Lustig Rebuffs Calorie Parity as Sugar Drives Diabetes Surge

卢斯蒂格驳斥“卡路里等价论”：糖推动糖尿病病例激增 添加糖通过独特的代谢途径引发肝脏脂肪堆积和2型糖尿病，其诱发慢性病的作用独立于总热量摄入。 罗伯特·卢斯蒂格（Robert Lustig）博士与克里斯托弗·加德纳（Christopher Gardner）博士打破了“卡路里就是卡路里”的传统观念，阐明了以去除膳食纤维和大量充斥添加糖为特征的50年工业食品加工历程，如何推动了全球2型糖尿病、脂肪肝和代谢功能障碍的流行。演讲梳理了果糖代谢的生物化学过程，指出糖作为一种肝毒素，能在独立于总热量摄入或体重的情况下推动从头脂质合成和细胞衰老。演讲者还揭示了企业寡头垄断、农业补贴以及激进游说如何改变了膳食模式，并将灾难性的医疗成本转嫁给公众。最终，他们呼吁重归具有完整纤维基质的天然全食物、重塑烹饪技能，并实施定向征收含糖饮料税等政策干预手段。 50年来公共卫生膳食向超加工食品的转变恰逢慢性代谢性疾病激增，目前美国每年约有1.4万亿美元的医疗支出用于可预防的慢性疾病。 (55:10) 流行病学和临床证据表明，添加糖引发2型糖尿病的作用独立于总热量摄入；每日额外从汽水中摄入150卡路里，其使糖尿病患病率增加的幅度是从其他食物摄入150卡路里的11倍。 (41:26) 工业加工为了实现商品冷冻和长货架期而系统性地去除天然纤维，破坏了减缓肠道碳水化合物吸收并滋养肠道微生物群所需的保护性基质。 (7:36) 在不改变总热量摄入或体重的情况下，仅在儿童饮食中限制果糖10天，肝脏脂肪便减少了30%，胰岛素抵抗指标也得到了改善。 (44:14)

[64:04] Robert Lustig: Being fat and being sick are not the same thing. [61:08] Robert Lustig: Kids basically, if you don't know how to cook, you're hostage to the food industry for the rest of your life. [41:26] Robert Lustig: Whenever sugar changed, diabetes changed in the same direction 3 years later; that's causation—same level of proof we have today for tobacco and lung cancer. [44:14] Robert Lustig: Alcohol is dangerous because it's alcohol. Sugar is the same thing: it's dangerous because it's sugar, because of its unique stereochemistry, because of what it does and because of how the liver metabolizes it.

[0:00] [Applause] [0:01] thank thank thank you Norah and thank [0:02] you Chris um they said it couldn't be [0:05] done but you can do it because this is [0:08] actually a real mench this guy actually [0:12] there aren't too many Stanford people I [0:14] would appear with but uh [0:15] Chris Chris is one of them um thank you [0:20] very much for coming and thank you for [0:21] the invitation um this is the problem of [0:26] the [0:27] Millennium and in the last um what 50 [0:33] years we have gone from a uh society [0:38] that basically cooked at home uh [0:41] prepared its own food to now a society [0:44] that doesn't even know how to cook we've [0:47] lost a an important and I would say [0:51] seminal and integral component of our [0:54] lifestyle in the process of basically [0:57] two parent Working Families um uh shut [1:01] shuttling kids back and forth to and [1:03] from this activity that activity and of [1:06] course the money that has gone out the [1:09] window in terms of uh processed food and [1:12] in terms of health care so I want to [1:16] today take a step backward and do for [1:21] you what Chris and I do on a daily basis [1:25] how many of you in the room today are [1:27] scientists how many of you use the [1:29] scientist ific method in your daily [1:32] lives or in your research couple of you [1:35] okay well for those of you who don't I [1:38] have to describe for you what it is that [1:41] we do in order for you to understand how [1:43] we come to such a conclusion as what's [1:46] on this title slide an experiment that [1:48] failed so you have to understand what an [1:50] experiment is and you have to know what [1:53] success or failure is so let me take you [1:55] through that so here's a slide of sort [1:58] of what I do on a daily basis you pose a [2:01] hypothesis based on the data that's [2:04] currently available and you say this [2:06] must be true and I'm going to test it [2:11] by setting up a procedure that will [2:14] evaluate that [2:16] hypothesis and exclude all confounders [2:19] so you design the experiment and you [2:21] determine what the outcome should be a [2:24] priori and you then either support or [2:29] you refuse that [2:30] hypothesis right you assess the Baseline [2:33] parameters before you walk into the [2:35] experiment so you know where you're [2:37] starting so you know what the change [2:39] will be over the course of the [2:40] experiment you carry out the experiment [2:43] and you gather the data as you go and [2:45] you figure out what's going on during [2:47] the course of the experiment so that you [2:49] can ultimately work backwards to figure [2:51] out what happened if you need to you [2:53] assess the outcome parameters as you [2:55] reach the end of whatever the interval [2:58] that you were studying was and if the [3:00] outcome is as expected you publish it [3:02] you get grant money you know you move on [3:04] to the next experiment then the next [3:06] hypothesis that's great and if the [3:09] outcome is not as expected which is [3:11] about 10 times more likely than the [3:15] experiment actually working your job is [3:19] to figure out what happened what went [3:22] wrong was it because the procedure [3:24] itself was flawed and you couldn't [3:26] actually get the data out of it that you [3:28] thought because it's garbage in garbage [3:30] out or was it because the hypothesis was [3:33] flawed and you need to move on to [3:35] another hypothesis so you have to ask [3:37] the question do I want to repeat the [3:39] experiment and do it differently or do I [3:42] want to do a completely different [3:43] experiment and that's the uh situation [3:47] that all scientists face when an [3:49] experiment fails which is virtually all [3:51] the time everybody got it that's what I [3:54] have to do that's what Chris has to do [3:56] that's what the people who raise their [3:58] hands have to do okay and I'll tell you [4:01] it's a hell of a way to make a living [4:03] but that's what we do all right so let's [4:07] imagine that the food [4:10] industry 50 years ago posed a hypothesis [4:14] and that hypothesis is Illustrated on [4:17] this slide right here that processed [4:20] food is better than real [4:24] food that's what they said 50 years ago [4:30] and they said it for a whole bunch of [4:31] different reasons and we understand what [4:32] those reasons are and we've adopted a [4:35] lot of those reasons and we've sort of [4:37] inculcated those into our daily [4:40] lives now what are the outcomes that you [4:43] have to look at to determine whether or [4:45] not this hypothesis is correct well you [4:49] have to look at consumption did [4:51] consumption go up yes or no did Health [4:55] improve yes or no did the environment [5:00] get better or [5:01] worse and finally cash flow did [5:05] companies make money did consumers save [5:09] money and did Society do well or not [5:13] these are the questions that ultimately [5:15] will determine the success or failure of [5:19] this experiment everybody got it so [5:22] that's what we're going to analyze [5:24] today because the food industry refuses [5:27] to so we're going to do it for them got [5:30] okay so here's the experiment 1965 [5:34] everybody remember these okay Swanson TV [5:37] dinners the first Ultra processed [5:41] marketed fast food processed food and it [5:46] was in everybody's home and they told us [5:50] that this was going to liberate women [5:53] from the kitchen now has [5:57] it yeah it sort of has [6:00] and that's one of the reasons why we [6:01] have two parent Working Families now and [6:03] nobody to shuttle your kids and all the [6:05] daycare and everything else in fact it [6:07] did liberate women from the kitchen [6:09] because if we didn't have those they [6:11] probably still would be in the kitchen [6:13] whether that's a good thing or not is up [6:14] to your own uh uh decision [6:18] making and spam everybody REM spam right [6:22] so that's that was 50 years ago okay [6:24] this is what we have now everybody [6:26] recognizes all of these okay so we the [6:29] processed food industry has certainly [6:32] Advanced and evolved over the past 50 [6:34] years to provide us with all of this [6:37] Fair which we are now consuming but [6:39] what's interesting is with all of the [6:41] different processed food that's out [6:43] there for us to be able to choose from [6:46] today how many companies do you think [6:49] make [6:54] those not it turns out they're 10 and [6:58] here they are okay okay craft Coke Pepsi [7:01] Kelloggs Mars Unilever J&J PNG and [7:05] Nestle okay they control 90% of the food [7:10] distribution and marketing in this [7:12] country these 10 conglomerates and to be [7:16] honest with you they all do the exact [7:18] same [7:19] things so that's very interesting so [7:22] basically our food has been uniformly [7:26] changed over the past 50 years a very [7:29] good good [7:30] experiment in terms of before and after [7:33] so let's talk about that okay so here's [7:36] what processed food is number one it has [7:38] to be [7:40] mass-produced okay on a big scale you [7:42] know we're not talking about individual [7:44] chefs here we're talking about you know [7:46] conglomerates anybody ever been to a [7:49] food processing [7:51] plant you have huh what was it [7:55] like it's a plant are there any windows [8:00] there are no windows why is that why are [8:04] there no windows in a food processing [8:06] plant because they don't want you to see [8:09] what's going on in [8:11] there because if you did you wouldn't [8:13] eat it okay [8:16] truly you can't believe what's going on [8:18] there there is not one piece of [8:21] Machinery that is recognizable that [8:23] would be in a normal kitchen nothing [8:27] NADA it's fascinating really very [8:30] interesting it has to be consistent [8:32] batch to batch because not just batch to [8:34] batch but in fact location to location [8:36] because they're making it in different [8:38] places at different times okay has to be [8:41] consistent country to Country for [8:44] obvious reasons like McDonald's right [8:46] you know because after all you know it's [8:47] McDonald's it carries the brand it's got [8:49] to you know convey a certain [8:53] taste specialized ingredients from [8:55] specialized companies we're not talking [8:58] about you know just food here we're [9:00] talking about all sorts of additives and [9:02] we're talking about all sorts of other [9:04] things that you add to the food in order [9:07] to make those things consistent from [9:10] country to Country virtual every [9:13] macronutrient is prefrozen the only [9:15] thing that's not prefrozen are the [9:17] spices everything comes from a [9:20] freezer [9:21] fascinating okay and that means that the [9:24] fiber had to be removed because what [9:25] happens when you freeze [9:27] fiber you get [9:30] mush go home take an orange put it in [9:33] your freezer overnight take it out the [9:35] next day put it on the counter thought [9:37] try to eat it see what you get what do [9:39] you get you get mush because the ice [9:43] crystals mate the cell wall of the plant [9:46] with the orange okay and allow the water [9:48] to rush in and turns it into mush but of [9:50] course food industry knows that so what [9:52] do they do they squeeze it and freeze it [9:54] lasts [9:55] forever becomes goes from being a food [9:58] to being a [10:01] commodity that's the diff the definition [10:03] of a commodity storable [10:05] food and you can buy and sell [10:08] Commodities on a Commodities exchange [10:11] you can't buy and sell food on a food [10:15] exchange but you can with commodities so [10:19] this works for people trying to make [10:22] money okay it has to stay emulsified [10:26] what does that mean anybody know what [10:27] emulsifiers are so these are chemicals [10:31] they're detergents really that help [10:34] bring fat and water together all right [10:38] that's why you add detergents to the [10:40] washing machine is so that you can get [10:43] the uh uh soaps to the stain otherwise [10:46] you couldn't do that so what happens if [10:49] those emulsifiers are working inside [10:51] your intestine what do you think [10:54] happens it actually strips off the mucus [10:57] layer of the um epithelial cells inside [11:02] your intestine and there are actually [11:03] studies now in animals at least we don't [11:05] have a human studies that say that you [11:07] can actually show Closer apposition of [11:10] the food to the cells because the mucus [11:13] layer has been damaged and has actually [11:16] been Lo lost in some in some cases and [11:19] that may be part of the problem of food [11:22] allergy and uh irritable bowel syndrome [11:26] and several of the other uh uh food Rel [11:29] ated diseases that we know about today [11:31] although that's not known for sure yet [11:34] but there was a paper in nature just 3 [11:35] weeks ago that U pose that at least in [11:38] animals okay and again it has to have [11:41] very long shelf life or freezer life [11:44] everybody knows the 10-year-old Twinkie [11:46] right right it's got to last forever [11:50] right and that's again for depreciation [11:53] okay so let's list what processed food [11:58] is how it's different from from Real [11:59] Food everybody got it so not enough what [12:04] not enough fiber because you have to [12:06] take the fiber out in order to freeze it [12:08] not enough omega-3 fatty acids which you [12:12] find in wild fish not farmed fish [12:15] because the fish don't make the [12:18] Omega-3s what makes the Omega-3s the [12:21] algae make the Omega-3s the fish eat the [12:23] Aly we eat the fish so if you're [12:26] consuming farmed fish which is processed [12:28] food you might as well be eating a steak [12:31] right everybody got that very important [12:33] you understand that so you have to know [12:36] where your fish comes from well of [12:38] course how do you find out sometimes not [12:40] so easy micronutrients okay not enough [12:44] micronutrients because the [12:45] micronutrients travel with the fiber [12:47] fraction so when you remove the fiber [12:49] you remove a lot of the micronutrients [12:50] so most of the processed food is [12:52] deficient in micronutrients that we need [12:55] in order to be able to metabolize food [12:57] properly and then there's a whole bunch [12:59] of things that are too much too much [13:01] trans fats now we know that trans fats [13:03] are bad this stuff is consumable poison [13:06] so much so that the Food and Drug [13:08] Administration finally after 25 years [13:12] finally on November 7th 2013 agreed that [13:15] trans fats were not generally recognized [13:18] as safe and so they will be disappearing [13:21] from our food supply hooray took 25 [13:25] years okay what else Branch chain amino [13:28] acids loose isoline veine these are [13:31] three amino acids that you have to eat [13:33] you can't make and levels of these in [13:37] your blood correlate with metabolic [13:38] syndrome all the cardiovascular diabetes [13:41] diseases the non-communicable diseases [13:43] all the chronic diseases that we know [13:45] are all on the rise and levels uh of [13:48] these uh amino acids correlate with [13:51] those in humans and they are higher in [13:55] cornfed anything which of course is [13:58] processed food cornfed beef cornfed [14:00] chicken cornfed fish which is Farm fish [14:04] okay omega-6 fatty acids so what are [14:06] omega-6 those are pro-inflammatory now [14:09] you need omega-6s you need Omega-3s you [14:11] need both but you need them in the right [14:14] ratio and Omega 6 is is what you find in [14:16] seed oils like corn oil soybean oil and [14:20] these are pro-inflammatory now you need [14:22] inflammation because you need to be able [14:24] to knock out bacteria you need to be [14:26] able to mount an immune response when [14:28] you're sick and have a virus Etc but you [14:30] don't need it all the [14:32] time so we're supposed to have an Omega [14:35] 6 to Omega-3 ratio of about 1:1 we're [14:37] told we right now have an Omega 6 to [14:39] Omega-3 ratio of about 25 or 30 to1 so [14:43] the question is is that pro-inflammatory [14:45] or [14:46] not all these different additives and I [14:48] don't want to get into all the different [14:50] additives because we could go off for 10 [14:51] hours on all the different additives and [14:54] you know that would just you know [14:56] there's not enough videotape in the [14:57] camera for that emulsifiers like I [15:00] mentioned okay the ones that you may [15:01] have heard of are called polysorbate ad [15:03] and carboxymethyl cellulose those are [15:06] the emulsifiers that are typically used [15:09] too much salt right everybody knows [15:11] about salt so Salt's very complicated [15:14] there are some people who are [15:15] exquisitely salt sensitive and they need [15:18] a reduction in their salt content and [15:21] there are some people who aren't as salt [15:23] sensitive and it's not as important now [15:26] as a doctor I care about everybody and [15:29] we are triple over our salt limit so I'm [15:33] for reducing salt but it's in but when [15:35] you look at the data it's complicated as [15:37] to who benefits and who doesn't but [15:39] nonetheless it's still a good thing to [15:41] reduce salt and then the big one the Big [15:44] Kahuna the in your face the you can't [15:47] touch this sugar okay and that's what [15:50] we're going to talk mostly about today [15:52] because the food industry uses [15:56] sugar like you use salt [15:59] okay they hype up virtually every food [16:03] to make it more palatable and they do it [16:06] with sugar why because there are five [16:10] taste buds on your tongue okay there's [16:12] sweet of course there's salty there's [16:14] sour there's Umami everybody knows what [16:16] that is that's like roast beef or soy [16:19] sauce and then there's bitter so here [16:22] are examples of each of those so sugar [16:24] hides salty that's like cheex mix or [16:27] honey roasted peanuts it hides sour like [16:31] the German wines you know I mean nobody [16:32] would drink that stuff except that they [16:34] add a little bit of su Reserve back [16:36] because there's so much citric acid in [16:38] the German wines because they don't get [16:39] any sun okay that you have to cut the [16:43] acidity and you do it with sugar it's [16:45] the same reason why you add a little [16:46] sugar to your salad dressing when you [16:48] make balsamic vinegar and oil because it [16:51] make you know it it cuts the sourness or [16:53] the uh a little bit how about and [16:55] lemonade of course it cuts Umami like [16:58] sweet and sour pork you know that's half [17:00] soy sauce you wouldn't touch that except [17:02] you add a little sugar you can't even [17:03] tell that there was any soy sauce in [17:05] there and then finally it cuts bitter [17:08] like milk chocolate right okay so why [17:13] here's why because there are no food [17:15] stuffs in nature that are both sweet and [17:18] acutely [17:20] poisonous none it was the signal to our [17:23] ancestors that any given food that they [17:26] found in nature was safe to eat wouldn't [17:29] make him Kel over and [17:31] die liking sweet is ingrained into our [17:36] DNA we love this stuff we will go out of [17:39] our way for this stuff it is completely [17:41] vestigial from a metabolic standpoint it [17:45] it gener it gives us no benefit in terms [17:49] of anything but as an energy source [17:52] there is no biochemical reaction in the [17:55] body that requires dietary sugar yet we [17:59] love it anyway and a perfect example of [18:01] this is Aki fruit everybody know [18:03] Jamaican Aki fruit so anybody ever seen [18:06] this stuff you it's over here on the [18:08] right so if you live in Jamaica you know [18:12] don't eat the Aki fruit until it's [18:15] either bloomed like here or it's fallen [18:17] from the tree because if you eat the Aki [18:20] fruit when it's immature there is a [18:23] compound in it called [18:24] hypoglycin and this hypoglycin can [18:27] actually lower your blood sugar to about [18:28] five and causes something called [18:30] Jamaican vomiting sickness and you can [18:31] die from it and I've actually seen a [18:33] case of that okay but if you wait till [18:36] it blooms the hypoglycin is metabolized [18:38] and now it's safe to eat and of course [18:40] it's the Jamaican national dish and they [18:41] can it and send it all over the country [18:44] all over the world okay and it's [18:46] basically you know what they eat okay so [18:51] the question is is this stuff addictive [18:56] well we know that there are certain [18:57] things that are addictive and hazardous [18:58] our health the question is what about [19:00] this stuff is this stuff addictive and [19:03] hazardous to our health depends on who [19:04] you ask if you ask the chief medical [19:07] officer of Amsterdam Paul vanderin he [19:10] will tell you that sugar is both [19:14] addictive and The Most Dangerous Drug of [19:16] our times okay this is coming from [19:25] Amsterdam really [19:29] and they would know something about [19:31] that okay I mean you know think about [19:34] that really well in fact we actually [19:37] know this too why do we know this [19:39] because of this stuff anybody recognize [19:41] this anybody work in a neonatal [19:42] Intensive Care Unit or in a newborn [19:44] Nursery anybody know what this stuff [19:46] over here is it's called sweeties [19:50] sweeties what is it it is a super [19:53] concentrated sucrose sugar solution that [19:56] you dip the pacifier in and then stick [19:59] in the newborn boy's mouth before you do [20:01] the [20:06] circumcision the Jews use [20:09] wine everybody else uses [20:13] sweeties so we know okay it releases [20:16] endogenous opioids okay because that's [20:19] our endogenous painkiller it's an opiate [20:22] okay and it does the same thing as [20:24] opiates [20:25] do so here's the key of the [20:29] 600,000 food items that you can find in [20:32] the American grocery store today 74% of [20:35] them have added [20:37] sugar and of the 4,000 packaged items in [20:41] the American food supply that were [20:43] looked at recently in this article that [20:46] just came out like a week ago only 50% [20:50] had greater than the recommendation for [20:51] added salt so what does that mean that [20:53] means that sugar is actually the marker [20:55] for processed food even more than Salt [20:57] is because sugar is in more things than [21:00] Salters so that's the question for today [21:03] is sugar Public Enemy Number [21:06] One because it is not just the marker [21:10] for processed food but it is the thing [21:12] that distinguishes processed food and [21:14] the question is is it okay in the doses [21:18] that we are currently exposed to in [21:22] processed food by the food industry [21:25] because it hides all the other negative [21:28] aspects of food and gets you to buy [21:32] more that's the question for today and [21:36] that's the experiment if you add food to [21:40] if you add sugar to your diet what [21:44] happens to you and that's the last 50 [21:47] years okay so let's look at the outcomes [21:51] so remember we said consumption Health [21:54] environment cash flow those are our four [21:57] outcome variables so let's look at the [21:59] first one consumption so you could say [22:02] well we definitely have a consumption [22:06] problem because there over there on the [22:08] left we have the original White Castle [22:11] hamburger right before processed food [22:14] 210 calories and then over there in the [22:17] middle we have Bob's Big Boy at 618 [22:21] calories and in the midst of the Obesity [22:24] epidemic Hardies had the tarity to offer [22:27] us the thick burger at 1420 calories and [22:30] of course you can go today to Carl's Jr [22:33] just down the street on El cinal and get [22:35] the six dollar burger at 2,000 calories [22:39] and so you say QED there you go that's [22:42] what it's all about consumptions up oh [22:45] consumption is way up no question in [22:48] fact total calories are up over the last [22:51] 25 years in men 187 calories per day [22:55] more than 25 years ago in women 3 35 [22:59] calories a day more than 25 years ago in [23:02] teen boys in this slide 275 calories [23:05] more than 25 years ago yes we are all [23:08] eating more consumption is definitely up [23:10] since the Advent of processed food slam [23:14] D but what are we eating more [23:17] of is it [23:20] fat not really no in fact Fat's about [23:24] the [23:26] same 5 gram 45 [23:29] calories so here's the secular Trends in [23:33] specific food intake and if you take a [23:35] look at what's circled in purple that's [23:39] all the fats so whole milk way down [23:43] right we were told really bad for you [23:45] because it had saturated fat Well turns [23:47] out you know what a saturated fat isn't [23:49] necessarily a saturated fat turns out [23:52] that Dairy saturated fats have a very [23:54] different metabolic signature than do [23:57] red meat saturated fats fats and they [23:59] may actually be protective for diabetes [24:01] and possibly even protective for heart [24:03] disease based on epidemiologic studies [24:06] but we lumped them all together okay so [24:09] whole milk way down meat and cheese up [24:11] very slightly milk desserts bottom line [24:13] it's a wash that's what the data say and [24:16] in fact we are eating exactly the same [24:19] amount of fat as we did before but [24:22] because calories have gone up because [24:25] consumptions gone up the percent of [24:28] calories as fat has gone down because [24:31] we've gone from 40 to 30% because we [24:33] were told to we were told by the USDA [24:37] the original dietary guidelines of [24:41] 1977 told us to reduce our consumption [24:44] of total fat and saturated fat from 40 [24:46] to 30% guess what we've done it and look [24:49] what has [24:50] happened wow you want an experiment you [24:52] want an outcome that you can measure oh [24:54] we got it we got it big okay so what are [24:58] we eating more of if it's not fat well [25:00] it's carbohydrate 228 calories lot [25:03] eating lots more carbohydrate okay and [25:05] here's that [25:07] same slide I showed you before but now [25:09] the carbohydrate is circled as well and [25:12] you can see all of them through the roof [25:15] that's what's gone up carbohydrate and [25:19] in particular what carbohydrate well 41% [25:22] increase in soft drinks 35% increase in [25:24] fruit drinks fruit AIDS Etc okay just [25:27] remember one can of soda a day is 150 [25:30] calories times 365 days a year divided [25:32] by the magic number 3500 calories in a [25:34] pound which I don't even believe but [25:36] that's what the dietitian will tell you [25:39] okay and so that's worth 15 and a half [25:40] pounds a year it's actually worth more [25:43] it's worth more because things that make [25:46] your insulin go up higher make you gain [25:49] more weight even on the same number of [25:52] calories and my friend Dr Gardner will [25:55] explain that when he talks with you [25:57] later [25:59] okay so what is this [26:02] stuff well in America it's this stuff [26:04] here right high fructose corn syrup why [26:07] high fructose corn syrup well number one [26:09] it's from [26:11] corn right anybody know the dirtiest [26:14] four-letter word in the English [26:17] language no it's not [26:20] corn there's a dirtier four-letter word [26:23] in the English [26:24] language Iowa [26:30] because Iowa is the first presidential [26:33] caucus and you can't win the presidency [26:36] if you don't win [26:38] Iowa asked John [26:41] McCain [26:43] okay no one wants to touch this this is [26:45] the third rail of American [26:48] politics no one wants to touch this and [26:52] of course corn is the second dirtiest [26:54] word for the same reason okay so our our [26:58] current annual consumption is 63 pounds [27:00] per person but interestingly only the US [27:04] Canada Japan and very limited exposure [27:07] in parts of Europe use this stuff yet [27:11] the entire rest of the world has the [27:12] exact same problem we do in fact [27:15] diabetes rates are higher in China and [27:18] in India than they are here and they [27:19] don't have high fructose corn [27:21] syrup they it's actually as high in [27:24] Australia as it is here and they don't [27:25] have high fructus corn syrup what do [27:27] they have they just have table sugar [27:29] they have sucrose so here's the [27:31] difference so high fructose corn syrup [27:34] is on the top so it's either 42 or 55% [27:38] fructose that five membered ring on the [27:41] right that's the sweet molecule that's [27:43] the one we seek that's the one that's [27:46] addictive glucose over there on the left [27:48] that Six membered [27:49] Ring that's the energy of life every [27:53] cell on the planet Burns glucose for [27:55] energy glucose is so godam am important [27:59] that if you don't consume it your body [28:01] makes [28:03] it so is glucose a [28:07] nutrient sure is glucose an essential [28:11] nutrient no because you don't need it [28:16] because your body will make it unless [28:18] you have glycogen storage disease in [28:20] which case then you have to come to me [28:21] as a pediatric endocrinologist but short [28:24] of that everybody else makes it [28:28] but this stuff over here this this five [28:30] membered ring fructose no biochemical [28:33] reaction on the on the in in a [28:35] vertebrate that requires dietary [28:38] fructose it's completely vestigal it is [28:40] an energy [28:42] source that's true but it provides no [28:45] nutrition because there's no biochemical [28:48] reaction that requires [28:50] it can anybody name an energy [28:54] source that has absolutely no function [28:57] in the body [28:58] that we like a lot but that is toxic in [29:02] high [29:04] dose alcohol thank you alcohol alcohol [29:08] is an energy source but alcohol is not [29:11] nutrition yet we love it yet it's toxic [29:14] and we regulate it Sugar's the same [29:17] thing because fructose is metabolized [29:20] exactly like [29:22] alcohol in fact sugar is the alcohol of [29:24] the child and that's why children today [29:27] are getting the diseases of alcohol type [29:30] 2 diabetes and fatty liver disease [29:32] without drinking [29:33] alcohol because they've just substituted [29:37] one addictive substance for another [29:40] everybody got it and that's of course [29:42] why the food industry puts it [29:45] in okay so that explains this right here [29:50] so I call this slide very specifically [29:52] the Coca-Cola conspiracy and you'll see [29:54] why in a moment okay they haven't sued [29:56] me yet [29:58] so over there on the left 1915 the [30:02] original 6 1 12 ounce bottle of [30:05] Coca-Cola standardized out of Atlanta if [30:08] you drank one of those every day for a [30:09] year that'd be worth eight pounds of fat [30:11] per year then after World War II when [30:14] sugar became plentiful again after [30:16] rationing okay we had the 10 oun bottle [30:18] first one found in vending machines over [30:20] there that would be worth 13 pounds of [30:22] fat per year okay then of course in 1960 [30:24] we got the ever ubiquitous 12 O can okay [30:27] which is Worth 16 pounds of fat per year [30:30] and of course today that is the single [30:33] unit of measure over there the 20 o [30:35] bottle it's the only one you can now [30:36] find anywhere that's if you drank one of [30:39] those every day that would be worth 26 [30:41] pounds of fat per year but how many [30:42] servings are in that bottle anybody [30:45] know two and a half two and a half 8 [30:48] ooun servings in that bottle anybody [30:50] know anybody who gets two and a half 8 O [30:52] servings out of that that's a single [30:54] serving okay and then finally in the [30:57] middle we have the 7-Eleven Big K Thirst [30:59] Buster Big Gulp 44 Oz worth 57 lb per [31:04] year and my colleague Dr Dan hail tells [31:07] me that down at the University of Texas [31:08] San Antonio they got a Texas sized Big [31:12] Gulp 60 o of Coca-Cola Snickers bar and [31:16] a bag of Doritos all for [31:18] 9 that is what processed food has [31:21] brought us that would be worth 112 [31:23] pounds of fat per year and by the way in [31:26] case you didn't know [31:28] on April 11th that is this Saturday two [31:32] days from today [31:35] 711 is offering a [31:38] promotion bring any vessel from your [31:43] home that is not an inflatable [31:46] pool and fill it up with Slurpee for [31:53] $149 you think I'm kidding I ain't [31:56] kidding okay [31:58] that they will not take inflatable [32:01] pools [32:02] okay so oh before I get there so why do [32:06] I call the Coca-Cola [32:08] conspiracy well what's in [32:12] cook let's start with something else [32:16] what caffeine caffeine thank you [32:18] caffeine so what's caffeine it's a mild [32:22] stimulant and it's also a diuretic works [32:25] on the kidney to make you urinate free [32:27] water [32:28] what else is in [32:30] Coke salt 55 milligrams per [32:34] can so what happens if you take on salt [32:38] and lose free [32:39] water you get thirstier right so why is [32:45] there so much sugar in [32:47] coke to hide the [32:50] salt I showed you that [32:52] already now do you have to make soda [32:56] with salt [32:58] anybody ever heard of Royal Crown Cola [33:01] it's long gone okay but you probably [33:03] grew up with it okay tastes bad no it [33:06] was perfectly fine zero [33:09] sodium you don't have to put salt in [33:12] Coke but they do because they know [33:16] because they get you to drink more so [33:21] Coca-Cola [33:23] conspiracy they know what they're doing [33:26] and you don't [33:28] so here is the last 200 years of sugar [33:32] consumption in the United States [33:34] starting at 1820 when we got fruits and [33:37] vegetables out of the ground with the [33:38] occasional honey was worth about 4 [33:40] pounds of sugar per year and over here [33:42] we topped out at about 100 pounds of [33:44] sugar per year you can see the different [33:47] phases of sugar consumption and uh [33:50] production in the United States we had [33:52] the growth of the sugar industry in the [33:53] late 1800s early 1900s you know in [33:56] Louisiana in the Bayou and in Hawaii [34:00] okay and then we had stabilization where [34:02] you know production you know uh uh [34:05] correlated with price you know so you [34:06] reached equilibrium then you had [34:08] rationing during World War II as you can [34:10] see there and then it came back up to [34:12] the same level and then we had processed [34:14] food and then on top of that we got high [34:16] fructose corn syrup which was half the [34:20] price and so what happened oh and plus [34:23] we went low fat all at the same time [34:27] everything happened at once and so we [34:29] went sailing [34:32] over so where is the sugar in our cons [34:35] our food right now so half of it's in [34:37] soft drinks as you can see and by the [34:39] way on April [34:40] 22nd our state legislators will be [34:43] debating a soda label warning ban on the [34:49] on the on the can or on the bottle okay [34:51] I was actually in Sacramento lobbying [34:54] for this for the California Center for [34:56] public health advocacy just three weeks [34:58] ago okay and I will tell [35:00] you I followed the chief scientist for [35:04] pepsicola [35:06] who was there as well Danielle Greenberg [35:10] fascinating okay so you know what's [35:12] going on there's a lot of stuff going on [35:15] so yeah half of it's in soft drinks but [35:16] that means that half of it's not half of [35:18] it's in stuff you didn't know had it [35:20] like salad dressing barbecue sauce [35:22] tomato sauce breakfast cereal hamburger [35:25] buns hamburger meat for that matter [35:27] yogur [35:28] yurt and who here thinks that yogurt is [35:32] healthy plain yogurt is [35:34] healthy okay the Europeans eat plain [35:36] yogurt and then throw whole fruit in to [35:38] cut the sourness because you know like [35:40] what is yogurt it's sour milk right [35:45] what's the difference between yogurt and [35:47] the milk that sour in your [35:50] refrigerator so for yogurt you get to [35:52] choose the bacteria that does the [35:53] souring that's it that's the big [35:55] difference all right but in America [35:58] yogurt is not sour milk yogurt is [36:04] dessert that's what's happened that's [36:07] what processed food brought us yogurt [36:10] for dessert okay so now we've agreed [36:15] that consumption is up let's do health [36:18] so what's happened to health I know it's [36:20] happened to health care okay because I'm [36:22] a doctor and let me tell you it sucks [36:25] but what's happened to health so let's [36:27] look this is from the New England [36:28] Journal let's look at what's happened so [36:31] smoking down blood pressure down [36:34] cholesterol down physical activity up we [36:39] should be re reaping a health benefit [36:42] from all of those things happening right [36:45] shouldn't we well we're not how come [36:48] because obesity is up and diabetes is [36:54] way [36:56] up off the charts in every developed and [37:01] developing [37:02] country right India 11% diabetes China [37:06] 11% diabetes we're only at [37:09] 99.3% diabetes but another 40% of us are [37:14] pre-diabetic so just diabetes waiting to [37:17] happen and that is cutting Our Lives [37:19] short and that is reducing money going [37:22] into the system and it's increasing the [37:24] money going out of the system which [37:25] we'll talk about when we get the cash [37:27] flow [37:28] so here's the problem right here it's on [37:30] this slide everybody remember [37:32] Coca-Cola's coming together campaign [37:34] from two years ago was on all the [37:36] football games this was their response [37:38] to the Obesity epidemic and this is a [37:41] direct quote from their campaign [37:44] commercial beating obesity will take [37:46] action by all of us based on one simple [37:48] Common Sense fact all calories count no [37:52] matter where they come from including [37:54] Coca-Cola and everything else with [37:56] calories [37:58] in other words you can get your calories [38:00] from carrots or you can get your [38:02] calories from cheesecake or you can get [38:04] your calories from Coca-Cola or you can [38:07] get your calories from kumquats doesn't [38:09] matter if you eat more than you burn [38:11] you'll gain weight if you eat less than [38:13] you burn you will lose weight [38:16] therefore a calorie is a [38:19] calorie it's about calorie [38:22] balance it's about you eat too much you [38:25] exercise too little it's about diet and [38:30] exercise it's about if you're fat it's [38:32] your [38:33] fault it's about any calorie can be part [38:37] of a balanced diet and it's about why [38:40] pick on our calories go pick on somebody [38:42] else's calories now every one of those [38:46] mantras has been ingrained across your [38:50] forehead over the last 50 years a [38:53] calorie is a [38:55] calorie and it's com common sense they [38:59] say [39:00] so you know what I don't believe in [39:03] common sense I believe in science I [39:05] believe in data and what the data says [39:09] is say are completely different what the [39:11] data say are that some calories cause [39:13] disease more than others because [39:14] different calories are metabolized [39:16] differently in the body it's called [39:18] nutritional [39:19] biochemistry and you want to know the [39:21] kicker of all [39:22] this I learned this in college I majored [39:26] in nutritional bi chemistry at MIT in [39:29] 1975 I knew [39:31] this and then I went to medical [39:34] school and they beat it out of [39:38] me and I forgot all [39:41] this because that wasn't what we learned [39:45] in medical school we learned a calorie [39:47] was a calorie we learned obesity was the [39:49] problem we learned that if you eat too [39:50] much and you exercise too little you [39:52] gain weight and we learned that that fat [39:55] that you gained caused all of the [39:57] metabolic [39:59] disturbances that we now [40:04] see and then I started doing my own [40:07] research in 1995 and you know what by [40:12] 2005 I was absolutely convinced a [40:14] calorie was not a calorie and I came to [40:16] the realization wait a second I I [40:18] started having night sweats I started [40:20] waking up in the middle of the night [40:23] with like post-traumatic stress disorder [40:26] because like I knew [40:29] this and I had lost it and I got it back [40:33] maybe that's why I'm so passionate about [40:35] it now is because medical education does [40:39] not discuss this because they don't get [40:42] it they don't understand it and this is [40:46] sort of a one of the u u um seminal uh [40:51] um uh uh uh uh ends of the stool you [40:56] know that you you can basically you know [40:59] hold on to and if you kick that out from [41:01] under what happens to you know your your [41:04] understanding of physiology of Science [41:07] of nutrition of of biochemistry and of [41:10] Health basically we're kicking it out [41:12] from under and people don't want it [41:15] kicked out and so there's this big fight [41:17] this big tension and that's why we're [41:18] having this discussion now but a calorie [41:21] is not a calorie now how do I know that [41:23] because we have the data so here is a [41:26] study [41:27] from Europe called The Epic interact [41:29] study what they did was they asked do [41:31] sugar sweeten beverages cause [41:33] diabetes so if you look at the black the [41:36] red box at the bottom what they did was [41:38] the was called the adjusted model they [41:39] looked at Sugar every uh sugar beverage [41:42] per day adjusted for its calories and [41:45] adjusted for its effects on obesity by [41:47] BMI and they showed that every sugar [41:50] beverage increases your risk for [41:51] Diabetes by [41:54] 29% and we're not consuming one sugar [41:56] beverage we're consuming two and a half [41:59] on average so take that up to [42:02] 68% we did this study which didn't look [42:05] at consumption we looked at availability [42:08] within countries what we did was we took [42:10] the uh food and agriculture organization [42:13] statistics database which listed line [42:16] item country by country for the entire [42:18] decade 2000 to 2010 total calories [42:22] fruits excluding wine Meats cereals [42:25] fiber containing foods oils [42:27] Sugar Sugar crops and sweeteners line by [42:30] line item by item for the Whole Decade [42:33] country by country we then regress that [42:35] with the international diabetes [42:36] Federation statistics database for [42:39] diabetes prevalence country by country [42:40] for the same period and then we regress [42:43] that with the World Bank gross national [42:45] income database which controls for [42:47] poverty urbanization aging physical [42:49] activity and obesity all the confounders [42:51] remember you have to adjust for the [42:53] Compounders when you do science right [42:55] and we asked the question what about the [42:56] world diet predicts diabetes change [43:00] country by country over the decade and [43:01] the answer only sugar nothing else [43:05] nothing else even came [43:07] close for every 150 calories extra any [43:11] country [43:12] at diabetes prevalence went up a total [43:15] of [43:17] 0.1% NADA but if those 150 calories [43:21] happen to be a can of soda instead [43:22] diabetes prevalence went up 11 fold 1.1% [43:26] and again we're not drinking one soda [43:28] they were drinking two and a [43:30] half this study actually meets the [43:33] criteria which were set up by Austin [43:34] Bradford Hill back in the 60s to [43:37] implicate tobacco and lung [43:39] cancer that is dose more sugar more [43:42] diabetes duration longer sugar exposure [43:45] more diabetes directionality countries [43:48] where sugar went up more diabetes [43:50] countries where sugar went down and [43:51] there were a few less diabetes and most [43:53] importantly for causation you have to [43:56] show press prence 3 years whenever sugar [44:00] changed diabetes changed in the same [44:02] direction 3 years later that's [44:06] causation same level of proof we have [44:08] today for tobacco and lung [44:10] cancer okay [44:14] okay why here's why because sugar drives [44:17] fat accumulation in the liver that's why [44:20] because when you put fat in your liver [44:23] then your pancreas has to make more [44:24] insulin and that burns out the pancreas [44:27] and causes diabetes and you can see from [44:29] this study from my colleague Jean Mark [44:31] Schwarz that was just uh in jcnm uh like [44:35] three weeks ago you can see that you can [44:37] put the you can do the uh control period [44:40] and then the sugar or you can do the [44:41] sugar period Then the control bottom [44:42] line it doesn't matter the amount of [44:44] liver fat went up [44:46] 38% for the same number of calories over [44:49] a two we period and that drives insulin [44:52] resistance and that drives increased [44:55] pancreatic insulin release which then [44:57] drives chronic metabolic disease and we [45:00] just had an abstract at the endocrine [45:03] Society just a month ago and you can [45:05] read it here restricting fructose and [45:07] obese Latin Latino and am [45:09] African-American children reduces fat [45:11] accumulation in the liver 30% reduction [45:13] on the same number of calories in 10 [45:17] days which also improved their insulin [45:20] resistance and every other aspect of [45:23] their metabolic Health without changing [45:25] weight it didn't change their [45:27] subcutaneous or big butt fat it changed [45:30] their visceral fat and it absolutely [45:33] lowered their liver [45:34] fat same number of calories because a [45:37] calor is not a [45:39] calorie and this is for heart disease [45:42] death this was uh published last year by [45:45] Yang adol from uh Harvard school public [45:47] health in the CDC so what you're looking [45:49] at here is a histogram of percent of [45:52] calories consumed as added sugar over a [45:54] two decade period and the median of this [45:57] histogram is [45:59] 18% can you believe that half the [46:02] country consumed more than 18% of their [46:05] calories is added sugar that's insane [46:09] supposed to be 4% was it [46:12] 18% okay now that red line in the center [46:15] is the hazard risk ratio for heart [46:17] disease [46:19] death and the inflection point is at [46:23] 15% medians 18% inflection point 15% so [46:27] what does that mean it means that more [46:28] than half of the United States has an [46:30] increased risk of heart disease death [46:32] due to their added sugar consumption [46:34] controlling for obesity controlling for [46:36] calories just because of the added [46:38] sugar because it's not about the [46:41] calories and it's not about the Obesity [46:43] alcohol is not dangerous because it's [46:45] calories alcohol is not dangerous [46:47] because it causes obesity alcohol is [46:49] dangerous because it's [46:50] alcohol sugar is the same thing it's [46:53] dangerous because it's sugar because of [46:55] its unique stereochemistry because of [46:57] what it does and because of how the [46:58] liver metabolizes it because it's not [47:00] necessary because it's not really a [47:02] nutrient it's an energy source it's not [47:03] a nutrient in fact we have causation for [47:06] these four diseases and these four [47:08] diseases will be on that warning label [47:10] if the California state legislature [47:13] passes the motion diabetes heart disease [47:17] fatty liver disease and tooth decay we [47:19] have causation for every single one of [47:22] those the ones we only have correlation [47:24] for today so we don't discuss them yet [47:27] is cancer and dementia but I'm really [47:30] interested in both of those and I just [47:32] met with Stan prer the Nobel Prize [47:34] winner up at UCSF about whether or not [47:36] sugar could cause dementia and how we [47:38] might be able to actually look at that [47:40] question uh going forward in the next [47:43] couple of years so now let's do envir [47:46] now we've talked about health now let's [47:48] do environment is sugar good or bad for [47:50] the environment what do you [47:53] think so this was from the World [47:55] Wildlife Fund sugar in the environment [47:58] and what does it do well it does a lot [48:01] of bad stuff okay basically what it does [48:03] is it causes a lot of soil erosion and [48:05] it causes a lot of phosphate runoff and [48:08] so it's actually poisoning the [48:11] Amazon and it's poisoning the Everglades [48:15] here's the sugar Holdings in the [48:16] Everglades just look at the Orange and [48:17] the yellow and the light green that's [48:19] all [48:20] sugar that's like okobi there in the [48:23] upper left [48:25] corner and in fact it's getting worse [48:29] because Florida's governor has actually [48:32] given them a bigger subsidy to be able [48:35] to expand their operations in the [48:37] Everglades now who here thinks that's a [48:39] good [48:41] idea and finally let's do cash flow so [48:45] we said we start with companies so [48:47] here's what processed food did so here's [48:51] 1982 over here on the left and here's [48:53] 2012 over here on the right look what's [48:55] happened meets down 10% because we're [48:58] all told to go low [49:00] fat fruits and vegetables notice exactly [49:04] the same no change in fruits and [49:06] vegetables now we're always told we [49:08] don't eat it enough eat enough fruits [49:09] and vegetables and that's likely true [49:11] I'm I'm sure that is true we don't eat [49:13] enough fruits and vegetables but you [49:14] know what we never did we never did and [49:18] we didn't have this problem in 1982 but [49:21] we sure as hell have it [49:24] now grains and baked goods 13 1% to 14% [49:28] And that's important because grained and [49:29] baked goods mean refined carbohydrate [49:32] which means glucose which means insulin [49:33] and Insulin means weight gain and that's [49:35] part of the Obesity equation no argument [49:38] there and that is a problem and that's [49:39] of course another marker for processed [49:41] food all that carbohydrate we talked [49:43] about [49:45] right dairy products 10.5% 13.2% down to [49:50] 10.6% because now we're all lactose [49:54] intolerant you laugh [49:57] okay um but if Dairy is actually [50:00] protective for diabetes and heart [50:01] disease which actually some of the data [50:03] now is starting to look like that's a [50:05] problem too and then finally in yellow [50:08] processed foods and sweets 11.6 [50:12] 22.9% a doubling in the span of 30 years [50:16] that's what processed food brought us [50:19] and the question is is that okay well [50:23] was okay for stock prices that's for [50:25] sure so here's the S&P 500 from 2007 to [50:28] 2011 notice the economic downturn of [50:31] 2008 right over there okay in blue is [50:34] the S&P and you can see there's [50:36] McDonald's Coke and Pepsi stock price [50:38] over that period of time they were doing [50:39] very well thank you okay and here's [50:42] Hormel ADM General Mills ConAgra Proctor [50:45] and Gamble and craft against the S&P [50:48] want to make money invest in a food [50:49] company for that same period of time [50:51] 2007 to 2011 [50:54] but guess what [50:57] the word is out there's a problem and so [51:01] these are the sugar companies notice ton [51:04] ly a loo sudzer against the S&P not [51:06] doing all of a sudden so well over the [51:08] past two years so all of a sudden cash [51:11] flow not so good if stock prices are [51:13] going down and take a look at soft ring [51:15] companies they're off of a sudden [51:16] experiencing a drought here's McDonald's [51:18] there's Coke there's Pepsi there's Dr [51:20] Pepper Snapple they've introduced a [51:22] couple of new products which kind of [51:24] peak them over here recently but they're [51:26] having problems too because people are [51:28] on to it there's been a definite [51:31] reduction in soft drinks except for one [51:35] thing there's been a commensurate [51:38] increase in [51:40] what well yeah but that's s that this [51:43] they still run those energy [51:47] drinks [51:48] monster right and all those so what did [51:52] Koch do they bought monster [51:57] because that's where the money is okay [52:01] how about consumers what's gone on cash [52:03] flow wise now there is no question that [52:07] eating processed food costs less money [52:12] long term here's less healthy food going [52:15] up by 7 cents per dollar versus healthy [52:19] food going up 17 cents per dollar in the [52:22] UK over a 10-year period so the rise in [52:25] cost of processed food has been much [52:28] lower than that of real and healthy food [52:31] no argument so you'd say well that means [52:34] that there's a monetary benefit right [52:38] you're saving money by consuming process [52:41] of food except of course you're [52:42] consuming a whole lot more right because [52:44] of all of the effects that we've talked [52:46] about which aren so [52:48] good so look at this this is how much [52:52] money as a percent of GDP each country [52:55] on the planet spends on food and take a [52:58] look at us over there 7% we spend the [53:01] least amount of our GDP on food at 7% [53:04] and of course we're the most obese [53:06] Nation next comes the UK at 9% next [53:09] comes Australia at 11% now take a look [53:12] at the countries in purple that spend [53:14] more than 36% of their GDP on food [53:18] they've all been in Revolution in the [53:19] last 3 to four years and that's [53:22] why so there is [53:25] definitely a cost benefit analysis to be [53:28] done here fluctuating food prices [53:31] definitely cause political unrest and [53:34] process food instituted in the 1960s and [53:38] early 1970s by policies passed by our [53:41] country for instance Richard Nixon's uh [53:45] uh uh advocate advocation of um changing [53:49] the Paradigm for farming you know that [53:51] before Richard Nixon we used to pay [53:54] Farmers not to grow certain crops [53:56] everybody some of you may remember that [53:59] that was to artificially prop up the [54:01] price of certain crops for the farmers [54:03] so what happened in [54:07] 1971 he told Earl Butz his agriculture [54:11] secretary to make food cheap because [54:14] fluctuating food prices cause political [54:16] unrest and Richard Nixon had a lot of [54:18] political unrest to deal with and so [54:20] what did Earl Butz do he went to the [54:24] heartland of the United States to to [54:26] Nebraska to Kansas to Iowa and told them [54:31] three [54:31] things row to row Furrow to Furrow get [54:36] bigger get [54:38] out and they [54:40] did that's what's happened and so now we [54:43] have monoculture now we have all the [54:45] corn in Iowa and we have all the cattle [54:47] in Kansas and so we have to use [54:49] petroleum products to grow the corn in [54:50] Iowa and we have to used antibiotics to [54:53] control the diseases in Kansas because [54:56] there's no [54:57] manure so we have basically distorted [55:02] the [55:03] market yes food's cheap but what does [55:06] that do that causes disease so take a [55:10] look at this slide so we're looking now [55:12] at health care costs in this country and [55:15] projected over the course of the next 10 [55:17] years and what you see is there's [55:19] Hospital in red there's physician in [55:22] green and there's Pharma in purple and [55:25] they don't add up to the total [55:27] because what's going on it's going to [55:29] Chronic metabolic disease that's where [55:31] all the extra money is going and who's [55:33] paying that Freight you are so you're [55:38] paying less for your food but you're [55:41] paying more for your health care and if [55:44] you're not paying more for your health [55:46] care because you're not sick you're [55:48] paying more for the guy sitting next to [55:51] you's health care because insurers and [55:54] employers charge [55:57] $2,750 per employee for obesity related [56:00] health care whether your the employee is [56:03] obese or not who's paying that [56:05] Freight you are you're paying it so your [56:10] cash flow is not as good as you think it [56:13] is yeah you're saving money on food [56:16] processed food like I just showed you [56:18] but you're paying it in health care I [56:20] guarantee you you're losing on the [56:24] dollar and what about Society how is it [56:26] affecting Society so remember here's [56:29] processed food remember this slide now [56:31] I'm going to Overlay onto this Slide the [56:34] percent of GDP spent on Health Care in [56:37] the United States over the same period [56:39] of time everybody [56:41] ready there it [56:43] is what do you [56:45] see when processed food started [56:50] being uh produced that's when healthc [56:53] care costs skyrocketed [56:56] so we don't have the prevention the [56:58] treatment model in America we have the [57:00] sugar [57:01] model that's what this is okay now if [57:05] you do the math on this the food [57:07] industry grosses $1 trillion doll a year [57:10] of which 450 billion is gross profit 45% [57:13] gross [57:14] profit yet healthc care costs in America [57:16] are $2.7 trillion a year 75% of those [57:20] are chronic metabolic disease all the [57:22] diseases we've been talking about and [57:23] 75% of those are preventable if we could [57:26] fix our [57:28] diet so when you do the math that's $1.4 [57:31] trillion dollar a year going down a rat [57:34] hole you think we could do something [57:36] with $1.4 trillion do a [57:38] year [57:40] so the food industry makes 450 billion [57:45] we spend 1.4 trillion cleaning up their [57:48] mess we spend triple what they make this [57:52] is a bad deal this is a bad deal for [57:55] society [57:57] and you're paying the freight while they [57:59] get rich and now they're not even [58:01] getting so [58:03] rich credit swi knows this and they [58:06] published this just two years ago called [58:07] sugar consumption at a Crossroads and [58:09] get this this is an Global International [58:11] Investment bank and they said we believe [58:14] higher taxation on sugary food and [58:16] drinks would be the best option to [58:17] reduce sugar intake and help fund the [58:19] fast growing healthc care cost [58:20] associated with type 2 diabetes and [58:21] obesity this is an a global Investment [58:23] Bank calling for taxation are you [58:25] kidding me me are you freaking kidding [58:28] me that's how big and bad this has [58:31] gotten and Morgan Stanley just two weeks [58:35] ago published their report called The [58:37] Bitter aftertaste of sugar and I just [58:40] throw one slide up here looking modeling [58:44] into the future based on high sugar or [58:46] low sugar the amount of economic [58:51] growth that we can expect around the [58:54] world [58:56] doesn't look so good so this is costing [58:59] Society big time and more sugar is [59:01] costing Society even more so let's do [59:06] the [59:07] scorecard so let's imagine that the food [59:09] industry posed this experiment and put [59:13] all of these procedures into motion as a [59:17] scientist [59:19] would processed food is better than real [59:22] food so what do you think consumption [59:26] way up that's for sure [59:29] Health way down in fact death way up the [59:34] IRB makes you report all deaths all [59:38] Adverse Events and if they saw that [59:41] graph of cardiovascular mortality they [59:44] would have shut this thing down in a [59:48] nanc there wouldn't be an experiment [59:51] with those death [59:54] rates environment [59:56] clearly no [59:58] good with the Amazon and the Everglades [60:01] being raped and pillaged and cash flow [60:05] companies they made out really well [60:08] their annual cash flow went from 1% at [60:11] their annual profit margin went from 1% [60:13] per year to 5% per year with the Advent [60:15] of processed food they did really really [60:17] well this was their Juggernaut but you [60:19] know what now we see that not in the [60:21] last two years not so much now they're [60:24] now they're in trouble [60:26] consumers do well in the short term [60:29] because they save on the cost from 7 [60:33] cents per dollar to 17 cents per dollar [60:36] but they spend it instead long term on [60:39] Health Care instead and finally Society [60:42] what a [60:43] disaster this is eating us up alive and [60:46] completely unsustainable and the general [60:49] accountability off the government [60:50] accountability office says that Medicare [60:52] will be broke by the year [60:54] 2026 well I'm going to be 6 in the year [60:56] 2026 and I want my fraking [60:58] medicare and so should [61:01] you so with that all of this is in Fat [61:05] Chance which Nora told you about we [61:08] published a cookbook Fat Chance cookbook [61:10] because one-third of American Now does [61:12] not know how to cook because of the [61:13] processed food pandemic because they [61:16] forgot and you can't where do you learn [61:19] to cook you learned it in one of two [61:21] places you learned it from your parents [61:22] or you learned it in homech we don't [61:24] have any homech and the parents now [61:26] don't know how so kids basically if you [61:29] don't know how to cook you're Hostage to [61:31] the food industry for the rest of your [61:32] life and this is what we have to bring [61:35] back we have to bring back real food and [61:37] we have to bring back how to cook it and [61:40] then we will be able to solve this [61:42] problem sugar science is a website that [61:44] UCSF started in November 8,000 clinical [61:49] research articles vetted by 12 [61:51] independent scientists who don't take [61:52] money and distill down to five messages [61:55] for the entire population that anyone [61:58] can [62:00] understand the movie fedup which you may [62:02] have heard about is now on Netflix okay [62:05] which explains all of this very very [62:07] nicely there is a new movie a [62:10] documentary that will be screened for [62:12] the first time two weeks from now and [62:14] I'm going to Toronto to do Q&A called [62:16] the sugarcoated you know you all know [62:18] about the tobacco documents well guess [62:21] what there are sugar documents too and [62:25] this is an analysis of the sugar [62:27] documents and how the sugar industry [62:29] basically obfuscated the truth in the [62:32] 60s and 70s to get us to where we are [62:35] today and I can't [62:38] wait Sweet Revenge a PBS special that we [62:41] did that maybe some of you have seen [62:43] which explains all of this in shall we [62:45] say a little bit more palatable uh way [62:48] and we have started a nonprofit here in [62:50] San Francisco called The Institute for [62:52] responsible nutrition to take on big [62:53] food to provide medical nutritional and [62:57] legal analysis in the fight against big [62:59] food because we have to solve this we [63:03] have no choice and so if you liked what [63:06] you heard today log on read it sign up [63:10] be apprised know what's going on [63:13] obviously the fact that you're here [63:14] today means you care and I appreciate [63:17] that we have to solve this problem we [63:19] have no choice because it's our kids our [63:22] kids are getting the diseases that you [63:25] know old people got that alcoholics got [63:29] okay and they can't pay into the system [63:32] so there's no money for anything [63:35] else and that means you and that means [63:38] your Medicare that means your livelihood [63:40] that means the United States so if you [63:43] care about our country if you care about [63:45] your kids you need to care about this [63:48] okay with that I'm going to turn it over [63:49] to Chris and I appreciate you thank you [63:52] so [64:04] Q&A the way the [64:06] conversation that the conversation might [64:08] go from here is the conversation with [64:11] the audience asking you and Dr Gardner [64:14] questions and um uh we'll uh until we [64:18] get the microphones going if they if you [64:20] take a question please repeat it so it [64:21] can be picked up on the [64:24] mic who's bold and brave enough yes so [64:29] the question is well then could you just [64:32] substitute glucose for fructose well [64:33] that's what we did in that study that I [64:35] uh showed you the abstract for so [64:38] basically glucose raises your insulin [64:40] and Insulin drives energy into fat so it [64:43] definitely increases your subcutaneous [64:45] fat and that's one of the reasons we've [64:47] gotten fatter but as what I've hope I've [64:49] shown you is that metabolic disease is [64:51] not obesity they are two different [64:54] things so [64:56] China is not fat India is not [64:59] fat but they have chronic metabolic [65:02] disease now for the same reason we have [65:04] chronic metabolic disease in addition we [65:07] have fat healthy people they're called [65:08] metabolically healthy obese [65:11] MHO okay so being fat and being sick are [65:15] not the same thing glucose definitely [65:18] causes insulin release which definitely [65:20] drives energy into fat I don't argue [65:22] that we definitely need to reduce our [65:25] refined carbohydrate consumption also [65:29] but that's what processed food is too [65:31] processed food is fiberless food and [65:34] when you take the fiber out you get [65:35] refined carbohydrate so let's eat real [65:37] food and then we don't have to worry [65:39] about the [65:40] carbohydrate would you uh it's fine yeah [65:44] next question and thank you enough for [65:47] this have you been to the White House [65:49] yet oh they don't want to hear this and [65:52] uh so we need to get you into Michelle [65:54] and we need to get you in into and and [65:56] you should be on Oprah and Eliz [65:59] Elizabeth Warren should walk you into [66:01] the White House and we'll work on that [66:04] um so you at one point and I missed [66:06] because I was writing so fast who um [66:10] near the end you said somebody or some [66:12] Institute or something didn't have the [66:14] data to realize X how how good is your [66:20] organization at getting this data to [66:22] those kinds of decision makers that [66:25] that's I I mean it feels as though this [66:26] room should be stand I'm tell I'm gonna [66:28] tell you very honestly the question is [66:30] how good is our organization at getting [66:31] this information to decision makers the [66:34] answer is the decision makers don't want [66:36] to hear [66:38] it that's the problem okay there's [66:40] something called Al or Alec you've heard [66:42] yeah so anybody heard of the American [66:44] legislative exchange Council okay so [66:47] it's a front for the food industry and [66:49] the PHA industry and they give caign [66:51] contributions to 338 out of 535 [66:54] congressmen [66:56] okay so there's other money involved [66:59] here let me tell you a quick [67:01] story um we're trying to work with the [67:04] government of Mexico to monitor the [67:07] effects of their soda tax I was down in [67:10] Mexico City in November and I had to [67:13] give a talk on economics to 20 [67:16] economists PhD economists okay they're [67:19] all Mexican but they got their phds from [67:22] Harvard MIT Stanford you Chicago and [67:26] London School of Economics 20 economists [67:28] I'm talking economics to economists okay [67:31] I got to tell you that was really [67:35] weird and they told me straight out and [67:37] I said I I understand this he said it's [67:40] not about the people it's about the [67:44] money it's only about the money you have [67:47] to show us how this is going to either [67:50] save us money or make us [67:52] money I said I get it well so let me [67:55] respond and tell you what we got going [67:56] on right now so as many of you know [67:59] every 5 years we redo the dietary [68:01] guidelines for Americans and it's 2015 [68:03] it's time to do them again and before [68:05] you release them uh a panel of about 15 [68:09] scientists a newly elected panel each [68:11] five years gets assigned to this and a [68:13] lot of you have probably seen this in [68:15] the newspaper now that just recently in [68:17] last month the dietary guidelines [68:18] advisory committee gave the [68:20] recommendations to the USDA and the [68:22] DHHS of what they should do this next [68:25] round and they want to put added sugar [68:28] out there that's one of their biggest [68:29] things is to cut back on added sugar [68:31] there's a lot of really interesting [68:33] things they looked at cholesterol [68:34] they're actually backing off on [68:35] cholesterol we could get into that [68:37] discussion if you want they've stuck [68:39] with saturated fat being not so good for [68:41] you what I really like what they did [68:43] though is they said we really got to [68:45] stop arguing about nutrients we just [68:47] everybody games the system on the [68:48] nutrients so what we're proposing in [68:51] this round is that the Mediterranean [68:53] diet the DASH diet and the vegetarian [68:54] diet all have a lot of things in common [68:56] and they all have less packag processed [68:58] food and so if we can stop bickering [69:01] about nutrients and look at patterns of [69:04] foods to eat including having less [69:06] animal-based foods and more plant-based [69:08] foods and so that's a discussion that's [69:10] going on right now comments are open [69:12] until May 88th and it's a fascinating [69:15] time because uh the food industry has [69:18] launched a huge offensive against this [69:21] and they're giving comments that this is [69:23] unrealistic one in particular the link [69:25] to the environment they've even got Tom [69:27] vsac the secretary of agriculture to say [69:30] you know what they're coloring Outside [69:32] the Lines that's not really their job [69:33] their job was supposed to be nutrition [69:36] whereas there's really a pretty active [69:38] vocal group I signed this thing that [69:40] ended up being on a onepage ad in the [69:42] New York Times and oh my God I get 10 [69:43] emails a day now that I signed this [69:45] thing from this group it's actually [69:47] pretty well organized saying you know we [69:49] got to push back on the food industry [69:51] let's show them all the scientists that [69:52] believe in the dietary guidelines [69:54] advisory committee's recommendations and [69:55] the scientists who spent two years [69:58] looking at the evidence there really is [70:00] evidence for the environmental [70:02] connection and that's another link to [70:04] change some people's behavior at the end [70:06] of the day what we're after is behavior [70:08] change and what Rob was talking about [70:10] was how sugar affects our Behavior [70:13] because it's driving a lot of our [70:14] behaviors but there's other strategies [70:16] so let's focus on the positive [70:18] strategies I teach a class on the [70:20] Stanford campus doesn't talk about [70:22] health at all talks about animal rights [70:24] and Welfare CL climate change human [70:27] labor abuses in slaughterhouses and fast [70:29] food workers almost every student in the [70:31] class changes their diet because they're [70:33] engaged in a bigger issue a broader [70:36] issue and so at the level of the [70:39] government we have these dietary [70:41] guidelines going on there's currently a [70:42] battle I'm going to tell you what I [70:44] predict is going to happen I predict in [70:47] 2015 they reject a lot of the dietary [70:50] guidelines advisories committees [70:53] recommendations um just like so many [70:55] communities rejected a soda tax and I [70:58] heard Marco Wooten one time from the [71:00] Center for Science and public interest [71:02] listen to somebody give a talk about oh [71:03] my God here's all the great things we [71:05] did to get the soda tax passed and it [71:08] failed and we're crestfallen and she [71:10] stood up and said Bravo you got that out [71:13] there again that soda tax really this is [71:15] really ingrained thing this is [71:17] Grassroots keep pushing pushing pushing [71:19] and what happened in Berkeley this year [71:22] they passed a soda tax what happened [71:24] with Gab marriage no no no oh now 37 [71:28] States okay I'm going to guess in a few [71:30] years we get 37 states with a soda tax [71:33] and I'm going to guess the dietary [71:34] guidelines advisory committee's [71:35] recommendations are not taken this round [71:38] because the link to the environment is a [71:40] little too new and the discussion hasn't [71:42] gone on but you have to get this in the [71:44] dialogue I'll bet you in 2020 the link [71:47] is made that's my prediction you guys [71:49] can write it down today get back to me [71:50] in five years okay and the other thing [71:53] by the way these these recommendations [71:55] are not new the 2005 dietary guidelines [71:58] committee made these recommendations [72:00] Janet King who's at Children's Oakland [72:02] Research Institute was the chairwoman of [72:04] that dietary guidelines committee and [72:06] she told me that they submitted to the [72:09] USDA a 480 page document in 2003 80 [72:15] pages on sugar 80 pages on fiber and [72:18] when the final document from the USDA [72:21] came out it was a total of 80 pages [72:24] instead of 480 and everything about [72:26] sugar and fiber had been removed and I [72:28] said to her I said Janet are you kidding [72:31] me you didn't have any recourse and she [72:34] says we're an advisory committee we have [72:36] no [72:38] teeth but it's becoming more and more [72:40] obvious so I'm hopeful I'm more [72:42] optimistic maybe I don't know am I more [72:44] optimistic than you I think I think you [72:46] are should we take another question so [72:48] we can roll through could could I just [72:49] say yes but for for so if everybody in [72:51] the room could write to the USDA by May [72:54] 8th that's one thing [72:55] and the other thing for Alec is to go on [72:58] the common cause website because we've [73:00] gotten 300 companies who are members of [73:03] Alec down to [73:05] 102 and there are still companies like [73:07] Coca-Cola that are part of that but if [73:09] you join what com the common cause push [73:11] they they're all getting out of it [73:13] little by little thank you so [73:18] much what are your positions on [73:20] artificial sweeteners ah you could ask [73:24] me because I actually got selected to [73:26] write the American Heart association's [73:28] position on artificial sweeteners okay [73:31] you ready for this we don't have enough [73:33] data to have a [73:35] position I tell you how confusing it is [73:38] I mean it actually sounds simple the one [73:40] area where it could be the simplest is [73:42] actually Coke in in our world when we [73:44] set up experiments there are lots of [73:46] confounders as Rob has done a nice job [73:48] explaining right Coke is actually the [73:50] one sort of simplest place to do it [73:52] because you just have a regular Coke or [73:54] Diet Coke [73:55] although there's a difference the [73:56] regular Coke folks got more calories so [73:59] was it the sugar or was it the coke okay [74:02] so anyway you've got artificial [74:03] sweeteners in this thing and if you look [74:05] at all the available data it's [74:07] inadequate to make a definitive [74:09] conclusion you can actually say so [74:11] actually here's a general conclusion [74:12] that we came up from looking at the [74:14] papers general not definitive so we [74:17] never have really adquate evidence for [74:19] super definitive but we have partial [74:21] evidence we make the best statement we [74:23] can it looks like when you add sugar to [74:26] food and replace it with artificial [74:29] sweetener you you later in the day you [74:31] compensate for some of that and you make [74:33] up for some of the calories you missed [74:34] from the sugar but not so much when you [74:37] drink Beverages and you switch to an [74:39] artificial sweetener um the beverage [74:41] thing you don't you overcompensate for [74:44] that and so the beverages are a little [74:46] different than the food and so the sodas [74:49] are worse like you don't know you're [74:51] drinking you don't get satiated from the [74:53] coke calories the artificial sweeteners [74:55] ERS can help you show that that shift is [74:57] a little better with beverages so sodas [75:00] are one of the things we should cut back [75:02] the most on and I looked at when we were [75:04] all done with this said there's [75:05] inadequate evidence I thought ah as a [75:07] scientist and I always need grant money [75:10] let's see maybe I should write one of [75:11] these new studies to look at artificial [75:13] sweeteners then I thought oh I don't [75:16] want to do that then really I'm studying [75:18] to see if packaged processed food with [75:20] artificial sweeteners is better than [75:22] adding sugar to food I don't even want [75:24] to touch that so there really isn't [75:26] adequate evidence to provide that and at [75:29] the end I actually got approached by a [75:31] dietician who was on our writing panel I [75:33] said please be very cautious what you [75:35] say I have a diabetic patient who's [75:37] drinking a Big Gulp every single day I [75:39] got them to a smaller dose and diet soda [75:42] if you say you can't find a difference [75:45] between artificial sweetener and Diet [75:46] Coke he's going to go back to real coke [75:49] I don't care if you can prove that or [75:50] not don't let my patient go back to that [75:52] Big Gulp and so we had to couch it is it [75:56] looks like it's bad we can't really [75:58] prove that the sugar I'm sorry it looks [76:00] like the artificial sweeteners are [76:02] helpful we can't definitively prove it [76:05] um how about coffee what if you're going [76:07] to have coffee every day and you're [76:09] going to sweeten it and you're either [76:11] going to put sugar or artificial [76:13] sweetener I don't know I would I would [76:15] say the artificial sweetener but you're [76:18] going to have the coffee every day [76:19] anyway so you're gonna have to put it in [76:21] the context of what you're adding it to [76:23] my biggest fear is we just keep [76:26] perpetuating our sugar [76:27] pallet so where do artificial sweeteners [76:30] go packaged processed crap so is it [76:34] helpful to go from sugar to artificial [76:37] sweetener yeah because you have a little [76:39] less glucose than fructose but ah in the [76:42] end it's really a slippery slope sorry [76:45] for the lack of [76:46] answer and your your point your question [76:49] is very very well taken we understand [76:52] but you know the what do you do with [76:54] this [76:55] what I would argue is that diet [76:57] sweeteners are like [77:00] methadone if you're trying to get a [77:02] heroin addict off heroin you put them on [77:05] methadone and then you wean the [77:07] methadone down the problem is the [77:09] methadone clinics don't do it they just [77:11] keep you on [77:12] it if you're using diet sweeteners to [77:15] get people off sugar because sugar is [77:16] addictive and so you get them on to diet [77:19] sweeteners and then wean it down then [77:21] that would be a good thing to do but [77:23] that's not what we do so think of it in [77:26] that in in with that analogy maybe [77:28] that'll [77:30] help thanks good question next please so [77:35] I I I read an uh article and it was like [77:38] in the newspaper or maybe a magazine it [77:41] wasn't a scientific uh magazine or or [77:45] article uh and I can't remember if it [77:47] was artificial sweeteners or high fru [77:50] high fructose corn syrup but they said [77:52] that it changes the gut bacteria ah [77:56] artificial sweeters okay elov in science [78:00] uh September [78:01] 2014 so it it apparently changes the gut [78:04] back microbiota the bacteria in the gut [78:07] and led to glucose intolerance in [78:10] animals now we don't know if that's true [78:11] in humans I would say it's preliminary [78:13] it's preliminary okay interesting yeah [78:15] is it another reason to not have [78:17] artificial sweeteners and package [78:18] processed food sure if that works for [78:20] you it works for me yeah I I couldn't [78:23] agree more [78:25] do you know as of yet if there has been [78:28] any class action lawsuit so similar to [78:30] The Tobacco industry um regarding the [78:33] sugar industry or I'm kind of interested [78:35] what's the call to action as far as what [78:38] we can do I mean I think if anybody [78:39] works here we can certainly ask our [78:42] corporate offices to get those vending [78:45] machines and those candy bars that are [78:47] right at the cafeterias you know just [78:49] still enticing us to take that sugar but [78:51] I am interested if there's been anything [78:53] about any lawsuits I I can answer that [78:56] um so I went to law school for this [78:58] reason y i i i i don't have a JD I have [79:01] an MSL masters of studies and law so I [79:03] can't sue but I can talk to people who [79:05] can and they talk to me so I actually [79:07] know this the the deal on this so the [79:11] initial study the initial uh lawsuits [79:13] were for misbranding and you may have [79:14] heard of those in fact one of them was [79:16] right here in San Jose k v chabani [79:19] familiar with that one that was [79:20] basically about evaporated cane ju so [79:24] evaporated k juice is not a sanctioned [79:25] sweetener by the [79:26] FDA but every yogurt says evaporated [79:30] cane juice because it sounds healthy [79:32] because if you said oh it's sugar you [79:35] know well gee why is there sugar in my [79:37] yogurt evaporated kangu sounds good [79:39] right except it's not a sanction [79:40] sweetener so basically every carton of [79:43] yogurt that says evapor can juice is by [79:46] definition [79:48] misbranded and you entitled to your [79:50] money back and so there's a CL there was [79:52] a class action lawsuit in Superior Court [79:54] of Northern California Lucy Co same [79:56] person the same judge who did Apple V [79:58] Samsung presided over that and it ended [80:00] up at the ninth circuit and was [80:02] ultimately dismissed and I we can talk [80:04] about why that was there's one [80:07] individual case of an minor of a [80:10] 12-year-old who sued high fructose corer [80:14] manufacturers for her type 2 diabetes in [80:17] Buffalo New York and that was also [80:19] dismissed but it was dismissed for very [80:22] inappropriate reasons because the judge [80:23] didn't get it and it may come back in [80:26] another uh guise uh and then finally [80:29] there are several uh plaintiffs [80:32] attorneys who have approached me about [80:35] class action lawsuits and trying to [80:37] decide what the appropriate plaintiff [80:40] would be and I can tell you what the [80:42] appropriate plaintiff would be [80:44] adolescence with type 2 diabetes because [80:47] the Baseline was zero and we have the [80:50] causation we have the proof and so and [80:53] and they're are very shall we say say um [80:56] uh also a lot of them a minority which [80:58] you know works well in court and so um [81:01] they're a very uh sympathetic uh [81:03] plaintiff so we're going to see what [81:06] what happens over the next couple of [81:08] years good luck on that thank you hi [81:14] Steve um so do you have any comments on [81:17] the milk mandate so that we're [81:20] actually um it's one thing to have [81:23] recommendations to dietary guidelines or [81:25] recommendations for how people should [81:26] eat um but it's another thing to [81:29] actually enforce that and force our kids [81:32] to get fatter and the remarkable thing [81:35] is that I've I've talked to school [81:37] administrators and said hey you know the [81:38] government is actually not allowing you [81:40] to serve whole milk or 2% milk it has to [81:43] be 1% or less and the only studies I [81:46] could find all [81:48] show that that makes the kids [81:51] fatter because and you know they'll [81:53] they're going to eat more car you know [81:56] sugars and and you know because we're [81:58] taking the fat out of their diet and so [82:01] there's actually you know it's actually [82:04] required for schools to make our kids [82:07] fatter and I'm amazed that parents [82:10] aren't up in arms about the government [82:14] actually making our kids less [82:19] healthy you want to take that it's a [82:22] really tough question really the I mean [82:24] so the dairy thing is actually maybe in [82:27] theory one of the biggest Public Health [82:29] successes in their eyes because they [82:31] took this whole fat and people thought [82:33] that lower fat was more watery and not [82:35] good tasting and now people try it and [82:37] it's the norm they have low fat the the [82:40] data for getting at that kind of [82:41] question are really tough so darish MOS [82:43] farian did this fabulous um paper in the [82:46] New England Journal of Medicine looking [82:47] at whole milk and low fat and looking [82:51] over time they have this new model they [82:53] have this they've been following nurses [82:54] and health professionals forever it was [82:56] always just observational Association [82:58] but now they have changed every four [83:00] years and Chang in other things so not [83:02] instead of just looking at Association [83:04] they say they're looking at change [83:05] versus change which is a little [83:07] contrived to be perfectly honest but [83:09] what was really fascinating was the [83:11] whole milk versus the reduced fast milk [83:13] on weight had no impact uh no but [83:17] there's a uh it was zero that's on his [83:20] there there's an actual clinical trial [83:21] that was done at University of Virginia [83:24] on this low fat makes them fatter so let [83:26] me make sure I'm understanding what [83:27] you're saying whole fat makes them [83:29] fatter or low fat makes them fatter it [83:31] it it when when they restricted the Melt [83:34] just like the the USDA is requiring of [83:37] schools kids got [83:39] fatter I'm still not clear restricting [83:41] milk or restricting the type of restrict [83:44] the fat milk yeah they took the fat [83:46] basically they switched they they took [83:48] the fat out of milk by by moving the [83:50] milk got fatter and it wasn't because [83:51] they switched to chocolate milk no cuz [83:53] that's what happened [83:55] that's the reason that the dietitians in [83:57] the schools say they have to have [83:59] chocolate milk is because well no one [84:01] would drink the lowfat milk otherwise [84:03] because it doesn't taste good you know [84:05] we all grew up on whole milk and it was [84:07] perfectly fine and there was no problem [84:09] and then you take the fat out of the [84:10] milk and then you have to do something [84:12] to substitute so you look at Berkeley [84:14] Farm's 1% chocolate milk okay it's got [84:17] an extra 60 calories all of which are [84:18] high fructose corns well so but but the [84:21] point is there was actual clinical d a [84:23] clinical stud that that proved that if [84:26] you did exactly what the USDA did that [84:29] kids would get fatter and I asked the [84:31] USDA you know because I got routed to [84:33] because I know all the the guys there I [84:35] I got routed to the right person I said [84:36] hey do you have any act um you know [84:39] there was a study that that showed kids [84:41] get fatter do you have any study at all [84:43] that shows that kids actually lose [84:45] weight when you cut the fat out of the [84:48] milk and they they stopped responding at [84:50] that point yeah well and one of the [84:52] issues is it's a single study so in any [84:54] of these things that are big questions [84:55] you need to replicate it again but you [84:57] can't you can't go and base food policy [85:00] when if you have a single study that [85:02] says kids do get fatter and you have no [85:03] studies at all that show the opposite [85:06] then it's it's unbelievable that we [85:09] require them based on no scientific data [85:13] whatsoever that conflicts with the study [85:15] that we do have I won't argue with you [85:17] the fact of the matter is one of the [85:18] reasons credit s came out with its uh uh [85:22] response in that slide I showed you is [85:24] because they could not find any studies [85:27] anywhere that said that Sugar had a [85:29] health benefit so they said if you're [85:31] trying to prove the null [85:33] hypothesis that proved the null [85:35] hypothesis I mean they did their own [85:37] science the fact of the matter is you're [85:38] saying the same thing there are no [85:40] studies that say that low fat is good [85:42] for [85:43] you the only thing we said was that we [85:45] had to go low fat so you find a study [85:48] that says low fat is good for you there [85:50] are none in fact that's what the [85:52] physician that's what the um Women's [85:54] Health Initiative showed is that lowfat [85:57] is not good for you but we're still [85:58] doing it well I wouldn't go there that's [86:00] touchy we could get into that but I [86:02] would so Steve your question is [86:03] answerable we could do more of those [86:05] studies if more of those studies got [86:07] funded that we have a lot of questions [86:09] that are difficult to answer if you [86:10] wanted to look at weight in kids [86:13] shifting back and forth from whole milk [86:14] to lowfat milk that's an answerable [86:17] question there should be dozens of those [86:18] right now but there was a study and and [86:20] it makes total sense right because when [86:22] you have the fat and the milk the fat [86:23] makes you less hungry so you eat fewer [86:26] calories and you get less fat it doesn't [86:28] the fat doesn't raise your insulin and [86:30] so forth so everything about that study [86:32] made intuitive sense AB you know the [86:35] science matched all everything we know [86:37] about uh metabolism well we haven't [86:39] gotten rid of the low fat directive yet [86:41] no we haven't no after all these years [86:43] and in fact I mean that you never talked [86:45] about the history of the dietary [86:47] guidelines but it was all driven by [86:48] George McGovern and it was not based on [86:51] any was it wasn't driven by George [86:52] McGovern was driven by the food industry [86:54] well but but you know McGovern was was [86:56] really the you know it was politically [86:58] uh motivated and the scientists at the [87:00] time were were against it because there [87:01] was no evidence that said uh cutting the [87:04] uh the that cutting fat will make you [87:07] thin so let me bring up a parallel [87:09] example that could be useful unless Nora [87:11] has a point because she's raising her [87:13] finger running on running on time okay [87:16] I'm G to make this a quick example how [87:18] many of you know that on food stamps you [87:19] can buy soda with your food stamps and [87:22] food stamps the name now is snap the [87:24] supplemental nutrition assistance [87:27] program sugar from soda doesn't seem to [87:30] be much of an assistance so Bloomberg [87:32] said in New York City we would like to [87:34] do a trial not really impose this we [87:36] would like to do a trial with this USDA [87:38] program and see if we can ban the [87:40] purchase of sodas with SNAP dollars but [87:43] you have to get USDA approval to do this [87:45] kind of trial the USDA turned them down [87:47] the beverage company opposed the trial [87:50] the hunger Coalition of New York City [87:53] opposed [87:54] the trial Minnesota actually proposed [87:57] that they change it not just for soda [87:59] but also for junk food if you're going [88:01] to get food stamps you should only be [88:03] able to buy a certain number of foods [88:04] it's kind of ridiculous because Wick is [88:06] another Federal program and you can't [88:08] buy crap with Wick you have to buy good [88:10] food but there's a lot of misinformation [88:12] out there there's a lot of push back and [88:14] to the point that Steve is just making [88:16] one of the issues is that sounds obvious [88:19] that if you can't buy soda you'll buy [88:21] something better but it's not [88:22] necessarily true what if you didn't [88:24] spend the money on soda and you bought a [88:26] candy bar you actually have to do that [88:29] study to see what happens when you don't [88:31] have this thing what the next behavior [88:33] is so they're waiting for those studies [88:35] and there aren't enough and we should [88:36] have [88:40] more could you go back to the advisory [88:42] committee Whose advice is being ignored [88:44] uh is there an alternative way to get [88:46] the information out the dietary advisory [88:49] committee is there an alternate way to [88:51] get it [88:52] out well when they sign up for the [88:55] committee do they promise not to go [88:57] around there or something oh yes they do [88:59] no question about that the 15 scientists [89:01] who are part of the Dak the dietary [89:04] advisory dietary guidelines advisory [89:06] committee have to basically sign their [89:07] life away and say they won't talk about [89:09] it outside of uh uh administrative [89:11] channels that's absolutely true yes so I [89:14] mean we're trying to do it I mean that's [89:16] one of the reasons why sugar science.org [89:18] exists is to try to get the information [89:20] out you know that's one of the reasons [89:22] why all these documentaries are being [89:23] made right now is to try to get the [89:25] information out but you know it's it's [89:28] hard it's hard and they have a much much [89:31] more uh um U Valu expensive [89:35] mouthpiece but is there a sort of [89:38] equivalent format for [89:40] the is it the Who's the who puts out the [89:44] dietary recommendations I've I've lost [89:46] the government USDA they actually trade [89:48] back and forth between the USDA and the [89:49] DHHS they're responsible for the final [89:51] document they rotate off every five [89:53] years so part of it is writing Tom [89:55] vilsack part of is making a comment part [89:58] of it is better evidence and part of it [90:00] is getting fun to do that evidence and [90:01] getting it reported so we're actually [90:03] doing a pretty neat paper right now to [90:05] look at how much protein Americans think [90:07] they need how much they eat how [90:10] misinformed they are how much protein [90:12] America produces through a livestock [90:14] that Americans eat more meat than any [90:16] country in the entire planet and yet the [90:19] cattle industry and the Egg industry and [90:21] the pork board and everything else say [90:22] you need all that protein because [90:24] Americans are freaked out about protein [90:26] and we're linking that on the Stanford [90:27] campus with environmental scientists [90:30] who're taking the health perspective [90:32] linking it with what the shift would be [90:33] in agricultural policy in terms of what [90:35] we're growing and trying to show the [90:37] environmental impact and the health [90:39] overlap and Kathleen mergan who is the [90:41] under secretary of agriculture under Vil [90:44] saac for a long time said please send me [90:46] that paper as soon as you have written [90:48] it I want to read it and help you get it [90:51] published and get it out there so that [90:52] we have more [90:54] evidence so that when the dietary [90:55] guidelines advisory committee goes in [90:57] and says we're making this [90:58] recommendation and the beef Council says [91:00] you can't make that recommendation there [91:02] isn't enough evidence you can say yes [91:04] there is there's more evidence will my [91:06] one paper do this no not at all but [91:09] that's what our job is our job is to [91:11] figure out what those gaps are in the [91:12] evidence and try to put it together in a [91:15] digestible communicable [91:17] way I guess I was looking for the sort [91:19] of in the same format so I could take [91:21] the one that gets published and the one [91:23] that should have been published and [91:25] carry the the the the the non-existent [91:27] one around with me when I wanted to look [91:29] at the back of a package label oh you [91:31] want to carry it around with you the 571 [91:33] page document is online including a [91:35] seven page executive [91:38] summary yeah thanks thank you hi Robert [91:42] uh I had a question about the uh Pepsi [91:44] COA Chief scientist I was wondering if [91:46] you could share a little more about what [91:48] that person said inm I don't know what [91:49] that person said I wasn't allowed in the [91:50] room oh okay I just know she was there [91:54] really oh that's interesting I wasn't [91:56] allowed in there I wonder why you com on [91:58] that are you kidding that the the food [92:00] the food industry does not want to be on [92:03] the same day as as a scientist who's not [92:05] bought off well just a broader question [92:07] then what what are the opponents um to [92:09] your arguments the work in the food [92:11] industry what are the what are the the [92:12] worst things they say and the best [92:13] things they say uh if you want I can [92:15] show [92:16] you well Ser seriously um the sugar [92:20] industry has some very specific [92:24] uh talking points that they promulgate [92:27] and they Trot out in fact I'm going to [92:29] have this argument with John stepen [92:31] Piper at the international diabetes [92:32] Federation in December um and I've [92:35] debated food industry concerns on two [92:38] other occasions so I'm very prepared for [92:40] this the first thing they say is number [92:43] one sugar has a low glycemic [92:47] index so everybody understand glycemic [92:50] index everybody know what it is so [92:53] glycemic index is defined as how high [92:55] does your blood glucose rise when you [92:58] consume 50 gram of carbohydrate in a [93:00] specific food that's the definition of [93:03] glycemic index and indeed sugar has a [93:05] low glycemic index because half of it is [93:07] fructose not [93:09] glucose so the glycemic index of sugar [93:13] is 53 the glycemic index of fructose [93:16] alone is 19 everybody with me those are [93:19] low glycemic index [93:21] Foods who cares glycemic index is a [93:24] Canard glycemic index doesn't matter [93:27] what matters is glycemic [93:29] load because glycemic load is defined as [93:32] how much food do you have to eat to get [93:34] the 50 grams of carbohydrate so the [93:37] perfect example of how this works is [93:38] carrots so carrots have a relatively [93:41] high glycemic index if you eat 50 grams [93:44] of carbohydrate in carrots your blood [93:45] sugar will go pretty high but you have [93:48] to eat [93:50] 1.3 lb of carrots to get 50 g of [93:54] carbohydrate you have to eat the whole [93:55] fraking grimmway truck in 5 [93:58] minutes in 5 minutes right in 5 minutes [94:02] ain't going to happen so carrots are [94:05] high glycemic index low glycemic load so [94:08] if you believe glycemic index you would [94:09] stay away from carrots carrots are the [94:10] best thing you can possibly put in your [94:12] mouth okay broccoli huh brocc and [94:15] broccoli carrots and [94:17] broccoli second problem with glycemic [94:20] index is the fact that fructose doesn't [94:22] cause its problems because of it [94:24] glycemic index it's beyond glycemic [94:25] index fructose causes problem is because [94:28] of its stereochemistry and it binds to [94:30] proteins so when you overwhelms the [94:33] liver the liver's capacity to extract it [94:35] on the first pass which happens at about [94:39] a 8 O soda you get a serum fructose [94:41] level so fructose does not raise your [94:44] serum glucose it raises your serum [94:46] fructose which is even worse because [94:48] that binds inside the arteries causes [94:50] aging of the arteries causes aging of [94:52] proteins causes is this thing called the [94:54] myard reaction is the reason you paint [94:56] barbecue sauce on your meat before you [94:58] grill it to get that nice brown color [95:00] we're all Browning even as we speak and [95:02] fructose does it seven times faster than [95:04] glucose if I opened you up if I did uh [95:07] you know if I did a heart heart [95:08] operation on you right now your [95:10] cartilage would be brown and I can show [95:13] you the picture if you want of newborn [95:15] rib cartilage nice and white against 88y [95:17] old rib cartilage nice and brown because [95:20] we're all Browning it's part of aging [95:22] and if something caus you to age faster [95:25] is that a good thing or a bad thing and [95:27] it has nothing to do with glycemic index [95:29] so that's the first thing they say [95:31] second thing they say a little fructose [95:36] causes an improvement in insulin [95:38] response it's a phenomenon that was [95:41] first uh observed by sharington back in [95:44] 1968 bottom line there's a fructose [95:47] receptor on the beta cell and so when [95:50] you to consume a 20 ooun soda you're [95:52] getting a huge insulin respon response [95:54] and that's actually driving all these [95:55] chronic metabolic diseases so when you [95:57] overdo it that's actually a problem [96:00] that's not a good thing that's a bad [96:01] thing they would say it's a good thing [96:03] because it's helping clear blood sugar [96:06] not that's not true okay the next thing [96:09] they would say is that it's all on the [96:13] label for you to decide yourself except [96:16] that's not true either because it's [96:17] total sugars it's not added sugars you [96:20] don't know what they added okay and the [96:22] perfect example of that is yoga YT so we [96:25] talked about yogurt before so how many [96:27] grams of sugar in a plain yogurt seven [96:31] that's a lactose milk sugar no problem [96:33] your liver turns the galactose into [96:35] glucose like that how many grams of [96:38] sugar in a pomegranate yogurt 22 so when [96:43] you cons thank you when you [96:46] consume so when you consume a [96:48] pomegranate yogurt you are consuming a [96:50] plain yogurt plus a bowl of c and crunch [96:53] now did you know that but if you look at [96:56] the side of the package it's total [96:58] sugars you don't know what's the [97:00] endogenous you don't know what's not a [97:02] problem and you don't know what's added [97:04] and the same thing for whole fruit you [97:06] you know I mean people say oh but [97:08] there's there's sugar and fruit right [97:10] yeah but there's an equal amount of [97:12] fiber and the fiber mitigates the [97:15] negative responses of sugar on your [97:17] digestive and on your uh system and on [97:20] your liver why because the fiber causes [97:23] a gel to form on the inside of your [97:25] intestine it act the insoluble fiber [97:28] forms the scaffolding and then the [97:29] soluble fiber plugs up the holes it's [97:31] kind of like the hair catcher on your [97:32] bathtub drain okay it's a little plastic [97:35] lattice work and when the hair falls off [97:37] your body and you know covers the holes [97:39] you get a barrier and the water doesn't [97:40] go down until you clean it off right [97:42] okay same thing's happening in your [97:43] intestine when you consume the insoluble [97:45] and the soluble fiber together you're [97:47] getting this gel which is preventing the [97:49] rate of absorption from the gut into the [97:51] bloodstream thereby keeping your liver [97:54] safe because it changes the flux from [97:57] the gut to the liver which is a good [98:00] thing in [98:01] addition because you develop that gel [98:04] because you make that gel more of the [98:06] calories that you consume since they're [98:07] not getting absorbed high up in the [98:08] dadum they're getting transported [98:10] further down the junim further down the [98:13] intestine where the bacteria live that's [98:15] where the microbiota are they have to [98:18] eat too so what do they eat well they [98:20] eat what you eat the question is how [98:21] much did you get versus how much did [98:22] they get so when you consume foods [98:25] containing fiber they get more so that [98:28] means you didn't even absorb it so you [98:30] consumed it but you didn't absorb it [98:32] which is another reason why a calorie is [98:34] not a calorie because when you consume [98:36] your sugar with fiber and you consume [98:38] any nutrient with fiber you're getting [98:41] less and the bacteria are getting more [98:43] and then that means the good bacteria [98:44] will proliferate like bacteroides and [98:46] the bad bacteria won't like FM acutus [98:49] which has been shown to cause chronic [98:51] metabolic disease because it releases is [98:53] more cyto kindes so bottom line when you [98:56] consume your food with fiber you're [98:58] mitigating all those negative effects [99:01] that's called real food processed food [99:03] is fiberless food and so you get [99:06] basically when you eat processed food [99:08] you're getting it all and you're getting [99:09] it right away and it's driving your [99:11] liver [99:14] nuts I think we're going to have to let [99:16] that be the last question for this [99:18] evening I think we could go on and on [99:20] and on but did you know your speakers [99:21] will be up here some of them who want to [99:23] to answer one-on-one questions but out [99:25] of respect for your time and thank you [99:28] so much both of you this has been an [99:29] incredibly Illuminating evening thank [99:32] you thanks for the good questions