#187

Read the show notes for this episode: bit.ly/30gkQUZ
Sam Apple is the author of the book Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection, published in May 2021. In this episode, Sam describes the fascinating life story of Otto Warburg, a Nobel Prize-winning scientist who, despite being both Jewish and gay, survived Nazi Germany because of his valuable research on cellular metabolism and cancer. Sam describes Warburg’s observation that cancer cells consume large amounts of glucose anaerobically - a phenomenon subsequently known as the “Warburg Effect” - and relates how Warburg’s seminal work on this topic was largely forgotten after the discovery of oncogenes, only to regain relevance decades later within the field of cancer biology. Sam sheds light on the current debate around Warburg’s interpretation of the causes of cancer, and Peter gives his personal take on the matter. Finally, Peter and Sam tie it all together with a discussion about cancer prevention, the role of hyperinsulinemia, and the link between dietary sugar and cancer.
We discuss:
00:00:00 - Intro
00:00:10 - Sam’s interest in Otto Warburg and work as a writer [2:30];
00:13:35 - Otto Warburg’s dedication to science and his complicated life in Germany
00:23:27 - Warburg’s interest in cancer and early discoveries about cellular consumption of oxygen
00:35:57 - The role models who fueled Warburg’s desire to make a great discovery
00:45:28 - How Warburg described the primary and secondary causes of cancer
00:49:15 - Warburg’s Nobel Prize in 1931
00:50:05 - Warburg’s life and work during WWII in Nazi Germany
01:05:09 - Warburg’s research in hydrogen transfers and coenzymes-his best science?
01:09:02 - Warburg’s decision to stay in Germany after WWII
01:13:34 - Discovery of oncogenes in the 1970s and the decline in interest in Warburg’s ideas
01:20:52 - The renaissance of Warburg’s ideas on cancer metabolism and a new explanation for the Warburg Effect
01:28:59 - The argument against the Warburg Effect as a primary cause of cancer and the potential role hyperinsulinemia
01:35:33 - Identifying primary and secondary causes of cancer for the purpose of cancer prevention
01:45:00 - The link between sugar, fructose, and cancer
01:50:00 - Sam’s reflections on the work that went into Ravenous
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 35 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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[@lizasmith1212]

I've listened to this book 2.5X on Audible. I loved it and have referred many people to listen to it. Peter Attia, your Google talk on Ketosis changed my life in 2017. To see this tonight, all life paused until I finished this talk. Thank you both. A million times!

[@yl1487]

Peter's attitude has been brought up in Andrew Huberman's discussions with Rick Rubin and Jack Kruse ... lipoproteins in blood altered by light regime - Peter would create a less than wonderful impression by continuing to avoid addressing his gaps in knowledge.

[@riceexperiment]

Such an intelligent conversation. While aware that cellular respiration is different than breathing, we should involve the importance of mindful breathing in the discussion of "nutrients" from clean air. Breathe in and mindfully exhale with a clear mind.

[@isak771]

An unbelievable display of self-control not to query about whether he is related to Tim Apple.

[@bennguyen1313]

I always like the 2x2 framing that Peter uses to breakdown a problem (1h41m41s)! Regarding how cancer metastasizes, for example, often its due to the first capillary bed that is found after it leaves the primary tumor (ex. colon / pancreas always goes to the liver).. or Stephen Paget's “seed and soil” hypothesis to explain why breast/prostate cancer most commonly spreads to the bone.. On the recent Finding Genius Podcast, Danny Welch talks about suppressor genes (ex. KISS1), early detection (disseminated tumor cells), as well as a new class of mitocondrial signaling molecules that are secreted into plasma (tRNA and ribosomal RNA fragments)! Since mitochondria is thought to be ancient bacteria, it may have retained the ability to communicate to gut-bacteria (quorum sensing) and therefore understanding those signaling molecules may have huge impact. He also mentions that the mitochondria appears unchanged in cancer, but is modifying loci in the surrounding tumor tissue (stroma). He recommends the work of Matthew Vander Heiden (MIT), Chi Van Dang (Wistar) and Craig Thompson (Memorial Sloan Kettering).

[@yl1487]

Melanin. Check Rick Rubin with Andrew Huberman and Jack Kruse.

[@nuraykilic5031]

Could you please interview Prof.Thomas Seyfried on "Cancer as a Metabolic Disease"?

[@robh8057]

He did already. See kzbin.info/www/bejne/bIGtl4J8icaMpdk

[@ohplezz]

Yes please interview him. He is outstanding.

[@lewisschaffer9707]

kzbin.info/www/bejne/bIGtl4J8icaMpdk

[@billytheweasel]

Grateful for this. My wife just had breast mastectomy; surgeon was brilliant, margins clear and not in lymphs. But her medical oncologist is a huge disappointment as is the medical system's brokenness. MammaPrint wont disclose the oncogene "because they have to make a profit so they keep it private". Is this right? MammaPrint says she's Luminal-B 'high risk'. And we can't ask the medical oncologist because she has shown herself to be very ill-informed or is BS'ing us.

[@pcread]

I've read it. Fascinating and compelling read. Not just the personal story of Warburg, nut the Nazis fixation on cancer. As well as a clear explanation of the science down to a molecular level.

[@chrisbenton5335]

Excellent interview. Hitler, Nazis, Holocaust, Nobel prizes, German scientists, and cancer causes. That’s a mix you don’t get in many interviews!

[@Agapy8888]

Rebounding is a cleanser of the lymphatic system. Dr West’s book is a must read.

[@kkouz45]

Loved it! Thank you, Sam and Peter!

[@jayalanlife5926]

Peter and Sam, thank you so much. I selldom listen to any podcast in continuous, uninterrupted fashion. Sam a beautiful concept of human interaction with science. Peter fantastic addition to you mixed bag of entertaining and thought provoking pods. Made me think about Hitler being a cancer that required the sugar of political support to ferment. Cheers Alan

[@rubygreta1]

How hard would it be for every oncologist to tell their patients to complement their standard treatment with a near zero sugar/grain diet? What do you have to lose (except for more lucrative chemotherapy treatments)?

[@billytheweasel]

My wife's radiation oncologist, surgeon, and medical oncologist 100% denied the Warburg Effect had any effect on reducing growth rate for my wife's solid tumor breast cancer. They had bowls of chocolate candy in the radiation oncology check in counter, patient in-office counter, and the MRI tech plopped a handful down on the wide armrest of the phlebotomy/injection chair. They all also denied that insulin if a growth hormone too. Tere's much more, the medical system in 100% broken I've discovered, though surgeons and researchers are often brilliant.

[@rubygreta1]

@@billytheweasel Terrible!

[@sandrahightower3674]

@@billytheweasel Exactly the same sugary garbage where I was treated for my Triple negative breast cancer.

[@billytheweasel]

@@sandrahightower3674 I hope you're ok. You're here, so I bet you refused the sugar. May I ask what protocol you used? My wife is onto that testimonial-base Gerson juicing therapy and I just don't know despite "studying" this stuff for years.

[@anacf6747]

​@@billytheweasel I am sorry to hear your wife had to face the adversities of breast cancer. I hope you and your family will soon overcome the anxieties and uncertainties brought by her illness. Considering your comments, my thoughts are that every single person out there, regardless of qualification, have their own bias and a degree of delusional professional competence. And it doesn't matter what they do for a living. Nurses. Doctors. Bin collectors. We are humans and our fragility is exposed when we refute concepts we find difficult to grasp or go contrary to our values, preconceptions, knowhow and even faith. The truth is we are only as knowledgeable as the incontestable information available at any given time. Things change, and medical protocols follow research and evidence, eventually. So, it is worrisome to hear that an oncologist has complete disregard for nutrition, or metabolic response for that matter. I confess that I am more concerned about doctors who assume they know it all; than the ones who say they are limited by their speciality. Modesty should be taught at medical schools. A matter of etiquete, really, when dealing with the suffering of others. Most people would change their diets, would take up exercise, would do any 'extras' to optimise their changes of survival.

[@SisterKristen]

OMG I LOVE YOU SO MUCH for this video!!!

[@4angayoga]

Great job great, long form, you two.

[@adrianpullar]

Another outstanding video - thanks.

[@joshuabowman7210]

What a great talk i really enjoyed i been studying Cancer for 3 years and loved Otto Warburg and i could never find all his work he did so thanks for making this book Sam. Another area that no one talks about is the Motility of the Mitochondria is done only by the Kinesin and Dyinen Motor Molecules no one talks about there health? No one could answer my question can Mitochondria move on there own ? Could i ask Sam Apple more questions ?

[@wmp3346]

Really enjoyed the talk - thanks so much. Hoping to run into Sam at a Penn game - Go Quakers. Prevention is the best medicine.

[@jamesoommen]

~ 22:00 Rockefeller supported science and research with out really trying to influence the outcome - yeah.

[@jeffrey4577]

Is the Iowa workshop still on for writing?

[@sonjak8265]

yes

[@zacharyswain7034]

off topic but wondering if anyone can tell me where to find info on what peter is doing with his diet nowadays. carb intake timing, etc

[@nwobob]

This is going to be a viral sensation. Two brilliant scientists with extraordinary communication skills synergising, on a topic of universal interest and mystery. Step aside Lustig (sugar the bitter truth)

[@edwigcarol4888]

None is a scientist.

[@Eternity0815]

The juice is really effectve especially getting rid of pain(not related cancer as well).

[@t.c.s.7724]

You can decipher literary skills in one sentence. Writing is rewriting. Otherwise, as Capable quipped, "That's not writing, that's typing." Btw, the University of Iowa is actually the most highly acclaimed nonfiction program...for what that's worth. I haven't heard much about Columbia.

[@mpoharper]

I developed cancer when prediabetic but I believe it was caused by exposure to a dog park over a superfund site. Lost my dog to lung cancer from this exposure. That said the genetic analysis of the tumor indicates it is highly drive by insulin and glucose. In my case keeping insulin low has made my cancer more treatable. I don’t care about whether the Warburg effect is correct but I do care about how to live with cancer. Diet seems to help.

[@edwigcarol4888]

I miss following consideration, which I would have wanted to be confirmed or infirmed or simply mentioned during this conversation: If there was no need of a special positive cause for cancer cells to appear and grow ? (Means that cancerization of cells might have ever happened in organisms for thousands of years.. an hypothesis.) If the cause was a negative one: they were simply no longer controlled by the immune system, which would have lost its complex balance? This has consequences for the sense of aggressive screenings The raise of cancers comes along with the raise of autoimmune diseases and diseases related to chronic inflammation. There might be then a lot more factors involved than insuline or nutrition.. sleep, stress, the gut microbiome, allergenes and so on I can't follow the argument with obesity. My direct experience contradicts that: In the last five years 4 direct members of my family and a colleague have died of cancer ( ages 49 - 65) None is overweighted, even 4 out of the five are slim persons. No DB2. Only one might have metabolic syndrome (Waist / Size ratio). Only one had smoked. One cancer was directly caused by hepatitis virus C.

[@kylec7924]

Wonder if this guys related to Tim Apple?

[@forajc]

Please interview Dr Jason Fung and his Cancer Code book. He seems to have no vested interest in the business of cancer.

[@margarethren2363]

From my understanding of the research on insulin the glycemic index and the insulin index are not directly correlated. Dairy is more insulinogenic than an orange etc. Bran has a low insulin index. Body builders use whey protein to stimulate insulin to aid in muscle growth. We really need to look at how each food stimulates insulin.

[@sulosmolo1708]

With respect to sugar, is it excess sugar or just sugar in general that is a problem? What about athletes who intake lots of carbs and sugar and yet have very low insulin and no insulin resistance? Is sugar in such case problem provided that is is natural sugar from whole grains, honey and tubers? I would guess that if most of sugar is burned by intense exercise and used up by your activity then there isn't much leftover to feed any cancer growth.

[@robh8057]

I think it's excess sugar. Marathon runners that carb load do suffer from hyper insulinemia. (search Prof. Tim Noakes). I too, carb loaded before marathon runs. Basically, my diet had a lot of carbs because I would run long distances daily before I knew better that too much carb is bad for you. I was recently diagnosed with stage 4 prostate cancer, which I blame carb loading as the cause of it.

[@sulosmolo1708]

​@@robh8057 How do we define "too much" carbs though? If those carbs get used up in exercise it cannot be considered too much? My diet is relatively high in carbs too but my insulin is actually very low. This might be because my exercise is high intensity which relies completely on carbs rather like marathon runs which do not have to. Also we do not see prevalence of cancers among athletes who eat lots of carbs, but then again what is difference between "lots of" and "too much" for athlete? Also I am always thinking about our ancestors and many tribes today who eat lots of carbs from honey and tubers. I personally think that cancer can feed on sugar but sugar itself is not cause of cancer. I am sorry to hear about your diagnosis and I hope you will win the battle.

[@johnny7808]

@@sulosmolo1708 carb intake versus tissue glucose utilization (yours is likely very high) is the trade off. Paul Jaminet explores this thoroughly on his site and a google search of this phrase - Jimmy Moore’s seminar on “safe starches”: My reply - will take you to a long post about it

[@robh8057]

@@sulosmolo1708 Are you measuring your insulin or glucose? Your glucose can be low, but insulin can stay high for a while if you are prediabetic. I think many athletes get cancer, but we just don't get to hear about it because they'd be retired and old when they get diagnosed with cancer. But that's just my guess. Remember, you can't exercise your way out of a bad diet. (Unfortunately, I did not heed this good advice.) Also, I'm guessing our ancestors didn't get cancer because they ate real food with carbs, not the processed foods like donuts, bread and pastry, which I ate when I carb loaded.

[@sulosmolo1708]

@@robh8057 I measured my insulin, but both insulin and glucose are low for me. But for the record, I eat about 4g of carbs per 1kg of my bodyweight per day. It comes from fruits, vegetables, tubers and whole grains. So nothing processed or added sugar, but I still dont understand what difference this really makes, at least to cancer altough I can imagine it makes difference with respect to effects it has on insulin and glucose response. Also questions isnt whether athletes get cancer, they for sure do, as do sharks. But whether they get more or less cancer than general population.

[@yamishogun6501]

Apple said toward that end that cancer was "so much rarer before the shift to the Western diet" but this isn't true when adjusted for age of population.

[@yl1487]

Light, more so than food perhaps...?