The Case Against Sugar l Doctor's Farmacy with Mark Hyman, M.D. EP12

[Music] so welcome Gary you know we're here in Switzerland at the conference that's put on by the British Medical Journal about the science and the politics of food both of which you have written extensively about and are passionate about and the first article that I ever read by you was back in 2002 in the era when we were still pretty focused on a high carb low fat diet as a solution to all of our ills and you wrote a very radical radical article which turned all that upside down saying that maybe what it's wrong what if it's all been a big fat lie and this had a big steak and butter and on the cover of the New York Times Magazine and I read that I was like I see this in my practice I've been reading dr. Ludwig work who you quoted in the article how did you come to kind of have this aha moment because it was sort of bucking the tide now every book on the bestseller list is a ketogenic high-fat diet but back then it wasn't like that yeah okay so I had done a couple of investigative pieces for science first on the idea that salt causes high blood pressure the evidence for which is poor to put it mildly and that got me into this question about the low-fat diet and heart disease and while I was interviewing doing interviews for the low for the fat story i interviewed a administrator that in National Institutes of Health who said to me I remember we were sitting in a Starbucks in Potomac Maryland and he said you know 20 years ago 15 years ago we put everyone on this low-fat die and we thought if nothing else they would lose weight right because fat has the densest calories you tell people not to eat it they'll lose weight and it's more than twice as many calories as carbs yeah and 13 15 years later we've got an obesity epidemic and people stopped eating fat and started eating carbs and it looks like they got fat so I was living in New York I was pitching out of the New York Times Magazine editor or I used to meet it's gonna be restaurant specific and a wonderful cafe and a village that we both haunted we wouldn't pitch stories back and forth and I said let's do a story how about a story on what started the obesity epidemic you know was knew enough at the time and there were basically two obvious suspects one was high fructose corn syrup which was introduced in 1977 over the market by 84 and the other was this sort of institutionalization of the low-fat high-carb diet as a healthy diet and the transition of the carbohydrate from being thought of as fattening in the 1960s to heart healthy diet foods in the 1980s yeah that was a food pyramid right that was loyals only sparingly at the top and six to 11 servings of bread rice certainly positive exactly and I you know we lived through it to remember when suddenly baked potatoes and pasta became health food yeah butter on and bagels like bagels used to be Sunday morning maybe and suddenly they were every day so that was it that was a pitch and I looked into it and as I was doing the research I came upon five studies that had been finished and submitted for publication but not yet published all trials of the Atkins diet the ketogenic diet versus low-fat the American Heart Association diets they all found the same thing and this is kind of fundamental idea that people still don't get in this whole nutrition debate the ketogenic diet is the what scientists would call the anomalous observation so we have a hypothesis that says dietary saturated fat causes heart disease and the sort of ketogenic diet it's traditionally prescribed the Atkins induction phase is full of saturated fat so it should make butter heart disease fact they meet you know lobster Newburg and then we have a hypothesis that people get fat cuz a too much and it's an ad libitum eat as much as you want diet so if you randomized people to a diet with a lot of saturated fat a lot of meat that you could eat as much as you want versus a diet that's low in fat and low in saturated fat and mostly plans and calorie restrict and calorie restricted people should be dropping dead on the Atkins diet and not only did there heart disease risk factors improve compared to the low-fat diet and this was a case in all five of these studies but they lose more weight yeah so if this were a sort of rigorous science instead of arguments between competing religious factions which yeah unfortunately science has become you know I had this view of science as this pure elite you know above politics and prejudice and bias that would give us the true answer what nature is about boy was I right yeah no that's a very idea I mean it's fine I've been spent much of the last two years reading a lot of memoirs on scientists and they'd it's always been full of these you know you come to a conclusion and somebody else disagrees with you one of you is right one of you is wrong one of you is smart one of you is not it's hard not to get somebody plus opposite yes not only to very sorry or to reasonably but to people have been rewarded their whole lives for what they've done or have gotten copious feedback that they know what they're doing and they're good at it too you know people who are at the height of their professions and when it's right one is wrong the good one is bad it's sort of it's just a situation for vitriol anyway getting back to this if so the whole point of that article is if these you know what these studies are telling you what this Atkins ketogenic diet thing is telling you is there something wrong with the conventional way we think about heart disease and obesity yeah and I have a background in science not medicine and I had been trained earlier in my career mentored by some very brilliant scientists in my first two books and I don't use the word brilliant lightly or often and they had taught me to I hope to think critically and rigorously about this and when you have that kind of observation you don't dismiss it right you examine it you should make you curious it should make you want to learn more and that was basically that's been the last you know 16 years of my life unless the trick science is you know if you find some doesn't fit and you go y-yeah and you try to dig in and figure it out instead of go well no we've got to bolster our current viewpoint but its dogma and we we don't challenge it it's very easy for us to and everyone does us I mean it's it's human nature to say when you say why you go oh wait they did this here's a reason I could dismiss this and we all do that every day and the best scientists can is you know Francis Crick talks about this if you find a scientist who isn't dismissing experiments that he doesn't like he's not doing his job because clearly a lot of them have been done poorly and when you've got you know it's never white and black it's always shades of grey and you have to figure out what you're gonna which studies you're gonna believe in which you are in and that's part of the the job of doing science it's also that's the scientific studies only give you answers to the questions that are asked exactly and so sometimes the questions aren't formulated properly the design of the study isn't awesome it doesn't provide the conclusions that are valid and that's on the best day on the worst day these studies are corrupted by industry influence and you know bias and all sorts of things that you know allow you to prove for example it's smoking as something into a lung cancer right so yeah it's funny because today Preda meds in the news again huh and so the Preda med try out that they had problems with their randomization scheme that was pointed out to them by an astute on a website apparently by understood researchers said you know the results they claim here & Pasta tist eclis impossible possible so they have actually retracted the paper really reassessed it and republished it and luckily they came to the same conclusion they were right all along so that study was as one of the few randomized control trials comparing a low-fat to a high-fat diet and I Mediterranean contact right where they gave the fat group olive oil litre a week and or a couple of big handfuls of nuts every day and the nuts and the fat group had dramatically lower heart disease mortality diabetes all kinds of things even though they're eating more fat and they had to stop the study because it was unethical to continue because the people who were not eating the fat were dying right that's there but again what you just described was one of the problems with the trial there were a lot of problems at the trial weight if you're giving one group nuts and olive oil and the other group nothing every week or every month or every quarter you're telling one two of the group's eat healthy here here's your nuts here's your olive oil eat healthy and every time they reach for the olive oil to cook a meal or every time they take handful of nuts they're reminding themselves that they're on a clinical trial they have to eat healthy and where the other guys are out you know McDonald's or the I mean I've been to Spain there McDonald's so you've got a can study that's got a very poor control group but yeah free living humans those pesky free living humans but here's the point is what you said is that you only get the answer for the question you ask so the question that was asked was it's a quote Mediterranean diet unquote better than a low-fat American Heart Association type diet and the answer was if you ignore all the problems with the study yes but it doesn't tell you that that Mediterranean diet is better than compared to what some of them so this morning this conference I looked in on the breakfast room and they're serving a classic Swiss hotel breakfast which is you know fishes herring salmon near Isola yeah exactly it's got nothing to do with the Mediterranean diet the Swiss had one of the longest life longevity highest longevity numbers in the world so they had bread but you had to cut it with like a meat slicer we say yeah it's hard it ain't it ain't Wonder Bread no and so it's an entirely different diet and so what we have there was a medical community that announces we have to tell everyone to eat a Mediterranean diet because we didn't did well right but compared to what what right that's I was like the joke my sister used to tell us when the Vermont farmer was asked how's your wife you know as compared to what it's true are we comparing a low-fat to Mediterranean to a ketogenic diet to a extremely low carb diet well I mean how do we then begin to sort through this question if you don't ask those questions and again that I think in general physicians aren't trained as scientists you know trained journalists aren't either all knowledge that but um you're vitally important to know what question was asked cuz that's the only answer you're getting in that draw it's true you know I was recently at a meeting food leaders meeting our friend dari Mazda firing was there Francis Collins was there the head of NIH and they had an interesting debate conversation because the head of a license well we don't know much about nutrition research and what the science is and about calories and dr. Maas a friend was the head of tufts who's gonna be on this podcast is that a tough Cesc of nutrition health and policy and science he said we do know and I think there's this debate about you know what makes people fat and you wrote a book called why we get fat and I read it and it's a short little book and it's brilliant in that it actually distills the obvious into almost to me an arguable thesis which is that the reason we get fat is not because we too many calories but because we eat the wrong calories and they have different effects in our biology and the science of obesity we do know a lot about so can you break down what is that science and why did we get it so wrong and how do how do we not sort of stay stuck in this idea that all calories are the same could you also address that in good calories bad calories and I've kind of address it in the next book as well because until we get this point right it's still not the prevailing dogma and recommendations conference today and then so the conference is a BMJ Swiss Re conference about called food for thought right and there's going to be a paper published in the BMJ this week that's gonna be presented today on obesity and it sees obesity as an energy balance problem calories and - calories and yeah so the history of that idea which I've discussed in my book is fast because it's a hypothesis it's not a fact of life and it comes out of the history of modern nutrition which starts in the late 1860's in Germany I'd love to make a short story long and is exactly which is basically could have been the epigraph of my first book um the anyway the point is for 50 years in nutrition from the 1860s onward all 'van the entire science of nutrition was measuring the calories and food and the calories expended by humans that's one thing they could measure because it's device called a calorimeter yeah it was invented in the 1860s and then you could study vitamin and mineral nutritional deficiencies you could study protein deficiencies fiber deficiencies things like that this is what nutrition science was so with the early 19th century early 20th century when it comes around to developing a hip hypothesis of obesity it's hard to see how vitamins and minerals and protein could be involved so but you had these calories thing and you had physicists talking about the laws of thermodynamics yeah so you come out with a you're measuring energy and an energy Alice as we just said your answers to problems depend on the questions you ask and the questions you ask depend on the technology available to ask a question mm-hmm so you come out with this energy balance hypothesis because all you can measure is energy and then the science of nutrition doesn't kick up the science of endocrinology so you know how foods how much energy is carried into the body you don't know how foods influence hormonal yes dates because you can't measure hormones Suntech 1922 that insulins discovered the whole science of endocrinology is this sort of inchoate thing that most physicians and researchers know nothing about I mean the problem with the law of thermodynamics is not that it's false it doesn't tell you anything about why it's not true it's physics it's not biology so when you mix physics and biology it gets confusing yeah I've been thinking about questions I could ask at this conference today of the sort of conventional wisdom experts on obesity and one of them I would ask is you've got this disorder of excess fat accumulation it's as simple a way to describe it why are isn't there any discussion and your paper your book so your articles about the hormonal enzymatic regulation of fat accumulation like we were talking about height disorders you know why someone is uh eight feet tall or four feet tall fully grown all we're talking about is growth hormone growth hormone receptors insulin like growth factors receptors you know we're good at talking about height but not with but when you talk about width it's like how much we need exercise and it's even if that's not true why isn't there some discussion about why the hormones are regulate fat accumulation we know what they are for mm-hmm going on 80 hundred years and known the system well for 50 years why aren't we discussing it if nothing else to say this is how we know they're not involved so that's you know what happened in this field is you get this energy balance idea it comes out of a Germany and when endocrinology starts to emerge as a viable science in the 1920s nobody's really the endocrinologist really aren't thinking in terms of obesity there's it's not something they weigh yeah it was like the world war ii every was starving today and when world war ii comes along and everyone's starving it's not an issue and by the time that 1959-60 when a technologies invented that allows you to measure hormones and the bloodstream accuracy there's something called the radio immunoassay to new york researchers Rosalyn Yalow when Solomon bursts in yellow gets the Nobel Prize for this after birth and dies it's a revolution in the science of endocrinology because now you could actually measure or hormones yeah and you could figure out their effect on you know endpoints tissues organs in the body the field of obesity's basically dominated by psychologists and psychiatrists who are trying to figure out why fat people eat so much and there's awesome moral failing some more well they might not think about it that way but they're they're gonna try and because you have a willpower they treat it as much yeah you don't have willpower and so how can we get fat people to eat less that's what they're doing that's what they care about and they're not endocrinologist they don't care about hormones they believe that a hormonal explanation of obesity is like an excuse for fat people to get to do whatever they want and you have this sort of monstrous day I mean it would be trivial if it would be science this stuff happens in science all the time people get the wrong answer they push wrong hypotheses for decades but in this case are huge implications for us yeah and so our obesity and the prevention and treatment and so then so then when you sort of started thinking about this you you sort of realize it was this whole body of literature that was putting the run wrong direction from where we're going right but it was sort of ignored and so years been really bringing that information research to light but that's yeah and explaining how we get fat as something to do with energy balance which is yet what all nutritionists doctor scientists governments and food industry are all telling us there's no good at bad calories you have Big Gulp which has 46 teaspoons of sugar and 750 calories it's exactly the same is 21 cups of broccoli which has a half a teaspoon of sugar and 35 grams of fiber and they're exactly the same and ya know or even a fifth grader could pretty figure that it's not Troma's crazy to us because yeah obesity and diabetes go hand in hand and so the and diet diabetes specialists or endocrinologist so all they you know it's completely it's clear as day to them that different foods have different effects on hormone status enormous them particularly insulin which is a hormone it's sort of driving the fat accumulation and they tell you if you eat more carbs just increase your insulin just increased your insulin so there's it's sort of this perfect storm of bad science and inconvenient facts that the diabetes specialists in the 1920s as soon as insulin discovered it's a lifesaver right so and it is for type 1 diabetics it's clearly a lifesaver and just at the same time that insulins discovered there's a physician in Minnesota who's publishing papers saying you know we're trying these low carb high fat diets ketogenic diets in effect on diabetics and they're doing terrific mm-hmm and he's publishing in this in major medical journals and Emily is Jocelyn who's the god of diabetes was like a hundred years ago this is a hundred years ago so we finally gotten back to where we were a hundred years ago but his studies 1920-21 so insulins discovered i was forget if it's twenty-one or twenty-two it's embarrassing but you're close enough I don't even I place in the early 1920s Eliot Jocelyn at Harvard is a god of diet becomes a god of diabetes because of his expertise with insulin therapy and he's a wonderful clinician he starts using this ketogenic diet for his patients but then boom you got insulin it's like it's it's a miracle drug and because of the the art of dosing insulin was it you know unknown at the time you often get you often as much and then you get hypoglycemia and you want to give people sugar to bail them out some yeah sugar and cars become a way to basically you know way to allow you to use insulin to save their lives mm-hmm so the diabetes community is just you know suddenly well that was the standard treatment back then for I used to be 70% of that yeah 27% protein and like 5% carbs that was the diet yeah because you can't tolerate the carbs that's with diabetes isn't but now we have insulin which is keeping the type ones alive but they're not really differentiating well enough so wait a minute are you saying that obesity is a disease of carbohydrate intolerance uh it's a hormonal regulatory disorder that's triggered by yeah you could call it carbohydrates so there are people are gonna get obese anyway because of hormonal disorder it's a dysfunction but the carb content of the diet is always going to promote that so you're on a pan interview video with a panel of the trainer from The Biggest Loser who's saying that weight gain is all about calories and calories out it's in such a pervasive myth and it is just a math problem its energy balance calories in calories out and you're proposing a different idea which is often called the carbohydrate insulin hypothesis or the hormonal hypothesis which suggests that it's not about the calories it's about what calories you eat can you take us down into how that works if someone's listening they want to know well what should i eat what should I eat what's gonna actually liberate fat for my fat cells and what's gonna store fat and how do I understand this new science of it why we get fat well this old science it's all science which is actually by the way gaining traction again in fact much of this conference is about examining some of this new science as a whole section on diabetes for vision is ashes the idea that our view that diabetes type 2 diabetes is a one-way street it's a reversible chronic progressive condition is being turned on its head and saying no no wait we can cure this disease yeah so this is um you know again the idea that the obesity just is a hormonal regulatory disorder so it's and this was a another German idea it was gaining traction it actually sort of won over the German research community and by the late 1930s when yeah the Germans and Austrians were doing the best medical research in the world and then the war comes and it just evaporates but the idea is it's gotta be a hormonal regulatory disorder in there all kinds of ways that that's clear you know you just look at how people fatten differently men and women fatten differently so men get fat above the waist women below the waist that tells you that sex hormones are playing a role you could have sort of isolated areas of fat accumulation we all know where they are on our body although now women drinking soda and sugar it is above the waist - I was I was at a family member had surgery at Stanford about four years ago and I was sitting in the waiting room waiting for her and it was fascinating to see that yeah all the women all of them had upper body obesity and it used to be you know that men had upper body so the question is in effect what regulates fat storage in different fat depots in the even body and clearly hormones are playing a role and everyone always new insulin played some role because type one diabetics who lack in someone can't store body fat yeah man metabolize in fat they can't burn the fat that they eat they can so that's right they can't store it like as a doctor treating type 1 diabetic that when they come in there they're producing zero insulin yeah they're eating 10,000 calories a day they're harming they're hungry and they're losing weight even though they're eating 10,000 calories a day so how could that be yes that was a disassociation between caloric intake and fat accumulation and that insulin is in that pathway yeah and so the 1960's I said you get this science of endocrinology sun-li and by 1965 or so it's it's been pretty well worked out how insulin regulates fat accumulation does it through a the whole you know sort of sea of enzymes and receptors and on that it up regulates lipoprotein lipase on the fat cell which pulls fat into fat cells that down regulates hormone sensitive lipase which should liberate fat from fat cell and sort of locks it in the fat cells and they can't get it out exactly so and this is textbook medicine it's in the endocrinology textbooks it's in the bio chemistry textbooks if you look at what makes a fat cell fat it's insulin high insulin low glucagon you could include Google uka Ghana and so startling Gary to me that the science is so clear and yet the practice of medicine is so far from the science well because the practice of medicine has always been about energy balance so the same textbooks that will say fat cells get fat because of elevated insulin will tell you that obesity is caused by taking more calories and we expend um there's this disconnect this energy balance paradigm and again we're going to see it at this conference when the presentation on obesity is going to be all be about energy balance and I would love it if somebody like you so I don't have to ask all the questions the insulin is in this pathway yes we and macronutrients influence insulin differently yeah so carbohydrates stimulate insulin secretion and protein stimulates in a little bit fat does not mm-hmm and if you drink a liter of olive oil and your insulin would not go up no you will store that and you won't store it no you will that's the interesting thing so it's sort of one of the if you don't eat carbs you'll store it or only when you eat it with more so you're gonna have to clear it out of your bloodstream anyway I don't want it floating around in your bloodstream yet it said it's gonna be stored on some level even without with low levels of insulin but then it's gonna be mobilized yeah so you basically you think of your fat stores is like the wallet that you go to the ATM you take money out of the ATM that's the food you're eating and you got to do something with it so you put it in your wallet but you've got to be able to get it out of your wallet freely when you need it an insulin doesn't let you get it out of your wallet so long eating a high starch sugar diet you can't get the money namely the fat yeah here well I'd only your son so it's you know what happened is and there was a lot of discussion back then that carbohydrates are turned into fat when you eat excess carbs and they're not really turned into that that's a difficult process for your body to do what its energy expensive and it doesn't do it that much but what your body does is make sure you burn the carbs and when that L of insulin is elevated that's what you're burning so it's not only telling your fat tissue to store fat it's telling your lean tissue your muscles and your organs to burn carbohydrates and not to burn fat yeah so it wasn't a carbohydrate increase what we call lipogenesis which is our own production factory like well wait that's why we get fatty liver and it in the liver well I'm but again that could be sugar the fructose and sugar dependence so that's the case against sugar story we're gonna get to that soon so on in pretty well done controlled studies the amount of what's called the novella the genesis so making fat out of nothing from carbohydrates was very low and less you had sugar in the diet which is one reason why sugar might be key to this process because like ninety 90 million Americans have fatty livers one of the most prevalent diseases and heart disease cancer diabetes yeah and which write 20 years ago liver failure nobody knew existed if you were diagnosed with fatty liver disease 20 years ago and you told your doctor you didn't drink alcohol the doctor would assume you were lying mm-hmm and when it starts showing up in kids yeah and suddenly it's like okay these kids are probably not heavy drinkers so it was of soda yeah I mean I met at a obesity conference a pediatric gastroenterologist and I'm like what are you doing here he says well I focus on fatty liver disease in kids and we're seeing it in three-year-olds and five-year-olds and I'm like wow they're needing transplants as they get a little older I'm like wow and so and then huge pharmaceutical effort new you know come up with a drug that you can give those kids for the rest of their lives that's a great market yeah or you could maybe just which can help reverse that yeah yeah so anyway it's that's that the gist of the science is you elevate insulin you store fat you want to get rid of the fat you have to drop insulin so how do you do that well you were the bad color the good calories by this paradigm and it's very much a paradigm our fat healthy fats and we could discuss what those are what are and and the bad calories are gonna be carbohydrates some more refined and fructose rich the bad calories some more they're going to work elevate and so on and keep sad locked away and that's it's simple okay well you've jumped in there a couple of times with this fructose thing and you said we didn't even have it until the 70s and then in prevalently 80s and now it's a big portion of our sugar consumption well so how is that different and why should we be worried about fructose okay so we actually there was a there's always been a lot of sugar and not always since eighteen nineteenth century sugar intake goes from five pounds per capita per year at the beginning of the nineteenth century that's like coca cola's worth of sugar once a week yeah 290 pounds by the end of by 1900 and and a hundred pounds by 1920 and then it stays relatively stable because when people are consuming a lot of sugar they're getting tend to get fat so it tends to be self-limiting yeah and then um the 1980s had shoots up again because we start blaming everything on fat and high fructose corn syrup comes into the the same time yeah so high fructose corn syrup sugar and this is where this is what Eliot Jocelyn didn't know this was the I you know and it very specified a siloed knowledge bases so a physician is not it's not a biochemist might have taken biochemistry courses right come a physician but you're right it's basically biochemistry yeah so I booked it back and looked in my first-year med school biochemistry text but it's all there yeah it's all there I'm like okay so sugar sucrose the white powdered but you know is a molecule glucose bonded to a molecule four thousand half yeah they're both carbs they're both simple well sugar is a simple carb the fructose is the sweetest of all the carbohydrates so any sweet substance naturally occurring is gonna have mmm except mother's milk it's gonna have fructose in it um the fructose glucose is metabolized but virtually every cell in the body's who gets into your bloodstream you secrete insulin in response to it you know we did talk about high GI foods they're foods that break down into glucose quickly the fructose is metabolized not by every cell in your body but it goes through your long preston and then into the liver and in high doses it's converted into fat in the liver so the way I think about it now is our livers evolved to see the fructose and fruit so a very small amount of fructose in fruit month or two a year yeah and bound up in the fruit so with all the fiber and the fruit so you would get you know a small amount of the substance it would take a long time to digest and we'll have to make it through the portal the portal system it may or may not do it there was a paper that came out this summer that says at low doses at least in rats fructose is not gonna make it through the small intestine yeah then as we increase her sugar consumption and worse than that Turnham once we start drinking sugary beverages in huge doses so the soft drink industry begins the 1870s and 1880s with Pepsi and dr. pepper Coca Cola and Pepsi in that order um the now you're suddenly drink you're drinking this stuff and you're drinking it between meals and 50% of the calories are folk toast and there's no fiber to slow down the digestion and you're getting massive amounts compared to what we would have been was I freaked toast which is more than the glucose well the high fructose corn syrup is high it was called high fructose because there were lower fructose corn syrups that had been developed over the years there's 55 percent up to 75 percent for years some of these drinks true and may or may not make a difference I know I just don't know but the liquid sugars are a problem compared to so you're getting in between meals you're getting sugar from basically breakfast through dessert so rather than alcohol an empty stomach you get the buzz faster you get the buzz and you get it all day long and that's all your liver is doing all day long is basically processing fructose two doses it's never been designed never evolved to see before unlike any machine it's asked to do a job it wasn't designed to do it doesn't portland and then making it do it year in and year out constantly like remember a little bit of fructose dribbled into the member over the course of a couple of months summer years on some fruit okay fine it's just the daily and repetitive doses that are on Robin for breakfast lunch and dinner and in between yeah because were remember we're drinking the Coca Cola's not just at our meals but between illness and and then like I said the 1980s with the low-fat Dogma or the 1960s with sugary cereals come in they've come and start coming in late 1940s and by the nineteen sixties it's you know there's an entire industry from the cereal companies to Madison Avenue TV shows that we grew up loving in Rocky and Bullwinkle was created to sell cereal sugary cereals it's true right I mean even Fred Flintstone was promoting cigarettes good like a cigarette should so Rudy pebbles right it's it's yeah so it's frightening so the the Kasich in sugar is your next big tome that was I thought incredibly well researched really historical and sort of caught us up-to-date on why we have this sugar glut and actually what it's doing to us so tell us more about this sort of case against sugar and should we be having any sugar and is it well so that's okay so there's no issues here is there always are multiple issues like when in talking about the case against sugar I am implying that there's a crime that's been committed and that sugars so the question is what's the crime yeah so the crime is obesity and diabetes epidemics worldwide recently described by the director-general of the World Health Organization slow-motion disasters although in some places there's nobody know about it so these epidemics occur and whenever a population transitions from whatever its native diet is to a Western diet so it doesn't matter what the native diet was could be Southeast Asia where it's mostly carbohydrates a lot of rice and we would be Inuit diet where its CEO meat and whale meat and a parable it could be a you know a pastoral Masai diet warrior diet and in Kenya where it's you know the blood meat milk from the cattle it could be Native American diet that's primarily carnivorous her name is and diet that's primarily agricultural right on and a Western diet and lifestyle you get obesity diabetes and like I said some populations like in the the same as the Pima Native American tribe in Arizona the diabetes appears in the course of a decade just explodes in this population eighty percent nineteen sixties yeah diabetes at that time in 30 so question is what are you adding it's not the native it's not the baseline diet and it's probably simple because you add it to anything any baseline diet you get obesity and diabetes and the conventional wisdom is so I mean Michael Pollan talks about this in in defense of food in the book that I disagree with almost entirely we're working from the same observation which is this what is it that causes this disease of Western diet and it says don't eat food like substances which is problem so one answer is processed foods and a lot of people like that it's a simple answer we don't have to be wrong about the saturated fat thing so it's an interesting issue because in the u.s. when we focused on saturated fat it's because researchers like Ansel keys and other research they're asking Mirman the question determines the answer so question is why do we have such high levels of heart disease in the US we live in the u.s. what we see is massive amounts of heart disease what's causing that we'll do studies to try and figure that out and the answer we come up with the saturated fat which wasn't based on cause and effect just a bunch of patterns and the data there nothing before we've done clinical trials so british researchers they have the british empire they're all over the world right missionary colonial hospitals and all over the british said the remains of the british empire are asking a different question why is it that we have obesity and diabetes epidemics appearing in all these different populations all over the world yeah and they're coming to conclusion is for fine grains and sugars uh-huh the only caveat with that is that the same thing happens to populations that are already eating refined grains Southeast Asia right yeah so though they're also working in the rice paddies hours a day and that's one possibility so what exercise twelve hours a day it's fine eat more carbohydrates quite possibly quite possibly so that's one and that's the first first time I heard this story from a epidemiologist at Harvard who is Chinese and his answer to this question because I asked him what about China they're reading it was their peasants they're out in the fields all day long said and mitigates ameliorates the problem although clearly doesn't these are people who are working all day long we still get obese I actually one of the first observations of interest here within the Pima back in 1902 so the Pima had been through 30 years of famine horrible devastating famine and famine and toward the end of this period Harvard anthropologist comes to live with the Pima and study the Pima he actually had tuberculosis so he wanted to go to Arizona and an effort to to cure the tuberculosis which didn't work but he spent six months nine months with the payment of Rights a seminal book about he takes a photo of a Native American he may points out that they have a high level obesity in the tribe particularly in the older population particularly in the women there's a photo in the tribal woman he calls fat Louise it was clearly obese and he asked us it's sort of the interesting thing is the older population they had lived through the famine 30 years of famine is 30 years of calorie restricted diet right yeah and it's very high carb and low fat and the question is why are these people fat anyway and then of course you start looking what's happened there a reservation a reservation they've been introduced to Western foods the commodities to commodities which are at the time was mostly white flour some powder or some short Lord large or nay oh by the way they have a word for Native Americans who eat those commodities on the reservations and get fat it's called Kumada that's interesting yeah I know that I learned that from a hopi chief yeah so anyway did the simple way to answer this question is just say it's worth its food-like substances its processed food in general now you don't have to think more deeply about it so you want to know what causes yellow fever of malaria you blame it on me asthma bad air from swamps this was the miasma theory of disease which was like because the people who live in low-lying areas and cities and coastal areas tended to get these diseases and the rich people lived on hills so they'd be away from the bad air in the bad water and they wouldn't and you could you know avoid the disease with the miasma theory but it didn't tell you what was causing other day they were mosquito-borne illnesses that they were by more than once you know it's a mosquito-borne illness you can you can save the poor people too sure the ones who can't afford to move away from the water yeah so the prey mile with DDT and so yeah this is a refined processed food thing is to me like a miasma theory it's great but it doesn't you know there is an agent here mm-hm it may be multiple agents may be physical and activities involved may be but it turns out your conclusions were that it was sugar yeah so I conclude it's sugars the simplest possible explanation and the obvious explanation and for two real our because we also seen a spike in flour consumption what do you do but so here's the issue again because remember we got those all those Southeast Asians hi dear buddy David Ludwig and I argue about this about once a year I say I'm not willing to ignore 2 billion possible black swans to my flower theory on the basis that they're out there in the fields in on all allottee you know so even in Southeast Asia see an increase so obesity and diabetes are now manifesting themselves and these were always low sugar consumed yeah so to me it's it's a simpler hypothesis and there are two so we have the fatty liver link but there's also a link with insulin so type 2 diabetes is sort of insulin fundamentally and one of the arguments I make in my books and David makes and others and has now been embraced is that that and actually Brasilia a low and Solomon person suggests in nineteen sixty five is that the route from health to obesity and diabetes doesn't go you know health and lean this obesity diabetes it goes health and leanness and insulin resistance and hyperinsulinemia to obesity and type you absolutely know as a doctor seeing patients and testing all this stuff for thirty years I would completely agree yeah and so and a significant amount of evidence laboratory research and animal evidence and then 50 60 70s and 80s implicated fat accumulation the liver in insulin resistance and once we start talking fat accumulation the liver if I'm a investigator I'm gonna start wondering about sugar these are the fructose yeah and there's a link between insulin resistance and fatty liver disease again these are all the same correlations all the same problem you note that liver the the livers role in all this tends to implicate something unique to hepatic metabolism of something and fructose is just the prime suspect and the argument I make in the book is it's I'm just arguing it's a prime suspect and you go back to the late 19th century so you can actually see diabetes when you go to hospital records from the 19th century and buy there are hospitals like Massachusetts General Hospital in Boston Pennsylvania house yeah Philadelphia it's their records yeah and you just if you're a researcher or an author you could contact their archivists and they will do this very search for you amazing yeah resource on you can see diabetes rate you can see the diabetes epidemic again in those Hospital series it's like seeing Ebola patients come into a hospital once a year or something for the first one and then three more from a village in this case there are years I could mask their years in the from 1925 or set of 1918 1825 to 1850 were there no cases okay zero this is the major urban hospital and now it's the main diagnosis in almost assuredly Medicare dollars is for type two diabetes if you add in pre-diabetes is probably two out of three Medicare dollars yeah yeah so and there are hospital systems like the VA system where one in four patients are diagnosed diabetics and here the entire years were there zero cases and then the 1840s you have the beginning of the candy and the soft drink the candy industry in the chocolate industry and the ice cream industry and sugar prices are coming down and sugar consumptions going up and by the 1850s 1860s just you see the numbers in this hospital record so they go to two to three cases a year four to seven cases a year Eliot Jocelyn sees us in his first paper and back then people are saying well it could be all this sugar work consumer yeah now they might have said they didn't but they might have said could be all the white flour were consumed because you're right they both they develop sort of simultaneously but even back then they're thinking it's a sugar and then people like Jocelyn talked them out of it I don't know about I mean I would suggest that if people cut on all the sugar in their diet and consumed you know a loaf of bread or two a day that it's not going to work out one question is what's what's the fundamental cause of the epidemic mm-hmm what do you have to add to any diet whether it's refined grain rich to begin with or you know purely carnivorous to begin with what do you add to any diet to end up with obesity and my answer is you've got its start with sugar absolutely so so and then the second answer is what do we do it's like why we get fat what do we do about it how do we get thin right how do we get thin and how do we get thin is like it ain't gonna work if you wait - so I'm saying if we go back to human beings circa 1830 yeah and give them two loaves of white at a day it ain't gonna be pretty right but I don't think they're gonna get diabetes although the funny thing about white bread is it's got white bread can be I think up to 12% fructose sugar and it's higher glycemic index let's hunt but it's also higher in sugar so they didn't swing French white bread and Wonder Bread is the refinement to the grain it's more highly fermentation present a fermentation process and the sugar content yeah and so again we don't know what it is so but we had people back in the 1820s 1830s basically living on bread that's what poor people did mm-hmm it's really no processed food yeah I mean it is multifactorial right it's our government or biome it's environmental toxins well so this is where all these variables in there that are impacting us right so well yeah but there's I'm but this is the big elf in the room yeah I'm not fun the multifactorial explanations are often used to a make everyone happy because you're not rejecting anything and B to say well we have no clue what's going on and yeah we probably got the wrong answer since we clearly haven't been able to stem these epidemics so it's multifactorial and it's complex and anyone who says it was a simple answer is not even wrong mm-hm and my counter-argument is you just start with a simple hypothesis I think if you look at you know the big elephant in the room and gotta cut down sugar yeah and I would add to that you know refined starches I think well this is so that's like the the solving the problem yeah thanks so before we get to I think the world is full of people diabetics who don't eat are smart enough not to eat sugar train coca-cola all right and are still diabetic cuz they're eating a high carbohydrate they're eating I can't die so you you were an Oracle with Nina Thai cults in the US News and World Report which was pretty provocative I was in the LA Times it was the LA Times about that report which and their report is sort of an annual report says here the best diets that you should follow and they list the Mediterranean diet and the - diet which is a dietary approach to stop hypertension and you and Mina do a major take down on that and suggest that you know compared to what you know you didn't you sort of that question sort of left out so well they that's like what what is a problem with those diets and and mode B your approach to find the right advice around nutrition and and figure out what their dietary guidelines should be for America Wow so we live in a world and you live in a world where if you put people on car very tiny carbohydrate restricted diets high in fat will call them low carb high fat mm-hmm yes even necessarily keto but yeah somewhere in that range low carb high fat you tell them don't eat these foods these foods are fine and these foods are carbs and those foods are high in fat and their you know um they get better right you see we're mark fairly remark mark on a conference we live in a world where doctors office if you're an internal medicine or family medicine your your doctor's offices fallen basically people with overweight obesity diabetes hypertension all the concomitant diseases and go with with insulin resistance in metabolic syndrome and the medical community over the years they had these two hypotheses one was that salt cause blood pressure because high blood pressure and one was that you know saturated fat caused heart disease and they're both kind of have flaws both gone away and they end up with the two diets that they've kind of the the establishment researchers have pushed as healthy diets and have tested a few times in limited trials this is the dash diet dash stands for Dietary Approaches to stop hypertension and the Mediterranean diet and and the dash thought is a low fat high plant-based it's actually not that low-fat was the thing it's low SAP and not look dairy fat right oh it's low fat dairy it is low-fat dairy low-fat dairy yeah and when if you put together a group of dietitians and nutritionists and health authorities who have grown up with thee without questioning the medical establishment sort of believing what they've read and which is a reasonable thing to do with your in that world and then we have a world of and these are diets that are given with the hypothesis not that they'll make you healthier immediately but they will make you healthier in the long rail prevents illness if you eat a - diet you oh you will lower your blood pressure it's a good thing and that will prevent stroke and there'll be no side effects no fattening or diabetes or anything else that might happen from the high carb part of the diet mm-hmm or Mediterranean diet supposed to prevent heart disease and diabetes so you won't see any real significant changes immediately unless you calorie restricted and a few calorie restricted you probably won't be able to stay with that on it well cuz nobody likes to be hungry that means being hungry your whole life anyway so these are angry these are sort of hypothesis based Dietary Approaches and then there's this low-carb high-fat thing where you put your patients on it they lose weight they're hyper their blood pressure comes down their blood sugar control gets much better they might get off their type 2 diabetes yeah medications then all we see people get off their cardiac meds their high blood pressure meds yeah their kidney function gets better their testosterone hormones improve they have yeah improve cognitive function and everything gets better look good yeah it's hard to imagine that you're killing people but then somebody like US News and World Report comes along not only they rank the sort of conventional wisdom diets the highest of the healthy diets they have I think was 38 diets they study they look at they assess and thirty-fifth 238th least healthy diets that you're recommending for your patients because you see them get healthy yeah so there's a disconnect here and if you even so you ask the question how do we fix that well why is here the disconnect so one possibility is we're quacks right I mean the world is full of physicians who are pushing questionable medical procedures and think they're doing good andand and we're just them where you are and I'm a bad job I actually thought on my career really hit a high point when I was on quack watch yeah we made it yeah the other possibility is that the way US News and World Report does their diet rankings is by getting experts and the experts our people have risen to the top of their professions or we're close to the top in this case by reiterate reiterating and believing in the conventional wisdom and so they're just going to they're there a way to filter through these diets to recapitulate what the establishment has been telling us for 50 years and ignoring the over seventy studies look like yeah a lot of low carb higher fat diets is effective first so this is a point in and I just wanted to make was that you know when you actually looked at the trials instead of asking the opinion of establishment authorities you find that the establishment diets are not very well tested when they are tested they don't do all that well and they do as very limited questions like is a Mediterranean diet better than a low-fat diet in the context of you know all the problems we discussed and yeah I tried to actually I contacted the editors at US News and World Report through I fast David Katz know your introduction yes David and I are you know we don't think very highly of each other but the work munication or in communication David was very kind to make the connection and I said I'm gonna be in Washington I'd like to meet with you and discuss the rankings and I've won many awards for my journalism I you know whatever you think of my beliefs people won't think highly of my journalism and we're colleagues in that way and yeah and they said yeah we'd love to meet you what do you want to talk about and I said I want to talk about potential problems with the diet rankings and that was the last they would answer an email it's like and this is what happens with this sort of the whole group thing phenomenon yeah Tamizh you know you think science is about discourse and debate and science good science is yes but all this sort of once science becomes and again the whole diet thing is kind of you know religious factions arguing with each other then we fix and get the right guidelines and change what we're doing and how would you think I thing that well we continue doing what we're doing so good or bad you know again I mean I eat more of us there's a lot more of us when I first started this my research that 2002 article I'm thinking there were half a dozen physicians in America who were outwardly promoting these diets and they were all writing diet books and now there's probably a few tens of thousands is my estimate so that's a tiny percentage of the overall medical community but it's a huge absolute increase and they're all people who did it because they learned they experienced with you experience they can make their patients healthy I mean I was always recommending low-fat high-carbohydrate diets and didn't see real serious benefits and yes I got people out processed food and tried to eat healthier and whole grains and beans and but it was really clear to me that you know I couldn't get people off their insulin and now within three weeks I've got someone who's been on insulin for 20 years this is a question why wouldn't you want to if you were a patient or a physician and you heard somebody say that why wouldn't you want to try that yeah let me see what happens because I video unless maybe they made their patients we're doing better but the obesity and diabetes epidemic suggests that we are not normally missing correctly okay so you're president king for a day and you can change policy change businesses change something that you think would have an impact and making all this better what would it be well like I said I'd start with getting people to think of sugar kind of the way we think of cigarettes mmm you know I don't know if everyone is the new tobacco yeah I think that's that's of everything that's the worst yeah I mean it brings a huge amount of pleasure so we have to deal with well it's even you look at the data obesity and sugar is far greater killer now than smoking and it's physical inactivity by far yeah yeah so although I don't buy the physical inactivity stuff I lived in Paris in the 80s when they I've always had among the highest longevity in the world this is these are not people who were working out I don't know what they were doing is absolutely what they're their friends wives and husbands that might have been physically rigorous that was but you know if you saw a jogger in Paris in 1985 it was an American yeah interspersed with all the obese Americans in their Bermuda short share backpacks this is a new phenomenon physical activity for urban populations so anyway but yeah I would get rid of the sugar first now I would try to get I don't know what organization by regulation of I think just by awareness I'm not a fan of government regulation and in general in this but but if the hypothesis is true that sugar is biologically addictive just saying get rid of the sugars I'm gonna works like they're in a heroin it's like well yes and no I mean I think for a lot of us yeah it takes an act of will but I I think for many of us it's easier the problem is it takes active biology yeah it's everywhere so you have to make it less you know you're gonna get rid of the candy bars and the you know place in the supermarkets and that I mean stores like Best Buy have candy bars yeah that you have to walk by to get to the cash registers and they 50 years ago that would have had cigarettes next to the candy bars and then maybe that's a regulation thing maybe that's an image thing or but I just we got into this problem because some very well-meaning meaning liberals like myself thought the government should start telling people what to eat so you know I just and there are I have allies in the sugar world who as soon as they get sugar handled would then go after red meat or processed meat and I'm not sure that's a way to make people healthier it's better for the animals I buy that but I'm not sure it's better for the people and so I would you know in my universe I want to get rid of the sugar however we do and then I want to do the best I want the science to be nailed down and unfortunately that requires the anniversary you can take 50 years of rigorous science and so you ride your day you'd put a few billion into studying this more rare so you know kind of Manhattan Project like approach to this we very concerted we're very smart scientists without preconception say this is what we don't know what we have to study this is the studies we have to do and here are new ways we can do the studies and new populations in which we can do them so we can get the kind of rigorous control we need I mean this is a real pie in the sky mm-hmm you know but we spend okay so our enteric right we're few hundred miles from Geneva and CERN the Center for European Center for Nuclear Research where they built spend ten billion dollars to build a single particle accelerator to see what's beyond the standard model and ended up discovering a particle when it was era called the Higgs boson but they were willing to spend ten billion dollars that I knew what they had to answer yeah you know in the past few years have been a series of naval destroy yourself to sea of japan' that have run into local boats and done an enormous amount of damage for themselves those destroyers custom billion dollars each had one of them was a class of 60 so I spent sixty billion dollars building a cloud a class of destroyers just a matter of which is a very hard these studies may be practically impossible they're certainly difficult but the societal motivation to do them has to be there and you have to not have these authorities out there saying oh we don't have to do these studies we know answer so you've been listening to the doctors pharmacy with Gary Taubes about sugar and fat and everything in between this is a place for conversations that matter and if you like this podcast please subscribe wherever you get your podcasts and leave a comment in a review that really helps us and share with your friends and family and we'll see you next time on the doctors pharmacy [Music]

Channel: Mark Hyman, MD

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Keywords: doctors farmacy, the doctors farmacy podcast, mark hyman md, mark hyman podcast, dr mark hyman, dr mark hyman interview, mark hyman md podcast, doctors farmacy with mark hyman, gary taubes, gary taubes interview, ifm conference, ifm, functional medicine, founder of functional medicine, advice for health, health advice, dieting advice

Id: dQsRJTnwgkE

Length: 63min 27sec (3807 seconds)

Published: Wed Aug 01 2018