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Sodas are very prevalent. Every restaurant, every movie theater, every party usually offers some soda (or pop to this former midwesterner) as a refreshment. Try as some might, sodas hit the spot for them. And when they’re everywhere, it’s easy enough to just pick up a quick soda when you’re thirsty. But what if we removed the convenience of sodas? Do people miss it? Laura Schmidt, a professor at UCSF School of Medicine, was a proponent of an initiative to sell only zero-calorie or non-sweetened beverages on the UCSF campus. What are the dangers of drinking too much soda? What changes do we see in public health when we adjust the culture around sodas?
Interview Notes From The Show:
– Welcome back to the Urban Monk. Here in studio with Dr. Laura Schmidt, who is visiting via Skype, from UC San Francisco, she’s at the School of Medicine and, man, they’ve been doing some cool work out there going after soda, and what soda means to us as a public health disaster, and just going after not just the healthy stuff that we know but going after the policy and being able to transform how we legislate around this so that we don’t put people at risk and so, lots of cool stuff to talk about. Doc, welcome to the show.
– Yeah, good to be here.
– And thanks for doing the work that you do, this is important.
– Thank you.
– This is important stuff.
– Thank you.
– And so, let’s start from the top, I mean, most people already know soda is probably not the best thing for you, let’s get into a little bit of the public health issue with the sugar in soda and why, what’s driven you to do this work in the first place.
– A lot of people want to ask the question why sugar, why now, is it the new tobacco? Why do we care so much all of a sudden? And the truth is, a lot of this is spurred by new science. Science that’s evolved in the last five to 10 years and, in particular there are two public health consequences of heavy sugar consumption that were either underappreciated or even unknown up until fairly recently. The first has to do with the appearance of adult onset diabetes in children. So, in our parents’ generation, they called it adult onset diabetes because only adults got it. And suddenly, we’ve started seeing an epidemic of diabetes in, that’s not type one diabetes that you’re born with, this is type two that you acquire through unhealthy diet, obesity, other related causes, and sugar being one of them, we’re seeing marked rise in childhood diabetes to, the Centers for Disease Control and Prevention predict that of children alive today, one in four will be diabetic at some point in their lifetimes, and of those children of color, one in two will be diabetic. And so, what we’re looking at is a public health crisis. Diabetes is not a condition that goes away, it gets worse if it’s not recognized early on and treated with insulin injections and other forms of, you can’t make it go away, but you can contain it, prevent it from damaging your body further. But if it’s left untreated, it leads to blindness, limb amputations, kidney disease, it’s a big problem for the individuals, as well as the society. When you’re talking about maintaining 1/4 of our population on diabetes.
– Dealing with the consequences and the complications of type two diabetes as these people age over time, so we’re really looking down the barrel of a gun on that one. Then the other fairly recent, even more recent observation in the scientific community has to do with a condition that didn’t even have a name 30 years ago, it’s called nonalcoholic fatty liver disease. We think it’s affecting about 1/3 of the adult population, and about maybe a smaller proportion of children, maybe around 11% to 13%. The only known risk factors for nonalcoholic fatty liver disease, or as we say, NAFLD, are the trans fat consumption, heavy sugar consumption, and obesity. Soon, in about five years, we’re looking at NAFLD will be the number one cause of liver transplantation in America. So, this condition that we didn’t even have a name for before our obesity epidemic, before we started consuming excess sugar, took the fat out of our diet, put the sugar in, this condition will be the leading cause of liver transplantation. The liver surgeons here at UCSF that I’ve spoken to are really concerned about this. There are a lot of issues, most of these people are diabetic as well as having fatty liver disease. Once they get a transplant, assuming we have enough livers to go around, there are often problems with their diabetes treatments not doing so well with the anti organ rejection drugs, it’s really a mess. So this is a condition that we’ve only recently come to appreciate, and this is true, we’ve now got very solid evidence from animal studies, studies of rats, studies of humans in clinical trials, and so forth, population-based evidence to demonstrate that fructose consumption, a particular kind of sugar, is definitely linked to the rise in this condition. And this, of course, is a major concern in the medical community.
– So, it’s obviously a no-brainer, we’re taking this thing, a species is poisoning itself with fructose and causing two things that down the barrel, I mean, I’ve looked at studies that say that 70% of ER visits are often times sequelae of diabetes and things that kinda come downstream from having all these out of control internal chronic health issues. And so, we now recognize that it’s dumb to be doing this. Well, it’s just dumb as a species. Why would you poison yourself? Yet we continue to do so. So, fructose is the enemy in this lineup, is that what I’m hearing?
– Well, they’re different, it’s complicated because there are different types of sugars, and depending on the type of sugar, your body will metabolize it differently. The concern with fructose is that it’s almost exclusively metabolized by the liver. Our livers are, pretty much everything that goes in and out of our bodies gets somehow processed by the liver, goes through the liver, it’s a really vital organ, and when you start clogging it up with fat, with this fatty liver disease, it becomes more and more dysfunctional, and that leads to a cascade of problems, hormonally, it changes the insulin response, we think. The liver is a pretty fundamental organ in your body, you don’t wanna be messing with it. And then, other kinds of sugars come in and affect the pancreas, which is the organ in our body that regulates blood sugar, and that’s when you start developing type two diabetes, your insulin resistance, the organ responsible for regulating the sugar in your blood, for getting the cells to take up sugars and use them for energy, or store them as fat, becomes unable to regulate your blood sugar, you get out of control blood sugar levels, and people wind up in the ER, as you’re pointing now.
– Sure, so, we have the traditional sugars, sucrose, fructose, all these things, so we have issues with the pancreas and the ability to move sugar and do things. Separately, we have the new fatty liver thing that we’re figuring out. I’d love for you to tease this out a little bit more ’cause people are now, you know, if I’m hearing fat in the liver, I’m not getting the sugar connection, so a lot of people don’t see the fructose creating that kind of fat deposits in the liver, so I’d love for you to tease that out a little bit.
– Yeah, sure. The perfect analogy is alcoholic fatty liver disease, namely cirrhosis of the liver, which is something that we’ve known about for hundreds of years. If people drink too much alcohol, their liver will become damaged, the liver becomes inflamed, it gets scarred, and that has to do with the deposition of fats in the liver and, eventually, it fails, it becomes cirrhotic, and they need a liver transplant. It turns out that fructose is through the very same metabolic mechanism. Fructose is taken up by the liver in the identical manner. So, people often will talk about people who drink too much get a beer belly, well, there’s also a sugar belly, and there’s a reason for that. The exact same mechanism in your liver that transforms ethanol or alcohol metabolizes fructose. So through this process, de novo lipogenesis, the liver is basically looking at, say you’re sitting on your couch, you’re a couch potato, you’re watching the game, and you down a giant 48-ounce Gatorade, or sugary beverage, you’re not moving around, you’re not gonna mobilize that sugar, the fructose, for energy, you’re just sitting there, and maybe it’s even taking it on an empty stomach. So, essentially what happens is that fructose is gonna slam your liver with this heavy dose of, and your liver is gonna say, oh, okay, I’d better deal with this, I gotta metabolize it. Because you’re not using this energy, and mobilizing it, and burning it off, your liver will transform it into fat, transform the sugar, the fructose into fat, through this process of de novo lipogenesis. What happens is some of those fats get laid down in the liver itself, and some get sent out into the bloodstream, which will raise what we call triglycerides in the bloodstream, so one way you know if you have this problem with fructose, fatty liver disease potentially, metabolic syndrome, we call it, is because when you go to your doctor and you get a blood test, they’ll say, “Hey, you got high triglycerides in your blood.” That’s a sign that you’ve got a problem. Another way you can know is if you tend to have a lot of fat around the waist. That selected deposition, those fats that go out into the bloodstream get selectively deposited around the waist which is why you get that sugar belly. As it is now, we don’t have the greatest ways of figuring out without doing lab testing on an individual whether they have metabolic syndrome, which is really the precursor for most forms of chronic disease, not just heart disease, diabetes, but interestingly, Alzheimer’s disease, and we’re seeing this tremendous uptick in Alzheimer’s disease, and probably poor nutrition is a cause of this. But the short of going into your doctor and getting a blood test to see if you’ve got problems with hormonal, insulin resistance, high triglycerides, uncontrolled blood sugar, the best way to know if you might be at risk for this NAFLD and other related conditions is if you have a lot of visceral fat, it’s really the only way an individual knows. If you do, it’s time to get into the doctor and get assessed for metabolic syndrome. One of the big pushes right now, we know, diabetes is a silent disease at first, people don’t know they’ve got it, and so, one of the big pushes in medicine right now is to get people who are pre-diabetic, who are not yet suffering from the permanent irreversible condition, get people screened, and if they’re pre-diabetic, they have insulin resistance, there are things that can be done to prevent them from getting the permanent condition, and so, that’s a big push right now, and that’s why we tell people, if you’ve got a lot of fat around your gut, and if you’re obese, if your waist is bigger than your hips, those are very important visible signs that you might have a problem that you need to deal with right away, don’t let it wait. The worst thing in the world is to go blind, have your limbs amputated. For the physicians that I work with, who are on the front lines, this is really tragic, to see this happen, specially in children.
– So you are somewhere maybe 20 feet behind the front lines looking at the MASH unit of people coming in on this, and it’s a completely preventable, like, we shouldn’t even be taking these bullets.
– [Laura] Exactly.
– So, let’s talk about why sugar consumption, it’s such a no-brainer that we gotta change this, but then we have these sodas in the schools, we have this sugar industry pushing this stuff, and keeping their products going for commercial reasons, and you guys are trying to stop this, obviously. There’s a lot of people out there that have been talking about this, you’ve had some success, I wanna talk about what you’ve done over at UCSF, and talk about how we can set this as a precedent for future successes and really get out ahead of this thing, this thing is ridiculous, and so there’s no reason we should be waging this war, we got bigger fish to fry, but here we are.
– Well, the big concern is that we’ve allowed our food system to just get out of whack. We have become a population that eats primarily through convenience, we eat processed and packaged foods, these are foods that are designed to have a very long shelf life, sugar is a great way to increase the shelf life of products, as well as salt. Some people call them Frankenstein foods, they are often scientifically engineered in labs by food scientists to get our hedonic system, our reward system, in the hyperdrive, in the brain, there’s literally, you know, I come from an addiction research background, and food scientists in corporations are taking people and using the very technologies that we developed to cure addictions, namely functional MRI testing of the limbic region of the brain, the reward center, they’re using it to figure out how to make a Dorito chip taste better. At this point, it’s very difficult for individuals to turn back the clock and eat like out grandparents did. Michael Pollan says, “Eat like a grandmother.” Well, good luck. You know, you got two kids, two-income family, and your grocery store, 84% of the foods in your grocery store have added sugar, your kids go to school and eat junk, they’re used to this, our palates changed, so only hyper sweet stuff even taste good, you know, good luck. That puts an incredible burden on the individual to try to figure out a way to carefully navigate this crazy food environment to find an apple, to find a drinking fountain, and I have a colleague, Anisha Patel, who does work in schools with water, and in California we’re required to have at least one drinking fountain in the school, in the cafeteria. And half the time she goes in and it’s like, there’s a bunch of junk and stored stuff in front of it, and the kids literally don’t have access to water.
– And so, our food environment has just become completely distorted and out of whack, it’s nobody’s, no individual’s fault, we have a real problem actually with the population, and many people blaming the individual for something that is an environmental problem. And, I mean, if we were all breathing in asbestos and developing lung disease, we’d all say, well, that’s not your fault, you need to breathe. But at the same time we’re all eating crap, and it’s all that’s around us, we gotta eat, and yet we blame the individual. And so it really is, at this point, it’s beyond, unless you are very wealthy, somebody to cook for you, you have a lot of money to spend on very high-priced fruits and vegetables, and you have a tremendous amount of will power, and you don’t work in a typical workplace, where the food environment is saturated with junk, maybe you have a chance. But for most of the population, that’s just not a reasonable solution, and so we have to look to environmental solutions to the problem. You asked about what UCSF decided to do last year. On the 1st of November, the leadership of the university said, “We’re a health sciences university, “we run one of the top elite medical centers in the country, “we’re the second largest employer in San Francisco, “what are we doing in the business “of selling these products, these sugary beverages “that we know cause the very diseases “that clog up our hospitals? “We’re supposed to be about health. “Why should we make a profit off this stuff?”
– Good for you.
– And they made a bold decision to just stop selling the stuff. They didn’t want it to be moralistic, or nanny state, or pushing anybody to do what other people wanted them to do, they just said, “We’re getting out of the business of selling it. “And if we take a hit financially.” And literally, the chief medical officer from medical center, when the idea was proposed, said, “Look, we don’t put cigarettes in our vending machines, “why should we put this stuff in our vending machines?” That’s the spirit of it. And since then, we’ve conducted a careful evaluation, including doing full physicals and blood testing of representative sample of our employees to see what the effects of just this one small change, the university, both the medical center and the campus, just stop selling this stuff. We’re not saying you can’t bring it in in a six-pack and put it in the office fridge, we’re not saying you can’t go out and buy it somewhere else, we’re just saying we’re out of the business. And remarkably, we’ve learned many things, a year later we’ve seen very substantial decline in consumption, specially among our manual and service workers, these are the people who are the janitors in the hospitals, and they’re the typically low income individuals who work in the cafeterias. At the beginning, before we passed the. They were consuming almost a liter a day of soda. By six months later, their consumption was down by 25%, 1/4 decline. We’re seeing tremendous benefits in our biomarker study in terms of actual health and this is just one small change in the food environment, it’s a gentle nudge, just making it a little harder to grab for that soda, and making it a little easier, we have lots of, over a 100 different bottled beverages in our refrigerators all around, in our cafeterias, in our vending machines, we have millions of food courts, and Panda Express, and Subway, and Jamba Juice, and they all voluntarily participated, and all of our vendors did, in making this move, and it’s supporting not only our employees, but also patients, the families. When you go to the hospital, and you have a family member in the hospital, you’re basically captive, right? If you’ve had a family member in the hospital, you’ve nowhere to go. And if the food environment in that hospital is junk, if your kid is in being treated for diabetic coma, and you’re in the hospital with that kid for several days, and the only thing you can get is junk food, that’s a real problem.
– And so, what’s been very encouraging is to see the tremendous interest in the health sector. We’ve been called by hospitals, universities, literally, Australia, Poland, people in Poland calling us to say, “How did you do that? “Did it work? “Did it make a difference?” So we’re hoping that this will be something that the health sector really can show some leadership in. It’s really a private sector solution because if employers, and hospitals, if a large sector of our economy can say, look, this is a simple change we can make, we’re hoping that that will spread spontaneously without anybody having to hassle–
– Get draconian.
– Yeah, no government interference, this is a private choice that employers, and one of the big questions on everyone’s mind now is what would be the long-term healthcare savings? Think of it, if you’re an employer, you have a large population of people, you’re paying for insurance, their health insurance, even within a few years, if they reverse their metabolic disease, you’re gonna see massive savings in healthcare costs. They don’t have to go in maybe for as many people for insulin injections anymore. They’re not gonna develop chronic illnesses. And the other exciting thing that we’ve found was that the sales of beverages were basically flat during the first year, and this is most likely because there were so many healthy alternatives that we could put in refrigerators, in our retail stores, in our cafeterias. We did a very careful search over 100 different unsweetened teas, flavored waters, all sorts of things that people can drink that are refreshing and delicious, and don’t harm their health.
– And so, bottom line, did it really get impacted and your conscious decision to do this actually is transforming the health of the entire campus. We’re doing this whole series on conscious capitalism right now, and so this is a market driven decision that really shifted things and I wanna see these ripples into all the industries. I think it was CVS, I don’t wanna give them credit if they didn’t do it, but one of them said, we’re a drugstore, why are we selling cigarettes? Same thing.
– Exactly. Yeah, exactly, and I think for our campus, and our medical center, it was really almost, dare I say, a moral decision, or an ethical decision. If we’re exclusively a health sciences university, we have the top school of dentistry here. Why would we possibly
– Pushing sugar.
– Be encouraging people to bathe their teeth in sugar that rots their teeth? Why would we possibly wanna be doing that? So, for us, it was very much a decision about who we are and what we stand for. But even any private sector entity, any employer cares about the people in their organization, and I think the same argument can be made, specially given that we didn’t lose money. We worried, I know, our chief financial officer was very worried that we were gonna lose money on beverage sales, but the reality is everybody’s gonna drink something. When you go in to buy your sandwich at lunch, you’re gonna buy a drink, so, and this has been born out in the studies where they taxed soda, in Berkeley and in Mexico. Sugary beverage sales go down, bottled water consumption goes up, it’s as simple as that, because people are gonna drink something, it’s habitual, you’re used to it. And I’ve talked to many crowds around UCSF, giving guest lectures, and grand rounds, and so forth, and I’ll ask, how many people noticed that we stopped selling sugary beverages? And a substantial number of people will not raise their hands ’cause it’s subtle enough, you know, it’s not like you go into a restaurant on campus and there’s nothing to buy. And so, this is, I think, a misnomer that if we aren’t selling sugar and sugared water, people won’t drink anything.
– That just has not been born out in the research. Or in our experience.
– Well, which is even better than that, right, ’cause researches can miss predictions, your experience is gold, right? So, there’s a couple of things here, a cynical person would say effectively this would be bad for your hospital business because within five to 10 years there’s less diabetic complications coming in for the medical business, right?
– That’s a pretty cynical person.
– Right, but that is a full circle thing.
– That we’re not transplanting more livers.
– Right, so the business of medicine is what it is, but I don’t think anyone wants to be transplanting livers, we wanna be talking about epigenetics, we wanna be talking about curing other things.
– Yeah, why would we want, these are preventable diseases, not even hard to prevent. In our current food environment, maybe they are hard to prevent. I think that’s the piece of the story that I think gets obscured in the public discourse. People very quickly jump to this idea, it’s all about nanny state, and government has to tinker in people’s individual choices, but when you really back up and look at the situation you start noticing that somebody is tinkering in our choices and it’s not government, it’s food companies that wanna sell us hyperpalatable foods, that are habit-forming, they’re competing for shelf space, they’re competing to make it eye level, they’re competing to market it and push it on our kids, and they’re not pushing broccoli, right? They’re not aggressively trying to get our kids hooked on apples.
– They’re not addictive.
– That’s important to notice. That is constraining our choices. That’s what I call limited choices, when you can’t, when 84% of the stuff in your grocery stores has sugar added to it, you have a very small limited set of choices in terms of what you’re gonna buy. And I don’t think, personally, why should I, as a consumer, have to shop around the perimeter, go out of my way to buy something that’s healthy and delicious? Why should I have to do that? Let the companies go through the extra trouble. This whole discussion around choice, to me it’s kinda upside down and backwards. I’m not so sure we’ve got choice, I think my grandmother had better choices over what she ate than I do.
– Well, I mean, the odds are stacked against us, I mean, they have gagillions of dollars in neuroscience, and colors, and smells, and textures, and all sorts of really insidious things that are really stacked against us. I’d like to actually speak to that, before we got on camera here, we were speaking about this little thing that happened in the industry and how there was some kind of bought science that came out again, so I’d love for you to share that, because this is important, to understand that this is what happens.
– Some of the researchers here at UCSF are conducting what we call industry documents research, and UCSF has been the home to the worldwide resource, which is a digital library of documents from tobacco corporations. They’re required to, on a regular basis, to give their internal documents to the UCSF library, where they’re archived, digitized, and put online, so that any member of the public, any journalist, any academic, anybody interested in what’s going on behind the veil of the tobacco industry can look inside and see in their words what they’re up to. And this was part of a master settlement agreement where the tobacco companies got sued and basically agreed to do this, it’s part of the conditions of the settlement. It turns out that there are other sources out there for documents like this and we’ve started to look into food industry documents, food company documents, and try to understand in a similar way how is it that food companies operate to manipulate our choices, do they intentionally try to get us hooked on hyperpalatable foods and so forth. And some of the materials we have are historical and have been very enlightening, we have a pretty sizable cache of documents on the main trade organization for the beet and cane sugar producers currently called The Sugar Association, and these documents go way back into the ’50s. So we can really understand how the trade organizations for the sugar industry have been, what their agenda has been, what they’ve been up to, and a big revelation from this line of research is that they’ve done, historically and currently as well, considerable amount of meddling in the scientific enterprise and even in the funding of federally funded research in the medical field. So the first paper that we published in this area demonstrated that in the 1970s The Sugar Association wrote 78% of the strategic plan for the NIH around dental disease, and this was a strategic plan that steered the course of dental disease for a decade and a half, it very carefully was set up to avoid any mention or any research on dietary sugars. It had scientists in labs trying to find a vaccine to prevent cavities, as opposed to just the simple thing, don’t bathe your teeth in sugar. Like, every mom knows that. But no, we needed a vaccine, right? And so that was the first piece that came out from this archive. A more recent one that just got published towards the end of last year shows that in the mid ’60s The Sugar Association approached a team of elite scientists at Harvard University in the nutrition field, and paid them $50,000 to publish a review paper in The New England Journal of Medicine, which is the most prestigious U.S. medical journal, and the review systematically assessed the evidence that, it asked the question, what causes cardiovascular disease, heart disease?
And the review concluded that the dietary villain was cholesterol and saturated fats, and we need not worry about sugar. This paper came out in The New England Journal in the mid ’60s. Right about 1970, we started to see the anti-fat craze, where the snack-well generation, where we were all eating margarine, not butter, and we were eating cookies that had no fat but were loaded with sugar, and boom, we got this massive obesity epidemic, really the beginning of the obesity epidemic was the early ’70s. And so, this really raises, this line of research really raises some very profound questions about how industry and its trade organizations can and do meddle in science, meddle in federal agencies that are supposed to be neutral and focused on health and health promotion. There was a recent scandal at the Center for Disease Control and Prevention where it was determined that key senior people in the CDC were funded by Coca-Cola and the beverage industries, and were giving them all sorts of information, and trying to steer policy, people got fired a week later, or quit a week later. And so, we’re starting to see the ways in which industry has deeply penetrated the scientific community, scientific enterprise, in order to distort the facts around what’s good for our health, and this is an issue of tremendous concern. Industry will come back and say, we’ve had quite a bit of discussion in the media, in the news media, TV news, and so forth, with spokespeople for The Sugar Association when this paper of ours came out, and they say, “Well, today, we’re all just fine.” Scientists are required to report their scientific conflicts of interest when they publish papers in scientific journals. Ironically, the Harvard scientists who wrote that review in the ’60s in The New England Journal of Medicine and were paid by The Sugar Association to do so did declare scientific conflicts of interest, they declared all of their funders, except one, The Sugar Association. They neglected to point out that they had been funded by The Sugar Association. So, many of us are not convinced that what the public is hearing around nutrition advice is neutral scientific information, a lot of it is tainted.
– Well, listen, I think prostitution is older than medicine as a profession. And so, this is what we’re dealing with, this is what we fight. Let’s get clear about this. You’re at UCSF, you’ve looked at all the literature, your colleagues, there’s a huge board of people here, I’m looking at all these doctors and dentists, and people that are part of this SugarScience understanding, is sugar bad for our health? Right, I mean, come on.
– That’s why UCSF decided to sponsor the SugarScience initiative. There was just a need to get scientists together who don’t have scientific conflicts of interest, who have never taken money from any vested interest. A scientific conflict of interest is when somebody who paid me has a financial stake in the outcomes of my research, in what I conclude in my research. And so, UCSF organized about a dozen scientists who have no conflicts of interest to review the body of literature around specific disease outcomes and sugar consumption, and to report in a pretty user friendly way what is our conclusion. Is there a link between sugar consumption and diabetes? Yes or no? Industry denies it, the Dietary Guidelines Committee that is organized by the U.S. government, they say there is a connection. Who am I to believe? And so, SugarScience is a resource, a public education resource sponsored by UCSF, sugarscience.org, where people can go and get information that’s been looked at for conflicts of interest, as well as the robustness of the evidence, do we have a substantial amount of evidence to say yes, sugary beverage consumption leads to obesity. Remarkably, the beverage industry continues to deny that sugary beverages cause weight gain or obesity. And they fund scientists to draw this conclusion as well and try to get it published in the peer-reviewed literature. So, there’s a need for somebody to kinda cut through all that discussion and say, look, we’re independent scientists and we looked at the literature and here’s what we think.
– Yeah, I mean, look, we might be looking at an era where shortly you can only buy these sugary beverages at liquor stores, parts of restaurants where you can go drink this stuff, I don’t know. Look, people can decide for themselves, and I understand this whole thing about big government, I get it, but the odds are stacked against us, these are addictive substances, they’re not playing fair. Children in particular being exposed to things that it’s really hard to undo, specially if they’ve already gone to diabetes. I know we got a couple of questions from our audience, and I wanna make sure that we honor that, so I’m gonna kick over to Sean over here.
– The Sean cam, hi. M. K. said that she hears the liver is one most resilient organs in our body, so, does mineral consumption and absorption aid the liver recovery alongside getting rid of fructose and stopping the drink?
– Mineral absorption?
– And consumption, yeah, did you hear all that?
– Yeah, I did, I think the question is about if I stop drinking sugary beverages and I cut back on my sugar consumption, keep it within 10% of daily calories, which is the current limit, it’s not like the committees that set dietary guidelines are saying don’t have any added sugar, it’s just keep it within a limit. For women we say 60 spoons a day or less, for men 90 spoons a day or less, which is, when you think about it, that’s a lot of sugar. If you were to add it to a glass of water, 60 spoons would make it taste pretty darn sweet. Essentially, you use up your bank account of sugar as a man, by just drinking one soda. So that gives you a feeling for how much sugar is in there. But one of the remarkable things, in answer to the viewer’s question, about the liver is that it heals, as long as you’re not into full blown what we call NASH or cirrhosis, where there’s tremendous scarring, the liver has a remarkable capacity to regenerate, unlike some organs in our bodies. And so, liver damage, as long as it’s not too far along, is reversible. For a person who has had a liver scan and knows they have NAFLD, the most important thing would be to reduce or cut out all trans fats and added sugars, that’s gonna give your liver a breather and a chance to regenerate and, in fact, one of the cutting edge surgeries that we do here at UCSF is what they call a partial liver transplant, where a surgeon will take a healthy donor’s portion of their liver and put it into a person with a failed liver and the liver just regenerates very quickly–
– In both people?
– In both people, the donor, literally, very quickly. And so, it’s a remarkable organ that way. It’s probably not so true for the pancreas, and for people who have developed insulin resistance. But for the liver aspect of what sugar does to our bodies, we’re really lucky to be able to reverse that damage. Anyone who’s overweight or obese, anyone who eats a poor diet, eats a lot of processed junk food, is very much at risk for some degree of fatty liver and should be just like someone who’s drinking too much. More than one drink a day for women, more than two for men, you’re putting your liver at risk, and so reducing that is a really smart idea.
– And taking minerals or anything else for regenerative support, I mean, I’m not sure wh–
– I’m not a nutritionist and I wouldn’t wanna speak to that. I know that the liver stores vitamin D, you’d need to speak to a nutritionist about what about minerals.
– Cool, cool. You got one more, Sean?
– Got one more, yeah. So, besides sugary drinks, after that, what’s the next thing that we should get rid of?
– Okay, so, assuming we’ve gotten rid of sugary drinks, what’s the next run, what’s the next thing to get rid of that’s causing some of these problems?
– For an individual?
– For an individual. Okay, so I quit soda, and now how can I even do better?
– Oh, if you quit soda, you have done a remarkable favor to your body. Sugary beverages are about 36% of the total added sugar consumed in the American diet. So, that’s why the public health community is so focused around this, one of the reasons why the public health community is advising the public to cut down on those sugary drinks. So you have done yourself an enormous favor. Diet drinks have somewhat questionable scientific track record. There’s some evidence that diet drinks’ saccharin, sucralose, these artificial sweeteners actually are not the best long-term substitute for added sugars, that they actually, ironically, produce weight gain, and a condition called glucose intolerance, which is very closely related to insulin resistance, namely diabetes. And the mechanism scientists think is associated with these, and I know this is bad news, because a lot of people who have worked so hard to get off the sugar, they use the diet drinks as a substitute, and while that’s a great thing to do on a short-term basis, because your palate has just been sensitized to hyper sweet stuff, and you can titrate off of the sugar that way, probably best to let go of the diet drinks if you can, or at least not drink them in heavy doses, because of this evidence, there’s still controversy in the field around this, but there’s some pretty compelling studies of animals, as well as humans that suggest that the artificial sweeteners are damaging, lead to weight gain and glucose intolerance. The mechanism is what we call the microbiome, the healthy gut bacteria that is essential to good health, immunity, and turns out that what the scientists think is true is that these artificial sweeteners actually damage those healthy bacteria, and that microbiome is supportive of our health in very profound impactful ways, and so, our diet is very directly associated with the health of the microbiome. So, if you can, what we recommend, is to titrate yourself off. A good strategy, whether it’s a sugary drink or a diet drink, is to just start mixing half and half fizzy water with the drink, get yourself used to a lower dose and get to the point where you’re adding fresh fruit, rather add lemon, rather. The sweet stuff, or the artificially sweetened stuff, and I swear to you, if you do that, you will take one little sip of a soda and you’ll go ugh! Or you’ll drink a diet and you’ll go, gosh, that tastes terrible. You will not believe what a difference it makes. Our palates in America have just become just sensitized to the sweet factor, and if you cut the stuff out of our diet, and your kids’ diet, it’s remarkable when you realize how sweet many of these foods and beverages are.
– Yeah, and to know how far off we’ve gone. I got one follow-up question, we’re almost out of time, but it’s an important one, because I’ve also heard a lot of people that lean in to this too much and say, oh, you say fructose is bad for fatty liver, therefore, don’t eat any fruit, right? And I’ve seen people take this kinda step, and go into some of these kinda excessive conversations. I’d love to hear your opinion on that.
– Thanks for bringing that up, because it’s always hard, and specially with nutrition, when you’re trying to communicate to the public, it’s really easy for the message to get distorted or lost, and we’re talking about pretty subtle aspects of diet and nutrition, and what we know scientifically. The evidence on fruit is overwhelmingly positive, fresh fruit, whole fruit, not even in a smoothie, whole fruit, chewed, is the way to eat it, and the reason is because it’s gonna take you a long time to chew through the number of apples that will wind up in an apple juice, or in a smoothie, and the sugars in the fructose remains often, the hypothesis the David Ludwig has put forward, he’s at Harvard, a nutrition scientist, is that, it may even be that some of that fructose stays inside the membrane of the plant cell, and passes through our system through the small intestine, it doesn’t even get absorbed. And so, when that fructose comes in fiber, with a lot of fiber, in the plant membrane, chewed in our mouths, it slowly goes through our system, and comes packaged with vital nutrients, nutrients that we don’t even have names for, we don’t even know how many nutrients there are that make plants colorful, and tasty, and flavorful, and smell beautiful, those are all healthy nutrients that can serve to fight metabolic disease. And so, if you look at the cohort studies and long-term trials, people who eat fruit tend to have lower risk for cardiovascular disease later in life, and controlling on other factors. So there’s very good evidence that fruit is heart healthy, and probably a lot of it has to do with the fiber and the micronutrients that come contained in the fruit. And the fructose, that fiber is gonna slow down the speed in which the body is gonna metabolize the fructose, and so it’s not like slamming your liver with a 28-ounce Gatorade, it’s slowly, it’s a wonderful source of these other nutrients as well.
– But I’m only gonna drink organic Gatorade, so I’m fine.
– There is an organic Gatorade now.
– Of course there is.
– This is the latest.
– Yeah, and it’s less sugar, yeah, gluten free cookies, and organic Gatorade, problem solved, right? It’s just this waving of the wand, it’s just words.
– I call it organic junk. And it’s a new market, right? Because for every action there’s an opposite and equal reaction. And so, our population, because of getting the word out there, all these public health officials and dietary committee saying, “People, stop drinking the sugary drinks, “they’re not good for you,” we’ve seen a 25% decline in soda consumption since its peak in the late ’90s. And so what are these companies gonna do? They’re gonna make organic Gatorade, they’re gonna turn it into a marketing opportunity. We have to be smarter than that, and we have to realize that just because it says organic, or healthy on the label, they can put whatever they want on the front of that package, we don’t have laws that require them, I mean, there have been some lawsuits around some of these extreme claims, but the front of packaging labeling is poorly regulated, and so, don’t believe what’s on the front of the package, turn it around and look at the label, and if you’re a woman, and it’s got 28 grams of sugar in it, that’s your total daily dose. And so, think about 25 grams, 38 for a man. It’s very important to turn that package around, and just ’cause it says organic doesn’t mean anything.
– Amen. Doc, thank you so much. The website is called sugarscience.org. I love the work that you’re doing, I encourage anyone who is in a university, school, any organization to kinda follow this step that UCSF has taken, and look, the market will drive the change, you know, at the end of the day, no one’s got a gun to your head saying buy this bottle of Coca-Cola, so, as a consumer, you gotta make decisions too, and so, the ecosystem at UCSF makes it way more conducive to do so, and so we can work together with businesses to do it. I wanna thank you for being on the show, any other questions we’ll get in the chat thread, and we’ll forward them over to you. Thank you for being here, let me know what you think, I’ll see you on the next episode
– [Laura] Thank you.