rapidly improve health markers of those most at risk of COVID-19. We must help and empower people to make those changes as a matter of urgency.”
– Dr. James DiNicolantonio, Cardiovascular research scientist, St Luke’s Mid-America Heart Institute

“Scientific literature regularly reports on hypertension, cardiovascular disease and diabetes as risk factors for worse outcomes in COVID-19. The prevalence and seriousness of poor metabolic health in COVID-19 is an important public health message. But this is not for scare-mongering. Dietary change with reduction in ultra-processed foods, sugar and refined carbohydrates can lead to a rapid improvement in metabolic health and weight loss. People need awareness, knowledge and support to make choices that are best for their health. This article is important for raising awareness and knowledge. We must all rise to the challenge to provide support to the nation, and take the necessary actions, to improve metabolic health and reduce the lethality of COVID-19.” 
– Dr. Campbell Murdoch, GP (Special Interest in Metabolic Health), NHS England Sustainable Improvement Team – Clinical Adviser, Royal College of General Practitioners – Clinical Adviser and Entrepreneur

“COVID19 has brought the world to a standstill like no other phenomenon since WWII. And whilst much of the hype has been about morbidity and mortality figures and managing the pandemic by social measures, it is an inescapable fact that some individuals have been more susceptible to the disease than other because of their inherent risks from overt or covert medical problems. It was not until Dr Aseem Malhotra, renowned cardiologist, drew my attention to risks from obesity and diet related disease that I have become aware that this is a major predisposing factor in the majority of individuals, especially those from BAME backgrounds struck by the virus. Let’s not wait till the next pandemic to implement his advice. Let’s do it now.” – Dr. JS Bamrah CBE, FRCPsych; Consultant Psychiatrist, GMMH; Hon Reader, University of Manchester and Chairman of British Association of Physicians of Indian Origin

“The best we can do to prevent getting COVID-19 or to reduce its virulence if you do get it is to have a strong immune system and good metabolic health. To achieve both of these, it’s critical to eat whole unprocessed foods that promote a stable blood sugar – of course alongside other lifestyle behaviours such as getting enough sleep, sunshine (where possible),regular exercise, engaging with friends and family (easily done on-line) and managing stress. The problem is, in high stress-times, when it comes to food, many turn to highly processed, packaged food for comfort. Now is the worst possible time for such choices. As the government is trying new things some mere endorsement of eating healthy wholefood from our leaders should be mandatory. It always matters to look after your weight, and your metabolic health, but now’s likely the most important time ever to do this”.
– Caryn Zinn, PhD, Senior Lecturer  & Dietitian, AUT University, Head of Research – School of Sport & Recreation

“The beauty of this is that making meaningful change to your diet is actually quite easy, and in many cases, can actually save you money as well. Start to build your diet around lean proteins, healthy fats, plenty of fibre, and non starchy vegetables. Think vegetable and goats cheese omelette for breakfast. A good dense salad with a few mixed beans, a few nuts, maybe some cooked meats or tofu for lunch Chicken and vegetable curry with spiced greens or baked salmon and roasted Brussels sprouts for dinners. Delicious food, easy to prepare, and in most cases far cheaper than many packaged foods. When you eat like this you are creating meals that support so many aspects of metabolic health. They keep blood sugar stable, reduce inflammatory load, cut out the array of pro-inflammatory fatty acids found in processed foods, and have a far superior nutritional density. The other sad irony here is that in many of our supermarkets these foods, that so effectively support our health, are there in abundance and even going to waste, as the nation stockpiles pasta.”
– Dale Pinnock BSc (Hons), PgDip Nutritional Medicine, Nutritionist and Author

“Associations between our health status and the extent to which COVID-19 is likely to affect us are becoming increasingly apparent. We are now well aware of the increased risk of death to those carrying excess weight. There has been the tendency to tiptoe around the issue of obesity, with clinicians hesitant to point it out to their patients for fear of repercussion and accusations of ‘fat shaming’. While this is without doubt a very sensitive subject which must be handled with care, the current pandemic highlights the very real fact that overlooking the seriousness of excess weight is costing lives. Black, Asian and minority ethnic people are not only more likely to die from COVID-19, this darker-skinned demographic are also known to be at higher risk of vitamin D deficiency, known to play an important role in immunity. The good news is that with positive changes to our nutrition, improvements can come rapidly. On the right diet, body fat can reduce quickly and healthily.  Daily exercise, particularly in daylight and surrounded by nature, can have profound effects on our mental wellbeing, as well as physical. Cultivating mindfulness through practices like meditation and conscious eating can help us become aware of our non-hunger drivers for eating and implement strategies to fulfil those needs more effectively. All of these practices not only have the potential to dramatically improve our physical and mental health, they could mean the difference between life and death.”
– Kimmy Pearson, Harley Street and BANT Registered Nutritionist


Ultra-Processed Foods
Ultra-Processed are packaged food usually of five or more ingredients with additives and preservatives which are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on the international NOVA classification show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view.

Metabolic Health
Good metabolic health is defined by having optimal levels of

  1. Waist circumference ( <102/88 cm for men/women)
  2. Blood pressure < 120 mmHg systolic and diastolic < 80 mmHg
  3. Hemoglobin A1C < 5.7%
  4. Triglycerides < 1.7 mmol/L
  5. HDL cholesterol > 1 mmol/L and not being on any medication

Metabolic syndrome which is associated with the highest risk of health complications from COVID -19 is having three or more of the above risk factors

For additional information, please contact Dr. Aseem Malhotra.

Real Food is your best defense against dying from coronavirus

Real Food is your best defense against dying from coronavirus

Like everyone else in California this week, I made an emergency provisions trip to the supermarket in response to our state’s “shelter in place” order to try to flatten the coronavirus infection curve. What I saw amazed me. All the produce, all the meat, all the milk, all the nuts, all the dairy, were fully stocked. What was gone from the shelves? Pasta, breakfast cereal, and candy. Really?

Now, I understand that these consumables last a long time. I understand that people are not sure about the resilience of the food supply. I understand that people are worried that the fresh food somewhere along the food chain might have been handled by a virus carrier. And, as an obesity researcher, I understand that they are “tasty”, and right now, everyone is just a little bit stressed which drives the brain’s need for some form of “reward”. Parents are using sugar as the reward for good behavior while cooped up in the house, while the mom is guzzling Ben and Jerry’s.

But this is the exact WRONG formulation. This isn’t going away soon. We’re in this for the long haul, and what we eat matters. Who dies from coronavirus? The elderly, and those with pre-existing conditions, such as diabetes, heart disease, hypertension, and kidney disease — and these affect young people as well. The current thinking is that these people don’t have the resilience to stand up to the virus. This is partially true, they don’t. But why not? Because these groups are already in a state of chronic inflammation, which stems from their prior poor nutrition.

The elderly lose muscle and brain function as they age. Is this just from aging? Not specifically — there is a subset of octogenarians who are doing just fine, and there are centenarians who can run rings around you. Rather, most of the elderly fall prey to malnutrition, which can be due to any one of the Nine D’s: Depression, Dementia, Diarrhea, Drugs, Dentition, Dysgeusia (inability to taste), Dysfunction (specifically immune), Dysphagia (inability to swallow), and Disease (the same diseases that younger people get).

And what are these diseases that serve as risk factors for dying from COVID-19? They are the diseases of metabolic syndrome. Diabetes, heart disease, hypertension, kidney disease — these are the diseases that travel with obesity. But obesity is not a cause, because 20% of obese people don’t have them, while 40% of normal weight people do. Rather, obesity is a marker for the two underlying cellular pathologies — mitochondrial dysfunction (the inability to utilize energy properly) and insulin resistance (the inability of cells, especially the liver, to respond to the insulin signal). Because of these two problems, people with metabolic syndrome are already in a high cytokine (inflammation) state, which is what drives these chronic diseases.

Then throw COVID-19 on top, and you have the makings of a tsunami of inflammation. You’ve heard that this virus causes pneumonia. That’s true, because pneumonia just means lung inflammation. But it’s not due to the virus itself. It’s due to the ensuing cytokine response, known as Adult Respiratory Distress Syndrome (ARDS), which destroys normal lung tissue.

Your inflammatory status is the single best predictor of survival. What worsens your inflammation? Processed food, because of three inherent problems: 1) excess omega-6 fatty acids (seed oils like soybean oil) which are pro-inflammatory; 2) lack of omega-3’s (oily fish), which are anti-inflammatory; and 3) excess sugar (virtually all processed food), as the fructose (sweet) molecule in sugar poisons mitochondria and induces insulin resistance directly.  Conversely, improving your inflammatory status is the single best way to improve your chance for survival. Flavonoids, polyphenols, vitamin C, vitamin D, all of which have anti-oxidant, anti-inflammatory, and immune strengthening capacities. That’s called REAL FOOD — the stuff that’s still in the supermarket!

But what about food-borne viral transmission, you ask? While it is true that COVID-19 is very resourceful and can bind to intestinal epithelial cells, no one appears to have contracted the virus through the oral route. This is a droplet disease. My UCSF colleagues have posted a full assessment of the virus’ transmission and epidemiology, and the gut is not a route of infection. If you’re still worried, cook the hell out of it; it’s still better than eating the crap out of the box.

The big problem is that 33% of Americans today don’t know how to cook; because a whole generation has grown up on processed food. To this end, my non-profit Eat REAL <> is posting food guides on how to eat immune system-boosting food, and the contents of my Fat Chance Cookbook is online so that adults can make easy quick recipes using real food; and the only extra piece of cooking equipment you would need is a blender.

Processed food kills. It kills by causing chronic disease. But chronic disease puts you at risk for acute disease as well. Real Food won’t prevent you from becoming infected with COVID-19. But it certainly can help you to survive it.

– Robert H. Lustig, M.D., M.S.L.

Robert H. Lustig, M.D., M.S.L. is Emeritus Professor of Pediatric Endocrinology in the Division of Endocrinology and member of the Institute for Health Policy Studies at the University of California, San Francisco. He is also Chief Science Officer of the non-profit Eat REAL and Medical Advisor for the Hypoglycemia Support Foundation. He takes no money from the food industry.

Eat Real Food Poster by Joe Wirtheim.

Subscribe for news and updates...

Join this mailing list to receive the latest news and updates from Dr. Robert Lustig.

You have Successfully Subscribed!