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, we 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 dollars 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 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.
So, what does this mean?
This means that we're screwed.
(Laughter)
The fact is, that we cannot afford this.
Where is this coming from?
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.
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.
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.
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!"
(Laughter)
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.
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.
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 in the audience has diabetes?
Anybody?
Must be a few of you, because diabetes is 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 fat.
Conversely, up to 40% of the normal weight population
have the exact same diseases.
They get type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease.
And you know what?
They don't 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.
Here is an example of how that works.
Here are two people of equal weight; one's healthy, one is sick.
Want to take a guess which one the sick one is?
Can you tell?
I can tell.
The one in the bottom is sick; why?
The guy on the top, he's just got big love handles.
The guy in the bottom has got fat all around his organs,
and that is what's making him sick.
And this is called TOFI; T,O, F, I.
Thin on the outside, fat on the inside.
I venture to guess there's a few TOFIs in the room right now,
and you think you are just fine, and you are not.
So lets talk about the last public health crisis that we experienced.
HIV; remember HIV?
1979; Patient Zero.
1981; the term "AIDS" got coined.
1986, Everett Koop said, "You know, we've got a problem."
When did HIV become a public health crisis?
1991.
Why?
Because Magic Johnson got HIV.
And everybody said, "Holy ____, this could happen to me."
This really is something where everyone is at risk.
Because it's not a behavior, it's an exposure.
So the question is, how do we resolve this?
Well, here's the problem; it's on this slide, right here.
This is Coca Cola's "beating obesity" campaign, "Coming Together."
"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."
A calorie is a calorie, and you can get your calories from carrots,
or you can get your calories from cheesecake,
or from Coca Cola,
or anything else with a "C" for that matter.
It doesn't matter where the calories come from,
it's, "a calorie is a calorie", that's what they say.
Well, you know what?
I don't believe in common sense.
I believe in data.
And the data say something else entirely.
What the data say is some calories cause disease more than others,
because different calories are metabolized differently,
because a calorie is not a calorie.
And when you believe that a calorie is not a calorie, a whole world opens up,
and actually, how to fix this problem becomes very clear.
This is because of our new diet.
It is 40 years old now. It is called "the Western diet",
it is called "the industrial global diet",
and it is basically the processed food diet.
And everyone of you is eating it all the time,
whether you like it or not.
There are eight things wrong,
not one, but eight things wrong with processed food, and here they are.
Three thing too little, five things too much.
Not enough fiber, not enough omega-3 fatty acids,
which you get from wild fish not farmed fish,
not enough micro-nutrients, all the vitamins and minerals.
In addition, too much trans-fats, but we know that they're coming down,
branched-chain amino acids;
they're amino acids you get in corn-fed beef, chicken and fish,
omega-6 fatty acids in seed oils, alcohol, and finally, the big kahuna,
the one that blows all the other seven out of the water, sugar.
Sugar, okay?
We're going to talk about that for the rest of the time.
Does sugar cause diabetes?
Everyone says, "Well, yeah, but it's because of the calories."
"Sugars are empty calories," that's the mantra.
It is not; this is absolutely not true.
Sugars are "toxic calories".
In fact, studies from Europe show that if you consume one soda per day,
your risk for diabetes goes up 29%, irrespective of the calories,
irrespective of your weight, irrespective of anything else you eat.
We've shown that for every 150 calories the world consumes,
diabetes prevalence goes up a total of 0.1%, which is nothing.
But if those 150 calories happen to be a can of soda, diabetes goes up 11 fold.
1.1%, and we're not consuming one can of soda,
we're consuming two and a half.
So 29% of all the diabetes in the world
is due to sugar, and sugar alone.
This study actually satisfies both the scientific and legal criteria
for proximate cause.
You have to be able to show that something causes something else
before you can do something about it.
Well, we've proven it; we've shown it.
It's shown here as well; same thing.
Now, the question is, why does this happen?
Number one: sugar causes liver fat accumulation.
All that fat around the organs that I just showed you?
For sure, that's what that did.
And that's not love-handle fat, that's inside you.
Number two: sugar's addictive.
Weakly so, but it's everywhere, it's like alcohol.
And about 20% of people are addicted to alcohol,
probably about the same for sugar.
So you can't stop.
So this slide over here shows the prevalence of diabetes
worldwide as we speak right now.
Who's worst?
Saudi Arabia, Kuwait, UAE, Qatar, and Malaysia.
The worst.
Why them?
No alcohol.
But they've got soft drinks like they're going out of style.
Because it's hot, and the water supply's a question mark,
and no alcohol.
(Laughter)
This is their reward.
But you know what, I'd rather have alcohol.
Because you can only drink yourself under the table once a day.
(Laughter)
But for soft drinks; all day, all night.
Sugar in the morning, sugar in the evening, sugar at supper time.
That's what we're seeing.
So, we've been overdosed.
The American Heart Association says
we should be consuming six to nine teaspoons of sugar per day;
we are up to 22.
And 80% of foods that are available in the American grocery store today
are spiked with added sugar.
And that's for the food industry's purposes, not for yours.
So, no access.
You don't have access because it doesn't exist.
Real food is hard to find.
Number two:
How about that there are 56 names for sugar,
so you don't even know what you're consuming.
And here there are.
No knowledge.
And how about this?
Everybody knows what a "Nutrition Facts" label is.
There's a number over there in the purple.
It's called the "Daily Value".
Notice, there's none for sugar, and that's on purpose
because they don't want you to know how much is too much.
So, no knowledge.
How about the National School Lunch Program?
Six cents extra.
Six cents, Michelle Obama got out of Congress.
That's not even enough for two grapes.
And, if you are eating school breakfast,
you're getting Fruit Loops and a glass of orange juice.
That's 11 teaspoons of sugar; you're already over your limit.
You want to know why we have a problem?
This is why we have a problem.
So everyone says, "Education!"
"Educate the public, educate the populace, tell them what's going on!"
Except for one thing: education hasn't worked for any other substance of abuse.
Did Nancy Reagan's "Just Say No" work?
(Laughter)
Really?
(Laughter)
And you know what?
I can prove that it doesn't work because here is the stock prices
against the S&P 500 for McDonald's, Coke, and Pepsi,
and look at what happened at the economic downturn in 2008.
They did very well, thank you.
In fact, if you want make money, invest in a food company.
So, where does that leave us?
It leaves us with this question of freedom and personal responsibility.
What does personal responsibility really mean?
Well, if the information is kept secret and you don't have knowledge,
if your access is limited because you can't even find it,
and if society can't afford it,
and we can't even give our kids something healthy to eat,
is it really personal responsibility?
And lastly, if your decision to drink a soda
lands you in the emergency room, and costs me dollars,
and if your decision to be fat and sick
costs your employer $2750
per employee, whether you're obese or not, you know what that is?
That's not called freedom, that's called anarchy.
That's what we've got.
So the libertarians say, "Wait a second; don't tell me what to eat!"
Well, you know what? You've already been told what to eat.
Where were you for the last 40 years
as your food supply was being changed under your nose.
Were you protesting then?
The libertarians say, "Get government out of my kitchen!"
You know, I don't want government in my kitchen either,
unless there's somebody more dangerous already there.
So the real question is, who the hell do you want in your kitchen?
The government, who will take your freedom and your wallet?
Or the food industry,
whose already taken your freedom, your wallet, and your health?
That's your only choice.
Now, having said all this,
the food industry is composed of a lot of people,
and you know what?
They really want to do the right thing, they do.
Individually, they would actually like to do the right thing.
And I have met with these people, and they are actually very nice people,
but, they work for a food company.
and contrary to what the Supreme Court says,
corporations are not people.
Because corporations have a fiduciary responsibility to their stockholders,
and people don't.
Corporations get three month profit cycles, and Wall Street earning reports.
And they have to make those reports.
So I've met with the food industry, and I will tell you about one story,
which will remain nameless,
They told me very straight out, ten scientists, ten corporate executives,
they said, "You know, we can change.
We've changed before.
we had to change back in the 80s when we went low fat,
with two provisos;
we wont go it alone, and we can't lose money."
Those are two non-starters today.
So what does that mean?
That means that they have to be told what to do,
and they have to do it all at the same time
so that there's no competitive disadvantage.
What does that mean?
That means government.
But governments are complicit and complacent.
They're getting paid off.
Over half of Congress takes money from the food industry.
And 6% of our exports are food.
What do you think what happen if all of a sudden we told the world,
"You know, all that shit we put in food?
It really isn't so good for you."
What happened when that one downer cow went from Canada to Washington state?
That was at the end of meat sales to Britain and South Korea for two years.
So, they're on the other side.
But we've got a crisis, because we will not have healthcare.
Here is a report that just came out from an investment bank,
an international investment bank, Credit Suisse,
called Sugar Consumption at a Crossroads, and this is a direct quote from this tome:
"We believe higher taxation on sugary food and drinks would be the best option
to reduce intake and fund the healthcare costs
associated with diabetes and obesity."
An investment bank is calling for taxation.
That's how big and bad this problem has gotten.
I believe food should confer wellness, not illness,
and it used to.
But you know what?
This is a public health crisis,
and you cannot solve public health crisis one person at a time.
Here is a list of diseases that were all personal responsibility issues,
except for the sheer gravity of each of them,
became a public health crisis.
Why don't we add sugar to the list?
Personal responsibility isn't ideology.
It's the elephant in the kitchen, and we can't afford it.
What we need is a policy based in biology.
And it's got a name.
It's called real food.
And the only way we can solve this
is by kicking that elephant out of the kitchen.
Thank you.
(Applause)