Watch “The Skinny on Obesity” with Dr. Lustig:
Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. Series: UCSF Mini Medical School for the Public [7/2009] [Health and Medicine] [Show ID: 16717]
More UCTV videos about sugar:
Dr. Lustig’s book (comes out Dec 27, 2012), “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease”:
Thank you to Centar dr Gifing for providing the Serbian subtitles for Sugar the Bitter Truth.
this program is presented by university of california television like what you learn visit our website or follow us on Facebook and Twitter to keep up with the latest UC TV programs 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 no we think it's missing a sex but we 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 let's start with a little quiz what are the Atkins diet and the Japanese diet have in common anybody hmm oh yo you have you have the answers right yep 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 now 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 N Haynes 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 in 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 or of course that's true but in fact the entire 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 base 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 gonna 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 are you gonna 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 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 to behaviors right gluttony and sloth after all you see anybody on the street oh he's a glutton on a sloth that's all there is to it you know Tommy Thompson said it on the TV show we just need to 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 gonna get even further in a minute okay there's another way to state this first law and that is if you're going to store it that is biochemical forces that drive energy store 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 a Fed Rijn it's off the market coffee for two hours and 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're burning 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 a sudden these two behaviors the gluttony and the sloths 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 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 like Gazza Ladra marriage of figaro 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 an 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 here 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 five grams 45 calories out of the 275 nothing in fact it's all in the carbohydrate fifty seven 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 US Department of Agriculture admonished us to reduce our total fat consumption from 40 to 30% everybody remember that okay that's how intense 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% I 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 percent 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 fruit aids whatever you want to call them okay just remember down here one can of soda a day it's 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 fifteen and a half pounds of fat per year one soda a day is 15 and a half 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 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 in 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 Two and sugar became plentiful again and wasn't being rationed we have the appearance of the ten 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 2.5 8 ounce servings out of that bottle that's a single serving right okay so that would be worth 26 pounds of fat for you if you did that every day and then of course over here we have the 7-eleven 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 dalton 60 ounces of coca-cola a Snickers bar in a bag of Doritos all for 99 cents okay so if you did that every day for a 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 fifty five 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 what 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 all 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 our soft drinks the cause of obesity well it depends on who you ask if you ask the scientists for the National soft drink Association he'll tell you there's absolutely no association which sugar consumption obesity okay if you ask my colleague dr. David Ludwig remember I'm elastic he's Ludwig okay he's it does what I do at Boston Children's Hospital someday we're gonna open a law firm each additional sugar 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% 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 and take adequate nutrition all showing significant associations and some of these being longitudinal this came from Kelly brownells 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 state 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 our 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 call a 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 circa sugared sweetened soft drinks just the the downward arrow shows that there was a significant rye 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 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 Lengths 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 a hundred and twenty 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 crystal and fructose and they're starting to put crystalline fructose into some of the soft drinks you can 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 at milk sugar it's not sweet at all okay and glucose I should point out over here 74 it's not particularly sweetened we're gonna get to that at the end okay and what goes on with glucose alright 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 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 though it's the that they're the same the the soft drink companies and the Corn Refiners because here are their misses okay this comes from the Corn Refiners Association obesity research shows high fructose corn syrup metabolizes an impact satiety similar to sugar indeed it does I agree okay you know decent you know 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 all want to see all of them they're a whole bunch of them you can go to WWE surprise calm 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 in the public interest and the Corn Refiners Association everybody remember last year when Gavin Newsome floated a soda tax okay last February okay governor paterson of New York has since floated one and other people are starting to talk about it so why are they saying this while 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 gonna show you that nonetheless I just want to read you this paragraph here okay in yellow we respectfully urged 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 on my Frek toast today okay prior to World War two okay before it becomes got rationed again okay we were up to about 16 to 24 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 8% 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 ten point two 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 an adolescent's today we're up to almost 75 grams 12 percent 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 fats going down the sugars 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 the way 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'ma show you that on the next slide hey 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 ok that's what this is 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 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 haunt you 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 US producer price index of sugar going up and down and up and down okay this is not good okay stability is it a hundred percent 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 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 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 Hey almost everything okay somebody has 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 is gone up the sugars going 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 tooth by 2,000 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 face 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 a WIC you know what Wikus women infants children right a government type entitlement program set up under who Nixon cake 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 a hundred and thirteen 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 for juice intake goes up and this is in the nurses 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 – stop what – 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 ok 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 see ok so we learned that be lit LED to see 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 way no C this was the logic now any logicians in the room anybody see any problems with that logic good 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 know a no see it's no C no a ok so the logic isn't even right that's faulty logic here okay so this doesn't work on any level all right so I'm gonna show you why this doesn't work and here's what but before I show you why it doesn't work I'm gonna show you that this was a battle royal back in the 1970s ok this was not a simple thing there were people lined up on both sides of this story ok so this over here is a book 1972 it came out and 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 Yadkin now I never knew John Yadkin he's he's passed away ok but I read this book about a year ago and without even knowing it I was a young acolyte I was a youngin 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 Ancel keys anybody heard of him okay so ansvil 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 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 from page of Time magazine in nineteen eighty okay so here's the data on the seven countries study so we have the US with Canada Australia England and 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 oh look at that I mean it's very obvious isn't it sure percent calories from fat correlates very nice the coronary disease mmm except for one little problem anybody see it Japan and Italy so how much sugar does aid didn't I tell you the Japanese diet eliminates fructose they never even had it till we brought it to him after World War two Italy you know aside from gelato I mean what else they got okay they got a lot of pasta there's a lot of glucose but no fructose okay if there's no sugar in the Italian diet other than the occasional sweet which they moderate they're very careful about modern and they cost a lot okay but here we got England Wales Canada Australia u.s. you know we are sugar holics aren't we we're also fatty hogs so in fact the fat migrated with the sugar so here's this is from Keyes's 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 inter correlation of sucrose with saturated fat in other words doughnuts okay wherever there was the fat there was sucrose – because these guys here eat doughnuts 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 sucrose cons that constant showing the 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 doing 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 US coal USS Cole alright you got it everybody I might 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 gonna argue that that is true but it's not this one pattern a lvl 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 yes but over here we have this other guy over here called pattern B or a 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 the 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 LDL 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 a 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 gonna die of a heart attack no question about it triglyceride to HDL ratio actually predicts cardiovascular disease way better than LDL ever did and 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 a percent carbohydrate and here's your pattern be going up everybody got it so what did we do what are we doing 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 okay but when you process it low-fat processed food it tastes like cardboard it tastes like okay so the food companies knew that so what they do how to make it palatable so how do you make you 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're right 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 decrease 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 fifty thousand years ago used to consume a hundred to three hundred grams of fiber per day we now consume twelve 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 fiber list 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 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 gotten 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 about 25% 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 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 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 okay 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 – color change to 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 that they eat more or do they eat less they eat more they just took on 150 calories yet they eat our 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 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 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 but 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 phenomenon 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 a hundred and twenty calories in glucose two slices of white bread okay what happens to that hundred twenty calories now you eat the 120 calories 96 or 80% 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% 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 Kulu two 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 irs-1 insulin receptor substrate one that's not important right now don't worry okay and it's gonna tyrosine phosphorylated okay and it's gonna be tyrosine irs-1 which is now active that's active and it's gonna stimulate the second messenger here called a KT okay now what a KT does is it stimulates this guy down here srebp one sterile receptor binding protein number one don't worry about it okay but this is the thing that ultimately gets fat mechanics going okay so you'll see in a minute so one of the things that sorry bp1 does is it activates this enzyme here called gluco kinase 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 you liver store before it gets sick the answer's any amount unlimited okay we have carb loaders who run marathons right okay it's a birthday middle 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 hunger Keys disease that 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 gonna fall down here it's going to get metabolized down to this stuff here called pyruvate and the pyruvate is gonna enter your mitochondria over here I might remember your mitochondria are the parts of your cell that actually burned the energy they're your little factories okay they make the stuff that lets you live okay called eight P ATP adenosine triphosphate that's the energy of life right there okay so the pyruvate comes in gets converted to something called a Steel Co way it 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 a steel Kawai gets burned off in the TCA cycle now maybe you won't burn all of it often 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 srebp one this is ATP citrate lyase acid Oh a carboxylate 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 koa 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 the LDL 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 eaten 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 glucose made a little-bitty the LDL okay and that serves as a substrate for at a post deposition into your fat cell here triglyceride in addition because the insulin went up in response to the glucose your brain sees that risk 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 egg energy balance this is good this is not dangerous this is what's supposed to happen alright 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 let's talk about how it's bad for you so here's a cute ethanol exposure okay CNS depression visibility ssin hypothermia tachycardia myocardial depression people re 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 take the Nordic countries take all the liquor stores or state run in an attempt to try to set the price of ethanol high enough to as so as to discourage consumption for public 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 a hundred and twenty calories in ethanol shot a makers mark everybody taste it yeah good okay so twenty four calories right off the top okay the stomach in the intestine have something called the first pass effect so ten percent off the top and kidney muscle and brain will consume the other ten percent so there goes twenty percent or twenty four calories right off the top 96 calories of the hundred and twenty are gonna hit the liver now how many was it for glucose was twenty four okay so four times the substrate is gonna hit the liver and there's the rub okay this is a volume issue okay we're gonna show you how so the ethanol comes in this passive diffusion there's no receptor for 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 our 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 like 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 when 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 I said all the hi will come down here to something called acetate acetate will enter the mitochondria just like the pyruvate did before will get converted to ask away 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 it's everything else they don't have okay they're gonna 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 1/2 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've talking about big citrate now okay and so the big citrate is going to get metabolized all the way to VLDL by this srebp one and so you're gonna get a lot of the LDL and this is the disappear of alcoholism right here okay everybody see that so the livers gonna try to export this VLDL out so that it doesn't get sick because the wedding fat builds up in the liver that's not good for it okay some of its 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 asic oh I won't even make it out and we'll precipitate as a lipid droplet so there's your alcoholic steatohepatitis this a soak away and this ethanol and these reactive oxygen species can start this enzyme in activated okay it's called c-jun and terminal kinase 1 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 and we like it and everything we like it in our bread we like it in our pretzels we like it everywhere we look okay so let's consume a hundred and twenty 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 hundred twenty 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 sixty of the calories of 120-hour glucose twelve are gonna 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 let's watch the fructose so the fructose comes in through this transporter now before it was glued to now it's glued five okay no insulin remember because fructose does not stimulate insulin the fructose then gets metabolized by this guy over here called fructose kinase 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 gonna lose a lot of phosphate aren't we so there's a scavenger enzyme in your liver called a MP deaminase one to rescue the phosphates off the rest of the ATP molecule and it takes adp down to a MP adenosine monophosphate down to i MP an acetal mono phosphate and finally to the waste product uric acid anybody ever heard of uric acid what is it it's a waste product goes out in your urine causes what disease gout right okay also it causes another disease called hypertension okay let me show you how because your gas it 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 enno 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 acids 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 impressive ok showing that this is in the N Haines 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 sure good sweetened beverages and here's your systolic blood pressure going up now here's a study done by Dan fyg 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 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 desireless 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'd it taste like tasted horrible okay it tasted like something that you might find you know in 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 5-phosphate just to show you so here's if you take a rat and you glycogen deplete them by making them run on an exercise wheel okay and then yuri 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 Zyliss 5 phosphate well here's why because it stimulates this guy over here called PP 2a 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 a silcoon a is the way into fat okay which then gets packaged all right with the via to the VLDL and I've got the dis lipid II me ax 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 a fructose load same number of calories 30% of it ends up as fat so when you consume fructose you're not consuming the 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 okay this is a study where they gave a cute administration of fructose and you can see the triglycerides going up compared to the control okay 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 it causes 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 steatohepatitis so this is work that we did in our clinic okay looking at sugar can sweeten beverage consumption against the liver enzyme marker alt a alanine aminotransferase which tells you about fatty liver and sure enough here's sugar sweetened beverages against alt and can see a nice linear relationship in Caucasians african-americans it's a different relationship and that's a whole nother story all by itself okay so there's the lipid droplet of alcohol a non-alcoholic steatohepatitis some of it will come out of 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 jungle one does so the ASIC away 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 IRS one and Syrian IRS one 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 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 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 and set 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 I'll get out this just how it shows you how it goes so the high insulin generates the obesity because this is that remember that first the the first law of thermodynamics the biochemical force generating the energy storage as the primary phenomenon remember if you 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 feedback 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 nonce no stopping so here we are hypertension inflammation hepatic insulin resistance hyperinsulinemia dis lipedema 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 dilatation cardiomyopathy dis lipid EMU 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 metabolize the same way because they are the same they come from the same place right how do you make ethanol naturally right your 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 ok it's as simple as you can imagine we write this on the back of a matchbook ok I mean 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 ok 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 ok because then they couldn't sell food abroad wait 20 minutes for second portions ok to get that satiety signal and finally by your screen time minute for a 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 I think 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 and 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 burned 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 got to be joking me okay you can't do it I mean one Big Mac you know and you got a you know mountain bike for ten hours are you joking okay so why is fiber important in obesity so this is my motto and 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 Garrus each piece of sugarcane 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 gonna get out of a piece of sugarcane okay it 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 fruits 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 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 ileum okay and that raises this hormone over here called pyy which goes to your brain and tells you the meals over that's your satiety signal so when you add fiber to your diet you actually get your satiety signals 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 in the Sun so there are a whole bunch of reasons why fiber is good anybody ever heard of the Paleolithic diet okay go home and read up 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 it takes about a week okay because you're getting that hundred to three hundred 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 tube not type one type of 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 fructose off' occation of america and of course the world ready another quiz can you name the seven foodstuffs at mcdonalds that don't have high fructose corn syrup or sucrose no mustard has it oh come on come on the big one french fries is 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 Seoul starts at 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 aiming the crankenstein creation okay but nonetheless no no no sook 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 Fructis sausage diet coke I coffee if you don't add the sugar and iced tea if you don't have 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 alright so who's really drinking this when we talked about this before Gatorade a.m. so this is an attempt by Pepsi to capture market share on the juice market right do you think they're 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 1% low-fat Nell 130 calories 15 of them are sugars because it's lactose right which is okay and here's Berkeley farms 1% chocolate milk 190 calories 29 grams of sugar all high fructose corn syrup hmm 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 you know with these of the nutrition department at the SFU SD 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 WIC okay so we talked about 112 pounds of orange juice that the kid down in Salinas was drinking what about WIC 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% it's a baby milkshake soda coca cola is 10.5 percent sucrose formula is ten point three percent 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 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 in Schlitz or anything I means you know any beer you want okay so 150 calories each no difference in terms of total calories percent carbohydrate so point five percent from sucrose here except that's high fructose corn syrup who cares okay three point six percent alcohol here's the breakdown seventy-five fructose seventy-five glucose for the coke okay ninety alcohol sixty maltose for the beer remember the first passed GI metabolism takes ten percent 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 terms of what happens that's bad okay bottom line no difference so we have a something called beer belly well welcome to soda belly because that's what America is suffering from no ifs ands or buts 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 percent of any ingested fructose load ends up as fat okay so when people talk about high fat diets doing bad things know 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 to 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 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 US UCSF legacy tobacco documents library that Stan Glantz runs right across the street okay Stan's a good guy okay like Stan a lot okay and 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 GRA s status generally regarded as safe now where'd that come from nowhere it came from nowhere okay it came from the notion that well dose is natural sin fruit must be okay right yeah well tobacco's natural – but it's not ethanol is natural but it's not okay a whole bunch of you know Jamaican Aki fruits natural but it's not either it killed 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 it render it injurious to health fructose fits that description right but not 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 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 it gets sick after a thousand fructose meals but that's how many weed 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 do I mean you can anybody think of anything else that another country wants of ours what tobacco right to back up all right you get the picture all right so the USDA doesn't want to know about this okay because this is bad news and so who runs the food pyramid the USDA it's the Fox in charge of a henhouse okay 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 consumptions increase in the past 30 years coinciding with the obesity epidemic a calorie is not a calorie okay and the dieticians in this country are actually perpetrating this on us because the more you think at calories a calorie the more you think well then 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 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 a patek fructose metabolism leads to all the manifestations of the metabolic syndrome hypertension through that Urich a pathway de novo epigenesis dis lipedema hepatic steatosis through that dnl pathway those three enzymes the new fat making pathway inflammation through junk one hepatic insulin resistance because of the Syrian phosphorylation of IRS one 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 practice ingestion interferes with obesity intervention as we showed in our clinic the more soft drinks the less well diet exercise actually worked fructose is a chronic hepatotoxic 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 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 14 and child health clinic UCSF Department of Epidemiology and biostatistics and also Department of nutritional sciences at UC Berkeley in particular dr. jean mark 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