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'We Are Seeing People Getting Sicker and Sicker, and We Can’t Do a Damn Thing About It'

Robert Lustig, the doctor who wrote the book on Big Sugar is back, and taking on Big Pleasure.

Robert Lustig

This is "Think Tank," an occasional series of conversations with Bay Area power players, conducted by
San Francisco editors. Interviews have been condensed and edited for clarity.

Occupation: Professor of pediatrics, UCSF School of Medicine
Age: 60
Residence: San Francisco

San Francisco: Your new book, The Hacking of the American Mind, is about how corporations exploit our confusion over happiness and pleasure. What’s the difference between the two?
Robert Lustig: Pleasure is the mental state of “This feels good, I want more.” Happiness is the state of “This feels good, I don’t need any more.” Pleasure is short-lived; happiness is long-lived. Pleasure is felt in the body; happiness is above the neck. Pleasure can be achieved with substances; happiness cannot. Extremes of pleasure lead to addiction. There’s no such thing as being addicted to happiness. Pleasure is related to dopamine in the brain, while happiness is related to serotonin.

We’re confused.
We have been confused. I don’t blame people for not knowing the difference.

So people selling us things—whether it’s sugar or smartphones or clothes—feed off our desire for quick pleasure, but actually hurt our chances at achieving real happiness. Is the solution to just ban the bad stuff?
No, we saw what happened with the prohibition of alcohol. The goal is to ultimately make these things safe, but rare. The way you do that is to bring the rate of taxation—or the inhibition of access—to an equivalence point between how much society wants it and how much corporations want to supply it.

How does that work?
The most price-inelastic item there is is restaurant food, which has an elasticity of 0.81. Meaning, if the price goes up by 1 percent, consumption goes down by just 0.19 percent. Soda has a price elasticity of 0.79, making it the second-most-inelastic category. We are addicted. Eggs, on the other hand, are the most price-elastic foodstuff : If the price goes up 1 percent, consumption goes down a lot more. That says it all. Eggs may give you happiness, but not pleasure.

Price elasticity. Prohibition. You sound like an economist, but you’re actually a pediatrician. What does this have to do with healthy kids?
My job is to help children. The problem is, there’s no medicine to fix this. There’s no medicine to fix obesity, type 2 diabetes, chronic metabolic diseases, addiction, or depression. Every single problem we have in our society, there’s no medicine for. We are seeing people getting sicker and sicker, and we can’t do a damn thing about it.

This brings us back to serotonin.
Yes, and there are four things people can do to up their serotonin: You can connect with other people; contribute to society; cope with sleep, mindfulness, and exercise; and cook for yourself and your family.

Your argument for cooking isn’t really about taste, right? It’s just that substances found in fish and eggs are the actual building blocks of serotonin.
Nutritional biochemistry—the concept that the stuff in the food we eat dictates not just disease, but emotional health—has been known for a while, but it’s not taught in medical school. It’s not taught anywhere! We should be teaching it to fourth graders, which is what we are doing in the East Bay. We’re working with the Mount Diablo school district to teach fourth graders in Concord about it. How do you expect kids to generate a serotonin response if they don’t get the precursor?

As a research pediatrician, you’re known for your work on the dangers of sugar. What’s so bad about it?
For a substance to be controlled, it needs to be ubiquitous, toxic, subject to abuse, and have a negative impact on society. Tobacco meets them all, alcohol meets them, and various street drugs do, too. In a paper in Nature several years ago, we outlined all the reasons sugar did as well. It is a drug, but the addiction and toxicity data have been deep-sixed for decades—on purpose. Alcohol is an acute toxin and a chronic one. Sugar is a chronic toxin. If it were an acute toxin as well, it would have never been in our food. Alcohol isn’t.

This is not news to you, but human beings are very bad at dealing with chronic threats. How close are we to kicking the sugar habit?
We’re still at the beginning. There have been four tectonic shifts in public health in the last 30 years: bicycle helmets and seat belts, [banning] smoking in public places, [curbing] drunk driving, and condoms in bathrooms. Today they’re all facts of life. Kids are now being educated about sugar, but it’s going to take until they get to voting age for you to see a change. You have to work upstream of the problem. If you have a wasp in your attic, you have to find its nest.


Originally published in the January issue of San Francisco

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