Sugar: The Bitter Thruth- Lecture Transcript- Part 1

Here is part 1 of the transcript of the excellent lecture given by Dr Robert Lustig.



Robert: I’m going to tell you tonight a story and this story dates back about 30 years. This story has a little bit of something for everybody. It has a little bit of biochemistry, a little bit of clinical research, a little bit of public health. A little bit of politics, a little bit of racial innuendo, the only thing it’s missing is sex but well we can see what we can do about that too. By the end of the story I hope I will have debunked the last 30 years of nutrition information in America. I would very much appreciate it if at the end of the talk you would tell me whether or not I was successful or no, okay.

In order to get you in the mood as it were, let’s start with a little quiz. What do the Atkins diet and the Japanese diet have in common? Anybody? You have the answers right, never mind that’s right, you have the answer right there. The Atkins diet of course is all fat no carb, the Japanese diet it’s all carb no fat they both work. Right so what do they share in common, they both eliminate the sugar fructose. With that think about what it means to be on a diet and what macro nutrients you are eating and which ones you are not and then will go from there and I’ll try to explain how this all works.

You’ve all heard about the obesity epidemic here are the numbers. These are the NHANES database body mass index everybody knows what that is now, histograms matching ever right word as time has gone on this is what was projected for 2008 in blue. We had so far exceeded and surpassed this is not even funny so from 2003. The reason I show this is not just to show that the obese are getting more obese, of course that’s true but in fact the entire curve has shifted. We all weigh 25 pounds more today than we did 25 years ago all of us. Now it is often said that obesity is the ultimate interaction between genetics and environment.

Dr. Christian Vase who’s sitting in the back of the room will be talking to you next week about the genetic component which I’m also very interested in. Having said that our genetic pool did not change in the last 30 years but boy oh boy has our environment sure changed. Tonight we are going to talk about the environment rather than genes. Now in order to talk about the environment we need to talk about what is obesity. Of course you are all familiar with the basic concept of the first law of thermodynamics which states that the total energy inside a closed system remains constant.

Now, in human terms the standard interpretation of this law is the following. If you eat it, you better burn it or you are going to store it. Now who here believes that? Come on you all do. I used to believe that I don't anymore. I think that’s a mistake. I think that is the biggest mistake and that is the phenomenon I’m going to try to debunk over the course of the, over the next hour. Because I think there’s another way to state the law which is much more relevant and much more to the point. Before I get there of course if you believe that these are the two problems, right. Calories in calories out two behaviors right, gluttony and sloth. After all you see anybody on the street, “He’s a glutton and a sloth that’s all there is to it.” Tommy Thomsen said it on the TV show, “We just eat too damn much.” Well if that were the case how did the Japanese do this?

Why are they doing bariatric surgery on children at Tokyo Children’s Hospital today? Why are the Chinese? Why are the Koreans? Why are the Australians? All these countries who have adopted out diet all suffer now from the same problem and we are going to get even further in a minute. There’s another way to state this first law and that is, if you are going to store it that is biochemical forces that drive energy storage and we’ll talk about what they are in a few minutes. You are expected to burn it that is normal energy expenditure for normal quality of life.

Because energy expenditure and quality of life are the same thing. Things that make your energy expenditure go up make you feel good. Like ephedrine, it's off the market, coffee for two hours and you need another hit like me. Things that make your energy expenditure go down like starvation, hypothyroidism make you feel lousy. How many calories you burn and how good you feel are synonymous. If you are going to store it that is an obligate weight gain set up by a biochemical process and you are expected to burn it that is normal energy expenditure for normal quality of life then you are going to have to eat it.

Now all of a sudden these two behaviors the gluttony and the sloth are actually secondary to a biochemical process which is primary. It’s a different way to think about the process and it also alleviates the obese person from being the perpetrator but rather the victim. Which is how obese people really feel because no one chooses to be obese … Certainly no child chooses to be obese, you say, “Sure I know some adults who don't care.” You know Rossini the famous composer like LA Gazza Ladra from marriage figure and all that he retired at age 37 to a lifetime of gastronomic debauchery.

Maybe he choose to be obese but the kids I take care of in obesity clinic do not choose to be obese. In fact this is the exception that proves the rule. We have an epidemic of obese six month olds. Now if you want to say that it’s all about diet and exercise then you have to explain this to me. Any hypothesis that you want to proffer that explains the obesity epidemic you’ve got to explain this one too. This is not just in America these six month olds obese kids but these are around the world now. Alright so open your minds and let’s go and figure out what the real story is.
Now let’s talk about calorie intake because that’s what today is about. We are going to talk about the energy intake side of the equation. Sure enough we are all eating more now than we did 20 years ago. Teen boys are eating 275 calories more. American adult males are eating 187 calories more per day. American adult females are eating 335 calories more per day, no question we are all eating more. Question is why? How come? Because it’s all there, you know what it was there before. We are all eating more there’s a system in our body which you’ve heard about over the last couple of weeks called Leptin.

Everybody hear Leptin. It’s this hormone that comes from your fat cells tells your brain, “You know what, I’ve had enough. I don't need to eat anymore, I’m done and I can burn energy properly.” Well you know what if you are eating 187 or 335 calories more today than you were 20 years ago, your Leptin isn't working. Because if it were you won't be doing it whether the food was there or not. There’s something wrong with our biochemical negative feedback system that normally controls energy balance and we have to figure out what caused it and how to reverse it and that’s what tonight is about.

Nonetheless there are 275 calories we have to account for so where are they? Are they in the fat? No, they are not in the fat. Five grams, 45 calories out of the 275 nothing. In fact it’s all in the carbohydrate, 57 grams, 228 calories we are all eating more carbohydrate. Now you all know back in 1982, the American Heart Association, the American Medical Association and the US Department of Agriculture admonished us to reduce our total fat consumption from 40 to 30% everybody remember that? That’s how anti-fat free cakes came into being, remember that.

What happened? We did it, we’ve done it 40% cal down to 30% and look what’s happened to the obesity, metabolic syndrome, nonalcoholic fatty liver disease, cardiovascular disease, stroke prevalence all jacked way up. As our total fat consumption as a percent has gone down. It isn't the fat people, it isn't the fat so what is it? Well it’s the carbohydrate specifically which carbohydrate? Well beverage intake, 41% increase in soft drinks, 35% increase in fruit drinks, fruit aids whatever you want to call them. Just remember down here one can of soda a day is 150 calories multiply that by 365 days a year and then divide that by the magic number of 3,500 calories per pound.

If you eat or drink 3,500 calories more than you burn you’ll gain one pound of fat. Okay that’s the first law of thermodynamics no argument there. That’s worth 15 ½ pounds of fat per year. One soda a day is 15 ½ pounds per year now you’ve all heard that before that’s not news to you. The question is how come we don't respond? How come Leptin doesn’t work? How come we can't stay energy stable? That’s what we are going to get to. I call this slide very specifically the Coca Cola conspiracy. Anybody here work for Coke? Pepsi? Okay good, alright so this over here 1915 the first standardized bottle of Coca Cola out of Atlanta anybody remember this bottle? Sure a lot of you do right.

I remember this bottle because my grandfather in Brooklyn took me on Saturday afternoon down to the local soda shop on Avenue Arm in Ocean Avenue and every Saturday afternoon I had one of this I remember very well. Now if you drank one of those everyday assuming of course that the recipe hasn’t changed because after all only two people in the world know the recipe and they are not allowed to fly in the plane at the same time you know that. Assuming the recipe hasn’t changed if you drank one of those every day for a year 6 ½ ounces that would be worth eight pounds of fat per year.

Now in 1955 after World War Two and sugar became plentiful again and wasn’t being rationed we have the appearance of the 10 ounce bottle, the first one that was found in vending machines and you probably remember that one as well. Then in 1960 the ever Ubiquitous 12 ounce can worth 16 pounds of fat per year and of course today this over here is the single unit of measure 20 ounces. Anybody know how many servings are in that bottle?

Male: 2.5.

Robert: 2.5 eight ounce servings that’s right. Anybody know anybody who gets 2.5 eight ounce servings out of that bottle? That’s a single serving. That would be worth 26 pounds of fat per year if you did that every day and then of course over here we have the 7/11 big K thirst buster big gulp whatever you want to call it, 44 ounces worth 57 pounds of fat per year and if that wasn’t bad enough my colleague Dr. Dan Hale at the University of Texas San Antonio tells me that down there they’ve got a Texas size big gulp. 60 ounces of Coca Cola, a sneakers bar and a bag of Dorado’s all for 99 cents …

Okay so if you did that every day for a year that will be worth 112 pounds of fat per year. Why do I call it the Coca Cola conspiracy? Well what’s in cup?

Female: Caffeine.

Robert: Caffeine good, good so what’s caffeine? It’s a mild stimulant right. It’s also a diuretic it makes you pee free water, what else is in coke?

Male: Sugar.

Robert: We will get to the sugar in a minute what else? Salt, salt. 55 milligrams of sodium per can it’s like drinking a pizza. What happens if you take on sodium and lose free water, you get …

Female: Thirsty.

Robert: Thirstier right. Why is there so much sugar in coke? To hide the salt. When was the last time you went to a Chinese restaurant and had sweet and sour pork? That’s half soy sauce you won't eat that except the sugar plays a trick on your tongue you can't even tell it’s there. Everybody remember new coke 1985 more salt more caffeine, they knew what they were doing that’s the smoking gun, they know, they know. Alright so that’s why it’s the Coca Cola conspiracy. Alright soft drinks is the cause of obesity, well it depends on who you ask. If you ask the scientist for the Natural Soft Drink Association he will tell you, “There’s absolutely no association between sugar consumption and obesity.”

If you ask my colleague Dr. David Ludwig remember I’m Lustig he’s Ludwig he does what I do at Boston Children’s Hospital someday we are going to open a law firm. Each additional sugared sweetened drink increase over a 19 month follow up period in kids increased their BMI by this much and their odds risk ration for obesity by 60%. That’s a prospective study on soft drinks and obesity, the real deal. If you look at meta-analysis everybody know what a meta-analysis is? Okay it’s a conglomeration of numerous studies subjected to rigorous statistical analysis.

88 cross-sectional and longitudinal studies regressing soft drink consumption against energy intake body weight milk and calcium intake adequate nutrition all showing significant associations and some of these being longitudinal. This came from Kelly Brownell’s group at Yale. I should comment a disclaimer those studies that were funded by the beverage industry showed consistently smaller effects that those that were independent I wonder why? Now, how about the converse, what if you take the soft drinks away? This was the Fizzy Drink Study from Christ Church England James At Al British medical journal where they went into schools and they took the soda machines out.

Just like we did here in California we haven’t seen the data yet but they went ahead and did it for a year. The prevalence of obesity in the intervention school state absolutely constant near change where’s the prevalence of obesity in the control schools where nothing changed continued to rise over the year … That’s pretty good so how about type two diabetes. Are soft drinks the cause of type two diabetes? Well this study from German in 2004 looked at the relative risk ratio of all soft drinks, cola fruit punch and found a very statistically significant trend.

Of sugared soft drinks, food aids etcetera causing Type Two Diabetes and you know we’ve got just as bigger problem with Type Two Diabetes as we do with obesity for the same reasons. This was the sugared sweet beverage against risk for Type Two Diabetes in African American women. Looking here, sugared sweetened soft drinks just the downward arrow shows that there was a significant rise as the number of drinks went up, you can see that here whereas orange and grape fruit juice interestingly did not. Okay so two different studies, two different increases in Type Two Diabetes relative to soft drink consumption. What’s in the soft drinks? Well in America it’s this stuff, high fructose corn syrup everybody has heard of it right. It’s been demonized something awful so much so that the corn refiners industry has launched a mega campaign to try to absolve high fructose corn syrup with any problems which we’ll talk about in a moment.

The bottom line is, this is something we were never exposed to before 1975 and currently we are consuming 63 pounds per person per year every one of us. 63 pounds of high fructose corn syrup.

Part 2 coming soon.

Vince said:

http://www.thefatemperor.com/blog/

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What *exactly* is a LCHF diet? What is low carb. What is high fat. What carbs? What fats?

I've read all this stuff for so long and I've tuned out all these fad stuff because a lot of these folks are not even researching, they are only trying to cherry-pick links and papers to defend their diet beliefs.

There's a book called "The Blue Zones" - a collaboration between Dan Buettner and National Geographic that examined 5 cultures/peoples that consistently had great health and longevity. There were a lot of factors involved, social interaction, activity (these folks were very active), spiritual practice, and so forth. Diet was important, but the other factors were nearly as so.

None ate any red meat. They did have varying amounts of pork, chicken, fish, and eggs, but not on a frequent basis, anywhere from once or twice a week to once a month. The Okinawans' diet consisted of primarily sweet potatoes. The author does not advocate a specific way of eating, he just identified the basics followed by these long-lived cultures:

1) Plants - about 95% of the diet.
2) Minimize meat (chicken/pork/lamb) - once or twice a week, and make it sustainable, free-range and in small amounts. Avoid all processed meats.
3) Good sustainable fish (trout, sardines, etc) up to 2 or 3 times a week.
4) Minimize dairy. Small amounts of goat or sheep milk products; none of the long-lived cultures ate beef or had cow's milk or relevant products.
5) Eggs are fine, up to 2 or 3 times a week.
6) Beans!! Beans are the cornerstone of all the diets. Eat beans daily.
7) No added sugar. These folks rarely had sweets and only used local honey or dates as sweeteners for their treats.
8) Nuts
9) They all had whole grains on a daily basis - from quinoa/brown rice/millet/barley etc. And most of the populations had bread, but baked with whole grains such as durum wheat or rye, not the processed flour; and their breads had small amounts of gluten and the bread was slow-fermented.
10) Local whole foods. They ate mostly locally-grown produce or meat or fish.
11) Some drink a lot of strong coffee, all drank local teas, and most had some form of red wine.
12) The Power Foods - beans/greens/sweet potatoes/nuts/olive oil/oats/barley/fruit/teas/turmeric.

There you go. A common-sense whole food, plant-based diet without any diet dogma. These people sure as hell did not go around thinking "Low-Carb High-Fat", "Vegan", or "Paleo". They just ate what was local and what was available and cooked their own food. Overall - their diets were about 20% fat, 65% carbs, and 15% protein, with some local variations, e.g. the ones who had olive oil had a higher fat content - but again, they were not worrying about how much fat or carbs they were getting.

croaker24 said:

What *exactly* is a LCHF diet? What is low carb. What is high fat. What carbs? What fats?

I've read all this stuff for so long and I've tuned out all these fad stuff because a lot of these folks are not even researching, they are only trying to cherry-pick links and papers to defend their diet beliefs.

There's a book called "The Blue Zones" - a collaboration between Dan Buettner and National Geographic that examined 5 cultures/peoples that consistently had great health and longevity. There were a lot of factors involved, social interaction, activity (these folks were very active), spiritual practice, and so forth. Diet was important, but the other factors were nearly as so.

None ate any red meat. They did have varying amounts of pork, chicken, fish, and eggs, but not on a frequent basis, anywhere from once or twice a week to once a month. The Okinawans' diet consisted of primarily sweet potatoes. The author does not advocate a specific way of eating, he just identified the basics followed by these long-lived cultures:

1) Plants - about 95% of the diet.
2) Minimize meat (chicken/pork/lamb) - once or twice a week, and make it sustainable, free-range and in small amounts. Avoid all processed meats.
3) Good sustainable fish (trout, sardines, etc) up to 2 or 3 times a week.
4) Minimize dairy. Small amounts of goat or sheep milk products; none of the long-lived cultures ate beef or had cow's milk or relevant products.
5) Eggs are fine, up to 2 or 3 times a week.
6) Beans!! Beans are the cornerstone of all the diets. Eat beans daily.
7) No added sugar. These folks rarely had sweets and only used local honey or dates as sweeteners for their treats.
8) Nuts
9) They all had whole grains on a daily basis - from quinoa/brown rice/millet/barley etc. And most of the populations had bread, but baked with whole grains such as durum wheat or rye, not the processed flour; and their breads had small amounts of gluten and the bread was slow-fermented.
10) Local whole foods. They ate mostly locally-grown produce or meat or fish.
11) Some drink a lot of strong coffee, all drank local teas, and most had some form of red wine.
12) The Power Foods - beans/greens/sweet potatoes/nuts/olive oil/oats/barley/fruit/teas/turmeric.

There you go. A common-sense whole food, plant-based diet without any diet dogma. These people sure as hell did not go around thinking "Low-Carb High-Fat", "Vegan", or "Paleo". They just ate what was local and what was available and cooked their own food. Overall - their diets were about 20% fat, 65% carbs, and 15% protein, with some local variations, e.g. the ones who had olive oil had a higher fat content - but again, they were not worrying about how much fat or carbs they were getting.

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when you have time please research the hunter-gatherer diet

THERE'S no Shangri-La, but Okinawa comes pretty close to being that mythical land of perpetual youth.This chain of islands off Japan is home to some of the liveliest oldsters on the planet.
Many live more than a century and have the birth certificates to prove it. Heart disease and dementia are rare and breast and prostate cancer are practically unheard of.
How they do it – and how you can try to duplicate it – is the focus of a new book that contends that lifestyle, not genetics, is the key to a healthy and active old age.
It's called “The Okinawa Program,” and its authors – twin-brother gerontologists Bradley Willcox and D. Craig Willcox and Japanese doctor Makoto Suzuki – offer tips on everything from meditation to meal-planning.
One of the biggest challenges in researching it, says 39-year-old Bradley Willcox, a geriatrics fellow at Harvard Medical School, was keeping up with the elders.
“There was one 108-year-old guy who was living in Ontario but maintained the Okinawan way of life. Every time we called him, he was out fishing,” says Willcox. “His 90-odd-year-old wife would say, ‘You just missed him!'”
The Willcoxes and Suzuki examined over 600 Okinawan centenarians, plus countless “youngsters” in their 70s, 80s and 90s. Not only were many still fishing, but others were farming, running food stands or practicing the gentle martial art of t'ai chi.
“There is no word for ‘retirement' in the Okinawan language,” Willcox says. “People keep doing what they've always done.”
Just how big a part genetics plays in all this is open to debate. “A lot of gerontologists feel [longevity] is two-thirds lifestyle, one-third genetics,” Willcox says. “While there are several genes clearly associated with premature or delayed aging, lifestyle still acts on these genes.”
Indeed, the younger people of Okinawa, seduced by fast food and TV, are succumbing to the illnesses – heart disease, stroke, cancer – their elders have avoided.
So what are the older Okinawans doing right?
According to the researchers, everything. They eat lots of plant foods – soy, vegetables, fruit and whole grains – a diet that's shown to keep the arteries unclogged, the better for cardiovascular health. They get most of their soy from tofu and edamame, the raw soybeans that the Canadian-born Willcox reports “go great with beer.”
Not that Okinawans drink much. Nor do they eat much, averaging 500 fewer calories a day than Americans. And while they love their pork stew – a traditional delicacy some Okinawans swear is the secret of their longevity – they eat it only occasionally, and cook the meat so long the fat disappears.
Personality plays a part, too. The Okinawan attitude, Willcox says, is part Type A self-confident ****iness and another part “go with the flow” adaptability. Rarely do they feel rushed, and that laid-back attitude goes a long way toward minimizing stress.
“We in the West suffer from hurry sickness,” Willcox says. “We try to do more and more in less and less time, and that kind of constant stress can have devastating long-term consequences – like dementia, the premature aging of the brain.”
On the other hand, he says, physical stress – exercise – is good for the body, and Okinawa, home of karate and other martial arts, preaches a life of physical and mental fitness.
Not only that, he says, but “I've never seen a place where people dance so much.” In Okinawa, dancing breaks out spontaneously – not only at parties, but at the end of a long work day.
Since embarking on the study seven years ago, Willcox says he's incorporated a little bit of Okinawa into his own life.
“I was always into fitness but now I meditate more and eat more soy foods,” he says. “I've also become more relaxed . . . I figure I'm in here for a century and I'm planning my life accordingly.”
———
Longevity 'round the globe (chart)
What do the Japanese know that we don't?
Japan placed first among 191 countries in the World Health Organization's new way of measuring life expectancy – the number of years a resident can expect to live without disability.
Life is short in AIDS-stricken sub-Saharan Africa – Sierra Leone, for instance, finished last with a healthy life expectancy of only 25.9 years.
In most countries worldwide, women outlive men by as many as seven years.
Healthy life expectancy — Overall life expectancy
1. Japan: 74.5 — 80.7
2. Australia: 73.2 — 79.8
3. France: 73.1 — 78.8
6. Italy: 72.7 — 79.0
14. U.K.: 71.7 — 77.7
23. Israel: 70.4 — 78.6
24. U.S.A.: 70.0 — 77.1
27. Ireland: 69.6 — 76.8
81. China: 62.3 — 71.4
134. India: 53.2 — 62.5
191. Sierra Leone: 25.9 — 45.3
Sources: World Health Organization, U.S. Census Bureau
http://nypost.com/2001/05/01/live-to-100-with-japanese-recipe-for-a-long-life/

my oldest living relative is japanese and still eats the traditional japanese way

Good stuff Vince. That was the gist of the Blue Zones book, that lifestyle and culture played a big part in longevity and health. I don't think the specific details of the diet itself is so important as long it's primarily plant-based and clean - no processed western junk.

As for the hunter-gatherer diet (Paleo) - I don't think it is relevant. Genetically we are not the same - we've adapted to changes in our environment, e.g. dairy, the adventure of agriculture, different diseases, and so on. And do you really think that bacteria comprising our gut biome has remained unchanged? Bacteria evolves quickly - just look at all the bacteria developing antibiotic resistance in a short period of time. Gut bacteria plays a big part of what we can eat successfully.

And what foods that our ancestors ate are still still available in it's original form? Either it no longer exists, or it's been selected for and adapted into many other forms by humans.

Also - there was never one hunter-gatherer diet - it was very localized to what was available in the area - so there were many different diets all over the world, and I have not seen any indication of any commonality between them. You want to eat Paleo? How about eating some grubs and insects now and then

I don't read paleo dogma, I read what the scientists who are actually researching this stuff, who are analyzing paleo dig sites; and I don't recall any of them taking the paleo diet seriously. They are constantly pushing back the dates at when we started eating grains and legumes, and finding that the diets varied quite widely. And I don't recall any of them advocating that we eat the same way, because 1) we can't, and 2) they were not exactly robust specimens of physical health.

It's nuts: we have the low-carb diet, the high-fat diet, the gluten-free diet (for non-celiacs), the glycemic index diet, the blood type diet, the vegan diet, paleo diet, and many other variations. Lifestyle changes are very hard to make, especially in our western culture where most of us grew up drinking milk, eating fast food, and relying on processed foods out of cans and boxes. So the tendency is to look for silver bullets - the magical diet to fix all our problems.