Robert Lustig [ 30 JUL 2009 | Obesity Epidemic | 1:29:36 ] I’m going to tell you, tonight, a story. And this story dates back about 30 years. This story has a little bit of something for everybody. It has a little bit of biochemistry, a little bit of clinical research, a little bit of public health, a little bit of politics, a little bit of racial innuendo.
But, well, we can see what we can do about that, too. By the end of the story I hope I will have debunked the last 30 years of nutrition information in America [the United States].
And I would very much appreciate it if at the end of the talk, you would tell me whether or not I was successful or not. Okay?
So, in order to get you in the mood, as it were, let’s start with a little quiz. What do the Atkins Diet and the Japanese Diet have in common? Anybody? Hm? Oh, you have the answers right, never mind. That’s right, you have the answer right there.
So the Atkins diet, of course, is all fat no carb.
The Japanese diet’s all carb, not fat.
They both work, right? So what do they share in common?
They both eliminate the sugar, fructose.
So, with that, think about what it means to be on a diet, and what macro-nutrients you’re eating and which ones your not. And then we’ll go from there, and I’ll try to explain how this all works. So, you’ve all heard about the obesity epidemic. Here are the numbers. These are the NHANES database Body Mass Index. Everybody knows what that is now. Histograms marching ever rightward as time has gone on. This was what was projected for 2008 in blue. We had so far exceeded and surpassed, this is not even funny. This was from 2003. The reason I show this is not just to show that the obese are getting obeser, of course, that’s true, but in fact the entire curve has shifted. We all weigh 25 pounds more today than we did 25 years ago, all of us. Now, it is often said that obesity is the ultimate interaction between genetics and environment. And Doctor Christian Vaisse, who’s sitting in the back of the room, will be talking to you next week about the genetic component, which I am also very interested in. But, having said that, our genetic pool did not change in the last 30 years, but, boy oh boy, has our environment sure changed. So, tonight, we’re gonna talk about the environment rather than genes. Now, in order to talk about the environment, we need to talk about what is obesity. And, of course, you’re all familiar with the basic concept with the first law of thermodynamics, which states that the total energy inside a closed system remains constant. Now, in human terms, the standard interpretation of this law is the following. If you eat it, you better burn it, or you’re gonna store it. Now, who here believes that? Oh, come on, you all do. (audience laughs) I used to believe that. I don’t anymore. I think that’s a mistake. I think that is the biggest mistake. And that is the phenomenon I’m going to try to debunk over the course over the next hour. Because I think there’s another way to state the law which is much more relevant, and much more to the point. Before I get there, of course, if you believe that, these are the two problems, calories in, calories out. Two behaviors, gluttony and sloth. After all, you see anybody on the street, “Oh, he’s a gluttonous sloth, that’s all there is to it.” Tommy Thompson said it on the TV show. “We just eat too damn much.” Well, you know, if that were the case, how did the Japanese do this? Why are they doing bariatric surgery on children at Tokyo Children’s Hospital today? Why are the Chinese, why are the Koreans, why are the Australians? I mean, all these countries who’ve adopted our diet all suffer now from the same problem. And we’re gonna get even further in a minute. There’s another way to state this first law. And that is, if you’re gonna store it, that is biochemical forces that drive energy storage, and we’ll talk about what they are in a few minutes, and you expect to burn it, that is normal energy expenditure for normal quality of life. Because energy expenditure and quality of life are the same thing. Things that make your energy expenditure go up, make you feel good. Like ephedrine, it’s off the market, coffee for two yours, then you need another hit, like me. Things that make your energy expenditure go down, like starvation, hypothyroidism, make you feel lousy. And how many calories you burn and how good you feel are synonymous. So, if you’re gonna store it, that is an obligate weight gain set up by a biochemical process, and you expect to burn it, that is normal energy expenditure for normal quality of life, then you’re gonna have to eat it. And now, all of the sudden, these two behaviors, the gluttony and the sloth, are actually secondary to a biochemical process, which is primary. And it’s a different way to think about the process. And it also alleviates the obese person from being the perpetrator, but rather the victim. Which is how obese people really feel. ‘Cause no one chooses to be obese. Certainly, no child chooses to be obese. Oh, you say, “Oh, yeah, sure, “I know some adults who don’t care.” You know, Rossini, the famous composer, you know La gazza ladra, Figaro, and all that. He retired at age 37 to a lifetime of gastronomic debauchery. Maybe he chose to be obese. But the kids I take care of in obesity clinic do not choose to be obese. In fact, this is the exception that proves the rule. We have an epidemic of obese six month olds. Now, if you wanna say that it’s all about diet and exercise, then you have to explain this to me. So, any hypothesis that you wanna proffer that explains the obesity epidemic, you’ve got to explain this one too. And this is not just in America, these six month old obese kids, but these are around the world now. So, open your minds?, and let’s go and figure out what the real story is. Let’s talk about calorie intake, because that’s what today is about. We’re gonna talk about the energy intake side of the equation. Sure enough, we are all eating more now than we did 20 year ago. Teen boys are eating 275 calories more. American adult males are eating 187 calories more per day. American adult females are eating 335 calories more per day. No question, we’re all eating more. Question is why, how come? ‘Cause it’s all there? You know what, it was there before. We’re all eating more, there’s a system in our body, which you’ve heard about over the last couple of weeks called leptin. Everybody heard of leptin? It’s this hormone that comes from your fat cell, tells your brain, “You know what, I’ve had enough. “I don’t need to eat anymore. “I’m done, and I can burn energy properly.” Well, you know what? If you’re eating 187 or 335 calories more today than you were 20 years ago, your leptin ain’t working. ‘Cause if it were, you wouldn’t be doing it. Whether the food was there or not. So, there’s something wrong with our biochemical negative feedback system that normally controls energy balance. And we have to figure out what caused it, and how to reverse it. And that’s what tonight is about. But, nonetheless, there are 275 calories we have to account for. So where are they? Are they in the fat? No, they’re not in the fat. Five grams, 45 calories out of the 275, nothing. In fact, it’s all in the carbohydrates. 57 grams 228 calories. We’re all eating more carbohydrate. Now, you all know, back int 1982, The American Heart Association, The American Medical Association, and the US Department of Agriculture admonished us to reduce our total fat consumption from 40% to 30%. Everybody remember that? That how Entenmann’s fat free cakes came into being. Remember that? So what happened? We did it, we’ve done it. 40% down to 30%, and look what’s happened to the obesity, metabolic syndrome, non-alcoholic fatty liver disease, cardiovascular disease, stroke prevalence, all jacked way up, as our total fat consumption as a percent has gone down. It ain’t the fat, people, it ain’t the fat. So what is it? Well, it’s the carbohydrate. Specifically, which carbohydrate? Well, beverage intake, right? 41% increase in soft drinks, 35% increase in fruit drinks, fruitades, whatever you wanna call them. Just remember, down here, one can of soda a day, is 150 calories. Multiply that by 365 days a year, and then divide that by the magic number of 3500 calories per pound, if you eat or drink 3500 calories more than you burn, you will gain one pound of fat. That’s the first law of thermodynamics, no argument there. That’s worth 15 1/2 pounds of fat per year. One soda a day is 15 1/2 pounds per year. Now, you’ve all heard that before. That’s not news to you. The question is how come we don’t respond? How come leptin doesn’t work? How come we can’t stay energy stable. That’s what we’re gonna get to. So, I call this slide, very specifically, the Coca Cola Conspiracy. Anybody here work for Coke, Pepsi? Okay, good. All right, so, this over here, 1915, the first standardized bottle of Coca Cola out of Atlanta. Anybody remember this bottle? Sure, a lot of you do. I remember this bottle, because my grandfather in Brooklyn, took me on Saturday afternoon down to the local soda shop on Avenue M and Ocean Avenue, and every Saturday afternoon I had one of these. I remember it very well. Now, if you drank one of those every day, assuming of course that the recipe hasn’t changed, ’cause after all, only two people in the word know the recipe, and they’re not allowed to fly on the plane at the same time. You know that, okay. Assuming the recipe hasn’t changed, if you drank one of those every day for a year, 6 1/2 ounces, that would be worth eight pounds of fat per year. Now, in 1955, after World War II, when sugar became plentiful again, and wasn’t being rationed, we have the appearance of the 10 ounce bottle, the first one that was found in vending machines. You probably remember that one, as well. Then in 1960, the ever ubiquitous, 12 ounce can, worth 16 pounds of fat per year. And, of course, today, this, over here is the single unit of measure, 20 ounces. Anybody know how many servings are in that bottle? – [Audience Member] 2.5. – 2.5 eight ounce servings, that’s right. Anybody know, anybody gets 2.5 eight ounce servings out of that bottle? That’s a single serving, right? So that would be worth 26 pounds of fat per year if you did that every day. And then, of course, over here, we have the 7/11 Big K, Thirst Buster, Big Gulp, whatever you wanna call it, 44 ounces, worth 57 pounds of fat per year. And if that wasn’t bad enough, my colleague, Dr. Dan Hale, at the University of Texas San Antonio, tells me that down there they got a Texas size Big Gulp. 60 ounces of Coca Cola, a Snickers bar, and a bag of Doritos, all for 99 cents. – [Audience] Oh. – So if you did that every day for a year that would be worth 112 pounds of fat per year. So why do I call it the Coca Cola conspiracy? Well, what’s in Coke? Caffeine, good, good, so what’s caffeine? It’s a mild stimulant, right? It’s also a diuretic, right? It makes you pee free water. What else is in Coke? We’ll get to the sugar in a minute, what else? Salt, salt. 55 milligrams of sodium per can. It’s like drinking a pizza. So what happens if you take on sodium and lose free water, you get… – [Audience] Thirsty. – Thirstier, right. So, why’s there so much sugar in Coke? To hide the salt. When was the last time you went to a Chinese restaurant, had sweet and sour pork? That’s half soy sauce, you wouldn’t eat that. Except the sugar plays a trick on your tongue, you can’t even tell it’s there. Everybody remember New Coke, 1985? More salt, more caffeine. They knew what they were doing. That’s the smoking gun. They know, they know. All right, so, that’s why it’s the Coca Cola conspiracy. So, are soft drinks the cause of obesity? Well, depends on who you ask. If you ask the scientists for the National Soft Drink Association, they’ll tell you there’s absolutely no association between sugar consumption and obesity. If you ask my colleague, Doctor David Ludwig, remember, I’m Lustig he’s Ludwig, he does what I do at Boston Children’s Hospital. Some day we’re gonna open up a law firm. (audience laughs) Each additional sugar sweetened drink increase over a 19 month follow up period in kids increased their BMI by this much in their odds risk ratio for obesity by 60%. That’s a prospective study on soft drinks and obesity. The real deal. If you look at meta-analysis, everybody know what a meta-analysis is? It’s a conglomeration of numerous studies subjected to rigorous statistical analysis. 88 cross sectional and longitudinal studies regressing soft drink consumption against energy intake, body weight, milk and calcium intake, adequate nutrition, all showing significant associations. And some of these being longitudinal, this came from Kelly Brownell’s group at Yale. I should comment, a disclaimer, those studies that were funded by the beverage industry showed consistently smaller effects than those that were independent. Wonder why. Now, how ’bout the converse? What if you take the soft drinks away? So this was the fizzy drink study from Christ Church England James et al, British Medical Journal, where they went into schools and they took the soda machines out. Just like we did here in California. We haven’t seen the data yet, but they went and did it for a year. So the prevalence of obesity in the intervention schools stayed absolutely constant, no change. Whereas the prevalence of obesity in the control schools where nothing changed continued to rise over the year. So that’s pretty good. So, how ’bout type two diabetes? Are soft drinks the cause of type two diabetes? Well, this study from JAMA in 2004 looked at the relative risk ratio of all soft drinks, cola, fruit punch, and found a very statistically significant trend of sugared soft drinks, fruitades, et cetera, causing type two diabetes. And you know we’ve got just as big a problem with type two diabetes as we do with obesity for the same reasons. And this was a sugared sweetened beverage against risk for type two diabetes in African American women. Looking here at sugar sweetened soft drinks, just the downward arrow shows that there was a significant rise as the number of drinks went up. You can see that here. Whereas orange and grapefruit juice, interestingly, did not. So, two different studies, two different increases in type two diabetes, relative to soft drink consumption. So, what’s in soft drinks? Well, in America, it’s this stuff, right? High fructose corn syrup. Everybody’s heard of it, right? It’s been demonized something awful. So much so that the corn refiners industry has launched a mega-campaign to try to absolve high fructose corn syrup of any problems, which we’ll talk about in a moment. But the bottom line is, this is something we were never exposed to before 1975. And currently we are consuming 63 pounds per person per year, every one of us, 63 pounds of high fructose corn syrup. – [Audience Member] That’s America? – That’s America, yes. Now, what is high fructose corn syrup? Well, you’ll see in a minute. It’s one glucose, one fructose, we’ll talk about those at great length. One of the reasons we use high fructose corn syrup is because it’s sweeter. So here’s sucrose, this is cane or beet sugar, standard table sugar, you know, the white stuff, and we give that an index in sweetness of 100. So here’s high fructose corn syrup, it’s actually sweeter, it’s about 120. So, you should be able to use less, right? Wrong, we use just as much, in fact, we use more. So, here’s lab fructose over here, crystalline fructose. And they’re starting to put crystalline fructose into some of the soft drinks. They’re actually advertising it as a good thing. Phew. And that’s got a sweetness of 173, so you should be able to cut that way back, right? They’re not. Lactose, down here, milk sugar, it’s not sweet at all. And glucose, I should point out over here, 74. It’s not particularly sweet, and we’re gonna get to that at the end, and what goes on with glucose. But anyway, there’s why we use it, it’s sweeter, it’s also cheaper as I’ll show you. So, here’s high fructose corn syrup. One glucose, one fructose. Notice the glucose is a six membered ring, the fructose is a five membered ring. They are not the same. Believe me, they’re not the same. That’s what this whole talk is about is how their not the same. And here’s sucrose, and they’re just bound together by this ether linkage. We have this enzyme in our gut called sucrose, it kills that bond in two seconds flat, and you absorb it and, basically, high fructose corn syrup, sucrose, it’s a non issue, it’s a wash. They’re the same. And they know that they’re the same, the soft drink companies and the corn refiners. Because here are their missives. This comes from the Corn Refiners Association. Obesity research shows high fructose corn syrup metabolizes and impacts satiety similar to sugar. Indeed it does, I agree. Decent meetings, academic meetings around the country. Hunger and satiety profiles energy intakes following ingestion of soft drinks, bottom line, research supported by the American Beverage Institute and the Corn Refiner’s Association. They are correct, there is absolutely no difference between high fructose corn syrup and sucrose. So much so that the Corn Refiner’s Association, in attempt to capture market share, came out with this entire ad campaign. You probably saw it on the back page of the New York Times, it was on TV, it’s everywhere. “My hairdresser says that sugar’s healthier “than high fructose corn syrup. “Wow, you get your hair done by a doctor?” I didn’t know I could cut hair. If you all wanna see all of them, there are a whole bunch of them. You can go to www.sweetsurprise.com and see how you’re being hoodwinked. But indeed, this is true. High fructose corn syrup and sucrose are exactly the same. They’re both equally bad. They’re both dangerous, they’re both poison. Okay, I said it, poison. My charge before the end of tonight is to demonstrate fructose is a poison, and I will do it, and you will tell me if I was successful. None the less, here’s Center for the Science and Public Interest and the Corn Refiners Association. Everybody remember last year, when Gavin Newsom floated his soda tax, last February? Governor Patterson of New York has since floated one. And other people are starting to talk about it. So, why are they saying this? Well, they’re saying obesity’s a problem, kids are drinking soda, let’s tax it. So they’re talking about soda like it’s empty calories. I’m here to tell you that it goes way beyond empty calories. The reason why this is a problem is because fructose is a poison, it’s not about the calories. It has nothing to do with the calories. It’s a poison by itself, and I’m gonna show you that. Nonetheless, I just wanna read you this paragraph here in yellow. “We respectfully urge that the proposal “be revised as soon as possible to reflect “the scientific evidence that demonstrates “no material differences in the health effects “of high fructose corn syrup and sugar.” I agree. Here’s the important sentence. “The real issue is that excessive consumption “of any sugars may lead to health problems.” I agree, that’s exactly right. Not may, does, does. So, here’s the secular trend in fructose consumption over the past 100 years. Before we had food processing, we used to get our fructose from fruits and vegetables, and if we did that today, we would consume about 15 grams per day of fructose. Not sugar, fructose. So sugar would be 30 grams, it’d be double. We’re just talking about fructose, today. Prior to World War II, before it got rationed again, we were up to about 16 to 24, about 20 grams. So, a small increase from the beginning of the century to World War II. Then, in 1977, just as high fructose corn syrup was hitting the market, we had increased that, we had, basically, doubled up to 37 grams per day, or 8% of total caloric intake. By 1994 we were up to 55 grams of the stuff per day. Remember, if you wanna do sugar, then double the number. So, that’s 10.2, so you can see that more and more of our caloric intake, a higher percentage is being accounted for by sugar every single year. So, it’s not just that we’re eating more. We’re eating more sugar. And for adolescents today, up to almost 75 grams, 12% of total caloric intake. 25% of the adolescents today consume at least 15% of their calories from fructose alone. This is a disaster, an absolute unmitigated disaster. The fat’s going down, the sugar’s going up, and we’re all getting sick. Now let me show you why. How’d this happen? Why’d it happen? So, this is where the politics comes in. This is the perfect storm, and it was created from three political winds that swirled around all at the same time to create this perfect storm. So, the first political wind, everything bad that ever happened in this country started with one man. (audience laughs) And it’s still being felt today. So, Richard Nixon, in his paranoia back in 1972, food prices were going up and down, and up and down. I’m gonna show you that on the next slide. And he was worried that this was actually gonna cost him the election. So, he admonished his Secretary of Agriculture, Earl Rusty Butz, I love that name, to basically take food off the political table, to make food a non-issue in presidential elections. Well, the only way to do that was to make food cheap. So, he was out to find all methods to be able to decrease the price of food. Remember Nixon’s war on poverty? We’re suffering from it today. That’s what this is. Second political wind, the advent of high fructose corn syrup. So, this was invented in 1966 at Saga Medical School in Japan, by a guy named Takasaki, who’s still alive. As far as I’m concerned, this stuff is Japan’s revenge for World War II, except, of course, that they’re suffering from it now, themselves. Like everything, it always comes back to haunt you. And it was introduced to the American Market in 1975. So, what do you think happened to the price of sugar when this thing hit the market? Here’s what happened. So, here’s the US producer price index of sugar going up and down, and up and down. This is not good. Stability is at 100%, if it stays nice and stable at 100%, that’s what you want if you’re a politician. Up and down, here’s where corn sweeteners entered the market, 1975, 1980. And you can see that since then the price of sugar has remained remarkably constant. And it did so, not just in the US, but also on the international stage. Here’s the London price doing the same thing. And when you look at the difference in price between sugar and high fructose corn syrup, you can see that high fructose corn syrup’s about half the price. So, in other words, it’s cheap. So, high fructose corn syrup is evil. But it’s not evil because it’s metabolically evil. It’s evil because it’s economically evil. Because it’s so cheap that it’s found it’s way into everything. It’s found it’s way into hamburger buns, pretzels, barbecue sauce, and ketchup, almost everything. Somebody emailed me the other day and told me they went into their local grocery store and went through every single loaf of bread on the shelf, and out of 32 types of bread on the shelf, only one of them did not have high fructose corn syrup in it. So, we are being poisoned by this stuff, and it’s been added surreptitiously to all of our food, every processed food. The question is why? Well, you’ll see why in a minute. So, the corn refiners like to point out, “Well, you know, it’s just been a substitution. “As the high fructose corn syrup’s gone up, :the sugar’s gone down. “You know, we’re just replacing, like gram for gram.” Well, not exactly, because here’s 73 pounds of sugar per year. This is from the Economic Research Service of the US Department of Agriculture. So disappearance data. 73 pounds, up to 95 pounds by 2000. And there’s something missing from this slide. Anybody wanna tell me what it is? What’s missing? Juice, juice is missing. ‘Cause juice is sucrose, right, sugar. And juice causes obesity. So this is a study done by Myles Faith, a prospective study in inner city Harlem toddlers. And the number of juice servings per day predicts the change in BMI score per month in these inner city Harlem toddlers. Now, where do these inner city Harlem toddlers get their juice? From what, from where, from whom? From WIC. Anybody heard of WIC? You know what WIC is? Women Infants Children, right? A government entitlement program set up under who? Nixon, to prevent failure to thrive. They did. This is the equal and opposite reaction. So, let’s add juice in, here it is. So, most fructose items when you put it together, now we’re up to 113 pounds on this graph, and I just heard from Brian Williams, of NBC News, after the most recent study came out, that was in the Journal of Clinical Investigation, that we are actually up to 141 pounds of sugar per year. Each of us. That’s what we’re up to. 141 pounds of sugar per year. Now, do you think that this might have some detrimental effects on you? Hasn’t stopped you, has it? That’s the point, it hasn’t stopped you. That’s why we need to talk about this. So, juice consumption increases the risk for Type 2 diabetes. So this is the relative risk ratio as juice intake goes up, and this is in the Nurse’s Study. Showing again, juice consumption, sucrose, obesity, diabetes. Okay, the third political storm, that’s swirling around to create this disaster, this mega-typhoon, that thing that happened in 1982, the USDA, the American Hearth Association, the American Medical Association, all telling us we had to reduce our consumption of fat. Now, why did they tell us that? To stop what? To stop hear disease. Did we? No, we didn’t, did we? In fact, it’s worked the exact opposite. We’ve only created more. So, now how did this come to be? Why did they tell us to stop eating fat? Well, in the early 1970s we discovered something in our blood called LDL, low-density lipoproteins. You’ve heard of that, right? Is it good or bad? – [Audience Member] Bad. – Not so bad, we’ll talk about it. In the mid 1970s we learned that dietary fat raised your LDL. So, if dietary fat is A, and LDL is B, we learned that A lead to B. Dietary fat definitely increases your LDL, no argument, it’s true. And then, finally, in the late 1970s we learned that LDL correlated with cardiovascular disease. So let’s call cardiovascular disease C. So we learned that B lead to C. So, the thought process by some very smart nutritionists, et cetera, the USDA et cetera, said, “Well if A leads to B, and B leads to C “then A must lead to C, therefore, no A, no C.” This was the logic. Now, any logicians in the room? Anybody see any problems with that logic? Go ahead. (speaking away from microphone) – That’s right, the premise is incorrect. And I’ll tell you why the premise is incorrect. Because this suggests that this is all transitive. But, in fact, only the contrapositive is transitive. So, it’s not no A, no C, it’s no C, no A. So, the logic isn’t even right. There’s faulty logic here. So, this doesn’t work on any level. So, I’m gonna show you why this doesn’t work. But, before I how you why it doesn’t work, I’m gonna show you that this was a battle royal back in the 1970s. This was not a simple thing. There were people lined up on both sides of this story. So, this, over here, is a book, 1972 it came out, and it was called Pure White and Deadly. It’s all about sugar. Written by a British physiologist, nutritionist, endocrinologist, by the name of John Yudkin. Now, I never knew John Yudkin he’s passed away. But, I read this book about a year ago. And without even knowing it, I was a Yudkin acolyte. I was a Yudkin disciple. Every single thing that this man said in 1972 is the God’s honest truth. And if you wanna read a true prophecy, you find this book. It’s not easy to find, but you go find this book. And I’m telling you, every single thing this guy said has come to pass. It’s astounding, I am in awe of this guy. But on the other side we had this guy over here. His name was Ancel Keys. Anybody heard of him? So, Ancel Keys was a Minnesota epidemiologist, very interested in the cause of cardiovascular disease. And he performed the first multivariate regression analysis without computers. Now, anybody know what that means? Multivariate regression analysis? So, this is where you take a whole lot of data, and normally you would just run a few computer programs, but basically, the object is to try to figure out what causes what, and to try to factor out other things and determine what the contribution of various things all at once are to an outcome that you’re looking for. So, he was interested in cardiovascular disease. So, what he did was he did this study, along with other people around the world, called the Seven Countries Study. Very famous, front page of Time Magazine in 1980. So, here’s the data on the Seven Country Study. So, we have the US, Canada, Australia, England and Wales, Italy, Japan. And here’s percent calories from fat on the x axis, and here we have coronary disease death rate on the y axis. And so you’d say, “Oh, look at that.” I mean, it’s very obvious, isn’t it. Sure, percent calories from fat correlates very nicely with coronary disease, right? Except for one little problem. Anybody see it? Japan and Italy? So, how much sugar do they eat? Didn’t I tell you the Japanese diet eliminates fructose? They never even had it ’til we brought it to them after World War II. Italy, aside from gelato, I mean what else they got? They got a lot of pasta, there’s a lot of glucose, but no fructose. There’s no sugar in the Italian diet other than the occasional sweet, which they moderate. They’re very careful about moderating, and they cost a lot. But, here we got England, Wales, Canada, Australia, US, you know, we are sugarholics, aren’t we? We’re also fataholics. So, in fact, the fat migrated with the sugar. So, here’s, this is from Keys’s own work. Page 262, if you wanna pick up the 500 page volume. And I’m just gonna read you the one paragraph that talks about this. The fact that the incidence rate of coronary heart disease was significantly correlated with the average percentage of calories from sucrose in the diet, is explained by the intercorrelation of sucrose with saturated fat. In other words, donuts. Where ever there was the fat, there was sucrose too. Because these guys here eat donuts. (audience laughs) Partial correlation analysis show that with saturated fat constant, there was no significant correlation between dietary sucrose and the incidence of coronary heart disease. Okay, when you do a multivariate linear regression analysis, you have to do it both ways. You have to do holding fat constant showing the sucrose doesn’t work, and then you have to hold sucrose constant and who that fat still works. You see that anywhere? He didn’t do it, he didn’t do it. He didn’t do the thing that you need to do to do a multivariate linear regression analysis. Now, this was done before computers. We can’t check the work. He’s dead, he died in 2004. So, we’re left with a conundrum. Do we believe this? Do we believe this study, because we based 30 years of nutrition education, and information, and policy in this country on this study. And, as far as I’m concerned, it has a hole as big as the one in the USS Cole, all right, you got it? Everybody, am I debunking, yes, no? Let’s keep going. Remember, I told you LDL may be not so bad? Well, here’s why. Because there really isn’t one LDL, there are two. There are two LDLs. Here’s one over here, it’s called pattern A or large buoyant LDL. So, everybody knows that LDL correlates with cardiovascular disease, and that’s true. I’m not gonna argue that, that is true. But, it’s not this one, pattern A LDL. These guys are so light, they are buoyant, they float. So, they get carried through the bloodstream, and they don’t even have a chance, because they’re so big and they’re so buoyant, they don’t even get underneath the edge of the endothelial cells in the vasculature to start the plaque formation process. But, over here we have this other guy, over here, called pattern B or small dense LDL. You see the difference? These guys are dense. These guys don’t float. These guys are small, they get underneath the edge of the surface of the surface of the endothelial cells, and they start the plaque formation. And it’s been shown by numerous investigators now, the dense LDL is the bad guy. Okay, now, when we measure LDL in the bloodstream, when you do a lipid profile, you measure both of them together, because it’s too hard to distinguish the two. So, when you get an LDL, you’re getting both LDLs. The neutral one and the bad one. Now, how can you tell whether your LDL is the neutral one or the bad one. What you do is you look at your triglycerides level in association with it, ’cause your triglycerides tell you which one it is. So here, here’s pattern A over here, big large buoyant LDLs, and you’ll notice that the triglycerides are low, and your HDL is high. That’s what you want, you want a low triglyceride, high HDL, ’cause that’s the good cholesterol. You want high good cholesterol. Over here, you have pattern B. And here you have high triglyceride, low HDL. That’s the bad guy, that’s the guy you don’t wanna be. ‘Cause you’re gonna die of a heart attack. No question about it. Triglyceride to HDL ratio actually predicts cardiovascular disease way better than LDL ever did. Point is, when you measure LDL, you measure both. So, dietary fat raises your large buoyant. What do you think raises your small dense? Carbohydrate. Okay, so here’s percent carbohydrate, and here’s your pattern B going up. Everybody got it? So what did we do? What did we do in 1982? (speaking away from microphone) What did we do? We went on a high carb diet, which was supposed to be a low fat diet, right? So, here’s the low fat craze. Took America and the world by storm. Because the content of low fat home cooked food, that you cook by yourself, in your house, you can control the content of fat. But when you process it, low fat processed food, it tastes like cardboard. It tastes like (bleep). So the food companies knew that, so what’d they do? They had to make it palatable? So, how do you make something palatable that has no fat in it? You add the, sugar. So, everybody remember Snackwells? Two grams of fat down, 13 grams of carbohydrate up, four of them being sugar, so that it was palatable. Well, we’ve just shown you that that’s the worst thing you could do. And that’s what we’ve done. And we’re still doing it, today. So when you find a mistake, what do you do? You admit the mistake and you right the ship. We haven’t admitted the mistake, and we haven’t righted the ship. So, we’ve our food supply adulterated, contaminated, poisoned, tainted. On purpose, and we’ve allowed it, and we’ve let it, thought the addition of fructose for palatability, especially because of the decreased fat, and also as a ostensibly browning agent, which actually has it’s own issues. Because why it browns so well with the sugar in it, actually is what’s going on in your arteries. Because that’s causing what we call protein glycation and cross linking, which is actually contribution to atherosclerosis. So it works on your steak on the grill, it works in your arteries the same way. And removal of fiber also. Now, why did we remove fiber from our diet? We, as human beings walking the earth 50,000 years ago, used to consume 100 to 300 grams of fiber per day. We now consume 12. Why? What did we do? We took the fiber out. So, why’d we take the fiber out? It takes too long to cook, takes too long to eat, and shelf life. So, people ask me, “What’s the definition of fast food.” Fiberless food. I dare you, other than a salad, I dare you to go to any fast food restaurant and find anything on their menu that they actually have to cook, that has more than one gram of fiber in it. ‘Cause there isn’t any, and that’s on purpose. Because they take the fiber out, ’cause that way they can freeze it, ship it around the world, and cook it up fast, and not only is is fast cooking, but it’s fast eating, which also causes it’s own satiety issues. Bottom line, we have a typhoon on our hands. And then, finally, the last issue was the substitution of transfats, which are clearly a disaster, but those have been going down, because we know that those are a problem. So we’ve actually gotten rid of most transfats, not completely, but most. So this is it, this is what we’ve done over the last 30 years. Now, to the biochemistry. Now, how many of you here have taken biochemistry? About 25%. I am going to show you a lot of reactions in excruciating detail. (audience laughs) If you’ve studied biochemistry, you will have an anaphylactic reaction. (audience laughs) If you haven’t studied biochemistry, you will fall asleep. So, what I’m gonna suggest that you all do is just let me do my thing, to show you that, at least it works, and just count the arrows. Okay? You can do that, right? Can you count the arrows, it’s not like counting sheep. Okay, you can count the arrows, and just stick with me. Just let me do my thing, and let me show you why fructose is not glucose. ‘Cause what the liver does to fructose is really unique, and you’ve gotta understand it to understand everything I’ve just told you. So, number one, fructose is seven times more likely than glucose to do that browning reaction. The advanced glycation end-products. The thing that happens on your grill, happens in your arteries for the same reason. You can actually see the color too, the color change too. Fructose does not suppress the hunger hormone. There’s a hormone that comes form your stomach called ghrelin you’ve heard about, already. So, if you preload a kid with a can of soda, and then you let him loose at the fast food restaurant, do they eat more, or do they eat less? They eat more. They just took on 150 calories, yet they eat more. Reason? ‘Cause fructose doesn’t suppress the hunger hormone ghrelin, so they eat more. Acute fructose ingestion does not stimulate insulin, because there’s no receptor for fructose, no transport for fructose on the beta cell that makes insulin, so the insulin doesn’t go up. Well, if the insulin doesn’t go up, then leptin doesn’t go up, and if leptin doesn’t go up, you’re brain doesn’t see that you ate something. Therefor, you eat more. And finally, I’m gonna show you liver hepatic fructose metabolism is completely different between fructose and glucose, completely different. And I’m going to show you, before the evening is out, that chronic fructose exposure alone, nothing else, causes this thing we call the metabolic syndrome. Everybody knows what the metabolic syndrome is? So, this is the conglomerate of the following different phenomena, obesity, Type 2 diabetes, lipid problems, hypertension, and cardiovascular disease. Those all cluster together, called metabolic syndrome. I’m gonna show you how fructose does every one of those. I wanna show you the difference between glucose and fructose in a way that will be glaringly apparent. So, let’s consume 120 calories in glucose. Two slices of white bread. What happens to that 120 calories? You eat the 120 calories, 96 or 80% of the total will be used by all the organs in the body. 80% off the table. Why? Because every cell in the body can use glucose. Every bacteria can use glucose, every living thing on the face of the earth can use glucose, because glucose is the energy of life. That’s what we were supposed to eat. 24 of those calories, or 20% will hit the liver. So let’s watch what happens to those 24 calories. Here they go. So, the glucose comes in through this transporter called Glut2, out here, the glucose is gonna stimulate the pancreas to make insulin, the insulin’s gonna bind to it’s receptor, and it’s gonna take this substrate over here called IRS-1, insulin receptor substrate 1. That’s not important right now, don’t worry. And it’s gonna tyrosine phosphorylate it. And it’s going to be tyrosine IRS-1, which is now active, that’s active. And it’s gonna stimulate the second messenger here called AKT. Now what AKT does is, it stimulates this guy down here. SRABP1, sterol receptor binding protein number 1. Don’t worry about it. But this is the thing that, ultimately, gets fat mechanics going. So, you ‘ll see in a minute. So, one of the things that SRABP1 does, is it activates this enzyme here called glucokinase, which takes glucose to glucose 6 phosphate. Now, glucose 6-phosphate can’t get out of the liver. The only way to get glucose 6-phosphate out of the liver is with hormones. Glucagon or epinephrine, that’s the way it can get it out. So now, the glucose is fixed in the cell, but it’s only 24 calories worth, so it’s not a big bolus of it. Now, the glucose 6-phosphate almost all of it, is gonna end up going over here to something called glycagen. Now, glycagen is the storage form of glucose in the liver. Because glycagen’s easy to fish the glucose out with glucagon and epinephrine. So, my question to you, and granted, this is a physiology question, is how much glycogen can your liver store before it gets sick? The answer’s any amount. It’s unlimited. We have carb loaders who run marathons, right? Does it hurt them at all? We have kids with a disease where they can’t get the glucose out of the glycagen, called glycagen storage disease type 1A, or von Gierke disease. They got livers down to their knees their so big. They’re hypoglycemic like all get out ’cause they can’t lift the glucose out of their liver. But, they don’t go into liver failure. Because glycagen is a non-toxic storage form of glucose in the liver. So, the whole goal of glucose is to replete your glycagen. So, this is good, this is not bad, this is good. Now, a little of that glucose is gonna fall down here, it’s gonna get metabolized down to this stuff here, called pyruvate. And the pyruvate is gonna enter your mitochondria, over here. Remember, your mitochondria are the parts of your cell that actually burn the energy. They’re your little factories. They make the stuff that lets you live. Called ATP, ATP, adenosine triphosphate, that’s the energy of life, right there. So, the pyruvate comes in, gets converted to something called acetyl-CoA, gets metabolized by this thing called the Krebs cycle, TCA cycle, and you throw off ATP and carbon dioxide which you breath off. So far, so good? Have I snowed anybody yet? You’re with me? I snowed one guy back there. (audience laughs) I’m doin’ my best, I swear to God, I’m doing my best. Anyway, so this stuff over here, this acetyl-CoA, gets burned off in the TCA cycle. Maybe you won’t burn all of it off, and so, some of it may exit as citrate. And the citrate then leaves the mitochondria through a process known as the citrate shuttle. And then that citrate can then be broken down by these three enzymes, which are all subservient into this SRABP1. This is ATP citrate lyase acetyl-CoA carboxylase fatty acid synthase. They’re not important. The only thing to know is these three enzymes together turn sugar into fat. This is called denovo, meaning new, lipogenesis, fat making. This is denovo lipogenesis. So you take the citrate which came form the glucose, and you end up with something called acetyl-CoA, which then gets packaged with this protein here, and you end up with something called VLDL, very low density lipoprotein. Now, anybody heard of that before? Is it good or bad? It’s bad, that’s bad. VLDL is bad because that’s one of the things that causes heart disease. It’s also a substrate for obesity. So, you don’t wanna make much of this. But the point is, you started with 24 calories, maybe a half a calorie will end up as VLDL. So, that little Japanese guy with the little hat, you know, working out in the field, eating rice for the next 90 years, can he die of a heart attack at age 90? Sure. But that’s not so bad. If you make it to 90, you’re doing alright. Because that VLDL coming from glucose. Glucose made a little bitty VLDL. And that serves as a substrate for adipose deposition into your fat cell, here triglyceride. In addition, because of the insulin went up in response to the glucose, your brain sees that signal. And it knows that that is supposed to shut off further eating. In other words, hey, I’m busy metabolizing my breakfast. I don’t need lunch. And so, you have a nice negative feedback loop between glucose consumption, the liver, the pancreas, and the brain, to keep you in normal negative, yin yang energy balance. This is good, this is not dangerous. This is what’s supposed to happen. So now, let’s talk about a different carbohydrate. Let’s talk about my favorite carbohydrate, maybe yours too. (crowd murmuring) Ethanol. Ethanol is a carbohydrate, isn’t it? Here’s the structure, carbon hydrogen oxygen, it’ a carbohydrate. But, we all know that ethanol is a toxin, right? A poison, right. You can wrap your Lamborghini around a tree, or you can fry your liver, your choice. Depends on how much you drink and how often. Right? Okay. So, we know that ethanol is not good for you, except, of course, a little bit is good for you. So, we can talk about that too, later, if you want. But, let’s talk about how it’s bad for you. So, here’s acute ethanol exposure. CNS depression, vasodilatation, hypothermia, tachycardia, myocardial depression, pupillary responses, respiratory depression, diuresis, hypoglycemia, loss of fine motor control, you all went to college. (audience laughs) Here’s fructose, nothing. It doesn’t do any of those. Because the brain doesn’t metabolize fructose. Alcohol gets metabolized in the brain, to cause all of those things, but fructose doesn’t. So, fructose is not an acute toxin, ethanol is. We control ethanol, don’t we? We have something called the Bureau of Alcohol Tobacco and Firearms. We have all sorts of things, we tax ethanol. We do all sorts of things to limit consumption of ethanol. The Nordic countries, all the liquor stores are state run in attempt to try to set the price of ethanol high enough so as to discourage consumption for public health reasons. We have 1500 years of alcohol control policy in this world to draw on, in terms of how to limit consumption. Got it? Because ethanol is a toxin, and we know it. So, let’s consume 120 calories in ethanol. Shot of Makers Mark. Anybody taste it? Yeah, good, okay. So, 24 calories right off the top. The stomach and the intestine have something called the first pass effect, so 10% off the top, and kidney, muscle, brain will consume the other 10%. So there goes 20% or 24 calories right off the top. 96 calories of the 120 are gonna hit the liver. Now, how many was it for glucose? It was 24. So, four times the substrate is gonna hit the liver, and there’s the rub. This is a volume issue. We’re gonna show you how. So, the ethanol comes in, passive diffusion, there’s not receptor for it, not transporter. First thing that happens is ethanol gets converted to this guy, over here, called acetaldehyde. Anybody know anything about aldehydes? Like formaldehyde? Right? Are aldehydes good for you or bad for you? They’re bad, right? ‘Cause what do they do? They can cause cancer, they cross link proteins is what they do. So, if you cross link enough proteins in your liver, what do you think happens to it? You get something called… Cirrhosis, right exactly. So this guy, over here, is bad. And it generates something called reactive oxygen species. Reactive oxygen species damage proteins in the liver. And the more alcohol you drink, the more of this stuff you get. So far, so good? So, this is one of the reasons why alcohol’s bad. Now the acetaldehyde will come down here to something called acetate. The acetate will enter the mitochondria, just like the pyruvate did before. Will get converted to acetyl-CoA and participate in the TCA cycle, just like before, to generate energy. So that alcoholics don’t die form lack of energy, they got energy, it’s everything else they don’t have. They’re gonna have a whole lot of citrate. Because they have 96 calories that have to get metabolized. How many calories made it to the mitochondria with glucose? About half, right? Because most of it went to glycogen. So, we’ve got a big citrate, so it’s in big font to show you that we’re talking about big citrate now. And so, the big citrate is gonna get metabolized all the way to VLDL by the CRABP1. And so you’re gonna get a lot of the LDL. And this is the dyslipodemia of alcoholism, right here. Everybody see that? So, the liver’s gonna try to export this VLDL out so that it doesn’t get sick, because when fat builds up in the liver, that’s not good for it. Some of it’s gonna exit as free fatty acids, and those free fatty acids, will take up residence in the muscle, and you get something called muscle insulin resistance. So insulin resistance, that’s a bad thing. That makes your muscles and your liver now work so well. And can cause all sorts of other problems like diabetes. Some of the acetyl-CoA won’t even make it out, and will precipitate as a lipid droplet, so there’s your alcoholic steatohepatitis. This acetyl-CoA, and this ethanol, and these reactive oxygen species can start this enzyme activated. It’s called c-jun n-terminal kinase 1, or JNK1, and it really is JNK1 because it is the bridge between metabolism and inflammation. So, when you generate JNK1, you do bad things to your liver, which I will show you when we talk about fructose. So let’s talk about fructose. Fructose is sweet, we like it a lot. We like it in everything, we like it in our bread, we like it in our pretzels, we like it everywhere we look. So, let’s consume 120 calories in sucrose. A glass of orange juice. Everybody got it? So, two slices of white bread, a shot of makers mark, a glass of orange juice, all the same 120 calories. But, three different substrates. Let’s see what happens to the fructose. So, number one, the glucose, remember, ’cause sucrose is half glucose half fructose, so 60 of the calories of the 120 are glucose. 12 are gonna make it into the liver, 48 out here for the rest of the body. The same 20/80 split we had before with glucose. So far, so good. But all 60 calories of fructose are gonna be metabolized by the liver. Why? Because only the liver can metabolize fructose. So, what do we call it, where when you take in a compound that’s foreign to your body, and only the liver can metabolize it, and in the process, generates various problems? What do we call that? We call that a… Poison. So, let me show you how it’s a poison. So, let’s watch the fructose. So, the fructose comes in through this transporter, now. Before it was Glut2, now it’s Glut5 No insulin, remember, ’cause fructose does not stimulate insulin. Fructose, then, gets metabolized by this guy, over here, called fructokinase, to form something called fructose 1-phosphate. In the process, ATP has to give up one phosphate to ADP ’cause the phosphate had to come from somewhere, so it comes from here. Now, before we had 24 calories that had to be phosphorylated. Now we have 72 calories that have to be phosphorylated. So, we have three times the substrate, and there’s the rub. It’s a volume issue, for right now. So, we’re gonna lose a lot of phosphate, aren’t we? So there’s a scavenger enzyme in your liver called AMP deaminase 1 to rescue the phosphates off the rest of the ATP molecule, and it takes ADP down to AMP, adenosine monophosphate, down to IMP, Inositol monophosphatase, and finally, to the waste product uric acid. Anybody every heard of uric acid? What is it? It’s a waste product. Goes out in your urine. ‘Causes what disease? Gout, right. Also causes another disease called hypertension. Let me show you how. Because uric acid, turns out, blocks the enzyme in your blood vessels called endothelial nitric oxide synthase. And that’s the enzyme that makes the stuff called nitric oxide, NO. And that is your endogenous blood pressure lowerer. That keeps your blood pressure low. So, when you can’t make it, your blood pressure goes up. So, this just shows that fructose consumption increases gout in adults. So, this is a study that came out last year showing that fructose consumption increases the risk for gout, showing that uric acid’s going up. And this is a study done by pediatric renal fellow, Stephanie Winn, just published in Journal of Pediatrics, it’s not submitted any more, it’s long in press, showing that this is in the NHANES database in the adolescents, showing that sugar sweetened beverages, as it goes up, your uric acid goes up. And, not only does your uric acid go up, but here’s your sugar sweetened beverages, and here’s your systolic blood pressure going up. And here’s a study done by Dan Fige, at the University of Texas San Antonio, where he took obese adolescents with hypertension, and he gave them the drug Allopurinol. And Allopurinol is the drug that you treat gout with, to lower the uric acid. And look what happened to the blood pressure. Systolic, diastolic, went down. Showing that, in fact, uric acid is an important part of hypertension. We have a hypertension epidemic in this country. Here it is. It’s the sugar. Okay, so, so far we have high blood pressure. Let’s keep going. The fructose will get metabolized down to pyruvate, the pyruvate will enter the mitochondria just like before, throwing off a lot of citrate. And here’s a little trick that fructose does that glucose doesn’t. ‘Cause these to can reform this stuff over here called fructose 1 6 bisphosphatase, which can then reform with glyceraldehyde to form this guy, over here, called xylulose-5-phosphate. And I get to xylulose-5-phosphate in a moment. But I wanna point out this asterisk. That’s there to remind me to tell you something. That’s there to remind me to tell you that this is why the sports drink companies put high fructose corn syrup in the sports drinks. Because if you are glycogen depleted, in other words, if you just ran a marthon, and you have no glycogen left in your liver because you burned it all, and you take in a sports drink with high fructose corn syrup, you can replete your glycogen faster than with glucose alone. That’s true. So, for elite athletes, a high fructose corn syrup containing sports drink actually makes sense. And so, indeed, sports drinks have high fructose corn syrup. The question is who drinking the sports drinks? Any elite athletes you know? Who’s drinking the sports drinks? The kids, right? Why are they drinking it? Because it’s cool, right? ‘Cause it’s cool and it tastes good. So, before we go on, I just wanna, now, digress for a moment. 1967, University of Florida patents Gatorade. Everybody remember Gatorade? Okay, 1970, the Florida Gators win the NCAA Championship in football. Gatorade makes a big splash. Okay, big deal. Anybody ever taste the original Gatorade? Yeah? What’d it taste like? Tasted horrible. It tasted like something that you might find coming out of you instead of going into you. (audience laughs) It tasted awful. 1992, Pepsi buys Gatorade, and they say, “How are we gonna market this swill?” So, what did they do? They added the high fructose corn syrup. So, now who drinks it? Fat kids, right? Not even skinny kids, fat kids drink it. Okay, so there’s a problem here. Okay, and we’re gonna show you how that works. Okay, so xylulose-5-phosphate, just to show you, if you take a rat, and you glycogen deplete him by making him run on an exercise wheel, and then you re-feed them with starch or with sucrose, the xylulose-5-phosphate goes way up with the sucrose. So you get more xylulose-5-phosphate through this pathway here, going over here. So why do we care about xylulose-5-phosphate? Well, here’s why. Because it stimulates this guy, over here, called PP2A, which then activates this transcription factor here, carbohydrate response element binding protein, which then activates what three enzymes? New fat making right, the novo lipogenesis. So here’s the citrate, we got lot’s of that. And here we’ve got acetyl-CoA, which is the way into fat, which then gets packaged to the VLDL, and now you’ve got the dyslipidemia of obesity of fructose consumption, which has, been known for many years. So, here’s normal medical students, if you can call them normal, taking in a glucose load. Notice, almost none of it ends up as fat. Taking in a fructose load, same number of calories, 30% of it ends up as fat. So when you consume fructose, you’re not consuming a carbohydrate, you’re consuming fat. So everybody talks about a high fat diet. Well, high sugar diet is a high fat diet. That’s the point. That’s exactly the point. This is a study where they gave acute administration of fructose, and you can see the triglycerides going up compared to the control. Serum triglyceride, right there. Here’s normal medical students, again, six days of high fructose feeding. Triglycerides doubled, de novo lipogenesis went up five times higher, and here’s free fatty acids, which then cause insulin resistance, doubled. Six days. So, here’s the dyslipidemia of fructose consumption. We’re not done. Some of the fat won’t make it out of the liver, just like with ethanol. And now you’ve got a lipid droplet, so now you’ve got this nonalcoholic steatohepatitis. So, this is work that we did in our clinic looking at sugar sweetened beverage consumption against the liver enzyme marker ALT, alanine aminotransferase, which tells you about fatty liver. And sure enough, here’s sugar sweetened beverages against ALT, and you can see a nice linear relationship in Caucasians. African Americans, it’s a different relationship, and that’ a’ whole ‘nother story all by itself. So, there’s the lipid droplet of nonalcoholic steatohepatitis. Some of it will come out as free fatty acids and populate the muscle, will also tell the insulin to go up higher. Remember that JNK1? So, here’s what JNK1 does. So, the acetyl-CoA and the fructose can all activate JNK1. And what JNK1 does is, remember when we used glucose, this IRS became tyrosine IRS-1 and that was good? Remember that? Well, JNK1, what it does, is it’s serine phosphorylated IRS-1. And serine IRS-1 is inactive. So now, the insulin can’t even do it’s job in the liver. So, now you have liver insulin resistance as well. That’s gonna make the pancreas work that much harder generating higher insulin levels, which raise your blood pressure even further, cause further fat making, cause more energy to go into your fat cell. There’s your obesity. And finally, our research has shown that the higher the insulin goes, the less well your brain can see it’s leptin. And so there you’ve got continued consumption because your brain thinks it’s starving. And it’s been shown in many different ways that fructose consumption changes the way your brain recognizes energy. All in a negative fashion, so that you, basically, think you’re starving. Your brain gets the signal that you’re starving even though your fat cells are generating a signal that says, “Hey, I’m full like all get out.” So, this just shows you how it goes. So, the high insulin generates the obesity because this is that, remember the first law of thermodynamics, the biochemical force generating the energy storage as the primary phenomenon, remember, if you’re gonna store it, and you expect to burn it then you’re gonna have to eat it. So, here’s the store it. Normally, that would make leptin, and the leptin should feed back and turn everything off, but it doesn’t, because the insulin gets in the way, and the high fat diet gets in the way. Also, the hyperinsulinemia stops the leptin from acting on that nucleus accumbens, and so you get an increased reward signal. So that continues your appetite, continues more fructose, more carbohydrate, generating more insulin resistance than you can see. You generate a vicious cycle of consumption and disease, and no stopping. So, here we are, hypertension, inflammation, hepatic insulin resistance, hyperinsulinemia, dyslipidemia, muscle insulin resistance, obesity, and continued consumption. Looks like metabolic syndrome to me. So, here are the phenomena associated with chronic ethanol exposure. Hematologic disorders, electrolyte abnormalities, hypertension, cardiac dilation, cardiomyopathy, dyslipidemia, pancreatitis, malnutrition, obesity, hepatic dysfunction, that’s alcoholic steatohepatitis, fetal alcohol syndrome, and addiction. Here’s fructose. Eight out of twelve. Why? ‘Cause they do the same thing. ‘Cause they metabolize the same way. Because they are the same. They come from the same place, right. How do you make ethanol? Naturally. Right, you ferment sugar. Hasn’t changed, ’cause it has all the same properties. Because it’s basically taken care of by the liver in exactly the same way, and for the same reason. Because sugar and ethanol are the same, every which way you turn. So, here’s our clinic intervention. This is what we do in our clinic. It’s as simple as you can imagine. We write this on the back of a matchbook. It’s just as simple as you can make it. We have four things we teach the kids to do, and the parents. Get rid of every sugared liquid in the house, bar none. Only water and milk, there is no such thing as a good sugar beverage, period. Eat your carbohydrate with fiber. Why? Because fiber is good. Fiber is supposed to be an essential nutrient. And we can talk later, if you want, after the cameras turn off, as to why fiber is not an essential nutrient. Because the government doesn’t want it to be. ‘Cause then they couldn’t sell food abroad. Wait 20 minutes for second portions, to get that satiety signal. And finally, buy your screen time minute-for-minute with physical activity. That’s the hardest one to do. So, if you play for half an hour, you can watch TV for half an hour. You wanna watch TV for an hour, play for an hour. That one’s a hard one, but anyway. We follow our patients every three months. So, here’s my question. Does it work? What do you think? Yeah, it works. So, this is BMI z-score time from initial visit. It works. But, we were interested in what made it work, and made it didn’t work, so we did a multivariate linear regression analysis. The thing that made it not work, sugared beverage consumption. The more sugar beverages the patient drank at baseline, the less well lifestyle intervention worked for all the reasons I just showed you. So, why is exercise important in obesity. Because it burns calories? Come on. 20 minutes of jogging’s one chocolate chip cookie. You can’t do it. (audience laughs) Are you joking me? So, why is exercise important? I’ll tell you why, here’s why. Number one, it improves that skeletal muscle insulin sensitivity because you’re insulin actually works better at your muscle, which then brings your insulin levels down. Which is good for you. Number two, it’s your indigenous stress reducer. It’s the single thing that actually stress reduces. And if you stress reduce, what do you think your appetite does? Goes down, because stress and obesity go hand in hand, for all sorts of reasons which are beyond the scope of this lecture today. But, we can talk about it in the question period, if you want. And then finally, remember that de novo lipogenesis? Remember those three nasty enzymes? What if you burned the stuff off before you made the fat? That’s what exercise does, ’cause it makes that TCA cycle run faster, so you don’t get the citrate leaving the mitochondria, so it doesn’t get turned into fat, so it doesn’t precipitate and cause all the problems you just saw. (speaking away from microphone) That’s what they mean by a higher metabolism, yes. But it has nothing to do with burning of calories. That is the stupidest reason that I’ve every heard of for exercise. You gotta be joking me. You can’t do it. I mean one Big Mac and you gotta mountain bike for ten hours. (audience laughs) Are you joking? So, why is fiber important in obesity? So, this is my motto in clinic. When God made the poison, he packaged it with the antidote. ‘Cause fructose is a poison. I think I’ve, hopefully, shown you that. But, wherever there’s fructose in nature, there’s way more fiber. You ever see a piece of sugar cane? It’s a stick, right? (audience laughs) You can’t even chew the damn thing, right? You gotta suck the stuff out. (sucking) Like that, right? I mean, how many calories you think you’re gonna get out of a piece of sugar cane? They actually did studies on the sugar plantations back in the early 1900s. All of the workers were healthy and lived longer than the sugar executives who got the processed product. How ’bout that, wonder why. So, eat your carbohydrate with fiber, that’s why we say that. That includes sugar, that’s why fruit’s okay. Because number one, it limits how much fructose you’re gonna take in, and number two, it gives you an essential nutrient which you needed in the first place. And you get some micronutrients along with it so that you actually, your liver works healthier. So, here’s what fiber does. Number one, it reduces the rate of intestinal carbohydrate absorption. Now, sometimes that’s bad. I’ll tell you when that’s bad. Now when that’s bad? That’s bad when you’re at a formal function. ‘Cause what happens if you reduce the rate of carbohydrate absorption in your gut? The bacteria get to it. So, as far as I’m concerned, in life you’ve got two choices. It’s either fat or fart. (audience laughs) It increases the speed of transit of the intestinal contents to the ilium, and that raises this hormone over here called PYY, which goes to your brain and tells you the meal’s over. That’s your satiety signal. So when you add fiber to your diet, you actually get your satiety signal sooner, because the food moves through faster. And then, finally, it also inhibits the absorption of some free fatty acids all the way to the colon, and then those get chopped up into little itty bitty fragments called short chain fatty acids, and those actually suppress insulin, as apposed to long chain fatty acids which stimulate insulin. So there are a whole bunch of reasons why fiber is good. Anybody ever heard of the Paleolithic Diet? Go home and read up on it on the internet. The Paleolithic Diet. Basically, if you east everything as it came out of the ground raw, with no cooking, you would cure diabetes on a dime. Takes about a week. Because you’re getting that 100 to 300 grams of fiber I mentioned before. That’s why, ’cause fiber is good for you. And the more, the better. – [Audience Member] Type 2. Type 2, right, Type 2, not Type 1. I stand corrected, Type 2. Now, for some fun. That’s the end of the biochemistry. Phew, how’d I do? (audience applauds) I told you I’d get you through it. So, now comes the fun part. The racial innuendos, and all the political stuff. The fructosification of America, and, of course, the world. Ready? Another quiz. Can you name the seven foodstuffs at McDonald’s that don’t have high fructose corn syrup or sucrose? – [Audience Member] Mustard? – (laughs) No, mustard has it. (audience chatter) Oh, come on, come one, the big one. French fries, but they have salt, starch, and fat. So, they’re not so good either. Okay, what else? We’ll get to coffee. Hash browns, for the same reason, salt starch and fat. What else, chicken McNuggets, I was shocked. I was shocked. No sucrose or high fructose corn syrup in chicken McNuggets. But, as the Circuit Court Judge in New York called them, they are still a McFrankenstein creation. (audience laughs) But, nonetheless, no sucrose, I was really shocked. Sausage. Oh, they’re terrible, they’re just disastrous. But, I mean, there’s nothing good in them at all, but there’s not fructose. Sausage, Diet Coke, Coffee, if you don’t add the sugar, and ice tea, if you don’t add the sugar. By the way, the chicken McNuggets, we have a disclaimer, because no one eats the chicken McNuggets without a dipping sauce. And there’s a whole bunch of high fructose corn syrup in the dipping sauce, right? Okay, good, all right. So, who’s really drinking this? We talked about this before. Gatorade AM. So, this is an attempt by Pepsi to capture market share on the juice market. Do you think there are any elite athletes who actually drink this stuff? You gotta be kidding me. Okay, this is for kids, right? So, this really blew my socks off. This was my daughter, when she was in second grade, two years ago, Miriam Lustig, brought these two cartons of milk home for me, and said, “Dad, you’re not gonna believe this.” Second grade. So, here’s the calories in Berkeley Farms 1% low fat milk, 130 calories, 15 of them are sugars, ’cause it’s lactose, which is okay. And here’s Berkeley Farms 1% chocolate milk, 190 calories, 29 grams of sugar, all high fructose corn syrup. It’s like a glass of milk plus a half a glass of orange juice. And that’s what we’re giving to our kids. And do you know what the nutrition department at the SFUSD says? “Well, we have to get our kids to drink milk some how.” Is that brilliant, or what? I don’t know. Now, what about WIC. So, we talked about the 112 pounds of orange juice that the kid down in Salinas was drinking. What bout WIC? Remember what we started with? We have an epidemic of obese six month olds. Remember? So, could this be the reason? So, here’s a can of formula. 43.2% corn syrup solids, 10.3% sugar. It’s a baby milkshake. Soda, Coca Cola, is 10.5% sucrose. Formula is 10.3% sucrose. Any difference? And there’s a huge literature that’s now coming of age that shows that the earlier you expose kids to sweet, the more they’re gonna crave it later. Plus, there’s a new literature that shows the more sugar the pregnant woman drinks or eats during the pregnancy, the more that gets across the placenta, and actually causes what we call developmental programming, changing the kids adiposity even before the kid is born, and driving this whole epidemic even further. So, we’ll close in a few minutes. But, I just wanna point out what’s the difference. Here, we got a can of Coke. Here we got a can of beer. And I’m not picking on Schlitz, or anything. It’s any beer you want, okay. So, 150 calories each, no difference in terms of total calories. Percent carbohydrate, so 10.5% from sucrose here, except it’s high fructose corn syrup, but who cares. 3.6% alcohol, here’s the breakdown. 75 fructose, 75 glucose for the Coke. 90 alcohol 60 maltose for the beer. Remember, the first pass GI metabolism takes 10% of the alcohol off the table. So, when you actually compute the number of calories hitting the liver, which remember was the big difference between glucose and fructose, remember? 72 versus 24 and started the whole thing into motion as term of what happens that’s bad. Bottom line, no difference. So, we have something called beer belly. Well, welcome to soda belly. ‘Cause that’s what America’s suffering from. No ifs ands or buts. That’s what it is. Now, you wouldn’t think twice about not giving your kid a Budweiser. But, you don’t think twice about giving your kid a can of Coke. But, they’re the same, in the same dosing, for the same reason, through the same mechanism. Fructose is ethanol without the buzz. Fructose is a carbohydrate. Yes, it is. But fructose is metabolized like a fat. And I’ve just shown you that 30% of any ingested fructose load ends up as fat. So when people talk about high fat diets doing bad things, no, what they’re really talking about is high fructose diets, and that’s what Ancel Keys was looking at. So, the corollary to that is, in America at least, and around the world too, a low fat diet isn’t really a low fat diet. Because the fructose or sucrose doubles as fat, it’s really a high fat diet. That’s why our diets don’t work. And fructose, just like ethanol, for the same reason, through the same mechanism, and in the same dosing, is also as toxin. Now, last, what can we do about it? Can we do anything about it? How ’bout the FDA? You think they can do something about it. After all, aren’t they supposed to regulate our food? Aren’t they supposed to regulate what they can put in food? Weren’t they supposed to regulate tobacco? Now they are, actually. So, you know, weird things. So, I wanna just show you what the tobacco company thinks of all this. This is actually from the UCSF Legacy Tobacco Documents Library that Stan Glantz runs right across the street. Stan’s a good guy, like Stan a lot. And he showed me this. “Under the regulations governing food additives,” so this came from an Altria or Phillip Morris executive, “it is required that additives be safe, “defined as a reasonable certainty “by competent scientists that no harm “will result form the intended use of the additive.” Now, does fructose meet that standard? Well, the FDA says that fructose, high fructose corn syrup, has what’s knows as GRAS, G R A S status, generally regarded as safe. Now, where’d that come from? No where. It came from no where. It came from the notion that, “Well, fructose “is natural, it’s in fruit, it must be okay.” Well, tobacco’s natural too. But it’s not. Ethanol’s natural, but it’s not. A whole bunch of, you know, Jamaican ackee fruit’s natural, but it’s not either. It kills you. Keeping on going. “A food shall be deemed to be adulterated “if it bears or contains any poisonous “or deleterious substance which may “render it injurious to health.” Fructose fits that description, right? Uh-uh, but now with the prevention of chronic diseases, even though it’s own regulations explicitly postulate the connection between such products and such diseases. In other words, the FDA will only regulate acute toxins, not a chronic toxin. Fructose is a chronic toxin. Acute fructose exposure did nothing, remember. ‘Cause the brain doesn’t metabolize fructose. The liver does. And the liver doesn’t get sick after one fructose meal. It get’s sick after 1000 fructose meals. But, that’s how many we eat. So, the FDA isn’t touching this. The USDA isn’t touching this. Because if the USDA touched this, what would that mean? That would mean an admission to the world that our food is a problem. So, what to you think that would do? There are three things in this country that we can still sell overseas. Weapons, entertainment, and food. Cars? (laughs) Computers? I don’t thinks so. Can anybody think of anything else that another country wants of ours? What? Tobacco, right, tobacco. (laughs) All right, you get the picture. So, the USDA doesn’t wanna know about this. ‘Cause this is bad news. And so, who runs the food pyramid? The USDA. It’s the fox in charge of the hen house. Because their job is to sell food. And who’s eating it? We are. So, in summary, fructose, and I don’t care what the vehicle is, it’s irrelevant, sucrose or high fructose corn syrup, I don’t care, fructose consumption’s increased in the past 30 years, coinciding with the obesity epidemic. A calorie is not a calorie. And the dietitians in the country are actually perpetrating this on us. Because the more you think a calorie’s a calorie, the more you think, well than if you ate less and exercise more, it would work. It doesn’t. All of the studies show it doesn’t work. Here’s why it doesn’t work, because a calorie is not a calorie. Fructose is not glucose. We know a calorie is not a calorie. ‘Cause there are good fats and bad fats. There’s good protein and bad protein. Okay, there’s good carbohydrate and bad carbohydrate. And glucose is good carbohydrate. Glucose is the energy of life. Fructose is poison. You are not what you eat. You are what you do with what you eat. And what you do with fructose is particularly egregious and dangerous. Hepatic fructose metabolism leads to all the manifestations of the metabolic syndrome. Hypertension through that uric acid pathway, de novo lipogenesis, dyslipidemia, hepatic steatosis through that DNL pathway, those three enzymes, the new fat making pathway, inflammation through JNK1, hepatic insulin resistance because of the serine phosphorylation of IRS-1, obesity because of the VLDL transport to the adiposite, and leptin resistance promoting continuous consumption, basically starving your brain, making you think you need more. Fructose ingestion interferes with obesity intervention, as we showed in our clinic. The more soft drinks, the less well diet and exercise actually worked. Fructose is a chronic hepatotoxin for the same reason that alcohol is. The only difference is alcohol is metabolized by the brain, so you get alcohol effects. Fructose is not metabolized by the brain so you don’t get those effects. But everything else it does is the same. But the FDA can’t and won’t regulate it. It’s up to us. I’m standing here today to recruit you. That’s a famous saying here in San Francisco, right? “I’m Harvey Milk, and I’m here to recruit you.” I’m Robert Lustig, and I’m here to recruit you in the war against bad food. And this is what’s bad. With that, I wanna thank my colleagues at the UCSF Department of Pediatrics in our Weight Assessment for Teen and Child Health Clinic, UCSF Department of Epidemiology and Biostatistics, and also Department of Nutritional Sciences at UC Berkeley, in particular Doctor Jean-Marc Schwarz, who is a card carrying fructose biochemist, PhD biochemist, who vetted all of these pathways that I’ve shown you today, and looked at this and said, “Oh my God, it is a toxin.” He worked in the stuff for 15 years, and he didn’t even realize it was a toxin until he saw this. So, with that, I’ll close. Thanks you. (audience applauds) (upbeat techno music)