FoodGate: The Break-in, the Cover-up, & the Aftermath

[Music] welcome tonight we're going to talk about the second biggest scandal of the 1970s and we had Watergate well this one is food gate and you'll see why this is as we as we go all right I think you're aware that we have a healthcare crisis in this country yes yes question is why so if you look at the causes of preventable disease on this slide here what you will notice is that a lot of the things that have to do with behavior are getting better for instance smoking down cholesterol down blood pressure down physical activity up we should be reaping a health benefit we're not why because obesity is up and diabetes is through the friggin roof and the question is why is that diabetes when I started medical school diabetes was for people over 65 now it's for children age 8 and the question is what in the world is going on so this paper in Lancet was written in 2000 okay and it was projecting what was going to happen around the world by the year 2010 and you look down here it says we went we were at 151 million in 2000 and it said we would reach a a prevalence of 221 million that would be an amortized increase of 3.8 percent per year what we ended up seeing was instead 285 million which was an amortized rate of eight point nine percent per year and in the next four years we saw four hundred and twelve of a million that's an amortized rate of 11.7% per year in other words the more time goes on the faster this is going w.t.f when we thought we knew what was going on so here we have the projected costs for healthcare so in red we have hospitals for green we in green we have physician costs and in purple we have blue we have Pharma clause and they don't even come close to the staggering overall costs of healthcare because all the rest is going to the care of chronic metabolic disease such as diabetes a problem is that all of the healthcare policy all of the stuff that you've heard about with ACA and Trump care and every other kind of care ignores two inconvenient truths and those truths are number one there is no medicalised prevention for chronic metabolic disease there is only treatment and those pharma companies are really happy to sell you those chronic treatments because you're gonna be on them for twenty or thirty years in fact all the pharma companies have basically abdicated the search for acute care drugs like antibiotics in favor of all of these chronic care drugs that you're going to be on forever the second inconvenient truth is you can't fix health care until you fix health and you can't fix health until you fix diet and you can't fix diet until you know what the hell is wrong and we've got it wrong and the reason was food gate so how did it start started here everybody remember this Time magazine cover yep them now the bad news right so that was 1984 and that was followed up by this Newsweek cover and this said six million kids are seriously overweight in 2001 and now it is 24 million knowing everything we know with all of the health care efforts with all of the ih funding with all the obesity programs with Michelle Obama's vegetable gardens 24 million so in order to understand this we have to understand at the D me ology we have to understand surrogate risk factors we have to understand randomized clinical trials so we're going to take those in order this was the original 1977 dietary goals for Americans okay this was the McGovern Commission this is what they told us to do with our food they said increase carbohydrate consumption now why did they say that well you got to eat something that's right and also remember carbohydrate was subsidized reduce saturated fat consumption why did they tell us to do that they said across heart disease right and then finally it says reduced sugar consumption which was a good idea except didn't happen so here's what really happened okay so you can see that the carbohydrate went up the fat as a percent went down although as a total amount it actually stayed the same because we were just eating more carbohydrate and of course obesity went through the roof and diabetes like I said just nuts so the question is was this the right remedy so we have a study now done all over the world called the pure study the prospective urban and rural epidemiology study and what it looks at is total mortality and cardiovascular disease based on the different percent of energy from the different food groups in the Left we have energy from total cap total fat and you'll notice it goes down the more fat the lower the mortality and the lower the heart disease now that is somewhat paradoxical but actually when you understand what the problem is it's not fatty a saturated fatty acids still below the line mono saturated fatty acids significantly below the line because my saturates are good and I'm not gonna argue that that is a good polyunsaturated look what's above the line carbohydrate okay this is from all over the world not just from here now everyone says saturated fat is bad and they say red meat is bad well actually red meat probably as bad but not for the reasons you think and the reason is on this slide as an example there are many studies like this looking at hazard risk ratios for heart disease based this is tied to type 2 diabetes I apologize based on consumption of red meat poultry and fish and what you'll notice is that when you control for the iron and the heme which is model 2 and model 3 the effect goes down so it might actually be the iron and the heme that's in the red meat rather than the saturated fat in the red meat because iron and him are both oxen that's oxidative stress and that does cause disease so it is possible that red meat is a bad actor but not because of the saturated fat everybody just assumed because you have to cut the stuff off the t-bone that that's what the problem was not necessarily it might have been the meat itself so take a look at this picture on the top we have Italian beef in the middle we have Argentinian beef and in the bottom we have good old USA choice beef what do you see yeah there's a lot of fat in ours isn't there us a corn-fed beef because that's what happens when you corn feed animals take a look at the Argentinian beef you know they eat twice as much beef as we do we eat 23 kilos a year they eat 44 kilos a year and they have a lower risk of heart disease than we do because they eat that beef because their cows graze in the mendoza valley any grass hours eat corn so the question is what is it about eating corn that's a problem and I will tell you that your muscles look just like that because you ate that beef so corn has high levels of branched chain amino acids leucine isoleucine and valine and when the liver usual utilizes those for energy it has to take the amino group off and it then goes straight into the Krebs cycle ends up promoting liver fat accumulation in the liver which then gets exported out to the muscle and this study done by Chris new guard over there in the upper left shows that as the branch chain amino acids go up so does insulin resistance that means heart disease and diabetes and that's the pathway that it takes there on the bottom left and over here is yet another potential reason why our red meat is particularly bad because it has a lot of choline so choline is an important part of muscle like stl choline it's a part of a neurotransmitter you have to eat it's also part of phosphatidyl choline which helps you transport lipids bacteria in your intestine break choline down to something called trimethylamine which then gets oxidized to something called trimethylamine oxide TMAO which has actually been shown to be the stickiest most inflammatory substance that we actually have in our bodies this is work from stanley Hazen at the Cleveland Clinic so it is entirely possible that red meat is a bad actor but not necessarily because of the saturated fat so we have to be clear about what we're really talking about here and saturated fat also includes something else is called dairy it turns out that dairy is protective against diabetes and heart disease the reason is because dairy has different saturated fat than red meat does red meat has even chained 16 or 18 carbon saturated fat like palmitate or stearate whereas dairy saturated fat has odd chain C 15 or C 17 okay what you can see down here is plum in oleic acid which is a good you can see that the risk ratio goes down for all of those because it turns out that very saturated fat is protective but when you put red meat saturated fat and dairy saturated fat together and just call it saturated fat you're missing the point so everyone's scared of saturated fat and they're still saying it so let's look at surrogate markers now okay everybody thinks LVL is a bad guy who here thinks LDL is a bad guy that's so bad so if you look at the Diamonds here okay you'll notice that's the hazard risk ratio of high LDL for heart disease is at 1.3 the public health officials say that that is the lower limit threshold for it to be a public health issue at one point three so it just makes it so if it was one point two nine it would be like so what but at one point three all right maybe a little bit of a problem I think it turns out if you take all the people who are under sixty out of the analysis and just look at people ages 60 to 95 turns out LDL levels correlate with longevity so when you take the people with genetic reasons out who are gonna get their heart disease early LDL levels actually predict living longer not living shorter so how do you explain that turns out there's a much better way to assess risk and it's with something called serum triglyceride now the reason you don't know much about serum triglyceride is because number one you have to draw it fasting for a demeaning thing and a lot of people don't get their blood fasting and number two we didn't have a method for reducing triglyceride the pharma companies couldn't sell it to you because they didn't have it until about ten twelve years ago but they did have statins they had statins in 1987 and they wanted you to have statins and they still want you to have statins it turns out when you do them math and the hazard risk ratio for triglyceride turns out that the hazardous ratio is one point eight way more important than an LDL level of 1.3 that turns out there are different kinds of lipids in your bloodstream over there the big one on the left is called chylomicrons those are the fats that you absorb through your lymphatic system after you've eaten a meal they're mega and they go to your liver and then the liver turns out these other ones the one that we're concerned with is the one called VLDL very low density lipoprotein that is your serum triglyceride for all intents and purposes and only your liver makes VLDL and the question is what does it make it out of because it turns out that's the bad guy in this story much more so than LDL and I'll show you why because there's not one LDL there are two okay and you have to understand these two in order to understand why LDL is not the bad actor that everybody said it was so in this slide you're looking at the probability of event free survival on the y axis and what you'll notice is that your LDL cholesterol can be high or low it's not your LDL cholesterol that matters it's your LDL particle number so think of it this way okay you can have little cookies or you can have big cookies okay you can have twice as many little cookies or you can have half as many big cookies it turns out the big cookies the big large buoyant LDL are not so bad and the reason is because they're large they don't get under the surface of the endothelial cell your arteries to start the plaque formation process and their buoyant they float so the bloodstream carries them along and they don't have a chance to set up the plaques the bad guys are the little cookies the small dense LDLs they're small they can get under the surface they're dense they sink so they come out of laminar flow through the arteries they are the bad guys and this kind of data shows that it's the little guys that matter so when you do the electrophoresis of these different lipids through the bloodstream you can get what's on the top there that's lvl that big hump there and you can have large buoyant ones so that's called pattern a and down here you can also you can see they're stretched out more and they're also measured in the LDL fraction those are small dense those are pattern v so what you want to know is okay which one do I have how do you figure it out since they're both measured when you measure LDL it turns out 80% of your LDL is the large buoyant 20% is the small dense that's the one that's going to kill you so you want to know how much of that LDL you got that little one so how do you figure it out you got to look at the triglyceride so it turns out when you're high triglycerides when your LDL is high if you have high triglyceride and low HDL that's in this box here that's pattern B so you can't look at LDL levels in a vacuum looking at an LDL number and saying you're in good shape or not is garbage useless worse than useless in fact detrimental because it will lead you into a false sense of security what you have to do is look at the pattern and the problem is that all of the associations only give guidelines for thresholds which is why we are in such a mess now how about randomized clinical trials what do they say well we all went low-fat right because we were told to eat less saturated fats or low-fat guess what no effect no effect in the Women's Health Initiative not a thing nada it turns out that when you try to lower LDL cholesterol randomized control trials of 41 studies of drugs and three dietary interventions showed no overall benefit on mortality and most of these trials did not reduce cardiovascular events and some of the drug studies actually reported harm because there's a whole hidden literature on statins and rhabdomyolysis so if you want to know what's going on in diet don't ask a doctor who should you ask ask somebody who doesn't have a horse in the race how about the banks now the banks are completely transparent they only have one goal make money okay and they'll tell you so they only care about making money and that's good because they li can analyze the data with a clear eye without rose-colored glasses and report on exactly what's truly going on and so this report came out from the Credit Suisse Research Institute that the new health paradigm and here's what it said a high intake of omega-6 fats vegetable oils has not been proven as beneficial to our health and trans fats have been shown to have negative health effects the higher intake of vegetable oils and the increase in carbohydrate consumption in the last 30 or 40 years are the two leading factors behind the high rates of obesity and metabolic syndrome in the United States saturated and monounsaturated fats are not 100% correct absolutely correct I stand by I didn't have nothing to do with this okay but I might I could have said it but they said it okay and they said it better than I could okay they got it right and you know what some doctors are coming along so this was an editorial written by my colleague assy Malhotra who's a member of the NHS Health Trust in the UK along with Rita red Berg who is a physician right here at UCSF who happens to be the editor-in-chief of JAMA internal medicine and Pascal Meyer at in chief of BMJ open-heart not exactly lightweights who said saturated fat does not clog the arteries coronary heart disease is a chronic inflammatory condition the risk of which can be effectively reduced from healthy lifestyle interventions like what like getting rid of excess sugar and carbohydrate except that's what we were told to eat more of food gate refined carbohydrate yes refined carbohydrate you're right refined carbohydrate so it's the word refined that sorry about that you're right the problem is there are a whole bunch of other doctors saying otherwise so this just appeared on my screen about three days ago so the ketogenic diet sure it'll cause you to lose weight in the short term but so with cholera or cocaine binge that doesn't mean it's a good idea observe dr. David Katz at the 7th international congress on vegetarian nutrition there is more than one way to eat badly and the American public is committed to exploring the mall that's the only sentence that he got right okay excuse my french zcz okay and I'll tell you why is because this is the bad guy okay and that's the thing that no one's talking about except now we are because of the work we've done here at UCSF my colleagues here and I okay this is the reason fatty liver disease so over here we have a normal liver on the left and over here we have fatty liver disease all those fat vacuoles and macrophages and the beginning of scarring this is not good here's a way to look at this this is called an MRI fat fraction map and what you see here is an obese person see the love handles on the side but I want you to take a look at this guy's the liver nice and dark 2.6 percent fat this is good this is a metabolically healthy obese person this person will live a normal life diet a normal age not cost the taxpayer dime not get diabetes not get heart disease okay he's just fat now this is what you more normally would expect this is metabolic syndrome this is fat and take a look at this guy's liver 24% liver fat that guy's got a problem okay and now over here you have a thin person notice no love handles but take a look at that guy's liver 23% this guy's just as sick as that guy okay thin sick fat sick fat healthy so my question to you is which are you do you know how would you know how could you know what your doctor no we're gonna explain we've done some studies here one of which is gotten a lot of press New York Times Washington Post what we did was we took 43 kids from our clinic here at UCSF who were high sugar consumers who had metabolic syndrome and we removed the sugar from their diet and substituted it with starch over ten days and what we did was we took their fatty liver they see it's in brown or orange because it's fatty okay we took nine days of sugar restriction and substituted starch so we took the pastries out we put the bagels in okay got the idea okay no change in weight and we cleared their liver fat their liver stopped making those vldls okay and their insulin kinetics from their pancreas did better we reversed their metabolic disease just by getting rid of the sugar so we now have causation causation for sugar and for diseases diabetes heart disease fatty liver disease and tooth decay we have correlation indirect data on cancer and dementia we're working on those we don't we can't say conclusively that those are causative yet and I wrote this article last year called processed food an experiment that failed and the reason is because processed food is high sugar low fiber high sugar for palatability low fiber for shelf-life but the fiber is what reduces the absorption of that sugar so fruit is okay but fruit juice is not real food is low sugar high fiber all diets that work are real food and this proves it because this came out just two weeks ago from Stanford Chris Gardner's diet fits study where they put people on a low-carb healthy diet or a low-fat Hill the diet and they both lost equal amounts of weight and they looked exactly like each other the one thing they didn't eat was processed carbohydrate and sugar because they ate real food real food works processed food doesn't but that's not what the food industry is selling moving on with food gate ok so my job tonight is to talk about the cover up side of the story and to do that I like to start off with a little bit of background on how I got to UCSF in the first place and I received this brochure in 2007 at a dental conference so I'm a dentist I was looking at ways to get physicians and dentists to work together to manage diabetic patients when I worked for Kaiser and so this conference was all about looking at the links between gum disease and diabetes so I was really excited to go so this brochure was given to me by someone from the CDC who was there to talk to us about our national diabetes education program and I opened it up and looked at the dietary advice and it said that increasing fiber and limiting saturated fats and salt will help control blood glucose blood pressure and cholesterol but it didn't say anything about reducing sugar consumption which I found strange since we were talking about diabetes after all there was another speaker at this conference and he handed out this book the stop-and-go guide for fast food and he I flipped open to the page on the drinks so how can you pick a healthy drink if you're eating fast food and I noticed that Lipton brisk sweet tea got a green light and it has something like 65 grams of sugar in it and I was sitting at the back of the ballroom and I noticed the the guy he was getting up to try and go catch his flight and actually jumped up and chased him down and said how can you possibly say you know sweet tea is healthy and his response was there is no evidence linking sugar to chronic disease and I was literally speechless I couldn't even say a word and he just turned turn around and walked out the door so I went home you know after my day job and just started wondering you know what is going on did I miss something about diabetes when I was in dental school you know I started digging out my old textbooks eventually I started wanting to know about the sugar industry and wondering if they had something to do with this so this is actually a screenshot from the sugar association's website back in 2007 and when I looked at it it said they were boasting a thousand number a thousand is the number of scientific papers dispelling sugar of the links to diabetes hypertension behavior problems and obesity and then they listed these government and institutional reports that were apparently exonerating the link between sugar in these diseases and again I was just flabbergasted and didn't understand what was going on so I started to learn more about the sugar industry in their tree groups and who these guys are I'd heard a lot about high fructose corn syrup that was getting a lot of attention at the time but I realized that the cane and beet sugar producers have actually been in the game for quite a long time you know high fructose corn syrup and get popular until the 1970s but cane sugars been around for for centuries so in the yellow that's where we make corn and corn sweeteners in this country the green is where we actually raised sugar beets and the red is where we grow sugar cane and the sugar Association which is the trade group that represents cane and beet sugar growers and manufacturers has a long history it dates back to 1943 and really it goes back further than that but 1943 is when the cane and beet sugar company started working together and so the sugar Association is the big group in the US but then there's also an international version called the world sugar research organization based in London and where you see a flag on this map is where they're each owned each country has their own version of the sugar Association and so it's a global organization connected through to the world sugar organization in London and then you also notice that coca-cola and another group called the Internet life sciences Institute are also connected into these sugar trade groups and we consider the sugar Association to be a 501 C 6 group according to the IRS you could actually look up there are tax documents online if you're curious I would recommend it if you're interested in the subject we treat them as a business league it's perfectly legal for them to work together and promote sugar consumption and you know their program services they work with scientists to spread their message that sugar is healthy they have sophisticated public relations programs and education programs and they work to influence public policy so I started collecting books from the library believe it or not the sugar Research Foundation you could type that into your local library catalog and it will bring up over a hundred books published by the sugar Research Foundation and so I started to get a sense for who this group was and this one book in particular listed all of the sugar industries research projects from between 1943 and 1972 so these were the types of projects they were looking at nutrition cardiovascular disease tooth decay diabetes the number of projects that they had funded between 1943 and 1972 and then the number of scientific publications that came out of these projects so I was starting to get the picture that this group has probably had quite a bit of influence on our public health policy so one day I was in Denver at the time I went to my local Denver Public Library to pick up one of these books and I typed sugar into the local library catalog and I noticed a reference to the Great Western sugar company and the Great Western sugar company had been located in Denver a sugar beet company they went out of business in the 1970s and they actually donated some of their records to local libraries all up and down Colorado sugar beets had been a major crop and so there was interest in agricultural issues and labor issues but somehow a few boxes on nutrition policy slip past the lawyers screening and ended up in Colorado State University so I noticed that there were some references to nutrition policy and so I went up to colors Colorado States in those files and the first thing I found was a confidential memo this is the exact one the first one I saw with the letterhead of the sugar Association and what I'd stumbled upon were documents supporting the sugar industry's public relations award that they received in 1976 so couldn't believe that I found it but I did so here is an example of what was in there so I had board of directors memos documents financial statements list of all the research projects funded and then here's a key quote from one of the board of directors reports the fact that no confirmed scientific evidence links sugar to the deck dealing diseases is the lifeblood of the sugar Association so now that advice I got from that brochure at that dental conference was starting to make a little more sense so I actually teamed up with Gary Taubes who's a science writer very involved in this area and we wrote an article together back in 2012 that came out and Mother Jones but I knew about UCSF and I knew about this guy who's Stan Glantz I don't know if any of you know him but he's been a major figure in taking on the tobacco industry and here at UCSF we have something called the industry documents library where we actually have 90 million pages of tobacco industry documents online and available to researchers and I knew that the sugar industry had been up to very many similar things and so I wanted to come to UCSF to learn how to do document analysis and that's what brought me here so because I'm a dentist I was very interested in obviously the tooth decay issues so one of the first things I looked at was what were they doing on tooth decay and in 1950 there are pretty clearly stating their position that the aim of the foundation and dental research has been to discover effective means of controlling tooth decay by methods other than restricting carbohydrate intake so they were doing things like trying to discover a vaccine for tooth decay creating enzymes that we could maybe put into our toothpaste or even to our foods that would break up the plaque on your teeth so you could keep eating sugar but have a plaque busting toothpaste it didn't work but they're still trying another really interesting thing so knowing about the the tobacco industry documents I started wondering what what might be in the tobacco industry documents about the sugar industry and so I actually found that the president of the sugar Research Foundation from 1943 went on to work for the tobacco industry so this is a letter that he wrote in 1954 1954 it was the year the tobacco companies announced in the newspapers that they were the good guys and trying to solve the problem between smoking and health that they were going to do the right thing and so he wrote them a letter telling them ten years ago a very similar organization the sugar Research Foundation was formed to investigate charges that refined sugar is a primary cause of diabetes tooth decay polio B vitamin deficiencies and obesity I organized and directed research projects in medical schools hospitals universities and colleges which exonerated sugar of most of the charges that have been laid against it and he wanted them to hire him to do the same thing for tobacco and they did he went to work for tobacco became their associate scientific director so could it be that the tobacco industry learned from the sugar industry this is a snippet from a document in 1954 where the industry began to see an economic opportunity in the low-fat diet advice that was becoming popular back in the 50s this is the president of the sugar Research Foundation talking to his sugar beet technologists saying if the American public switched to a low-fat diet this change would mean an increase in the per capita consumption of sugar by more than a third and they paid attention to what the American public was thinking about sugar versus fat in 1965 there was a surge in media attention and they clipped a full page article that was in the New York Herald Tribune which was a competitor to the New York Times that talked about that it may be to the sugar that you eat rather than or in addition to the type of fat in your diet that increases your risk of heart attack and that up to now the sugar hypothesis had been mainly theoretical supported by only a few studies and this was the trigger that God the sugar Research Foundation to start funding their own heart disease research program back in the 1960s to take on this media attention and to counter it they were particularly concerned about triglycerides which Rob was just telling us about that link between sugar and triglycerides is what this article in the Tribune was about one of the first things they did when are their first heart disease research projects they engage scientists from Harvard at their School of Public Health and had them write a literature review looking at the evidence linking sugar and fat versus the evidence linking sugar and heart disease and as you would imagine it came out in favor of the sugar industry and we did it we did an analysis on this paper which took about a year of my life but really showed the bias that's in this this study it's clearly a biased evaluation if you ever have any interest I have about a twenty page supplement that can explain it to you but much more than we need to go into tonight but this review was published in the New England Journal of Medicine high credibility obviously the journal the Harvard scientists and interestingly the paper did disclose some industry funding but it did not disclose the sugar Research Foundation funding so that's one example that was just their first project we've also written about their next heart disease project that they took on which was a study in rats so interestingly the review had discredited animal studies for having any relevance to humans and then the sugar industry went on to fund their own study in rats and they were looking at the difference between rats that had bacteria in their gut versus rats that didn't have bacteria in their gut and then they were feeding them sugar to see if it had made any difference to the triglyceride level in the blood and in fact it did and so here is the the scientist writing to the sugar industry saying of interest are the human implications of this work it could be that those people showing extreme sucrose induced Hyperlite Kimia which is another word for hydric high triglycerides are harboring an atypical intestinal flora so they did this study they got the the preliminary results and then they terminated the funding for the study it didn't get completed and it never got published so again this is another one that we've written up but it demonstrates that the industry was actually getting an idea of the mechanisms behind how sugar leads to high triglycerides going all the way back to the 1960s and early 1970s and not letting on that they knew again going back to a tooth decay example of how they influenced policy in 1970s our National Institute of dental research there was an article in New York Times saying we're going to halt tooth decay within a decade we came out with this big plan on research priorities well the sugar industry work to influence that plan one of the things that they did among many was to submit their own report their own review of what they thought the research priority should be for a tooth decay program and I compared that to the research priorities of the National Institute for dental research and 78 percent of that report went in to our national priorities for dental research and I mentioned those enzymes and that dental caries vaccine and all those research priorities that the industry was cooking up to take our eye off sugar one of them also was phosphates and so here's a quote from the the sugar report that says but since it's not practicable to replace sucrose in our diet can anything be added to mitigate it scary janessa T which is mean meaning getting rid of tooth decay the point is that language is exactly the same if it's not practical to replace sucrose and our diet can anything be added to the diet to mitigate as carriage Anissa T so our dental Research Institute nearly verbatim took the sugar industry's priorities related to tooth decay and then finally another example is the impact of this 1976 public relations award that the industry was given the silver anvil is like getting an Oscar if you're doing public relations and the main target of that PR campaign was our very first review done by the Food and Drug Administration looking at the safety of sugar which happened in nineteen seventy-six and in the application the industry boasted that the report had been highly supportive making it unlikely that sugar would be subject to legislative restriction in the coming years and so I'm working on a paper right now that I'd go into a lot more detail about what was behind that public relations campaign but they a very sophisticated campaign to influence this report and then finally bringing it up to the present we actually have had something historic happen even though those dietary goals and in the 1970s talked about talked about reducing sugar consumption every subsequent Dietary Guidelines since then then ignored that goal and had very wishy-washy language about reducing sugar moderate your consumption they were avoiding any type of quantitative concrete limit and that changed with our 2015 Dietary Guidelines they actually implemented a concrete limit saying we shouldn't eat more than 10 percent of our daily calories from added sugars but the sugar Association is still up to their old tricks they're still funding research and this is an article in a trade publication where the new president of the sugar Association is encouraging their members that they're going to keep up the fight we're gonna make sure that that 10% limit doesn't stick their reasoning is that sugar makes many healthful foods palatable which helps contribute to increase intakes of many essential vitamins and minerals the 10% recommendation for added sugars would bring our intake to levels we haven't seen in the American diet since nutrient deficiencies were a major public health concern so if we adhere to that we're going to see major nutritional vitamin deficiencies that's so logic it's funny however they are powerful they have a six million dollar budget this year they've already been funding scientific research and supplements they're lobbying they are have their eye on our 2020 Dietary Guidelines to try and get that guideline removed so it's something that we need to be vigilant of and with that I'm going to pass it off to Laura for our final segment so I'm in charge of the aftermath now that whole food gate idea was Rob's idea when I said well what should I talk about he said talk about the call to justice after the cover up the call to justice what brought it unfortunately I'm not really ready yet to talk about the call to justice I can talk about some hopeful things that are going on in the world today around this whole issue of sugar in our diet so I'm going to try to share with you a little bit about how the research you just heard about on metabolic disease on obesity and on industry documents research and the sugar Association and I'm mainly going to focus on the soda companies here because they're in the eye of the storm how that has affected our public policy discussions around nutrition and health and the rising rates of obesity and chronic disease worldwide and I'm gonna talk a little bit about the tobacco experience because it's so relevant to what we're seeing in the world right now so the current focus of the policy debate and I'm not just talking about in the bay area I'm not just talking about in California the United States I'm talking global we are seeing rising rates of obesity and diabetes all over the world developing countries developed countries and a lot of the flashpoint at this point in the in the debate is around soda and a lot of the time the soda industry says why us why are you picking on us and well because they're the first first part of the problem well the public health community is going to be moving forward into thinking about junk food and we're already seeing in some parts of the country like the Navajo Nation which has a soda tax they've created a fat tax so they're also taxing processed food and that's also happening internationally but right now the focus on soda is really largely driven by the fact that this is the main source of added sugars in our diet it's about 36 of the daily calories we consume and sugar is coming in the form of soda and sugary drinks so it's low-hanging fruit from a public health standpoint it also these are products that have virtually no nutritional value they have nutritional they have addictive substances added originally coke had cocaine now it has a lot of caffeine there's a debate that you'll be hearing about later in this series on the addictive properties of sugar potentially and of course research regardless of what the industry says and they can continue to maintain not just the sugar Association but the soda companies as well maintain that their science shows their products have no relationship whatsoever to weight gain obesity diabetes anything bad in our in our nutritional landscape so that's why soda so I think the debates and the way this debate is shaping up right now has a lot of parallels with the tobacco story and it's easy to forget that back in the 50s and the 60s everybody smoked it was absolutely normative even buying cigarettes and smoking in the hospital bed we're in a medical school here they were selling cigarettes crazy and and today we just take our clean air for granted right you know we think about we go on an airplane we don't think about having been suffocated the way we used to be but smoke we don't go into a hospital wondering where the cigarette machine is right we just take this all for granted and so the norms have completely shifted and in from a sociological standpoint in not that much time norms change slowly culture changes slowly but it has been literally decades that we've seen this come about and so just like seatbelts and cars seatbelts and airbags and cars motorcycle helmets what this is about is getting basic public health protections in place and in each of these areas including tobacco it was a huge public health battle at the time and that's what I think is going on right now around sugar we're in the beginning stages of that kind of a knock-down drag-out public health battle now this is the kind of picture that epidemiologists all around the world would hope to someday live long enough to be able to see this for the obesity epidemic for the diabetes epidemic the black line shows you rising tobacco consumption in the United States writer in 1964 the Surgeon General issued a report that said hey people wake up this smoking causes cancer that got publicized and by the 70s you start to see the decline in a precipitous decline in tobacco consumption and a couple years later the blue is men the reddest females you're seeing the death rate this is two decades later the death rate for lung cancer starts to plummet right so this is what we want to see to happen with sugar and with with junk food and with obesity and with diabetes we want to see that kind of a curve so how did they do it how did we do the tobacco war is what they called it right I view this I've unpacked this history and I think there are basically four steps in the process and you need science like the science that Rob presented you need unbiased science you need industry documents work like the stuff that Kristin's doing in order to make this process go so the first thing is public health officials who aren't afraid they stand up in the case of tobacco it was the Surgeon General and a committee that bucked the trend we don't care if everybody's smoking we don't care if this there's a powerful lobby here we're gonna tell the truth and they they compiled the science and this report is credited as really being a linchpin in the tobacco 's debate the second thing has to do with taxation this is what we're starting to see right now in countries around the world and in the Bay Area with soda taxes taxes on on cigarettes they they trigger what I call a virtuous cycle of policymaking because they accumulate money they on the one hand they can discourage people from buying the product but in some ways what's more important is that they that they give government's money that they can pour into say lung cancer prevention and what's what's happening right now is the beverage industry is claiming that the taxes on soda are too small to make a difference but this is exactly what happened with tobacco and at first they were very small and now in some states these ones in red you have to pay four dollars in tax just to buy a pack of cigarettes so we're now at the point where most people who smoke wish they didn't this is partly why and so and by the way even a small tax so Mexico has a soda tax that's half of what's recommended by most of the expert committees and they saw in their first year initially a six percent decline in soda sales and by the end of that year a 12% decline and that's where the tax that's supposed to not even be all that large so the taxes start small and then governments start to raise them and ultimately in the food in the food fight we're likely to see the taxes go into junk foods and processed foods I mean that would be the trajectory from a public health standpoint we'd like to see now where do those tax dollars go one of the most important things that we do with them is public education and this is a good example of the kind of vivid graphic image that you got in the counter advertising campaigns around tobacco cessation this is a and I'm going to show you some examples from our Sugar's story the other thing the the government's can do with the tax money is roll out warning labels these are some very graphic images the tobacco lobby was able to oppose their use in the United States but all of the research shows that graphic images images that are large on the container make a difference in shaping people's consumption behavior and then finally the the penultimate thing that happened with tobacco was we got the first un global treaty to protect public health 181 countries signed on to the convention treaty the for tobacco control and it was passed in 2003 and this is a piece of legislation that in acts universal public health controls all around the world just the basic package of stuff we need to prevent disease taxation warning labels counter advertising plain packaging that kind of thing so that's the tobacco story that's how we got this this wonderful thing that we're hoping we can see with the obesity crisis and and so where are we at now if we were to imagine that this was what's going on with the obesity epidemic diabetes epidemic we're probably in around 1970 we've started to see a decline in soda consumption it peaked in the 1990s and we're now down 25% so we're already on the downhill of the consumption curve it's gonna probably take some time before we start to see dramatic that see that tipping point in the disease profiles we haven't started seeing it for obesity yet but we have for diabetes we've started started to see that the diabetes incidence rate is going down so this is so this is very helpful the other thing we're seeing is sugary beverage taxes and if people are interested I'm in the eye of the vortex around soda taxes so if you're ever interested in knowing about it I can tell you a lot about it from the inside currently we've got eight US localities that have a soda tax but globally look at that 30 countries now so this is where the momentum is taking off and this is no different from tobacco the u.s. is the last to sign on we still haven't formally signed on to the convention treaty officially because we produce the stuff right and then we export it around the world so we're the last to go the other thing we're starting to see are the kinds of graphic counter advertising campaigns this is this wonderful I would have shown you the commercial if I had time but it's called man drinking fat and basically the New York City Health Department put globules of fat into a coke can and you just watch the guy drink it down but this is the kind of graphic image we know from research this is what grabs people's eyes and it changes the norms right it makes people think twice before they reach for that product and then we're also seen in our own city of San Francisco the first warning label on soda warning label legislation to pass this unfortunately was passed in 2016 the American Beverage Association the trade organization for the soda companies quickly sued our city and currently it's hung up in the courts one of the issues they have with it in their lawyers is the size of the warning label right and I mentioned this is actually the coca-cola sign right when you're driving in on the freeway this is what it would look like if this if our city was able to actually implement the law that it passed now I just want to really reinforce and I can't tell you too many stories from the field but what a big battle this is for public health advocates and for groups within civil society that are taking this on this is not it is no small matter the New York Times featured this case recently of a Colombian she's actually a physician and she runs a consumer rights organization in Colombia and her group dared to educate the public about the hazards of sugar and soda what happened to her was she was threatened she was harassed she was physically threatened and ultimately her government censured her whole organization so that she's no longer able to speak about the health risks associated with sugar consumption so this is and while the the New York Times journalists weren't able to get anybody from the industry to own up to being involved the Columbia invert arm of the the beverage Association didn't say they didn't have anything to do with it this is bringing it home this is a little excerpt from an email that showed up in the remember the Hillary Clinton DC leaks documents well her aide had a little side gig working for coca-cola and so we courtesy of this we got about 300 documents on the coca-cola corporation I'm going to focus a little more on coke here because they are the largest they own about 30 they own 31% of the global market share in sugary beverages so they are the leader in the market and and the DC leaks documents this one showed up there were some actually about colleagues of mine that got trailed when they were going around and giving talks about food politics and so forth but this is one on the our own San Francisco and Oakland soda taxes Assemblyman bloom put a state of California tax and they what you can see here in red as they are alerting each other to the fact that they are following this these taxes this document is pages and pages every tax anywhere Russia anywhere that there was a consideration of a government even deliberating you would see a report on what we're doing in Oakland the coalition ground work is underway in Oakland to build early opposition to the potential beverage tax proposal before they even announced they were going to put it a ballot a measure out there in Oakland so these are these are hard won battles by public health advocates and of course they're outgunned right these companies have a lot of money in in San Francisco in Oakland alone they spent 31 million dollars trying to convince us that we shouldn't vote for soda taxes in one election so we're seeing some encouraging trends we're seeing the beginning of what I am hoping is a virtuous cycle like what we saw with tobacco but we're still we're still a long way off from having solved that the the situation and the cover-up definitely continues so in this last part I just want to talk a little bit about how these companies and I'm gonna have mainly focus on coke I'll leave Pepsi alone for tonight but and and how they're reacting to this situation so this is a quote from 2007 as Rob showed the obesity epidemic was in full force by then and this is a marketing executive our Achilles heel is the discussion about obesity it's gone from a small manageable put us issue to a huge global issue it dilutes our marketing and works against us it's a huge huge issue now what's interesting about this quote and others there are others like it and some of the documents we have is that if you were to look at the forward-facing corporate response to the city to the obesity epidemic you'd see a much kinder friendlier kind of approach and in fact the CEO of current CEO of coke right there we must grow with conscience grow our business with conscience we we need to grow it the right way and the and really at this point the company is is trying to get us to believe that they are mainly interested in being part of the solution rather than part of the problem and so they're they're reformulating into smaller package sizes they're marketing more water they've dramatically expanded their their beverage offerings beyond just the red can and they're coming up with these wonderful products like anybody try to coke life I it's it's a well you can see it's green it's in a you know it's it's really good for you right it's really increases your life right it's actually it's it's not sweetened with high fructose corn syrup like most coke here is right it's got a combination of beautiful healthy weight cane and beet sugar which is way better than high-fructose corn syrup and with a plant extract stevia or leaf extract sometimes they talk about it right this is more more commonly referred to as health washing so here's the cover up part this is actually another one of these documents that came out of the DC leaks and this is actually Coca Cola's European game plan for doing everything they possibly can to forestall or make public health regulations that we know would work go away and so on that on the y-axis you've got the business impact what how much they think it's gonna affect their bottom line and then on the x-axis you've got their best guessed at whether this is really gonna happen so things like taxation the view is very likely and we need to fight back some of the other you know like public procurement you know there are a lot of different approaches I mean they came they are following some public health regulations that I don't even know I didn't even know existed but our potential ones like mandus mandatory recycling and but those are things they're monitoring now they're fight back piece they never say we're fight you were fighting back what we get is is this persona right they do it all through the International Beverage Association it looks a lot like the sugar Association it's all over the world and in the States the American Beverage Association the other thing that they've done is they've as I mentioned they continue to deny that there's any connection between soda and sugar and weight gain or obesity and they have plenty of industry-funded science to make their case right these are scientists who are paid for by the industry to produce bad science like Kristen was explaining what they're doing right now is they're promoting the idea that we can drink all the soda we want as long as we just exercise it away you guys know how many calories you burn on a on a on a treadmill for a couple hours right it's probably not even a Rob would be able to tell us it's not much so it's so our products can be part of an active healthy lifestyle it's our problem we just we don't move around enough sensible and balanced diet regular physical activity and the focus is on calories the very issue that Rob is pointing out is not really the big concern it's not so much the calories it's other things that sugar does to the liver and so forth same with the American Beverage Association it has its balance calories initiative and this anybody recognize her she was running our Centers for Disease Control and Prevention within of HHS she just stepped down in January Brenda Fitzgerald because she was caught buying tobacco stock after having taken over her role running our main Public Health Protection Agency so her what'd she think so this is all off the coke website solving childhood obesity requires movement those kids it's all their fault they're lazy the other thing that they're doing is what they call transparency initiatives this is industry-wide but this is an example from coke what here what they do courtesy of people like Kristin who have gotten them on the defensive about paying off scientists and dental organizations and health organizations they said okay we'll just come clean and we'll just put on our website all the organizations and individuals that we pay for and we won't stop paying them but we'll be transparent about where we're putting our dollars and this is a who's who of in the public health world and then finally as as Kristen mentioned they still are working through these front groups she mentioned ill see International Life Sciences Institute this is a global organization its mission you'd never know that they were funded by the tobacco and beverages so corporations bringing scientists together to improve environmental sustainability and human health what's wrong with that they're very there's not much transparency there so to sum up from our panel first we heard from Rob about medical research and that it suggests that excessive sugar consumption is uniquely harmful to health not just the cat above and beyond the calories in the in the sugary products Kristen shared a little bit about the sugar and beverage industries and how influential they are in nutrition science and then finally I kind of brought it home to talk about how that evidence from the medical research and from the industry documents has played such an important role in cueing us up for a global conversation about what we're gonna do about obesity and cardio metabolic disease thank you the question was can we talk about the benefits of stevia and the answer is no we can't we can talk about it but there are no documented benefits as of yet here's the problem we have the pharmacodynamics for stevia it doesn't hurt you in terms of the chemical Roberta site a is not dangerous it passes through your urine doesn't seem to do anything other than be sweet here's the problem you put something sweet on the tongue message goes tongue to brain sugar bolus is coming message goes brain to pancreas sugar balls is coming get ready to release the insulin but then the sugar bolus never comes because it was stevia what does the pay increase do does it go this I'll just wait till tomorrow or does it go you know I got all these insulin vesicles sitting here ready to explode into the bloodstream I'm gonna go find me some calories to work on and you end up overeating there you end up overeating overeating sorry potentially or just extra calories because insulin drives food intake so right now there are four studies that I know of that are acute studies not long-term chronic studies but acute studies that suggest that by adding stevia at least acutely you end up overeating later so it may not be a benefit after all but we don't know that yet if you go to UCSF sugar Science org you can find some reviews and people have asked this question when our medical librarian looked at the literature it was all funded by producers of stevia and so we we that's why we have to be agnostic on the issue until independent scientists start doing the studies it's we're what we can say you were showing slide if you nope again there's you if you paid him $1,300 for an MRI of your liver and you could look but that's what it would take and there ain't no insurance company that's going to do that so what we do in our clinic and works for adults as well as children fasting insulin fasting glucose and hemoglobin a1c are the last things to change that's what your doctor knows to order they're the last things to change if they're already high the horses out of the barn so fasting insulin alt alanine aminotransferase it's a measure of liver fat it's as proxy for liver fat uric acid which is a proxy for sugar consumption and most importantly lipid the fasting lipid profile specifically focusing on the triglyceride to HDL ratio which it tells you whether or not those LDL particles are small dense or large buoyant what about it absolutely so sugar and alcohol have exactly the same biochemical profile in the liver and that's why children are getting the diseases of alcohol without alcohol type 2 diabetes and fatty liver disease were the diseases of alcoholics before they were the diseases of 13 year olds okay and the reason is because sugar and alcohol metabolize the same way in the liver the difference sorry what do you mean I don't understand the question so if you you mean if you consume captain and coke would you consume the captain before the coke metabolize is that what you mean I know what you mean they come together the point is the point is that for alcohol the yeast does the first step for sugar we do our own first step but after that the mitochondria and your liver don't care where it comes from and so ultimately sugar alcohol same thing and that's why kids get these diseases today yes so the question is really around the cot the high cost of eating healthy diet and what do we do about that and one strategy is to raise the cost of an unhealthy diet and ideally when you're doing that you're collecting tax dollars that you then devote to getting to in one way or another lowering the cost of a healthy diet so at least getting people access to food food repurposing programs there are a lot of different ways that you can do it but you need money to it especially these days to implement those kinds of policies and that's why taxation is such a wonderful first step in this cycle of Public Health improve regulations I'm gonna add to that okay the tax is actually the third tax the first tax is the subsidy the subsidy for the problematic foods the commodity foods because when you when you subsidize one thing that means you have to tax everything else in order to make break even number two is the fee you pay every time you go see the doctor for obesity related health services whether you're obese or not that's a tax whether you want to call it or not and number three is the tax on the soft drink itself you could wipe all three of those out by just getting rid of the subsidies in the first place so the Giannini foundation at UC Berkeley model that questions what would food prices look like if we got rid of all food subsidies because there's no economist on the planet who believes in food subsidies because they distort the market so if you actually got rid of them the only reason we have them is because this idiot thing called the farm bill which made sense in 1933 and doesn't make sense today but you got rid of that what would happen to the price of food and the answer is nothing except two items which will go up corn and sugar and that's exactly what we want so the question was about food stamps and how that relates to purchasing sugary beverages and sweetened things that type of thing potato chips well I mean that gets to kind of the subsidy issue and and where we put our dollars related to our our policies or nutrition policies and efforts to try and limit food stamp purchases so that you couldn't apply those to sugary beverages have not been successful they've been blocked so there's there's power keeping that from being implemented in the food stamp program just like there's power keeping those subsidies going one of the really disturbing policy agendas it's currently being floated at the federal level is the idea of giving people a box of food under snap this is America's harvest box they called it and in the our our country does not have a good track record in that department we have a very bad track record in that department in giving boxes of food and it would be a box of processed junk and one of the many real concerning policy issues being floated at the federal level right now well we sort of answered that before the answers it doesn't fit it Yeah right the people who people with diabetes think they're doing a great thing by drinking diet soda except that all the studies show that diet soda consumption correlates with metabolic syndrome and diabetes too now the problem is directionality with these studies because their correlation not causation so is it that diet soda causes diabetes or is it the diabetics drink diet soda as an attempt to try to modulate their circuit consumption and the question is does it and the answer to that is no it doesn't make a difference they still consume just as much I want to point out one thing about the artificial sweeteners so my dad for example is diabetic and raising the South that loves sweet tea every Christmas he makes Russian tea for the family he started using Splenda to Sweden that Russian tea and you buy the bag in the grocery store that's you know like like real sugar would be you get a cup of it and you pour it in I had to point out to him that that bag is actually a bag of corn sugar so it's dextrose with tiny tiny little bits of Splenda the artificial sweetener in there really that whole bag is corn sugar they have to have a bulking agent in order to make it like a cup of sugar yet for some reason they're actually allowed to advertise that as being a no calorie sweetener so I don't know how that works but it's definitely not a no calorie sweetener when you're dumping in a cup of dextrose into your your teeth it's very good questions that the question is what about the effects of sugar on the microbiome and those studies are in process and they're actually being done here we think we think that within two days the cutting of sugar alters the microbiome significantly irrespective of calories that's work done by Peter turnbaugh here at UCSF the sugar industry knew about the microbiome according to that rat study that I briefly mentioned they realized that drinking a large bolus of sugar so a large coke would flood your small intestine and that sugar would be fermented leading to the production of triglycerides so that was one of the mechanisms that were they were looking at linking sugar to the microbiome and triglycerides and then cardio metabolic disease which they never published all the way in the back there they're all the same calorie for calorie gram for gram ounce for ounce they're all sucrose they're all the same thing as table sugar cane sugar beet sugar the stuff you put in your coffee you know maple syrup and honey are more expensive they have their own unique flavor profile so people tend to use less of them and anything that makes you use the less of them is a good thing but in terms of what's in them it's the same next it's been so virtually all of the produce that we currently grow and consume has been bred to be very specific so the fruits have been bred to be higher sugar and the corn has been bred to be higher branch chain amino acids which is you know then being fed to the cows so they're getting metabolic syndrome that's why there's all that fat in the meat which we love because it tastes good but in fact that cow has metabolic syndrome it used to take 18 months to go from birth to slaughter for a cow today it takes six weeks okay and that so basically that cow is metabolic syndrome we're just killing it before it gets sick so that's happening to you it's a refined carbohydrate it's like it's processed food it's there's no fiber the fiber is what makes carbohydrate safe so brown food beans lentils quinoa farro nuts brown rice brown food that's fiber containing food that lowers glycemic load low glycemic load food that's called real food all real food is local i semen load food okay fiber works processed carbohydrate doesn't where's the way yeah one thing at a time yeah we also have diet beverages we have a lot of nurses who stay up all night and use it for caffeine even though there's some accumulation of evidence that maybe they're adverse effects on the microbiome and so forth so it was a heavy lift it was a really really hard thing to do and we were the first campus and academic Medical Center that did it in the country one of the really exciting things that's happened since then has been that many health systems around the country Geisinger and the Cleveland Clinic and a lot of different health systems have have have started to do this but one of the most exciting things is one day we got a call from the National Health Service of the United Kingdom the entire health system for the UK and they said hey you know what's that like how do you do it and we talked to them and sent them some stuff and helped them and and they just announced they're doing it all over every Hospital and England is going to stop selling and stuff and yeah so we're hoping that you know it like I mentioned you know the battles the advocates are under such firepower when it comes to these government policies and Eve not just in the US all over the world these companies just double down on them and they're typically really resource trained a lot of these are grassroots organizations and very poorly resourced and so we're trying to think through solutions that would follow a public health model but there could be led by the private sector and like you saw that picture of the the candy stripers selling tobacco to a patient that was the health care system during that we were we called candy stripers remember yeah yeah for a reason but by the way to your point about juice Swedish Hospital in Seattle has been juice yeah I mean it does deliver a pretty heavy load there are some you know my understanding from Kimber's Stan Stan Hope slab Papa Davis is that probably juice is a little has a little bit of an edge over it's clear sugary beverage but that there it's a very under researched question and so when the bar for telling a patient don't eat that is is a lot lower or telling a friend than the bar for passing a law right you want to get it right we don't want to reefer madness the population right and tell them something's really bad and now it's legal right and so and we made some and and obviously the dietary guidelines have made some bad mistakes around fat and other issues so we try to you know you set that bar pretty high you need a robust evidence base before you start passing policies so the question is about fiber you know I've been I've been banging the drum on fiber and there are two kinds of fiber there's soluble and insoluble okay soluble is like pectins like what holds jelly together insoluble fibers like cellulose the stringy stuff in celery right they're not the same you need both now real food has both almonds have both regular strawberries have both but you need both what they're adding to soda or what they're adding to fiber one bars or what they're adding to cereal is soluble fiber because that's the only thing that is soluble otherwise the stuff would precipitate out and when you basically get gunk so you can't add soluble fiber back and expect it to work like the combination of the two together so what does the combination do you got a hair catcher on your bathtub drain okay so it's a plastic latticework with holes in it right you take a shower the hair covers the holes and you get an impenetrable barrier and then the water won't go down till you clean it right okay so the insoluble fiber forms a latticework on the inside of your duodenum the soluble fiber plugs the holes in that latticework and you form an impenetrable whitish gel you can actually see it on electron microscopy coating the inside of your small intestine which therefore limits the rate of glucose and fructose and some fatty acid absorption from the gut into the bloodstream thereby keeping your liver from accumulating all that substrate so it doesn't turn into liver fat keeping your liver healthy and if you didn't absorb it early that means it gets moved further down the intestine and what's in the second part of the intestine that's not in the first part the microbiome the bacteria well once it gets to the second part once it gets to the jejunum it's a free-for-all whether you absorb it or whether the bacteria use it to metabolism italo's you know it's probably equal so if you consumed it with fiber you may it may have passed your lips but that doesn't mean a pastor intestinal lumen so just because you ate it you didn't get it which is why a calorie is not a calorie because if you consumed it with fiber it wasn't for you it was for your bacteria therefore kill the calorie it I just want to quickly say I also want to know more about what added fiber really is I mean I think there's a huge difference between what we're calling fiber in these drinks versus what you actually get in a piece of fruit and I think there's an entire industry that promotes added fiber that I haven't even begun to explore out there one more question so in the question is in the tax debate what's the passive smoking for obesity how does your or someone else's obesity adversely impact my well-being right and that's what economists call externalities right well I mean just look around what about the first thing Rob said rising health care costs metabolic diseases driving it what about making airplanes bigger what about the fact that we have so many obese young young adults that our army can't find enough people to recruit I mean where where why do I you know yeah passive smoking was a at a certain point and advocates came along and and latched on to the externality argument but that doesn't mean that other public health problems don't have externalities your so a good example helmets on motorcyclists you can you know Kristin can you know right around without a helmet she's very cool person on her on her hog and she can she can you know what what's it affect me that she gets in a crash and dies it's her problem right no it's my problem too I have to pay the ER costs when they wheel are in I its taxpayer money a lot of the time right and so all of these debates have externalities inherent in them it's just about how advocates think about how do we spin it how do we how do we create an argument and as said in a case and those things evolve over the course of a debate and at some point very soon I think we're gonna start well we've already seen some what is Credit Suisse did a wonderful analysis the externalities associated with global obesity let me just add okay do you expect to see Social Security you're right you won't see it because by the Year 2029 it will be dead and the reason is because Social Security is a Ponzi scheme you know that right you have to have the young healthy people at the bottom paying in so that the old infirm people at the top of the pyramid can take out what if the young healthy people aren't paying in what if they're all in disability which they are what if they're taking out because they're in dialysis which they are the whole pyramid crumbles and it will crumble in the Year 2029 according to the Congressional Budget Office in their last estimate you want Social Security stop drinking soda and tell all your friends to do so too [Applause] [Music] you

Channel: University of California Television (UCTV)

Views: 2,116,040

Keywords: Sugar, diet, obesity, soda, metabolic disease

Id: -s5szfPYKY4

Length: 88min 30sec (5310 seconds)

Published: Wed May 02 2018