Robert Lustig, MD

Robert H. Lustig, M.D., M.S.L., is emeritus professor of pediatrics in the Division of Endocrinology, and the Institute for Health Policy Studies at University of California, San Francisco, and adjunct professor of research at Touro University-California. Dr. Lustig’s career has focused on the regulation of energy balance by the central nervous system and the pathogenesis of chronic disease such as type 2 diabetes. He is one of the leaders of the "anti-sugar" and "real food" movements to improve global health. Dr. Lustig is also the chief science officer of Eat REAL, a non-profit dedicated to reversing childhood obesity and diabetes by impacting the global food supply; the chief medical officer of Foogal, a platform that ties together the patient, the doctor, the grocery store, and the insurance company.




Mountain Dew Mouth has been the scourge of dentists for decades. Dental caries are the greatest single cause of craniofacial pain. But there’s a new disease which affects even more people: Mountain Dew Liver. Non-alcoholic fatty liver disease (NAFLD). wasn’t even discovered until 1980; and now up to 1/3 of Americans suffer from it. Especially children - 13% of autopsies in children show NAFLD; and 38% of obese children.

Both tooth decay and non-alcoholic fatty liver disease rates have been increasing. And excessive sugar consumption explains both. 

It's a popular misconception that glucose can cause cavities. Not true; glucose polymerizes on the teeth and forms a "biofilm" which actually protects the tooth from decay. This is why cavemen didn't get cavities.

Glucose also doesn't cause NAFLD. Only 20% of the glucose consumed finds
its way to the liver, and the overwhelming majority of that glucose is turned into glycogen (liver starch), which is not dangerous. It's the fructose moiety of the sugar molecule that causes both diseases.

Fructose doesn't contribute to the mouth biofilm. It is metabolized by the
mouth bacteria into lactic acid, which burns a whole right through the
biofilm and through the tooth. And fructose in the liver gets turned into fat in the mitochondria, which drives NAFLD, which is the leading cause of liver transplantation now, surpassing alcohol. And yet who is most susceptible to both diseases? Children, because they are the biggest sugar consumers.


Physicians and dentists must be united in supporting public health measures to reduce chronic disease.



“Personal responsibility” is an ideology championed as the solution for every one of our societal ills. In other words, blame the individual’s behavior. It is in industry’s best interest to promote such a paradigm, as it contributes to the bottom line. The problem is that every personal responsibility issue eventually morphs into a public health crisis. Because these diseases are not due to behaviors, but rather exposures.

Lead poisoning, vitamin deficiencies, TB, asthma; all of these were initially blamed on personal responsibility, but science made it clear that each of these were really exposures.

More perniciously, teen pregnancy, smoking, and HIV were also attributed to personal responsibility. How about guns? And now, of course, the obesity epidemic falls under the same rubric. Diet and exercise, gluttony and sloth, “it’s your fault” — individuals exercise free choice as to what they put in their mouths. But what if you don’t have a choice? And what if society cannot afford the health consequences of the Industrial Global Diet?

The problem is that we rely on politicians to protect us, but corporate wealth speaks louder than public health. Ultimately, personal responsibility loses its luster when the costs (economic, environmental, and human) finally outweigh the dollars, and we reach the “tipping point”.

“Personal responsibility” is a dogma that denies biology and obscures reality. Public health crises cannot be resolved one person at a time. We cannot afford ideology. It’s time for a change in policy based in biology, recognizing that exposures cannot be fixed by individuals, but rather by society.

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