Sugar: The Elephant in the Kitchen by Robert Lustig (Full Transcript)

Robert Lustig

Transcript – Robert Lustig, an American pediatric endocrinologist, discusses Sugar: The Elephant in the Kitchen at TEDxBermuda 2013.

Listen to the MP3 Audio here: Sugar – the elephant in the kitchen by Robert Lustig at TEDxBermuda 2013


I would like to talk to you right now about perhaps the most over-used and misunderstood word in the English language: freedom. Freedom has two parts: freedom from — freedom from oppression, freedom from search and seizure; and freedom to — freedom to choose.

But freedom to choose has some caveats, has some provisos. The one we ascribe is called personal responsibility, and that’s an ideology. And there are some basic principles that we ascribe to personal responsibility, that is, you have to have knowledge. The five-year old who accidentally shoots his brother is not guilty, because he didn’t have the knowledge.

Access. We have 57,000 people being thrown off voting rolls right now in America because of redistricting; they don’t have access. They can’t have personal responsibility to vote.

And finally, affordability. You have to be able to afford your choice, and society has to be able to afford your choice. An example: In California we’ve just released 100,000 inmates who are drug addicts. We said, “Drug addicts have to be locked up.” You know what? We can’t afford it. So, these are all caveats to personal responsibility.

And then the last one, really important, is that your actions can’t hurt anyone else, because if they do, then that’s breaking the law. Well, the fact is, we’ve got a healthcare crisis, and it’s a big one. In fact, Medicare will be broke by the year 2026. We do not have the money to keep doing what we’ve been doing. And this healthcare crisis is not due to physician reimbursements, it is not due to hospital charges, it is not due to infrastructure, or administration. This healthcare crisis is due to chronic metabolic disease. That’s where the money’s going. $245 billion last year in America for diabetes. $200 billion for dementia, another chronic disease. And Obamacare promises us that we’re going to be able to put 32 million sick people on the rolls, and we’re going to be able to do it by providing preventative services. Well, guess what? There are no preventative services for these chronic metabolic diseases. They don’t exist. The only thing that works is prevention, and we don’t have a prevention.

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So, what does this mean? This means that we’re screwed. The fact is, that we cannot afford this. Where is this coming from? Well, it’s coming from this thing called the obesity epidemic, right? Everyone says, “If only these people could just eat less and exercise more, we would solve this problem; it’s their fault.” That’s where this comes from.

You know, we have these things called the seven deadly sins. We have absolved all five of the other sins. We’ve absolved jealousy, greed, wrath, pride, and lust. In fact, we have TV shows that exhort them. The only two that we have not been able to get rid of, the only two that still stand are gluttony and sloth. It’s your fault.

Well, you know what? I’m a pediatrician, and I take care of kids. And I have a hard time ascribing personal responsibility to their obesity. In fact, we have an epidemic of obese newborns. Obese newborns. Now, you want to assign them personal responsibility? I take care of kids with brain tumors. You can see right here this arrow pointing to a goombah sitting right in the middle of this patient’s energy balance pathway. A brain tumor that is causing massive obesity. Let me tell you about two of those patients.

Here’s a patient that I took care of many years ago. And she had a brain tumor, and she gained 150 pounds. You can see her here right now at 220 pounds. And we put her on an experimental medication to lower her insulin level. Remember, insulin is the diabetes hormone, it’s also energy storage hormone. It’s the hormone that tells your fat cells to take up extra energy. There is no weight gain without insulin. And we knew that these patients had very high insulin levels. So we gave her a drug to drop her insulin in an experimental fashion.

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A week later, the mother called me up, the kid hadn’t lost any weight yet, and she says, “Doctor Lustig, something’s going on here.”

I go, “How do you mean?”

“Well, we would go to Taco Bell, and she would eat five tacos and an Enchirito, and she’d still be hungry. We just went to Taco Bell and she only ate two tacos, and she was full. And she just vacuumed the house!””

I go, “Really? Isn’t that interesting.”

In fact, we did this many times, and the exact same thing happened. And here she is, one year later having lost 48 pounds, and feeling much better about herself, as you can imagine.

Now the next patient I’m going to show you isn’t even my patient. This is a beautiful 13 year old girl who lives in Hawaii. Notice the lily in her hair. And one month after this picture was taken, she was in a car accident, and she stroked her hypothalamus, that area of the brain where that tumor was for the other patient. And this is her, one year later. Now, does anyone really want to tell me that this is personal responsibility? That this was this young girl’s fault? Well, I was giving grand rounds at Kaiser, Honolulu, and they said maybe we should put this girl on this same drug. And there I am with her.

And her mother said, “Yes, go ahead and try.” And here she is one and a half years later at her high school graduation. Now, does anybody really want to make the argument that this is this kid’s fault? I have a hard time with that. In fact, what we learned from these experiments is that the behavior is secondary to the biochemistry. When you fix the biochemistry, the behavior improves, and we’ve seen it now in adults as well.

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So, everyone says the behavior’s the problem. No, it isn’t. The biochemistry underlying is the problem. Well, so now you say to me, “What about the rest of us? We don’t have brain tumors.” Well, in fact, it’s the exact same problem. Nothing’s different. All of us now have insulin levels three times higher than we used to. And the question, of course, is where did that come from? Who here in the audience has diabetes? Anybody? Must be a few of you, because diabetes is a pretty big problem here.

Here’s the problem: seven out of eight of you, seven out of eight people with diabetes don’t even know they have it. You are blind to diabetes, until you become blind from diabetes. So you don’t even know you have a problem yet.

So here’s the way to look at this. Here is the American population: 30% obese, 70% normal weight. The standard mantra is, “It’s the obese person’s fault because 80% of those obese people are sick. They have type 2 diabetes; they have hyperlipidemia; they have cardiovascular disease; they have hypertension; they have cancer; they have dementia; and they are breaking the bank. Those 80%, those 57 million people, if we could just get them to diet and exercise, we could solve this problem.” That’s the standard mantra; this is incorrect. Because 20% of those obese people are actually metabolically healthy. They will live a completely normal life, die at completely normal age, not cost the tax payer a dime. They’re just that.

Conversely, up to 40% of the normal weight population have the exact same diseases. They get type 2 diabetes, they get hypertension, they get dyslipidemia, they get cardiovascular disease. And you know what? They don’t even know they have a problem. When you add them up, it’s more than half the US population. In other words, this is a public health crisis.

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