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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.
* 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.
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.
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?
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).
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.
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]