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BOOK
REVIEW

Diet, Mitochondria and a Leaky Gut:

Navigating Nutrition and Wellness

By David Alex Schulz

“Buckle up — I’m going to take you on a ride,” promises Robert
Lustig, MD, MSL, in the introduction to Metabolical: The Lure and
the Lies of Processed Food, Nutrition, and Modern Medicine (2021,
Harper Collins Publishers). He’s not kidding, bringing the reader “on
a journey from the ultra-micro to the ultra-macro — from molecule to
planet, and everything in between. We’re going to get both the subcel-
lular and the thirty-thousand-foot view” to fully reckon the relation-
ship between diet, health and illness.
Why? In order “to answer these questions: why has our health status
declined, our healthcare system devolved and our climate immolated?”
The connective tissue between the three phenomena is the gut, says
Lustig: the gastrointestinal tract, and the microcosm of its inhabitants;
the relationship of a person’s diet to healthy mitochondria — the or-
ganelles found in the cells of living organisms responsible for producing
adenosine triphosphate (ATP), which is the primary source of energy
used by the cell.
In clear, concise and compelling prose, Lustig’s 400-page narrative
asks the reader to shift their intellectual curiosity into high gear —
learning or relearning some basic biochemistry — yet simplifies the so-
lution to our health and, as a result, our healthcare paradigm in six
words: “Protect the liver; Feed the gut.”
Protecting essential organs and providing vital bacteria their suste-
nance (“You’re not eating for one … but for a hundred trillion.”) begins
by recognizing that food drives wellness and illness. The study of nu-
Nutrition’s fundamental role in illness was recognized over decades
trition has been de-emphasized in medical education, leaving physi-
of Dr. Lustig’s patient-facing practice. A neuroendocrinologist, with
cians poorly equipped to spot the patterns in patient maladies.
basic and clinical training relative to hypothalamic (the area of the brain

that controls hormones) development, anatomy and function, he
“Only 28 percent of medical schools have a formal nu-
worked at St. Jude Children’s Research Hospital in Memphis, TN.
trition curriculum, even fewer than in 1977,” when the There, he was charged with the endocrine care of children whose hy-
new Dietary Guidelines called for more nutrition science pothalami had been damaged by brain tumors, or subsequent surgery,

in the medical classroom. “Now, medical students receive radiation or chemotherapy.
Many patients who survived became massively obese. Dr. Lustig the-
on average 19.6 contact hours of nutrition instruction,
orized that hypothalamic damage led to the inability to sense the hor-
during their four-year medical school careers, about 0.27
mone leptin, which in turn, led to the starvation response. Since
percent of the time in class.” repairing the hypothalamus was not an option, he looked downstream,
and noted that these patients had increased activity of the vagus nerve

34 SAN ANTONIO MEDICINE • January 2024