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serious readers. .. creative writing english, from university of michigan. and creative nonfiction from columbia university. has published short stories, personal essays journalistic features, and a wide range of topics. in recent years is primarily written about science and health is work has appeared in the new york times magazine, new yorker, the atlantic, los angeles times, the financial times magazine, and mit technology review among

other publications. and of course he is the author of the book which can see the title on your screen and you are able to order it. that is what we are talking about today. so welcome sam apple. sue and thank you for inviting me. a. patty: of course is wonderful to have you. i love your book edit raises i said, on social media, every dislike a novel. i was glued to it, it is all true. i am sure that you will talk as we go through about your work how you came up with the idea about writing this book. i connecting all of these thoughts. it is about the biochemist. biochemist otto warburg he was gay and jewish of living openly with his male partner nazi party

in germany and hitler protected him. in hopes of curing cancer. but this is true. but there are many parts to this book. but i would like to start with biochemist otto warburg as you. his family dynamics. his early life rated let's start there and tell us about his family. sam: so his father was very prominent physicist. he was jewish, and part of the famous warburg family that is best known as a financial family of the warburg bank. and trento is a product of these other warburg senate the time it was unusual for somebody of jewish descent to rise to a high academic position and his father really rises all of the way to the top of the civics world and

otto warburg present the sum of the greatest scientists in history. a regular einstein it was very close to camille warburg and fisher and was great chemistry to so many of these world-famous personalities and someone, they had already one the nobel prizes enterprises added otto warburg pretends to be a world changing scientist in his life. he grows up with it. his natural surroundings and what he feels is expected of him. and the question in his mind is really not busy going to make world changes discoveries but in what field it's going to be. many does feel a certain competitiveness with his father. i think he was out to him. but that's not easy to date, and einstein loved his father.

any help show this some of einstein's theories were correct. he provided experimental evidence and otto warburg decided that he is going out to his father and make his name is a great scientist and he is going to do it on the realm of physics but in the realm of biology and analytic world. but throughout his life he continues to approach ballots from the lens of a physicist and always interested in energy and how we view energy. some really that's the background gradient somebody to be described it as a prophet with a religious devotion. that's how he felt about science rated he couldn't imagine anybody not becoming a scientist pretty so that the world he grows up in so we talk about more things city does with these world changing discoveries. patty: and a little pressure from his family. i have a feeling that it was just who he was.

it was just ingrained in him to be a scientist like you said. because of it so before we move on to his work in his lab in all of these other things, i want to talk a little bit about, the main part of the book. these two very different people are tied together so in order to understand the relationship, you need to understand hitler's childhood. and i learned a lot about hitler that i did not know, the kind of child that he was but mostly about his mother. so let's now talk about his relationship with his mom. sam: sure, when i started to run with the smoke it didn't really plan to talk a lot about hitler. and sure enough, they collided

in the 1940s as we will talk about. both stories are very much wrapped around the this. so march part, the cancer had been a relatively rare disease in the early 19th century. and then otto warburg and hitler were both born in the 80s by then cancer is becoming more and more common in the next decade, because really the application of determined people. they both fight cancer and the environment and they both grew up in and hitler, sort of a disgruntled teenager and his father died when he was 13. he was to be an artist but this kind of bank, the only connection that he had within the world was his mother. really the only human being that

it was capable of loving. and run at the time when hitler was becoming an artist, his mother was dying of breast cancer. these actually taken. sort of one friend at the time, he never seen so many look so depressed. and actually a jewish - in germany including austria and jewish doctor who is setting and for hitler's mother and hitler actually very grateful to have a good relationship with a stopper. everything but his mother is dying of breast cancer. and nothing can really be done hitler's just alarmed the devastated and the doctor also had never seen like a human being that was so depressed.

and so she of breast cancer and cancer remains threat through the end of his life in central focus coming season extreme hypochondriac to free to more so than cancer read a story that is just one after another one point, everything that is doing things right out of will because he's sure he will die of cancer. is a horrible stomach cramps and all sorts of conditions that it was a simple answer. are the chilling aspect is he said multiple different times that one of the reasons he was such a hurry to do all of these horrible things that he wants to do is because his way to do so no cancer. his gotta take care of business before he dies. two stories are really bizarre. demanded an obsession with shellfish which somewhat speculative that the crab and

cancer some people thought that even that was a part of it. patty: evidently his mother died a long painful horrific death. that he witnessed. unwilling that you talk about, wasn't that's written or did he stop everything meeting that he was punching some big battles and he stopped to this pretty was mentoring for time freighted. sam: i think will itself was during a different time but yes, the he actually talked about that as well pretty remarkable. in the 1940s. i can talk about that now, comes a little bit later in the progression of the book. patty: what anything, is more family, were you going to go with this.

sam: that comes up a little bit later pretty. patty: okay so later is fine, so now we understand a little bit more where the early life for what are driving these people read prison focus and the passion if you will. overused word business printed you in case i think it is appropriate. about his lab. tell us about his lab and finally the amazing lab that he designed freighted that was quite frankly very interesting as well but then how he behaved in the lab. so walk us through the lab. sam: the 1920s, otto warburg has a reputation as a brilliant self physiologist biochemist and

in 1931, foundation actually built the lab of the dreams. and otto warburg design institute and in this country matter and kind of extraordinary thing pretty after remover the this is afterthought to monitor world war i printed working foundation filling and institute for german and he has several well he doesn't really want academics working for him. he prefers the technicians who are brilliantly skilled but don't have their own academic interests. and physic scientists in these expert technicians who do whatever he says name runs this in world war i and the runs basically like a military operation in these meetings we just command them what to do. nobody says anything they collect the lab. it is incredible.

relatively small operation but they are changing the world of biochemistry phenomenon rated in this continuous even into 1930s under the come to power and is under incredible pressure. patty: was a man who like the finer things in life rated the arts and furniture in the 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 patriots, he believed in 1914 that the just cause germany and is also of

jewish descent not really out with a homosexual which could be about as out as you could be at the time. as open with his partner but i think particularly if you look at german and jews in 1914, their patriotic and very anxious to prove that they were full-fledged germans committed to the fatherland and sign up for the work by the tens of thousands and also he loved horses. any sign up for union which really was sort of an aristocratic unit. was really drawn to it in a lot of ways. i don't think he was particularly grateful to them to their stories about him but i think he served admiral.

and one of the remarkable parts of the story is that my 19701918 but he was really paying attention, the deaths and the disasters in germany and his parents, the german army and they were sending letters and talking to the ministry need him to come home and do research german food production and so on. but otto warburg stays in the army and albert feinstein of all people printable letter and said that you're too important for science, you we need you tomorrow. and it was otto warburg's parents who asked feinstein to write him a letter and otto warburg does come home after einstein asked him to it it's interesting because einstein said you too important for science not really it was very

arrogant. and i think that, i think that einstein understood how to convince otto warburg in turn if he comes home. it is possible that does not, he died in the mark. and is incredible answers never happened. so i think i'm sign in theory could've really played a very important role in the story. patty: back to the lab now that we our world war i which was very interesting. so talk about missus egerton's, what was it. the sea creature that it worked with. sears. explain his work, what was his goal, what was he searching for. almost single-mindedly.

sam: it even starts before when he was in training as a medical student and physiologist but he is going about the same european scientist to special train station in enables and a lot of the scientists at the time are using these eggs to as an experimental tool and trying to understand chromosomes in the very foundation of of modern genetics with sea urchin. he was there with all of these famous scientists at same time but as i mentioned before he was the son of a physicist noise focus on energy and he wants to under stand how it appears in the growing these energies. he's coming up with these really innovative devices to sort of

measure, talk to jen was being used and how much carbon dioxide is given often someone in fines with these sea urchins eggs was taking up a lot of oxygen and realizes that to the extent, if you're going in this energy and so that is a reason in his 90s try to understand it how it manages to grow. from the very beginning was to understand the answers and want to understand cancer you have to understand self growth. so really interesting thing of this is when he starts to really harness full attention to cancer 1923, he had these sea urchins experiments the back of his mind rated this sea urchins eggs is growing in cancer cells can do the same thing. and it's really surprising of the discovery 1923, is why they're not taking up more oxygen, it's very strange and

surprising as fermenting and taking it out of life glucose is. and you would expect this turning into this interactive acid and coming out of the cells. is the same fermentation process that microorganisms deal in and wine and cheese and yogurt. very strange that the cancer cells were doing this and really a big part of cancer science and really trying to understand why was it off. and continues to this day. patty: yes, that we could take from science to talk about that as far as what he discovered. there was a couple of aha moment and that was one of them. and in his scientific community when he started talking about this, what was the reaction from

a stellar scientist when he started to talk about what he was working on this discovery. sam: in early years for the very early years of such a new surprising discovery that cancer behaves like used to growing on the brain. it took a while to set in but in time, people started to take this is true from the experiments themselves, then every cancer they tested, seem to be true. originally they were looking at cancers in the laboratory or in rats. the same effects in human cancers and so people accepted that this was valid from the cancer cells in a very unusual way take up and perform fermentation just like microorganisms but remains controversial part is otto warburg is sure that the cells

not eating oxygen, it must be something must be broken. but we not eat oxygen. he had an extremely autocratic view pretty brought this to our oxygen to is the proper way it's what it a cell as opposed to. and a lower organism and the sale does this, then it must be somehow broken. and to this day as well. it is there a problem with respiration rent breathing with oxygen for cancer cells doing this for another reason. for that continuous but in time, just affected the cancer cells are doing this, is widely accepted and considered very important discovery. in the cancer cells taking up all of this glue close and sugar and possibly start the cancer cells.

so it's really all extremely important. and being discussed and after the war, sort of disappeared which is another strange part of the story. patty: is making a name for himself with his lab. he gets attention by the rockefeller institute pretty and he gets hitler's attention again a jewish man and were in a war now and jewish people are a lot of his scientists leave, the walk-through walk us through the beginning of the war and otto warburg absolute, you gotta hand it to the man, he was sure that nobody was going to test him. he was just too important. in his basic persona as - tells

about that. sam: most extraordinary part of the stories 1933 comes around and otto warburg won the nobel prize in 1931. and released at the top of the scientific world, and scientific nation and he was at the top of the german science. he is everything that he could want to do. he was with his partner in a beautiful home, a block away. nila comes power and then suddenly everything is in jeopardy. in many of his colleagues leave right away. in otto warburg think about it coming at the opportunity to leave in 1933 in 1934 printed but, he decides to stay. he believes that the nazi party

phenomenon will be short-lived. and just saying in this will be over in six months a lot of people believed this and otto warburg, he said i was here before hitler nobody is going to chase me out of here. an amazing thing is that he was harassed again and again in the early 30s. they come to his institute and they're saying why don't you why aren't you sending them to our marches and stuff and why aren't you using hitler's solution you refuse to do it. what if you have a flag upgraded is limited and he chases them out of the screams at them. and he gets away with it. i almost doesn't. they tolerated him because he was such an important scientists in the early years he had all of this rockefeller backing. in the early 30s, germany to

some extent took care of the national reputation. so he had some advantages over other scientists, he was only half joyce, only his mother was left 1935, there's essential rule. there was a lot going on but really nobody was more vulnerable, not only he had jewish father but he was living with his now partner. the nazi party could've gotten rid of him at any time. they put up with him. they harassed him but they don't chase him out of his institute. in the meanwhile, all of colleagues by the late 30s are gone. it's too late for him to leave. he started to close this down. and it really come to a head extraordinary way 1941 were finally is literally the only

jewish descendents in the society that is left now. in his running, like a dictatorship. too much for many of the people they dislike them. a lot of people dislike him even be for nazi party because of his personality. a lot of enemies in a 1941, it was the beginning of the end for him. so he had an international reputation in he calls the nazi party headquarters. to my chance to see if hitler's imposing building and think they claim and it looks like, what is going to happen. i sit down with victor - joyous one of the worst, he designs a euthanasia program. and also worked in later with

the nasi killings. he sits down with otto warburg and he tells him were going to let you live as long as you create this first cancer prayed was more extraordinary is one that we find out that you discovered the sort of daily planner that he met on the same day to talk about otto warburg and victor and that would be interesting in any event on junf the most important dates and all of nazi party projects. only hours later, of dawn the next morning, march operations for the time, the biggest military operation the history of the germans, hours later he's willing into soviet territory

and cap risk the entire nazi party project and meanwhile in june 31st, just before it happens, they're dealing with otto warburg in talking about his cancer science. and sure enough, in the diary late that night, he and hitler are staying up talking about how they will announce to the german people that have just invaded the soviet union in the middle of this, they stop and talk about cancer. just gives you a sense of how strange the nazi party rule deal at this critical moment, there focused on otto warburg and cancer science. any explain it in this book. it is truly bizarre. patty: yes, i thought so too great was absolutely fascinating. almost hard to put somewhere in your head up in any way that is

what happened. and now, let's continue on. might be getting my timelines well, he left the lab and he moved the u.s. for a while and drove this foresight is absolutely crazy was a very kind soul that was just didn't know what to deal with otto warburg. tell us what happened and why it happened. and that would happen after. sam: swept the cement i just told you about, otto warburg is totally focuses on cancer he will be protected. say makes it to the end of the work and amazingly, not only to be survived, but in 1942, bombs start to fall, i'm sorry 1943, near his institute that essentially moved to new

institute which is sort of refurbish mentioned. famous place in the german countryside and by the late 40s when nobody is allowed with the work efforts of using building materials. because what they're doing to build a new institute for otto warburg. and he carries out biggest trouble and again, almost arrested again but in the end he survives. and he is as extraordinary treatment. in the soviets come to power in sort of takeover and part of germany and american part of it and otto warburg is hardcoded between these two worlds. and he doesn't have the institute and the americas take over his institute after war and they turn it into a military headquarters so is nowhere to go

and no lab. ... ... >> robert anderson, famous researcher, and it was hard for him to find a place in part because, you know, when he stayed in nazi germany, people thought, well, he must be a nazi. 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 his appointment, and he comes to the university of illinois and, you know, he brings his partner, jacob. one of my favorite details from

the book is thathe's the most pathetic human being -- [laughter] >> right. >> the look on his face walking into the frat house. but, you know, he gets involved in this huge debate about photosynthesis, you know? his life was always competing with other scientists about photosynthesis in particular, and then 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 these cold german buildings, so everybody is walking around in their winter coats, and he's never happy with the equipment or with who his given, you know, assistant is. at one point he literally is driverring emerson -- driving

emerson crazy. he doesn't know what to do with himself. emerson was, like, a saint who, you know, one of the nicest human beings who ever livedded from everything i've read about him, and he nearly pushes him to the brink so it's a book about nazis, there are not many funny parts in the book -- >> that was a nice story, yeah. >> that, the comic relief, it, you know, if you can put up with the antics. meanwhile, he's alienating more and more people, and he's making more and more extreme statements about cancer not saying not only is this -- saying not only is the thing he discovered important, but in the 1950s, there's a group of nobel laureates, and he says everything else is unimportant.

he literally uses the word garbage for everything else. and he insists that, you know, if only the cancer lab would just pay attention to him, we could so this disease. and, you know, it is the incredibly important, what he's saying. but the times are already sort of changing, and, you know, in the 1950s we had the discovery of the structure of dna, there's all these interesting discoveries about viruses that are taking place in the '60s, and in the 1970s we had this real breakthrough where, you know, modern molecular biology is born. they start to think that particular mutated genes can cause cancer. and by this point, it start to fade away. he dies in 1970, and, you know, the stuff that he studied, that was considered old world science. that was considered basic

biochemistry, you know? sure, you know, metabolic enzymes are part of, you know, what a cell does, but they don't really matter in cancer. cancer is a sophisticated disease of genes and, you know, it's not basic biochemistry. so it just gets lost. it's just amazing how quickly it happens. partially because people don't like warburg, but more so just because new science is so much more sophisticated. and, you know, by, you know, the 1980s, you know, people had heard of warburg, and you have these famous papers and textbooks coming out that don't mention hum. even as lawsuit -- mention him. even as late as 2006 you have the seminal textbook that's put out that doesn't mention warburg at all. you know, the emperor of all maladies doesn't even mention warburg, the famous paper the hallmarks of cancer which talks about the six basic functions of

cancer that comes out in 2000. and it doesn't even mention, you know, the shift offer fermentatn which really is fundamental to cancer. so it's 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 discovered and why it's to important. >> can that's what i would -- and that's what i would like to talk about now. just for our members and those who are listening to this, i always like to give people sort of something to take home, the story in your book is what makes it so interesting. but you tied together a lot of science and great information that people can learn from. so talk about how it shifted and whew we're talking about it again. -- and whew we're talking about it again. so i'm sure you'll have to talk about, you know, fructose and glucose and metabolism and insulin resistance.

so all those things from warburg, and then it got lost, and then now, why again now. >> sure. sure. so the story really picks up again, you know, warburg is lost, and then in the late 1990s these molecular biologists are focused on cancer in the modern sense looking at mutated genes and how these signals go out from one protein to the next which cause a cell to replicate. you know, that's part of fundamentals, it's what cancer is, replication. and so they're tracing these genetic pathways, and they find that they lead them back to, you know, they seem to be causing these met boll you can enzymes to -- metabolic enzymes to change and rev up their activity. it seems like why is, what are these old world enzymes. it's peculiar to them because

they literally called them housekeeping enzymes. sure, a cell needs energies but that's an afterthought. the energy just comes in when it needs it. but sure enough, the cancer networks seem to be bringing them back to these fundamental metabolic enzymes. so a few scientists, you know, rather than ignoring it and thinking, you know, this is just irrelevant, a strange mistake in findings, why is metabolism being connected to all this. and they start to look for the connections between these cancer genes and how cells take up nutrients. and, you know, it really is remarkable over the next, you know, at first everybody's skeptical of it. but over the next decade, 15 years, they start to see that cancer, these signaling networks are actually fundamentally linked to metabolism. and it seem the most fundamental role of many of these networks

is actually controlling metabolism, getting the nutrients into the cell. and it's when the nutrients come into the cell that the proliferation process occurs. you know, sort of the causal error, the direction that people thought the cancer cells -- i'll step back and say they thought that metabolism was an afterthought where, in fact, it seem like metabolism is driving the process. and it's kind of remarkable because when you think as a creme starts to divides and -- a cell starts to divide and divide and doesn't have a way to take up nutrients, it's going to collapse. one cancer scientist referred to it as a catastrophe with the cell whereas with if you think about it from the perspective of a single-celled organism, i said before that the cancer cell acts a lot like a single-cell organism that just comes into nutrients and grows. the nutrients are a fundamentalled road signal as

well. that's what you put yeast onto, your bread or grain, you know, it grows because it has the nutrients that makes as many copies of itself as it can. if it doesn't have a nutrient, it doesn't go into that proliferation mode. so scientists really start to see that there's a fundamental link between me tab limb and nutrient uptake and growth and proliferation. and they started to rediscover that, you know, what warburg had found which was that the cell shifts to this grow mold. he thought it was because a cell couldn't use oxygen. but another hypothesis not because it can't use oxygen, but with because the metabolic enzymes are caused to turn on, and it's shifting it into this growth mode. so it's really fundamentally a different way to think about cancer, you know? it really hit home for me when i saw the famous cancer scientist,

craig thompson, who's now the president and coo of memorial sloan-kettering. he did a talk where he put up a piece of bread, and he shows mold, and he says, okay, this is the everybody's first cancer experiment. everybody's done this. this is what cancer does. so that's sort of the rediscovery. and the question i was interested in is, okay, cells, cancer cells are getting more glucose than they should, and they're proliferating. well, how does the 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 blast this, and that is extremely important, and there are some amazing new drugs that have come out of this return to warburg. but i was interested in, naturally, a, you know, the cancer cell's overeating. is that in any way, does our eating in the any way affect

that. >> yep. yep. >> and 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, it literally just shows you where in the body cells are overeating glucose, and that's where the cancer is. but at the same time, other scientists, epidemiologists have studied cancer in populations. they're finding that obesity is profoundly linked to cancer. thirteen 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 so this is the fundamental question in my mind, can we connect these two stories. is there something about this obesity-cancer connection which, you know, obesity is now overtaking smoking as the

fundamental, sort of most prominent, preventable cause of cancer. and then you have the warburg story, the cancer cells overeating glucose and multiplying. how are these two stories connected. and that, in a way, is my big project to see if there's a connection there. i'm a journalist. i'm a science writer. i'm not a scientist, but what i can do, what i can tell you try to connect the dots between these different fields because scientists from different fields aren't often talking to each other focused on the same things. and i think, and, you know, this is really what i discuss a lot in the last chapters of i my book. i think these really are part of the same story and that the fundamental thing that connects them is this hormone, insulin. and i don't know if i should pause here, or do you want me to go on? >> no. no, no, this is where i wanted to be on this point -- at this point. focus on this point the rest of our time together. >> okay. so the question is, you know, if

you think about a cancer, if you think about a microorganism, you know, you put the wreath, you know -- the yeast, you know, the grains, whatever, it makes copies of itself. but when you get into multicellular organisms, it's more complicated because our cells don't just eat whenever they encounter food. if they did, it would be anarchy. [laughter] so, again, craig thompson said you can think about a multicellular or nhl, it's almost like an agreement to eat only when they're told to eat. it's kind of a remarkable thing because all our cells have the ability to take up nutrients, but they don't. and we have this food distribution system which is regulated by hormones. and, you know, first and foremost, the hormone insulin which sort of tells which cells to take up nutrients and how to store them as fuel in our body. so to understand cancer as, you

know, this permutation of overeating glucose, you have this question, well, what makes our cells take up glucose. and first and foremost, it's this hormone insulin. so if a cell is overeating glucose, you have that. the cell has too much insulin could that be a part of this story. could that be driving this, you know, what they call the warburg effect, the warburg metabolism. and sure enough, there is a remarkable body of evidence that insulin is plague a huge role in human -- playing a huge role in human cancers. it's a growth hormone that tells cells to eat and to divide and grow. and they don't, you know, really since, for decades people with elevated insulin have higher levels of cancer. this has been known for a long time. it also sort of became clear in the 1990s. and a number of fascinating discoveries were made. one -- well, first of all, it became increasingly clear that

insulin drives obesity and that to obesity is, like, the cancer. insulin also activates all of these same networks that i talked about before that are changing the way a cell eats. these are what scientists use with the word downstream, they're downstream of insulin. insulin activates that in the same way that a mutation would. it sort of clauses them to -- causes them to keep going, keep taking the nutrients. insulin's a natural hormone, we all need it. but if you have an insulin resistance, a condition where insulin is elevated all the time, then you're going to have far more insulin signaling than you ever would x it's going to be activating a cancer pathway. and once this mutation arrives, you can just think of it as a path that responds -- once mutation rises -- [inaudible] sensitive to insulin and little

microscopic cancers that might appear all the time, ine stetted of dying, instead of being starved by the body, insulin keeps this many awe live. and you see 90% of cancer has many, many more insulin reaccept to haves than other cells. it's really striking to the extent which elevated insulin seems to pay a causal role in all these cancers. and, you know, it also possibly one of the more provocative things in my book is to suggest that, you know, 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 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, 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 do we end up with 50 times more in the blood. and, to me, that's the real question. 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 -- when i say sugar, i don't mean glucose, i mean sucrose. yeah. so it's the sweet white stuff that we add to everything. it's one-half glucose, one-half sucrose and no molecule that we know of seems to cause this

internal met boll you can destruction d metabolic destruction in the fat storage which seems to cause the elevated insulin. so to me, you know, there's a lot of nuance to all this. but to me, you know, there's one simple takeaway that it should be that insulin seems to be carcinogenic, elevated insulin. and if you want to keep your insulin lower, the first thing you should do is avoid sugar. >> yeah. and refined carbohydrates and, basically, ultra processed foods. hamburger's a processed food because it's beef ground up, but i mean ultra-processed food and a chunk of which are the ingredients in processed foods other than the food colorings and all that. it's back to sugar. and our mutual friend, you know, is on a little 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've hard that many times over the years, but warburg was working on fundamentals, the fundamentals of the metabolism. and then we got away from that and got to, you know, sexier things or more, you know, the dialdown of the genetics and all these things which is amazing. but now we're going back to sort of the fundamentals. and warburg, who does not guess what's in our food system right now, but insulin, so what is it other than -- we know sugar and ultra-processed foods. so what about, and i know you touch on this a little bit, and, you know, i'm a nutritionist,

but i'm not dogmatic with people's eating styles other than i hope people eat most of their meals at home, and they use real food no matter what their diet is. but you talk in the book and i know another mutual friend, you know, gary, is very keto. and then you talk about low carbs. basically, there's all these different eating styles, and there's no -- we don't have to make a decision as to what works for us. but talk about eating styles. what are we eating that we can work through somehow other than to remove sugars and processed, ultra-processed foods from our diet? what about the protein teens and the carbs -- proteins and the carbs and the fat, how they tie together. i'm sure you're going to do a little focus on the carbohydrates and the types thereof. and one other thing on that mold is, you know, the whole -- and i

don't mean to be pitching rob, but his new book, you know, the metabolic, it's protect the liver and feed the gut. and that tie it is all into this. so start with carbohydrates and bring in pro if teens and healthy fats if need by. >> sure. i was going to say, rob ludwig deserves an enormous amount of credit for waking everybody up to the harms of too much sugar in our duet. but, you know, from my perspective -- and i want to specify that i'm really talking about prevention. i'm not talking about cancer treatment when i talk about all this. but from my perspective, i think the science that i've looked at, you know, i spent five years working on this book, and it's really pointing strongly in the direction of insulin resistance and elevated insulin being a

causal factor in cancer. to me, we have to think of the carcinogen as something that causes cancer. and if it were some or sort of,u know, manmade chemical that was in our food or in our -- we'd be terrifying, it'd be banned. but the strange thing is it's part of our biology. just our biology exaggerated, you know? it's a growth hormone that's just, you know, ramped up to levels that should never be. so think about that as a carcinogen. a carcinogen is metabolic disregulation, and any dietary strategy of prevention, therefore should be avoiding, lowering that carcinogen. what you do is you eat a diet which, you know, causes insulin resays tan -- resistance to improve. one study found that 88 of american adults have some type

of it. if you want to -- i could say a sensible strategy is to follow a diet which would lower insulin levels and would be healthy for many different conditions. and that is what will probably make you less likely to get cancer. some cancers are bad luck, but some are genetically inherited. but, you know, so what causes insulin to rise. dietary fats seem to have, you know, as little if effect as possible, almost no effect. carbohydrates cause the most. but, you know, if you follow, you know, if you're metabolically healthy, you may be able to eat a fairly normal diet. and i think the best that suggests is once sugar is introduced into the diet, that a lot of the metabolic problems

start to happen. and once you have those metabolic problems, if you have the insulin resistance, then getting rid of sugars may not be enough. then you may have to focus more on healthy fats and proe teens. i think in terms of prevention, in term of lowering insulin resistance, the best evidence suggests that a diet that's high in proteins and low in carbohydrates is key. some scientists and doctors point more towards protein, some towards fat. but i think that the agreement at least, you know, in certain -- 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 cash carbohydrates as well. i really like the notion that michael pollack, an important cancer doctor in canada, said think of it like a condiment.

think of it like -- don't eat a lot and certainly don't drink it because drinking sugar, you know, seems to cause the worst metabolic effects of all in terms of quickly hitting your liver and causing this liver fat storage which is part. >> and people need to be very careful, well, ideally, you know, -- there's no labels on broccoli, but you have to be careful with thed ad sugar. that's sugars. but just with carte blanche the word carbohydrate. there are carbohydrates in process, there are carbohydrates in bread, but then there are different types of carbohydrates. i mean, there are intact carbohydrates meaning they've never been fractionalized and back together like whole grain bread is usually taken apart put

back together of but they're intact. i think for people sugar's a carbohydrate, but i think people hear carbohydrates and, you know, i'm not on the 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 carbohydrate speak out there, and everybody has a different story. so what is your take on that or do you have an interest or research done from your perspective on carbohydrates other than avoid sugar? >> sure. yeah, and it's very clear that, you know, more carbohydrates cause a more profound influence. think about proof, i said all these awful things about sugar,

but fruit is full of sugar, and host scientists are comfortable with fruit in the diet because, you know, as you talk about, the cell structure and the fiber in the fruit causes the i glucose to, you know, rise dramatically, and you don't get the same metabolic impact. i don't think i'll be, you know, you have to figure out what they call the glycemic effect, how much of the glucose insulin it causes and some people if you're met boll you cannily healthy, there aren't many adults in that situation, but if you are, i don't think you have to worry that much about -- i think you can tolerate a lot of carbohydrates. you know, there are many societies in human history that have eaten a lot of carbohydrates and been metabolically healthy. it's rolle only, i think, after

the introduction of sugar first and foremost that they could start to see a lot of these problems. i think you want to avoid most, certainly, processed carbohydrates. but, you know, i think each individual, you know, you can get a pretty good sense of what's working for you by looking at, you know, your waste. i don't think it has to be one size fits all, but i think a common sense thing is, you know, to focus more on fats and proteins and less carbohydrates. when your insulin's lower, part of what it does is it trapped fat inside your fat cells so your insulin's lower. there are gary used the analogy of a wallet. you burn it. but if you have elevated insulin all the time, the fat is getting

mopped in, and it's just a natural sort of logical response to keep insulin lower to sort of restore the metabolism of your body. i'm only talking about the cancer, but there's even more evidence in other conditions. >> right. well, you know, years ago, i mean, i did the some volunteer work at a breast health center with my if local hospitals, and the women would come in that were in treatment, and we would all recommend a very low sugar diet because simplistically, sugar's a cancer feeder. not everybody agreed with that e time, but with i think everybody pretty much agrees with it now. again, i know you were working primarily on prevention, so eat a healthy diet if you want to avoid any kind of metabolic

disease and cancer. healthy fat, you know, omega 3 fatty acids and the 60s and the healthy fats and whatever kind of protein you eat. .. that'ses probably a little bit of a summary through this. and for those of you who haven't read sam's book, we just touched on some of these details. we didn't really talk about his partner all that much and what he did. oh, man, holy cow. anyway, really interesting. and more dialed down into food, but the take-home is watch your sugar and know that it's

everywhere. and your sugary drinks, your sodas and the fatty liver disease. nonalcoholic fatty liver disease showing up in kids, that's all sugar. so the sugar is, met bollically e speaking, is a nightmare. cancer speaking it is as well. we already talked about fiber mitigating glucose rising through. is insulin the culprit or the elevated sugar causing insulin to rise the threat? what about igf1? >> yeah, that's certainly, yeah, that's another hormone that's part of the story. there's a lot of nuance to that science, but the elevated insulin seems to also increase the igf1 signaling. so i sort of lump them together for the sake of simplicity. but i think it does sort of, the

igf1 you should sue follows the elevated insulin. so i just focus on the insulin when i talk about it. but one of the interesting things about -- you know, when i started writing this book, i taught the whole damaging effect -- i thought the whole damaging effect of sucrose was elevated insulin, but there's evidence that some cancer, colon cancer in particular, can consume the fructose. so the case against sugar continues to build even in the time that i was working on the book. fein>> yeah. well, a fascinating book. and we could talk for probably a couple more hours on this, but hopefully everybody listening has, you know, a reason to go purchase your book, read this incredible story and how hisas work from this very difficult, orbrilliant man is front and center again and what that meanc

to us. so i -- so basically, sam, i want to thank you so much -- >> oh, thank you. >> -- for your comments here today. it was wonderful. and as well, i want to thank all of you who are listening today. this program will be on the commonwealth club's web site, commonwealthclub.org. and now this meeting of the commonwealth club of california commemorating its 118th year of enlightened discussions is adjourned. ♪s ♪ >> on our weekly author interview program "after words," robert woodson argues that the 1619 project replaces history with a more polarizing version. he was interviewed by harvard university law professor randall kennedy. here's a portion of that

conversation. >> we were, with wrote this in response to "the new york times"' publication of 1619: a series of essays of black journalists, led by nikole hannah-jones, where in essence it redefined america's birthday from 1776 to 1619 at the time that the slaves, 20 slaves first arrived on the shores of virginia. and it goes on to say that the revolutionary war was fought to defend slavery. it also made other false claims. but it also i tried to redefine -- it also tried to redefine america as systemically racist and that all white are villains and that all blacks are victims. and it offers a very dire picture of the country. it also makes the false claims that the current challenges facing many in the black

community are a direct legacy of the shadow of slavery and jim crow. and so since the messenger here was black, we thought the counternarrative should be also authored by blacks. and so, but we did not want to author a point-by-point debate or rebuttal. we wanted to offer an inspirational and an aspirational alternative narrative that acknowledges what 1619 is about slavery, it has been underreported and poorly examined. we acknowledge that. but the conclusions that we reached are very different than that which is articulated in 1619. and so we brought together a group of scholar ares, journalists -- scholars, journalists and activists of

different ideological stripes. and so we or authored theses says the offer -- these essays to establish the fact that 1776 is the birthday of america, and the values of our founders, no matter how fraud, have been the foundation upon which blacks were able to survive slavery and discrimination, the foundation of family, faith and an attitude of self-determination. and is so we felt that it was important for this book to be written to give with an alternative vision to americans about the plight of blacks. we should never be defined by slavery or jim crow. we were or more than that. >> to watch the rest of this program, visit booktv.org and click on the "after "after wordb to watch this and all previous episodes.

>> c-spanshop.org is c-span's online store. there's a collection of c-span products. browse to see what's new. your purchase will support our nonprofit operations, and you still have time to order the congressional directory with contact information for members of congress and the biden administration. go to c-spanshop.org. .. her most recent book for which she joins us this evening is "the kissing bug: a true story of a family, an insect, and a nation's neglect of a deadly disease." she has written for national geographic, npr, all things considered and code switch, the atlantic, slate and she is the author of the award-winning