12. The Science of Starving Cancer: Sam Apple on Otto Warburg's impact today

Unlocking the Sweet Secrets of Cancer Prevention: A Journey with Dr. Lemanne, Dr. Gordon, and Sam Apple

In this thought-provoking episode, we explore the discovery of the link between diet, glucose metabolism, and cancer growth. Join us as we sit down with Sam Apple, the author of the compelling book, "Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection."

Our guest, Sam Apple, tells the hidden story of Otto Warburg, a Nobel laureate who in spite of his Jewish heritage, not only survived Hitler's Germany, but uncovered the link between  sugar and cancer. 

Sugar, Cancer, and the Rise of Cancer Rates

We kick off our conversation with a startling revelation: Germany's financial ruin and desperate quest to compete with sugar-cane-producing European powers drove the mass cultivation of sugar beets for table sugar production. Sam Apple points out how this historic shift in diet and the rampant consumption of sugar may have played a pivotal role in the alarming rise of cancer rates over the past two centuries. Prepare to be astounded by the unexpected connection between sugar, cancer, and world history.

Hitler's Sugar Addiction and Ironic Phobia

As we dig deeper into the narrative, we explore the eccentricities of history's most infamous dictator, Adolf Hitler. Discover how Hitler's insatiable sugar addiction led to the deterioration of his health, even causing his teeth to rot. The irony of Hitler's profound fear of cancer while he indulged in a sugar-laden lifestyle serves as a stark reminder of the hidden dangers lurking in our diets.

Warburg's Survival and Post-War Ostracism

Otto Warburg survived Nazi Germany, only to find himself and his work shunned by the post-war cancer research establishment in the United States. This unfortunate political reality led to a nearly 100-year delay in connecting the dots between diet and cancer. 

Sam Apple's Personal Transformation

Our guest, Sam Apple, shares the profound impact Otto Warburg's work had on his own lifestyle choices. Discover the dietary changes that Sam has embraced as he continues to uncover the secrets of cancer prevention, inspired by the remarkable legacy of Otto Warburg.

Prepare to be captivated, enlightened, and inspired by this eye-opening conversation that bridges the gap between history, science, and personal wellness. Whether you're a cancer patient seeking new insights or someone passionate about preventive healthcare, this podcast promises to provide you with valuable knowledge that can transform your understanding of cancer prevention.

More on Sam Apple
Link to Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection 

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Chapters

• 8:34 How Hitler's fear of cancer allowed Warburg's research to flourish
• 14:13 Warburg's discovery: how the metabolism of cancer cells differs from that of normal cells
• 27:05 Sucrose, the "bad" sugar?
• 49:35 trials suggest maintaining a low-carb diet is difficult
• 50:38 fecal transplants can cause and reverse insulin resistance and obesity
• 1:05:42 metabolic shifts cancer makes to survive

Transcript

[00:00:00.330] - Sam Apple

A lot of the sort of whole foods type of thinking and organic type of thinking came out of post war Germany and began even during the nazi era. And it is maybe to some extent tainted by some of the stuff I talked about in terms of concerns about impurities and sort of a nazi paranoia. But that mean it's not true. I mean, a lot of good ideas have been embraced by terrible people. So I don't think the fact that the Nazis were into some of this stuff or that some of the people that made it popular in the 1950s had actually been Nazis in the means that they're wrong about everything. But it is true that a lot of those ideological concerns that I talked about before played a role in popularizing sort of organic farming in Germany in the 1950s and beyond. So I think it's fascinating history, but shouldn't be used to discredit any of it, because a lot of those ideas may have been right even though terrible people were focused on them.

[00:01:13.350] – Dr. Lemanne

You have found your way to the.

[00:01:16.070] – Dr. Lemanne

Lemanne Gordon podcast, where docs talk shop.

[00:01:21.530] – Dr. Lemanne

Happy eavesdropping.

I'm Dr. Dawn Lemanne.

I treat cancer patients.

[00:01:32.090] – Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:01:35.890] – Dr. Lemanne

We've been in practice a long time.

[00:01:38.270] – Dr. Gordon

A very long time.

[00:01:39.970] – Dr. Lemanne 

We learn so much talking to each other.

[00:01:42.100] – Dr. Gordon

We do. What if we let people listen in?

[00:01:49.490] – Dr. Lemanne

Cancer eats sugar whether you agree with this idea or not, it has certainly become a mantra among cancer patients and health seekers. Many of our health conscious listeners naturally think of this diet cancer connection as a given. But why is it that standard medical opinion is slow to acknowledge a link? Why do many oncologists avoid having a conversation about diet and cancer with their patients, with colleagues, with themselves? In this episode, Dr. Gordon and I talk with Sam Apple, author of a best selling biography I found mesmerizing. The book is called Ravenous Oto Warburg, the Nazis, and the search for the cancer diet connection. In it, Sam Apple traces the life and work of Oto Warburg, the brilliant german scientist who discovered that dietary sugar feeds cancer. But that's only half the story. Warburg, despite being of jewish descent, managed to make his discoveries during the heyday of German Nazism. Warburg survived because his work caught the attention of Adolf Hitler, sugar addict and an extreme cancer phobe. In the following discussion, Sam Apple describes Oto Warburg's unusually modern organic diet and how learning about Oto Warburg's work on sugar and cancer made Sam dramatically change his own diet.

[00:03:21.570] – Dr. Lemanne

We also talk about the role of the microbiome on insulin resistance and how fecal transplant can cause or fix the problem, at least in the lab. We also dive into the modern repercussions of Warburg's work, why it's been ignored in the day to day work of the cancer clinic, and why it's taken a century for this field of oncology to rediscover that cancer eats sugar. Sam Apple is on the faculty of the MA in science writing and MA in writing programs at Johns Hopkins University. He is the author of Ravenous of Schlepping through the Alps, and of American Parent. His work has appeared in the New York Times Magazine, the New Yorker, the Atlantic, Wired, the Los Angeles Times, the Financial Times Magazine, ESPN the Magazine, the MIT Technology Review, and McSweeney's, among many others. Enjoy.

[00:04:22.470] – Dr. Lemanne

I remember reading about Robert Weinberg's hallmarks of cancer and wondering why there were not any mentions of metabolism in there until ten or 15 years later when he wrote his second version. And you found this, where Weinberg says, quote, I confess to harboring very negative feelings about Warburg because of his nazi affiliations, end quote. So I wonder if you could just tell us a little bit about how you ended up feeling about Oto Warburg and how you think other people's feelings about him might have actually held back, possibly. I think I get that drift in your writing, how that held back cancer science.

[00:05:10.630] - Sam Apple

Yeah. He's a complicated figure. He was, without question, an extremely important scientist who made major discoveries, and I certainly don't think that he deserves to be labeled as a nazi sympathizer. People like Weinberg were skeptical of him because he survived in Nazi Germany despite having a jewish father and a prominent jewish name. So there was a lot of suspicion. But I never found any evidence that he collaborated in any way with the Nazis. And, in fact, he despised the Nazis and spoke out against them all the time. So it's quite surprising that he was tolerated. And I think in the end, he was tolerated because the Nazis, correctly, I think, recognized that he was an important scientist and may have been on the path to making a major cancer breakthrough. So I don't think he was a particularly good person. He was a narcissist, certainly, and he was not very sympathetic to the plight of other jewish scientists. He was a difficult personality, maybe, I think I say in the book, among the most arrogant scientists who have ever lived. My favorite example of that is he once refused to take a photo with other scientists because he felt he was above all of them, and they were all Nobel laureates.

[00:06:40.740] - Sam Apple

That's one of many examples. So he wasn't the most sympathetic figure, but he certainly wasn't a Nazi. And I think after the war, scientists like Weinberg and others were skeptical of him, and that was among the reasons they lost interest in metabolism. But I don't think that was the only reason. There was also sort of the swinging pendulum of science, and the discovery of cancer, genetics and metabolism started to seem like old world science that wasn't relevant to new and breakthrough discoveries. But it is fascinating that the politics played a role. Chivan Dang was one of the scientists who brought Warburg back into the mainstream in the late ninety s. And he told me that somebody took him aside and warned him that by talking about Warburg, he was entering into sort of dangerous political territory and he might want to rethink things. So politics was certainly there in a big part of the story.

[00:07:50.710] - Dr. Gordon

You talked about the Nazis supporting him, really. But I was fascinated by all I learned about actually Hitler from your book. Like Dawn, I really enjoyed the book, and I must admit, skipping over some of the science parts, and I'm very impressed that you, as a literature major, could follow all the different research techniques that you described really well in the book, the picture of Hitler. I mean, I knew he'd been a starving artist when he was young, but he know, I think there were these two prominent, powerful, narcissistic figures, and Hitler came from more of a background of ill favor and want, poverty and artistic temperament. But it was his tremendous anxiety, his hypochondria, and his fear about, like, if he hadn't been that interested in cancer, we might not have.

[00:08:55.610] - Sam Apple

Yeah, yeah. And there's a lot of evidence that Hitler was obsessed with cancer. His mother died of breast cancer. Hitler was by her side. She was actually cared for by a jewish doctor, Edward Block, who later said that Hitler was the most depressed person he had ever seen, watching him by his mother's side as she died. So that clearly played a huge role in his psyche. And his hypochondria was focused on other diseases, but cancer first and foremost. He was very focused on new cancer discoveries and constantly worried about carcinogens in the environment. And it became, in some ways, it's progressive, of course, to be aware of carcinogens. And the Nazis were at the forefront of a lot of the science regarding carcinogens, in part because they know one of the world's best scientific establishment, and in part because Hitler and other top Nazis were hypochondriacs. But I came to see in part through the research or a book called the Nazi War on cancer. That influenced a lot of my thinking that the way the Nazis thought about cancer was actually tied into sort of the grotesque way they thought about the entire world, that carcinogens were one more sort of impurity that was infecting the aryan body.

[00:10:33.020] - Sam Apple

So they were worried about Jews in the same context. They were worried about bacteria and carcinogens. And Robert Proctor, who wrote the nazi war on cancer, described it, the nazi experiment or the nazi project, as sort of a great hygienic experiment in which they could attempt to cleanse everything they perceived as an impurity from the aryan body. So it's a strange phenomenon, in a way, that the Nazis, in some ways, were ahead of the times and made the first discoveries with respect to linking smoking and cancer. For example, did some of the first cancer screenings. But it really was in the context of broader nazi pathology, I think, and.

[00:11:24.750] - Dr. Gordon

Narcissism at the head of both camps, one of them ending up being very constructive and purposeful. Oto Warburg's narcissism served him and science and the world well. And of course, the Nazis didn't. And Nazis, probably the more general word, which is being used a little bit with our modern, most prominent narcissist fascism, that you refer to the people that you want to oust as vermin, and then that means automatically someone has to either self identify as vermin or jewish in that regard, or the person who's going to vanquish all that. And how much more productive if our narcissists would all be well educated and become scientists rather than good charlatans and performers and military?

[00:12:22.170] - Sam Apple

Yeah, well, one of the things that always surprised me most about Warburg was that he was able to be a truly brilliant scientist, and I think, truly a genius in conjunction with being such a know somebody like Hitler or Trump, they have these narcissistic tendencies, and it plays into their sort of sloppy thinking, and they often seem to get everything wrong. Remembering Trump's press conferences about COVID and Hitler was kind of making similar sort of absurd mistakes. But Warburg managed to combine genius with that type of narcissistic thinking. I think that's truly unusual. Although later in his life, his science certainly did suffer as he became more and more of a narcissist.

[00:13:20.830] - Dr. Gordon

I realize we are jumping right into this because we're both so fascinated with the topic and impressed by your writing, but let's just imagine there might be two or three of our listeners who haven't heard about you or your book or read your book, and I know what I would take away from it, which is kind of leaping before and after of what we're talking know, the recognition of the diseases of modern civilization, and then the incredible role of glucose and subsequently insulin and fructose. But in the middle is really the Warburg story and what you identified, and I bet you have a short version of it for our listeners who haven't read the book. What did Oto Warburg really discover that was legendary then and should be instructive to us now? How would you put it in a.

[00:14:12.630] - Sam Apple

Succinctly, his most sort of fundamental cancer discovery was that cancer cells have a different metabolism than other cells, that they take up glucose more rapidly. And rather than processing that glucose in the mitochondria, which are often referred to as the power plants of the cell, they shunt a lot of it aside and use it as they use the glucose to power glycolysis, which I refer to in the book as sort of a backup generator. It's another way for the cell to take energy from our food, but it's less efficient. So it was very surprising that cancer cells did this. You would think that cancer cells would want to get the most out of all of their glucose because they need so much energy to grow and build. And Morburg found that they were using it in this inefficient way, and it was mysterious. And his conclusion in the end was, if cancer cells were doing this, it had to be because of a defect that prevented them from processing glucose in the mitochondria. Warburg thought that the fundamental problem was that they couldn't use the oxygen that was available to them, and sort of out of desperation, turned to glycolysis.

[00:15:41.210] - Sam Apple

So that was his sort of key discovery, that cancer cells have this altered metabolism. And it was so fundamental that Warburg concluded that this has to be central to the cancer story.

[00:15:57.330] - Dr. Gordon

Is it fair to say that their actual inefficiency, the fact that they use glucose but need more of it than other cells to generate energy because they don't use glycogen, they don't run it through the mitochondria? It's almost as if their inefficiency is what makes glucose such a potent. They want more and more glucose, and it is glucose so preferentially that feeds the cancer cells, because they need so much of it. They don't have a diversity or an efficiency with it. Their avid hunger makes glucose an even stronger fuel for them. Is that sort of fair to say it that way?

[00:16:41.040] - Sam Apple

Yeah. I mean, a lot of these questions are still being worked out and still debated. I think the most mainstream view right now is that the cancer cells, despite what Warburg said, most cancers do, still tend to use their mitochondria to some extent, though certainly less than a typical cell. But one of the leading hypotheses now is that all this extra glucose still helps a cancer cell build. Even when they're not processing at all for ATP, for energy. They're still using the glucose, those carbon backbones, to basically construct the parts of daughter cells which they can then use to grow and build. So they're not burning it at all for fuel, for energy, for the cell in the way you would expect. But they are still using parts of that glucose as part of the building project. So that's one hypothesis. Other people are focused on how the cancer cell takes advantage of the lactate, the byproduct that is emitted from the glycolysis process. I haven't talked about the book in a while, so I'm a little out of practice and other people, and maybe this is what you're referring to, glycolysis allows the cells to sort of process glucose more quickly.

[00:18:15.920] - Sam Apple

So even though it's inefficient, if you're using more glucose, then you can make up a lot of the energy deficit in that way. So there are a lot of different hypotheses. And I don't think Warburg got the story exactly right. But what he did get right, I think, is that this is fundamental, that you can't study cancer without thinking about and trying to understand this really fundamental way that a cancer cell processes glucose and other growing cells, rapidly growing cells will do this as well. So something sort of a fundamental growth program that Warburg identified and never lost sight of, even as other scientists moved on.

[00:19:00.510] - Dr. Gordon

And this is in an era when really the whole world was becoming gradually aware that a disease, which had been rare previous to modern civilizations, food changes, was emerging as prevalent, if not at epidemic proportions, then maybe now.

[00:19:20.290] - Dr. Lemanne

That was one of the best parts of the book, in my opinion, the connection between Germany's economic problems and disparity compared to the rest of the world, which had access to, I guess, sugar plantations through colonies and things like that, the rest of the european world. And there was an urgency to catch up. And ironically, to my mind, and I think you were pointing this out in your book, they turned to beets and made sugar out of beets to try to fill in the gap of sugar production that they saw. And at the same time, there was this growing fear about the rising cancer rates, that was really ironic. And also, everything just fits together so wonderfully. So the idea that you hint at this is excess glucose production, and industrially and the cancer rate rise, are they connected? I think the answer that you hint at is yes. And the political situation that, ironically turned the german people to that kind of production when it was actually harming their physical health, and Hitler's great fear of cancer and his addiction to sugar, all of those things were really interesting. And it also kind of dovetails with the idea that cutting glucose is the way to cancer's weak point and a way to start controlling cancer, both in prevention and possibly in the treatment phase of things.

[00:21:05.830] - Dr. Lemanne

So I wonder how you, after publishing this book and maybe sitting with all of these ideas, have you come to any changes in your own life? I mean, do you watch sugar intake and did you change? Maybe you were never a big sugar holic or anything like that, but is there anything that you took away from this that you've put in place in your life?

[00:21:30.910] - Sam Apple

Yes, I think so. Even before writing this book, I'd become interested in metabolic health and interested in diet and what triggers obesity and insulin resistance and diabetes. And I hadn't really connected cancer to all these stories. And one of the reasons I wrote the book is I became fascinated by the possibility that cancer, too, could be understood as a metabolic disease. So as I learned more and became increasingly convinced that many types of cancer, including typically the most common ones, are related to metabolism, that I started to get a little more strict with my own diet. It helps that cancer is scary, and we certainly can't prevent all kinds of it, but you want to improve your ods. So I think I got more strict about the low carb diet that I was already interested in. After starting this research.

[00:22:36.450] - Dr. Gordon

One of the questions that came up in my mind, and I've got several dovetailed pages about it anyway, is Warburg existed pretty much at the same time as Weston Price, and they had a similar awareness that there's something about the diseases of modern civilization, but to your knowledge, they had no awareness. Do you know, you know who I mean by.

[00:23:07.160] - Sam Apple

Yeah, yeah. I never found any connection between the two of them, although I think they did have similar interests for Warburg. One of the things that interested me a lot about him is that he came to the conclusion that something in the environment was causing the increase in cancer, and he tried to understand it through his own discovery, which we already talked about, this shift to glycolysis. So Warburg's conclusion was that all the pollutants in the environment were damaging the mitochondria, these energy plants in our cells, and forcing the cell to metabolize glucose in this inefficient way. So I think he deserves a lot of credit for thinking about the environment, recognizing that it had to be something in the environment. But in the end, I became more focused on diet. Warbrook was also focused on diet, but his concern with diet was specifically things in our diet that could poison the mitochondria. He didn't know about the insulin stuff, which know insulin certainly was known about, but the modern science of insulin resistance wasn't known about in his lifetime. So I tried to take a step back in the book and think about what is it in our environment that could be causing the cancer cell to the cell to shift its metabolism in this way?

[00:24:38.860] - Sam Apple

And then one hypothesis was the existence of all the refined carbohydrates and sugar in our environments that was increasing in very much the same way as cancer was increasing, and also obesity and diabetes and other of these so called diseases of civilizations. So then the tricky part of it becomes, how do you connect eating sugar, or eating a lot of carbohydrates to the cancer cell eating sugar? It seems like there must be a parallel between these two things. But even so, mechanistically, it's not that easy to explain, because there is always glucose running through our blood, whether or not we eat sugar. And it's possible that just a mutation arises that allows the cancer cell to take up more glucose. And you don't really need any changes in our diet to explain that. So that's what I was trying to unravel in the science that I get into. In the second part of the book. I try to make the case that there's a lot of compelling science which shows how elevated levels of insulin are really the key to this story, that allow the cancer cell to instruct the cancer cell to over consume glucose.

[00:25:54.770] - Sam Apple

And the evidence for this is widespread. I think the cancer cells are covered in insulin receptors. There's really powerful correlations between elevated insulin and cancer. Certainly in mouse models, you can manipulate insulin levels and see the restrict certain types of cancer, and you're working it. In addition, the lab. Some cancers won't even grow until you add insulin into the experiment, because it's part of the formula, it's a growth factor. And if you have insulin resistance, which maybe we'll talk about more, you have insulin coursing through your blood all the time at maybe 10, 20, 50, times the normal level. So I think that is really the key to the environmental factor that Warburg didn't know about and which sort of puts the whole thing together. And sugar is. When I say sugar, I mean sucrose. I don't mean glucose. That drives me crazy that the terminology is so imprecise. But sugar as sucrose, this molecule that's half glucose and half fructose, seems to be the worst of all the carbohydrates, because it does the most to sort of cause insulin resistance to develop, which in turn causes insulin levels to rise. And it's this elevated insulin which appears to be one of the keys to triggering this Warburg metabolism and allowing a cell that might otherwise be eliminated by apatosis, as we talked about, to instead survive and thrive and grow.

[00:27:41.650] - Dr. Lemanne

Well, let's talk a little bit about insulin resistance and sucrose and the difference between the glucose, fructose, and sucrose, which is a combination of glucose and fructose. Do you think that there's something special about sucrose itself, apart from its makeup that includes fructose in terms of insulin resistance and possibly cancer?

[00:28:08.510] - Sam Apple

I do. I mean, there are societies that have consumed a lot of carbohydrates in the absence of sucrose.

[00:28:19.710] - Dr. Lemanne

I'm going to just take it a little aside here for our audience. So, sucrose is what we get from cane sugar and sugar beets. It's table sugar. So just want to put that in there for anybody in the audience that's wondering.

[00:28:33.660] - Sam Apple

Yeah. For the whole sort of metabolic world, people are interested in low carb. This is one of the hard questions. Are all refined carbohydrates equally bad, or is it the sucrose in particular? And it's extra tricky, because if you look at the research of Richard Johnson, who's been at the forefront of a lot of this stuff, he shows that our bodies can actually convert glucose into fructose. And so it's not always easy to separate the two. But when you take a step back and look at the sort of epidemiology, it is true that there are a lot of societies that have eaten a lot of carbohydrates, not always sober, fine, but have certainly eaten a lot of carbohydrates and remained metabolically healthy. But as soon as sucrose, the sweet white stuff, or fine sucrose, comes into the diet in a big way, then all the metabolic problems start to arise. As Gary Talbs says, sucrose is always at the scene of the crime. And so that's why I think it should be the first thing to eliminate. Ideally, you would probably eliminate other carbohydrates as well.

[00:29:56.190] - Dr. Lemanne

So these other carbohydrates that the societies that don't have an excess of cancer are eating, tell us a little bit about what types of carbohydrates you're talking about there that may be less dangerous than sucrose.

[00:30:09.170] - Sam Apple

Yeah, I mean, certainly a lot of asian populations have been metabolically healthy, consuming a lot of rice, for example, maybe not always refined. And other populations have done well on fruit heavy diets. So I think that once the sucrose is introduced into the diet and somebody starts to develop insulin resistance, as most of us have, I don't know if I have it now, but I certainly did at one point in my life. Once you're at that state, I don't think it's usually enough to just eliminate the sucrose to reverse it. I think once you have the insulin resistance, you have to go sort of lower carb across the board to kind of reverse things. But I do think that it's possible that if you never have sucrose, then you might do fairly well on a diet that has a number, significant amount of carbohydrates and not develop insulin resistance. So it's tricky. And when in doubt, I think it's better to go low carb if you can. But I do think sucrose is sort of the main thing in the diet that one should focus on, if one is focused on only one thing.

[00:31:31.390] - Dr. Lemanne

One thing that I focus on a lot is calories. And you touch upon this in the book, that low calorie diets have been seen in many species to prolong life, delay and decrease the incidence of cancer. How much do you think that plays a role? Would it be reasonable to assume, know, one could take some sucrose as long as the caloric intake is pretty low? And that brings me to Thomas Seyfried's work, which is this wonderful opus, looking at very low carbohydrate diets, zero carbohydrate diets in animal models and cancer treatment. And the effect is beautiful. We really see a better treatment effect, lower cancer rates, all sorts of things with that type of work. But one of the things that struck me about Thomas Saifried's work is that this is ketogenic diet, a very low carbohydrate diet, and it's usually a lower calorie, calorically restricted ketogenic diet. So I wonder if you have any thoughts about how that has been teased out or how people are, how scientists now are trying to tease out those two effects, the effects of calories as well as carbohydrates.

[00:32:49.590] - Sam Apple

Yeah, I think it's hard to tease it out, and a lot of scientists I respect have different opinions on these matters. I do think that low calorie, if you can sustain it, could be very healthy and potentially be used in combination with other cancer therapies as being effective, as seafried has showed. But I think for most people, a very low calorie diet is not sustainable. It's just incredibly hard to do in some cases. It also doesn't have the intended effect because metabolism slows down to sort of match the calorie intake. Outside of the context of cancer, I tend to favor more of a ketogenic diet rather than a low calorie diet, mostly because I think it's more sustainable. And I think you sort of get the best of both worlds. They sometimes refer to it as a fasting mimicking diet, because you see a lot of the same effects at the cellular level without actually having to fast for a long time. So I think it's the best approach for most people. But if somebody is doing well on a low calorie diet, I think that it can be a very healthy way to go.

[00:34:17.160] - Dr. Lemanne

So it's one way to lower insulin levels and decrease exposure to insulin over time. Another way that you're just touching on is fasting. There's intermittent fasting, long term fasting, having punctuations in your insulin exposure. And do you want to talk a little bit about that and what your.

[00:34:38.870] - Sam Apple

Recent have shown you? Yeah, I don't claim any expertise on that, but I think that in the context of cancer, what we've seen is a striking correlation between elevated insulin and many of the most dangerous cancers. So one strategy should be to keep insulin lower, to keep insulin at a healthy level, to restore metabolic health. And so if somebody can do that by low calorie, if they can do it by a ketogenic diet, intermittent fasting, if somebody is doing well on a low fat diet. My concern is sort of the end product, and it's not that hard to measure. You can have your insulin test if you request it, you can look at your triglyceride hdl ratio, and a lot of times you can just see just visually, if you have insulin resistance. So whatever is working for somebody, say.

[00:35:46.540] - Dr. Lemanne

A little bit about that, say what some of the visual signs of insulin resistance are. For our audience, I think they'll be interested in that?

[00:35:55.650] - Sam Apple

Sure. Well, when I was younger, in my thirty s, I remember my doctor telling me that my triglycerides were pretty high. And I remember asking him, should I be worried about that? And he kind of shrugged. He was a good doctor, but he just kind of shrugged. And I don't think he even told me what the total were. But in retrospect, it's clear that if I had very high triglycerides, that I probably had some degree of insulin resistance. And when I look at pictures of me from that period, I can see that my face was kind of heavier. My face looked somewhat different than it does now. I didn't know about insulin resistance at the time, but what strikes me is that I was always somebody even then, who would have been thought of as thin. But I do believe I had insulin resistance based on, I can see it in the pictures of my face. And I think that I have a certain phenotype that's very common in some communities and also in some parts of the world, where sometimes the casual term that's used is skinny fat, where I didn't store fat easily subcutaneously.

[00:37:20.910] - Sam Apple

So it sort of went, like, straight into insulin resistance. And I had a lot of diabetes in my family, and nobody in my family would have been considered really heavy. So I think it's important for people to realize that you can see it, but that doesn't mean that what you see is typical of what you might think of as being overweight or obese. Nobody would have called me that, but I think it was visible. And I think that these problems affect all of us, not just people that we think of as obese. And that's why it's so hard for people to realize how wide the effects are, because it's really all of us, by some measures, like 80, 90% of american adults, have insulin resistance. I'm virtually certain I did, even though I don't have any actual evidence beyond that report of my triglycerides.

[00:38:13.380] - Dr. Lemanne

Well, that's really something that's always fascinated me in my medical practice. I do look at patients and try to see if they have a lot of subcutaneous fat, which is actually a little bit protective. If your body can put excess calories into subcutaneous fat, that's a little safer than if your body wants to put it straight into visceral fat. But apparently we can all, at some point, at various levels personally, though, fill up our subcutaneous fat capacity. And at that point, we think the visceral fat starts to collect and that can be in someone who can't store a lot of subcutaneous fat, which sounds like maybe use them can happen pretty early in the process. And then we start seeing fat collecting around the internal organs, the liver, the pancreas, the heart, and in the abdominal cavity, the omantum, those kinds of things. And we think that the waist to hip ratio is maybe a better measure of a crude measure, but a better easy measure of a person's propensity to insulin resistance than, say, the BMI, which is rather nonspecific when it comes to where the fat is located and how much of your weight is fat versus muscle.

[00:39:28.800] - Dr. Lemanne

So that's really interesting. Did you find yourself feeling better after changing your diet?

[00:39:37.570] - Sam Apple

Yeah, it's been a big improvement. Yeah, I felt healthier in my 40s than really since I was a teenager, and I've returned to the weight that I was at in my late teens, early 20s.

[00:39:59.790] - Dr. Lemanne

So you did lose some weight even though you weren't overweight to start with?

[00:40:04.450] - Sam Apple

Yeah, I lost probably about ten or 15 pounds. And my wife does think that I got too skinny. So maybe it wasn't entirely a positive development for my appearance, but nevertheless, I don't particularly worry about my appearance. I'm just trying to focus on my metabolic health.

[00:40:28.390] - Dr. Gordon

As speaking as a primary care physician, I want to say two things to our audience, and then I have a question for you about your skinniness. The two things that people, I think can really do for their own insulin resistance testing is to measure their waist. And if you look at the common literature, they give a number for waist, like women's whose waists are more than 26 inches. But the important thing is your waist. And I like to use height because more people sort of know their height, and it's hard to figure out where to measure hip. Measuring waist for women is at the smallest point. Measuring waist for men is at the belly button, and it should be less than half your height. And if it's more than half your height, I think you have insulin resistance. So caveat number one. Caveat number two is just what you said. Ask your doctor. Most doctors do not order fasting insulin levels, which drives me crazy. What good does it know to know what somebody's blood sugar is unless you know what their insulin is at the same time? So on behalf of being your best physician approaching your primary care doctor, you should know your waist to height ratio or waist to hip, which Dr.

[00:41:36.350] - Dr. Gordon

Lamont's saying. I just don't even know where to measure my hips, and they're all over the place, and people should know their insulin levels. But my question, and my question pointedly to you. So, in general, the other thing that can really raise insulin levels is protein. And I'm a big protein advocate, and I think one of the big problems with a calorie restricted fasting mimicking intermittent fasting diet is they end up being reduced in protein, which I think compromises muscular reserve and possibly immunoglobulin function. And we are in the real world, we're not laboratory animals. And I think protein is really good for us. But what about the insulin that protein can generate? And what's your theory? What's your practice for protein in your own dietary plan?

[00:42:35.650] - Sam Apple

Yeah, I try to stay relatively low carb, but I don't restrict fatter or protein at all. I don't count calories. So I think I have a high protein diet. I do think certainly after consuming protein, you will get short term insulin spike, perhaps, but it doesn't seem, in the context of a low carb diet, to contribute to insulin resistance. So I think if you're metabolically healthy, then a diet high in protein, despite the postprandial glucose or insulin excursions, will nevertheless be a fairly healthy way to eat. I'm more worried about the systematic insulin resistance and insulin, 24 hours a day, coursing through your blood at 50 times the normal level, as opposed to what happens in the short term after a meal.

[00:43:41.830] - Dr. Gordon

Maybe this is something obvious that I'll know after I ask the question, but why does glucose provoke a more enduring insulin spike than protein does?

[00:43:53.450] - Sam Apple

Well, I think the two of you know more, much more about this than I do. But why glucose?

[00:44:04.310] - Dr. Gordon

Well, I think I know why. I think we're better at maintaining a circulating serum level of amino acids, and I think we break up the protein faster. I think that's why.

[00:44:16.680] - Sam Apple

Yeah, glucose, again, this is out of my expertise, but I kind of think about it as glucose is toxic. If it stays at high levels in your blood, you've got to get it out of there. So I think the insulin has many jobs, but that first job is just to clear it away, to make sure you don't stay at high levels or your life will be in jeopardy fairly soon.

[00:44:42.890] - Dr. Lemanne

Glucose is pretty addictive, isn't it? I mean, one of the interesting things in the book is Hitler's addiction to sugary snacks. You talk about that a lot, and you talk about his health issues. It sounds like he was obese, had rotten teeth, was so addicted to sugar that he ate amazing amounts of food, cakes and cookies and things like that that appalled his aides. Tell us a little bit about that. That was a really fascinating part of the book and a part of Hitler's history that I wasn't aware of and was really interesting to.

[00:45:17.830] - Sam Apple

He was. He was a sugar addict. He was an addict more broadly. He was taking a lot of different drugs. But at the end of his life, particularly when he didn't have access to.

[00:45:34.190] - Dr. Lemanne

The other drugs, what were these other drugs? For our audience?

[00:45:39.230] - Sam Apple

He was taking stimulants of various kinds. There's a really interesting book on this topic called Blitz that goes over all of his different drugs that he was taking, but he was on a lot of different stimulants. He had a doctor who was sort of by his side all the time, injecting him with different things. And he had an addictive personality, I say in the book, and I think it's important to mention that. I don't believe that his sugar addiction caused his craziness or his mania, his deep seated pathology. But it is interesting that he had an obsession with cancer. At the same time he was obsessed with sugar, as I said earlier, that he had a way of getting everything wrong. Kind of like one more thing that I believe he got wrong. And, yeah, he was just in horrible health. His teeth were rotting. I think I say this in the book, that his dentist was horrified by Hitler, not because of his murdering millions of people, but because of his teeth were so disgusting to know. People wrote in their memoirs and their diaries. They were just astonished by. By the amount of sugar he was consuming.

[00:47:16.890] - Sam Apple

Six, seven teaspoons and a glass of tea. But again, I don't think that's responsible for who he was. It's kind of just an interesting side fact.

[00:47:25.580] - Dr. Lemanne

I remember a scene where he's at a meeting or something like that, and somebody has to keep going and getting him some cakes or something like that. He wouldn't stop eating them. He would have eat the whole thing as a cook would bake something and Hitler would eat it. Sugar is addictive. In other words, when you have it, you want more and you want more than you had in the recent past. Have any of your investigations led you into any ideas for people on how to break that type of habit and addiction and how long it might take? I've read recently and I haven't looked into this, maybe you know something about this. Deborah or Sam. There's now an inpatient sugar addiction rehabilitation ward in a hospital somewhere. I don't know anything more about that. I just read it on one of my metabolism listservs, but I was surprised at that, but then not surprised. Yeah, maybe it's a strong enough addiction so that inpatient rehab is necessary.

[00:48:31.090] - Sam Apple

Yeah. I personally don't know a lot about the best strategies. I certainly think that switching to a ketogenic diet or a diet that's high in fat and protein makes it a little easier because it's very filling. But certainly a lot of people find it hard to adjust to the low carb diets. I think one of the interesting questions is the role of sugar substitutes. I know that some people are very skeptical of sugar substitutes. I'm not sure where the two of you fall on that, but I personally am not convinced that they're harmful, at least in the context of the risk of cancer. But some people do worry about just the taste of sweetness on the tongue triggering the sort of initial insulin response. So I'm not sure where that falls. But if someone's struggling. I do think that sugar substitutes can sometimes be a helpful way to make the transition. But it's a really interesting question, because I find it fascinating that there are so many people on the Internet and that have success with low carb diets and manage to break their sugar addictions. And yet, when you do these clinical trials of six months or a year is usually as long as they go in a controlled setting, most people don't seem to maintain the low carb diet.

[00:49:56.260] - Sam Apple

So what's interesting to me is what is the difference between these people on the Internet that have success and these people in the trials that can't seem to maintain it? And I don't know the answer, but I think it certainly helps if you arrive at the information by yourself, if you have that motivation to seek it out and understand the science. Because if you're just in a study and put into one arm and told to eat a certain way and you don't really believe it and buy into it, I think it's really hard to maintain.

[00:50:24.690] - Dr. Lemanne

I think it's a really complex topic. I remain agnostic on sugar substitutes. If people need them and it seems to help and we can measure their metabolism and they're improving, I guess I wouldn't have a problem with that at all. But I am really interested in some of the studies that show that fecal transplants in both directions from insulin sensitive to insulin resistant animals and vice versa, can change the phenotype. It's usually temporary, wears off after a few weeks or a couple of months. But that really is an interesting area. And there's a case study of a woman who receives a fecal transplant from her daughter. And the purpose of the fecal transplant was to treat clostridium difficile colitis, which is also related to antibiotic induced colitis. It's very, very difficult to treat. So this patient received a transplant from her daughter. Her daughter was overweight. The patient was not overweight before this transplant, ever. And after the transplant, her C. Diff, the colitis went away. The treatment was successful in that regard, but she became overweight and could not become un overweight after that. So that was a really interesting case study, and that's in the literature also in animals.

[00:51:45.530] - Dr. Lemanne

If you take insulin resistant mice and take some of their feces and donate it to insulin sensitive mice, the insulin sensitive mice become obese. Even with fewer daily calories. Their calories can be controlled. They become obese and insulin resistant with fewer calories. So those kinds of things add many layers of complexity to this story that I think we're only starting to understand, that we need to figure those out. We don't know what we don't know. And so it's not completely simple for everyone. But I do think that the stories on the Internet are really fascinating. For instance, I think low carbohydrate and even carnivore diets, this isn't exactly insulin resistance, but I think Jordan Peterson's daughter, who went on a carnivore diet, says that this resolved her autoimmune issues. And then she talked her father, who's the famous Jordan Peterson psychologist, an Internet figure, into trying this. And he says that it resolved his overweight and depression issues. So, yes, there are stories like that, and one wonders why certain people have such tremendous success, while others really struggle to get the same outcome with the same approach. So those are really interesting questions.

[00:53:15.530] - Dr. Gordon

My impression about the non caloric sugar substitutes is that are different. So, for instance, some of them provoke illicit, and it might be individually person variant as well, but they evoke more of an insulin response than others. So the fact that stevia lowers your blood sugar is not really a good thing. It means stevia provokes insulin and probably is not your friend in this. But I think there's some research out recently suggesting that alulose works differently than stevia, or even xylitol, which has some other health benefits, clearly, as well, particularly exposure to your oral microbiome. But that alulose might work a little bit like the semiglutide drugs, that it has a beneficial action, mechanistically, on the activities of insulin and the cell's response to carbohydrates and might lower appetite and help you lose weight more than just as a substitute for more than its caloric loss. Have either one of you heard that about alulose?

[00:54:27.360] - Sam Apple

Yeah, I've seen the same stuff. I've been very intrigued by alulose. I'd like to learn more about it, but right now it looks, I think, like the most promising of the various substitutes.

[00:54:39.550] - Dr. Gordon

Not only that, it actually looks moves in a recipe and somewhat tastes like sugar.

[00:54:47.680] - Dr. Lemanne

Somewhat?

[00:54:48.790] - Dr. Gordon

Yeah, it's like, not quite so sweet. But if you're making pear crisp, the pears have their own sugar. So for cooking, I think aluloses, that's certainly been my go to, and I am no accomplished pastry chef, so don't anybody take my word for it. My greatest success with patients trying to get them off their sweet addiction is really making them push, not just low carb. In fact, I don't even talk about that, but going high protein. So, yes, you can have the ice cream, but first you have to eat two or three burgers without the bun when you go to McDonald's after your volleyball game. Speaking of one patient in particular, you eat two burgers, and if you still want the ice cream, you can have it. And that was sort of the little magic roller skate key in her brain.

[00:55:45.150] - Sam Apple

Yeah, I think that makes a lot of sense. I know that grocery stores now sell bags of hard boiled eggs. Really talking about how whenever he got any kind of craving, he just popped in a hard boiled egg, and that did the trick.

[00:56:04.070] - Dr. Gordon

And it's hard to overeat hard boiled eggs.

[00:56:07.280] - Sam Apple

Yeah.

[00:56:07.800] - Dr. Gordon

Nobody's going to eat 20 of them.

[00:56:09.990] - Sam Apple

Yeah. Having the right foods around and consuming them without any concern about calories, I think, is often a good strategy, but not for everybody.

[00:56:24.570] - Dr. Lemanne

What was Warberg's diet like?

[00:56:27.710] - Sam Apple

Yeah, as I was talking about before, he was after the war, very focused on his diet, and he was sort of, like, of the first generation, one of really the first sort of people who was really into organic foods. He was so concerned about pesticides and other potential chemicals in the diet that he started growing all of his own food. He got his milk from a special herd of special cows that were in a nearby institute.

[00:57:04.550] - Dr. Lemanne

What was special about these cows?

[00:57:07.130] - Sam Apple

They were just raised, I guess. They were all grass fed, and they.

[00:57:13.710] - Dr. Gordon

Had their tails combed and braided.

[00:57:18.030] - Sam Apple

So he would use the centrifuge in the lab to make his own cream. And he was just really terrified of chemicals and how they might poison his mitochondria. So I think he took it to an extreme, but was certainly ahead of his times in a lot of ways. He probably would have been a whole foods shopper nowadays, very focused on organics.

[00:57:50.070] - Dr. Lemanne

Interesting.

[00:57:51.430] - Sam Apple

Yeah. And a lot of the whole idea of whole foods actually came out of Germany from that era. As I talk a little bit about.

[00:58:00.120] - Dr. Lemanne

Talk more about that, that was really fascinating. Know, the idea of purity and organic food and everything was enmeshed in the minds and philosophies of Nazi Germany.

[00:58:12.010] - Sam Apple

Yeah, it's true. Know, a lot of the sort of whole foods type of thinking and organic type of thinking came out of post war Germany and began even during the nazi era, and is maybe to some extent tainted by some of the stuff I talked about in terms of concerns about impurities and sort of a nazi paranoia. But that doesn't mean it's not true. I mean, a lot of good ideas have been embraced by terrible people. So I don't think the fact that the Nazis were into some of this stuff or that some of the people that made it popular in the 1950s had actually been Nazis in the means that they're wrong about everything. But it is true that a lot of those ideological concerns that I talked about before played a role in popularizing sort of organic farming in Germany in the 1950s and beyond. So I think it's fascinating history, but shouldn't be used to discredit any of it, because a lot of those ideas may have been right, even though terrible people were focused on them.

[00:59:28.740] - Dr. Lemanne

Well, certainly your book talks about narcissism and the coordinating ways of thinking about the world, which have themes of purity and separateness and rightness, and also mixing all of that in with heredity and the ideas of removing impurities. And it sounds as though you've been able to come to a nice synthesis, personally, about Oto Warburg. I found it a sympathetic book. Would you say that that was your feeling about Oto Warburg when you finished this, in spite of all of these forces that he was playing into and also used for his benefit, and he was a very interesting and helpful person to the larger picture of cancer metabolism, in the end?

[01:00:37.050] - Sam Apple

Yeah, it's tricky. I think that one fair criticism of the book might be that I was too sympathetic to him. I tried to point out his flaws and also admired him, for he was as close to being openly gay as one could be at that time. And so I admired his sort of boldness for embracing his gay identity to the extent that he could. I mean, he traveled everywhere with his partner, and I liked that he stood up to the Nazis, and when the brown church would come to his institute, he would scream at them and chase them away. And first and foremost, I liked the fact that he was able to not only make this fundamental discovery about cancer, but not be distracted by all the sort of changing the blowing winds of science that distracted so many other people. He saw what was fundamental. In a way. It took, really, until the development of the PET scan decades later, for people to see what Warbrook had seen all along, which is just that. If you want to identify cancer, is you can literally look and see all of the sugar are taking up more of the glucose.

[01:02:01.010] - Sam Apple

Yeah. So I have a lot of admiration for him. But at the end of the war, as I talk about in the book, there were people in his lab that he really sent. You know, he could have protected. He sent away to the front lines to be killed. He just had no sympathy for. For other people. He was concerned about himself. I mean, he thought these lab mates had betrayed him. And it's complicated. But after the war, he returned to Germany, reestablished his lab. And I kept looking for evidence that he had internalized the horror of what had happened, but I never really found it.

[01:02:41.650] - Dr. Lemanne

What might have convinced you that he had internalized the horror? Well, what were you looking for?

[01:02:49.650] - Sam Apple

Well, I mean, any kind of public statements. I found in one private letter to a. You know, he made reference to what had happened and the fact that this jewish scientist should return to Germany and reestablish his lab. And that would be an important thing. But that was literally about the only thing I found. You would think that somebody of a jewish heritage who spent. He lived until 1970, spent decades there after the war, would have spoken out more, would have talked about his jewish heritage, but he never really seemed concerned about it. I think he just wanted to push it all behind him. And it was some extent understandable. He had been traumatized at one point in 1941, as I talk about in the book, he had been called into nazi headquarters. It looked like it was the end of his life at that point, and he wanted to move on. To some extent, that's understandable. But I think he was a part of the post war sort of german attitude in the 1950s in particular, where they were trying to push it all under the rug and not talk about the nazi period very much.

[01:04:05.230] - Sam Apple

Of course, in later decades, Germany, to its credit, did start to recognize its crimes and to eliminate some of the high profile Nazis from society. But I don't think Warburg, because of his narcissistic personality was ever fully capable of sort of processing the magnitude of the tragedy.

[01:04:31.670] - Dr. Gordon

One can only hope that some of the people complicit with some of today's misbehavior will come to reconcile with a longer arc of justice. Okay. It's just so hard not to think of modern politics when you think of these two larger than life figures, one which took us down a very dark road, and this man who in his lifetime really never received the light he deserved, the focus of attention for his contribution that Warburg deserved, except in mean, he won the Nobel Prize. But I think he would feel a completely different sense of gratification to understand even that podcasts and Seyfried and that so many people have leapfrogged from his work onto the development of the PET scan and understanding. It's not the only thing that leads to cancer, but this is a big deal, and it's an important part of dawn, you and I have talked about when somebody has cancer, that cancer can be very, very clever and shift from a high sugar diet to a vegan diet, if that's what you do. Some cancers can do that and some don't. So this is a completely sort of like separate little thread here.

[01:05:57.810] - Dr. Gordon

But in existing cancers, even the ones that, so the ones that switch from thriving primarily on sugar, would they still follow the principles that Warburg describes of finding whatever sugar they can and existing in that way? Does that question even make sense?

[01:06:20.520] - Dr. Lemanne

I think what you're asking is a really interesting question, and Sam actually touches upon this in the book, and it's an area of hot research, and that's that cancer is very, very able to switch. So in Sam's book, he talks about, I think it was in the Craig Thompson lab, maybe one of his grad students, talking about the ability of cancers to deal with a dearth of glucose. So say the glucose is removed, they'll switch to glutamine, and then if the glutamine is removed, they'll switch to fatty acids, et cetera.

[01:06:56.910] - Speaker 3

They'll go down the list.

[01:06:59.430] - Dr. Lemanne

The way I think of it is like a big city. And you block off one block of road, well, there is a little isle up of traffic for a little while, but people and cars and whatever else find their way to their destination by just going to the next block and turning, going around the block. And cancer works that way, too. It finds a way to adjust its metabolism, to adjust its location in space. It metastasizes to a place that's a little bit better in some way. Yes, it's a very plastic process. It's a very complex, dynamic system. You poke it in one place, and it responds and adjusts and keeps going. So, Sam, I don't know if you have some comments on.

[01:07:50.860] - Sam Apple

I mean, that's very much how I view it as well. And for that reason, I decided in the book to largely focus on prevention. There could have been a whole other book, and there have been plenty of other things written about ketogenic diet or lowering insulin in the context of cancer itself. And there are some remarkable stories, particularly with leoplastomas, brain cancers, where you've seen people do very well on specialized ketogenic diets. But for the most part, what I've seen is that what you say is correct, that once the cancer develops, cancer is unusually good, that the cells evolve, adapt, find new ways to get their nutrients. They always have new tricks. So I think what's really exciting, from what I've seen in early sort of data, is the combination of diet with conventional treatments. Chemotherapy in conjunction with ketogenic diets, for example, is one hot area of investigation. But I think the primary focus should be on diet in the context of prevention, because once the cancer takes off, then it becomes very skilled at finding new ways to get its nutrients.

[01:09:16.050] - Dr. Lemanne

I mean, the whole process of cancer, by the time the patient gets to the clinic with a diagnosed cancer, we're talking about the last 10th of the cancer's lifetime. And so the cancer has been developing in some preexisting form for years or decades. And so you're at the very last stages, even with an early stage cancer, when you finally get to the clinic with that, and that cancer's been in your body for a while and is very, very good at making adjustments to your body.

[01:09:50.460] - Dr. Gordon

But I would like to say to all those people who now think, oh, my God, I have a cancer growing in my body. Something you and I have talked about, Dawn, is, yes, we probably all have had cancers and doing things like even just paying attention to this, oops, sorry, sugar restriction might forestall cut the throat of deprive the life of a cancer. Just because you have a cancer growing in your body doesn't mean it will continue to grow in your body.

[01:10:15.920] - Dr. Lemanne

So, no, but by the time it gets to the clinical stages where the doctor has said, you have a cancer, we can see it.

[01:10:21.850] - Dr. Gordon

Here it is.

[01:10:22.250] - Dr. Lemanne

We've got a know that's a pretty serious, you know, fasting studies. Valter Longo's lab in southern California, for instance, has shown that in some cancers, you can actually control the growth and maybe even shrink some of these cancers with what he calls cyclical fasting or cyclical starvation. So he'll put animals on no food for a few days and go through that. The effect is even better, however, if it's combined usually with radiation or chemotherapy or targeted drugs that particularly attach and disable a particular pathway that may be overactive in cancers. So certainly you don't want to be nihilistic and say, well, there's nothing we can do and not try anything. And certainly these dietary maneuvers are helpful. They're very, very stringent, though it's not just a little bit of, oh, I'll just cut out the cake once a week or something like that. These are pretty dramatic dietary maneuvers that are clinical maneuvers. There's measurements and blood tests and things like that that have to go into this daily to move the needle with cancer treatment.

[01:11:38.590] - Sam Apple

With respect to what you're saying, Deborah, about all us having microscopic tumors, or maybe even larger ones, some of the scientists I interviewed talked about that being the key role of insulin. Not that it's necessarily triggering these microscopic tumors that might arise in everybody naturally, but so much as that it's allowing them to survive and thrive, giving them that little sort of survival push that keeps them going when they might otherwise be eliminated by the immune system through apoptosis, et cetera.

[01:12:12.650] - Dr. Gordon

That is such an important point that we have so much power over all this early stage of so many cancers. I'm sure not everyone, but really matters what's on your plate and in your fork. On your fork, yeah.

[01:12:28.270] - Sam Apple

My sort of hope would be that we come to think of elevated insulin, insulin resistance, as just one more carcinogen. It's not the entire cancer story. Certainly cigarettes remain a big part of the cancer story. There's plenty of other environmental causes of cancer. But if people could view it in that way, as a carcinogen that just happens to be coursing through our blood, then I think it would cause many more people to wake up to this phenomenon.

[01:13:05.130] - Dr. Gordon

I hope we play that line in the podcast twice. That is really important. That's where we have the power, and we're doing it all the time. Feeding it one way or another. Starving it or feeding it.

[01:13:21.970] - Sam Apple

Yeah.

[01:13:25.650] - Dr. Lemanne

All right. How about ending there? What do you think? Anything else anybody has to say that needs to be dropped into this wonderful conversation?

[01:13:37.990] - Dr. Gordon

Not really. But I do just keep wondering, like, with all this evidence, why have all the dietary standard councils in this country historically either focused on fat or meat as the problem? But that's a whole nother topic for a whole nother day.

[01:13:58.170] - Dr. Lemanne

Well, Gary Taubes talks about that a lot. And Sam, I know you talk to Gary Taubes and read his work. Do you have any comments on that work of your own on that topic?

[01:14:09.490] - Sam Apple

Yeah, well, Gary's work was definitely very influential in my work. And first and foremost, I think he awakened me to the problems with epidemiology, which he talks so much about, and how easy it is to go wrong when you don't actually have experiments, but only these observational studies. So that was kind of my starting point. If we eliminate all this unreliable observational data, what's left and how we can piece it together? We still don't have the perfect proof that I would love to have, which would be to have randomized people to different diets and to track them for many, many years and see who developed cancer and who didn't. So it's really challenging to get the answers in the absence of that. So what I tried to do in the book is kind of piece a lot of the different bits of evidence together, one being what's happening on the cell, what's happening in terms of long term historical trends. We see these problems starting to arise in the late 19th century and then continuing throughout the 20th century. So it certainly correlates with sugar. But as I was just saying, that enough, certainly that alone is not enough.

[01:15:29.150] - Sam Apple

When you piece that together with what's happening at the level of the cell and then some of the strongest epidemiology and the short term clinical trials, you get to create a picture which seems very compelling with respect to insulin. But I still like to refer to as a hypothesis, just because we don't have the level of study that I think we need, we probably never will get. Just because you can't really force people to stay on diets for a very.

[01:16:00.530] - Dr. Gordon

Long time or afford them if you're general meals and have other vested interests. Yeah, I guess I do. Really, though, have one more question for you to wrap up, which is, what are you working on next?

[01:16:15.850] - Sam Apple

Yeah, I've actually been working on smaller scientific things here or there. I've wanted to do a piece on some of the stuff we talked about in this discussion, actually, with respect to the protective nature of subcutaneous fat and insulin resistance. But when I have time to write, I'm mostly teaching science, journalism and writing in the Johns Hopkins programs. But when I have time to write, I've also been working on a novel lately. So, pace, be sure and let us.

[01:16:53.680] - Dr. Gordon

Know when it's out yeah, I will.

[01:16:57.110] - Sam Apple

After years of research about Warburg and metabolism, I needed a little break, but I hope to get back to it eventually.

[01:17:03.790] - Dr. Gordon

I hope so. I hope so. Both I'm looking forward to.

[01:17:07.850] - Sam Apple

Thank you. Yeah.

[01:17:11.210] - Dr. Lemanne

Sam, thank you so much for coming to talk with us today. It was really a pleasure. It was really fun. My pleasure. Such a wonderful book.

[01:17:21.210] - Sam Apple

Thank you. I enjoyed know I did do a bunch of interviews after the book came out, but it's been a while, so I was trying to sort of remember stuff as I was going, but I hope I managed to answer the question.

[01:17:36.260] - Dr. Lemanne

It was great. Anything that we'll make a copy. I'm going to edit out my gaffes and let you see what you think and anything you don't like or want to change. We can always rerecord something quickly if there's something you want to.

[01:18:00.570] - Dr. Gordon

But thank you. So know I am charmed by the confluence of science and literary ability, and it's always a thanks.

[01:18:12.190] - Sam Apple

Yeah. And Dawn, as you were talking about trying to move away from courses that forced you to write a lot of papers, I was the opposite as an undergraduate I was running away from. Very surprising that I came back in this direction.

[01:18:28.610] - Dr. Gordon

I think we followed some similar footpaths, Sam.

[01:18:32.690] - Dr. Lemanne

And in self defense, I had to take a course at Johns Hopkins that you're now teaching at about ten years ago or so, just so I could learn some basic writing techniques and managed to work my way through the world because writing is important.

[01:18:51.660] - Dr. Gordon

Writing is important.

[01:18:53.530] - Sam Apple

Great. Thank you again.

[01:18:56.520] - Dr. Gordon

Thank you so much.

[01:18:57.290] - Dr. Lemanne

Take care, Sam. Bye bye.

[01:18:59.130] - Dr. Gordon

Bye bye. You have been listening to the Le Mon Gordon podcast where Docs talk Shop.

[01:19:07.920] - Speaker 3

For podcast transcripts, episode notes and links, and more, please visit the podcast website@docstalkshop.com.

[01:19:17.520] - Dr. Lemanne

Happy eavesdropping.

[01:19:27.750] - Speaker 3

Presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[01:19:44.240] - Dr. Gordon

We make no warranty as to the accuracy, adequacy, validity, reliability, or completeness of the information presented in this podcast or found on the podcast website.

[01:19:56.270] - Speaker 3

We accept no liability for loss or damage of any kind resulting from your use of the podcast or the information presented therein. Your use of any information presented in this podcast is at your own risk.

[01:20:10.810] - Dr. Gordon

Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

[01:20:17.560] - Speaker 3

You must not take any action based on information in this podcast without first consulting your own qualified medical profession. Channel Everything on this podcast, including music, dialog and ideas, is copyrighted by Docs Talk Shop.

[01:20:35.850] - Dr. Gordon

Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.