Kopriva Science Seminar Series, Robert Lustig, M.D., M.S.L., March 8, 2018

[Music] Thank You Edie and thank all of you for coming tonight it's my honor my pleasure and especially to be in a distinguished Science Forum as the Caprivi lectures and I very humbled by the invitation tonight first of all let me just start with the disclosures so I did write these two books I also want to mention that I am the chief science officer of a nonprofit called eat real devoted to trying to change the global food supply from the bottom up by certifying restaurants cafeterias hospitals schools that serve real food as an attempt to try to jumpstart and bring shall we say appropriate nutrition to the people who need it the most and the other thing I am is a the chief medical officer of a for-profit as I've retired from UCSF clinically called Slendy n-- where we're trying to mitigate the negative aspects of processed food in terms of health and disease so those are my disclosures they have nothing to do with this with this talk today so tonight I have a very modest agenda I hope by the end of the evening tonight that we will have solved the healthcare crisis solve the social security crisis solve the opioid crisis solve the depression crisis and perhaps most importantly made America happy again now these all sound like different phenomena the point I'm going to try to make the thesis I will try to pull together during the course of this lecture tonight is the fact that these are actually four or five manifestations of a single crisis and you can't solve a problem until you understand it and that's what we're going to try to do tonight let's start with the healthcare crisis anybody know who this is familiar to anyone Thank You Zeke Emanuel Rahm Emmanuel's brother he's a hematologist oncologist at the University of Pennsylvania he's a bioethicists and he is the architect of Obamacare and in 2014 he penned this article in the Atlantic called why I hope to die at 75 because he needed to justify how Obamacare was going to work and that basically 50% of the health care costs spent in this country are in the last month of life and so why would you need health care after 75 well excuse me but I don't plan on dying at 75 I plan on dying a whole lot later than that and being functional way past that point and I really took umbrage with this article when it came out and I will tell you that in this article and in the entire 1,000 page of Act the Affordable Care Act the word diet is not mentioned weight loss is mentioned but diet is not mentioned so my question to you is did Obamacare deliver President Obama promised that we could put thirty two million sick people onto the rolls and we would pay for this by providing preventative services that is by providing access to everyone so that everyone could see their doctor we could keep people out of the emergency room that was the goal okay how well did it work well we had this instead the government can't make by health insurance and why would I oh it can adjust go here and you'll pay for it that's what we ended up with in fact after Obamacare was instituted we actually saw an uptick in ER visits not a downturn but an uptick so much so and because insurance companies were capped this to their profit three of the insurers the big insurers Humana United and Aetna actually left the exchanges which ended up leading to the election of 2016 and you're all familiar with that in fact under Obamacare the cost for diabetes went from 245 billion to 345 billion that sure doesn't sound very preventative to me does it and under Trump care we have this instead this is Nick Mulvaney saying Trump's budget director says you brought this on yourself so like the Soup Nazi no health care for you the problem is Obamacare Trump care and every other care on the planet ignores two very inconvenient truths and these truths are there is no medicalised prevention for chronic metabolic disease it doesn't exist there are no medicines for this there's just long-term treatment and I'll prove it to you so here we have a meta-analysis of type two diabetes prevention strategies both lifestyle on this side and drugs on this side and what you see is you see the diamond there and you see the straight line so the diamond is to the left of the straight line for both diet and drugs which means it's it's significant statistically but that's missing the point of this slide because what the number needed to treat right here is is 25 that means that you have to institute preventative strategies on 25 people to prevent diabetes in one considering we have a nine point four percent diabetes prevalence right now and a 40 percent diet pre diabetes prevalence we would have to basically treat everybody and we won't even get anything out of it at twenty five to one it doesn't work it can't work and the reason it can't work is because we've ignored the problem 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 well this is what we were told was wrong everybody remember this Time magazine cover 1984 so we did what they said we went low-fat low-cholesterol lots of pasta and we got this instead we traded in one problem which was actually I mean it was a problem not saying it wasn't a problem but it was actually not that expensive a problem into a problem that is enormous ly expensive and now affecting children and this was from 2001 six million kids are seriously overweight well with all of the nutritional knowledge and I put that in quotes with all of the obesity management programs with all of the drugs on the market and with Michelle Obama's vegetable gardens we are now up to 24 million here's the reason it's on this slide how many of you watch football come on you can raise your hand is still socially acceptable today in 2013 this TV commercial 2-minute TV commercial aired on every single football game the entire year sponsored by coca-cola and this was called coming together this is a sentence straight from that video beating obesity will take action by all of us based on one simple common-sense fact all calories count no matter where they come from including Coca Cola and everything else with calories so you can get your calories from carrots or you get your calories from cheesecake you can get your calories from coca-cola or you get your calories from kumquats done that because calories are fungible because a calorie is a calorie therefore it's about energy balance therefore it's about calories in and calories out therefore it is about two behaviors gluttony and sloth therefore if you're fat it's your fault therefore any calorie can be part of a balanced diet therefore don't pick on our calories go pick on somebody else's calories all of that comes from this single mantra that a calorie is a calorie and after all it is common sense well I don't believe in common sense I believe in data I believe in science at UCSF we have in god we trust' everyone else has to produce the data we're hard asses and it's a good thing we are okay so who is saying this well these guys here and you recognize all of them in fact they control 90% of the world's food supply and they're making a whole lot of money on it and that's why they're saying it so they say it's about calories they say it's about obesity is that true I'm gonna give you three reasons to doubt that hypothesis so on this slide you see a scattergram of all the countries in the world obesity prevalence here on the x-axis diabetes prevalence here on the y-axis and you would look at the scattergram and you would say well dr. Lustig very clearly there is a correlation and there it is there is a correlation i don't argue that there is but correlation is not concordance they're not the same thing because there are countries that are obese without being diabetic such as Iceland Mongolia Micronesia and there are countries that are diabetic without being obese such as India Pakistan and China India and China today have an 11% diabetes rate and they're not that we are the fattest nation on the planet we have a nine point four percent diabetes rate if diabetes is because of obesity how come they're more diabetic than us problem number one problem number two obesity is increasing worldwide by the amortised rate of 2.7 percent per year over the last 40 years yet diabetes is increasing worldwide at the amortized rate of four point zero seven percent per year over those same 40 years if diabetes was just a subset of the larger subgroup of obese persons then how could you explain that well you can't because ah maybe it ain't true number three on this slide we have the secular trend in new incidence cases of type 2 diabetes in the American population over a 25-year period you can see that the increase is significant than going up on this side we have the same data stratified by weight status so here are the obese here are the overweight and here are the normal weight people and what you'll notice is that there's been a 25% increase in the incidence of type 2 diabetes in the obese but there's also been a 25% increase in incidence in the normal weight population as well if diabetes is just a manifestation of obesity how come the normal way people are getting diabetic just as fast problem number 3 so this is the most important thing I'm going to teach you tonight this is a Venn diagram of the entire United States population 240 million adults got it 30% obese BMI over 30 70 % normal weight BMI under 30 everyone is in one of these two circles and you know who you are okay and they are mutually exclusive circles okay the standard mantra from the doctors and the dietitians and the Surgeon General and the Institute of Medicine and the National Institutes of Health and the White House and Congress and the food industry is the following 80% of that obese population eighty percent of 30 percent these 57 million people here they're sick they're sick they're fat and they're sick and they're sick because they're fat and if they would only just diet and exercise we could solve this problem that's what they say garbage complete trash sounds right common sense garbage how come it's on the slide anybody well it is true that 80% of 30% are metabolically I don't argue that that is true but that means that 20% of 30% are not we have a name for these people mhm Oh metabolically healthy obese we study them to try to figure out how come they didn't get sick conversely and this is the important thing 40% of the normal weight population get the exact same diseases as did the obese for the exact same reason they're just not obese normal way people get type 2 diabetes hypertension lipid problems heart disease cancer and dementia - now they get it at a lower prevalence forty percent versus eighty percent I don't argue that Oh clearly obesity is a risk factor I don't argue that even for sure but risk factor and cause are not the same thing because normal weight people get it too and it's these thin sick people over here who are telling the fat sick people it's all their fault and when you do the math there's actually 67 million thin sick people compared to the 50 million 7 million fat sick people they're more thin sick people than there are fat sick people and when you do the math on the two of them together it's more than half the u.s. population which makes this a public health crisis and if thin people get it too how can it be about behavior this looks more like exposure this looks like cholera or tuberculosis or influenza we're affected people and not affected people live in the same house so what's going on here I will prove this to you so any radiologists in the room good perfect okay so [Laughter] here are one slice CT scans through the abdomen of two equally weighted people notice trunk fat 12.8 12.8 okay ones healthy ones sick which ones sick eh or B I here both can we have a consensus please be Thank You B is the sick one why a he's just got big love handles something to hold on to be he's got fat all around his organs visceral fat big but fat big belly fat if you will okay and we have a name for this it's called tophi tof i fin on the outside fat on the inside real medical term 1500 MEDLINE citations go look it up coined by dr. jimmy bell university college london so my question to you tonight is are you a tophi how would you know how could you know does your doctor know and if your doctor knows how come he hasn't told you how could you figure it out this is kind of important isn't it yeah I'll prove it to you another way so this is what we call an MRI fat fraction map and this is an healthy obese person healthy metabolically healthy obese MHO notice the big love handles no problem there but take a look at this guy's the liver right there dark 2.6 percent fat this is normal there's a metabolically healthy obese lots of sub-q fat very little liver fat now this is what you've more normally expect to see this is a patient with metabolic syndrome and non-alcoholic fatty liver disease here are the love handles and take a look at that guy's liver 24% liver fat this is grade 3 hepatic steatosis on its way to fibrosis and cirrhosis and in need of a liver transplant that's like a look at this guy Finn no snow love handles take a look at his liver 23% liver fat this guy's just as sick as this guy thin sick fat sick fat healthy so which are you so in order to understand this we have to understand a little bit of how we got here so we went low-fat right we were told to reduce our fat consumption from 40% of calories to 30% of calories and we sort of did it in the process we increased our carbohydrate consumption from 45% of calories to almost 60% of calories and that is keeping protein constant and as we did our obesity went through the roof and so did our diabetes okay turns out that wasn't such good advice this is a study that just got published last year called the perspective urban and rural epidemiology study it looks all over the world all over the world different populations looking at the percent of energy from fat saturated fatty acids monounsaturated fatty acids polyunsaturated fatty acids and carbohydrate looking at total mortality and mortality from heart disease and what you can see is that for every one of these fat categories the line the curve is below the line meaning the fat is protective total fat saturated fat monounsaturated fat polyunsaturated fat protective the only one where it's above the line is carbohydrate we went low-fat which was high carbohydrate now there are a lot of people who decry and are upset about red meat and they may even have a point I'm gonna show you the data so we're looking here red meat we're looking at poultry we're looking at fish and we're looking here at the hazard risk ratio for type 2 diabetes what you'll notice is that red meat does have an effect consumption of red meat has an effect however when you factor out in these two models iron and human take because after all meat is muscle and muscle has iron and he minute the effect actually dissipates an iron and him are both oxidative stresses and oxidative stress definitely can promote heart disease and diabetes we don't argue that but you'll notice poultry it goes away and then fish it goes away completely so it might be that red meat is a bad actor but it might not be because of the saturated fat because if it was the saturated fat then it wouldn't be adjusted when we take away the iron and the heme so I want you to take a look at these three steaks this is Italian steak right here this is Arjun Tinian steak and here's us a grade-a corn-fed beef what do you see you're on well why don't these two steaks have that because they're corn-fed these guys are grass-fed okay their arms and Tinian from the Mendoza Valley they got with grass they got place for the pasture okay you know it used to take eighteen months in this country to go from birth to slaughter today it takes six weeks this is metabolic syndrome the cow has metabolic syndrome we just kill the cow before it gets sick that's happening to you now it's probably not because of the saturated fat because the Argentinian beef is not a problem in fact the Argentine's eat twice as much red meat as we do and they have a lower incidence of heart disease what it might be due to is what we call branch chain amino acids leucine isoleucine and valine which are very high in corn and very low in grass and it turns out when you consume branched chain amino acids if you need them for building muscle so that's what's like in protein powder like what bodybuilders take you know to build muscle well then they're going to muscle which is okay but what if you're not a bodybuilder what if you're a mere mortal like me okay and you consume all this excess branched chain amino acids body stores that stuff in muscle but if you're not building muscle where's it go goes to your liver the liver takes the amino group off it becomes an organic acid enters the Krebs cycle in the liver cell ends up overwhelming the mitochondria and ends up being thrown off as liver fat so where inch chain amino acids are actually associated with liver fat and insulin resistance through this pathway right here making insulin resistance in addition Stan Lee Hazen at the Cleveland Clinic has found out that muscle particularly American corn fed beef has a lot of a compound called choline now you need choline you need to make phosphatidylcholine for lipid export you need to make a CT of choline for neurotransmission so you need choline okay but we have a lot of it and it turns out that bacteria in your intestine take excess choline and turn it into a compound called trimethylamine oxide which then gets oxidized to something called TMAO trimethylamine oxide which is one of the stickiest most inflammatory substances on the planet that's lining your arteries and it might be that this is the reason for heart disease with red meat in other words what I'm saying is I'm not exonerating red meat as a promotive factor what I'm saying is it's probably not the saturated fat as we've been told for the last 50 years in fact when you talk about saturated fat they're really two saturated fats there's red meat saturated fat and then there's dairy saturated fat butter you've heard that butters back right well here's the reason why they say it now I'm going to tell you butters back or not that's not the issue the issue is that butter or dairy saturated fat is different from red meat saturated fat because red meats saturated fat are even chain fatty acids 16 and 18 palmitate and stearate whereas dairy saturated fat are odd chain 15 and 17 and they have a specific phospholipid signature that's been associated with heart disease and diabetes protection protection and that's what this is is diabetes protection with the fats involved with dairy but when we got rid of saturated fat we got rid of all of it so we may have thrown the baby out with the bathwater because there's not one saturated fat there's - how about surrogate markers everybody's familiar with this one called LDL you've heard of it your doctor told you it's bad right not really not so much so here are a whole bunch of studies it's a meta-analysis and we're looking at the diamonds again and we're looking at whether or not across is one in a thousand cross 1 so it is clinically significant you know statistically significant significant but the hazard risk ratio here at is at 1.3 the public health officials actually say 1.3 is the baseline for anything to actually be clinically relevant so it just makes it at 1.3 if it was 1.29 they wouldn't even care but it's 1.3 so why does everybody makes such a big deal about lvl turns out if you take the group of people who are most likely to get a heart attack the people ages 30 to 60 and you take them out of the equation and you look at the people from 60 to 90 five turns out that LDL actually correlates with heart disease prevention longevity the higher your LDL the better off you are how can that be if LDL is the bad guy turns out there's a much better marker but we don't use it and it's called triglycerides one of them there are two reasons we don't use triglycerides the first is you have to get the specimen fasting and everyone cheats that's the first reason everybody had the cream cheese in the bagel and didn't tell the lab drawer the second reason is because we figured out how to treat triglycerides 20 years after we figured out how to treat LDL we treat LDL with statins and now we're all on statins it's statin nation triglycerides Kaimal you know we had a drug that actually worked for triglycerides way later so no one got on the bandwagon okay but when you look at the data the hazard risk ratio is 1.8 remember 4 LDL was 1.3 for triglycerides is 1.8 so what is that telling you telling you your triglycerides actually matter more than your LDL does and here's the reason so here are the different lipids in your bloodstream chylomicrons are what happens right after you eat a meal they go straight to your liver and get ultimately the fat comes off it and then gets diverted via the liver to something else so the LDL is what your liver makes out of sugar and carbohydrate the LDL is your liver carbohydrate turned into fat so it can be stored in the periphery in your adipose tissue LDL is your dietary fat rerouted in some fashion an HDL is what happens to LDL after the fat has been offloaded okay it's an evolutionary species turns out your LDL cholesterol is irrelevant what's important is your LDL particle number imagine you had a box of chips ahoy cookies okay and there are different sizes there's still the box they're still in the box but the chips some of the chips are my cookies are huge and big and some of them are really small what if you just ate the small ones would you be any better off than if you ate a couple of large ones not really no well that's what this is so if you look at the LDL cholesterol it doesn't matter if your LDL cholesterol is low or high okay what matters is your LDL particle number if your LDL particle number is low then you survive and if your particle number is high you die because it's the little ones it's the little ones but there are more of them that matter LDL particle number so you say to me well why don't we measure that and the answer is because it's expensive five hundred bucks instead of twenty-five bucks that's why and it's only done in research labs because they won't approve it for good laboratory practice because it's finicky from one place to another here's the problem on this slide here's LDL here's LDL here's HDL over here okay so this is called pattern a LDL notice these globules are large they're called large buoyant pattern a they're so large they don't get under the surface of the arteriole cell to start the plaque formation process in addition they're buoyant they float so laminar flow takes them through the capillaries and they come out the other end and don't do any damage they are for all intents and purposes cardiovascularly neutral and that's 80% of your LDL is type a this guy down here is type B small dense LDL notice they're smaller they can fit under the surface of the endothelial cells to start the plaque formation process they're dense they sink and they get taken out of laminar flow and can actually make it underneath that that that in the field will sell to start the plaque formation process and they're stickier and they oxidize faster which makes them more likely to lead to inflammation so these are the bad guys these guys these are the ones you care about problem is when you measure all the L you're measuring both at the same time so what are you gonna do so you have to have a way of figuring out is your LDL the good guy or the bad guy right and there's a way to do that you have to look at your triglycerides the one that everyone ignores that's the one that matters the most because it has the hazard ratio 1.8 so here's pattern a LDL over here and you have large buoyant LDLs over here see the way to figure it out is that you have low triglyceride high HDL low triglyceride high HDL the triglyceride to HDL ratio tells you what you need to know the higher it is the worse you are over here you have pattern B these are the small dense ones over here high triglyceride low HDL so my question to you is you may know your LDL level do you know your triglyceride level if you don't either your doctor didn't do his job or you didn't one or the other it's the pattern that matters not the number now how about randomized clinical trials well we all went low-fat guess what the Women's Health Initiative showed us that there was no effect no effect didn't matter reducing total fat did not change anything in fact randomized control trials of drugs and diet showed no overall benefit on mortality at all and in fact some of them didn't even reduce CVD events and some of the drug studies especially the statins reported harm like diabetes and there's reason why statins can actually foment diabetes so every doctor comes to this with a bias every doctor has rose-colored glasses or blue colored glasses or some colored glasses okay because they were taught something in medical school usually wrong if you want to know what's really going on you have to go someplace unbiased so who's unbiased the banks totally the banks because they only have one goal make money they're unbelievably transparent and they want to know what they should bank their money on so they want the real data they want to analyze the data properly without doctors getting in the way and they did this Credit Suisse Research Institute phat the new health paradigm and this is a direct quote from this 76 page report and I had nothing to do with this a high intake of omega-6 fats vegetable oils has not been proven as beneficial for 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 to 40 years are the two leading factors behind the high rates of obesity and metabolic syndrome in the u.s. saturated and monounsaturated fats are not 100% i completely agree with this they got it right and the reason they got it right was because they looked at the data without bias well some doctors are coming on board so this is an editorial that was written by my colleague Essene Malhotra who's a member of the NHS Health Trust in the UK along with Rita red Berg who is a physician at UCSF and happens to be the editor-in-chief of JAMA internal medicine and POSCO Meyer who happens to be the editor-in-chief of BMJ open heart not exactly lightweights and they published this editorial last year 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 also 100% agree and what did they target as those lifestyle interventions get rid of the excess fructose and refined carbohydrate I completely 100% agree that's processed food refined carbohydrates and sugar is processed food in fact a seam and I co-authored this along with Mary and DiMasi who's a researcher in Australia the cholesterol and calorie hypotheses are both dead it's time to focus on the real culprit insulin resistance which explains all of the problems and the things that improve your insulin sensitivity improve your risk for diabetes and URIs for heart disease and your risk for every other one of those diseases and I'll prove it to you we did a study in children we took 43 children out of our clinic at UCSF metabolic syndrome obesity plus at least one comorbidity and they were all eating processed food and drinking sodas that was normal I was standard operating procedure we studied them on their home diet we figured out what they were eating and what we did was we catered their meals for the next nine days no added sugar we didn't give them funky food we gave them you know we bought it at Safeway okay it's real food you buy it - okay but it was no added sugar food now if you remove the added sugar from these kids diets that would reduce their calorie intake by 350 to 400 calories a day in which case they'd be in a caloric deficit in which case they might lose weight in which case people would say well of course they got better they lost weight so we didn't want them to lose weight we wanted them to stay the same weight so we had to substitute those 350 to 400 calories with something else that was calorically equivalent we gave him starch refined carbohydrate we gave them starch we took the pastries out we put the bagels in we took the sweetened yogurt out we put the big potato chips in we took the chicken teriyaki out we put the turkey hotdogs in everybody got it shouldn't give them good food we gave him crappy food gave him processed food we gave him kid food food kids would eat okay but it was no added sugar food nine days and we gave him a scale and every day they would go home and we've call him up on the phone and say what's your way and if they were losing weight we said anymore we gave him extra okay to keep their weight stable for the whole 10-day interval okay that's just this whole thing and then we studied him again did the same things every aspect of their metabolic health got better all those red p-values that's all improvement okay everything got better their blood pressure went down by five points their blood glucose went down by five points their insulin went down 25% their glucose air into the curve on their insulin their glucose tolerance test went down 8% everything got better in particular their lipids got better here's the glucose tolerance test here's that 8% reduction I just told you about and here's their insulin response this is an insulin resistance curve because it's not coming down because the body's not responding well to it so it stays up and now on the same number of calories with no change in weight that's now going down and it's you know and it's clearing that's insulin sensitivity we also wanted to see what the liver was doing remember the liver fat so we wanted to measure how fast was the liver making fat so we gave them c-13 labelled acetate to be incorporated into new fat making palmitate and here's how fast they were making fat got cut in half and most importantly the fat depots so here's subcutaneous fat no change because we didn't let them lose weight right big butt fat stayed the same here's visceral or big belly fat down 7% that's good but take a look at their big liver fat down 22% with no change in calories and no change in weight and as the liver fat went away all their metabolic parameters got better in association because their liver got better because it's the liver fat that matters in addition remember those small dense LDLs are the bad guys here they are in red see him now you see him now you don't they disappeared after day 10 okay and their HDL went up which is good right there it is went up and all their lipids got better on the same number of calories with no change in weight and their improvement in their lipids all correlated with their insulin improvement so here's what happened fatty liver notice the color the LDL you know that's the bad guy the serum triglyceride nine days of sugar restriction liver fat cleared the Annelle down the LDL down and their insulin kinetics improved we reversed their metabolic disease with no change in calories and no change in weight proof proof that a calorie is not a calorie and guess what we knew this 50 years ago and it was deep sixed it's been a put up job all along who deep-sixed it the sugar industry so this is a paper that my colleagues Kristen Carnes lura Schmidt and Stan glance published in that in 2016 where they actually found the paper trail of the communications between the sugar Association and the Harvard School of Public Health the chairman of nutrition Fred Astaire and his assistant Marc hagstead who became the head of the USDA and they took $6,500 which would be 50 thousand and today's dollars to publish two articles in the New England Journal which singled out fat and cholesterol as the dietary causes of coronary heart disease and downplayed evidence that sucrose consumption was also a risk factor the sugar Research Foundation set the reviewers objective contributed articles for inclusion and received drafts the sugar research foundations funding and role was not disclosed you've been hacked all of you because what is hacking it's propaganda that's hacking so what's the difference between marketing and propaganda marketing is using information to espouse your point of view propaganda is using disinformation to espouse your point of view if you're being fed disinformation you've been hacked so here is the increase in sugar consumption in the United States over the last 200 years our ancestors getting fruits and vegetables out of the ground with the occasional honey about four pounds of sugar per year no problem here's the growth of the sugar industry in Louisiana Texas Hawaii here stabilization before World War two when price equal demand and here's the rationing of World War two right here and came back to the same level and here's the advent of processed food when we started taking the fat out of food started taking the fiber out of food and had to add the sugar back in and then of course we added high fructose corn syrup which was cheaper so everything got it okay so things that never had sugar before now we're loaded with it like ketchup okay and here is the change in percent of GDP spent on health care over the same period of time what do you see we started eating processed food we started getting sick so let's do the math okay this is a back of envelope calculation but it holds I've asked economists the food industry grosses one point four trillion dollars a year that's a lot of money of which 657 billion is gross profit that's an annual gross profit margin of 45% the next highest industry is Pharma at 18% now we all know Pharma are thieves but that's only 18% this is 45% what do you call them yet health care costs in the United States total three point two trillion dollars a year now of that seventy five percent is chronic metabolic disease the disease's we talked about and 75% of that could be prevented if we could just go back to rates that we saw in 1970 before the processed food debacle so that means that 75% of 75% of 3.2 trillion or 1.8 trillion dollars a year is going down a rat hole what do you think we could do with that 1.8 trillion or even a fraction of it I think we could healthcare for all how about budget for all can we solve the budget you actually could actually afford the tax break the point is we lose triple what the food industry makes cleaning up their mess this is unsustainable and it's why Medicare's going broke and Obamacare can't fix it Trump care can't fix it ain't nobody gonna fix it got it we modeled what would happen to fatty liver disease heart disease type 2 diabetes obesity if we could reduce consumption of sugar in this country by 20% which would be like a tax like we have in San Francisco and Oakland and Philadelphia I've heard about it right sugar tax or 50% reduction which would actually be adhering to what the USD guidelines said which is 6 to 9 to 12 teaspoons of sugar per day at maximum okay right now we're at 18 teaspoons per day media everybody got it and you can see weed you know reduce a lot of disease now on to Social Security you know the Social Security is a Ponzi scheme right you know that Ponzi scheme right the only difference between Social Security and Bernie Madoff is with Bernie Madoff you might have seen a return if you got in early enough in order for Social Security to work you need the young healthy people here at the bottom paying in so that the old infirm sick people up here at the top can take out right but what happens if the young people at the bottom aren't healthy what if they're not paying in what if they're on disability worse yet what if they're on dialysis and taking out the entire base of the pyramid crumbles which is exactly what we're seeing and exactly why the Congressional Budget Congressional Budget Office says that on the year 2029 we will have basically maxed out Social Security and everyone will have to take a 29% cut now I'll be honest with you I'm going to be 72 in the Year 2029 and I want my friggin Social Security and presumably you do too but it won't be there for you it will not be there for you you paid in and you will have lost it just like Bernie you okay with that again let's talk to somebody who actually knows what's going on let's talk to the banks this is from morgan stanley okay and what they did was they modeled what economic growth in the united states would look like on the y-axis going forward by twenty years based on a low sugar case which we don't have stabilization at two point nine percent growth versus a high sugar case here in gold which reaches zero point zero percent economic growth now who is that good for is that even good for the food industry that's not good for anybody but that's what's gonna happen but maybe it won't matter because we'll all have floated away by then because of the climate change maybe that's what they're banking on i don't know so again ask the banks so this is from credit suisse also sugar consumption at a crossroads from 2013 and here's what they said we believe higher taxation on sugary food and drinks would be the best option to reduce sugar intake and help fund the fast growing health care costs associated with type ii diabetes and obesity a global investment bank is calling for taxation now how effed up is that I mean really they have one job make money but they're not gonna make money because they see it so they know something has to happen duh so why is this all happening here's why National Geographic knew why we can't resist it because why because it's addictive because it's addictive now a lot of people who don't believe that but you know there are things that are addictive right so we have an opioid crisis in this country people are addicted all over the place probably here in Montana too right Ohio is ground zero but you know it's everywhere Trump declares opioid crisis a health care emergency but requests no funds to which Jeff sessions said people should just say no to opioids now did Nancy Reagan's just say no work why didn't it work because that's the definition of addiction because you can have the knowledge that this substance is ruining your health your life your family your community your country and you are powerless to do anything about it that's the definition of addiction so you can't just say no because you're addicted duh you don't have to believe me I'm gonna give you somebody you will believe I'm gonna give you a 30-second video and you're gonna go oh everybody ready that's eric clapton talking about how he got into heroin sugar is a gateway drug don't laugh that's exactly what it is it's a gateway drug and more importantly we now have early data in animals that the sugar that the mother eats gets across the placenta and actually changes food preferences in the mice new mouse and rat newborns before they've been exposed to anything so you may come out addicted for all I know so is there such a thing as food addiction processed food addiction well you know the lay public seems to be getting it the academics are a little slow to on the uptake but you know people are saying yeah probably so in fact there's a whole text book on food and addiction so here's the question now we're now we're at this point in this country we were promised three things what were they the claws everyone knows everyone on the planet knows one claws life liberty and the pursuit of happiness and I would argue that all of our problems stem from the misinterpretation of this clause so let's see how we're doing how are we doing on life what do you think so here's life expectancy in the OECD countries these are the 37 developed countries mine us continuing to go up here's us that's a hot stabilization worse yet look who's catching up this year Ethiopia Peru Portugal the Maldives they're all getting better we are getting worse in fact us life expectancy has declined now for two years in a row for the first time we've had little blips where one year compared to the other year we went down a slight bit but we've never gone down two years in a row but we are now now you say wait a second heart disease is getting better which it is but look at diabetes diabetes is what killing us and that's not the only thing killing us let's look at what's killing us so here we have death rates in different countries here's France Germany UK Canada Australia Sweden all going down over time here's the US Hispanic population they're actually doing pretty well but look at who is not us whites u.s. whites what's going on with the u.s. whites what are they died enough poisonings and suicides and chronic liver disease and diabetes poisonings and suicides it's the opioid epidemic in the fifth forty five to fifty year old age range this is not good here's illicit drug use in the United States going up for illicit drugs use marijuana here's this one's prescription drugs and said here's which one's this this is illicit drug use in older Americans 50 to 64 here we have overdose deaths from meth from non methadone opioids fentanyl and heroin here's cocaine here's benzos and the next one is particularly worrisome alcohol take a look at this this is alcohol use disorder from tooth to 2012 and you'll notice that there's been an increase but boy oh boy look at an eighty three point seven percent increase in women what are you ladies doing and worse yet it's not even the young women it's the older women what the hell so that's life how about Liberty how we doing on Liberty so this isn't a project at Harvard School of Economics called the equality of opportunity project run by Raj Chetty a brilliant economist and what they did was they looked at whether or not you are a prisoner of where you were born so while you have the capacity to be able to move yourself you can't move your station it's like the caste system in India so this is your salary compared to your parents salary based on what county you were born in adjusting for everything else you got it and what you see is that if you were born down here you are making a whole lot less than your parents did so let's get a little granular let's take someplace I know well New York City so over here we have the Bronx and over here we have Bergen County okay and we're looking now at the change in your salary compared to your parents based on whether you were born across the George Washington Bridge and if you were going in the Bronx you make 11% less than your parents did controlling for everything what's controlling for race education health status obesity you know age everything sex gender everything whereas if you were born in Bergen County you're making fourteen percent more you say well wait that's that sorry that's the the cheap the poor people at the 25th percentile but you know what it holds up at the 75th percentile too so we are prisoners of our own making based on where we were born so here are the top 10 counties to be born in and here are the bottom 10 counties to be born in so the moral and the lesson of this slide is whatever you do don't move to Baltimore and finally the pursuit of happiness how we doing there not so good so here we have children's hospital admissions with the diagnosis of either suicidal ideation or self-harm up in the 12 to 17 year old group significantly and here's just encounters in the outpatient department tripling in the span of seven years triple the kids thinking about suicide coming into clinic now let's look at the deaths so here we have total deaths in children ages 10 to 14 and you'll notice that motor vehicle accident deaths have gone down significantly because of improvements in transportation because of you know you know airbags and crush zones and stuff like that and also because the children aren't actually in the cars where are they they're at home playing video games getting depressed and committing suicide in fact suicides have now overtaken motor vehicle accidents as of a cause of death in ten to fourteen year olds you okay with this here's a me depressant use in the United States and you could say well that's us because you know we now have prozac but the fact is is happening all over the world four point four percent of the entire world is now clinically depressed and eighteen point five percent increase in prevalence in a decade it's not just us the whole world's depressed and it's not Donald Trump it came way before him the point I'm trying to make the thesis I'm trying to tie together for you is that I think that these four crises the healthcare crisis the social security crisis the opioid crisis and the depression crisis are actually one crisis that we've been hacked and the hack is on this slide it is the systemic confusion and conflation of these two terms pleasure and happiness now who here can tell me the difference between those two terms pleasure is short term happiness is long term that's first okay we got six more to go huh good so pleasure is visceral you feel it in your body happiness is ethereal you feel it above the neck you're on a roll come on let's have number three it's like Family Feud huh oh we go we're get that's number seven oh you you can't jump the gun on me I'm sorry no no no I don't know who she is but she's smart pleasure is taking happiness is giving pleasure is experienced alone happiness is usually experienced in social groups pleasure is achievable with substances happiness is not achievable with substances the extremes of pleasure whether it be substances or behaviors so substances like cocaine heroin nicotine alcohol sugar or behaviors like shopping gambling internet social media porn in the extreme all lead to addiction there's an a holic for every one of those but there's no such thing as being addicted to too much happiness and finally number seven as you called it pleasure is dopamine and happiness is serotonin so two positive emotions two motions we value treasure let's try to achieve pursue yes but two neurotransmitters to different areas of the brain two different sets of receptors two different mechanisms of action so like you say why we care like so what I like them both here's why the MRI shows that your brain has been hijacked by dopamine pirates you are now under the full control of social media corporations gambling casinos and big pharma are you writing me a prescription no I'm buying stock in those companies here's why we care dopamine and serotonin are not the same dopamine is an excitatory neurotransmitter when it's released from one neuron to the next in this area of the brain called the reward center or the nucleus accumbens it excites the next neuron now noise like to be excited that's why they have receptors in the first place but there is like to be tickled not bludgeoned okay neurons are fragile they die easy okay you know that like if you go underwater you know you drown but your brain goes first before the rest of you you know that right okay because your brain needs you know stuff more than the rest of your body does okay neurons die easy chronic excitation of any neuron can lead to neuronal cell death everybody got that and we know that because of kids with chronic seizure disorders where we can't stop the seizures and it fries their neurons and we know that from pathology I have to take care of the used to death to take care of these kids so to protect themselves the dopamine receptor neurons the second neuron the receiving neuron has a plan B it has a failsafe it has a self defense mechanism what it does is it down regulates the number of receptors so that it's less likely than any given molecule dopamine will find a receptor it's called the law of mass action so in human terms in vernacular you get a hit you get a rush the receptors go down then the next time you need a bigger hit to get the same rush and the receptors go down and then a bigger hit and a bigger hit and a bigger hit and a bigger hit until finally a huge hit to get nothing that's called tolerance and then when the neurons actually you start to die that's called addiction and when they die they ain't coming back everybody got that here are the dopamine receptors in a control brain and the red means there's lots of them and here's in an addicted brain notice way fewer okay so this is just a cartoon okay so here's an on drug abuser and there's lots of dopamine receptors here on the second neuron and here's an a drug abuser with way fewer everybody got the picture because the receptors have been down regulated in an attempt to try to salvage the neuron from dying and it's true in obesity too so here's that same area of the brain the nucleus accumbens the reward center and here's an obese person it's brain so they get less pleasure less reward from the same amount of food because their dopamine receptors have been down regulated now serotonin on the other hand is an inhibitory neurotransmitter it does not make the next neuron fire it actually puts the next neuron to rest now if you're putting the next neuron to rest you have to down regulate your receptor no that would actually be counterproductive wouldn't it so you can't overdose on too much happiness because the receptors don't go down but there's one thing that makes the serotonin go down dopamine so the more pleasure you seek the more unhappy you get so here's the pathway the ventral tegmental area is where the dopamine cell bodies are and here's the nucleus accumbens the reward center and then there's this area over here which is really important right above your eyes behind your forehead called the prefrontal cortex prefrontal cortex is super important okay we're talking about this today at MSU okay here's the serotonin system notice a different area called the dorsal raphe where the cell bodies are and the entire brain is affected especially that prefrontal cortex also and the prefrontal cortex is in reciprocal relation between these two areas and then finally is a third area called the stress fear memory pathway again the prefrontal cortex is inhibiting these areas the amygdala which is the fear center that's the area that goes bonkers when you're walking down a deserted alleyway at 3:00 in the morning okay the hippocampus which is where the memory of when you burned your hand on a hot stove at age three is kept okay and here's the hypothalamus which controls cortisol turns out cortisol puts that prefrontal cortex into suspended animation that prefrontal cortex is the thing that's keeping your dopamine in check so the more stress the more dopamine now that prefrontal cortex is right here you can see that in the squirrel monkey and the cat not so big again the dog a little bigger and here in man is huge okay this is what makes us us is that prefrontal cortex otherwise our brains are like everybody else all the other animals okay but it's our executive function our ability to inhibit stupid things okay the Jiminy Cricket part of your brain okay like Pinocchio you know the one they the conscience that tells him not to do that stupid thing okay that's the prefrontal cortex and when it's not working okay you got a problem and that's what all our kids have it's a problem well that ATD what do you think it is it's a problem with this so the prefrontal cortex does a whole bunch of things that are very very important to normal functioning in our society and I won't belabor this because we're you know time so I'm just going to show you here this is a video of here's the prefrontal cortex up here it's going to run on a loop and you can see that it's the last area to myelinate and the problem is that myelinated neurons are preserved from being killed you know it takes a lot more to kill them whereas unmyelinated axons are a lot easier to kill them think of it as the plastic coating around a copper wire okay if you have the plastic coating is it likely that you're gonna short-circuit but what if the copper what if the plastic isn't there same thing okay in fact you can see that there's an inverse association between obesity and prefrontal cortex in adults because that area is not doing its job and it's making you allowing you to eat because you're getting quote reward so here's addiction excessive reward from too much dopamine which down regulates its receptors then throw some stress on and you get the munition of pleasure here's depression deficient contentment from not enough serotonin and metabolic syndrome and all the things that basically go along with poor health down regulate serotonin then throw some stress on which reduces the receptors for serotonin and now you have the munition of happiness - so turns out that addiction and depression are just two sides of the same coin and here is what we have done to our environment these five things technology processed food sugar sleep deprivation and drugs and they all do the same they up your dopamine and they down your serotonin this is what's wrong and it's what's wrong for all four of those crises now how did this hack happen how did we get confused I would argue that this has been industry driven and government sanctioned that they knew what they were doing it's been orchestrated willful now it's not a conspiracy and the reason is not a conspiracy is because a conspiracy would require collusion between industry actors we have no data to support that what it is is it's a plot and the reason it's a plot is because every single organization or company has figured out that this is the way to get you to buy more of their stuff and then every other company who's in competition with them says hey they're devouring our market share we got to do what they're doing and so they've all basically figured it out for themselves and ratcheted it up whether it be technology or drugs or sleep deprivation or anything else for that matter so it's been engineered with a profit motive to basically steal everyone else's market share and we are the subjects we are the consumer so here's an example everybody familiar with this right ten years the longest-running campaign in the company's history ten years 2005 to 2015 open happiness any happiness in that bottle sugar dopamine caffeine dopamine caramel color and salt phosphoric acid carbonation no water any happiness in there nope how about this one the road to your happy place is paved with raisins and flakes and pavement what's that saying saying hey if you're fat it's your fault because you didn't exercise enough right and pavement now see the Raisin Bran falling from the sky my question to you is is this Raisin Bran yes no I hear no why is this not Raisin Bran yeah there you go that's the Raisin Bran 16 grams of sugar now if you actually separate the raisins from the brand and count up how much sugar is in the raisins the answer is is 7 grams so there's 9 grams of added sugar coating the raisins to make them sweeter so you'll eat it ok now if you go whole hog and you want to go you know for the full monty then you'll buy the raisin bran crunch at 29 grams of sugar where where sugar is the second ingredient and you got brown sugar syrup corn syrup and honey and also I think molasses over here too okay everybody got the picture all right how about the happy meal not-so-happy the good news is that there are a few hopper meals sold the bad news is kids are ordering the dollar menu instead and I think this is the next ones of video nope not yet okay how about Nestle okay I know I'm focusing on food we're gonna get to the other things in a minute so here's what Nestle has on their website which is kind of cool they say happiness and health are intimately linked together the healthier you are the happier you'll be and vice-versa so here's my question does happiness translate into health yes or no what you think turns out no it doesn't this is called the UK women million woman's study with Ashley looked at this question and it turned out that poor health at baseline was strongly associated with unhappiness but after adjustment for all the things the treatments turned out it had no effect what did have an effect were all of the hedonic behaviors associated with that unhappiness so if you were so unhappy you started drinking or smoking or eating chocolate then you had a problem with your health and with your longevity it's the UH knits the hedonic behaviors that contribute to the problem not the unhappiness itself humans have been unhappy for millennia but that didn't kill us what killed us was what we did about it so here's what Nestle said this was from 2016 notice right Nestle wants to sell you both sugary snacks and diabetes pills and when getting into the pharma business okay but a new CEO came along before I get there here's what they also said happiness comes from spending time with loved ones fostering relationships or learning how to cope with stress or depression I agree that's exactly right they got that right so the new CEO of Nestle mark Schneider who came from the health care industry actually this past month or two months ago agreed to sell the u.s. candy business to Ferrero Rocher you know the Nutella people for two point eight billion dollars because they want out of this because they know this is not good yet here's what they do in Brazil instead they're gone they're going offshore just like tobacco did so this is a Promotora okay with all Nestle packaged foods high sugar selling it in the favelas in Brazil okay so not so good and finally for this part another video tends to be loud so watch your ears oh no sorry before that one how about happy hour you know it's five o'clock somewhere right you know where it's five o'clock every day it's five o'clock every day at ten o'clock on NBC with Hoda and Kathie Lee drinking it's called The Today Show happy hour okay and this is particularly egregious because Hoda is a breast cancer survivor and alcohol has been shown to increase breast cancer recurrence and maybe just maybe this is the reason that there's been an eighty three point seven percent increase in alcohol use disorder in women is because they've been told they can you okay with this and finally this is the most pernicious of all ready [Music] watch [Music] Red Bull oh Henry another candy bar I don't know which one not done potato chips if you are consuming redbull at midnight in South Central LA at a convenience store you ain't happy think about it how about stress remembers let's ask them stress to the reward right when the time comes will you be ready now how stressful is that how about a little more stress about sleep deprivation okay you know everyone's sleep-deprived now okay and why is it the coffee or what it's the technology okay and we have this thing called Peck addiction in fact Sean Parker co-founder of Facebook said we built Facebook to exploit you okay direct quote here it is we need to sort of give you a little dopamine hit every once in a while because someone liked or comment that on a photo or post or whatever in fact there's a whole company devoted to turning your app into an addictive one called dopamine labs now what's the goal here's the goal everyone has habits those habits form because there's some reward associated with the habit that's what makes it stick okay but most people don't derive a whole lot of shall we say pleasure happiness or otherwise from their habit like twirling their hair you know or biting their nails or whatever okay what makes a habit a problem an addictive one is this cycle so you start with a trigger like for instance your emails going off in your pocket which then leads to an action which is checking your emails that and that action has to be socially acceptable at the present time which it is today trying to fix that which then leads to this is the most important part to make it addictive variable reward it can't be the same reward every time it's the same reward every time then it's gym I mean like do you check your GPS you know like just check it once it's done right okay do you keep going back but what about your emails what about Groupon or overstock they're designed how about when you try to book a plane with the Airlines online you ever notice you come back ten minutes later after you've checked your calendar and checked with your wife and the prices have gone up you know two hundred fifty bucks okay why do you think that is I'll prove it to you I'll prove it to you how many of you use Gmail yeah a lot of you because it's free right yeah yeah I use it to just just say you know all right have you ever noticed that it takes a second and a half for the new emails to populate your screen that's the dopamine hit that's been baked in on purpose to keep it addictive that's an example of this process and then of course that leads to investment which is the only thing that companies really care about is that you're willing to plunk down another thousand bucks on an iPhone in fact iPhones and children or a toxic pair say Apple investors Zuckerberg dilemma when facebook success is bad for society indeed in fact he wants to show Zuckerberg wants to show that the world can still be a positive force in people's lives or at least it shows truly trying to be he says Facebook is the most amazing connectivity which it is but connectivity is not connection big difference in fact what he says is well depressed people use Facebook because they're looking for social validation and they can't get it any other way which is undoubtedly true but he's missing half the story indeed if you do time lag analysis on people who are depressed or not depressed if they're depressed they get more depressed which is true after two weeks of Facebook but even if they're not the press they get more depressed everyone gets more depressed he's not telling you about that and we have causation on that that's not by accident okay life satisfaction goes down the tubes and by pray for our Tizen content that sparks conversation with friends Facebook could risk promoting more polarizing and opinionated posts that generate lots of comments only adding to the filter bubble because the filter bubble is dopamine what do you think's going on what do you think Fox News is it's validation of your own thoughts over and over again so this is Tristan Harris who used to work at Google actually is responsible for that second 1/2 gmail delay so he knows what it is because he did it and he has actually left the company and started a nonprofit called the Center for Humane technology to try to get software developers to take this issue and problem into account because we're not going to reverse from technology but we can certainly make technology safer for the last 10 years it's been the Wild West and the fact is the Wild West needed to be reined in ultimately every new industry needs to be reined in at some point and it's time for this to go as well so have smartphones destroyed a generation Jean Twenge at UC San Diego has looked at the data and the analysis and says yes it has it has destroyed a generation and common-sense media with the center from humane technology actually sponsored a conference in DC a month ago yesterday on technology addiction and I talked about this whole issue and I am an advisor to both of these companies organizations so here we are technology processed food sugar lack of sleep drugs add some stress and you got the whole enchilada so in summary we're not quite done yet but we're getting there reward is not contentment pleasure is not happiness reward is dopamine contentment of serotonin long term excess reward interferes with contentment chronic stress drives reward at the expense of contentment business has intentionally conflated the two terms pleasure and happiness specifically to get you to buy its junk because they say you're unhappy by this and we believe them and then when it doesn't work we go oh it's us or engage in the hedonic behaviors that are profitable to them that's why we are consumers government legislation and Supreme Court decisions have made it easier to buy that junk or engage in those behaviors and there are specific Supreme Court decisions that were all five to four that led to this and individuals in society if we become fat sick stupid broke addicted depressed and most decidedly unhappy so what can we do are we screwed is there anything we can do the answer is yes there is you can do something for yourself and your family that's all you can do right now for yourself in your family we're gonna need societal intervention to fix society but at least for yourself in your family they're called the four C's and they're all evidence-based they're all clinically proven with neuroscience and you know empiric outcome data to up your serotonin tamp down your dopamine and lower your cortisol or your money back but none of them cost anything so don't expect a refund they're all things your mother taught you which you have forgotten they are in order connect now connect does not mean Facebook Connect means interpersonal I too i face-to-face connection looking someone in the eye why do you have to look someone in the eye because you have a set of neurons in the back of your head called mirror neurons which transduce the facial expressions of the person you're talking to in real time and interpret that they as the emotions that that person is generating and you adopt those emotions yourself it's a process we have a name for it's called empathy and if you can't do it you are a psychopath got it think think okay empathy so Paul Ekman famous psychologist use at UC Berkeley went to Papua New Guinea they'd never seen a white person in their lives they had the same facial expressions for the same emotions that we do where they get them from they learn them from us no it's baked in okay it's part of our DNA everyone uses the same emotions for the same as the same facial expressions for the same emotions so you're getting that information and you're processing it and turning it into serotonin okay religion is a great way to explain this issue because religions of dopamine and serotonin so there are 4,200 religions on the planet how come so many because any of them work I don't know you tell me why are there so many religions on the planet every religion has one thing in common and that's it community a meeting place a place where you meet and greet and commune with other people the serotonin turns out what the religion espouses is the dopamine and we know that because when we started treating Parkinson's patients back in the early 70s with l-dopa the precursor to dopamine because they have a dopamine problem in a different part of the brain called the substantia which leads to motor problems we started giving them l-dopa and they would get better from their motor dysfunction and we still give them you know dopamine precursors today but back then when we didn't know what the dose was there's an entire literature on a sizable percentage of these people becoming compulsive gamblers and religious zealots anybody see the movie awakenings that's it that's what happened okay so that's the so that's the dopamine and dopamine leads to cell a tree serotonin leads to community and religion is both so face-to-face connection that's empathy and you need that for serotonin yet social media generates dopamine because of that filter bubble and Facebook again leads to social isolation and depression sherry Turkle at MIT said that we are now alone together that's exactly right we are all alone together that is not a good way to be that's a good way to get depressed number to contribute and this does not mean to your bank account this means outside of yourself is the Rick Warren's The Purpose Driven Life as an example okay padding your bank account does not work it's not contributing and lottery winners are not happy and those who have a value financial success actually derive less contentment saving rather than spending actually increases happiness and can and if you spend the money on yourself you get pleasure and makes you a consumer if you spend it on others and makes you an individual and you get happiness and there's actually data on that can you arrive derive happiness from work everyone wants to know can't I get this from work and the answer is yes you can if two criteria are met you can see your work helping others and your boss can see it too then you can get happiness from work but what if you can't what if that's not your working situation well then you have to find other ways altruism volunteerism philanthropy can pay somebody else to do it for you okay anything that contributes to the greater good outside of yourself that you're not getting the Boy Scout badge for will work number three cope ok that means three things sleep mindfulness and exercise everyone sleep deprived 35 percent of Americans get less than seven hours of sleep and 23 percent suffer from clinical insomnia some of those people have obstructive sleep apnea which only makes it worse and they then sued me take caffeine to reduce their sleep and increase their dopamine which only actually moments' the problem and makes it worse and I will tell you that dr. drats and i had about six cups this morning the buzzword of the millennium multitasking you can't get a job if you're not a multitasker nowadays right except for one thing only 2.5 percent of the population can actually do it everybody else is serially uni tasking and every time you switch from one task to the other guess what you get a hit of cortisol that's stress okay well it only makes you more and more unhappy and you can overload anybody pilots are the ultimate multitaskers they actually can multitask you can even overload a pilot okay if you give them enough tasks and you can actually see their serotonin in their brain fall they've done it with you know serotonin radionuclides you can see it on PET scanning okay screens are the antithesis of sleep this blue light actually keeps you up because it's telling your midbrain it's still light out okay so it affects your melatonin kids who charge their cell phone in their room at night get 28 minutes less sleep than those who charge their phones outside their room and smartphone apps for wellness have not yet shown benefit mindfulness activates the prefrontal cortex so when you concentrate on a single task that's exercising your prefrontal cortex that's basically getting rid of all the noise that's executive functioning so you exercise your body you need to exercise your prefrontal cortex so mindfulness is the way to do that and so it's now been shown to actually have effects on health and exercise is as good as SSRIs at alleviating depression and if you combine mindfulness plus exercise you can actually reverse depression completely without drugs and finally our next president Cook so it turns out there is a phenomenon called reward eating drive so you can give somebody a full plate of food have them completely not hungry and they'll still eat based on whether their dopamine is working and you can actually antagonize that with a opiate antagonist naltrexone we actually have done this and shown this reward eating drive associates with obesity and metabolic syndrome processed food has three things wrong with it low tryptophan tryptophan is the precursor to serotonin so if you have low tryptophane you're unhappy and when you get tryptophan you get happier and there's data on that low omega-3 fatty acids which are anti-inflammatory and they stabilize neuronal membranes turns out when you look at Omega 3 deficient mice there's an inflammatory haze around their serotonin synaptic Bouton's which goes away when you give them the omega-3s back so they improve their serotonin neurotransmission and then finally high sugar low fiber because they've added sugar for palatability and it's addictive and causes metabolic syndrome and low fiber which prevents it that's processed food so one third of Americans don't know how to cook and if you don't know how to cook your hostage to the food industry for the rest of your life and that's their goal that's why they did it because now you're a sucker the real food movement however is in high gear around the country especially in the Bay Area so we're pretty lucky ok but you know outside in the Midwest and maybe even here in Bozeman you know maybe not so much point is you need it's only about real food and I told you that at the beginning didn't I companies who don't change will ultimately be left in the dust unless they buy the startup and kill it which they're doing Campbell Soup actually broke with the grocery Manufacturers Association which is a good sign cooking is all for at once it's connecting it's contributing it's coping because you have to be mindful and it's cooking real food so sitting down to a home-cooked meal with your family is the single best thing you can do for yourself but we have lost that because of what Netflix soccer you name it okay you get it what can we do professionally five modest proposals not so easy to do but also effective at ucsf we've gotten rid of sugared beverages off campus it's called the healthy beverage initiative you go into our cafeteria can't buy a soda people go where's the soda it's a teaching moment where were where were cigarettes banned first hospitals we're supposed to role model for the public so we've gotten rid of sugar beverages because they're causing this and it's Swedish hospitals Seattle they got rid of juice how about that cool and guess what the NHS in the UK sugary drinks will be banned from sales starting in July and that's due to our work proposal number two let's rename type two diabetes no one knows what the hell it means anyway it's a Greek Egyptian word that means siphon because you're in the bathroom peeing your brains out now did you know that let's call it what it is oh you've got processed food disease I think that might make a impression on you process a proposal number three let's roll back all the subsidies for all the commodity crops that are killing us now there is no economist on the planet that believes in food subsidies because they distort the market let the market work even libertarians can get on board with that so people say wait if you get rid of all the subsidies then food will get expensive so the Giannini foundation that you at UC berkeley actually did this modeling they did this exercise and it turns out the only things that would go up corn him sugar the two things we would want to go up everything else will stay the same that's kind of good number four our nonprofit trying to jumpstart this real food thing from the bottom up so if you saw this in arrests in a restaurant window you might say hey what they're serving in there can't kill me maybe I'll go there and then the guy across the street say hey I'm losing business to him maybe I should do that too and you know you start out a little movement okay and ucsf is he real certified okay and finally let's get sugar off the generally recognized as safe list because it's not safe it's toxic it's toxic and addictive it is everywhere and it is killing everyone and it is bankrupting healthcare our economy our society and it is the Gateway to everything else that's wrong so a thought but you know this is a heavy lift because there are a lot of people on the other side a lot of money on the other side st. gonna happen any cut time soon so I hope tonight I have solved the healthcare crisis solve the social security crisis solve the opioid crisis solved the depression crisis and made you happy you came thank you you

Channel: College of Letters and Science, Montana State University

Views: 174,754

Rating: 4.8428617 out of 5

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Id: tHYu8NlWDLU

Length: 99min 22sec (5962 seconds)

Published: Mon Mar 12 2018

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[u/easilypersuadedsquid]

Speaker: Robert Lustig, Professor Emeritus of Pediatrics, Division of Endocrinology and Institute for Health Policy Studies, University of California, San Francisco; Adjunct Professor of Research, Touro University California

Robert Lustig gives his take on how to solve the health crisis, social security crisis, opioid crisis and depression crisis.

[u/shewel_item]

He could have been more progressive