With prosecutorial zeal, he picked apart the sugar industry's contention that its product is harmless.
Lustig quoted Paul van der Velpen, head of Amsterdam’s health service, who wants to see sugar closely regulated and has said that sugar is addictive and the most dangerous drug of the times.
“That’s a public health official in the Netherlands,” Lustig said. “And they know something about drugs.”
He criticized the “Coming Together” campaign by the Coca-Cola Co., which was launched last year to fight obesity. It maintains that all calories count and that they’re interchangeable.
“(But) what the data say is that some calories cause disease more than others because different calories are metabolized differently in our bodies,” Lustig said. “Where they come from has everything to do with where they go. It’s called nutritional biochemistry.”
In other words, a calorie is not a calorie, he said. It’s true that a calorie burned is a calorie burned. But a calorie eaten is not a calorie eaten.
“Does sugar cause weight gain? Yes. Is sugar a cause of obesity in some? Likely. Is sugar the cause of obesity? Not even close,” said Lustig, who mentioned a study showing it comes in third behind French fries and potato chips.
Then why pick on sugar, he asked, if it’s just another source of empty calories? “That’s the question,” he said. “And I’ll tell you: Who cares? Because obesity is not the problem. It never was. It’s what the food industry wants you to believe is the problem.”
People don’t die of obesity, Lustig said. Instead, they die of the diseases associated with metabolic syndrome, a cluster of factors elevating the risk of cardiovascular ailments and other health problems, especially diabetes.
“That’s where the money goes: $2.7 trillion spent on health care in America last year, 75 percent for chronic metabolic diseases – and 75 percent of (those) are preventable,” he said.
Lustig, director of the Weight Assessment for Teen and Child Health (WATCH) program at UCSF, said diabetes is increasing worldwide by 4 percent a year while obesity is rising 1 percent. They are not the same, he emphasized. Iceland and Mongolia, for example, have high obesity rates but not much diabetes, while India and China are the reverse.
A study he co-authored that was published last year asked a central question: What about the world’s diet is making diabetes increase over time? The researchers found that only changes in sugar availability predicted changes in the prevalence of diabetes. Total calories did not. For every 150 extra calories eaten worldwide, diabetes prevalence went up 0.1 percent – but it jumped eleven-fold if those calories happened to be in a can of soda.
“Sugar is not bad because it’s calories,” Lustig said. “Sugar is bad because it’s sugar.”
Whenever a country changed its sugar consumption, the rate of diabetes changed three years later. Cross-sectional studies don’t see that because it takes three years. “But it happens – in both directions. Proof positive: Causation,” said Lustig, author of "Fat Chance: Beating the Odds Against Suger, Processed Food, Obesity, and Disease," a New York Times best-seller.
Sugar and alcohol are metabolized in the same way, he said, and now children are getting the diseases associated with alcoholism. According to the American Heart Association, people in the United States are consuming on average 22 teaspoons of added sugar a day.
“We’re supposed to reduce that to nine for males, six for females and four teaspoons for children,” Lustig said. But there are more than nine teaspoons in a 12-ounce bottle of Coke.
“Can our toxic food environment be changed without some sort of societal intervention, especially if there are potentially addictive substances involved?” Lustig asked. “... And can we afford to wait to enact those public health measures when health care will be bankrupt due to chronic metabolic disease? Medicare will be broke by the year 2026 if we do nothing.”
He said public health prevention is the best approach. “It’s radical, it’s powerful and it always works,” Lustig said. “And the reason it works is because it changes the environment, not the behavior.”
There are three ways to do it: taxation, restriction of access or interdiction, which he said is just not feasible.
“It didn’t work for alcohol," Lustig said. "We’re not going to have ice cream soda speakeasies."
What to do and how to do it is a question that will be debated in the coming weeks both in Berkeley and San Francisco, where Measure E, a soda tax, is also on the ballot.
Lustig rested his case with a reference to Credit Suisse, an international financial services company that published a research report for its investors in September 2013. It’s called “Sugar: Consumption at a crossroads.”
“We believe higher taxation on ‘sugary’ food and drinks would be the best option to reduce sugar intake and help fund the fast-growing healthcare costs associated with diabetes Type II and obesity,” the report said on Page 26.
“A global investment bank calling for taxation,” Lustig concluded. “Because that’s how big and bad this problem has gotten.”
Pat Crawford, director of the Atkins Center for Weight & Health at UC Berkeley, mentioned one successful public health approach. In September 2005, Gov. Arnold Schwarzenegger signed legislation banning the sale of junk food and soft drinks in the state’s public schools.
“We’ve been measuring kids’ diets and we can see the changes in the diets,” Crawford said, speaking of the center’s work. “... But the fact is it’s not enough. ... We need other kinds of approaches that will do the same thing.”
Half of all added sugar in the nation's food supply comes from sugar-sweetened beverages, she said, and that doesn't include fruit juice.
Dr. John Swartzberg, chair of the editorial board of the UC Berkeley Wellness Letter, said cigarette smoking was the big problem in this country during the 25 years he practiced internal medicine in Berkeley. If trends continue, he said, deaths related to obesity will soon overtake those caused by smoking as the No. 1 preventable cause of death. Currently, 34 percent of adults in the United States are obese.
He said American adults get about 13 percent of their daily calories from added sugar -- and sugar-sweetened beverages are by far the biggest source. These SSBs account for about 16 percent of the total caloric intake nationwide of children and adolescents -- consumption among young people has skyrocketed 300 percent in the past two decades.
In Alameda County, more than half of all adults and one-third of all school-age children are overweight or obese, Swartzberg said. About a third of children ages 2 to 11, and almost two-thirds of adolescents in the county, drink more than one sugar-sweetened beverage a day.
The statistics were grim and, by the end of his talk, Swartzberg had broadened the bad news from the local and national level to beyond.
“Worldwide today there are an estimated 382 million people with diabetes,” he said. “We’ve essentially exported our diet to other countries,” including those where the prevalence of the disease was low.
In the United States, as many as one in three Americans could have diabetes by 2050 -- “an amazing number of people,” Swartzberg said.
Another speaker, Dr. June Tester, co-director of the Healthy Hearts program at Children’s Hospital Oakland, said she went into pediatrics because she didn’t want to nag people to take their blood pressure medications or watch their blood sugar levels.
“Oddly, that’s actually what I do,” Tester said.
She said parents are frequently shocked at how much of a jump-start their children have on adult diseases.
“If I had only 30 seconds of your time, the one thing I would talk to you about is what your child drinks,” said Tester, who stressed that sugar-sweetened beverages and sodas are the most important things to cut out.
She mentioned one success story: a boy from Tracy named Jorge Cota, who was interviewed by KQED’s Mina Kim two years ago when he was 17. The year before, his blood pressure was so high that Tester had sent him home with blood pressure medication the very day she’d met him. During that visit, when he weighed 321 pounds, he learned that he was a pre-diabetic and that there might be something wrong with his heart or kidneys.
He loved Dr. Pepper and drank two or three cans or bottles of soda a day, equivalent to as many as 50 teaspoons of sugar. After eliminating sugar-sweetened beverages and junk food, he lost 70 pounds.
Tester said most kids who are overweight or obese have heard the message that sugary drinks are problematic, but it’s a way of daily life for so many of them -- and it’s hard to compete with advertising, which taps into the social aspect of soda consumption.
She showed a Coke ad that featured dogs and dancing. “It’s pretty hard to be a do-gooder when you’re battling fun and love and friendship,” she said.
Unintentional sabotage also plays a role. Even children whose parents never buy soda get it at parties or friends’ houses or while visiting relatives.
“In a way, this is kind of like secondhand soda exposure,” Tester said, as the audience laughed.
She also mentioned that some of her patients put sugar on Fruit Loops cereal because they don't think it's sweet enough.
Measure D calls for soda distributors to pay a tax of a penny per ounce. They should be so lucky, Tester said. “Why does Coke get to fund feel-good stuff?” she asked. Instead, she suggested the company pay for the next 45-year-old man who has a liver transplant.
No on D proponents disagree with the sugar tax for several reasons. They say that there are too many arbitrary exemptions, that there's no accountability for how the money would be spent, that it's inconsistent and that it would make all of our food more expensive.
The next conversation in "Soda: the Series" takes place this Saturday. It's titled "Soda & Kids: A Predatory Relationship & How We Can Fight Back." Judging by the inaugural event, it will draw a big crowd and plenty of questions.