Commodity pathway diversion

Transcription

>>Male Presenter: I want to thank everybody for joining us today. We've got a very special speaker here today, Dr. Robert Lustig. He is gonna talk about sugar; kind of ironic that I am the person introducing him since I may be responsible for most of your sugar consumption here on campus with my micro kitchens. But Dr. Lustig is gonna talk about sugar and some of the dangers and things you need to watch out with regarding that. He is a graduate of MIT. He received his MD at Cornell, where a lot of us are eggheads so I thought some of us would appreciate that. He is currently the Professor of Pediatrics at the University of California, San Francisco and is now at the Benioff Children's Hospital. He is also the director of the Weight Assessment for Teen and Child Health, which is also known as WATCH Program at UCSF. He's published more than 85 research articles. He's very well-known also for his recent YouTube video. It's a 90-minute video on very, very technical stuff regarding sugars and all those things. And yet, he has received more than 1.5 million hits. Usually, those types of numbers are reserved for cat videos of someone getting hit below the belt. [laughter] So, he is-- >>Robert Lustig: Lady Gaga >>Male Presenter: Yeah, Lady Gaga, too. So, he has definitely got a loyal following and I'm gonna turn it over to him and let talk about this very, very important subject for all of us. And we'll have some time at the end for Q and A, so please jot down some notes and don't be afraid to step up to the microphone when he's all finished. Enjoy. Dr. Lustig. [applause] >>Robert Lustig: Thank you very much Dino. And thank you all for coming. And I apologize for the monkey suit. It's Friday and everywhere else in the world in the summer and on Friday it's dress-down Friday, but not at UCSF. So I apologize. But that's the way it goes. First of all, I'm supposed to show this slide very specifically. [laugher] And everybody got their chance to see it. OK, good. All right. So, I have no disclosures. Let's start. Look to the left of you. Look to the right of you. One of you is obese. [laughter] >>Female audience member: Hey! [laughter] >>Robert Lustig: According to these data. [laughter] Now, I'm looking around this room and I'm telling you, this looks like a pretty healthy crowd because after all, this is the Bay Area. This is Google. I'm not all that worried about you guys. But out there it's a different story. And indeed, we see this all throughout San Francisco. We see this all throughout the country. This is a huge problem that we've come up against. And the question is where did this come from? Now, this is an eleven inch statue. Excuse me. Just started to tickle. This is an eleven inch statue called the Venus von Willendorf. It was unearthed in Vienna in 1908. It carbon-dates back to 22 thousand BC. And what it shows us is that the ancients knew about obesity before they knew about McDonalds. Obesity is part of the human condition. Obesity has been around for a long time, but clearly something has gone on in the last 30 years to have created this epidemic. And the question is, what is it? And what do we do about it? On the left is a Time magazine, a Newsweek magazine article from eleven years ago and it says here, "Six million kids are seriously overweight." With all of the media attention, with all of the efforts, with all of the programs, with all of the White House working on this problem, we are now up to 20 million. So, we have tripled that number in a decade. The magazine article on the right you probably have seen or heard about. It's a nine-page article written about our work at UCSF in terms of what's going on with sugar in particular. And that's what we're gonna talk about mostly today and I would refer you to it. You can find it very easily on the web, "Is sugar toxic?" Now, to try to explain obesity, first I have to debunk what's going on in your head because you believe you think you understand this. And I'm telling you right now you don't. And I'm gonna try to un-debunk it for you so that this will actually make sense for you and will actually lead you, and hopefully the rest of the country, in a different direction. The first law of thermodynamics is a law. It's elegant. If I didn't believe in the first law, you'd call me a whack job and you'd have me out of here as fast as you could throw me. I believe in the first law. But, as the Supreme Court will tell you, all laws are open to interpretation. There are two interpretations to this law. Here's the first, the one you learned, the one I learned many years ago. If you eat it, you better burn it or you're gonna store it. OK, now who here believes that? Oh, come on, come on. You all do. [laughter] Thank you. If you believe that then what you're saying is obesity is a result of two behaviors--two apparent behaviors. The calories in, gluttony. The calories out, sloth. And indeed, when you go to the physician, he tells you "Eat less. Exercise more." Basically what he's telling you is you're a glutton and a sloth. [laughter] That's what it means. I don't do that. And I'm gonna show you why. From that concept, that these are two behaviors, the dogma that surrounds this is that a calorie is a calorie. In other words, if you eat a calorie more than you burn, you will gain weight. If you eat less calories than you burn, you will lose weight. That's where, that's what comes from that. And from that dogma comes the following corollaries. That this is free will. That you have a choice of what to put in your mouth. You have a choice of whether to exercise. That this is personal responsibility. You get to decide, nd from that, gluttony and sloth, and then for diet and exercise. Well, guess what? It doesn't work. And I'm gonna show you that it doesn't work. So, are we just in a caloric bacchanalia? Is that what this is? Well, wait. This is wrong. Sorry. That's much better. [laughter] Indeed, we are all eating more. I'm not arguing that. A hundred eighty-seven calories a day more for men in the last 25 years. Three hundred thirty-five calories a day more for women. Two hundred seventy-five calories a day for teen boys. We're all eating more. There's no argument about that. The question is, is that cause or effect? That's not clear. So, here's the evolution of fast food right here on the left. You have the original White Castle hamburger at 210 calories. In the middle is Bob's Big Boy at 618 calories. And in the midst of the obesity epidemic, Hardee's had the temerity to offer us the Thickburger over there at 1420 calories. And of course, we have Carl's Junior's six dollar burger at 2000 calories. That's the entire caloric allotment for the day. So you'd say, "Well, there you go. There's your obesity epidemic right there." Not so fast. How about this? Anybody had a Trenta? I got one over here. OK? [laughter] One taker. OK, the Trenta has 916 cc's. Your stomach can hold 900 cc's. It's bigger than your stomach. [laughter] OK? But people are buying them. So you say, "There's your obesity epidemic right there." And remember, that's not hot coffee. That's not black coffee. That's flavored with, that's a Frappuccino drink. That's a cold drink. And this I love. This came in the mail to be about three months ago. Free chicken sandwich with the purchase of a 32-ounce drink at KFC. Has the food gotten so cheap that we're actually giving it away now? I mean, so you'd say, "Don't these prove that this really just about too much intake, too little exercise?" Let's look at the exercise side. Do we have an activity famine? Is that what this is? So, on the left we have MET times, or a measure of physical activity. It's an accelerometer put on somebody's ankle. And on the right, I'm sorry. On the X-axis, we have age from nine to nineteen and you can see for white girls and white and black girls in the black circles. And but basically by the time they hit age 15, the black girls are laying prostrate on the floor, not moving at all. So you'd say, "Well, there's your obesity epidemic there. No exercise." So clearly, we know that these things are true. The question is, is that cause or effect? So, I'm here to tell you, and you know this because this is Google, that "education consists mainly of what we have unlearned." That's what research is. It's unlearning something that you thought was right to find out something that's new. OK? All of research is to debunk dogma. What we believed ten years ago is already wrong and what we believe today will be wrong ten years from now. So, I need to unlearn you right now as to what's going on in the obesity epidemic. And I'm gonna try to do that. So, is this behavior? Is this personal responsibility? I think not. There are six reasons to doubt this formulation. First of all, no child chooses to be obese. The quality of life of an obese child is the same as a child on cancer chemotherapy. They are ostracized from their peers. No kid will play with them. And it's actually gotten worse over the past 40 years as more kids have become obese. The ostracization has actually gotten worse. Now, maybe you know some adults who choose to be obese, but no child does. They are miserable. My colleague Marcia Wertz did a semi-quantitative analysis of kids coming through our clinic. And there is not one kid who, in even the remotest sense, wants to be that way. Number two. Does diet work? Well, you say, "Well sure. Look right there. Immediately after you start the diet, everybody loses weight." But look what happens after. Everything goes back to normal. In fact, higher. And if you look at the right graph, the maintenance of weight loss basically no one can do it. And we all know that. How many yo-yo dieters are there out there? Any yo-yo dieters in the room? It's Google. I guess not. [laughter] How about exercise? Does exercise work? If you're burning more calories you should lose weight, except for one thing. You don't. In fact, there's not one research study that shows that exercise causes weight loss. If anything, it causes weight gain because it builds muscle, which is good. That's a good thing. It builds bone. That's good. When you stand on the scale, it registers as weight gain, but you're healthier because your waist line has gone down and that's what's important. But if you tell somebody, "Oh, you'll lose weight if you exercise." And then they don't, what do you think is gonna happen? They're gonna get depressed and stop doing it. And that's what we've got when we say it's diet and exercise. If you look here, when compared with no treatment, exercise resulted in small weight loss across studies. One kilo. For rigorous exercise, one point five kilos. That ain't gonna do it. Number three. This isn't just about America. You wanna call us a bunch of gluttons and sloths here in America? Fine. How about the UK, Australia? OK, they're a bunch of gluttons and sloths, too, but except for one thing. It's going on everywhere. Whoever called the Japanese sloths? You know what? They're doing bariatric surgery at Tokyo Children's now. It's going on in Japan. It's going on in Korea. It's going on in India, Thailand. I mean, there are more obese people in the world now than malnourished people by 30%. In one decade, we have gone from malnourished to obese. And the United Nations has now declared it a non-communicable disease. That is, diabetes, cancer, and heart disease as a now bigger threat to world health than infectious diseases. So, this is a huge problem and the UN and the World Health Organization knows it, so you should know it, too. Number four. The poor are disproportionately affected. They don't get to choose what they eat. They don't even have a supermarket. They have what they call "food deserts." They have convenience stores; all processed food, all high sugar, low fiber food, which we'll talk about in a little bit. They don't get to choose what they eat. They can't afford otherwise. Michael Pollan said it very well. "If you have a dollar for food, are you gonna choose 1200 calories in potato chips or 200 calories in carrots?" Is that really a choice if you have a dollar to spend on food? So, if you don't have a choice how can you call it personal responsibility? Number five. The prevalence of obesity is going up fastest in the group that can't accept personal responsibility, the two to five-year old, the toddler age group. As was shown on the slide in the green. And finally, the kicker, the Big Kahuna, he slam dunk, the in yo face. We have an epidemic of obese six-month olds. They don't diet and exercise. So, any hypothesis you want to proffer to me about what's causing the obesity epidemic, you have to explain this. And you can't. And the reason is because a calorie is not a calorie. Gluttony and sloth, diet and exercise, personal responsibility, free will, are all just garbage. OK? Have I got your attention? Good. Now let's go and find out what the real problem is. So, you wanna call this "behavior." So here's the definition of behavior. This is the actual technical definition of behavior: a stereotyped motor response to a physiological stimulus. So, let's take that apart, stereotype, same every time. So, eating is a behavior. Motor. Muscles have to move. A thought is not a behavior. And finally, physiological. That's what I'm interested in. The point is that all behaviors have a biochemical basis. We may not be smart enough to know what that biochemistry is yet, but everything that goes on in your brain, is a phosphorylation of a protein, or the secretion of something, some neurotransmitter. Bottom line, how easy is it to control a biochemical drive? What we call behavior is the cognitive inhibition on a biochemical drive. And that biochemical drive is going on 24/7. How long do you think you can keep that up? That's the recidivism of obesity right there. It can't be done. So, what I'm interested in is what are the biochemical underpinnings of gluttony and sloth and what can we do try to mitigate that difference in order to solve the obesity epidemic? It's very different from diet and exercise. Now, Kelly Brownell, who is the head of the Rudd Center for Food Policy and Obesity at Yale University, wrote this book called "Food Fight" back in 2004. And in it, he coined the term the "toxic environment." And you've heard that term before. And what he was referring to was modern eating and exercise conditions. So let's look at those. So, food available 24 hours a day. No argument there. Accessible as never before right there, the micro kitchen. [laughter] Sold in places--. Hey, I think it's a great idea. Sold in places unrelated to eating. Whoever heard of having dinner at a gas station? Yeah? Really cheap, right? They're giving it away at KFC. Promoted very heavily. They're giving it away at KFC. And designed to taste really good indeed, to keep people eating. We'll talk about that at the end. On the activity side, decreased walking and biking. OK? There are some neighborhoods that don't even have sidewalks anymore, right? Little PE. Eighty percent of the San Francisco unified fifth graders can't pass the Phys Ed exam. Screen time makes kids inactive. OK? Actually, you guys are responsible for some of that. [laughter] And this you're not responsible for: parents are reluctant to let their kids out of the house for fear of crime. Which is a very sad commentary on our society when you can't let your kid play in their front yard because they might get picked up and indeed, you've all heard the stories of how that's happened. So, the toxic environment as Brownell defines it is a euphemism for these altered behaviors that we have manifested over this last 25-year period. True. I'm much more interested in real toxins, poisons. Is there something insidious and poisonous going on that's actually changing our biochemistry and driving the obesity epidemic? That's my question. And that's what I'm gonna try to show you today. So, let's talk about what we're eating. OK, yeah. We're all eating more. Agreed. What is it? So, 275 calories a day extra in teen boys. What are they? Are they fat? Nope. Five grams, forty-five calories. Nah. Nothing. And if you look at the secular trends in specific food intake, as you see here, here are the fats. Whole milk, way down. Meats and cheese up a little bit there. Dairy desserts up slightly. Bottom line, it's a wash. And indeed, that's what the data shows. And, in fact, as we have reduced our percent, not absolute amounts, but percent of fat consumption from 40 percent to 30 percent over the last 30 years, and everybody remember why we did that? Everybody know? >>FEMALE AUDIENCE MEMBER #1: Heart problems. >>Robert Lustig: To prevent heart disease. Right. To prevent cardiovascular disease. What's happened? It's gotten worse. Obesity and metabolic syndrome have just taken off completely. OK? And now, that's 75%of all of our health care expenditures. What do you think would happen to our health care budget if we could fix that problem? We wouldn't need health care reform if we had obesity reform. So, this is really important. So it ain't the fat. What is it? Well, it's the carbohydrates. Two hundred twenty-eight grams to calories. OK? And what? I'm sorry. Here's the secular trends. Look at the red circles. OK? That's all the carbohydrate. Everything way, way up indeed. And what carbohydrate? Well, beverages. Forty-one percent increase in soft drinks. Thirty-five percent increase in fruit drinks, fruit aids, etc. OK? For those of you who do obesity medicine, a can of soda a day is 150 calories. Multiply that by 365 days a year. Divide that by the magic number of 35 hundred calories in a pound. If you eat or drink 35 hundred calories more than you burn, you will gain one pound of fat. That's the first law. No argument there. I don't disagree with that. That's worth 15 and a half pounds of fat per year. And our kids aren't drinking one soda a day. They're drinking how many? Four. So, I love this. Here are the ten most obese states in the country. And this probably is not a shock to anybody. Here are the ten laziest states in the country. [laughter] What's going on in Nevada? [laughter] You know, you can only get so much energy loss out of doing this. [laughter] I was just in Las Vegas last week to give a talk and let me tell ya, it's true. It really is. Here's the adult diabetes rate. And finally, here's soda per capita consumption. Notice anything? That's interesting, but remember, correlation is not causation. Cause or effect. We're not there yet. OK? Is it that obese people drink soda? Or is it that soda causes obesity and diabetes? That's the question. We're not there yet. More to go. So, what is this stuff? Well, you know about this. It's high fructose corn syrup, right? Most demonized food additive known to man. Sixty-three pounds per person per year. We never had this before 1975. It was invented in Japan in 1966 and brought to the American market in 1975. Originally, the soda industry didn't do very much with this for the first five years. And then Hurricane Allen came along and destroyed the Caribbean sugar crop. And they said, "You know? We better look into this." And by 1985, the transition was complete. Everybody remember New Coke? That was high fructose corn syrup. So, we revolted. We went back to Coke Classic, except for one thing. What do you think you're drinking now? So, what is this stuff? Well, on the left is a molecule of glucose, six-membered ring. Now, glucose is not very sweet. You don't see people going around chugging Karo syrup, do you? Might be good in a pecan pie, but that's about it. OK? On the other hand, on the right, that's fructose. That's very sweet. That's what you're looking for. That's what desserts are about. But if you look down at the bottom, that's sucrose. That's table sugar, cane sugar, beet sugar, the stuff you put in your coffee in the morning, the crystal stuff. And you'll notice, one six-membered ring, one five-membered ring. They're the same. It's a wash. And indeed, all of the research studies that have compared the two say they're the same. So everybody's really excited about getting rid of high fructose corn syrup and substituting back sugar, like throw-back Pepsi and things like that. This is just marketing. They're equal. They're the same. They're equally bad and I'll show you how. And remember, the rest of the world doesn't have high fructose corn syrup. They have sugar. And here's world sugar consumption in the upper left, going from 50 million tons per year in 1960, up to 150 million tons. OK? The population hasn't increased that fast. So, you know we're eating more. And if you look at per capita consumption, look at Brazil. Brazil, remember, is a sugar exporter. Brazil has the highest rate of increase of Type 2 diabetes. It doesn't have the highest rate of Type 2 diabetes, but it has the highest acceleration in their rate of any place in the world. And if you look at who has the most Type 2 diabetes, down on the bottom, you know where it is? Saudi Arabia and Malaysia. Now why is that? Why do they have the highest rate of Type 2 diabetes? No alcohol. They're Muslim countries. So what do you think they drink? Soft drinks like it's going out of style. [chuckles] "Cause it's hot there. OK? And they've got diabetes like it's going out of style. So here's our, in America, secular trend in fructose consumption. Our ancestors a hundred years ago, pulling fruits and vegetables out of the ground, got about 15 grams of fructose per day. Prior to World War II with the nascent candy and soft drink industries, we got up to about 20 grams per day. By 1977, just before the advent of high fructose corn syrup, we were up to 37 grams a day. That was 8% of our caloric intake. By 1994, we were up to 55 grams a day. That's 10% of our caloric intake. And adolescents currently mean 75 grams a day. That's 12% of total caloric intake. And 25% of our adolescents consume 100 grams of fructose a day. So, it's four calories per gram. So that's 400 calories in fructose. Multiply that by two for sugar, so that's 800 calories in sugar a day. That's 40% of their allotment in just sugar. So the question is, what does that do to you? You think you can handle that? As Jack Nicholson said, "You can't handle the truth." OK. Well, you can't handle that fructose load is what you can't handle. So, where did this come from? So, this is the perfect storm from three political winds with a few extra things thrown on top. The first. Richard Nixon told his Agriculture Secretary, Earl Rusty Butz, love that name, that he wanted food off the table as a political issue. That changing food prices caused political unrest. Indeed, it does. And I'm gonna show you on this slide right here. This was in Time Magazine just four months ago and it's called "Hungry World." And what it is is color-coded countries based on the percent of their gross national product that they spend on food. So you can see, we in yellow, and UK and Australia, we're the three fattest countries because we spend the least of our percentage GNP on food. Now, look at the purple countries. They're all in revolution. They spend more than 35% of their GNP on food. When food prices go up, people get mad. Everybody remember three years ago, we tried to take our corn crop and divert it to ethanol? You know what that did? Raised the price of rice in Thailand. And that caused the rice riots and deposed the Prime Minister at the time in Thailand. Now, Thailand's got an unstable government for a while, but that was the reason for that deposition. OK? So, we know that we're now global society. So what we do affects food prices elsewhere. This is a big deal. Second political storm. The advent of high fructose corn syrup, as I said, invented in 1966 by Takasaki at Saga Medical School in Japan and introduced to the American market in 1975. And here you can see what Nixon was talking about. Look at the US producer price index on the left for sugar. Up down up down, prior to 1975 then with the advent of corn sweeteners, nice stabilization at a 100% showing price stability. That's what you want because what that says is you're not doing this up down. Look at what happened on the international stage. The London price of sugar also stabilized, even though high fructose corn syrup was only here. And of course, our cost of sugar is way lower than England's. And look at the US retail price of high fructose corn syrup versus sugar. It's half the price. So, it started appearing in everything because now you could. There were no two-liter bottles of soda before high fructose corn syrup because it was too expensive. But now there is. Now you can buy it for what? Ninety-nine cents, right? But what does it cost to make that bottle? About two cents. The price elasticity is enormous. They're making money hand over fist and I'll show you that at the end. So, here's high fructose corn syrup going up. And here is sugar coming down. So, the Corn Refiners Association says, "Well, you know it's just a substitution. We're substituting something that's cheaper for societal benefit." But not really because if you look at the blue line at the top, 73 pounds per year up to 95 pounds per year. So there's a 25% increase in total added sweeteners over this time. And there's something missing from this slide. Anybody know what it is? What's missing? Juice. 'Cause juice is sucrose, right? And we know that juice causes obesity. This is a study done by Myles Faith showing prospectively that juice servings per day increases BMI z-score in inner city Harlem toddlers. And where do they get their juice? From something called WIC. Anybody know what WIC is? W-I-C? Women Infants Children. Government entitlement program set up back in 1968 to prevent failure to thrive. Guess what? They did. And now we've got 20 million overweight or obese kids. So now we've got juice plotted here with most fructose items. Indeed, we are eating 141 pounds of sugar a year. That's seven ounces a day for every man, woman, and child in America. And the question is, is that OK? Can you do that? Can your liver handle it? Finally, the last of the political whims. Remember that admonition to reduce our dietary fat to prevent cardiovascular disease? So, where did that come from? In the 1970s, early 1970s, we learned about this thing called LDL, low density lipoprotein. Is it good for you or bad for you? Ah, it's not as bad as you think, but yeah I mean, it's not good. In the mid-1970s, we learned that dietary fat raised your LDL and that's true. That's still true. So if dietary fat is A and LDL is B, we learned that A led to B. In the late 1970s, we learned that LDL levels in large populations correlated with incidence of coronary heart disease. So, let's call coronary heart disease C. So we learned that A led to B and B led to C, so the logic was, "Well, if A leads to B and B leads to C, then no A, no C." Let's get rid of the dietary fat and cardiovascular disease will disappear. That was the idea. And McGovern, George McGovern, had a nutrition panel back in 1977 which advocated this. And I'll show you where that came from in just a second. OK? Clearly did not work. Anybody see any problem with the logic here? This is Google. You must have some logicians here. Randy, what do you see? >>Randy: Correlation is not causation. >>Robert Lustig: Right. Correlation is not causation. That's one. >>Randy: Something else could be going on here, like, as you pointed out, sugar is going up at the same time. >>Robert Lustig: Right. >>Randy: Maybe this is just tracking a sugar trend and has nothing to do with the dietary fat. >>Robert Lustig: Without question. OK? So, A. But there's another reason. A can lead to B, but it can lead to D, E, F, G, H, and I and never come back to C. And also, the contrapositive of a statement is not "no A, no C," it's "no C, no A." So, it doesn't even make sense in terms of the logic. OK? Now, here we have two books. The one on the right, called "Pure, White and Deadly" about sugar, written by a British physiologist nutritionist by the name of John Yudkin, written in 1972 and everything that this man prophesized in 1972 has come to pass. It's absolutely brilliant. And he was run out on a rail by the British food industry. Very, very, very smart guy and had a really tough time in the last 20 years of his life, even though he was full professor at Oxford. On the left, we have the book, "The Seven Countries Study," by a guy by the name of Ancel Keys. Anybody heard of him? OK. And Ancel Keys was a Minnesota epidemiologist interested in cardiovascular disease. And he spent a sabbatical in 1952 in England and he saw what crap they ate over there and said, "Clearly, dietary fat is the cause of cardiovascular disease." Here's the original case against fat. Here's Ancel Keys' Seven Countries Study over here on the left. So, he has Japan, Italy, England and Wales, Australia, Canada, and the US. That's only six countries as far as I can tell. But anyway, maybe he thought England and Wales are two different countries. I don't know. But in fact, he actually studied 22. And the 22 are plotted over on the right. So the question is, why did he do that? I don't know. No one really knows. But if you take a look, you can pick any series you want from those data. OK? So, there's one series over there on the upper-left that'll tell you, "Yeah, it makes sense. Coronary disease against total fat consumption." How about the others? It says the opposite. And the one below says, "Not at all." Bottom line, we don’t' really know. In addition, here are the outliers, by the way. These people eat only fat. And they have no coronary disease. In fact, the Aitkin’s Diet prevents coronary disease. And then finally, if you read Ancel Keys' own work, the "Seven Countries Study," page 262 where he describes the diet issue, this is from his own work. [reads from book] "The fact that the incidence rate of coronary disease was significantly correlated with the average percentage of calories from sucrose, sugar in the diet, is explained by the intercorrelation of sucrose with saturated fat." In other words, donuts, ice cream. "Partial correlation analysis shows that with saturated fat constant, there was no significant correlation between dietary sucrose and the incidence of coronary heart disease." So Keys said, "See? Sucrose isn't the cause." Except for one thing. When you do a multi-variant linear regression analysis like this, you have to do it both ways. So, you hold dietary fat constant and show that sucrose doesn't work, but then you have to do the opposite. You have to hold sucrose constant and show that dietary fat still works. Did he do that? He didn't do that. Why didn't he do that? We don't know. He's dead. Nobody to ask. All we know is that there's some real questions about the last 30 years of nutrition policy in America based on this study. So of course, this led to the fat-free craze. Sorry about the heading here. But bottom line. We live in a low-fat society. Remember Snackwells? They're still with us, right? OK? The content of low-fat home cooked food can be moderated. You can determine what you put in the food you cook yourself. But low-fat processed food tastes like cardboard. OK? The flavor is in the fat. So, when you take the fat out, what do you have to do? You have to substitute it. With what? With carbohydrate. Well, which carbohydrate? High fructose corn syrup or sucrose. So, there's the recipe for Snackwells. Two grams of fat out. Thirteen grams of carbohydrate in, four of which are sugar. How about chocolate milk? Kids won't drink milk today in school. Why? Because we took the fat out, saturated fat. Whole milk is 3% saturated fat. We took it down to 1%. Or even skim tastes like crap. Kids know that. [laughter] So what did they do? They said, "Well, we gotta make the kids drink the milk 'cause they need the Vitamin D, Calcium and Phosphorous." So, what did they do? They added the chocolate syrup. So now, chocolate milk has a half a glass of orange juices' worth of sugar. So the question is, which is worse, the sugar or the fat? That's the question. And here it is. One percent Berkeley Farms low-fat milk right there. One hundred thirty calories. Fifteen grams of sugar. And here's Berkeley Farms one percent chocolate milk. Hundred and ninety calories, 29 grams high fructose corn syrup. So, is this what you think we should be giving our children in school? Yes or no. But that's what they're getting. So, here's the reason. We have five tastes on our tongue. We have sugar. We have sweet. We have salty, sour, bitter, and something called umami, astringent, soy sauce. Sugar covers up the other four. It covers up salty, like Chex Mix or honey roasted peanuts. It covers up sour, like German wines, right? They don't get enough sun so they're highly acidic. The citric acid is very high so they gotta add some Sussreserve to cut it. So, all German wines are kinda sweet. Or, lemonade, you gotta add sugar. I mean, who would drink lemonade without sugar? Umami, sweet and sour pork. That's half soy sauce. You would never go eat that at the Chinese restaurant, except that the sugar cuts it and you can't even tell it's there. And finally, bitter. Caffeine is bitter. Dark chocolate is bitter. Milk chocolate's not. Bottom line, you can make dog poop taste good with enough sugar. [laughter] And indeed, that's what the food industry has done. They have mitigated the negative effects of the food that they are processing and serving with sugar for their own benefit, not for yours. So as far as I'm concerned, we've had our entire food supply fructosilated. OK? For palatability, especially with the decrease in fat, because of this nutrition policy, which is highly questionable at best and downright dangerous at worst, and also ostensibly as a browning agent. Go to Safeway and look at commercially available bread. You'll not find a bread at Safeway that doesn't have high fructose corn syrup in it. And they will tell you "because it browns better." Also, increases shelf-life. How long does a loaf of bread that you buy at your local bakery last before it goes stale? A day or two? Maybe? Put it in the microwave. It gets soft again. But bottom line, it goes stale pretty fast. How come? There's no high fructose corn syrup in it. The reason that the commercially available bread lasts two or three weeks is because the sugars displace the water. It's called water activity. And so, it doesn't evaporate and so it doesn't go stale. So, this is a shelf-life issue because then the supermarket can sell it for longer. So, this is not for you. This is for them. And finally also, the substitution of trans fats, which we know are really dangerous, but we know that and we're getting rid of them. And they're going down to close to zero now. And in New York, they're not even there. Right? Mayor Bloomberg. The point is that fructose is not glucose. No way, no how. The common wisdom is that sugar is just empty calories. And you can get your empty calories from anywhere you want. You can get your empty calories from carrots, or you get your empty calories from cheesecake. The food industry will say constantly, nonstop, every time they have a chance, "There is no bad food. Every food should be eaten in moderation." That's what they say as if somehow that's some sort of a magic spell that's supposed to basically divorce you from the reality. In fact, we're not eating it in moderation. We're eating it in way excess. And that's the point. And hepatic fructose metabolism is completely different from that of glucose. Glucose is the energy of life. Every cell in your body uses glucose. Every cell in every organism on the planet uses glucose for energy, fructose, not so. In fact, there is no requirement for fructose. There's no biochemical process that requires fructose. There's no place in your body that needs fructose except for semen and your body makes it from glucose through the Randle cycle and dietary fructose does not contribute to it. So, if there was no fructose on this planet, we wouldn't have desserts, but we would do just fine thank you. OK? And I'm also gonna show you that chronic fructose exposure alone promotes this thing we call the metabolic syndrome. All the cardiovascular co-morbidities: Type 2 diabetes, hypertension, dyslipidemia, and obesity. And lastly, fructose tricks the brain into increasing total food consumption. And that's where this enormous glut of fructose really comes from. It's from here because of the phenomenon of reward and the process of addiction. And I'll show you that. So in order to explain this, I have to basically show you fructose is different from glucose. So, let's consume 120 calories in glucose, two slices of white bread, a quarter cup of rice. OK? Eighty percent of that, on the right, 96 calories will be metabolized by all the organs in the body 'cause every organ has a glucose transporter to transport glucose. Twenty percent will hit the liver. So, we're gonna follow that 20%. Now, I'm standing over here and I don't have a laser pointer, but you can see in big font in the center the word "glycogen." Almost all the glucose goes to glycogen. Glycogen is liver starch. It is the storage form of glucose in the liver. Does glycogen hurt your liver? No. We have marathoning carb-loaders, right? They eat pasta like crazy before a race because they're trying to build up glycogen stores in their liver so that they'll have more energy for the race. We have kids with glycogen storage disease Type 1A. They've got livers down to their knees, they're hypoglycemic, they're sick as all get-out, but they don't get liver failure because glycogen doesn't hurt your liver. This is what your liver wants to do with excess energy is make glycogen. This is good. Now, let's do something that's not so good. Let's talk about a different carbohydrate. Let's talk about my favorite carbohydrate, maybe yours too. Right? It's a carbohydrate. There's the structure right there. But we know that ethanol is not just any old carbohydrate. Ethanol is a toxin. In fact, it's two toxins in one. You wrap your Lamborghini around a tree, acute ethanol toxicity. And you fry your liver, chronic ethanol toxicity. Two toxins in one. We keep it out of the hands of children. We have an agency in Washington DC that regulates it as a commodity specifically because we know this is dangerous and we have to be kept from ourselves. Called the ATF, right? Alcohol Tobacco and Firearms, all of which are bad for us so we need an agency to keep us from it. So anybody who talks about the need for public health, we already have it for these things. Over here on the left we have acute ethanol exposure. And you can read through it. You all went to college. And over on the right, acute fructose exposure. Nothing, because fructose is not metabolized by the brain, whereas ethanol is. Now, let's consume 120 calories in ethanol. A shot of Makers Mark. OK? My drug of choice, along with the caffeine. So what happens here? Remember with glucose it was 20/80? With ethanol, it's 80/20. So, 20% of the calories, 24 calories, will be taken off the table because of the stomach and the intestine or the kidney, muscle, and brain. Eighty percent of the calories, or 96 calories, are gonna hit the liver, four times the substrate as with glucose. Same number of calories. Isocaloric, but not isometabolic. Here's what happens to ethanol. Now, I'm not gonna go through all these pathways with you. If you wanna see how this works, you can go to the YouTube video. I spend a lot of time with them, 90 minutes worth. So you can look at them there. Bottom line, do you see glycogen anywhere? Nowhere. What you see is that the ethanol comes down to acetate and enters this thing down at the bottom called the mitochondria. The mitochondria is the energy burning factories of your cells that create the energy. You've got 96 calories of ethanol hitting the mitochondria all at once. And that's where things go bad. When that happens, and you don't have a pop-off to some storage form, that's when you get into metabolic trouble. So, the more calories that hit the liver and faster it gets to your mitochondria, the sicker you're gonna get. That's what metabolic syndrome is. And alcohol does it. Just ask anybody who drinks beer. Now let's do fructose. Let's consume 120 calories in sucrose, eight-ounce glass of orange juice. So, two slices of white bread, quarter cup of rice, eight ounce glass of orange juice. All 120 calories. All isocaloric. If a calorie is a calorie, it shouldn't matter, right? But a calorie is not a calorie. Isocaloric, not isometabolic. It is not what you eat, it is what you do with what you eat. So let's follow the 120 calories. The glucose will do the same 20/80 split. So, 12 calories to the liver, 48 to the periphery--20/80. But all 60 calories have to be metabolized by the liver because only the liver has the glucose transporter specific for fructose. So now we're hitting 72 calories are hitting the liver. And this is just for fructose. So, the glucose will go to glycogen, but the fructose, you see glycogen anywhere on there? You see a lot of arrows is what you see. And in blue, you see hypertension, inflammation, hyperinsulimia, hepatic insulin resistance, dyslipidemia, muscle insulin resistance, and obesity. Now, I don't have time to go through how we got there. Go to the YouTube video and you can see it, all the specifics. But the bottom line is that's metabolic syndrome. And the reason is because it all comes down to the mitochondria. And there's no glycogen pop-off. That's metabolic disease, and its' fast. So here's chronic ethanol exposure. And here's chronic fructose exposure. Eight out of twelve because they're the same. Because after all, where do you get ethanol from? Fermentation of fructose. It's called wine, right? We do it right here. The big difference is that for ethanol the yeast does the first step in metabolism. For fructose, we do our own first step in metabolism, but once you get down to the mitochondria they're all the same. And they cause the same diseases for the same reasons. So, consuming all of this fructose is not so good. And how did we get there? The food industry brought us there. So, what's the difference? Over here on the left we have a can of Coke. Over on the right we have a can of beer. Hundred fifty calories both. Clearly, the composition is different: 90 of ethanol, 60 of maltose, that's glucose. For the Coke, it's 75/75. But when you do the math on the first pass effect the calories hitting the liver are exactly the same. And we already showed you that it's not just, it's the calories hitting the liver and how fast the mitochondria can metabolize. So, in America we have something called beer belly. Well, guess what? We also have soda belly 'cause they're the same. In Saudi Arabia, they don't have beer belly. But boy, oh boy, do they have soda belly. And so does the whole world. Here are the four food stuffs that do this: trans fats do this; branched-chain amino acids: leucine, isoleucine, valine, for those of you who took biochemistry. They get metabolized to energy in the same way. And they are associated with metabolic syndrome as well. Where do you get branched-chain amino acids from? Soy protein, that's our whole diet now, ethanol and fructose. And so we have one fat. Amino acids, that's protein, and we have ethanol, which is sort of, I don't know what it is, and then fructose, which is carbohydrate. Different things all from different parts of our diet. But they all share two things in common. They're not insulin regulated and there's no glycogen pop-off in the liver. They go straight to the mitochondria and cause disease. That's metabolic syndrome right there. Now, the other thing that fructose does. It tells your brain you want more. Junk food addiction may be a clue to obesity. Indeed, binging on high-calorie foods may be as addictive as cocaine or nicotine and could cause compulsive eating and obesity, according to a study published on Sunday. This was back in March. So, is sugar addictive? The lay public seems to know. All these books, right? If you look in the brain at the reward center, called the nucleus accumbens, here's a control brain over on the left and here's a cocaine brain. You notice the red has gone down? Those are dopamine receptors. Down regulation of dopamine receptors is addiction. That's what causes addiction. Over on the right, you see a control brain, you see an obese brain, same thing, down regulation of dopamine receptors. When your dopamine receptors are down regulated, 'cause dopamine is the reward transmitter, when your receptors are down regulated, you need more dopamine to occupy those fewer receptors. Therefore, you have to eat more to get it. So it's basically, that's called tolerance and that's an addiction term. And when you're tolerant, you have to supply more substrate to get the same effect. And then when you take it away, that's withdrawal. So, tolerance means you're continuing it and withdrawal is when you lose it. For an addictive substance to be addictive, you have to fulfill four criteria. These are for animals now, for animals. Binging, withdrawal, craving, and what we call cross-sensitization with other drugs of abuse. In other words, if you expose an animal to say, morphine and you addict them, and then you take the morphine away and you expose them to amphetamine, they'd never seen amphetamine before. They will have a heightened response to the amphetamine because they were addicted to the morphine. That's called cross-sensitization because the D2 receptors are already down regulated. Everybody got the picture? Sugar does them all. And I don't have time to show you all the data, but we're publishing a paper out in the fall called "Is Fast Food Addictive?" where we show all of this. How about in humans? So here are the DSM-V criteria for addiction right here. So you have to show tolerance or withdrawal, and then all of these psychological dependencies in orange. And if you just read through them it sounds like every obese person I know. Indeed, I can show you withdrawal right now. Everybody see this movie? OK? If second-graders learn nothing else about nutrition except watching this movie, that would be enough. I'm gonna play one little clip from Day 18 of Morgan Spurlock's ordeal through McDonalds. Remember, this guy was a vegan, right? His girlfriend was a vegan chef. He was nice and thin and then he started gaining weight 'cause he started eating at McDonalds. This is Day 18. Here's what he says. [plays clip] >>Morgan Spurlock: I was feeling bad in the car. Feeling like shit. Really. I was feeling really, really, sick and unhappy. Started eating, feel great. Feel really good now. I feel so good, it's crazy. Isn't that right, baby? >>Girlfriend: Yeah, you're crazy all right. [end clip] >>Robert Lustig: So, I don't know if you could all hear him or not. He basically said, "I was sitting in the car. I was feeling really crappy. I was feeling like shit. I was feeling tired and unhappy. Started eating. I feel great. I feel so great, it's crazy. Ain't that right, babe?" And she yells back, "Yeah, you're crazy all right." That's what he said. [laughter] He just described withdrawal. Eighteen days on a McDonalds diet and he went from being a vegan to being an addict. 'Cause he just described drug withdrawal. So, who's winning the war? This is a war. 'Cause whatever is good for the food industry is bad for us and whatever's good for us is bad for them. There's no middle ground. And they're winning because the S&P 500 in blue. And here's the stock price of McDonalds, Coke and Pepsi. There's the economic downturn of 2008. And you can see that they're doing just fine thank you. OK? And over here, we have Con Agra, General Mills, Hormel, Kraft, Proctor and Gamble, and they're all doing better than the S&P as well. If you wanna make money, invest in a food company 'cause they know what they're doing. And they keep plying us with the sugar. They keep adding the sugar to the food specifically because it works for them. The annual profit margin of the food industry prior to 1975 was 1% per year. One percent per year. The increase in the general population was 1% per year. In other words, they sold more food because they sold the same amount of food to more people. Got it? Since 1975, the profit margin's been 5% per year. Now, the population hasn't gone up any faster than 1%. In fact, it's going up slower now. So if they're going up by 5% per year, how are they doing it? Selling more food to the same number of people. The American Heart Association has recognized this is a problem and they published this scientific statement in 2009, which I helped contribute to, called "Dietary Sugar Intake and Cardiovascular Health." Because they were the people who said low-fat, and they now got it. They now know that that was a mistake and they're trying to undo the mistake. When you make a mistake, what do you do? You admit the mistake and you try to right the ship. We haven't admitted the mistake and we haven't righted the ship, and things continue to go downhill. So, let me close by just re-stating the first law of thermodynamics that I started with. Here's how you should state it from now on. If you're gonna store it, that is, an obligate weight gain set up by biochemical forces out of your control, and you expect to burn it, that is, normal energy expenditure for normal quality of life, because energy expenditure and quality of life are the same thing. Things that increase your energy expenditure make you feel good, like ephedra, it's off the market, caffeine, exercise. Things that lower your energy expenditure make you feel lousy, like starvation, hyperthyroidism. So, if you're gonna store it and you expect to burn it, then you're gonna have to eat it. And now, the two apparent behaviors that we note that are markers for the obesity epidemic, rather than causes. Remember, correlation is not causation. I just showed you causation. And these are downstream. The gluttony and the sloth are downstream of the biochemical process of insulin resistance and fat deposition driven by sugar. Our biochemistry is a result of our environment. So, here we have Michelle Obama trying to do something about childhood obesity. And I applaud her for taking it on. And she has the "Let's Move" campaign, necessary, but not sufficient. And the reason is because it's focused on the individual, it's focused on the family, focus on the community, but leaves government and the food industry out because they don't want the fight. So the question I'm gonna leave you with is a big question. It's a global question. Can our toxic environment be changed without governmental/societal intervention? Especially when there are potentially addictive substances involved? We have needed government intervention for every other substance of abuse: cocaine, amphetamine, nicotine, cannabis, ethanol, morphine. Every single drug of abuse has required governmental intervention because they're public health problems. I've just shown you that this is a public health problem. For further reading, I'm gonna refer you to these papers. I'm not gonna, iIf you want, you can send me an email and I'll happily send you a pdf of any of them. And just for a little enticement, in 2013, look for this book, "Fat Chance: Gambling on our personal and public health." I'm writing it now and hopefully by January of 2013, it'll be at the publisher available not at Borders, but maybe at Amazon. And with that, I wanna thank my collaborators at UCSF, the Weight Assessment for Teen and Children Health Clinic, UC Berkeley Department of Nutritional Sciences, and also Touro University, in particular, my colleague Dr. Jean-Marc Schwartz who is a card carrying fructose biochemist, and also my colleagues at the Institute for Health Policy Studies, Laura Schmidt and Clare Brindis, who've helped with some of the policy work that we're trying to engage in right now. With that, I will close and I'll open it up to questions and I thank you all so very much for your attention. [applause] >>Male Presenter: I know a lot of you guys have to get running to your next meeting. I just wanna remind you if you wanna learn more about the Health at Google speaker series, check out go O-Y-L. You'll learn a lot about that there. We'll stay here as long as we can, letting some people step up to the microphone here and ask some questions. But I know a lot of you need to run. Thank you for your investment of an hour's worth of your time to learn more about this subject. >>Robert Lustig: Please. >>MALE AUDIENCE MEMBER #2: Thank you. This is instructive. I have a-- >>Robert Lustig: Speak up though. >>MALE AUDIENCE MEMBER #2: Oh, does this work better? >>Robert Lustig: A little, yeah. >>MALE AUDIENCE MEMBER #2: I have a key question about the calories in minus calories burned thing. It ignores the metabolism side,-- >>Robert Lustig: Right. >>MALE AUDIENCE MEMBER #2: which you started to get into. I mean, you talked about some of this. It's like, how much that you took in actually just passed through? Or otherwise,-- >>Robert Lustig: Sure. >>MALE AUDIENCE MEMBER #2: get metabolized in different ways? >>Robert Lustig: Absolutely. >>MALE AUDIENCE MEMBER #2: And I assume that metabolism is, there's self-regulation mechanism. There's a feedback loop. So, it's not just like putting more in is gonna mean you put more on. >>Robert Lustig: Right. >>MALE AUDIENCE MEMBER #2: 'Cause the feedback loop kicks in differently. >>Robert Lustig: It depends on what they are. For instance, protein costs more to burn than say, sugar. The metabolic debt from the burning of protein is much higher. There's something called the thermic effect of food. That is, the heat, the body heat given off when you burn any specific food. And what you do with protein is much higher than say, with sugar as an example. In addition, who says you absorb them? The best way to not absorb what you eat is fiber. Fiber acts as a barrier in the lumen of the intestine preventing the transfer of calories from your gut into the bloodstream. Number one, that gives your liver a chance to keep up because it's not just a dose issue, it's a flux issue and it also delivers some of the nutrients to your large intestine, so they don't get absorbed at all. And so, what happens in the large intestine is that those bacteria will use that for energy. And what will they do? They will make hydrogen sulfide. So, in my world, it's either fat or fart. [laughter] So, how many calories you eat is not the issue. How many calories you absorb, how fast you absorb them, whether or not you have a metabolic debt in terms of burning them, and then of course whether or not your insulin goes up because once your insulin goes up, you don't wanna exercise. So there are a lot of things going on that interfere with that calories in, calories out equation. That's why we gotta get off this. >>MALE AUDIENCE MEMBER #2: Exactly. So we have to learn more about those factors you're just mentioning to have control over the metabolism side. >>Robert Lustig: Absolutely. >>MALE AUDIENCE MEMBER #2: OK. Thanks. >>MALE AUDIENCE MEMBER #3: Hi. I think you might have answered this, but I'm curious about what your take is on fruit and then you also brought up soy in this lecture as well. >>Robert Lustig: Right. >>MALE AUDIENCE MEMBER #3: And I'd like to know, do you advocate eating a lot of fruit and a lot of soy? >>Robert Lustig: Right. OK. I don't advocate eating a lot of fruit. But you know what? I don't care. And here's the reason I don't care. First of all, fruit has fiber. It has way more fiber than it does sugar. If you plotted sugar against fiber for all fruits, it's almost a linear straight line. The only outlier is grapes. They have more sugar than fiber. But everything else, the fiber and sugar is the same. And it actually makes, I mean, what has the highest sugar content of anything? Sugar cane, right? It's a stick. [laughter] You can't even chew it, it's so fibrous, it's so tough, it's so chewy. How much sugar you think you get out of a piece of sugar cane from just chewing it or sucking on it? Almost nothing. On the other hand, if you put it in the still and you boil it up and you make the molasses and you chlorinate it and you make the white crystalline sugar and you have a hundred pound bag of sugar lying around to make a donut, then how much you gonna get? God made sugar hard to get, man-made sugar easy to get. So, I don't care if you eat God-made sugar. How's that? In addition, fruit is self-limiting. How many oranges can you eat in one sitting? One? Did you ever see a kid eat two oranges in a sitting? Pretty rare. On the other hand, how many glasses of orange juice can they drink in one sitting? So which would you rather have? An orange, which has 30 calories, 15 of which are fructose and plenty of fiber, or a glass of orange juice, which has 120 calories of sugar, 60 of which are fructose and no fiber? I put it to you. >>MALE AUDIENCE MEMBER #3: OK. So if we had like, four or five pieces of fruit a day-- >>Robert Lustig: I don't care. [laughter] >>MALE AUDIENCE MEMBER #3: What about the soy protein issue? >>Robert Lustig: Soy is a big question. Soy clearly delivers protein, but it's not high-quality protein. There's high-quality protein, there's low-quality protein. What distinguishes it? The essential amino acids. So, tryptophan, phenylalanine, tyrosine, the aromatic amino acids are the ones in shorter supply. The place you get that is eggs. Egg protein is the highest-quality protein there is. OK? Low-quality protein, soy. So, should we be making everything with soy? Well, only processed food has soy. What else has soy? Only processed food. So this is a processed food issue as far as I'm concerned. If you ate food as it came out of the ground, as God intended it, I wouldn't care what you ate. Processed food is the problem. And that's what we have shifted our entire economy and our entire diet to because it's cheap. Thank you. [applause]