-[Announcer] The show Broadcast by the University of California Television. Do you like what you learned? Visit our website, or on Facebook and Twitter Follow us to keep up The latest UCTV show. (Joy electronic music) -I want to tell you a story tonight. This story can be traced back 30 years ago. This story has some help for everyone. It has some biochemistry, Some clinical studies, Some public health, A little bit of politics, a little bit of racial discrimination. The only thing it lacks is sex. (Audience laughs) However, we can also see what we can do. At the end of the story, I wish I could Revealing the past 30 years Nutritional information for the United States. If you can tell me at the end of the speech whether succeed ,I will be very grateful. Ok? Therefore, in order to make you feel happy , Let’s start with a quiz. Atkins diet What does it have in common with Japanese dietary laws? anyone there Ok? Oh, your answer is correct, it doesn't matter.

Yes, you can find the answer there. Therefore, the Atkins diet is of course all fat, not carbohydrates. All the Japanese diet is carbohydrates, not fats. They both work, right? So what do they have in common? They have eliminated sugar and fructose. So, consider that dieting means What, what macro nutrients are you eating, and which is not. Then we will start from there and I will try Explain how this all works. So, you have all heard of the obesity epidemic. This is a number. These are the body mass indexes of the NHANES database. Everyone knows what it is now. As time passes, the histogram moves to the right. This is what is shown in blue in 2008. So far, we have surpassed and surpassed this point , It's not even funny. This is from 2003. I did this not only to show Obese people are becoming obese , This is true, but in fact The entire curve has changed. Today, the weight of all of us Both are 25 pounds more than 25 years ago. Now, people often say obesity Is genetics and environment The final interaction between.

Sitting at the back of the room Doctor Christian Vaisse will be Discuss genetic components with you, I am also very interested in this. But, having said that, our genetic pool There has been no change in the past 30 years. year, But, my goodness, our environment must have changed. So tonight we will talk about Environment, not genes. Now, in order to talk about the environment, We need to talk about obesity. And, of course, you are all familiar with The basic concept of the first law of thermodynamics, the law Point out that within a closed system The total energy remains constant. Now, in the name of people, the law The standard explanation is as follows. If it is eaten, it is best to burn it, otherwise it must be stored.

Now, who believes it? Oh please, you all do this. (Audience laughs) I used to believe this. I'm not anymore I think that was a mistake. I think this is the biggest mistake. This is what I will try in the next hour Debunking the phenomenon throughout the process. Because I think there is another way to state the law, It is more relevant and more important. Of course, before I get there, if you believe This is the problem of calorie intake and calorie consumption.

Two behaviors: binge eating and laziness. After all, you will see anyone on the street, "Oh, he is a lazy laziness, nothing more." Tommy Thompson (Tommy Thompson) said in a TV show. "We ate too damn." Well, if this is the case, How did the Japanese do it? Why they Are children undergoing bariatric surgery at Tokyo Children's Hospital today? Why are they Chinese, why are they Korean, Why are Australians? I mean, all these countries that adopt our diet Both suffer from the same problem now. Within a minute, we will go further. There is another way to state the first law. That is, if you want to store it, That is the biochemical force that drives energy storage, We will discuss their status in a few minutes, And you want to burn it, this is Life with normal energy consumption under normal quality. Because of energy consumption and quality of life It's one thing. Things that increase your energy consumption Make you feel good. Like ephedrine, it is no longer on the market. Two people’s coffee is enough, so you need to achieve better results just like me.

Things that make your energy consumption drop, For example, hunger, hypothyroidism, make you feel bad. How many calories burned And feel good is synonymous. So if you want to store it, That is The weight gain set by the biochemical process, And you want to burn it, this is normal Normal energy expenditure for the quality of life, Then you must eat it. And now, the two behaviors of gluttony and laziness Is actually following After the biochemical process, the biochemical process is the most important. This is another way of thinking process. This also reduces obesity The act of evil, but alleviated the suffering of the victim. What is the real feeling of obese people. Because no one chooses to be obese. Of course, no child chooses to be obese. Oh, you say: "Oh, yes, for sure, "I know some adults who don't care." You know, the famous composer Rossini, You know "Gagaradra", "Le Figaro" and so on.

He retired at the age of 37. A life of debauchery with good food. Maybe he chose to be obese. But, my child, the obesity outpatient care that I take Don't choose obesity. In fact, this is proof of the exception to this rule. We have six epidemics of obesity in one month children. Now, if you want to say, this is all about Diet and exercise, then you must explain to me. So, any assumptions you want to have no scruples , Explained the obesity epidemic, You have to explain this one. It’s not just in the U.S. These six-month-old obese children, And now all over the world. So please let go of your mind and let us Find out the real story. Let’s talk about calorie intake, Because that's what it is like today.

we want Talk about the energy intake side of the equation. Sure enough, we are all more now Eat it 20 years ago than we did :T Teenage boys eat 275 more calories. American adult men eat 187 more calories a day. American adult women consume an extra 335 calories a day. No problem, we all eat more. The question is why, why? Because everything is there? You know, it used to be there. We are all eating more, we have a system in our body , In the past few weeks I have heard of this system called leptin. Has everyone heard of leptin? It is this hormone from fat cells Tell the brain: "You know what, I have had enough. "I don't need to eat anymore.

"I'm done, I can burn energy appropriately." Okay, do you know? If you eat 187 or 335 more calories today than 20 years ago , Then your leptin will not work. Because if so, you would not do it. Is there food. therefore, Usually control energy balance The biochemical negative feedback system has problems. We must figure out what caused it, And how to reverse it. This is the purpose of tonight. But despite this, we still have to consider 275 calories. Where are they Are they getting fat? No, they are not fat people. Five grams, containing 45 calories out of 275 calories, is nothing. In fact, they all exist in carbohydrates. 57 grams and 228 calories. We are all eating more carbohydrates. Now, as we all know, as early as 1982, American Heart Association, American Medical Association And the U.S. Department of Agriculture Advise us to reduce total fat consumption from 40% Reduce to 30%. Does everyone remember? This is how Entenman's fat-free cake was born.

do you remember So what happened? We did it, we did it. From 40% to 30%, then look Obesity, metabolic syndrome, Non-alcoholic fatty liver, cardiovascular disease, The incidence of stroke has increased, Because our percentage of total fat consumption has fallen. It is not fat, human, not fat. what is that Well, that's carbohydrates. Specifically, what kind of carbohydrate? Okay, drink a drink? Soft drinks increased by 41%, fruit juice, fruit and vegetable drinks increased by 35% , Whatever you want. Just remember, here, A can of soda has 150 calories per day. Multiply it by 365 days in a year, Then divide by 3,500 calories per pound Magic number, Calories if eat or drink If you burn more than 3,500 calories, you will get a pound of fat. That is the first law of thermodynamics, there is no argument. It is worth 15 1/2 pounds of fat per year. A bottle of soda per day is 15 1/2 pounds per year. Now, you have all heard of it. For you, this is not news. The question is why don’t we respond? Why doesn't leptin work? Why can't we maintain energy stability. That's what we are going to do.

Therefore, I call this slide "The Coca-Cola Conspiracy." Does anyone work for Coca-Cola here, Pepsi? Ok. Well, this is 1915, This is the first standardized bottle of Coca-Cola in Atlanta. Does anyone remember this bottle? Of course, there are many of you. I remember this bottle of wine because my grandfather In Brooklyn, take me on Saturday afternoon I went to the local soda shops on M Avenue and Dayang Avenue, I have one every Saturday afternoon. I remember it well. Now, if you drink one of them every day, Of course it will assume that the formula has not changed, Because after all, there are only two people in the word Know the formula, so they are not allowed to Fly on the plane at the same time. You know, all right. Assuming that the formula has not changed, If you drink it every day of the year 6 1/2 ounces, then The annual fat value is 8 pounds. Now, in 1955, after the Second World War, When sugar becomes rich again And when it is not rationed, We have the appearance of a 10-ounce bottle, This is the first bottle found in a vending machine.

You may remember that. Then in 1960, this ubiquitous A 12-ounce can can add 16 pounds of fat per year. Of course, today, this The unit is 20 ounces. Does anyone know how many servings are in that bottle? -[Listener] 2.5. -2.5 eight-ounce servings, yes. Someone knows that someone from that bottle of wine Do you get a 2.5 eight-ounce serving? This is a copy, right? So if you do this every day, then every year Will be worth 26 pounds of fat. Then, of course, here, We have 7/11 Big K, Thirst Buster, Big Gulp, whatever you want to call it 44 ounces, 57 pounds of fat per year. If that's not bad enough, I Dr. Dan Hale, a colleague from the University of Texas at San Antonio Tell me, there they got a Big Gulp the size of Texas.

60 ounces of Coca-Cola, Snickers And a pack of Doritos, both cost 99 cents. -[Audience] Oh. -So if you do this every day of the year, then every year Will be worth 112 pounds of fat. So why do I call it a Coca-Cola conspiracy? Okay, what's in Coke? Caffeine, good, good, so what is caffeine? This is a mild irritant, right? This is also diuretic, right? It makes you pee free. What else is in Coke? Let's talk about sugar later, what else? Salt, salt. 55 mg sodium per can. It's like drinking pizza. Therefore, if you take sodium And without free water, it will happen…- [Audience] Thirsty. -Thirsty, yes. So why is there so much sugar in cola? Hidden salt.

The last time you went to a Chinese restaurant When do you eat sweet and sour pork ribs? That's half soy sauce, you won't eat it. Except that sugar plays a tricky role on your tongue, You can't even tell its existence. Do you remember the "New Coke" in 1985? More salt, more caffeine. They know what they are doing. That is a smoking gun. They know, they know. Well, this is the reason for Coca-Cola's conspiracy. So, are soft drinks the cause of obesity? Well, it depends on who you ask. If you ask a scientist In the words of the National Soft Drinks Association, They will tell you There is absolutely no correlation between sugar intake and obesity.

If you ask my colleague Dr. David Ludwig, Remember, I’m Lustig, he’s Ludwig, He did what I did at Boston Children's Hospital. One day we are going to open a law firm. (Audience laughter) During the 19-month follow-up period, the children For every added sugar sweet drink, Its BMI will increase 60%. This is a prospective study of soft drinks and obesity. The real deal. If you look at the meta-analysis, Everyone knows what a meta-analysis is? It is a rigorous statistical analysis The synthesis of numerous studies. 88 cross-sectional and longitudinal studies show that Soft drink intake and Energy intake, body weight, milk and calcium intake, Adequate nutrition is related, all of which show a significant correlation. Some of them are vertical, Kelly Brownell's group from Yale University. I should comment, disclaimer, those Funded by the beverage industry The research shows that the impact is always Smaller than independent research. Want to know why. Now, how to reverse it? What if you take away soft drinks? So this is James James and others from the Christian Church in England are here Carbonated beverage research conducted in the British Medical Journal, where they are Go to school and take out the soda machine.

Just like what we did in California. We haven't seen the data yet, But they did it for a year. Therefore, intervene in the school Prevalence of obesity Absolutely remain the same, there is no change. In a year No change in control school , The prevalence of obesity continues to rise. well. So, how to treat type 2 diabetes? Are soft drinks the cause of type 2 diabetes? Well, this research from JAMA in 2004 All soft drinks, cola, fruit drinks Relative risk ratio, Found sugary soft drinks, fruit candy The trend of causing type 2 diabetes is statistically significant. And you know, for the same reason , We are the same as obesity, Have type 2 diabetes There are equally big problems. This is a sugary sweet drink that can prevent African-American women suffer from type 2 diabetes. Looking at the sugary soft drinks here, Just the down arrow indicates Increase in the number of drinks , The number has increased significantly. You can see it here.

Interestingly, orange juice and grapefruit juice did not. Therefore, two different studies , Relative to the intake of soft drinks, there are two different increases in the incidence of two types of type 2 diabetes. So, what is in the soft drink? Well, in the United States, this is the thing, right? High fructose corn syrup. Everyone has heard of it, right? It was demonized. So much that the corn refining industry Launched a large-scale event to try Solve any problems in high fructose corn syrup, We will discuss it later. But most importantly, this is We have never been in contact before 1975 thing. Currently, each of us consumes 63 pounds per person per year High fructose corn syrup. -[Audience] Is that America? -That's America, yes. Now, what is high fructose corn syrup? Well, you will see in a while. This is a kind of glucose, a kind of fructose, We will discuss in detail. One of the reasons why we use high fructose corn syrup Because it is sweeter. So here is sucrose, this is sucrose or beet sugar, Standard white sugar, we know, Its sweetness index is 100.

This is high fructose corn syrup, It's actually sweeter, about 120. So, you should be able to reduce usage, right? Wrong, we used the same amount of things, in fact, we used more things. So, here is laboratory fructose, and here is crystalline fructose. They began to crystallize fructose Put it in some soft drinks. They are actually promoting it as a good thing. ew And its sweetness is 173, So you should be able to reduce this feeling, right? they are not. Lactose, this is milk candy, not sweet at all.

There is also glucose, I want to point out 74 here. It's not particularly sweet, we will Discuss the meaning of glucose at the end. But anyway, that’s why we want to use it, it’s sweeter, Also cheaper, I will tell you. So, this is high fructose corn syrup. One glucose, one fructose. Note that glucose is a six-membered ring, Fructose is a five-membered ring. They are not the same. Believe me, they are not the same. This is what the whole discussion is going to solve The problem. This is sucrose, they are just Bonded together by this ether bond. There is an enzyme called sucrose in our intestines, It will kill the key within two seconds, And then absorb it, basically high fructose corn syrup, Sucrose, this is not a problem, this is hand washing.

they are the same. they know Soft drink companies and corn refineries are the same. Because this is their creed. This comes from the Corn Refiners Association. Obesity research shows that high fructose corn syrup will Metabolizes like sugar and affects satiety. Indeed, I agree. Decent conferences, academic conferences all over the country. In the American Beverage Association and the Corn Refiners Association support me, Hunger and satiety affected Intake of soft drinks, Energy intake after the bottom line .

They are correct, There is absolutely no difference between high fructose corn syrup and sucrose. So much that In order to gain market share, The Corn Refiners Association in The whole advertising campaign has emerged. You may be in the New York Times I saw it on the back, I saw it on TV, everywhere. "My hairdresser said that sugar is better than high fructose corn syrup healthier.

" "Wow, did you give your hair to the doctor?" I don't know if I can cut my hair. If you all want to see all of this, Then there will be many. You can visit www.sweetsurprise.com , See how you are deceived. But indeed, this is true. High fructose corn syrup is exactly the same as sucrose. Both of them are equally bad. Both of them are dangerous, they are both poisons. Well, I said, poison. My accusation before the end of tonight It proves that fructose is poisonous, I will do this and you will tell me i whether succeed. Nevertheless, here is the science With the Public Interest Center and the Corn Refiners Association. Everyone remembers Gavin Newsom (Gavin Newsom) in February last year When the soda tax was abolished? Since then, New York State Governor Patterson issued one. Start talking about it with other people. So why do they say that? Well, they say obesity is a problem, The children drink soda and let us tax.

So they are talking about soda because it is empty calories. I am here to tell you that it far exceeds empty calories. The reason for this is because Fructose is toxic and has nothing to do with calories. It has nothing to do with calories. It is poison in itself, I want to tell you. But I just want Read this paragraph in yellow here. "We would like to urge this proposal "Revised as soon as possible to reflect "Scientific evidence shows that "High fructose corn syrup and sugar There is no substantial difference in the impact on health." I agree. This is an important sentence. "The real problem is that any sugar Excessive consumption may cause health problems.

" I agree that this is completely correct. This is not the case, this It is indeed a fact. So this It is the long-term trend of fructose consumption in the past 100 years. When we were doing food processing before, we used to Get fructose from fruits and vegetables, If we do this today, we will consume every day About 15 grams of fructose, and Not sugar, fructose, So the sugar is 30 grams, which is twice the original amount. What we are talking about is fructose, today Before the Second World War, it was rationed again. We can reach about 16 to 24 and about 20 grams respectively. Therefore, from the First World War of this century The beginning of a small rise II. Then, in 1977, when high fructose corn syrup When we put it on the market, we added Diet, basically doubled every day to 37 grams , Accounting for 8% of total calorie intake; By 1994, I had to eat 55 grams of things every day. Remember, if you want sugar, double it. So it’s 10.2, so you can see more things Our caloric intake, a higher percentage It is accounted for by sugar every year.

Therefore, it is not just that we have to eat more. We are eating more sugar. Today, teenagers weigh up to 75 grams, It accounts for 12% of total calorie intake. Today, 25% of teenagers Only consume at least 15% of calories from fructose. This is a disaster, and it is absolutely irreducible. Fat is decreasing, sugar is increasing, We are all sick. Now let me tell you why. how so Why does it happen? So this is where politics comes in. This is the perfect storm, It is made up of three that bypass everyone at the same time Created by the political wind, To create this perfect storm. Therefore, in the first political wind, All the bad things that happened in this country It all started with one person. (Audience laughs) Still feeling today. Therefore, in Richard Nixon's delusion in 1972, Food prices fluctuate up and down. I want to show you on the next slide. He worried about this It will actually disqualify him for election.

Therefore, he admonished my Minister of Agriculture, Earl Rusty Boots ( Earl Rusty Butz), I like this name very much, Is basically taking food away from the political table, Make food not a problem in the presidential election. Well, the only way is to make food cheap. Therefore, he wanted to find all Ways to reduce food prices. Remember Nixon’s war against poverty? Today we are suffering. That's it The second political wind, The advent of high fructose corn syrup . Therefore, this is the Saga Medical College in Japan in 1966 Invented by a guy named Takasaki, he is still alive. In my case, these things It’s Japan’s revenge for the Second World War , Of course, except that they themselves are suffering now . Like everything, it will always bother you again. It was introduced to the US market in 1975. Well, When this sugar entered the market, what do you think happened to the price of sugar? This is what happened.

So this is the producer price index of US sugar Fluctuate up and down. This is not good. Stability is 100%, if it stays in good condition and stability 100%, which is what politicians want. Up and down is corn sweetener It entered the market in 1975 and 1980. You can see that since then , The price of sugar has remained the same. It’s not only in the United States, And it did it on the international stage. This is the London price for doing the same thing.

When you view When the price difference between sugar and high fructose corn syrup, You will find high fructose corn syrup The price is about half. So, in other words, it is cheap. Therefore, high fructose corn syrup is evil. But this is not evil, because it is metabolically evil. This is evil because it is economically evil. Because it is so cheap that it is Discovery can be applied to everything. Found that it can almost be put in a hamburger, Pretzels, barbecue sauce and ketchup. Someone emailed me the other day And tell me they went to the local grocery store , Checked the Each loaf of bread, among the 32 types of bread on the shelf , There is only one without High fructose corn syrup. inside. Therefore, we are poisoned by these things, And it was added secretly To all our food, every processed food. The question is why? Well, you will understand why in a while. Therefore, corn refiners like to point out: "Well, this is just a substitute.

"With the rise of high fructose corn syrup, The drop of sugar. "You know, we are just replacing grams, just like grams." Well, not exactly, because this is 73 pounds of sugar per year. This is from the U.S. Department of Agriculture Obtained from the Economic Research Service. Therefore the data disappears. 73 pounds, which increased to 95 pounds in 2000. There is something missing in this slide. Does anyone want to tell me what this is? What is missing? Juice, juice is lost. Because fruit juice is sucrose, yes, sugar. Juice can cause obesity. So this is a study conducted by Myles Faith, The study is a prospective study of children in the inner city of Harlem. Daily intake of these juices Can predict these Harim city center children Changes in monthly BMI score . Now these inner cities Where does Harlem kid drink juice? From what, where, from whom? From WIC. Has anyone heard of WIC? Do you know what WIC is? Baby girls and children, right? Under whom is the government entitlement plan established? Nixon to prevent failure.

They did it. This is an equal and opposite reaction. So let's add juice to it. So when you put most of the fructose items together, Now this picture weighs 113 pounds, I just learned from NBC News I heard from Brian Williams that after the latest research was published, That is, after investigation in the "Clinical Journal", We can actually eat up to 141 pounds of sugar per year. Each of us. That is what we have to do. 141 pounds of sugar per year. Now, do you think this is possible Will it adversely affect you? Didn't stop you, right? The point is, this didn't stop you. That is why we need to talk about this. Therefore, drinking juice increases The risk of type 2 diabetes.

So this is when the juice intake increases The relative hazard ratio, which is in the nurse’s study. Again, the juice is consumed, Sucrose, obesity, diabetes. Okay, the third political storm is spinning , Caused this disaster, this giant typhoon, What happened in 1982, U.S. Department of Agriculture, American Fireplace Association, American Medical Association All tell us that we must reduce the fatness. Now, why did they tell us? What to stop? To stop hearing about the disease. Have it No, we don’t have one, do we? In fact, it does exactly the opposite. We only created more.

So, what is going on now? Why did they tell us to stop eating fat? Well, in the early 1970s, we Found in the blood called LDL Of low-density lipoprotein. Have you heard of it, right? Is it good or bad? -[Listener] Not good. -Not bad, we will discuss. In the mid-1970s, we learned Fat in your diet will increase your low-density lipoprotein (LDL). Therefore, if dietary fat is A and low-density lipoprotein is B, then We learned that A leads to B. Dietary fat will undoubtedly increase your LDL , This is self-evident. Finally, in the late 1970s, we learned LDL is related to cardiovascular disease.

Therefore, we call cardiovascular disease C. So we learned that B led to C. Therefore, some very smart nutritionists ( Such as USDA, etc.) thinking process Say: "Well, if A leads to B, and B leads to C "It will inevitably lead to C, therefore, there is no A, no C" This is logic Now any logician in the room Anyone see any problems with logic go ahead (Distance of speaking from microphone)- .

? . This is correct, but the premise is incorrect. I will tell you why, the premise is incorrect, Because it shows that this is all passed. But, in fact, only inversion is transitive. So, this is not no A, no C, this is no C, no A. Therefore, the logic is even incorrect. There is wrong logic here. So this won’t be for any level, so At work, I will tell you why this does not work. But how did I before you, why it didn’t work, I will tell you that this is There was a fierce battle in the 1970s. This is not a simple matter. There are people lined up on both sides of this story. So, this is a book in this, it came out in 1972, Known as "pure white and deadly". It's all about sugar. By a British physiologist, Nutritionist, endocrinologist Written by John Yudkin. Now, I don't know that John Yudkin has passed away. However, I read this book about a year ago. I didn't even know I was Yudkin's assistant. I am a disciple of Yudkin. Everything this man said in 1972 All are the honest truths of God.

If you want to read a true prophecy, you will find this book. It is not easy to find, but you can find this book. I tell you, what this guy said Everything has become a reality. Surprisingly, I am in awe of this guy. But on the other side, we have this guy here. His name is Ancel Keys. Has anyone heard of him? So Ancel Keys is an epidemiologist in Minnesota, Very interested in causing cardiovascular disease. And he doesn't have a computer The first multiple regression analysis was performed. Now, does anyone know what this means? Multiple regression analysis? So this is where you have to deal with a lot of data, Usually only run some computer programs, But basically, the goal is to try Find out the cause of the problem, And try to exclude other factors And determine the reason. Various things For the result you want All contributions are simultaneous.

Therefore, he is interested in cardiovascular disease. So what he did was to work with other people around the world For this research, Called "Seven Kingdoms Study". Very famous, the first page of Time magazine in 1980. Therefore, the following are the data from the "Seven Nations Study". So we have the United States, Canada, Australia, Britain and Wales, Italy, Japan. This is the percentage of calories from fat on the x-axis , And we have coronary heart disease mortality on the y-axis. So you would say: "Oh, look at that." I mean, it's pretty obvious, isn't it. Of course, the percentage of calories in fat Very related to coronary heart disease, right? Except for one small problem. Did anyone see it? Japan and Italy? So, how much sugar do they eat? Didn’t I tell you that the Japanese diet does not contain fructose? They never even owned it until We only brought it to them after the Second World War. In Italy, besides ice cream, I mean what else can they get? They have a lot of pasta, There is a lot of glucose, but no fructose.

Except for the occasional sweets, The Italians have no sugar in their diet, and they occasionally eat sweets. They are very cautious with the host and spend a lot of money. But here are England, Wales, Canada, Australia, the United States, You know, we are sugar freaks, don't we? We are also Fataheliists. Therefore, in fact, fat migrates with sugar. So, this is from Keys' own work. Page 262, if you want to get the volume of 500 pages. I just want to read to you Discuss the content of this paragraph. The relationship between sucrose and saturated fat Explained Coronary Heart Disease The incidence of The average calorie of sucrose in the diet The fact that the content is significantly related. In other words, donuts. Where there is fat, there is sucrose. Because these guys eat donuts here. (Audience laughs) Partial correlation analysis shows , When saturated fat is constant, Sucrose in the diet and Between the incidence of coronary heart disease No significant correlation.

Okay, when you do multiple linear regression analysis, It must be done at the same time. You have to keep fat constant, Shows that sucrose does not work, Then the sucrose must be kept constant , And the fat still works. You see that anywhere? He didn't do it, he didn't do it. He didn't do the thing that you need to do to do a multivariate linear regression analysis. Now, this was done before computers. We can't check the work.

He's dead, he died in 2004. So, we're left with a conundrum. Do we believe this? Do we believe this study, because we based 30 years of nutrition education, and information, and policy in this country on this study. And, as far as I'm concerned, it has a hole as big as the one in the USS Cole, all right, you got it? Everybody, am I debunking, yes, no? Let's keep going. Remember, I told you LDL may be not so bad? Well, here's why. Because there really isn't one LDL, there are two. There are two LDLs. Here's one over here, it's called pattern A or large buoyant LDL. So, everybody knows that LDL correlates with cardiovascular disease, and that's true. I'm not gonna argue that, that is true. But, it's not this one, pattern A LDL.

These guys are so light, they are buoyant, they float. So, they get carried through the bloodstream, and they don't even have a chance, because they're so big and they're so buoyant, they don't even get underneath the edge of the endothelial cells in the vasculature to start the plaque formation process. But, over here we have this other guy, over here, called pattern B or small dense LDL. You see the difference? These guys are dense. These guys don't float. These guys are small, they get underneath the edge of the surface of the surface of the endothelial cells, and they start the plaque formation.

And it's been shown by numerous investigators now, the dense LDL is the bad guy. Okay, now, when we measure LDL in the bloodstream, when you do a lipid profile, you measure both of them together, because it's too hard to distinguish the two. So, when you get an LDL, you're getting both LDLs. The neutral one and the bad one. Now, how can you tell whether your LDL is the neutral one or the bad one. What you do is you look at your triglycerides level in association with it,'cause your triglycerides tell you which one it is. So here, here's pattern A over here, big large buoyant LDLs, and you'll notice that the triglycerides are low, and your HDL is high. That's what you want, you want a low triglyceride, high HDL,'cause that's the good cholesterol. You want high good cholesterol. Over here, you have pattern B. And here you have high triglyceride, low HDL. That's the bad guy, that's the guy you don't wanna be. 'Cause you're gonna die of a heart attack.

No question about it. Triglyceride to HDL ratio actually predicts cardiovascular disease way better than LDL ever did. Point is, when you measure LDL, you measure both. So, dietary fat raises your large buoyant. What do you think raises your small dense? Carbohydrate. Okay, so here's percent carbohydrate, and here's your pattern B going up. Everybody got it? So what did we do? What did we do in 1982? (speaking away from microphone) What did we do? We went on a high carb diet, which was supposed to be a low fat diet, right? So, here's the low fat craze. Took America and the world by storm. Because the content of low fat home cooked food, that you cook by yourself, in your house, you can control the content of fat. But when you process it, low fat processed food, it tastes like cardboard. It tastes like (bleep). So the food companies knew that, so what'd they do? They had to make it palatable? So, how do you make something palatable that has no fat in it? You add the, sugar.

So, everybody remember Snackwells? Two grams of fat down, 13 grams of carbohydrate up, four of them being sugar, so that it was palatable. Well, we've just shown you that that's the worst thing you could do. And that's what we've done. And we're still doing it, today. So when you find a mistake, what do you do? You admit the mistake and you right the ship. We haven't admitted the mistake, and we haven't righted the ship. So, we've our food supply adulterated, contaminated, poisoned, tainted. On purpose, and we've allowed it, and we've let it, thought the addition of fructose for palatability, especially because of the decreased fat, and also as a ostensibly browning agent, which actually has it's own issues. Because why it browns so well with the sugar in it, actually is what's going on in your arteries.

Because that's causing what we call protein glycation and cross linking, which is actually contribution to atherosclerosis. So it works on your steak on the grill, it works in your arteries the same way. And removal of fiber also. Now, why did we remove fiber from our diet? We, as human beings walking the earth 50,000 years ago, used to consume 100 to 300 grams of fiber per day. We now consume 12. Why? What did we do? We took the fiber out. So, why'd we take the fiber out? It takes too long to cook, takes too long to eat, and shelf life.

So, people ask me, "What's the definition of fast food." Fiberless food. I dare you, other than a salad, I dare you to go to any fast food restaurant and find anything on their menu that they actually have to cook, that has more than one gram of fiber in it. 'Cause there isn't any, and that's on purpose. Because they take the fiber out, 'cause that way they can freeze it, ship it around the world, and cook it up fast, and not only is is fast cooking, but it's fast eating, which also causes it's own satiety issues. Bottom line, we have a typhoon on our hands. And then, finally, the last issue was the substitution of transfats, which are clearly a disaster, but those have been going down, because we know that those are a problem. So we've actually gotten rid of most transfats, not completely, but most. So this is it, this is what we've done over the last 30 years. Now, to the biochemistry. Now, how many of you here have taken biochemistry? About 25%. I am going to show you a lot of reactions in excruciating detail.

(audience laughs) If you've studied biochemistry, you will have an anaphylactic reaction. (audience laughs) If you haven't studied biochemistry, you will fall asleep. So, what I'm gonna suggest that you all do is just let me do my thing, to show you that, at least it works, and just count the arrows. Ok? You can do that, right? Can you count the arrows, it's not like counting sheep. Okay, you can count the arrows, and just stick with me. Just let me do my thing, and let me show you why fructose is not glucose. 'Cause what the liver does to fructose is really unique, and you've gotta understand it to understand everything I've just told you.

So, number one, fructose is seven times more likely than glucose to do that browning reaction. The advanced glycation end-products. The thing that happens on your grill, happens in your arteries for the same reason. You can actually see the color too, the color change too. Fructose does not suppress the hunger hormone. There's a hormone that comes form your stomach called ghrelin you've heard about, already. So, if you preload a kid with a can of soda, and then you let him loose at the fast food restaurant, do they eat more, or do they eat less? They eat more. They just took on 150 calories, yet they eat more. Reason? 'Cause fructose doesn't suppress the hunger hormone ghrelin, so they eat more. Acute fructose ingestion does not stimulate insulin, because there's no receptor for fructose, no transport for fructose on the beta cell that makes insulin, so the insulin doesn't go up.

Well, if the insulin doesn't go up, then leptin doesn't go up, and if leptin doesn't go up, you're brain doesn't see that you ate something. Therefor, you eat more. And finally, I'm gonna show you liver hepatic fructose metabolism is completely different between fructose and glucose, completely different. And I'm going to show you, before the evening is out, that chronic fructose exposure alone, nothing else, causes this thing we call the metabolic syndrome. Everybody knows what the metabolic syndrome is? So, this is the conglomerate of the following different phenomena, obesity, Type 2 diabetes, lipid problems, hypertension, and cardiovascular disease.

America

Those all cluster together, called metabolic syndrome. I'm gonna show you how fructose does every one of those. I wanna show you the difference between glucose and fructose in a way that will be glaringly apparent. So, let's consume 120 calories in glucose. Two slices of white bread. What happens to that 120 calories? You eat the 120 calories, 96 or 80% of the total will be used by all the organs in the body. 80% off the table. why? Because every cell in the body can use glucose. Every bacteria can use glucose, every living thing on the face of the earth can use glucose, because glucose is the energy of life. That's what we were supposed to eat. 24 of those calories, or 20% will hit the liver. So let's watch what happens to those 24 calories.

Here they go. So, the glucose comes in through this transporter called Glut2, out here, the glucose is gonna stimulate the pancreas to make insulin, the insulin's gonna bind to it's receptor, and it's gonna take this substrate over here called IRS-1, insulin receptor substrate 1. That's not important right now, don't worry. And it's gonna tyrosine phosphorylate it. And it's going to be tyrosine IRS-1, which is now active, that's active. And it's gonna stimulate the second messenger here called AKT. Now what AKT does is, it stimulates this guy down here. SRABP1, sterol receptor binding protein number 1. Don't worry about it. But this is the thing that, ultimately, gets fat mechanics going.

So, you'll see in a minute. So, one of the things that SRABP1 does, is it activates this enzyme here called glucokinase, which takes glucose to glucose 6 phosphate. Now, glucose 6-phosphate can't get out of the liver. The only way to get glucose 6-phosphate out of the liver is with hormones. Glucagon or epinephrine, that's the way it can get it out. So now, the glucose is fixed in the cell, but it's only 24 calories worth, so it's not a big bolus of it. Now, the glucose 6-phosphate almost all of it, is gonna end up going over here to something called glycagen. Now, glycagen is the storage form of glucose in the liver. Because glycagen's easy to fish the glucose out with glucagon and epinephrine. So, my question to you, and granted, this is a physiology question, is how much glycogen can your liver store before it gets sick? The answer's any amount.

It's unlimited. We have carb loaders who run marathons, right? Does it hurt them at all? We have kids with a disease where they can't get the glucose out of the glycagen, called glycagen storage disease type 1A, or von Gierke disease. They got livers down to their knees their so big. They're hypoglycemic like all get out 'cause they can't lift the glucose out of their liver. But, they don't go into liver failure. Because glycagen is a non-toxic storage form of glucose in the liver. So, the whole goal of glucose is to replete your glycagen. So, this is good, this is not bad, this is good. Now, a little of that glucose is gonna fall down here, it's gonna get metabolized down to this stuff here, called pyruvate. And the pyruvate is gonna enter your mitochondria, over here. Remember, your mitochondria are the parts of your cell that actually burn the energy.

They're your little factories. They make the stuff that lets you live. Called ATP, ATP, adenosine triphosphate, that's the energy of life, right there. So, the pyruvate comes in, gets converted to something called acetyl-CoA, gets metabolized by this thing called the Krebs cycle, TCA cycle, and you throw off ATP and carbon dioxide which you breath off. So far, so good? Have I snowed anybody yet? You're with me? I snowed one guy back there. (audience laughs) I'm doin' my best, I swear to God, I'm doing my best. Anyway, so this stuff over here, this acetyl-CoA, gets burned off in the TCA cycle. Maybe you won't burn all of it off, and so, some of it may exit as citrate. And the citrate then leaves the mitochondria through a process known as the citrate shuttle. And then that citrate can then be broken down by these three enzymes, which are all subservient into this SRABP1. This is ATP citrate lyase acetyl-CoA carboxylase fatty acid synthase. They're not important. The only thing to know is these three enzymes together turn sugar into fat.

This is called denovo, meaning new, lipogenesis, fat making. This is denovo lipogenesis. So you take the citrate which came form the glucose, and you end up with something called acetyl-CoA, which then gets packaged with this protein here, and you end up with something called VLDL, very low density lipoprotein. Now, anybody heard of that before? Is it good or bad? It's bad, that's bad. VLDL is bad because that's one of the things that causes heart disease. It's also a substrate for obesity. So, you don't wanna make much of this. But the point is, you started with 24 calories, maybe a half a calorie will end up as VLDL.

So, that little Japanese guy with the little hat, you know, working out in the field, eating rice for the next 90 years, can he die of a heart attack at age 90? Sure. But that's not so bad. If you make it to 90, you're doing alright. Because that VLDL coming from glucose. Glucose made a little bitty VLDL. And that serves as a substrate for adipose deposition into your fat cell, here triglyceride. In addition, because of the insulin went up in response to the glucose, your brain sees that signal. And it knows that that is supposed to shut off further eating. In other words, hey, I'm busy metabolizing my breakfast. I don't need lunch. And so, you have a nice negative feedback loop between glucose consumption, the liver, the pancreas, and the brain, to keep you in normal negative, yin yang energy balance.

This is good, this is not dangerous. This is what's supposed to happen. So now, let's talk about a different carbohydrate. Let's talk about my favorite carbohydrate, maybe yours too. (crowd murmuring) Ethanol. Ethanol is a carbohydrate, isn't it? Here's the structure, carbon hydrogen oxygen, it' a carbohydrate. But, we all know that ethanol is a toxin, right? A poison, right. You can wrap your Lamborghini around a tree, or you can fry your liver, your choice. Depends on how much you drink and how often. correct? Okay. So, we know that ethanol is not good for you, except, of course, a little bit is good for you. So, we can talk about that too, later, if you want. But, let's talk about how it's bad for you. So, here's acute ethanol exposure. CNS depression, vasodilatation, hypothermia, tachycardia, myocardial depression, pupillary responses, respiratory depression, diuresis, hypoglycemia, loss of fine motor control, you all went to college. (audience laughs) Here's fructose, nothing. It doesn't do any of those. Because the brain doesn't metabolize fructose. Alcohol gets metabolized in the brain, to cause all of those things, but fructose doesn't.

So, fructose is not an acute toxin, ethanol is. We control ethanol, don't we? We have something called the Bureau of Alcohol Tobacco and Firearms. We have all sorts of things, we tax ethanol. We do all sorts of things to limit consumption of ethanol. The Nordic countries, all the liquor stores are state run in attempt to try to set the price of ethanol high enough so as to discourage consumption for public health reasons.

We have 1500 years of alcohol control policy in this world to draw on, in terms of how to limit consumption. Got it? Because ethanol is a toxin, and we know it. So, let's consume 120 calories in ethanol. Shot of Makers Mark. Anybody taste it? Yeah, good, okay. So, 24 calories right off the top. The stomach and the intestine have something called the first pass effect, so 10% off the top, and kidney, muscle, brain will consume the other 10%. So there goes 20% or 24 calories right off the top. 96 calories of the 120 are gonna hit the liver. Now, how many was it for glucose? It was 24. So, four times the substrate is gonna hit the liver, and there's the rub.

This is a volume issue. We're gonna show you how. So, the ethanol comes in, passive diffusion, there's not receptor for it, not transporter. First thing that happens is ethanol gets converted to this guy, over here, called acetaldehyde. Anybody know anything about aldehydes? Like formaldehyde? Right? Are aldehydes good for you or bad for you? They're bad, right? 'Cause what do they do? They can cause cancer, they cross link proteins is what they do. So, if you cross link enough proteins in your liver, what do you think happens to it? You get something called… Cirrhosis, right exactly. So this guy, over here, is bad. And it generates something called reactive oxygen species. Reactive oxygen species damage proteins in the liver. And the more alcohol you drink, the more of this stuff you get.

So far, so good? So, this is one of the reasons why alcohol's bad. Now the acetaldehyde will come down here to something called acetate. The acetate will enter the mitochondria, just like the pyruvate did before. Will get converted to acetyl-CoA and participate in the TCA cycle, just like before, to generate energy. So that alcoholics don't die form lack of energy, they got energy, it's everything else they don't have.

They're gonna have a whole lot of citrate. Because they have 96 calories that have to get metabolized. How many calories made it to the mitochondria with glucose? About half, right? Because most of it went to glycogen. So, we've got a big citrate, so it's in big font to show you that we're talking about big citrate now. And so, the big citrate is gonna get metabolized all the way to VLDL by the CRABP1. And so you're gonna get a lot of the LDL. And this is the dyslipodemia of alcoholism, right here. Everybody see that? So, the liver's gonna try to export this VLDL out so that it doesn't get sick, because when fat builds up in the liver, that's not good for it. Some of it's gonna exit as free fatty acids, and those free fatty acids, will take up residence in the muscle, and you get something called muscle insulin resistance.

So insulin resistance, that's a bad thing. That makes your muscles and your liver now work so well. And can cause all sorts of other problems like diabetes. Some of the acetyl-CoA won't even make it out, and will precipitate as a lipid droplet, so there's your alcoholic steatohepatitis. This acetyl-CoA, and this ethanol, and these reactive oxygen species can start this enzyme activated. It's called c-jun n-terminal kinase 1, or JNK1, and it really is JNK1 because it is the bridge between metabolism and inflammation. So, when you generate JNK1, you do bad things to your liver, which I will show you when we talk about fructose.

So let's talk about fructose. Fructose is sweet, we like it a lot. We like it in everything, we like it in our bread, we like it in our pretzels, we like it everywhere we look. So, let's consume 120 calories in sucrose. A glass of orange juice. Everybody got it? So, two slices of white bread, a shot of makers mark, a glass of orange juice, all the same 120 calories. But, three different substrates.

Let's see what happens to the fructose. So, number one, the glucose, remember, 'cause sucrose is half glucose half fructose, so 60 of the calories of the 120 are glucose. 12 are gonna make it into the liver, 48 out here for the rest of the body. The same 20/80 split we had before with glucose. So far, so good. But all 60 calories of fructose are gonna be metabolized by the liver. why? Because only the liver can metabolize fructose. So, what do we call it, where when you take in a compound that's foreign to your body, and only the liver can metabolize it, and in the process, generates various problems? What do we call that? We call that a… Poison. So, let me show you how it's a poison. So, let's watch the fructose. So, the fructose comes in through this transporter, now. Before it was Glut2, now it's Glut5 No insulin, remember,'cause fructose does not stimulate insulin. Fructose, then, gets metabolized by this guy, over here, called fructokinase, to form something called fructose 1-phosphate.

In the process, ATP has to give up one phosphate to ADP'cause the phosphate had to come from somewhere, so it comes from here. Now, before we had 24 calories that had to be phosphorylated. Now we have 72 calories that have to be phosphorylated. So, we have three times the substrate, and there's the rub. It's a volume issue, for right now. So, we're gonna lose a lot of phosphate, aren't we? So there's a scavenger enzyme in your liver called AMP deaminase 1 to rescue the phosphates off the rest of the ATP molecule, and it takes ADP down to AMP, adenosine monophosphate, down to IMP, Inositol monophosphatase, and finally, to the waste product uric acid.

Anybody every heard of uric acid? what is it? It's a waste product. Goes out in your urine. 'Causes what disease? Gout, right. Also causes another disease called hypertension. Let me show you how. Because uric acid, turns out, blocks the enzyme in your blood vessels called endothelial nitric oxide synthase. And that's the enzyme that makes the stuff called nitric oxide, NO. And that is your endogenous blood pressure lowerer. That keeps your blood pressure low. So, when you can't make it, your blood pressure goes up. So, this just shows that fructose consumption increases gout in adults. So, this is a study that came out last year showing that fructose consumption increases the risk for gout, showing that uric acid's going up. And this is a study done by pediatric renal fellow, Stephanie Winn, just published in Journal of Pediatrics, it's not submitted any more, it's long in press, showing that this is in the NHANES database in the adolescents, showing that sugar sweetened beverages, as it goes up, your uric acid goes up. And, not only does your uric acid go up, but here's your sugar sweetened beverages, and here's your systolic blood pressure going up.

And here's a study done by Dan Fige, at the University of Texas San Antonio, where he took obese adolescents with hypertension, and he gave them the drug Allopurinol. And Allopurinol is the drug that you treat gout with, to lower the uric acid. And look what happened to the blood pressure. Systolic, diastolic, went down. Showing that, in fact, uric acid is an important part of hypertension. We have a hypertension epidemic in this country. here it is. It's the sugar. Okay, so, so far we have high blood pressure. Let's keep going. The fructose will get metabolized down to pyruvate, the pyruvate will enter the mitochondria just like before, throwing off a lot of citrate. And here's a little trick that fructose does that glucose doesn't. 'Cause these to can reform this stuff over here called fructose 1 6 bisphosphatase, which can then reform with glyceraldehyde to form this guy, over here, called xylulose-5-phosphate.

And I get to xylulose-5-phosphate in a moment. But I wanna point out this asterisk. That's there to remind me to tell you something. That's there to remind me to tell you that this is why the sports drink companies put high fructose corn syrup in the sports drinks. Because if you are glycogen depleted, in other words, if you just ran a marthon, and you have no glycogen left in your liver because you burned it all, and you take in a sports drink with high fructose corn syrup, you can replete your glycogen faster than with glucose alone. That's true. So, for elite athletes, a high fructose corn syrup containing sports drink actually makes sense. And so, indeed, sports drinks have high fructose corn syrup. The question is who drinking the sports drinks? Any elite athletes you know? Who's drinking the sports drinks? The kids, right? Why are they drinking it? Because it's cool, right? 'Cause it's cool and it tastes good. So, before we go on, I just wanna, now, digress for a moment. 1967, University of Florida patents Gatorade. Everybody remember Gatorade? Okay, 1970, the Florida Gators win the NCAA Championship in football.

Gatorade makes a big splash. Okay, big deal. Anybody ever taste the original Gatorade? Yeah? What'd it taste like? Tasted horrible. It tasted like something that you might find coming out of you instead of going into you. (audience laughs) It tasted awful. 1992, Pepsi buys Gatorade, and they say, "How are we gonna market this swill?" So, what did they do? They added the high fructose corn syrup. So, now who drinks it? Fat kids, right? Not even skinny kids, fat kids drink it. Okay, so there's a problem here. Okay, and we're gonna show you how that works. Okay, so xylulose-5-phosphate, just to show you, if you take a rat, and you glycogen deplete him by making him run on an exercise wheel, and then you re-feed them with starch or with sucrose, the xylulose-5-phosphate goes way up with the sucrose. So you get more xylulose-5-phosphate through this pathway here, going over here. So why do we care about xylulose-5-phosphate? Well, here's why. Because it stimulates this guy, over here, called PP2A, which then activates this transcription factor here, carbohydrate response element binding protein, which then activates what three enzymes? New fat making right, the novo lipogenesis.

So here's the citrate, we got lot's of that. And here we've got acetyl-CoA, which is the way into fat, which then gets packaged to the VLDL, and now you've got the dyslipidemia of obesity of fructose consumption, which has, been known for many years. So, here's normal medical students, if you can call them normal, taking in a glucose load. Notice, almost none of it ends up as fat. Taking in a fructose load, same number of calories, 30% of it ends up as fat. So when you consume fructose, you're not consuming a carbohydrate, you're consuming fat. So everybody talks about a high fat diet. Well, high sugar diet is a high fat diet. That's the point. That's exactly the point. This is a study where they gave acute administration of fructose, and you can see the triglycerides going up compared to the control. Serum triglyceride, right there. Here's normal medical students, again, six days of high fructose feeding.

Triglycerides doubled, de novo lipogenesis went up five times higher, and here's free fatty acids, which then cause insulin resistance, doubled. Six days. So, here's the dyslipidemia of fructose consumption. We're not done. Some of the fat won't make it out of the liver, just like with ethanol. And now you've got a lipid droplet, so now you've got this nonalcoholic steatohepatitis. So, this is work that we did in our clinic looking at sugar sweetened beverage consumption against the liver enzyme marker ALT, alanine aminotransferase, which tells you about fatty liver. And sure enough, here's sugar sweetened beverages against ALT, and you can see a nice linear relationship in Caucasians. African Americans, it's a different relationship, and that' a'whole'nother story all by itself. So, there's the lipid droplet of nonalcoholic steatohepatitis.

Some of it will come out as free fatty acids and populate the muscle, will also tell the insulin to go up higher. Remember that JNK1? So, here's what JNK1 does. So, the acetyl-CoA and the fructose can all activate JNK1. And what JNK1 does is, remember when we used glucose, this IRS became tyrosine IRS-1 and that was good? Remember that? Well, JNK1, what it does, is it's serine phosphorylated IRS-1. And serine IRS-1 is inactive. So now, the insulin can't even do it's job in the liver. So, now you have liver insulin resistance as well. That's gonna make the pancreas work that much harder generating higher insulin levels, which raise your blood pressure even further, cause further fat making, cause more energy to go into your fat cell. There's your obesity. And finally, our research has shown that the higher the insulin goes, the less well your brain can see it's leptin. And so there you've got continued consumption because your brain thinks it's starving.

And it's been shown in many different ways that fructose consumption changes the way your brain recognizes energy. All in a negative fashion, so that you, basically, think you're starving. Your brain gets the signal that you're starving even though your fat cells are generating a signal that says, "Hey, I'm full like all get out." So, this just shows you how it goes. So, the high insulin generates the obesity because this is that, remember the first law of thermodynamics, the biochemical force generating the energy storage as the primary phenomenon, remember, if you're gonna store it, and you expect to burn it then you're gonna have to eat it.

So, here's the store it. Normally, that would make leptin, and the leptin should feed back and turn everything off, but it doesn't, because the insulin gets in the way, and the high fat diet gets in the way. Also, the hyperinsulinemia stops the leptin from acting on that nucleus accumbens, and so you get an increased reward signal. So that continues your appetite, continues more fructose, more carbohydrate, generating more insulin resistance than you can see. You generate a vicious cycle of consumption and disease, and no stopping. So, here we are, hypertension, inflammation, hepatic insulin resistance, hyperinsulinemia, dyslipidemia, muscle insulin resistance, obesity, and continued consumption. Looks like metabolic syndrome to me. So, here are the phenomena associated with chronic ethanol exposure. Hematologic disorders, electrolyte abnormalities, hypertension, cardiac dilation, cardiomyopathy, dyslipidemia, pancreatitis, malnutrition, obesity, hepatic dysfunction, that's alcoholic steatohepatitis, fetal alcohol syndrome, and addiction. Here's fructose. Eight out of twelve. why? 'Cause they do the same thing. 'Cause they metabolize the same way. Because they are the same. They come from the same place, right.

How do you make ethanol? Naturally. Right, you ferment sugar. Hasn't changed,'cause it has all the same properties. Because it's basically taken care of by the liver in exactly the same way, and for the same reason. Because sugar and ethanol are the same, every which way you turn. So, here's our clinic intervention. This is what we do in our clinic. It's as simple as you can imagine. We write this on the back of a matchbook. It's just as simple as you can make it. We have four things we teach the kids to do, and the parents. Get rid of every sugared liquid in the house, bar none. Only water and milk, there is no such thing as a good sugar beverage, period. Eat your carbohydrate with fiber. why? Because fiber is good.

Fiber is supposed to be an essential nutrient. And we can talk later, if you want, after the cameras turn off, as to why fiber is not an essential nutrient. Because the government doesn't want it to be. 'Cause then they couldn't sell food abroad. Wait 20 minutes for second portions, to get that satiety signal. And finally, buy your screen time minute-for-minute with physical activity. That's the hardest one to do. So, if you play for half an hour, you can watch TV for half an hour. You wanna watch TV for an hour, play for an hour. That one's a hard one, but anyway. We follow our patients every three months. So, here's my question. Does it work? what do you think? Yeah, it works. So, this is BMI z-score time from initial visit. it works. But, we were interested in what made it work, and made it didn't work, so we did a multivariate linear regression analysis. The thing that made it not work, sugared beverage consumption.

The more sugar beverages the patient drank at baseline, the less well lifestyle intervention worked for all the reasons I just showed you. So, why is exercise important in obesity. Because it burns calories? Come on. 20 minutes of jogging's one chocolate chip cookie. You can't do it. (audience laughs) Are you joking me? So, why is exercise important? I'll tell you why, here's why. Number one, it improves that skeletal muscle insulin sensitivity because you're insulin actually works better at your muscle, which then brings your insulin levels down. Which is good for you. Number two, it's your indigenous stress reducer. It's the single thing that actually stress reduces. And if you stress reduce, what do you think your appetite does? Goes down, because stress and obesity go hand in hand, for all sorts of reasons which are beyond the scope of this lecture today.

But, we can talk about it in the question period, if you want. And then finally, remember that de novo lipogenesis? Remember those three nasty enzymes? What if you burned the stuff off before you made the fat? That's what exercise does,'cause it makes that TCA cycle run faster, so you don't get the citrate leaving the mitochondria, so it doesn't get turned into fat, so it doesn't precipitate and cause all the problems you just saw. (speaking away from microphone) That's what they mean by a higher metabolism, yes. But it has nothing to do with burning of calories. That is the stupidest reason that I've every heard of for exercise. You gotta be joking me. You can't do it. I mean one Big Mac and you gotta mountain bike for ten hours. (audience laughs) Are you joking? So, why is fiber important in obesity? So, this is my motto in clinic. When God made the poison, he packaged it with the antidote. 'Cause fructose is a poison. I think I've, hopefully, shown you that.

But, wherever there's fructose in nature, there's way more fiber. You ever see a piece of sugar cane? It's a stick, right? (audience laughs) You can't even chew the damn thing, right? You gotta suck the stuff out. (sucking) Like that, right? I mean, how many calories you think you're gonna get out of a piece of sugar cane? They actually did studies on the sugar plantations back in the early 1900s. All of the workers were healthy and lived longer than the sugar executives who got the processed product. How'bout that, wonder why. So, eat your carbohydrate with fiber, that's why we say that. That includes sugar, that's why fruit's okay. Because number one, it limits how much fructose you're gonna take in, and number two, it gives you an essential nutrient which you needed in the first place. And you get some micronutrients along with it so that you actually, your liver works healthier. So, here's what fiber does. Number one, it reduces the rate of intestinal carbohydrate absorption. Now, sometimes that's bad.

I'll tell you when that's bad. Now when that's bad? That's bad when you're at a formal function. 'Cause what happens if you reduce the rate of carbohydrate absorption in your gut? The bacteria get to it. So, as far as I'm concerned, in life you've got two choices. It's either fat or fart. (audience laughs) It increases the speed of transit of the intestinal contents to the ilium, and that raises this hormone over here called PYY, which goes to your brain and tells you the meal's over. That's your satiety signal. So when you add fiber to your diet, you actually get your satiety signal sooner, because the food moves through faster. And then, finally, it also inhibits the absorption of some free fatty acids all the way to the colon, and then those get chopped up into little itty bitty fragments called short chain fatty acids, and those actually suppress insulin, as apposed to long chain fatty acids which stimulate insulin. So there are a whole bunch of reasons why fiber is good.

Anybody ever heard of the Paleolithic Diet? Go home and read up on it on the internet. The Paleolithic Diet. Basically, if you east everything as it came out of the ground raw, with no cooking, you would cure diabetes on a dime. Takes about a week. Because you're getting that 100 to 300 grams of fiber I mentioned before. That's why,'cause fiber is good for you. And the more, the better. -[Audience Member] Type 2. Type 2, right, Type 2, not Type 1. I stand corrected, Type 2. Now, for some fun. That's the end of the biochemistry. Phew, how'd I do? (audience applauds) I told you I'd get you through it. So, now comes the fun part. The racial innuendos, and all the political stuff. The fructosification of America, and, of course, the world.

Ready? Another quiz. Can you name the seven foodstuffs at McDonald's that don't have high fructose corn syrup or sucrose? -[Audience Member] Mustard? -(laughs) No, mustard has it. (audience chatter) Oh, come on, come one, the big one. French fries, but they have salt, starch, and fat. So, they're not so good either. Okay, what else? We'll get to coffee. Hash browns, for the same reason, salt starch and fat. What else, chicken McNuggets, I was shocked. I was shocked. No sucrose or high fructose corn syrup in chicken McNuggets. But, as the Circuit Court Judge in New York called them, they are still a McFrankenstein creation. (audience laughs) But, nonetheless, no sucrose, I was really shocked. Sausage. Oh, they're terrible, they're just disastrous. But, I mean, there's nothing good in them at all, but there's not fructose. Sausage, Diet Coke, Coffee, if you don't add the sugar, and ice tea, if you don't add the sugar.

By the way, the chicken McNuggets, we have a disclaimer, because no one eats the chicken McNuggets without a dipping sauce. And there's a whole bunch of high fructose corn syrup in the dipping sauce, right? Okay, good, all right. So, who's really drinking this? We talked about this before. Gatorade AM. So, this is an attempt by Pepsi to capture market share on the juice market.

Do you think there are any elite athletes who actually drink this stuff? You gotta be kidding me. Okay, this is for kids, right? So, this really blew my socks off. This was my daughter, when she was in second grade, two years ago, Miriam Lustig, brought these two cartons of milk home for me, and said, "Dad, you're not gonna believe this." Second grade. So, here's the calories in Berkeley Farms 1% low fat milk, 130 calories, 15 of them are sugars, 'cause it's lactose, which is okay. And here's Berkeley Farms 1% chocolate milk, 190 calories, 29 grams of sugar, all high fructose corn syrup. It's like a glass of milk plus a half a glass of orange juice. And that's what we're giving to our kids. And do you know what the nutrition department at the SFUSD says? "Well, we have to get our kids to drink milk some how." Is that brilliant, or what? I do not know. Now, what about WIC. So, we talked about the 112 pounds of orange juice that the kid down in Salinas was drinking. What bout WIC? Remember what we started with? We have an epidemic of obese six month olds.

Remember? So, could this be the reason? So, here's a can of formula. 43.2% corn syrup solids, 10.3% sugar. It's a baby milkshake. Soda, Coca Cola, is 10.5% sucrose. Formula is 10.3% sucrose. Any difference? And there's a huge literature that's now coming of age that shows that the earlier you expose kids to sweet, the more they're gonna crave it later. Plus, there's a new literature that shows the more sugar the pregnant woman drinks or eats during the pregnancy, the more that gets across the placenta, and actually causes what we call developmental programming, changing the kids adiposity even before the kid is born, and driving this whole epidemic even further. So, we'll close in a few minutes. But, I just wanna point out what's the difference. Here, we got a can of Coke. Here we got a can of beer. And I'm not picking on Schlitz, or anything. It's any beer you want, okay. So, 150 calories each, no difference in terms of total calories. Percent carbohydrate, so 10.5% from sucrose here, except it's high fructose corn syrup, but who cares. 3.6% alcohol, here's the breakdown. 75 fructose, 75 glucose for the Coke.

90 alcohol 60 maltose for the beer. Remember, the first pass GI metabolism takes 10% of the alcohol off the table. So, when you actually compute the number of calories hitting the liver, which remember was the big difference between glucose and fructose, remember? 72 versus 24 and started the whole thing into motion as term of what happens that's bad. Bottom line, no difference. So, we have something called beer belly. Well, welcome to soda belly. 'Cause that's what America's suffering from. No ifs ands or buts. That's what it is. Now, you wouldn't think twice about not giving your kid a Budweiser. But, you don't think twice about giving your kid a can of Coke. But, they're the same, in the same dosing, for the same reason, through the same mechanism. Fructose is ethanol without the buzz. Fructose is a carbohydrate. Yes, it is. But fructose is metabolized like a fat. And I've just shown you that 30% of any ingested fructose load ends up as fat.

So when people talk about high fat diets doing bad things, no, what they're really talking about is high fructose diets, and that's what Ancel Keys was looking at. So, the corollary to that is, in America at least, and around the world too, a low fat diet isn't really a low fat diet. Because the fructose or sucrose doubles as fat, it's really a high fat diet. That's why our diets don't work. And fructose, just like ethanol, for the same reason, through the same mechanism, and in the same dosing, is also as toxin. Now, last, what can we do about it? Can we do anything about it? How'bout the FDA? You think they can do something about it. After all, aren't they supposed to regulate our food? Aren't they supposed to regulate what they can put in food? Weren't they supposed to regulate tobacco? Now they are, actually. So, you know, weird things. So, I wanna just show you what the tobacco company thinks of all this. This is actually from the UCSF Legacy Tobacco Documents Library that Stan Glantz runs right across the street.

Stan's a good guy, like Stan a lot. And he showed me this. "Under the regulations governing food additives," so this came from an Altria or Phillip Morris executive, "it is required that additives be safe, "defined as a reasonable certainty "by competent scientists that no harm "will result form the intended use of the additive." Now, does fructose meet that standard? Well, the FDA says that fructose, high fructose corn syrup, has what's knows as GRAS, GRAS status, generally regarded as safe.

Now, where'd that come from? No where. It came from no where. It came from the notion that, "Well, fructose "is natural, it's in fruit, it must be okay." Well, tobacco's natural too. But it's not. Ethanol's natural, but it's not. A whole bunch of, you know, Jamaican ackee fruit's natural, but it's not either. It kills you. Keeping on going. "A food shall be deemed to be adulterated "if it bears or contains any poisonous "or deleterious substance which may "render it injurious to health." Fructose fits that description, right? Uh-uh, but now with the prevention of chronic diseases, even though it's own regulations explicitly postulate the connection between such products and such diseases. In other words, the FDA will only regulate acute toxins, not a chronic toxin. Fructose is a chronic toxin. Acute fructose exposure did nothing, remember. 'Cause the brain doesn't metabolize fructose.

The liver does. And the liver doesn't get sick after one fructose meal. It get's sick after 1000 fructose meals. But, that's how many we eat. So, the FDA isn't touching this. The USDA isn't touching this. Because if the USDA touched this, what would that mean? That would mean an admission to the world that our food is a problem. So, what to you think that would do? There are three things in this country that we can still sell overseas. Weapo ns, entertainment, and food. Cars? (laughs) Computers? I don't thinks so.

Can anybody think of anything else that another country wants of ours? what? Tobacco, right, tobacco. (laughs) All right, you get the picture. So, the USDA doesn't wanna know about this. 'Cause this is bad news. And so, who runs the food pyramid? The USDA. It's the fox in charge of the hen house. Because their job is to sell food. And who's eating it? We are. So, in summary, fructose, and I don't care what the vehicle is, it's irrelevant, sucrose or high fructose corn syrup, I don't care, fructose consumption's increased in the past 30 years, coinciding with the obesity epidemic.

A calorie is not a calorie. And the dietitians in the country are actually perpetrating this on us. Because the more you think a calorie's a calorie, the more you think, well than if you ate less and exercise more, it would work. It doesn't. All of the studies show it doesn't work. Here's why it doesn't work, because a calorie is not a calorie. Fructose is not glucose. We know a calorie is not a calorie. 'Cause there are good fats and bad fats. There's good protein and bad protein.

Okay, there's good carbohydrate and bad carbohydrate. And glucose is good carbohydrate. Glucose is the energy of life. Fructose is poison. You are not what you eat. You are what you do with what you eat. And what you do with fructose is particularly egregious and dangerous. Hepatic fructose metabolism leads to all the manifestations of the metabolic syndrome. Hypertension through that uric acid pathway, de novo lipogenesis, dyslipidemia, hepatic steatosis through that DNL pathway, those three enzymes, the new fat making pathway, inflammation through JNK1, hepatic insulin resistance because of the serine phosphorylation of IRS-1, obesity because of the VLDL transport to the adiposite, and leptin resistance promoting continuous consumption, basically starving your brain, making you think you need more. Fructose ingestion interferes with obesity intervention, as we showed in our clinic.

The more soft drinks, the less well diet and exercise actually worked. Fructose is a chronic hepatotoxin for the same reason that alcohol is. The only difference is alcohol is metabolized by the brain, so you get alcohol effects. Fructose is not metabolized by the brain so you don't get those effects. But everything else it does is the same. But the FDA can't and won't regulate it. It's up to us. I'm standing here today to recruit you. That's a famous saying here in San Francisco, right? "I'm Harvey Milk, and I'm here to recruit you." I'm Robert Lustig, and I'm here to recruit you in the war against bad food.

And this is what's bad. With that, I wanna thank my colleagues at the UCSF Department of Pediatrics in our Weight Assessment for Teen and Child Health Clinic, UCSF Department of Epidemiology and Biostatistics, and also Department of Nutritional Sciences at UC Berkeley, in particular Doctor Jean-Marc Schwarz, who is a card carrying fructose biochemist, PhD biochemist, who vetted all of these pathways that I've shown you today, and looked at this and said, "Oh my God, it is a toxin." He worked in the stuff for 15 years, and he didn't even realize it was a toxin until he saw this.

So, with that, I'll close. Thanks you. (audience applauds) (upbeat techno music).

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