LWV, June 26, 2025

Death vs. Dollars:

​

The Role of Nutrition in Solving the

Health Care Crisis

​

Robert H. Lustig, MD, MSL

UCSF

Disclosures

Paid Advisor:

Myka Bio

Simplex Health

Levels Health

Chief Medical Officer:

Dory

BioLumen

Perfact

Unpaid Advisor:

Kuwaiti Danish Dairy Co.

Blue Oak Nutraceuticals

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption

Health

Environment

Cash flow

• companies

• consumers

• society

​

The experiment

1965

The experiment

1965

2025

Eleven conglomerates control 90% of the food supply

Definition

Ultraprocessed food

• Has to be mass produced
• Has to be consistent batch to batch
• Has to be consistent country to country
• Specialized ingredients from specialized companies
• Virtually all macronutrients are pre-frozen
• Which means that the fiber is usually removed
• Has to stay emulsified (fat and water don’t separate)
• Has to have long shelf-life or freezer life

​

​

The difference between ultraprocessed food�and real food

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

​

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

​

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

​

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

Additives

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

Additives

Emulsifiers (polysorbate-80, carboxymethylcellulose)

​

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

Additives

Emulsifiers (polysorbate-80, carboxymethylcellulose)

Salt

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

Additives

Emulsifiers (polysorbate-80, carboxymethylcellulose)

Salt

Nitrates, Heme (processed red meat)

The difference between ultraprocessed food�and real food

Not enough:

​

Fiber

Omega-3 fatty acids (wild fish)

Micronutrients

​

Too much:

​

Trans-fats

Branched chain amino acids (leucine, isoleucine, valine)

Omega-6 fatty acids (plant oils, polyunsaturates)

Additives

Emulsifiers (polysorbate-80, carboxymethylcellulose)

Salt

Nitrates, Heme (processed red meat)

Sugar

The four primary immuno-metabolic detriments of ultraprocessed food

• Too much sugar — mitochondrial dysfunction

— metabolic syndrome, depression, dementia

• Lack of fiber — reduced SCFA’s — CVD, dementia
• Low omega-3’s — increased ROS formation — diabetes, CVD, depression
• Emulsifiers — gut/systemic inflammation — —metabolic syndrome, osteoporosis, IBD

​

NOVA I

NOVA I

NOVA II

NOVA I

NOVA II

NOVA III

NOVA I

NOVA II

NOVA III

NOVA IV

NOVA I

NOVA II

NOVA III

NOVA IV

Only NOVA IV correlates with chronic disease

57% of US consumption

73% of US food supply

NOVA I

NOVA II

NOVA III

NOVA IV

Only NOVA IV correlates with chronic disease

57% of US consumption

73% of US food supply

Controversies around the NOVA system (e.g. salt, brown bread)

Consumption

The evolution of fast food

Thickburger

1420 calories

High Fructose Corn Syrup

Current US annual consumption of HFCS

​

• 63 pounds per person

​

Users:

U.S., Canada, Japan,

Europe

(limited exposure)

Srour et al. BMJ 365:l1451, 2019; Wang et al. JAMA 326:519, 2021 

56% of the food sold in America is ultraprocessed food

Accounts for 62% of the sugar in the American diet

And 67% of the sugar in kids’ diets

150

​

​

125

​

​

100

​

​

75

​

​

50

​

​

25

​

​

0

Growth of

Sugar Industry

Stabilization

HFCS +

Sugar for Fat

WWII

U.S. Commerce Service 1822-1910, combined with Economic Research Service, USDA 1910-2010

http://ushealthcarespending.gov

PROCESSED

FOOD

Addictive

Sugar and opioids

Sweet-Ease increases endogenous opioids to reduce pain,

Even in neonates

Lustig, J Am Diet Assoc 110:1307, 2010

Price Elasticity of Foodstuffs

Andreyeva et al. Am J Public Health 100:216, 2010

(London, UK, May 17, 2024)

Sugar is the payload

Ultraprocessed food is the vehicle

Toxic

​

The Global Pandemic of Chronic Metabolic Disease

​

​

• Obesity
• Type 2 Diabetes
• Cardiovascular Diseases (CVD)
• Hypertension (High Blood Pressure)
• Fatty Liver Disease
• Cancer
• Osteoporosis
• Gastrointestinal Disorders
• Dental Caries and Periodontitis
• Inflammatory Diseases
• Alzheimer’s Disease and Cognitive Decline
• Autoimmune Diseases
• Chronic Kidney Disease (CKD)
• Food Allergies and Intolerances
• Depression and Anxiety

​

None of these have cures, and the treatments only treat the symptoms

All are made worse by ultraprocessed food

Lane et al. BMJ 384:e077310, 2024

�Is ultraprocessed food ”food”?����What is the definition of “food”?����Substrate that contributes to growth or burning of an organism

�Is ultraprocessed food ”food”?����What is the definition of “food”?����Substrate that contributes to growth or burning of an organism

�Is ultraprocessed food ”food”?����What is the definition of “food”?����Substrate that contributes to growth or burning of an organism

Burning

Softic et al. Cell Metab 30:735, 2019

"The most important takeaway of this study is that high fructose in the diet is bad," says Dr. Kahn. "It's not bad because it's more calories, but because it has effects on liver metabolism to make it worse at burning fat. As a result, adding fructose to the diet makes the liver store more fat, and this is bad for the liver and bad for whole body metabolism."

Dr. C. Ronald Kahn,

CEO, Joslin Diabetes Center

Hall et al. Cell Metab 30:1, 2019

Burning:

Ultraprocessing determines weight gain

Growth: �Ultraprocessed food inhibits bone growth

Zarestsky et al. Bone Res 9:14, 2021

UPF: Ultraprocessed food

CSD: Caloric soft drink

X-ray

Growth:�Cancer incidence due to ultraprocessed food

Fiolet et al. BMJ 360:k322, 2018

Every 10% increase leads to 12% increase in cancer

Fiber

Whelan K et al. Nat Rev Gastroenterol Hepatol 21:406, 2024

Potential microbiome toxins within ultraprocessed food

Dietary AGE’s

Foods that generate dietary AGE’s

Cai et al. Am J Hum Pathol 173:327, 2008

Do dietary AGE’s lead to disease?

Animal model of Caloric Restriction + Heating Food

Cai et al. Am J Hum Pathol 173:327, 2008

CR increases lifespan, CR plus heating doesn’t

Environment

World Wildlife Fund, http://awsassets.panda.org/downloads/sugarandtheenvironment_fidq.pdf

Sugar holdings in orange, yellow, light green

Corn Planting 2007

Atrazine Use 2007

Ratio of Gov’t Payments to Farm Gross Income

Nitrate Contamination

Cash Flow

Cash Flow

​

Companies

Philpott, Mother Jones 2012 (from Bureau of Labor Statistics)

How our food dollars have been reallocated

Despite the economic downturn of 2008,

McDonald’s revenues and stock price

continued to rise between 2007-2011,

and Coke and Pepsi still fared better than the S&P 500

Pepsi

McD

Coke

S&P 500

Stock prices of processed food companies compared to the

S&P500, 2007-2011

Archer Daniels Midland

Proctor & Gamble/

Kraft

Kraft

General Mills

ConAgra

Hormel

S&P500

The word on Wall Street is out:

In the last few years, Big Sugar has taken a beating

S&P 500

Tate and Lyle

Illovo

Sudzucker

And soft drink manufacturers are now

experiencing a drought

S&P 500

Coke

Pepsi

Dr. Pepper/

Snapple

McD

Cash Flow

​

Consumers

Jones et al. PLoS One 9(10):e109343, 2014

The price of food (per 1000 kcal)

UK 2002-2012

Percent of Gross National Product

spent on food, by country

Time Magazine, Feb 28, 2011

Cash Flow

​

Society

150

​

​

125

​

​

100

​

​

75

​

​

50

​

​

25

​

​

0

Growth of

Sugar Industry

Stabilization

HFCS +

Sugar for Fat

WWII

versus US health care spending (% GDP)

U.S. Commerce Service 1822-1910, combined with Economic Research Service, USDA 1910-2010

http://ushealthcarespending.gov

PROCESSED

FOOD

150

​

​

125

​

​

100

​

​

75

​

​

50

​

​

25

​

​

0

Growth of

Sugar Industry

Stabilization

HFCS +

Sugar for Fat

WWII

versus US health care spending (% GDP)

U.S. Commerce Service 1822-1910, combined with Economic Research Service, USDA 1910-2010

http://ushealthcarespending.gov

PROCESSED

FOOD

Morgan Stanley Report, The Bitter Aftertaste of Sugar, March, 2015

Ultraprocessed foods are only “cheap” when the costs of their negative metabolic impact are externalized to health care and public health budgets.

Scientific Group of UN Food Systems Summit 2021

The net benefits of achieving a food system transformation are worth

5 to 10 trillion USD a year, equivalent to between 4 and 8 percent of global

GDP in 2020 … a food system transformation can ensure that global

warming stays well below 1.5 degrees C at the end of this century.

Jan 29, 2024

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption

Health/Disease

Environment

Cash flow

• companies

• consumers

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease

Environment

Cash flow

• companies

• consumers

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease XXX (death)

Environment

Cash flow

• companies

• consumers

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease XXX (death)

Environment XX

Cash flow

• companies

• consumers

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease XXX (death)

Environment XX

Cash flow

• companies √√ before, XX now

• consumers

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease XXX (death)

Environment XX

Cash flow

• companies √√ before, XX now

• consumers √√ short-term, XX long-term

• society

Imagine the last 60 years was an experiment

The food industry posed the hypothesis:

Ultraprocessed food is better than real food.

Outcomes:

Consumption √√

Health/Disease XXX (death)

Environment XX

Cash flow

• companies √√ before, XX now

• consumers √√ short-term, XX long-term

• society XXX

Imagine the last 60 years was an experiment

UCSF Resources

@ c2ech.bsky.social

idl.ucsf.edu