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tv   Machine Learning  CSPAN  December 1, 2013 1:55pm-2:51pm EST

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to serve, where do they need to go, and what is the combination of different services that might get them there, whether that be -- ride sharing volunteer, public transit service, within that community, what are all of the various options that might be there, and then to assist in what we hope more and more through a one call or one click web-based service of how someone can put together the customized ride from a to b need to have. again, we have been able to find those under -- in 2005, i believe, one of the important changes in our authorizing law was those of mobility management services can
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be funded from our core funding programs, both poor urban and rural areas, including section 53 of seven and 5311. the point being that there is an eligibility that was extended to these mobility management options that then can be funded with federal dollars because we would like to see them more and more. i think we had pre-hundred 25 -- 325,000 dollars was being spent with a eligibility first happened back in 2005, and out is more than $40 million i think per year on these services. we have seen a huge jump in interest. >> i think that reflects the growing need of our increasingly elderly population. i'm concerned that there is a aboutf public awareness these services and about the mobility managers. this is an issue that because of
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america ierica -- itn followed very closely. and somebody who represents a state by median age is the also havethe nation i a great interest in how we are going to meet this need. prior to this hearing, i was not aware of these mobility managers. i wonder what is being done to increase public awareness, to work more closely with perhaps the seniors, groups in the state, whether it is aarp or just senior centers in various communities. what are you doing to increase the visibility? >> well, there are a couple of things i would mention. i had mentioned before this coordinated plan that is
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required to access some of our funding. one recommendation that has been made is that there really needs to be an ongoing coordinating involves on an ongoing basis the very group we just mentioned besides -- whether it is aarp or senior community,in the faith-based organizations that can get the word out that these services are available. one thing that we did when we had our veteran transportation community living initiative that we funded in fiscal year 11 and 12 that i mentioned, we synthetically included as part of that program a marketing program, so there was assistance that was allowed for some folks to come and simply too, as he will observe, be able to get the , serving not only veterans and their families but also other community members
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that needed those same services, that there was a way of getting the word out. so it is a very important point that we need to keep in mind going forward with these programs. >> thank you. i think that one of the issues is that -- there is parallel with the element of mobility management. there is also an increasing thent of effort within aging network that provided general information and assistance to address transportation because there he very often,ause transportation rises out of a panoply of needs. the patient may need health care or home a community-based services, and transportation is an adjunct to that need. it is important that the equippedon lines are to know about the transportation resources and to connect with
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mobility managers where they exist in the community. i think a lot of that is happening. i would say that the association i work for administers an aoa- funded service call the eldercare locator. last year, the number one reason why people we got more than 18,000 calls about transportation between july of 2012 and june 2013. those numbers are increasing. people struggle with financial issues, health care issues and so forth, transportation remains number one. i also think there is a lot going on and communities to increase the expertise and connect this between the human services program and transportation so that when people call, they have the
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picture. you know there have been some problems with contractors who have been hired to individuals who receive services through the medicaid program. as part of i.t. and possibly laois and the reliability and quality and customer satisfaction, a few will, of your program? have an annual customer satisfaction survey that we do for itn in maine and across the country. the customer satisfaction ratings have been consistent think number of years. i
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98% of the people use the service would recommend it. the service. with 2% to 3% think it is too expensive for the services we receive and by about 10 to one, people think it is inexpensive for the service they received. questions and we do a survey of all of our volunteers every year and affiliates every year because if you are doing something wrong, you want to know right away. >> i think it is such an impressive program and i have been excited to see it replicated through your leadership and so many other states. i think it is a great model that we can encourage to be spread. i hope the federal department of transportation, which has been
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generous in its support in the early years will take notice of the program and the high satisfaction rates as well. this is a problem that is not going to go away and i think for rural states in particular, it poses a tremendous challenge for seniors living in very rural frankly there is no alternative to a car. that is one of the reasons i'm so grateful to the chairman is allowing us to have this hearing and i just want to thank all of you for adding to our knowledge. when i heard mr. frank gave those satisfaction rates, i can't help but think congress would be happy to have half those levels.
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they are truly impressive, so thank you very much, mr. chairman, and thank you all for testifying. it has been a great discussion, and it is a discussion about an obligation to society to take care of not only the very young, but very old. susan and i are very grateful to be part of this, so thank you very much. the meeting is adjourned. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> today, a train derailment in new york.
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the daily news has a picture. the ntsb investigating the new york train accident. governor cuomo saying four people lost their lives today in the holiday season right after thanksgiving. they are in our thoughts and prayers. 63 people seriously injured and according to a press release, there is a go team to investigate the accident. their team consists of specialists in tracks, mechanical systems and operations for performance. opentsb has said they will the briefing later today. span -- we bring public affairs events to washington directly to you, putting you in the room at congressional hearings, white house events, briefings, and conferences and offering complete gavel-to-gavel coverage of the u.s. house, all as a public service of high the industry.
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tv cablereated by the industry artie years ago and funded by your local cable and satellite provider. now, you can watch us in hd. >> next, look at food policy and specifically sugar. we will hear from a pediatric endocrinologist at the university of california, semper cisco. he gave a presentation in 2009 called sugar, the bitter truth that went viral on youtube and he spoke recently to students at californiaity of hastings law school where he studied food policy law. the conversation is about one hour and 50 minutes. [applause] >> thank you, david. thank all of you for coming. it is just wonderful to be back now at my alma mater. marsha cohen even gave me a decal to put on my car. i'm fully equipped. i really want to acknowledge so many of my mentors during this past year in the audience,
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david, pat davidson, marcia, and several other people here, as well, that have done a tremendous job. i have to say it was really an absolutely thrilling year. i wouldn't have given it up for the world. the homework was another story. [laughter] today, i want to talk to about what got me to law school in the first place, and hopefully, light a fire under all of you. in the way i first felt this as i started researching the topic. it is appropriate that this talk today be done on the 50th anniversary of the march on washington, because we are going to talk about a different form of oppression, one that is a little bit more pernicious. i also have a dream, and that dream is that our food supply would confer wellness, not
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illness. i have to take care of obese kids. we are losing the battle. the problem is, we are going to continue to lose the battle until we fix the food supply. i'm going to try to explain to you why that is and what we can do about it during the course of this lecture. i hope it won't be so hyperbolic as to get you all shouting in the aisles. it is not quite a revival, but there is going to be a lot of science. the science should influence the policy. the problem is, politics get in the way. that is where law comes in. with that, let's go ahead and start. first of all, i have no disclosures, no food industry entity is putting me up to this. [laughter] in 2011, just two years ago, u.s. secretary general announced that noncommunicable disease -- that is, type two diabetes, cardiovascular talese -- disease was now a bigger problem not just for the developed world,
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but for the developing world, than was infectious disease. this was a paradigm shift as to how medicine was going to be conducted from here on in and where the resources have to go. the question is, how do you deal with this? they plan to target tobacco, alcohol, and diet. tobacco and alcohol, that is easy. we have paradigms that already work for those. we have 15 years of alcohol control policy, for instance, but what about diet? are we going to influence total calories? we have been doing that for 30 years, and look where we are treated are we going to do that with changing fat? we did that for 30 years. red meat, dairy, carbohydrates? what is the factor within our diet? we cannot stop eating. something has to change. what is it? i think all of these are incorrect. i will let will smith tell you
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what the real answer to this story is. [phone ringing] >> i need some answers. i can't talk right now. i have a few cases i'm working on. all right. i'm hanging up. >> [indiscernible] >> sugar. [laughter] >> you know, if hollywood knows this, why don't you? [laughter] anyway, here is the problem. it is very clearly delineated on this slide. this comes from coca-cola's coming together youtube video. they are going to tackle childhood obesity. they say straight up, beating obesity will take action by all of us, based on one simple common sense fact: all calories
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count, no matter where they come from, including coca-cola and everything else with calories. in other words, a calorie is a calorie. you can get those calories from carrots or cheesecake or coca- cola or anything else, but the bottom line is, it doesn't matter where it comes from -- a calorie is a calorie. that is based on common sense. well, i don't believe in common sense. i believe in data. the data say something else entirely. what the data say is that some calories cause disease more than other calories, because different calories are metabolized differently in the body. not every calorie is handled the same way. that means a calorie is not a calorie. that is what i have spent the last 16 years figuring out, and i'm not the only one who has figured this out. many other investigators have figured this out. this is now a wave of
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controversy throughout the endocrine and nutritional literature and at meetings. i just debated the corn refineries association a week ago on exactly this point. so, the question is, if a calorie is not a calorie, could there be calories that are worse than others? of course, we know there are certain environmental toxins that are bad for you. the question is, what about the stuff over here? is this possible? could this be the problem? i'm going to be referring now to two papaers. -- papers. one is an article written about our research at ucsf, and also our comment last year were we actually called for regulation. in order to regulate an environmental substance, society has said that you have to fulfill four criteria. ubiquity. you cannot get away from it. toxicity -- it has to be dangerous.
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abuse -- you can't stop using it. finally, externalities or negative impact on society -- how does your use affect me? those are the four. i have to show you that sugar meets every single one of those four in order to be able to stand up here and talk about it. let's start with an affordability. we are all eating more, no arguments. 275 calories in teen boys over the past 20 years. no arguments. we are eating more. what are we eating more of? is it fat? we are told to go low-fat. we are not eating more fat. we are actually eating the same amount of fat as we were before. five grams. if you look at the secular trends of specific food intake, here is a fat -- whole milk, meat and cheese up slightly, milk desserts up slightly. bottom line, it is a wash.
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we are not eating more fat. in fact, as our percent of calories from fat has gone from 40% to 30%, because we were remanded to back in the 1980s as we were to go low-fat, our obesity and met a lot -- and metabolic syndrome prevalence has gone through the roof. no, it is not that. what are we eating more of? more carbohydrates. 228 calories, 57 grams in teen boys. here is the trend in carbohydrate intake, all through the roof. that is what we are eating more of. that was the bottom of the food pyramid. specifically, what carbohydrate? beverages. 41% increase in soft drinks, a 35% increase in for drinks, etc. this slide sort of says it all. here is the original bottle of coca-cola, 6.5 ounces, out of atlanta in 1915. if you drink one of those every
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day for a year, assuming that the formula hasn't changed -- we don't know if the formula has changed, because only three people in the world know the formula, and they are not allowed to ride planes at the same time -- that would be worth eight pounds of fat per year. in 1955 after sugar stopped being rationed, we got up to 10 ounces. 13 pounds of fat per year. then the ever-ubiquitous 12 ounce can, 16 pounds of fat per year. here we have the current ever- present 20-ounce coca-cola. does everybody know how many servings you get out of the 20 ounces? it is supposed to be 2.58-ounce servings. does anybody know who gets those servings? then you have the 7-eleven big gulp -- 44 ounces, 57 pounds per year if you do that everyday. my friend tells me that down in
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texas, they have a texas-sized big old. 50 ounces of coca-cola and a snickers bar, all for $.99. you would say, that is the obesity acted -- epidemic). you would be only partially right. what is this stuff? high fructose corn syrup. our annual consumption is 63 pounds per person. there is a problem. only the u.s., canada, and japan use it. there is very limited exposure in parts of europe, yet the rest of the world as just as much of an obesity metabolic syndrome epidemic as we do. in fact, everybody is so fond of mexican coke, mexico has the highest increase in the rate of obesity in the world today, and they don't have high fructose corn syrup. they have sucrose. here is high fructose corn syrup up here. one fructose. they are free. they are not bound together.
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here is sucrose. your enzyme leaves this in about a nanosecond. basically, it is a wash. they are the same. they are the equivalent. all of the studies pitting the two of them against each other show that they are equivalent. they are equivalent to data -- equivalently bad. that is why every other country has the exact same problem we do. here is what u.s. sugar consumption has done is we have developed the ability to refine isolated and market -- to refine, isolate, and market it. we have gone all the way up. you can see the different parts of the curve. here is the growth of the sugar industry in the late 1890s through the early 1900s, and stabilization before world war ii -- here is the dip from rationing -- here is the introduction of high fructose corn syrup and as we were remanded to reduce our fact.
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you will notice, in the last 5-6 years, there has been a decline, but that decline is nothing compared to the rest of the curve. if you believe that there is a limit to how much sugar you should consume, and the american heart association has set this threshold, and based on the analogy with alcohol that i have made, this would be the theoretical basis for alcohol right here -- the question is, do these actually work in terms of understanding how disease gets promulgated? here is the emergence of cardiovascular disease as a health risk in the united states in 1931, due to paul dudley white famous treatise on heart disease. we can see, as things went above the threshold, that is when heart disease started to become an issue. here is a 1988 when we started realizing that we have an epidemic of adolescent type 2 diabetes.
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you can see that the temporal relation between sugar consumption and our two biggest problems in terms of chronic metabolic disease -- heart disease and diabetes -- are at least temporally related to this increase. of course, temporal relation is not causation. this is a worldwide per capita sugar supply. you will notice the light blue here is how much of the american heart association says you can consume everyday. notice the entire world is darker than that. here we are, 629 calories. the rest of the world is right behind us. now sugar is cheap. the early history of the sugar epidemic was actually nicely delineated in this piece in the "national geographic" this past month, for anybody who is interested in how we got here and the slave trade and all the other things, the political and broglie owes sugar has caused over the centuries.
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we are going to talk about the last 30 years right now. that is what i have experienced. that is what i'm interested in. that has -- that is what has led to this adolescent type 2 diabetes pandemic that i have to take care of. that is what i'm trying to fix. let's talk about what happened in these 30 years. this is the perfect storm. it started with the fall of batista and the fact that we could now not rely on cuba for our sugar supply. this caused the increase in sugar production in florida, which actually took over the entire country to the point where now hawaii doesn't even have a sugar refinery. it is now florida. in 1973, richard nixon told his secretary of agriculture, earl butz, that food should never be an issue in a presidential election, that fluctuating food prices caused political unrest.
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indeed, we know that, it is just five years ago, we diverted some of our chrome -- corn crop to ethanol, and it caused the ouster of the tiling prime minister. whether or not that prime minister deserved to be ousted was a separate question, but that was the immediate and proximate cause. notice this slide right here. this is the percent of gross national product spent on food per country by "time" magazine. we are the worst. we have only 7% of our gdp spent on food. here is the u.k. at 9%. australia, 11%. we are the three most obese countries. notice the countries in purple they are all greater than 36% of gdp spent on food. they have all had a revolution within the last few years. indeed, fluctuating food prices caused political unrest. nixon had it right. with the advent of high fructose corn syrup that occurred in 1966 and introduced to the american market in 1975, now we have
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competition for sugar. we always had a sugar terrorist. in fact, it is the second oldest piece of legislation in america dating back to 1789. we always had propped up prices, but when hfcs invaded our shores, look at what happened. here is the price index. the goal is to keep the u.s. producer price index at 100%. that means price stability. any ups and downs mean fluctuating sugar prices. you can see what happened in the early 1970s -- up and down. this is what nixon was responding to. here is the advent of corn sweeteners. everything settles out at 100%. now there is competition. look what happened on the international stage. here is the london price. they didn't have high fructose corn syrup, but we still saw a stabilization in their prices compared to ours. here is the u.s. retail price for refined sugar -- it was half the price.
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now the food industry could start putting it in everything, because they could afford to, as it was cheap and admissible, because it was already in the solution. here is the change in high fructose corn syrup and the change in sugar. this comes from the corn refiners association themselves. they say, it is just a substitution. we are taking something that is cheaper and substituting it for something more expensive. not quite. if you look at the 73 pounds per year here back in the 70s -- the 1970s, this is missing something. does anybody know what is missing from this slide? juice. juice is sucrose. that is sugar, as well. we started making jews like crazy. anita bryant, a day without orange juice is a day without sunshine. that is because jews could be frozen and stored. it became a commodity. fruit is not a commodity, but fruit juice is.
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here is juice. in fact, we consume right now 120 pounds of sugar per year. the question is, is that over our limit based on the american heart association, based on the analogy with alcohol? we are way over our limits. the question is, is that what is causing the disease? the fourth item -- back in the late 1970s, we were told to go low-fat. why? in the early 1970s, we discovered this molecule in our bloodstream called ldl, low- density lipoprotein. we learned that dietary fat raise our ldl. let's call dietary fat a and ldl b, a led to b. we learned ldl levels of large appellations correlated with coronary -- large populations correlated with coronary disease. the logic was, if a leads to b and b correlates with c, get rid
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of dietary fats, ldl will go down, and cardiovascular disease will go -- will reverse. is that what happened? not at all. if anything, it got worse. why did it get worse? for a couple reasons. this was the fight going on back in the 1970s. there was a huge nutritional war going on. it was actually quite nasty, a lot of name-calling. over here, we had john yudkin, british physiologist, nutritionists, and physician who said sugar was the bad guy back in 1972. he wrote this missive called "pure, white, and deadly." i realized that i was basically parroting what he said 25-27 -- parodying what he said 25 years ago. here we have keys. he was the inventor of the k
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ration back in world war ii. he was sort of on the scene nutritionally. he was the one who said saturated fat was the bad guy. let's look at his data. this is his seven countries study writer could japan, italy, england and wales, australia, canada, and the united date. percent of calories from saturated fat, and here is coronary disease. it looks pretty good. except it wasn't the seven countries study. it was a 22 country study. there is still a minor correlation, but not nearly as good looking as it was before. the question is, why did he cherry pick those seven countries? why is it that he left out countries that actually blew a hole in his -- in his hypothesis? here are indigenous tribes. all they eat is fat. they don't have any carbohydrate and all. they have the lowest rate of heart disease on the planet. let's read what keys himself said.
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this is from page 262 of his own work -- in other words, doughnuts. [laughter] these guys here eat doughnuts. these guys don't. partial correlation analysis shows that with saturated fats present, there was no significant correlation between dietary sucrose and the incidence of coronary heart disease. when you do a multivariable linear regression, you have to do it both ways. you hold one constant and show that the other one still works. he didn't do it. he only did it one way. the question is, why did he only do it one way?
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i don't know the answer to that because i don't have his data, and this was before computers. it is kind of hard to check the work. it leaves a major question as to whether or not this was actually correct. nonetheless, the start of the low-fat craze in america. the content of home-cooked food, you can control the fat. you can decide how much that you're going to put in your own food. low-fat processed food tastes like cardboard. the flavor was in the fat, which meant that you had to do something when he took the fat out. you had to substitute something. carbohydrates. which carbohydrates? sugar. here is snack wells. they are still with us. two grams of fat down, 13 grams of carbohydrate up. which was worse for you, the fat or the sugar? that is the question we are asking today. here is berkeley farms 1% low- fat mark -- milk. my daughter brought these two containers home and said, dad, you're not going to believe this. this is 130 calories, 15 grams
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of sugar, all lactose, and here is berkeley farms 1% chocolate milk. 190 calories, 29 grams of sugar, high fructose corn syrup as the second ingredient. when you give your kid chocolate milk, you are giving them chocolate milk and a half a glass of orange juice. is that ok to do? the school dietitians say, we've got to get our kids to drink milk somehow. wide awake with the fat back in the milk in the first place? that made it perfectly fine. i drink that my entire young life. number five -- the third worst hurricane in american history, and it never even hit our shows. everyone knows katrina and sandy, but this was hurricane allen in 1980. what it did was it destroyed the entire caribbean sugar crop, which really put a fire under u.s. sugar consumption, because now we knew that we needed to
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have another sugar source aside from a farm. that led to this right here. does everybody remember new coke? we revolted. they brought back coke classic. where did coke classic go? that is coke classic right there. you are looking at it. that is what you are drinking today. as far as i'm concerned, from a ubiquity standpoint, we have had our food supply adulterated right under our own noses and with our tacit approval, because we haven't complained. with the addition of fructose for palatability, and also because it is a browning agent, that is the maillard reaction. it is a sign of cellular aging. if you had orange juice this morning, you are browning faster.
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added the removal of fiber for shelf life and for freezing, because you cannot freeze fiber, and finally, the substitution of trans fats, which we used as a hardening agent and increased shelf life vis-à-vis the 10- year-old 20. we know those are bad. we are removing those did we know those are the devil incarnate. we are trying to get those out of the food supply. there are certainly issues with that, as well, as marcia: and i have explored this year. next, toxicity. this is the tough one. i'm going to try to convince you that obesity is not a problem. obesity is irrelevant. obesity is the marker for the disease, not the disease itself. you don't die from obesity. you die from the disease is that travel along with it, which are called metabolic syndrome. those are type two diabetes, hypertension, ardea vascular disease, cancer, dementia,
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nonalcoholic fatty liver disease, and the list goes on. that is what you die of. we are going to talk about diabetes, because diabetes we've got the best data on. that is where the money goes. that is what is breaking the medical bank, the bank. here is how you need to look at this. here is a venn diagram of the entire u.s. adult population. 72 million obese people, 30%, 168 million people at normal weight, about 70%. everyone thinks these are the bad guys, these are the sick guys, these are the guys costing us the money. 80% of obese people are sick and cost money. usually double the medical expenditures of the general population. everyone assumes these 57 million are the problem, and they are costing us the big bucks. this is incorrect. this is completely incorrect. here is what the real story is. we will start at the beginning.
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yes, 80% of obese people are sick, but that means 20% of obese people are healthy. they are metabolically normal. a paper came out today showing exactly why they are normal, because they do not have inflammation. they are metabolically normal. they are just fat. conversely, up to 40% of the normal weight population has the exact same chronic metabolic dysfunction due to inflammation as does the obese. they get type 2 diabetes. they get cardiovascular disease. they get cancer. they get dementia. they get it at a slightly lower rate, but they actually, 40% of 168 million, they actually outnumber the obese. really, what we are talking about is more than half the u.s. adult population. this is not a personal issue. this is more than half of the
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population. this is a public health problem. in addition, everybody thinks that it is the obese persons fault, because it is convenient to think so. let's hearken back just 30 years to a different public health disaster, hiv. hiv, 1979, patient zero. 1981, aides got coined as a term aids got coined as a term. 1986, see edgar coop said we have to do something about this. when did hav become a public health crisis? when? does anybody know? 1991. why in 1991 did hav become a public health crisis? because that is when magic johnson got aids. all of a sudden, everybody said, you know what? it is not the gays and the addicts anymore. it is not them. everyone is at risk. it is now us.
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everybody realized, we needed to do something about this as a society. it became a public health crisis. this is a public health crisis. everyone is at risk, whether you are fat or not. it is not about obesity. let's talk about what it is. toxicity -- how do we define it? the degree to which a substance can damage an organism. a substance could damage an organism in several different ways, and a nutrient could potentially damage an organism through calories. if i'm going to say that sugar is specifically toxic, i have to show that it is toxic irrespective of its calories, unrelated to its calories and on related to obesity. it does everybody understand? that is my charge. i have to meet that bar in order to make my case. those are the caveats. it has to be exclusive calories,
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obesity, human data only, because the food industry will say, who cares about animals? it has to be in doses routinely consumed. it cannot be using doses that are so outlandish that you could basically argue that it is an artifact. is everybody with me? those are my charges. i have to meet those. here we are. here is the world sugar consumption tripling over the past 50 years, from 50 million tons per year to 150 million tons per year. notice brazil. they used to be so poor they couldn't afford their own sugar. they were always sugar exporters, but they weren't consumers. now they are a bric country. they've got lots of money. now they have the highest rate of increase of type 2 diabetes on the planet. now they are consuming their own sugar. where is diabetes the highest? the middle east, saudi arabia, qatar, uab, malaysia. why them?
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no alcohol. that's right. no alcohol. they have soft drinks like they are going out of style. why? it is hot. the water supply is a question mark. no alcohol. this is their reward. i'm going to tell you, alcohol is better than soft drinks. you know why? number one, it is way more fun. [laughter] number two, alcohol, for lack of a better word, is self limiting. you can only drink yourself under the table once a day. i have a little shot glass at home -- beat hangovers, stay drunk. the fact of the matter is, with soft drinks, you can keep doing it and doing it, and that is exactly what is going on in the middle east today. that is their reward. that is their oppression.
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this is an analysis called the epic interactive study from europe, and what it shows is that when you adjust for calories, when you adjust for bmi, and you look for sugar- sweetened beverages against the risk for diabetes, every sugar- sweetened beverage that you consume increases your risk for diabetes by 29% over time. this is in doses commonly used. this is human data. it is correlational data. this is a snapshot in time. the question is, do we have causation of data? that is what we have to meet. that is what we supply. this is a study we published in february this year. it is called an econometric analysis. that is very specific. it actually uses what economists use to predict stock market changes and fluctuations and crashes. we melded for databases together, food and agricultural
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organizations, melded with the international diabetes federation database which had diabetes prevalence. we looked at total calories, fruits excluding wine, oils, nuts, vegetables, meat, cereals, and sugar, sugar crops, and sweeteners. we melded that with the world bank world development indicators database to control for poverty, urbanization, aging, and physical activity and obesity. we have data for 175 countries. the countries we did not include were not different based on a test. we had a very fancy data monitoring and analysis. that is what an econometric analysis gets you. we had a hazard model to control for selection bias, called the heckman test. in order to show causation, you have to show precedents. you have to show that something
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occurs before the other thing. in a correlation analysis, you only have a snapshot. you can't tell directionality. you can't tell what caused what. you can't tell if sugar caused diabetes were diabetics ring sugar beverages. you couldn't tell that. if you had the whole decade, now you have a movie. now you can determine precedence. we controlled for gdp, obesity, urbanization, aging, and physical activity. we controlled for everything we could control for. here is the data. during the decade, diabetes rose from 5.4% to 7% worldwide. here is the effects model. you will notice it does not cross zero, which is significant. for every 100 calories, diabetes prevalence went up by 0.87%. here is the adjusted association of sugar with diabetes
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prevalence, a very clearly significant correlator. here's the take home message. only changes and sugar availability predicted changes in diabetes prevalence, not total calories. total calories were irrelevant. that doesn't mean total calories cannot cause diabetes. that is not what this means. it could. in this study, for every extra 150 calories that every country consumes, it only increased by beatty's by 0.5%. if those 150 calories happen to be a can of soda, diabetes prevalence increased 11 fold. here in america, we do not consume one soda a day. we consume 2.5 sodas per day. that is nearly a 2.4% increase in prevalence. when you consider that diabetes prevalence in america is 8.3%, that means that 29% of all diabetes in america is explained
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by sugar and sugar alone. that is irrespective of its calories and irrespective of its effect on weight. that is causation. these data meet what is known as the austrian bread for hill cut austin bradford hill standard for causation. we showed a duration, the higher they were exposed, the higher the diabetes rate. we showed directionality -- those countries where sugar went down, and there were a few, showed lower diabetes rates. we should precedents by free -- by three years. whenever sugar cane into a country, diabetes followed in three years in either direction. that is causal medical inference. we estimate that one quarter of all the diabetes in the world today is explained by sugar and sugar alone. if you want something to work on
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or something that is actionable, here it is. this is direct and causation. this is proximate cause. it has limitations. i'm going to take us through this very quickly because of time. it is not a raw data analysis. it is not person by person. that would be even better. it is country by country. it has time course and precedents. who says that the people who drink the sodas were the people who got the diabetes? except of course that we know that from other studies where they did have raw data analysis. could the sugar consumers and diabetics be different people? really unlikely. it is food supply, not consumption data, because we don't have consumption data. studies have shown 29% wastage across foodstuffs, not anything
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specific for sugar. leaving u.s. out of the analysis, were we waste the most food, did not change the findings. it was only one decade, but it was a hell of a decade. could micronutrients be important in this? we didn't look at those. that might actually be very important. that is a potential couple getting factor. different techniques used to screen for diabetes in different countries, different diagnostic criteria for diabetes in different countries, and some countries use self-reported data. about two thirds of diabetics don't know they have it. that would make the data even worse. the data includes both type one and type two diabetes. type one has been relatively stayed up -- stable on a percentage basis. this is driven by type two. 90% of diabetes is type two. just so you don't think i am fructose-centric -- [laughter] there are actually four foodstuffs that are metabolized all the same way to cause this
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same chronic metabolic disease. trans fats do this. trans fats are going down. branched chain amino acids -- these are decent and i terry amino acids, and the place to get them, koran-fed beef -- corn-fed beef. that might be a problem, as well. alcohol, a little bit is ok, and a lot is not. same with fructose. the reason that these for travel together is because they are essentially metabolized all the same way and differently from other calories. the liver is the only site for energy metabolism. everything goes to the liver. when your liver gets overloaded, it has to do with the excess. it is not insulin-regular kid. there is no way to die for the calories into another direction. no polite and jim popoff. glycogen is liver starch. it is non-toxic. if you make glycogen, you're
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helping yourself. that is why marathoners cartload before a marathon race, to up their glycogen. the mitochondria of yourselves, the energy burning factors, are overwhelmed. all these go straight to the mitochondria. they have no way to stop the onslaught. what the mitochondria do, they turn all the excess into liver fat, and liver fat drives chronic metabolic disease. what this proves is that a calorie is not a calorie. if you believe a calorie is a calorie, number one, you are lost. number two, we are sunk. number three, the food industry wins. if a calorie is not a calorie, that is a place where we can exert some action. abuse -- we will do this really quick. is sugar addictive? yes or no? what do you think?
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for some people, just like alcohol, lots of people can drink alcohol and be fine, and there is a small minority of people who are clearly alcoholic and addicted. about 20% of the american population is alcohol-addicted. this is something called addiction transfer. opera is the world's expert on addiction transfer, ok? the lay public seems to know this. the scientists are having a hard time getting on board with this. if you look at a brain of a controlled patient, you are looking at the dopamine receptors and the reward system dopamine is the feel-good neurotransmitter. when your brain sees dopamine, it goes, i like that. that is good. as long as it has receptors to receive that information, you will get rewarded. notice, here is a cocaine brain. it is a cocaine-addicted were -- adult. the receptors are unregulated greed that is what addiction is.
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now it means you need more of the substrate, more cocaine in order to get the same level of reward. you have fewer receptors to bind that dopamine. that is called mass action. this phenomenon is called tolerance. this is the neural anatomic equivalent of tolerance. here is a controlled brain over here. notice there is an obese brain right next-door. what do you see? same thing. in fact, the head of the national institute of drug abuse has said that obesity is a form of food addiction for many patients. i'm not the only one who says this. is there really such a thing as sugar addiction? we have similarities to other drugs of dependence. the one i think is the most appropriate is alcohol, because, number one, that is what sugar gets turned into, right? it is called wine. metabolism is the same.
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number two, it is a market commodity, just like sugar is. number three, it affects the brain in the same way. i'm not the only one who thinks that sugar is a problem. let's see. i thought i took care of this. why is it not working yet so i thought we had this working. -- why is it not working? i thought we had this working. i apologize. i'm going to have to pass on this. this is eric clapton talking about his addiction to sugar when he was five or six years old. i apologize. i had it working before the meeting started. let's go on. i apologize for that. ok. in animals, here are the criteria for addiction. binging, withdrawal, craving, and cross sensitization with other forms of abuse, meaning that you expose an animal to one drug of abuse for three weeks
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and you addicted them to the one drug, and then you expose them to a second drug they have never seen before, and they are addicted to that one. the dopamine receptors are the same. once you down regulate them, you down regulate them for all substances of abuse. that is called across- sensitization. in animals, we have slamdunk evidence shown -- showing that sugar is addictive. what about humans? it is really hard to determine this in humans. number one, everyone has a baseline. there is nobody who is naïve. number two, we cannot grind up people's games -- brains. number three, it is very hard to show causation, especially with our current diet. here are the criteria for addiction -- tolerance and withdrawal -- here are all the psychological dependencies great if you read through this, this reads just like obesity.


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