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[Music]
so
[Music]
i'm going to tell you tonight a a story
and this story dates back about 30 years
uh 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
the only thing it's missing is sex
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 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 uh let's start with a little quiz
what are the atkins diet and the
japanese diet have in common
anybody
oh yeah you have you have the answers
right yeah
never mind that's right you have the
answer right there okay so the atkins
diet of course is all fat no carb the
japanese diets all carb no fat they both
work
right so what do they share in common
they both eliminate the sugar fructose
okay so
with that
think about
what it means to be on a diet and what
macronutrients you're eating and which
ones you're 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
this is the these 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 obese
er 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 dr
christian vase 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
okay so tonight we're going to talk
about the environment rather than genes
okay 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 of 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 going to store it
now who here believes that
oh come on you all do
okay
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
uh phenomenon i'm going to try to debunk
over the course of the
over the next hour because i think
there's another way to state the law
okay 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 right
calories in calories out two behaviors
right gluttony and sloth after all you
see anybody on the street oh he's a
glutton and a sloth that's all there is
to it you know tommy thompson said it on
the tv show we just eat too damn much
right
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 you know
these all these countries who've adopted
our diet all suffer now from the same
problem and we're going to get even
further in a minute okay
there's another way to state this first
law okay and that is
if you're going to 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 hours then
you need another hit like me
things that make your energy expenditure
go down
like starvation hypothyroidism make you
feel lousy
okay and how many calories you burn and
how good you feel are synonymous so if
you're going to 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 going to have to eat it and
now all of a sudden these two behaviors
the gluttony and the sloth are actually
secondary to a biochemical process which
is primary
that'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
because 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
larger marriage of figure and all that
he retired at age 37 to a lifetime of
gastronomic debauchery okay maybe he
chose to be obese okay but the kids i
take care of in uh 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 want to say that it's all
about diet and exercise then you have to
explain this to me
so any
hypothesis that you want to proffer that
explains the obesity epidemic you've got
to explain this one too
okay and this is not just in america
these six-month-old obese kids but these
are around the world now
all right so open your minds
and let's go and figure out what the
real story is okay
now
let's talk about calorie intake because
that's what today is about we're going
to talk about the energy intake side of
the equation okay
sure enough we are all eating more now
than we did 20 years 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 because it's all there you know
what it was there before
okay
we're all eating more
there's a there's a system in our body
which you've heard about over the last
couple of weeks called leptin
everybody heard a leptin okay 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
because 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
5 grams 45 calories out of the 275
nothing
in fact
it's all in the carbohydrate
57 grams 228 calories we're all eating
more carbohydrate now you all know back
in 1982 the american heart association
the american medical association and the
u.s department of agriculture admonished
us
to reduce our total fat consumption from
40 to 30 percent everybody remember that
okay that's how intimate
fat free cakes came into being remember
that
okay so what happened
we did it
we've done it
40 count percent down to 30 percent 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 perce 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 percent
increase in fruit drinks fruit aids
whatever you want to call them okay
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 3 500 calories per pound
if you eat or drink 3 500 calories more
than you burn you will gain one pound of
fat okay that's the first law of
thermodynamics no argument there that's
worth 15 and a half pounds of fat per
year one soda a day is 15.5 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
going to 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 so a lot of you do right 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 very well
now if you drank one of those every day
assuming of course that the recipe
hasn't changed because after all only
two people in the world know the recipe
and they're not allowed to fly on the
plane at the same time right you know
that okay assuming the recipe hasn't
changed if you drank one of those every
day for a year six and a half ounces
that would be worth eight pounds of fat
per year
okay now in 1955 after world war ii and
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 and 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
right 20 ounces anybody know how many
servings are in that bottle
2.5 8 ounce servings that's right
anybody know anybody who gets 2.58 oz
servings out of that bottle that's a
single serving
right
okay 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
711 big k thirst buster big gulp
whatever you want to 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-sized big gulp
60 ounces of coca-cola a snickers bar
and a bag of doritos all for 99 cents
okay so if you did that every day for
year that would be worth 112 pounds of
fat per year okay 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 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
thirstier right so why is 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
right
everybody remember new coke
1985
more salt more caffeine they knew what
they were doing okay that's the smoking
gun
okay 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 it 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 okay if you ask my colleague
dr david ludwig remember i'm lustig he's
ludwig okay he does what i do at boston
children's hospital someday we're going
to open a law firm
each additional sugared sweetened drink
increase over a 19-month follow-up
period in kids increase their bmi by
this much and their odds risk ratio for
obesity by 60 percent
okay that's a prospective study on soft
drinks and obesity the real deal
if you look at meta-analyses everybody
know what a meta-analysis is okay it's a
conglomeration of numerous studies
subjected to rigorous
statistical analysis okay 88
cross-sectional and longitudinal studies
regressing soft drink consumption
against energy intake body weight milk
and calcium intake adequate nutrition
all showing significant uh associations
and some of these being longitudinal
this came from kelly brownell's group at
yale
okay 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 about the converse what if you
take the soft drinks away so this was
the fizzy drink study from christchurch
england james at all british medical
journal where they went into schools and
they took the soda machines out okay
just like we did here in california okay
we haven't seen the data yet but they
went and did it for a year
so the prevalence of obesity in the
intervention school stayed absolutely
constant no change whereas the
prevalence of obesity in the control
schools where nothing changed continued
to rise over the year
okay so that's pretty good
so how about type 2 diabetes are soft
drinks the cause of type 2 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 fruit aids etc
causing type 2 diabetes and you know
we've got just as big a problem with
type 2 diabetes as we do with obesity
for the same reasons and this was a
sugared sweetened beverage against risk
for type 2 diabetes in african-american
women looking here at sugar sugar sweet
and soft drinks just the 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 2 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 okay
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
that's american 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 okay and we give that an
index and sweetness of a hundred 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 if
you crystalline fructose and they're
starting to put crystalline fructose
into some of the soft drinks you can
they they're actually advertising it is
a good thing
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 okay and glucose i should
point out over here 74. it's not
particularly sweet and we're going to
get to that at the end okay and what
goes on with glucose right 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 they're not
the same okay and here's sucrose and
they're just bound together by this
ether linkage we have this enzyme in our
gut called sucrase it kills it kills
that bond in two seconds flat okay and
you absorb it and basically
high fructose corn syrup sucrose it's a
non-issue
it's a wash they're the same
okay and they know that it's it's the
that they're the same the uh the uh uh
soft drink companies and the corn
refiners because here are their missives
okay 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 okay
at you know decent uh uh you know uh
meetings you know academic meetings
around the country okay hunger and
satiety profiles energy intakes
following ingestion of soft drinks
bottom line research supported by the
american beverage institute and the corn
refiners association they are correct
there is absolutely no difference
between high fructose corn syrup and
sucrose
so much so that the corn refiners
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 okay it
was on tv it's everywhere my hairdresser
says that hot sugar is healthier than
high fructose corn syrup wow you get
your hair done by a doctor i didn't know
i could cut hair
okay if you want to 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
okay but indeed this is true
high fructose corn syrup and sucrose are
exactly the same they're both equally
bad
okay they're both dangerous they're both
poison
okay i said it
poison my charge before the end of
tonight is to demonstrate that fructose
is a poison
and i will do it and you will tell me if
i was successful
nonetheless
here's center for the science and public
interest and the corn refiners
association everybody remember last year
when gavin newsom floated a soda tax
okay last february
okay 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 is a problem kids are drinking
soda let's tax it okay so they're
talking about soda like it's empty
calories i'm here to tell you that it
goes way beyond empty calories okay the
reason why this is a problem is because
fructose is a poison
okay it's not about the calories it's
not has nothing to do with the calories
it's a poison by itself
and i'm going to show you that
nonetheless i just want to read you this
paragraph here okay 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 hundred 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 would be
double okay we're just talking about
fructose today okay
prior to world war ii okay before it
become got rationed again okay 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 hit in the market we had increased
that we had basically doubled up to 37
grams per day or eight percent of total
caloric intake by 1994 we were up to 55
grams of the stuff per day remember if
you want to do sugar then double the
number so that's 10.2 so you can see
that more and more of our caloric intake
more 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
okay and for adolescents today we're up
to almost 75 grams 12 percent of total
caloric intake 25
of the
adolescents today consume at least 15
percent of their calories from fructose
alone this is a disaster
an absolute unmitigated disaster the
fat's going down the sugar is going up
and we're all getting sick
now let me show you why
okay
how'd this happen
why did 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
okay and it's still being felt today
okay so richard nixon in his paranoia
back in 1972
okay
food prices were going up and down and
up and down i'll show you that on the
next slide okay and he was worried that
this was actually going to cost him the
election so he
admonished his secretary of agriculture
earl rusty butts 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 this
we're suffering from it today
okay that's what this is okay
second political wind the advent of high
fructose corn syrup okay so this was
invented in 1966
at saga medical school in japan by a guy
named takasaki who's still alive okay 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
okay like everything you know it always
comes back to honshu okay 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 u.s
producer price index of sugar going up
and down and up and down okay this is
not good okay um stability is at 100 if
it stays nice and stable at 100 that's
what you want okay 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 u.s 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
uh sugar and high fructose corn syrup
you can see that high fructose corn
syrup is about half the price
okay 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 its way into everything
it's found its way into hamburger buns
pretzels
barbecue sauce and ketchup
okay almost everything okay somebody um
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 low you know types of
bread on the shelf only one of them did
not have high fructose corn syrup in it
okay so we are being poisoned by this
stuff and it's been added
surreptitiously
to all of our food every processed food
okay and the question is why
well you'll see why in a minute okay
so the corn refiners like to point out
well you know it's just been a
substitution
okay as the high fructose corn syrup has
gone up the sugar's gone down you know
we're just replacing you know 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 okay so
disappearance data okay 73 pounds
up to 95 pounds by two by two thousand
okay and there's something missing from
this slide anybody want to tell me what
it is what's missing
juice
juice is missing because juice is
sucrose right sugar
and juice causes obesity okay so this is
a study done by miles 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
wick
anybody heard a wick
you know what wick is women infants
children right a government entitlement
program set up under who
nixon okay to prevent failure to thrive
they did
this is the equal and opposite reaction
so let's add juice in here it is and 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
okay
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 okay so this is the
relative risk ratio as juice intake goes
up and this is in the nurse's study okay
showing again juice consumption
sucrose obesity diabetes okay the third
political storm okay that swirling
around to create this disaster this mega
typhoon okay
that thing
that happened in 1982 the usda the
american heart 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 heart disease did we
no we didn't did we okay in fact it's
worked the exact opposite we've only
created more okay 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
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 led to b okay dietary
fat definitely increases your ldl no
argument it's true
okay and then finally in the late 1970s
we learned that ldl correlated with
cardiovascular disease okay so let's
call cardiovascular disease c
okay so we learned that b
led to c
so
the thought process you know by some
very smart nutritionists etc you know
the usda etc 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
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
okay so the logic isn't even right
there's faulty logic here
okay so this doesn't work on any level
right so i'm going to show you why this
doesn't work and here's what but before
i show you why it doesn't work i'm going
to show you that this was a battle royal
back in the 1970s okay this was not a
simple thing there were people lined up
on both sides of this story okay so this
over here is a book
1972 it came out it was called pure
white and deadly it's all about sugar
okay 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 want to 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 okay his name was ansel keyes
anybody heard of him
okay so ansel keyes 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 okay so
this is where you take a whole lot of
data okay and normally you would just
you know 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 and so what he
did was he
did this study along with other people
around the world called the seven
countries study okay very famous front
page of time magazine in 1980. okay
so here's the data on the seven
countries study
so we have the us with canada australia
england wales italy japan okay 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 well
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 until we brought it to them after
world war ii
italy
you know cypher and gelato i mean what
else they got
okay they got a lot of pasta there's a
lot of glucose but no fructose okay
there's no sugar in the italian diet
other than the occasional sweet which
they moderate they're very careful about
monitoring and they cost a lot okay but
here we got england whales canada
australia us you know we are sugar
holics aren't we we're also fataholics
so in fact the fat migrated with the
sugar so here's this is from keys own
work okay page 262. if you want to pick
up the 500 page volume okay and i'm just
going to read you the one paragraph okay
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
doughnuts
okay wherever there was the fat there
was sucrose too because these guys here
eat
donuts
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 multi-linear regression
analysis you have to do it both ways
you have to do holding sucrose
fat constant showing that sucrose
doesn't work and then you have to hold
sucrose constant and show 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 u.s coal
uss cole
all right you got it
everybody am i debunking
yes no
all right let's keep going
remember i told you ldl maybe 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 a large buoyant ldl so everybody
knows that ldl correlates with
cardiovascular disease and that's true
and i'm not going to 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 endothelial
cells and they start the plaque
formation and it's been shown by
numerous investigators now that small
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 is the neutral one or the bad one
what you do is you look at your
triglyceride level in association with
it because your triglycerides tell you
which one it is so here here's pattern a
over here okay big large
buoyant ldls okay 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 because that's the
good cholesterol you want good 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 want to be because you're
going to 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
what do we do we went on a high carb
diet which was supposed to be a low-fat
diet right
right so here's the low-fat craze okay
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 crap
okay so the food companies knew that so
what'd they do
they had to make it palatable so how do
you make it something palatable it has
no fat in it you add the
sugar
right so everybody remember snack wells
okay so two grams of fat down 13 grams
of carbohydrate up four of them being
sugars so that it was palatable
okay 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
okay
you admit the mistake and you write the
ship
we haven't admitted the mistake and we
haven't righted the ship
so we've had our food supply adulterated
contaminated poisoned tainted
okay on purpose
and we've allowed it and we've let it
through the addition of fructose for
palatability especially because of the
decreased fat and also as a ostensibly
browning agent which actually has its
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
contributing to atherosclerosis so it
works on your steak on the grill it
works in your arteries the same way
okay 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 we take the
fiber out
it takes too long to cook takes too long
to eat and shelf life okay
so the people ask me what's the
definition of fast food
fiberless food
okay 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 because there isn't any and that's on
purpose because they take the fiber out
because that way they can freeze it ship
it around the world and cook it up fast
and not only is it fast cooking but it's
fast eaten which also causes its own
satiety issues bottom line we have a
typhoon on our hands okay and then
finally the last issue was the
substitution of trans fats which are
clearly a disaster but those have been
going down because we know that those
are a problem so we've got actually
gotten rid of most trans fats not
completely but most okay so this is it
this is what we've done over the last 30
years
okay now to the biochemistry okay now
how many of you here have taken
biochemistry
25 percent
i am going to show you a lot of
reactions
in excruciating detail
if you've studied biochemistry you will
have an anaphylactic reaction
if you haven't studied biochemistry you
will fall asleep
so what i'm going to 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 okay just let me do my
thing and let me show you why fructose
is not glucose okay because what the
liver does to fructose is really unique
and you've got to 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
glycosylation end products the thing
that happens on your grill happens in
your arteries for the same reason okay
you can actually see the color too color
change too
fructose does not suppress the hunger
hormone there's a hormone that comes
from your stomach called ghrelin you've
heard about already okay so when you if
you pre-load a kid
with a can of soda and then you let them
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 because 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 transporter 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 your brain doesn't see
that you ate something
therefore you eat more
and finally i'm going to show you liver
hepatic fructose metabolism is
completely different between fructose
and glucose completely different and i'm
going to show you before the day is out
the evenings out that chronic fructose
exposure alone
nothing else causes this thing we call
the metabolic syndrome everybody knows
what the metabolic syndrome is okay so
this is the conglomerate of the
following different uh phenomena
obesity
type 2 diabetes
lipid problems
hypertension and cardiovascular disease
okay those all cluster together okay
called metabolic syndrome i'm going to
show you how fructose does every one of
those
i want to 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
okay what happens to that 120 calories
now you eat the 120 calories 96 or 80
percent of the total will be used by all
the organs in the body
okay 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
okay that's what we were supposed to eat
okay 24 of those calories or 20 percent
will hit the liver okay so let's watch
what happens to those 24 calories here
they go so the glucose comes in through
this transporter glut2
out here the glucose is going to
stimulate the pancreas to make insulin
the insulin is going to bind to its
receptor
and it's going to take this substrate
over here called irs1 insulin receptor
substrate one that's not important right
now don't worry okay and it's going to
tyrosine phosphorylate it okay and it's
going to be tyrosine irs1 which is now
active that's active and it's going to
stimulate the second messenger here
called akt okay now what akt does is it
stimulates this guy down here srebp1
sterol receptor binding protein number
one don't worry about it okay but this
is the thing that ultimately gets fat
uh mechanics going okay so you'll see in
a minute so one of the things that srebp
1 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
you 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
you know bolus of it okay now the
glucose 6-phosphate almost all of it is
going to end up going over here
to something called glycogen now
glycogen is the storage form of glucose
in the liver okay because glycogen is
easy to fish the glucose out with
glucagon and epinephrine
so my question to you and i granted this
is a physiology question is how much
glycogen can your liver store before it
gets sick
the answer is any amount
it's unlimited okay we have carb loaders
who run marathons right
okay so hurt them at all
we have kids with the disease where they
can't get the like the glucose out of
the glycogen called glycogen storage
disease type 1a or van gierke's disease
they got livers down to their knees
they're so big they're hypoglycemic like
all get out because they can't lift the
glucose out of their liver okay but they
don't go into liver failure
because glycogen is a non-toxic storage
form of glucose in the liver
so the whole goal of glucose is to
replete your glycogen
so this is good this is not bad this is
good now a little of that glucose is
going to
fall down here it's going to get
metabolized down to this stuff here
called pyruvate and the pyruvate is
going to enter your mitochondria over
here might remember your mitochondria
are the parts of your cell that actually
burn the energy they're your little
factories okay they make the stuff that
lets you live okay called atp atp
adenosine triphosphate that's the energy
of life right there okay 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 breathe
off so far so good
have i
snowed anybody yet
you're with me
i snowed one guy back there okay i'm
doing 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 now maybe you won't burn all
of it off and so some of it may exit as
citrate okay 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
to this srebp1 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
okay this is called de novo meaning new
lipogenesis fat making okay this is de
novo lipogenesis so you take the citrate
which came from the glucose okay and you
end up with something called acyl 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
okay bldl is bad because that's one of
the things that causes heart disease
it's also a substrate for obesity
okay so you don't want to make much of
this okay 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 you know 90 years you
know can he die of a heart attack at age
90
sure
okay but that's not so bad okay if you
make it to 90 you're doing all right
okay because that vldl coming from
glucose okay glucose made a little bitty
vldl okay and that serves as a substrate
for adipose deposition into your fat
cell here triglyceride
in addition because the insulin went up
in response to the glucose your brain
sees that res that that signal
and it knows that that is supposed to
shut off further eating
okay in other words hey
i'm busy metabolizing my breakfast i
don't need lunch
okay
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
all right so now let's talk about a
different carbohydrate let's talk about
my favorite carbohydrate maybe yours too
okay
ethanol ethanol is a carbohydrate isn't
it
here's the structure carbon hydrogen
oxygen it's 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 right so we can talk about
that too later if you want okay but
let's talk about how it's bad for you
so here's acute ethanol exposure okay
cns depression vasodilation hypothermia
tachycardia myocardial depression
pupillary responses respiratory
depression diuresis hypoglycemia loss of
fine motor control you all went to
college
here's fructose
nothing doesn't do any of those because
the brain doesn't metabolize fructose
okay
alcohol gets metabolized in the brain to
cause all of those things but fructose
doesn't okay so fructose is not an acute
toxin ethanol is
we control ethanol don't we okay we have
something called the bureau of alcohol
tobacco and firearms right we have all
sorts of things we tax ethanol we do all
sorts of things to limit consumption of
ethanol okay the nordic countries okay
all the liquor stores are state-run
in an attempt to try to set the price of
ethanol high enough to as so as to
discourage consumption for public health
reasons we have 1500 years of alcohol
control policy in this in this world to
draw on in terms of how to limit
consumption got it
okay because ethanol is a toxin and we
know it
so let's consume 120 calories in ethanol
shot a maker's mark
anybody taste it
yeah good okay so
24 calories right off the top okay the
stomach and the intestine have something
called the first pass effect so 10 off
the top and kidney muscle and brain will
consume the other 10 so there goes 20
percent or 24 calories right off the top
96 calories of 120 are going to hit the
liver now how many was it for glucose
it was 24 okay so four times the
substrate is going to hit the liver and
there's the rub
okay this is a volume issue okay we're
going to show you how
so the ethanol comes in
passive diffusion there's no receptor
for it no transporter first thing that
happens is ethanol gets converted
to this guy over here called
acetaldehyde okay anybody know anything
about aldehydes like formaldehyde
right are aldehydes good for you or bad
for you they're bad right because what
do they do
they can cause cancer they cross-link
proteins is what they do okay so if you
cross-link enough proteins in your liver
what do you think happens to it
you get something called
cirrhosis right exactly all right so
this guy over here is bad okay and it
generates something called reactive
oxygen species and 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
okay so this is one of the reasons why
alcohol is bad
now the acetaldehyde will come down here
to something called acetate okay 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 okay
to generate energies you know so that
alcoholics don't die from you know from
lack of energy they got energy
everything else they don't have okay
they're going to have a whole lot of
citrate
right because they have 96 calories that
have to get metabolized
how many calories made it to the
mitochondria with glucose
about a half
right because most of it went to
glycogen
so we've got a big citrate so it's a big
font to show you that we've talked about
big citrate now okay and so the big
citrate is going to get metabolized all
the way to vldl by this sri bp1 and so
you're going to get a lot of vldl and
this is the dyslipidemia of alcoholism
right here okay everybody see that
so the liver is going to 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
okay some of it's going to 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 lip muscles
and your liver not work so well okay and
can cause all sorts of other problems
like diabetes
some of the acelcoa won't even make it
out and will precipitate as a lipid
droplet so there's your alcoholic
steatohepatitis
this acyl coa and this ethanol and these
reactive oxygen species can start this
enzyme in
activated okay it's called c june n
terminal kinase one or junk one and it
really is junk one because it is the
bridge between metabolism and
inflammation
so when you generate junk one you do bad
things to your liver which i will show
you when we talk about fructose so let's
talk about fructose okay fructose is
sweet we like it a lot okay we like it
in everything we like it in our bread we
like it in our pretzels we like it
everywhere we look okay
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
maker's 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
because sucrose is half glucose half
fructose so 60 of the calories of the
120 are glucose
12
are going to make it into the liver 48
out here for the rest of the body okay
the same 20 80 split we had before with
glucose so far so good
but all 60 calories of fructose are
going to 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
far into 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 glued to
now it's gluten five okay no insulin
remember because fructose does not
stimulate insulin the fructose then gets
metabolized by this guy over here called
fructokinase
to form something called fructose one
phosphate in the process atp
has to give up one phosphate to adp
because the phosphate has 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 going to lose a lot of phosphate
aren't we so there's a scavenger enzyme
in your liver called amp deaminase one
to rescue the phosphates off the rest of
the atp molecule and it takes adp down
to amp adenosine monophosphate down to
imp and acetone monophosphate and
finally to the waste product uric acid
anybody ever heard of uric acid
what is it
it's a waste product it goes out in your
urine causes what disease
gout right okay
it also causes another disease
called hypertension
okay 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 this
stuff called nitric oxide no and that is
your endogenous blood pressure lower
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
okay so this is a study that came out
last year showing that fructose
consumption
increases the risk for gout showing that
uric acid is going on
this is a study done by our pediatric
renal fellow stephanie wynn just
published in journal of pediatrics okay
it's not submitted anymore it's long
impress okay showing that this is in the
nhanes database in the adolescence
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 feig at
the university of texas san antonio
where he took obese adolescence with
hypertension and he gave them the drug
allopurinol an 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 now here's a little trick that
fructose does that glucose doesn't
because these two can reform this stuff
over here called fructose 1 6
bisphosphate
which can then reform with
glyceraldehyde to form this guy over
here called xylose 5-phosphate and i'll
get to xylose 5-phosphate in a moment
but i want to 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 marathon 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's 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
because it's cool and it tastes good
okay so before we go on i just want to
now digress for a moment okay
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 it tastes like
tasted horrible
okay it tasted like something that you
might
find you know you know coming out of you
instead of going into you
okay
it tasted awful
okay
1992 pepsi buys gatorade
and they say
how are we going to market this swill
so what did they do
they added the high fructose corn syrup
okay so now who drinks it
right fat kids
right not even skinny kids fat kids
drink it okay so there's a problem here
okay we're gonna show you how that works
okay so xylose five phosphate just to
show you so here's if you take a rat and
your glycogen depletion by making them
run on an exercise wheel okay and then
you re-feed them with starch or with
sucrose the xylose 5-phosphate goes way
up with the sucrose okay so you get more
xylose 5-phosphate through this pathway
here going over here so why do we care
about xylose 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 right we got lots of
that
and how here we've got acyl coa which is
the way into fat okay which then gets
packaged sorry oops with the via to the
vldl and now you've got the dyslipidemia
of obesity a fructose consumption which
has been known for many years
so here's
normal medical students if you can call
them normal
okay
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 a high sugar diet is a high fat
diet that's the point
that's exactly the point
okay
this is a study where they gave acute
administration of fructose and you can
see the triglycerides going up compared
to the control okay certain 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
okay six days
so here's the dyslipidemia
of fructose consumption we're not done
the 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 non-alcoholic steato hepatitis
so this is work that we did in our
clinic okay looking at
sugar sweetened beverage consumption
against the liver enzyme marker alt
alanine amino transferase 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's a whole other
story all by itself okay so there's the
lipid droplet of alcohol non-alcoholic
steatohepatitis some of it will come out
as free fatty acids and populate the
muscle we'll also tell the insulin to go
up higher
remember that junk one so here's what
jung one does so the acyl coa and the
fructose can all activate junk one and
what junk one does is remember
when we use glucose this irs became
tyrosine irs one and that was good
remember that well junk one what it does
is it's serine phosphorylates irs1 and
syrian irs1 is inactive
so now the insulin can't even do its job
in the liver so now you have liver
insulin resistance as well
that's going to 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
okay and finally
we've our research has shown that the
higher the insulin goes the less well
your brain can see its leptin
and so there you've got continued
consumption because your brain thinks
it's starving
and it's been shown on set 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 okay so this just
shows you how it goes so the high
insulin generates the obesity because
this is that remember that first the
first law of thermodynamics the
biochemical force generating the the
energy
storage as the primary phenomenon
remember if you uh if you're going to
store it and you expect to burn it then
you're going to 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 and
you can see you generate a vicious cycle
of consumption and disease
and non 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
hemetologic disorders electrolyte
abnormalities hypertension cardiac
dilatation cardiomyopathy dyslipidemia
pancreatitis malnutrition obesity
hepatic dysfunction that's alcoholic
steatohepatitis fetal alcohol syndrome
and addiction
here's fructose
8 out of 12.
why
because they do the same thing because
they're metabolized 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
because 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 okay it's as
simple as you can imagine we write this
on the back of a matchbook okay i mean
it's just as 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 okay 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
okay because then they couldn't sell
food abroad
wait 20 minutes for second portions okay
to get that satiety signal and finally
buy your screen time minute for minute
with physical activity that's the
hardest one to do okay so if you play
for half an hour you can watch tv for a
half an hour you want to 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
right
so this is bmi z score time from initial
visit it works but we were interested in
what made it work and what made it
didn't work so we did a multivariate
linear regression analysis right
the thing that made it not work
sugared beverage consumption
the more sugar beverages the patients
drank at baseline
the less well
the lifestyle intervention worked for
all the reasons i just showed you
okay
so
why is exercise important in obesity
because it burns calories
come on
20 minutes of jogging is one chocolate
chip cookie you can't do it
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 your
insulin actually works better at your
muscle okay which then brings your
insulin levels down which is good for
you number two it's your endogenous
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 right for all sorts of
reasons which are beyond the scope of
this lecture today but we can talk about
in the question period if you want and
then finally
remember that de novo lipogenesis
remember those three nasty enzymes
okay what if
you burn the stuff off before you made
the fat
that's what exercise does because 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
that's what they mean by a higher
metabolism yes okay but it has nothing
to do with burning of calories that is
the stupidest reason
that i've ever heard of for exercise you
gotta be joking me
okay you can't do it i mean one big mac
you know and you gotta you know mountain
bike for ten hours
are you joking
okay 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
okay because fructose is a poison i
think i've hopefully shown you that okay
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 you can't even chew the damn thing
right you gotta suck the stuff out
like that right i mean how many calories
you think you're going to get out of a
piece of sugar cane
okay they actually did studies on the
sugar plantations back in the early
1900s okay
all of the workers were healthy and
lived longer than the sugar executives
who got the processed product
how about that wonder why okay 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
going to 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 can
your liver works healthier so here's
what fiber does number one it reduces
the rate of intestinal carbohydrate
absorption okay now sometimes that's bad
i'll tell you when that's bad
okay you know when that's bad
that's bad when you're at a formal
function
because what happens if you reduce the
rate of
carbohydrate absorption in your gut
the bacteria get to it okay so as far as
i'm concerned in life you've got two
choices
it's either fat or fart
it increases the speed of transit of the
intestinal contents to the ilium okay
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 opposed 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
okay go home and read it read up on it
on the internet okay the paleolithic
diet basically if you eat everything as
it came out of the ground raw
okay with no cooking okay
you would cure diabetes on a dime okay
takes about a week
okay because you're getting that 100 to
300 grams of fiber i mentioned before
that's why because fiber is good for you
okay and the more the better
type two right type two not type one
type i i stand corrected type two okay
okay now for some fun okay that's the
end of the biochemistry
how'd i do
i told you i'd get you through it
okay so now comes the fun part okay the
racial innuendos and the you know all
the political stuff okay the
fructosification of america and of
course the world ready
another quiz
can you name the seven food stuffs at
mcdonald's that don't have high fructose
corn syrup or sucrose
no mustard has it
oh come on come on the big one
french fries but they have salt starch
and fats they're not so good either okay
what else
we'll get to coffee hash browns for the
same reason right salt starch and fat
okay
what else
chicken mcnuggets i was shocked
i was shocked no sucrose or high
fructose corn syrup and chicken
mcnuggets but as the
circuit court judge in new york called
them they are still a mcfrankenstein
creation
okay but uh nonetheless no no no
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 no
there's no fructose
sausage
diet coke
i coffee
if you don't add the sugar
and iced tea
if you don't add the sugar by the way
the chicken mcnuggets have you know we
have a disclaimer because no one eats
the chicken mcnuggets without the
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 and we
talked about this before
gatorade am
so this is an attempt by pepsi to
capture market share on the juice
market right
do you think there are any elite
athletes who actually drink this stuff
you got to 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
okay brought these two cartons of milk
home for me and said dad you're not
gonna believe this okay second grade
okay so here's the calories in berkeley
farms one percent low-fat milk 130
calories 15 of them are sugars because
it's lactose right which is okay
and here's berkeley farms one percent
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
okay and that's what we're giving to our
kids and you know what the
cat you know what these uh the nutrition
department at the sfusd says well we
have to get our kids to drink milk
somehow
now is that is that is that brilliant or
what i don't know
now what about wick
okay so we talked about 112 pounds of
orange juice that the kid down in
salinas was drinking what about wick
so 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 percent sugar
it's a baby milkshake
soda coca-cola is 10.5 percent 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 going to 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
uh adiposity even before the kid is born
and driving this whole epidemic even
further so
we'll close in a few minutes okay but i
just want to point out what's the
difference
okay here we got a can of coke
here we got a can of beer and i'm not
picking on schlitz or anything i mean
it's you know any beer you want okay
so 150 calories each no difference in
terms of total calories
percent carbohydrate so 10.5 percent
from sucrose here except it's high
fructose corn syrup but who cares okay
3.6 alcohol here's the breakdown 75
fructose 75 glucose for the coke okay 90
alcohol 60 maltose for the beer
remember the first pass gi metabolism
takes 10 percent of the alcohol off the
table
so when you actually compute the number
of calories hit in the liver which
remember was the big difference between
glucose and fructose remember 72 versus
24 and started the whole thing into
motion as terms of what happens that's
bad okay bottom line no difference
so we have some something called beer
belly
well
welcome to
soda belly
because that's what america is suffering
from
no ifs ands or butts that's what it is
okay 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
so
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
okay 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 ansel keyes 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 in the same
dosing is also a toxin
now
last
what can we do about it
can we do anything about it
how about 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
right
weren't they supposed to regulate
tobacco
now they are actually so you know
weird things so i want to just show you
what the tobacco company thinks of all
this so here's this is actually from the
ucsf legacy tobacco documents library
that stan glance runs right across the
street okay stan's a good guy okay likes
dan a lot okay and he he he showed me
this he said under the regulations
governing food additives so this came
from an altria or philip morris
executive
it is required that additives be safe
defined as a reasonable certainty by
competent scientists that no harm will
result from 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 known as
grass
gras status generally regarded as safe
now where'd that come from
nowhere
it came from nowhere okay it came from
the notion that well fructose is natural
it's in fruit must be okay
right
yeah well tobacco's natural too
but it's not ethanol is natural but it's
not okay a whole bunch of you know
jamaican aki fruit's natural but it's
not either it kills you
okay
keeping on going a food shall be deemed
to be adulterated if it bears or
contains any poisonous or deleterious
substance which may render render it
injurious to health fructose fits that
description right
but not with the prevention of chronic
diseases even though its 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 right acute
fructose exposure did nothing remember
because the brain doesn't metabolize
fructose the liver does and the liver
doesn't get sick after one fructose meal
it gets sick after a thousand 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 do you think that would do
there are still there are three things
in this country
that we can still sell overseas
weapons
entertainment
and food
cars
computers i don't think so what i mean
can anybody think of anything else that
another country wants of ours
what
tobacco right tobacco all right you get
the picture all right so the usda
doesn't want to know about this okay
because this is bad news
okay and so who runs the food pyramid
the usda
it's the fox in charge of the hen house
okay because their job is to sell food
and who's eaten 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 has increased in
the past 30 years coinciding with the
obesity epidemic
a calorie is not a calorie okay and the
dietitians in this country are actually
perpetrating
this on us
because the more you think a calories a
calorie the more you think well then if
you ate less in 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 the
calorie is not a calorie fructose is not
glucose
we know a calorie is not a calorie
because 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
okay 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 junk one hepatic
insulin resistance because of the serine
phosphorylation of irs1 obesity because
of the vldl transport to the adipocyte
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
okay that's a famous
saying here in san francisco right
um what was it i'm harvey milk and i'm
here to recruit you okay i'm robert
lustig and i'm here to recruit you in
the war against
bad food
okay and this is what's bad
with that i want to 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 dr jean-marc schwartz 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 thank you
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