"The Case Against Sugar," Gary Taubes, Investigative Science & Health Journalist

hello welcome to the seventh annual C everett Koop institute Distinguished Lecture I'm really pleased to have the Rockefeller Center partnering with us on bringing Gary Taubes to talk about talk to us about sugar and I want to just say a little something about C everett Koop and the coop Institute before I introduce Steve Lowell Ocean who introduced the speaker I you know I teach a course to Dartmouth students and I asked them if they've ever heard of C everett Koop and almost none of them raised their hand now but if I asked this audience how many of you have heard of C everett Koop right it's like everybody right so so I don't have to say much about him except that you know he got his BA at Dartmouth at a really way before I was born and he was surgeon in chief at Children's Hospital he really is the father of pediatric surgery he's the person that taught other surgeons had to operate on premature babies and to fix congenital problems that babies are born with it was appointed by Ronald Reagan as the 13th US Surgeon General and served from 82 to 89 through the Clinton administration it was the only Surgeon General to my you know from my perspective that really became a household name he published the first Surgeon General guidelines on secondhand smoke he'd worked a lot on tobacco and he's the the person that really introduced the American public to the AIDS epidemic so he's a very important person in my life as a physician and many of our lives as as people that live through that era the C everett Koop institute is now kind of REIT shaping its mission our mission is going to is built around the prevention of disease through research education and policy and what we recognize is that diseases that that we're not going to be able to cure modern chronic diseases by treating them exclusively in the hospital we have to address the products that cause the diseases and the products are tobacco alcohol energy dense foods and opiates and guns and so we at the Institute want to focus on these products and the better regulation these products so that people don't use them in ways that cause the diseases that are choking up our hospitals so that's that's what we focus on it part of that is this distinguished lecture series and you'll see other people coming through here like Gary that will be talking about the products that cause the chronic diseases so without saying more I want to introduce Steve elosha who's a physician at the coop Institute he's a general internist one of my colleagues and I have tremendous respect for him and his partner Lisa Schwartz and stiva Lynn traduced Gary [Applause] thank you Jim so I'm really pleased to introduce our speaker gary is one of my heroes and he's just the perfect person to give the coop lecture like dr. koop he's fearless he's dogged and he's effective dr. koop fundamentally changed how the public views smoking and Gary's work is doing much the same about of that diet I first came across Gary long time ago with the beginning of the century through his New York Times magazine cover story is it all a big fat lie which exposed the shaky science behind the conventional wisdom and I should add National Policy promoting a low-fat diet through that article and his subsequent work he's really changed the debate about diet weight and health from how many calories we - what kinds of calories were we're eating I met Gary for the first time about 10 years ago he accepted my invitation to speak at the NIH medicine in the media workshop which I helped run and I wanted him to inspire other journalists to adopt his rigorous and critical approach to covering medical research now as I've come to know Gary over the time what's impressed me most about him is that he's not satisfied with just reporting on science or pointing out the flaws and limitations in what we what we know he wants to make things better if we're gonna have evidence-based Food Policy we really need to have good evidence and that's why he founded the nutrition science institute an independent non-profit which funds a collaboration of scientists and researchers to design and conduct high-quality trials to answer fundamental questions that will inform food policy so that it's driven by science rather than belief or commercial interests Gary is an award low he wake up everybody he's a sugar rush Gary is an award-winning author and journalist he graduated from Harvard which if you don't know that's the Dartmouth of Massachusetts with a degree in physics and he's got master's degrees in engineering from Stanford and journalism from Columbia and his work regularly appears in a host of important publications including science of the Atlantic Monthly in New York Times Esquire slate the host host of others but most importantly he's here with us today so please join me in welcoming Gary Taubes I just want to say um Steve forgot one thing I actually met him before they invited me to speak at his course he got me invited to give Grand Rounds at the medical school here and I don't know if you remember and he was formative in developing my speaking style because he said you're gonna be talking to doctors so make it like your talk if you could get your dog to understand and you'll be hitting the right level and in the other talk I give that exact level give me the same talk since I we designed it for the Grand Rounds here so yeah today I'm talking about the case against sugar I'm a big fan of epigraph so my favorite part of writing any book is choosing the epigraphs to open chapters with um so I have to do this with talks too so this starts with one from Peter Medawar the Nobel laureate scientific theories begin if you like his stories and the purpose of the critical or rectifying episode and scientific reasoning is precisely to find out whether or not those stories or stories about real life so today I'm going to tell you a story about sugar I am also going to explain why the critical or rectifying episode in scientific reasoning never happened okay so what I'm telling you about sugar is gonna be speculation and a hypothesis I the title of the talk is a second sugar the way I put it is I think I'm confident I could get an indictment I don't think I could get a conviction because the science necessary to get a conviction has never been done as I had been writing about and studying science good science and bad science for about 20 years when I came upon this line from Claude Bernard who wrote what I think is a single best book on the scientific method and how to think critically which was an introduction to experimental medicine in 1865 Claude Bernard was a great French physiologist and he said to have our first idea of things we must see those things to have an idea about a natural phenomenon we must first of all observe it all human knowledge is limited to working back from observed effects to their cause and when he said that he also pointed out that the absolutely critical to doing good science is to be unbiased enough to make good observations and once you can make critically clear observations and you know what you were trying to explain so what the effect that we're trying to explain here the observed effect is worldwide epidemics of obesity and diabetes and chromic diseases those are diseases in which the speaker can't spell the word chronic and doesn't proofread is slide despite having given this talk about seven times okay so any population I'm gonna get here later they're basically any population in the world makes a transition from its traditional diet whatever its traditional diet is to eating a Western diet living a western lifestyle and you see sooner usually sooner occasionally later explosions in the prevalence of obesity and diabetes that's what we're trying to explain so the implications for personal diet and personal health are obvious but the exponential is the white powdered sugar we put on our coffee and high fructose corn syrup or high fructose syrups are the cause okay so I'm going to start with the story and the stories about Elliot Johnson so only at Joslin was a young doctor trained in Harvard in the 1880s 1890's who by the 20th century by the 1920s became the leading diabetes specialist in the u.s. who's known as the god of diabetes among diabetes researchers when he was just a young doctor just out of medical school in 1898 with Reginald Fitz a pathologist at Harvard he decided to he was obsessed with diabetes he had already treated a case he had a relative with diabetes he went through he and Fitz went through the case records of Mass General Hospital so the major Boston Hospital back to 1824 when it was founded to look at all any case of diabetes they could find hoping to establish what did you know learned something about how to treat this disease and what might be the cause um forty-eight thousand inpatient records over 74 years they went through them by hand by the way Mass General has all these records and their archives so one of the things I did and of course my researchers I went back and I asked the archivist at Mass General to confirm Jocelyn's account which they did it's an amazing institution so the question is how many cases of diabetes did they find in the 48,000 inpatient records over 74 years I'll give you a hint that's completely useless today one in 11 Americans has diabetes and in some medical systems like the VA system one in four patients have diabetes so you might expect somewhere between 4,800 and maybe 15,000 cases of diabetes they found 172 of them and what was interesting when they went through it is they saw this steady increase in diabetes prevalence so among the patients both the percentage of patients and the number of cases of diabetes went up with each passing year and they commented on this basically the number of cases from 1985 1885 to 1898 equals the number of cases in all the years before that and he said it appears from this table that within the past thirteen years of many cases of diabetes were admitted to the hospitals in the previous 61 years and the percent in the past 13 years in proportion to the total number of hospital entries has increased fourfold over that of the first 15 years here's the same slide from Philadelphia Pennsylvania Hospital in Philadelphia which also has their records in patient records back to 1867 and they also have archivists and you could just email them if you're doing a project like I was and asked them for their diabetes in patients and you could see the same trend beginning in 1867 through years up until 1910 or so there were years where there were zero cases of diabetes so you're actually watching the diabetes epidemics begin in these inpatient records back in the 19th century and one of the things you would want to do to understand the beginning of any epidemic or the cause of any epidemic is you want to go back to the roots if it's a bola you want to go back to the area in Africa where the Ebola showed up if it's a Zika you want to go to its roots here you can actually see its roots in the impatiens records in these hospitals from the period Jocelin didn't use the word daya demek to explain what he was seeing he actually thought what he was seeing was a good thing he thought it meant more patients with diabetes were taking themselves off to the hospitals to be treated by doctors so it was a sort of diagnostic effect on in the 19th century avoiding a doctor if you were sick wasn't a bad idea so whether or not it was a good thing is questionable but by 1920 Johnson was using the word 9 1921 he was using the word daya demek to explain what he was seeing said 1900 the death rate from diabetes in the Reston's registration area of the US was 10 per hundred thousand and in 1915 18 for a hundred thousand in the same period in Boston rose from 14 to 26 on the same basis there probably more than half a million diabetics in the United States and he had seen the numbers from Mass General 80 years earlier where they were virtually at least if they existed they weren't showing up in the hospitals and this is what this looked like in 1924 when haben Emerson it was head of the Department of Public Health in New York it was at Columbia University and Louise Larimore documented these changes in diabetes incidents from 1900 to 1921 in major American cities and when they went back to the Civil War up to 1920 in some cases or increases 15 fold and diabetes mortality and again this could always be a diagnostic effect that people are now putting diabetes a disease they weren't aware of on death certificates it doesn't necessarily mean that the prevalence is increasing but the numbers were stunning and certainly Joslin and Emerson and Larimore thought that what they were seeing reflected really dramatic increases in diabetes this is how Jocelyn put it in his 1921 article there are entirely too many diabetic patients in the country statistics for the last 30 years show so great an increase in the number that unless this were in part explained by a better recognition of the disease the outlook for the future would be startling and this is easy actually started off this article we started off talking about a small area in Oxford Massachusetts which is a town he grew up on and he said there was a street there was a single block in which seven four of seven adults and three houses had died diabetes and he said if this was any other disease any chronic to any infectious disease there would be health agencies and you know experts crawling all over it trying to figure out what the cause of the disease were but because it was a chronic disease nobody was interested so he talks here about the outlook for the future and I just want to now jump almost a hundred years into the future and ask the question today and we have 30 million Americans with diabetes in the numbers is 1 in 11 and worldwide according to the World Health Organization diabetes numbers among adults has quadrupled since 1980 and the global prevalence has doubled since 1980 and Margaret Chan when she gave this talk in October 2016 at the annual meeting of the National Academies of science has called this a a slow-motion disaster and what she said which was even more interest she gave an estimate of the probability of keeping a bad situation from getting much worse so she asked this question what are the odds of public health organizations like hers her own are going to prevent the increase in diabetes and obesity that was overtaking the world and her estimate of the possibility that they would do so was virtually zero which I found fascinating is imagine a head of the the world's greatest public health organization basically predicting with complete and utter certainty that they were going to fail to control this epidemic not reverse it but prevent it from getting worse so this is the observation for which we need to cause this dramatic increase this is the same in the Navajo Indians and the Native Americans and the beginning in the early 1950s you see the same chart in Japan beginning in the eighteen this chart begins around the 1940s here's the increase in the US according to the CDC since the early 1960s this is a 700 percent increase in prevalence I mean the fact that people is this isn't a constant conversation about what's going on in this country and why and I'll explain shortly why it isn't but imagine any other chronic disease imagine this chart being the chart of you know AIDS prevalence or lung cancer prevalence or you know pick your disease I'm saying the exact same thing Jocelyn did a hundred years ago or a hundred and you know yeah a hundred years ago so similar patterns observed in the Inuit First Nations people Polynesians Micronesians Melanesians Aboriginal populations in Australia and Maui's and New Zealand populations throughout South America the Middle East Asia and Africa nashor defectively every population the world after a transition to Western diet and lifestyle so some obvious questions it's a pandemic what's the cause of the pandemic what's the environmental trigger ie the agent okay if this were AIDS we want to identify the HIV virus if it's a bola you want to identify the Ebola virus if it's tuberculosis I mean if it's malaria let's find the agent it's not enough to say it's a Western diet lifestyle which is sort of the vector or processed foods which is another way to look at it or ultra-processed foods which are kind of the vector but what's the actual agent what's because unless we can identify the agent we can't solve this problem so what aspect of diet and/or lifestyle is to blame and here's some other obvious questions why are we doing everything we can possibly to find out why aren't we questioning our assumptions about this disease why is no one being held accountable other than the victims and maybe the food industry why are no heads rolling okay I mean again 700 percent increase in any other disease since the 1960s and nobody gets fired you know the I could give this whole talk about obesity I find diabetes in easier argument to make of obesity plays into it as you'll see shortly and the National candy obesity medicine Society every year gives awards for you know meritorious research and obesity and the obesity epidemic has also kept going up and up and up in the world I come in if you have failed to control the disease you don't get awards and I'm waiting for somebody who gets an award to say don't give it to me I would like to turn it down clearly failed so what's going on here why not why do we threw in the answer why nobody cares is we think we know the answer okay type two diabetes is caused by obesity or excess fat accumulation or it's exacerbated by obesity or excess fat accumulation excess fat accumulation is caused by overconsumption eating too much or sedentary behavior okay that makes perfect sense and diabetes epidemics are certainly associated with obesity epidemics and we've had an obesity epidemic and you could go to any of these countries in the world that have had diabetes epidemics and obesity has increased as well and childhood obesity has increased dramatically you don't need statistics you only have to be old enough to remember when there was one obese child in a grade and not 20 percent of them obese so the complication here is that we also see so on one level these diseases are seen as very simple diabetes is driven by obesity obesity is driven by eating too much calories and over calories out over consumption on the other hand these are seen as complex multifactorial diseases so you've got all these various activities socioeconomic status environment physical and activity dietary trends genetic factors and by talking about as a multifactorial complex problem it somehow seems understandable that we failed okay this problem is too big to solve and there's too many things working together and too many things that have to change and it's a perfect storm of explanations here's the complan okay diabetes and obesity are multifactorial complex disorders so other possible triggers and here's my response to that and I actually got spanked for believing in Occam's razor by Jerome Grubman in The New Yorker so I'm still a little sensitive about this he said I use Occam's razor to prove that sugars a problem and I say I use Occam's razor because anyone who doesn't use Occam's razor to solve a problem it's not thinking critically okay that's an absolutely vital scientific if you start with the assumption that when you have is a multifactorial complex problem you will never solve it but if you start with the assumption that it's simple and then you find your simple hypothesis can't explain what you're observing and then you complicate it eventually you get to a level of complexity that explains the problem as Einstein said or it was para Phi's as saying everything should be as simple as possible but no simpler and so the question then becomes what's the simplest possible hypothesis what is the agent of this disease and the obvious question is what about sugar okay if we can't explain it with sugar then more complicated or will reject sugar as a hypothesis but we start with the simplest possible hypothesis and that sugar consumption because one of the things with sugar consumption is as populations transition from their traditional diets to their Western diets and lifestyles a lot of things change okay they become more sedentary they get more automated mechanised lives they tend to eat more processed foods in general but the very first things that change is they get sugar and white flour basically traded to them from the West I mean Darwin when he travelled around the world on the Beagle they travel around with barrels of sugar and flour that they traded to the natives wherever they went and they watched the natives eat the sugar and danced all night long they thought this is wonderful they loved us so is it possible that sugar is the agent and here's what happens sugar consumption in the US which is rather remarkable so remember we're dating the beginning the diabetes epidemic - around the 1840s 1850s Oh in the Mass General records from 1824 through about 1865 there many years where they have zero cases of diabetes zero and then the rest of the years 18 are you know one case two cases and then it starts turning up right around the 1880s so around 1900 we were consuming about five pounds of sugar per capita back then it was exclusively sugarcane and by 1900 we were consuming about 90 pounds to about an eighteen fold increase and the beet sugar industry kicks in around the 1860s and what's interesting is in 1800 there were no none of the things we consumer going today really existed back then you bought sugar and barrels at the general store and that was this so there's no candy there was no sodas there were no fruit juices there were no ice creams or that I mean ice cream had come about but it was a kind of rare treat for the wealthy that if somebody went to a party and they served ice cream and made it into the newspapers in the 1840s the candy industry the chocolate industry and the ice cream industry I'll kick in the 1880s a soft drink industry kicks in with coke actually first dr. pepper then coca-cola and PepsiCo by 1900 the the these are nationwide phenomenon and they're exploding the soft drinks so it's possible at least they're on that they're at the scene of the crime as the way I described but when I discuss this and they were always an interesting because they were always considered the obvious suspect so they were considered the prime suspect Frederick Allen who was the leading authority on diabetes in the United States pre joseline joseline took over once insulin was discovered he kind of pioneered insulin therapy but in Allen's book in 1913 on diabetes said the consumption of sugar is undoubtedly increasing it's generally recognized that diabetes is increasing and to a considerable extent its incidence is greatest among the races in the class of society that consume the most sugar so in 1907 the British Medical Association had a meeting at their annual meeting of the the BMA they had a symposium on diabetes in the tropics and it was basically about the rampant diabetes that was appearing in the wealthier classes in India including the the vegetarians sex and the obvious culprit was I mean there were a lot of culprits being debated maybe it was the stress of a Western kind of lifestyle and maybe it was a lack of physical activity when you become a wealthier population you're not out in the fields all day long but the recurrent theme was maybe it's sugar on Emerson and Larimore when they did their study in 1924 said the same thing with sugar was the obvious suspect you add sugar to a diet sugar consumption goes up during World War one there's sugar rationing diabetes rates plummet in all the countries in what it's going up and again there are a lot of things are changing during Wars and a lot of things Arash ined so you can't lock it into sugar but it's quite possible this is from the embassy Larimore report in 1924 and again these are various the US the UK and Paris I think and then you could see sugar cone and this is the dip during World War one in each population again it's an association it's a coincidence it's circumstantial evidence so by the mid 1920s this was being debated heavily in the US and sugar was a serious cause and then it vanished and one of the reasons that vanished is because medicine had a history of being very authoritarian so there were certain individuals like Jocelyn who were seen as sort of the defining figures they wrote the textbooks and back then there would be one or maybe two or three text books on a subject and you read whatever they said you believed if you were a doctor and Jocelyn didn't like it Johnson wasn't considered the god of diabetes in the u.s. so one of the reasons you didn't like it is because the Japanese ate a lot of carbs and they had very little diabetes this has been a recurrent theme so japanese clearly have a high carbohydrate diet and jocelyn didn't realize that carbohydrates rice carbohydrates are different than sugar carbohydrates he was a wonderful doctor and a gift to the diabetics of america but he was a lousy biochemist so sugar sucrose is made up of a molecule of glucose combined with a molecule of fructose so glucose is the stuff of starch and grains when you eat rice you digest it you break it down into glucose so that's what you're absorbing and fructose is a sugar that makes sugar sweet they're all sugars anything ending in OSE is a sugar and it's fructose that makes sugar sweet its fructose that makes fruit sweet fruit has some sucrose and some fructose in it but sucrose white sugar is 50% it's a molecule of glucose bonded to a molecule of fructose high fructose corn syrup when it came in in 1977 was 45% glucose and 55% fructose and it was a level that it happened - when you consumed that in coca-cola and Pepsi it tasted identical that's why they stopped at 55:45 so that's beating cane sugar it's a combination Johnson didn't just realize that he didn't know he thought it's all the same the Japanese are eating carbs they don't have diabetes and meanwhile there was a British Authority named Harold Hemsworth was the god of diabetes in the UK he went on to become the head of the Medical Research Council and he was arguing the same thing in Jocelyn and Hemsworth decided each other and they piggybacked on each other they would each sight multiple papers from the other and their research and the argument was it's not sugar the problem was when you looked at sugar consumption Japan versus diabetes it actually tracked with the diabetes rates so sugar was low diabetes was love their sugar consumption during the same period so that if they understood about sugar they might have asked this question is it possible that it was sugar and they would not have been able to refute it from the evidence the second problem is that sugar was valuable for hyperkalemic a hypoglycemic episodes caused by insulin so once insulin came in in 1921 and you start treating diabetics with insulin it's very difficult to properly gauge the insulin dose so you end up with hypoglycemic an episode you want to give those people candy or orange juice to bail them out before they go into hypoglycemic shock and joseline knew that and hims Werth knew that so they thought if sugar so valuable for diabetes clearly can't be the cause right and then the third possibility was that most IBS was caused by getting fat which was caused by eating too much or exercising too little and joseline believed this as well so as he put a diabetes is largely a penalty of obesity and the greater the obesity the more likely its nature to enforce it with an excess of fat diabetes begins and from an excess of fat diabetics die so why don't we get fact I have an entire lecture I gave at the med school was why we get fat I wrote a book called why we get fat the conventional wisdom as obesity is an energy balance disorder caused by the overconsumption of calories you guys probably believe this a calorie is a calorie so the influence that foods have our weight is how much we so we get fat because we eat too much or we exercise too little and this is a conventional wisdom in my sugar book I have a chapter called the gift that keeps on giving and I'm gonna explain why so this is actually from expert testimony a few years ago the city of San Francisco passed a labeling law where they would label sugary beverages with skull and crossbones and a label that says these can contribute to obesity and diabetes it's a pretty benign label because anything if you believe that you get fat and diabetic because you eat too much anything can contribute to obesity and diabetes and they're expert witness was the the most notable nutritional epidemiologist at the Harvard School of Public Health and in his expert witness he said well obesity Rises as a result of an energy and balance between calories consumed in calories expended creating an energy surplus in a state of positive energy balance which in turn results in excess body weight over time and so if you believe this it means that the only way that sugar can be bad for you is if you consume too much of it because the way you get fat is by consuming an energy surplus and they've actually the city of San Francisco lost in the circuit court because the circuit court said if this is why sugar is bad for you then we're penalizing it because people like it too much and we can't do that and in fact there's Harvard research that shows that french fries are more fattening than sugar but that's Harvard nutritionists didn't think we have to label french fries because we don't need quite as much from them as we do sugar so we only have to label sugar and the court wasn't having it and I don't blame it so here's the problem with that or this is how the sugar industry took this caloric balance idea so the sugar industry loves us right because all it says is that the way you get fat isn't through the toxic nature the unique nature of some of the macronutrients but through how much you eat and exercise and how many calories you consume so they could use this idea to advertise sugar as a basically a weight reduction tool certainly sugar for energy and remember three teaspoons contain fewer calories than your egg which is I love this kind of thinking like how do they pick three teaspoons well cuz it has fewer calories in an egg they could have said Anjali they have other ads comparing it to grapefruits once the grapefruit diet came in if sugar is so fattening how come so many kids are so thin well the fact is you constantly take in more food than your body needs you'll probably get fat if you eat a balanced diet moderation you probably won't trigger in moderation as a place in a balanced diet so this calorie and calorie out energy balance idea which has existed since the early 20th century sort of the the general hypothesis of obesity made obesity all about calories that made obesity about all about eating too much not specifically about sugar and then we have diabetes linked to obesity so here's the problem with that logic well this is still the sugar industry steak so sugar is not the cause of obesity consuming more food than needed to maintain energy balance causes overweight and obesity if you eat more calories than you need it's all about personal responsibility it's nothing about sugar if you're getting fat you just eat less sugar right or you exercise more that's the whole Gatorade concept drink your Gatorade workout look at what great shape LeBron James is in and he drinks Gatorade if you want to lose weight you need to cut calories or increase your activity level in other words there's no bad foods only bad behaviors okay so what's the catch with this thinking makes no sense okay it's a tautology I'll give you an example so here's that Harvard explanation obesity Rises the relative an energy imbalance between calories consumed the calories expended creating an energy surplus in a state of positive energy balance which in turn results in excess body weight over time makes sense right I believe this when I wrote one if it's all been a big fat lie what if we were talking about wealth I was giving a lecture about wealth generation and I said wealth arises as a result of a money imbalance between dollars earned and dollars spent creating a money surplus in a state of positive money balance which in turn results in excess wealth over time okay the exactly logical equivalent if I told you anything you didn't know right and would you continue to listen to what I have to say about money if my advice to you for how to get rich and ensure your retirement was to make more money than you spent okay how about we were talking about climate change very important critical subject I said climate change arises a result of a heat imbalance between energy entering the atmosphere and energy leaving it creating a heat surplus in a state of positive heat balance which in turn results in excess heat and climate change over time it's also nonsense right climate change is a heat trapping problem but we know that more energy is entering the atmosphere than is leaving it do you know why we know that because the atmosphere is heating up okay so when you say that it's the fact that the atmosphere is heating up means more energy is entering it than leaving it the fact that somebody's getting wealthy means that they're taking in more money than their spending the fact that someone's getting fat means they're taking in more energy than they're expending but in none of these cases are these causal explanations these are tautologies in these other areas they don't have to be said people economists don't discuss the money balance theory of wealth because it's a tautology and it's absurd climate change discussions aren't about the energy balance theory of climate change despite the energy imbalance because it actually directs attention away from what's actually causing the problem which is in climate change its energy trapping in the atmosphere of certain wavelengths of light by very specific greenhouse gases and the energy imbalance is just something that happens when you trap it so this kind of explanation is absurd for wealth and climate change why is it accepted explanation for obesity what has been the accepted explanation for a hundred years and there's another catch with its science circa 1870 to 1920 okay so we need one of the revelations in doing my research is something good scientists will tell you so moves forward when a new technology comes along to look at something in a new way okay so if you look at something in a new way a new wavelength of light or the electromagnetic spectrum an astronomy you're going to see new things and you're going to learn those things and that's when science moves forward in the modern nutrition began in the late 1860's with the creation let me see if I have a slide I don't on the creation of room size calorimeter these are devices that could measure the energy expended by dogs or humans since the 8th the early 18 mid 18th century nutritionist could measure the caloric content of foods and then beginning in the 1860s they could actually measure the caloric expenditure of humans and dogs by putting him in these room size calorimeter so now they can measure the calories into animals or humans and the calories expended and they could start studying things like caloric balance at a period in time the late 19th century when the chemists and physicists were working out the laws of thermodynamics all about energy transfer so energy was on everyone's mind and all the nutritionists were doing was studying energy and energy out vitamin and mineral content fiber content and vitamin and mineral deficiency diseases and so by the early 19th century you had a theory of obesity that it was caused by energy in and energy out because that's all they could study they knew vitamins and minerals weren't related so they ruled that out and sugar became empty calories empty of vitamins and minerals calories because that's what they were studying the problem is it leaves out a century of post 1920 science so a 1921 insulin is discovered and the science of endocrinology which science of hormones begins to emerge growth hormones discovered in that decade but even endocrinology can't get that far because it takes a tool in order to measure hormones accurately in the bloodstream and that isn't developed until 1960 with the radio immunoassay by Rosalyn Yalow when Solomon Bursa and the alo won the Nobel Prize for it after Burson died babe we got the Nobel Prize for revolutionising the field of endocrine by the 1960s you could actually measure the effect of different foods not just caloric content but on how it affected hormones and enzymes in your body that affected things like fat accumulation but by that time obesity for 40 years research has been thinking about obesity as an energy balance problem the field was dominated by psychologists and psychiatrists who were trying to figure out how to get obese people to change their behavior my favorite example was to get men to eat less by having their wives to refused to have sex with them and if the men gained weight no sex because it's clearly an eating behavior issue it's a behavioral problem and these people didn't even know anything about endocrinology they didn't read the endocrinology journals and it read the textbooks so an entire field of medicine directly related to fat accumulation like you everyone knew I mean the German and Austrian medical authorities knew that obesity had to be a hormonal defect because men and women fatten differently right they fatten differently then home sex hormones are involved with fattening yeah women go through menopause they gain weight when you read the endocrinology literature on menopause it was about lack of estrogen secretion the effect of estrogen on fat accumulation when you read the obesity literature's about women not carrying them much about how they looked anymore and sitting around playing cards all day long and sharing you know snacks with their other women who are getting heavier I mean it was crazy and it was all left out and it's been left out ever since so consuming sugar happens to have unique hormonal metabolic effects that favor fat accumulation and insulin dysregulation which is what diabetes is so this is how you could think of it there's two different ways to look at it sugars empty calories versus sugar is having this unique metabolic hormonal effect so 100 calories of sugar this I borrowed from Rob Lustig who's sort of the he's a pediatric endocrinologist at UC San Francisco became the modern era sort of anti sugar crusader and he said 100 calories of sugar it's just me it's metabolized differently from 100 calories of glucose alone it's which is metabolized differently from 100 Cal a protein or 100 calories of found the hormonal responses are entirely different the fructose moiety that's the chemical term fructose moiety of sugars metabolized in your liver primarily and the glucose is metabolized in every cell in your body so why would you expect them to have the same effect and why would you expect this sort of hormonal enzymatic respect the response to be the same so by the 1960s we had worked out way after yellow and Burson came along basically a whole rule whole world of science explaining fat metabolism in the human body and was all linked to the hormone insulin which is insulin because obese have a very high rates of diabetes and diabetics have very high rates of insulin and his yellow and Burson put it in one they gave the Banting lecture at the American Diabetes Association 1965 annual convention they said insulin is a principal regulator of fat metabolism and if you want to get fat out of fat cells the primary way to do it you have to lower insulin it requires only the negative stimulants of insulin deficiency so insulin drives fat accumulation in many different ways and insulin is a hormone that's dysfunctional in type 2 in all diabetes but in different ways so in 1960s 1970s who had this period where the endocrinologists are working out the science of fat accumulation but it's being ignored by the psychologists and the psychiatrist's the idea that dietary fat causes heart disease rose as a hypothesis beginning in the 1950s and it started to come of age in the 1960s it was in the paper researchers were doing tests to try and test and the idea was that dietary fat raises cholesterol but simultaneously other researchers were looking at the effect of sort of meta what's called metabolic syndrome or insulin resistance on heart disease risk as well john Yadkin came along john Yadkin was a leading British nutritionist he founded the first dedicated nutrition department at a university in Unum UK his work had been used as postgraduate work had been used by um from SWAT coab to leading to the work that won him the Nobel Prize in biology was a very smart guy and they're asking a different question so in the US researchers led by nan Toki's at the University of Minnesota start asking this question they want to know why is there so much heart disease in the United States she let me ask you a question how many of you read Thinking Fast and Slow by Kahneman a great book I'm reading that I understood what people said about my first book but like very thought-provoking could have been 200 pages shorter in a concept called what you see is all there is why see adding which to me is the most so if you're in the US and you're a doctor and you're treating heart disease and you're looking at heart disease rates in the u.s. what you want to understand as heart disease rates in the United States okay very important question and the hypothesis they come up with so saturated fact sweet high-fat diets here so first it's total fat then it's saturated fat and elevates cholesterol and that causes heart disease but if you're in the US or the UK you've got missionary and Kelowna hospitals all around the world and in those hospitals all around the world people are seeing a different phenomenon they're seeing this obesity diabetes epidemics emerge hypertension emerge and heart disease emerge and gout and cancer the whole cluster of chronic disease is basically metabolic syndrome insulin related clusters so they want to know what's the explanation for that because they see something different and they're seeing more of the world and Yadkin beginning in the 1960s right so if we're looking for a dietary cause of some of the ills of civilization they start talking about this idea of diseases of civilization they later refer to it as diseases of Western diets or Western diseases we should look at the most significant changes in the man's die and the most significant change was sugar sugar had exploded in Western diets again it's the same thing that Emerson and Larimore said the same thing that that Alan said so national levels of consumption of fat and sugar are closely similar but statistics relating fat intake to heart disease or diabetes in different populations may therefore Express only an indirect relationship the causal relationship may be with sugar and then he started talking about the effect of sugar on her and enzymes and he did a whole series of experiments with students and with animals basically demonstrating that sugar consumption could cause all the various metabolic symptoms that go along with insulin resistance in this cluster of metabolic diseases called metabolic syndrome and by 1970 was getting a lot of publicity he wrote this book sweet and deadly I know these people they pick well I won't get into book titles I don't like the title of my books so what happened this argument by the 1970s we're having they're making progress is actually a congressional hearings to discuss sugar in the diet and chronic diseases and then in the 1970s it evaporates and evaporated the same reason it did 40 years earlier when it was a diabetes argument with very specific nutritional authorities didn't like it and the authoritative authoritarian sort of thinking in the medical community if these people said something was bogus it was bogus and Ancel keys didn't like and in Ancel keys was the leading nutritionist in the US and he was a leading authority along with the leading proponent of the dietary fat dogma NIF dietary fat caused heart disease then sugar couldn't is that simple and if dietary fat was a problem with modern diets then sugar couldn't be the problem with modern diets and these two diets were conceivable so Keyes wrote an article on sucrose in the dye and coronary heart disease where he basically ridiculed Yadkin and he first submitted this he disseminated this a letter to his friends and then it got published in the journal me see if I hear some of the languages the widely publicized theory that sucrose in the diet is a major factor in the development of coronary heart disease has been examined the theory is not supported by acceptable clinical epidemiological theoretical or experimental evidence has been claimed that the theory is supported by international statistics by the time trend by comparison of dietary habits of coronary patients and controls and by experiments not one of these claims is justified by the actual evidence and Yadkin was ridiculed and in fact by that time you'd can head tired from his position as head of the department of nutrition at I always forget King's College in London and the administration had promised in the laboratory to work with and they hired somebody to replace him who is a sort of keys Ally and they didn't go through with the promise to give him a laboratory and he ended up working at like the economics building and writing his books and slowly being ignored the other problem is a sugar industry didn't like it okay the sugar industry was justifiably burst while hypothesis claiming sugar is the cause of modern chronic diseases beginning in the 1960s they put together a public relations campaign to fight back and I don't blame him for this in confronting Jack Tatum who was the president of the sugar Association incorporated and that was a sugar industry's lobbying and research arm said confronting our critics we try never to lose sight of the fact that no confirmed scientific evidence links sugar to the death-dealing diseases this crucial point is a lifeblood of the Association so what the sugar industry did is they basically beginning in the 1970s they put together a couple of seminars symposiums where they got experts together to discuss the science and the experts actually said that what they should do and including the consultants they hired as they should test this idea if even 15 percent of the public was sugar intolerant and getting metabolic syndrome they didn't use a term at the time but if even 15 percent of the public was getting this disorder they had to know that and they should spend any amount of money to study it and the sugar industry didn't want I didn't justify ibly didn't want to do this they saw people like Yadkin as fringe quacks and in fact it's fun in 1960s wrote down the founder of the organic food movement wrote a book an anti sugar book in which he blamed Hitler's Final Solution on Hitler's sweet tooth and Napoleon on Napoleon's sweet tooth and so it was easy to see these people as quacks it wasn't that much of a leap to assume that they were all like Rodale so instead of doing the studies with the sugar industry did is a tired Fred stair who was the head of the Harvard nutrition department and been a friend of the sugar industry since the founding of the department the Harvard sugar nutrition department had been founded in par with sugar industry money and they'd funded it along long and it wasn't it wasn't a crime back that nutrition departments were actually founded to collaborate closely with industry you know they were gonna generate nutritionists who were gonna go off to work for industry so it made perfect sense back then for industry to help fund these departments it wasn't until Ralph Nader came along in the late 60s that because this became seen as a kind of unholy alliance but stare was clearly a friend of the sugar industry stare like to say that yeah it's true he didn't eat pies because he liked and he didn't eat sugar because he liked to save his calories for his martinis but it was all about calories and so they hired stayer who hired a group of researchers were all anti fat people to write a report called dietary sugar or sugar in the diet of man was it called sugar in the diet of man that would basically argue that dietary fat was the issue and sugar was benign and that's what they did and at that time the FDA was in the process of examining whether sugar should be considered generally recognized as safe as a food additive and they had put together there was a committee put together by the FAFSA of experimental experiment the biologists society to look and see whether sugar should be generally recognized as safe in this document sugar in the diet of man was used heavily by them and the evidence included that sugar is safe and the sugar industry took this well this is sugar is safe the federal Federation of American societies for Experimental Biology after four years studies concluded in a recent published report commissioned by the Food and Drug Administration that sugar at current levels of consumption is safe that was a sort of general consensus and it was a general consensus at the time because everyone believed that that was the problem in 1986 the FDA and fast sub returned to this question they put together a group of bureaucrats at the research administrators at the FDA to address whether sugar should be generally recognized as safe and they came to pretty much the same conclusion this is a language they had to use no conclusive evidence on sugars demonstrates a hazard to the general public when sugars are consumed at the levels that are now current and was interesting about that conclusion is when sugars are consumed the levels that are now current so how much sugar were they were consuming in the 1980s so the FDA did its own assessment I threw out everything that the the US Department of Agriculture had done everything that the NIH had done over the years and concluded that we were eating about 40 pounds per person per year that's about a coca-cola per person per day the USDA estimate at the time was 75 pounds per person per year the USDA estimate for 2016 was 90 pounds per person per year and when I say 131 pounds available you're actually the reliable number that we have for sugar consumption is sugar availability that's how much sugar does the food industry make available for the food supply how much is imported - how much is export and that's a reliable number and that number peaked in 1999 when I gave you the number of 90 pounds per capita at the end of the 19th century that was a food availability number it stayed relatively stable went up to about a hundred hundred and ten pounds by the 1920s and it stayed stable until the 1970s and then we decided dietary fat was a cause of heart disease and high fructose corn syrup entered the food supply when in the high fructose corn syrup was another form of sugar and by 1999 that food availability number was 155 pounds per person per year so it's about 4/10 of a pound of sugar per person per year out of that you then estimate how much is thrown out how much is you know fed to Pat's how much metabolise is transformed in cooking or other chemical processes and you get lower numbers but one way the other by 2016 the USDA numbers we were consuming more than twice as much as the FDA established in 1986 might be safe for consumption once the FDA did their job a series of government reports followed by 1984 we had already law also locked in this idea that dietary fat causes heart disease and a series of government reports a surgeon general's report nutrition and health is C everett Koop report the National Academy of Sciences diet and health hammered on this idea that dietary fat is a problem so we were told to avoid sugar we were actually told by the first Dietary Guidelines to avoid eating too much sugar which is about as benign a statement as you could make as too much of anything is technically bad for you right it's another tautology so you want to avoid doing too much of anything but what happened in the 1980s is we developed this obsessive focus on the fat content of the diet and chief among the food factors involved in overconsumption is the disproportionate consumption of foods high in fats often at the expense of foods high in complex carbs so our authorities are actually telling us to eat green vegetables and eat the intrude meat lean protein and eat fiber and avoid too much sugar but the message was dietary fat caused heart disease and we should eat low-fat diets and those of you who lived through that era remember when suddenly the idea of eating sour cream on your baked potato was like you might as well just kill yourself the baked potato is fine unintended consequences there's always something tender consequences of any government report on government action so these these are heart healthy diet foods ok Yoplait Greek calorie it's only a hundred calories zero grams of fat zero grams of saturated fat low in salt this is also zero grams this is a heart healthy the government actually went out and told the food industry to create foods like this that's the heart-healthy part and the hundred calories makes it a diet food it's not that much sugar right seven grams of sugar 12 grams of sugar the 12 grams is 48% sugar so you remove the fat from a food yogurt is of food it's not a food like substance like Michael Pollan would say you removed the fat you now have this insipid worthy watery low-fat thing I mean you could condense it down but then you have smaller portions so you want to keep the portion size large so what you do is you add back fruit and high fructose corn syrup to make it taste good again and now you have a heart healthy diet food that's 48 percent sugar by calories this is what we've been eating this is more than you hear about the snack Wells effect this happened to virtually every food in every processed food in America on some form so what's changed since the late 1980s remember so Yadkin is trying to explain this cluster of metabolic disorders that associated with obese with obesity and diabetes in the 1960s it doesn't really have a name back then but by 1988 a Stanford University physician named Gerald reeben calls it syndrome X and syndrome X is excess weight your waist size is getting bigger your glucose intolerant so you're becoming diabetic you have low HDL cholesterol the good cholesterol and high triglycerides and high blood pressure how many of you have high blood pressure in here okay and how many of you wait I won't get into an um so we've it has been sunny this since the 1960s at Stanford puts us all together in syndrome AXA became known as metabolic syndrome it's technically insulin resistance syndrome so insulin resistance is a condition where your cells in your body are resistant to the hormone insulin and you have to secrete more insulin to do the same job until your insulin resistant it got the name metabolic syndrome instead of insulin resistance or because it's hard to measure insulin resistance directly in a physician's office so in the National Heart Lung and Blood Institute started discussing this they didn't want to discuss it as in some resistance syndrome because they couldn't tell doctors the measurements and distant you could get HDL and triglycerides in blood pressure and waist circumference and glucose tolerance measured an easy trip to the doctor so they caught a metabolic syndrome its associated with obesity because associated right with getting fatter as part of metabolic syndrome and it's associated with type 2 diabetes because glucose intolerance is part of matter by type 2 diabetes as part of metabolic syndrome it increases the risk of developing heart disease it affects 1 in 5 people Wikipedia is my ironclad source on this and some studies estimate the prevalence in the u.s. we up to 25 percent of the population not just 25 percent the older you get the more likely you are to have it so by the time you're in your 50s and 60s roughly half of all adults in America happen that's getting worse and if again if you're overweight if you're diabetic you went through insulin resistance and the truth is if you get heart disease you're not going to get heart disease because you had LBO high LDL cholesterol for most of us are some huge proportion it's going to be because we had metabolic syndrome and what's interesting is even go back in the research to when Ansel P started studying the effect of saturated fat on cholesterol they were concerned with what they saw as an epidemic of heart disease in overweight executives soaky's who was a little bit lacked at this tiny bit of confidence about the cholesterol heart disease thing thought if nothing else people with less fat they lose weight and he would say things like if those fatties would only stay away from the fat they would lose weight even Keyes was looking at metabolic syndrome he just wasn't recognizing it as such so the question is what causes metabolic syndrome or what causes insulin resistance because now we have we can look at those epidemics of obesity and diabetes as an effect epidemics of insulin resistance worldwide and heart disease it's associated with heart disease with hypertension and the conventional wisdom is sedentary behavior maybe eating too much the reason its sedentary behaviors because a lot of thin people have metabolic syndrome so you can't blame eating too much of their thin so we say sedentary behavior and the biochemical wisdom is sugar or sucrose and high fructose corn syrup so this was a review article done in 2010 by Luc tapi who's the world's leading authority on fructose metabolism he also I have heard and I hope I'm right about this Luc it's some funding from coca-cola so you would expect him to go easy on sugar as a possible cause but as he said in this article high fructose intake has indeed been shown to cause dis lipedema and to impair hepatic insulin sensitivity although there's compelling evidence and very high fructose intake and abdullah Terius metabolic effects in humans as in rodents they're all of fructose in the development of the current epidemic of metabolic disorders remains controversial and this is how it would happen if it happened so fructose consumption metabolic syndrome is o as I said it's associated with with low triglycerides high triglycerides low HDL cholesterol and also small dense LDL particles or a high number of LDL particles and that's technically known as dis lipedema or atherogenic dyslipidemia so they're all invented various mechanisms reactive oxidant species when you take antioxidants it's to in theory combat reactive oxidant species hyperuricemia is the condition that leads to gout which leads to impaired advice' dilation which increases blood pressure so these are all mechanisms by which fructose could lead to insulin resistance and these are tapis mechanisms for how fructose can lead to obesity insulin resistance dis lipedema a heart disease stroke high blood pressure so the point is again i told you this is a story that starts in the 1880s with you know the 1840s with the increased sugar consumption the beginning of diabetes and obesity so there are caveats it's controversial I said I could get it I think I can an indictment I can't get a conviction studies of sugar primarily in animals and animals aren't humans I spend about half my life exaggerating looking at articles in the paper and adding you know it says doing X causes Y and I want to say doing X in rats causes Y in rats because you have no idea what it'll do in humans studies in humans tend to be a focus tended to be a fructose alone so it's a complicated studying these things in humans and when you're studying we don't eat toast alone we don't drink fructose alone we drink it with sucrose and the sucrose the glucose and the glucose stimulates insulin secretion while your liver is metabolizing fructose and then the studies tend to last weeks to a few months and you're looking at diseases that develop slowly over years to decades so type-2 diabetes obesity heart disease they all develop you know I'm arguably over decades but you can only afford to do the studies for six months maximum a year so that science is very ambiguous and you can make an argument that you can disassociate in the studies effective sugar from the effect of the calories in the sugar so you can't prove that the gift that keeps on giving this caloric balance hypothesis what's wrong so meaningful studies are simply not being done one of the reasons I co-founded this not-for-profit is to try and get them done and to resolve the issue the research has to be able to disassociate metabolic hormonal effects of sugar from its calories and it's surprisingly difficult to do although it can be done if you put your mind to it so the conclusion for the moment sugar may well be the fundamental cause of obesity diabetes and heart disease vietze effect on insulin resistance and saying as tapi did or the Institute of Medicine does that there's a lack of scientific agreement or that it's controversial or that the science is unsettled should not be compelled I should not be reassuring you know we have a serious problem we have these slow-motion catastrophes as Margaret Chan put it and we have to establish the cause I love this it's my last issue I think we have time my wife calls us the Grinch that stole Christmas issue that's right if you're eating sugar and you're getting fat or leaving the sugar industry would admit this consume my sugar right but cancer when I started my research I would have thought clearly only a quack would link sugar to cancer like Final Solution Napoleon cancer what's interesting so obesity in diabetes this is a from a nature article in 2006 so I said they're linked to a whole host of this metabolic diseases in metabolic syndrome so insulin resistance at the heart of it and type 2 diabetes fatty liver disease we have an epidemic of fatty liver disease which is interesting children in this country have fatty liver disease um it could be another catastrophe in the making and you might consider sugar suspect because the fructose component of sugar is metabolized in the liver and it's converted into fat heart disease hypertension cancer as part of this metabolic disease cluster it's interesting when you go back into the history and you look at the emergence of these Western diseases in the history cancer was one of the diseases that emerges in these populations cancer was always there and you could find cancer in lauda animals but as populations become westernized cancer rates tend to explode also the problem is Western doctor rates also tend to explode so you have to be able to disassemble a cancer rates are growing because there are more doctors there to diagnose cancer and in traditional populations they knew enough not to go to doctors if they had cancer one of the first cases of cancers ever discovered in western Africa was an epithelium of the penis and the surgeon happily removed it you know and you might not want that to happen so if you had cancer you might just not go to the doctor and they talked back in the early 19th century about cancer patients showing up and then after the doctor talked about treatment the patient would vanish back to the bush um but cancer is linked to metabolic syndrome obesity is associated with cancer so the fatter you are the more likely I ought to get cancer diabetes is associated with cancer type 2 diabetes particularly on it's known now to be linked to both insulin and an insulin like hormone called insulin like growth factor and this is all part of a new sort of there's a whole kind of slow paradigm and shift in cancer to look at it not as a genetic disease but a metabolic disease so cancers fundamentally change their metabolism when they become cells change their metabolism when they become malignant and start growing out of control and they start metabolizing blood sugar at massive rates and they up regulate insulin receptors on their membranes so they could suck in sugar and they up regulate insulin like growth factor and there's a series of very good people who now believe that basically insulin resistance drives cancers through a series of mechanisms so insulin resistance makes insulin levels go up which makes blood levels of this insulin-like growth factor binding protein go down which makes insulin like growth factor itself become more bioavailable which dries metastases and target the target cells and you end up with tumor development and so the question is whatever causes insulin resistance whatever that question mark is is going to increase cancer prevalence and cancer rates and like I said you could look through the literature from that observation of cancer rates developing and primitive populations that become westernized through cancer rates climbing in Native American populations from the nineteen forties onward despite the presence of Bureau of Indian Affairs ish ins in these populations all along to cancer rates climbing and Inuits dramatically breast cancer rates in Inuits went from virtually zero in the 1960s close to similar to other ethnic groups you also have situations like Japanese immigrant Javanese women in Japan had very rates of breast cancer they come to the US within two generations of breast cancer rates are similar so you've got something driving cancer rates that's diet lifestyle dependent and if you believe this particular science it's whatever causes insulin resistance thank you [Applause] tell us about your diet look you're a very lean and healthy looking sir I don't need a lot of sugar I this is how I described it now I'm one of these people who's convinced myself that bacon and butter are health foods and I hope the hell I'm right yeah I experimented with when I first started my research actually for the New York Times Magazine article 20 years ago economists at MIT we were talking about good science and bad science I said I've been working on this series of investigative pieces on dietary fat and he set off your studying dietary fat you've got to do an Atkins diet as an experiment he has a colleague at Wharton whose father lost 200 pounds on the diet he told me and he it was Asian American he said he basically gave up white rice and lost 40 so I went back to California where I lived then I didn't have a wife her family at the time and nobody would really care if I had a massive heart attack and so I did the experiment and tried the diet and it does what everyone says it does I lost weight effortlessly weirdly effortlessly it's a fascinating phenomena I fell off it and then by the time I was about the third of the way through the research for my first book as I was understanding that basically that's a diet that lowers insulin and that quote from Alan bersin that if you want to get fat out of fat cells what you need is basically the insulin deficiency that a low carb high fat diet a ketogenic diet they're all fundamentally diets at lower insulin as low as they can go and there's a school of thinking which I'm now one of the leaders which is weird being a journalist which is that the lower your blood sugar the lower your insulin the healthier you are and so that's how I eat and mmm it's weird I got butter in the bag that I'm taking back to California because there's Vermont Creamery butter is among the best in the world and it's hard to get in Oakland oh good yeah two quick questions but you obviously have highlighted a lot about insulin I wonder even if it's some rats and mice if you have any comments on what sugars do to the other 50 or so or exogenic anorexia genic peptides and also what sugar does and epigenetics and the answer is no I don't so I look at the big picture my brain doesn't do trees it does for us it's all I can say that's why we had a okay it was a b-minus student at Harvard I'll cop to at the UM but let me put it this way when those papers cross my desk they never say good things you know I will skim them enough to see is there something I should there was an article in The Guardian or something lately about if you put sugar on wounds it'll kill bacteria maybe but that's about the only good thing I've seen come out but there's also there's selection bias in which once people start seeing something as bad although report is bad so even if sugar was God's gift to humanity in our health you might not see it once people like me start talking about how bad it is I will say this thing with sugar and wounds that works a good treatment for dogs with abscesses it selects the water out of the bacteria well I will keep it in mind because I now have a nine-year-old who plays basketball in concrete so we'll probably get to theirs they're walking around with okay hi so as an undergraduate student taking a statistics course this is kind of on my mind you talked about some of the difficulties with doing research and specifically long-term experiments to really study the effects of sugar and to create that statement to be able to say it's a causation so how do you and your nonprofit that you founded proposed actually conducting these experiments to separate sugar from outside factors okay so it's in time we one of the things you want to do is test this energy balance idea of obesity so you can think of obesity is in the one level we have this idea its caloric imbalance and on the other level it's basically the hormonal effect of the foods you're eating and those hormones affect fat accumulation oh so we have to UM we have to disassociate somehow calories from macronutrients so the way you would do it is you have to fix the calories that the people eat so means you basically have to lock them away somewhere and then you have to feed them a specific amount of calories every day depending on what you want to achieve with their body weight and then you could manipulate the macro nutrient composition and the groups that they're randomized to so those are exceedingly expensive studies to do because as soon as I say lock them away and feed them so we did a pilot study of 17 subjects for eight weeks wasn't even randomized it was about four and a half million dollars I would say that the experiment midway through they learned why the its methodology didn't work and it was a rat experiment you to euthanize the rats and done it again but because it was a human experiment than four and a half million dollar one even though we said we would try to raise another four and a half million to do it right the researchers weren't interest and we funded some studies we have a study coming out I should have the paper waiting for me to read from a group at Harvard there was a 12 million dollar study doing a similar approach not quite so locked in so it's a little cheaper but more subjects that study should be out if that gets accepted and within two months or so while we were doing this we decided to do a pilot study so non-alcoholic fatty liver disease I said it used to be 20 years ago if you were diagnosed with fatty liver disease and you told your doctor you didn't drink your doctor would assume you were lying and then fatty liver disease starts showing up and children who clearly aren't alcoholics so now like I said it's epidemic I think the estimate is something like forty million kids might have it it's particularly prevalent in the Hispanic population because they have a gene that predisposes them and fructose is metabolized in the liver so it makes sixth sense so we put together a pilot study of sugar and non-alcoholic fatty liver disease that was just about a million and a half dollars and it's being done at UC San Diego and Emory and forty kids with diagnosed non-alcoholic steatohepatitis which is a more severe version of it and they would be randomized to two arms and one arm would get a sugar free diet so we give their whole family 120% of the food they need all of it prepared without any added sugar at all and they're not drinking any should beverages and the other it's not a well controlled trial that's why it's a pilot study the other family gets basically the food card every week to go buy $200 worth of food so they at least get some attention from us um that study was finished running subjects last May last December the researchers were excited about the results and all anxious to publish them and now we haven't heard from him in two months so I have no idea what happened but it looked at least as of last December that if we it's not a well controlled study you could find like for instance if it the fatty liver disease resolved which is what would have explained their excitement you might have said well resolved because they lost weight and it's likely the kids would lose weight because they wouldn't like the non sugar food as much as they liked their original food and they just ate less of it so the sugar industry kiddo we're still not disassociating calories and the reason we were doing this study was because we thought if we could show an effect in four weeks we could take kids and put them in a summer camp where we could lock their calories and now we can disassociate the effect of the sugar from the calories this group at Harvard that has this paper coming out at 12 million from this foundation in Texas to do a follow-up study where they will possibly be able to disassociate the effect of sugar from other carbohydrates if it exists so it's just thinking about how to just like you would do an eighth grade science experiment you want to minimize the variables that are changing so we want to fix the calories are reading or fix how much they weigh if such a thing is possible and then manipulate the macronutrient content or manipulate the sugar content last question for the evening and then Gary will be outside signing books an orange bookstore is here so last question hi I was wondering what your opinion is about products like trivia ok I think there's two questions when it comes to artificial sweeteners are they safer than sugar and are they safer than no sweeteners at all so when it comes to are they safe from the sugar the science with the artificial sweeteners and Truvia and stevia and pick your artificial sweetener is as bad as the rest of the nutrition sciences for the most part and it's very hard to do these studies because when you're doing sweeteners you have trouble controlling for calories also but sweeteners tend to be a hundred two hundred three hundred times lower than sugar so if you ask the question is it safer than sugar and this was something the head of the National Academy of Sciences pointed out in 1976 at a symposium it's you're getting a hundred pounds of sugar a year and you want the equivalent sweetness from say saccharine which is one three hundred times as sweet as sugar you'll take a third of a pound of saccharin a year to get that sweetness and I'm going to say that the third of a pound the saccharine is safer it's been tested wouldn't be the FDA won't allow it as a short-term toxin so we know it doesn't kill animals and we know it doesn't give them cancer even when given massive doses so I'm going to a therm assume that the artificial sweeteners are safer then the question is the artificial sweetener safer than no sweetener at all and that's probably pretty easy I can't imagine why no sweetener at all would be dangerous at all but there is research coming out recently than linking artificial sweeteners to diabetes and obesity I don't find that very compelling and sometimes I wonder sugar industry is very smartly fun to hit but you know many people can't give up sugar you tell them to give up sugar and not drink not have something sweet life loses its meaning I understand that I tried to give up coffee a few years ago and no caffeine you know wasn't worth getting out of bed for a year so you know so that's so it's kind of a trade-off I personally see when I give advice I see Sweden it is like a parachute you know it's a crutch get off the sugar if you have to have sweeteners have sweeteners I think Truvia stevia are the probably the best because they're naturally-occurring they've been consumed by Central American populations for hundreds of years with no apparent damage they've been used in Japan for like since the 40s or so but ideally you get rid of your sweet tooth [Applause]

Channel: Dartmouth

Views: 92,284

Rating: 4.801775 out of 5

Keywords: The Case Against Sugar, Gary Taubes, C. Everett Koop, Dartmouth College, Nelson A. Rockefeller Center, Norris Cotton Cancer Center, Nutrition Science Initiative

Id: IwuuKwGzc6Y

Length: 82min 57sec (4977 seconds)

Published: Thu May 10 2018