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1:06 - I'm going to tell you, tonight, a story.
1:10 And this story dates back about 30 years.
1:15 This story has a little bit of something for everybody.
1:18 It has a little bit of biochemistry,
1:21 a little bit of clinical research,
1:23 a little bit of public health,
1:25 a little bit of politics, a little bit of racial innuendo.
1:29 The only thing it's missing is sex.
1:31 (audience laughs)
1:32 But, well, we can see what we can do about that, too.
1:37 By the end of the story I hope I will
1:39 have debunked the last 30 years
1:41 of nutrition information in America.
1:44 And I would very much appreciate it
1:45 if at the end of the talk, you would tell me
1:47 whether or not I was successful or not.
1:50 Okay?
1:51 So, in order to get you in the mood,
1:54 as it were, let's start with a little quiz.
1:57 What do the Atkins Diet
1:58 and the Japanese Diet have in common?
2:03 Anybody?
2:05 Hm?
2:06 Oh, you have the answers right, never mind.
2:10 That's right, you have the answer right there.
2:13 So the Atkins diet, of course, is all fat no carb.
2:16 The Japanese diet's all carb, not fat.
2:18 They both work, right?
2:22 So what do they share in common?
2:24 They both eliminate the sugar, fructose.
2:28 So, with that, think about what it means to be on a diet,
2:34 and what macro-nutrients you're eating
2:37 and which ones your not.
2:38 And then we'll go from there, and I'll try
2:40 to explain how this all works.
2:42 So, you've all heard about the obesity epidemic.
2:45 Here are the numbers.
2:47 These are the NHANES database Body Mass Index.
2:52 Everybody knows what that is now.
2:53 Histograms marching ever rightward as time has gone on.
2:58 This was what was projected for 2008 in blue.
3:01 We had so far exceeded and surpassed,
3:03 this is not even funny.
3:04 This was from 2003.
3:05 The reason I show this is not just to show
3:08 that the obese are getting obeser,
3:10 of course, that's true, but in fact
3:12 the entire curve has shifted.
3:14 We all weigh 25 pounds more today
3:17 than we did 25 years ago, all of us.
3:19 Now, it is often said that obesity
3:22 is the ultimate interaction between
3:24 genetics and environment.
3:26 And Doctor Christian Vaisse, who's sitting
3:27 in the back of the room, will be talking
3:29 to you next week about the genetic component,
3:31 which I am also very interested in.
3:33But, having said that, our genetic pool
3:36did not change in the last 30 years,
3:38but, boy oh boy, has our environment sure changed.
3:42So, tonight, we're gonna talk about
3:43the environment rather than genes.
3:46Now, in order to talk about the environment,
3:48we need to talk about what is obesity.
3:50And, of course, you're all familiar with
3:52the basic concept with the first law of thermodynamics,
3:55which states that the total energy
3:56inside a closed system remains constant.
3:59Now, in human terms, the standard interpretation
4:02of this law is the following.
4:05If you eat it, you better burn it, or you're gonna store it.
4:11Now, who here believes that?
4:13Oh, come on, you all do.
4:14(audience laughs)
4:16I used to believe that.
4:18I don't anymore.
4:19I think that's a mistake.
4:21I think that is the biggest mistake.
4:22And that is the phenomenon I'm going to try to debunk
4:27over the course over the next hour.
4:30Because I think there's another way to state the law
4:33which is much more relevant, and much more to the point.
4:36Before I get there, of course, if you believe that,
4:39these are the two problems, calories in, calories out.
4:42Two behaviors, gluttony and sloth.
4:45After all, you see anybody on the street,
4:47"Oh, he's a gluttonous sloth, that's all there is to it."
4:50Tommy Thompson said it on the TV show.
4:52"We just eat too damn much."
4:54Well, you know, if that were the case,
4:57how did the Japanese do this?
4:59Why are they doing bariatric surgery
5:00on children at Tokyo Children's Hospital today?
5:04Why are the Chinese, why are the Koreans,
5:06why are the Australians?
5:08I mean, all these countries who've adopted our diet
5:12all suffer now from the same problem.
5:14And we're gonna get even further in a minute.
5:17There's another way to state this first law.
5:20And that is, if you're gonna store it,
5:22that is biochemical forces that drive energy storage,
5:27and we'll talk about what they are in a few minutes,
5:29and you expect to burn it, that is normal
5:33energy expenditure for normal quality of life.
5:36Because energy expenditure and quality of life
5:38are the same thing.
5:40Things that make your energy expenditure go up,
5:43make you feel good.
5:44Like ephedrine, it's off the market,
5:46coffee for two yours, then you need another hit, like me.
5:50Things that make your energy expenditure go down,
5:53like starvation, hypothyroidism, make you feel lousy.
5:58And how many calories you burn
6:00and how good you feel are synonymous.
6:02So, if you're gonna store it,
6:04that is an obligate weight gain
6:05set up by a biochemical process,
6:07and you expect to burn it, that is normal
6:09energy expenditure for normal quality of life,
6:12then you're gonna have to eat it.
6:14And now, all of the sudden, these two behaviors,
6:18the gluttony and the sloth, are actually secondary
6:20to a biochemical process, which is primary.
6:24And it's a different way to think about the process.
6:26And it also alleviates the obese person
6:29from being the perpetrator, but rather the victim.
6:33Which is how obese people really feel.
6:36'Cause no one chooses to be obese.
6:38Certainly, no child chooses to be obese.
6:40Oh, you say, "Oh, yeah, sure,
6:42"I know some adults who don't care."
6:43You know, Rossini, the famous composer,
6:46you know La gazza ladra, Figaro, and all that.
6:48He retired at age 37
6:50to a lifetime of gastronomic debauchery.
6:52Maybe he chose to be obese.
6:55But the kids I take care of in obesity clinic
6:58do not choose to be obese.
7:00In fact, this is the exception that proves the rule.
7:06We have an epidemic of obese six month olds.
7:10Now, if you wanna say that it's all about
7:12diet and exercise, then you have to explain this to me.
7:16So, any hypothesis that you wanna proffer
7:20that explains the obesity epidemic,
7:22you've got to explain this one too.
7:25And this is not just in America,
7:27these six month old obese kids,
7:28but these are around the world now.
7:32So, open your minds?, and let's go
7:35and figure out what the real story is.
7:40Let's talk about calorie intake,
7:42because that's what today is about.
7:43We're gonna talk about the
7:44energy intake side of the equation.
7:47Sure enough, we are all eating more now
7:50than we did 20 year ago.
7:53Teen boys are eating 275 calories more.
7:56American adult males are eating 187 calories more per day.
8:01American adult females are eating 335 calories more per day.
8:06No question, we're all eating more.
8:08Question is why, how come?
8:11'Cause it's all there?
8:12You know what, it was there before.
8:15We're all eating more, there's a system
8:18in our body, which you've heard about
8:19over the last couple of weeks called leptin.
8:22Everybody heard of leptin?
8:23It's this hormone that comes from your fat cell,
8:25tells your brain, "You know what, I've had enough.
8:27"I don't need to eat anymore.
8:29"I'm done, and I can burn energy properly."
8:32Well, you know what?
8:33If you're eating 187 or 335 calories more today
8:36than you were 20 years ago, your leptin ain't working.
8:39'Cause if it were, you wouldn't be doing it.
8:41Whether the food was there or not.
8:43So, there's something wrong with our
8:46biochemical negative feedback system
8:49that normally controls energy balance.
8:52And we have to figure out what caused it,
8:55and how to reverse it.
8:56And that's what tonight is about.
8:58But, nonetheless, there are 275 calories
9:00we have to account for.
9:02So where are they?
9:03Are they in the fat?
9:05No, they're not in the fat.
9:08Five grams, 45 calories out of the 275, nothing.
9:11In fact, it's all in the carbohydrates.
9:1557 grams 228 calories.
9:17We're all eating more carbohydrate.
9:19Now, you all know, back int 1982,
9:22The American Heart Association,
9:24The American Medical Association,
9:26and the US Department of Agriculture
9:28admonished us to reduce our total
9:31fat consumption from 40% to 30%.
9:34Everybody remember that?
9:36That how Entenmann's fat free cakes came into being.
9:41Remember that?
9:42So what happened?
9:44We did it, we've done it.
9:4640% down to 30%, and look what's happened
9:49to the obesity, metabolic syndrome,
9:52non-alcoholic fatty liver disease, cardiovascular disease,
9:54stroke prevalence, all jacked way up,
9:58as our total fat consumption as a percent has gone down.
10:03It ain't the fat, people, it ain't the fat.
10:06So what is it?
10:07Well, it's the carbohydrate.
10:08Specifically, which carbohydrate?
10:10Well, beverage intake, right?
10:1341% increase in soft drinks, 35% increase in fruit drinks,
10:18fruitades, whatever you wanna call them.
10:22Just remember, down here,
10:23one can of soda a day, is 150 calories.
10:27Multiply that by 365 days a year,
10:30and then divide that by the magic number
10:32of 3500 calories per pound,
10:34if you eat or drink 3500 calories
10:36more than you burn, you will gain one pound of fat.
10:40That's the first law of thermodynamics, no argument there.
10:43That's worth 15 1/2 pounds of fat per year.
10:45One soda a day is 15 1/2 pounds per year.
10:47Now, you've all heard that before.
10:49That's not news to you.
10:51The question is how come we don't respond?
10:55How come leptin doesn't work?
10:57How come we can't stay energy stable.
11:00That's what we're gonna get to.
11:02So, I call this slide, very specifically,
11:05the Coca Cola Conspiracy.
11:07Anybody here work for Coke, Pepsi?
11:11Okay, good.
11:12All right, so, this over here, 1915,
11:16the first standardized bottle of Coca Cola out of Atlanta.
11:19Anybody remember this bottle?
11:21Sure, a lot of you do.
11:23I remember this bottle, because my grandfather
11:25in Brooklyn, took me on Saturday afternoon
11:28down to the local soda shop on Avenue M and Ocean Avenue,
11:32and every Saturday afternoon I had one of these.
11:35I remember it very well.
11:37Now, if you drank one of those every day,
11:39assuming of course that the recipe hasn't changed,
11:42'cause after all, only two people in the word
11:43know the recipe, and they're not allowed
11:45to fly on the plane at the same time.
11:47You know that, okay.
11:48Assuming the recipe hasn't changed,
11:50if you drank one of those every day for a year,
11:516 1/2 ounces, that would be worth
11:53eight pounds of fat per year.
11:56Now, in 1955, after World War II,
11:59when sugar became plentiful again,
12:01and wasn't being rationed,
12:02we have the appearance of the 10 ounce bottle,
12:04the first one that was found in vending machines.
12:07You probably remember that one, as well.
12:09Then in 1960, the ever ubiquitous,
12:1112 ounce can, worth 16 pounds of fat per year.
12:15And, of course, today, this, over here
12:17is the single unit of measure, 20 ounces.
12:20Anybody know how many servings are in that bottle?
12:23- [Audience Member] 2.5.
12:24- 2.5 eight ounce servings, that's right.
12:27 Anybody know, anybody gets 2.5 eight ounce
12:30 servings out of that bottle?
12:31 That's a single serving, right?
12:34 So that would be worth 26 pounds of fat per year
12:36 if you did that every day.
12:37 And then, of course, over here,
12:38 we have the 7/11 Big K, Thirst Buster,
12:40 Big Gulp, whatever you wanna call it,
12:42 44 ounces, worth 57 pounds of fat per year.
12:45 And if that wasn't bad enough, my colleague,
12:47 Dr. Dan Hale, at the University of Texas San Antonio,
12:50 tells me that down there they got a Texas size Big Gulp.
12:54 60 ounces of Coca Cola, a Snickers bar,
12:57 and a bag of Doritos, all for 99 cents.
12:59 - [Audience] Oh.
13:01 - So if you did that every day for a year
13:03 that would be worth 112 pounds of fat per year.
13:06 So why do I call it the Coca Cola conspiracy?
13:11 Well, what's in Coke?
13:14 Caffeine, good, good, so what's caffeine?
13:16 It's a mild stimulant, right?
13:18 It's also a diuretic, right?
13:19 It makes you pee free water.
13:21 What else is in Coke?
13:24 We'll get to the sugar in a minute, what else?
13:27 Salt, salt.
13:29 55 milligrams of sodium per can.
13:31 It's like drinking a pizza.
13:33 So what happens if you take on sodium
13:36 and lose free water, you get...
13:38 - [Audience] Thirsty.
13:38 - Thirstier, right.
13:40 So, why's there so much sugar in Coke?
13:43 To hide the salt.
13:45 When was the last time you went to a Chinese restaurant,
13:46 had sweet and sour pork?
13:48 That's half soy sauce, you wouldn't eat that.
13:50 Except the sugar plays a trick on your tongue,
13:52 you can't even tell it's there.
13:54 Everybody remember New Coke, 1985?
13:58 More salt, more caffeine.
14:00 They knew what they were doing.
14:02 That's the smoking gun.
14:04 They know, they know.
14:07 All right, so, that's why it's the Coca Cola conspiracy.
14:10 So, are soft drinks the cause of obesity?
14:13 Well, depends on who you ask.
14:14 If you ask the scientists for the
14:16 National Soft Drink Association,
14:17 they'll tell you there's absolutely
14:18 no association between sugar consumption and obesity.
14:22 If you ask my colleague, Doctor David Ludwig,
14:24 remember, I'm Lustig he's Ludwig,
14:26 he does what I do at Boston Children's Hospital.
14:28 Some day we're gonna open up a law firm.
14:31 (audience laughs)
14:31 Each additional sugar sweetened drink increase
14:34 over a 19 month follow up period in kids
14:36 increased their BMI by this much
14:37 in their odds risk ratio for obesity by 60%.
14:42 That's a prospective study on soft drinks and obesity.
14:46 The real deal.
14:48 If you look at meta-analysis,
14:49 everybody know what a meta-analysis is?
14:51 It's a conglomeration of numerous studies
14:53 subjected to rigorous statistical analysis.
14:57 88 cross sectional and longitudinal studies
14:59 regressing soft drink consumption against
15:01 energy intake, body weight, milk and calcium intake,
15:03 adequate nutrition, all showing significant associations.
15:08 And some of these being longitudinal,
15:09 this came from Kelly Brownell's group at Yale.
15:13 I should comment, a disclaimer, those studies
15:15 that were funded by the beverage industry
15:17 showed consistently smaller effects
15:19 than those that were independent.
15:21 Wonder why.
15:23 Now, how 'bout the converse?
15:24 What if you take the soft drinks away?
15:27 So this was the fizzy drink study
15:28 from Christ Church England James et al,
15:30 British Medical Journal, where they went
15:33 into schools and they took the soda machines out.
15:35 Just like we did here in California.
15:38 We haven't seen the data yet,
15:39 but they went and did it for a year.
15:41 So the prevalence of obesity in
15:43 the intervention schools stayed
15:44 absolutely constant, no change.
15:46 Whereas the prevalence of obesity
15:47 in the control schools where nothing changed
15:50 continued to rise over the year.
15:53 So that's pretty good.
15:55 So, how 'bout type two diabetes?
15:57 Are soft drinks the cause of type two diabetes?
16:00 Well, this study from JAMA in 2004
16:03 looked at the relative risk ratio
16:05 of all soft drinks, cola, fruit punch,
16:07 and found a very statistically significant
16:09 trend of sugared soft drinks, fruitades,
16:13 et cetera, causing type two diabetes.
16:15 And you know we've got just as big a problem
16:17 with type two diabetes as we do
16:18 with obesity for the same reasons.
16:21 And this was a sugared sweetened beverage against
16:23 risk for type two diabetes in African American women.
16:25 Looking here at sugar sweetened soft drinks,
16:27 just the downward arrow shows that
16:30 there was a significant rise
16:32 as the number of drinks went up.
16:34 You can see that here.
16:35 Whereas orange and grapefruit juice, interestingly, did not.
16:39 So, two different studies, two different increases
16:43 in type two diabetes, relative to soft drink consumption.
16:47 So, what's in soft drinks?
16:49 Well, in America, it's this stuff, right?
16:52 High fructose corn syrup.
16:54 Everybody's heard of it, right?
16:55 It's been demonized something awful.
16:57 So much so that the corn refiners industry
17:00 has launched a mega-campaign to try
17:03 to absolve high fructose corn syrup of any problems,
17:06 which we'll talk about in a moment.
17:08 But the bottom line is, this is something
17:10 we were never exposed to before 1975.
17:14 And currently we are consuming
17:15 63 pounds per person per year, every one of us,
17:19 63 pounds of high fructose corn syrup.
17:21 - [Audience Member] That's America?
17:22 - That's America, yes.
17:25 Now, what is high fructose corn syrup?
17:27 Well, you'll see in a minute.
17:28 It's one glucose, one fructose,
17:30 we'll talk about those at great length.
17:32 One of the reasons we use high fructose corn syrup
17:34 is because it's sweeter.
17:35 So here's sucrose, this is cane or beet sugar,
17:38 standard table sugar, you know, the white stuff,
17:41 and we give that an index in sweetness of 100.
17:44 So here's high fructose corn syrup,
17:45 it's actually sweeter, it's about 120.
17:47 So, you should be able to use less, right?
17:51 Wrong, we use just as much, in fact, we use more.
17:56 So, here's lab fructose over here, crystalline fructose.
17:58 And they're starting to put crystalline fructose
18:00 into some of the soft drinks.
18:03 They're actually advertising it as a good thing.
18:06 Phew.
18:07 And that's got a sweetness of 173,
18:09 so you should be able to cut that way back, right?
18:12 They're not.
18:13 Lactose, down here, milk sugar, it's not sweet at all.
18:16 And glucose, I should point out over here, 74.
18:19 It's not particularly sweet, and we're gonna
18:20 get to that at the end, and what goes on with glucose.
18:24 But anyway, there's why we use it, it's sweeter,
18:27 it's also cheaper as I'll show you.
18:30 So, here's high fructose corn syrup.
18:32 One glucose, one fructose.
18:35 Notice the glucose is a six membered ring,
18:37 the fructose is a five membered ring.
18:39 They are not the same.
18:41 Believe me, they're not the same.
18:43 That's what this whole talk is about
18:45 is how their not the same.
18:47 And here's sucrose, and they're just
18:49 bound together by this ether linkage.
18:51 We have this enzyme in our gut called sucrose,
18:53 it kills that bond in two seconds flat,
18:56 and you absorb it and, basically, high fructose corn syrup,
19:00 sucrose, it's a non issue, it's a wash.
19:03 They're the same.
19:05 And they know that they're the same,
19:10 the soft drink companies and the corn refiners.
19:11 Because here are their missives.
19:14 This comes from the Corn Refiners Association.
19:16 Obesity research shows high fructose corn syrup
19:18 metabolizes and impacts satiety similar to sugar.
19:22 Indeed it does, I agree.
19:27 Decent meetings, academic meetings around the country.
19:32 Hunger and satiety profiles energy intakes
19:34 following ingestion of soft drinks,
19:36 bottom line, research supported by
19:37 the American Beverage Institute
19:39 and the Corn Refiner's Association.
19:41 They are correct, there is absolutely
19:43 no difference between high fructose corn syrup and sucrose.
19:47 So much so that the Corn Refiner's Association,
19:49 in attempt to capture market share,
19:51 came out with this entire ad campaign.
19:55 You probably saw it on the back page
19:57 of the New York Times, it was on TV, it's everywhere.
20:00 "My hairdresser says that sugar's healthier
20:02 "than high fructose corn syrup.
20:03 "Wow, you get your hair done by a doctor?"
20:06 I didn't know I could cut hair.
20:08 If you all wanna see all of them,
20:10 there are a whole bunch of them.
20:11 You can go to www.sweetsurprise.com
20:14 and see how you're being hoodwinked.
20:16 But indeed, this is true.
20:18 High fructose corn syrup and sucrose are exactly the same.
20:22 They're both equally bad.
20:26 They're both dangerous, they're both poison.
20:30 Okay, I said it, poison.
20:33 My charge before the end of tonight
20:35 is to demonstrate fructose is a poison,
20:40 and I will do it, and you will tell me
20:41 if I was successful.