Fat Chance: Fructose 2.0 by Dr. Robert Lustig is his latest update and a sequel to his popular YouTube video Sugar: The Bitter Truth. We decided to produce the whole transcript of the video just as we did with his former one. Below is the full transcript…
Robert Baron – UCSF Professor of Medicine
Good evening everyone. Welcome again to our penultimate class in this semester’s course on nutrition. A reminder that next week we will be talking about vitamins and minerals and vitamin and mineral supplements, so please join us for that last class. Dr. Jeffrey Tice will be the professor joining us that evening.
Tonight we have what I guess for some of you has been the lecture you’ve been waiting for since the beginning. Dr. Lustig gave a similar lecture in 2009. Little did we know at the time that it would have 3.5 million downloads since then but also in this room at a course very similar to this that I also chaired, and it’s really, I think, changed his life more than anything else but I think the hope is that it’s also changed the field and the topic and the policies and the politics that we are going to talk about tonight.
Many of you know Dr. Lustig is an internationally known neuroendocrinologist in pediatrics. He trained for part of his time at UCSF, then went back east to do a clinical neuroendrocrinology and came back to UCSF in 2001 where he’s continued to do his clinical science on factors that control appetite, particularly the interaction between the hormones of insulin, leptin, ghrelin, and appetite control and metabolic syndrome and obesity.
More recently, in part around the time of the video and certainly in the four years since Rob has become an international leader in the efforts to improve our nutrition not only in the United States but around the world. He’s focused a larger part by putting a real microscope on the issues of fructose and sugar in general and refined foods in general, the relationship of the dietary fiber and the many of the other topics that we’ve been talking about over the course of the course.
Rob just returned from Europe this morning, in fact arrived here at 5 o’clock this evening. We think he had dinner. We know he hasn’t had sleep, it’s 4 o’clock Europe time for him. So this was really a heroic effort. Our fingers were crossed that all the flights would be on time, and I’m very pleased more than you can imagine that he’s here tonight, because I didn’t want to give this lecture as well.
But in addition to his work, Rob recently took a sabbatical in order to further this work and spend a large part of that time at Hastings [ph] School of Law getting a Master of studies in Law, and part of his aspiration I think is really to add his legal training now to his science and medical training to continue to advocate for good nutrition around the world.
So we’re very anxious to hear about his newest thoughts on this topic. We’ve entitled the talk the same title as his best-selling book “Fat Chance” and added the subtitle “Fructose 2.0”. Rob?
Robert Lustig – Professor of Pediatrics, Endocrinology Division, UCSF
Thank you, Bobby and thank all of you for coming, you know, to some extent this is sort of like déjà vu all over again, having done this 4 years ago and it really did change my life and hopefully changed a few peoples’ lives in the audience and certainly around the world. I still get emails from that video today, people who’ve seen it for the first time.
That video, we’re going to refer back to it in some — to some extent tonight because I am not going to redo the biochemistry, there’s no point in doing it twice.
What we’re going to talk tonight about is primarily the physiology. So in essence, the two videos will end up being complementary on YouTube and hopefully people who watch it will end up watching both, so keep that in mind so, in essence, the two videos will end up being complementary on YouTube and hopefully people who watch it will end up watching both, so keep that in mind.
All right. Well, a lot’s happened in four years, and the data just keeps rolling in, and unfortunately for us all the data is pretty awful. So you’ll see why as we go and I will try to delineate that as we go.
So first of all I have no disclosures, no food industry is putting me up to this, be sure of that. So here’s the past, this is 2001. 6 million kids are seriously overweight. Well, with all of the media attention, with all of the NIH money, with all of the clinical programs and with Michelle Obama’s vegetable gardens we are now up to 20 million.
What’s now at the present?
Here’s the present. Currently there are 30% more obese people on the planet than undernourished people. And this has happened only within 15 years because 15 years ago it was exactly the opposite. And it’s occurring in countries that still have under nutrition.
So how do you explain that, other than to say that can’t be behavior, that’s got to be an exposure. This looks like any standard pandemic influenza, typhoid, etc. This looks like a microbial phenomenon rather than a behavioral phenomenon, we’re going to go there.
366 million diabetics walking the earth, that’s 5% of the worlds’ population. And they are chewing through all the health-care resources.
This was just three months ago, diabetes costs the US $24 billion. Now if we could recoup even a fraction of that, we wouldn’t even need health-care reform. In fact, it’s been suggested that we wouldn’t even need financial reform. Okay, 41% rise in 5 years, this is going up so fast it makes your head spin.
What’s the future going to be like
And here’s the future if we do nothing. Experts predict 165 million Americans, 42% would be obese by the year 2030. 100 million Americans, that’ll be 33%, will have diabetes by 2050, but fear not, because it won’t really matter because Medicare will be broke by 2026.
So, as the Soup Nazi once said: “No health-care for you”. Well, the fact of the matter is, I’m going to be 69 in 2026 and I want my freaking Medicare. And so should you all. The point is we have to do something different, and you know the old adage, right? Of the definition of insanity is doing the same thing over and over again and expecting a different result.
Well I’m here to tell you for the last 30 years we’ve done the same thing over and over and over again and there has been no change in the result. So we have to rethink this, we have to reframe the argument and that’s what we are going to try to do tonight. And I’m going to do it right now.
So here’s the way people view this issue. This is a Venn diagram of all the adults in America: 30% obese over here, and 70% normal weight over here. And everybody assumes that the problem is this group over here because 80% of the obese population is sick in some fashion with type-2 diabetes, lipid problems, hypertension, cardiovascular disease, cancer, dementia, non-alcoholic fatty liver disease, polycystic ovarian disease, etc, etc.
So if you do the math on this, that’s 80% of 30% of 240 million, that’s 57 million sick, and it’s those 57 million that are bankrupting the country. And so it’s the obese person’s fault only. And that’s the way everyone views this.
This is wrong, this is a mistake, this is a disaster actually, because it is not correct.
Here’s the real story. In fact, 20% of the obese population is completely metabolically normal. They have normal insulin dynamics. They don’t get sick. They will live a completely normal life, die at a completely normal age, cost the taxpayer nothing, they’re just fat.
Conversely, up to 40% of the normal weight population have the exact same metabolic dysfunction that the obese do, they are just normal weight. And so they don’t even know they are sick, until it’s too late, because normal weight people get type-2 diabetes, they get hypertension, they get dyslipidemia, they get cardiovascular disease, they get cancer, they get dementia, etc, etc.
And so when you do the math on that, that’s another 67 million. So that’s actually outclassing the obese, and so the total is 124 million, that’s more than half of all of America.
Now you may remember HIV. Remember HIV? When did HIV become a public health crisis? No, not in the 80s. In 1991.
1979 patient zero, so we first learned about the diagnosis. Throughout the entire 80s it was all about the gays and the addicts. And it was always, it’s their problem, their personal responsibility, their behavior, their fault. And then something happened in 1991, anybody remember what it was?
Magic Johnson, Magic Johnson got HIV. And all of a sudden everyone went “Holly Mother…” you know what and everybody realized, you know what? Everyone’s at risk, and all of a sudden it became a public health crisis.
So when does a personal responsibility issue become a public health crisis? And that’s what we’re going to talk about tonight. Because this is a public health crisis.
Here’s the slide that demonstrates the phenomenon. So here are two equally weighted adult men, which one’s healthy and which one’s sick. Anybody know? The one on the bottom is sick, right, he’s sick.
Why? All that visceral fat, all that fat surrounding the organs, see this guy over here he’s got big love handles, but you know, so what? In fact, this is perfectly healthy, it’s no problem, because subcutaneous fat is actually kind of good for you. There are actually studies that show more subcutaneous fat, more longevity.
Whereas this stuff, this is the bad stuff, this is the poison stuff over here. So the fact is, standing on a scale doesn’t tell you where your fat is, what does? Well your waist circumference is a good start, and then there’s some lab tests you can do as well. The bottom line is there are a lot of normal weight people who have this phenomenon called TOFI. Thin in the outside, fat on the inside.
Probably some right here in the audience. And they get type-2 diabetes, they get dyslipidemia, they get hypertension, etc, etc, you get the picture?
Everyone’s at risk, because everyone’s exposed, the question is, what it is you’re exposed to? Because obesity is not the problem, it never was. They want you to think it’s the problem, but it ain’t the problem.
What is the problem? Metabolic syndrome is the problem, the cluster of diseases that I’ve just described you, because that’s where all the money goes. Obesity costs almost nothing, metabolic syndrome is 75% of all health-care costs today. And there’s the list right there, everyone with me now? Okay, do I have your attention?
So how does this work? So this actually is a redundancy from the previous YouTube video, so I apologize for that.
Obesity obeys the first law of thermodynamics
It has to do with how you view the question of obesity and what does it mean. So of course obesity obeys the first law of thermodynamics, and I don’t argue that. The total energy inside a closed system remains constant. It’s a law.
If I didn’t believe in the first law of thermodynamics you’d have me written out on the rail, I’d be the ultimate heretic and zealot and I would be discredited. Of course I believe in the first law of thermodynamics, it’s a law.
The question is, as I’ve learned from my legal training, who’s truth, which interpretation. The Supreme Court always comes down 5-4 on everything, right, right? True, because there are two interpretations, I mean, basically that’s what the Supreme Court is for, interpreting the law, the law is the law, but the interpretation is something else.
So here are the two interpretations. If you eat it, you better burn it, or you’re going to store it. If that’s true, then this is a matter of energy balance — energy balance, that’s what everyone will tell you. And it’s the result of two aberrant behaviors, calories in – gluttony, calories out – sloth. And that’s what everybody assumes, is, if you’re obese, well you must eat too much or exercise too little, or both. And therefore, it’s your fault.
And that’s what we believe and to this day we still don’t have insurance for obesity, although just today, you know that the AMA finally said “obesity is a disease”. So it’s funny, because actually in 2004 HHS said obesity was a disease. It took the AMA 9 years to catch up with HHS, figure that out.
It’s based on this dogma, the dogma is, that if you eat more than you burn you’ll gain weight, if you eat less than you burn you’ll lose weight, because all calories are the same, a calorie is a calorie.
This is the biggest pile of you-know-what there is. This is absolute not true.
But if you believe it, then the corollaries of a calorie is a calorie are that this is free will, you get to choose what you get to put in your mouth, it’s personal responsibility because if you are obese you chose to be gluttony and sloth that is your problem and diet and exercise will fix it. And that’s what everyone believes from a calorie is a calorie.