Fructose, Obesity and Fatty Liver

my name is dr. al D'Amato a pediatric gas that means I'm a doctor for kids who have liver problems and testing problems pancreas problems nutritional problems so it's it's a really big honor for me to be here today I'm originally from El Paso and I actually grew up not too far away from here I lived with my grandma off of Aubrey Street off Alameda Alameda if you know where that is so it's kind of like a really nice homecoming and it really is a truly great honor for me to be here and speaking to to my community El Paso so today we're going to be talking about obesity fatty liver and fructose all right so it's a very big problem and I and I think that at the end of this talk what my goal is for everyone here is hopefully generate enough interest that we can say hey there's there's something really serious going on in our community maybe we didn't know about it before but now we do and when we see kids or we we have maybe our grandchildren I see a lot of grandparents in here we speak to our grandchildren or our nieces or nephews you know we start talking about this problem and hopefully we can change our behavior in terms of eating our eating habits and maybe we can we can stop this epidemic and we'll talk about why this is this is important so before I get started though I have to make an announcement for those all those that know me I'm a huge salsa fan I'm a big salads instructor okay I don't know if you know this I usually have a salsa class here but it's canceled okay I just want to make sure you know that the salsa salsa class is dr. Aldo has been cancelled all right okay that's not really my hairy chest okay can somebody else's all right so I have no conflict of interest so my story starts at here I moved from San Francisco California I was living at the time and I went to medical school in Dallas at UT Southwestern and this is our county hospital Parkland all right and it was there when I started I took care of a patient we're gonna call her Emma all right I'm always it was a very large woman they had to get a special bed made for Emma she was at least over 350 maybe 400 pounds I don't really remember but I would I do remember is that she needed a special bed to take care of her and she had been in the hospital for six months right and she was a very very first patient that I ever took care of and her medical chart was about this big she was there she had a heart attack she had diabetes high blood pressure very sick lady and on this day that I started my first day that I started taking care of her she needed a special imaging study a CT scan and this CT scan though she didn't fit oh you she was said something okay how's that right whatever all right so she didn't fit in the CT scan that we had in Dallas and so we had to actually move her from the hospital to the zoo where she can get a CT scan done in the zoo all right and and so moving from San Francisco to Dallas like wow what is going on I had never heard of this problem it was so serious okay and while I was while I was in Dallas there was a lot of construction going on they were building a lot of new hospitals at our new hospital wings and I noticed that the benches were bigger the doorways were wider and I wondered to myself why well Dallas knew that the country was getting bigger all right so if we look here that's Texas 1990 2x since 1998 and Texas in 2006 and it went from 14% of the population of Texas being obese and we'll talk about the definition of obesity to 1998 being about 20% to 2006 29% 2006 almost 30% of all Texans were obese right so what is BMI and this is where we come to the definition of obesity excuse me body mass index exactly I allowed us asking for price I think she wants surprise at the end all right okay so body mass index is a formula it's weight divided by the height and when you do that then you can break up you know are you underweight it gives you a value when you when you plug in this formula gives you a value are you underweight are you normal weight are you overweight or are you considered obese and why the reason why these lasts who are important overweight and obesity is because if you are in that category you put yourself at high risk for high blood pressure high risk for diabetes heart problems okay so having those puts you at a higher risk so I went from Dallas and I ended up here in Houston Texas Texas Children's is where I trained to do my specialty and I had a lot of hard time sorry a lot of long nights go to the mourn him go into the hospital early in the morning six sometimes five sometimes four in the morning and get off of work pretty late midnight sometimes 1:00 in the morning and I wouldn't really eat that much on my way to work glass of water lunch you know when it happened it happened and know most times I didn't eat dinner so I just skipped one I either skip lunch or I skip dinner and so on my way home this would be about midnight there wasn't anything open the only thing open was Taco Bell all right and I was like man I had a hard day I deserve Taco Bell right and and I loved it it was fantastic this is great you know I didn't eat anything all day boom I was going to town drinking a lot of soda I'm not a big sort of em but that time I was I was a huge soda fan and so what happens is that I started gaining weight I gained 20 almost 23 pounds so you know I'm a little bigger and I was considered actually overweight when I went I gained that though those extra pounds and so I tell you that story because it can happen to anybody all right it's not you know people have this idea in their mind obese huge no it can happen to anybody and I'm a physician and it happened to me all right so this is what happened the reason why I got to be you know way 23 pounds without really noticing it is because I wore scrubs everybody know what scrubs are those those pants you put the all strings or you can tighten them had no idea and I was getting pretty tired tired tired tired and I'm like you know what today I'm going to dress up no I'm gonna wear a nice nice pants I'm gonna put a nice tie on and dress up and everybody noticed Oh dr. must once you you're dressed up today oh yeah that's right thanks for noticing it's fantastic but when I put on these clothes a little a little tighter like man my wife my wife may put him in the dryer a little longer tonight I noticed I was like when I was in my car is getting a little tired like oh man rough this tight clothes it's a my wife I got to talk to her when I get back and so then I go I go visit a patient's room I go to the room and my pen drops and I bend over and there was a huge boom and people people hit the ground people hit the ground my pants exploded okay you don't believe me there it is right there those are my pants is pretty medicine but there it is there's a big hole in my pants huge it just opened up my god so my nickname was doctor muffins for a while all right so I won 6-1 I weigh 210 pounds might be my was twenty seven point seven pounds I was overweight overweight and I felt it I mean my knees were hurting and I really thought I really felt different kids are measured a little bit differently all right so we get kids when we let's say we get a ten-year-old boy and we compare his weight to his height we get a value we compare them to other kids his age and we stack them up so let's say you know this boy let's call him Juanito Juanito is compared to a hundred kids and out of those hundred kids he's he's bigger than all of them right and so that's how we can we can determine who's overweight for kids so underweight is this in a lesson fifth percentile overweight eighty fifth to 95th percentile so are they are is Quan Ito bigger than 85 or 95 of those kids or it's going into a bigger than ninety five of those kids and then there's a severe obesity which is greater than ninety nine of those kids all right so what I like for you to do when you go home is to calculate your BMI go home go to the internet google it what is my BMI few have kids do it too so - the in 2009 2010 there was a 78 million adults that were considered to be obese pretty big number now you think about 78 million people Los Angeles has 8 million people right 12.5 million children a pathologic population of about a million my quad is 2 million 3 million watts more more kids 12.5 million kids who are considered to be obese and why is this important we talked about in the beginning puts them at higher risk for developing diabetes high blood pressure cardiac problems this is such a serious problem that this generation of kids right now will be the first generation to live less than their parents their parents will outlive their kids today these kids today so it's very very important and and this is uh this hits home especially for me because what you know I think I'll pass so gets a lot of bad press you know if you see popular press about what kind of city we are and all this all the people around here think pretty poorly of us but what I would like to do knowing that we have an obesity problem if you look around you if your elementary schools your neighborhood you look around a lot of big kids you know I I would like for the Nash the nation to see a Paso as the model say hey they have a lot of Hispanic kids there in El Paso but they know how to treat their kids right their kids are doing a lot better than maybe Houston or Los Angeles Dallas oh I want to be that model alright so if we continue on the same rate of obesity we are today in 2030 half of the population of Texas will be obese half that means one and every other person is going to be overweight it's a pretty big problem right it is not just a health problem all right it's a big problem right for adults but also for kids look at this this is not a common all right you know this is this is an extreme example okay and when I was in training I took care of kids five-year-olds await a hundred pounds you know waddling and things very severe example but it this this picture reminds me of a story when I was when I was growing up not too far away from here we had a lot of cousins living with my grandma and we were all shapes and sizes same age different sizes one of my cousins who's not here thankfully rose you can get really upset was a little bigger than the other ones okay and my grandma would give him more why because he needs more he's bigger esta Husky she would say the Husky my Costa Husky then Akiko made a mess so you know you know that's good that that's our culture right food and family more food I love you more eat more I love you more alright so this is what we're seeing kids with adult diseases kids with high blood pressure kids taking blood pressure medications that maybe their grandparents are taking kids taking cholesterol-lowering medications that their grandparents are taking you know what is this kind of life for our kids every day that they wake up and take a medicine I remember think about what your child who was like 20 years ago three years ago four years ago 50 years ago six years ago think about it who took medicines daily unless you know for adult medicines that's what that's the kind of kids that we have today and so how common is obesity in kids and specifically this this is a Mexican American example here these blue bars represent obesity in kids and 1988 to 1994 all right we have white black Mexican American 1988 blue bars you can see that basically about 10% 10% for all three groups as time goes on so does the obesity trend and we see whites white kids more boys increased black kids increase Mex American kids increase but we're the most look at this nice step up 3 so we are the heaviest we look nationally in terms of race mexican-americans heaviest kids all right this is not just a disease problem but it's also an economic problem and it's this is especially true for cities like Oh Paso because we spend a lot of money on Medicaid a lot of Medicaid dollars on obese obesity-related diseases all right 147 billion dollars in health care costs related to obesity issues alone alone health care costs if we look at obese patients versus non obese patients we spend 42 percent more on obese patients and I think about my patient Emma in the beginning who was in the hospital for six months all these complications are kept happening this is exactly why obesity Medicaid dollars we spend four thousand dollars more on obese patients because they have more diseases hypertension cardiac heart problems a lot more complications this when when I was training I spent a lot of time in the intensive care unit and as a you know part of my training is being a nutritionist sort of and I realize the power of calories when patients when people are in when people are in intensive care unit and they can't eat you know they sometimes they can't use their intestines to put fruit in there they need and they need food through their veins and that's called GPM total parenteral nutrition through the vein this is a bag that's basically a bag of nutrition here and it has protein has carbohydrates sugars and you can mix fats in there too and has everything you need to survive and I notice the power of being able to make somebody really really really big or really really really small depending on just the numbers that I put in I'm going to calculate I'm going to give this kid more calories today and I and we could really see we can definitely make somebody big or small depending on how many calories they take and this is this is true here in this Twinkie diet anybody here the Twinkie diet you're about this guy lost weight surviving on Twinkies alone he probably is missing his eyebrows and his hair now and his toenails or something but he lost weight he got the job done okay I don't recommend this to anybody but basically what he did it was figured out how much how many calories do I need and I mean I'm going to hit that mark I'm going to give it give myself a little bit less surviving on Twinkies alone and he lost weight right so calories in calories out or just give me a little bit less than I need I'm going to lose weight as expected so as obesity is increased so has diabetes they've marched forward together hand in hand on the top a map of the United States from 1994 2000 2007 where you know that right the rhetoric gets the the more obese patients are or the more common it is diabetes same thing marches on as obesity increases so does diabetes hypertension same thing BCD is increasing high blood pressure also increasing right but there's another disease and this is a disease we're going to focus on right now is fatty liver disease by to deliver disease is also increasing and what is fatty liver disease this is non-alcoholic fatty liver disease this is basically the liver of a person who hasn't had anything to drink non-alcoholic but it looks like an alcoholic liver so if you didn't know any better you would say oh this is an alcoholic liver but in fact you know these are kids have there's livers like this and they never had alcohol to drink eventually what happens is this fat you know the liver doesn't like fat in it that leads to inflammation and inflammation is kind of like when you cut yourself you cut your arm you've got a lot of inflammation there and what happens you get a scar right you get scarring same thing happens to liver inflammation scarring it does anybody know what that's called scarring the liver cirrhosis right you've heard of cirrhosis that's cirrhosis so you have you have a couple things that happens once you get fat in the liver that leads to inflammation scarring cirrhosis and you have a few options all right you're going to develop cancer your liver can start failing or you need a liver transplant right and and this reminds me of a story of a kid that I took care of when he was fifteen when I was training of a kid whose liver was failing because he had too much fat in it liver started failing what does he need is a liver transplant all right juanita leaves means a liver transplant let's get it to him if he doesn't get deliver he's gonna die we gave him the liver transplant two years later his liver starts failing again didn't lose weight he was he was a big kid to begin with didn't lose weight drinking the same so does bad diet same thing what happens liver starts failing again he's 18 years old nobody wants to give him a liver more right nobody what do we do he already proved to to some if you knew an alcoholic who who needed a brand new liver and they go into liver failure they get a and they get their transplant fantastic but they keep drinking what's why would anybody want to give that person another liver you look these are tough decisions I how can you tell I took a kid you know I'm sorry you didn't even cut it but it happens it happened and I don't know what happened to honey till you turn 18 and left I don't I don't know what happened but I do know he needed another liver so not alcoholic fatty liver disease is actually the number one the most common liver disease and kids today and so it's number one and if one percent just one percent of all of these kids of FI a liver disease just one percent of them were to develop liver failure and need a liver transplant there wouldn't be enough there'd be zero and not enough livers to transplant them all okay serious we don't even need to get to the transplant stage just take care of the problem now right that's the whole point so it is estimated this is a dr. Schwimmer dr. Schwimmer is at a San Diego he's considered the authority on fatty liver disease he looked at he did a some analysis and try to find out well just how many kids have fatty liver disease in the in the country when he found what they estimated was about six million kids plus in the country had fatty liver disease huge number right almost all of Los Angeles their kids right so this is another another study here this is one of my mentors here dr. Karpin he is also considered one of the world's authority in the liver and he wanted to know well let's let's in obese kids and big kids and overweight kids how many of them have had liver disease alright so in 1988 to 1994 11% of all teenagers is for teenagers 11% of them had value liver disease 2007 2010 20% doubled not surprising right severely obese this is when kids who are who are bigger than 99% of other kids severely obese went from one point five percent five point five percent what about obese kids with fatty liver disease it went from 21 percent to double or nearly double 38% to really obese not surprising 27 percent of kids to 52 percent of kids all right so what does this mean well if you're obese and you're a male if you're a teenager almost 50 percent so if you know Mexican American male who is a teenager chances are you had a 50/50 shot that kid has fatty liver disease 50/50 shot or actually more right 56 percent mexican-americans teenage boys 56 percent sir doctor kind of a fatty liver can it be reversed yeah good kind we're going to talk about that treatment it absolutely can and that's the whole point is it you don't need anything fancy at all just change your diet you once you know you got it you got it change the way you're living life problem solved alright so there's a big jump here so we know that look at this obese kids went from 11% to 20% what's responsible for the obese kids having so much fatty liver disease why did it jump so much why did it jump so so so high you know it's huge non-alcoholic fatty liver disease is a lot more common than these and then all the obese kids and I think it's because of this because of the way we're living our life right we have on the left side here we have portion Distortion right bagels three inches twenty years ago six inches today 4.5 ounces hamburgers now eight ounces a tub of popcorn used to be that big now it's 11 cups standard soda bigger right now it's supersize everything super-sized right super-sized kids think about yesterday when you're on your way home how many kids you see playing in the street doesn't happen you know when I was growing up you to worry about cars oh my god cars gonna burn so birds were playing all the time doesn't have anymore you don't see kids playing alright big gulps and then we have a big family here when I get kids who are overweight or in my office never do I see an overweight kid and ten parents or ten siblings never it's an overweight kid big mom big dad big brothers and sisters all the time right so it's a it's a family thing and it's really difficult for me to say hey Quan Ito you need to lose weight my friend you need to do all these programs you need to not drink soda and then everyone else is you know they can live their whole life that's not not fair at all all right it's got to be for everybody because the parents have to be the role models a 17 year girl needs about 1800 calories 1800 calories every day to the pretty good life the average teenager though drinks 1.7 Kansa soda a day so does anybody know how many calories are in a can of soda yeah 140 calories okay so I'm going to lift up here okay so this is a nine cubes of sugar in one can of soda mine cubes of sugar all right if you were to drink this every single day one kind of soda every single day for a week 980 calories in one week of extra calories that you don't need nobody answers nobody needs to survive on sugar water right it's Coca Cola sugar water with with a kick right nobody needs that all you need is you need liquids to to hydrate yourself that's it if you were to drink a soda every day for a week for a month 3,120 calories okay for a year every day for a week for a month for a year it's 47,000 calories that you do not need at all so what is that equal that equals 26 extra days of calories nearly one month of calories so you don't eat right so you've managed if this is the seventeen-year-old teenage girl she managed to pack in 13 months of calories in one calendar year all right so for those of you who like to know how many pounds is that equal right so 13 3,500 calories one pound if she were to do this that's 13 extra pounds okay in a year calories in calories up you don't need this absolutely not so liquid calories my message to you is the liquid calories are dangerous and the reason why is because they don't fill you up all right your body you don't drink a soda and say I'm done for the day I've met my caloric max that doesn't happen your body doesn't know that right just I've had a soda to wash down my hamburger I got a pink take another soda maybe to take the edge off I mean I don't know all right so sort of consumption on the right soda drinking increasing everyone's drinking soda kids adults milk drinking decreasing juices been pretty stable the whole time but sort of drinking definitely on the rise why because it's cool right a lot of its there's no secret that if you spend a lot of money and get really cool people to promote your product you're gonna sell right LeBron James Michael Jordan capri-sun who makes oh man I was so shy I hate it when I found out about whom x/y who makes my grandma said was so good for me right Powerade right so what what do all of these things have in common mmm I know what all these things haven't come sugar there's a specific type of sugar and that's the one we're talking about here fructose high fructose corn syrup what is this whoo-hoo 20 years ago 30 years ago even read about high-fructose corn syrup is like a new thing what's going on all right high fructose corn syrup what it is is 42% to 55% fructose plus glucose glucose glucose is found in everything it's it's the energy of the world it's it's found in rice and pasta and milk everything we need it when you need to survive right we don't need fructose so I'm going to prove why sucrose 50% fruit or it's half fructose and half glucose half and half that's what sucrose is right so just to give you a sense of why fructose is popular well number one it's cheap it's cheap to produce number two it's very sweet in the blue that sucrose looks like table sugar okay if you were to test if you have like a blind taste test and you said table sugar versus fructose fructose a lot sweeter right nearly double the amount of sweetness as regular sugar that's why people like it it's nice and sweet alright this is for my sister it's like her favorite movie hands okay so before World War two the amount of calories that people consumed from fructose was 5% in the 70s the amount of calories that people consumed and from the total of fructose from the total amount of calories that they needed 7% in the 90s people were consuming 10% of their calories from fructose of eight that they needed alright so it's been steadily increasing the group they eats the most fructose teenagers they eat the most twelve percent of their calories come from fructose and there's a small group of kids 20% of of teenagers that actually take more than 25% of their calories from fructose pretty big number hey yeah what we'll talk about that I know you'll see okay so this is a study that they went to elementary schools and they wanted to take they want to talk about soda so what they did was a program and they went to group a group of schools and said hey so it is bad you got to drink all this stuff we're going to give you water fruits vegetables so they taught kids how to eat differently so at one group here that another group they didn't do anything let's see how let's see how big these kids get so the group of kids that didn't get any special program their obesity rates increased oh that's the red line and that blue line shot up more common poor kids could be bigger kids who got this pep talk frequently stay the same in fact decrease a little bit right so if you educate kids I work there's another nice study then this is a very prestigious Journal a New England Journal of Medicine is considered like the probably the best general medicine and what they looked at was they they want to see if we give a kid a sweetened beverage of sugar-sweetened beverage every day versus a kid that we don't give it to what's going to happen alright so we got a bunch of kids all them for 18 months you have one group of kids every day zero calorie drink and I gave another one and now the other group of kids 140 calories that they drink every day they had to drink one of these every day they had to drink a zero calorie sort of every day and the reason why they're both green is because it can looked exactly the same okay there's no difference I got a soda maker to say please make a sis make it identical to this they're identical in taste and in appearance but not in calories what happened the group they had the regular sugar sugar soda sweetened beverage the soda they all in they all gained weight although the other group not very much compared to in the beginning when they first started to when the end of the study nothing happened - so now we're going to talk about three different sugars alright and the reason why this is important because this is this is a pot the part in the talk we're going to talk about why fructose is different from other sugars alright glucose I said before it's found in everything milk pastas rice the energy that everybody needs absolutely everybody needs and using it for instance beginning a time ethanol alcohol everybody's favorite sugar okay nobody wants to laugh okay thanks okay and fructose which is the sugar that everybody should be hating hopefully at the end of this all right so we're going to I'm going to show you why fructose makes you eat more leaves the high blood pressure leads to high triglycerides or cholesterol leads to diabetes and leads to fatty liver right I'm going to show you why this is different so well complicated slide it's really intense so we're going to break this up into pieces okay we're gonna I'm going to show we're going to take a we're going to take 120 calories of each sugar and we're going to we're going to go through how the body takes care of those sugars okay so we're going to break it up two nice pieces 120 calories this is like basically like two slices of bread two slices of white bread that doesn't have fructose in there okay just regular old school pieces of white bread 120 calories gets broken up into 24 and 96 96 of those calories gets used up by the body by the brain your muscles by your blood your your body really likes glucose and importantly when your body receives glucose it works on insulin and tells your brain hey I've had enough to eat I'm through I'm done I don't want to eat anymore sends a signal because insulin is what sends that signal so then you don't want to eat anymore you're done 24 of those calories go to your liver alright from those 24 calories 20 of them get stored as glycogen glycogen are like sugar packets that your your liver has and when your body needs them sugar packets open up and releases the sugar and now you can keep working all right that's what glycogen is and we know that if you have a glycogen a lot of glycogen right so if you keep eating glucose and you have a huge amount of glycogen nothing happened your liver doesn't go into failure your liver doesn't fail we know this because there's a disease called Banger Keys disease which doesn't allow glycogen to get released from liver it just accumulates and they have huge these kids have huge huge livers lots of glycogen but nothing have their livers don't fail they have other problems but their livers don't fail alright and then importantly here is you form triglycerides as cholesterol but not that much zero point five calories not that much at all so the biggest difference in the sugar is this going to be important here out of 120 most of them get used up and very little of them go to your liver all right so now we're going to talk about alcohol ethanol we're going to break it up into pieces here and we're going to we're going to show you I'm going to show you how it gets broken in broken up so I've had 120 24 of them go to your body I work on your brain this is what exactly why you get and a little crazy sometimes you're when you're drinking and there is no signal notices there's no X here keeps going back and forth oh nice nice keep drinking tricky drinking there's nothing to keep you from drinking other in your conscience right maybe your wife I don't know but there's no stop and 96 calories go to your liver now that's that's a huge difference right because we're talking about glucose 24 of them went to your liver now in all-call 96 of it of it goes to your liver huge difference and alcohol produces this compound called zero aldehyde and that leads to inflammation this junk this jump one needs to inflammation this is why you get alcoholic cirrhosis and inflammation of your liver that's the reason cito aldehyde junk one inflammation and you also get formation of lipid droplets right I said before the the picture of that fatty liver you can tell if it's from a person who's had alcohol part ensues never had alcohol looks the same fat droplets and also because of this ninety six you got a lot of triglyceride formation the cholesterol you also get free fatty acid the reason why this is important is because this leads to diabetes insulin resistance diabetes is basically when your insulin takes glucose or sugar and it doesn't be it's not able to go into where it needs to go that's insulin resistance that's diabetes so look at this inflammation lipid droplets cholesterol diabetes alcohol alcoholic fatty liver that's all Colin I wanna talk about fructose there's a glass of orange juice 120 calories in a glass of orange juice alright orange juice has sucrose sucrose is half fructose and half glucose all right so we're starting off and I'm just going to talk about fructose part so in fructose because I said it's half when we're talking about hundred and twenty three when sixty calories of 120 of fructose so we're starting off with less but notice that this side of the picture doesn't light up the reason why is because fructose only goes to your liver your liver is the only organ your body that that metabolizes or breaks down fructose so doesn't work on anything else but into your liver one of the first things that it makes because as fructose goes into your liver creates uric acid anybody heard of uric acid no that is anybody lot I want to answer but she already answered once gout exactly so you people oh don't eat meat or Adoni you know this Goudy diets because of uric acid actually there is a study i'm not going to talk about it i'm not gonna show a picture about it but your study that you drink a lot of fructose you lead to more episodes of gout alright so uric acid leads to high blood pressure reason why that happens is because uric acid stops nitric oxide from working a nitric oxide is what relaxes your vessels right and that leads to increases in blood pressure because you don't have that relaxation anymore it's gone so can we prove it though right right I'm talking about it but can we prove it well yeah we can this is dr. Pike he's a he's a kidney doctor out of Texas Children's Houston he his research what he did was he got a lot of overweight kids out of obese kids who had high blood pressure and you put him in two different groups yeah I'm gonna take this group here and I'm gonna give them this medicine called allopurinol for those of you who have gout or know somebody who has gout they take a leap urine all the reason why it works is because it stops uric acid from forming okay so i'll paranal dose so he says I'm going to take this group but I'm going to give them a leaper now this group I'm not gonna give them anything so what happens well the group who didn't get anything as expected blood pressure stayed high high blood pressures but the group they received i prunella get this overall trend boom decrease decrease decrease that's for kids adults same thing I got a I got a group of adults here this is dr. Pettis puzzle here got a group of adults I gave in fructose blood pressures increase your malady Rennell decrease alright so blood pressure that's one to high cholesterol remember before and glucose and the beginning the form is first start talking about the pathway 0.5 calories went to formation of cholesterol here 30 calories half go to formation of cholesterol half so essentially what's happening is you're you're drinking fat right that's essentially what you're doing it may say sugar free or a fat free but we know better we know that eventually this sugar turns into fat all right can we prove it yes patients who were given people who are given soda to drink daily soda consumption daily six months afterwards what do we see cholesterol levels increase 10% they increase 10% other people who just said milk small increase butter decrease triglycerides drinking soda increases 30% milk very small barely tiny line water decreases you just need water all right lipid droplets does lip does fructose cause lipid to get deposited in your liver yeah there it is all right Mickey Mouse oh my god everybody love Mickey Mouse who loves Mickey Mouse okay look I'm sorry to you had to break some news they got Mickey Mouse's cousins and they did some did some science experiments on Mickey Mouse his cousins cousins okay so what they did when this experiment they got they got some mice I'm gonna give them Mouse water all right for a couple months just water water water you take an eel into the liver what does the liver look like fine no problems its water I'm going to give this Mickey Mouse's other cousin Panchito I don't know and and we can improve those oh man look at that inflammation looks just like the alcoholic fatty liver disease right so it looks like fructose there it is we can prove it this is hard to do in kids because it's I don't think there's a parent that says oh yeah please stick a needle in my kids liver so that's why they do it in rats okay so eating more and diabetes so this this when you take fructose it stops insulin from working the reason why is because you get this free fatty acid production just like an alcohol causing insulin resistance insulin doesn't work anymore and so it doesn't tell your brain to stop so can we prove it yes Grillin Berlin is a hormone that increases it helps you eat more as Grillin increases it's time to eat increasing hamlet and increase in Grillin eat more eat more eat more this blue line here traces out patients who just got fructose and the bottom one is just glucose and you see ghrelin levels boom higher a lot higher this after dinner after dinner time every alias high high high eating time the signal to eat to stop eating doesn't stop it just keeps going EEE and this is why there's a few studies you look at kids they give them fructose sodas and they see what their calorie consumption is how much they're eating afterwards and all these kids are get soda they all eat more afterwards they all gain weight every single no because they eat more all right so can we prove are there studies out there that can bring everything together are there patients who have high blood pressure who have high cholesterol who have inflammation and liver yes here it is fructose males okay so they gave males 200 grams of fructose and what do they see lower price Jeremy anybody go to like Albertsons or Walgreens then they get their blood pressure checked ok so the top number is that systolic as top number increases by 7 points bottom number increases by 5 points cholesterol triglycerides increase good cholesterol HDL that's the good one goes down liver inflammation they do the test increase all right and then are there patients at everything yeah 30% of these patients of these people here in 741 30 for 30 percent of them had everything up like high blood pressure high cholesterol high insulin levels also known as diabetes liver inflammation they got everything just from this fructose so the question is what's the difference I told you about alcohol and I told you about fructose told you about how one causes one causes inflammation the other one does too so you know ask yourself here they cause the same thing all right this is this is beer I have nothing against the cot they just his first one that I found in my cart and I'm just I'm just going to be this is so so if this causes inflammation right alcoholic liver disease causes fat deposition causes high cholesterol causes diabetes we saw that and this one does the same thing why would you give your kids this right you wouldn't do that but you are sort of the only difference is they're not acting silly when they when they drink a soda but essentially you're doing the same thing inflammation high cholesterol non-alcoholic fatty liver disease why would you do it all right so if you're overweight if you have inflammation of the liver if you have an ultrasound that shows something liver you might have a liver disease you might have it if you have high if you have diabetes you have high blood pressure if your cholesterol is high you should get checked at least tell your kids to get checked every time when you see your pediatrician your kids see your pediatrician you should ask your pediatrician what's my kids blood pressure is it normal what's my kids weight is it normal should we be doing something for my kids weight I think there's a there's a common belief here is that you know my kids are big my sister's kids are big it's normal right every it ends up being normal if everyone's the same they're all big but they might have problems we just don't know it okay just don't know it so what do I do now I see a lot of kids of these problems and in a what I do is not magic at all not at all my job is to figure to make sure that the liver is working ultimately though the hardest thing is it's for parents and it's behavior changes so I tell them absolutely no liquid calories zero hardest thing for them to do oh my god no more choco milk zero okay so who makes Matta out Tampico tampoco all right I just came up with a punchline Tampico tampoco I got all right so milk skim milk or 1% sit lunch there at school well you take it from home how parents make it and it has roots and vegetables school lunch your dietitian reviews pros and cons I looked at the school lunch a couple weeks ago for I remember what school district was pancakes - toast corn syrup right 100% juice it's bad yeah oh it's juice it's good we just saw it's bad it's no good restaurants eating out one one time a week are limited to one time a week and the reason why there's a lot of hidden calories a lot of stuff mayonnaise butter the things taste good for a reason and it's not that you know eating healthy is bad but all right exercise and television watching if you want to watch an hour of television that's great you got to do an hour exercise alright hardest thing to do you want which 30 30 minutes 30 minutes of exercise and that exercise better be sweating it is some sweat and I really encourage parents to go walking or doing exercise with their kids because it's not fair just tell you know if you have big parents hey son go exercise and then they're watching TV that's not that's not good yeah it's not good parents are the role models I'm only you know physicians are only as good as their team hands down if I got a bad team I'm a bad doctor and my best team are my parents if I have good parents I'm amazing I look great they make me look good all right otherwise they make me look bad this doctor can fix my kid his livers still inflamed am I supposed to do so last thing here is I choose myplate.gov this is a government's government's role in trying to limit portion sizes to have half of the plate here fruits and vegetables and the other half grains and a protein dairy some some water and I have parents look at labels fructose isn't absolutely everything oh my god fat-free Thousand Island fat-free just kidding it's really not that free right we know that Powerade ketchup crackers and cheese dips everything bread even yeah there's a movement I think people are starting to catch on there's no lactose No I put this corn syrup bread now all right so what can we do well I you know I told you there's diet and and I told you what I do when I meet with kids and parents but I'm only one physician my partner is only one position we can't see all of these kids pediatricians can't see everybody it has to happen on a larger scale it has to be a huge behavioral change with everybody and I really mean this I would really love for our city to be the model City for the country to say we know how to take care of our kids we deserve our kids azar better I'm not sure what the right answer is but but I think that if we know there is a behavior that's bad like smoking then we should do things that change it right so what did I'll pass or do to change smoking or Paso banned smoking and restaurants and bars I was such a big deal right I read about I was out of town I was living away and I was reading about this huge deal Pass was the first city to ban smoke in Texas to ban smoking in restaurants and bars and it worked absolutely worked can we do the same for sodas a few years ago a couple friends and I we worked with the Yale University it's a Nutrition Center and we asked them can you help us come up with a formula to tax all right there's a tax is never popular sorry but we asked miss kick around some ideas if we tax one cent for every ounces produced and eventually you know just like soda are just like cigarettes as a price of cigarettes increase so to do the number of people buying cigarettes right so eventually it gets too expensive because it's such a bad habit you don't want to deal with it same thing with sodas can we do the same thing you know this is this is a national movement happening New York DC San Francisco and what we found it if we taxed one cent on every ounce of soda we would generate 15 million dollars for the city just a soda total sugar sweetened beverages so I'd include sports drinks energy drinks coffee that's sweetened that's ready ready to drink thirty million dollars for the city and money doesn't solve everything right but I had to start in Texas that increases to 1 billion dollars 1 billion dollars just so you get a sense of what $1,000,000,000 means well the budget in 2010 / Texas form edit Medicare and Social Security was two billion 2.7 billion dollars that's nearly half if we tax the soda we come up with nearly half of the budget for Medicare it's a lot of money all right and I and I really stand by this here vote at the dinner table I think as a city as a family as a community what we have to do is is really realize that the food industry and I have nothing against food industry ok but they're an industry and their bottom line is to make money if they're not making money they're out of business and if we choose or change the way we eat we force them to change their strategy if we say oh pass oh we don't pass aligns we don't want this kind of food we want healthy stuff you know we want bigger produce sections let me just think even think about for those of you use of shopping quarries the produce section in El Paso versus the produce section of widest huge difference so much better producing Cuates bigger - it's like half the store sometimes bigger I mean why why can't what we need better stuff I think this is where we this is where this is where we come up with that at the dinner table where as a family we decide we need to eat better all right so we talked about overweight and blood pressure and sugar cholesterol levels fatty liver inflammation so what about your child you really got to think about your knees your nephew your grandkids and and really as a family say hey I think we need to be better as a family and eat better as a family because in the long run it's going to get number one really expensive if you have really high medical bills you're in the hospital just because of something you're doing to yourself people putting more money into their cars and they do into their body and you can change that so we learned about a lot of things today learn about obesity is increasing we learned about fatty liver disease we learned about kids learn about liquid calories devil juice right from now on this is this is a devil's juice okay so I'd like to thank everybody for coming today it's the end of the talk if this is something that you really you know want to want to pursue if you want to get involved I don't have anything formally organized at all but what I like to do is hopefully keep the conversation going and hopefully this conversation doesn't die here that it continues and maybe in an organized way maybe we can have a Facebook a Facebook group or website or something

Channel: UMC El Paso

Views: 61,871

Rating: 4.7463412 out of 5

Keywords: Obesity (Disease Or Medical Condition), el paso healthcare, el paso hospitals, university medical center of el paso, Fructose (Chemical Compound), umc, juvenile obesity, fatty liver, texas tech, lectures

Id: fuXd0kduO5I

Length: 50min 51sec (3051 seconds)

Published: Mon Jul 29 2013