Transcript for:
The Impact of Processed Food on Health and Society

thank thank thank you nor and thank you Chris um they said it couldn't be done but you can do it because this is actually a real mench this guy actually there aren't too many Stanford people I would appear with but uh Chris Chris is one of them um thank you very much for coming and thank you for the invitation um this is the problem of the Millennium and in the last um what 50 years we have gone from a uh society that basically cooked at home uh prepared its own food to now a society that doesn't even know how to cook we've lost a an important and I would say seminal and integral component of our lifestyle in the process of basically two parent Working Families uh uh shut shuttling kids back and forth to and from this activity that activity and of course the money that has gone out the window in terms of uh processed food and in terms of health care so I want to today take a step backward and do for you what Chris and I do on a daily basis how many of you in the room today are scientists how many of you use the scientist ific method in your daily lives or in your research couple of you okay well for those of you who don't I have to describe for you what it is that we do in order for you to understand how we come to such a conclusion as what's on this title slide an experiment that failed so you have to understand what an experiment is and you have to know what success or failure is so let me take you through that so here's a slide of sort of what I do on a a daily basis you posee a hypothesis based on the data that's currently available and you say this must be true and I'm going to test it by setting up a procedure that will evaluate that hypothesis and exclude all confounders so you design the experiment and you determine what the outcome should be a priori and you then either support or you refuse that hypothesis right you assess the Baseline parameters before you walk into the experiment so you know where you're starting so you know what the change will be over the course of the experiment you carry out the experiment and you gather the data as you go and you figure out what's going on during the course of the experiment so that you can ultimately work backwards to figure out what happened if you need to you assess the outcome parameters as you reach the end of whatever the interval that you were studying was and if the outcome is as expected you publish it you get grant money you know you move on to the next experiment then the next hypothesis that's great and if the outcome is not as expected which is about 10 times more likely than the experiment actually working your job is to figure out what happened what went wrong was it because the procedure itself was flawed and you couldn't actually get the data out of it that you thought because it's garbage in garbage out or was it because the hypothesis was flawed and you need to move on to another hypothesis so you have to ask the question do I want to repeat the experiment and do it differently or do I want to do a completely different experiment and that's the uh situation that all scientists face when an experiment fails which is virtually all the time everybody got it that's what I have to do that's what Chris has to do that's what the people who raise their hands have to do okay and I'll tell you it's a hell of a way to make a living but that's what we do all right so let's imagine that the food industry 50 years ago posed a hypothesis and that hypothesis is Illustrated on this slide right here that processed food is better than real food that's what they said 50 years ago and they said it for a whole bunch of different reasons and we understand what those reasons are and we've adopted a lot of those reasons and we've sort of inculcated those into our daily lives now what are the outcomes that you have to look at to determine whether or not this hypothesis is correct well you have to look at consumption did consumption go up yes or no did Health improve yes or no did the environment get better or worse and finally cash flow did companies make money did consumers save money and did Society do well or not these are the questions that ultimately will determine the success or failure of this experiment everybody got it so that's what we're going to analyze today because the food industry refuses to so we're going to do it for them okay got it okay so here's the experiment 1965 everybody remember these okay Swanson TV dinners the first Ultra processed marketed fast food processed food and it was in everybody's home and they told us that this was going to liberate women from the kitchen now has it yeah it sort of has and that's one of the reasons why we have two parent Working Families now and nobody to shuttle your kids and all the daycare and everything else in fact it did liberate women from the kitchen because if we didn't have those they probably still would be in the kitchen whether that's a good thing or not is up to your own uh uh decision making and spam everybody REM spam right so that's that was 50 years ago okay this is what we have now everybody recognizes all of these Okay so the processed food industry has certainly Advanced and evolved over the past 50 years to provide us with all of this Fair which we are now consuming but what's interesting is with all of the different processed food that's out there for us to be able to choose from today how many companies do you think make those no it turns out they're 10 and here they are okay craft Coke Pepsi Kelloggs Mars Unilever J&J p& and Nestle okay they control 90% of the food distribution and marketing in this country these 10 conglomerates and to be honest with you they all do the exact same things so that's very interesting so basically our food has been uniformly changed over the past 50 years a very good experiment in terms of before and after so let's talk about that okay so here's what processed food is number one it has to be mass-produced okay on a big scale you know we're not talking about individual chefs here we're talking about you know conglomerates anybody ever been to a food processing plant you have huh what was it like it's a plant are there any windows there are no windows why is that why are there no windows in a food processing plant because they don't want you to see what's going on in there because if you did you wouldn't eat it okay truly you can't believe what's going on there there is not one piece of Machinery that is recognizable that would be in a normal kitchen nothing NADA it's fascinating really very interesting it has to be consistent batch to batch because not just batch to batch but in fact location to location because they're making it in different places at different times okay has to be consistent country to Country for obvious reasons like McDonald's right you know because after all you know it's McDonald's it carries the brand that's got to you know convey a certain taste specialized ingredients from specialized companies we're not talking about you know just food here we're talking about all sorts of additives and we're talking about all sorts of other things that you add to the food in order to make those things consistent from country to Country virtual every macronutrient is prefrozen the only thing that's not prezen are the spices everything comes from a freezer fascinating okay and that means that the fiber had to be removed because what happens when you freeze fiber you get mush go home take an orange put it in your freezer overnight take it out the next day put it on the counter thought try to eat it see what you get what do you get you get mush because the ice crystals mate the cell wall of the plant with the orange okay and allow the water to rush in and turns it into mush but of course food industry knows that so what do they do they squeeze it and freeze it lasts forever becomes goes from being a food to being being a commodity that's the diff the definition of a commodity storable food and you can buy and sell Commodities on a Commodities exchange you can't buy and sell food on a food exchange but you can with commodities so this works for people trying to make money okay it has to stay emulsified what does that mean anybody know what emulsifiers are so these are chemicals they're detergents really that help bring fat and water together all right that's why you add detergents to the washing machine is so that you can get the uh uh soaps to the stain otherwise you couldn't do that so what happens if those emulsifiers are working inside your intestine what do you think happens it actually strips off the mucus layer of the um epithelial cells inside your intestine and there are actually studies now in animals at least we don't have it human studies that say that you can actually show Closer apposition of the food to the cells because the mucus layer has been damaged and has actually been Lo lost in some in some cases and that may be part of the problem of food allergy and uh irritable bowel syndrome and several of the other uh uh food related diseases that we know about today although that's not known for sure yet but there was a paper in nature just 3 weeks ago that uh pose that at least in animals okay and again it has to have very long shelf life or freezer life everybody knows the 10-year-old Twinkie right right it's got to last forever right and that's again for depreciation okay so let's list what processed food is how it's different from Real Food everybody got it so not enough what not enough fiber because you have to take the fiber out in order to freeze it not enough omega-3 fatty acids which you find in wild fish not farmed fish because the fish don't make the Omega-3s what makes the Omega-3s the algae make the Omega-3s the fish eat the algae we eat the fish so if you're consuming farmed fish which is processed food you might as well be eating a steak all right everybody got that very important you understand that so you have to know where your fish comes from well of course how do you find out sometimes not so easy okay micronutrients okay not enough micronutrients because the micronutrients travel with the fiber fraction so when you remove the fiber you remove a lot of the micronutrients so most of the processed food is deficient in micronutrients that we need in order to be able to metabolize food properly and then there's a whole bunch of things that are too much too much trans fats now we know that trans fats are bad this stuff is consumable poison so much so that the Food and Drug Administration finally after 25 years finally on November 7th 2013 agreed that trans fats were not generally recognized as safe and so they will be disappearing from our food supply hoay took 25 years okay what else Branch chain amino acids Lucine isoline veine these are three amino acids that you have to eat you can't make and levels of these in your blood correlate with metabolic syndrome all the cardiovascular diabetes diseases the non-communicable diseases all the chronic diseases that we know are all on the rise and levels uh of these uh amino acids correlate with those in humans and they are higher in cornfed anything which of course is processed food cornfed beef cornfed chicken cornfed fish which is Farm fish okay omega-6 fatty acids so what are Omega sixes those are pro-inflammatory now you need Omega sixes you need Omega-3s you need both but you need them in the right ratio and Omega 6es is what you find in seed oils like corn oil soybean oil and these are pro-inflammatory now you need inflammation because you need to be able to knock out bacteria you need to be able to mount an immune response when you're sick and have a virus Etc but you don't need it all the time so we're supposed to have an Omega 6 to omega3 ratio of about one: one we're told we right now have an Omega 6 to omega3 ratio of about 25 or 30 to1 so the question is is that proinflammatory or not all these different additives and I don't want to get into all the different additives because we could go off for 10 hours on all the different additives and you know that would just you know there's not enough videotape in the camera for that emulsifiers like I mentioned okay the ones that you may have heard of are called polysorbate ad and carboxymethyl cellulose those are the emulsifiers that are typically used too much salt right everybody knows about salt so Salt's very complicated there are some people who are exquisitely salt sensitive and they need a reduction in their salt content and there are some people who aren't as salt sensitive and it's not as important now as a doctor I care about everybody and we are triple over our salt limit so I'm for reducing salt but it's in but when you look at the data it's complicated as to who benefits and who doesn't but nonetheless it's still a good thing to reduce salt and then the big one the Big Kahuna the in your face the you can't touch this sugar okay and that's what we're going to talk mostly about today because the food industry uses sugar like you use salt okay they hype up virtually every food to make it more palatable and they do it with sugar why because there are five taste buds on your tongue okay there's sweet of course there's salty there's sour there's Umami everybody knows what that is that's like roast beef or soy sauce and then there's bitter so here examples of each of those so sugar hides salty that's like cheex mix or honey roasted peanut NS it hides sour like the German wines you know I mean nobody would drink that stuff except that they add a little bit of su Reserve back because there's so much citric acid in the German wines because they don't get any sun okay that you have to cut the acidity and you do it with sugar it's the same reason why you add a little sugar to your salad dressing when you make balsamic vinegar and oil because it make you know it it cuts the sourness or the uh a little bit how about and lemonade of course it cuts umami like sweet and sour pork you know that's half soy sauce you wouldn't touch that except you add a little sugar you can't even tell that there was any soy sauce in there and then finally it cuts bitter like milk chocolate right okay so why here's why because there are no food stuffs in nature that are both sweet and acutely poisonous none it was the signal to our ancestors that any given food that they found in nature was safe to eat wouldn't make him Keel over and die liking sweet is ingrained into our DNA we love this stuff we will go out of our way for this stuff it is completely vestigal from a metabolic standpoint it it gener it gives us no benefit in terms of anything but as an energy source there is no biochemical reaction in the body that requires dietary sugar yet yet we love it anyway and a perfect example of this is Aki fruit everybody know Jamaican Aki fruit so anybody ever seen this stuff you see it's over here on the right so if you live in Jamaica you know don't eat the Aki fruit until it's either bloomed like here or it's fallen from the tree because if you eat the Aki fruit when it's immature there is a compound in it called hypoglycin and this hypoglycin can actually lower your blood sugar to about five and causes something called Jamaican vomiting sickness and you can die from it and I've actually seen a case of that okay but if you wait till it blooms the hypoglycin is metabolized and now it's safe to eat and of course it's the Jamaican national dish and they can it and send it all over the country all over the world okay and it's basically you know what they eat okay so the question is is this stuff addictive well we know that there are certain things that are addictive in hazardous to our health the question is what about this stuff is this stuff addictive and hazardous to our health depends on who you ask if you ask the chief medical officer of Amsterdam Paul Vander velpen he will tell you that sugar is both addictive and The Most Dangerous Drug of our times okay this is coming from Amsterdam really and they would know something about that okay I mean you know think about that really well in fact we actually know this too why do we know this because of this stuff anybody recognize this anybody work in a neonatal Intensive Care Unit or in a newborn Nursery anybody know what this stuff over here is it's called sweeties sweeties what is it it is a super concentrated sucrose sugar solution that you dip The Pacifier in and then stick in the newborn boy's mouth before you do the circumcision the Jews use wine everybody else uses sweeties so we know okay it releases endogenous opioids okay because that's our endogenous painkiller it's an opiate okay and it does the same thing as opiates do so here's the key of the 600,000 food items that you can find in the American grocery store today 74% of them have added sugar and of the 4,000 packaged items in the American food supply that were looked at recently in this article that just came out like a week ago only 50% had greater than the recommendation for added salt so what does that mean that means that sugar is actually the marker for processed food even more than Salt is because Sugar's in more things than suters so that's the question for today is sugar Public Enemy Number One because it is not just the marker for processed food but it is the thing that distinguishes processed food and the question is is it okay in the doses that we are currently exposed to in processed food by the food industry because it hides all the other negative aspects of food and gets you to buy more that's the question for today and that's the experiment if you add food to if you add sugar to your diet what happens to you and that's the last 50 years okay so let's look at the outcomes so remember we said consumption Health environment cash flow those are our four outcome variables so let's look at the first one consumption so you could say well we definitely have a consumption problem because there over there on the left we have the original White Castle hamburger right before processed food 210 calories and then over there in the middle we have Bob's Big Boy at 618 calories and in the midst of the Obesity epidemic Hardies had the tarity to offer us the thick burger at 1420 calories and of course you can go today to Carl's Jr just down the street on elale and get the $6 burger at 2,000 calories and so you say QED there you go that's what it's all about consumptions up oh consumption is way up no question in fact total calories are up over the last 25 years in men 187 calories per day more than 25 years ago in women 335 calories a day more than 25 years ago in teen boys in this slide 275 calories more than 25 years ago yes we are all eating more consumption is definitely up since the Advent of processed food slam dun but what are we eating more of is it fat not really no in fact Fat's about the same five grams eh 45 calories so here's the secular Trends in specific food intake and if you take a look at what's circled in purple that's all the fats so whole milk way down right we were told really bad for you because it had saturated fat Well turns out you know what a saturated fat isn't necessarily a saturated fat turns out that Dairy saturated fats have a very different metabolic signature than do red meat sat saturated fats and they may actually be protective for diabetes and possibly even protective for heart disease based on epidemiologic studies but we lumped them all together okay so whole milk way down meat and cheese up very slightly milk desserts bottom line it's a wash that's what the data say and in fact we are eating exactly the same amount of fat as we did before but because calories have gone up because consumptions gone up the ENT of calories as fat has gone down because we've gone from 40 to 30% because we were told to we were told by the USDA the original dietary guidelines of 1977 told us to reduce our consumption of total fat and saturated fat from 40 to 30% guess what we've done it and look what has happened wow you want an experiment you want an outcome that you can measure oh we got it we got it big okay so what are we eating more of if it's not fat well it's carbohydrate 228 calories L eating lots more carbohydrate okay and here's that same slide I showed you before but now the carbohydrate is circled as well and you can see all of them through the roof that's what's gone up carbohydrate and in particular what carbohydrate well 41% increase in soft drinks 35% increase in fruit drinks fruit AIDS Etc okay just remember one can of soda a day is 150 calories time 365 days a year divided by the magic number 3500 calories in a pound which I don't even believe but that's what the dietitian will tell you okay and so that's worth 15 and a half pounds a year it's actually worth more it's worth more because things that make your insulin go up higher make you gain more weight even on the same number of calories and my friend Dr Gardner will explain that when he talks with you later okay so what is this stuff well in America it's this stuff here right high fructose corn syrup why high fructose corn syrup well number one it's from corn right anybody know the dirtiest four-letter word in the English language no it's not corn there's a dirtier four-letter word in the English language Iowa because Iowa is the first presidential caucus and you can't win the presidency if you don't win Iowa ask John McCain okay no one wants to touch this this is the third rail of American politics no one wants to touch this and of course corn is the second dirtiest word for the same reason Okay so so our current annual consumption is 63 lb per person but interestingly only the US Canada Japan and very limited exposure in parts of Europe use this stuff yet the entire rest of the world has the exact same problem we do in fact diabetes rates are higher in China and in India than they are here and they don't have high fructose corn syrup they it's actually as high in Australia as it is here and they don't have high fructus corn syrup what do they have they just have table sugar they have sucrose so here's the difference so high fructose corn syrup is on the top so it's either 42 or 55% fructose that five membered ring on the right that's the sweet molecule that's the one we seek that's the one that's addictive glucose over there on the left that Six membered Ring that's the energy of life every cell on the planet Burns glucose for energy glucose is so godamn important that if you don't consume it your body makes it so is glucose a nutrient sure is glucose an essential nutrient no because you don't need it because your body will make it unless you have glycogen storage disease in which case then you have to come to me as a pediatric endocrinologist but short of that everybody else makes it but this stuff over here this this five membered ring fructose no biochemical reaction on the on the in in a vertebrate that requires dietary fructose it's completely vestigal it is an energy source that's true but it provides no nutrition because there's no biochemical reaction that requires it can anybody name an energy source that has absolutely no function in the body body that we like a lot but that is toxic in high dose alcohol thank you alcohol alcohol is an energy source but alcohol is not nutrition yet we love it yet it's toxic and we regulate it Sugar's the same thing because fructose is metabolized exactly like alcohol in fact sugar is the alcohol of the child and that's why children today are getting the diseases of alcohol type 2 diabetes and fatty liver disease without drinking alcohol because they've just substituted one addictive substance for another everybody got it and that's of course why the food industry puts it in okay so that explains this right here so I call this slide very specifically the Coca-Cola conspiracy and you'll see why in a moment okay they haven't sued me yet so over there on the left 1915 the original 6 and 1 12 ounce bottle of Coca-Cola standardized out of Atlanta if you drank one of those every day for a year that'd be worth eight pounds of fat per year then after World War II when sugar became plentiful again after rationing okay we had the 10 oun bottle first one found in vending machines over there that would be worth 13 pounds of fat per year okay then of course in 1960 we got the ever ubiquitous 12 O can okay which is worth 16 pounds of fat per year and of course today that is the single unit of measure over there the 20 ounce bottle it's the only one you can now find anywhere that's if you drank one of those every day that would be worth 26 pounds of fat per year but how many servings are in that bottle anybody know two and a half 2 and a half 8 ooun servings in that bottle anybody know anybody who gets to and half down servings out of that that's a single serving okay and then finally in the middle we have the 7-Eleven Big K Thirst Buster Big Gulp 44 Oz worth 57 lb per year and my colleague Dr Dan hail tells me that down at the University of Texas San Antonio they got a Texas sized Big Gulp 60 o of Coca-Cola Snickers bar and a bag of Doritos oil for 9 that is what processed food has brought us that would be worth 112 PBS of fat per year and by the way in case you did know on April 11th that is this Saturday two days from today 711 is offering a promotion bring any vessel from your home that is not an inflatable pool and fill it up with Slurpee for a149 you think I'm kidding I ain't kidding okay that they will not take inflatable pools okay so oh before I get there so why do I call the Coca-Cola conspiracy well what's in Coke let's start with something else what caffeine caffeine thank you caffeine so what's caffeine it's a mild stimulant and it's also a diuretic works on the kidney to make you urinate free water what else is in Coke salt 55 milligrams per can so what happens if you take on salt and lose free water you get thirstier right so why is there so much sugar in coke to hide the salt I showed you that already now do you have to make soda with salt anybody ever heard of Royal Crown Cola it's long gone okay but you probably grew up with it okay tastes bad no it was perfectly fine zero sodium you don't have to put salt and Coke but they do because they know because they get you to drink more so Coca-Cola conspiracy they know what they're doing and you don't so here is the last 200 years of sugar consumption in the United States starting at 1820 when we got fruits and vegetables out of the ground with the occasional honey was worth about four pounds of sugar per year and over here we topped out at about 100 pounds of sugar per year you can see the different phases of sugar consumption and uh production in the United States we had the growth of the sugar industry in the late 1800s early 1900s you know in Louisiana in the bayou and in Hawaii okay and then we had stabilization where you know production you know uh uh correlated with price you know so you reached equilibrium then you had rationing during World War II as you can see there and then it came back up to the same level and then we had processed food and then on top of that we got high fructose corn syrup which was half the price and so what happened oh and plus we went low fat all at the same time everything happened at once and so we went sailing over so where is the sugar in our cons our food right now so half of it's in soft drinks as you can see and by the way on April 22nd our state legislators will be debating a soda label warning ban on the on the on the can or on the bottle and I was actually in Sacramento lobbying for this for the California Center for Public Health advocacy just 3 weeks ago okay and I will tell you I followed the chief scientist for pepsicola who was there as well Danielle Greenberg fascinating okay so you know what's going on there's a lot of stuff going on so yeah half of it in soft drinks but that means that half of it's not half of it's in stuff you didn't know had it like salad dressing barbecue sauce tomato sauce breakfast cereal hamburger buns hamburger meat for that matter yogurt and who here thinks that yogurt is healthy plain yogurt is healthy okay the Europeans eat plain yogurt and then throw whole fruit in to cut the sourness because you know like what is yogurt it's sour milk right what's the difference between yogurt and the milk that sour in your refrigerator so for yogurt you get to choose the bacteria that does the souring that's it that's the big difference right right but in America yogurt is not sour milk yogurt is dessert that's what's happened that's what processed food brought us yogurt for dessert okay so now we've agreed that consumption is up let's do health so what's happened to health I know it's happened to health care okay because I'm a doctor and let me tell you it sucks but what's happened to health so let's look this is from the New England Journal let's look at what's happened so smoking down blood pressure down cholesterol down physical activity up we should be re reaping a health benefit from all of those things happening right shouldn't we well we're not how come because obesity is up and diabetes is way up off the charts in every developed and developing country right India 11% diabetes China 11% diabetes we're only at 99.3% diabetes but another 40% of us are pre-diabetic so just diabetes waiting to happen and that is cutting Our Lives short and that is reducing money going into the system and it's increasing the money going out of the system which we'll talk about when get the cash flow so here's the problem right here it's on this slide everybody remember Coca-Cola's coming together campaign from two years ago was on all the football games this was their response to the Obesity epidemic and this is a direct quote from their campaign commercial beating obesity will take action by all of us based on one simple Common Sense fact all calories count no matter where they come from including Coca-Cola and everything else with calories in other words you can get your calories from carrots or you can get your calories from cheesecake or you can get your calories from cocacola or you can get your calories from kumquats doesn't matter if you eat more than you burn you'll gain weight if you eat less than you burn you will lose weight therefore a calorie is a calorie it's about calorie balance it's about you eat too much you exercise too little little it's about diet and exercise it's about if you're fat it's your fault it's about any calorie can be part of a balanced diet and it's about why pick on our calories go pick on somebody else's calories now every one of those mantras has been ingrained across your forehead over the last 50 years a calorie is a calorie and it's common sense they say so you know what I don't believe in common sense I believe in science I believe in data and what the data says is say are completely different what the data say are that some calories cause disease more than others because different calories are metabolized differently in the body it's called nutritional biochemistry and you want to know the kicker of all this I learned this in college I majored in nutritional biochemistry at MIT in 1975 I knew this and then I went to medical school and they beat it out of me and I forgot all this because that wasn't what we learned in medical school we learned a calorie was a calor we learned obesity was the problem we learned that if you eat too much and you exercise too little you gain weight and we learned that that fat that you gained C caused all of the metabolic disturbances that we now see and then I started doing my own research in 1995 and you know what by 2005 I was absolutely convinced a calorie was not a calorie and I came to the realization wait a second I I started having night sweats I started waking up in the middle of the night with like post-traumatic stress disorder because like I knew this and i' had lost it and I got it back maybe that's why I'm so passionate about it now is because medical education does not discuss this because they don't get it they don't understand it and this is sort of a one of the uh U um seminal uh um uh uh uh uh ends of the stool you know that you you can basically you know hold on to and if you kick that out from under what happens to you know your your understanding of physiology of Science of nutrition of of biochemistry and of Health basically we're kicking it out from under and people don't want it kicked out and so there's this big fight this big tension and that's why we're having this discussion now but a calorie is not a calorie now how do I know that because we have the data so here is a study from Europe called The Epic interact study what they did was they asked do sugar sweeten beverages cause diabetes so if you look at the black the red box at the bottom what they did was it's called the adjusted model they looked at Sugar every uh sugared beverage per day adjusted for its calories and adjusted for its effects on obesity by BMI and they showed that every sugar beverage increases your risk for Diabetes by 29% and we're not consuming one sugar sugar beverage we're consuming 2 and a half on average so take that up to 68% we did this study which didn't look at consumption we looked at availability within countries what we did was we took the uh food and agriculture organization statistics database which listed line item country by country for the entire decade 2000 to 2010 total calories fruits excluding wine Meats cereals fiber containing food oils Sugar Sugar crops and sweeteners line by line item by item for the Whole Decade country by country we then regress that with the international diabetes Federation statistics database for diabetes prevalence country by country for the same period and then we regress that with the World Bank gross national income database which controls for poverty urbanization aging physical activity and obesity all the confounders remember you have to adjust for the confounders when you do science right and we asked the question what about the world's diet predicts diabetes change country by country over the decade and the answer only sugar nothing else nothing else even came close for every 150 calories extra any country ate diabetes prevalence went up a total of 0.1% NADA but if those 150 calories happen to be a can of soda instead diabetes prevalence went up 11f 1 1% and again we're not drinking one soda day we're drinking two and a half this study actually meets the criteria which were set up by Austin Bradford Hill back in the 60s to implicate tobacco and lung cancer that is dose more sugar more diabetes duration longer sugar exposure more diabetes directionality countries where sugar went up more diabetes countries where sugar went down and there were few less diabetes and most importantly for causation you have to show precedence 3 years whenever sugar changed diabetes changed in the same direction 3 years later that's causation same level of proof we have today for tobacco and lung cancer okay okay why here's why because sugar drives fat accumulation in the liver that's why because when you put fat in your liver then your pancreas has to make more insulin and that burns out the pancreas and causes diabetes and you can see from this study from my colleague Jean Mark Schwarz that was just uh in jcnm uh like three weeks ago you can see that you can put the you can do the uh control period and then the sugar or you can do the sugar period Then the control bottom line it doesn't matter the amount of liver fat went up 38% for the same number of calories over a two- we period and that drives insulin resistance and that drives increased pancreatic insulin release which then drives chronic metabolic disease and we just had an abstract at the endocrine Society just a month ago and you can read it here restricting fructose and obese Latin Latino and African-American children reduces fat accumulation in the liver 30% reduction on the same number of calories in 10 days which also improved their insulin resistance and every other aspect of their metabolic Health without changing weight it didn't change their subcutaneous or big butt fat it changed their visceral fat and it absolutely lowered their liver fat same number of calories because a calorie is not a calorie and this is for heart disease death this was uh published last year by Yang adol from uh Harvard school public health in the CDC so what you're looking at here is a histogram of percent of calories consumed as added sugar over a two decade period and the median of this histogram is 18% can you believe that half the country consumed more than 18% of their calories as added sugar that's insane it's supposed to be 4% was it 18% okay now that red line in the center is the hazard risk ratio for heart disease death and the inflection point is at 15% median 18% in flection 15% so what does that mean it means that more than half of the United States has an increased risk of heart disease death due to their added sugar consumption controlling for obesity controlling for calories just because of the added sugar because it's not about the calories and it's not about the Obesity alcohol is not dangerous because it's calories alcohol is not dangerous because it causes obesity alcohol is dangerous because it's alcohol Sugar's the same thing it's dangerous because it's sugar because of its unque stereochemistry and because of what it does and because of how the liver metabolizes it because it's not necessary because it's not really a nutrient it's an energy source it's not a nutrient in fact we have causation for these four diseases and these four diseases will be on that warning label if this California State Legislature passes the motion diabetes heart disease fatty liver disease and tooth decay we have causation for every single one of those the ones we only have correlation for today so we don't discuss them yet is cancer and dementia but I'm really interested in both of those and I just met with Stan prer the Nobel Prize winner up at UCSF about whether or not sugar could cause dementia and how we might be able to actually look at that question uh going forward in the next couple of years so now let's do envir now we've talked about health now let's do environment is sugar good or bad for the environment what do you think so this was from the world Wildlife fun sugar in the environment and what does it do well it does a lot of bad stuff okay basically what it does is it causes a lot of soil erosion and it causes a lot of phosphate runoff and so it's actually poisoning the Amazon and it's poisoning the Everglades here's the sugar Holdings in the Everglades just look at the Orange and the yellow and the light green that's all sugar that's like okobi there in the upper left corner and in fact it's getting worse because Florida's governor has actually given them a bigger subsidy to be able to expand their operations in the Everglades now who here thinks that's a good idea and finally let's do cash flow so we said we start with companies so here's what processed food did so here's 1982 over here on the left and here's 2012 over here on the right look what's happened Meats down 10% because we were all told to go low fat fruits and vegetables notice exactly the same no change in fruits and vegetables now we're always told we don't eat it enough eat enough fruits and vegetables and that's likely true I'm I'm sure that is true we don't eat enough fruits and vegetables but you know what we never did we never did and we didn't have this problem in 1982 but we sure as hell have it now grains and baked goods 133% to 14% And that's important because grained and baked goods mean refined carbohydrate which means glucose which means insulin and Insulin means weight gain and that's part of the Obesity equation no argument there and that is a problem and that's of course another marker for processed food all that carbohydrate we talked about right dairy products 10.5% 13.2% down to 10.6% CU now we're all lactose intolerant you laugh okay um but if Dairy is actually protective for diabetes and heart disease which actually some of the data now starting to look like that's a problem too and then finally in yellow processed foods and sweets 11.6 22.9% a doubling in the span of 30 years that's what processed food brought us and the question is is that okay well was okay for stock prices that's for sure so here's the S&P 500 from 2007 to 2011 notice the economic downturn of 2008 right over there okay in blue is the S&P and you can see there's McDonald's Coke and Pepsi stock price over that period of time they were doing very well thank you okay and here's Hormel ADM General Mills ConAgra Proctor and Gamble and craft against the S&P want to make money invest in a food company for that same period of time 2007 to 2011 but guess what the word is out there's a problem and so these are the sugar companies notice ton ly Alo sudzer against the S&P not doing all of a sudden so well over the past two years so all of a sudden cash flow not so good if stock prices are going down and take a look at soft ring companies they're all of a sudden experiencing a drought here's McDonald's there's Coke there's Pepsi there's Dr Pepper Snapple they've introduced a couple of new products which kind of peak them over here recently but they're having problems too because people are on to it there's been a definite reduction in soft drinks except for one thing there's been a commensurate increase in what well yeah but that's soft this they still run those energy drinks monster right and all those so what did kooch do they bought monster because that's where the money is okay how about consumers what's gone on cash flow wise now there is no question that eating processed food costs less money long term here's less healthy food going up by 7 cents per dollar versus healthy food going up 17 cents per dollar in the UK over a 10-year period so the rise in cost of processed food has been much lower than that of real and healthy food no argument so you'd say well that means that there's a monetary benefit right you're saving money by consuming processed food except of course you're consuming a whole lot more right because of all of the effects that we've talked about which aren so good so look at this this is how much money as a percent of GDP each country on the planet spends on food and take a look at us over there 7% we spend the least amount of our GDP on food at 7% and of course we're the most obese Nation next comes the UK at 9% next comes Australia at 11% now take a look at the countries in purple that spend more than 36% of their GDP on food they've all been in Revolution in the last 3 to four years and that's why so there is definit a cost benefit analysis to be done here fluctuating food prices definitely cause political unrest and process food instituted in the 1960s and early 1970s by policies passed by our country for instance Richard Nixon's uh uh uh advocate advocation of um changing the Paradigm for farming you know that before Richard Nixon we used to pay Farmers not to grow gr certain crops everybody some of you may remember that that was to artificially prop up the price of certain crops for the farmers so what happened in 1971 he told Earl Butz his agriculture secretary to make food cheap because fluctuating food prices cause political unrest and Richard Nixon had a lot of political unrest to deal with and so what did Earl Butz do he went to the heartland of the United un states to Nebraska to Kansas to Iowa and told them three things row to row Furrow to Furrow get bigger get out and they did that's what's happened and so now we have monoculture now we have all the corn in Iowa and we have all the cattle in Kansas and so we have to use petroleum products to grow the corn in Iowa and we have to used antibiotics to control the diseases in Kansas because there's no manure so we have basically distorted the market yes food's cheap but what does that do that causes disease so take a look at this slide so we're looking now at health care costs in this country and projected over the course of the next 10 years and what you see is there's Hospital in red there's physician in green and there's Pharma in purple and they don't add up to the total because what's going on it's going to Chronic metabolic disease that's where all the extra money is going and who's paying that Freight you are so you're paying less for your food but you're paying more for your health care and if you're not paying more for your health care because you're not sick you're paying more for the guy sitting next to you's health care because ures and employers charge $2,750 per employee for obesity related health care whether your the employee is obese or not who's paying that Freight you are you're paying it so your cash flow is not as good as you think it is yeah you're saving money on food processed food like I just showed you but you're paying it in healthcare I guarantee you you're losing on the dollar and what about Society how is it affecting Society so remember here's processed food remember this slide now I'm going to Overlay onto this Slide the percent of GDP spent on Health Care in the United States over the same period of time everybody ready there it is what do you see when processed food started being uh produced that's when healthc care costs skyro rocketed so we don't have the prevention the treatment model in America we have the sugar model that's what this is okay now if you do the math on this the food industry grosses $1 trillion dollar a year of which 450 billion is gross profit 45% gross profit yet health care costs in America are $2.7 trillion a year 75% of those are chronic metabolic disease all the diseases we've been talking about and 75% of those are preventable if we could fix our diet so when you do the math that's $1.4 trillion a year going down a rat hole you think we could do something with $1.4 trillion doll a year so the food industry makes 450 billion we spend 1.4 trillion cleaning up their mess we spend triple what they make this is a bad deal this is this is a bad deal for society and you're paying the freight while they get rich and now they're not even getting so rich credit s knows this and they published this just two years ago called sugar consumption at a Crossroads and get this this is a Global International Investment bank and they said we believe higher taxation on sugary food and drinks would be the best option to reduce sugar intake and help fund the fast growing Healthcare cost associated with type 2 diabetes and obesity this is an a global Investment Bank calling for tax ation are you kidding me are you freaking kidding me that's how big and bad this has gotten and Morgan Stanley just two weeks ago published their report called The Bitter aftertaste of sugar and I just throw one slide up here looking modeling into the future based on high sugar or low sugar the amount of economic growth that we can expect around the world doesn't look so good so this is costing Society big time and more sugar is costing Society even more so let's do the scorecard so let's imagine that the food industry posed this experiment and put all of these procedures into motion as a scientist would processed food is better than real food so what do you think consumption way up that's for sure Health way down in fact death way up the IRB makes you report all deaths all Adverse Events and if they saw that graph of cardiovascular mortality they would have shut this thing down in a nanc there wouldn't be an experiment with those death rates environment clearly no good with the Amazon and the Everglades being raped and pillaged and cash flow companies they made out really well their annual cash flow went from 1% at their annual profit margin went from 1% per year to 5% per year with the Advent of processed food they did really really well this was their Juggernaut but you know what now we see that not in the last two years not so much now they're now they're in trouble consumers do well in the short term because they save on the cost from 7 cents per dollar to 17 cents per dollar but they spend it instead long term on Health Care instead and finally Society what a disaster this is eating us up alive and completely unsustainable and the general accountability off the government accountability office says that Medicare will be broke by the year 2026 well I'm going to be 69 in the year 2026 and I want my fraking medicare and so should you so with that all of this is in Fat Chance which Nora told you about we published a cookbook Fat Chance cookbook because one-third of American Now does not know how to cook because of the processed food pandemic because they forgot and you can't where do you learn to cook you learned it in one of two places you learned it from your parents or you learned it in homech we have any homec and the parents now don't know how so kids basically if you don't know how to cook you're Hostage to the food industry for the rest of your life and this is what we have to bring back we have to bring back real food and we have to bring back how to cook it and then we will be able to solve this problem sugar science is a website that UCSF started in November 8,000 clinical research articles vetted by 12 independent scientists who don't take money and distill down to five messages for the entire population that anyone can understand the movie Fed Up which you may have heard about it's now on Netflix okay which explains all of this very very nicely there is a new movie a documentary that will be screened for the first time two weeks from now and I'm going to Toronto to do Q&A called a sugarcoated you know you all know about the tobacco documents well guess what there are sugar documents too and this is an analysis of the sugar documents and how the sugar industry basically obfuscated the truth in the 60s and 70s to get us to where we are today and I can't wait Sweet Revenge a PBS special that we did that maybe some of you have seen which explains all of this in shall we say a little bit more palatable uh way and we have started a nonprofit here in San Francisco called The Institute for responsible nutrition to take on big food to provide medical nutritional and legal analysis in the fight against big food because we have to solve this we have no choice and so if you liked what you heard today log on read it sign up be apprised know what's going on obviously the fact that you're here today means you care and I appreciate that we have to solve this problem we have no choice because it's our kids our kids are getting the diseases that you know old people got that alcoholics got okay and they can't pay into the system so there's no money for anything else and that means you and that means your Medicare that means your livelihood that means the United States so if you care about our country if you care about your kids you need to care about this okay with that I'm going to turn it over to Chris and I appreciate you thank you for I think that Q&A way the conversation that the conversation might go from here is the conversation with the audience asking you and Dr Gardner questions and um uh we'll uh until we get the microphones going if they if you take a question please repeat it so it can be picked up on the mic who's bold and brave enough yes so the question is well then could you just substitute glucose for fructose well that's what we did in that study that I uh showed you the abstract before so basically glucose raises your insulin and Insulin drives energy into fat so it definitely increases your subcutaneous fat and that's one of the reasons we've gotten fatter but as what I've hope I've shown you is that metabolic disease is not obesity they are two different things so China is not fat India is not fat but they have chronic metabolic disease now for the same reason we have chronic metabolic disease in addition we have fat healthy people they're called metabolically healthy obese MHO okay so being fat and being sick are not the same thing glucose definitely causes insulin release which definitely drives energy into fat I don't argue that we definitely need to reduce our refined carbohydrate consumption also but that's what processed food is too processed food is fiberless food and when you take the fiber out you get refined carbohydrate so let's eat real food and then we don't have to worry about the carbohydrate would you uh fine yeah next question and thank you enough for this have you been to the White House yet oh they don't want to hear this and so we need to get you into to Michelle and we need to get you into and and you should be on Oprah and Eliz Elizabeth Warren should walk you into the White House and we'll work on that um so you at one point and I missed because I was writing so fast who um near the end you said somebody or some Institute or something didn't have the data to realize X how how good is your organization at getting this data to those kinds of decision makers that that's I I mean it feels as though this room should be tell I'm going to tell you very honestly the question is how good is our organization at getting this information to decision makers the answer is the decision makers don't want to hear it that's the problem okay there's something called ale or Alec you've heard yeah so anybody heard of the American legislative exchange Council okay so it's a front for the food industry and the Pharma industry and they give caign contributions to 338 out of 500 35 congressmen okay so there's other money involved here let me tell you a quick story um we're trying to work with the government of Mexico to monitor the effects of their soda tax I was down in Mexico City in November and I had to give a talk on economics to 20 economists PhD economists okay they're all Mexican but they got their phds from Harvard MIT Stanford you Chicago and London School of Economics 20 economists I'm talking economics to economists okay I gotta tell you that was really weird and they told me straight out and I said I I understand this they said it's not about the people it's about the money it's only about the money you have to show us how this is going to either save us money or make us money I said I get it well so let me respond and tell you what we got going on right now so as many of you know every five years we redo the dietary guidelines for Americans and it's 2015 it's time to do them again and before you release them uh a panel of about 15 scientists a newly elected panel each five years gets assigned to this and a lot of you have probably seen this in the newspaper now that just recently in last month the dietary guidelines advisory committee gave the recommendations to the USDA and the DHHS of what they should do this next round and they want to put added sugar out there that's one of their biggest things is to cut back on added sugar there's a lot of really interesting things they looked at cholesterol they're actually backing off on cholesterol we could get into that discussion if you want they've stuck with saturated fat being not so good for you what I really like what they did though is they said we really got to stop arguing about nutrients we just everybody games the system on the nutrients so what we're proposing in this round is that the Mediterranean diet the dash diet and the vegetarian diet all have a lot of things in common and they all have less packag processed food and so if we can stop bickering about nutrients and look at patterns of foods to eat including having less animal-based foods and more plant-based foods and so that's a discussion that's going on right now comments are open until May 8th and it's a fascinating time because uh the food industry has launched a huge offensive against this and they're giving comments that this is unrealistic one in particular the link to the environment they've even got Tom vilsack the secretary of agriculture to say you know what they're coloring Outside the Lines that's not really their job their job was supposed to be nutrition whereas there's really a pretty active vocal group I signed this thing that ended up being on a one-page ad in the New York Times and oh my God I get 10 emails a day now that I signed this thing from this group it's actually pretty well organized saying you know we got to push back on the food industry let's show them all the scientists that believe in the dietary guidelines advisory committee's recommendations and the scientist who spent two years looking at the evidence there really is evidence for the environmental connection and that's another link to change some people's behavior at the end of the day what we're after is behavior change and what Rob was talking about was how sugar affects our Behavior because it's driving a lot of our behaviors but there's other strategies so let's focus on the positive strategies I teach a class on the Stanford campus doesn't talk about health at all talks about animal rights and Welfare climate change human labor abuses in slaughterhouses and fast food workers almost every student in the class changes their diet because they're engaged in a bigger issue a broader issue and so at the level of the government we have these dietary guidelines going on there's currently a battle I'm going to tell you what I predict is going to happen I predict in 2015 they reject a lot of the dietary guidelines advisory committees recommendations um just like so many communities rejected a soda tax and I heard Marco woen one time from the Center for Science and public interest listen to somebody give a talk about oh my God here's all the great things we did to get the soda tax passed and it failed and we're Crest fallen and she stood up and said Bravo you got that out there again that soda tax really this is really ingrained thing this is Grassroots keep pushing pushing pushing and what happened in Berkeley this year they passed a soda tax what happened with gay marriage no no no oh now 37 States okay I'm going to guess in a few years we get 37 states with a soda tax and I'm going to guess the dietary guidelines advisory committee's recommendations are not taken this round because the link to the environment is a little too new and the discussion hasn't gone on but you have to get this in the dialogue I'll bet you in 2020 the link is made that's my prediction you guys can write it down today get back to me in five years okay and the other thing by the way these these recommendations are not new the 2005 dietary guidelines committee made these recommendations Janet King who's at Children's Oakland Research Institute was the chairwoman of that dietary guidelines committee and she told me that they submitted to the USDA a 480 page document in 2003 80 pages on sugar 80 pages on fiber and when the final document from the USDA came out it was a a total of 80 pages instead of 480 and everything about sugar and fiber had been removed and I said to her I said Janet are you kidding me you didn't have any recourse and she says we're an advisory committee we have no teeth but it's becoming more and more obvious so I'm hopeful I'm more optimistic maybe I don't know am I more optimistic than you I think I think you are should we take another question so we can roll through could could I just say yes but for for so if everybody in the room could write to the USDA by May 8th that's one thing and the other thing for Alec is to go on the common cause website because we've gotten 300 companies who are members of Alec down to 102 and there are still companies like Coca-Cola that are part of that but if you join what com the common cause push they they're all getting out of it little by little thank you so much what are your positions on artificial sweeteners ah hi you could ask me because I actually got selected to write the American Heart association's position on artificial sweeteners okay you ready for this we don't have enough data to have a position I'll tell you how confusing it is I mean it actually sounds simple the one area where it could be the simplest is actually Coke and in our world when we set up experiments there are lots of confounders as Rob has done a nice job explaining right Coke is actually the one sort of simplest place to do it because you just have a regular Coke Coke or Diet Coke although there's a difference the regular Coke folks got more calories so was it the sugar or was it the coke okay so anyway you've got artificial sweeteners in this thing and if you look at all the available data it's inadequate to make a definitive conclusion you can actually say so actually here's a general conclusion that we came up from looking at the papers general not definitive so we never have really adequate evidence for super definitive but we have partial evidence we make the best statement we can it looks like when you add sugar to food and replace it with artificial sweetener you you later in the day you compensate for some of that and you make up for some of the calories you missed from the sugar but not so much when you drink Beverages and you switch to an artificial sweetener um the beverage thing you don't you overcompensate for that and so the beverages are a little different than the food and so the sodas are worse like you don't know you're drinking you don't get satiated from the co Coke calories the artificial sweeteners can help you show that that shift is a little better with beverages so sodas are one of the things we should cut back the most on and I looked at when we're all done with this said there's inadequate evidence I thought ah as a scientist and I always need grant money let's see maybe I should write one of these new studies to look at artificial sweeteners then I thought oh I don't want to do that then really I'm studying to see if packaged processed food with artificial sweeteners is better than adding sugar to food I don't even want to touch that so there really isn't adequate evidence to provide that and at the end I actually got approached by a dietitian who was on our writing panel said please be very cautious what you say I have a diptic patient who's drinking a Big Gulp every single day I got them to a smaller dose and diet soda if you say you can't find a difference between artificial sweetener and Diet Coke he's going to go back to real coke I don't care if you can prove that or not don't let my patient go back to that big gulp and so we had to couch it as it looks like it's bad we can't really prove that the sugar I'm sorry it looks like the artificial sweeteners are helpful we can't definitively prove it um how about coffee what if you're going to have coffee every day and you're going to sweeten it and you're either going to put sugar or artificial sweetener I don't know I would I would say the artificial sweetener but you're going to have the coffee every day anyway so you're going to have to put it in the context of what you're adding to my biggest fear is we just keep perpetuating our sugar pallet so where do artificial sweeteners go packaged processed crap so is it helpful to go from sugar to artificial sweetener yeah cuz you have a little less glucose than fructose but ah in the end it's really a slippery slope sorry for the lack of answer and your your point your question is very very well taken we understand but you know the you what do you do with this what I would argue is that diet sweeteners are like methadone if you're trying to get a heroin addict off heroin you put them on methadone and then you wean the methadone down the problem is the methodone clinics don't do it they just keep you on it if you're using diet sweeteners to get people off sugar because Sugar's addictive and so you get them onto diet sweeteners and then wean it down then that would be a good thing to do but that's not what we do so think of it in that in in with that analogy maybe that'll help thanks good question next please so I I I read an uh article and it was like in the newspaper or maybe a magazine I wasn't a scientific uh magazine or or article uh and I can't remember if it was artificial sweeteners or high fru high fructose corn syrup but they said that it changes the gut bacteria ahal sweet okay elov in science September 2014 so it it apparently changes the gut back microbiota the bacteria in the gut and led to glucose intolerance in animals now we don't know if that's true in humans yet I would say it's preliminary it's preliminary okay interesting is it another reason to not have artificial sweeteners and package processed food sure if that works for you it works for me yeah okay I I couldn't agree more do you know as of yet if there has been any class action lawsuit so similar to The Tobacco industry um regarding the sugar industry or I'm kind of interested what's the call to action as far as what we can do I mean I think if anybody works here we can certainly ask our corporate offices to get those vending machines and those candy bars that are right at the cafeterias you know just still enticing us to take that sugar but I am interested if there's been anything about any lawsuits I I I can answer that um so I went to law school for this reason y i i i i don't have a JD I have an MSL masters of studies and law so I can't sue but I can talk to people who can and they talk to me so I actually know this the the the deal on this so the initial study the initial uh lawsuits were for Miss branding and you may have heard of those in fact one of them was right here in San Jose Kan V chabani familiar with that one that was basically about evaporated kju so evaporated cane juice is not a sanctioned sweetener by the FDA but every yogurt says evaporated cane juice because it sounds healthy because if you said oh it's sugar you know well gee why is there sugar in my yogurt evaporated KW sounds good right except it's not a sanctioned sweetener so basically every carton of yogurt that says evapor can juice is by definition misbranded and you entitled to your money back and so there's a CL there was a class action lawsuit in Superior Court of Northern California Lucy Co same person the same judge who did Apple V Samsung presided over that and it ended up at the ninth circuit and was ultimately dismissed and I we can talk about why that was there's one individual case of an minor of a 12-year-old who sued high fructose quiner manufacturers for her type 2 diabetes in Buffalo New York and that was also dismissed but it was dismissed for very inappropriate reasons because the judge didn't get it and it may come back in another uh guise uh and then finally there are several uh plaintiff's attorneys who have approached me about class action lawsuits and trying to decide what the appropriate plaintiff would be and I can tell you what the appropriate plaintiff would be adolescence with type two diabetes because the Baseline was zero and we have the causation we have the proof and so and and they're are very shall we say um uh also a lot of them are minority which you know works well in court and so um they're a very uh sympathetic uh plaintiff so we're going to see what what happens over the next couple of years good luck on that thank you hi Steve um so do you have any comments on the milk mandate so that we're actually um it's one thing to have recommendations the dietary guidelines or recommendations for how people should eat um but it's another thing to actually enforce that and force our kids to get fatter and the remarkable thing is that I've I've talked to school administrators and said hey you know the government is actually not allowing you to serve whole milk or 2% milk it has to be 1% or less and the only studies I could find all show that that makes the kids fatter because and you know they'll they're going to eat more car you know sugars and and you know because we're taking the fat out of their diet and so there's actually you know it's actually required for schools to make our kids fatter and I'm amazed that parents aren't up in arms about the government actually making our kids less healthy you want to take that it's a really tough question really the I mean so the dairy thing is actually maybe in theory one of the biggest Public Health successes in their eyes because they took this whole fat and people thought that lower fat was more watery and not good tasting and now people try and it's the norm they have low fat the the data for getting at that kind of question are really tough so darish MOS farian did this fabulous um paper in the New England Journal medicine looking at whole milk and low fat and looking over time they have this new model they have this they've been following nurses and health professionals forever it was always just observational Association but now they have changed every four years and change in other things so not instead of just looking at Association they say they're looking at change versus change which is a little contrived to be perfectly honest but what was really fascinating was the whole milk versus the reduced fast milk on weight had no impact no but there's a uh it was zero that's on his there there is an actual clinical trial that was done at University of Virginia on this it says low fat makes them fatter so let me make sure I'm understanding what you're saying whole fat makes them fatter or low fat makes them fatter well but it it it when when they restricted the Melt just like the the USDA is requiring of schools kids got fatter I'm still not clear restricting milk or restricting the type of mil restrict the fat milk yeah they took the fat they basically they switched they they took the fat out of milk by by moving the fat milk got fatter and it wasn't because they switched to chocolate milk no cuz that's what happens that's the reason that the dietitians in the schools say they have to have chocolate milk is because well no one would drink the lowfat milk otherwise because it doesn't taste good you know we all grew up on whole milk and it was perfectly fine and there was no problem and then you take the fat out of the milk and then you have to do something to substitute so you look at Berkeley Farm's 1% chocolate milk okay it's got an extra 60 calories all of which are high fructose corns well so but but the point is there actual clinical d a clinical study that that proved that if you did exactly what the USDA did that kids would get fatter and I asked the USDA you know because I got routed to because I know all the the guys there I I got routed to the right person I said hey do you have any act um you know there was a study that that showed kids get fatter do you have any study at all that shows that kids actually lose weight when you cut the fat out of the milk and they they stopped responding at that point yeah well well and one of the issues is it's a single study so in any of these things that are big questions you need to replicate it again but you can't you can't go and base food policy when if you have a single study that says kids do get fatter and you have no studies at all that show the opposite then it's it's unbelievable that we require them based on no scientific data whatsoever that conflicts with the study that we do have I won't argue with you the fact of the matter is one of the reasons credit s came out with its uh uh response in that slide I showed you is because they could not find any studies anywhere that said that Sugar had a health benefit so they said if you're trying to prove the null hypothesis that that proved the null hypothesis I mean they did their own science the fact of the matter is you're saying the same thing there are no studies that say that low fat is good for you the only thing we said was that we had to go low fat so you find a study that says low fat is good for you there are none in fact that's what The Physician that's what the um Women's Health Initiative showed is that lowfat is not good for you but we're still doing it well I wouldn't go there that's touchy we could get into that but I would so Steve your question is answerable we could do more of those studies if more of those studies got funded that we have a lot of questions that are difficult to answer if you wanted to look at weight in kids shifting back and forth from whole milk to lowfat milk that's an answerable question there should be dozens of those right now but there was a study and and it makes total sense right because when you have the fat and the milk the fat makes you less hungry so you eat fewer calories and you get less fat it doesn't the fat doesn't raise your insulin and so forth so everything about that study made intuitive sense AB you know the science matched all everything we know about uh metabolism well we haven't gotten rid of the low fat directive yet no we haven't no after all these years and in fact I mean that you never talked about the history uh the dietary guidelines but it was all driven by George McGovern and it was not based on any science driven by George McGovern was driven by the food industry well but but you know McGovern was was really the you know it was politically uh motivated and the scientists at the time were were against it because there was no evidence that said uh cutting the uh the that cutting fat will make you thin so let me bring up a parallel example that could be useful unless Nora has a point because she's raising her finger running running on time okay I'm going to make this a quick example how many of you know that on food stamps you can buy soda with your food stamps food stamps the name now is snap the supplemental nutrition assistance program sugar from soda doesn't seem to be much of an assistance so Bloomberg said in New York City we would like to do a trial not really impose this we would like to do a trial with this USDA program and see if we can ban the purchase of sodas with SNAP dollars but you have to get USDA approval to do this kind of trial the USDA turned them down the beverage company opposed the trial the hunger Coalition of New York City opposed the trial Minnesota actually proposed that they change it not just for soda but also for junk food if you're going to get food stamps you should only be able to buy a certain number of foods it's kind of ridiculous because Wick is another Federal program and you can't buy crap with Wick you have to buy good food but there's a lot of misinformation out there there's a lot of push back and to the point that Steve is just making one of the issues is that sounds obvious that if you can't buy soda you'll buy something better but it's not necessarily true what if you didn't spend the money on soda and you bought a candy bar you actually have to do that study to see what happens when you don't have this thing what the next behavior is so they're waiting for those studies and there aren't enough and we should have more could you go back to the advisory committee Whose advice is being ignored uh is there an alternative way to get the information out the dietary advisory committee is there an alternate way to get it out well when they sign up for the committee do they promise not to go around there or something oh yes they do no question about that the 15 scientists who are part of the Dak the dietary advisory dietary guidelines advisory committee have to basically sign their life away and say they won't talk about it outside of uh uh administrative channels that's absolutely true yes so I mean we're trying to do it I mean that's one of the reasons why sugar science.org exists is to try to get the information out you know that's one of the reason why all these documentaries are being made right now is to try to get the information out but you know it's it's hard it's hard and they have a much much more uh um U valuable expensive mouthpiece but is there a sort of equivalent format for the is it the Who's the who puts out the dietary recommendations I've I've lost the government USDA they actually trade back and forth between the USDA and the DHHS they're responsible for the final document they rotate off every five years so part of it is writing Tom vilsack part of is making a comment part of it is better evidence and part of it is getting funded to do that evidence and getting it reported so we're actually doing a pretty neat paper right now to look at how much protein Americans think they need how much they eat how misinformed they are how much protein America produces through a livestock that Americans eat more meat than any country in the entire planet and yet the cattle industry and the Egg industry and the pork board and everything else say you need all that protein cuz Americans are freaked out about protein and we're linking that on the Stanford campus with environmental scientists are taking the health perspective linking it with what the shift would be in agricultural policy in terms of what we're growing and trying to show the environmental impact and the health overlap and Kathleen mergan who is the under secretary of agriculture under Ville saac for a long time said please send me that paper as soon as you have written it I want to read it and help you get it published and get it out there so that we have more evidence so that when the dietary guidelines advisory committee goes in and says we're making this recommendation and the beef Council says you can't make that recommendation there isn't enough evidence we can say yes there is there's more evidence will my one paper do this no not at all but that's what our job is our job is to figure out what those gaps are in the evidence and try to put it together in a digestible communicable way I guess I was looking for the sort of in the same format so I could take the one that gets published and the one that should have been published and carry the the the the the non-existent one around with me when I wanted to look at the back of a package label oh you want to carry it around with you the 571 page document is online including a seven page executive summary yeah thanks thank you hi Robert I had a question about the Pepsi COA Chief scientist I was wondering if you could share a little more about what that person said in terms I don't know what that person said I wasn't allowed in the room oh okay I just know she was there really oh that's interesting wasn't allowed in there I wonder why you comment on that are you kidding that the the food the food industry does not want to be on the same day as as a scientist who's not bought off well just a broader question then what what are the opponents um to your arguments they work in the food industry what are the what are the the worst things they say and the best things they say uh if you want I can show you well I mean Ser seriously um the sugar industry has has some very specific uh talking points that they promulgate and they Trot out in fact I'm going to have this argument with John Stephen Piper at the international diabetes Federation in December um and I've debated food industry concerns on two other occasions so I'm very prepared for this the first thing they say is number one sugar has a low glycemic index so everybody understand glycemic index everybody already know what it is so glycemic index is defined as how high does your blood glucose rise when you consume 50 gram of carbohydrate in a specific food that's the definition of glycemic index and indeed sugar has a low glycemic index because half of it is fructose not glucose so the glycemic index of sugar is 53 the glycemic index of fructose alone is 19 everybody with me those are low glycemic index Foods who cares glycemic index is a Canard glycemic index doesn't matter what matters is glycemic load because glycemic load is defined as how much food do you have to eat to get the 50 grams of carbohydrate so the perfect example of how this works is carrots so carrots have a relatively high glycemic index if you eat 50 grams of carbohydrate in carrots your blood sugar will go pretty high but you have to eat 1.3 pounds of carrots to get 50 gram of carbohydrate you have to eat the whole fraking grimmway truck in 5 minutes in five minutes right in five minutes ain't going to happen so carrots are high glycemic index low glycemic load so if you believe glycemic index you would stay away from carrots carrots are the best thing you can possibly put in your mouth okay broccoli huh BR and broccoli carrots and broccoli second problem with glycemic index is the fact that fruct doesn't cause its problems because of its glycemic index it's beyond glycemic index fructose causes its problems because of its stereo chemistry and it binds to proteins so when you overwhelms the liver the liver's capacity to extract it on the first pass which happens at about a 8 ooun soda you get a serum fructose level so fructose does not raise your serum glucose it raises your serum fructose which is even worse because that binds inside the arteries causes aging of the arteries causes aging of proteins causes this thing called the myard reaction is the reason you paint barbecue sauce on your meat before you grill it to get that nice brown color we're all Browning even as we speak and fructose does it seven times faster than glucose if I opened you up if I did uh you know if I did a heart heart operation on you right now your cartilage would be brown and I can show you the picture if you want of newborn rib cartilage nice and white against 88-year-old rib cartilage nice and brown because we're all Browning it's part of aging and if something causes you to age faster is that a good thing or a bad thing and it has nothing to do with glycemic index so that's the first thing they say second thing they say a little fructose causes an improvement in insulin response it's a phenomenon that was first uh observed by sharington back in 1968 bottom line there's a fructose receptor on the beta cell and so when you to consume a 20 o soda you're getting a huge insulin response and that's actually driving all these chronic metabolic diseases so when you overdo it that's actually a problem that's not a good thing that's a bad thing they would say it's a good thing because it's helping clear blood sugar not that's not true okay the next thing they would say is that it's all on the label for you to decide yourself except that's not true either because it's total sugars it's not added sugars you don't know what they added okay and the perfect example of that is yogurt so we talked about yogurt before so how many grams of sugar in a plain yogurt seven that's all lactose milk sugar no problem your liver turns the galactose into glucose like that how many grams of sugar in a pomegranate yogurt 22 so when you cons thank you when you consume so when you consume a pomegranate yogurt you are consuming a plain yogurt plus a Bap and crunch now did you know that but if you look at the side of the package it's total sugars you don't know what's the endogenous you don't know what's not a problem and you don't know what's added and the same thing for whole fruit you you know I mean people say oh but there's there's sugar and fruit right yeah but there's an equal amount of fiber and the fiber mitigates the negative responses of sugar on your digestive and on your uh system and on your liver why because the fiber causes a gel to form on the inside of your intestine it act the insoluble fiber forms the scaffolding and then the soluble fiber plugs up the holes it's kind of like the hair catcher on your bathtub drain okay it's a little plastic lattice work and when the hair falls off your body and you know covers the holes you get a barrier and the water doesn't go down until you clean it off right okay same thing's happening in your intestine when you consume the insoluble and the soluble fiber together you're getting this gel which is preventing the rate of absorption from the gut into the the bloodstream thereby keeping your liver safe because it changes the flux from the gut to the liver which is a good thing in addition because you develop that gel because you make that gel more of the calories that you consume since they're not getting absorbed high up in the dadum they're getting transported further down the junam further down the intestine where the bacteria live that's where the microbiota are they have to eat too so what do they eat well they eat what you eat the question is how much did you get versus how much did they get so when you consume foods containing fiber they get more so that means you didn't even absorb it so you consumed it but you didn't absorb it which is another reason why a calorie is not a calorie because when you consume your sugar with fiber and you consume any nutrient with fiber you're getting less and the bacteria are getting more and then that means the good bacteria will proliferate like bacteroides and the bad bacteria won't like focuus which has been shown to cause chronic metabolic disease because it releases more cyto kindes so bottom line when you consume your food with fiber you're mitigating all those negative effects that's called real food processed food is fiberless food and so you get basically when you eat processed food you're getting it all and you're getting it right away and it's driving your liver nuts I think we're going to have to let that be the last question for this evening I think we could go on and on and on but did you know you're speakers will be up here some of them who want to volunteer to answer one-on-one questions but out of respect for your time and nor thank you so much both of you this has been an incredibly Illuminating evening thank you thanks for the good questions