April 2, 2024 • 35 mins
Many of us are aware that a steady diet of candy, cookies and soda isn’t the best thing for our health, but few know just how dangerous these products can be. Physician and public health expert Dr. Dean Schillinger has witnessed the “absolute explosion” of Type 2 Diabetes in America. Dr. Schillinger is founder of the University of California San Francisco Center for Vulnerable Populations, Professor of Medicine in Residence at UCSF and was featured in the PBS documentary on diabetes, “Blood Sugar Rising.” He believes that sweeping legislative and societal changes are necessary to reverse the ravaging effects of this disease. Dr. Schillinger shares with host Alec Baldwin how corporations knowingly fuel our addiction to sugar, why the disease disproportionately affects vulnerable populations and the most important change you can make to help fight diabetes.
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Speaker 1 (00:02):
This is Alec Baldwin and you're listening to Here's the
Thing from iHeart Radio, a chocolate chip cookie, a bite
of Devil's Food cake, or a gigantic cup filled with
your favorite soda. Sugar is a simple chemical compound, yet
so powerful and so hard to refuse. The traditional advice
(00:24):
about avoiding sugar seems simple put down the doughnut, but
few people know how much the deck is being stacked
against them. Food and beverage corporations spend billions of dollars
to ensure their customers remain addicted to their products, which
has contributed to an epic surge in type two diabetes.
(00:46):
In order to reverse these rising rates, my guest today
believes we need to embrace deep legislative and societal change.
Physician and public health expert, doctor Dean Schillen is a
professor of medicine at the University of California, San Francisco.
He is the co founder of the UCSF Center for
(01:09):
Vulnerable Populations. I was featured in the PBS documentary on
Type two diabetes Blood Sugar Rising. As someone with type
two diabetes, this issue hits close to home for me.
I wanted to begin my conversation with doctor Schillinger, learning
how he went from simply treating individual patients to calling
(01:31):
for a public health war on diabetes.
Speaker 2 (01:35):
I work at San Francisco General Hospital, which is the
city and County of San Francisco's public hospital, which is
for the New Yorkers on the call, sort of like
a small.
Speaker 3 (01:44):
Version of Bellevue.
Speaker 2 (01:46):
And if you had told me thirty years ago that
I was going to become a specialist and expert in
diabetes when I was coming out of medical school, I
would have laughed at you. It was not something that
I was interested in when I was training. And when
I started out as a primary care physician general internest
this Stan Africa General Hospital, I'd say about one out
of fifteen of my patients had type two diabetes. And
(02:07):
now I just think about the clinic that I had
on Monday, one out of two of my patients has
type two diabetes. So in one generation, we have seen
an absolute explosion in type two diabetes in America, and
that can't possibly be managed by endocrinologists. There just aren't
enough of them on the planet. And truth be told,
most of diabetes can be handled by family doctors.
Speaker 3 (02:27):
In general interness but it.
Speaker 2 (02:28):
Has become the proverbial bread and butter of my practice,
and it has also led me to try to combat
the illness not only in the clinic, but also outside
in society, this diobetogenic society, to move the fight sort
of beyond one patient at a time to sort of
the general population.
Speaker 1 (02:47):
Where'd you grow up, where you from originally?
Speaker 3 (02:49):
I'm originally from Buffalo, New York.
Speaker 1 (02:52):
And where did you go unto grad?
Speaker 3 (02:53):
I went to Brown University.
Speaker 1 (02:55):
And where'd you go to medical school?
Speaker 2 (02:57):
University of Pennsylvania in Philadelphia, Which is interesting because the
University of Pennsylvania in Philadelphia was home to the country's
largest public hospital, Philadelphia General. But you know, it lost
a lot of money, as you can imagine, and so
they shut it down just a few years before I
entered the medical school, And so I had never had
exposure to working in a public hospital as a medical student.
(03:18):
And you talk about the high level hospitals that New
York and San Francisco have, and that indeed is true.
But until you've worked in a public hospital, you don't
realize the fact that we really operate in a two
tier medical system, and that a lot of the consequences
of our social ills end up at the door of
public hospitals. So if you're only working in private hospitals
(03:40):
or nonprofit hospitals, you don't see what's really going on
in society until you set foot in a public hospital.
And it's really it's transformative as a clinician. And what
I try I have been trying to do in the
last few decades, has been to share the stories that
I've been witnessed to in the public hospitals to the
general public so we can begin to understand how public
health happens or doesn't happen in this country. And that's
(04:02):
sort of what you saw in Blood Sugar Rising.
Speaker 1 (04:04):
And the fundamental difference between the two is what.
Speaker 2 (04:07):
Well, the fundamental difference between the two is the burden
of disease that we see in low income communities and
people of color far outstrips that which we see in
the private hospital. So the reason that the waiting rooms
are so packed in public hospitals is not just because
we don't have enough doctors and nurses, but because the
demand for healthcare is so logarithmically exponentially higher because of
(04:32):
the burden of disease that comes with poverty. Think about
what it's like to be a poor person working two jobs,
the stress that they have in their daily lives, and
all that is around them in the every corner store,
every advertisement, every billboard is pushing the food that you
appropriately described is causing your diabetes. And it's the same
(04:52):
for people who are poor but really on steroids, no
pun intended.
Speaker 1 (04:57):
Well, what's interesting to me? You know, I'm some and
this is just my belief that when you abuse alcohol,
when you wake up in the morning and you look
at yourself, you don't like what you see. Maybe if
you smoke too much, you know it's wrong. Sugar is
something that is indoctrinated into our lives from day one.
We have appended the consumption of some sugary product with
(05:19):
nearly everything we do. Birthday caicks. You don't have a
birthday salad, you have a birthday cake. Everything has their
designated sweets.
Speaker 2 (05:29):
I mean, the holiday is just that it's a holy
day and we are meant to celebrate it as a
very special and unique day in the year for whatever ritual,
whatever reason, And so the introduction of sweets into that
holiday was a signal, a symbol of the sweetness of
life that we celebrate or whatever the memory is that
(05:49):
we're trying to celebrate. And you're absolutely right that what
the food industry and the hallmark industry has done is
take this natural joy we feel when we consume added
sugar and essentially make it such that every meal now
has to have that endorphin and dopamine rush experience that
(06:13):
we used to only experience two or three times a year.
And what we've learned increasingly from both basic science and
behavioral science, is that added sugar, particularly liquid added sugar
in the form of sugar sweetened beverages.
Speaker 3 (06:26):
Are addictive.
Speaker 2 (06:27):
They have all the characteristics in terms of brain response
that we see with alcohol, cocaine, etc. And I am
not exaggerating when I say this. The cravings, the joy,
the withdrawal, all of these things the food chemists have
learned and have then implemented into marketing strategies and distribution strategies.
(06:49):
And for those who are under stress or depressed or
down and need to pick me up, this is the
perfect drug. And the modern food system has trained, has
formed itself, to deliver high doses of added sugar, particular
liquid sugar on an ongoing basis and we create the
false belief that this is part of our culture, and
(07:10):
I think that it indeed is, but it's based on
a model of addiction and the corporate takeover of the
food system by harnessing the addictive properties of their foods.
It's not a level playing field. Your body has natural
hormones and chemical messages that say my appetite is satisfied,
(07:32):
I'm going to stop eating. But the food chemists have
created foods that do not stimulate the appetite suppressant hormone.
I mean specifically that so that we're being played, so
that you feel that you and your willpower are inadequate
in terms of your question as to when we should
be screened. This is highly controversial, and I can tell
(07:55):
you what I do in my practice and my practices,
I take care of low income people who have a
very high point revalence of type two diabetes. If you
take the average adult who is a person of color
in the United States, there's about a twenty twenty five
percent chance that that person off the street's going.
Speaker 3 (08:09):
To have diabetes at one age.
Speaker 2 (08:11):
That's the average age, so we're talking about in their fifties.
But we see the incidence of diabetes occurring younger and younger,
and particularly in people of color. In fact, we're seeing
it now in children. We're seeing type two diabetes emerge.
If I had said twenty five years ago, I've got
a child with type two by diabetes as supposed to
type one, people would you know, laugh me off the stage.
(08:32):
But now this is this is just an everyday phenomenon,
and the rates of type two diabetes and children of
color has gone up three four fold over the last decade.
Speaker 1 (08:43):
The young man you see in the film who you're
taking care of, the black guy who's going to be
lose his foot, Yeah, Montille, Montille. Now he looks pretty
whippity and pretty lean. So I'm assuming you don't have
to be morbidly obese to qualify for this.
Speaker 2 (08:58):
Correct, That's absolutely true. I think there is a there.
Of course, obesity and high BMI is a risk factor
for the development of type two diabetes. But I have
plenty of patients, particularly young patients, who have type two
diabetes who are not overweight. So yes, he developed diabetes
in his late twenties. He was born in poverty and
(09:21):
raised in poverty, severe food and security. He grew up
eating what he told me were syrup sandwiches, which is
syrup put in between two pieces of wonderbread. For much
of his childhood, his father was incarcerated. He raised himself
and his younger brother, and they would drink you know,
high Sea and the fruit, you know, the powder mixes
(09:41):
of sugar, sweet and beverages, three meals a day. So
he was really addicted, if you will, but also overly
exposed to added sugar, particular liquid sugar. And in his
twenties he came in at a diabetic coma. And you know,
in the old days, we would have thought that was
type one diabetes, the so called autoimmune disease where you
you know, children, juvenile onset diabetes, where the body attacks itself,
(10:04):
you know, the pancreas stops producing insulin. But what we're
seeing now in these younger people is type two diabetes,
which I like to think of as the body politic
attacking the child or the young person. It's not the
body attacking itself, it's our society attacking the body of
that young person. And that's what happened with Montille, and
he has suffered all of the consequences of uncontrolled type
(10:24):
two diabetes. He's now forty, and he just sustained another amputation.
Speaker 1 (10:28):
The sugar consumption in my family as a child was habitual.
My mother was diabetically. Yeah, it was diabetic, and she
did had no amputations. But she was really very sick
from diabetes for many, many years.
Speaker 3 (10:42):
But how old was she when she developed diabetes? I'm
interested to her.
Speaker 1 (10:45):
I would say that she was identified and treated when
she was She died at ninety two last year.
Speaker 3 (10:49):
Do you remember how old she was when she was sixty?
Speaker 1 (10:52):
I'd say, okay, probably sixty.
Speaker 2 (10:54):
Yeah, it's interesting because you would say to your doctor,
I have a family history of diabetes. It's interesting. Many
of my patients say, oh, this is happening because of
my genetics. I have a family history of diabetes. And
I say, well, that's interesting. How old was your grandmother
when she got diabetes? Oh she was eighty okay.
Speaker 3 (11:11):
And how old was your mother when she got diabetes?
Speaker 2 (11:13):
She was seventy. And how old are you now? Oh,
I'm forty five. And how about your son who has diabetes?
Oh he's twenty one. I have patients who tell me
the story and so say, yeah, you have a family history.
We are all vulnerable to getting diabetes. But your history
went from ninety to seventy to fifty to thirty. And
it's very different to have diabetes at a young age
(11:33):
than it is to have an old age. And so
something has gone on in our environment, something pathologic has
gone on our environment. To unmask this nearly human, universal
human tendency, we have to acquire diabetes such that it's
happening at younger and younger ages, with tremendous implications for
work productivity, raising a family, sexual activity, you know, and
(11:57):
all of those things. And so it's really you know,
in the context of the COVID pandemic, of course that's
gotten all the intention. But what's happening at a much
more chronic, slow growing, and insidious pace is the diabetes epidemic.
And the two of them together, of course, were a disaster,
you know, the so called syndemic of having diabetes making
(12:21):
you much more likely to die of COVID than you
see how these two things interact with each other. So
it's a very important national urgent problem. And you know,
we've recently had some federal policy work around this that
I hope will change the conversation such as well, the
conversation is focused very much on you know what you
and I have been talking about, which is people's individual
choices that they make in their day to day lives,
(12:42):
right the intimates and donuts that your mother served you
and that you enjoyed. Really much of this exposure is
occurring in the context of federal policy that in many
ways promotes the diabetes epidemic.
Speaker 3 (12:56):
Let's take, for.
Speaker 2 (12:57):
Example, the most important nutrition assistance program, the SNAP Program
Supplemental Nutrition Assistance Program formerly known as food stamps. Something
like forty forty five million individuals receive SNAP benefits every year,
and because of the efforts of the junk food industry
in particular, we have never been able to actually make
that a nutrition assistance program. Rather, what it is is
(13:20):
it gives people a little bit of money to buy food,
including junk food. So last year we spent maybe eighty
billion dollars on providing SNAP benefits to low income America.
It's very important program to reduce poverty and food and security.
Four billion dollars four billion of the eighty billion was
spent only on sugar, sweet and beverages.
Speaker 1 (13:40):
And any attempts we've made to attach restrictions to that
money have been rebuffed by even civil rights activists who
are saying, don't tell us what.
Speaker 3 (13:49):
To eat, right.
Speaker 2 (13:51):
We have the misconception that this freedom to eat in
some way restricts our freedom of life. And you know,
we're not saying you can't drink a sugar sweet and beverage.
What we're saying is that the government funding should not
be used in a nutrition assistance program. And just by
way of comparison, with the four billion dollars in that
same year, the CDC would have spent six hundred million
(14:13):
dollars on all chronic diseases in America.
Speaker 3 (14:16):
So what is that like?
Speaker 2 (14:17):
A sevenfold greater expenditure on sugar sweet and beverages than
the prevention of all chronic diseases.
Speaker 1 (14:27):
Doctor Dean Schillinger. If you enjoy conversations on public health,
check out my episode with doctor Robert Lustig, a pediatric
endocrinologist who studied the link between sugar and childhood obesity.
Speaker 4 (14:42):
Sixteen percent of all of the corn grown in America
today ends up as high fructose corn syrup. We have
boatloads of it, and it's cheap, and because it's cheap,
it started finding its way into things that never had
sugar before. Like hamburger buns, hamburger meat, barbecue, sauce, ketchup, salad, dressing.
I mean pretty much everything you can imagine in the store. Indeed,
(15:04):
Barry Popkin at the University of North Carolina has just
done a study that shows that eighty percent of the
food items there are six hundred thousand food items in America,
eighty percent of them relays with sugar added sugar.
Speaker 1 (15:17):
To hear more of my conversation with doctor Lustig, go
to Here's Thething dot org. After the break, Doctor Dean
Schillinger shares how conflicts of interest in scientific studies and
lobbying prevent change from within the sugar industry. I'm Alec Baldwin,
(15:46):
and you're listening to Here's the Thing. Doctor Dean Schillinger
served as a co chair of a federal Advisory Commission
on Diabetes policy and Chief Medical Officer for Diabetes Prevention
for the State of care California, among many other high
profile appointments. I wanted to learn about his approach to
(16:06):
advising elected officials and trying to bring about real legislative change.
Speaker 2 (16:12):
You know, we've gotten to the point now where one
in seven adults on average has diabetes in America one
in seven, and in communities of color, it's, like I said,
one in four, sometimes one in three. We can't avoid
hearing stories of the consequences of diabetes. And what I've realized,
I've stopped giving talks on the statistics and the p
(16:33):
values and the you know, and graphs, and I've just
started telling real stories from my own practice that sort
of give people a wake up call around like this
is like really important shit here. These aren't just numbers.
And this sort of happened to me when I was
working as chief of the diabetes Prevention Control Program in
the state of California. So when I started the job
(16:55):
in two thousand and eight, two and a half million
Californians had diabetes, and when I left twenty thirteen to
four million Californians had diabetes.
Speaker 3 (17:03):
So I'm like, gee, I did a great job, right,
what a fantastic job I did.
Speaker 2 (17:07):
And the reason I wasn't able to do my job
is I couldn't get into the heads of legislators how
important this was. And then I quickly learned, probably too late,
that I needed to tell them real stories. And the
story that I told them then and I've told another
regulatory in policy settings was a story of Melanie, a
lovely forty year old African American woman who had developed
(17:32):
diabetes just like Montelle in her late twenties and had
been addicted to a number of things, smoking cocaine, sugar
sweeten beverages, but the addiction she could not kick. With
sugar sweeten beverages, she loved seven ups. She just could
not give up the seven up and she was desperate.
And I remember on her fortieth birthday, I came into
clinic and I saw her hospital card, like, it's your
(17:54):
fortieth birthday, Why are you here? You should be celebrating,
And she said, oh, don't worry. You know, my girlfriend
going to take me tomorrow to the water park, my
favorite thing to do. I'm going to go to the
water park and do the water slides. I haven't done
it in fifteen years. I was like, oh, that sounds
like a great birthday. And then a couple months later,
at her follow up appointment, she didn't show, but her
girlfriend showed and I said, where's Melanie And she said
(18:15):
I it was horrible. We went to the water park
and you know Melanie who can't feel her feet because
of her. The nerve damage from the diabetes burnt the
bottom of her feet while she was standing on the
hot staircase, and she developed gangreen in both feet, hospitalized
and had amputations, and then the gangreen spread to her
(18:37):
body and she died. And this is what I learned,
you know, at her follow up visit.
Speaker 1 (18:43):
And for those people that don't know, for those people
who don't have a real sense of the diabetic neuropathy
where and for some of my friends, that neuropathy came
on in somewhat rapid surges.
Speaker 3 (18:57):
Yeah.
Speaker 1 (18:57):
I had friends of mine who had along that outer
pad of your foot, the balls of the feed and
then the heel. They had a neuropathy like sensation for
an extended period of time, like let's say a year,
and they felt the tingling right, and then all of
a sudden, it seemed like they told me, like overnight
he went to burning and numbness.
Speaker 3 (19:17):
And then numbness. Yeah.
Speaker 2 (19:19):
You know, the statistic that I think is most compelling is,
you know, we think of amputees, We think of soldiers, right,
we think of the Iraq War and IEDs and people
getting their leg blown off, and that indeed happened in
the fifteen years of that conflict, twenty five hundred soldiers
lost a limb and it's a catastrophe. It's devastating. In
that same period of time, one million people with diabetes
(19:42):
in the United States lost a limb. And we think
of amputation as like this most catastrophic thing, but it
is happening. If you go into low income neighborhoods, you
see people in wheelchairs. Why are they in wheelchairs? They've
lost a limb. So I mean, at some point, and
I think we've hit this point, the discourse begins to
change around, just like we saw with tobacco use, that
(20:04):
maybe this is something we need to do in moderation,
and we have to recognize it's not only we who
have to change, it's the businesses that are pushing this
at us that need to change.
Speaker 1 (20:15):
I was told by people years ago when I was
more active on an ongoing basis in advocacy work in
the nineties and so forth, the sugar lobby is like borderline,
like the Mediine cartel. You know, the biggest sugar producer
I was in Brazil. The great families that are some
of them Cuban expatriates in the Miami area Great Miami
(20:37):
Fortunes logged countless millions of dollars in federal subsidies for
these products. You know, it's almost like they look at
sugar like oil, Like if we don't have a steady
supply of this stuff, the country is going to grind
to a halt. You know, sugar is a heavily What
do you think about that? In terms of this idea,
people was talking about putting warnings on candy labels.
Speaker 2 (20:58):
Yeah, I think this is a critical, critical issue. The
outsized influence in this case of the American Beverage Association,
which is, you know, in cahoots with the sugar industry.
It's part of it, and I mean I've had firsthand
experiences with them.
Speaker 3 (21:12):
I'll give you example.
Speaker 2 (21:13):
So in twenty fifteen, the City and County of San
Francisco passed an ordinance because we've had this explosion of diabetes,
that would place warning labels on billboards that advertise sugar,
sweet and beverages, you know, warning consuming one or more
of these. The City County of San Francisco that consuming
one or more of these may contribute to OBEs, diabetes,
tooth decay, and heart disease.
Speaker 3 (21:35):
Pretty reasonable and this went to court.
Speaker 2 (21:38):
The American Beverage Association sued the city and county for
breach of their First Amendment rights, so called compelling their
free speech making them say something that they claimed was misleading,
scientifically false, and controversial.
Speaker 3 (21:52):
And so this went to of all places.
Speaker 2 (21:54):
Of federal court, the Ninth Circuit Court because it's a
constitutional case.
Speaker 1 (21:58):
And who were the litigants again, the the.
Speaker 2 (22:00):
American Beverage Association, the City and County of San Francisco
to plaintiff with you. And so I was asked to
be the expert scientist to develop a report around, Okay,
is this warning actually scientifically factual? And I provided that
report and that case was one but was interesting. In
the research that I was doing to try to determine
whether sugar, sweet and beverages were causally associated with these outcomes,
(22:24):
something sort of interesting happened, which is about half of
the studies showed that, yes, there is a causal relationship
between these products and these outcomes, but half of them
found no effect. I would say fifty to fifty was
kind of, you know, coincidental. And so after that court
case happened, I went back and I very carefully went
(22:45):
through the funding sources of each of these studies there
were something like sixty studies in a fifteen year period,
and looked at the funding sources of the scientists who
had written those coursers. And as it turned out, not
surprisingly those studies that were funded in some way by
the American Beverage Association or the scientists had been sent
on trips to Hawaii or whatever. It was almost universally,
(23:08):
with only one exception, thirty three out of thirty four
found no association between their product. No diabetes is zero, right,
And every study that was independently funded founded, and so
the likelihood of having an association found if you were
funded by the industry was basically zero.
Speaker 3 (23:26):
And so I wrote up these findings because that, I mean, everybody.
Speaker 2 (23:29):
Knows there's conflicts of interest, right the chemical industry and
the tobacco industry. But this strength of the conflict of
interest essentially entirely determining the result of the study, showed
how the industry controlling the scientists, controlling and hijacking science itself.
Being on the editorial boards of nutrition journals, for example.
Speaker 3 (23:50):
Really was unprecedented.
Speaker 2 (23:52):
And so I wrote this up in the Anamals of
Internal medicine, and needless to say, the American Beverage Association
responded immediately and quote a scathing letter to the editor
saying that Okay, yeah, he claims doctor Schellinger claims that
there are conflicts of interest at play here. He needs
to understand that they are intellectual conflicts of interest that
he is subject to. In other words, saying, I somehow
(24:14):
religiously believe that sugar sweeten beverages are cause of diabetes,
and therefore that belief is a conflict of interest that
undermines the scientific study that I did, and intellectual conflicts
of interest.
Speaker 3 (24:28):
The last time I saw.
Speaker 2 (24:29):
That raised was when the tobacco industry, you know, went
against the scientists who found the relationship between tobacco and
lung cancer. So then about a year later, two years later,
a study came out in that same journal, the Annals
of Internal Medicine, that claimed that all of the national
guidelines internationally that said that we should have less than
ten percent of our caloric consumption from added sugars are fraudulent,
(24:52):
They're bad science.
Speaker 3 (24:53):
You know.
Speaker 2 (24:53):
It was a very well done systematic review funded by
the International Life Science Institute, which is the Americ Beverage Association, Snickers,
Mars Bar, all of these people. And I was asked
to write an editorial about this study, and I basically
called them out in the editorial, and then The Atlantic
Monthly said, well, wow, what's going on with this sugar controversy.
(25:14):
We're going to have a story about the sugar controversy,
and they interviewed me, and they interviewed the editor of
the Anamals of Internal Medicine, an esteemed physician colleague of mine,
and they said, you know what, why did you publish
this study funded by the Beverage Association? And she said, well,
I felt like it was really important to have two
sides of the story. And I learned that yes, there
(25:36):
are financial conflicts of interests, but they're also intellectual conflicts
of interest. So this idea of intellectual conflicts of interest
is being pushed by the industry and is finding its
way into scientific discourse and really creating another mechanism for disinformation.
Speaker 1 (25:55):
Now, in the time we have left, I wanted to
highlight the fact that your wife is a public interest
attorney who serves a director of the Program and Advocacy
at Bay Area Legal Aid. So both of you did
your wife's and your own public service mindedness, your civic mindedness,
your commitment to helping the less fortunate. Is that a
(26:16):
glue that drew you to your wife, something you admired
about her?
Speaker 2 (26:20):
Yeah, absolutely, it's something that I think she's been an
inspiration for me. She I mean, we often joke that
we serve the same clients, you know, and I'm trying
to promote their health and she's trying to promote their rights,
and in some cases we have shared clients coincidentally.
Speaker 1 (26:33):
That's funny.
Speaker 2 (26:34):
But I grew up in a public housing project actually
in Buffalo in my early years, and I saw what
poverty was like, and then we came out of that,
and I saw how different life was for me, you know,
once we had some money, and how that impacted my health.
On the other side of my family, my uncle was
running science education for UNESCO in Paris, and my aunt
(26:58):
was a radio broadcaster in Israel for Colistrael. And so
this idea of communication and science and health all sort
of I think I grew up with somehow, and so
I'm able now to try to harness science and communication
to make the world a better place. And it's extremely gratifying.
(27:20):
To be able to work in a public hospital where
you're working side by side with others who.
Speaker 3 (27:24):
Who they're not in for the money. I mean we
get paid, we get.
Speaker 2 (27:26):
Well paid, but really get to see their efforts returned.
Speaker 3 (27:31):
You know, so many times.
Speaker 1 (27:32):
Over, Doctor Dean Schillinger. If you're enjoying this conversation, tell
a friend and be sure to follow Here's the Thing
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When we come back, doctor Dean Schillinger shares the most
(27:52):
important change you can make to help fight diabetes. I'm
Alec Baldwin and you're listening to Here's the Thing. Doctor
Dean Schillinger co founded a nonprofit campaign, The Bigger Picture,
(28:16):
to help young people of color tell their stories about diabetes.
They share how the issue affects their families, their communities,
and themselves through poetry, song and film. I wanted to
know what was behind the campaign and how it might
change the public perception surrounding sugar. Well.
Speaker 2 (28:37):
I mean, I think there are two parts of the
conversation about diabetes. The first part is the individual patient right,
get your A one C, get tested, treat your diabetes,
eat right, exercise, I think we do a really good
job of that in the United States. The American Diabetes
Association is front and center where we don't have the megaphone. However,
(28:58):
is ref framing the conversation about diabetes to be not
just a biomedical problem at the individual level, but that
it is a societal problem.
Speaker 3 (29:06):
That needs societal fixes.
Speaker 2 (29:07):
And that's where this Bigger Picture campaign, with these young
poets of color basically speaking truth to power about what's
going on, has really changed the conversation away from this
individual blame and shame kind of narrative to actually, we're
kind of being victimized here, and it's not just people
of color being victim but we're all being victimized by
(29:28):
these insidious practices around the food industry. And this requires
a movement alec if we are going to change the
course of the epidemic, and we've begun to see that.
As I mentioned earlier, it's going to require a social movement.
And you know that the impact of these young people
in the Bigger Picture campaign, when they get in front
of policymakers and bang out a poem in front of them,
(29:52):
far outstrips the impact that I've been able to make
as and so.
Speaker 1 (29:55):
I wouldn't have thought that.
Speaker 2 (29:56):
I think bringing together the arts and public health in
terms of a megaphone around changing the conversation around diabetes
to be reframed as a social problem that we can
get our arms around. Is where the money should be.
It's where the money is. So it's where the money
should be. And I mean, you have a tremendous megaphone
at your disposal, and I hope you use it in
(30:18):
that regard. But there are many gifted members, particularly of
disproportionately affected communities, who can do a much better job
representing the experiences of individuals and communities more than the
public health expert can. So bringing together the public health
experts with vocal community members, who's.
Speaker 1 (30:38):
Doing the talking and who's delivering the message exactly?
Speaker 3 (30:41):
And what is that message? Yeah, I mean my message.
Speaker 2 (30:43):
If I had said, oh, go do a diabetes campaign,
it probably would have been far less effective than what
you heard Obassi Davis and Joker Rosco's say.
Speaker 3 (30:52):
In their poems.
Speaker 2 (30:53):
Joker Orosco's poem, you know he's a kid who grew
up in Central Valley of California, which is, you know,
the fruit basket of the world, world growing fruits and vegetables,
and all the kids exposed to his junk food. He
can't you know, his family's farming the Bounty of America
and everywhere in Stockton is just junk food, and everybody's
got diabetes.
Speaker 1 (31:13):
But you always see, I mean I did for a
period of time. You always see where they're going into
the school lunch program and they're taking the administrators of
the school district, and they're taking the administrators of the
individual school, and they're saying, you got to get the
soda machines out of the school. You got to get
the high fructose vending out of the school.
Speaker 2 (31:32):
How do we not have federal legislation around that?
Speaker 1 (31:35):
I wonder who can defend that? Who wasn't just completely
in the pocket of the beverage lobby or the sugar lobby.
You're sitting there saying you want your children, don't condemn
your children to what you have.
Speaker 2 (31:48):
Right, Well, that's why we need a social movement. I mean,
we don't have cigarette vending machines in high schools right anymore?
Speaker 3 (31:55):
We don't. That's true that we used to.
Speaker 1 (31:58):
Now one last question, which is that so you're not
an endoquinologist and I'm assuming you're not a nutritionist either.
So when people come to you, whether it's the young
man who lost who was the subject of the film
who had the amputation, very sad case. And when people
are coming to you, I'm assuming within your body or
your network of your organizations you work with in hospitals,
(32:19):
there's a nutritionists you pass them on to who can
give them some guidance about what to eat, not eat. Eat.
Speaker 2 (32:24):
Yeah, I provide basic nutritional counseling. Often it's not rocket science.
When you hear what people are you just have to
take a good history. You have to hear the story.
Tell me what you ate yesterday, Tell me what It
doesn't take long to figure out that they're having four
bowls of rice with every meal, or you know, having
three sugar sweetened beverages a day. And you know, a
lot of this is pretty out there and obvious. But yes,
(32:46):
we do have nutritionists who work in the outpatient's setting,
and they're very effective. I think the most effective thing
that they do is they have the person keep a
food diary and then they review the food diary.
Speaker 1 (32:56):
Because I'm always saying to people it's an incremental change.
I said, just give up one thing. I had a
doctor sit me down when I was fifty years old,
so it's fifteen years ago, and he said, here's my philosophy.
He said that is, once you turn fifty, start to
minimize or completely give up one of each category gradually
every five years.
Speaker 2 (33:14):
I mean, I do think certainly individual decision making is
really important, which is what we do with an attritionness.
At the same time, we have to ensure that when
the person walks out of their home that within a
mile or two miles there's some place.
Speaker 1 (33:27):
That's option go, there's oppositation that you can get.
Speaker 2 (33:30):
And the price of healthy food over the last thirty
years has exorbitantly increased relative to the price of junk food,
which has declined adjusted for inflation. So the stress on
the pocket is real. And you know, a lot of
that is subsidized by the farm bill. Paradoxically, so if
we could have a farm bill that subsidizes the growth
of healthy food, which we do not have a program
(33:53):
to do, we could turn that around to.
Speaker 1 (33:56):
Well, let's just say this, which is when you're ready
to go to Washington and fight the fight about school
lunches and vending and lunches, when you're ready to do
the next charge up that hill. Count me and I'll
go with you.
Speaker 3 (34:09):
Thanks, So I appreciate it.
Speaker 1 (34:10):
Your kids are how old?
Speaker 3 (34:12):
I have twins who are twenty four.
Speaker 2 (34:13):
They're jazz musicians in New York actually, and then I
have a sixteen year old daughter.
Speaker 1 (34:17):
So your daughter, And what's the shill in your house
on a dietary basis cooking at home?
Speaker 3 (34:23):
Yeah, we mostly cook at home.
Speaker 2 (34:25):
Occasionally we order in, you know, when I'm lazy, and
we have desserts. I mean a lot of fruit, a
lot of fruit. But well, we'll have desserts every now.
And that we do not have sugar, sweet and beverages.
That's something that's very different from my chi. And we
didn't have the fruit loops that I grew up with,
you know, the pop tarts that I grew up And
my kids, my boys are like five or six inches
(34:45):
taller than me and look a lot better than I did.
Speaker 1 (34:49):
Well, listen, I enjoyed so much seeing you in the film,
and I was so captivated by the work you're doing
and your articulation and your just your whole energy in
terms of you're caring for your your constituents there that
I was dying to talk with you, and thank you
so much for doing with us. Okay, thank you, my
(35:09):
thanks to doctor Dean Schillinger. This episode was recorded at
CDM Studios in New York City. Were produced by Kathleen Russo,
Zach MacNeice, and Maureen Hobin. Our engineer is Frank Imperial.
Our social media manager is Danielle Gingrich. I'm Alec Baldwin.
Here's the thing is brought to you by iHeart Radio
This is Alec Baldwin and you're listening to Here's the
Thing from iHeart Radio, a chocolate chip cookie, a bite
of Devil's Food cake, or a gigantic cup filled with
your favorite soda. Sugar is a simple chemical compound, yet
so powerful and so hard to refuse. The traditional advice
(00:24):
about avoiding sugar seems simple put down the doughnut, but
few people know how much the deck is being stacked
against them. Food and beverage corporations spend billions of dollars
to ensure their customers remain addicted to their products, which
has contributed to an epic surge in type two diabetes.
(00:46):
In order to reverse these rising rates, my guest today
believes we need to embrace deep legislative and societal change.
Physician and public health expert, doctor Dean Schillen is a
professor of medicine at the University of California, San Francisco.
He is the co founder of the UCSF Center for
(01:09):
Vulnerable Populations. I was featured in the PBS documentary on
Type two diabetes Blood Sugar Rising. As someone with type
two diabetes, this issue hits close to home for me.
I wanted to begin my conversation with doctor Schillinger, learning
how he went from simply treating individual patients to calling
(01:31):
for a public health war on diabetes.
Speaker 2 (01:35):
I work at San Francisco General Hospital, which is the
city and County of San Francisco's public hospital, which is
for the New Yorkers on the call, sort of like
a small.
Speaker 3 (01:44):
Version of Bellevue.
Speaker 2 (01:46):
And if you had told me thirty years ago that
I was going to become a specialist and expert in
diabetes when I was coming out of medical school, I
would have laughed at you. It was not something that
I was interested in when I was training. And when
I started out as a primary care physician general internest
this Stan Africa General Hospital, I'd say about one out
of fifteen of my patients had type two diabetes. And
(02:07):
now I just think about the clinic that I had
on Monday, one out of two of my patients has
type two diabetes. So in one generation, we have seen
an absolute explosion in type two diabetes in America, and
that can't possibly be managed by endocrinologists. There just aren't
enough of them on the planet. And truth be told,
most of diabetes can be handled by family doctors.
Speaker 3 (02:27):
In general interness but it.
Speaker 2 (02:28):
Has become the proverbial bread and butter of my practice,
and it has also led me to try to combat
the illness not only in the clinic, but also outside
in society, this diobetogenic society, to move the fight sort
of beyond one patient at a time to sort of
the general population.
Speaker 1 (02:47):
Where'd you grow up, where you from originally?
Speaker 3 (02:49):
I'm originally from Buffalo, New York.
Speaker 1 (02:52):
And where did you go unto grad?
Speaker 3 (02:53):
I went to Brown University.
Speaker 1 (02:55):
And where'd you go to medical school?
Speaker 2 (02:57):
University of Pennsylvania in Philadelphia, Which is interesting because the
University of Pennsylvania in Philadelphia was home to the country's
largest public hospital, Philadelphia General. But you know, it lost
a lot of money, as you can imagine, and so
they shut it down just a few years before I
entered the medical school, And so I had never had
exposure to working in a public hospital as a medical student.
(03:18):
And you talk about the high level hospitals that New
York and San Francisco have, and that indeed is true.
But until you've worked in a public hospital, you don't
realize the fact that we really operate in a two
tier medical system, and that a lot of the consequences
of our social ills end up at the door of
public hospitals. So if you're only working in private hospitals
(03:40):
or nonprofit hospitals, you don't see what's really going on
in society until you set foot in a public hospital.
And it's really it's transformative as a clinician. And what
I try I have been trying to do in the
last few decades, has been to share the stories that
I've been witnessed to in the public hospitals to the
general public so we can begin to understand how public
health happens or doesn't happen in this country. And that's
(04:02):
sort of what you saw in Blood Sugar Rising.
Speaker 1 (04:04):
And the fundamental difference between the two is what.
Speaker 2 (04:07):
Well, the fundamental difference between the two is the burden
of disease that we see in low income communities and
people of color far outstrips that which we see in
the private hospital. So the reason that the waiting rooms
are so packed in public hospitals is not just because
we don't have enough doctors and nurses, but because the
demand for healthcare is so logarithmically exponentially higher because of
(04:32):
the burden of disease that comes with poverty. Think about
what it's like to be a poor person working two jobs,
the stress that they have in their daily lives, and
all that is around them in the every corner store,
every advertisement, every billboard is pushing the food that you
appropriately described is causing your diabetes. And it's the same
(04:52):
for people who are poor but really on steroids, no
pun intended.
Speaker 1 (04:57):
Well, what's interesting to me? You know, I'm some and
this is just my belief that when you abuse alcohol,
when you wake up in the morning and you look
at yourself, you don't like what you see. Maybe if
you smoke too much, you know it's wrong. Sugar is
something that is indoctrinated into our lives from day one.
We have appended the consumption of some sugary product with
(05:19):
nearly everything we do. Birthday caicks. You don't have a
birthday salad, you have a birthday cake. Everything has their
designated sweets.
Speaker 2 (05:29):
I mean, the holiday is just that it's a holy
day and we are meant to celebrate it as a
very special and unique day in the year for whatever ritual,
whatever reason, And so the introduction of sweets into that
holiday was a signal, a symbol of the sweetness of
life that we celebrate or whatever the memory is that
(05:49):
we're trying to celebrate. And you're absolutely right that what
the food industry and the hallmark industry has done is
take this natural joy we feel when we consume added
sugar and essentially make it such that every meal now
has to have that endorphin and dopamine rush experience that
(06:13):
we used to only experience two or three times a year.
And what we've learned increasingly from both basic science and
behavioral science, is that added sugar, particularly liquid added sugar
in the form of sugar sweetened beverages.
Speaker 3 (06:26):
Are addictive.
Speaker 2 (06:27):
They have all the characteristics in terms of brain response
that we see with alcohol, cocaine, etc. And I am
not exaggerating when I say this. The cravings, the joy,
the withdrawal, all of these things the food chemists have
learned and have then implemented into marketing strategies and distribution strategies.
(06:49):
And for those who are under stress or depressed or
down and need to pick me up, this is the
perfect drug. And the modern food system has trained, has
formed itself, to deliver high doses of added sugar, particular
liquid sugar on an ongoing basis and we create the
false belief that this is part of our culture, and
(07:10):
I think that it indeed is, but it's based on
a model of addiction and the corporate takeover of the
food system by harnessing the addictive properties of their foods.
It's not a level playing field. Your body has natural
hormones and chemical messages that say my appetite is satisfied,
(07:32):
I'm going to stop eating. But the food chemists have
created foods that do not stimulate the appetite suppressant hormone.
I mean specifically that so that we're being played, so
that you feel that you and your willpower are inadequate
in terms of your question as to when we should
be screened. This is highly controversial, and I can tell
(07:55):
you what I do in my practice and my practices,
I take care of low income people who have a
very high point revalence of type two diabetes. If you
take the average adult who is a person of color
in the United States, there's about a twenty twenty five
percent chance that that person off the street's going.
Speaker 3 (08:09):
To have diabetes at one age.
Speaker 2 (08:11):
That's the average age, so we're talking about in their fifties.
But we see the incidence of diabetes occurring younger and younger,
and particularly in people of color. In fact, we're seeing
it now in children. We're seeing type two diabetes emerge.
If I had said twenty five years ago, I've got
a child with type two by diabetes as supposed to
type one, people would you know, laugh me off the stage.
(08:32):
But now this is this is just an everyday phenomenon,
and the rates of type two diabetes and children of
color has gone up three four fold over the last decade.
Speaker 1 (08:43):
The young man you see in the film who you're
taking care of, the black guy who's going to be
lose his foot, Yeah, Montille, Montille. Now he looks pretty
whippity and pretty lean. So I'm assuming you don't have
to be morbidly obese to qualify for this.
Speaker 2 (08:58):
Correct, That's absolutely true. I think there is a there.
Of course, obesity and high BMI is a risk factor
for the development of type two diabetes. But I have
plenty of patients, particularly young patients, who have type two
diabetes who are not overweight. So yes, he developed diabetes
in his late twenties. He was born in poverty and
(09:21):
raised in poverty, severe food and security. He grew up
eating what he told me were syrup sandwiches, which is
syrup put in between two pieces of wonderbread. For much
of his childhood, his father was incarcerated. He raised himself
and his younger brother, and they would drink you know,
high Sea and the fruit, you know, the powder mixes
(09:41):
of sugar, sweet and beverages, three meals a day. So
he was really addicted, if you will, but also overly
exposed to added sugar, particular liquid sugar. And in his
twenties he came in at a diabetic coma. And you know,
in the old days, we would have thought that was
type one diabetes, the so called autoimmune disease where you
you know, children, juvenile onset diabetes, where the body attacks itself,
(10:04):
you know, the pancreas stops producing insulin. But what we're
seeing now in these younger people is type two diabetes,
which I like to think of as the body politic
attacking the child or the young person. It's not the
body attacking itself, it's our society attacking the body of
that young person. And that's what happened with Montille, and
he has suffered all of the consequences of uncontrolled type
(10:24):
two diabetes. He's now forty, and he just sustained another amputation.
Speaker 1 (10:28):
The sugar consumption in my family as a child was habitual.
My mother was diabetically. Yeah, it was diabetic, and she
did had no amputations. But she was really very sick
from diabetes for many, many years.
Speaker 3 (10:42):
But how old was she when she developed diabetes? I'm
interested to her.
Speaker 1 (10:45):
I would say that she was identified and treated when
she was She died at ninety two last year.
Speaker 3 (10:49):
Do you remember how old she was when she was sixty?
Speaker 1 (10:52):
I'd say, okay, probably sixty.
Speaker 2 (10:54):
Yeah, it's interesting because you would say to your doctor,
I have a family history of diabetes. It's interesting. Many
of my patients say, oh, this is happening because of
my genetics. I have a family history of diabetes. And
I say, well, that's interesting. How old was your grandmother
when she got diabetes? Oh she was eighty okay.
Speaker 3 (11:11):
And how old was your mother when she got diabetes?
Speaker 2 (11:13):
She was seventy. And how old are you now? Oh,
I'm forty five. And how about your son who has diabetes?
Oh he's twenty one. I have patients who tell me
the story and so say, yeah, you have a family history.
We are all vulnerable to getting diabetes. But your history
went from ninety to seventy to fifty to thirty. And
it's very different to have diabetes at a young age
(11:33):
than it is to have an old age. And so
something has gone on in our environment, something pathologic has
gone on our environment. To unmask this nearly human, universal
human tendency, we have to acquire diabetes such that it's
happening at younger and younger ages, with tremendous implications for
work productivity, raising a family, sexual activity, you know, and
(11:57):
all of those things. And so it's really you know,
in the context of the COVID pandemic, of course that's
gotten all the intention. But what's happening at a much
more chronic, slow growing, and insidious pace is the diabetes epidemic.
And the two of them together, of course, were a disaster,
you know, the so called syndemic of having diabetes making
(12:21):
you much more likely to die of COVID than you
see how these two things interact with each other. So
it's a very important national urgent problem. And you know,
we've recently had some federal policy work around this that
I hope will change the conversation such as well, the
conversation is focused very much on you know what you
and I have been talking about, which is people's individual
choices that they make in their day to day lives,
(12:42):
right the intimates and donuts that your mother served you
and that you enjoyed. Really much of this exposure is
occurring in the context of federal policy that in many
ways promotes the diabetes epidemic.
Speaker 3 (12:56):
Let's take, for.
Speaker 2 (12:57):
Example, the most important nutrition assistance program, the SNAP Program
Supplemental Nutrition Assistance Program formerly known as food stamps. Something
like forty forty five million individuals receive SNAP benefits every year,
and because of the efforts of the junk food industry
in particular, we have never been able to actually make
that a nutrition assistance program. Rather, what it is is
(13:20):
it gives people a little bit of money to buy food,
including junk food. So last year we spent maybe eighty
billion dollars on providing SNAP benefits to low income America.
It's very important program to reduce poverty and food and security.
Four billion dollars four billion of the eighty billion was
spent only on sugar, sweet and beverages.
Speaker 1 (13:40):
And any attempts we've made to attach restrictions to that
money have been rebuffed by even civil rights activists who
are saying, don't tell us what.
Speaker 3 (13:49):
To eat, right.
Speaker 2 (13:51):
We have the misconception that this freedom to eat in
some way restricts our freedom of life. And you know,
we're not saying you can't drink a sugar sweet and beverage.
What we're saying is that the government funding should not
be used in a nutrition assistance program. And just by
way of comparison, with the four billion dollars in that
same year, the CDC would have spent six hundred million
(14:13):
dollars on all chronic diseases in America.
Speaker 3 (14:16):
So what is that like?
Speaker 2 (14:17):
A sevenfold greater expenditure on sugar sweet and beverages than
the prevention of all chronic diseases.
Speaker 1 (14:27):
Doctor Dean Schillinger. If you enjoy conversations on public health,
check out my episode with doctor Robert Lustig, a pediatric
endocrinologist who studied the link between sugar and childhood obesity.
Speaker 4 (14:42):
Sixteen percent of all of the corn grown in America
today ends up as high fructose corn syrup. We have
boatloads of it, and it's cheap, and because it's cheap,
it started finding its way into things that never had
sugar before. Like hamburger buns, hamburger meat, barbecue, sauce, ketchup, salad, dressing.
I mean pretty much everything you can imagine in the store. Indeed,
(15:04):
Barry Popkin at the University of North Carolina has just
done a study that shows that eighty percent of the
food items there are six hundred thousand food items in America,
eighty percent of them relays with sugar added sugar.
Speaker 1 (15:17):
To hear more of my conversation with doctor Lustig, go
to Here's Thething dot org. After the break, Doctor Dean
Schillinger shares how conflicts of interest in scientific studies and
lobbying prevent change from within the sugar industry. I'm Alec Baldwin,
(15:46):
and you're listening to Here's the Thing. Doctor Dean Schillinger
served as a co chair of a federal Advisory Commission
on Diabetes policy and Chief Medical Officer for Diabetes Prevention
for the State of care California, among many other high
profile appointments. I wanted to learn about his approach to
(16:06):
advising elected officials and trying to bring about real legislative change.
Speaker 2 (16:12):
You know, we've gotten to the point now where one
in seven adults on average has diabetes in America one
in seven, and in communities of color, it's, like I said,
one in four, sometimes one in three. We can't avoid
hearing stories of the consequences of diabetes. And what I've realized,
I've stopped giving talks on the statistics and the p
(16:33):
values and the you know, and graphs, and I've just
started telling real stories from my own practice that sort
of give people a wake up call around like this
is like really important shit here. These aren't just numbers.
And this sort of happened to me when I was
working as chief of the diabetes Prevention Control Program in
the state of California. So when I started the job
(16:55):
in two thousand and eight, two and a half million
Californians had diabetes, and when I left twenty thirteen to
four million Californians had diabetes.
Speaker 3 (17:03):
So I'm like, gee, I did a great job, right,
what a fantastic job I did.
Speaker 2 (17:07):
And the reason I wasn't able to do my job
is I couldn't get into the heads of legislators how
important this was. And then I quickly learned, probably too late,
that I needed to tell them real stories. And the
story that I told them then and I've told another
regulatory in policy settings was a story of Melanie, a
lovely forty year old African American woman who had developed
(17:32):
diabetes just like Montelle in her late twenties and had
been addicted to a number of things, smoking cocaine, sugar
sweeten beverages, but the addiction she could not kick. With
sugar sweeten beverages, she loved seven ups. She just could
not give up the seven up and she was desperate.
And I remember on her fortieth birthday, I came into
clinic and I saw her hospital card, like, it's your
(17:54):
fortieth birthday, Why are you here? You should be celebrating,
And she said, oh, don't worry. You know, my girlfriend
going to take me tomorrow to the water park, my
favorite thing to do. I'm going to go to the
water park and do the water slides. I haven't done
it in fifteen years. I was like, oh, that sounds
like a great birthday. And then a couple months later,
at her follow up appointment, she didn't show, but her
girlfriend showed and I said, where's Melanie And she said
(18:15):
I it was horrible. We went to the water park
and you know Melanie who can't feel her feet because
of her. The nerve damage from the diabetes burnt the
bottom of her feet while she was standing on the
hot staircase, and she developed gangreen in both feet, hospitalized
and had amputations, and then the gangreen spread to her
(18:37):
body and she died. And this is what I learned,
you know, at her follow up visit.
Speaker 1 (18:43):
And for those people that don't know, for those people
who don't have a real sense of the diabetic neuropathy
where and for some of my friends, that neuropathy came
on in somewhat rapid surges.
Speaker 3 (18:57):
Yeah.
Speaker 1 (18:57):
I had friends of mine who had along that outer
pad of your foot, the balls of the feed and
then the heel. They had a neuropathy like sensation for
an extended period of time, like let's say a year,
and they felt the tingling right, and then all of
a sudden, it seemed like they told me, like overnight
he went to burning and numbness.
Speaker 3 (19:17):
And then numbness. Yeah.
Speaker 2 (19:19):
You know, the statistic that I think is most compelling is,
you know, we think of amputees, We think of soldiers, right,
we think of the Iraq War and IEDs and people
getting their leg blown off, and that indeed happened in
the fifteen years of that conflict, twenty five hundred soldiers
lost a limb and it's a catastrophe. It's devastating. In
that same period of time, one million people with diabetes
(19:42):
in the United States lost a limb. And we think
of amputation as like this most catastrophic thing, but it
is happening. If you go into low income neighborhoods, you
see people in wheelchairs. Why are they in wheelchairs? They've
lost a limb. So I mean, at some point, and
I think we've hit this point, the discourse begins to
change around, just like we saw with tobacco use, that
(20:04):
maybe this is something we need to do in moderation,
and we have to recognize it's not only we who
have to change, it's the businesses that are pushing this
at us that need to change.
Speaker 1 (20:15):
I was told by people years ago when I was
more active on an ongoing basis in advocacy work in
the nineties and so forth, the sugar lobby is like borderline,
like the Mediine cartel. You know, the biggest sugar producer
I was in Brazil. The great families that are some
of them Cuban expatriates in the Miami area Great Miami
(20:37):
Fortunes logged countless millions of dollars in federal subsidies for
these products. You know, it's almost like they look at
sugar like oil, Like if we don't have a steady
supply of this stuff, the country is going to grind
to a halt. You know, sugar is a heavily What
do you think about that? In terms of this idea,
people was talking about putting warnings on candy labels.
Speaker 2 (20:58):
Yeah, I think this is a critical, critical issue. The
outsized influence in this case of the American Beverage Association,
which is, you know, in cahoots with the sugar industry.
It's part of it, and I mean I've had firsthand
experiences with them.
Speaker 3 (21:12):
I'll give you example.
Speaker 2 (21:13):
So in twenty fifteen, the City and County of San
Francisco passed an ordinance because we've had this explosion of diabetes,
that would place warning labels on billboards that advertise sugar,
sweet and beverages, you know, warning consuming one or more
of these. The City County of San Francisco that consuming
one or more of these may contribute to OBEs, diabetes,
tooth decay, and heart disease.
Speaker 3 (21:35):
Pretty reasonable and this went to court.
Speaker 2 (21:38):
The American Beverage Association sued the city and county for
breach of their First Amendment rights, so called compelling their
free speech making them say something that they claimed was misleading,
scientifically false, and controversial.
Speaker 3 (21:52):
And so this went to of all places.
Speaker 2 (21:54):
Of federal court, the Ninth Circuit Court because it's a
constitutional case.
Speaker 1 (21:58):
And who were the litigants again, the the.
Speaker 2 (22:00):
American Beverage Association, the City and County of San Francisco
to plaintiff with you. And so I was asked to
be the expert scientist to develop a report around, Okay,
is this warning actually scientifically factual? And I provided that
report and that case was one but was interesting. In
the research that I was doing to try to determine
whether sugar, sweet and beverages were causally associated with these outcomes,
(22:24):
something sort of interesting happened, which is about half of
the studies showed that, yes, there is a causal relationship
between these products and these outcomes, but half of them
found no effect. I would say fifty to fifty was
kind of, you know, coincidental. And so after that court
case happened, I went back and I very carefully went
(22:45):
through the funding sources of each of these studies there
were something like sixty studies in a fifteen year period,
and looked at the funding sources of the scientists who
had written those coursers. And as it turned out, not
surprisingly those studies that were funded in some way by
the American Beverage Association or the scientists had been sent
on trips to Hawaii or whatever. It was almost universally,
(23:08):
with only one exception, thirty three out of thirty four
found no association between their product. No diabetes is zero, right,
And every study that was independently funded founded, and so
the likelihood of having an association found if you were
funded by the industry was basically zero.
Speaker 3 (23:26):
And so I wrote up these findings because that, I mean, everybody.
Speaker 2 (23:29):
Knows there's conflicts of interest, right the chemical industry and
the tobacco industry. But this strength of the conflict of
interest essentially entirely determining the result of the study, showed
how the industry controlling the scientists, controlling and hijacking science itself.
Being on the editorial boards of nutrition journals, for example.
Speaker 3 (23:50):
Really was unprecedented.
Speaker 2 (23:52):
And so I wrote this up in the Anamals of
Internal medicine, and needless to say, the American Beverage Association
responded immediately and quote a scathing letter to the editor
saying that Okay, yeah, he claims doctor Schellinger claims that
there are conflicts of interest at play here. He needs
to understand that they are intellectual conflicts of interest that
he is subject to. In other words, saying, I somehow
(24:14):
religiously believe that sugar sweeten beverages are cause of diabetes,
and therefore that belief is a conflict of interest that
undermines the scientific study that I did, and intellectual conflicts
of interest.
Speaker 3 (24:28):
The last time I saw.
Speaker 2 (24:29):
That raised was when the tobacco industry, you know, went
against the scientists who found the relationship between tobacco and
lung cancer. So then about a year later, two years later,
a study came out in that same journal, the Annals
of Internal Medicine, that claimed that all of the national
guidelines internationally that said that we should have less than
ten percent of our caloric consumption from added sugars are fraudulent,
(24:52):
They're bad science.
Speaker 3 (24:53):
You know.
Speaker 2 (24:53):
It was a very well done systematic review funded by
the International Life Science Institute, which is the Americ Beverage Association, Snickers,
Mars Bar, all of these people. And I was asked
to write an editorial about this study, and I basically
called them out in the editorial, and then The Atlantic
Monthly said, well, wow, what's going on with this sugar controversy.
(25:14):
We're going to have a story about the sugar controversy,
and they interviewed me, and they interviewed the editor of
the Anamals of Internal Medicine, an esteemed physician colleague of mine,
and they said, you know what, why did you publish
this study funded by the Beverage Association? And she said, well,
I felt like it was really important to have two
sides of the story. And I learned that yes, there
(25:36):
are financial conflicts of interests, but they're also intellectual conflicts
of interest. So this idea of intellectual conflicts of interest
is being pushed by the industry and is finding its
way into scientific discourse and really creating another mechanism for disinformation.
Speaker 1 (25:55):
Now, in the time we have left, I wanted to
highlight the fact that your wife is a public interest
attorney who serves a director of the Program and Advocacy
at Bay Area Legal Aid. So both of you did
your wife's and your own public service mindedness, your civic mindedness,
your commitment to helping the less fortunate. Is that a
(26:16):
glue that drew you to your wife, something you admired
about her?
Speaker 2 (26:20):
Yeah, absolutely, it's something that I think she's been an
inspiration for me. She I mean, we often joke that
we serve the same clients, you know, and I'm trying
to promote their health and she's trying to promote their rights,
and in some cases we have shared clients coincidentally.
Speaker 1 (26:33):
That's funny.
Speaker 2 (26:34):
But I grew up in a public housing project actually
in Buffalo in my early years, and I saw what
poverty was like, and then we came out of that,
and I saw how different life was for me, you know,
once we had some money, and how that impacted my health.
On the other side of my family, my uncle was
running science education for UNESCO in Paris, and my aunt
(26:58):
was a radio broadcaster in Israel for Colistrael. And so
this idea of communication and science and health all sort
of I think I grew up with somehow, and so
I'm able now to try to harness science and communication
to make the world a better place. And it's extremely gratifying.
(27:20):
To be able to work in a public hospital where
you're working side by side with others who.
Speaker 3 (27:24):
Who they're not in for the money. I mean we
get paid, we get.
Speaker 2 (27:26):
Well paid, but really get to see their efforts returned.
Speaker 3 (27:31):
You know, so many times.
Speaker 1 (27:32):
Over, Doctor Dean Schillinger. If you're enjoying this conversation, tell
a friend and be sure to follow Here's the Thing
on the iHeartRadio app, Spotify or wherever you get your podcasts.
When we come back, doctor Dean Schillinger shares the most
(27:52):
important change you can make to help fight diabetes. I'm
Alec Baldwin and you're listening to Here's the Thing. Doctor
Dean Schillinger co founded a nonprofit campaign, The Bigger Picture,
(28:16):
to help young people of color tell their stories about diabetes.
They share how the issue affects their families, their communities,
and themselves through poetry, song and film. I wanted to
know what was behind the campaign and how it might
change the public perception surrounding sugar. Well.
Speaker 2 (28:37):
I mean, I think there are two parts of the
conversation about diabetes. The first part is the individual patient right,
get your A one C, get tested, treat your diabetes,
eat right, exercise, I think we do a really good
job of that in the United States. The American Diabetes
Association is front and center where we don't have the megaphone. However,
(28:58):
is ref framing the conversation about diabetes to be not
just a biomedical problem at the individual level, but that
it is a societal problem.
Speaker 3 (29:06):
That needs societal fixes.
Speaker 2 (29:07):
And that's where this Bigger Picture campaign, with these young
poets of color basically speaking truth to power about what's
going on, has really changed the conversation away from this
individual blame and shame kind of narrative to actually, we're
kind of being victimized here, and it's not just people
of color being victim but we're all being victimized by
(29:28):
these insidious practices around the food industry. And this requires
a movement alec if we are going to change the
course of the epidemic, and we've begun to see that.
As I mentioned earlier, it's going to require a social movement.
And you know that the impact of these young people
in the Bigger Picture campaign, when they get in front
of policymakers and bang out a poem in front of them,
(29:52):
far outstrips the impact that I've been able to make
as and so.
Speaker 1 (29:55):
I wouldn't have thought that.
Speaker 2 (29:56):
I think bringing together the arts and public health in
terms of a megaphone around changing the conversation around diabetes
to be reframed as a social problem that we can
get our arms around. Is where the money should be.
It's where the money is. So it's where the money
should be. And I mean, you have a tremendous megaphone
at your disposal, and I hope you use it in
(30:18):
that regard. But there are many gifted members, particularly of
disproportionately affected communities, who can do a much better job
representing the experiences of individuals and communities more than the
public health expert can. So bringing together the public health
experts with vocal community members, who's.
Speaker 1 (30:38):
Doing the talking and who's delivering the message exactly?
Speaker 3 (30:41):
And what is that message? Yeah, I mean my message.
Speaker 2 (30:43):
If I had said, oh, go do a diabetes campaign,
it probably would have been far less effective than what
you heard Obassi Davis and Joker Rosco's say.
Speaker 3 (30:52):
In their poems.
Speaker 2 (30:53):
Joker Orosco's poem, you know he's a kid who grew
up in Central Valley of California, which is, you know,
the fruit basket of the world, world growing fruits and vegetables,
and all the kids exposed to his junk food. He
can't you know, his family's farming the Bounty of America
and everywhere in Stockton is just junk food, and everybody's
got diabetes.
Speaker 1 (31:13):
But you always see, I mean I did for a
period of time. You always see where they're going into
the school lunch program and they're taking the administrators of
the school district, and they're taking the administrators of the
individual school, and they're saying, you got to get the
soda machines out of the school. You got to get
the high fructose vending out of the school.
Speaker 2 (31:32):
How do we not have federal legislation around that?
Speaker 1 (31:35):
I wonder who can defend that? Who wasn't just completely
in the pocket of the beverage lobby or the sugar lobby.
You're sitting there saying you want your children, don't condemn
your children to what you have.
Speaker 2 (31:48):
Right, Well, that's why we need a social movement. I mean,
we don't have cigarette vending machines in high schools right anymore?
Speaker 3 (31:55):
We don't. That's true that we used to.
Speaker 1 (31:58):
Now one last question, which is that so you're not
an endoquinologist and I'm assuming you're not a nutritionist either.
So when people come to you, whether it's the young
man who lost who was the subject of the film
who had the amputation, very sad case. And when people
are coming to you, I'm assuming within your body or
your network of your organizations you work with in hospitals,
(32:19):
there's a nutritionists you pass them on to who can
give them some guidance about what to eat, not eat. Eat.
Speaker 2 (32:24):
Yeah, I provide basic nutritional counseling. Often it's not rocket science.
When you hear what people are you just have to
take a good history. You have to hear the story.
Tell me what you ate yesterday, Tell me what It
doesn't take long to figure out that they're having four
bowls of rice with every meal, or you know, having
three sugar sweetened beverages a day. And you know, a
lot of this is pretty out there and obvious. But yes,
(32:46):
we do have nutritionists who work in the outpatient's setting,
and they're very effective. I think the most effective thing
that they do is they have the person keep a
food diary and then they review the food diary.
Speaker 1 (32:56):
Because I'm always saying to people it's an incremental change.
I said, just give up one thing. I had a
doctor sit me down when I was fifty years old,
so it's fifteen years ago, and he said, here's my philosophy.
He said that is, once you turn fifty, start to
minimize or completely give up one of each category gradually
every five years.
Speaker 2 (33:14):
I mean, I do think certainly individual decision making is
really important, which is what we do with an attritionness.
At the same time, we have to ensure that when
the person walks out of their home that within a
mile or two miles there's some place.
Speaker 1 (33:27):
That's option go, there's oppositation that you can get.
Speaker 2 (33:30):
And the price of healthy food over the last thirty
years has exorbitantly increased relative to the price of junk food,
which has declined adjusted for inflation. So the stress on
the pocket is real. And you know, a lot of
that is subsidized by the farm bill. Paradoxically, so if
we could have a farm bill that subsidizes the growth
of healthy food, which we do not have a program
(33:53):
to do, we could turn that around to.
Speaker 1 (33:56):
Well, let's just say this, which is when you're ready
to go to Washington and fight the fight about school
lunches and vending and lunches, when you're ready to do
the next charge up that hill. Count me and I'll
go with you.
Speaker 3 (34:09):
Thanks, So I appreciate it.
Speaker 1 (34:10):
Your kids are how old?
Speaker 3 (34:12):
I have twins who are twenty four.
Speaker 2 (34:13):
They're jazz musicians in New York actually, and then I
have a sixteen year old daughter.
Speaker 1 (34:17):
So your daughter, And what's the shill in your house
on a dietary basis cooking at home?
Speaker 3 (34:23):
Yeah, we mostly cook at home.
Speaker 2 (34:25):
Occasionally we order in, you know, when I'm lazy, and
we have desserts. I mean a lot of fruit, a
lot of fruit. But well, we'll have desserts every now.
And that we do not have sugar, sweet and beverages.
That's something that's very different from my chi. And we
didn't have the fruit loops that I grew up with,
you know, the pop tarts that I grew up And
my kids, my boys are like five or six inches
(34:45):
taller than me and look a lot better than I did.
Speaker 1 (34:49):
Well, listen, I enjoyed so much seeing you in the film,
and I was so captivated by the work you're doing
and your articulation and your just your whole energy in
terms of you're caring for your your constituents there that
I was dying to talk with you, and thank you
so much for doing with us. Okay, thank you, my
(35:09):
thanks to doctor Dean Schillinger. This episode was recorded at
CDM Studios in New York City. Were produced by Kathleen Russo,
Zach MacNeice, and Maureen Hobin. Our engineer is Frank Imperial.
Our social media manager is Danielle Gingrich. I'm Alec Baldwin.
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