Dr. Robert Lustig
speaker
405 appearances
4 recordings
4 series
first heard Dec 2024
last heard 12 Jan
Dr. Robert Lustig’s voice in public audio — every appearance, attributed to the second.
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fat depot number one subcutaneous or big butt fat as in does this bathing suit make me look fat never answer that question total loser okay guaranteed okay now here's the question how many pounds of subcutaneous fat do you have to gain before you get sick oh I'd love to know. About 22 on average. 10 kilos.
Now, why so much? The answer is because subcutaneous fat does not drain into the liver. Subcutaneous fat drains into the heart. So when subcutaneous fat accumulates, The border of the fat vacuole in the fat cell starts to break down. The grease gets spilled. The macrophages come in to clean up the grease. They release the cytokines.
The cytokines then circulate in the peripheral bloodstream, which is six liters. And so the concentration doesn't go up very high. And so the liver doesn't see a very high concentration of these cytokines. And it's the concentration of cytokines that the liver sees that determines whether or not the liver gets sick. So about 22 pounds. All right, fat depot number two, visceral fat, belly fat.
Yeah. The visceral fat. It's cool. How many pounds or kilos of visceral fat do you have to gain before you get sick? I would guess it's probably less than 22. Five. Five. Maybe six. Okay, 22 for sub-Q fat because it drained into the general circulation. Five or six for the visceral fat because it drains into the portal vein. The portal vein goes straight to the liver.
So if your visceral fat accumulates and you start breaking down that fat vacuole and the grease starts spilling and the macrophages start coming in, Those cytokines are going to be at much higher concentration because they only have to populate the portal system, the portal vein, from the gut to the liver. There are two portal systems in your body. What's a portal system?
Exactly. So that's right. What does it drain? So normally... The way blood goes in your body, it goes heart, aorta, artery, organ, vein, vena cava, heart. Okay. That's called a systemic circulation. A portal circulation goes like this, heart, aorta, Artery 1, organ 1, artery 2, organ 2, vena cava, heart. So the blood has to go through two organs to come back to the heart.
And there's information being carried from organ 1 to organ 2, which tells organ 2 what to do. So there are two portal systems in the body. One is the hypothalamus to pituitary. We know why that is because that runs all the different hormonal systems of the body. And the other one's pancreas to liver because the liver is the primary target of insulin action.
And so when the liver gets fat, the pancreas has to make more insulin to make the liver do its job. And because the liver gets fat and because it's at the end of that portal system, the Liver doesn't have to get very sick for the pancreas to start making extra insulin and causing problems. Now, the question is, where did the visceral fat come from? Did it come from the diet? No.
People think that belly fat is from the diet. No. This is the big, you know, mistake. Yeah, where does it come from? Stress. And the reason we know that is because you can take people who are chronically depressed, who are suicidal, who basically have to be admitted to the hospital to keep themselves from killing themselves. And you put them in a scanner and they're not eating.
And so they're losing weight. Hallmark of depression, losing weight. and their subcutaneous fat is going down and their visceral fat is going up. They're losing weight and their visceral fat is going up because cortisol, the stress hormone, is the driver of that visceral fat.
Absolutely.
So we did the opposite at UCSF. We did a study where we took patients with exactly that situation and taught them mindfulness. So yeah, can you explain what that study was? What was the condition?
We took postmenopausal women and we basically taught them how to meditate. So you weren't controlling their food or anything like that? We didn't touch their food. We only taught them to meditate, but we studied them before and six months and 18 months later. And when you say studied, what were you looking at? We were looking at their fat depots. And cortisol as well.
And cortisol and also insulin and insulin resistance. Exactly. And what we found was that weight didn't change that much. But in the mindfulness group, their belly fat went way down and their insulin levels went way down.
Exactly. And that correlated with improvement in their metabolic health unrelated to weight. Another reason why this is not about calories.
Indeed. And that's what we showed in this mindfulness study. So it's called the Shine Study. It was run by Rick Hecht and Alyssa Epple, my colleague. Yeah, we've had her on the podcast before. She's great. Absolutely. She was the co-PI on this. And we showed that So mindfulness did not change weight.
It changed health because it got rid of the cortisol, because it got rid of the insulin resistance, because it got rid of the visceral fat.
Right. What that would do is that would help reduce subcutaneous fat. Which of course is the fat that everyone sees. Right. But it's not the fat you can see that makes you sick. It's the fat you can't see that makes you sick. That's the nugget of truth that people don't want to own up to.
And number three. Liver fat. Liver fat. So how many pounds or kilos of liver fat do you have to accumulate before you get sick?
Half a kilo, one pound.
Showing 301–320 of 405 · page 16 of 21
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