you are diabetic. what happens then is your brain does not get the message from the leptin hormone that you should stop eating that you are full. you just continue to feel hungry and you want to eat more. i personally have experienced this. lastly sugar alters the reward center in our brains. similar to addictive substances like alcohol, cocaine and nicotine, sugar downloads the similar receptors in your brain and we develop greater tolerance of those substances and in the case of sugar we crave more sugar and it bgs a -- becomes a vicious cycle. i think it's fortunate understand -- important to understand

that. when you take a look at the food system, sugar is really all over our food system. and as was mentioned previously about half of those sugars come from beverages. when you take a look at the beverages, soda contributes to the added sugar in our diets. when you -- calories from beverages that we drink often don't displace the calories that you might eat. so you will add those calories next to that burger and fries and again it has to do with your if physiological response where a drink may make you feel hungry. and from an environmental perspective when you look at

the setting we are living in when mcdonald's introduced it's first coke was 7 ounces and now you can go to 7-eleven and get 128-ounce gulp. you can also take a look at pricing and the prices for healthy food and fruits and vegetables have south -- courting -- according to the consumer price index and coupled with the fact that your body craves it, it's something of an important dynamic that's going on here. we can see that over the decades as soda consumption has increased so has childhood over weight. you can see that correlation here. we are really pleased to see this is newer data from the california for

public health advocacy showing consumption among adolescence and we have seen a decrease by younger children. that's positive. i think some of the education efforts we have taken have made greater impact. however we have not seen that among older children. that is a concern that we have heard earlier. if you are over weight as a young person, there is a 63 percent chance that you are going to be overweight as an adult. >> what is the percent? 63 percent. >> yes. looking at local data, there is this slide that talks a little bit about the disparities in san francisco that roberto spoke to. here we are looking at ninth graders, african americans and latinos.

we see this translated down to san francisco. it's not just national data. we see this also among our adults and with the latino and african american populations that consume more sugary drinks. >> can i ask about adolescence. it's my understanding that a ucla study shows slight decrease in younger children but in adolescence there has been an increase in energy drinks and marketing are tied in with a lot of the types of sugary beverages. can you touch a little bit on that? >> yes. i think it's part of the environment that children are in and as an adolescence you are going to have more independence and more pocket

change. the industry does a lot of marketing towards young people and whereas in the younger age groups parents have more control of what their children drink. i think that contributes. the whole series of pieces that contribute to children drinking more sugary drinks. does that answer your question? >> yes. >> so, taking a look at soda expenditures it tracks pretty closely to what we see with over weight and diabetes. it's more with people of color and the diabetes rate you see that same pattern emerging. it speaks to the fact that we have significant health inequities and desperate health outcomes. lastly, a couple of points of impacts on sugary drinks. there

is a recommendation -- >> can i go back to the diabetes hospitalization map. roberto vargas pointed out area code 94124 on the bottom side of the further eastern zip code of the city and supervisor cohen raised concern about that, she asked about the fillmore district. it's areas with heavily low in come population and african americans and people of color and heavily on the eastern neighborhoods in the city and a little bit up there in china down toun and tenderloin and other spots. >> that is correct. so in terms of the a sugar that we are consuming, average americans are consuming about 22 teaspoons a day and recommended

that men not have more than 9 teaspoons and women and children 3. >> for a 20 ounce. >> i was looking at the can assuming that people are still drinking the cans and not the 20 ounceers. even the small size would blow that recommendation out for the day. the graphic just represents that and roberto was get to go that as well in terms of the fact that sugar drinks really impact our entire system, every part of our body. we don't have a lot of information on the impact on oral health . we know it impacts oral health. children under the age of one

have a tremendous increase in dental carries. the children are among the heaviest consumers of sugary drinks. that becomes an issue because the phosphorous can lead to calcium leaching from the bones and this can replace healthier drinks from homes such as milk. it used to be twice a day and now soda is consumed twice as much. this is a picture of a liver. a normal liver and a fatty liver. what we understand from our partners at ucsf is

that not alcohol liver disease is accounting for 20 percent of liver transplant per day that is something that didn't happen in the past. >> that's non-alcoholic liver disease? >> non-alcoholic fatty liver disease. and then lastly to what we've been speak together issue of over weight and obesity. there are many other health impacts. guma referred to others. these are ones that we see from tremendous impacts with sugary drinks. i will take questions. >> that is a really helpful presentation. you mentioned a statistic that we talked about before that a 12 ounce can of soda has 9 teaspoons of sugar

and 17 ounces and a 20 ounces bottle. you showed a slide the biggest of the big gulps. so for example the teen gulp at 7-eleven, i hadn't heard of that one. 128 ounces. that would put us at over 100 teaspoons depending on how much ice the person would put in there. it could be more than 100 teaspoons of sugar in one beverage. even if you go down to the king size burger king, that would be 45 teaspoons of

sugar? >> yes. i think that's about right. >> i think if you would ask any person particularly a parent, but i think for example a parent or anyone, would you sit down with a bag of sugar and eat it whether it's 15 or 20 or 40 or maybe 100 teaspoons of sugar, i think most people would find that to be pretty compulsive and not to mention in incredibly unhealthy. it's such a useful sight in terms of the sizes and the sugar and not because of the reaction some of us might have but it shows why sugary beverages are so different even in sugary foods. sometimes what we hear from the

beverage industry why are you posting a tax on sugary beverages? why not donuts and cookies. we know that eating a cookie or cake, it eventually shuts off your appetite. but just the shear amount of sugar rushing your system quickly in quantities that it's going to be very hard to get from even a cake or a cookie, it's really extraordinary and it's why sugary beverages are a health detriment that is very different and above and beyond the health detriment from sugary foods. i think this chart showing the difference sizes is very instructive. going back to the 1960s and 70s

just the sizes of the sugary drink containers, the size was so much smaller and it's gotten bigger and bigger. in richmond one of the biggest oh opponents of the sugar and beverages tax was the movie theatres. if you look at the size that movie theatres are selling is pretty extraordinary. i'm glad you put this chart in because it's instructive. you may want to consider modifying this chart to show what the range of teaspoons of sugar is for x size of drinks. >> thank you supervisor, i think you really hit the nail on the head with your comments. >> any other questions, colleagues? >> i think the mother jones magazine graphic should be an educational piece used everywhere. even just the names of the drinks humongous to the

big drinks are really outrageous. thank you. seeing no other questions, thank you so much, miss gupta. dr. from ucsf professor of health policy. thank you, dr. smith. >> thank you. i come from a background of having spent over 25 years in my career doing research on public health prevention. i recently spent three years working for the un commercial term nants of health to prevent and health strategies to one of the most effective strategies for

affecting the consumable products that are harmful to health that being sugary beverages and doing studies in national institutes of health. when i speak about what we don't know about sugary beverages and taxation. i spent a quarter of my lifeworking in this area of research. i want to first speak to some of that, i think budget and legislative analyst report, i was able to read it. i think it's a wonderful piece of work. the ability to bring national and local data to bear is great. i want to speak to some things that are not in the report and that as your representative said, it's a very conservative report. and there are a number of aspects of what we know in

the scientific community and the public health communities that could be brought to bear in this discussion. the first one is the larger evidence around taxation. someone mentioned that mexico had just passed a soda tax. i want you all to know that i'm doing research on this now with a law professor at georgetown law school. 14 countries around the globe have national soda taxation regimes and many more are currently deliberating. so the city of san francisco is in very good company with most of the nord icic countries and increasing developing countries are using taxation as a strategy to protect public health. the body of evidence which you are proposing to do

is vast and extensive. we know about, in the world of science we talk about robust evidence. that means evidence that applies in numerous areas and points to the same conclusions. the evidence around taxation is that it works in all areas from alcohol to tobacco to sugar sweet and beverages. the policy that you are considering here and especially the threshold of a $0.02 per ounce tax is highly valid, it has tremendous support in a large body quasi experimental epideem logical research. at the level of medical science, i want to hit on a few words that were not hit on as it possibly could have been from the report of

the budget and legislative analyst office. the first has to do with what we are learning and this is fairly new research but very much a growing consensus among scientist especially those funding by national health, the world health organization, the research that doesn't have a particular agenda behind it but it's neutral and objective research about the effects of sugar and added sugar and particularly sugary beverages on human health. one of the newer set of findings, with tremendous amount of scientific consensus is the impact of heavy fructose consumption of sugar. fructose is one form of sugar but a very common form of sugar. it can have anywhere

from 45-90 percent from when laboratories produce it. fructose is metabolized in the liver. that is where the difficulties start. the fact that fructose is metabolized in the liver. as christina gets from the health department alluded to. when it is metabolized in the liver, if it is in large quantities and in a very quick dose such as the kind of heavy dose you might get from having a sugar sweet and beverage on an empty stomach, the liver is bombarded by a large quantity of fructose and this particular substance within the liver is known to be toxin. it's what we call a hepatic toxin, a substance toxic to the liver like alcohol. this is when we see

non-alcoholic liver cirrhosis, non-alcoholic fatty liver disease and what we used to see as belly is now sugar belly. for people who don't have alcohol have a considerable amount of fatty deposits around the weight with the sugary products. so very complex cascade of events that go on inside the human body. it's not exactly easy to present to the public but there is a very, a growing and important body of evidence that fructose is a toxic substance that harms the liver and causes a very similar set of consequences in the human body and in the liver to alcohol. it makes perfect sense

when you think about it because where does alcohol come from? sugar. so the connection that we are seeing between alcohol and sugar is related. i'm speaking from the journal one of the most prestigious journals in the world and one of the most rigorously received journals in our scientific community. i'm not speaking from -- i'm speaking from a place of high scientific credibility when i report to you this new research. this is largely not well enough publicized and we at ucsf part of the service mission are doing everything we can to get the word out to the general public about what we are learning about the effects of fructose on the liver. >> can i say that alcohol

depending on the affects on the liver that we have one from department of public health organizations to talk about the double whammy of sugary and alcohol. he's going to speak about that too. >> the reason that sugary benefits are a special concern is that if you are consuming, say you are consuming fructose which is the sugar that comes in fruit or take it out of corn and turn it into a very concentrated fructose. if you eat it with an apple, it comes with fiber. when you eat that apple, that fiber slows that fructose in the body and you are not flooding the liver with

hepatotoxin. when you take it out of nature and we put it out of products that do not include fiber and when we take those substance and sugary substances on an empty stomach is a real shock to the liver. what we are seeing over time is a rising rate of fatty liver disease that has no relationship to alcohol consumption in the american public to the tune of 33 percent of adults with some level of fatty liver disease that is not related to alcohol consumption. this is a new thing for the scientific community. we are doing the fastest rising cost for liver transplantation in america and what we see in our own medical center is non-alcoholic liver cirrhosis. this is a public health crisis. unfortunately the science is new and the public isn't aware. one of the things i would be welcomed with your effort is helping the san

franciscans learn more about these toxics affects about hour -- how sugar in packets our health. we have data from neuro imaging studies that show the brain how it's affected by concentrated sugar consumption or craving of sugar in very much the same ways that we see in neuro imaging studies of cocaine and alcohol and other drugs of abuse. this was work pioneered by the director of national institute on drug abuse. it's highly regarded in my field of addictive research as the most cutting edge research. dr. vocal herself, director of nih has been a person who has published some of the premiere medical

journeys specifically about the effects of sugar of dopamine response in the limbic region of the brain. i want to also speak about the work that is recently done by the disease control, senior scientist there who are showing that one 112 ounces can of soda a district -- day increases cardiovascular disease by 1/3. we are seeing epidemiology seeing a high rate of cardiovascular disease. very severe disease. i also want to speak to some of the research that we have that is demonstrating that some ethnic

populations maybe not only vulnerable from a social standpoint in that they are disproportionately bombarded by marketing by sugary beverage companies, but in addition there may be genetic vulnerabilities to heart disease and diabetes who have relationship with sugar consumption. these are doubly vulnerable populations and deserve all we can do to mitigate the impact and these saturated communities and lack of healthy alternatives ideally i would urge you to develop legislation that would compensate those communities for the disproportionate harm that is being done to them by the under health product marketing. to sum up, i wanted to just applaud you for the

efforts, this is a very courageous effort and i want to remind you that you are not alone. there are policy makers all over the world, in 14 nation states already that are doing this. and i would love and be thrilled to see san francisco be on the forefront of making a real difference in america and really break through the barriers and doing what you guys really need to do as government officials in your capacity to protect public health. >> thank you so much, dr. smith. >> any questions? >> i see no questions, thank you. that's all of our presentations. i have a number of speakers from the audience. i'm going to call on them. beatrice duncan. people don't to have come up in this order, the presses of the san

francisco board of education rachel norton. >> good afternoon supervisors, my name is beatrice did -- duncan and a senior citizen and advocate for healthy living and wellness. as a member of two communities of color. i find this report timely, important and essential. scientific research data. which i hope will be able to contradict the current misinformation that has been printed in the written media. as the report indicates, the connection that sugar sweetened beverages has to chronic disease such as obesity and diabetes, seeing this increase amongst adults, children and youth, as a grandmother and great grandmother, i find this quite

frightening. it is therefore that the current discussions that are taking place and i am thankful to be part of a stake holders such as shape up san francisco. the medical entities present here, the community activist that have worked so unselfishly on this issue. regardless on the critical subjects taken place by perhaps the other side of the fence. i think that this is very important and i have learned a lot and again as a senior citizen in the late 60s it's very very rewarding to be able to learn all of this. i pledge to be the messenger that brings this data to my contemporaries. the many grandmothers and great grandmothers who are care takers of our children to be better care takers and aware of sugary beverages. it is essential since the children will be our next generation and

we want them to be health and immune to the effects of diabetes and obesity and stop the consumption of sugary sweets and drinks. >> just one more. on behalf of our families in our communities, i thank you to bring this very critical issue to the forefront on a scientific and clear manner in making a difference to our society, to our community and the residents of san francisco. thank you very much supervisor mar, wiener and those paying attention to this very critical issue that not only affect you, affects your siblings and your children. thank you very much. >> thank you, miss cardenas duncan. next speaker. president norton? >> thank you, suer