This show is presented by the University of California Television Do you like what you learn? Visit our website or follow us on Facebook and Twitter to see the latest UCTV broadcasts. UCSF's Osher Center for Integrative Medicine presented small college of medicine for the public Current controversies around nutrition – let science speak Sugar – The Bitter Truth presented by Dr. Robert H. Lustig Professor of Pediatrics Department of Endocrinology University of California, San Francisco I'll tell you a story tonight. This happened about 30 years ago. It contains a little something for everyone. It's about a little bit of biochemistry, about clinical research, about the health system, politics, ethnic issues, – the only thing missing is sex. But we can see if something can be done there. At the end of the story, I hope I have refuted America's nutritional science for the past 30 years.
And I would very much appreciate it if you could tell me afterwards whether I succeeded. To get you in the right mood, so to speak let's start with a little puzzle. What do the Atkins diet and the traditional Japanese diet have in common? Anyone? … Oh, there you have the answer … Don't worry. So the Atkins diet is high in fat and not carbohydrates, and the Japanese diet is high in carbohydrates and not fat. And both work, don't they? What do the two have in common? They have in common that they do not use the sugar fructose. So, think about what it means to be on a diet and which macronutrients (fat, protein, carbohydrates) you eat and which you don't. Then we start there and I try to explain how it all works. So, I'm sure you've all heard about the obesity epidemic. Here are the numbers. These are the figures from the NHANES database for the development of the body mass index. You can see histograms that continue to move to the right as time progresses.
The blue line shows what was forecast for 2008. So far, we have far surpassed this and already overtook it in 2003. Why I’m showing this is not just to point out that the overweight are getting overweight, which of course is true, but to show that the entire curve has shifted. We all weigh 12.5 kilos more than we weighed 20 years ago. So. It is often said that being overweight is the perfect interplay between genetics and the environment and Dr. Christian Vase, who is sitting in the back, will talk about the genetic influence next week, which I am also very interested in. But as for that – our genetic makeup has not changed in the past 30 years. But boy, boy has our environment changed. So, tonight it should be about environmental influences. In order to be able to talk about the environment, we have to clarify what overweight means. They all have an idea of the first law of thermodynamics, which says that the total energy remains the same within a closed system. Applied to humans, the common interpretation of this law is as follows: If you eat it, you'd better burn it, otherwise you'll save it.
Now who believes this? Oh come on, you all believe that! I believed that too. Not any longer longer. Because that's a mistake, the biggest mistake. That is the phenomenon that I am trying to refute within the next hour. Because I think there is another way to state the law. Much more relevant and more to the point. Before I get to that, of course, if you believe in it, these are the two problems: Calories in and calories out.
The focus is on two behaviors: greediness and laziness. So when you see someone on the street, you think, "He's a glutton and a lazybone, that's all." Tommy Thomson said it on a television program: "We just fucking eat too much!" Well, if it were, how did the Japanese do it? Why are they already doing gastric band surgery on minors at the Tokyo Children's Hospital? Why do the Chinese, the Koreans, the Australians, all these countries that have adopted our diet all have the same problems? And in a moment it goes even further. There is another way of expressing this first law. When energy is stored, ie through biochemical processes that drive energy storage. We'll talk about this in a few minutes. And if you want to burn the energy, which means normal energy consumption for normal quality of life – because energy consumption and quality of life are the same. Things that increase energy consumption make you feel good. For example, coffee that works for two hours and then you need another kick, like me. Things that reduce energy consumption, such as malnutrition or hypothyroidism, make you feel miserable.
How many calories you burn and how good you feel is synonymous. So when it is saved, through an obligatory weight gain that arises through a biochemical process and it should be burned under normal energy consumption for normal quality of life, then you have to eat it. And now these two behaviors (gluttony and laziness) are suddenly secondary to a biochemical process, which is primary. This is another way of thinking about the process. And it also reduces the suffering of the overweight, who is no longer the perpetrator, but rather the victim. Because that also corresponds to how overweight people really feel. Because nobody tries to be overweight. In particular, no child decides to be overweight. Of course there are some adults who say they don't care. Rossini, the famous composer, was tired at the age of 37 because of a life full of gastronomic debauchery. He may have decided to be overweight. But the kids I deal with in the overweight clinic didn't choose to be overweight. In fact, this is the exception that proves the rule. We have an epidemic of overweight children aged six months.
So if you say it's just about nutrition and exercise, you have to explain it to me. Any hypothesis that you want to put forward that tries to explain the obesity epidemic must be able to explain that. And these cases of overweight children with half a year are not only found in America, but all over the world. So open yourself up to find out where the truth is. Let's talk about calorie intake because that's what it's about today. We consider the equation from the side of energy consumption. In fact, we all eat more today than we did 20 years ago. Male adolescents eat 275 more calories. In America, men eat 187 more calories a day. Women eat 335 more calories. Without question – we all eat more. Why? Because it's available everywhere? Well, it was there before.
We all eat more. There is a system in our body that you have heard of in the past few weeks called leptin. Did you hear about it? Leptin is the hormone that is produced by the fat cells and that tells the brain: "You know what, I've had enough. I don't need anything to eat. I am full and I have enough energy to burn ” But if you eat 187 or 335 more calories today than 20 years ago, your leptin won't work. Because if it worked, you wouldn't do it whether the food is there or not. Something is wrong with our biochemical negative feedback system, which normally controls the energy balance.
And we have to find out what is causing it and how we can reverse it. That is what it should be about today. Anyway, there are 275 calories to consider. How are they composed? Fat? ~ No, not fat. 5 grams of fat, which corresponds to 45 calories out of 275. Almost nothing. In fact, it's the carbohydrates, up 57 g, or 228 calories. We all eat more carbohydrates. So, you all know that in 1982 the American Heart Association, the American Medical Association, and the United States Department of Agriculture have urged us to reduce our total fat consumption from 40% to 30%. Do you remember that? This is how Entenmann's fat-free cakes came about. So what happened? We succeeded in. From 40% to 30%. Well, look at what happened to the incidence of overweight, metabolic syndrome, non-alcoholic fatty liver, cardiovascular disease and heart attack. Everyone jumped upwards while our total fat consumption decreased. It's not fat, people.
It is not the fat. ~ Well, it's the carbohydrates. Which carbohydrate to be exact? Drink intake. There was a 41% increase in soft drink consumption and a 35% increase in fruit drinks. Let us remember – a can of lemonade a day contains 150 calories. Multiply that by 365 days a year and then divide that by the magic number of 7000 calories per kilo. If you consume 3500 calories more than you consume, you gain one pound of fat. That is the first law of thermodynamics. A can of lemonade a day equates to £ 15.5 a year.
But you already knew that, this is not news. The question is, why don't we respond? Why doesn't the leptin work? Why can't we not have a balanced energy budget? We'll get to that. Well, I call this slide the Coca-Cola conspiracy. Someone here who works for Coca-Cola or Pepsi? ~ Ok, good. In 1915, this was the first standardized bottle of Coca-Cola from Atlanta. Does anyone remember? ~ Sure, many remember. I remember that because my grandfather took me to Brooklyn's local beverage store on Ocean Avenue on Saturday afternoons and I drank one every Saturday afternoon. I remember that very well. If you would drink one every day – assuming, of course, that the recipe has not changed, after all, only two people in the world know the recipe and they are prohibited from flying by plane at the same time … Assuming the composition has not changed and you soak one bottle every day for a year (6.5 oz corresponds to about 192 ml) then that would add up to 8 pounds of fat a year. Then in 1955, after World War II, when sugar was back in excess and it was no longer rationed, the 296 ml bottle was brought onto the market.
It was the first to be found in vending machines. You may also remember that. Then in 1960, the 355 ml can, which is responsible for 16 pounds of fat a year. And then of course this one here, 1992 is the only unit of measure, 20 ounces (591 ml) Does anyone know how many servings it contains? 2.5 servings, with a serving size of 8 ounces (236 ml). Is there anyone who makes two and a half servings out of this bottle? ~ It's a serving, isn't it? So that would be 26 pounds of fat a year if you drink one every day.
And here of course we have the Seven Eleven Super Giant Thirst Quencher, or whatever you want to call it, at 44 ounces (1.302 L), responsible for 57 pounds of fat a year. And as if that wasn't bad enough, my colleague Dr. Dan Hailer of the University of Texas San Antonio, that they have the Super Size Coca-Cola with 60 ounces (1,774 l) down there, together with a sneaker bar and a bag of Doritos for 99 cents. Well, if you were to eat this every day, we would be 112 pounds of fat a year. So why am I talking about the Coca-Cola conspiracy? What is in cola? Caffeine. It is one of the weak stimulants, it is also diuretic – ensures that you have to pee free water …
What is still in Coke? We'll take care of the sugar right away … Salt. 55 mg sodium per can. It's like drinking a pizza. So what happens if you consume sodium and lose free water? You will be even more thirsty! Why is there so much sugar in cola? To hide the salt. When was the last time you went to Chinese and had pork sweet and sour? Half of it is soy sauce, you wouldn't eat it. But the sugar is playing a trick on your tongue, so you won't even notice there is soy sauce in it.
Do everyone remember New Coke 1985? It contained more salt and more caffeine – they knew what they were doing. That is the striking proof. You know it… That's why it's the Coca-Cola conspiracy. So are soft drinks the cause of obesity? It depends on whom you ask. If you ask the scientist for the National Soft Drink Association, he will tell you that there is absolutely no link between sugar consumption and obesity. If you tell my colleague Dr. Ask David Ludwig (he does the same as I do at the Boston Children's Hospital, one day we'll open a law firm): Each additional drink sweetened with sugar increases the BMI in children over a period of 19 months by as much and their probability of being overweight by 60%.
It is a prospective study on soft drinks and obesity. If you look at the meta-analysis – a collection of numerous studies that are subject to strict statistical analysis shows 88 cross-sectional and longitudinal studies showed that the consumption of soft drinks is associated with increased energy consumption and increased body weight and reduced milk and calcium intake and poor nutrition (see source) All of them show significant links. That was determined by the group around Kelly Brownell at Yale University. I should also mention that those studies that were funded by the beverage industry consistently showed less effects than those that were independent.
I wonder why? So what happens if you take away the soft drinks? That was the lemonade study from Christ Church in England by James et. al, that appeared in the British Medical Journal So they went to school and took out the sweet drink machine. just like we did in California. We haven't evaluated it yet, but they did it for a year. The frequency of overweight remained exactly the same in the affected schools, no change, while the incidence of overweight in control schools where nothing had changed continued to increase in the same year. That is remarkable. So how about type 2 diabetes? Are Soft Drinks the Cause of Type 2 Diabetes? In 2004, this study from the JAMA Medical Journal compared the relative risk indicators of all soft drinks, colas and fruit drinks and discovered the statistically significant trend that sugared soft drinks, fruit drinks, etc. cause type 2 diabetes. And you know we have as much of a problem with it as with obesity for the same reasons. Here you see the risk of type 2 diabetes in relation to the consumption of sugar-sweetened beverages in African-American women.
Here the arrow shows that with the consumption of sugar-sweetened beverages there was a significant increase the more beverages were consumed. You can see that here. Interestingly, orange and grapefruit juice did not increase the risk. So, two different studies and two different increases in type 2 diabetes in relation to soft drink consumption. Now what's in soft drinks? In America it's this stuff: High Fructose Corn Syrup (high fructose corn syrup) Everyone has heard of it, right? It was demonized, something terrible, So much so that the grain processing industry tried to launch a mega campaign To exonerate High Fructose Corn Syrup from any problems.
We'll talk about that in a moment. The bottom line, however, is that it is something we have never been exposed to in 1975. And right now we're consuming £ 63 a person a year. All of us. 31.5 kilos of high fructose corn syrup. In America? ~ In America, yes. So what is high fructose corn syrup? You will find out in a moment. It is a glucose and a fructose molecule. We will talk about this in detail. One reason why high fructose corn syrup is used is because it is sweeter. There is sucrose. This is cane and beet sugar, the normal table sugar, the white stuff. And we assign the degree of sweetness 100 to this in the index. There's high fructose corn syrup. It is even sweeter. It has 120. So it should be possible to use less, right? ~ Wrong. We use just as much.
We actually use more. There's laboratory fructose, crystalline fructose And they're just starting to use crystalline fructose in some soft drinks. They even advertise that as a good thing. It has a sweetness level of 173. So it should be possible to use a lot less, right? But they don't. There, the lactose – milk sugar is not sweet at all. I should point out that glucose at 74 is not particularly sweet. We'll get to that in the end. Anyway, here's why it's used: it's sweeter and cheaper too. So here you can see high fructose corn syrup: A glucose and a fructose molecule Make sure that the glucose has a six-chain ring and the fructose has a five-chain ring. Not the same, believe me: you are not the same. That's what it's about here.
That they're not the same thing at all. And below is the sucrose, in which glucose and fructose are only coupled with this ether compound. We have an enzyme in our gut called sukrase which splits this connection within just 2 seconds. Then it is recorded. High fructose corn syrup or fructose – it has no meaning. It makes no difference. It is the same. And the soft drink companies, like the grain processing industry, know that it's the same. Because here are their failures. This was released by the grain processing industry: Overweight studies show that high fructose corn syrup is metabolized just as much and has the same feeling of satiety as sugar. Indeed it does. I agree, at prestigious academic meetings across the country. Hunger and satiety profiles and energy intake as a result of taking soft drinks sweetened with sugar or high fructose corn syrup … The bottom line is research funded by the American beverage industry and the Corn Refiners Association. They are right.
There is not the slightest difference between high fructose corn syrup and sucrose. So much so that the grain processing industry is trying to gain market share with this advertising campaign – maybe you saw it on the last page of the New York Times, she was on TV, she is everywhere – "My hairdresser says sugar is healthier than high fructose corn syrup." ~ "Wow, do you have a doctor cut your hair?" I can't cut hair. If you want to see all of them, you can look at http://sweetsurprise.com and see how they are misled. But really, that's true: High fructose corn syrup and sugar are exactly the same. They are both equally bad. They are both dangerous. They are both poison. Yes, I said it: poison. It is my responsibility to show until the end of the evening that fructose is a poison. And I will succeed. And you tell me if I was successful.
Nonetheless, here is a press release from the Center for Science of the Grain Processing Industry in the public interest Everyone remembers last year when Gavin Newsom proposed a lemonade tax last February … Governor Patinson from New York has put one in the room since then and other people are starting to talk about it. So why do they say that? Being overweight is a problem Children drink soda Let's put a tax on it. Well, they're talking about soda like it's empty calories.
I'm here to tell you that empty calories go way beyond … The reason why this is a problem is because fructose is a poison. It's not about calories. It has nothing to do with it. It is a poison in itself. And I'll show you that. I just want to read the part in yellow to you. We politely request that you revise your proposal as soon as possible by providing scientific evidence that there is no actual difference is involved in the health effects of high fructose corn syrup and sugar. I agree. Here comes the important sentence: The real problem is that excessive consumption of any sugar can lead to health problems.
I agree. Not can, but it does. It does. Here is the last century trend of fructose consumption within the past 100 years. Before there was food processing, fructose came from fruits and vegetables. And if we did that today, we would eat about 15 g of fructose a day. Not sugar … Fructose Sugar would be 30 g, twice as much Today we're just talking about fructose.
Before World War II, before it was rationed again, it was 16-24 g, say 20 g. So a slight increase from the beginning of the century to World War II. Then in 1977, just when the high fructose corn syrup came on the market, we had increased the consumption, almost doubled, to 37 g a day which is 8% of total calorie intake. By 1994 it had risen to 55 grams of the stuff a day. Remember, if you want to know how much sugar you have to double the number. That is 10.2%. You can see that more and more of the calories we consume – a higher percentage – are sugar. Every year more So it's not just that we eat more. We eat more sugar. And adolescents today eat almost 75 g, 12% of the total calorie intake. 25% of adolescents consume at least 15% of their calories from fructose alone. That's a catastrophe. An absolute, total disaster. The fat decreases proportionately, the sugar proportion increases and we all get sick. Now let me show you why.
How did this happen? Why did it happen? Now politics come into play. That is the perfect storm and it was caused by three political forces whirling around – all at the same time to create this perfect storm. The first political wind: The worst thing that ever happened in this country started with a man. And it is still noticeable today. Richard Nixon, with his paranoia 1972 … Food prices were in a constant up and down. I'll show you that on the next slide. And he worried that it might cost the next reelection. So he instructed his Agriculture Minister Earl Rusty Butz (I love this name) to make sure that food disappeared from the political agenda, for the fact that food was absolutely no longer an issue in the presidential election. The only way to do that was to make the food cheap. He was determined to find all the methods to lower the price of food.
Do you remember: Nixon's war on poverty? We still suffer from it today. That's it. The second political wind: The beginning of high fructose corn syrup It was in 1966 at Saga Medical School in Japan invented by a guy named Takasaki who is still alive. As for me, this stuff is Japan's revenge for World War II. Apart from the fact that they now suffer from it themselves. As with everything – it always comes back to one … In 1975 it was launched on the American market. So what do you think happened to the market price of sugar when this stuff was approved? That happened: There is the US producer price index for sugar, which is constantly going up and down. This is not good. Stability remains the same at 100%. It is desirable that it remains stable at 100%, as a politician. Up and down – this was where corn sweetness came onto the market in 1975/1980. And you can see that the price of sugar has remained astonishingly constant since then.
And that was not only the case in the USA, but also on the international stage. There is the London Prize that does the same thing. And if you compare the differences in the prices of sugar and high fructose corn syrup (HFCS) you can see that HFCS only costs about half as much. In other words – it's cheap. So HFCS is bad but it's not bad about metabolism, It is bad because it is economically bad. Because it is so cheap that it has found its way into everything.
It found its way into hamburger buns, Pretzels, Barbecue sauce, ketchup, in almost everything. Someone recently emailed me and told me that he went to his local grocery store and went through every single loaf of bread on the shelves and of 32 types of bread, only one was without HFCS. We're poisoned by this stuff and it is secretly added to all of our food. for every processed food. The question is why? Well, you'll see it in a minute. The grain processing industry likes to say: "Well it's just a replacement" as HFCS increased as a food additive, the sugar content decreased "You know, we're just exchanging it, gram for gram." Well, not exactly.
Here it's 73 pounds of sugar a year (from the Economic Research Service of the Department of Agriculture, so vanishing data) From £ 73 high to £ 95 in 2000 And there is something missing on this slide. Can anyone tell me what? What is missing? ~ Juice. Juice is missing. Because there is sucrose in juice, right? ~ Sugar. And juice causes obesity. This is a study by Miles Faith. It is a prospective study of urban toddlers from Harlem. The frequency of serving juice a day predicts the change in BMI per month with these urban toddlers from Harlem. So, where do these toddlers from the city get their juice from? Of what? From whom? By WIC.
Anyone heard of it? Women, Infants, Children A government utility program implemented by whom? ~ Nixon to prevent a lack of weight gain. They succeeded. On the contrary, it was wrong. Let's add the juice. There he is. And most of it with fructose when you put it together. Now rose to 113 pounds on this chart. And I just heard from Brian Williamson of NBC News that after the latest study came out (in the Journal of Clinical Investigation) we're actually at 141 pounds of sugar a year now. All of us. That's what we're talking about – 141 pounds of sugar a year.
Do you think that could have a harmful impact on you? That doesn't stop you, does it? That is the point – it does not stop you. So we have to talk about it. Drinking juice increases the risk of type 2 diabetes. This is the relative risk indicator when juice consumption increases (that's in the Nurse's Study) This again shows that fruit juice consumption, sucrose, obesity and diabetes. The third political wind that blows around and triggers this catastrophe, this mega typhoon is this thing that happened in 1982. The U.S. Department of Agriculture, the American Heart Association, and the American Medical Association are asking us to cut down on our fat intake. Why did they tell us that? To stop what? To prevent heart disease. Did you succeed? ~ No, it didn't work, did it? In fact the opposite has happened we created more. How come? Why did they tell us to stop eating fat? In the early 1970s, something was discovered in our blood called LDL. Low-density lipoprotein. You heard about that, right? Is it good or bad? Not so bad, we're talking about it.
In the mid-1970s, we found that dietary fat increased LDL. So when dietary fat is A and LDL is B, we have found that A led to B. Dietary fat definitely increases your LDL, no question, that's true. And then we finally found out in the late 1970s that LDL correlated with cardiovascular disease. Let's call cardiovascular disease C So we found that B led to C. So, the train of thought of some very intelligent nutritionists and the like (Ministry of Agriculture, etc.) went like this: So if A leads to B and B to C, then A must lead to C. – therefore: no A – no C. That was the logic. Well, are logicians in the room? Is there anyone who sees any problems with this logic? Shoot it.
~ That's right. The premise is wrong. And I'll tell you why the premise is wrong. This indicates that the one is aimed at the other, but in fact only the opposite is transitive. So not "no A -> no C" is correct, but "no C -> no A". Not even the logic is right, that is faulty logic. That doesn't work on any level. I'll show you why that doesn't work.
But before I show you that, I want to show you that a Battle Royal took place back in the 1979s. It was not an easy thing. People faced each other on this story. This is a book that was published in 1972 the Pure, White, Deadly titled. It's about sugar. Written by a British physiologist, nutritionist and endocrinologist named John Yudkin. I have never met him, he has already passed away.
But I read the book about a year ago. And without even knowing it, I was a Yudkin follower. I was a Yudkin disciple. Every single thing this man said in 1972 is the absolute truth. And if you want to read a real prophecy, you can find them in this book It's not easy to find, but you can find it in this book. And I'm telling you every single thing this man says has come true.
It is amazing. I am in awe of this man. On the other hand, we had this man His name was Ancel Keys. Anyone heard of him? Ancel Keys was an epidemiologist from Minnesota. He was very interested in the cause of cardiovascular diseases. He did the first multi-variable regression analysis without a computer. Does anyone know what that means? ~ Multivariate regression analysis? You take a lot of data normally you would just run a few computer programs over it, but basically the goal is to find out what is causing what.
And trying to rule out other things and determine what contribution different things with regard to the goal that you aim to achieve in detail. He was interested in cardiovascular disease, so that was what he did this study, along with other people from around the world. It was referred to as the Seven Countries Study. Very famous, she was on the front page of Time Magazine in 1980. Here are the data from the Seven Countries Study The United States, Canada, Australia, England and Wales, Italy and Japan were involved. This graph shows the percentage of calories from fat on the x-axis, and the death rate from coronary artery disease on the y axis. And then you say, "Wow, that's obvious, isn't it?" Clear – the percentage of fat correlates very nicely with coronary artery disease.
Except for a little problem. Does anyone see it? Japan and Italy? How much sugar do they eat? Didn't I tell you that the Japanese diet does not use fructose? They didn't even have that until we brought it to them after World War II. Italy? Except for ice cream, I mean. What else do they have? You eat a lot of pasta, that's a lot of glucose, but no fructose. It is not a sugar in the Italian diet. Except for the occasional candy that they only consume in moderation. So they are very careful and they are very expensive. But here we have England, Wales, Canada, Australia and the United States and we're sugarholics, aren't we? We are also fatholics.
In fact, the fat rose with the sugar. The following is from Key's own work. On page 262 – if you want to consult the 500-page manuscript – I’m just going to read you this one paragraph that looks at: The fact that the likelihood of occurrence of coronary artery disease has a significant correlation with the average intake of calories from sucrose – in the diet – can be explained by the correlation of sucrose with saturated fat. In other words: donuts Wherever the fat was, there was sucrose. Because these people eat donuts. The partial analysis of the correlation shows that if the proportion of saturated fat remains the same, that there was no significant link between dietary sugar and coronary artery disease.
OK. If you do a linear regression analysis with multiple variables you have to do it in both directions. You have to keep the fat constant to show that sucrose doesn't work, and you have to keep the sucrose constant to show that the fat is still working. Do you see that anywhere? ~ He didn't do that. He didn't do that. He didn't do what you have to do to do a multivariate linear regression analysis. That was done before there were computers. We cannot check the work. He is dead. He died in 2004. We are left with a real problem. Do we believe that? Do we believe this study? Because we have built 30 years of nutritional science, information and politics in this country on this study. And as for me, it has a huge hole. Do you understand? Can I disillusion you? Yes? No? Let's move on.
Do you remember that I said LDL wouldn't be that bad? There is the reason. Because in reality there is no LDL, There are two – two LDLs. There is one. It's called Pattern-A or large-floating lipoprotein Everyone knows that LDL correlates with cardiovascular diseases. ~ That's right, I don't dispute that. But it is not this. Not the pattern A-LDL, because that's so easy.
It is buoyant, it practically floats. So, these are carried by the bloodstream They don't even have a chance because they're so big that they don't even get under the edge of the endothelial cells inside the blood vessels to start the process of plaque formation. But here we have this other type called pattern B or small density lipoprotein (LDL) Do you see the difference? These guys are very dense, they don't hover.
They are small and can get under the edge of the surface of the endothelial cells. And they start to build up plaque. And many who have studied this have shown that small-dense lipoproteins are the bad ones. If you measure LDL in your bloodstream when you check your lipid levels, both values are measured together. Because it is too difficult to tell the two apart. So if you get an LDL, that includes both LDL and HDL. The neutral HDL and the bad. How can you distinguish whether it is the neutral or the bad? By looking at the level of triglycerides associated with it. Triglycerides provide information about what it is. Here is the pattern A LDL. Large, receptive LDLs And you can see that the triglycerides are low and the HDL is high. That is desirable. One strives for low triglycerides and high HDL. Because that's the good cholesterol.
One strives for a high level of good cholesterol. Here is the pattern B lipoprotein and here the triglycerides are high, and low HDL. That is the culprit. That is the kind that you don't want. Because you will die of a heart attack. Triglycerides in relation to high density lipoproteins can predict cardiovascular diseases. – Much better than LDL has ever done. The point is that when measuring LDL, both are captured. Dietary fat increases the large, buoyant HDL What do you think increases your low-density lipoprotein? ~ Carbohydrates. There is the percentage of carbohydrates and thus the LDL increases. Did everyone understand that? So what did we do? 1982? What did we do? We switched to a diet high in carbohydrates, although it should be a low-fat diet.
Here's the low fat trend, that has taken America and the rest of the world by storm. The content of low-fat home-made dishes can be checked by yourself But when processed – low-fat ready meals – taste like cardboard. It tastes really bad. The food companies knew that. So they did what? How did they make it tasty? How do you make something tasty that doesn't contain fat? You add sugar. Does everyone remember snackwells? 2 grams less fat, 13 grams carbohydrates, of which 4 g sugar. So that it became acceptable. Well, you just saw that that was the worst thing you could have done. We did that – we still do it today. If you discover a mistake, what are you doing? You admit the mistake and correct the course. However, we did not admit the mistake and did not correct the course. We have contaminated our food supply, contaminated, poisoned, spoiled. Intentionally. We have allowed and allowed it.
By adding fructose to make it tasty – especially because of the reduced fat content and also as a tanning dye, which is a thing in itself, because: The fact that it browns so well with sugar also happens within the arteries Because that causes what we call the glycation and cross-linking of protein. Which in turn contributes to atherioslerosis. It works with your steak on the grill and the same thing happens in the arteries. And fiber was also removed. Why were they removed from our food? We humans, who lived on earth 50,000 years ago, ate 100-300 grams of fiber a day. Nowadays it is 12 g. Why? What did we do? We took out the fiber. Why did we take them out? It takes too long to cook, eat and it's about durability. When people ask me what the definition of fast food is, I say fiber-free food. I dare to bet that apart from a salad, can go to any fast food restaurant and look for something on their menu that contains more than 1 g of fiber.
Because there is no such thing. And that is by design. Because that way they can freeze it, ship it around the world and warm it up at lightning speed. And it's not just quick cooking, it's also quick food, and that causes problems with satiety The bottom line is that we are dealing with a cyclone. And the last topic was the replacement of trans fats, that are clearly catastrophic. These decreased proportionately, because we know that they are a problem. In fact, we got rid of most trans fats – not completely, but most. So that's what we've been doing for the past 30 years. Ok, now we come to biochemistry. How many of you had biochemistry? ~ About 25%. I will show you many reactions. Unbearably detailed. If you have studied biochemistry, you will get an anaphylactic reaction. If you haven't studied it, you'll nod off. So I suggest that you let me all do my thing, at least to show you that it works. And just count the arrows. OK? You can, can't you? Just count the arrows – it's not like counting sheep. Just stay with me, ok? Just let me do my thing.
Let me show you why fructose is not the same thing as glucose. Because what the liver does with fructose is really unique. And you have to understand that to understand everything I just told you. First, fructose is seven times more likely to trigger this browning reaction than glucose, with advanced glycation end products What happens on your grill happens in your arteries for the same reason. You can even see the color, it changes too. Fructose does not suppress the hunger hormone. There is a hormone that comes from the stomach and is called ghrelin. You have heard of that. So if you pre-load a child with a can of soda, and then you let it go to a fast food restaurant – does it eat more or is it less? It eats more. It just ate 150 calories and yet it eats more.
The reason? Fructose does not suppress the hunger hormone ghrelin. So it eats more. Instant fructose intake does not provide insulin release. This is because there is no receptor, no transport on the beta cell that produces insulin. So the insulin doesn't increase However, if the amount of insulin does not increase, the level of leptin does not increase. And if the leptin doesn't go up, the brain won't see that anything has been eaten. That's why you eat more. In conclusion, I show you that the metabolism of fructose in the liver, is completely different from the metabolism of glucose. Completely different. Before the day comes to an end, I will show you that just by chronic fructose exposure nothing else – causes what we call metabolic syndrome. Does everyone know what that is? This is the aggregation of the following different phenomena: Overweight Type 2 diabetes Problems with blood lipid levels, High blood pressure, and cardiovascular diseases These are all grouped together and are called the metabolic syndrome. I'll show you how fructose triggers every one of these diseases. Now I want to show you the difference between glucose and fructose, in a way that will be completely obvious.
So, let’s eat 120 calories of glucose. Corresponds to two slices of white bread. What happens to these 120 calories? So you eat 120 kcal. 96 kcal or 80% of it is used by all organs of the body. 80% are off the table. Why? ~ Because every cell in the body can use glucose. Any bacterium can use glucose. Everything living on earth can use glucose. Because glucose is the energy of life. This is what we should have been eating. 24 kcal, which corresponds to 20% of the liver. Let's see what happens to these 24 kcal. Glucose enters the liver using a type 2 glucose transporter. Out here, glucose stimulates the pancreas to produce insulin. The insulin docks onto its receptor. And it will take this substrate here, called IRS 1 (Insulin Receptor Substrate 1) That is not important at the moment And the IRS 1 is linked to a tyrosine phosphate. It is the tyrosine IRS-1 that is now becoming active. And it now stimulates the second messenger called act. What Akt does now is that it stimulates this guy here now.
SREBP1 (Sterol Regulatory Element-Binding Protein) Do not worry, but this is how the mechanism of fat is finally triggered. You will see it in a moment. One of the things SREBP-1 does is that it gets the glucokinase going. This turns glucose into glucose-6-phosphate. Glucose-6-phosphate cannot get outside of the liver. The only way to get glucose-6-phosphate from the liver is made using the hormones glucagon and epinephrine. So it can be brought outside. The glucose is stuck in the cell. But that's only 24 kcal. Almost everything of the glucose-6-phosphate finally goes there. It becomes Gykogen. Glycogen is the storage form of glucose in the liver. Because for glycogen it is easy to fish out the glucose with glucagon and epinephrine. So, my question to you – a physiological question: How much glycogen can a liver store before it gets sick? The answer is: ~ Any number. It is unlimited. There are carbloaders running marathons, right? There are children with an illness in which the glucose cannot be obtained from the glycogen, called type 1A glycogen storage disease also called Von Gierke disease, they have livers down to their knees.
They are low in sugar because they cannot get the glucose from the liver But the liver doesn't fail. Because glycogen is a non-toxic form of storage of glucose in the liver. The only goal of glucose is to replenish the glycogen. So that's good. – Not bad, but good. A little bit of the glucose will fall down here It is metabolized to pyrovat. And the pyrovat enters the mitochondria here. Remember, mitochondria are the part of the cell that really burns the energy.
They are like small factories. They make the stuff that makes you live – called ATP (adenosine triphosphate) That is the energy of life there. Pyrovat comes in and is transformed into something called acetyl-CoA. This is metabolized by something called the tricarboxylic acid cycle. Or the citric acid cycle releasing ATP and carbon dioxide, which is then exhaled. So far so good? Have I already wrapped up someone? Are you with me? I wrapped one up there.
I do my best, I swear … In any case, the acetyl-CoA is burned in the citrate cycle. Maybe not all of it will be burned and some of it will go outside, – as citrate. And the citrate leaves the mitochondria through a process known as the citrate shuttle. This citrate can then be broken down by these three enzymes, which are all subordinate to the SREBP-1. These are ATP citrate lyase, acetyl-Co-A carboxylase and fatty acid synthase That is not important. The only thing you need to know is that these three enzymes together turn sugar into fat. De novo, which means "new".
Lipogenesis, the formation of fat. That is the De Novo lipogenesis. So you take the citrate that came from the glucose and this is how acyl-CoA comes out. This is packaged with this protein here. And finally you get something called VLDL. -> Very low density lipoprotein Has anyone heard of it? Is it good or bad? ~ It's bad. This is bad. VLDL is bad because it is one of the things that cause heart disease. It is also a breeding ground for obesity.
So you don't want to produce much of that. But what matters is that we started with 24 kcal and that maybe half a calorie ends up as VLDL. Well, the little Japanese with the little hat, you know, who works in the field and eats rice for over 90 years – Can he die from a heart attack at the age of 90? Clear. But that's not so bad. When you turn 90, it's okay. Because of the VLDL from glucose. Glucose has produced a little bit of VLDL. The VLDL serves as a breeding ground for the storage of fat in the fat cells, here the triglycerides. Additionally – because insulin has increased in response to glucose – the brain sees this signal. And therefore it knows that it should switch off food intake. In other words, it says, "Hey, I'm busy processing my breakfast – I don't need lunch. " And so you have a nice negative feedback spiral, between consuming glucose, liver, pancreas and brain to keep you with normal negative yin & yang energy balance.
It's good. It is not dangerous. That is how it should be. Then let's talk about another carbohydrate. Let's talk about my favorite carbohydrate, maybe it's yours too. Ethanol is a carbohydrate, isn't it? Here is the structural formula. Carbon, hydrogen, oxygen. We all know that ethanol is a toxin. A poison, right? You can wrap your Lamborghini around a tree or you can fry your liver. That is your choice. It depends on how much you drink and how often, right? OK.
So we know that ethanol is not good for you. Except for a little bit that's good for you, isn't it? We can talk about that later if you want. But let's talk about the bad side. This happens with acute alcohol influence: Central nervous system depression, the dilation of the blood vessels, hypothermia, Rapid heart rate, depression of the heart muscles, various pupil reactions, respiratory depression, frequent urination, Low blood sugar, reduced control of fine motor skills They were all at school … Here is the fructose: Nothing. Does nothing of the sort. Because the brain does not process fructose. Alcohol is metabolized in the brain and that causes all of this. Fructose doesn't do that. So fructose is not an acute poison – ethanol is. We control ethanol, don't we? There's the Office for Alcohol, Tobacco, and Firearms, right? We have a variety of ways, e.g. B. we tax alcohol. We do all kinds of things to limit alcohol consumption.
In the Nordic countries, all liquor stores are run by the state. Trying to make ethanol so expensive to keep from consuming for public health reasons. We look back at 1500 years of political alcohol control around the world in terms of how to control consumption. Is that clear? Because ethanol is a poison and we know it. So, we consume 120 kcal of ethanol. Corresponds to a glass of Maker's Mark. Has someone already tried this? 24 kcal go straight through the so-called first pass effect on the stomach and intestines. And the kidneys, muscles and brain consume the other 10%. So 20% or 24 kcal are already gone. 96 kcal of the 120 kcal get into the liver. How many were there with glucose? It was 24 kcal. So four times as much of the substrate hits the liver.
And there is the catch. This is about volume. I'll show you why. The ethanol comes in through passive diffusion, there is no receptor for it, no transport molecule. The first thing that happens is that it is converted to acetaldehyde. Does anyone know anything about aldehydes? Such as B. formaldehyde? Are aldehydes good or bad for you? ~ You are bad, aren't you? What are they doing? They can cause cancer. They link proteins, that's what they do. So if you link enough proteins in the liver, what do you think happens to the liver? ~ You get cirrhosis of the liver. So, the acetaldehyde is bad. It creates something called reactive oxidative species. The reactive oxidative species damage proteins in the liver. And the more alcohol you drink, the more of that stuff you get. So far so good? Okay, so that's one of the reasons alcohol is bad. The acetaldehyde now becomes something called acetate. The acetate enters the mitochondria, just like the pyrovat did before. It is converted to acetyl-CoA and becomes part of the citric acid cycle just like before. ~ To gain energy.
Alcoholics don't die from lack of energy – they do. It's anything else they don't have. You have a huge amount of citrate. Because they have to metabolize 96 kcal. How many calories did the mitochondria get with glucose? About half. Because most of it has been converted into glycogen. So we have a lot of citrate, so the large font size, to make it clear that there is a lot of citrate now. And all that citrate is completely metabolized by the SREBP-1 to VLDL. So a lot of very low density lipoprotein (VLDL) is created. This is alcoholism's fat metabolism disorder, right here. Did everyone see that? The liver will now try to export the VLDL to the outside in order not to get sick. Because when fat accumulates in the liver, it takes damage. And when it comes out as free fatty acids, which accumulate in the muscle then insulin resistance arises in the muscle. This is very bad. It causes the muscles and liver to not work as well. And it can do a lot of other things, like diabetes. Some of the acyl-CoA won't even make it outside, and will fail as oil droplets.
So we have alcoholic fatty liver disease. The acyl-CoA, the ethanol and the reactive oxidative species can get this enzyme going. It is called c-Jun N-terminal kinase-1. or junk-1 because it's really junk-1. Because it is the bridge between metabolism and inflammation. So if you create JNK-1, you harm your liver, which I'll show you when we talk about fructose. So let's talk about fructose. Fructose is sweet, we like it very much. We like them in everything in our bread, in the pretzels, everywhere we look.
So, let's consume 120 kcal of sucrose (table sugar) Corresponds to a glass of orange juice. Did everyone understand that? Two slices of white bread, a shot of Maker´s Mark (bourbon) and a glass of orange juice. Always the same 120 kcal. But three different carriers. Let's see what happens to fructose. First: the glucose – sucrose consists of half of glucose and fructose – so 60 out of 120 calories are glucose. 12 kcal get into the liver.
48 kcal remain outside and are used by the rest of the body. The same 20 to 80% separation that we had with glucose before. So far so good. But all 60 kcal of fructose is metabolized by the liver. Why? Because only the liver can metabolize fructose. What is it called when you make a connection that is foreign to the body and if only the liver can metabolize it and the process causes various problems? How is this called? ~ We call this a poison. So I'm going to show you why it's a poison. The fructose comes in with the help of this transport molecule. Before it was glow-2, now it is glow-5. Without insulin – remember – fructose does not stimulate an insulin response. The fructose is then metabolized by the fructokinase. Fructose-1-phosphate is formed from this. In the process, ATP has to release a phosphate and becomes ADP (adenosine diphosphate), because the phosphate has to come from somewhere, so it comes from there. Before that we had 24 kcal that had to be phosphorylated. Now we have 72 kcal that need to be phosphorylated. So three times as much substrate. That is the catch. It's a volume problem.
So we lose a lot of phosphate, don't we? There is a scavenger enzyme in the liver called AMP deaminase-1 that saves the phosphates from the rest of the ATP molecules. It breaks down ADP to AMP (adenosine monophosphate). Then it breaks down AMP to IMP (inosine monophosphate) And finally down to the waste product uric acid. Anyone heard of uric acid? What's this? It is a waste product and is excreted in the urine. Which disease triggers? ~ Gout. It causes another illness called hypertension (high blood pressure). Let me show you why. Because, as it turns out, uric acid blocks an enzyme in the blood vessels called endothelial nitric oxide synthase. This is the enzyme that does the stuff called nitric oxide. And that is the body's own blood pressure lowering. Endothelial nitric oxide synthase keeps blood pressure low. And when the body can't produce it, blood pressure rises.
This just shows that fructose consumption and increased gout in adults. This is a study that was published last year. It shows that fructose consumption increases the risk of gout and shows that uric acid increases. This is a study by our children's kidney specialist Stefanie Nguyen, which was just published in the Journal of Pediatrics. This is from the NHANES adolescent database. It shows that as sugar-sweetened beverages increase, uric acid increases. And not only the uric acid increases with sugar-sweetened drinks, but also the systolic blood pressure. Here is a study by Dan Feig from Texas San Antonio University. He took overweight adolescents with high blood pressure and he gave them the drug allopurinol. Allopurinol is the drug used to treat gout, to lower uric acid.
And see what happened to blood pressure – the systolic and the diastolic. He sank. This shows that uric acid is indeed an important element in high blood pressure. We have a high blood pressure epidemic in this country. Now we have it: It's the sugar. OK. So much for high blood pressure. Lets move on. The fructose is metabolized to pyrovat. The pyrovat enters the mitochondria as before, with a lot of citrate. Here's a little trick fructose does and glucose doesn't: Because these two can form fructose 1,6-bisphosphate, which in turn can then form xylulose-5-phosphate together with glyceraldehyde. I'll get to xylulose-5-phosphate in a moment. But I would like to draw your attention to this asterisk (behind fuktose-6-phosphate). This is there to remind me to tell you something. That is why the sports drink manufacturers add high fructose corn syrup to their sports drinks.
Because if the glycogen stores are empty – in other words, if you've just run a marathon – and there is no more glycogen in the liver because everything has been burned and then you drink a sports drink with HFCS, then the glycogen can be replenished faster, than with glucose alone. That's true. So an HFCS sports drink really makes sense for a top athlete. And that's why sports drinks actually contain HFCS. The question is – who drinks these sports drinks? Any top athletes you know? Who drinks the sports drinks? The kids, right. Why are you drinking it? ~ Because it's cool. Is not it? Because it's cool and it tastes good. Before we continue, I would like to digress a bit. In 1967 the University of Florida patented "Gatorade". Do you still know Gatorade? In 1970 the Florida Gators won the NCAA Football Championship. Gatorade is causing a sensation. Total. Has anyone tried the original Gatorade? Yes? How did it taste? ~ Tasted awful. Tasted like something that might come out of you instead of inside you.
It tasted terrible. In 1992 Pepsi bought Gatorade. And they said to themselves, "How can we market this junk?" What have you done? They put HFCS on. And now who's drinking it? ~ The fat kids. Not the thin children, but the fat ones drink it. Here's a problem. I'll show you why. So to xylulose-5-phosphate. If you take a rat and empty its glycogen stores by letting them run in an impeller and then you feed them again with starch or sucrose, then the xylulose-5-phosphate rises sharply with the sucrose. So you get more xylene 5-phosphate on this path here. Why are we interested in xylulose-5-phosphate? It is because it stimulates PP2A, which in turn activates this transcription factor: Carbohydrate Responsive Element Binding Protein, which then activates which three enzymes? New fat storage – de novo lipogenesis. There's the citrate, we have a lot of that And here we have acyl-CoA, which means the way into the fat. This will be packed to VLDL. This results in the fat metabolism disorder overweight due to fructose consumption. This has been known for years. So here are normal medical students, if you can call them normal …
You take a load of glucose, You see, almost none of it ends up being fat. Let's give them a load of fructose with the same number of calories 30% of them end up as fat. So if you consume fructose, don't eat carbohydrates. You eat fat. Everyone is talking about a high-fat diet. Well, a sugar-rich diet is high in fat. That is the point. That's exactly the point. This is a study in which acute fructose was administered. And you can see that the triglycerides increase compared to the control group. Here, again normal medical students, were fed with high fructose amounts for six days. The triglycerides have doubled. De novo lipogenesis rose five times as high. And here are the free fatty acids that eventually cause insulin resistance – twice as many. After six days. There is the fat metabolism disorder of fructose consumption. That is not all. Some of the fat doesn't make it out of the liver like ethanol does – therefore there are oil droplets and this results in non-alcoholic steatohepatitis (non-alcoholic fatty liver).
This is one of our work from our clinic. which relates the consumption of sugar-sweetened drinks to the liver enzyme marker ALT. (ALT – alanine aminotransferase) This says something about fatty liver. And in fact we have sugar-sweetened drinks related to ALT, and you can see a nice, linear link in whites. It's a different relationship with African Americans, that's a different story. Here are the oil droplets of the non-alcoholic fatty liver disease. Part of it will come from free fatty acids and colonize the muscles. It will also cause insulin levels to go higher. Do you remember JNK-1? Here's what JNK-1 does: The acyl-CoA and fructose can all activate the JNK-1. Remember when we took glucose, IRS-1 became tyrosine-IRS-1 and that was good. Do you still remember? Now what JNK-1 does is that it serin phosphorylates IRS-1. And serine IRS-1 is inactive. This means that the insulin cannot even do its job in the liver. Now you also have liver insulin resistance. That's why the pancreas has to work so much more. This generates a higher level of insulin that puts a further strain on blood pressure.
It causes further fat storage. Ensures that even more energy is stored in the fat cells. There is your overweight. And finally, our research has shown that the higher the insulin, the worse the brain can recognize leptin. There is continued consumption because your brain thinks it is starving. In many different ways, fructose consumption has been shown to change the way the brain recognizes energy. In a negative way. So that you practically think you're starving. Your brain gets the signal that you're starving, although your fat cells send out the signal: "I'm full to the brim." That shows you how to do it.
The high insulin level creates the overweight, because – think again of the 1st law of thermodynamics: The biochemical forces that drive energy storage as a primary phenomenon If you want to save it and burn it, you have to eat it. Here is the storage. Normally, being overweight would cause leptin. And the leptin should actually give feedback and switch everything off. But it doesn't because the insulin gets in the way. and the high-fat diet gets in the way. Hyperinsulinemia prevents leptin from acting on the nucleus akkumbens. So you get an amplified reward signal, so that the appetite is maintained and more fructose and carbohydrates are absorbed, so that there is more insulin resistance. Can you see it? ~ A vicious cycle of consumption and illness arises. Without stopping. So there we are: High blood pressure, inflammation, liver insulin resistance, hyperinsulinemia, Fat metabolism disorder, muscle insulin resistance, obesity and continued consumption. Looks like metabolic syndrome to me. Here are the phenomena associated with chronic alcohol consumption. Blood disorders, electrolyte abnormalities, high blood pressure, heart disease Diseases of the heart muscle, fat metabolism disorders, inflammation of the pancreas, malnutrition, obesity, Liver dysfunction (alcoholic fatty liver), fetal alcohol syndrome and addiction.
Here is the fructose: Eight out of twelve. Well. Because they behave the same way. Because they are metabolized in the same way. You are the same. You're from the same place, aren't you? How do you make ethanol? The natural way? Correct. Sugar is fermented. That hasn't changed. It has the same percentage and is processed by the liver in exactly the same way. And for the same reason.
Sugar and ethanol are the same thing. No matter which direction you look. Here is our clinical intervention. That is what we do in our clinic. It's as easy as you can imagine. We write that on the back of a matchbook. It is as easy as you can make it. There are four things we teach children and their parents: Dispose of all sugared drinks, absolutely all – only water and milk. There is no good sugared drink. Point. Eat your carbohydrates with fiber. Why? ~ Because fiber is good. Dietary fiber should be an essential nutrient. And later, when the cameras are off, we can talk about why fiber is not a vital nutrient. Because the government doesn't want that. Because then they could not sell food abroad. Wait 20 minutes for a second serving. ~ To get the feeling of satiety.
And finally: buy your time in front of the screen minute by minute with physical activity. That is the most difficult advice. So if you play for half an hour you can watch TV for half an hour. If you want to watch TV for an hour, play an hour. It's difficult, anyway … We meet our patients every three months. Now my question: does it work? What do you think? Yes it works. This is the BMI value in relation to the time since the first visit. It works. We were interested in finding out what made it work and what made it not work. So we did a multivariate, linear regression analysis. The thing that made it not work: consumption of sugary drinks. The more sugared drinks the patients drank in the initial situation, the worse it worked. For all the reasons I just showed you.
Why is exercise important when you are overweight? Because it burns calories? Oh come on! 20 minutes of jogging corresponds to a chocolate chip cookie. You can never do it. Are you kidding? Now why is exercise important? I can tell you that. That is the reason: It improves the insulin sensitivity of the skeletal muscles, because insulin works better on the muscle. That lowers the level of insulin, which is good. Second, it is your body's stress reliever. It's the one thing that really reduces stress. And when you reduce stress, what do you think your appetite does? It drops because stress and obesity go hand in hand, right? For many different reasons that go beyond the scope of this talk today. But we can talk about it in the question and answer session if you want. And finally, do you remember the new fat production? Do you still know these three bad enzymes? What if you burn the stuff before the fat is made? ~ This is what the movement does.
It makes the citrate cycle run faster, so that the citrate does not leave the mitochondria and is turned into fat. So it doesn't trigger and cause all of the problems we've just seen. That is what is meant by increased metabolism, yes. But it has nothing to do with burning calories. This is the stupidest reason I've ever heard of movement. Are you kidding me? That is not feasible. I mean a Big Mac and you have to go mountain biking for 10 hours. Are you kidding? Why are fiber important in obesity? This is my motto in the clinic: When God created the poison, he wrapped it in the antidote. Because fructose is a poison. I hope I could show you that. Wherever fructose occurs in nature, there is a lot more fiber. Have you ever seen sugar cane? ~ It's a stick, isn't it? You can't even chew the damn thing, can you? You have to suck the stuff out, so! Or not? I mean, how many calories do you think you can get from a piece of sugar cane? Studies were even carried out on the sugar plantations in the early 20th century all about the workers who were healthy and longer than the sugar industrialists who got the processed product.
What about it? Not surprising, is it? Eat your carbohydrates with fiber, that's why we say that. That includes sugar. That's why fruit is okay. First, it limits how much fructose you consume. Second, it provides you with a vital nutrient that you need anyway. And you get some micronutrients at the same time, so the liver can work healthier. Here's what fiber does: 1. They slow down the process of carbohydrate absorption through the intestinal wall, Well, sometimes that's bad. I'll tell you when that's bad. Do you know when that's bad? This is bad when you are at a festive event. Because what happens when you reduce the rate of carbohydrate intake in the intestines? Bacteria are added. So as far as I'm concerned, you have a choice in life.
It is either fat or fart. It increases the speed of passage of the contents of the intestine into the intestine. And this increases this hormone, called PYY, that goes to the brain and says, "The meal is over." This is the saturation signal. If you add fiber to your diet, you get satiety earlier, because the food moves through faster. And it also inhibits the absorption of some free fatty acids in the colon, and these are then broken down into short chain fatty acids that suppress insulin. In contrast to long-chain fatty acids that stimulate insulin. There are many reasons why fiber is good. Has anyone heard of the paleo diet? Go home and find out about it online.
If you followed the Paleo diet and you eat everything as it is grown – raw, without cooking – then diabetes would be cured. On the spot. It takes about a week. Because you get the 100-300 g of fiber that I mentioned. Therefore … fiber is good for us. And the more, the better. Type 2 diabetes, not type 1, I have to correct that. Then, to everyone's delight: that's it with biochemistry. I told you, I'll get you through it. Now comes the fun part. The ethnic allusion and the political part. The "Frucosification" of America and the World. Are you ready? Another puzzle. Can you name the seven foods at McDonald's that do not contain HFCS or sucrose? Mustard? ~ No, mustard contains some. Oh come on. The great! ~ French fries, but they contain salt, starch and fat. So not that good either. What else? ~ We'll come for coffee. Potato pancakes, for the same reason (salt, starch, fat).
What else? ~ Chicken McNuggets, I was shocked – no sucrose or HFCS in Chicken McNuggets. But as the New York District Judge judged, they're still a McFrankenstein creation. Still, no sugar. I was shocked. Hot dog. They are terrible, just disastrous. There is nothing good in them. But no fructose. Sausages, diet cola, coffee, if you don't add sugar, And iced tea if you don't add sugar. By the way, there is a revocation for the Chicken McNuggets, because nobody eats the Chicken McNuggets without the sauce dip. And there's a lot of HFCS in the sauce dip, right? So who's really drinking this? We have already spoken about this. Gatorade AM It's an attempt by Pepsi to gain market share in juice, right? Do you think there are any top athletes who drink that stuff? You must be kidding me.
It is for children. Is not it? So. That really blew me away. That was my daughter when she was in second grade, Miriam Lustig, two years ago. She brought those two packs of milk home and said, "Dad, you won't believe that." (in the second class) These are the calories in Berkeley Farms reduced fat milk (1%): 130 kcal 15 of them from sugar, lactose, that's fine. And here we have Berkeley Farms 1% chocolate milk: 190 kcal, 29 g sugar from HFCS. It's like a glass of milk plus half a glass of orange juice.
We give that to our children. Do you know what the San Fransisko Unified School District Nutrition Department says? ~ Well, somehow we have to get our kids to drink milk. That's awesome, isn't it? ~ I don't know. Now what about WIC (women, infants, babies)? We talked about the 112 pounds of orange juice the child drank from Salinas. What about WIC? Do we still remember what we started with? That we have an epidemic of overweight children at six months? Do you still remember? Well, could that be the reason? Here we have a pack of baby food.
43.2% corn syrup, 10.3% sugar This is a baby milkshake. Soda, cola has 10.5% sucrose. Baby food has 10.3% sucrose. Is there a difference? There is a lot of literature that is growing that shows that the sooner children are exposed to sweets, the more cravings they have later. In addition, there is new literature that shows the more sugar the pregnant woman drinks or eats during pregnancy, the more it crosses the placenta and causes developmental programming, what changes the adipose tissue of the child, even before it is born. So this epidemic continues to thrive. In a few minutes we have reached the end. I would like to show you the difference. We have a can of coke and a can of beer here.
And I don't insist on slit or anything, you can take any beer. Both have 150 kcal, there is no difference in the total number of calories. The percentage of carbohydrates: here 10.5% sucrose (although it is HFCS, but what does it matter) and there 3.6% alcohol This is the breakdown: 75 fructose, 75 glucose in the cola. 90 alcohol, 60 maltose with beer. Remember, the first gastrointestinal metabolism takes 10% of the alcohol off the table. If you really calculated how many calories hit the liver, which as you remember, the big difference between glucose and fructose is 72 kcal (fructose) as opposed to 24 kcal (glucose) what made the whole thing go off, related to what things are bad, The bottom line: no difference.
There is something called a beer belly. Welcome to the limo belly. Because that's what America is suffering from. No ifs and buts. That's it. You wouldn't think twice about not giving your child a Budweiser beer. But don't give your child a can of cola twice. But they are the same; in the same dosage, for the same reason through the same mechanism Fructose is ethanol, only without the fraud. Fructose is a carbohydrate – yes it is. But fructose is metabolized like fat.
I just showed you that 30% of any fructose ingested ends up being fat. So when people talk about what high fat diet does bad ~ No, what they're really talking about is fructose-rich diets. That was what Ancel Keys looked at. The following sentence is (at least in America and also in the rest of the world): A low-fat diet is not really a low-fat diet Because the fructose or sucrose doubles as fat. It is actually a high-fat diet.
That's why our diet doesn't work. And fructose – just like ethanol, for the same reason, through the same mechanism and in the same dosage – is also a poison. And finally – what can we do? Can we do anything about that? What about the FDA (U.S. Food and Drug Safety Agency) Do you think they can do something? After all, isn't it their job to regulate our food? Isn't it their job to regulate what goes into food? Wasn't it their job to regulate tobacco? They are doing it now, actually. ~ Strange. Now I want to show you what the tobacco companies think about all of this. This is from the UCSF library, in which previously confidential tobacco industry documents are collected, which Stan Glantz directs directly opposite. Stan is a good man. I like him very much. He showed me this: The regulations that regulate food additives … (This is from an Altria Phillip Morris board.) "Additives have to be safe, ie it has to be proven with sufficient certainty by qualified scientists that no damage may be caused by the intended addition.
Does fructose now meet this standard? Well, the FDA says HFCS has GRAS status (broadly considered safe). Where does this assessment come from? ~ Nowhere. This assessment comes from nowhere. It comes from the idea "Well, fructose is natural." "It's in fruit, it has to be okay." Well, tobacco is natural too. But he's not healthy. Ethanol is natural. But unhealthy. Yes, the Jamaican ackee fruit is natural. But unhealthy, she'll kill you. Lets move on. "Food should be considered spoiled if it contains a substance that is harmful to health." This description applies to fructose, doesn't it? "… but not with the prevention of chronic diseases, even though their own regulations explicitly require the connection between such products and diseases." In other words, the FDA only regulates poisons with an acute effect – no chronic poisons. Fructose is a chronic poison. Acute fructose intake did nothing, do you remember? Because the brain doesn't metabolize fructose. The liver metabolizes them. And the liver doesn't get sick after a fructose meal. She gets sick after 1000 fructose meals.
But we eat so many. The FDA doesn't touch that. The U.S. Department of Agriculture doesn't touch that. Because if the Ministry of Agriculture touched it, what would that mean? That would mean admitting to the world that our food is a problem. What do you think would trigger that? There are still three things in this country that we can still sell overseas. Looting / robbery, entertainment and food. Cars? Computer? ~ No, rather not. Can anyone think of something another country wants from us? What? Oh yes, tobacco. You got it. The Ministry of Agriculture does not want to know about it. Because that's bad news. Who dictates the food pyramid? The Ministry of Agriculture. It's like when the fox is responsible for the chicken coop.
Their job is to sell food. And who eats them ~ We. So, the summary. Fructose (and it doesn't matter what the carrier is, it's irrelevant – sucrose or HFCS) Fructose consumption has increased in the past 30 years, coinciding with the epidemic of obesity. A calorie is not a calorie. And the nutritionists in this country are making this mistake and telling us that. The more you think a calorie is a calorie and the more you think when you eat less and exercise more it works …
It doesn't work. All studies show that it doesn't work. Here's why it doesn't work: Because a calorie is not a calorie. Fructose is not glucose. We know that a calorie is not a calorie because there are good fats and bad fats. There is good and bad protein. There are good and bad carbohydrates. Glucose is a 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. What you do with fructose is particularly outrageous and dangerous.
The metabolism of the liver from fructose leads to all the manifestations of the metabolic syndrome. High blood pressure, through the path of uric acid, new fat formation, fat metabolism disorder and fatty liver, through the new fatty acid synthesis; these three enzymes and the process of creating new fat. Inflammatory processes through JNK-1 Liver insulin resistance due to serine phosphorylation of IRS-1, Obesity, through the VLDL transport into the fat cells, and leptin resistance, which leads to continued consumption, basically the brain is starved, so you think you need more. Fructose intake contradicts the overweight intervention, as we were able to show in our clinic. The more soft drinks, the worse the change in diet and exercise worked. Fructose is chronically harmful to the liver.
For the same reason alcohol is. The only difference is that alcohol is metabolized by the brain, so there are alcohol effects, Fructose is not metabolized by the brain, so there are no such effects. But everything else it does is the same. But the Food and Drug Safety Authority cannot and does not want to regulate it. It is up to us. I'm here today to recruit you. This expression is famous here in San Francisco, isn't it? "I am Harvey Milk and I am here to recruit you." Okay, so I'm Robert Lustig and I'm here to recruit you.
In the war against bad food. That is what is bad. I would like to thank my colleagues from the University of California, San Francisco from the Pediatrics Department in the weight determination for adolescents and children of the health clinic. the Department of Epidemiology and Biostatistics, and also the Department of Nutrition at the University of California, Berkeley. And especially Dr. Jean-Marc Schwarz, who is a staunch fructose biochemist (doctor in biochemistry) who checked all of these chains of reactions that I showed today and who looked at it and said, "Oh my god, it's a poison." He's looked at it for 15 years and hasn't even noticed that it's a poison. Until he saw that. I close with that, thank you very much. University of California, San Franzikos Osher Center for Integrative Medicine Small medical school for the public Current controversies around nutrition: Let science guide you Sugar: The bitter truth Robert H.
Lustig, Doctor of Medicine Professor of Pediatrics, Endocrinology Department, University of California, San Francisco For more information: http://lifelonglearning.ucsf.edu The views, content, and opinions expressed in this video are not necessarily those of the University of California .