Welcome to the stanford Health Policy
Forum I’m Dan Kessler I’m a professor in the business and
law schools here at Stanford and a member of the Advisory Council of the
Stanford Health Policy Forum that’s why I’m here today. I’d like to make just
a couple of brief opening remarks and then introduce our panelists. First, most
important, please turn off your cell phones and pagers put them on silence
mode. Second, Gary’s books are for sale out front
along with some complementary publications from Chris Gardner who I’ll
introduce also in a moment. And third, you can see all of our events,
this one included, on the web filmed at HealthPolicyForum.
stanford.edu. But before I introduce our panelists I’d
like to just take a moment to thank Dean Philip Pizzo for his
leadership and commitment to our Stanford Health Policy Forum. And I’m not
just saying this because I’m a member of the advisory board. I’m saying this is a member of the Stanford
community and someone who’s really enjoyed coming to these things. We’ve
covered a wide array of topics of broad importance to health policy and I think
it’s been a wonderful service to the University and to the community as a
whole. So now let me just move right to introducing our speakers
today. First is Gary Taubes. Gary is a science
journalist, the author and co-founder of the Nutrition
Science Initiative. His two books of which I own multiple copies and suggest
you guys do — why we get fat and what to do about it, and Good Calories, Bad Calories. He’s also
a contributing correspondent for Science and recipient of a the Robert Wood
Johnson Independent Investigator Award in Health Policy. He’s won numerous awards for his
journalism including the International health reporting award, and the
National Association of Science Writers in Society Journalism award three times,
the only print journalists ever to do so. He’s also the co-founder as I said of
the nonprofit nutrition science initiative. Taubes has argued and will
today explain to us how our diets overemphasis
on certain kinds of foods, carbohydrates, has led directly to the obesity epidemic
that we’re facing with us also today. With us also today is Chris Gardner. Chris is an associate professor of
medicine and director of the Nutrition Studies at the Stanford Prevention
Research Center. He serves on the nutrition committee of
the American Heart Association and the Education Committee of the Obesity
Society. Chris is actively involved in research focused on dietary intervention
trials designed to test the effects of food components and food eating patterns
on chronic disease factors, including body weight lipids and inflammatory
markers. Moderating our discussion today is Paul Costello. Paul is the
chief communications officer for the Stanford University Medical School he leads the medical schools
communication and public relations efforts, and will be serving as the as
the ringleader from now on. So with that, I’ll turn it over to you Paul. Thank you Dan and thank you everyone for joining us today. I want to begin by asking you how many
of you have ever been on a diet? Okay, how many have been on a low-fat diet? How many had been on a low carb diet? Okay. I want to begin by asking the two
people here on stage what did you have for Thanksgiving
dinner and how what does what you had for Thanksgiving dinner tell us about your beliefs about food
and nutrition. [Gary] Or what does it tell us about my family’s beliefs? [Paul] Either way. If you can’t control your family that’s another
issue, but what does it tell us about food that you chose. [Gary] So what we
have is what everyone has when I actually put on my plate yep was mostly
the turkey and some and green beans and brussel sprouts and yeah I had a little
dessert, a little bit of sweet potatoes and my
wife insisted I tried the mashed potatoes. The stuffing didn’t look that
appetizing I have to say so I had it look better I had a little. Thanksgivings is a lousy
example for what it says about the my nutritional beliefs but I do you know I
obviously believed that they could see the carbohydrate content for the diet
that’s problematic i’m in for reasons I hope to explain
tonight and so that the less starch, the less refined
grains and sugar, the better I feel and the lighter I am. I think
this is possibly a universal phenomenon which will also talk about Christopher well I’m not everyone is that’s not that so and i love the part about the
family the family is enormous in this so my father-in-law has a history of
heart disease and his family he’s been a vegetarian for years I’ve been a
vegetarian for 30 years we had a little bit of duck for the
mother in law but the rest of us what I made was Jesse tools butternut
squash soup and a vegetable broth with figs and pine nuts and white wine and a
splash of maple syrup i also baked up some acorn squash and I
put an onion for color red bell pepper mixture on top sauteed and mixed with a little rice and
apples and raisins grand i’m going to interrupt for one second if my wife had her way we would be
eating at his house next Thanksgiving that’s a given and part of that that I
want to emphasize is I cook and I think that’s a big issue that we have to deal
with today my father knocked this amazing green
bean dish with pearl onions and they made a fabulous salad that has
everything and the kitchen sink on the salad so it’s not just a green leaf lettuce
salad it’s a work of art you know interesting that that one of the things
that I’ve just heard you both say is you can eat well eat well and and do it
within a confines of you know not feeling that sure abstaining or not
feeling that your restraining and that you can also have a day or a week or or
a moment that you celebrate something very different than keeping yourself restrain from food is that right is that
basically the way you approach food well yeah in general but i also think that
everybody is different so you could make the argument for instance that on this
day of thanks we could have all had a few cigarettes and we could have all had a few drinks
and that would be true for many of us and not true for some of us who are more
or less tolerant of these and perhaps for whom these foods are more than these
substances are more addictive so I think one of the mistakes we make
is that there’s a spectrum of assuming that you again something that we talked
about that a calorie is not a calorie is not a calorie these foods have different
metabolic hormonal and cognitive effects then there’s a spectrum a maybe a
bell-shaped curve of how we respond to them and most of us can do exactly what
you said but some of us might be better off if they don’t and those are the kind of questions that
haven’t been answered what are the biggest misconceptions and that the
Americans particularly Americans have about food diet and nutrition today
Christopher well they think a lot of food like
substances are food and they’re not really if they’re packaged processed
manipulation so that would be the biggest food but it what does that mean
it so we’ve taken what was food and we
packed it and brought added value to it so the farmers out there growing stuff
and getting six cents on the dollar for it and the middle people took it and
added fat and sugar and coloring and a label on the front of the package that
says it’s got this and it’s absolutely fabulous despite all the other junk that we put
in it and you should buy it for the fabulous thing that we put in it so i’ll
be my comment on the food like substance the wait I’m not sure people have misconceptions
it we have really interesting studies where
people look at different shapes of body you ask them what’s normal and
culturally it’s very different what’s a normal body size what’s
acceptable and then was less food wait and generate the misconception about
food waiting diets and diets Indiana well yeah so the term diet actually means whatever
dieter on weight loss time where you gain diet habitual diet I think the American public theme thanks
diet is a time of deprivation and a time of change that you will soon go off and
that’s the worst part about how many of you agree with that diet is something
you do and then you go off of here so educated thank you we always get overeducated people at
these so it’s America’s misconception but not yours thank you what about you hear what are
what are the biggest misconceptions about food diet and weight well i paid more attention to what the
research community and the public health authorities have been telling us I don’t
know if how many of us agree on to me the greatest misconception out there is
that the reason we get fat is because of this idea that we just take in more
calories and we expend if you read the literature you’ll see this phrase all
the time that obesity is an energy balance disorder it is otay
thermodynamics or physics issue and arm I think that’s just that is kind of the
original sin in obesity research and nutrition and so everything we’ve done
since then that was embraced in the nineteen fifties in the United States
everything we’ve done since then has been misconceived an attractive but it’s
been based on this idea so when you go on a diet the primary thing you want to
do on the diet is eat less or if you’re too heavy want to exercise more and eat
less and some combination of manipulating your energy and take an
output in a way that you go into what we call negative energy balance and now
you’re losing weight and by the same token you know this idea that when you
get down to the way you like you can now just move into energy
balance and stay that way although nobody really understands what
that means but that also feeds into this idea that we go on diets we lose a
certain amount of weight and then we could go back to eating the way either
we used to eat or the way other people around us seem to eat to maintain their
weights and we end up you know going on and off diets our whole lives in part
because this concept is simply misconceived you you pretty much
attacked the department of agriculture food pyramid would you say that’s fair it’s one of
the the institutions like pretty much attack what why what’s wrong with the food I
mean the major issue is you know until the nineteen sixties the conventional wisdom where that
carbohydrate-rich foods had some characteristic that we call fat night so bread pasta potatoes grains of any
kind for anything from flower sweets had this magical quality of being fattening
and so we avoided them and then in the 1960s we began to embrace the idea that
dietary fat caused heart disease heart disease and obesity are so intimately
associated you can’t tell people to lower fat need more carbohydrates if carbohydrates are going to be
fattening so dietary fat had to become fattening as well and between the sixties and the nineties
when the food guide pyramid was instituted we took this concept of the
fattening carbohydrate and turned it into the heart healthy carbohydrates
diet food so by the late nineteen eighties all of
I remember when baked potatoes became a diet food my life and suddenly we were
all waiting baked potatoes every night because the idea was it was a sour cream
and the butter that was really fattening and the potato was you know not with
somehow a diet food words in the 1960s my mother would believe that a baked
potato was fat night and all of this would be meaning what wouldn’t be a
problem with the food pyramid if it was correct this transition but again the
argument i’ve been making that then that’s taken beyond some of my argument
that I think that’s in my books is that these carbohydrate-rich foods really are
fanning that they do have this characteristic of being family and we
should know why that is because of their effect on the hormone that regulates fat
accumulation and so what we ended up doing was embracing you know building a
food pyramid where we were all supposed to eat fattening foods is this tape over
diet those exact foods that my mother’s generation and like no French woman and
brother certain age would ever be seen eating by the foods were supposed to eat all
the time and then we can begin their heart healthy so if we get off them are doctor tells
us we’re going to call it give ourselves a heart attack and we have a serious
problem in all of this coincides with an obesity and diabetes up to them what about the food pyramid I mean it’s
the Department of Agriculture US government is that was tested i’m sure
they didn’t come up with it out of you know thin air what about the if you go into a
historically it was tested less than you would believe testing it requires long
follow-up of people and randomization to prove cause and effect and it was a lot
of common sense that was built into it and i would suggest a lot of it that
came into the fat vilification had to do with some earlier trials that tried to
look at diet and decided what you know waiting for somebody to deliver guy get
cancer heart disease that’s going to blow the whole nih budget I tell you what let’s go for something
like lowering blood cholesterol which we know from drug trials has been shown to
save lives and saturated fat raises the bad cholesterol and that was a proxy for
this so if you were on a high fat diet and was high saturated fat you raised your LDL and that should have
been bad so what was the counter to that it would have been carved you would have
lowered your fat and have to replace it with something so you replaced it with
card but it’s seriously a case of perhaps good intentions know certainly
good intentions gone awry because of what the food industry did without
health message so some of my favorite examples are low-fat organic yogurt I mean what could be more heartwarming
than low fat or can I ask who’s had low fat organic yogurt in the last week now how many of you had plane and how
many of you had raspberry or peach or apricot or raspberry peach apricot as
the raspberry peach apricot has almost no fruit in it it’s got some sweetener
before the berries that it doesn’t even have enough Barry to color the yogurt so they add coloring and flavor and
sugar and then the berry and you’ve got a low-fat product but it’s yo turn it
out going to be bad because it’s full of sugar so what
happened is when we push this low-fat thing we made a lot of foods that
technically were low fat but when they took the fat out the mouth taste is gone
the field was gone and they replaced it with various forms of sugar high
fructose corn syrup being the worst offender not any worse than sugar but
cheaper so easier to add and slip into almost everything so I mean food
companies are there to make money so they test pant they use test panels to
see what people like oh the fat was gone you don’t like it as much how about to
put a little more sugar little more sure I got that ok so now we can do the low-fat version
and what we ended up with was a lot of simple carbohydrates that are quickly
absorbed and have done us in I want to get to sugar and add in a
little bit but I want to go back to something you’ve written about in your
book gary is it we really began this this
obesity surge in the late eighties or in the eighties what happened in the eighties that this
will be it was it was it portions became larger was at the addition of the sugar
into everything was it additives what happened to you but this is what
actually got me into this research but yeah I started actually around 2001 when
I pitch an article in The New York Times which is what caused the obesity
epidemic because back then it was new and i had done a year-long investigation
for the journal Science on the dietary fat beliefs and I knew two things had
changed in the the the nineteen eighties or from nineteen seventy-seven in
nineteen eighty-four we could localize the beginning of the obesity epidemic
between two national health you know I examination in Haines
national health and nutrition examination survey days and and so it sometime between the late
nineteen seventies and the very early nineteen nineties and in that time . but
we introduce high fructose corn syrup in 1977 and by 1984 did pretty much taken over
the soft drink market and replace sugar sucrose in Coke and Pepsi and then we
instituted this low-fat diet is a healthy diet dogma that process was
institutionalized beginning in 1977 by a Senate committee run by George McGovern
and then by 1984 the national institutes of health that had a consensus
conference on declaring that the entire country over the age of two should be on
a low-fat diet and Time magazine ran this very famous cover which was a
dinner plate with their breakfast plate with two fridays is the eyes and a piece
of bacon for the frowning mouth and it was cholesterol now the bad news and I
was working at time inc at the time and I remember that cover and how our diets
literally changed from that day so the two three prime suspects would be this
introduction of high fructose corn syrup and then this belief that I said that a
low-fat diet where you replace the fat with carbohydrates and simple
carbohydrates is a healthy diet and when we brought in high fructose corn syrup
is chris there is some evidence that it’s a little bit worse and sugar maybe ten percent worse if we assume
that sugars bad high fructose corn syrup is maybe maybe ten percent worse or five
percent worse and some evidence may or may not be true on but we get no high
fructose corn syrup was sugar and actually the corn refiners i find it
very amusing because the quarter finals went out of their way to present that
they would refer to it is fructose to differentiate it from sucrose and then
they were group would prefer to fructose is a naturally occurring fruit sugar and
sucrose is a 50-50 it’s a molecule of glucose bonded to a molecule fructose
it’s a 50-50 mixture and high fructose corn syrup as we were consuming it in soft drinks and tease is 55 fructose 45
glucose so they’re effectively identical but
when you see in the the food availability data is the consumption of
all caloric sweeteners which is about ninety-five percent sucrose and high
fructose corn syrup starts turning upward in the nineteen eighties and my
contention is it just because we didn’t know that high fructose corn syrup sugar
so that the primary ingredients in whatever we were drinking didn’t have to
say sugar and water they could have this sort of naturally
occurring fruit sugar and sugar consumption then collects weiner
consumption climb steadily to the end of the the century and then it starts to
turn over around 1999-2000 and again that pretty much parallels the obesity
epidemic it’s very hard to make sense of this kind of observational data because
a lot of other things also change yeah chime in so the the data set that
he was referring to this national health and nutrition examination survey has
been done over time and there may be some methodological issues but if you
track calories over time they were fairly stable and then they jumped in
nineteen eighty by about two or three hundred calories in men and women and
then they were stable again it and i happen to really like Marion Nestle’s
take on this which doesnt contrast your years at all it just complements it and
it has to do is very initial marion Nestle is at New York University she’s written a book called food
politics she’s written what we eat she’s got a great new book
have you seen the calorie book oh I guess you don’t like it okay I like
a great new border not that I don’t like it actually blocks
you step-by-step through uh-huh so to complement what Gary said
it’s fascinating whoever was head of General Electric in
1981 and I’m gonna blank and I think it’s james welt came up with the idea is
that and Jack Welsh Jack wells came up with the idea of shareholder value and
started this movement that you can’t just have profit from year to year and
not even near to your quarter quarter you need a short show growth and that
was about the time that people started supersizing things and so that was part
of that I think what they were super super sizing win which fits with your
discussion is more sugary packaged processed food so I mean to say don’t
eat so much sugar won’t work if wall street is totally geared up to super
size and show growing profits on a quarterly basis to investors which I I
think it’s part of the complexity that underlies this how much of this low-fat mantra that
we’ve been consumed with an obsessed with sense the eighties nineties how
much of that is responsible for obesity today well this is one of the interesting
points I would like to make on I you could argue a lot of it you could
see in the data that we did embrace this these dietary beliefs to some extent so
industry is putting more and more sugar refined grains processed food out there
was simultaneously we are eating healthier the USDA is telling us to eat so we’re lowering our fat consumption
little red meat consumption comes down significantly sugar consumption goes up significantly
but something I point out my books that i think is crucial is that you can find
populations with high levels of obesity as open as as high as we have in the
United States today that had none of this toxic food environment in which we
kind of want to blame our obesity problem so beginning with the Pima Indians and I
the native american tribe the Pima 1902 a Harvard anthropologist comes to visit
the spot this this population on their reservation south of Phoenix in 1902 and
comments that all the other women seem to be obese on and they just gone
through a 20-year period of family which is Caillou could think of was like 20
years on a very low calorie diet and yet then there’s a photo in the book that
was published in nineteen 6068 fat people woman he calls fat Louisa 1928 a
couple university of chicago economist study the Sioux on the crow creek
Reservation in South Dakota and they do they describe the unbelievable almost
unimaginable both poverty on this reservation and yet they point out that
a quarter the women are what they call distinctly fat while they’re obviously
children who are starving and not getting enough food and this is an
observation that you see on throughout history of in the fifties and the
sixties and central on a Caribbean island populations in African
populations and South Pacific Islanders arm and what’s called the double double
burden of obesity and malnutrition there was recently a paper published of
western sahara refugees and Algerian refugee camps right if I remember the
numbers correctly twenty-five percent of the families had
obese mothers and starving children and they don’t have this toxic food
environment that we have there something obviously toxic about their environment
that’s the issue but they don’t mcdonald’s or burger kings or the
process food we’re talking about they had some processed food and so the
question is why were those populations fat because we can now start ruling out well what do we know why are they fat
well the two things is far as i can tell they all have in common is then
something is true of virtually all impoverished populations you live in a
carbohydrate rich diet sugar is a primary rice right although you have
Southeast Asian who live on carbons diets lot Bryce who
are not obese and not diabetic so the Grand you could ask a question what’s
the difference between the southeast asian populations and these other
populations I’ve been describing like trinidad and women in the early nineteen
stranded at the early nineteen sixties is having a malnutrition crisis the US
government sends a team a nutritionist down to help out and they come back
saying look the other people have the other vitamin deficiency diseases are
right if you can see all these signs of malnutrition and yet obesity’s in a
quote explosive medical problem and the next year at MIT nutrition is comes back
and reports that the average diet is less than 2,000 calories twenty one percent fat so you can ask
what’s the difference between that population in the southeast asians and
it sugar in the diet sugar is usually relatively new to the diet is a
population on we have to sue the Native Americans who would not have had either
refined flour or sugar until the mid 19th century and then arm you know so
that’s a kind of getting the prime suspect for what’s driving obesity in
these populations you could have an extremely poor
population eating a carbohydrate rich diet with refined grains and sugars and
that’s enough to cause obesity even if there’s not enough calories to
constitute any degree of gluttony is we would describe you raised the issue of
heredity and I wonder if you could both talk about heredity and genetics what we
know about the different populations which you said in Asia they are
carbohydrate-rich rice at an example but relatively thin what we know so far in terms of science
heredity food and a bay city so you can look at different populations
will never be cause and effect so that a lot of other differences that go on I mean interestingly to cherry pick some
populations the New York Times just had that the longevity group and the island
of I carry i see they quoted you a little if they ask you what you thought this is
a very plant-based diet but they live to a hundred they also sleep till 11 every
day then they work for a while then they take an afternoon nap and then they all
get together for a really small dinner and the Tarahumara Indians survive
almost all on corn and being but their ultra marathoners filled with know about
the ultra marathoners so there is some genetic predisposition you could look
from population the population that’s why it’s valuable to look at pacific
islanders or south asians clogged with chard to this amazing study in 1990 you got 15 monozygotic twins and he /
fed them a thousand calories a day for something like 80 days now it if that if
that math had worked out regardless of what size you were that excess excessive
caloric intake should have been about eight kilos of added weight by the time
you’re done so among the monozygotic twins there was
a significant correlation there were differences between groups of twins but
within twins it was smaller than between different groups of twins but
interestingly one of the twins gained four kilos and one gained eight in one
pair won game six and one game 12 and the whole group of 30 individuals won
Game four kilos and one gained 13 kilos with the same thousand calories so
there’s clearly some genetics there and it’s clearly not entirely genetics so
that this is a I don’t know that’s a scary well no this is as early as in nineteen
thirty german-austrian research had established that obesity is a huge
genetic component and we all know this is you know identical twins don’t just
have the same faces they have the same bodies on obesity runs in families
although there have been arguments over the years that runs in families because
some parents just like to cook too much food and everybody in the family eats
too much food and other parents don’t so you could argue that one way or the
other but it’s always been a well known that this is a huge genetic component a
quick question is the jeans are obviously being triggered by something
in the environment because we know we have populations where there is simply
not a lot of obesity and one of the observation that was made beginning in
the nineteen sixties on is that you have populations that immigrated from what
for instance in the 1930s 1940s obesity was virtually unknown in Africa and yet physicians who work in Africa hospitals
would come to the United States for year and work in an inner say one example was
a South African name George Campbell came to work in philadelphia for a year
and he was stunned when he went to diabetes clinic in south africa where he
had virtually zero case of diabetes in the black African population and then he
gets to Philadelphia and the hospitals are full of diabetic you know african-americans are only 300
years or 200 years removed from Africa so what’s the difference what’s
triggering this obese what you could call the obese and diabetic phenotype in
the environment and the obesity epidemic is another example because the 30 or 40
years of the epidemic has been happening is too short to have been any
significant genetic changes there could have been epigenetic issues are changes
in the in utero that suddenly tip their ways to explain that without evoking a
new factor in the environment but most likely thing is something in the
environment changed and triggers obesity and type 2 diabetes in a greater
proportion of the population I wonder if one way to ask a question
about obesity and is that it’s so easy to get fat and obese and overweight
especially as one moves into middle age perhaps the better question is why are
some people slim yes that is a great question i mean if
you look at what it would take to put on pounds let’s try some simple math here these
numbers don’t actually work if you do this in real life but it’s a
3500 calories is the equivalent of a pound of battle so if you can access the 3500 calories
you would gain a pound there’s 365 days in a year you had 10
extra calories a day for a year that would be a pound x 20 years is 20
pounds that’s all it would take 10 extra calories a day it’s off by at least a factor of 2 I
know you have a chapter that’s 20 calories so let’s use that 20 calories a
day if you can imagine how many Eminem’s
that is it’s only a few Eminem’s and it’s probably one or two chips a day couldn’t I mean couldn’t you just have
that many fewer chips that just seems insane the challenge in all this is most of us
are daily caloric intakes shifts from day to day by hundreds of calories sometimes a thousand calories from one
day to the other I would think that people might find it
hard so to explain that more how does it shift so dramatically you woke up late you skipped breakfast
you ran the work you thought there was going to be something offered there
wasn’t and then the next day after having an enormous breakfast and a
good-sized lunch you walked in there was a surprise party
for you had cake and after your surprise part of your office mate had a surprise
party and you had to have another piece of
cake just to be polite and at the end of the day you’ve eaten a thousand calories
differently than you did the day before so it what’s amazing is that people are
slim there is food everywhere all the time now and how do some people do if
you do the map roughly a million calories a year that
you eat and if you’re in theory off by 3500 one way or the other you gain or lose a pound how do you do
that i mean you’re not even being conscious of this and most of you
maintain a fairly stable wait so you’re right what’s more amazing is that more of us
aren’t overweight given the ubiquitous availability of food let’s use the example used clock with
shards study on so he was a population where they go again they measured their
energy expenditure and then they force them to 2,000 calories more a day and
yet some of them still remained relatively lean and some didn’t there
was a wide variation and how much weight they gained even when they were going
having the two surprise birthday parties a day so the question is in one way you could
ask that question is what’s the difference between the ones who only
gained four pounds i don’t remember then ones who gained 20 pounds kilos on the
same amount access eating now these studies are flawed to begin with because
they assume that the way people get fat is by eating too much so they feed them
too much and that’s not necessarily true but you can see that even under those
circumstances some people have the ability to let’s
say upregulate for at least the length of the study their energy expenditure maybe even feel more physically active
there used to be this concept of the impulse of physical activity so maybe
some of the twins thought I’ve got to go for run you know man it could have been behavior
or could have been psychological someone just thought I’m not gaining all this
weight i don’t care how much they are going for a run even though I feel like
taking a nap like my twin brother uh-huh but they’re all these you know there’s
what you want to know why is it that some of them when force-fed gained only
a little bit of weight because we could assume those are the ones we’re going to
stay lean when they’re not force fed and the others gain so much weight their fat
just gonna inflate to embrace these calories you wrote a piece for The New York Times
Magazine not long ago that i would say was pretty controversial and it’s based
on the u.s. ucsf researcher Robert low sticks work and it charge that sugar is
toxic and I wonder if you could first of all what does it mean the sugar is tossed toxic and what we do
about it i mean what do you do we regulated to we have it is Mayor
Bloomberg a hero of yours who is really setting policy in place to control what
we drink what what do we do knowing the
implications the health implications and that that sugar is such a significant
contributor to obesity ok i’m actually going to start with the
easy question i remembered is not a hero of mine but i do wish she would move to
oakland run from air and then band juice boxes at birthday parties that’s like more than my primary
fantasies in life on it I know it’s yeah oh he ever wanted to show there and go
to a birthday party are they the article actually didn’t
wasn’t based on dr. al agua la rambla Lustig’s work it they did use him as the lead of the
article because Rob loves to give ucsf has really put themselves out there
attacking sugar in the diet and making this argument that sugar is toxic and so
I got to use our Rob to as kind of launch into this argument that’s been
around for arguably maybe a hundred thirty hundred forty years that there’s
something unique about the way we metabolize sugar that’s uniquely
deleterious to our body so the way Rob lusting does describe it like it is it
you know a hundred calories of sugar are metabolized entirely differently than a
hundred calories of the glucose from starch or the fat or protein from some
other food and so something can be isoka Laura it could be the same amount of calories
but have a different be metabolized differently to have a different hormonal
response in your body and create a different hormonal sort of enzymatic
milieu in the body that could be deleterious it could lead to the chronic
diseases we suffer from today and one of the fundamental observations on which my
books are built is that there’s a kind of a cluster of chronic diseases that
are common in western populations eating Western diet containing western
lifestyle she’s our obesity diabetes heart disease cancer neurodegenerative
diseases possibly including Alzheimers and so you see these pop you see these
diseases in westernize populations and at least from the mid to late 19th
century through the Second World War when their world at british colonial on
missionary physicians had spread around the world running hospitals all around
the world you didn’t see these diseases in the isolated populations whether they
were the marathon runner is in the Mexican hills or a pastoralist
like the Maasai that we’re living on the other blood milk and meat from the
cattle they raised or the Inuit or you know any baseline population simply
didn’t seem to have these diseases and then when Western foods became available
or when these populations moved into urban centers and began eating Western
diets you started to see these diseases and when you say Western diets are used
significantly is the major contributing factor there sugar and fructose well and this is the question what is it
about the western lifestyle right so this is not a very controversial idea
although it’s embraced a little more by some than others I embrace it and I
built it you know an effect these books on it so what is it about the western
lifestyle if you don’t like you know if you think we’re all too sedentary and
your marathon runner you blame it on sedentary behavior is one of the
problems that could be the vegetable oils it could be the refined grains and
sugars it could be that we just eat too much it could be that you know you could
again it’s one of these observations that it’s bounded only by your
imagination again the simplest possible hypothesis i would argue and it’s backed
up by what we’ve learned about metabolic syndrome and insulin resistance a lot of
work done by Gerald R even here at Stanford is that it is indeed the sugar
and refined grains that are the problems and so on and then you have these
obesity and diabetes epidemic since we’ve talked about one of the things i
pointed out this is sugar toxic piece in The New York Times Magazine is there was
a diabetes epidemic that followed the civil war in the united states and from
the eighteen seventies through the nineteen twenties on diabetes rates
skyrocketed they went up 10 15 fold in some American cities and in fact i got
the data for a book i’m supposed to be writing on sugar and high-fructose corn
syrup I got the inpatient data from
Pennsylvania Hospital in Philadelphia from date and they had years in the
eighteen seventies when they had zero cases of diabetes which is unimaginable today now a lot of
the increase is due to diagnostic factors life insurance came in suddenly
middle-aged men who are prone to diabetes were getting checked for a test
to measure blood sugar and sugar in the urine came in so that used to be that
the physicians assistant had to taste the urine and so you could imagine there
are a lot of reasons diabetes would be diagnosed but the numbers were so large
that as late as in nineteen twenties and people arguing the leading public health
authority of columbia university was saying like sugar is the culprit it
should be the prime culprit and this argument was made over and over and over
again that we would not have type 2 diabetes if we didn’t have significant
amounts of sugar in the diet so Christopher debrie is sugar toxic
sure yes in the amount that we eat right now
yeah we should cut down and what is toxicity mean and what what he did to me
next to her the half its fructose and the amount
that we eats it go specifically to the liver doesn’t go to the bloodstream to
the liver clears it in excess amounts to get fatty liver disease which mirrors
alcoholism and contributes to this insulin resistance that we’re probably
going to get into a little more as part of this debate and in the
amounts we eat it it still appears to our health almost impossible to separate out if the
sugar board or on the stage with us from calories you’re eating too many it’s not
the sugar it’s the calories okay well I cut back on the sugar well
then you cut back on the calories add something that no no then you’re so you
get stuck in these arguments anytime you change one thing and I you have to
change something else at the same time which is my ear and some of what gary is promoting in terms of shifting
everybody from fat carbs so I agree the low-fat message had unintended
consequences if I can go back to that just four minutes so that I can work my
way back to carbs the bottom of the food pyramid it is bread cereals rice and pasta right
those are the four groups well most Americans just deep breath and
they just eat white bread and the health professionals forever have been
promoting whole grains or a lot of people that means i’m going to switch
from white Wonder Bread the whole wheat flour bread which is not a whole grain
that’s a highly refined grain it’s pulverized into flour gets absorbed
like that as the same glycemic index which is how fast the glucose ends up in
your blood as white bread does the whole grain is wheat berry i’m guessing almost everybody in this
room has had a serving of bread in the last week and I’m guessing a small
proportion of you have had wheat berries wheat berries are the whole grain so if
we were to take the bottom part of the food pyramid and eat whole grains it might be a different story but we’ve
been eating lots and lots of bread or we’ve been taking pasta which could have
been the basis of this massive thing of pasta and a little sauce on top or we
have a big tortilla and a little bit of cheese on top I mean the base of a lot of those meals
it was like holding the meal but too much of it was holding the meal just to remind you remember i talked
about populations that had high levels of obesity and did not have huge
platters and pasta and did not have you know huge tortilla so this whole concept
of eating too much is actually tautological is present you know you eat too much if you’re too
fat right Michael Phelps can eat three times as
much as any of us but he’s not eating too much because he’s perfectly lean so
the question is if you can have obese populations without too much without the
amount of sugar that we today for instance the Pima 1902 would have been
eating about five to 10 pounds of sugar per year per capita maximum actually one
of the our articles i found in my research was a doctor and 17 15 in the
united kingdom an article is called the vindication of
sugar and people have been attacking sugars an oxygen part of the british
diet and 1715 this British doctor takes it upon himself to say sugar is
perfectly healthy is just as healthy as tobacco and alcohol uh-huh but then he says in 1715 when the
per capita consumption of sugar in the UK was probably five to ten pounds per
year or say one twentieth of what we’re eating today or 140th then he says but
it makes young women fat so question is what does too much mean
and if you are getting fat than whatever the amount you’re eating is too much let me ask one question just in on how
many of you doing it you know we asked how many been on a
diet how many of you in here are actually happy with your weight okay and how many of you make a real
effort me this is palo alto and Stanford how many of you make a real effort to
eat healthy ok so how many of you eat that platter
of spaghetti and the huge you know the junk there’s there’s a there’s a
disassociation between how people think they do you think they are eating
healthy and yet they’re overweight and or obese anyway so the question is what’s
happened what what what it has what do you want to get in there
Christopher well yeah i got interrupted i get to go back and finish my story so
sorry the problem was that we vilified fat and
it we tried to simplify the public health
message and it had unintended consequences weight from the bottom of
the pyramid in ways that people didn’t anticipate I think that the signers of the food
pyramid wanted us to eat more leafy greens and acorn squash with that
wonderful onion for color red bell pepper thing and I put on top of it and
instead they ate white Brad so we can shift it now and this would be
a really I think exciting discussion to get in between the two of us because we
agree on some level three different disagree on others about a calories of
calories so if it’s really the carbs and if it’s really the sugar then we should
shift gears get out of the low fat and go to
low-carbon we’ll be all set and the problem with that Gary is I’ve
gotta study going on right now I random I 60 people to go
Louis fat humanly possible lowest card humanly possible six months
later the average weight loss is 20 pounds in both groups in both groups somebody lost 0 and somebody lost 50 and
it’s an absolute continuum in both groups so the issue is if you just say
low carb or low-fat what you’re missing out on is the amazing heterogeneity that’s what this is hard of your
metabolism everyone out there so if we I think insulin resistance and
carbs is a big issue for a proportion of the population and if you in over
simplified and exaggerated too much you’re going to get people mad at us
again that oh they said low fat and now they said low carbon that doesn’t work
either so i’m going to eat whatever I want to give up ok it’s actually in charge because one
of the arguments you I heard since 2002 when i first wrote this very
controversial new york times magazine article is I mean you’re not making this but I
understand the argument is it on we all must agree because otherwise
we’re going to get this and RK and everyone is going to give up the
argument I’m making isn’t that we should all eat high-fat diets isn’t that you know and then the
question is what fundamentally causes obesity and type 2 diabetes we as we said we know that it’s
triggered by the environment so what is it we can figure this is a
scientific issue i mean this is a scientific institution that can be
established and yet everybody responds whatever it is there are people are
going to respond differently but it’s pretty clear that this has been
triggered by something in the environment and what I’m arguing is the
sugar and the refined grains the high glycemic index grains and i would argue
on both your diets the low fat and the very low fat in the very low carb
they’re probably avoiding to hide i see make index carbohydrates and sugars so the question is you know is that why
they’re both groups are getting healthier or is it because something
about maybe dietary fat is bad for someone maybe for some of us maybe this you know there’s arguments that
vegetable oils polyunsaturated fats could be a problem omega-6 fatty acids
could be triggering it but the fundamental issue here is that
it is a something is triggering this problem but how do people dig through
this I mean what if there’s can great
confusion if the science is so poor if you have many different still
variations how does the average person dig through
this and have a sensible diet keep their weight in control what do they do what’s the what’s the path to to sort of
a a healthy lifestyle have to cook more sorry you have to cook more I need to go
out buy food and get back in touch with your food and not get swayed every time the scientists which their
mind and go out and buy the latest greatest food product because they don’t
work so we’ve become so disconnected with our food and it’s such a
complicated problem it’s going to require some policy
because some of these things are beyond our control so we are some of us are
addicted to food and literally can’t stop it was that old lays potato chip
add can eat just one it’s true they know you can t just one
they had test panels and they made it addictive if you read David Kessler’s book and
it’s not your brother is it No ok anyway David caster from the ad a
who identified the addictive properties of nicotine has gone on to write a book
called the end of overeating and he’s gone around the world to see all the
evidence for food addictions which he covers in Chapter after Chapter 1 i
think it’s called fat salt and sugar one is called sugar salt and fat one is
called fat sugar salt chef sugar fat fat sugar salt and his whole point is that
the food industry is relying on us to be confused and manipulating our taste buds
so that we eat more calories ok back to you what about these
populations that I keep mentioning that didn’t have the opportunity to eat more
calories so it didn’t matter how addictive their food may or may not have
been there are total amount was capped by the availability of food in their
environment why were they obese we would have to go
back there’s a lot of complex things if you look at those icarians that eat a
plant-based low-fat diet their whole culture about so many different factors
that would impact this so are our bigger issue is helping
people Americans well it’s becoming global now to lose
weight and i will agree i mean– actually one of the more interesting
publications that’s come out lately is in developing countries there’s a simultaneous rise in
malnutrition and obesity in the same populations so I I do agree that something is there and
part of its the Western diet again but at you can see that combination as early
as 1928 but so and part of this is so what were they eating was there only a
tuber around provided almost all their calories and nothing else which may be
the part where we get into this there’s carbs insulin puts away your car
if you have if you’re continually challenging your system your insulin
level goes higher and higher you become instant resistant it goes higher and
higher and higher and then you’re diabetic and that would parallel some of
this rising obesity and diabetes that you’re talking about so it is one
important factor but i think it’s being overplayed here and the difference to
see I’m a huge believer and Occam’s razor ok which is never simplified never
complicated hypotheses beyond necessity so this is a fundamental tenet of all
science it’s what we need to make progress in one thing that’s happened in
obesity and in what you have to understand the argument I’m making in my
books is that prior to world war two in Europe where all the major clinical
medical research was done actually all of the best science in the world
pre-world war two was done in science in Europe and when i was writing about
physics which i started my career the physicist you say the best thing that
ever happened American science was Hitler because he chased all these
brilliant Europeans with their culture of science to the US and to Israel and
that’s why these universities countries have such great science in specific
fields but pre World War two in Europe obesity was perceived as a hormonal
regulatory disorder not a energy balance this order not an eating too much
disorder not a food addiction disorder but literally a hormonal regulatory
defect on all of that was lost with the war and I document this in my books was
fascinating the lingua franca of science went from being German to English pre
post war and in nutrition and public health we simply stop citing the german
literature and I say imagine what would happen in physics if we decided that
none of the physics done pre-world war two was important to pay attention to Heisenberg because
he was a Nazi with his silly uncertainty principle and and you know any of these
guys with their accents and literally this is what happened in medicine and
public health and nutrition so the post-war understanding of obesity is a
hormonal regulatory defect was replaced pre-war with the simplistic idea of
obesity is gluttony and sloth energy balance and everything went off the
rails from there and so today what we have is this idea
that obesity is a complex multifactorial disorder if you think of it in terms of trying to
understand the solar system if you think that the Sun rotates around the earth
instead of vice versa or you think that the orbits of the planets have to be
perfect circle this is what historians of science philosophers of science would
call epicycles we have to keep complicating everything to make to
somehow understand what we’re seeing but one very simple possibility is that when
we lost this concept of obesity is a hormonal regulatory disorder and
replaced it with obesity is an eating disorder by the nineteen sixties the
major figures in obesity research for psychologists and imagine any other
FISMA imagine if diabetes was treated by psychologists how many dead diabetics we
have and yet this is what we did with obese today and so by today we have all
these ideas it’s a cultural thing is a food addiction thing it’s a you know
there are about complex cultural factors whereas you have somebody’s walking
around with 200 pounds of excess growth on his body in any sane world this would
be perceived as a growth defect like if somebody walked in the store
right now and he was eight feet tall you wouldn’t think about all the complex
things that made him eat that much you if you’re a physician you think that
fellow had a tumor in his pituitary gland and when he’s over secreting
growth hormone and even if he weighs 500 pounds we don’t care we know the cause
it’s a simple hormonal defect but if its twin brother walks in and he’s five foot
ten and weighs 500 pounds we’re going to blame it on eating too
much the addictive nature of food the culture in which he grew up the fact
that he wasn’t on this Greek island and the argument is you know simplest
possible hypotheses it is conceivable that most people argue this amateurs
like myself are wrong usually were quacks who say look the
establishment missed everything and that’s the real difficult thing is
how do you tell you know how do you tell whether I’m a quacker not i mean all
quacks sound reason to hold out detail i’m going to ask Cristen a second yeah
anyway but they did the fundamental argument here is that when we lost the
pre-world War to learning how many obesity are there any obesity
researchers in the audience 12 you guys did the name is carbon or
didn’t mean anything to you Lewis newburgh are you read my book ok there are figures pre-world War two who
are the equivalent of the Heisenberg’s and the boars and the directs and your
major figures in your peace in medicine who have just been their careers have
been forgotten it’s been blamed down like a 50-year period that’s been erased from the medical
public health and what I’m saying is if you bring this back then you end up with
if obesity is a hormonal regulatory defect then it’s the carbohydrate
content to the diet that’s driving it through this hormone insulin it should have been solved in the
nineteen sixties when we worked out the accumulation that insulin regulates the
accumulation of fat and fat cells for all intents and purposes and we have a
simple hypothesis doesn’t mean that every individual will be able to reverse
30 or 40 years of metabolic disturbance by removing the cards from the diet but
it does mean that if we never started eating these foods which are in the
process foods that presses talking about we would never have these obese it this
issue to deal with this epidemic would never have happened it could be right it could be wrong and
it can be tested and one of the things I’m hoping to do is get this tested
through this not-for-profit we found them but it’s a simple argument and it you know there’s very few epidemics in
the history of it modern medicine that are caused by
simple cure your lung cancer cigarettes it’s not cigarettes and
cultural issues its tobacco and so it’s not that out of the question that this
doesn’t have a simple cause Christopher I’m it gives you for this
portion and then we’re going to take questions from the audience the final
work ok so first I want to applaud you in all
your writing you have done this amazing investigative work of all of history and
pulled lots of things together you really have a very rational hypothesis absolutely and it’s compelling and it’s
fascinating that you are revered and vilified for what you’re doing and
you’re vilified by some of the people that you’ve scared that have banked on a
low-fat thing working and your revered by the folks who thought they were wrong let me turn this into something a little
more simple because a lot of your history there’s a lot of complexity to it that
culture that you found these observations in i’m going to give you
the head of news I eighty eight hundred million dollars to run this study ready ok the average person has died is
2500 calories higher for men and women who let’s say average twenty twenty-five
hundred I want it to caloric regiments 1,500
today or 3500 today you should lose weight I think on 1500 you should gain
weight and 3,500 hang on now there’s two . to caloric
levels but there’s two diets one istwentylow fat and
one istwentylow carb okay and they’re both going to be about
twenty percent protein we can argue that the one that’s the higher fat will have
more protein but protein never gets with real food much higher than thirty
percent so keep the protein fairly constant to locale diets one over low
carbon will have had to high fat too high calorie diets same difference now there’s another
level of whose insulin resistant or not but forget that for the moment on the
four diets who gains weight and who loses wake clean that’s a very good question Chris and
thank you for not answering how do we know if I’m a quack or not question earlier no this depends on how you
answer it now let me get that why i asked um and
i’ll tell you that the problem with that . right now and see what we want to test
this hypothesis that obesity is caused by positive energy balance by eating too
much or is it a hormonal regulatory defect that in turn causes positive
energy balance so if I start driving calories into your
face is a drug magical drug that could make you fatter excuse me on and I give you this drug
and you start accumulating fat you’re fat tissue and by the way there any type
2 diabetics and in here okay you probably know what this drug is
because we have one it’s called insulin if you start expanding your fat tissue
because we’ve changed the hormonal milieu in which your fat tissue is
living to it so it’s now accumulates being told to take up fat and it’s doing
it you will then start you will then move
into positive energy balance you’re not taking in more calories you expand and
see the problem with your hypothesis is you are on your your study is you’re
assuming off the get-go that if we make people with a thousand calories more
doesn’t matter what the constant with the the dietary composition is you’re
going to get fatter and if we make me 2,000 calories less doesn’t matter what
the dietary compositions are going to get on they’re going to get leaner but how much
they want to eat is also biologically regulated ok and it’s going to be regulated think
of growing children this is the example that the pre-world
War two Germans and Austrians use when a child is going through a growth spurt
right how many of you have young kids okay they eat voraciously right they lie
around the house all day long ok so growth is a side effect so they
you know it’s not that and this how the Europeans but they said
the kids don’t grow because they are eating voraciously you’re lying around
the house all day long they’re eating voraciously and lying
around the house their gluttony and sloth is a side effect of their drive to
growth and the growth is caused by a hormonal you know they start growth
hormone secretion that’s stimulating insulin-like growth
factor that’s driving them to grow the same thing could be happening with their
fat tissue but their appetite is going to respond and if you have small kid
again this is anecdotal but sometimes the kids are going through a growth
spurt to eat everything you give them and more and then complain that they’re
hungry and sometimes they’re not going through a growth spurt or so it seems
and they’d only half of what you give them and then wander off to watch
spongebob um here’s the experiment i would do this
is the first experience it’s not fair I asked you to tell me what’s going to
happen in my experience and I guess I can go lad and I gave you my question i
don’t think your experiment is physiologically reasonable and we don’t
actually know what will happen well they’re going to get this question
i would argue that on 33 again you can argue that on the 1500 calorie a day
diet huh ok people might lose weight but then
their energy expenditure you know your semi starving people and we know that we
send my star either lean or obese people their energy expenditure will come down oh yeah some people remember the 3500
calories a day mimics the club which our experiment but without the variation on
arm on dietary composition which and the interesting thing is because the
experiment i would like to describe to you if I get a few minutes we’re gonna
go to what we’re going to go to where it is an experiment that i described at the
Pennington Biomedical Research Center that Claude Bouchard runs and clubs
shard told us what he thought would happen in that experiment and i would
like to tell that story if I could on but again so you don’t know the
questions you’re assuming off the get-go I don’t like the experimental design so
it is the co-founder of news you were not going to spend the 800 million i was
giving you the 800 million that was part of the deal were refusing it because we
have a better way to spend okay i’m gonna add a robbery and answers
out of questions from the audience thank you for a great discussion I think I think . I’ve been curious
since we started as a fructose in that drink you know this is pure black coffee
at caps I don’t flip out halfway through we’re gonna go right here to there is a
microphone coming to you hi thank you so much that was great so I
read a couple months ago this study that said once you get to a certain weight
and then you try to come down your body now thinks it’s starving so if you’ve got to that way to begin
with the dieting or cutting down your or increase cutting down you your energy
intake is going to be harder and harder because the heavy you were to begin with
the more of your body thinks it’s starving absolutely true the simple thing you’re
resting energy expenditure goes down it thinks you’re starving it’s trying to
compensate and be more efficient and if you want to lose that way you shouldn’t
be thinking six months you should be thinking three years minimum so how long did it take someone to put
on that way they didn’t put it on and six months it’s not coming off in six
months if it does come off and six months going to come right back on
because your body is going to work against you and make it harder and
harder every extra pound you lose is going to make it that much harder to
lose the next pound so I like a term that somebody’s using we have a term
called set . and you may have reset your set . i can remember who said this but
there’s another one called settling . so you have settled up there and if you
want to resettle at a lower rate it will take a lot of time it’s not simple um and this is again we
have two competing paradigms here so what you just heard is sort of the
conventional wisdom explanation for what happens when people get fatter so the
ideas we don’t really know why you got fatter but once you get that higher way
again if you lose weight your energy expenditures in part the determined by
your body mass your surface area so it goes down and you have to compensate the
argument that we’ve made is that the weight gain is driven by the
carbohydrate content of the dying the problem is most people they lose weight
they go on low-calorie low-fat diets it’s a traditional way of doing it and so when you do that you would affect
starve yourself and I just said if we start leaning individuals they’ll have
the exact same response which is their metabolic expenditure will go down even
before they lose any significant way this was shown back in nineteen
seventeen ok so the question is why is it if
you’re thirty or forty or fifty or a hundred pounds overweight you are an
energy balance if your weights table so what you want to know is why are you
an energy balance at a hundred pounds overweight or 50 pounds overweight
because it doesn’t matter whatever way you are and you could college you’re set
. if you try to send my starve yourself you will lose weight now if you flip
your paradigm that the problem the reason you’re fatter is because of the
carbohydrate content of the diet and its effect on this hormone insulin so instead of putting you on a low-fat
low-calorie diet a low-fat diet keeps the carbs kind of constant ok probably improves the quality of the
carbs we’re going to put you on a very low
carbohydrate diet and you can eat as many calories as you want this is
classically an Atkins diet and one of the reasons the medical community has
such trouble embracing this is because we’ve thought of Atkins is a quack for
so long we don’t like to think otherwise but now
we have a diet that’s arguably triggered just to mobilize fat from your fat
tissue when you lower in some levels to send the text books you mobilize fat
from your fat tissue and you oxidize that fat can you burn it for fuel so that’s the
only thing you wanted you want to get insulin as low as possible now in theory
you can lose weight and your energy expenditure will go up ok the opposite of what Chris decided
then this can be tested and in fact this past summer David lugging and and his
colleagues from the Harvard Medical School published a study in the Journal
of the American Medical Association where they did just this is a semi
starve people overweight will be subject so that they lost i think it was ten
percent of their fat masts and then they measured their
energy expenditure and they randomized them to three diet where they kept they
gave them match their intake exactly to their expenditure so calories than or
equal to calories out what was a low-fat diet was a low glycemic index tire which
is lower in carbohydrates and the carbohydrates in them are less refined
and higher quality and one was a very low fat arguably an Atkins diet matched
energy expended to the intake so if you believe it’s all about calories then you believe that these people’s
weight won’t change in their intake their expenditure won’t change what they
found they only did it they did it for months at a time it’s a very short period but the fewer
the carbohydrates in the diet the greater the energy expand the chart
so in the atkins like diet energy expended to one up three or four hundred
calories despite these people maintaining a weight reduced state so the argument would be if what I’m
arguing is right if this carbohydrate insulin hormonal defect hypothesis is
correct the reason that you see the wood
reduction and energy expenditure on the typical diet when people lose weight is
because it diet is the wrong diet it’s a low Kat a low-calorie low-fat
high-carbohydrate diet if they merely remove the cause of the obesity the
carbohydrates and you wouldn’t see that reduction and expand the chart and it’s
actually one of the things that we are going to be testing with this nutrition
science initiative with the money we have been given because if we can
demonstrate is David Ludwig arguably already did but we’ll do it in a much
more rigorous well controlled manner if we can demonstrate that people can lose
weight the other end energy expenditure goes up
it’s contrary to one of the fundamental tenets of the obesity sort of our
understanding of obesity Christopher let me give you a minute we got another question to respond just
a tree man whose wait while your energy intake goes up not as your energy expenditure of energy
expenditure will well actually I arguably one of the interesting
experiments have always wanted to do is already no no I get to go now all right you you have a lot of answers
let’s go to another question over here what do you think about types of carbs
you mentioned the rice paradox in eastern Asia and also whether the
glycemic index of carbs matters as opposed to the total amount of carbs it’s a great question and i’m working on
a carbohydrate pyramid I know that the pyramids out of fashion now we have my
plate but just because it’s so ingrained in a lot of people’s heads love some feedback here so in my
carbohydrate pyramid the bottom of my carbohydrate . pyramid is legumes and
leafy greens and then after that is some whole fruits and then after that is some
whole grains so really the wheat berries not the bread and some pasta and some
rice especially brown rice and after that is white red and white donuts and
white bagels and after that is fruit juice and sugar and candy and I think
part of the issue is and I think Gary would agree to some extent here if we
locked off the top of that pyramid in our diet you’re getting at the quality
of the carbohydrate and the biggest portion of our diets right now in carbs
is really simple poor quality carbs and in that regard we
would both agree so Gary’s right in this trial that we’re doing right now both groups the low fat and the low-carb
of wiped out all fruit juice all sugar all coat all simple carbs all white
bread all white rice and both groups eat a lot of vegetables and when we do that
on both groups some people lose weight on both diets
and some lose no weight so your answer might be right for her if we figured out
how insulin resistance and whether or not we’re we’re just have seven minutes
left so yeah I’m gonna get some more questions you don’t Chris said I do basically
agree with it but the issue is that you could look at it is there there are several things were looking at
the quality of the carbohydrates in the diet so how quickly they are digested the
quantity of carbs and how quickly the digested so the green vegetables have
actually very few digestible carbohydrates in them and that
carbohydrate is bound up with fiber so it’s very slowly digested as a low
glycemic index then you have the sugar content so how much fructose is in it is another
issue which doesn’t reflect the glycemic index but it is also important and then there could be other issues
like gluten and glycoproteins and breads that are less well-armed art with you
know we just don’t really know about how serious and how widespread that problem
is but the fundamental difference like if every 18 um if we went back in time a hundred
fifty years and we always chris is carbohydrate pyramid we locked off the
top I think we’d be a wonderfully healthy
population actually I wonder what would we die up if i’m blaming heart disease
diabetes cancer and everything on these the top but the pyramid we just lopped
off the problem is we’ve been eating these foods for a long time so now if you’re obese or overweight
type 2 diabetic can you is it enough to lop off the top
of the pyramid and eat at the base of the pyramid or do you have to perhaps
minimize it all in one of the things i come back with single anecdotal
observation the nineteen fifties by a research who arguably should have been
perceived as like the Einstein of obesity and instead it was also
forgotten and he was a doctor and upon 2 is putting obese diabetic obese to Pont
executives on it effectively and all meat diet with some green vegetables and
he said he had one obese dupont executive lost 50 pounds effortlessly
but if you need a single apple a day his weight-loss stopped and I have no
reason to doubt that that was true and so the question is if you’re already if you’re overweight
or obese as we’re talking about two separate issues what causes obesity both
individuals on a population-wide level which is the top of that pyramid and
what you have to do to be as healthy as possible once you become metabolically
disturbed by the top of that pyramid being in your population and your diet
and your mother’s diet and her mother’s diet for a hundred some-odd years and
what you now have to do to be as healthy as possible which are two different
things in the second case the whole pyramid
except for the base the green leafy vegetables could be problematic even the
wonderful wheat berries and looking at we don’t know we do not know what okay we’re going to
take a question over here do studies show or not show a difference in caloric
intake between obese and non-obese people that’s fascinating often not so part of
but part of it is energy expenditure something that Gary was alluding to so
if you’ve changed your diet have you changed it does that caused you
to change your physical activity not physical activity changing your weight
so TV you do you become more sedentary so it’s really complicated attract the
different pieces down so part of it is digesting your food that’s a tiny part
part of it is just what it takes for your heart and lungs to work all day
long and part of it is your physical activity which is the most variable
between people and the hardest to measure we’re all so horrible at measuring how
many calories you eat unless we stick you in these really contrived places
where you can’t leave and there’s a camera on you and we feed all your food
and that’s not really the general population so if you tell us which we’d
is honest and scientific as you are you will mislead us unintentionally and trying to tie the
calories you took into the calories you expended is so crude that it looks like
in many cases the obese are eating the same amount as the lead but there’s
wiggle room for error even if they’re not here’s the point of
fighting suddenly gained 50 pounds for whatever reason so instead of being 259
out 265 pounds I have a larger body to move around i
have more surfacer i am going to expend more energy than i did it – 15 i have
some relatively sedentary right now so it’s hard to imagine that i
will be less sedentary on are more more sedentary but the point is on so i’m going to want
to eat more because my expenditure is greater and so if you look at the curves as best
we can tell us as Christians very hard to measure these things but curves of
intake versus I’m expenditure they overlap between lean and obese people
the interesting thing is the people in the Middle where overlap so you could
have and again there was a study done and not
nineteen thirties where they looked at this how much energy people expend that women
and their women who weighed a hundred seven pounds would spend the same amount
of energy as women away 280 pounds so if their weight stable they would be
taking in the same amount of calories and yet tho be an energy balance at 70
pounds different so one of the arguments that I’ve been
making is that this paying attention to how much people are eating and
exercising is not what you should be doing what we have here is a disorder of
fat accumulation ok people are overweight and obese have
too much fat you should be paying attention who cares how much they
exercise just as a growing child you don’t care how much they exercise you
care that they’re growing because you know so what you want to do with study
the hormone Oh enzymatic regulation central nervous system regulation of
their fat tissue and pay attention to that and if you doing that you’ll solve
the problem if you pay attention to eating and exercise you want I really
want to reframe that for 10 seconds part of my argument for them maybe not eating
so differently as the obese get victimized and that’s not fair some of this is really beyond their
control they are not overeating they are not slothful they are really
frustrated and we are not doing enough to help them and that’s I had a
conversation yesterday with a reporter from both where the tension if you tend
to think like there’s this obese population out there that’s eating at
McDonald’s every day and they should know better but they’re not they’re all
around us there are friends and our relatives in ourselves and they’re doing
they’re trying just as hard as every lean person and probably harder is if
you lean you can usually whatever you want probably harder and the
determination is extraordinary over here one last question coming to you too is warring factions
and I’m wondering if we can come to a common ground that you to share and what
I’m hearing from you and correct me if i’m wrong and summarizing where you
might have common ground one is my favorite phrase eat your fruit
don’t drink it so perhaps the elimination of all juice
and two is decreasing our amount of fluffy white carbohydrates so the other
is pushing I believe in the plane model where only
a quarter of your plate should be carbohydrate half of the plate should be
fruits and vegetables and a quarter of a protein how valid do you feel that is and then I just watched a movie and I’m
a carnivore but i just watched forks and knives and the China Study and that has
just totally flipped me out so I would love to hear your comments oh you really don’t want to get into the
China Study there’s actually a lot of assumptions that that may not be true
and it’s filling in some blanks between the science i would say they are not coming around
did you not rap out a common ground the pyramid that i described which isn’t a
real pyramid i hope you understand that i’m making this pyramid up a
carbohydrate pyramid there’s no meat or dairy or anything
it’s really the carbs here and i would totally agree on the top section and
then as you move to the white bread and the fruit juice sonia set we would keep agreeing and
then we would start to divert so our common ground is the amount of calories
that come from high fructose corn syrup sugar refined carbs breakfast cereals I
mean it’s ubiquitous donuts bagels everywhere and it served all the time marion Nestle favorite line for me is we
eat more places more frequently and larger portions and the simplest things
that stay well our breaths they don’t really go there easy to put
out donuts bagels those things so if we’re eating them more frequently in
more places in our car and that we would agree there are we do but remember i’m
concerned about those populations it didn’t didn’t have the opportunity to
frequently more places and still have high levels of obesity on so yeah we
agree on this carbohydrate pyramid I think a fundamental area making with this plate and I don’t know
what to do but to assume that every you know what we have it i mean you could
imagine i just did a thought experiment on my mind and my seasonal blog entry i
get around the blog about once every three months and I just said let’s
assume we have identical twins and they we put them in our laboratory we measure
their energy expenditure and we find out there each expanding 2,500 calories a
day and then we feed them identical diet accept 300 calories are from sugar and
one diet and the other twin gets 300 calories from glucose from fat and then
because it’s a thought experiment we could keep them in our laboratory for 20
years and run it out and end up are they going to have the exact same
body types are they going to still be identical for 20 years with the only
difference in their diet is at 300 calories of sugar versus from and you
can do the same thing with the population you can imagine we have two
identical populations we have 5,000 identical twins and a half of them live
in one village and the other their siblings live in the other village and
we feed them the exact same diet but 300 calories from sugar and one village and
not the other we’re gonna have the same number of obese and diabetic subjects
and the answer is I don’t think we will okay i think that one change independent
of calories is going to have a significant difference on how they
evolved and how it affects their health and for all I know the sugar people
sugar industry would say that sugar group might be healthier and that’s but
the point is you can’t assume that something like you can turn and say look
here’s this person is a hundred pounds overweight they have been eating exactly
like you have ok exactly the problem is whatever it is something in that died
and made them fat wasn’t cuz i went to mcdonalds any more than you did it
wasn’t that they ate more white bread than you did to diet you can eat keeps
you relatively lean the diet they makes them fat the same food so you can say i
love the MyPlate it should be a quarter carbs it should be this much food this
much vegetable because that could be a perfectly healthy diet for sixty percent
of the population forty percent will keep them fat or make
them fatter and one of our problems with government guidelines as we don’t
differentiate so we say we should all we prove you know and fruit i don’t i don’t
die I think they’re basically chris and i
agree on everything if we were all in population the only thing we disagree on are some
ethical issues about meeting and I haven’t seen force versus nice and maybe
if i watch it like swing but we don’t have a healthy population anymore and so
what the overweight obese diabetic population eat is may not be the same
you know the same thing that a lean person eats and tolerates is likely to
make them fatter keep them that we’re going to wrap up I met and we’re going to lunch
afterwards I might be really watching with these guys thanks everyone the preceding program is copyrighted by
the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu