be part of the national conversation by creating a documentary that answers the question how can the federal government impact your life. find the six minute video or program that affects you for your community. student can competition has $100,000 in total cash prizes and you have a shot at the grand prize of $5000. entries for the competition will begin to be received wednesday, september 8 . for competition rules and more information on how to get started visit our website at student cams.org. >> is now my pleasure to introduce sam apple. sam is on the faculty of the end a and science writing and an a in writing program at johns hopkins. prior to his arrival at johns hopkins, sam taught creative writing and journalism at the university of pennsylvania. he hosts an ama in english and creative writing for the

university of michigan and an mfa in creative nonfiction from columbia university. he has published short stories, personal essays, satires, journalistic features on a wide range of topics. in recent years he has primarily about science and health and his work has appeared in the new york times magazine, the new yorker, theatlantic , wired, the los angeles times, the financial times magazine and mit technology review among other publications. and of course he is the author of the book ravenous which we have seen the title in your screen. and your supporter and that's what we're talking about today so welcome sam. >> thanks so much for inviting me on. >> is wonderful to have you. i love your book and it reads as i said on a social media here, it reads like a novel.

so i was glued to it but it's all true. i don't know, i'm sure you talk as we go through about your emphasis and how you came up with the idea of not writing this book. and connecting all the stocks but anyway, it is about the nobel laureate biochemist lana warburg who was a homosexual living openly with a male partner in nazi germany. yet hitler protected him. so in the book, this again reads likefiction but it's true . there are many parts to this book but i'd like to start with otto warburg's view. his family dynamic, his early life. let's start there, tell us about family. so i know barbara's father was very prominent citizen.

he was jewish, he was a part of the famous word family that is best known as a financialfamily, they were birds back . auto word and his father eli are cousins of these other words . and the time it was unusual for somebody of jewish descent to rise to a high academic position so his father really rises really all the way to the top of the physics world and otto grows up in this house and is full of the world's greatest physicists, some of the greatest scientists in history. just a regular einstein, he was very close with emile warburg . one of the great chemists so many of these world-famous personalities who gone on and are ready to win nobel prizes and auto word intends to be a

world changing arscientist just like the people he grows up with. it's his natural surroundings and what he feels is expected of him. and you know, the question in his mind is really not is going to make the world changing discovery or what field is going to be and he does feel a sense of competitiveness with his father. and i think he wants to outdo him which is not easy to do. his father, einstein loved his father otto warburg and he helped atindia warburg helped show einstein's theories were e correct. he provided theexperiential evidence . so otto warburg decides that is going to outdo his father and make his name is a great scientist. he's going to do it not in the realm of physics but in the real biology, in the living world. throughout his life he continues to approach biology

from the lens of a physicist. he's always interested in energy . that's the background. he had somebody described as almost a profit with a religious devotion and that's what he tells about scienceis anybody who didn't become a scientist , he couldn't imagine it. that's the world he grows up in and sure enough he does make hisworld changing discovery . >> a little pressure from the family. i have the feeling he just was to be was. he was just, was ingrained in him so before we move on to this work and his life and all these other things, i wanted to talk about hitler because it's a main part of the book how these two very different people tied together. so in order to understand that relationship you have to understand hitler's childhood. and i learned a lot about

hitler that i didn't know, hthe kind of child he was and mostly about his mother. so let's now talk about hitler's youth tied into his mom. >> sure. when i started to write this book i didn't plan to write a lot abouthitler's life but the more research i did , the more clear it became that almost from the time they were little, warburg and hitler were on a collision course that sure enough they did collide in the 1940s and we will talk about but both stories are wrapped around history and the reason in large part is that cancer had been a relatively rare disease in the early 1960s and warburg and hitler are both born in 1880s and by then cancer is becoming more and more common and over the

next decade it becomes really a preoccupation of the german people , a cancer panic emerges so this is the world they both grew up in. hitler is sort of a disgruntled teenager and his afather dies when he's 13 if i recall correctly and he wants to be an artist but is kind of a hapless figure, nobody really likes him and the only connection he has in the world is hismother . she's the only human being he was capable of loving . so right time when hitler's trying and failing to become an artist 's mother is as diagnosed with breast cancer. and he's absolutely shaken. it's his one friend at the time that he's never seen somebodylook so depressed . it's actually an austrian

jewish doctor who is caring i said germany and obviously austria but a jewish doctor who is caring for hitler's mother and hitler is very grateful and seems to have a good relationship with this doctor. and they tried everything but his mother dies of breast cancer and nothing really can be done and hitler is just forloan and devastated . he said he's never seen another human being look so depressed. so his mother dies of breast cancer and cancer remains to the very end of his life a central focus. he's an extreme hypochondriac, afraid of many diseases but none so much as cancer. the story is just one after another, at one point he stopped everything he does to write a well because he's sure he's goingto die of cancer . there's all sorts of things

about cancer and part of the chilling aspect is he says multiple different times that one of the reasons these pl encouraged to do all the au horrible things he wants to do is because he's going to die soon cancer and he's got to take care of this before he dies. so the stories are really bizarre.e. he even had an obsession with his shellfish which some historians see as somewhat speculative. the word for crap, some people even that was thought that was dangerous. >> evidently his mother died a long, painful, horrific death that he witnessed. and that's that will you talked about, wasn't that written ? didn't he stopped everything to launch some big battle and

he stopped to do this? wasn't it during wartime? >> i think the well itself was at a different period but i can talk about that as well. i know what you're referring to, there was this remarkable period in the 1940s which i can talk about that now or it comes a little later in the progression. >> what do you think, isit more family where you were going to go with this ? >> i think that comes up a little bit later. >> so now we understand a little bit more aware their early lives, what is driving these two people, what is their focus, what is their passion if you will, i'm open to use the word of this particular tank i think is appropriate . so let's talk about his last.

how tell us about his lab and not only is it this amazing lab that he's design. that was quite frankly really interesting to but then how he believed in that black so walk us through the lab. >> so by the 1920s, warburg has a reputation as a brilliant physiologist and biochemist and in 1931, the rockefeller foundation actually says we're going to build you the lab of your dreams. warburg personally designs the institution, he wanted to look like a country manor. it's kind of an extreme everything, you have to imagine this was not too long after world war i and the american foundation building, and institute for germans and you know, he assembles, he

doesn't really want academics working for him, he prefers technicians who are brilliantly skilled but don't have their own interests and he has visiting scientists but he has expert technicians that just do whatever he says aand he's been in world war i and he runs basically like a military operation . they have these meetings where he just commands them what to do andno one says anything and they go back to the lab . you know, it's remarkable, it's a relatively small operation that there changing the world of biochemistry one phenomenal discovery after another that just continues even into the 1930s after the nazis are under this incredible pressure. >> .. >> .. horses and butlers truck back a minute.

you just about world war i intimate, the part of his life, almost didn't fit. i was surprised at his service in world war i. tell us about that a little bit. sam: he was a german patriot and like many german >> he believes, you know, 1914 that it was a just cause for germany, and he also was of jewish descent and not really out was a homosexual was about as out as you could be at the time. particularly, if you look at german jews, in 1914, very patriotic and very anxious to prove they were full-fledged germans and committed to the

father land and they signed up for the war by the tens of thousands. he signed up for a calvary unit which was sort of an aristocrat unit and was really drawn to it. i don't think he was particularly a great soldier. there were some stories about him. he served admirably and got an iron cross. >> he was on the front lines; right? >> yeah, certainly for part of the war on the eastern front. >> yeah. >> one of the remarkable parts of the story is that by 1917, 1918, anybody who's really paying attention, certainly by 1918 sees that, you know, it's a disaster for germany, and the deaths are mounting and his parents are desperate to get him out of the german army, and it's -- you know, they are sending letters. they're talking to the ministry

and interior saying we need him to come home and do research for german food production, so on, but he stays in the army until albert einstein of all people writes him a letter and says you are too important for science. we need you to come home, and it was his parents that asked einstein to write the letter, but he does come home after einstein asks him to. einstein says you're too important for science, and that really, you know, he was very arrogant and, you know, i think that's -- einstein understood how to convince him by playing to his arrogance. sure enough, he comes home. you know, it is possible that, you know, if he doesn't come home, he dies in the war, and, you know, his incredible discovery never happened. i like to think that einstein in theory could have played a very important role in this story >> back to the lab now that we

did our world war i which again was very interesting, so talk about, was it sea urchins, what was it a sea creature he worked with? >> sea urchins. >> okay. explain his work. so he's in his lab. what was his goal? what was he searching for? almost single mindedly. >> sure. yeah, so his sea urchin research actually starts even before he has his own lab, when he's still in training, as a medical student, and, you know, physiologist, but he's studying -- he goes with all these famous european scientists to a special marine station in naples, and he's studying sea urchin eggs, and a lot of famous scientists at the time are using

sea urchin eggs as an experimental tool in trying to understand chromosomes and the very foundation of modern genetics. he was there with all these famous scientists at the same time, but he was, you know, i mentioned before, he was the son of a physicist. he's always focused on energy. he wants to understand how a sea urchin grows. to grow you need energy. so he comes up with these really innovative devices to sort of measure how much oxygen is being used, you know, how much carbon dioxide is given off and so on. and he finds that these sea urchin eggs are taking up a lot of oxygen as they grow. that sort of makes, you know, intuitive sense, if you're growing, you need energy. and so that's always in his mind, you know, trying to understand how a cell manages to grow because, you know, from the very beginning, he wants to

understand cancer. if you want to understand cancer, you have to understand cell growth. you know, the really interesting thing is that when he starts to really turn his full attention to cancer in 1923, he has these sea urchin experiments in the back of his mind. he thinks the sea urchin egg is growing. the cancer cell is going to do the same thing. a really surprising discovery, it is not in fact taking up more oxygen. it is actually doing something strange and surprising. it is fermenting, taking up a lot of glucose, but instead of burning it with oxygen, as you would expect, it is breaking down, turning into lactic acid and spitting it out of the cell. it is the same fermentation process that microorganisms do, you know, beer, wine, cheese, yogurt, so it was strange that the cancer cells were doing this, and, you know, really a

big part of cancer science for many years was trying to understand why and what sets it off, and it continues to this day. >> yeah. yeah. well, and that we could take sometime talking about that, you know, as far as what he discovered. there was a couple real moments, that was one of them. in his -- in his scientific community, when he started talking about this, what was the reaction from his fellow scientists when he started talking about what he was working on and his discovery? >> sure. in the early years, i think, you know, in the very early years, it was such a new surprising discovery that cancers behave like, you know, like yeast growing on grain. it took a while to set in. in time people really did start to accept this is true. they did the experiment themselves. every cancer they tested seemed

to be true. you know, they tested -- originally they were looking at cancers, you know, in the laboratory or in rats, and eventually they see these same effects in human cancers, and so people accept that this is experimentally valid, that cancer cells in a very unusual way take a lot of glucose and perform fermentation, just like microorganisms, but what is not accepted and what remains controversial is why they are doing this. if a cell is not using oxygen, something must be broken. he had an extremely aristocratic view, and he brought this to a cancer cell or any cell. he said oxygen is what the cells are supposed to do. that's the proper way. fermentation, if a cell does this, then it must be somehow broken in some way, and that

debate really continues to this day as well. you know, is there a problem with respiration, breathing with oxygen, or are cancer cells doing this for another reason? that debate continues. but in time, you know, just the fact that cancer cells were doing this was widely accepted and considered very important discovery. you know, of course it leads to all these questions, if cancer cells are taking up all this glucose, blood sugar, is it possible to block it with some sort of therapy or starve the cancer cells? this is really all extremely important science that's being discussed. then, you know, maybe we will talk about it later, after the war, it sort of disappears which is another strange part of this story and then is rediscovered. >> he is making a name for himself with this lab. he gets attention, funded by the rockefeller institute, and then he gets, you know, hitler's

attention. again, a jewish man. we're in a war now. jewish people are -- a lot of his scientists leave. walk us through the deginning of the war -- walk us through the beginning of the war and how his absolute -- i mean you got to hand it to the man. he was sure nobody was going to touch him. he was just too important. his basic persona is part of this. he was harassed. so tell us about that. >> yeah. yeah to me, in a way, that's the most extraordinary part of his story, that, you know, 1933 comes around, and he just won the nobel prize. in 1931, he is at the top of the scientific world. you know, germany is the leading scientific nation, and he's at the top of german science. he has everything that he could want. he has the beautiful institute, as we talked about.

he lives with his partner in a beautiful home a block away. and then hitler comes to power, and then suddenly, you know, everything is in jeopardy. and many of his colleagues leave right away. and he thinks about it. you know, he has the opportunity certainly to leave in the early 1933, 34, but he decides to stay, and there's, you know, many different reasons. part of it is that he believes that the nazi phenomena is going to be short lived. you know, his cousin said just give hitler enough rope to hang himself. it will be over in six months and so on. a lot of people believed this. he said i was here before hitler. no one is going to chase me out of here. and the amazing thing is that he is harassed again and again in the early 30s. [inaudible] come to his institute, you know, why aren't

you sending your researchers to nazi marches and stuff? why aren't you using hitler's salute? he refused to do it. why don't you have the nazi flag up. he's livid. he chases them out. he screams. you know, it is amazing gets away with it. he almost doesn't, but, you know, they tolerated him ultimately because he was such an important scientist. in the early years, he had all this rockefeller backing. in the early 30s, germany to some extent still cared about its international reputation, so he had some advantages over other scientists. he was only half jewish. his father was jewish. his mother wasn't. so after 1935, there were special rules according to whether or not you had one or two jewish parents. so there was a lot going on, but really nobody should have been more vulnerable. you know, he had not only a jewish father, but living with his male partner, the nazis

could have gotten rid of him at any time, but they put up with him. they harassed him, but they don't chase him out of his institute. meanwhile, you know, all his colleagues, you know, by the late 30s are gone. and it is too late for him to leave. you know, things are sort of closing in on him. and it really comes to a head in an extraordinary way in 1941 where finally, you know, he's literally like the only person of jewish descent in this society who is left now, and he's running. you know, he's got all these working for him, and he is running it like a dictatorship, and it is too much for many of the people that dislined him. -- disliked him. a lot of people disliked him before the nazis because of his personality. he had a lot of enemies. they finally succeed in evicting him in 1941. it looks like the beginning of the end for him. germany no longer cares about

its international reputation, and he's called to nazi headquarters. you know, hitler has built this really imposing building. they call him in. it looks like, you know, who knows what's going to happen. and he sits down with one of the worst nazis, the guy who designed the euthanasia program who, you know, also worked on, you know, later would help sort of map out the nazi killing machinery, so, you know, just one of the worst nazis. he sits down with him and he tells him we will let you live as long as you agree to focus on cancer. you know, it is an extraordinary moment. what makes it more extraordinary is one, that you find out that i discovered in a daily planner that he has met on that same day

to talk about him with victor. and that would be interesting in any event. the day is june 21, 1941. this is one of the most important days in all of nazi -- in the entire sort of nazi project. only hours later, at dawn the next morning, they launch an operation, which is at the time the biggest military operation in history. the german tanks will hours later be rolling into soviet territory, you know, risking the entire nazi project. and meanwhile, on that date, june 21st, just before it happens, they are all busy dealing with him, talking about his cancer science. sure enough, in a diary late that night, he and hitler are staying up and talking about how they will announce to the german people that they have just invaded the soviet union, and in the middle of this, they stop and talk about cancer science.

it just gives you a sense of how strange the nazi world view is that even at this critical moment, they're focused on him and cancer science. you know, it makes no sense. i try to explain it in the book. we can talk about how that would be. but it is truly bizarre. >> yeah, i thought so too. so that was actually fascinating, almost hard to put somewhere in your head. but anyway, that's what happened. okay, so -- and now let's continue on. when did he -- i might be getting my timelines wrong. he left the lab and he moved to the u.s. for a while and drove this poor scientist absolutely crazy, who was a very kind soul and didn't know what to do with him. tell us when that move happened

and why it happened then what happened after that. >> sure. so, you know, after this event, that i just told you about, you know, he's told if he focuses on cancer, he will be protected. so he makes it to the end of the war, amazingly not only, you know, in 1942, bombs start to fall near -- sorry 1943, bombs start to fall near his institute, and he's actually moved to a new institute, which is, you know, sort of refurbished mansion on a famous estate in the german countryside. you know, this is at a time by the late 40s when nobody's allowed to use gasoline for anything but the war effort. they are not allowed to use building materials. they pause what they are doing to build a new institute for him. you know, he carries out, you know, he gets in trouble again

and almost, you know, is almost arrested again, but in the end, he survives. and, you know, he has this extraordinary treatment. so then the soviets come to power and take over part of germany and the americans take over the other part. he is sort of caught in between these two worlds and doesn't have the institute. the americans take over his institute after the war and turn it into a military headquarters, so he has nowhere to go and no lab, and for him not to have a lab -- it's like babe ruth not having a baseball bat or baseball. you know, it is like his entire existence. he's trying to find something to do, a place to go, and he ends up managing in the late 40s to get a six-month appointment at the university of illinois with robert emerson, a famous photo

synthesis researcher, and it was hard for him to find a place, in part, because when he stayed in nazi germany, people thought he must be a nazi and he must have worked with them. in fact, he despised the nazis and hated them, but, you know, it didn't look good that he had stayed the whole time, so he gets this appointment for six months. he comes to the university of illinois, and he brings his partner -- one of my favorite details from the book is his partner is put into a frat house to stay and he comes and sees the frat house and is just mortified. you know, he's like the most aristocratic human being. coming from a german mansion, i can imagine the look on his face walking through the frat house. but, you know, he gets involved in this huge debate about

photosynthesis, always feuding with other scientists about cancer and photosynthesis in particular. he proceeds to drive everybody in the laboratory crazy, not just with his disputes, but he says it's too warm. you know, he's used to working in cold german buildings, so he refuses to put on the heat in the winter. everybody is walking around with winter coats. he's never happy with the equipment or who his assistant is. at one point, he is literally driving emerson crazy. emerson circles around the town because he doesn't know what to do with himself. emerson was like a saint, one of the nicest human beings who ever lived from everything i read about him, and he pushes him to the brink. so, you know, it's a book about cancer and nazis. there aren't many funny parts in the book -- >> emerson is a nice story, yeah. >> that chapter is kind of comic

relief, if you can put up with his antics. but so, you know, meanwhile, he's alienating more and more people. he's making more and more extreme statements about cancer saying not only is this thing he discovered, the fermentation is important, but it is the only thing that matters. he appears in 1950 before a group of nobel laureates. he says everything else is garbage. all you need to know is that cancer cells are different than other cells. they can't use oxygen, so they ferment. he literally uses the word garbage for everything else. he insists that, you know, if the cancer world would pay attention to him, we could solve this disease. you know, it is incredibly important what he's saying, but the tides of science are already changing. in the 1950s, we have the discovery of the structure of dna.

there's all these interesting discoveries about cancer, viruss that are taking place in the 60s. in the 1970s, they had this real breakthrough where cancer, you know, modern molecular biology is born, and they start to see that particular mutated genes can cause cancer, and by this point, all of his stuff starts to fade away. he dies in 1970. you know, the stuff that -- the cell energy, that was considered old world sips science. -- old world science. that was sort of basic biochemistry. cancer is a sophisticated disease of genes, and it is not basic biochemistry, so it gets lost. it is just amazing how quickly it happens. partially, you know, because people don't like him, but more so i think because the new science seemed so much more

sophisticated, and, you know, by the 1980s, some people haven't heard of him, and you have, you know, these famous papers and textbooks coming out that don't mention him. even as late as 2006, you have, you know, this textbook that robert weinberg that puts out. it doesn't even mention him. the famous paper, the hallmarks of cancer which talks about the six basic functions of cancer comes out in 2000 and it doesn't even mention this shift of fermentation which, you know, really is fundamental to cancer. it is amazing how it got lost, and, you know, a lot of what i write about in the last part of my book is how it was rediscovered and why it is so important. >> that's what i would like to talk about for now. for our members and those listening to this, i always like

to give people sort of something to take home, so the story in your book is what makes it so interesting, but you tie together a lot of science and great information people can learn from. talk about how it shifted and why we're talking about it again. so i'm sure you will have to talk about, you know, fructose and glucose, and back to metabolism, insulin resistance. all those things from warburg and then it got lost, and then now, why again now? >> sure, sure. so you know, the story really picks up again, you know, warburg is lost, and then in the late 1990s, the molecular biologists that are focused on cancer in the modern sense of looking at mutated genes and how

these signals go out from one protein to the next, which causes the cell to replicate. you know, that's part of fundamental. that's what cancer is, replication. so they seem to be causing these metabolic enzymes to change. it seems like why are these old world enzymes a part of this story? it seemed particular to them. they literally called them housekeeping enzymes. sure a cell needs energy. that's an afterthought, but the energy comes in when it needs it. but it seems to be bringing them back to metabolic enzymes. a few scientists rather than ignoring it and thinking of, you know, this is just ir relevant, strange, mistaken finding, they

wonder why is metabolism being connected to all this? they start to look for connections between the cancer genes and how cells take up nutrients, and, you know, really it is remarkable over the next -- first everybody is skeptical of it, but over the next decade, 15 years, they start to see that these cancer -- these signalling networks are actually fundamentally linked to metabolism, and it seems that, you know, the most fundamental role of many of these networks is actually controlling metabolism, getting the nutrients into the cell, and it is when the nutrients come into the cell that the proliferation process occurs. you know, the direction that people thought the cancer cell -- i will step back and say that they thought that metabolism was an afterthought, where in fact, it seems like metabolism is driving the

process, and it's kind of remarkable because if you think if a cell starts to divide and divide, and it doesn't have a way to take up nutrients and then nutrients aren't integrated into this process. it is going to collapse. one cancer scientist referred to it as a catastrophe for the cell, whereas if you think about it from the perspective of a single cell organism, as i said before, the cancer cell acts a lot like a single cell organism that just comes into knew treenlts and grows -- nutrients and grows. the nutrients are fundamental themselves. that's what you put yeast on to, bread, grains, it grows because it has a nutrient and makes copies of itself. if it doesn't have the nutrient, it doesn't go into that proliferation mode. so scientists really start to see there's a fundamental link between metabolism and nutrient up take and growth and proliferation and they started to rediscover that what warburg

had found which is that the cell will shift to this growth mode. he thought it was because a cell couldn't use oxygen. but another hypothesis is that the cell shifts its growth not because it has because it can't use oxygen but because these metabolic enzymes are getting turned on and causing it to overeat glucose and this overeating it is shifting it into this growth mode. it is really fundamentally a different way to think about cancer. you know, it really hit home for me when i saw a famous cancer scientist, craig thompson, president and ceo of memorial sloan kettering. he puts up a piece of bread and shows mold growing over it and it says this is everybody's cancer experiment. everybody's done this. this is what cancer does. that's sort of the rediscovery, and then the question that i was interested in is, okay, so cells -- cancer cells are getting more glucose than they should and they're

proliferating, well, how does that -- you know, you always want to go one step, how does that happen? what does it have to do with our diet? for some cancer scientists, they're not interested in a diet. they're just interested in okay, this is what's happening. let's create a drug that can somehow block this. that's extremely important. and there are some amazing new drugs that have come out of this return to warburg. but, you know, i was interested in naturally, you know, well if a cancer cell is overeating, does that in any way affect how -- does our eating in any way affect that? >> yep. >> you know, what's really interesting to me is that it really all comes together in the late 1990s because at the same time, that these cancer scientists are rediscovering that a cancer cell overeats glucose and that's fundamental to cancer, i mean, so fundamental that if you do a pet scan, it literally just shows you where in the body cells are overeating glucose. that's where the cancer is.

but at the same time, other scientists, epidemiologists that study cancer in populations, they're finding that obesity is profoundly linked to cancer, 13 different cancers have now been linked to obesity, strongly linked. others less strongly. i think it's probably just the tip of the iceberg, and this is the fundamental question in my mind. can you connect these two stories? is there something about this obesity cancer connection which obesity has now overtaken smoking as the fundamental sort of most prominent preventable cause of cancer, and then you have the warburg story, the cancer cell overeating glucose and multiplying. are these two stories connected? that in a way was my big project to see if there is a connection there, because, you know, i'm a journalist. i'm a science writer. i'm not a scientist. what i can do or try to do is try to connect the dots between

these different fields because scientists from different fields aren't often talking to each other or focused on the same things. i think -- and this is what i discuss in the last chanters, -- chapters, i think these are connected and the fundamental thing that connected them is the hormone insulin. do you want me to pause here? >> no, this is where i wanted to be at this point. i want to focus on this for the rest of our time together. >> okay. the real question is, if you think about a microorganism, you know, you put the yeast, you know, the grains, whatever, it eats and eats and makes copies of itself. when you get into a multicellular organism, it is more complicated because our cells don't just eat whenever they encounter food. if they did, it would be anarchy. again this cancer scientist craig thompson said you can think about a multicellular

organism almost like an agreement between all the cells, the trillions of cells in your body to eat only when they are told to eat. it is kind of a remarkable thing because all our cells have the ability to take up nutrients, but they don't. we have this food distribution system which is regulated by hormones. you know, first and foremost, the hormone insulin, which sort of tells, you know, which cells to take up nutrients and how to store them and how to partition the fuels in our body. to understand cancer as, you know, this fermentation overeating glucose, you have to ask the question, what makes our cells take up glucose? first and foremost, it is this hormone insulin. if a cell is overeating glucose, you have to ask yourself, you know, is there too much insulin in the environment? could that be a part of this story? could that be driving, you know, what they call the warburg effect or the warburg

metabolism. sure enough, there is a remarkable body of evidence which suggests that insulin is playing a huge role in human cancers. insulin is a growth factor. it is a growth hormone that, you know, tells cells to eat and to divide and grow, and they have known really since -- for decades that people with elevated insulin have higher levels of cancer, so this has been known for a long time. it also only sort of became clear in the 90s, and a number of fascinating discoveries were made. one, first of all, it became increasingly clear that insulin drives obesity and obesity is linked to cancer, but insulin also activates all these signalling networks that i talked about before that are changing the way a cell eats. scientists use the word downstream. they are downstream of insulin. insulin activates them in the same way that a mutation would. it sort of causes them to rev up and keep going and keep taking up nutrients. now, insulin is a natural

hormone. we all need it. but, you know, when you have insulin resistance, this condition where insulin is elevated all the time, then you are going to have 24 hours a day far more insulin signalling than you ever would and it could be activating these cancer pathways. once a mutation arrives that's called the ak 3 pathway, think of it as a growth pathway that responds to insulin, once a mutation arises, it is more sensitive to insulin. little microscopic cancers that might appear all the time, instead of dying, you know, instead of wiped out by the immune system, insulin keeps them alive. you see many different types of cancer, many many more insulin receptors than other cells, and, you know, it's really striking to the extent at which elevated insulin seems to play a causal role in all these obesity-linked

cancers, and, you know, also possibly, you know, one of the more provocative things in my book is to suggest that cancer used to be a fairly rare disease in the early 19th century and maybe that's because, you know, insulin resistance was, you know, fairly nonexistent in the early 19th century. you see sure enough in lock step that cancer and diabetes and obesity growing throughout the late 19th and 20th centuries, so it's very clear to me that cancer is tied up into these metabolic diseases of obesity and insulin -- and diabetes. i don't think that's controversial, and i think insulin is really a piece of the puzzle that sort of makes all the data fit, and that of course, you know, there's always like one layer back. if you accept all this, then the obvious question is, well, how does our insulin -- you know, how did we end up at 50 times more insulin signalling in the blood?

you know, to me, that's the real question, and, you know, all this gets a little bit controversial, but i think that, you know, sugar first and foremost is, you know, sort of the most worrisome part of the story because sugar has been shown -- when i say sugar, i don't mean glucose. i mean sucrose, the sweet white stuff that we add to everything. one half glucose, one half fructose and no molecule that we know of seems to sort of cause this internal metabolic disruption in the storage around our internal organs which seems to cause the insulin resistance and the elevated insulin, so to me, that, you know, there's a lot of nuance to all this. to me, if there's one simple take away, it should be that insulin seems to be carcinogenic, elevated insulin, and if you want to keep your insulin low, the first thing you would do is avoid sugar.

>> yeah, and refined carbohydrates and basically ultra processed foods. i mean, hamburger is a processed food because it is just beef ground up, but i mean ultra processed food, and a chunk of which the ingredients in ultra processed foods, other than, you know, the food colorings and all that, but it is back to sugar, and our mutual friend, a doctor who is on a bit of a mission about sugar and removing it from our diets. well, that's -- our food system has to have a complete rework. wouldn't it be interesting -- i guess you mentioned the word fundamentals, and i have heard that many times over the years, but warburg was working on fundamentals, the fundamentals of metabolism, and then we got away from that and got to, you know, more -- you know, the dial

down of the genetics and all these things, which is amazing, but now we're going back to sort of the fundamentals. warburg could have not guessed what is in our food system right now. otherwise my guess is, you know, he might have dialled down into this a little bit. but insulin, so what is it? we know sugar and ultra processed foods. so what about -- and i know you touch on this a little bit. i'm a nutritionist, but i'm not dogmatic with people's eating styles, other than i hope that people eat most of their meals at home, and then they use real food, no matter what their diet is, but you talk in the book, and i know another mutual fund, you know, who is very into keto, and then you talk about low-carbs, so basically with all these different eating styles, and there's no -- we all have to

make a decision as to what works for us. what works for you may not work for me. but talk about eating styles. what are we eating that we can work through somehow other than to remove sugar and process -- ultra processed foods from our diet? what about the proteins and the carbs and the fats, how they tie together? i'm sure you are going to do a little focus on carbohydrates and the type thereof. one other thing on that mode is, you know, you know, the whole -- i don't mean to be pitching the new book "protect the liver and feed the gut". that ties into this too. start with carbohydrates and bring in protein and healthy fats, if need be. >> sure. i was going to say, he is most

famous on talking about sugar. that deserves credit of waking everybody up to the harms of too much sugar in our diet. from my perspective, and i want to specify that i'm talking about prevention. i'm not talking about cancer treatment when i talk about this. from my perspective, i think the science that i've looked at, you know, it's been five years working on this book, really points strongly in the direction of insulin resistance and elevated insulin being a causal factor in cancer. so to me, you know, we have to think of this elevated insulin as a carcinogen. it's something that causes cancer. and if it were some sort of, you know, man made chemical, you know, that was in our food, we would be terrified. it would be banned. but the strange thing is it's in us. it is part of our biology. it is just our biology exaggerated. you know, it is a growth hormone

that's just ramped up to levels it should never be. think about that as a carcinogen. a carcinogen is metabolic disregulation. any dietary strategy of prevention therefore should be, you know, lowering, you know, avoiding that carcinogen. how do you do that? what you do is you eat a diet which, you know, causes insulin resistance to improve because almost all of us have had it or had it. you know, one study found that 88% of american adults showed some signs of it. to avoid that, i think a sensible strategy is to follow a diet which would lower insulin levels and would be healthy for many deferent conditions, but as an added bonus would probably make you less likely to get cancer. there are no guarantees with cancer. some cancers are bad luck. but some are, you know, genetically inherited. but, you know, so what causes

insulin to rise? dietary fats seem to have, you know, as little effect on insulin as possible. almost no effect. protein causes you know some insulin spike, but not like carbohydrates. carbohydrates causes the most. but, you know, if you follow -- if you're metabolically healthy, you may be able to eat a fairly normal diet. i think the best evidence is when sugar is introduced into the diet, that a lot of the metabolic problems start to happen. and once you have those metabolic problems, once you have the insulin resistance, then getting rid of sugar may not be enough. you may have to cut more carbs and focus more on healthy fats and proteins. i think in terms of prevention and in terms of lowering insulin resistance, the best evidence suggests that a diet that's high in fats and proteins and low in

carbohydrates is key. some scientists and doctors point towards more protein. some towards fat. but i think that the agreements at least, you know, in certain circles is that, you know, the one thing you want to watch out for is too many carbohydrates. sugar first and foremost, but if you already had insulin resistance, then probably other carbohydrates as well. i really like the notion that michael pollack, an important cancer doctor in canada said to me, you know, not that people can never eat sugar. but think of it like a condiment, like salt and pep their you sprinkle on your -- salt and pepper that you sprinkle on your foods. but don't drink it because it quickly hits your liver and causes liver fat storage which is part of the insulin resistance phenomena. >> people need to be very careful and ideally, you know, don't eat a whole lot of food with labels. you know, there's no labels on

broccoli or roasted chicken, you know, but you have to be careful with the added sugar. but that's sugar. but carte blanche the word carbohydrates. there are carbohydrates in pasta. there are carbohydrates in bread. but then there are different types of carbohydrates. i mean there are carbohydrates that have never been [inaudible] and then put back together. like whole grain bread it's been taken apart and put back together. but wheat berries are whole. they are intact. i think for people -- i mean sugar is a carbohydrate. but i think people hear carbohydrates and, you know, and i am not a keto diet personally, but, you know, there's no root vegetables or potatoes or certain things that have some nutrients in them. so there's different carbohydrates to speak out

there, and everybody has a different story, but so what is your take on that? or do you have an interest or research done from your perspective on types of carbohydrates other than avoid sugar? >> sure, it's very clear that, you know, more refined carbohydrates, you know, cause a more profound insulin spike. think about fruits. i said these things about sugar. but fruit has sugar. most scientists are comfortable with fruit in the diet because, you know, as we talked about, the cell structure and the fiber in the fruit causes the glucose to rise less dramatically and you don't get the same metabolic impact. so i don't think all, you know, carbohydrates need to be thought of as, you know, bad. you have to, you know, figure

out, you know, the -- you know, what they call the glycemic effects. you know, how much glucose and insulin it causes. some people if you are metabolically healthy and you don't have insulin resistance, there aren't many adults in that situation, but if you are, i don't think you have to worry about that much -- still avoid sugar, but i think you can tolerate a lot of carbohydrates. there are many societies in human history that have eat an lot of carbohydrates and been metabolically healthy. it is really only i think after the introduction of sugar first and foremost that you start to see a lot of these problems. once you have these metabolic problems, then i think you want to avoid most certainly processed carbohydrates, but, you know, i think each individual, you know, you can g et a pretty -- you can get a pretty good sense of what's working for you, by a simple blood test, looking at your weight. are you losing weight?

i don't think it has to be one size fits all, but i think a common sense thing, you know, to focus on more fat and protein and less carbohydrates because that keeps your insulin lower. when your insulin is lower, part of what it does is it traps fat inside your fat cells, so if your insulin is lower, you know, the fat -- the analogy is of if you have elevated insulin all the time, the fat is getting locked in and it is a natural sort of logical response is to keep insulin lower to sort of restore the metabolism of your whole body. i'm only talking about cancer. there's more evidence for insulin's role in other conditions. >> you know, years ago, i mean, i did some volunteer work at a

health center at local hospitals. women would come in that were in treatment. we would recommend a very low sugar diet. not everybody agreed with that at the time, but everybody has pretty much agreed with that now. i know you are working primarily on prevention. eat a healthy diet if you want to avoid any kind of metabolic disease, of course, and cancer. so healthy fats, you know, omega 3 fatty acids in relationship to omega 6's, you know, the healthy fats and whatever kind of protein you eat, but the big thing is, you recommend limiting the obviously sugar, sugary drinks, particularly, and staying low on the carbohydrates. if you have cancer, that's

probably even more so important. so that's probably a little bit of a summary through this -- for those of you who haven't read sam's book, we just touched on some of these details. we didn't -- we didn't really talk about it all that much. really interesting. we more dialled down into food. the take home is watch your sugar and know that it is everywhere. and your sugary drinks, your sodas, and, you know, the fatty liver disease, you know, non-alcoholic fatty liver disease, you know, showing up in kids. that's all sugar. so the sugar metabolically speaking is a nightmare. cancer speaking, it is as well. somebody had a question, we already talked about fiber mitigates the glucose rise in fruit. we did talk about that.

is insulin the culprit or elevated sugar causing insulin to rise the culprit? what about igf 1? >> yeah, the igf 1 story is that insulin growth factor one, that's certainly -- that's another hormone that's part of this story. there's a lot of nuance to that science, but elevated insulin seems to also increase the igf 1 signalling. so i sort of lumped them together for the sake of simplicity, but i think it does sort of -- the igf 1 issue follows the elevated insulin. i focus on the insulin when i talk about it. you know, one of the interesting things about, you know, when i started writing this book, i thought the whole damaging effect of sucrose the sugar by its effect on insulin and elevated insulin, but there's emerging evidence that colon

cancer can consume the fructose and that is uniquely good at driving the warburg effect. the case of sugar continues to build even on the time i was working on the book. >> well, a fascinating book. we could talk more probably couple more hours on this. but hopefully everybody has -- listening has, you know, a reason to purchase your book, read this incredible story, on how his work from the very difficult brilliant man is front and center again, and what that means to us. so basically sam, i want to thank you very much. >> thank you. >> it was wonderful. as well, and i want to thank all of you who are listening today. this program will be on the commonwealth club's website soon. again that's commonwealth club.org. now, this meeting of the commonwealth club of california

commemorating its 118th year of enlightened discussion. now on book tv, more television for serious readers. >> here's a look at some books being published this week. in the afghanistan papers, the washington post craig whitlock uses official documents and original reports to take an in-depth look at america's 20-year war in afghanistan. former democratic senator from nebraska ben nelson offers his thoughts on how to fix the senate in "death of the senate". a historian recalls the life of civil rights activist in "walk with me". also being published this week, best-selling science writer richard dawkins provides a collection of his book reviews and essays in "books do furnish

a life, in power and liberty" pulitzer surprise winning historian gordon wood examines the political debates that surrounded the creation of the u.s. constitution. and a physicist argues that good physics requires stepping outside conventional thinking in "fear of a black universe". find these titles this coming week wherever books are sold. and watch for many of these authors to appear in the near future on book tv. >> good evening. i'm the president of the council of the library foundation of los angeles. it is my great pleasure to welcome you all to this evening, which has been co-produced by the council and the library foundation program. we needed a big hand to share this evening's interv