May 2025

Robert H. Lustig, MD, MSL, is an Emeritus Professor of Pediatrics in the Division of Endocrinology, and a member of the Institute for Health Policy Studies at the University of California at San Francisco. He earned his undergraduate degree in nutritional biochemistry from Massachusetts Institute of Technology and his MD from Cornell University, and he has practiced medicine for over 40 years. Dr. Lustig has written several books, such as "Fat Chance" and "The Hacking of the American Mind." "Metabolical" was published in 2021, and much of the book was written during the Coronavirus lockdowns of 2020.

The main theme of the book centers around the dangers of processed food, and how the American diet has been hijacked over the past six decades by the rise of the Big Food corporations as well as a seismic shift in agricultural practices. The author is quite candid about much of the resistance that he has faced from the medical establishment during his medical career, and he says that in spite of all of the attention and importance placed upon exercise and being active, "You can't outrun a bad diet." Nutrition labels and calories really do not matter; it is about what you're eating and what has been done to your food that makes the difference. According to Dr. Lusting, there are only two precepts that you need to know: 1) protect the liver, 2) feed the gut. He goes on to say, "Those foods that satisfy both precepts are healthy; those that do neither are poison, and those that do one or the other are bad (but less bad)-no matter what the USDA and FDA allow to be stated on the package."

I completely agree that modern medicine is a large part of the problem. As Dr. Lustig says, "We spend 97.5 percent of our healthcare budget on individual treatment, and only 2.5 percent on prevention." I believe that is because it is much more lucrative for Big Pharma and the insurance companies to treat a disease than it is to prevent or cure it. The author believes there are several reasons why we need to rethink modern medicine (and this is coming from someone who has been in practice for over four decades). First, is it better to be cured of cancer or not get it in the first place? Second, poor cancer cure rates come with a hefty price tag. Third, fewer people today actually die from heart attacks, but more people suffer from one. In addition, a smaller percentage of baby boomers today report that they are in excellent health, as compared to their counterparts of the late 80s and early 90s. Finally, our healthcare system is collapsing due to the fact that there are more people to treat for chronic diseases, and treatment often does not result in a cure. It is estimated that smoking and diet are the leading factors for approximately half of all cancers. Why does the U.S. rank only 28th among developed countries in life expectancy? Rates continue to drop.

Metabolic dysfunction occurs as a result of eight intracellular processes that have gone awry. The first is glycation, which is the primary process of aging and is a byproduct of how we live. Sugar exacerbates this process. Second is oxidative stress. This can cause cellular dysfunction, structural damage to DNA, and cell death. Third is mitochondrial dysfunction. The mitochondria are the powerhouse of the cell, and if they do not function properly you cannot process energy efficiently, thus leading to decreased brain and organ capability. Fourth is insulin resistance. This means that what you consume cannot pass through the membranes of your cells, and can lead to obesity, chronic stress, and diabetes. Fifth is membrane integrity. If the membranes of your cells become damaged, cell dysfunction and death can ensue. Sixth is inflammation. A poor diet and high percentage of body fat (particularly visceral fat) will increase systemic inflammation and can lead to an increased risk for cancer, heart disease, and autoimmune disorders. Seventh is epigenetics. Studies say that only about 15 percent of the cause of metabolic syndrome is genetic, while the rest is environmental. However, there is something known as transgenerational epigenetic inheritance, which means that alterations in disease can affect as many as four generations going into the future. Lastly, we have autophagy. This is the way that the body clears waste products, which can include damaged cells and other debris. Not getting enough sleep interferes with this process.

Dr. Lustig discusses the importance of insulin. So much of the time we hear about the importance of keeping down one's blood sugar, and that is usually tested as part of a standard blood panel. However, insulin doesn't garner nearly enough attention. Insulin is the hormone secreted by the pancreas that allows glucose to travel into your cells. If you consume a diet that is high in sugar and other processed foods, your pancreas must secrete greater and greater levels of insulin in order to accomplish this task. This eventually results in obesity, insulin resistance and metabolic syndrome, or even diabetes. According to Dr. Lustig, "The issue is that doctors are still targeting obesity, which they think is the disease. Rather, it's just another symptom." Connected to insulin resistance are two other important hormones: leptin, which is a hormone released by your brain that tells you when to stop eating, and ghrelin, which signals that you are hungry. When you are insulin-resistant, the signals for these hormones do not function properly. Any type of metabolic therapy must center on getting your insulin levels down.

There are two chapters in particular that can help us to debunk some nutritional myths that we have been fed over the years, and also to give us some strategies to improve and maintain our metabolic health going forward. Chapter 12 is titled "Nutrition 'Unwrapped'," and it discusses in great length how unimportant calories are, the importance of dietary fiber, how little attention should be paid to glycemic index, and the difference between saturated fat and saturated free fatty acids. Chapter 28 makes the argument in favor of real food over processed food. According to Dr. Lustig, we need to change our mindset when it comes to food and money. He states, "One way or another, you're going to pay. You can either pay the farmer or the doctor-which would you prefer? Real food will protect the liver and feed the gut, and you don't need to read any nutrition labels or sift through a ton of ingredients you can't pronounce. The author has seen real food work wonders as he cared for obese children for two decades. There are even a few tips for how to approach shopping in the grocery store.

I believe that this book is so important that I could go into even much greater detail in reviewing it. My hope is that I have given you just enough information that it will inspire you to read it in its entirety. I first learned about Dr. Lustig several years ago when a Total Results client told me about his video lecture titled "Sugar: The Bitter Truth," which is still available on YouTube. While Dr. Lustig can come across as a bit abrasive and arrogant, his accomplishments speak for themselves and I believe he has provided a valuable public service by writing this book. Reading "Metabolical" from cover to cover has prompted me to take a closer look at my own eating habits and institute a few changes. I encourage all of you to read this book; it could make a profound impact on your life.

Collectively, we are more distracted than ever: emails, text messages, social media notifications, and YouTube video suggestions pop up all the time. The digital world presents challenges that most of us never had to face in our teens and twenties. These days it is very easy to lose perspective on what is truly important, and to give more weight to things that are outside of our control. It's time for a reality check: there are things in life that truly matter, and there are things that do not. How well we are able to distinguish between the two will have a tremendous impact on our success.

In a recent viral YouTube video, seven-time Super Bowl winning quarterback Tom Brady demonstrated the proper mechanics of throwing a football. The video wasn't really created for those that have a desire to play the position, but for anyone that simply wanted to learn. The lesson that Brady puts across is that in order to learn how to do anything the right way, there are three things one must keep in mind. First, start from the ground up. Second, everything is connected. Finally, don't get ahead of yourself. Brady pointed out that mechanically speaking and in terms of creating torque, throwing a football is very similar to swinging a golf club or hitting a hockey slap shot. Metaphorically, the three things Brady says to keep in mind can also apply to playing a musical instrument, running a business, and even high intensity exercise. Again, there are things that matter, and things that don't.

What are the important takeaways for exercise and what should we emphasize?

Effort. I describe effort as a commitment to a task and using every ounce of your momentary capability (such as reaching muscular failure). Effort is a large component of being process-oriented (as I have mentioned in previous articles), and it is something that everyone can improve.

Attitude. How do you approach a task? Are you dialed in and positive about what you are undertaking, or would you rather be somewhere else? Having a positive attitude requires no special ability and doesn't cost a dime.

Focus. I mentioned earlier that we are collectively more distracted than ever, but exercise success can be greatly enhanced by shutting everything else out for 20 minutes during your workout. Stay present (as Brady says, don't get ahead of yourself).

Knowledge of results. This is how you can objectively gauge your progress, and it is why we give clients access to their exercise spreadsheets so they can see for themselves how they are doing. It affirms if you are doing well or doing poorly, and it provides feedback for making changes if necessary.

Be a learner and a listener. You have two ears and one mouth for a reason, as the old saying goes. We often think of listening as a passive skill, but it is really quite active if you are doing it correctly. Total Results exercise is a new concept for more than 90 percent of people who walk through our door for the first time, and in order to learn you will initially make mistakes. Nobody gets it right the first time.

Now that we know what is important to focus on in order to achieve success, what are some things that we shouldn't waste our time worrying about?

Time under load. This is but one measurement of progress, and while it is great to see an increase in TUL from one workout to the next, it only tells one part of the story. Many of our clients are competitive, and if they don't see an increase in either weight or TUL they often think their workout wasn't effective. Don't fall into this trap! Focus on the process, effort, and form in order to achieve a favorable outcome.

Genetics. You cannot pick your parents. Some of us were born with certain advantages, while others were not. Work as hard as you can and play the hand that you are dealt. A genetic propensity for something doesn't guarantee anything. Be proud of and accept who you are! Don't waste time and emotional resources worrying about what you don't have, and be thankful for good health and the opportunity you have to maximize your genetic blueprint.

Natural ability or your starting fitness level. Some people over the years have hesitated in starting the Total Results exercise program because they "wanted to get in shape first." They miss the point. It doesn't matter where you start, it's where you finish. Talent is overrated, and you do not have to have an elite athletic background to succeed as a Total Results client. Taking the first step is the most important action.

Age. This is simply a number. You are never too old to start the Total Results program. Some of our hardest working and most attentive clients are in their 60s and 70s, and they may have the most to gain from strength training. We have a wide age range of clients, and while your goals may change as you get older, our philosophy with everyone is the same.

Focus on what you can control; these are the things that matter. Don't spend time or energy worrying about the things that take place outside of your orbit. Retired U.S. Navy Admiral and Top Gun fighter pilot Mike Manazir says, "You can create your own self-fulfilling prophecy by deliberately speaking with intent about the future you want." Successful people set goals and make a plan to achieve them. If they accomplish one goal, they set another. If they don't achieve that goal, they find out why and make adjustments. Be honest with yourself and practice accountability. Maintain a positive attitude and celebrate your accomplishments. We are here to help. Exercise smarter with Total Results.