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Book Review: Robert Lustig’s “Metabolical”

Member Forum >> Food and Diet >> Book Review: Robert Lustig’s “Metabolical”

Bob Niland

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Posted: 6/23/2021 10:26:05 AM
Edited: 6/24/2021 4:12:14 PM (5)
 
Book Review: Robert Lustig’s “Metabolical”

Metabolical
The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine

Review edition: 2021-06-23


Robert H. Lustig, MD, MSL
Published: 2021-05-04
416* pages in hardcover
ISBN-10: 0063027712
ISBN-13: 978-0063027718

The Amazon page has the Look-Inside feature enabled, including a full Index.

#citeless: permalink to citeless * No cites in sight
Presume the print edition page count to actually be more like 486, because the 1054 reference cites relied upon (an extra 70 pages worth), are not present, footnoted or endnoted. In a novel (to me) approach, they are all found at metabolical.com, and keys to page numbers (which presumes print edition). This makes the print edition an annoying and somewhat peculiar read, particularly for anyone not broadly familiar with nutrition, modern health issues and related events. If anyone obtains an eBook edition of this work, let us know how this was handled (e.g. by hovertext pop-up or hypertext link). I have more comments on this in the first Reply below.


As is customary for my book reviews on the Undoctored Inner Circle site, the read was undertaken to determine if this book might provide health benefits beyond what’s expected by someone already following the latest program advice here. The reader of this brief review is presumed to be following Undoctored or 2014+ Wheat Belly.

#nutshell: permalink to nutshell So then, worth a read?

  • Yes:
    if you’d like an overlapping, and somewhat wider or deeper view of more problems in modern settler diets. Metabolical dives down most of the rabbit holes in the lawn, lays out the histories, the festering scams, and names names.
     
  • Yes:
    if you have children, or your kids do (and especially if your kids are vegan). Being a pediatrician, Dr. Lustig is willing to face young diets head on.
     
  • Yes:
    if you want more biochemistry detail on metabolic syndrome, or are looking for hints of new rabbit holes that might be promising. Its view on nutrient sensing may be novel.
     
  • Yes:
    if you want an implied update on Dr. Lustig’s personal rediscovery of what makes a sane human diet.
     
  • Yes:
    if you think that Dr. Davis has been too kind on Big Food™, BigPharma™, Corrupt Practitioner Guilds, Affliction Perpetuation Associations, the FDA, FTC or the USDA.
     
  • No:
    if you’re looking for advantageous tweaks to the Undoctored or Wheat Belly programs. Those already doing enlightened ancestral diets are not really the target audience.

Metabolical may, however, turn out to be a great lead-in to someone else’s upcoming book on microbiome, because it does see the topic as a major emergent health strategy.

#overview: permalink to overview What Metabolical Is About

protect the liver,
feed the gut

Real Food

The above are recurrent themes. Real Water, so to speak, is not, which may explain some oversights in the Micros.

In case Undoctored didn’t convince you of just how screwed up modern “food” and sickcare has become, this book lays out much of the history of modern food-like substances, and how what could have been emergent healthcare instead became dogmatic sickcare, failing to react and counter diet trends, and becoming reliant on patented potions to sort-of manage symptoms. And this is from the trenches, by a just-retired pediatrician who has seen it all, and was figuring out metsyn early on.

The book also invests many pages on the false dichotomy of vegan .vs. keto, perhaps subtlety using that setup as a platform for cautioning on both — particularly vegan for infants and kids.

Page 121 describes a sleep-related glymphatic mechanism I don’t recall seeing before, but it’s not explored and exploited. Sleep otherwise gets seriously overlooked.

The claim frequently appears that “real food costs more than processed food”, but this is never clarified as to “per what”: per calorie? per kilogram? per quality-adjusted hour of extra life expectancy? And does the “cost” include the hidden costs of extra sickcare and lost productivity due to QoL damage?

#macros: permalink to macros Comparative Macronutrients

For a work with as much detail as this one has on carbohydrate metabolism, and the metsyn that it can drive, the book is surprisingly vague on how to plan your intake. It thinks GL is useful, but there aren’t even vague targets for total carb intake, nor net (and although Atkins gets a nod, the concept of “net carb” isn’t mentioned).

Macronutrient Metabolical Undoctored
Carbohydrate
(non-fiber)
0 free/added fructose, but surprisingly no real target for intake, other than an NF panel check for
  TotalCarb:TotalFiber of <10:1
Dr. Lustig is personally wheat-free. Can we figure a carb guideline from his lab targets? Not really.
Grain-free,
Net carb ≤50g/day,
≤15g/interval
which allows for little or no added sugar, and free/added fructose is specifically cautioned
Fat debunks sat fat mania;
details transfat warning;
cautions on excess ω6LA (as highly pro-inflammatory)
unlimited specific fats encouraged;
cautioning on excess ω6LA
Protein presumably RDA, complete, quality — much info on deficiency and BCAA cautions — nothing on whey ad lib, complete, caution on whey
Menus & Recipes none provided, but more to the point, there are no lists of specific foods to seek and avoid (other than avoid nearly all processed) how-to is either included or linked to

 

#micros: permalink to micros Comparative Micronutrients (including Supplements & Condiments)

Micro Name Metabolical Undoctored
B Vitamins Mentions folic acid but fails to clarify whether it’s always a safe substitute for a real folate B9. Likewise mentions cyanocobalamin as B12 (ignoring methyl-), both of these in the epigenetic discussion (MTHFR is not in the book). B12 in upper half of RR.
Recommends methyl forms of both B9 & B12.
Vitamin C focus is on loss in processing; also mentioned as useful in COVID-19 Not program core; also not discouraged (other than as being not magical in CAD)
Vitamin D presumably RDA, also mentioned as useful in COVID-19 program core, with 25OH-D3 target
Fiber no intake target, although it’s enthusiastically advocated, and the difference between soluble and insoluble is covered; cautions on processing damage specific 20g/day target for mixed and varied prebiotic (soluble) fiber
Iodine not found, per se
book cautions on fish, due to toxins, and salt, so you’re not going to get much from those
350-500µg/day for adults w/o thyroid AI conditions
Magnesium not found program core, 400-500mg/day, with RBC-Mg target
Probiotics fermented foods endorsed retail blend recommendation(s) that vary over time, program yogurt recipes, fermented foods generally
Omega 3 Dr. Lustig takes, but didn’t say how much. The book also discusses the importance of DHA & EPA, but then suggests flax for vegans (but that’s the ineffective if not counter-productive ALA form). See also Omega markers below. program core, at least 3000mg of DHA+EPA per day
Salt (Sodium)) seems to have somewhat fallen for low-salt mania (and, to be sure, excess salt can be a problem with unresolved metsyn) Salt Your Food
Sweeteners avoid-all, it appears, and no real distinction is made between artificial and non-nutritive naturals 0 artificials;
presently allows allulose, erythritol, inulin, monk fruit, stevia & {limited} xylitol

 

#markers: permalink to markers Comparative Markers

The Assembling the Clues chapter promises to cover things you can check yourself to assess health, and there are others scattered about the book. Units of Measure are distressingly absent. Here’s what I was able to gather up (compared to my program roll-up here). Rely on the site Abbreviations list as needed.

Marker Name Metabolical Undoctored
ALT marker mentioned, but no target provided within RR
AST ≤ 25 (UoM?) within RR
BMI caveats usefully on this generally vague marker ditto
BP 125/80 somewhat lower
CCS not mentioned 0, and if non-0, -100% to +10% annual increase
25OH-D3 D3 status discussed, but no target 60-70 ng/mL
FBG <90 (presumably mg/dL) 60-90 mg/dL, so very similar
GGT ≤35 (UoM?) and if higher check uric acid not presently a core program marker
Gut Flora no testing suggestions found prebiotic fiber challenge, AIRE (1.0) test for H2-specific issues, evolving recommendations for stool sample sequencing services
HbA1c ≤5.5? (presumably %NGSP), which is surprisingly vague for what the book clearly considers to be an important marker 4.0-5.0% (NGSP) and without using meds, even metformin
Hcy considers it important, but doesn’t provide a target 0 to 10 µmol/L
(0 to 1.35 mg/L)
HDL >60 (UoM?) ≥60 mg/dL; no difference
HOMA-IR ≤2.8 (UoM?) rely on the component markers
Insulin, fasting ≤15 (UoM?) 0-4 mIU/L
0-27.8 pmol/L
LDL-C <100 (UoM?) not harmful.
100-300 check TG
>300 check for FH.
Fails to define LDL-C.
ignores this fake number
LDL-P considers it worth mentioning, but still a “research” marker (after a quarter century? how long do we wait?) NMR Small LDL-P <200 nmol/L
OGGT (3-hour w/insulin, so ~Kraft Assay) no interpretive detail provided discouraged due to sugar bolus
Omega 3 Index no target found 10-12%
Omega 6:3 Ratio 3:1 2:1 or lower
PPBG tracking postprandial response surprisingly not mentioned ideally no rise, and <100 mg/dL in any case
TC considered useless concurs
TG No target, but the TG:HDL caps
would imply 150 mg/dL for Caucasian and 90 for African-American. It does identify being >150 mg/dL as metsyn
≤60 mg/dL for all
TG:HDL <2.5:1 caution in Caucasians
<1.5:1 caution in African-Americans
No target, but the HDL floor and TG cap imply 1:1 or less for all.
Thyroid MIA, which is odd, considering how both hyper- and hypo- can bias metabolism. The book also opens a discussion on fluoridation and endocrine disruption, but doesn’t run either to ground, nor consider the other non-native halogens that pollute tap water, and constitute a threat to both microbiome and thyroid. a core focus of program
Uric Acid ≤5.5 (UoM?) not presently a program marker
Waist Size 40in (Male), 35in Female not a program focus, as it tends to take care of itself if all the other markers are optimized

 

#nitpicks: permalink to nitpicks Nitpicks

Drs. Davis and Perlmutter get mentions, but Dr. Lustig seems to have at least partially mistaken the grain-free message for gluten-free. He thinks barley and rye are OK (for him, anyway), overlooking amylopectin-A, phytates, lectins and any threats posed by their gliadin analogs.

Some other false memes do make appearances, in addition to the lingering low-salt mania and LDL-C mentioned above. Red Meat (TMAO) is one.

Page 166 mentions Spurlock, but uncited … so did Dr. Lustig get to see the fabled foods logs, and if so, did they include all of the beverages?
___________
Bob Niland [disclosures] [topics] [abbreviations]

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Posted: 6/23/2021 10:27:12 AM
Edited: 6/23/2021 10:28:57 AM (1)
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Posted: 6/23/2021 10:52:02 AM
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A masterful review, Bob!

Thank you for taking the time and energy for such a detailed assessment.
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Posted: 6/23/2021 10:59:56 AM
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Posted: 6/23/2021 1:19:12 PM
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