Ep. 180 – Fascinating Link Between Nutrition, Metabolism & Cancer with Sam Apple

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. And now here’s your host Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I’m delighted to have Sam Apple. He’s on the faculty at Johns Hopkins and prior to his arrival at Hopkins he taught creative writing and journalism at the University of Pennsylvania. He holds a BA in English and creative writing from the University of Michigan and a masters in fine arts and creative non-fiction from Columbia. He is the author of many books, but most recently Ravenous which is about the German biochemist Otto Warburg and new developments in cancer science. Welcome Sam.

Sam: Thanks. Happy to be here.

Cynthia: Yeah. So it was really interesting to read this book for multiple reasons, largely because so much of Otto Warburg’s research was largely not really discussed over the last 30 plus years until this concept of cancer metabolism and looking at the contributions that he made to science, I was telling my husband as I was reading your book that I had no idea that he even existed before I read your book and yet he had so much to contribute to the field of chemistry and cancer science and metabolism science which nowadays has become much more popular with people like Jason Fung and Ben Bikman that are providing context about the changes that go on with cancer cells. So, what got you interested in writing about Otto, he’s quite a character and I’m sure listeners will want to learn more about him. But really given the fact that he was Jewish in the time of Nazi Germany and was able to mitigate and navigate continuing his research despite living in a pretty profoundly challenging time in Germany.

Sam: Yeah. I really came to Warburg through my interest in metabolism and nutrition and reading the works of a lot of popular writers in that area, Gary Taubes in particular was a big influence. So, what really stood out to me as I was reading about these topics was that I came across a mention of cancer being linked to obesity and diabetes and that really caused me to pause because I hadn’t heard that before. I always thought cancer, you know, you have unlucky mutations and these oncogenes or maybe it’s caused by radiation, sun exposure, smoking. But I didn’t think about it as being a metabolic disease in any sense. So, I saw a mention of this and then that mention said in 1923 a German scientist had made a discovery about how cancer cells take up a lot of glucose. So, I Googled the scientist Otto Warburg again, read just a little bit about his life and the stuff you referenced to Nazi Germany, I was just blown away. There wasn’t that much in English actually, but the little I could find it’s just fascinating.

I’m not a scientist, I’m a writer and I’m always looking for stories and thinking about how I’m going to tell a story. I was interested in the science first and then when I had the character Warburg then I knew like I had at least a magazine article and eventually it turned into a book. But he was a way for me to tell the story, but it’s ultimately the story about cancer is a metabolic disease that interested me most.

Cynthia: For the benefit of the listeners, let’s unpack what makes cancer cells unique based on his research and which has now been substantiated many years later with greater emphasis and focuses on this really being a metabolic disease as opposed to something that’s primarily just genetic in origin.

Sam: Sure. So, Warburg’s key discovery made in 1923 was that cancer cells were taking up enormous amounts of glucose instead of burning it in the mitochondria which are often referred to as the power plants of the cell, they were instead using this what I call as a backup generator, fermentation and that’s a way to basically get energy without using oxygen. It’s much less efficient and it basically splits the glucose into, quickly turns it into lactic acid and spits it out of the cell. So, it’s not a very efficient way to make energy. It was very surprising that cancer cells were doing this, this fermentation is the same thing that microorganisms do, they give us all our favorite foods and beer and wine etc. So, it was an odd thing to find in cancer science.

Really ever since cancer scientists have been debating why cancer cells do this and what causes it to happen? Warburg had his own hypotheses and he felt very strongly about them. In the end I didn’t fully agree with Warburg’s explanation for why it happened, but that mattered less to me than the fact that it does happen and it’s fundamental to cancer. As you’ve already referenced it was completely forgotten about for decades and it just blows my mind because it’s so fundamental to what cancer is. Fortunately, it’s back now and the last 15, 20 years, there’s been an explosion of research. So, it was rediscovered and that research has really led back to this idea which I explore in the end of my book that the way we eat and how that changes our hormonal environment, particularly insulin, might be the real answer to this mystery that Warburg first discovered.

Cynthia: It’s really fascinating. I think what I also found really intriguing was that the Germans as a population of scientists were very concerned about the exposure to pollutants and the quality of food additives and things that they believed kind of fervently were contributing to cancer and so for me to think about World War II timeframe that there were scientists and a country that was largely very focused, very proactive about the concern about toxins in our environment, in our food and personal care products was really surprising because I feel like in many ways, then you referenced this in your book when you talk about Rachel Carson’s Silent Spring, that was really like the beginning of people taking these things much more seriously that the role of things were exposed to an environment can be toxins that can make us more susceptible to developing metabolic diseases and cancer. So, I found that really interesting that this overfed state in the context of looking at toxin exposure could also be a huge contributor and that they were talking about this so many years before I even recall ever seeing anything in the research from the United States.

Sam: Yeah. It’s strange how far ahead the Nazis were on cancer. It’s so unsettling, but it makes sense in the historical concept. The Nazis inherited a German scientific establishment that was on top of the world and they were very focused on cancer– Germany was focused on cancer before the Nazis came to power and that was maintained. So, for all the monstrous things they did, their researchers including Warburg who worked under the Nazis continued to focus on cancer and made important discoveries, particularly in the realm of environmental carcinogens, and they were decades ahead about understanding the smoking cancer link. So, it is true that German science continued in some areas throughout the Nazi years.

But as I point out in the book that even in this context, there was something profoundly creepy about the way the Nazis were going at it because in their minds, there was no sympathy for cancer sufferers. Cancer was an impurity and these things that got into our food are impurities and that you know in a way was the entire Nazi project was eliminating impurities of every kind. So, they managed to make some progress on cancer, but it was always through a dark ideology.

Cynthia: It’s very, very interesting to me and I’m someone that’s of German descent and talking to my grandmother, my grandparents had emigrated to the United States way before that timeframe, but talking to them about how unique the culture is that this purification, kind of pre-occupation, there’s no other way to put it, how that created the environment where there could be this concern for weeding out diseases and disorders, and obviously cancer being one of them. Now, I thought it was really interesting also as someone who’s trained, primary care trained although I never worked in primary care as a nurse practitioner, I was also really impressed about how proactive Germany was about screening for certain types of cancers both talking about breast cancer exams, which was way ahead of the curve and cancer counseling centers.

This is really unusual. It’s something that’s not oftentimes discussed, but they were very proactive about trying to be preventative focused as opposed to reactive, which is really largely what we see here in the United States are very reactive to diseases and disorders instead of being proactive which I think is part of our problem for why we have so much metabolic disease right now.

Sam: Yeah. That’s absolutely true and I want for listeners who are interested in this, I want to mention the historian Robert Proctor at Stanford wrote a book called The Nazi War on Cancer and it’s really critical source for my understanding of these topics. He goes into great detail on these prevention programs, and the Nazis really introduced widespread screening for the first time. So, it’s really fascinating. I tried to understand it and the historical context of the Germans making tremendous progress before the Nazis against infectious diseases and really figuring out that microorganisms were responsible, figuring out which microorganisms cause which disease. It was part of the flourishing of German science that was really changing the world.

Cancer was the one disease they couldn’t make progress against. They really– in the early 20th century, really put a tremendous amount of effort into understanding it, and trying to treat, and prevent it. Warburg was part of that story but there are many other important scientists among the many tragedies of the Nazi era is that all that work was disrupted ultimately by the Nazis by the end and then in the post-war period, all the German science was lost. So, that definitely set cancer science back and it was probably part of the reason it got lost in the post-war years.

Cynthia: For listeners that are not familiar with what the focus was during this time period, what happened in the 1950s that shifted a lot of the medical and research focus in another direction looking at an ideology for why cancers developed. This is a massive shift, a complete departure from this kind of metabolism-focused ideology to more genetically mediated.

Sam: Yeah. I mean there were always these competing theories about cancer in the pre-war era. Warburg and his followers focused on the metabolic changes, other researchers interested in how viruses might cause cancer, and then in the post-war period, you have in the 1950s, the discovery of the structure of DNA, Watson, and Crick, and Franklin, and that sets in motion a series of– It doesn’t happen all at once but over the next two decades, genetics comes into center stage and cancer research, particularly in the mid-1970s when scientists are first able to identify specific human genes that get mutated and cause cancer. These are the oncogenes and once that is discovered it’s really– everything is genetic and still is largely to this day as I’ve mentioned it’s changing, but at that point that was called molecular biology– the new molecular biology, and that kind of stuff Warburg discovered how a cell takes up glucose and processes it, that was old world biochemistry like, “Why would you be interested in stuff that was done in the early 20th century when you could be studying modern genetics?”

It seemed backward as one cancer scientist put it to me, it was like, “We wanted to do the cool stuff.” [chuckles] We didn’t want to do Warburg and stuff. So, I literally found these stories of people like taking their Warburg equipment, this metabolism equipment and throwing it in the trash. So, it’s just on a– Science swings, you know, it’s a pendulum and to some extent natural, but extent to which it happens is pretty shocking. One of the aspects of it, I think that which makes it so surprising is that, even as everybody was abandoning metabolism this new cancer screening test, this PET scan which basically looks, you make glucose radioactive and then look where it’s being taken up in the body, and that’s where you have cancer, this diagnostic test. So, in a way, cancer metabolism was staring everybody in the face and yet it wasn’t being studied at all.

Cynthia: I know and I almost think we shoot ourselves in the foot. I trained at a big research institution and I think sometimes we like to make things more complicated than it needs to be and really getting back to basics and so, I’m grateful for the contributions that you’re making, Gary who I’ve had the pleasure of having on the podcast as well, asking the tough questions and asking him from different angles and medical professionals are doing kind of thinking outside the box much like I always say that I’m grateful for their people like Gary Feldman who talks about looking at cholesterol from a different way, and I’m like, “Thank goodness for the engineers because they’re giving us different ways of looking at different problems.”

When we’re thinking about cancer treatment, one of the things that I found really interesting in the book was, the use of mustard gas. This is kind of pivoting off what we’re talking about and I found it really interesting that it actually was found to prevent rapidly dividing cells from replicating their DNA. So, mustard gas was used during, I believe World War I and World War II, and not realizing that ultimately it turned out that it could actually be used for metabolic therapies and towards certain types of cancers I thought was really interesting. So, people really thinking outside the box and forcing us to consider ulterior uses of a lot of things that are used in wartime or drugs that are used in wartime for other reasons.

Sam: Yeah, absolutely. As you referenced it, it was really an accident that they discovered that mustard therapy had this power and then it became the first chemotherapy, which was thought to just be a cellular poison, but decades later we came to understand how many of these chemotherapies worked. They are actually metabolic drugs in terms of disrupting metabolic processes. So, it’s another way that it’s amazing that metabolism was lost because the drugs that work are the metabolism drugs in the broader sense.

Cynthia: Absolutely. When we think about the role of other things, our environment that can be contributory or problematic for the influence of changes to our soil is one example, the role of nitrogen. I’m not sure how many listeners really appreciate the importance of nitrogen and how the changes in soil accumulation have really impacted the way the types of foods that are grown, the nutrient density or lack thereof. What I found interesting was really looking at having to import nitrates from, I believe it was Chile-

Sam: Yeah.

Cynthia: -in order to beef up the soil, which was largely depleted from nitrogen and how nitrogen can be really critically important for health and the nutrient, as I said, nutrient density of a lot of the foods that we’re consuming.

Sam: Yeah. I think that’s really important at the most basic level but also, I wanted to include that story because I wanted to put the emphasis on the fertilizer. You can think of sometimes the cancer cells called the seed, and sometimes the place in the body that it grows is referred to as the soil and cancer scientists talk about the seed and the soil. But I wanted to talk about the seed, the soil, and the fertilizer, like, what causes the cancer cell to grow? That’s how I sort of transitioned into the insulin conversation.

Cynthia: Let’s unpack the insulin conversation. I’ve had the great honor of being able to connect with some of the biggest insulin researchers that are out there, not only medical researchers but also medical professionals and so I’m a fervent believer in that insulin is driving so much of the metabolic disease that we are currently seeing. So, let’s talk about that, you know, this whole insulin model which there are definitely individuals that are out there that don’t embrace this idea or this concept, but for many of us it really just intrinsically makes common sense when you unpack all of that what it represents.

Sam: Yeah. No, absolutely and I could have written in theory about insulin and many other diseases because it’s so connected to so many of these chronic diseases. But I think, the cancer insulin connection is less well known than some of the others. So, that was part of the reason I wanted to explore it and I think that people that are not particularly nervous about diabetes, maybe, they’ll wake up [crosstalk]

Cynthia: [laughs]

Sam: -and they understand that cancers are part of the story as well. You should be nervous about diabetes as it’s a massive problem. But I think that the cancer-insulin connection can help people become more aware of how serious this is. As I mentioned before that Warburg discovered how cancer cell ends up overeating glucose. So, insulin should immediately be a suspect because insulin tells our cells to take up glucose. But at that time, he made this discovery, insulin had actually had been discovered almost at exactly the same time, but nobody knew anything about insulin. It was only in the late 60s when they even began to be able to measure insulin in our blood. So, there was no way really to make the connection between insulin and the overeating glucose of the cancer cell at that time. But now, when we understand what insulin does, you can start to put the pieces together and start to understand that when you have insulin at extremely high levels, 50 times the normal level in the case of hyperinsulinemia, it’s instructing a cell to take up more and more glucose.

Now, some cells might be resistant to it but cancer cells actually get more insulin receptors and tend to have mutations in the very enzymes that respond to insulin. So, they are hyperresponsive to insulin. If you give them this insulin stimulus, it’s powerful growth stimulant for potentially microscopic cancer that might not otherwise be a threat. It really all came together in the early 21st century when they started to do the sequencing of cancer cells and they could see where the mutations were most common. The most common ones were the very enzymes that respond to insulin. There’s just a tremendous amount of evidence. So, as I begin to unpack that, the next question that came up is, “Okay, well, what causes our insulin to get out of control?” That of course comes back to diet.

Cynthia: I think for anyone who’s listening that saying, well, I don’t need to be concerned about this. I remind people that the latest statistic I read was that 88% of Americans are metabolically inflexible and unhealthy. So, that means there’s a very small percentage of Americans that are not insulin resistant, not overweight, not obese, and I think when you read statistics like there were some that I wrote down while I was reading, one of them was in 2014, the CDC said, 600,000 Americans were diagnosed with body fat related cancers.

Sam: Yeah.

Cynthia: That’s in 2014. That’s seven years ago. I’m sure that rate is probably not improving. In fact, it’s probably going up. So, if anyone’s listening and thinking, “I’m not susceptible” statistically very likely are and I like to remind men and women you need to know your numbers, you need to know what your fasting insulin is, you need to ask your healthcare professional even if they don’t know how to interpret it, you need to know those numbers. I cannot tell you how many women come to me and they’ll tell me, “I’m stuck, I can’t lose weight, I’m weight loss resistant, and we do a fasting insulin, and it’s 20.” I remind them, I mean, that’s like five times more than what it should be or four times more than what it should be. So. it’s important for us to understand that interrelationship with being overfed, hyperplastic, these cells that– insulin instructs the cells to get bigger and in terms of what that represents for upping your likelihood of developing cancer, it’s fairly significant.

I think that you touched the nail on the head when you mentioned that cancer cells have more insulin receptors and they’re overexpressed. So, cancer cells really thrive on glucose and carbohydrates, and throughout your book you’re identifying researchers in the 1920s as one example identified that these cancer cells, their uptake of glucose is significant, and why we aren’t speaking to our patients more proactively and obviously I’m not an oncologist and I’m not going to assume that every oncologist isn’t having this conversation. But why we’re not being more proactive starting from a primary care base level to having these discussions with patients really educating them about their macros or their food intake to me is astounding.

Sam: Yeah. I think it’s starting to change slowly but I don’t think many oncologists are having these conversations. I’ve asked them, why or I’ve asked those who are studying this why more aren’t studying it? The explanation given is that, everybody’s in their own silo. The endocrinologists are in one area, and the oncologists are on another, and they’re not speaking to each other, they’re not necessarily looking at the same research. I think we’re starting to see a little bit of change, but I completely agree with everything you said. One key fact just to build on what you said is that, your glucose might look normal for many, many years even as your insulin is elevated because that extra insulin is actually keeping the glucose under control. So, you have no way of knowing and people store body fat in different ways.

I was in my early 30s, I had all the signs of insulin resistance. I’m 100% sure I had it, even though, I didn’t actually directly test my insulin, but I had elevated triglycerides and people would say, “Oh, you’re not overweight,” but you could actually see the way I was carrying my weight on my face and things. But in some ways being able to store more fat subcutaneously under your skin or under your limbs is actually an advantage. My family will go straight to diabetes, straight to insulin resistance without much storage. So, being thin is not really protective in the way people think, you have to be metabolically healthy. Not just thinner than average or whatever it is. So, I think those are really important points.

Cynthia: Yeah, and I think the practical application as always when I bring guests on, for anyone that’s listening it’s like, “Okay, how do we unpack the practical implications of your book and your message, and a lot of it is saying get informed, ask for these tests, it’s really critically important?” You kind of touched on that metabolic syndrome of high triglycerides, low HDL, sometimes high LDL, elevated blood glucose, but it can start with elevated insulin. That’s usually the first biomarker. In fact, I know my buddy’s a low-carb MD, [unintelligible [00:23:49] and Brian, we talk a lot about this that, “You’ve got to test that fasting insulin.” So, for everyone that’s listening, test your fasting insulin, know what that number is because your hemoglobin A1c may not look all that bad which is a 90-day snapshot. Your fasting blood sugar may not look all that bad.

It harkens back to my father-in-law, who is a wonderful man was diagnosed with esophageal cancer. He was treated at Hopkins, leading renowned Oncology Center. And that poor man, after he had his esophagus removed and spent a lot of time in radiation, and surgery, and just really suffered quite a bit. I remember him saying to me, “Cynthia, all they want me to do is to drink Ensure.” It makes me cringe when I think about what we know now and how many oncology patients or people who are chronically ill are being instructed to drink what is essentially high fructose corn syrup and a lot of food additives which we know are not beneficial now.

We’ve touched on Gary Taubes research and I know that you’re obviously well familiar with him as well. Another amazing science writer and he talks a lot about the role of fructose. So, I touched on high fructose corn syrup. But let’s talk a little bit at least touch on like, what fructose does differently in our body than other types of sugar? Now, people will make the argument that fructose is, we find fructose and fruit. I always say, “Well, yes, we do.” But high fructose corn syrup is entirely different, literally animal. It’s something that’s created in the lab. We know it’s processed very differently, it’s highly toxic. But let’s at least touch on that because that’s another thing. If you’re doing nothing else, get your fasting insulin checked, read food labels because high fructose corn syrup isn’t just about everything then you want to avoid this because it’s a particularly toxic ingredient.

Sam: Yeah, absolutely I was interested in you know once I came to the conclusion that, that insulin– hyperinsulinemia, elevated insulin is a key driver of cancer. The next question I wanted to answer is, how do we end up with hyperinsulinemia? The very simple answer would be that we get overweight, but it’s more complicated than that and I tried to look back in the history into the 19th century, you have these societies in the 19th century and even into the early 20th century where cancer is extremely rare, and then they transitioned to the western diet and western lifestyle, and then suddenly, you see more obesity, more diabetes, more cancer. So, tried to look back and see what is it that comes into the diet that serves to set off this trend. The most compelling evidence I think is that it’s the addition of sugar. Not all carbohydrates but sugar in particular. When I say sugar, I don’t mean glucose, I’m referring to sucrose, this sweet white stuff that’s half glucose and half fructose and the fructose seems to be the most metabolically harmful part or fructose together with the glucose and sucrose, this terminology is a little confusing.

Cynthia: [laughs]

Sam: Because when people say, “Well, how can glucose cause cancer?” Because we have glucose in our blood all the time. But you have to understand that this is multistep progression. Eating sucrose sugar having fat accumulate because that’s what it does, it causes fat to accumulate in your liver and around your organs that will then interrupt insulin’s ability to get glucose into your cell, the pancreas will respond by producing even more insulin, you’ll put on more weight, develop more insulin resistance, and meanwhile all that elevated insulin will drive cancer. So, that’s convoluted but I like to just put out the basic information, but the root of the story is fructose as being a part one half of sugar which is the part that makes it particularly dangerous, I think, and it seems to be that when you turn it into this high fructose corn syrup or when you put sugar, when you refine it and put it into drinks, drinks seem to be worst of all, they cause this fat accumulation, the insulin resistance more rapidly than with glucose alone.

Once you are already insulin resistant, you probably have to restrict a lot of carbohydrates. Not just sugar, but if you’re metabolically healthy to start with and you just keep out the sugar, you’ll probably be in pretty good shape. But unfortunately, as you said, 88% of us are not in that position. So, you probably have to restrict more than just sugar, more than just the sucrose, but if you’re one of the lucky ones it’s really healthy then maybe some other carbs are okay.

Cynthia: Yeah, and it is really interesting how bio individuality really plays a key role here. I’ve had the opportunity to wear a continuous glucose monitor since last fall and it’s been fascinating/depressing. Being metabolically healthy and anytime it doesn’t matter if it’s my son’s birthday is today, and so we went out for a celebration, he wanted Mexican food, and I ate sauteed shrimp and had peppers and onions, and I had a couple chips last night and I was telling my husband, I was like, “I’m metabolically healthy and my blood sugars usually really well controlled all the time and my insulins, too. So, I mean I’m very metabolically flexible.” A handful of chips, my blood sugar stayed elevated for hours and it was fascinating.

You think about the context that most of us that are consuming sugar sweetened beverages that are maybe indulging in sweets every day, maybe not making the best food choices, eating a lot of highly processed foods, most of us and I would imagine most middle-aged individuals’ males and females are probably in this position where our blood sugar is not well controlled. And yet, we– these little subtleties, you gain a pound or two every year, maybe your sleep isn’t as good. What are some of the changes that you made in your personal life based on your research for this book because I would imagine this book probably took several years to write and I always love connecting with writers and saying, “What changed about your personal choices while you were writing this book or after you wrote this book?” Because once you see you can’t unsee. That’s the challenge of those of us that maybe the 12%, it’s like we’re a little bit more attuned to what’s changing the general population and how we don’t want to mimic that in our own personal lives.

Sam: Sure. Yeah. I mean, even before starting this book, I had grown interested in low carbohydrate nutrition, but I wasn’t especially strict and the more research I did and the more I learned, the more strict I became, it’s hard not to when you’re reading these studies. With cancer there, I like to point out there are no guarantees. Some cancers are not related to insulin, some are unlucky mutation. So, I don’t think that I can guarantee that I’m ever going to get cancer by following this diet. But I do think that it can increase my chances and give me a better chance of preventing disease. So, I’ve been more careful about sugar in particular ever since, I’m doing this research Lewis Cantley, one of the most distinguished cancer researchers in the country, I asked him this question. He just says, sugar scares me. The more you learn the scarier it looks. So, I’ve eliminated almost all sugar. My kids get annoyed with me and sometimes like try to shove a cupcake in my mouth.

Cynthia: [laughs]

Sam: I’m not perfect with it but I try. I think there’s an optimistic message in all this. For all this scariness like– I had the worst diet in the world. I used to walk around in my 20s, living alone in New York with a bag of white bread and [crosstalk] drinking Coke and everything. So, I think it’s wonderful that you can turn it around just by making these relative– I don’t want to call it simple. It’s hard to change your diet, but it’s not all gloom like you have these just hundreds and thousands of stories online of people changing their lives and reversing that type 2 diabetes by making these changes. So, I’m inspired and hopeful that more people will start to do this I hope after reading my book and other books on similar topics.

Cynthia: Yeah. I think that the greatest hope is that, my platform on this podcast is to bring on interesting individuals in the literary world, and medicine, and research to be able to take tangential concepts and be able to apply them to real life. Now, for the benefits of listeners who may not be as familiar with some of the lifestyle-related cancers, the cancers that are more likely based on the research to develop if you are overfed, eating far too often, not practicing intermittent fasting, or low carb, or a less processed diet, for the benefits of listeners let’s at least touch on the cancers that we know are associated with being in this overfed high insulin state.

Sam: Sure. You have colon cancer, endometrial cancer, pancreatic cancer, breast cancer. It looks more compelling I think post menopause. But I think altogether, I think, the evidence is quite strong with prostate cancer, although that’s a little, it’s considered less strong than the other evidence. But if you added in prostate cancer the number you mentioned that 600,000 number, they didn’t include prostate cancer in that, so it’d be vastly higher. So, it’s just across the board the most deadly cancers tend to be these ones that are linked to obesity and elevated insulin.

Cynthia: I think we need to ‘we’ meaning, healthcare professionals need to be more proactive. I know that my whole backgrounds in ER medicine and cardiology and so, I saw evidence of metabolic disease every single day and it was in people as young as 30 all the way up to 80, and the one thing that was fairly consistent for me was watching this interrelationship between inflammation, and food choices, and eating more frequently or too frequently. We used to tell our patients and– trained in the 1990s, trained at a big research institution, and we used to tell our patients that, “You need to eat snacks and mini meals, and you just stoke your metabolism.” And yet, I cringe when I think about that now because no one should be eating snacks.

I think about any time I travel, obviously, most of us haven’t been traveling as much as we did pre-pandemic, but anytime I’m in the airport now or traveling with my family trying to explain to my kids like, “You are teenagers now. There is no need to snack. If you’re hungry in between meals that means you didn’t put your protein and your healthy fats together in the right way and non-starchy vegetables,” and then they cringe when they hear me say that. But the point of why, I think, it’s important– I thought it was so important to bring you on was just to create growing awareness that these lifestyle choices really do have bearing on our health, and our longevity, and the quality of life that we lead. I think it’s really important for people to understand that it doesn’t just happen to us. There are catastrophic, horrific things that happen that we have no control over. But a lot of these lifestyle choices do have a long-term impact on our health whether it’s positively or negatively.

Sam: Yeah, no, absolutely. You know the COVID outbreak is another reminder, how important metabolism is because if you’re not metabolically healthy you’re at greater risk for a COVID complication. So, it’s really so many different conditions. You mentioned Ben Bikman before. He’s written this wonderful book which covers all the different conditions, I just focused on cancer, and Jason Fung, and others. It’s just so important. One thing I think is also encouraging that people tend to think, “Oh, you have to be wealthy to eat this way.” But I think it’s really not true. I eat so many eggs and they’re relatively cheap.

Cynthia: [laughs]

Sam: I think, it’s doable on a budget and we just need to convince people that this is a healthy way to live.

Cynthia: Absolutely and I remind people you buy the best protein that your budget permits and if it’s conventional beef that you purchase, the only real difference based on the research I have done between conventional feedlot beef is one example versus grass-fed, grass-finished beef is the omega-3 to omega-6 profile. So, you’re really talking about the differences between different types of fatty acids and I would argue that feedlot conventionally raised animals are going to be a better choice than eating a Big Mac or a chicken nugget. I’d say the more processed it is, the less benefit it is to your health. Although, I’m also a realist. I’m not going to sit here and say that I don’t eat out in restaurants on occasion. Sometimes, I do get stuck paces and I may have to resort to having a protein bar which I love that. Some of the low carb community and I always think about one person in particular calls them ‘carbohydrate bars’ to remind people that they’re generally not protein dense, they’re usually pretty carbohydrate dense. Ken Berry is usually on the pulpit talking about that quite a bit.

Sam: Yeah. I do think it’s true that, people say fast food and think it’s horrible. But if somebody wants to go low carb, and they eat a lot of fast food, and they throw out the bun, and don’t get the Coke, and just take the burgers and the lettuce, I think, they could be pretty healthy.

Cynthia: Absolutely and that’s the concept of good better best, really meeting people where they are. So, if you’re listening and you love Chick-fil-A or love McDonald’s, you can navigate fast food restaurants and make better choices. It doesn’t all have to be this pristine grass-fed steak with organic vegetables. I mean, obviously, we want to get to a point where we’re eating less processed food, but there are all sorts of ways to get there.

Sam: Yeah. I’ll make– even to make your listeners feel better, I’ll make my grand confession is that I still have some diet soda here and there. So, it’s probably not ideal, but particularly if you’re transitioning between diets for a lot of people that can be a way to do it.

Cynthia: Absolutely. I think all of us in this health and wellness space, we all acknowledge we have our own vices. I’ve got a penchant for dark chocolate. That’s probably my one vice that’s left after going gluten and dairy free. It cuts out a lot of what’s available there. So, for the benefit of listeners, what are you working on next? Are you working on a new book? I know that you’re still teaching avidly. What’s next for you?

Sam: It’s a good question. I’m going to figure that out. I’ve been thinking about it a lot. I would like to do another book that covers some of these topics. But I’m teaching full time now at Johns Hopkins and the MA, and writing an MA and science writing programs. So, I don’t have that much time right now, but eventually, I like to find another Warburg like character and go at this again from a different angle.

Cynthia: Absolutely. What was the one thing about Warburg that was really surprising? I guess not having known much about him, I found him personality wise to be a little bit of a spectacle. Really, I don’t know if it was arrogance or just completely being clueless against what he was living with and he was almost within a bubble that he wasn’t paying attention to what was going on in Nazi Germany during World War II.

Sam: Yeah. He was a very difficult human being to put it nicely. He was one of the most arrogant human beings I think of all time-

Cynthia: [laughs]

Sam: -on a scale of 1 to 10 on arrogance, he rated it 20. One of my favorite stories.

Cynthia: [laughs]

Sam: He was asked to take a picture of other scientists. They said he couldn’t do it because they were not at his level. They were all Nobel prize winner. That’s how he viewed the world. It was in many ways a weakness because he couldn’t see his own faults. But it was also, his self-belief was also a strength. He did these bold experiments that other people weren’t doing, that other people thought, “Well, I don’t have the right scientific tool. I can’t do this.” Warburg’s attitude was, “Okay. I’ll just go in and invent the tool.” His father was a brilliant physicist who worked with Einstein and Warburg grew up with all these famous German scientists in his childhood home and just assumed, “I’m going to be the next one too,” is like assumed that you would win a Nobel prize. When he finally won, his response was, “Well, it’s about time.” Yeah, it’s about time they gave it to him. So, he really deserved to win it three times based on totally different experiments.

Just a fascinating character but not totally sympathetic. I was drawn to him in part because he hated the Nazi so much, but the more they would come to his institute, and bang on the door, and try to get him to sign papers, and even throw him out of his institute. I realized over time that he hated the Nazis, but not necessarily for all the right reasons, what he really couldn’t stand is that they dared interrupt him and interrupt his work. He wasn’t a great champion of the Jewish people or human rights. So, he was a very complicated figure, but to be in a way that made it interesting it wasn’t just like a simple hero, he is a complicated hero.

Cynthia: Absolutely. Well, it’s been such a pleasure to connect with you and I encourage my listeners to check your book out. What is the easiest way to connect with you on social media, your website?

Sam: Sure. My website is samapple.com. On Twitter as where I’m most active, it’s @sam_apple1 and Instagram, I’m new to Instagram. I’m trying to figure it out. It’s very confusing.

Cynthia: [laughs] It’s very different animal for sure.

Sam: Yeah. I literally can’t like what to click on but it’s @samapplebooks. Yeah and that book is Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection.

Cynthia: Well, I really enjoyed your book and my family was hammered. I was sitting in my study, you know taking notes and reading it and I found Otto Warburg to be a fascinating individual, more interesting beyond that was just this role of cancer science and metabolism, and realizing that there was so much incredible research that was being done, and even the early 20th century that I was completely unaware of despite having a solid science background in my– [crosstalk] [laughs]

Sam: Yeah.

Cynthia: But thank you again for connecting with listeners and hopefully, they will be checking out your book and connecting with you on social media as well.

Sam: Oh, thank you so much. I really appreciate it.

Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating and review, subscribe and remember tell a friend. And if you want to connect with us online, visit the link in the show notes.