Sugar: The elephant in the kitchen | Dr. Robert Lustig | TEDxBermuda

Robert H. Lustig is an American pediatric endocrinologist at the University of California, San Francisco (UCSF) where he is a Professor of Clinical Pediatrics.

Dr. Lustig assesses the health dangers of sugar and its link to type 2 diabetes and the global obesity epidemic. He is the author of several books and many articles on childhood obesity, including the recent "Obesity Before Birth."

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

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 extort 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 here 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 people'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, 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 "Dietary 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)