"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 UCTV programs." "Mini Medical School for the Public" "Current Controversies in Nutrition:" "Letting Science Be the Guide" "Sugar:" "The Bitter Truth" "Robert H. Lustig, M.D. Professor of Pediatrics" " Division of Endocrinology University of California, San Francisco" "I'm going to tell you tonight a..." "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... 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 appreciated if, at the end of the talk, you would tell me whether or not I was successful or not, ok?" "So, in order to get you in the mood, as it were... let's start with a little quiz." "What do the Atkins Diet and the Japanese Diet have in common?" "Anybody?" "Oh, yeah, you have the answers right here." "Never mind." "That's right." "You have the answer right there, ok?" "So, the Atkins Diet, of course, is all fat no carb... the Japanese Diet is all carb no fat, they both work, right?" "So, what do they share in common?" "They both eliminate the sugar fructose." "So, with that, think about what it means to be on a diet?" "And what 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 epidemics, here are the numbers." "This is... these are the n Haynes database body mass index." "Everybody knows what that is now." "Histograms marching ever right word as time has gone on, this is what was projected for 2008 in blue." "We had so far exceeded and surpassed, it's not even funny, so, from 2003, the reason I show this is not just to show that the obese are getting obeser, of course that's true." "But, in fact, the entire curve have shifted." "We all weigh 25 pounds more today then 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'm 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, ok?" "So, tonight, we're gonna talk about the environment rather than genes, ok?" "Now, in order to talk about the environment, we need to talk about what is obesity, 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 gonna store it." "Now, who here believes that?" "Oh, come on... you all do." "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." "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... 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 do 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 adopted our diet, all suffer now from the same problem." "And we're gonna get even further in a minute, ok?" "There's another way to state this first law, ok?" "And that is if you're gonna store it, that is, biochemical forces that drive energy storage." "And we'll talk about what they are in a few minutes." "And you expect to burn it, that is, normal energy expenditure for normal quality of life." "Because energy expenditure and quality of life are the same thing." "Things that make your energy expenditure go up... make you feel good." "Like Ephedrine, it's off the market;" "coffee, for two hours, then you need another hit like me." "Things that make your energy expenditure go down... like starvation, hypothyroidism, make you feel lousy." "And how many calories you burn and how good you feel are synonymous." "So, if you're gonna store it, that is an obligate weight gain set up by a biochemical process and you're expect to burn it, that is, normal energy expenditure for normal quality of life," "then you're gonna have to eat it." "And now, all of the sudden, these two behaviors our gluttony and 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 Ladra, marriage a figure and all that?" "He retired at age 37 to a lifetime of gastronomic debauchery, ok?" "Maybe he chose to be obese." "But the kids I take care of in a obesity clinic do not choose to be obese." "In fact, this is the exception that proves the rule." "We have an epidemic of obese 6-month olds." "Now, if you wanna say that it's all about diet and exercise, then you have to explain this to me." "So, any hypothesis that you wanna proffer that explains the obesity epidemic, you've got to explain this one too, ok?" "And this is not just in America these 6-month olds obese kids, but these are around the world now." "Right?" "So, open your minds and let's go and figure out what the real story is, ok?" "Now, let's talk about calorie intake, because that's what today is about." "We're gonna talk about the energy intake side of the equation, ok?" "Sure enough, we are all eating more now then 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." "The question is why?" "How come?" "Because it's all there?" "You know what?" "It was there before, ok?" "We're all eating more... there's a system in our body which you heard about it over the last couple of weeks, called leptin." "Everybody heard leptin?" "It's this hormone that comes from your fat cell, tells your brain" ""you know what?" "I 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 then 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 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." "5g, 45 calories out of the 275, nothing." "In fact, it's all in the carbohydrate." "57g, 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 percent." "Everybody remember that?" "That's how fat-free cakes came into being, remember that?" "So, what happened?" "We did it." "We've done it." "40 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 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 wanna call'em, ok?" "Just remember, down here, one can of soda a day is 150 calories." "Multiply that by 365 days a year and then divide that by the magic number of 3500 calories per pound." "If you eat or drink 3500 calories more than you burn, you will gain one pound of fat, ok?" "That's the first law of thermodynamics, no argument there." "That's worth 15.5 lbs of fat per year." "One soda a day is 15.5 lbs 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 where we're gonna get to." "So, I called this slide very specifically 'The Coca-Cola Conspiracy'." "Anybody here work for Coke?" "Pepsi?" "Ok, good." "All right, so..." "This over here, 1915, the first standardized bottle of Coca-Cola out of Atlanta, anybody remember this bottle?" "Sure, some, 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 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." "Assuming the recipe hasn't change, if you drank one of those every day for a year, 6.5 oz, that'd be worth 8 lb of fat per year, ok?" "Now, in 1955, after WWII and sugar became plentiful again and wasn't being rationed, we have the appearance of the 10 oz 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 oz can, worth 16 lb of fat per year and, of course, today, this over here is the single unit of measure... right?" "20 oz." "Anybody know how many servings are in that bottle?" "2.5, 8 oz servings, that's right." "Anybody know anybody who gets 2.5, 8 oz servings out of that bottle?" "That's a single serving!" "Right?" "That'd be worth 26 lb 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 wanna call it, 44 oz worth 57 lb of fat per year." "And if that wasn't bad enough, my colleague Dr. Dan Hale, at the University of Texas, San Antonio, tells me that down there, they got a Texas-size big gulp." "60 oz of Coca-Cola, a Snickers bar and bag of Doritos, all for 99 cents." "So, if you did that every day for you, that would be worth 112 lb of fat per year." "So, why do I call 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 mg 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 there's 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." "That's the smoking gun... ok?" "They know, they know." "All right." "So, that's why it's the Coca-Cola conspiracy." "So, are soft drinks the cause of obesity?" "Well, depends on who you ask." "If you ask the scientists for the National Soft Drinks Association, they'll tell you there's absolutely no association between sugar consumption and obesity, ok?" "If you ask my colleague Dr. David Ludwig, remember I'm Lustig, he's Ludwig, ok?" "He does what I do at Boston Children's Hospital." "Some day we're gonna open a law firm." "Each additional sugar-sweetened drink increase over 19 month follow-up period in kids increased their BMI by this much and their odds-risk (OR) ratio for obesity by 60%... ok?" "That's a prospective study on soft drinks and obesity, the real deal." "If you look at meta-analysis, everybody know what meta-analysis is, ok?" "It's a conglomeration of numerous studies subjected to rigorous statistical analysis." "88 cross-sectional and longitudinal studies regressing soft drink consumption against energy intake, body weight, milk and calcium intake, adequate nutrition, all showing significant associations and some of these being longitudinal, this came from Kelly Brownell's group at Yale, right?" "I should comment a disclaimer, those studies that were funded by the beverage industry showed consistently smaller effects than those that were independent..." "I wonder why." "Now, how about the converse?" "What if you take the soft drinks away?" "So, this was the Fizzy Drink Study from Christ Church England, James et al," "British Medical Journal, where they went into schools and they took the soda machines out, ok?" "Just like we did here in California, ok?" "We haven't seen the data yet, but they went and did it, for a year." "So, the prevalence of obesity in the interventioned schools stayed absolutely constant, no change." "Whereas the prevalence of obesity in the controlled schools, where nothing changed, continued to rise over the year, ok?" "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 statistical significant trend." "Of sugar, 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." "This was a sugar-sweetened beverages against risk for type 2 diabetes in African-American women." "Look in here." "Sugar-sweetened soft drinks, just the downward arrow shows that was a significant rise as the number of drinks went up, you can see that here." "Whereas orange and grapefruit juice interestingly did not, ok?" "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 refineries 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, ok?" "But the bottom line is this is something we were never exposed to before 1975." "And currently, we are consuming 63 lb per person per year." "Every one of us." "63 lb 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, ok?" "And we give that in index in sweetness of a hundred." "So, here is 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 the lab fructose, over here, crystal in fructose, and they're starting to put crystal in fructose into some of the soft drinks." "They're actually advertising it as 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, ok?" "And glucose, I should point out, over here, 74." "It's not particularly sweet and we're gonna get to that at the end, ok?" "And what's go on with glucose, right?" "But anyway, there is 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 6-membered ring;" "the fructose is a 5-membered ring." "They're not the same..." "believe me, they're not the same." "That's what this whole talk is about, it's how they're not the same, ok?" "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 that bond in 2 seconds flat and you absorb it." "And basically, high fructose corn syrup sucrose is a non-issue, it's a wash, they're the same, ok?" "And they know that they're the same." "The soft drink companies and the corn refiners, because here ate their missives." "This comes from the Corn Refiners Association." "Obesity research shows high fructose corn syrup metabolizes and impacts satiety similar to sugar." "Indeed, it does." "I agree, ok?" "You know, decent... meetings, academic meetings around the country." "Hunger and satiety profiles energy intakes following ingestion of soft drinks." "Bottom line." "Research supported by the American Beverage Institute and the Corn 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 an attempt to capture market share, came out with this entire ad campaign." "You probably saw on the back page of the New York Times, ok?" "It was on TV, it's everywhere." ""My hairdresser says that 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." "If you wanna see all of them, there're a whole bunch of 'em," "But indeed, this is true... high fructose corn syrup and sucrose are exactly the same." "They're both equally bad, ok?" "They're both dangerous." "They're both poison, ok?" "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 Newson floated the soda tax, ok?" "Last February?" "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, ok?" "So, they're talking about soda like it's empty calories." "I'm here to tell you that it goes way beyond empty calories, ok?" "The reason why this is a problem is because fructose is a poison, ok?" "It's not about the calories, it's nothing to do with the calories, it's a poison by itself and I'm gonna show you that." "Nonetheless, I just wanna read you this paragraph here, in yellow." ""We respectfully urge that the proposal be revised as soon as possible to reflect the scientific evidence that demonstrates no material differences in the health effects of high fructose corn syrup and sugar. "" "I agree." "Here's the important sentence:" ""The real issue is that excessive consumption of any sugars may lead to health problems. "" "I agree." "That's exactly right." "Not may, does... does." "So, here's the secular trend in fructose consumption over the past 100 years." "Before we had food processing, we used to get our fructose from fruits and vegetables." "And if we did that, today, we would consume about 15g per day of fructose, not sugar, fructose." "So, sugar would be 30g, would be double, ok?" "We're just talking about fructose today." "Prior to WWII, before it got rationed again, we were up to about 16 to 24, about 20g, so, a small increase from the beginning of the century to WWII." "Then, in 1977, just as high fructose corn syrup was hitting the market, we had increased that, we had basically doubled up to 37g/day, or 8% of total caloric intake." "By 1994, we were up to 55g of the stuff per day." "Remember, if you wanna do sugar, then double the number." "So, that's 10.2." "So, you can see that more and more of our caloric intake, higher percentage is being accounted for by sugar every single year." "So, it's not that we're just eating more, we're eating more sugar, ok?" "And for adolescents today, we're up to almost 75g, 12% of total caloric intake." "25% of adolescents today consume at least 50% 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." "How this happened?" "Why it happened?" "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." "1." "Richard Nixon and USDA Secretary Earl Butz (1973) * food should never be an issue in a presidential election" "And it's still being felt today, ok?" "So, Richard Nixon, in his paranoia, back in 1972..." "Food prices were going up and down, and up and down..." "I'm gonna show that you on the next slide." "And he was worried that this was actually gonna cost him the election." "So, he admonished his Secretary of Agriculture, Earl R. Butz, I love that name... to basically take food off the political table." "To make food a non-issue in presidential elections." "Well, the only way to do that was to make food cheap." "So, he was out to find all methods to be able to decrease the price of food." "Remember Nixon's war on poverty?" "This we're suffering from it today, ok?" "That's what this is." "Second political wind:" "the advent of high fructose corn syrup." "So, this was invented in 1966, at Saga Medical School in Japan, by a guy named Tagasaki, who's still alive." "As far as I'm concerned, this stuff is Japan's revenge for WWII." "Except, of course, that they're suffering from it now themselves." "Like everything, it always comes back to haunt you." "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." "This is not good." "Stability is at 100%, if it stays nice and stable at 100%, that's what you want, if you're a politician." "Up and down... here's where corn sweeteners entered the market in 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 sugar and high fructose corn syrup, you can see that high fructose corn syrup is about half the price." "So, in other words, it's cheap." "So, high fructose corn syrup is evil, but it's not evil because it's metabolically evil." "It's evil because it's economically evil." "Because it's so cheap, that it's found its way into everything." "It's found its way into hamburger buns, pretzels, barbecue sauce and ketchup, ok?" "Almost everything." "Somebody e-mailed me the other day and told me they went in their local grocery store and went through every single loaf of bread on the shelf." "And, out of 32 types of bread on the shelf, only one of them did not have high fructose corn syrup in it." "So, we are being poisoned by this stuff and it's been added surreptitiously to all of our food." "Every processed food." "And the question is why." "Well, you'll see why in a minute." "So, the corn refiners like to point out" ""well, you know, it's just been a substitution." "As the high fructose corn syrup's going up, the sugar's going down." "You know, we're just replacing, you know, like gram for gram. "" "Well, not exactly." "Because here's 73 lb of sugar per year." "This is from the Economic Research Service of the U.S. Department of Agriculture." "So, disappearance data." "73 lb up to 95 lb by 2000." "And there's something missing from this slide." "Anybody wanna tell me what it is?" "What's missing?" "Juice." "Juice is missing, because juice is sucrose, right?" "Sugar?" "And juice causes obesity." "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 WIC." "Anybody heard of WIC?" "You what WIC is?" "Women Infants Children, right?" "A government entitlement program set up under who?" "Nixon, ok." "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 syrups, when you put them together, now we're up to 113 lb 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're actually up to 141 lb of sugar per year, each of us." "That's what we're up to, 141 lb of sugar per year." "Now, do you think that this might have some detrimental effects on you?" "Hasn't stopped you, has it?" "That's the point, it hasn't stopped you." "That's why we need to talk about this." "So, juice consumption increases the risk for the type 2 diabetes, ok?" "So, this is the relative risk ratio as juice intake goes up and this is in the Nurse's Study." "Showing again... juice consumption, sucrose, obesity, diabetes..." "The third political storm, that swirling around to create this disaster, this mega typhoon." "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?" "In fact, it's worked the exact opposite, we've only created more, ok?" "So, how did this come to be?" "Why did they tell us to stop eating fat?" "Well, in the early 1970's, 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-1970's, 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." "Dietary fat definitely increases your LDL, no argument, it's true." "And then, finally, in the late 1970's, we learned that LDL correlated with cardiovascular disease." "So, let's call cardiovascular disease C." "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'." "So, the logic isn't even right, it's faulty logic here." "So, this doesn't work on any level." "So, I'm gonna show you why this doesn't work." "And here's... but before I show you why it doesn't work," "I'm gonna show that this was a battle royal, back in the 1970's." "This was not a simple thing." "There were people lined up on both sides of the story." "So, this, over here, is a book, 1972 it came out, and was called 'Pure, White and Deadly'." "It's all about sugar." "Written by a British physiologist, nutritionist, endocrinologist by the name of John Yudkin." "And 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 accolade, I was a Yudkin disciple." "Every single thing that this man said in 1972 is the God's honest truth." "And if you wanna read a true prophecy, you find this book." "It's not easy to find, but you go find this book, and I'm telling you, every single thing this guy said has come to pass." "It's astounding." "I'm in awe of this guy." "But on the other side, we had this guy over here." "His name was Ancel Keys." "Anybody heard of him?" "So, Ancel Keys was a Minnesota epidemiologist, very interested in the cause of cardiovascular disease." "And he performed the first multivaried regression analysis without computers." "Now, anybody know what that means?" "Multivariate regression analysis?" "So, this is where you take a whole lot of data, and normally you would just, you know, run a few computer programs." "But, basically, the objective 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." "Very famous, front page of Time Magazine in 1980." "So, here's the data on the Seven Countries Study." "So, we have the U.S., Canada, Australia, England, Wales, Italy, Japan." "And here's percent calories from fat on the X axis and here we have coronary disease death rate on the Y axis." "And so, you'd say "oh, look at that." "I mean, it's very obvious, isn't it? "" "Sure, percent calories from fat correlates very nicely with coronary disease." "Except for one little problem..." "anybody see it?" "Japan and Italy?" "So, how much sugar do they eat?" "Didn't I tell the Japanese diet eliminates fructose?" "They never even had it until we brought to them after WWII." "Italy?" "You know, aside from gelatto?" "I mean, what else they got?" "They got a lot of pasta, it's a lot of glucose, but no fructose." "There's no sugar in the Italian diet other than the occasional sweet, which they moderate, they're very careful about moderating and they cost a lot." "But, here we got England, Wales, Canada, Australia, U.S., you know, we are sugarholics, aren't we?" "We're also fataholics." "So, in fact, the fat migrated with the sugar." "So, here's... this is from Keyes's own work, ok?" "Page 262, if you wanna pick up the 500 page volume." "I'm just gonna read you the one paragraph that talks about this." ""The fact that the incidence rate of coronary heart disease was significantly correlated with the average percentage of calories from sucrose in the diet is explained by the intercorrelation of sucrose with saturated fat. "" "In other words, donuts." "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. "" "Ok." "When you do a multivariate linear regression analysis, you have to do it both ways." "You have to do holding fat constant showing the sucrose doesn't work, 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 in policy in this country..." "on this study." "And as far I'm concerned, it has a hole as big as the one in the U.S. 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're two LDLs." "Here's one, over here, it's called 'pattern A' or large buoyant LDL." "So, everybody knows that LDL correlates with cardiovascular disease and that's true and I'm not gonna argue that, that is true." "But it's not this one, pattern A LDL." "These guys are so light, they are buoyant, they float." "So, they get carried through the blood stream 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." "Now, when we measure LDL in the blood stream, when you do a liquid profile, you measure both of them together, because it's too hard to distinguish the two." "So, when you get an LDL, you're getting both LDLs." "The neutral one and the bad one." "Now, how can you tell whether your LDL is the neutral one or the bad one?" "What you do is you look at your triglyceride level in association with it." "Because your triglycerides tell you which one it is." "So here, here's pattern A over here." "Big, large, buoyant LDLs." "And you'll notice that the triglycerides are low and your HDL is high." "That's what you want." "You want a low triglyceride, high HDL, because that's the good cholesterol." "You want high good cholesterol." "Over here, you have pattern B. Here you have high triglyceride, low HDL." "That's the bad guy." "That's the guy you don't wanna be 'cause you're gonna die of a heart attack." "No question about it." "Triglyceride 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." "So, here is percent carbohydrate and here's your pattern B going up." "Everybody got it?" "So, what do we do?" "What were we doing 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, ok?" "Took America and the world by storm because the content of the low fat, home cooked food, that you cook by yourself, in your house, you can control the content of fat." "But you process it, low fat processed food, it tastes like cardboard." "It taste like crap." "So, the food companies knew that, so what did they do?" "How to make it palatable?" "So, how do you make it something palatable, has no fat in it?" "You add the sugar, right?" "So, everybody remember Snackwells?" "So, 2g of fat down, 30g of carbohydrate up, 4 of them being sugar, so that it was palatable." "Well, we've just shown you that's the worst thing you could do." "And that's what we've done and we're still doing it today." "So, when you find a mistake, what do you do?" "You admit the mistake and you right the ship." "We haven't admitted the mistake and we haven't righted the ship." "So, we've had our food supply adulterated, contaminated, poisoned, tainted." "In 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 extensively browning agent, which actually has its own issues, because why it browns so well with the sugar in it," "actually it's 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 stake on the grill, it works in your arteries the same way." "And removal of fiber also." "Now, why did we remove fiber from our diet?" "We, as human beings, walking the earth, 50,000 years ago, used to consume 100 to 300 g of fiber per day." "We now consume 11." "Why?" "What did we do?" "We took the fiber out." "So, why did we take the fiber out?" "It takes too long to cook, takes too long to eat and shelf life." "So, people ask me what's the definition of fast food." "Fibreless food." "I dare, other than a salad, I dare you to go to any fast food restaurant and find anything on their menu that actually have to cook, that has more than 1g 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 a fast cooking, but it's fast eaten, which also causes a its own satiety issues." "Bottom line, we have a typhoon on our hands." "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 problem." "So, we've actually gotten rid of most trans-fats, not completely, but most." "So, this is it." "This is what we've done over the last 30 years." "Ok, now to the biochemistry." "Now, how many of you here have taken biochemistry?" "About 25%." "I'm 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." "Ok?" "You can do that, right?" "Just count the arrows?" "It's not like counting sheep." "You can count the arrows and just stick with me, ok?" "Just let me do my thing and let me show you why fructose is not glucose." "Because what the liver does to fructose is really unique and you've gotta understand it to understand everything I've just told you." "So, number 1:" "fructose is 7 times more likely than glucose to do that browning reaction, the advanced glycation end-products." "The thing that happens on your grill happens in your arteries for the same reason." "You can actually see the color too, 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." "So, when you..." "if you pre-load a kid with a can of soda and then you let him loose at the fast food restaurant, did they eat more or did they eat less?" "They eat more." "They just took on 150 calories yet, they eat more." "Reason?" "Because fructose does not 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, ya (?" ") eat more." "And finally, I'm gonna show 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 evening is out, that chronic fructose exposure alone, nothing else, causes this thing we call the metabolic syndrome." "Everybody knows what the metabolic syndrome is?" "So, this is the conglomerate of the following different phenomena:" "obesity, type 2 diabetes, liquid problems, hypertension and cardiovascular disease." "Those all cluster together, called metabolic syndrome." "I'm gonna show you how fructose does every one of those." "I wanna show you the difference between glucose and fructose in a way that will be glaringly apparent." "So, let's consume 120 calories in glucose..." "two slices of white bread." "What happens to that 120 calories?" "Now, you eat that 120 calories, 80% of the total will be used by all the organs in the body." "80% off the table." "Why?" "Because every cell in the body can use glucose." "Every bacteria can use glucose." "Every living thing on the face of the Earth can use glucose because glucose is the energy of life." "That's what we're supposed to eat." "24 of those calories, or 20% will hit the liver." "So, let's watch what happens to those 24 calories." "Here they go." "So, the glucose comes in through this transport of glucu2." "Out here, the glucose is gonna stimulate the pancreas to make insulin." "The insulin is gonna bind to its receptor." "Ant it's gonna take this substrate over here called IRS-1, insulin receptor substrate 1, that's not important right now." "Don't worry." "And it's gonna tyrosine phosphorylated" "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 AKT." "Now, what AKT does is it stimulates this guy down here, SRIBP-1, still receptor binding protein 1." "Don't worry about it." "But this is the thing that ultimately gets fat mechanics going." "So you'll see in a minute." "So, one of the things that SRIBP-1 does is it activates this enzyme here called glucokynase, 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 norepinephrine." "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, ok?" "Now, the glucose-6-phosphate almost all of it is gonna end up going over here to something call glycogen." "Now, glycogen is the storage form of glucose in the liver." "Because glycogen is easy to fish the glucose out with glucagon and epinephrine." "So, my question to you, and I grant this is a physiology question, is how much glycogen can your liver store before it gets sick?" "The answer is any amount." "Unlimited." "We have carb loaders who run marathons, right?" "So, hurt them at all?" "We have kids with the disease where they can't get the glucose out of the glycogen called glycogen storage disease type 1A, or von Gierke's disease." "They got livers down to their knees they're so big." "(?" ") They're hypoglycemic like ?" "because they can't lift the glucose out of their liver." "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 gonna get metabolized down to this stuff here called pyruvate." "And the pyruvate is gonna enter your mitochondria over here." "Remember, your mitochondria are the parts of your cell that actually burn the energy." "They're your little factories." "They make the stuff that lets you live, called ATP." "ATP, adenosine try-phosphate, that's the energy of life right there." "So, the pyruvate comes in, gets converted to something called Acetyl-CoA, gets metabolized by this thing called the Krebs cycle, TCA cycle, and you throw off ATP and carbon dioxide, which you breath off." "So far, so good?" "Have I snowed anybody yet?" "You with me?" "I snowed one guy back there." "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 have exited as citrate." "And the citrate then leaves the mitochondria through a process known as the citrate shuttle and then that citrate can then be broken down by these three enzymes, which are all subservient to this SREIBP-1." "This is ATP-citrate lyase (ACL), Acetyl-CoA carboxylase (ACC), fatty acid synthase (FAS)." "They're not important." "The only thing to know is these three enzymes together turn sugar into fat." "This is called de novo, meaning new, lipogenesis... fat making." "This is de novo lipogenesis." "So, you take the citrate, which came from the glucose, 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." "VLDL is bad because that's one of the things that causes heart disease." "It's also a substrate for obesity." "So, you don't wanna make much of this." "But the point is you started with 24 calories, maybe a half a calorie will end up as VLDL." "So, that little Japanese guy with the little hat, you know, working out in the field, eating rice for next 90 years, you know, can he die of a heart attack at age 90?" "Sure." "But that's not so bad." "If you make until 90 you're doing all right." "Because of that VLDL coming from glucose." "Glucose made a little bitty VLDL." "And that serves as a substrate for adipose deposition into your fat cell here, triglyceride." "In addition, because the insulin went up in response to glucose, your brain sees that signal and it knows that that it's supposed to shut off further eating." "In other words, hey, I'm busy metabolizing breakfast, I don't need lunch." "And so, you have a nice negative feedback loop between glucose consumption, the liver, the pancreas and the brain to keep you in normal, negative, ying-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." "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?" "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." "But let's talk about how it's bad for you." "So, here's acute ethanol exposure:" "CNS depression, vasodilatation, hypothermia, tachycardia, myocardial depression, pupillary responses, respiratory depression, diuresis, hypoglycemia, loss of fine motor control, you all went to college." "Here's fructose:" "nothing." "Doesn't do any of those, because the brain doesn't metabolize fructose." "Alcohol gets metabolized in the brain to cause all of those things, but fructose doesn't." "So, fructose is not an acute toxin; ethanol is." "We control ethanol, don't we?" "We have something called the Bureau of Alcohol, Tobacco and Firearms, right?" "We have all sorts of things." "We tax ethanol." "We do all sorts of things to limit consumption of ethanol." "The Nordic countries, all the liquor stores are state run... in an attempt to try to set the price of ethanol high enough so as to discourage consumption for public health reasons." "We have 1500 years of alcohol control policy in this world to draw on, in terms on how to limit consumption, got it?" "Because ethanol is a toxin and we know it." "So, let's consume a 120 calories in ethanol." "A shot of Maker's Mark." "Anybody tasted it?" "Yeah, good, ok." "So, 24 calories right off the top." "The stomach and the intestine have something called the first pass effect, so 10% off the top." "And kidney, muscle and brain will consume the other 10%." "So, there goes 20%, or 24 calories right off the top." "96 calories of the 120 are gonna hit the liver." "Now, how many was it for glucose?" "It was 24." "So, 4 times the substrate is gonna hit the liver." "And there's the rub." "This is a volume issue." "We're gonna show you how." "So, the ethanol comes in, passive diffusion, there's no receptor for it, no transporter." "First thing that happens is ethanol gets converted to this guy over here called acid aldehyde." "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 crosslink proteins, is what they do." "So, if crosslink 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 and it generates something called reactive oxygen species." "Remember, 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?" "Ok, so this is one of the reasons why alcohol is bad." "Now, the acid aldehyde will come down here to something called acetate." "The acetate will enter the mitochondria, just like the pyruvate did before, will get converted to Acetyl-CoA and participate in the TCA cycle just like before, to generate energies, you know, so that alcoholics don't die from lack of energy." "They got energies, everything else they don't have." "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 half, right?" "Because most of them went to glycogen." "So, we got a big citrate, so it's in big font to show that we're talking about big citrate now." "And so, the big citrate is gonna get metabolized all the way to VLDL by the SRIBP-1." "And so, you're gonna get a lot of VLDL and this is the dyslipidemia of alcoholism right here." "Everybody see that?" "So, the liver is gonna try to export this VLDL out, so that it doesn't get sick, because when fat builds up in the liver, that's not good for it." "Some of it is gonna exit as free fatty acids and those free fatty acids will take up residence in the muscle and you get something called muscle-insulin resistance." "So, insulin resistance, that's a bad thing." "That makes your muscles and your liver not work so well." "And can cause all sorts of other problems, like diabetes." "Some of the Acyl-CoA won't even make it out, 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 activated." "It's called c-Jun N-terminal kinase-1 or JNK1 and it really is JNK1 because it is the bridge between metabolism and inflammation." "So, when you generate JNK1, you do bad things to your liver, which I will you when we talk about fructose." "So, let's talk about fructose." "Fructose is sweet." "We like it a lot." "We like it in everything." "We like it in our bread." "We like it in our pretzels." "We like it everywhere we look." "So, let's consume 120 calories in sucrose." "A glass of orange juice." "Everybody got it?" "So, two slices of white bread, a shot of 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 1:" "the glucose, remember, because glucose is half sucrose, half fructose... so, 60 of the calories of the 120 are glucose. 12... are gonna make it into the liver, 48 out here for the rest of the body." "The same 20/80 split we had before with glucose... so far, so good." "But all 60 calories of fructose are gonna be metabolized by the liver." "Why?" "Because only the liver can metabolize fructose." "So, what do we call it when you're taking a compound that's foreign to your body and only the liver can metabolize it and in the process generates various problems?" "What do we call that?" "We call that a... poison." "So, let me show you how it's a poison." "So, let's watch the fructose." "So, the fructose comes in through this transporter now, before it was Glut2, now it's Glut5, no insulin, remember, because fructose does not stimulate insulin." "The fructose then gets metabolized by this guy over here called fructokinase to form something called fructose-1-phosphate." "In the process, ATP has to give up one phosphate to ADP, because the phosphate has to come from somewhere, so comes from here." "Now, before we had 24 calories that had to be phospho-related." "Now, we have 72 calories that have to be phospho-related." "So, we have three times the substrate and there's the rub." "It's a volume issue for right now." "So, we're gonna lose a lot of phosphate, aren't we?" "So, there's a scavenger enzyme in your liver called AMP deaminase 1 to rescue the phosphates off the rest of the ATP molecule." "It takes ADP down to AMP, adenosine monophosphate down to IMP, inosine monophosphate." "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, ok?" "Also causes another disease... called hypertension." "Let me show you how." "Because your uric acid turns out blocks the enzyme in your blood vessels called endothelial nitric oxide synthase." "And that's the enzyme that makes the stuff called nitric oxide NO." "And that is your endogenous blood pressure lowerer." "That keeps your blood pressure low." "So, when you can't make it your blood pressure goes up." "So, this just shows that fructose consumption increases gout in adults." "So, this is a study that came out last year showing that fructose consumption increases the risk for gout, showing that uric acid is going up." "This is a study done by our pediatric renal fellow Stephanie Wynn, just published in Journal Pediatrics." "It's not submitted anymore, it's long impressed." "Showing that, this is in the Nhanes database, in the adolescents, showing that sugar-sweetened beverages, as it goes up, your uric acid goes up." "And, not only does your uric acid goes 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 Faig, at the University of Texas in 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." "So, so far we have high blood pressure... let's keep going." "The fructose will get metabolized down to pyruvate... the pyruvate will enter the mitochondria, just like before, throwing off a lot of citrate." "And here's a little trick that fructose does that glucose doesn't, because these two can reform this stuff over here called fructose-1,6-bis-phosphate, which can then reform with glyceraldehyde to form this guy over here called xylulose-5-phosphate." "And I'll get to xylulose-5-phosphate in a moment." "But, I wanna point out this asterisk, that's there to remind me to tell you something." "That's there to remind me to tell you that this is why the sports drink companies put high fructose corn syrup in the sports drinks." "Because if you are glycogen depleted, in other words, if you just ran a marathon, and you've no glycogen left in your liver because you burned it all, and you take in an 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 drinks, actually makes sense." "And so, indeed, sports drinks have high fructose corn syrup." "The question is:" "who's drinking the sports drinks?" "Any elite athlete 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." "Ok, so, before we go on, I just wanna, now, digress for a moment, ok?" "1967..." "University of Florida patents Gatorade." "Everybody remember Gatorade?" "1970... the Florida Gators win NCWA Championship in football." "Gatorade makes a big splash." "Big deal." "Anybody tasted the original Gatorade?" "Yeah?" "What it taste like?" "Tasted horrible!" "It tasted like something that you might find, you know, in... you know, coming out of you instead of going into you." "It tasted awful!" "1992, Pepsi buys Gatorade..." "and they say:" "how we're gonna market this swill?" "So, what did they do?" "They added the high fructose corn syrup." "So, now, who drinks it?" "Right, fat kids... right?" "Not even skinny kids, fat kids drink it." "So, there's a problem here." "We're gonna show you how that works." "So, xylulose-5-phosphate, just to show you." "So, here's, if you take a rat and you glycogen deplete him by make him run on an exercise wheel, and then you refeed them with starch or with sucrose, the xylulose-5-phosphate goes way up with the sucrose." "So, you get more xylulose-5-phosphate through this pathway here, going over here." "So, why do we care about xylulose-5-phosphate?" "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?" "De 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... which then gets packaged... to the VLDL..." "and I've got the dyslipidemia... of obesity, of fructose consumption, which it's been known for many years." "So, here's... normal medical students..." "if you can call them normal." "Taking in a glucose load... notice?" "Almost none of it ends up as fat." "Taking in a fructose load, same number of calories, 30% of it ends up as fat." "So, when you consume fructose, you're not consuming 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, ok?" "This is a study where they gave an acute administration of fructose and you can see the triglycerides going up, compared to the control." "Serum triglyceride right there." "Here's normal medical students again, 6 days of high fructose feeding:" "triglycerides doubled, de novo lipogenesis went up five times higher... and here's free fatty acid, which then caused insulin resistance doubled." "6 days." "So, here's the dyslipidemia of fructose consumption... we're not done." "Some of the fat won't make it out of the liver, just like with ethanol." "And now you've got a liquid droplet, so, now, you've got this non-alcoholic steatohepatitis." "So, this is work that we did, in our clinic, looking at sugar can sweetened beverages consumption against the liver enzyme marker ALT, alanine aminotransferase, which tells you about fatty liver." "And sure enough here, 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 another story all by itself." "So, there's the liquid droplet of non-alcoholic steatohepatitis." "Some of it will come out of free fatty acids and populate the muscle, will also tell the insulin to go up higher..." "remember that JNK1?" "So, here's what JNK1 does, so, the Acyl-Coa and the fructose can all activate JNK1." "And what JNK1 does is..." "remember when we used glucose... this IRS became tyrosine-IRS-1 and that was good?" "Remember that?" "Well, JNK1, what it does is it's searing phosphorylate IRS-1 and pSer-IRS-1 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." "And, finally, our research has shown 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 in many different ways that fructose consumption changes the way your brain recognizes energy, all in a negative fashion," "so that you basically think you're starving, your brain gets the signal that you're starving, even though your fat cells" "(?" ") are generating a signal that says "hey, I'm full like all get-out"." "This just shows you how it goes." "So, the high insulin generates the obesity because this is that..." "remember that first law of thermodynamics?" "The biochemical force generating the energy storage as the primary phenomenon, remember?" "If you're gonna store it, and you expect to burn it, then you're gonna have to eat it?" "So, here's the stored... 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 no stopping." "So, here we are." "Hypertension, inflammation, hepatic insulin resistance, hyperinsulinemia, dyslipidemia, muscle insulin resistance, obesity and continued consumption." "Looks like metabolic syndrome to me." "So, here are the phenomena associated with chronic ethanol exposure:" "hematologic disorders, electrolyte abnormalities, hypertension, cardiac dilatation, cardiomyopathy, dyslipidemia, pancreatitis, malnutrition, obesity, hepatic dysfunction, that's alcoholic steatohepatitis, fetal alcohol syndrome and addiction." "Here's fructose:" "8 out of twelve." "Why?" "Because they do the same thing." "Because they metabolize the same way." "Because they are the same." "They come from the same place, right?" "How do you make ethanol?" "Naturally." "Right, you ferment sugar." "Hasn't changed, because it has all the same properties, because it's basically taken care by the liver in exactly the same way and for the same reason." "Because sugar and ethanol are the same." "Every which way you turn." "So, here's our clinic intervention." "This is what we do in our clinic." "It's as simple as you can imagine." "We write this on the back of a matchbook." "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 all sugared liquids in the house, bar none." "Only water and milk." "There is no such thing as a good sugar beverage, period." "Eat your carbohydrate with fiber." "Why?" "Because fiber is good." "Fiber is supposed to be an essential nutrient... and we can talk later, if you want, after the cameras turn off, as to why fiber is not an essential nutrient." "Because the government doesn't want it to be, ok?" "Because then they couldn't sell food abroad." "Wait 20 minutes for second portions." "To get that satiety signal." "And finally, buy your screen time minute-for-minute with physical activity." "That's the hardest one to do." "So, if you play for half an hour, you can watch TV for half an hour." "You wanna watch TV for an hour, play for an hour." "That was 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, works, ok?" "So, this is BMI z-score time from an 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 sugared beverages the patients drank at baseline, the less well the lifestyle intervention worked, for all the reasons I just showed you." "So, why is exercise important in obesity?" "Because it burns calories?" "Come on... 20 minutes of jogging 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 1: it improves that skeletal muscle insulin sensitivity, because your insulin actually works better at your muscle, which then brings your insulin levels down, which is good for you." "Number 2:" "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 the beyond the scope of this lecture today, but we can talk about it in the question period, if you want." "And then finally, remember that de novo lipogenesis, remember those three nasty enzymes?" "What if you 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 turn 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, ok?" "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!" "You can't do it..." "I mean, one Big Mac, you know, you gotta, you know, mountain bike for 10 hours!" "Are you joking?" "Ok, 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. "" "Because fructose is a poison." "I think I've hopefully shown you that." "But wherever there's fructose in nature, there's way more fiber." "Did ever see a piece of sugar cane?" "It's a stick." "Right?" "You can't even chew the damn thing, right?" "You have to suck the stuff out, like that, right?" "I mean, how many calories you think you're gonna get out of a piece of sugar cane?" "They actually did studies on the sugar plantations back in the early 1900's." "All of the workers were healthy and lived longer than the sugar executives, who got the processed product." "How about that?" "I wonder why..." "So, eat your carbohydrate with fiber." "That's why we say that." "That includes sugar." "That's why fruits are ok." "Because, number 1, it limits how much fructose you're gonna take in;" "and, number 2, 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 1, it reduces the rate of intestinal carbohydrate absorption." "Now, sometimes that's bad." "I'll tell you when that's bad." "You know when that's bad?" "That's bad when you're at a formal function." "Because what happens when you reduce the rate of carbohydrate absorption in your gut?" "The bacteria get to it." "So, as far as I'm concerned, in life, you've got two choices:" "it's either fat or fart." "It increases the speed of transit of the intestinal contents to the ileum." "And that raises this hormone over here called PYY, which goes to your brain and tells you the meal is 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?" "Go home and read upon it on the internet." "The Paleolithic diet basically, if you eat everything as it came out of the ground, raw, with no cooking, ok?" "You would cure diabetes on a dime." "Takes about a week... because you're getting that 100 to 300g of fiber" "I mentioned before, that's why." "Because fiber is good for you." "And the more, the better... type 2, right, type 2, not type 1." "I stand corrected, type 2." "Ok, now, for some fun, that's the end of the biochemistry." "How did I do?" "I told I'd get you through it." "Ok, so now comes the fun part, the racial innuendos and, you know, all the political stuff." "The "fructosification" of America and, of course, the world, ready?" "And now, the quiz:" "Can you name the seven foodstuffs at McDonald's that don't have HFCS or sucrose?" "No, mustard has it." "Oh, come on, come on, the big one." "French fries!" "But they have salt, starch and fat, they're not so good either." "What else?" "We'll get to coffee." "Hash browns, for the same reason, right, salt, starch and fat." "What else?" "Chicken Mcnuggets, I was shocked." "I was shocked, no sucrose or HFCS in Chicken Mcnuggets, but as the..." "Circuit Court Judge in New York called them, they are still a McFrankenstein creation." "But, nonetheless no sucrose, I was shocked." "Sausage." "Oh, they're terrible, they're just disastrous, but, I mean, there's nothing good in the middle of all of them, but there's no fructose." "Sausage, diet coke, 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, have a disclaimer." "Because no one eats the Chicken Mcnuggets without the dipping sauce." "And there's a whole bunch of HFCS in the dipping sauce, right?" "So, who's really drinking this?" "We talked about this before." "Gatorade AM." "So, this is an attempt by Pepsi to capture market share on the juice market, right?" "Do you think there are any elite athletes who actually drink this stuff?" "You gotta be kidding me." "This is for kids." "Right?" "So, this really blew my socks off." "This was my daughter when she was in second grade two years ago, Miriam Lustig." "Brought these two cartons of milk home for me and said:" ""Dad, you're not gonna believe this. " Second grade." "So, here's the calories in Berkeley Farms 1% low fat milk." "130 calories, 15 of them are sugar, because it's lactose, right, which is ok." "And here's Berkeley Farms 1% chocolate milk." "190 calories, 29g of sugar, all HFCS." "It's like a glass of milk plus a half of glass of orange juice." "That's what we're giving to our kids and you know what the the nutrition department at the SUFD says?" ""Well, we have to get our kids to drink milk somehow. "" "Now, is that brilliant or what?" "I don't know." "Now, what about WIC?" "So, we talked about the 112 lb of orange juice that the kid down at Salinas was drinking, what about WIC?" "So, remember what we started with, we have an epidemic of obese 6-month olds?" "Remember?" "So, could this be the reason?" "So, here's a can of formula." "43.2 % corn syrup solids, 10.3 % sugar." "It's a baby milk shake." "Soda, Coca-cola is 10.5 % sucrose." "Formula is 10.3 % sucrose." "Any difference?" "And there's a huge literature, that's now coming of age, that shows that the earlier you expose kids to sweet, the more they're gonna crave it later." "Plus, there's a new literature that shows the more sugar the pregnant woman drinks or eats during the pregnancy, the more it gets across the placenta." "And actually causes what we call developmental programming, changing the kid's adiposity even before the kid is born and driving this whole epidemic even further." "So, we'll close in a few minutes, but I just wanna point out what's the difference." "Here we got a can of coke, here we got a can of beer." "(?" ") I'm not picking on a Schlitz or anything, any beer you want." "So, 150 calories each." "No difference in terms of total calories." "Percent carbohydrate." "So, 10.5 % from sucrose here, except it's HFCS, who cares?" "3.6 % alcohol." "Here's the breakdown:" "75 fructose, 75 glucose for the coke." "90 alcohol, 60 maltose for the beer." "Remember, the first pass GI metabolism takes 10% of the alcohol off the table?" "So, when you actually compute the number of calories hitting the liver, which, remember, was the big difference between glucose and fructose, remember?" "72 versus 24?" "And started the whole thing into motion, as terms of what happens that's bad?" "Bottom line:" "No difference." "So, we have 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." "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." "So, when people talk about high fat diets doing bad things... no, what they're really talking about is high fructose diets and that's what Ancel Keys was looking at." "So, the corollary to that is, in America at least, and around the world too, a low fat diet isn't really a low fat diet... because the fructose or sucrose doubles as fat, it's really a high fat diet." "That's why our diets don't work." "And fructose, just like ethanol, for the same reason, through the same mechanism, and in the same dosing is also 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 wanna 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 Glens runs right across the street, Stan's a good guy, ok, I like Stan a lot." "And he showed me this:" "(?" ") Under the regulations governing food additives... so, this came from an ?" "," "Philip Morris executive..." "it is required that additives be "safe", defined as reasonable certainty by competent scientists that no harm will result from the intented use of the additive." "Now, does fructose meat that standard?" "Well, the FDA says that fructose, HFCS has what's known as GRAS, G-R-A-S status," "Generally Regarded as Safe." "Now, where do that come from?" "Nowhere." "It came from nowhere." "It came from the notion that well, fructose is natural!" "It's in fruit, must be ok... right?" "Well, tobacco is natural too!" "But it's not." "Ethanol is natural, but it's not." "A whole bunch..." "Jamaican Ackee fruit is natural, but it's not either, it'll kill you!" "Keeping ongoing... a food shall be deemed to be adulterated if it bears or contains any poisonous or deleterious substance which may render it injurious to health." "Fructose fits that description, right?" "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 three things in this country..." "that we can still sell overseas:" "weapons, entertainment and food." "Cars?" "!" "Huh!" "Computers?" "I don't think so." "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 wanna know about this, ok?" "Because this is bad news." "And so, who runs the food pyramid?" "The USDA." "It's the fox in charge of the hen house." "Because their job is to sell food." "And who's eating it?" "We are." "So, in summary:" "fructose, and I don't care what the vehicle is, it's irrelevant, sucrose or HFCS, I don't care... fructose consumption's increased in the past 30 years, coinciding with the obesity epidemic." "A calorie is not a calorie." "And the dieticians in this country are actually perpetrating this on us." "Because the more you think a calorie is a calorie, the more you think well, then if you ate less and exercised more, would work." "It doesn't!" "All of the studies show it doesn't work." "Here's why it doesn't work, because a calorie is not a calorie." "Fructose is not glucose." "We know a calorie is not a calorie, because there are good fats and bad fats." "There's good protein and bad protein, ok?" "There's good carbohydrate and bad carbohydrate." "And glucose is good carbohydrate." "Glucose is the energy of life." "Fructose... is poison." "You are NOT what you eat." "You are WHAT YOU DO with what you eat." "And what you do with fructose is particularly egregious and dangerous." "Hepatic fructose metabolism leads to all the manifestations of the Metabolic Syndrome:" "hypertension, through that uric acid pathway;" "de novo lipogenesis, dyslipidemia, hepatic steatosis, through that DNL pathway, those 3 enzymes, the new fat making pathway, inflammation through JNK1;" "hepatic insulin resistance, because the serine phosphorylation of IRS-1, 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 work." "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, ok?" "That's a famous saying here in San Francisco, right?" "I'm Harvey Milk and I'm here to recruit you." "Ok, I'm Robert Lustig and I'm here to recruit you." "In the war against... bad food." "And this is what's bad." "With that, I wanna thank my colleagues at the UCSF Dept. of Pediatrics in our weight assessment for teen and child health clinic." "UCSF Dept." "of Epidemiology and Biostatistics and also the Dept." "of Nutritional Sciences at UC Berkeley, in particular Dr. Jean-Marc Schwarz, who is a card-carrying fructose biochemist, PhD biochemist, who vetted all 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 fifteen years and he didn't even realized it was a toxin until he saw this." "So, with that I'll close." "Thank you." "subtitle by:" "Tio Beto from Brazil  suggestions/corrections: tiobetonh@gmail. com ... =Peace Through Anarchy=..."