Robert Lustig - Bad Sugars: Addictive and Hazardous to your Health

today what I want to talk to you about is as Mark said the flip side of the sugar story Carol Umberto Z talked to you about glucose how glucose can be attached to proteins on the surface of cells and allow for cell to cell communication very important in endocrinology and we care about that but we're going to talk today about is where sugars go wrong as it were you know sugars gone wild and that is very specifically the compound truck toast and we're going to talk about what it does what it doesn't do and its relationship to health and I'm going to try to have just enough science to keep you interested and hopefully a little bit of you know popular stuff to make it fun first of all I have no disclosures no food industry concern is putting me up to this so this is the past 2001 six million kids are seriously overweight well in the last 12 years with all of the attention to obesity with all the NIH money with all of the research and programs that have gone on around the country and around the world with Michelle Obama's vegetable gardens we are now up to 20 million here's the present currently there are 30 percent more obese people on the planet than there are undernourished people this is a complete switch from just 15 years ago when it was the other way around and this is in countries that still have malnutrition they now have obesity this makes no sense it actually looks more like an exposure like an infectious disease epidemic than it does anything else 366 million diabetics walking the earth that's 5% of the world's population and they are chewing through all the healthcare dollars and this is a problem and it's a problem for me and it's a problem for you and it will be a bigger problem for you in the future this just came out two months ago diabetes cost the u.s. 245 billion dollars a year if we could recoup even part of that we could actually fix healthcare we could actually make a big dent in the federal budget and that's just for diabetes never mind all the other chronic metabolic diseases such as heart disease cancer dementia and things that are related to the obesity epidemic which we call metabolic syndrome and this is the future if nothing happens if we just keep doing what we're doing 165 million Americans will be obese by 2030 that will be 42 percent of the u.s. population 100 million Americans will have diabetes by 2050 that will be 33% and so that means no health care for you because Medicare will be broke by the year 2024 that's just 11 years from now well I'm going to turn 67 in 2024 and I want my Medicare and I hope you do too because some of you are already paying into it probably with your summer jobs you will never see that money again unless we do something question is what now to understand obesity we have to understand the fact that there's a reason for obesity this is an 11-inch statute that currently lives in the Vienna Museum of Natural History carbon dates back to 22,000 BC and what it shows us is called the Venus of Willendorf and it what it shows us is that the ancients knew about obesity before they knew about McDonald's obesity is part of the human condition there are reasons for obesity it actually helps promote storage for a rainy day and we've had a lot of rainy days in our history there are 60 different medical diagnoses if you pull out a textbook of medicine or Peter or endocrinology that contribute to obesity or cause obesity and so the fact that obesity has been with us for millennia is should be no surprise the question is what happened in the last 30 years you have lived through this you have been part of this you know that this is going on in your schools and despite the fact that all of this attention is being paid to this problem nothing seems to happen the statistics just seem to get worse how did this happen and how did it happen so fast and that's what we're going to talk about today now to understand obesity first you have to understand this law of physics right the first law of thermodynamics which states that the total energy in static closed system remains constant now that's a law I believe in the first law the first law is sacrosanct the first law is airtight if I didn't believe in the first law you didn't ride me out on a rail and call me a an idiot and an heretic in a zealot and whatever else the point is that like any law there are different interpretations as the Supreme Court since everything's five-to-four I've learned all about that in my law school studies there is no Supreme Court decision that isn't five-to-four that means that there are different interpretations of the same law well I'm going to give you the two interpretations of this law right right now and we're going to see which one makes more sense so this is the first interpretation the one I learned way back when the one you've learned if you eat it you better burn it or you're going to store it now who here believes that come on come equip all right everyone and his brother has told you that this is the case the NIH the US Surgeon General the Institute of Medicine the president Michelle Obama and the food industry have all said if you eat it you better burn it or you're going to store it in which case the obesity that's over here is a result of too much in gluttony not enough out sloth two behaviors obesity is the result of behavior and this works for the administration it were for the food industry it worked for the insurance industry because if it's a behavior it's your fault and if it's your fault they don't have to pay because if it were anything else and they had to pay it would break the bank so everyone is lined up on the side of this interpretation of the first law and it's based on this Dogma a calorie is a calorie that you can get your calories from carrots or you can get your calories from cheesecake if you eat more calories than you burn you will gain weight that's a calorie is a calorie that's the dogma and anybody who goes against that Dogma is considered a heretic and a zealot well guess what I'm going against it the corollaries to this Dogma are this is free will you get to choose what you eat you get to choose how much you eat it's personal responsibility when that doughnut is staring at you you don't have to eat it right and it's your choice to do so and therefore it's your responsibility therefore if you're obese its gluttony and sloth after all the obese are the last group of people that we can still make fun of right just turn on Jay Leno any given night and at least one-eighth of the jokes are about obesity and finally it must be about diet and exercise because if you eat less and you exercise more you'll lose weight and everybody knows somebody where they've been able to be successful one person problem is we have many people most people who are not successful the question is why because they are gluttons and sloths because they don't have enough intestinal fortitude they don't have enough backbone is that what this is really about this is going on all over the world the Japanese are beating the pants off us in terms of you know knowledge and you know where where their high school students are not you guys but you know in general the the level of their high school students but they're doing Barry surgery at Tokyo Children's right now something's going on something bigger than this we're going to talk about so what is it is it just a caloric Bacchanalia we're all just awash in this stuff up wait this is wrong that's much better okay indeed we are all eating more no argument American men are eating 187 calories a day more than 25 years ago adult women 335 calories a day more than 25 years ago and teen boys 275 calories more per day than 25 years ago agreed we are all eating more the question is why well this would be the obvious answer right this is what fast-food has turned into this was the original White Castle hamburger in 1957 when I was born one ounce 210 calories this is bob's big boy over here at 6 ounces and that's 618 calories and in the midst of the obesity epidemic Hardee's had the temerity to or bring on the thick burger at 1420 calories and everybody knows that Carl's jr. has the $6 burger which is 2,000 calories so you'd say well there you go that's obesity right there anybody had a treinta okay there's a Trent 2 right over there ok 916 C seems ok and that's not black coffee that's a sugar sweetened beverage right because it's cold right your stomach is 900 CCS it's bigger than your stomach now Mayor Bloomberg in New York has tried to institute the big gulp ban and the judge in New York struck it down on the basis of freedom of choice personal responsibility and all that other stuff it'll be appealed and we'll see where it goes and I've learned a lot about that in law school and we can talk about that at the end if you like how about this free double is just sandwich with the purchase of a 30 ounce drink has the food gotten so cheap that we're giving it away now or is it the other side of the equation is it an activity famine kids aren't exercising very much anymore so this is a measure of physical activity called met teens how much exercise and this is white kids and the white girls and this is black girls ages 9 all the way up to 19 and you can see the black girls ages 15 to 19 are basically lying prostrate on the bed or the floor not moving at all so you'd say well there's your obesity right there and that's exactly what everyone tells you is we eat too much we exercise too little and indeed we do the question is why because the food is there it was there before because the TV is there it was there before and we didn't have this caloric catastrophe something else is going on Mark Twain said it best education consists mainly of what we have unlearned okay there's only one dogma there is no dogma that's the dog whatever we believe 10 years ago is already wrong and whatever we believe today will be wrong 10 years from now that's why we do research is to advance the ball because if any Dogma were true that would be the end of research there wouldn't be any need to do further research would there so all of you have to basically leave your dogma at the front door and let's talk about what's really going on all right so behavior personal responsibility that's what you walked in with is that right I have 6 reasons to doubt this here's the first no child chooses to be obese the quality of life of an obese child is the same as a child on cancer chemotherapy you think anybody chooses that you think anybody goes out and says I think I'll be obese today what's in it for any given kid to be obese now maybe some adults choose to be obese I don't know but no kid does nobody will play with an obese kid they've done these studies where they show pictures of deformed kids to other kids and say which of these kids would you rather play with and the obese kid is the kid that nobody wants to play with so who would choose that second does diet work everybody's diet works for the first six months and then look what happens doesn't matter very low calorie diet with behavioral therapy without behavioral therapy by the end of five years it's all back to the same baseline and here's the number of patients who can keep their weight off for nine years or greater about one percent about one in a hundred can keep their weight off for any length of time at all bottom line diets work and they don't work the question is why because there's more going on does exercise work so this is the identity line right here and here are a bunch of meta is a meta-analysis of a bunch of studies looking at whether exercise can allow you to burn off calories enough to actually lose weight and the answer is no when compared with no treatment exercise resulted in very small changes in weight a total of 0.5 BMI points that ain't going to do it but you say if the first law was right then you should lose weight right doesn't work number three this isn't about America it's not about the UK it's not about Australia it's about everywhere and every country on the planet has experienced an uptick in obesity over the last ten years doesn't matter where doesn't matter who doesn't matter what doesn't matter genetics nothing every country has seen it so you can tell me everybody's a bunch of gluttons and sloths now number four the poor are disproportionately affected if you believe in personal responsibility if you believe in free choice then you have to have a choice the poor don't have a choice they can't buy reasonable foods they don't even have grocery stores in their local neighborhoods they have to go to convenience stores where it's all processed I sug er low-fiber processed foods they don't have a choice they don't have they can't diet and exercise they can't even go out for fear of crime they won't let their kids out because they might get shot so if you don't have a choice how can it be personal responsibility number five the prevalence of obesity is going up in the group that can't accept personal responsibility the toddler age group you're going to tell me that a two-year-old can accept personal responsibility and number six the the slam dunk the in yo face we have an epidemic of obesity they don't diet and exercise so any hypothesis you want to proffer to me about what's causing the obesity epidemic has to explain obese six month olds and you can't do it not on diet and exercise you can't not on personal responsibility not on free will something else is going on have I got your attention good so let's talk about this behavior right personal responsibility it's a behavior it's gluttony and sloth and you get to choose it's a behavior here's the definition of behavior a stereotyped motor response to a physiological stimulus so let's take that apart stereotype same every time so yes eating is a behavior because it looks the same every time you do it motor muscles have to move a thought is not a behavior and finally physiological that's the key one behavior is driven by biochemistry always sometimes we're smart enough to figure out what the biochemistry is sometimes we're not but the bottom line is behavior is always secondary to some change in brain chemistry or brain function behavior has a biochemical basis and so when you understand that biochemistry then obesity actually makes sense we're going to talk about that a little bit now so what are the biochemical underpinnings of gluttony and sloth what does the brain see that makes this happen in this book food fight came out in 2004 Kelly Brownell who is now the dean of public policy at Duke University coined this term the toxic environment and what he was talking about were the behaviors that lead to obesity that are now promulgated basically throughout the United States on the food side we have food available 24/7 365 accessible as never before sold in places unrelated to eating who ever heard of having dinner at a gas station right but you go on i-5 that's where you have dinner she unbelievably cheap right promoted heavily designed to taste really good to keep people eating we'll talk about that in a minute on the activity side decreased walking and biking little PE over across the bay and the San Francisco Unified School District they 80% of kids can't pass the phys ed exam and fifth grade why because you need a certificate to teach phys ed but you don't need a certificate to teach so the teachers have to pay for that themselves so they don't get it so there are no teachers who can teach phys ed so there's no phys ed that's brilliant absolutely brilliant but that's what's going on little a screen time makes kids inactive yes no I don't know that's a tough one and parents again are reluctant to let their children out of the house for fear of crime this is a disaster all these things are true the question is is this a causative piece is this what's going on the toxic environment has Brunel defines it is really a euphemism for our altered behaviors I'm more interested in whether or not there's really a toxin a poison that's actually driving the obesity epidemic and I'm not the only one who thinks this but I'm certainly one of the people who thinks this so we know that there are substances that are out there that are both addictive and hazardous to your health and we regulate them because they're addictive and hazardous to your health tobacco alcohol other street drugs right well what I'm going to try to show you today is that this guy right over here the stuff in that yellow package the stuff that's in every processed food on purpose is killing you slow not fast slow not one meal but 10,000 overtime and that's we're going to talk about and this is been parlayed in the press quite a bit this was in the New York Times magazine back on two years ago sweet and vicious is sugar toxic this was a nature article that we published just last year that basically called for regulation I'll show you why and how so let's talk about hazardous to your health it's all about whether or not that Dogma a calorie is a calorie is correct because if a calorie is not a calorie all hell breaks loose then the type of calories determine your metabolic fate and that's indeed what's happening so what I have to do is show you that the kind of calories you consume make a difference that's what we're going to do so yes we're all eating more total caloric intake 275 calories more in teen boys like we talked about what are they are they fat nope they're not fat 5 grams 45 calories basically our fat consumption has stayed pretty much constant over the last thirty years because we were told back in the 1980s to reduce our percent consumption from fat from 40 to 30% and guess what we've done it with all the low fat stuff that's out there because we were told to do it by the USDA the AMA the aah a everybody told us get your fat down now why did they tell us that heart disease try to prevent heart disease well as that has occurred the obesity and metabolic syndrome diabetes prevalence has just gone through the roof as I shown you no it's not the fat what are we eating more of well we're eating more carbohydrate there it is right there fifty seven grams 228 calories that's what we're eating more of the low-fat craze drove this why because the content of low-fat home-cooked food that your mother makes you can control that you can control how much fat you put in something but low fat processed food tastes like cardboard the flavor was in the factory okay and if anybody doesn't understand that justtake tastes whole milk versus skim milk okay skim milk tastes like dishwater and of course the schools know that so what do they do add the chocolate right which carbohydrate either high fructose corn syrup most demonized food additive known to man or sucrose which is a table cane table sugar you know beet sugar and here's an example snack Wells two grams of fat down 13 grams of carbohydrate up for over to sugar you got to do something to make it taste good when you take the fat away because otherwise no one will buy it and then the food industry goes out of business and indeed which carbohydrate well beverage intake 41% increase in soft drinks 35% increase in fruit drinks fruit aids just remember one can of soda a day as a hundred fifty calories that times 365 days a year divided by the magic number of 3,500 calories in a pound so each can of sodas worth fifteen and a half pounds of fat per year and we don't drink one can of soda in America we drink 2.5 so there's a lot of calories so what is this stuff so here it is right here so everybody remembers glucose from dr. Roberto C's lecture that's right over here this six membered ring right here glucose is not very interesting it's a little sweet it's not very sweet now you don't see people going around chugging Cairo syrup do you might be good in a pecan pie but it's not very interesting and you would never make like a soft drink out of it would you because it's not very exciting yeah sweet but it's not fun this stuff over here though is fun okay fructose fructose is very sweet fructose on a sweetness index is a hundred and seventy-three compared to glucose which is 74 sucrose being a hundred everybody got it this the stuff we seek this is the stuff we go out of our way for this is the stuff that beckons us and there are reasons why well your sucrose right over here table sugar one glucose one fructose an oak like acidic linkage linking the two the enzyme in your intestine called sucrase cleaves us in about a nanosecond you absorb both so bottom line high fructose corn syrup up here sucrose down here they're the same they're equal they're equally bad they're equally poisonous and I will show you how and why that's the problem and it's everywhere so here's what's happened to our consumption over the last hundred years our ancestors 100 years ago getting fruits and vegetables out of the ground with the occasional honey consumed 15 grams of fructose per day so that's 1/2 an ounce double for sugar so that's an ounce of sugar per day and we could handle that just fine no problem prior to World War 2 we got to about 20 grams of fructose per day with the nascent candy and soft drink industries in America by 1977 before high fructose corn separated our shores we were up to 37 grams a day and that was 8 percent of our total caloric intake by 1994 we were up to 55 grams a day that was 10% of our total caloric intake and currently adolescents you guys right here in this room on average consume 75 grams of fructose per day double that for sugar 150 grams of sugar per day multiply that by 4.1 calories per gram that's 600 calories in sugar per day and 25 percent of adolescents consume a hundred grams of fructose per day so that's 840 calories and sugar that's 40 percent of calories as sugar the question is is that okay does that do something can you handle that can you or liver handle that that's the question for today is there a dose-response relationship Paracelsus very famous scientist in the 1500s said the dose determines the poison we are over dosed and the question is how did we get over dose so does sugar cause obesity if you look at this table right here the worst foods are potato chips and french fries for obesity yes I know I know me too Speirs sugar sweets and desserts sugar sweetened beverages they come in a distant third okay so does sugar cause obesity the answer is yes it does here are as a meta-analysis everybody knows what that is it's a bunch of analyses that have very specific criteria that they are subjected to statistically to determine whether or not when they are all pooled together whether they actually meet the criteria for for significance and the answer is yes they do right here so sugar does promote weight gain but not a lot the BMI change on in this study was a total of 0.8 okay and if you know anything about BMI that's not a lot okay we've got two BMI disaster of about 7 to 8 so 0.8 is not a lot so does sugar cause obesity well it's one of the things it's not the only thing there are a lot of things that cause obesity and that's one of the problems it's because the food industry will say well wait we're not guilty because there are so many different things that cause obesity because it's not about obesity obesity doesn't cost any money diabetes costs money heart disease cost money fatty liver disease costs money cancer costs money dementia costs money everybody got the picture so don't let them talk about obesity anymore irrelevant let's talk about disease now as far as I'm concerned we've had our entire food supply fructose elated right under our noses for palatability especially with decreased fat and also ostensibly as a Browning agent because foods brown better when you add sugar go to the grocery store and go to the bread aisle and check out the 32 commercially available breads at Safeway and look at the ingredients list 31 of the 32 will have added sugar ostensibly to promote Browning but really the reason is because you like it a lot and so you eat more of it in addition we've had the removal of fiber for shelf life and for freezing because you can't freeze fiber go home take an orange put it in your freezer overnight take it out the next day put it on the counter thought try to eat it see what you get what do you get you get mush yet mush why do you get mush the ice crystals form inside the cell wall damage the cell will macerate the cell wall so that when you thought all the water rushes in turns it to mush food industry knows that but when you squeeze it and freeze it it lasts forever you've taken a fruit called orange and you've turned it into a commodity called frozen concentrated orange juice which you can sell on the open market and make money on because there's no depreciation in addition a lot of the pro of entitlement programs like food stamps will give you money for juice but not for fruit and that's on purpose because fruit is expensive and juice is cheap the point is the fructose is not glucose because a calorie is not a calorie the common wisdom is that sugar is just empty calories and we all get discretionary calories and we could use them on anything we want and we do and then some but if sugar is not just empty calories if sugar work say toxic calories and actually did something bad to you then we've got a different paradigm don't we because a calorie is not a calorie so what's different well liver fructose metabolism is completely different from that of glucose chronic fructose exposure promotes all the diseases that I talked to you about I'm going to show you that in very gory detail second fructose tricks the brain into increasing total consumption because fructose does not get logged by the brain as having eaten if you take a kid and you give them a can of soda 150 calories and then you let them loose at the fast-food restaurant do they eat less or do they eat more they eat more how come they eat more because the 150 calories didn't get logged by the brain as even having eaten there's a hunger hormone in your stomach called ghrelin that goes to your brain tells you you're hungry you put soda in the stomach ghrelin does not go down if you put glucose in the stomach ghrelin does go down that's kind of weird fructose does not get trigger does not trigger any form of ending of hunger you end up eating more so if anybody wants all the biochemistry we don't have time for all of it today there's a YouTube video called sugar the bitter truth that currently has 3.5 million hits all you have to do is go on YouTube and and it'll go through all the biochemistry and exhausting detail so I'm not going to do that for you today I'm just going to point out the salient features of what's going on let's consume 120 calories in glucose half a cup of rice two slices of white bread everybody got that glucose what happens to those hundred twenty calories 96 of those calories will be metabolized by all the organs in the body because every organ in the body can metabolize glucose every cell on the planet can metabolize glucose for energy every organism on the planet uses glucose for energy it is the energy of life and we can turn glucose into neat things like say aaalac acid like dr. Bertoli talked to you about several months ago only 24 calories 20% of the total will hit the liver so let's see what happens to those 20% most of it goes right here to glycogen liver starch and liver starch is good liver starch the is a readily available source of stored energy liver starts glycogen is what you're trying to build when you're a marathoner and you carb load before a marathon we have kids with glycogen storage disease type 1a bunger Keys disease where they can't fish the glycogen out of their liver their livers are down to their knees because they are filled with glycogen they're stuffed with glycogen they're hypoglycemic low blood sugar like all get-out they are sick kids but they don't get liver failure because glycogen is a non-toxic storage form of glucose in the liver this is what your liver wants to do with energy it wants to make glycogen and the majority of the glucose that hits the liver will get turned into glycogen everybody got that now a little bit will make it down through the Emden Meyerhoff or glycolytic pathway down to pyruvate will enter the tricarboxylic acid cycle and get turned into energy here ATP and very little of that will get thrown out via citrate via a process called the citrate shuttle and will get built up into free fatty acids this process here called de novo lipogenesis new fat making this is how your liver turns carbohydrate into fat and then that little bit will get exported as something called VLDL very low density lipoprotein which you can measure in your triglycerides in your blood and then that will go to your fat cells and will get stored as triglyceride and that can cause some weight gain so can carbohydrate cause weight gain the answers yeah but not much everybody see that because most of the glucose went to the rest of the body for burning because all the organs use it only a little bit will get turned into fat for storage now let's talk about a different carbohydrate my favorite carbohydrate and hopefully no one in this room's yet but you know college is coming ok alcohol to carbohydrate right there it is carbon hydrogen oxygen but you know what alcohols also a toxin right it's not one toxin it's two toxins is acute toxin you wrap your car around a tree and it's a chronic toxin you fry your liver to toxins in one toxic and abused and we keep it out of the hands of children very specifically and for good reasons right okay let's talk about alcohol here's a cute alcohol exposure okay you all have college to look forward to they'd be careful okay now notice fructose on the right side acute fructose exposure none of those things because the brain does not metabolize fructose it does metabolize alcohol so let's talk about alcohol let's consume 120 calories in alcohol shot of scotch okay everybody got that before it was two slices of white bread now it's a shot of scotch both 120 calories yech weak caloric but not eques metabolic because a calorie is not a calorie so let's follow those 120 calories in scotch where do they go 96 we'll hit the liver only 24 10 20 percent of it will get metabolized by other organs exactly the opposite of glucose remember with glucose it was 20 80 now it's 80 20 so the liver has to now bear a greater burden of metabolism and what happens to that alcohol you see glycogen anywhere no glycogen doesn't go to glycogen where does it go come straight down here to the mitochondria and it stops at several places that cause toxicity these are os's reactive oxygen species also known as oxidative stress this is the aging process this is why alcohol kills you is because it makes more reactive oxygen species and anything that makes more reactive oxygen species is going to make you sick Anna comes down here to the mitochondria which then are overwhelmed because there's so much alcohol coming down that you throw up a lot of citrate and so you get big VLDL and so you end up with hypertriglyceridemia in the bloodstream you end up with lipid droplets in the liver you can't export all of it out and so some of its sticks and so now you got fatty liver disease okay and we also know that alcohol influences the brain to make you drink more alcohol right it's called addiction so now we have a problem of overconsumption and disease now would anybody like to tell me that that's behavior yes no is it behavior we'll talk about now let's do fructose so let's consume 120 calories in sucrose okay eight ounces of orange juice so two slices of white bread shot of scotch eight ounces of orange juice 120 calories all of them right but not metabolized the same so let's look at fructose so the glucose will do the same twenty eighty split it did before so there's 12 and 48 the 48 for the rest of the body the twelve for the liver but only the liver has the fructose transporter only the liver has the glute five transporter that allows fructose to enter the cell so let's follow what happens to that fructose you see glycogen anywhere nope no glycogen comes all the way down here to the mitochondria does the same thing the alcohol does makes that fat lipid droplet also makes your insulin receptor not work through this process over here makes insulin resistance which is the signal feature of all of these chronic metabolic diseases that I've talked about the fatty liver disease the diabetes the dementia all starts right there at liver insulin resistance causes the hypertriglyceridemia you have to export the VLDL out that's obesity and we also have learned that the higher your insulin goes the less well your brain senses you're at level of adiposity through a hormone called leptin and so by upping your insulin fructose causes you to be hungrier and so you eat more okay this is a problem so now what we have is consumption and disease just like we had with alcohol so here's chronic alcohol exposure just list down the down the list in terms of diseases and here's chronic fructose explosion eight out of twelve because they are metabolized the same and it makes sense that they should be metabolized the same because after all where do you get alcohol from fermentation of fructose it's called wine we do it in Napa and Sonoma every day the big difference between alcohol and fructose is that for alcohol the yeast does the first step called glycolysis for fructose we do our own first step but after that what hits the mitochondria is exactly the same and causes the same diseases this is mitochondrial overload and any substance that overloads the mitochondria will cause these diseases now Proc toast is not the only one there are several alcohol is another trans fats is another and we know those are bad and the last one is branched chain amino acids leucine isoleucine and valine they are also metabolized by the liver straight to the mitochondria with no glycogen Popoff valve and they cause the same problems when they're over consumed as well who over consumes those bodybuilders that's one of the ways they make extra muscle is with branched chain amino acids and that's fine if you're building muscle but it's not fine if you're not so be careful about those protein powders if you're not in active muscle building mode so here's what's the difference we've got a can of coke we got a can of beer both 150 calories different different compositions of course 75 fructose 75 glucose over here 90 percent 90 calories alcohol 60 molto's that's glucose over there the liver does there's a first pass metabolism effect on ten percent of the alcohol so the number of calories hitting the liver are exactly the same so in America we have this thing called beer belly well guess what we also have soda belly because they're the same they're exactly the same because they do the exact same thing they're handled the exact same way cause the same problems okay this is the fun part I love this part here are the ten most obese states in the nation here are the ten laziest states in the nation what's going on over there in Nevada I guess you can only burn so much energy going like that now they just go like that yes all red states - yes there's it and there's a reason for that here are the 10 most unhappy states in the nation what do you notice if you fountain lazy you're pretty unhappy alright good all right here's the adult diabetes rate here's the adult heart disease rate and finally here's soda per capita consumption what do you see so this is called correlation now correlation is not causation that's true let's talk about the world now here's the global consumption of sugar and sugar crops per day here's us oh boy here's the rest of the world the American Heart Association says 150 to 200 calories in added sugar that's this color here take a look at the rest of the world where are they everybody's over it and what is everybody seeing everybody's seeing a rise in obesity a rise in chronic metabolic disease a rise in diabetes rise and heart disease etc why well I think we know what here is world sugar consumption tripling over the last 50 years this is per capita consumption look at Brazil Brazil used to be just a sugar exporter because its populace was too poor to purchase the sugar it was exporting but now Brazil is a brick country right Brazil Russia India China right they now have some money they have an economy and so they can now afford sugar and now Brazil has the highest rate of increase in prevalence of type 2 diabetes in the world now they don't have the highest prevalence who has the highest prevalence Saudi Arabia United Arab Emirates Qatar and Malaysia now how do they do that no alcohol no alcohol but they got soft drinks like they're going out of style why because it's hot because the water supply is a question mark and no alcohol this is their reward okay so I can have a gin and tonic but they have a coke and they now have the highest prevalence of type 2 diabetes in the world this is a problem now you'd say to me dr. lesyk this is all correlation and correlation is not causation that's true correlation is not causation but we have causation also I'm going to show it to you now this is a paper that we just published two months ago what we did here and this was actually done in part by a berkeley undergrad named Paula Yaffe who got her integrated Health Studies BS from Berkeley and is now applying to medical school along with my colleague Sanjay Basu who is now at the Stanford prevention Institute and what we did was we took four databases and we melded them the first database is called the Food and Agriculture Organization statistics database the FAO this is part of the World Health Organization and what we had was for the entire decade 2000 to 2010 we had food supply it per capita consumption we had total calories we have fruits excluding wine oils roots tubers pulses nuts and vegetables for fiber containing foods meat cereals and sugar sugar crops and sweeteners everybody got it we then melded that with the International Diabetes Federation database for the decade to look at diabetes prevalence country by country we then melded that with the World Bank gross national income database to control for poverty to control for urbanization and to control for aging we then also melded that with an N Haines database that controlled for physical activity we asked the question what about the world's food supply predicts diabetes worldwide that was the question 204 countries we had complete data for 154 turns out the 50 were not different when we subjected it to an analysis we did a lot of fancy statistics and I'm not going to bore you with the statistics but we took this to the mat the people who developed this kind of analysis is called an econometrics analysis won two Nobel prizes for economics this is how you predict how your stock market is going to crash okay not that it works but anyway bottom line this gives us what we call causal inference I'll show you why we control for everything we could control for we controlled for gross domestic product obesity urbanization aging and physical activity and we asked what predicted the change in diabetes rates so during that decade diabetes rates rose from 5.5 to 7 percent and here's the model and you can see here sugar sugar plus various controls 0.87 percent for every hundred calories consumed as sugar and this was adjusted for total calories total calories had no effect no effect obesity had no effect got that controlled for obesity obesity had no effect so you'd say well the sugar caused the obesity the obesity caused the diabetes no it didn't because when you took obesity out of the equation the sugar still worked still showed increased prevalence of diabetes and here's the adjusted Association of sugar against diabetes prevalence worldwide over the decade so here's what you need to know if you consume 150 calories extra total your diabetes prevalence goes up by a total of 0.1% nothing who cares but if those 150 calories happen to be a can of soda diabetes prevalence increased 11 fold by 1.1 percent and we don't consume one soda we consume two and a half so that's 2.4 percent the average the prevalence of diabetes in America is eight point three percent so that means that 33 percent of all diabetes in America is explained by sugar and sugar alone that's pretty bad and for the whole world it's 25 percent but in America it's 33 this is the important part these data meet the criteria for what we call causal medical inference causal medical inference not scientific proof but causal medical inference we have dose we have duration we have directionality that is those countries where sugar went up so increasing diabetes those countries where sugar went down showed decreasing diabetes prevalence and we also have precedents we showed that every every country where when sugar went up diabetes followed by three years and every country where sugar went down diabetes reduction followed by three years that's absolutely essential for proving causation is precedence something has to precede something to be causative right proximate cause the lawyers will tell you so this leads us to this question of what do you need for proof and this is an important question in all of science not just for what I'm doing but for all of you if you're planning on going to science you need to ask the question how much proof do you need so of course it's something called anecdotal data that's garbage then there's something called correlation we talked about correlation but correlation is not causation a lot of people think correlation is causation and that's a big problem and I do not talk about things that where I don't have positive data all right and you need to be very wary because that's what happens in the newspapers that's what happens a lot in the medical literature is association or correlation you have to be very careful then there's this thing called causal medical inference which you're going to talk about in a minute and then there's something called scientific proof where you actually do an intervention and you control for the intervention and you show that only the intervention can explain the outcome and that's considered the highest level of proof everybody got that now scientific proof is great when you can get it but the fact is scientific proof is often hard to come by because it costs money and sometimes doing those experiments are unethical 90% of what we know about in medicine today is based on causal medical inference not scientific proof so slow so medical inference is kind of important so here's a question for you who here believes in global warming why got any proof what he got you have causal inference is what you have now is it good enough depends on who you ask is it good enough for Washington not really because otherwise we be doing something about it is it good enough for scientists scientists accept it but Washington doesn't how does that work how about football trauma causing Alzheimer's that who here believes that football trauma causes chronic traumatic encephalopathy yes no come on only half of you is that right only half the half that raised their hands how do you know you have proof you have causal medical inference how about tobacco causing lung cancer who believes that why you got scientific proof has anybody done a study where you take naive patients and you randomized them into two groups and you let one group smoke and the other one not and you show lung cancer in the group that smoked and you don't show it in the group that didn't we have data like that no so here we are 50 years after the Surgeon General told us that smoking caused lung cancer and we still don't have scientific proof and you know what the tobacco industry would like you all to believe that we don't have enough information that we need more research but we finally called the question and we finally said you know what we have enough and you know why we said we had enough because we got the documents in 1994 and that led to the master settlement agreement that's what it took it took the documents to show that they knew what they were doing that's the only reason anything that happened and finally now sugar causes diabetes now who here now believes that why did I give you scientific proof how would we do that study we'd have to take people who are completely sugar-free which nobody is and we'd have to then expose them to a high sugar diet for the next 50 years where we control how much they took in and knew how much they took in anybody think that's ethical anybody think that's even doable do you think we'll ever actually have scientific proof for that we have animal models they're useless because the food industry says that's animals they wanted in humans do you think Washington is going to change on the basis of animal models no they because we already have that we already have causation and evidence this is the point the question is what level of proof do you need in order to actually change policy and this is a concept that's very very important for all of you in the audience to understand because you are the next generation of policy makers okay you are our future I am happy to talk to you because you need to get this the food industry will always tell us we need more research we need more research you know what why they say that because that's moving the goalposts because we'll never get there that's their way of saying haha you screw you everybody got that all right you need to know what you need to know in order to make change and I'm very clear about it let's go finish this up with addictive this will be short junk food addiction it may be clue to obesity indeed high-calorie foods may be as addictive as cocaine or nicotine and could cause consultive eating and obesity according to a study obesity and reward look at all these books that are out for the lay public saying sugar is addictive so why is it that Washington doesn't know that if you look in the brain this is the area of the brain that's called the reward Center the nucleus accumbens and in the nucleus accumbens there are dopamine receptors dopamine is the feel-good pleasure reward neurotransmitter and dopamine receptors when they get occupied give you the feeling of reward and that's why you wake up in the morning and that's why you go seeking sugar is to occupy those receptors and there are lots of substances that will occupy those receptors and will cause dopamine to be released cocaine amphetamines nicotine cannabis alcohol morphine heroin they all do the same thing they're all reward generated but notice here's a cocaine brain what happened to the receptors downregulated that's the problem with all of these substances is dopamine down regulates its own receptor and that's a phenomenon called tolerance and if you have tolerance and withdrawal what do you have you have addiction that's what constitutes addiction tolerance and withdrawal well there's tolerance right there you're looking at the neuroimaging correlative tolerance well here's a control brain and here's an obese brain what do you see same thing not as bad but same concept so does sugar cause addiction in animals slam dunk we got the data here are the four criteria for animals and addiction binging withdrawal craving cross sensitization with other drugs of abuse meaning you expose an animal to one drug for three weeks get them addicted then you expose them to another drug that they've never seen before and they're addicted to that one too because the dopamine receptors are down regulated and it doesn't matter which drug did it and Oprah talked about this all the time about addiction transfer that's why when people stop smoking they start eating is because they need that dopamine reward and they have to generate more dopamine to occupy fewer receptors and that means that they start eating anybody see this movie oh good as far as I'm concerned if we showed this to every second grader in America maybe we would actually solve the obesity epidemic so the question is is fast-food addictive we wrote a paper on this just two years ago take a look at this this is really kind of fun this is from 1972 Federal Trade Commission versus sugar information 1972 the fad time of day you're really hungry and ready to eat two of everything here's how sugar can help they actually passed sugar off as a weight-loss aid back in 1972 based of course on no data how about this why we have the youngest customers in the business nobody does it like 7f now obviously this would never be allowed today but you can see that you've all been marketed to write marketing to children is a big issue how about this one drinks are on us Publix is rewarding top grades with free apple juice and soda students we salute your thirst for knowledge the next time anybody offers your soda for doing something good say just say no okay American Heart Association gets it and I am very proud to be a member of the board of directors of the Bay Area American Heart Association because they get it this was a paper we put out dietary sugars and cardiovascular health that we put out in 2009 and we recommended reduction from 22 teaspoons a day average for America down to nine for males and six for females that's a reduction by two-thirds to three-quarters in order to improve heart health and to improve diabetes here's the problem who's winning this war what's good for the food industry is bad for you what's good for you is bad for them there's no middle ground this is a war and you don't even know you're fighting this is the Standard & Poor 500 right here over the last five years and you can see here's the economic downturn of 2008 right over here October 2008 and here is the stock price for McDonald's Coke and Pepsi during that same period of time what do you see they're doing very well thank you here's ConAgra General Mills Hormel Kraft Procter & Gamble Archer Daniel all doing better than the S&P want to make money invest in a food company because they've got a product that is toxic and addictive and they know it and they're doing it and it's legal today so what I'm going to leave you with is this notion that you've got it all wrong and I'm hoping that you'll at least see things maybe my way that there's another way to interpret the first law of thermodynamics and when you do everything makes sense here it is if you're going to store it that is an obligate weight game set up by biochemical and neural endocrine forces beyond your control and you expect to burn it that is normal energy expenditure for normal quality of life because energy expenditure and quality of life are the same thing things that make your energy expenditure go up make you feel good for instance ephedrine off the market calf for two hours exercise things that make your energy expenditure go down make you feel lousy like hypothyroidism starvation so if you're going to store it and you expect to burn it then you're going to have to eat it in other words the gluttony and the sloth are secondary to a biochemical process the behavior is secondary to the biochemistry and the biochemistry of sugar fructose the sweet stuff drives these processes that then cause you to under a burn and over consume driving all of these chronic metabolic diseases this is a very different way of thinking about things and if you understand that then you'll understand what's going on and maybe we can actually do something about it the two aberrant behaviors a result of our biochemistry our biochemistry as a result of our environment change the environment change the disease so my question to you your homework for today two questions can our toxic environment of Kelly Brownell be changed without governmental or societal intervention especially if they're potentially addictive substances involved every addictive substance has required personal intervention which for lack of a better word we can call rehab and societal intervention which for lack of a better word we can call laws rehab and laws rehab and laws for tobacco for alcohol for nicotine for cocaine for cannabis for heroin you name it rehab and laws for sugar nada and that's on purpose because they don't want rehab and laws because they're making money and over fist question number two can we afford to wait to enact some form of public health measure when health care will be bankrupt in 2024 due to chronic metabolic disease such as diabetes which we now have causal medical inference as to to do so the question is do we have enough proof do we have enough proof to act should we change policy now before healthcare is completely broken for further reading lots and lots of peer-reviewed articles in the medical literature and more peer-reviewed articles in the medical literature and more peer-reviewed articles in the medical literature and more peer-reviewed articles in the medical literature and I'll give dr. Alper a list of all of these and you can access all of these online and if you'd like and also some non medical literature a popular book that came out four months ago fat chance beating the odds against sugar processed food obesity and disease written for your friends written for your family members written for politicians in order to try to fix the problem and with that I want to thank all of you for your attention unhappiness

Channel: Berkeley Lab

Views: 146,353

Rating: 4.7914176 out of 5

Keywords: Robert Lustig (Author), Health, Sugar (Nutrient), UCSF Medical Center (Hospital), Diet (Website Category), addiction, Obesity (Disease Or Medical Condition), nano high, lawrence berk, Research (Industry), Dieting (Symptom), fitness, Endocrinology (Medical Specialty), Type 2 Diabetes (Disease Or Medical Condition), diabetes, University Of California Berkeley (College/University), Medicine (Field Of Study)

Id: aXlL7yWtAAg

Length: 65min 34sec (3934 seconds)

Published: Fri Aug 30 2013