Darwin, Diet, Disease, and Dollars: How the Sugar in Processed Foods Has Changed Society

well good evening my name is mark Pesce levine and i have the privilege of serving as president of the Rockefeller University I want to thank everyone for joining us this evening for our inaugural parents and science celebrating science benefits redux throughout its history Rockefeller has been committed to educating the public about the latest biomedical breakthroughs and five years ago it's strengthened these outreach efforts by creating the parents and science initiative parents and science educates parents about science and provides a forum to learn about emerging discoveries and to engage in an intellectual exchange with scientists and with each other now I think you know it's been a long journey to today's program tonight's benefits as you know was originally scheduled for November 7th but was postponed due to the storm after Hurricane sandy after consulting with the parents and science steering committee we decided to reschedule the event but redefine its format tonight you will attend a reception and dinner buffet that may turn out to be even more festive than what was originally planned as I'll explained after dr. Lustig talk now since some of you have asked I wanted to mention that everything purchased for the November event was reused either tonight our programs are a perfect example of that or it was donated to worthy charitable organizations the food from the canceled benefit was given to the Lenox Hill neighborhood house which helps many elderly New Yorkers homeless families and others in need and the floral arrangements were donated to patients at Memorial sloan-kettering Cancer Center I want to take this opportunity to thank Julia and David Koch for their extraordinary generosity in underwriting this event this evening would not have been possible without them David and Julia have done so much not only for cultural and educational institutions but also to advance biomedical research and we're fortunate that David is here with us this evening and I'd like to thank you David I'd also like to thank our parents in science leadership the outstanding group of co-chairs and committee members who took the reins for this new celebration it's an extraordinary accomplishment to undertake planning an inaugural event of this scale not once but twice in just a few short months and were extremely grateful to you all and I also want to recognize the parents and science steering committee a core group of volunteers who've done a tremendous amount of work over the years to ensure the growth and success of parents in science the names of these individuals are in your programs and I'd like to take this opportunity to thank all of them and finally I'd like to thank all of you for your generous support proceeds from tonight's benefit will help launch a new center for research on child and adolescent health to provide vital resources to the rockefellers scientists who are transforming our understanding of human development and childhood diseases so it gives me great pleasure to announce that we've raised a remarkable 1 point 1 million dollars for parents in science through this benefit well done and thank you now tonight is also extraordinary because we have so many new friends with us we have 150 guests who are visiting Rockefeller for the very first time I'm delighted to welcome you to campus since so many of you are new to our campus I'd like to say a few words about Rockefeller University which is an exceptional place founded in 1901 the university is devoted to research and graduate education in the biomedical and related Natural Sciences it's home to many of the world's leading investigators the university has an unparalleled record of achievement including more Nobel prizes in medicine and chemistry than any other institution in the world 24 to be exact if Rockefeller University were a country it would rank fourth in the world in Nobel prizes after the United States the UK and Germany now so because so many guests are new to Rockefeller tonight we thought we be nice to share a short video about the University so Todd if we could have the video please [Music] my daughter came down with a bad case of psoriasis but she was going to a dermatologist who was treating her and she'd been through a number of treatments and nothing was working and so finally I said to him who was the leading psoriasis expert in New York City and he said it's dr. Martin Carter at the Rockefeller University she wound up spending a month in the hospital the first time I remember I went over to pick her up and I said the nurse where do I go to pay the bill the nurse said there's no there's no charge it's a research hospital and so I went back to my office and I got out my checkbook and I said I checked and Marty Carter for what I thought a month in the hospital would cost that's surprisingly about two weeks later I got a call from the chairman of the board of Rockefeller who said he'd like to come over and see me and that was the beginning of what now has been 20-year relationship with the with the University [Music] Rockville University was formed in 1901 by john d rockefeller senior and the reason it was formed was that we had reached the point in the state of Medicine where you could diagnose what was wrong with people but we have no ability to stop the disease that they had from killing them Rockefeller had an advisor named gates so gates came up with the idea of bringing together the best and the brightest in one location to basically study how do we interact with disease and how do we stop disease my own laboratory studies a rare group of patients who amazingly enough have an immune response against their own cancers we're able to discover something that people haven't seen before which is human beings have a natural ability to get rid of cancer not only do the best scientists want to come here but the best students the best fellows the best clinicians want to come work here this is the number one place in the country possibly the world to do this kind of research so I'm privileged to have an absolutely spectacular group of people working with me in the laboratory now and hopefully in the future Rockefeller is important to what we're doing because it's one of the only places in the world that actually prizes risk-taking has allowed us to do completely improbable scientific experiments that we just wouldn't be allowed to do with any other University mosquito disease transmission is an enormous problem in the developing world malaria kills a million people a year several hundred million people are sick and infected with the malaria parasite to try to find out what that substance is that's either attracting or repelling mosquitoes and that substance if bottled could be an incredibly important tool in preventing mosquito disease transmission the rock color is just an incredibly exciting place to be because of the strength of the basic sciences on the one hand and the commitment that's always existed here to taking that knowledge and translating it into medicines that can help patients we need to identify those with passion and with intellectual capabilities to back up that passion to go into medicine and science biomedical research is our only focus when we're here as opposed to being at a large Medical Center where often your research competes with the time that's spent in clinical care Rockefeller is second to none in providing that protected time obviously I'm very thankful for the investment that Rockefeller is made in me he as part of the clinical Scholars Program I had three years of protective time that gave me enough time to focus on my research generate data now I'm an NIH funded investigator and that was not a small accomplishment and I could do it thanks to the investment that rocked the darkness Rockefeller University is very unusual in that it is not divided up into departments reflecting different disciplines because departments can form barriers between different sorts of research workers what we have here no barriers between the basic researchers and the clinical researchers having no departments is critical every head of lab tenured are not tenured reports to the president of the university period this is really the golden age of disease research translational medicine and drug discovery and I think that medicine is going to be transformed profoundly in all of those different areas I think we have an outstanding opportunity here we have a small institution with world-class people in it and I think we need to continue to think aggressively about what else we can be doing it Rockefeller and how do we expand beyond our current scientific horizons my family have been involved in a number of enormous Li with while philanthropies but I believe that perhaps the most significant is Iraq for the University and our hospital in that connection I think going back even to grandfather and father they would probably agree with that somebody asked me well how can you keep talking about Rockefeller you don't even work there you're at Harvard what's that all about and I once said to a group there well I guess it sounds a little bit like Macy's complimenting Gimbels and most people don't understand what I mean would not say that anymore but I do feel that it is a place that sets a standard it is my single most important philanthropic Association it's an institution that has had a large impact on my family it's been a very important place to be for a long time I am totally honored to be chairman of the board it's a place that I think the world of you know we want to do as much as I can to help [Music] [Applause] well the the scientific theme of tonight's benefit is most appropriate because Rockfeller is such a distinguished history in the science of obesity and nutrition in fact the modern field of obesity research began here with the groundbreaking investigations of Yule Hirsch medjool is now in his 80s but he continues his scientific work here at Rockefeller the tradition continued with Rockefeller Professor Jeffrey Friedman who won the Lasker Award in 2010 for his discovery of the hormone leptin that helps to regulate appetite energy expenditures and body waited a great breakthrough in understanding how the body controls food intake and body weight it's now studied by scientists worldwide and so it now gives me pleasure to introduce tonight's speaker dr. Robert Lustig dr. Lustig served as an associate physician at the Rockefeller University Hospital in the campus in the late 1980s and early 1990s we're very pleased that he's returned to the campus to deliver this evening's presentation especially after having been here in the fall as well to make that presentation now dr. Lustig is a professor of pediatrics at the University of California San Francisco his work exploring the role that excessive sugar consumption plays and disease has received extensive media coverage including a 60 minutes feature last spring his new book fat chance beating the odds against sugar processed food obesity and disease was released on December 27th and - thank you all for joining us you will be receiving a copy of his book in your gift bag when you depart tonight please see dr. Lustig biography and her programs for additional information but in the interest of time I'd like to proceed to his talk and so please join me in welcoming dr. Lustig to the well thank you very very much mark and I cannot tell you what an honor and what a privilege and what a pleasure it is to be able to come back and stand behind this podium when I spent so many hours in those seats where you are right now listening to other professors that you saw on the video and many others as well and also to be able to talk to some of the professors that taught me for instance Bruce McEwen who I always considered my Dutch uncle and I'm sure the reason I'm here tonight Sarah Leibowitz is in the audience as well who has done groundbreaking work on the regulation of food intake and has been a very important influence on the work that I'm going to show you as well I want to thank my family as well for being here tonight and many many friends and honored guests and I want to thank all of you for caring about this issue and I'm going to tell you you better care about this issue because this is the biggest issue in public health in the history of mankind it Dwarfs everything else it dwarfs the Black Plague it Dwarfs tuberculosis it Dwarfs influenza it Dwarfs pollution the dwarfs HIV it Dwarfs everything and there are 35 million people dying every year from the diseases we're going to talk about tonight in developing countries not developed countries so much so that the UN Secretary General in 2011 declared that non communicable disease that is chronic metabolic disease which we're going to talk about tonight is now a bigger threat around the world then acute infectious diseases including HIV so when you think about that and you think about the allocation of resources that has been made and you think about what has happened to our health care system you realize just how important this is from a public health standpoint worse yet you're going to find out tonight there's no medicine for this so understanding it as Rufus Coulson is what it's about because that's the only way to deal with it and I'm gonna try to get you to understand it tonight so with that let me go ahead and get started I have no disclosures promise no food industry is concerns putting me up to this certainly not all right here's the past 2001 twelve years ago six million kids are seriously overweight well with all of the media attention with all of the NIH research with the discovery of leptin which you will hear about with Michelle Obama's vegetable gardens we are now up to 20 million and Counting here's the present currently there are 30% more obese people walking the earth than there are undernourished people and this is in the same country that has the undernourished people I mean this makes absolutely no sense how can there be more obese people in Africa than in than undernourished people but that's what's going on right now 366 million diabetics walking the earth 5% of the world's population and they are chewing through all of the healthcare resources there's no money for anything else and here's the future experts predict 165 million Americans will be obese by 2030 1/2 of the adult population 100 million Americans will have diabetes by 2050 one-third of the American population again no healthcare for you because Medicare will be broke by 2024 I will be 67 in 2020 for no health care for me and to be honest with you no health care for you either so this is a problem and if you don't think it is just go to Disney World all right so what are we talking about this is an 11 inch statue unearthed in 1908 that carbon dates back to 22,000 BCE it's known as the Venus von villian Dorf and what it shows us is that the ancients knew about obesity before they knew about McDonald's obesity is part of the human condition if you go to the medical textbook there are 60 different diagnoses that carry obesity as at least one of its markers and none of them explain what has happened in the last 30 years this is a phenomenon that has basically exploded in just the last 30 years the question is how did the world get so obese and how did it do it so fast so that's where this guy comes in okay sort of one of our you know guiding lights in in medicine so here's what you know obesity work worsens yes in both prevalence and severity it's increasing and all developed and developing countries and is increasing in all age groups particularly in children and recidivism is very high the number of people who can lose weight and keep it off is vanishingly small on the order of about 1% oh you hear about them you see pictures of them in the newspapers in the magazines I lost 100 pounds you know doing you know this crazy diet or that you know you know Hydroxycut this medicine whatever bottom line no one can do it because if anyone could do it I wouldn't be standing here the question is why well the obvious explanation the one you've been fed gluttony and sloth your gluttony sloth you eat too much you exercise too little every doctor will tell you that set me let's ask Darwin what he what what's really going on what would Darwin say he would say this is evolutionary he would say this is a mismatch between our environment that we have created for ourselves and our biochemistry because our biochemistry was not adapted to our current environment and when we understand what those mismatches are we should be able to solve the problem that's where we're going all right so understand that first we have to understand why is the obesity around in the first place why is it part of the medical condition well there's a selective advantage energy storage for a rainy day seven years of famine you know Joseph proclaimed so those who could store energy better survived longer this actually took place in Arizona twice the Pima Indians have been selected for in 1912 when a train trestle went out during a huge snowstorm and 90% of the Pima population was lost the 10% who could who survived it were able to store energy the best and then it happened again in 1938 same thing happened and so the pima's have been selected for because they store energy the best the problem is now they are the sickest and the question is how is this selective advantage achieved and so what we're going to talk about tonight are two phenomena one called leptin resistance and dr. Tesla being introduced the concept of leptin I'm going to talk about it a little greater detail and also insulin resistance as well and to understand what's going on you have to understand these two and will have to do well just a little touch a smidgen of science to get you there okay so this is a very complex schema Tye's pathway but I want to have you focus on just one thing this area over here in the brain called the hypothalamus controls energy balance and these two hormones right over here leptin and insulin are what we're talking about tonight leptin discovered right here at Rockefeller University in 1994 by Jeff Friedman and colleagues is made by the adipose tissue and goes to your brain and tells your brain you have enough energy on board to engage in normal expensive metabolic processes you can burn energy at a normal rate and feel good doing it and you don't have to eat so much because you have enough for a rainy day everybody got it and then you have this other guy over here called insulin and insulin is very interesting because it has two different functions one it tells the fat cell hey store fat and it tells the brain hey I'm in the middle of metabolizing a meal I don't need to eat so much let me finish what I've started so it does two different things in two different parts of the body tells the fat cell store and it tells the brain don't eat more so that's kind of neat and that's the nightís of what the obesity problem is and I'll try to explain how so in order to understand this let's talk about the paradox how many of you have children yeah okay good it's parents in science alright so here's the question if you give a five-year-old kid a cookie what happens they're bouncing off walls it's called the sugar high every parent knows this right yes I got a nod over here they're there they're there they just go crazy okay and of course all the teachers know this too now how does this happen well you eat the cookie you lay down some more fat because insulin drove energy into the fat cell the fat cell made leptin the leptin goes to the hypothalamus and hypothalamus says hey I don't need all that energy I can burn it off and so what it does is it increases a part of the nervous system called the sympathetic nervous system which is also the fight-or-flight response the reason you're you get scared your heart beats faster etc and that goes to your muscles as increased sympathetic tone which causes your muscles to twitch or fidget so fidgeting is actually protection against obesity which is why all these kids phidget and then of course that burns off energy and so what you have here is a nice negative feedback pathway between the fat cell the brain and the sympathetic nervous system to keep you in relatively normal energy balance so that you don't go up or down too much so far so good so here's the paradox what if you give an obese five-year-old kid a cookie instead what happens so in the pantry looking for more cookies anybody ever see a sugar high in and a fat kid doesn't exist can't exist reason because this kids leptin isn't working because if his leptin was working he wouldn't be obese so he lays down more leptin brain doesn't see it because if the brain saw it then he'd fetch it off but no he's looking for more everybody see the paradox something about obesity drives leptin resistance and leptin resistance is obesity and we're gonna talk about that now here is the most famous patient at Rockefeller University right here right mark this is Jeff Friedman's leptin deficient Mouse it's actually Jackson labs leptin deficient mess before it was Jeff's but anyway if this leptin discovered right here in 1994 and this animal can't make leptin because he has a gene defect and so what happens is this animal eats everything in sight but more importantly this animal is the world's biggest couch potato I don't know how many of you have ever worked with rats or mice but they like to nest in their cages they build up the bedding or the sawdust underneath and they get into the corner and you know these animals just stay where you put them the only reason the sound will ever gets off is heinie is if you put the food on the other side of the cage and then they'll waddle over there eat the food and stay there instead okay these animals have no energy to be able to engage in normal nesting behavior they are too starved their brain never gets the signal that they're fat their brain sees only starvation because there's no signal from the fat cell to the brain to tell the brain that there's enough energy on board everybody understand okay so has this worked well here here's a fat cell Kelly making leptin and the left and tells the hypothalamus hey I'm good I've got enough and so this phenomenon will drive one of these two processes over here if leptin tells the hypothalamus what's going on then you get this one over here called anorexia Genesis that is hey I'm not hungry I don't need to eat so much and I can burn energy at a normal rate and so what it will do is it will tell the sympathetic nervous system go ahead and burn off the energy and it will also tell the vagus nerve the energy-storage nerve the appetite nerve shut down I don't need to eat so much and you'll notice the vagus nerve also innervates the pancreas and that becomes important in a moment but if leptin is low that is you're starving or you're undernourished then your hypothalamus senses energy deficiency and so then this guy over here goes into action erecta Genesis I'm hungry I need to eat bring me food and of course I don't want to burn I want to conserve I want to store and therefore I'm not gonna move I'm gonna sit on the couch I'm going to watch videos or text or something else but I'm certainly not going to engage in any form of that sighs sound familiar and so it is this balance between these two that drives energy storage versus expenditure now there are 14 leptin deficient people in the world 14 and they are all of concern when they're all of Turkish or Pakistani ancestry and they all live in the UK or Turkey 14 of them and if you take one of these patients and you can see this patient was normal weight at birth but started gaining weight immediately by age one this kid is already massively obese because this kid will eat anything in sight and the kids a hundred kilos 220 pounds by age nine and you start giving this kid shots of leptin every day and look what happens the kid loses weight on a dime and not only does he lose weight it's all fat mass this kid is fixed because the gene defect which didn't make the leptin is now being made up by the fact that the kids getting leptin from a bottle instead everybody got it hormone replacement therapy it's what I do for a living is an endocrinologist this is perfect okay problem is only got 14 people like that the rest of us are not leptin deficient the rest of us are leptin resistant we got plenty of leptin look plenty of it and it correlates with how fat we are so our leptin levels a marker for our body fat but if our leptin worked at the level of our brain we wouldn't be fat because we'd have burned it off and we wouldn't have eaten more so this is the phenomenon that we're talking about tonight leptin resistance how does this occur what is the phenomenon that allows this to occur and how did it occur in 30 years so this X over here marks the spot this is the holy grail of obesity right here if leptin is being blocked from being able to signal the hypothalamus then a Rexha Genesis takes over I'm hungry and I'm gonna play video games and that's what we're seeing in today's youth and to be honest with you all over the world the question is what is that X what's that question mark right all right so now let's now talk about the other hormone what is insulin do so remember I told you insulin tells the fat cells store energy and it tells the brain hey I'm in the middle of metabolizing a meal don't need to eat anymore it's part of the satiety signal acutely but not always this is the patient that started me in obesity now eighteen years ago when I was a an attending at st. Jude Children's Research Hospital in Memphis Tennessee this young man this unfortunate young man was perfectly normal weight at age seven and then he developed this brain tumor right here sitting in the middle of his hypothalamus and he required surgery and radiation and he became hormone deficient then I had to replace all of his hormones and he started gaining weight at the rate of thirty pounds a year non-stop ad nauseam ad infinitum and nothing this kid or his mother could do could stop the rolling on of the weight this form of intractable obesity we call hypothalamic obesity and if there's one thing that I'm sort of known for it's figuring this out what caused that well basically this brain tumor and the radiation killed that hypothalamus so this hypothalamus now cannot see the leptin signal so this kid can't ever feel normal this kid can't ever feel like he's got enough energy on board he's always tired he's always miserable and he's always hungry and he keeps gaining weight like this and the question is what are you gonna do about it I was faced with a stable of these patients what can we do about it so the question is how does this occur so two different hypotheses over here one that damage to the hypothalamus leads to obesity because it tells your brain hey eat more or damage to the hypothalamus leads to obesity because it tells the vagus nerve to release more insulin the more insulin drives more energy storage which therefore drives the weight gain now this is not much I could do about it because I can't fix the brain I think dr. testy Olli bean can do that but I can't do that but if this is the case over here it gives us a place where we could potentially intervene right here between the vagus nerve and the beta cell of the pancreas and we have a drug that blocks that insulin release at the level of the pancreas and it's called octreotide and i know how to use it because I'm an endocrinologist and so what we did we said let's take these kids and let's give them this drug and see if it has any effect on their food intake on their weight and on their quality of life so here's one patient 220 pounds here and here she is a year later 172 pounds and the apocryphal story about this patient was that after one week of therapy kid hadn't lost any weight yet one week mother called me up on the phone and said dr. Lustig I don't understand something's going on here how do you mean mother says well we would go to Taco Bell and she would eat five tacos and an insurer Ito and she'd still be hungry and now we just went to Taco Bell she ate two tacos and she was full and she just started vacuuming the house really well and in fact we started seeing this in all of our patients that they started exercising spontaneously one kid became a competitive swimmer two kids started lifting weights at home one kid became the manager of his high school basketball team running around collecting all the basketballs these were kids who sat on the couch ate Doritos and slept because their brain couldn't get the leptin signal and now they were burning energy voluntarily kind of meat well here's that patient the competitive swimmer here she is BMI of 28 over here at age 10 and here she is six months later BMI down to 24 and here she is in her swimming togs two years later after the study was over and you can see that despite her best efforts to try to do something about her weight her BMI had grown all the way up to 34 and a half because the problem was still there and the drug had been stopped because the study was over the insurance company wouldn't pay for it and so basically she was left to her own devices and here she is now trying desperately to do something about it and Kent we finally got the insurance company to foot the bill for the drug we put her back on and her BMI went back down to 27 that's Koch's postulates fulfilled not this code but different and finally here's that probe and patient I told you about before 364 pounds here and here's the 326 first time you took a picture with his shirt off and here's the PS de resistance this isn't even my patient so you lovely young thirteen-year-old girl in Hawaii see and two weeks after this picture was taken she was in a car accident and she stroked her hypothalamus and here she is one year later not able to control her weight because everything she eats gets stored because her insulin levels are so high it's driving her energy storage non-stop well I gave a talk at Kaiser Honolulu and they invited her and her mother to come hear it because they were thinking about putting this kid on this drug as well and here we are together and here she is two years later at her high school graduation pretty neat huh so here's how this works each of us is really two compartments there's you your heart your liver your lungs your kidneys your muscles you're a lean body mass which burns energy and then there's your fat which stores it now the substrate for both compartments is glucose glucose feeds both of those but glucose is never at saturation for both compartments at the same time you can't eat that much no one can that means there's a competition going on for the glucose which compartment gets the glucose well your insulin determines that when your insulin is high the glucose goes to your fat now normally your fat would make leptin the leptin would feedback on the hypothalamus and tell the brain hey I got enough so it reduced the food therefore it would reduce the glucose therefore the insulin would go down and so here you have that same nice negative feedback pathway I showed you at beginning except these kids have a CNS insult they have a brain insult and so their brain thinks they're starving so their vagus nerve goes into overdrive to tell the pancreas release more insulin driving everything into their fat so they keep gaining weight gaining weight gaining weight they have nothing to burn so therefore they feel lousy so we blocked that now the glucose goes to them now they lose weight eat less feel better reverse the metabolic process pretty neat and here's so then we ask the question ok this is pretty great for these kids what about garden-variety adult obesity out on the street so we did two studies one a pilot one a double-blind placebo control trial where we gave this same drug octreotide to overweight people without brain tumors and here's an example Christmas 1998 this lady's holding up food I believe and here she is 35 pounds later in her jogging togs because she wanted to show me that she actually liked to exercise she wanted to exercise so what does this all mean well when leptin tells the hypothalamus what's going on all's right with the world but clearly something gets in the way and the question is what's the thing that gets in the way well it's the insulin insulin blocks leptin signaling it also tells the fat cell to store so you store and you don't burn all at the same time so everybody thinks gluttony and sloth are two different problems no they're not they're the same problem because the insulin interfered with that leptin signal at the level of the brain the question is what's that insulin doing and why is it high so insulin is an endogenous that is you make it yourself leptin antagonist it blocks leptin signaling now why would God do this to us what's the selective advantage the answer is there are two times in your life you actually have to gain weight puberty and pregnancy and both of those are insulin resistant states on purpose because you need to gain the weight so your insulin goes up specifically to drive energy into fat for reproduction and so that the brain knows that it's time to gain the weight because if your brain was working right all the time and your leptin was working right all the time you could never gain the way species would die out so this makes perfect Darwinian sense doesn't it make sense that the same hormone that promotes the energy storage would also work at the brain so that the energy could be stored makes perfect Darwinian sense problem is we're only supposed to be able to do this twice in our lives and we're doing it 24/7 365 why because we're all hyperinsulinemic now our insulin levels are three times higher than they were thirty years ago if you do an oral glucose tolerance test today you get a peak insulin response of anywhere from 100 to 150 you did that same test to our our forebears 30-40 years ago you got a peak insulin of about 50 so we're all releasing more insulin than we used to the question is how come what happened what changed in the last 30 years and to answer that question I'm not actually I'm not going to answer it for you I'm gonna let Will Smith answer it for you okay because even Hollywood knows the answer to this question [Music] but I guess I'll use some answers Hoss what you feeling chatty all of a sudden sorry I can't talk right now I got some secret cases on my own I'm working on I hate to tell you away from your video game all right I'm hanging up the most destructive force in the universe sugar I'd say it but it is the most destructive force in the universe indeed it is and I'm going to show you why so this some of you probably saw in the New York Times back in April of 2011 is about our research at UCSF this is a comment that we had in nature last year called the toxic truth about sugar which goes into the reasons and the whys and wherefores of why this has occurred and what we need to do about it so what are we talking about when we talk about sugar well there are two kinds of sugar that we're talking about we're talking about sucrose or we're talking about high fructose corn syrup so high fructose corn syrup of course is the most demonized additive known to man everybody knows it's a problem but they don't know why they don't know why it's a problem well I'm going to show you why it's a problem it is one glucose right here six membered ring and one fructose five membered ring now glucose is not very interesting you see people going around chugging Cairo syrup yeah molasses but this stuff over here now this is you know this is the bomb this is what we care about this is what we go out and seek and in fact this is what we are addicted to and I'll show you that data as well but you can see one glucose one fructose but you notice sucrose table sugar cane sugar beet sugar one glucose one fructose o glycosidic linkage linking the two so what the intestine has an enzyme that cleaves this in about a nanosecond when you absorb it it's the same thing and all of the studies comparing high-fructose corn syrup to sucrose show absolutely no difference no metabolic difference high fructose corn syrup and sucrose are equivalent equivalently bad equivalently poisonous equivalently toxic and I'll show you how everybody got that plus high fructose corn syrup is only available in the United States Canada Japan and very limited exposure in parts of Europe yet the entire world this problem I already told you because they have sugar here's what's happened in America in terms of our fructose consumption our forbears about a hundred years ago getting fruits and vegetables out of the ground and the occasional honey consumed on average about 15 grams of fructose per day double that for sugar because glucose and fructose weigh the same so be about an ounce of sugar a day prior to World War two with the nascent candy and soft drink industries we got up to about 20 grams a day by 1977 just before the glut of high fructose corn syrup hit our shores we were up to 37 grams a day that was 8% of our total caloric intake by 1994 we're up to 55 grams that was 10% of our total caloric intake and currently adolescents average 75 grams a day or 12% of total caloric intake and 25% of adolescents consume 100 grams a day so double that for sugar that's 200 grams of sugar per day multiplied by 4.1 calories per gram that's 840 calories in sugar alone so for a normal caloric allotment of 2,000 calories a day that's 40% of calories of sugar that's what our kids are consuming today the question is is that okay can you handle it can you handle that much can your liver handle it could this potentially have downstream metabolic consequences that are a problem that's the question and here's the de Nomo of the 600,000 food items in the American food supply currently available 80% of them have added sugar by the food industry specifically for its purposes not because we asked for it but they gave it to us so if you think your food supply is your food supply think again it's their food supply because they have co-opted your choice and the question is is that okay you allowed it with your tacit approval they did it and they did it for two reasons one because they've mastered the two main philosophies of marketing one we give the public at once and two if you build it they will come and they've mastered both I'm going to show you what that has what what what problems that has wreaked upon us but you know this isn't just America that's doing this this is the whole world that's doing this I've already told you thirty-five million people a year dying of chronic metabolic disease so this is worldwide per capita sugar supply and here we are of course the most overwhelmed ok at 629 calories a day but you'll notice the American Heart Association says reduce your total sugar consumption to between 150 to 200 calories per day and sugar right here how much of the world is over that threshold and look what happened to world sugar consumption during that period of time so 1960 to 2006 tripled per capita consumption Brazil is now a sugar consumer it used to just be a sugar exporter because its populace couldn't afford the sugar it made but now Brazil has the highest increase in rate of prevalence of type 2 diabetes in the world not the highest prevalence Mathias increase in rate the highest acceleration of prevalence and they are the biggest consumers who are the big who has the highest prevalence of type 2 diabetes Saudi Arabia and Malaysia Saudi Arabian Malaysia how do they do this no alcohol no they got soft drinks like they're going out of style because it's hot and the water supply is a question mark and no alcohol right this is their award this is their award this is their addiction and they are consuming sugar like nobody's business I was just in Kuala Lumpur and let me tell you it's really a problem when everyone there enters a room ten minutes before their feet do that's how bad it is the point of this the point of this is that you have been told time and time again by the food industry by medical professionals and by the federal government eat less exercise more because a calorie is a calorie if you burn less than you eat you'll lose weight that's what they've told you ain't true and the reason it ain't true is because a calorie is not a calorie and if you take nothing away from tonight other than that notion I will have done my job a calorie is not a calorie how do we know that I'll give you four different ways number one almonds you eat a hundred and sixty calories and almonds how many of those do you absorb 130 when I'm near the other thirty the fiber in the almonds delivered more nutrient down the intestine preventing its absorption early so that the bacteria in your intestine to dedup instead of you getting it and that's good because that means you absorb less than you ate because the calorie is not a calorie protein it costs twice as much energy to metabolize protein for energy than it does to metabolize carbohydrates for energy that's a energy deficit because the calorie is not a calorie number three fats over here we have Omega threes which are fantastic heart-healthy save your life over here we got trans fats all right the devil incarnate poison it'll kill you okay they both nine calories per gram and one will save your life and the other will kill you why because a calorie is not a calorie and finally because fructose is not glucose what is different about that five membered ring everything proc dose is seven times more likely than glucose to form advanced glycation end-products that is the Browning reaction it's called the mired reaction and also used to be and it was in discovered here at Rockefeller University in terms of hemoglobin a1c by Toni cerami back in the early 80s and we worked with him on that proc dose does not suppress the hunger hormone ghrelin the hormone that basically goes to your brain and tells you you're hungry so if it doesn't suppress it you eat more truck toast does not stimulate insulin and therefore you don't generate a leptin response well if you get a leptin response you get the sugar high if you don't get the leptin response yet out so guess what you don't burn as much energy and finally liver fructose metabolism is completely different from that of glucose completely and I'm going to show you that chronic fructose exposure alone promotes all of those diseases those chronic metabolic diseases type-2 diabetes dis lipedema hypertension cardiovascular disease and likely cancer and dementia as well now if you want to see all the basic science and all the biochemical pathways there's a YouTube video that has 3.2 million hits on it called sugar the bitter truth where we go into this in exhaustive detail I am NOT gonna bore you and I don't have the time for that but I'm just going to show you one thing when glucose enters the liver what happens to it this is what happens to it it goes to this guy over here called glycogen glycogen is liver starch glycogen is what your liver wants to do with energy that's why marathoners post a load before a marathon is to try to build up their glycogen stores so they have more glycogen in their liver so this is a good thing to do this is a good thing to build out of it okay but that's the glucose does let's talk about a different carbohydrate my favorite maybe yours too let's talk about alcohol okay there is carbon hydrogen oxygen but you know what we know ethanol is at the toxin it's two toxins in one you wrap your lamborghini around the tree you fry your liver acute alcohol toxicity chronic alcohol toxicity we keep it out of the hands of children because we know it's a toxin but it's a nutrient right burns four calories here's acute alcohol exposure over here read through it you all went to college over here acute fructose exposure nothing because the brain does not metabolize fructose does metabolize alcohol so let's now consume alcohol instead of glucose see glycogen bypasses glycogen no glycogen what does it do it goes all the way down here to the mitochondria the little energy burning factories inside each cell and it makes fat over here lipid droplet alcoholic fatty liver disease and high triglycerides which then can promote obesity and also promote atherosclerosis not so good and now let's do fructose so let's consume proc toast instead instead of alcohol or glucose see glycogen anywhere bypasses glycogen same as alcohol down to the mitochondria so what do you get you get the fatty liver you get the triglyceride you get insulin resistance over here you get hypertension you get muscle insulin resistance that can be driven into the fat cells now you've got obesity and worse yet we know that because of that insulin resistance we block leptin so now what we have is a positive feedback effect between sugar the liver the pancreas and the brain to promote continued consumption and chronic metabolic disease not good so what's the difference can a coke can of beer what's the difference 150 calories both 75 glucose 75 fructose over here for the 150 90 alcohol 60 maltose that's glucose for the for the beer the liver of the GI tract metabolize is 10 percent of the alcohol so the number of calories reaching the liver are virtually the same and so the same strain on your liver occurs with either one so in America we have this thing called beer belly welcome to soda belly that's what we've got and that's what our kids suffer from soda belly because it's the same thing it's the same phenomenon because it's metabolized the same way so fructose induces insulin resistance at the level of the liver and when that happens the pancreas has to make extra insulin to make the liver do its job that gets in the way of the leptin and so now you've got than resistance and so you keep eating that's the reason for the continued consumption all right what would Darwin say would he say that this made any sense and the answers yeah it does makes perfect sense because there's a phenomenon called seasonal insulin resistance and we see it in animals the fact is fructose used to be hard to come by it was really only available one month a year was called harvest time harvest time and so the foot would have dropped from the tree and we would gorge on the stuff because hey it was good and we would lay down more fat and then what followed harvest time four months of winter and we would go with the caves and hibernate or otherwise and the bottom line was we needed that extra fat laid down in advance of winter specifically to be able to survive it so it actually makes perfect sense that fructose would induce insulin resistance it's part of survival the problem is if leptin worked all the time you couldn't store the energy so you have to have that selective advantage but now fructose is available globally 24/7 365 and consumed in unlimited amounts for instance the two-liter bottle and unopposed by fiber like orange juice so orange juice insulin resistance obesity chronic metabolic disease and how do we know this is true because this is data from orangutangs in Papua New Guinea so here is their mass tting of fruit or G over here where the availability of fruit goes haywire and here's what you can see that when that happens virtually everything they eat is fruit and nothing else and you can see that their calories go right through the roof while that's happening and notice their ketones disappear which is a sign of the fact that their insulin is high because insulin blocks ketone formation so you can see that this is Darwinian this is evolutionary this is what we're supposed to do we're just only supposed to do it one month a year and now we do it every day okay now remember we talked about this whole question about sugar making you eat more so the question now is is sugar addictive you know the whole public you know seems to know this I don't know why it's so hard for the scientists to get behind this but they will tell you we don't really know that this that the other thing okay bottom line we're gonna show you so we have five sets of taste buds five different taste on the tongue and sugar highs the other four it hides salty like Chex Mix or honey roasted peanuts it hides sour like German wines or lemonade right because you know citric acid is sour it hides will mommy that tastes like roast beef or a sweet and sour pork that's half soy sauce you wouldn't eat that except sure you can't even tell us there and it hides bitter like milk chocolate right because caffeine is bitter bottom line is you make dog poop tastes good with enough sugar and the food industry does and they know it and that's how they get you to eat more so does this make Darwinian sense and the answer is yeah that's Darwinian too because there are no foods anywhere on the planet that are natural that are sweet and both acutely poisonous think about that nothing on the planet that is both sweet and acutely poisonous you all have children you said so how many times do you have to introduce a savory food to an infant before they'll accept it thirteen science it's thirteen on average how many times you have to introduce a sweet food before they'll accept it just once just once it's ingrained in our DNA okay if it's sweet it's safe to eat and that's true acutely but now we've no chronically ate so our sugar craving is very Darwinian and here's a perfect proof of concept anybody ever heard of this stuff sweeties anybody know what it is your kids get circumcised they got it okay because this is a super concentrated sucrose solution that you dip the pacifier in you stick it in the baby's mouth and you do the circumcision and it promotes an opioid response in the reward center of the brain that's its analgesia even in neonates so we love this stuff this is addictive when you do it non-stop okay now Darwin diet now up the disease I love this part here are the ten most obese states in the nation no surprise here are the ten laziest states in the nation what's going on over there in Nevada guess you can only burn so much energy going like this now it's like this right here are the ten most unhappy states in the nation here's the adult diabetes rate here's the adult heart disease rate and finally soda per capita consumption what do you see wait is it virtual overlap yes now this is correlation not causation okay and I have been accused of pandering to the audience on this okay because maybe unhappy fat diabetics consume soda or is it that soda makes you unhappy fat and diabetic which you don't know directionality you can't tell this is correlation doesn't establish directionality does not establish causation but I wouldn't even show this to you if I didn't have causation so this is a paper that will appear in exactly two weeks from today in a very reputable journal called plus one public library of science one and I will tell you right now this is the best work I've ever done and I am very excited about it and there will be a press release and you will hear about it okay and you're getting first dibs what we did was we took three databases that exist on the web and we linked them together the Food and Agriculture Organization statistics database which has food supply country by country and all the way through the decade 2000 to 2010 and we looked at total calories fruits excluding wine oils roots tubers pulses nuts and vegetables as the fiber containing foods meat cereals and sugar sugar crops and sweeteners okay pretty much the whole gamut of the diet we didn't look at micronutrients which is important but we didn't have that we link that to the International Diabetes Federation database wit for diabetes prevalence country by country throughout the entire decade and then we linked that to the World Bank World Development indicators database to look at purchasing power parity and to control for urbanization aging obesity important obesity physical activity and GDP and we asked the question what about the world's food supply predicts diabetes prevalence over this past decade because we know diabetes has just gone through the roof what in the food predicts the change so we had 204 countries total but we had complete data for 150 for the 50 that were not included were not different we tested that statistically and we did a whole lot of fancy analyses and I'm just gonna point out one this one over here it's called the Granger causality test how do you do that well number one we don't have the photograph this isn't one snapshot in time we have the movie because we have the whole decade and we can determine whether the change in any given foodstuff precedes the diabetes rate increase or follows it instead in addition we can determine whether those countries who increased their consumption of any given foodstuff had an increase in prevalence and those who decreased consumption of a foodstuff had a decreased prevalence so we have bi-directional so this is the Granger causality test and it's the best you can do in terms of being able to figure out causation okay and we control for all these things GDP obesity urbanization aging and physical activity and here's the data so during this decade diabetes prevalence rose from 5.5 to 7% and here's the effect size right over here and you'll notice that for every hundred calories in sugar diabetes prevalence increased by close to 1% and here's the adjusted Association adjusting for all of those things of sugar versus diabetes prevalence having nothing to do with obesity because we controlled for it so here's the here's what you do the take-home message for all of you only sugar correlated with the changes in diabetes prevalence total calories was irrelevant irrelevant for every hundred 50 total calories you ingest extra your diabetes prevalence increases by 0.1 percent but if those 150 calories happen to be a can of soda instead then your diabetes and prevalence increased 11 fold by 1.1 percent and we don't consume 150 calories in added sugar in America we consume 450 calories per day in added sugar so that's three point three percent to you you've increased your diabetes prevalence by three point three percent if you consume sugar on an average basis in America and those countries whose sugar consumption declined showed decreased diabetes prevalence and when you do the math we show that 25% of the world's diabetes is due to sugar and sugar alone alone you want to do something about chronic metabolic disease here it is this is it do something about this now there are limitations to this kind of analysis it's called an ecological analysis it's not raw data and certainly there are issues about what what is known as the ecological fallacy could it be that the patients who did to consume the sugar were the ones who actually got the diabetes you can't tell from percentages that's why this is a kind of metric but we have other controls built in to make sure that its food supply not food consumption but wastage is about normal about 29% even in the United States and we looked at that it's only one decade in time but it's the whole decade it's not a complete dietary analysis like I said micronutrients were not included different techniques to screen for different diabetes in different countries different diagnostic criteria for diabetes in different countries but usually the same criteria for any given country and some countries use self-reported data and a lot of diabetics go undiagnosed so probably the data is actually worse than we even said and it includes both type 1 and type 2 diabetes but type 1 hasn't changed that much type 2 is the thing that's gone through the roof so we don't think it's being driven by the type ones so here's what we think is going on in very simple terms here's the fructose coming into the liver and the fructose will get metabolized by the mitochondria and will throw off these little hydrogen peroxides called reactive oxygen species this is the Browning reaction right here in addition the fructose will bind to proteins and throw off reaction oxygen species in addition as you lay down visceral fat the inflammatory cytokines like tnf-alpha and il-6 will bind to its receptor on the liver and generate more reactive oxygen species so you got this whole pool of these little hydrogen peroxides that want to do damage now you have an organelle in your liver called the peroxisome and that's where those little hydrogen peroxides go to die if you can handle if you got enough antioxidants to handle it in the liver that's called glutathione and if you don't then they come up here to the endoplasmic reticulum which is where insulin gets folded and if you don't fold the insulin right you get something called the unfolded protein response which can kill the cell or at least cause diabetes and there is no drug target for this there's no way to clear those there's no way to get rid of them the only thing you can do is reduce the availability that's called diet reduce the flux to the liver so it doesn't happen all at once that's cold fibre or burn them off before they have a chance to do damage and that's called exercise diet and exercise again but not exactly because we're not talking about eat less eat less what no one can eat less but could you eat less sugar damn right could you eat more fiber absolutely so what do you call a low sugar high fiber diet anybody know what's called it's called real food got it so this is a processed food phenomenon by taking the fiber out for shelf life because you can't freeze fiber and by adding the sugar so that we get to eat more the food industry has driven this pandemic of chronic metabolic disease and we can't fix it until the sugar leaves and the fiber comes back it's called real food and finally to end talk dollars so here's where our food dollars have gone in the last 30 years meats down a little because of the low fat directive of the 1970s and 80s fruits and vegetables about the same grains and baked goods about the same a little bit higher dairy products down a little because everybody thinks they're lactose intolerant and take a look processed food and sweets doubled doubled in the last 30 years there it is and who's making the money off that so this is stock prices for McDonald's Coke and Pepsi against the S&P 500 now this is not profitability of the companies this is profitability of the stockholders right but you'll notice they're doing very well here's the economic downturn of 2008 right over here and you'll notice they're all doing very well thank you and here's Hormel Archer Daniels Midland General Mills Kraft ConAgra Procter and Gamble all doing better than the SMP want to make money invest in a food company indeed and worse yet the food industry can't do anything about it and doesn't want to do anything about it anybody know who Indra Nooyi is she's the see she's the CEO of Pepsi right and they make more things than just Pepsi Cola they make all sorts of things they make snacks of various sorts right they have frito-lay etc and they so she is from India she's from Madras India and she sees what's going on in the Indian subcontinent and the diabetes epidemic there is a disaster and it was written up in the New York Times about two years ago big four-day article you know string of articles about what's going on in India and she wants to fix it and so they've introduced new products and they've put more money into their good-for-you category as opposed to the fund for you category and guess what happened Pepsi Cola went to number three after Diet Coke and so what do you think happened after that the stockholders and the board of directors called for her head because they're on a three-month cycle because it's all about the money so she would like to do something and can't this is what we've got as long as it's about money we can't fix this unless you fix this societal intervention requires negative impact on society we call externalities so if you smoke or drink or take drugs it's bad for me so like secondhand smoke is bad for me car accidents are bad for me declining house prices from you know because the crack crack then next door to my house is bad for me and you know because you smoke drink or take drugs you're out you know in terms of absenteeism that's bad for me too cause I got to do your job too so how does your obesity affect me that's the question two hundred and seventy four million dollars for jet fuel yeah that's not gonna do it discomfort on the subway you've all had that now sinking of boats due to the weight 2003 Lake George ferry coded for 17 people of 140 pounds and it was 24 people of 195 pounds and the ferry sank yeah I can't do it either so what we'll do it here's what we'll do it 65 billion reduction in work productivity 50% increase in absenteeism 50 percent increase in health insurance premiums that you all pay every single day 150 billion in wasted healthcare resources if you have an employee you have to pay two thousand seven hundred and fifty dollars extra for the for the premiums for their insurance because of obesity that your employee doesn't even have obesity is a threat to national security because 27 percent of recruits can't pass the physical because they're fat and finally most importantly the government pays twice they pay for the corn subsidy and then they pay for the ER visits and that's what's breaking the bank and that's why Medicare will be broke by 2024 we need to be able to recoup the money somewhere and we can't so let me summarize for you this is the Darwinian explanation not gluttony and sloth here's what I've told you obesity means leptin resistance or brain starvation the starvation response is what causes recidivism because your brain can't see the leptin energy expenditure and quality of life are the same thing how fast you burn energy is how good you feel and when your cancer your left and you feel lousy defects an insulin signaling promote leptin resistance insulin is an endogenous leptin antagonist getting in the way so your brain thinks it's starving fructose because of the effects it has on the liver induces that insulin resistance driving those chronic metabolic diseases and/or wasting all of those healthcare dollars and fructose is addictive and drives excess food consumption so it's a vicious cycle of toxicity and consumption our food environment is Tosa fide and in order to fix this we have to get the insulin down and the only way is to get rid of the sugar problem is the food industry has no impetus to change its practices whatsoever it's how we're gonna fix it the legislative and executive branches of government are co-opted co-opted because 6% of our exports of food what happened when that one downer cow one from Canada Washington State in 2006 that was the end of meat sales to Britain in South Korea for two years the government can't act on this Plus Congress is bought off by the food industry through various political action committees which I can tell you about later if you like so what do we have left we have legal and we have public media so public media well you know 60 minutes that was on CBS this morning this morning we're gonna have a press conference about our paper two weeks from now and what about legal you know this is how tobacco worked it was only a legal challenge that brought big tobacco to the table same things gonna happen here and that is why right now I am doing the first year of law school as a masters to learn the tobacco playbook at University of California Hastings College of the law and we're gonna bring it we're gonna bring it to them so for further reading I have whole bunches of academic tomes for you and more tomes for you and more tomes for you and finally you'll all be armed with something that is a little bit more palatable and storable on your way home tonight and with that I want to thank mark and Bruce and all of you for your patience because in question some consolation well thank you rob for a most provocative talk I know that they're going to be plenty of questions from the audience maybe I can can start with I'll use the Chairman's prerogative and ask you to first if you're longitudinal studies says that sugar accounts for 25% diabetes what accounts for the other 75% really good question they're going to be genetic influences they're not all of that is type 2 their other you know things factored in there there are a whole bunch of diabetes that aren't even you know type 2 or type 1 there's mitochondrial diabetes MODY etc you know they all figure in to a certain percentage but probably there are other factors in the environment that are also problematic for instance at Harvard School of Public Health what will its group thinks that processed red meat is an extremely important factor that might explain diabetes if you look at unprocessed red meat 100 grams extra per day increases your odds ratio by only 12% but processed red meat like bacon 50 grams increases your odds ratio by 51% that's what came out so there may be other factors that are involved I also think micronutrients are extremely important in this and we weren't able to assess that in this in this evaluation but for the most part type-2 diabetes is an environmental phenomenon this is an environmental insult not something that's really genetically driven maybe I can ask also in terms of establishing the the impact of sugar on on diabetes and fructose in particular the longitudinal study you described our you know seem to they all point in that direction as you described to us will be published in two weeks right are their clinical you know typically complimenting that we'd like to have you know randomized clinical data are there such data or there are you planning experiments like that well we are doing a study right now at UCSF which is a fructose withdrawal study in children so we're taking children who have ballek syndrome obesity plus at least one comorbidity and we are studying them at baseline with various parameters and then we're giving we're basically catering their meals for 10 days isocaloric in other words no change in calories so no change in weight but sugar free for 10 days like dominos we deliver and the question is not will they lose weight they won't the question is will their metabolism well their metabolic comorbidities improve in those 10 days now we're in the middle of that study we've done about half the patients that we need to I am blinded so I do not have the results of that we will probably have those results in about two years so we're trying to answer that question thank you heard your first on Alec Baldwin here's the thing that was great later for my whole family after that can you talk about diet soda yes everybody wants to know about diet sweeteners in diet soda you know a paper just got released three days ago that said diet soda was a cause of obesity as well and actually there are a lot of studies that actually intimated that I can't tell you the answer to diet soda or whether diet sodas are good or bad or otherwise and here's why there's something called pharmacokinetics and there's something called pharmacodynamics they're not the same pharmacokinetics is what your body does to a drug pharmacodynamics is what a drug does to your body not the same we have all the pharmacokinetics for all the diet sweeteners because the FDA demands it they won't put a sweetener on the market without all those pharmacokinetics because those pharmacokinetics tell you whether something is acutely poisonous but we have none of the farm of go dynamics because the FDA does not demand it so all of the pharmacokinetic pharmacodynamic studies would be six months or 12 months studies long-term studies so do any of these diets wieners affect your leptin or your ghrelin or your you know your long-term energy intake or your metabolism you know rate or any of those things we don't know we don't know what any of these diet sweeteners do does the body compensate for the lack of them we don't know we don't know any of those things because the FDA doesn't ask for and the food industry says well we can't sell anymore if we did them so they don't do it and the NIH says well that's the food industry's job so we're not going to pay for it so we have a dearth of information that basically means I can't tell you the answer I am about the science I only talk science and to do anything else would be pure conjecture so I can't answer your question and obviously inquiring minds want to know I want to know and I can't tell you and it's and it sucks ok question thank you so you just welcome cheese then about the impact of sugar from fruit yes on a child's diet or an adult's dessert so everybody wants fruit fruit is fine fruit is fine why because fruit has fiber if you did a little graph of fructose content versus fiber content it would be almost a virtual straight line and every fruit would be on that line except for one grapes grapes are just little bags of sugar okay but everything else is on that line okay and I'll prove it to you sugar cane okay the foodstuff that has the highest sugar content of anything on the planet it's a stick you can't even eat the damn thing right you can even chew it it's so fibrous okay so the fructose comes with the fiber so when you consume fruit you're consuming the requisite amount of fiber to delay the absorption from the gut into the bloodstream and that gives your liver a chance to catch up so that you can metabolize it before you turn it to liver fat so fruit is okay fruit juice is not oh and by the way smoothies are not either it seems to me that real food is what you've stressed absolutely and why are there no major studies of really the nutritional value wild strawberries versus processed strawberries and all of those different things because we had that data I want to tell you something I think that that would be a revelation everybody in change America yeah and who's gonna pay for it that's the problem who's gonna pay for it the food industry should pay for it right except they don't right their only job is to get it on the market all they have to show is safe that's all I have to show and that's not good enough but that's the way the FDA works what's the story with the other simple carbohydrates like rice and potatoes and bread and so-so there's brown food and there's white food brown food is fiber containing food when wheat comes out of the ground what color is it brown okay when you turn it into bread what color is it where'd the brown go got milled off at the mill right that was the fiber that was the brand so when you consume a whole grain and the starch is on the inside and the fibers on the outside you consume the whole thing the enzymes in your intestine the proteins that chew up your food okay have to strip that stuff off before the stuff comes out that delays its absorption that means that your liver doesn't get it all at once and it means that it's more likely that more of it will go down the intestine and get chewed up by the bacteria like I mentioned remember you got 100 trillion bacteria in your intestine you only have ten trillion cells in your body okay they your your bacteria outnumber you tend to one so what you really ought to be thinking of yourself of as okay is just a bacterial delivery device okay because they are and they gotta eat something okay they're usin what do they eat that you what you eat okay the only question is how much do you absorb before how much do they get and fibers the thing that gets them more so brown food like beans lentils nuts other legumes brown rice etc have the fiber yes right okay so glucose is not perfect right right right so no refined carbohydrate flour case starch bread rice pasta potatoes white food is glucose glucose now glucose without fiber will drive an insulin response so you will release more insulin and so that will store more fat so refined carbohydrate does Drive weight gain and that's one of the reasons why the low carb diet or the glycemic index diet or any of you know or the South Beach diet or any of the diets that you'd like to you know talk about you know will help with weight gain because it's keeping the insulin down that's true but I'm not talking about obesity I'm talking about chronic metabolic disease and refined carbohydrate can drive weight gain but it does not drive that insulin resistance that we talked about that's the key and that's what sugar does exclusively difference but thank you for pointing that out I didn't make that point question of the back IR glutamine and green coffee bean extract vitamins as good as people say for not absorbing sugar hell if I know I truly don't know the answer I mean there's a lot of stuff out there in terms of you know nutritional mumbo-jumbo and you know there's there's very little science to support almost any of it in the book there's a chapter called micronutrients home run or hyperbole and I take all of these things apart and when you actually look at the data it's not very good so I can't answer your question because I don't know the science of that we'll take one last question up there I'm just curious about since with the rise of antibiotics whether there might be any correlation with you know the sir the the change in the the composition of the stomach flora and the effects that you were talking about there have been about three studies that have looked at that question in fact one just in Pediatrics about two months ago that brought that question up that early antibiotic usage especially in you know young infants was like ear infections might change the flora and might actually contribute to obesity as well and it's very tantalizing and very possible because there's a plausible mechanism but these are again remember correlative studies you know it's very hard to do causative studies because you can't give kids antibiotics unless they're sick so we're gonna probably not have the studies we need to answer that question specifically but it is a big issue and at NYU Martin Blaser has written on this in science magazine about this exact issue about antibiotic use and possible its relation to its relation to obesity it's certainly a possible confounder so before we close with the Q&A I have an important announcement and a question the the announcement I know it'll quell some anxiety in the audience there will be dessert tonight not only that but it will be cake cheesecake and chocolate cake and and I believe Rob that your wife had a role in this evening stirs they were very important very important can you explain further yes so my wife is Norwegian okay and baking is therapy okay I cannot stop her from baking okay when she's mad at me she bakes okay she's doing it right now I guarantee it but she has experimented with all of this and she has found that she can take any recipe in any cookbook and reduce the sugar in any dessert by 1/3 1/3 and it will actually come out better it will taste better it will still rise everything will happen all the biochemical reactions in the baking process will still occur and it will taste better you can taste the chocolate you can taste the oatmeal you can taste the nuts it actually tastes better so that's this that's your your little extra added something for tonight that's right thank you rob [Applause] you

Channel: Parents & Science

Views: 66,548

Keywords: Robert Lustig, The Rockefeller University, Sugar, Parents & Science, diet

Id: rETxr9Zwx3U

Length: 88min 14sec (5294 seconds)

Published: Tue Nov 28 2017