Dr. Robert Lustig The Hacking of the American Mind at the San Francisco Public Library

okay, thanks, I'm just the messenger Jill. Thank you, Jana, thank you for that kind introduction, thank you for inviting me. I also want to thank Melissa Riley, who works at the West Portal branch of Yes, uh, very our, this appeal for suggesting that. We're having this discussion tonight and I have to tell you that I love that it's a

public

library

and you should too, and the reason I love it is because they have fiction and nonfiction, but there's one thing they don't have. fake news that is fiction masquerading as non-fiction, but tonight we are going to talk about the fourth group which is non-fiction masquerading as fiction and what I am going to argue is that you are all trapped in the matrix, a fictional Assembly of things that you don't know have been hidden from you and I'm going to try to expose them over the course of the next hour and a half to have some revelations.

I wrote these two books one that we're Talking about tonight, I'm the scientific director of this nonprofit called Eat Real, which certifies restaurants, hospital cafeterias, schools that serve real food with the idea that by making an effort From the bottom up, we can teach people what real food is and try to process it. foods of our lives because that's where the big problem is and I'm also the medical director of a for-profit company called Slendy that is developing specific products to try to mitigate the metabolic risks associated with processed foods because, by far I would like Just like processed foods are never going to go away because there's just too much money involved, but as long as health is at stake we have to do something to try to mitigate it, we have some ideas about how we could do it and so that's a company for-profit and you know, wait for that, okay, those are my revelations, so I have a very modest agenda tonight, I hope that at the end of the night we solve the health care crisis, we solve the social security crisis, let's solve the opioid crisis solve the depression crisis that no one talks about and make America happy again okay so we'll start here let's start with healthcare anyone knows this guy anyone's seen him before that's right , Ezekiel Emanuel, brother of Rahm Emanuel, mayor of Chicago, I'm sorry.

I don't know that he's at the University of Pennsylvania, he's a bioethicist and hematologist oncologist and he's also the architect of Obamacare, that's right, he wrote this article in the Atlantic three years ago, why I hope to die at 75, because he had to justify why. . Obamacare now, to be honest with you, if you read this article, it's pretty horrible and the reason it's horrible is because it misses the whole point, not once in the entire article is the word diet mentioned, we're going to spend a lot of time on that. . As we go through this, I hope I don't die at 75.

I hope to die much later and I hope to be much healthier than our current 75 years and the reason is because I think I understand what's going on and I'm going to try to convey that to you this night, so the question on our

mind

s is: Did Obamacare deliver? Sorry, bring it closer, oh, okay, because it's better. Well, Obamacare delivered, so Obamacare promised to put thirty-two million sick people on the rolls and believe it or not, it's still the law of the land, although the individual mandate no longer exists, which is going to create major problems.

The point is that President Obama told us that we could pay for this by providing preventive services, that is, by making health care accessible to everyone. to your doctor that we could keep people healthier and out of the emergency room where the costs are fifty times higher, that's the idea, that's why cartoons like this are created, the government can't force me to buy health insurance , why should I do it when I can go here? and you will pay for it and now that we have lost the individual mandate because of the tax reform bill we will actually be paying for it, okay, we will be paying for it because now you won't pay for it, so Worse yet, here is the Obamacare fallacy: In fact, we didn't keep anyone out of the emergency room.

There has been a real increase in emergency room visits to the point where health care plans had to increase their premiums by more than 25 percent and three of the insurers left the exchanges entirely Aetna Humana and United, which which of course led to the 2016 election. I think everyone remembers that that wasn't that long ago. In fact, if you look at what's happening in terms of dollar amounts, it's been huge. an increase of 100 billion dollars a year in just four years for diabetes alone, regardless of everything else, and 75% of all dollars spent on health care in this country are for chronic metabolic diseases, so You can see this is breaking the bank and if these people don't even have to pay for the individual mandate, how the hell are we going to be able to provide core health care that doesn't actually exist but actually exists?

Ultimately, he says this because this is Nik Mulvaney, director of OMB, who says you have diabetes. The fault is that you brought it on yourself, there is no medical care for you like Nazi soup. The point is that this is based on two uncomfortable truths that no one wants to say, but I'm going to terrify them. The first is that there is no medicalized prevention for chronic diseases. metabolic disease there is only treatment there is treatment for hypertension there is treatment for high lipids there is treatment for heart disease there is treatment for type 2 diabetes but there is no prevention no one talks about what is needed to prevent these diseases and until we prevent them we will not We can let you this is a meta-analysis of type 2 diabetes prevention strategies that came out about a month, two months ago, okay, and if you look at the diamond here, it's to the left of the identity line, which means which is statistically significant, these prevention strategies work, whether it's lifestyle or medications, here's the problem, here's the relative risk for lifestyle, here's the relative risk for medications, so you say, Well, that's good, these things work, but here's the real problem, the number needed to deal.

The NNT, which is what is really important, 25 must be invoked to treat or prevent 25 different people in order to prevent one of them from developing diabetes and currently we have a diabetes rate of nine point four percent and a 40 percent pre-diabetes rate. diabetes in this country, if we have a number needed to treat of 25 for these strategies, we are never going to catch up, that's what it comes down to, regardless of whether these things work or not, we can't do it in the second The inconvenient truth is that You can't fix healthcare until you fix health and you can't fix health until you fix diet and you can't figure out diet until you know what the hell is wrong and that's where I came in, what the hell is wrong So here's what that we thought was wrong.

Everyone remember this 1984. It's all about dietary fat. All about cholesterol. what happened instead this is the unintended consequence and this was in 2001 now it's 2018 and it's 20 times worse here's the fiction it's on this slide any of you watch football ok about five years ago this was at every football match every telecast one of the Coca Cola commercials, a two-minute video called "Coming Together" and this is a direct quote from that video and it said: leading on obesity, we will all take action based on a simple common sense fact: all Calories count, no matter where they come from. of including Coca Cola and everything else with direct calorie quote, so as far as they are concerned, you can get your calories from carrots or you can get your calories from cheesecake, you can get your calories from coke or You can get your calories from kumquats.

That's because it is the first law of thermodynamics that says that energy cannot be created or destroyed, simply changed, which in human terms means energy balance, therefore, it is about calories in, calories burned, therefore , it's all about diet and exercise, so if you're fat it's your fault because these are two behaviors that you're presumably in charge of yourself, so any calorie can be part of a balanced diet, so so much, don't mess with our calories, choose someone else's calories, oh that comes from this simple mantra that a calorie is a calorie and after all, it is a law of common sense I don't believe in common sense I believe in science I believe in data at ucsf we have a motto In God We Trust everyone else has to produce data that is called truth instead of post-truth which is what we have now and who has been saying calories calories .

Well, these guys are familiar with all of them, they control 90% of the world's food, 90%, so they'll tell you it's about calories, it's about obesity, you get fat. you get sick you get fat because you are glutton and lazy or your fault is what they say so the question is if its true what do you think science says? On this slide we have a country with obesity prevalence in the form of a scatter diagram. by country on the x-axis and diabetes prevalence country by country on the y-axis and if you looked at this scatter plot, it would say very clearly dr.

Lustig, clearly there is a correlation and there it is and in fact there is a correlation and I do not maintain that this correlation, the correlation is not concordance, they are not the same because we have countries that are obese without being diabetic, like Iceland, Mongolia. Micronesia, we also have countries that are diabetic without being obese, such as India, Pakistan and China. India and China today have a diet rate of 11%. We, the fattest nation in the world, have a 9.4% diabetes rate if it comes to obesity. How come non-obese countries? we have more diabetes than us first problem second problem obesity is increasing worldwide at an annualized amortization rate of two point seven eight percent per year for the last 40 years, yet diabetes is increasing at an annualized amortization rate four point zero percent annually for Those same years, if diabetes is only a subset of the larger subgroup of obese people, how can the fact that diabetes rates are increasing faster be explained?

Well, you can't because maybe it's not true and finally here's another piece of information. from JAMA and is looking at the secular trend over time in diabetes cases in the United States here's the total here and first we'll look at the right side here, okay, here's the rate of increase in the obese population, an increase of 25%. in incidents per year within the obese population, however, there has also been a 25% increase in incidence in the normal weight population. If diabetes really has to do with obesity, how is it possible that people of normal weight develop it as quickly?

Problem number three, this doesn't count. So this is the most important thing I'm going to tell you tonight. Here we have a Venn diagram of the entire US adult population, okay, 240 million total, 30 percent obese in this circle, that's 72 million, 70 percent normal weight, 168 million mutually exclusive circles for all. I understood that everyone in this in one of the two circles, they understood well, okay, BMI over 30, BMI under 30, everyone is in one of them, so here's the problem: the medical profession, the dietetic profession, The Institute of Medicine, the National Institutes of Health, the Surgeon General, the White House Congress and the food industry say that Opie's followers 80% of people 80% of people with a BMI over 30 these 57 million people are sick they are fat and they are sick and they are sick because you are fat and if they only dieted and exercised we could solve this problem that's what they say total garbage complete garbage everyone but me why is it garbage it's on the slide well, it's true that 80% of the 30% are metabolically not I don't dispute that, but that means that 20% or not, 20% are obese and healthy, we actually have a name for them, H Oh, metabolically healthy obese, the We study to try to find out why they didn't get it, they will live. a completely normal life died at a completely normal age it didn't cost the taxpayer a cent it's not the problem with Obamacare they're just fat the other way around and this is the important part 7 40% of the population with normal weight 40% of the 70% have exactly the same weight the same diseases for exactly the same reason that the obese are simply not obese they have type 2 diabetes they have hypertension they have lipid problems they have cardiovascular diseases they receive a response they also have dementia now they do not have it in the same prevalence, eighty percent versus forty percent, so obesity is undoubtedly a risk factor.

I am not arguing that if you are obese, you are much more likely to get sick than if you are of normal weight. I do not maintain that that is true. but it turns out when you do the math, there are actually more sick thin people than sick fat people and these are the ones who say it's their problem and when you do the math overall, it's more than half of the US.treat it. and in fact they have done it all over the world this was in the New York Times about how big companies got Brazil hooked on junk food all about Nestlé and these promoters going to these favelas that sell Nestlé products how about the little box not happy? very happy, okay, 1.5 billion toys around the world, okay, and there they are.

Oh, Disney stopped selling it in 2006, to their credit. The good news is that fewer happy meals are being sold. The bad news is that kids ordering off the dollar menu instead isn't much of a profit. Okay, and the toy thing, you know, we have a toy ban here in San Francisco. You have to pay a penny for the toy. You know it's not free there with the Happy Meal. Ok, after San Francisco instituted a three-state toy ban. banned boy bands oh yeah, later how about happy hour? You know it's five o'clock somewhere, you know where five o'clock is, it's five to ten on NBC, why do you think alcohol abuse has increased eighty-three points? seven percent in older women because they've been told it's okay, so and this is particularly pernicious because Hoda is a breast cancer survivor and alcohol leads to breast cancer.

An article appeared in Nature yesterday showing how Red Bull works, so my question is If you're drinking Red Bull at midnight in South Central Los Angeles at a convenience store, how happy are you and will that only cause you to lose sleep? , which will only make you more unhappy, that's called product placement, people that's on purpose. By accident, how about this? Let's add some stress. We think it's stress. Will be ready? Men, don't be ready because you know your name may be mentioned on network television tonight. How about more stress? How about lack of sleep? Let's go well, we understood that and the technology that causes lack of sleep.

Let's look a little more closely at this. Everyone check out this article that came out on Axios from Facebook co-founder Sean Parker. We built Facebook to exploit it. In fact, he says very specifically that it exploits a vulnerability. In human psychology we need to give you a little dose of dopamine from time to time because someone liked or commented on a photo or a post or whatever on purpose and I'll show it to you who uses Gmail here Gmail quite a bit. Some of you have ever noticed that when you open your mail, new emails take about one and a half to two seconds to complete.

They think Google is just slow, it's designed to give you dopamine. Take advantage of the anticipation so you can check it again and check it and check it some more now. I'm not saying all technology is bad, like who here uses their GPS? Has he ever saved your life? Save mine, okay? Checking it because it's the same every time you check it, you need a variable reward, it has to be different every time and lord knows the emails and likes are different every time and that's on purpose, in fact I think There's a company actually called dopamine dot-com. dopamine makes your app addictive, they will actually program the app you create to be addictive and there is a four step cycle to addiction.

This is from the Near Isles book. He's an Internet entrepreneur in the valley named Hooked. How to market habit formation. products and it has four parts: the first is called the trigger or the itch, so to speak, it has to be an acceptable itch in society, such as the email that goes off in your pocket, leading to action which is the proverbial scratch that is like checking your email, which is currently still socially acceptable. I think it shouldn't be okay for it to be done behind closed doors. In fact, if you text and walk around Honolulu, you're going to get a ticket now, which I think is really cool, we should do it.

Across the country, the third is a variable reward, so it can't be the same every time. Well, your likes, your emails, you know it's got to be something good, something bad, like overstock or Groupon, they're addictive on purpose because you're giving them something and they're actually adding to the stress, do it now or it'll go away. What about the airlines? How many of you have purchased rates online only to find that when you return ten minutes after you actually checked with your family that the price went up, you think it was by accident and finally, the only one who cares about the investment, you had than spending a thousand dollars on a new iPhone, in fact, we know this because we have done the studies now.

Mark Zuckerberg says, well, yes, Facebook is addictive, but it's only addictive for depressed people, depressed people or the problem, okay, so correlational studies show that depressed people use Facebook more than people who are not depressed , which is true. True, but that's correlation, not causation. In order to causality, you have to do time lag studies. Well, we made them and here they are fine. In fact, if you are depressed, yes, moment by moment, and in the long term, you are going to diminish your life. satisfaction and emotional well-being if you started out depressed, but even if you're not, you still aren't to the same degree.

This is the chi-square value, okay, but it's still very significant that everyone gets more depressed on Facebook. The whole world gets more depressed on Facebook this is not a good thing it is a bad thing something very bad and it is very bad for our children who are the ones who are committing suicide that is why in fact just two days ago iPhones and children are toxic A couple tells Big Apple investors, Jana Partners, the California Retirement System and the Zuckerberg dilemma, when Facebook's success is bad for society, in fact, anyone knows who this guy's name is, Tristan Harris, and he's a former exact ghoul who left the company because Google was actually creating addiction in their products like Gmail and he knew it and now he runs what he called a non-profit called time well spent and he's going to be one of the keynote speakers and I will be the other keynote speaker at a meeting in Washington in two weeks. now about technology addiction Jean Twenge at UC San Diego wrote a book called ijen about this whole phenomenon and wrote this article in the Atlantic: Have Smartphones Destroyed a Generation?

In fact, they have and Common Sense Media and Kaiser are sponsoring this technology addiction seminar-workshop in DC. and Cory Booker will be there, as will Katie Couric, so here we are, Tec, processed foods, sugar, sleep deprivation medications, all the things that have happened to our society, except they didn't just happen, they were designed for them to happen. not by accident driving addiction and depression consuming health care destroying social security and at the root of America's opioid and depression crises, so what can we do about it? Okay, so the reward is not satisfaction and the pleasure is not happiness, the reward is dopamine, satisfaction from chronic excess of serotonin. reward interferes with satisfaction stress drives reward at the expense of satisfaction and businesses have intentionally conflated those two terms pleasure and happiness to make you think they mean the same thing because that's how they get you to buy their junk, you're not happy, you need this and you actually need more, Marco Zuckerberg when he was faced with this, you know, he said that the cure for Facebook was for Facebook to engage in hedonistic behaviors that are profitable for them, not for you.

Government legislation and Supreme Court decisions have actually made it easier. buy that crap and engage in those behaviors and pull out those slides, otherwise we'd be here for three hours. Individuals in society have become fat, sick, stupid, broke, addicted, depressed and decidedly unhappy, so what can we do about it? Well, there are some things that you yourself, sitting in that chair right now, can do for yourself. They are called the four C's, they are all evidence-based, they are all clinically proven to work, they all increase your serotonin, they reduce your dopamine and they reduce your cortisol.

Or your money back, except none of them cost anything so don't look for a refund and they're all things your mom told you but you forgot while you were coughing up that Coke while texting your best friend. First, connect now, what does that mean? connect that means face to face face to face connection that's what that means why it has to be in person reason why you have a set of neurons in the head of the back ear called mirror neurons and what those mirror neurons are What they do It is reading the facial expressions of the person you are talking to in real time and translating them into a movement so that you end up adopting the emotions of the person you are talking to.

Paul Ekman, psychologist at UC Berkeley. They went to Papua New Guinea They never saw white people They never saw any people They had the same facial expressions for the same emotions that we do It is integrated into our DNA, so your brain interprets that signal in real time and what it does is it generates a process that increases your serotonin has a name called empathy and if you can't do that you're a psychopath, think about it how about religion turns out that religions are the best way to explain this whole damn thing? It doesn't matter if you believe in religion or not.

It is irrelevant, there are 4,200 religions on the planet. Do you think some of them were right? If any of them were right. There is only one, but every religion on the planet, all 4,200, has one thing. common community a meeting place a place where you see other people well the place where you belong a place where they see you and see you well and that is on purpose because that is serotonin it turns out that what religion is advocating is dopamine the vitriol anger xenophobia jealousy is dopamine and how do we know this we know this because patients with Parkinson's disease have defects in dopamine neurons and there are two parts of the brain that have dopamine neurons, one is the reward center and the another is called a substance that is in charge of gross motor movements, they have problems with both.

We started treating these patients with l-dopa, two precursors of dopamine, to improve them in the early 70s and they improved their motor impairment, which is good and we still do. If we give patients cinnamon for that reason today, that's fine, but what we found was that 20 to 30 percent of the patients became compulsive gamblers or religious fanatics. There's a whole literature on excess dopamine due to pharmacotherapy for Parkinson's disease, so he's the fan. the tree is dopamine the community is serotonin something great when you think about it interpersonal connection face to face that's what you're looking for empathy with social media generates dopamine and worse yet you end up in this thing called an echo chamber Have you heard of it What do you think causes dopamine to get out of control and increase your stress?

Studies show that Facebook use leads to social isolation and depression. Sherry Turkle at MIT, a very famous media watcher, and me. I've totally subscribed to this, she coined the term alone together, that's what we are today alone together, the number two a second, look, contribute now, what does that mean? Outside of yourself, contributing to your IRA is not contributing outside of yourself to others, not for Game Boy Scout. badges are not a contribution filler your bank account is not a contribution lottery winners are not happy those who value financial success get less satisfaction and saving brings more satisfaction than spending a lot and spending money on yourself increases your pleasure it makes you a de facto consumer, that's what we now call the Consumer Price Index, right, we're all consumers, we stop being individuals and now our consumers want us to be consumers, that's what they're doing and that's how we judge it, it's called gross domestic product, GDP, it's based on consumption that's how we measure progress, except it doesn't increase it and that's what spending money on others makes you an individual.

That is called charity and that increases happiness. Can you get happiness from your work? Everyone wants to know the answer is yes, you can, yes you can. See how your work helps others and your boss can see it too, if that is the case you can use your work to be happy. That used to be my job at UCSF, but not everyone has that opportunity, okay, in which case we have methods like altruism and volunteering. philanthropy anything that contributes to the common good will increase your serotonin and reduce your dopamine number three coping now coping means three specific things sleep

mind

fulness and exercise because all of that is exercise for your prefrontal cortex that's what you're doing, you're exercising Sleep deprivation of the prefrontal cortex increases the amygdala and causes the prefrontal cortex to sleep. 35% of adults sleep less than seven hours a night and 23 have clinical insomnia and some of them have obstructive sleep apnea, which makes it even worse andcaffeine reduces sleep. and it increases your dopamine just to make things worse the word of the millennium multitasking if you are not a multitasker you lose your job everyone has to be multitasking today being able to do five things at once turns out that only 2.5 percent of the population can do it we're actually multitaskers, the rest of us are serial single-taskers' he switches from one thing to another very quickly and every time that happens you get a cortisol bomb that makes things worse, but that's what's valued, we've created that thing that screens are the antithesis of sleep partly due to stress and blue light that activates the midbrain.

My colleague Chris Madsen at UC Berkeley showed that children who have their cell phones uncharged in their room sleep 28 minutes less per night than children who charge their cell phones. phone outside his room, you wonder why you think? And smartphone wellness apps have yet to show benefits. 27,000 wellness apps. None of them work because they all provide data, not information. None of them have figured out how to take that. data and use it for something that really helps you mindfulness activates the prefrontal cortex that's why meditation works because you focus on one thing improves metabolic health relieves depression and it turns out that exercises are just as good as SSRIs for relieving depression depression the problem is depressing someone who is depressed exercise, that's the hard part and finally cooking, there's our next president on the cover, why cook, because there are three elements in food that really matter to increase your serotonin, First a trip to fame, the precursor to serotonin, the rarest amino acid in the diet, so what happened? fish, eggs, poultry, not things commonly found in processed foods, okay, so you won't get much if you eat processed foods.

The process was low in tryptophan, low in omega-3 fatty acids, which are anti-inflammatory. Serotonin Boutons in the brain have been shown to have an inflammatory haze around them in omega-3 deficient animals and it goes away when you give them omega-3s, so you improve neurotransmission and then eventually the sugar high. increases your dopamine like crazy, decreases your serotonin, so a diet low in tryptophan, low in omega-3 and high in sugar, which is called processed food. a diet high in tryptophan, high in omega-3 and low in sugar, which is called real food. The problem is that a third of Americans don't know how to cook and don't know how to do it. cook your food industry hostage for the rest of your life and that's where we're good, real food matters and the real food movement is in full swing and companies that don't change will be left in the dust unless they are bought and new companies and we'll see what Amazon does with Whole Foods Campbell Soup broke with the Grocery Manufacturers Association of America on this real food thing, cooking is everything at once, it's about connecting over a meal with your friends or relatives, not with your extended family, that's what it's called.

On Thanksgiving Day, forget that helping to cope because you're aware because you actually have to pay attention and cooking, sitting down, cooking a meal and sharing it with your family is the best thing you can do for yourselves and no one is doing it. , so what can we do socially or professionally, five modest proposals for you to ponder first at UCSF we've gotten rid of soft drinks the healthy drinks initiative at Swedish Hospital in Seattle they've gotten rid of juices and just today the NHS in Great Britain has banned soft drinks and sweet drinks in all hospitals across the United Kingdom today January 9, 2018 Holy shit, and you know why they did that because we did it here at UCSF, they made it proposal number two, let's call it type 2 diabetes , which really is, you know, diabetes is a Greek Egyptian.

The word means siphon, do you know that because you're pissing your guts out all day? You know, let's call it what it is, you have a processed food disease. I think that might make a difference in how people approach it, because that's what it is. proposal number three let's reduce subsidies for all the things that are killing us these are all staple crops it's a legacy of the original 1933 Farm Bill when we had the Dust Bowl in the Depression when we needed storable food we don't need it today Storable food actually they're killing us so people say well that's going to make prices go up like crazy it's not true so this is from UC Berkeley the Gini Foundation farm subsidies and obesity in the United States and they really modeled how what food would look like if you got rid of all food subsidies and it turns out that the only things that would increase are corn and sugar, exactly what we want to increase, in fact, proposal number four is a trusted brand, so that if you see this in a restaurant you will know that whatever they are serving can't kill you, okay, and then the competitors will say wait, we are losing business to people who serve real food, maybe we need to serve real food, this is our non-profit organization that I mentioned at the beginning, eat real. and finally, oh, and by the way, the UCSF cafeteria is actually certified, as is the Boulder Valley School District, we are trying to do that here and finally , number five, let's take sugar off the list generally recognized as safe because it's not safe, it's like alcohol, the reason Children who today suffer from type 2 diabetes and fatty liver disease are because those are alcohol diseases, but kids don't drink alcohol and the reason is that sugar and alcohol are metabolized in exactly the same way in the liver, which causes the fatty liver disease that I showed. you and drive all the chronic metabolic diseases that we know today, in short, we have solved the healthcare crisis, we have solved the social security crisis, we have solved the opioid crisis, we have solved the depression crisis and I hope we have made you happy. came