welcome to the stanford health policyforum i'm dan kessler i'm a professor in the business andlaw schools here at stanford and a member of the advisory council of thestanford health policy forum that's why i'm here today. i'd like to make justa couple of brief opening remarks and then introduce our panelists. first, mostimportant, please turn off your cell phones and pagers put them on silencemode. second, gary's books are for sale out frontalong with some complementary publications from chris gardner who i'llintroduce 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'dlike to just take a moment to thank dean philip pizzo for hisleadership and commitment to our stanford health policy forum. and i'm notjust saying this because i'm a member of the advisory board. i'm saying this is a member of the stanfordcommunity and someone who's really enjoyed coming to these things. we'vecovered a wide array of topics of broad importance to health policy and i thinkit's been a wonderful service to the university and to the community as awhole. so now let me just
move right to introducing our speakerstoday. first is gary taubes. gary is a sciencejournalist, the author and co-founder of the nutritionscience initiative. his two books of which i own multiple copies and suggestyou guys do — why we get fat and what to do about it, and good calories, bad calories. he's alsoa contributing correspondent for science and recipient of a the robert woodjohnson independent investigator award in health policy. he's won numerous awards for hisjournalism including the international
health reporting award, and thenational 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 ofthe nonprofit nutrition science initiative. taubes has argued and willtoday explain to us how our diets overemphasison certain kinds of foods, carbohydrates, has led directly to the obesity epidemicthat we're facing with us also today. with us also today is chris gardner. chris is an associate professor ofmedicine and director of the nutrition studies at the stanford preventionresearch center.
he serves on the nutrition committee ofthe american heart association and the education committee of the obesitysociety. chris is actively involved in research focused on dietary interventiontrials designed to test the effects of food components and food eating patternson chronic disease factors, including body weight lipids and inflammatorymarkers. moderating our discussion today is paul costello. paul is thechief communications officer for the stanford university medical school he leads the medical schoolscommunication and public relations efforts, and will be serving as the asthe 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 manyof 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 twopeople here on stage what did you have for thanksgivingdinner and how what does what you had for thanksgiving dinner tell us about your beliefs about foodand 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 anotherissue, but what does it tell us about food that you chose. [gary] so what wehave is what everyone has when i actually put on my plate yep was mostlythe turkey and some and green beans and brussel sprouts and yeah i had a littledessert, a little bit of sweet potatoes and mywife insisted i tried the mashed potatoes. the stuffing didn't look thatappetizing 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 iobviously believed that they could see
the carbohydrate content for the dietthat's problematic i'm in for reasons i hope to explaintonight and so that the less starch, the less refinedgrains and sugar, the better i feel and the lighter i am. i thinkthis 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 thefamily the family is enormous in this so my father-in-law has a history ofheart disease and his family he's been a vegetarian for years i've been avegetarian for 30 years
we had a little bit of duck for themother in law but the rest of us what i made was jesse tools butternutsquash soup and a vegetable broth with figs and pine nuts and white wine and asplash of maple syrup i also baked up some acorn squash and iput an onion for color red bell pepper mixture on top sauteed and mixed with a little rice andapples and raisins grand i'm going to interrupt for one second if my wife had her way we would beeating at his house next thanksgiving that's a given and part of that that iwant to emphasize is i cook and i think
that's a big issue that we have to dealwith today my father knocked this amazing greenbean dish with pearl onions and they made a fabulous salad that haseverything and the kitchen sink on the salad so it's not just a green leaf lettucesalad it's a work of art you know interesting that that one of the thingsthat i've just heard you both say is you can eat well eat well and and do itwithin a confines of you know not feeling that sure abstaining or notfeeling that your restraining and that you can also have a day or a week or ora moment that you celebrate something
very different than keeping yourself restrain from food is that right is thatbasically the way you approach food well yeah in general but i also think thateverybody is different so you could make the argument for instance that on thisday of thanks we could have all had a few cigarettes and we could have all had a few drinksand that would be true for many of us and not true for some of us who are moreor less tolerant of these and perhaps for whom these foods are more than thesesubstances are more addictive
so i think one of the mistakes we makeis that there's a spectrum of assuming that you again something that we talkedabout that a calorie is not a calorie is not a calorie these foods have differentmetabolic hormonal and cognitive effects then there's a spectrum a maybe abell-shaped curve of how we respond to them and most of us can do exactly whatyou said but some of us might be better off if they don't and those are the kind of questions thathaven't been answered what are the biggest misconceptions and that theamericans particularly americans have about food diet and nutrition todaychristopher
well they think a lot of food likesubstances are food and they're not really if they're packaged processedmanipulation so that would be the biggest food but it what does that meanit so we've taken what was food and wepacked it and brought added value to it so the farmers out there growing stuffand getting six cents on the dollar for it and the middle people took it andadded fat and sugar and coloring and a label on the front of the package thatsays it's got this and it's absolutely fabulous
despite all the other junk that we putin it and you should buy it for the fabulous thing that we put in it so i'llbe my comment on the food like substance the wait i'm not sure people have misconceptionsit we have really interesting studies wherepeople look at different shapes of body you ask them what's normal andculturally it's very different what's a normal body size what'sacceptable and then was less food wait and generate the misconception aboutfood waiting diets and diets indiana so the term diet actually means whateverdieter on weight loss time where you
gain diet habitual diet i think the american public theme thanksdiet is a time of deprivation and a time of change that you will soon go off andthat's the worst part about how many of you agree with that diet is somethingyou do and then you go off of here so educated thank you we always get overeducated people atthese so it's america's misconception but not yours thank you what about you hear what arewhat are the biggest misconceptions about food diet and weight
well i paid more attention to what theresearch community and the public health authorities have been telling us i don'tknow if how many of us agree on to me the greatest misconception out there isthat the reason we get fat is because of this idea that we just take in morecalories and we expend if you read the literature you'll see this phrase allthe time that obesity is an energy balance disorder it is otaythermodynamics or physics issue and arm i think that's just that is kind of theoriginal sin in obesity research and nutrition and so everything we've donesince then that was embraced in the nineteen fifties in the united stateseverything we've done since then has
been misconceived an attractive but it'sbeen based on this idea so when you go on a diet the primary thing you want todo on the diet is eat less or if you're too heavy want to exercise more and eatless and some combination of manipulating your energy and take anoutput in a way that you go into what we call negative energy balance and nowyou're losing weight and by the same token you know this idea that when youget down to the way you like you can now just move into energybalance and stay that way although nobody really understands whatthat means but that also feeds into this idea that we go on diets we lose acertain amount of weight and then we
could go back to eating the way eitherwe used to eat or the way other people around us seem to eat to maintain theirweights and we end up you know going on and off diets our whole lives in partbecause this concept is simply misconceived you you pretty muchattacked the department of agriculture food pyramid would you say that's fair it's one ofthe the institutions like pretty much attack what why what's wrong with the food imean the major issue is you know until the nineteen sixties the
conventional wisdom where thatcarbohydrate-rich foods had some characteristic that we call fat night so bread pasta potatoes grains of anykind for anything from flower sweets had this magical quality of being fatteningand so we avoided them and then in the 1960s we began to embrace the idea thatdietary fat caused heart disease heart disease and obesity are so intimatelyassociated you can't tell people to lower fat need more carbohydrates if carbohydrates are going to befattening so dietary fat had to become fattening as well
and between the sixties and the ninetieswhen the food guide pyramid was instituted we took this concept of thefattening carbohydrate and turned it into the heart healthy carbohydratesdiet food so by the late nineteen eighties all ofi remember when baked potatoes became a diet food my life and suddenly we wereall waiting baked potatoes every night because the idea was it was a sour creamand the butter that was really fattening and the potato was you know not withsomehow a diet food words in the 1960s my mother would believe that a bakedpotato was fat night and all of this would be meaning what wouldn't be aproblem with the food pyramid if it was
correct this transition but again theargument i've been making that then that's taken beyond some of my argumentthat i think that's in my books is that these carbohydrate-rich foods really arefanning that they do have this characteristic of being family and weshould know why that is because of their effect on the hormone that regulates fataccumulation and so what we ended up doing was embracing you know building afood pyramid where we were all supposed to eat fattening foods is this tape overdiet those exact foods that my mother's generation and like no french woman andbrother certain age would ever be seen eating
by the foods were supposed to eat allthe time and then we can begin their heart healthy so if we get off them are doctor tellsus we're going to call it give ourselves a heart attack and we have a seriousproblem in all of this coincides with an obesity and diabetes up to them what about the food pyramid i mean it'sthe department of agriculture us government is that was tested i'm surethey didn't come up with it out of you know thin air what about the if you go into ahistorically it was tested less than you
would believe testing it requires longfollow-up of people and randomization to prove cause and effect and it was a lotof common sense that was built into it and i would suggest a lot of it thatcame into the fat vilification had to do with some earlier trials that tried tolook at diet and decided what you know waiting for somebody to deliver guy getcancer heart disease that's going to blow the whole nih budget i tell you what let's go for somethinglike lowering blood cholesterol which we know from drug trials has been shown tosave lives and saturated fat raises the bad cholesterol and that was a proxy forthis so if you were on a high fat diet
and was high saturated fat you raised your ldl and that should havebeen bad so what was the counter to that it would have been carved you would havelowered your fat and have to replace it with something so you replaced it withcard but it's seriously a case of perhaps good intentions know certainlygood intentions gone awry because of what the food industry did withouthealth message so some of my favorite examples are low-fat organic yogurt i mean what could be more heartwarmingthan 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 howmany of you had raspberry or peach or apricot or raspberry peach apricot asthe raspberry peach apricot has almost no fruit in it it's got some sweetenerbefore the berries that it doesn't even have enough barry to color the yogurt so they add coloring and flavor andsugar and then the berry and you've got a low-fat product but it's yo turn itout going to be bad because it's full of sugar so whathappened is when we push this low-fat thing we made a lot of foods thattechnically were low fat but when they took the fat out the mouth taste is gonethe field was gone and they replaced it
with various forms of sugar highfructose corn syrup being the worst offender not any worse than sugar butcheaper so easier to add and slip into almost everything so i mean foodcompanies are there to make money so they test pant they use test panels tosee what people like oh the fat was gone you don't like it as much how about toput a little more sugar little more sure i got that ok so now we can do the low-fat versionand what we ended up with was a lot of simple carbohydrates that are quicklyabsorbed and have done us in i want to get to sugar and add in alittle bit but i want to go back to
something you've written about in yourbook gary is it we really began this thisobesity surge in the late eighties or in the eighties what happened in the eighties that thiswill be it was it was it portions became larger was at the addition of the sugarinto everything was it additives what happened to you but this is whatactually got me into this research but yeah i started actually around 2001 wheni pitch an article in the new york times which is what caused the obesityepidemic because back then it was new and i had done a year-long investigationfor the journal science on the dietary
fat beliefs and i knew two things hadchanged in the the the nineteen eighties or from nineteen seventy-seven innineteen eighty-four we could localize the beginning of the obesity epidemicbetween two national health you know i examination in hainesnational health and nutrition examination survey days and and so it sometime between the latenineteen seventies and the very early nineteen nineties and in that time . butwe introduce high fructose corn syrup in 1977 and by 1984 did pretty much taken overthe soft drink market and replace sugar
sucrose in coke and pepsi and then weinstituted this low-fat diet is a healthy diet dogma that process wasinstitutionalized beginning in 1977 by a senate committee run by george mcgovernand then by 1984 the national institutes of health that had a consensusconference on declaring that the entire country over the age of two should be ona low-fat diet and time magazine ran this very famous cover which was adinner plate with their breakfast plate with two fridays is the eyes and a pieceof bacon for the frowning mouth and it was cholesterol now the bad news and iwas working at time inc at the time and i remember that cover and how our dietsliterally changed from that day so the
two three prime suspects would be thisintroduction of high fructose corn syrup and then this belief that i said that alow-fat diet where you replace the fat with carbohydrates and simplecarbohydrates is a healthy diet and when we brought in high fructose corn syrupis chris there is some evidence that it's a little bit worse and sugar maybe ten percent worse if we assumethat sugars bad high fructose corn syrup is maybe maybe ten percent worse or fivepercent worse and some evidence may or may not be true on but we get no highfructose corn syrup was sugar and actually the corn refiners i find itvery amusing because the quarter finals
went out of their way to present thatthey would refer to it is fructose to differentiate it from sucrose and thenthey were group would prefer to fructose is a naturally occurring fruit sugar andsucrose is a 50-50 it's a molecule of glucose bonded to a molecule fructoseit's a 50-50 mixture and high fructose corn syrup as we were consuming it in soft drinks and tease is 55 fructose 45glucose so they're effectively identical butwhen you see in the the food availability data is the consumption ofall caloric sweeteners which is about ninety-five percent sucrose and highfructose corn syrup starts turning
upward in the nineteen eighties and mycontention is it just because we didn't know that high fructose corn syrup sugarso that the primary ingredients in whatever we were drinking didn't have tosay sugar and water they could have this sort of naturallyoccurring fruit sugar and sugar consumption then collects weinerconsumption climb steadily to the end of the the century and then it starts toturn over around 1999-2000 and again that pretty much parallels the obesityepidemic it's very hard to make sense of this kind of observational data becausea lot of other things also change yeah chime in so the the data set thathe was referring to this national health
and nutrition examination survey hasbeen done over time and there may be some methodological issues but if youtrack calories over time they were fairly stable and then they jumped innineteen eighty by about two or three hundred calories in men and women andthen they were stable again it and i happen to really like marion nestle'stake on this which doesnt contrast your years at all it just complements it andit has to do is very initial marion nestle is at new york university she's written a book called foodpolitics she's written what we eat she's got a great new bookhave you seen the calorie book
oh i guess you don't like it okay i likea great new border not that i don't like it actually blocksyou step-by-step through uh-huh so to complement what gary saidit's fascinating whoever was head of general electric in1981 and i'm gonna blank and i think it's james welt came up with the idea isthat and jack welsh jack wells came up with the idea of shareholder value andstarted this movement that you can't just have profit from year to year andnot even near to your quarter quarter you need a short show growth and thatwas about the time that people started supersizing things and so that was partof that i think what they were super
super sizing win which fits with yourdiscussion is more sugary packaged processed food so i mean to say don'teat so much sugar won't work if wall street is totally geared up to supersize and show growing profits on a quarterly basis to investors which i ithink it's part of the complexity that underlies this how much of this low-fat mantra thatwe've been consumed with an obsessed with sense the eighties nineties howmuch of that is responsible for obesity today well this is one of the interestingpoints i would like to make on
i you could argue a lot of it you couldsee in the data that we did embrace this these dietary beliefs to some extent soindustry is putting more and more sugar refined grains processed food out therewas simultaneously we are eating healthier the usda is telling us to eat so we're lowering our fat consumptionlittle red meat consumption comes down significantly sugar consumption goes up significantlybut something i point out my books that i think is crucial is that you can findpopulations with high levels of obesity as open as as high as we have in theunited states today that had none of
this toxic food environment in which wekind of want to blame our obesity problem so beginning with the pima indians and ithe native american tribe the pima 1902 a harvard anthropologist comes to visitthe spot this this population on their reservation south of phoenix in 1902 andcomments that all the other women seem to be obese on and they just gonethrough a 20-year period of family which is caillou could think of was like 20years on a very low calorie diet and yet then there's a photo in the book thatwas published in nineteen 6068 fat people woman he calls fat louisa 1928 acouple university of chicago economist
study the sioux on the crow creekreservation in south dakota and they do they describe the unbelievable almostunimaginable both poverty on this reservation and yet they point out thata quarter the women are what they call distinctly fat while they're obviouslychildren who are starving and not getting enough food and this is anobservation that you see on throughout history of in the fifties and thesixties and central on a caribbean island populations in africanpopulations and south pacific islanders arm and what's called the double doubleburden of obesity and malnutrition there was recently a paper published ofwestern sahara refugees and algerian
refugee camps right if i remember thenumbers correctly twenty-five percent of the families hadobese mothers and starving children and they don't have this toxic foodenvironment that we have there something obviously toxic about their environmentthat's the issue but they don't mcdonald's or burger kings or theprocess food we're talking about they had some processed food and so thequestion is why were those populations fat because we can now start ruling out well what do we know why are they fatwell the two things is far as i can tell they all have in common is thensomething is true of virtually all
impoverished populations you live in acarbohydrate rich diet sugar is a primary rice right although you havesoutheast asian who live on carbons diets lot bryce whoare not obese and not diabetic so the grand you could ask a question what'sthe difference between the southeast asian populations and these otherpopulations i've been describing like trinidad and women in the early nineteenstranded at the early nineteen sixties is having a malnutrition crisis the usgovernment sends a team a nutritionist down to help out and they come backsaying look the other people have the other vitamin deficiency diseases areright if you can see all these signs of
malnutrition and yet obesity's in aquote explosive medical problem and the next year at mit nutrition is comes backand reports that the average diet is less than 2,000 calories twenty one percent fat so you can askwhat's the difference between that population in the southeast asians andit sugar in the diet sugar is usually relatively new to the diet is apopulation on we have to sue the native americans who would not have had eitherrefined flour or sugar until the mid 19th century and then arm you know sothat's a kind of getting the prime suspect for what's driving obesity inthese populations
you could have an extremely poorpopulation eating a carbohydrate rich diet with refined grains and sugars andthat's enough to cause obesity even if there's not enough calories toconstitute any degree of gluttony is we would describe you raised the issue ofheredity and i wonder if you could both talk about heredity and genetics what weknow about the different populations which you said in asia they arecarbohydrate-rich rice at an example but relatively thin what we know so far in terms of scienceheredity food and a bay city so you can look at different populationswill never be cause and effect so that a
lot of other differences that go on i mean interestingly to cherry pick somepopulations the new york times just had that the longevity group and the islandof i carry i see they quoted you a little if they ask you what you thought this isa very plant-based diet but they live to a hundred they also sleep till 11 everyday then they work for a while then they take an afternoon nap and then they allget together for a really small dinner and the tarahumara indians survivealmost all on corn and being but their ultra marathoners filled with know aboutthe ultra marathoners so there is some
genetic predisposition you could lookfrom population the population that's why it's valuable to look at pacificislanders 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 ifthat math had worked out regardless of what size you were that excess excessivecaloric intake should have been about eight kilos of added weight by the timeyou're done so among the monozygotic twins there wasa significant correlation there were differences between groups of twins butwithin twins it was smaller than between
different groups of twins butinterestingly one of the twins gained four kilos and one gained eight in onepair won game six and one game 12 and the whole group of 30 individuals wongame four kilos and one gained 13 kilos with the same thousand calories sothere's clearly some genetics there and it's clearly not entirely genetics sothat this is a i don't know that's a scary well no this is as early as in nineteenthirty german-austrian research had established that obesity is a hugegenetic component and we all know this is you know identical twins don't justhave the same faces they have the same
bodies on obesity runs in familiesalthough there have been arguments over the years that runs in families becausesome parents just like to cook too much food and everybody in the family eatstoo much food and other parents don't so you could argue that one way or theother but it's always been a well known that this is a huge genetic component aquick question is the jeans are obviously being triggered by somethingin the environment because we know we have populations where there is simplynot a lot of obesity and one of the observation that was made beginning inthe nineteen sixties on is that you have populations that immigrated from whatfor instance in the 1930s 1940s obesity
was virtually unknown in africa and yet physicians who work in africa hospitalswould come to the united states for year and work in an inner say one example wasa south african name george campbell came to work in philadelphia for a yearand he was stunned when he went to diabetes clinic in south africa where hehad virtually zero case of diabetes in the black african population and then hegets to philadelphia and the hospitals are full of diabetic you know african-americans are only 300years or 200 years removed from africa so what's the difference what'striggering this obese what you could
call the obese and diabetic phenotype inthe environment and the obesity epidemic is another example because the 30 or 40years of the epidemic has been happening is too short to have been anysignificant genetic changes there could have been epigenetic issues are changesin the in utero that suddenly tip their ways to explain that without evoking anew factor in the environment but most likely thing is something in theenvironment changed and triggers obesity and type 2 diabetes in a greaterproportion of the population i wonder if one way to ask a questionabout obesity and is that it's so easy to get fat and obese and overweightespecially as one moves into middle age
perhaps the better question is why aresome people slim yes that is a great question i mean ifyou look at what it would take to put on pounds let's try some simple math here thesenumbers don't actually work if you do this in real life but it's a3500 calories is the equivalent of a pound of battle so if you can access the 3500 caloriesyou would gain a pound there's 365 days in a year you had 10extra calories a day for a year that would be a pound x 20 years is 20pounds that's all it would take 10 extra
calories a day it's off by at least a factor of 2 iknow you have a chapter that's 20 calories so let's use that 20 calories aday if you can imagine how many eminem'sthat 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 havethat many fewer chips that just seems insane the challenge in all this is most of usare daily caloric intakes shifts from day to day by hundreds of calories
sometimes a thousand calories from oneday to the other i would think that people might find ithard so to explain that more how does it shift so dramatically you woke up late you skipped breakfastyou ran the work you thought there was going to be something offered therewasn't and then the next day after having an enormous breakfast and agood-sized lunch you walked in there was a surprise partyfor you had cake and after your surprise part of your office mate had a surpriseparty and you had to have another piece ofcake just to be polite and at the end of
the day you've eaten a thousand caloriesdifferently than you did the day before so it what's amazing is that people areslim there is food everywhere all the time now and how do some people do ifyou do the map roughly a million calories a year thatyou eat and if you're in theory off by 3500 one way or the other you gain or lose a pound how do you dothat i mean you're not even being conscious of this and most of youmaintain a fairly stable wait so you're right what's more amazing is that more of usaren't overweight given the ubiquitous
availability of food let's use the example used clock withshards study on so he was a population where they go again they measured theirenergy expenditure and then they force them to 2,000 calories more a day andyet some of them still remained relatively lean and some didn't therewas a wide variation and how much weight they gained even when they were goinghaving the two surprise birthday parties a day so the question is in one way you couldask that question is what's the difference between the ones who onlygained four pounds i don't remember then
ones who gained 20 pounds kilos on thesame amount access eating now these studies are flawed to begin with becausethey assume that the way people get fat is by eating too much so they feed themtoo much and that's not necessarily true but you can see that even under thosecircumstances some people have the ability to let'ssay upregulate for at least the length of the study their energy expenditure maybe even feel more physically activethere used to be this concept of the impulse of physical activity so maybesome of the twins thought i've got to go for run
you know man it could have been behavioror could have been psychological someone just thought i'm not gaining all thisweight i don't care how much they are going for a run even though i feel liketaking a nap like my twin brother uh-huh but they're all these you know there'swhat you want to know why is it that some of them when force-fed gained onlya little bit of weight because we could assume those are the ones we're going tostay lean when they're not force fed and the others gain so much weight their fatjust gonna inflate to embrace these calories
you wrote a piece for the new york timesmagazine not long ago that i would say was pretty controversial and it's basedon the u.s. ucsf researcher robert low sticks work and it charge that sugar istoxic and i wonder if you could first of all what does it mean the sugar is tossed toxic and what we doabout it i mean what do you do we regulated to we have it is mayorbloomberg a hero of yours who is really setting policy in place to control whatwe drink what what do we do knowing theimplications the health implications and that that sugar is such a significantcontributor to obesity
ok i'm actually going to start with theeasy question i remembered is not a hero of mine but i do wish she would move tooakland run from air and then band juice boxes at birthday parties that's like more than my primaryfantasies in life on it i know it's yeah oh he ever wanted to show there and goto a birthday party are they the article actually didn'twasn't based on dr. al agua la rambla lustig's work it they did use him as the lead of thearticle because rob loves to give ucsf
has really put themselves out thereattacking sugar in the diet and making this argument that sugar is toxic and soi got to use our rob to as kind of launch into this argument that's beenaround for arguably maybe a hundred thirty hundred forty years that there'ssomething unique about the way we metabolize sugar that's uniquelydeleterious to our body so the way rob lusting does describe it like it is ityou know a hundred calories of sugar are metabolized entirely differently than ahundred calories of the glucose from starch or the fat or protein from someother food and so something can be isoka laura
it could be the same amount of caloriesbut have a different be metabolized differently to have a different hormonalresponse in your body and create a different hormonal sort of enzymaticmilieu in the body that could be deleterious it could lead to the chronicdiseases we suffer from today and one of the fundamental observations on which mybooks are built is that there's a kind of a cluster of chronic diseases thatare common in western populations eating western diet containing westernlifestyle she's our obesity diabetes heart disease cancer neurodegenerativediseases possibly including alzheimers and so you see these pop you see thesediseases in westernize populations and
at least from the mid to late 19thcentury through the second world war when their world at british colonial onmissionary physicians had spread around the world running hospitals all aroundthe world you didn't see these diseases in the isolated populations whether theywere the marathon runner is in the mexican hills or a pastoralistlike the maasai that we're living on the other blood milk and meat from thecattle they raised or the inuit or you know any baseline population simplydidn't seem to have these diseases and then when western foods became availableor when these populations moved into urban centers and began eating westerndiets you started to see these diseases
and when you say western diets are usedsignificantly is the major contributing factor there sugar and fructose well and this is the question what is itabout the western lifestyle right so this is not a very controversial ideaalthough it's embraced a little more by some than others i embrace it and ibuilt it you know an effect these books on it so what is it about the westernlifestyle if you don't like you know if you think we're all too sedentary andyour marathon runner you blame it on sedentary behavior is one of theproblems that could be the vegetable
oils it could be the refined grains andsugars it could be that we just eat too much it could be that you know you couldagain it's one of these observations that it's bounded only by yourimagination again the simplest possible hypothesis i would argue and it's backedup by what we've learned about metabolic syndrome and insulin resistance a lot ofwork done by gerald r even here at stanford is that it is indeed the sugarand refined grains that are the problems and so on and then you have theseobesity and diabetes epidemic since we've talked about one of the things ipointed out this is sugar toxic piece in
the new york times magazine is there wasa diabetes epidemic that followed the civil war in the united states and fromthe eighteen seventies through the nineteen twenties on diabetes ratesskyrocketed they went up 10 15 fold in some american cities and in fact i gotthe data for a book i'm supposed to be writing on sugar and high-fructose cornsyrup i got the inpatient data frompennsylvania hospital in philadelphia from date and they had years in theeighteen seventies when they had zero cases of diabetes which is unimaginable today now a lot ofthe increase is due to diagnostic
factors life insurance came in suddenlymiddle-aged men who are prone to diabetes were getting checked for a testto measure blood sugar and sugar in the urine came in so that used to be thatthe physicians assistant had to taste the urine and so you could imagine thereare a lot of reasons diabetes would be diagnosed but the numbers were so largethat as late as in nineteen twenties and people arguing the leading public healthauthority of columbia university was saying like sugar is the culprit itshould be the prime culprit and this argument was made over and over and overagain that we would not have type 2 diabetes if we didn't have significantamounts of sugar in the diet
so christopher debrie is sugar toxicsure yes in the amount that we eat right nowyeah we should cut down and what is toxicity mean and what what he did to menext to her the half its fructose and the amountthat we eats it go specifically to the liver doesn't go to the bloodstream tothe liver clears it in excess amounts to get fatty liver disease which mirrorsalcoholism and contributes to this insulin resistance that we're probablygoing to get into a little more as part of this debate and in theamounts we eat it it still appears to our health
almost impossible to separate out if thesugar board or on the stage with us from calories you're eating too many it's notthe sugar it's the calories okay well i cut back on the sugar wellthen you cut back on the calories add something that no no then you're so youget stuck in these arguments anytime you change one thing and i you have tochange something else at the same time which is my ear and some of what gary is promoting in terms of shiftingeverybody from fat carbs so i agree the low-fat message had unintendedconsequences if i can go back to that just four minutes so that i can work myway back to carbs the bottom of the food
pyramid it is bread cereals rice and pasta rightthose are the four groups well most americans just deep breath andthey just eat white bread and the health professionals forever have beenpromoting whole grains or a lot of people that means i'm going to switchfrom white wonder bread the whole wheat flour bread which is not a whole grainthat's a highly refined grain it's pulverized into flour gets absorbedlike that as the same glycemic index which is how fast the glucose ends up inyour blood as white bread does the whole grain is wheat berry
i'm guessing almost everybody in thisroom has had a serving of bread in the last week and i'm guessing a smallproportion of you have had wheat berries wheat berries are the whole grain so ifwe were to take the bottom part of the food pyramid and eat whole grains it might be a different story but we'vebeen eating lots and lots of bread or we've been taking pasta which could havebeen the basis of this massive thing of pasta and a little sauce on top or wehave a big tortilla and a little bit of cheese on top i mean the base of a lot of those mealsit was like holding the meal but too
much of it was holding the meal just to remind you remember i talkedabout populations that had high levels of obesity and did not have hugeplatters and pasta and did not have you know huge tortilla so this whole conceptof eating too much is actually tautological is present you know you eat too much if you're toofat right michael phelps can eat three times asmuch as any of us but he's not eating too much because he's perfectly lean sothe question is if you can have obese populations without too much without theamount of sugar that we today for
instance the pima 1902 would have beeneating about five to 10 pounds of sugar per year per capita maximum actually oneof the our articles i found in my research was a doctor and 17 15 in theunited kingdom an article is called the vindication ofsugar and people have been attacking sugars an oxygen part of the britishdiet and 1715 this british doctor takes it upon himself to say sugar isperfectly healthy is just as healthy as tobacco and alcohol uh-huh but then he says in 1715 when theper capita consumption of sugar in the uk was probably five to ten pounds peryear or say one twentieth of what we're
eating today or 140th then he says butit makes young women fat so question is what does too much meanand if you are getting fat than whatever the amount you're eating is too much let me ask one question just in on howmany of you doing it you know we asked how many been on adiet how many of you in here are actually happy with your weight okay and how many of you make a realeffort me this is palo alto and stanford how many of you make a real effort toeat healthy ok so how many of you eat that platterof spaghetti and the huge you know the
junk there's there's a there's adisassociation between how people think they do you think they are eatinghealthy and yet they're overweight and or obese anyway so the question is what'shappened what what what it has what do you want to get in therechristopher well yeah i got interrupted i get to go back and finish my story sosorry the problem was that we vilified fat andit we tried to simplify the public healthmessage and it had unintended
consequences weight from the bottom ofthe pyramid in ways that people didn't anticipate i think that the signers of the foodpyramid wanted us to eat more leafy greens and acorn squash with thatwonderful onion for color red bell pepper thing and i put on top of it andinstead they ate white brad so we can shift it now and this would bea really i think exciting discussion to get in between the two of us because weagree on some level three different disagree on others about a calories ofcalories so if it's really the carbs and if it's really the sugar then we shouldshift gears
get out of the low fat and go tolow-carbon we'll be all set and the problem with that gary is i'vegotta study going on right now i random i 60 people to golouis fat humanly possible lowest card humanly possible six monthslater the average weight loss is 20 pounds in both groups in both groups somebody lost 0 and somebody lost 50 andit's an absolute continuum in both groups so the issue is if you just saylow carb or low-fat what you're missing out on is the amazing heterogeneity that's what this is hard of yourmetabolism everyone out there
so if we i think insulin resistance andcarbs is a big issue for a proportion of the population and if you in oversimplified and exaggerated too much you're going to get people mad at usagain that oh they said low fat and now they said low carbon that doesn't workeither so i'm going to eat whatever i want to give up ok it's actually in charge because oneof the arguments you i heard since 2002 when i first wrote this verycontroversial new york times magazine article is i mean you're not making this but iunderstand the argument is it on
we all must agree because otherwisewe're going to get this and rk and everyone is going to give up theargument i'm making isn't that we should all eat high-fat diets isn't that you know and then thequestion is what fundamentally causes obesity and type 2 diabetes we as we said we know that it'striggered by the environment so what is it we can figure this is ascientific issue i mean this is a scientific institution that can beestablished and yet everybody responds whatever it is there are people aregoing to respond differently but it's
pretty clear that this has beentriggered by something in the environment and what i'm arguing is thesugar and the refined grains the high glycemic index grains and i would argueon both your diets the low fat and the very low fat in the very low carbthey're probably avoiding to hide i see make index carbohydrates and sugars so the question is you know is that whythey're both groups are getting healthier or is it because somethingabout maybe dietary fat is bad for someone maybe for some of us maybe this you know there's arguments thatvegetable oils polyunsaturated fats
could be a problem omega-6 fatty acidscould be triggering it but the fundamental issue here is thatit is a something is triggering this problem but how do people dig throughthis i mean what if there's can greatconfusion if the science is so poor if you have many different stillvariations how does the average person dig throughthis and have a sensible diet keep their weight in control what do they do what's the what's the path to to sort ofa a healthy lifestyle have to cook more sorry you have to cook more i need to goout buy food and get back in touch with
your food and not get swayed every time the scientists which theirmind and go out and buy the latest greatest food product because they don'twork so we've become so disconnected with our food and it's such acomplicated problem it's going to require some policybecause some of these things are beyond our control so we are some of us areaddicted to food and literally can't stop it was that old lays potato chipadd can eat just one it's true they know you can t just onethey had test panels and they made it addictive
if you read david kessler's book andit's not your brother is it no ok anyway david caster from the ad awho identified the addictive properties of nicotine has gone on to write a bookcalled the end of overeating and he's gone around the world to see all theevidence for food addictions which he covers in chapter after chapter 1 ithink it's called fat salt and sugar one is called sugar salt and fat one iscalled fat sugar salt chef sugar fat fat sugar salt and his whole point is thatthe food industry is relying on us to be confused and manipulating our taste budsso that we eat more calories ok back to you what about thesepopulations that i keep mentioning that
didn't have the opportunity to eat morecalories so it didn't matter how addictive their food may or may not havebeen there are total amount was capped by the availability of food in theirenvironment why were they obese we would have to goback there's a lot of complex things if you look at those icarians that eat aplant-based low-fat diet their whole culture about so many different factorsthat would impact this so are our bigger issue is helpingpeople americans well it's becoming global now to loseweight and i will agree i mean-- actually one of the more interestingpublications that's come out lately is
in developing countries there's a simultaneous rise inmalnutrition and obesity in the same populations so i i do agree that something is there andpart of its the western diet again but at you can see that combination as earlyas 1928 but so and part of this is so what were they eating was there only atuber around provided almost all their calories and nothing else which may bethe part where we get into this there's carbs insulin puts away your carif you have if you're continually challenging your system your insulinlevel goes higher and higher you become
instant resistant it goes higher andhigher and higher and then you're diabetic and that would parallel some ofthis rising obesity and diabetes that you're talking about so it is oneimportant factor but i think it's being overplayed here and the difference tosee i'm a huge believer and occam's razor ok which is never simplified nevercomplicated hypotheses beyond necessity so this is a fundamental tenet of allscience it's what we need to make progress in one thing that's happened inobesity and in what you have to understand the argument i'm making in mybooks is that prior to world war two in
europe where all the major clinicalmedical research was done actually all of the best science in the worldpre-world war two was done in science in europe and when i was writing aboutphysics which i started my career the physicist you say the best thing thatever happened american science was hitler because he chased all thesebrilliant europeans with their culture of science to the us and to israel andthat's why these universities countries have such great science in specificfields but pre world war two in europe obesity was perceived as a hormonalregulatory disorder not a energy balance this order not an eating too muchdisorder not a food addiction disorder
but literally a hormonal regulatorydefect on all of that was lost with the war and i document this in my books wasfascinating the lingua franca of science went from being german to english prepost war and in nutrition and public health we simply stop citing the germanliterature and i say imagine what would happen in physics if we decided thatnone of the physics done pre-world war two was important to pay attention to heisenberg becausehe was a nazi with his silly uncertainty principle and and you know any of theseguys with their accents and literally this is what happened in medicine andpublic health and nutrition so the
post-war understanding of obesity is ahormonal regulatory defect was replaced pre-war with the simplistic idea ofobesity is gluttony and sloth energy balance and everything went off therails from there and so today what we have is this ideathat obesity is a complex multifactorial disorder if you think of it in terms of trying tounderstand the solar system if you think that the sun rotates around the earthinstead of vice versa or you think that the orbits of the planets have to beperfect circle this is what historians of science philosophers of science wouldcall epicycles we have to keep
complicating everything to make tosomehow understand what we're seeing but one very simple possibility is that whenwe lost this concept of obesity is a hormonal regulatory disorder andreplaced it with obesity is an eating disorder by the nineteen sixties themajor figures in obesity research for psychologists and imagine any otherfisma imagine if diabetes was treated by psychologists how many dead diabetics wehave and yet this is what we did with obese today and so by today we have allthese ideas it's a cultural thing is a food addiction thing it's a you knowthere are about complex cultural factors whereas you have somebody's walkingaround with 200 pounds of excess growth
on his body in any sane world this wouldbe perceived as a growth defect like if somebody walked in the storeright now and he was eight feet tall you wouldn't think about all the complexthings that made him eat that much you if you're a physician you think thatfellow had a tumor in his pituitary gland and when he's over secretinggrowth hormone and even if he weighs 500 pounds we don't care we know the causeit's a simple hormonal defect but if its twin brother walks in and he's five footten and weighs 500 pounds we're going to blame it on eating toomuch the addictive nature of food the culture in which he grew up the factthat he wasn't on this greek island
and the argument is you know simplestpossible hypotheses it is conceivable that most people argue this amateurslike myself are wrong usually were quacks who say look theestablishment missed everything and that's the real difficult thing ishow do you tell you know how do you tell whether i'm a quacker not i mean allquacks sound reason to hold out detail i'm going to ask cristen a second yeahanyway but they did the fundamental argument here is that when we lost thepre-world war to learning how many obesity are there any obesityresearchers in the audience 12 you guys did the name is carbon ordidn't mean anything to you
lewis newburgh are you read my book ok there are figures pre-world war two whoare the equivalent of the heisenberg's and the boars and the directs and yourmajor figures in your peace in medicine who have just been their careers havebeen forgotten it's been blamed down like a 50-year period that's been erased from the medicalpublic health and what i'm saying is if you bring this back then you end up withif obesity is a hormonal regulatory defect then it's the carbohydratecontent to the diet that's driving it through this hormone insulin
it should have been solved in thenineteen sixties when we worked out the accumulation that insulin regulates theaccumulation of fat and fat cells for all intents and purposes and we have asimple hypothesis doesn't mean that every individual will be able to reverse30 or 40 years of metabolic disturbance by removing the cards from the diet butit does mean that if we never started eating these foods which are in theprocess foods that presses talking about we would never have these obese it thisissue to deal with this epidemic would never have happened it could be right it could be wrong andit can be tested and one of the things
i'm hoping to do is get this testedthrough this not-for-profit we found them but it's a simple argument and it you know there's very few epidemics inthe history of it modern medicine that are caused bysimple cure your lung cancer cigarettes it's not cigarettes andcultural issues its tobacco and so it's not that out of the question that thisdoesn't have a simple cause christopher i'm it gives you for thisportion and then we're going to take questions from the audience the finalwork ok so first i want to applaud you in allyour writing you have done this amazing
investigative work of all of history andpulled lots of things together you really have a very rational hypothesis absolutely and it's compelling and it'sfascinating that you are revered and vilified for what you're doing andyou're vilified by some of the people that you've scared that have banked on alow-fat thing working and your revered by the folks who thought they were wrong let me turn this into something a littlemore simple because a lot of your history there's a lot of complexity to it thatculture that you found these
observations in i'm going to give youthe head of news i eighty eight hundred million dollars to run this study ready ok the average person has died is2500 calories higher for men and women who let's say average twenty twenty-fivehundred i want it to caloric regiments 1,500today or 3500 today you should lose weight i think on 1500 you should gainweight and 3,500 hang on now there's two . to caloriclevels but there's two diets one is
okay and they're both going to be abouttwenty percent protein we can argue that the one that's the higher fat will havemore protein but protein never gets with real food much higher than thirtypercent so keep the protein fairly constant to locale diets one over lowcarbon will have had to high fat too high calorie diets same difference now there's anotherlevel of whose insulin resistant or not but forget that for the moment on thefour diets who gains weight and who loses wake clean that's a very good question chris andthank you for not answering how do we
know if i'm a quack or not question earlier no this depends on how youanswer it now let me get that why i asked um andi'll tell you that the problem with that . right now and see what we want to testthis hypothesis that obesity is caused by positive energy balance by eating toomuch or is it a hormonal regulatory defect that in turn causes positiveenergy balance so if i start driving calories into yourface is a drug magical drug that could make you fatter
excuse me on and i give you this drugand you start accumulating fat you're fat tissue and by the way there any type2 diabetics and in here okay you probably know what this drug isbecause we have one it's called insulin if you start expanding your fat tissuebecause we've changed the hormonal milieu in which your fat tissue isliving to it so it's now accumulates being told to take up fat and it's doingit you will then start you will then moveinto positive energy balance you're not taking in more calories you expand andsee the problem with your hypothesis is you are on your your study is you'reassuming off the get-go that if we make
people with a thousand calories moredoesn't matter what the constant with the the dietary composition is you'regoing to get fatter and if we make me 2,000 calories less doesn't matter whatthe dietary compositions are going to get on they're going to get leaner but how muchthey want to eat is also biologically regulated ok and it's going to be regulated thinkof growing children this is the example that the pre-worldwar two germans and austrians use when a child is going through a growth spurtright how many of you have young kids
okay they eat voraciously right they liearound the house all day long ok so growth is a side effect so theyyou know it's not that and this how the europeans but they saidthe kids don't grow because they are eating voraciously you're lying aroundthe house all day long they're eating voraciously and lyingaround the house their gluttony and sloth is a side effect of their drive togrowth and the growth is caused by a hormonal you know they start growthhormone secretion that's stimulating insulin-like growthfactor that's driving them to grow the same thing could be happening with theirfat tissue but their appetite is going
to respond and if you have small kidagain this is anecdotal but sometimes the kids are going through a growthspurt to eat everything you give them and more and then complain that they'rehungry and sometimes they're not going through a growth spurt or so it seemsand they'd only half of what you give them and then wander off to watchspongebob um here's the experiment i would do thisis the first experience it's not fair i asked you to tell me what's going tohappen in my experience and i guess i can go lad and i gave you my question idon't think your experiment is physiologically reasonable and we don'tactually know what will happen
well they're going to get this questioni would argue that on 33 again you can argue that on the 1500 calorie a daydiet huh ok people might lose weight but thentheir energy expenditure you know your semi starving people and we know that wesend my star either lean or obese people their energy expenditure will come down oh yeah some people remember the 3500calories a day mimics the club which our experiment but without the variation onarm on dietary composition which and the interesting thing is because theexperiment i would like to describe to you if i get a few minutes we're gonnago to what we're going to go to where it
is an experiment that i described at thepennington biomedical research center that claude bouchard runs and clubsshard told us what he thought would happen in that experiment and i wouldlike to tell that story if i could on but again so you don't know thequestions you're assuming off the get-go i don't like the experimental design soit is the co-founder of news you were not going to spend the 800 million i wasgiving you the 800 million that was part of the deal were refusing it because wehave a better way to spend okay i'm gonna add a robbery and answersout of questions from the audience thank you for a great discussion
i think i think . i've been curioussince we started as a fructose in that drink you know this is pure black coffeeat caps i don't flip out halfway through we're gonna go right here to there is amicrophone coming to you hi thank you so much that was great so iread a couple months ago this study that said once you get to a certain weightand then you try to come down your body now thinks it's starving so if you've got to that way to beginwith the dieting or cutting down your or increase cutting down you your energyintake is going to be harder and harder because the heavy you were to begin withthe more of your body thinks it's
starving absolutely true the simple thing you'reresting energy expenditure goes down it thinks you're starving it's trying tocompensate and be more efficient and if you want to lose that way you shouldn'tbe thinking six months you should be thinking three years minimum so how long did it take someone to puton that way they didn't put it on and six months it's not coming off in sixmonths if it does come off and six months going to come right back onbecause your body is going to work against you and make it harder andharder every extra pound you lose is
going to make it that much harder tolose the next pound so i like a term that somebody's using we have a termcalled set . and you may have reset your set . i can remember who said this butthere's another one called settling . so you have settled up there and if youwant to resettle at a lower rate it will take a lot of time it's not simple um and this is again wehave two competing paradigms here so what you just heard is sort of theconventional wisdom explanation for what happens when people get fatter so theideas we don't really know why you got fatter but once you get that higher wayagain if you lose weight your energy
expenditures in part the determined byyour body mass your surface area so it goes down and you have to compensate theargument that we've made is that the weight gain is driven by thecarbohydrate content of the dying the problem is most people they lose weightthey go on low-calorie low-fat diets it's a traditional way of doing it and so when you do that you would affectstarve yourself and i just said if we start leaning individuals they'll havethe exact same response which is their metabolic expenditure will go down evenbefore they lose any significant way this was shown back in nineteenseventeen
ok so the question is why is it ifyou're thirty or forty or fifty or a hundred pounds overweight you are anenergy balance if your weights table so what you want to know is why are youan energy balance at a hundred pounds overweight or 50 pounds overweightbecause 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 flipyour paradigm that the problem the reason you're fatter is because of thecarbohydrate content of the diet and its effect on this hormone insulin so instead of putting you on a low-fatlow-calorie diet a low-fat diet keeps
the carbs kind of constant ok probably improves the quality of thecarbs we're going to put you on a very lowcarbohydrate diet and you can eat as many calories as you want this isclassically an atkins diet and one of the reasons the medical community hassuch trouble embracing this is because we've thought of atkins is a quack forso long we don't like to think otherwise but nowwe have a diet that's arguably triggered just to mobilize fat from your fattissue when you lower in some levels to send the text books you mobilize fatfrom your fat tissue and you oxidize
that fat can you burn it for fuel so that's theonly thing you wanted you want to get insulin as low as possible now in theoryyou can lose weight and your energy expenditure will go up ok the opposite of what chris decidedthen this can be tested and in fact this past summer david lugging and and hiscolleagues from the harvard medical school published a study in the journalof the american medical association where they did just this is a semistarve people overweight will be subject so that they lost i think it was tenpercent of their fat
masts and then they measured theirenergy expenditure and they randomized them to three diet where they kept theygave them match their intake exactly to their expenditure so calories than orequal to calories out what was a low-fat diet was a low glycemic index tire whichis lower in carbohydrates and the carbohydrates in them are less refinedand higher quality and one was a very low fat arguably an atkins diet matchedenergy expended to the intake so if you believe it's all about calories then you believe that these people'sweight won't change in their intake their expenditure won't change what theyfound they only did it they did it for
months at a time it's a very short period but the fewerthe carbohydrates in the diet the greater the energy expand the chartso in the atkins like diet energy expended to one up three or four hundredcalories despite these people maintaining a weight reduced state so the argument would be if what i'marguing is right if this carbohydrate insulin hormonal defect hypothesis iscorrect the reason that you see the woodreduction and energy expenditure on the typical diet when people lose weight isbecause it diet is the wrong diet
it's a low kat a low-calorie low-fathigh-carbohydrate diet if they merely remove the cause of the obesity thecarbohydrates and you wouldn't see that reduction and expand the chart and it'sactually one of the things that we are going to be testing with this nutritionscience initiative with the money we have been given because if we candemonstrate is david ludwig arguably already did but we'll do it in a muchmore rigorous well controlled manner if we can demonstrate that people can loseweight the other end energy expenditure goes upit's contrary to one of the fundamental tenets of the obesity sort of ourunderstanding of obesity christopher let
me give you a minute we got another question to respond justa tree man whose wait while your energy intake goes up not as your energy expenditure of energyexpenditure will well actually i arguably one of the interestingexperiments have always wanted to do is already no no i get to go now all right you you have a lot of answerslet's go to another question over here what do you think about types of carbsyou mentioned the rice paradox in eastern asia and also whether theglycemic index of carbs matters as
opposed to the total amount of carbs it's a great question and i'm working ona carbohydrate pyramid i know that the pyramids out of fashion now we have myplate but just because it's so ingrained in a lot of people's heads love some feedback here so in mycarbohydrate pyramid the bottom of my carbohydrate . pyramid is legumes andleafy greens and then after that is some whole fruits and then after that is somewhole grains so really the wheat berries not the bread and some pasta and somerice especially brown rice and after that is white red and white donuts andwhite bagels and after that is fruit
juice and sugar and candy and i thinkpart of the issue is and i think gary would agree to some extent here if welocked off the top of that pyramid in our diet you're getting at the qualityof the carbohydrate and the biggest portion of our diets right now in carbsis really simple poor quality carbs and in that regard wewould both agree so gary's right in this trial that we're doing right now both groups the low fat and the low-carbof wiped out all fruit juice all sugar all coat all simple carbs all whitebread all white rice and both groups eat a lot of vegetables and when we do thaton both groups
some people lose weight on both dietsand some lose no weight so your answer might be right for her if we figured outhow insulin resistance and whether or not we're we're just have seven minutesleft so yeah i'm gonna get some more questions you don't chris said i do basicallyagree with it but the issue is that you could look at it is there there are several things were looking atthe quality of the carbohydrates in the diet so how quickly they are digested thequantity of carbs and how quickly the
digested so the green vegetables haveactually very few digestible carbohydrates in them and thatcarbohydrate is bound up with fiber so it's very slowly digested as a lowglycemic index then you have the sugar content so how much fructose is in it is anotherissue which doesn't reflect the glycemic index but it is also important and then there could be other issueslike gluten and glycoproteins and breads that are less well-armed art with youknow we just don't really know about how serious and how widespread that problemis but the fundamental difference like
if every 18 um if we went back in time a hundredfifty years and we always chris is carbohydrate pyramid we locked off thetop i think we'd be a wonderfully healthypopulation actually i wonder what would we die up if i'm blaming heart diseasediabetes cancer and everything on these the top but the pyramid we just loppedoff the problem is we've been eating these foods for a long time so now if you're obese or overweighttype 2 diabetic can you is it enough to lop off the topof the pyramid and eat at the base of
the pyramid or do you have to perhapsminimize it all in one of the things i come back with single anecdotalobservation the nineteen fifties by a research who arguably should have beenperceived as like the einstein of obesity and instead it was alsoforgotten and he was a doctor and upon 2 is putting obese diabetic obese to pontexecutives on it effectively and all meat diet with some green vegetables andhe said he had one obese dupont executive lost 50 pounds effortlesslybut if you need a single apple a day his weight-loss stopped and i have noreason to doubt that that was true and so the question is
if you're already if you're overweightor obese as we're talking about two separate issues what causes obesity bothindividuals on a population-wide level which is the top of that pyramid andwhat you have to do to be as healthy as possible once you become metabolicallydisturbed by the top of that pyramid being in your population and your dietand your mother's diet and her mother's diet for a hundred some-odd years andwhat you now have to do to be as healthy as possible which are two differentthings in the second case the whole pyramidexcept for the base the green leafy vegetables could be problematic even thewonderful wheat berries and looking at
we don't know we do not know what okay we're going totake a question over here do studies show or not show a difference in caloricintake between obese and non-obese people that's fascinating often not so part ofbut part of it is energy expenditure something that gary was alluding to soif you've changed your diet have you changed it does that caused youto change your physical activity not physical activity changing your weightso tv you do you become more sedentary so it's really complicated attract thedifferent pieces down so part of it is
digesting your food that's a tiny partpart of it is just what it takes for your heart and lungs to work all daylong and part of it is your physical activity which is the most variablebetween people and the hardest to measure we're all so horrible at measuring howmany calories you eat unless we stick you in these really contrived placeswhere you can't leave and there's a camera on you and we feed all your foodand that's not really the general population so if you tell us which we'dis honest and scientific as you are you will mislead us
unintentionally and trying to tie thecalories you took into the calories you expended is so crude that it looks likein many cases the obese are eating the same amount as the lead but there'swiggle room for error even if they're not here's the point offighting suddenly gained 50 pounds for whatever reason so instead of being 259out 265 pounds i have a larger body to move around ihave more surfacer i am going to expend more energy than i did it - 15 i havesome relatively sedentary right now so it's hard to imagine that iwill be less sedentary on are more more sedentary
but the point is on so i'm going to wantto eat more because my expenditure is greater and so if you look at the curves as bestwe can tell us as christians very hard to measure these things but curves ofintake versus i'm expenditure they overlap between lean and obese peoplethe interesting thing is the people in the middle where overlap so you couldhave and again there was a study done and notnineteen thirties where they looked at this how much energy people expend that womenand their women who weighed a hundred
seven pounds would spend the same amountof energy as women away 280 pounds so if their weight stable they would betaking in the same amount of calories and yet tho be an energy balance at 70pounds different so one of the arguments that i've beenmaking is that this paying attention to how much people are eating andexercising is not what you should be doing what we have here is a disorder offat accumulation ok people are overweight and obese havetoo much fat you should be paying attention who cares how much theyexercise just as a growing child you don't care how much they exercise youcare that they're growing because you
know so what you want to do with studythe hormone oh enzymatic regulation central nervous system regulation oftheir fat tissue and pay attention to that and if you doing that you'll solvethe problem if you pay attention to eating and exercise you want i reallywant to reframe that for 10 seconds part of my argument for them maybe not eatingso differently as the obese get victimized and that's not fair some of this is really beyond theircontrol they are not overeating they are not slothful they are reallyfrustrated and we are not doing enough to help them and that's i had aconversation yesterday with a reporter
from both where the tension if you tendto think like there's this obese population out there that's eating atmcdonald's every day and they should know better but they're not they're allaround us there are friends and our relatives in ourselves and they're doingthey're trying just as hard as every lean person and probably harder is ifyou lean you can usually whatever you want probably harder and thedetermination is extraordinary over here one last question coming to you too is warring factionsand i'm wondering if we can come to a common ground that you to share and whati'm hearing from you and correct me if
i'm wrong and summarizing where youmight have common ground one is my favorite phrase eat your fruitdon't drink it so perhaps the elimination of all juiceand two is decreasing our amount of fluffy white carbohydrates so the otheris pushing i believe in the plane model where onlya quarter of your plate should be carbohydrate half of the plate should befruits and vegetables and a quarter of a protein how valid do you feel that is and then i just watched a movie and i'ma carnivore but i just watched forks and knives and the china study and that hasjust totally flipped me out so i would
love to hear your comments oh you really don't want to get into thechina study there's actually a lot of assumptions that that may not be trueand it's filling in some blanks between the science i would say they are not coming arounddid you not rap out a common ground the pyramid that i described which isn't areal pyramid i hope you understand that i'm making this pyramid up acarbohydrate pyramid there's no meat or dairy or anythingit's really the carbs here and i would totally agree on the top section andthen as you move to the white bread and
the fruit juice sonia set we would keep agreeing andthen we would start to divert so our common ground is the amount of caloriesthat come from high fructose corn syrup sugar refined carbs breakfast cereals imean it's ubiquitous donuts bagels everywhere and it served all the time marion nestle favorite line for me is weeat more places more frequently and larger portions and the simplest thingsthat stay well our breaths they don't really go there easy to putout donuts bagels those things so if we're eating them more frequently inmore places in our car and that we would
agree there are we do but remember i'mconcerned about those populations it didn't didn't have the opportunity tofrequently more places and still have high levels of obesity on so yeah weagree on this carbohydrate pyramid i think a fundamental area making with this plate and i don't knowwhat to do but to assume that every you know what we have it i mean you couldimagine i just did a thought experiment on my mind and my seasonal blog entry iget around the blog about once every three months and i just said let'sassume we have identical twins and they we put them in our laboratory we measuretheir energy expenditure and we find out
there each expanding 2,500 calories aday and then we feed them identical diet accept 300 calories are from sugar andone diet and the other twin gets 300 calories from glucose from fat and thenbecause it's a thought experiment we could keep them in our laboratory for 20years and run it out and end up are they going to have the exact samebody types are they going to still be identical for 20 years with the onlydifference in their diet is at 300 calories of sugar versus from and youcan do the same thing with the population you can imagine we have twoidentical populations we have 5,000 identical twins and a half of them livein one village and the other their
siblings live in the other village andwe feed them the exact same diet but 300 calories from sugar and one village andnot the other we're gonna have the same number of obese and diabetic subjectsand the answer is i don't think we will okay i think that one change independentof calories is going to have a significant difference on how theyevolved and how it affects their health and for all i know the sugar peoplesugar industry would say that sugar group might be healthier and that's butthe point is you can't assume that something like you can turn and say lookhere's this person is a hundred pounds overweight they have been eating exactlylike you have
ok exactly the problem is whatever it is something in that diedand made them fat wasn't cuz i went to mcdonalds any more than you did itwasn't that they ate more white bread than you did to diet you can eat keepsyou relatively lean the diet they makes them fat the same food so you can say ilove the myplate it should be a quarter carbs it should be this much food thismuch vegetable because that could be a perfectly healthy diet for sixty percentof the population forty percent will keep them fat or makethem fatter and one of our problems with government guidelines as we don'tdifferentiate so we say we should all we
prove you know and fruit i don't i don'tdie i think they're basically chris and iagree on everything if we were all in population the only thing we disagree on are someethical issues about meeting and i haven't seen force versus nice and maybeif i watch it like swing but we don't have a healthy population anymore and sowhat the overweight obese diabetic population eat is may not be the sameyou know the same thing that a lean person eats and tolerates is likely tomake them fatter keep them that we're going to wrap up
i met and we're going to lunchafterwards i might be really watching with these guys thanks everyone the preceding program is copyrighted bythe board of trustees of the leland stanford junior university please visit us at med.stanford.edu
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