← The Diary Of A CEO with Steven Bartlett
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- [00:00]
A
Is sugar poison?
- [00:02]
B
Sugar is like alcohol. So is alcohol poison. Depends on the dose, right? The dose determines the poison. Paracelsus 15:37. We have an innate capacity to metabolize alcohol. And if we stay below that, doesn't do too much damage. If we go above it, different story. Same thing with sugar, Same thing with this molecule, the sweet molecule, fructose. And the reason is because fructose and alcohol are metabolized virtually identically.
- [00:40]
A
What's the difference between sugar and fructose?
- [00:42]
B
So sugar, dietary sugar, the sweet stuff, the crystals, the stuff you put in your coffee.
- [00:48]
A
The stuff I've got over here.
- [00:50]
B
Yeah. Like that stuff. Yeah, that stuff. The five pound bag right there, that's called sucrose.
- [00:59]
A
Okay? This is sucrose.
- [01:00]
B
This is sucrose. Now, sucrose is two molecules bound together. One molecule called glucose, one molecule called fructose. They are not the same. Now, the food industry will tell you they are the same. They are not the same. The reason they tell you they are the same is because that's the way they assuage their own culpability for what they've done to the food. But they are not the same. They will say, a sugar is a sugar, a calorie is a calorie. Glucose and Fructose both have 4 calories per gram. Why should you care? Oh, you care a lot. You care a whole lot. Now, glucose is the energy of life. Every cell on the planet burns glucose for energy. Glucose is so important that if you don't consume it, your body makes it. The Inuit had no carbohydrate. They had ice, they had whale blubber. They still had a serum glucose level.
- [01:55]
A
Inuits are the people that live in the North Poles and stuff.
- [01:57]
B
That's right, yeah. Formerly known as Eskimos.
- [02:00]
A
Right.
- [02:01]
B
But they didn't have any carbohydrate. They ran off fat, but they still had a serum glucose level. Because your brain runs on glucose, it can also run on ketones, too. But your brain runs on glucose. My brain runs on glucose. And you need glucose because certain hormones and certain proteins in the body require glycosylation in order to be effective. An example, LH and fsh. When you don't have glycosylation of LH and fsh, the hormones that tell your testicle and your ovary to work, you are infertile. It's that simple. So survival of the species says you need some glucose, but. But if you're not consuming it, you'll still get it because your body will make it it will make it out of amino acids, it will make it out of fat. Gluconeogenesis, it's called. So glucose is essential. It's just not essential to eat. Fructose, on the other hand, the sweet molecule in that bag, which is sort.
- [03:07]
A
Of one of the two parts of the grain of sugar that I see, one part of it is fructose.
- [03:12]
B
That's right. It's the other half. It's the evil twin, if you will.
- [03:16]
A
What are the two halves again?
- [03:17]
B
Glucose.
- [03:18]
A
Yep.
- [03:19]
B
Fructose bound together.
- [03:20]
A
I need glucose to live. My body will figure that out. Fructose. Do I need this?
- [03:25]
B
Not only do you not need it, but in high dose, it's toxic. Now, your liver has the innate ability to metabolize a small amount on the order of about six to nine teaspoons per day of dietary sugar. So half of that being fructose. So about 12 grams. Your liver can manage about 12 grams of fructose a day in the same way it can manage about 12 grams of alcohol per day without showing any signs of any metabolic derangement. But if you go above that now you get problems.
- [04:07]
A
Are we above that?
- [04:08]
B
Oh, we are so above that. We are at 50 grams of fructose per day, 100 grams of sugar per day. We're supposed to be at 25. We are at 100. We are quadruple our limit.
- [04:25]
A
And also, just because grams are quite hard to wrap the head around. Right, okay. So if I was to get a tablespoon, do teaspoons. A teaspoon, two. How many teaspoons of sugar would I have to consume to get to that level of fructose? Because I say this in part because most of us don't realize that we're consuming sugar.
- [04:42]
B
That's right. Because it's hidden in all of the food. That's exactly right. We don't even know. We say, oh, I never even add sugar to my coffee, therefore my sugar consumption is zero. Wrong. That is not true. Okay? Because it is hidden in plain sight in virtually every processed food in the entire grocery store. 73% of all of the items in the American grocery store and in the British grocery store are spiked with added sugar by the food industry. For its purposes, not for yours. Cause they know when they add it, you buy more.
- [05:19]
A
And how much does that look like in teaspoons then?
- [05:21]
B
The upper limit is about six teaspoons of added sugar per day.
- [05:27]
A
The allowance. The recommended allowance.
- [05:29]
B
The upper limit.
- [05:30]
A
Okay.
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B
The recommended allowance is lower than that.
- [05:32]
A
Yeah.
- [05:33]
B
Okay. But the upper limit is about six teaspoons of added sugar per day. So we have an innate capacity to metabolize about 12 grams of fructose per day. By the way, that's for adults. For children, it's one third of that. Four grams of fructose per day. Okay, four to six. So we're talking very little. Talking very little. But when you think about, for instance, Kid In America, 29% of kids in America consume the National School Breakfast Program. Breakfast in School. Okay, 29%. So what is the National School Breakfast Program? It's a bowl of Froot Loops and a glass of orange juice. That is 41 grams of sugar. The upper limit for children in terms of their metabolism is 12 grams per day. They got 41 grams, and it's just breakfast. What do you think that's gonna do? Now, if a calorie were a calorie, and if glucose and fructose were the same, then you say, well, you gotta get your calories somewhere. But because fructose is not glucose, because fructose is more like alcohol, because fructose's toxicity has nothing to do with its calories. That is a huge overdose. And it has metabolic complications, systemic health complications, it has mental health complications.
- [07:12]
A
Sounds like a bit of a scandal when I hear that these kids are getting almost 30% of kids are getting, you know, almost, you know, three to four times their recommended daily allowance of sugar from school. And that it's having these sort of really adverse consequences on us. And the studies are there to prove that the consequences are very real. It sounds like a scandal in the sense that nobody's doing something about it.
- [07:39]
B
Ah, well, yes, that way it is. The point is that the food industry is very powerful, and they have, you know, swept virtually every aspect of this under the rug for 40 to 50 years. They knew back in the 1960s that sugar was a problem, but they paid off scientists to say it wasn't. And we actually have the documents from the food industry. They live at the UCSF Food Industry Documents Library, and we are doing research on corporate interference in health.
- [08:18]
A
What do those documents show?
- [08:20]
B
They show that in 1965, the sugar industry came to two Harvard School of Public Health scientists, the head of the Department of nutrition, Fred Stair, and his associate, Mark Hegstad, who became the head of the USDA five years later and paid them $50,000 in today's money to produce two articles for the New England Journal saying saturated fat was the bad guy and that sugar was exonerated.
- [08:53]
A
And they did it, and they did it.
- [08:57]
B
That's just one thing they did. They also infiltrated the National Institute of Dental Research, nidr, their stock study sections, and their executive committee to take money away from nutrition research for dental health and put it toward a caries vaccine.
- [09:22]
A
A what?
- [09:22]
B
A dental caries cavities vaccine. Okay, how's that cavities vaccine working for you? We have all of the data in their own words to demonstrate that they knew exactly what they were doing. This is not hallucination, this is hardcore fact. And we've published this and we now have a center at UCSF devoted to understanding the corporate determinants of health.
- [09:57]
A
And when we look across society at the consequences of this sort of corporate interference, some of the crazy stats in your book Fat Chance that I really struck, sort of highlighted were that by 2050, obesity will become the norm, not the exception. Correct. The World Health Organization said that the percentage of obese people globally has doubled in the last 28 years.
- [10:16]
B
Indeed.
- [10:17]
A
And in the UK, 28% of adults are obese and 36% of them are overweight. That's not from your book, but that's from some research we did on the UK numbers as well.
- [10:26]
B
Well, you know, the UK is the fat man of Europe.
- [10:29]
A
Yes, that's true. Having metabolic syndrome is equal to losing 15 to 20 years of life. That was in your book.
- [10:35]
B
That's correct.
- [10:36]
A
Which is startling. And worldwide sugar consumption has tripled in just the last 50 years.
- [10:43]
B
Correct. All true. Now, you could say that's correlation, not causation. But we actually have the causation. We have the data, we have it in mechanistic terms. We have it in clinical interventional efforts, we have it in societal efforts. There's a method for determining proof that doesn't need randomized control trials. It's called econometric analysis. This is what we have for, for instance, climate change. There's no control group for climate change, but we still know it's true. This is what we have for tobacco and lung cancer. You know, you don't have naive people start smoking. That would be illegal, immoral, get you thrown in jail. But we still know that tobacco causes lung cancer. We know that football trauma causes chronic traumatic encephalopathy. Okay, none of these have control groups, but we know it's true through econometric analysis. This is a method of using natural history data over time to be able to determine proximate cause. And we have that for sugar and diabetes, and we have it for sugar and heart disease, and we have it for sugar and fatty liver disease. And of course, we have it for sugar and tooth decay. We're working on sugar and cancer and sugar and dementia. We're not there yet.
- [12:04]
A
In your book Fat chance, on page 120, there was something particularly curious because I think this is a. Yeah, here we go. It says the bottom line is sugar consumption is a problem. 33% of sugar consumption comes from beverages.
- [12:23]
B
Yes.
- [12:24]
A
And the biggest abuses are the poor and underserved.
- [12:27]
B
Indeed.
- [12:28]
A
So let's talk about beverages to start with then. Diet beverages. Are they fine? And how bad are the sort of fizzy pop beverages that most of us consume every day?
- [12:42]
B
So let's do the sugared soft drinks first.
- [12:48]
A
Okay.
- [12:48]
B
Okay. They are really bad. If you consume one sugared beverage per day, your risk for diabetes goes up by 29%.
- [13:00]
A
Wow.
- [13:01]
B
Okay. And diabetes, and that's if you have one. If you have two, 58%.
- [13:08]
A
And diabetes is now the main cause of death in 40% of death certificates.
- [13:12]
B
Exactly right. So this is a big problem. So, you know, that's demonstrating its toxicity at, you know, shall we say medium dose, you know, at low dose you can handle it, but, you know, as soon as you go above that dose, it's a problem. And we have the data for it. Okay, and all of these are factored in. These are all econometric analyses. We've shown that sugar is a proximate cause of diabetes. Whenever sugar availability changes in any country, diabetes prevalence changes three years later. And we've also done what's known as advanced Markov modeling, where we go into the future and show that when sugar consumption goes down in any country, diabetes levels change and reduce three years later. So it's a three year window between the change in the diet and the change in the metabolic health consequences. We have those data, and the fact that they work both on the way up and on the way down is like, you know, take it to the bank. Now that's for the sugared beverages. You asked me about diet beverages.
- [14:18]
A
I've got one here.
- [14:20]
B
Let's. Let's look at it. All right.
- [14:25]
A
I've covered up the logos because I.
- [14:27]
B
Don'T want to call them. I've never seen this before. I wonder what that is. The data now show. I mean, it took a while for these data to come in, but the data now show that the toxicity of one sugared soda equals the toxicity of two diet sodas. Half as bad. Okay, half as bad does not mean good. Half as bad means half as bad.
- [14:54]
A
Well, it says zero sugar here, so how can it be bad?
- [14:56]
B
Well, so because it's bad for a different reason. So, yes, zero fructose, zero calories, I agree, but that doesn't make it good. Makes it better than the sugared alternative, but it doesn't make it good. Why? Number one, you put something sweet on the tongue. Message goes tongue to brain. Sugar's coming. Message goes brain to pancreas. Sugar's coming. Release the insulin.
- [15:27]
A
So I still get an insulin release?
- [15:28]
B
You still get an insulin response. And the more other food you ate, the bigger the insulin response. So you will have an accentuated insulin response because you were exposed to. To the diet sweetener. This is work from Janina Papino, 2013 at WashU St. Louis. And it's been corroborated multiple times since.
- [15:48]
A
And why does that harm me having an insulin response?
- [15:51]
B
Cause insulin's a bad guy. So we always talk about glucose being a bad guy in terms of diabetes. And it is, of course, but insulin's a bad guy, too. Glucose causes small vessels to be dysfunctional, causes endothelial cell dysfunction. It causes high blood pressure because it causes those small vessels to constrict. It interferes with nitric oxide, which is one of the things that relaxes the blood vessel, and it will basically reduce blood flow to specific organs. So high glucose is not good for you, and it's bad for small vessel disease. And that's why diabetics get retinopathy, nephropathy, neuropathy, kidney disease, nerve damage, and eye disease. But insulin is also a problem, because what insulin does is it causes cell growth. Insulin is a growth factor, and it causes vascular smooth muscle growth, like in your coronary arteries, and it causes glandular growth. So it is one of the primary drivers of heart disease and cancer. So you can be a diabetic, a type 2 diabetic, and have your hemoglobin A1c, a measure of your glucose control down near normal, near normal range, because you're on insulin or oral Hypoglycemics or even GLP1 analogs for that matter. Okay. And you will die just the same because you will die of a heart attack or of a cancer. Because diabetics have a much higher incidence of cancer. They also have a higher incidence of dementia as well. And the reason is because of insulin, because insulin's a bad guy. In this story, glucose causes microvascular disease. The insulin causes macrovascular disease. They're both bad. You need to control both of them. And this controls the glucose. It doesn't control the insulin.
- [18:02]
A
Do you drink that stuff?
- [18:03]
B
Of course not.
- [18:05]
A
Just checking Is there any other physiological consequences to diet sodas outside of the insulin response?
- [18:12]
B
Indeed. So the other thing that we've learned about non nutritive sweeteners across the board is that they alter the microbiome. Now the microbiome is the bacteria that live in your gut. Now you have to feed your microbiome, you have to feed your bacteria. Because if you don't feed your bacteria, your bacteria will feed on you. It will strip the mucin layer, a protective physical barrier, right off the surface of your intestinal epithelial cells. And when it does that, it denudes them and allows for other bacteria, toxic bacteria, to take up residence and cause irritable bowel syndrome, inflammatory bowel disease. The junctions between the cells become dysfunctional as well. And so cells become permeable. And so stuff in your intestine, the junk in your intestine, the sh. You know, what can actually make it through into the bloodstream. You can measure the endotoxins and the whole bacteria, the lipopolysaccharides in the bloodstream when the intestine is damaged, even from diet soda. And what that does is that ultimately leads to systemic inflammation. And that systemic inflammation also leads to metabolic disease, mental health problems, cognitive decline, early death.
- [19:34]
A
So what advice do we give that is simple and actionable for Jennifer or Judith or Dave, who's listening to this now? They are, you know, 40 years old potentially. They have a nine to five job. They're very busy. Maybe they have some kids to feed at the same time. They don't have time to be like, you know, looking at doing a fine sort of tooth comb over every single thing that they're putting into their body. They're not a scientist.
- [19:59]
B
Agreed. It's a problem because the food industry has made the grocery store a minefield. And it's really easy to set off an explosion. If you walk in, you're basically lost. That's how bad it is. Understood. So the simple rule is eat real food. So what's real food? Well, food that came out of the ground or animals that ate food that came out of the ground. The problem is we all lead busy lives and we're looking for labor saving devices because people don't even have time to cook. Most people, 33% of Americans don't even know how to cook anymore. So like, what are they going to do? So we understand this. I mean, it's a problem. Agreed. We need food that is metabolically healthy for us, not metabolically detrimental. And the problem is that as soon as you Put added sugar in the food, you have made it metabolically detrimental. Now, the food industry will say, well, there are all these other good things in there, like vitamins and minerals. We fortify it, et cetera. So I'm here to tell you toxin A plus antidote B still equals death, okay? Just because they put some vitamins in there or you take a dietary supplement, if it's not solving your mitochondrial dysfunction, what's the point? So you can't believe what the food industry is telling you, okay? If they say something is healthy, it's usually the opposite. Whatever it says on the package, believe the opposite because they have an incentive to put wrong stuff on the package. And I'll be honest with you, I'm part of numerous lawsuits suing the food industry for deceptive advertising, misbranding, mislabeling. 70% of all of the items in the American grocery store are misbranded or mislabeled.
- [22:01]
A
In what way?
- [22:03]
B
They say things that are not true.
- [22:04]
A
Give me some examples.
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B
Well, first of all, any time they use the word healthy, okay? They say no added sugar, okay? But in fact, they put in apple puree or raspberry puree or evaporated cane juice. You know, there are 262 names for sugar, and the food industry uses all of them. And so they will say that something's no added sugar, but that, in fact, is actually not the case. Okay? There's a whole, you know, whole host of this. Kellogg's has been sued for Raisin Bran. Okay? Everyone thinks Raisin Bran. Well, it's just raisins and bran. What color are the raisins in Raisin Bran?
- [22:50]
A
I've never seen it.
- [22:52]
B
Well, I mean, raisins are purple. Yeah, you know, purple, Brown.
- [22:56]
A
Yeah, yeah, yeah, yeah. Normally.
- [22:58]
B
Well, the raisins in Raisin Bran are white. Why? If you take the raisins and Raisin Bran, that's supposed to be 11 grams of sugar, but on the side of the package, it says that One serving is 18 grams of sugar. Where'd the other seven come from? It's the white. Because they've all been dipped in a sugar solution to make them sweeter, as an example. So Post has been sued, General Mills. Theirs was dismissed. Mondelez. A whole host of companies are actually under the gun now to change their practices.
- [23:46]
A
Why do you care so much?
- [23:49]
B
I am a pediatrician. My job is to take care of children. Children are vulnerable in the same way minorities are vulnerable in the same way prisoners are vulnerable, okay? They need a voice. My job is to give every kid a shot. Well, we now have neonatal obesity. We have babies being born Israel, South Africa, Russia, United States. Four separate studies showing that over the past 25 years, birth weight has gone up 200 grams, half a pound, in all four countries. And when you do DEXA scanning to look at body composition on Those newborns, those 200 grams are all fat. We have neonatal obesity. These kids did not get obese by dieting and exercising, by gluttony and sloth. They came out of the womb behind the eight ball. It's my job as a pediatrician to fix the problem. That's what I care.