c-span, powered by cable. >> weekends on c-span2 are an intellectual feast your every saturday american history tv documents america's stories, and on sunys booktv brings you the latest in nonfiction books and authors. funding for c-span2 comes from these television companies and more including buckeye broadband. ♪ ♪ ♪ ♪ ♪ >> buckeye broadband, along with these television companies, supports c-span2 as a public service. >> it is now my pleasure to introduce sam apple. sam is on the faculty of the

inmate and site writing an inmate writing programs at johns hopkins. prior to his arrival at johns hopkins, , sam taught creative writing and journalism at the university of pennsylvania for ten years. he holds an ma in english and creative writing from the university at michigan and an msa 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 written about science and health and his work has appeared in the "new york times" magazine, the new yorker, the atlantic, wired, the "los angeles times," the financial times magazine, and m.i.t. technology review, among other publications. and, of course, he's the author of the book "ravenous" which you can see the title of on your

screen, and are able to order. that's what were talking about today. so welcome, sam. >> thank you. thanks so much for inviting me on. >> of course. it's wonderful to have you. i loved your book. it reads as i said on social media, it reads like a novel. i was glued to it, but it's all true. i don't know, sure you'll talk as we go through about how you came up with the idea of writing this book, and connecting all these dots but anyway, so it is about the noble lord, the biochemist otto warburg who was a jewish homosexual living openly with his male partner in nazi germany, yet hitler protected him. so in the hope that he could cure cancer, so this again reads like fiction but it is true. there are many parts to discuss but i would like to start with

otto warburg youth. his family dynamic, his, his early life. let's start there. tell us about his family. >> sure. so his father was a very prominent physicist. he was jewish, he was part of the famous warburg family that is best known as financial family, the warburg bank. otto warburg and his father are cousins of these other war breaks, and at 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 civics world and auto grows up in this house that is full of the world greatest scientists in history, max planck was regular, einstein was very close.

on the official one of the great chemist. so many of these world-famous personalities would go on ahead and already gone on to win nobel prizes. otto warburg intends to be a world changing scientist, the people who grows up with, his natural surroundings and what he feels is expected of them. and the question in his mind is really not is he going to make world changes discoveries but in what field it's going to be, and he does feel a competitiveness with his father and i think once to outdo him which is not easy to do. his father, einstein loved his father, and he helped actually show that some of einstein series were correct. he provided the experimental evidence. otto warburg decides that his if

he gone out to his father make his name is a great scientist he's going to do it not in the realm of physics but in the realm of biology and in the living world, but throughout his life he continues to approach biology from the lens picky those interested in energy and how cells use energy. that's really the background. he had consummate discovered is almost a profit with the religious devotion. as i felt about science. he said he paid to anybody who didn't become a scientist, couldn't imagine it. so that's what he grows up in, and we'll talk about more, sure enough he does make his world changing discovery. >> yeah, and a little pressure from the family there, or not. i have a feeling he just was who he was. he was, it was just ingrained in them to be a scientist, like he said. so before we move on to his work in his lab and all these other

things, i want to talk a little bit about hitler because it's a main part of the book, how these two very different people are tied together. in order to understand the relationship you need to understand hitler's childhood. and i learn a lot about hitler that i didn't know, the kind of child he was, but mostly about his mother. so let's now talk about hitler's youth, talk about islam. >> sure. when i started to write this book i i really didn't plan to write a lot about hitler'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 sort of on a collision course. sure enough they collided in the 1940s as we will talk about, but both stories are very much wrap around cancer.

the reason in large part is that cancer had been a relatively rare disease in the early 19th century, and then warburg and hitler are both born in the the 1880s and fighting cancer is becoming more and more common, and over the next decade becomes really preoccupation of the german people. a full-fledged cancer panic emerges. this is if i'm they both grew up in. hitler is, you know, sort of a disgruntled teenager, and his father dies when he is 13 if i recall correctly, and he wants to be an artist but it's kind of, you know, hapless figure. nobody really likes them and the only connection he is really in the world is his mother, really the only human being he was capable of loving. right at the time when hitler is trying and failing to become an artist, his mother is diagnosed with breast cancer, and he's

absolutely shaken. his once with a friend at the time, you know, said that he'd never seen someone look so depressed. one of the extremely things, it's actually an austrian jewish doctor who is caring, and germany, including austria that but an austrian jewish doctor who is caring for hitler's mother, and hitler is very grateful and seem to have a good relationship with this doctor. they try everything. his mother is dying of breast cancer and nothing really can be done, and hitler is devastated. the doctor also left testimony had never seen like another human being so depressed. .. cancer remains threat through the end of his life in central focus coming season extreme hypochondriac to free to m

>> you know, stories,es it was just one after another. at one point, he stops everything he's doing and just writes out a will because he's sure he's going to die of cancer. and he had these horrible stomach cramps which he always assumed were cancer. and part of the chilling aspect of it is that he says multiple different times one of the reasons he's in such a hurry to do all the things he wants to do, because he's going to die soon of cancer, and he's got to talk care of business before he dies. so the stories are really bizarre. you know, he even had an obsession with shellfish, which some historians -- somewhat speculative. the word in german is kr are ebs for crabs. >> yeah. well, evidently his mother died a long, painful, horrific death

that he witnessed. so, and that's -- that will you talked about, wasn't that written, didn't he stop everything, and he was about to launch some big battle, and he stopped to do this? wasn't it during wartime? >> well, i think the will itself was at a different period, but,a yeah, i can talk about that as well. i know what you're referring to. there was this remarkable period in the 1940s which, you know, i can talk about that now, or that comes a little later in the progression of events. >> yeah, well, what do you think? is it more family where you're going to go with this or -- >> yeah. i think that comes up a little bit later. >> okay, we'll get to it later then. so nowe we understand, you know, a little bit more where, you know, where their early lives,

what is driving these two people, what is their focus, what is their passion, if you will. an overused word, but in this particular case i think it's appropriate. so let's talk about his lab. how, tell us about his lab and, you know, and not only this amazing lab that he designed, i mean, that was, quite frankly, really interesting too, but then how he behaved in that lab. so walk us through the labs. >> sure. sam: the 1920s, otto wag 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 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, manmade chemical, you know, that was in our food or in

our pans or whatever, we'd be terrified, it would be banned, there'd be warnings on it. but thehe strange thing is it's part of our biology. it's just our biology exaggerated, you know? 'sit's a growth hormone that's just exaggerated, you know, ramped up to levels it should never be. so think about that as a carcinogen. a carcinogen is metabolic disregulation, and any dietary strategy of prevention, therefore, should be,re you kno, lowering, you know, avoiding that carcinogen. so how do you avoid that carcinogen? what you do is you eat a diet that causes insulins resistance to improve. one study found that 88% of adults had some signs of it. if you want to avoid that, i think a sensible strategy is to follow a diet which would lower insulin levels and would be

healthy for many different conditions, but as an added bonus would probably make you with less likely to get cancer. there are no guarantees with cancer. some cancers are bad luck but some are, you know, genetically inherited. so, you know, so what causes insulin to rise. dietary fats seem to have, you know, as low an effect on insulin as possible, almost no effect. protein causes some inlins spikes butec not -- insulin spis but not like carbohydrates. carbohydrates causes the most. but, you know, if you follow, you know, if you're met bollically healthy, you may be able to eat a fairly normal kite. and once sugar is introduced into the diet, a lot of the metabolic problems have, start to happen. and once you have those metabolic problems, once you have theem insulin resistance, then getting rid of sugar may not be enough.

you may have to cut more carbs and position more on healthy fats and proteins. so i think that in terms of prevention, in terms of e lowering insulin resistance, the best evidence suggests that a diet that's high in fats and proteins and low in carbohydrate is key. you know, some scientists and doctors point more towards protein, some towards fat, but i think t that the agreement at least, you know, in certain circles is that, you know, the one thing you want to watch out for is too many carbohydrates. with but if you already have insulin resistance, then probably other carbohydrates as well. i really like the notion that michael pollack, an important cancer doctor in canada, said, you know, that -- not that people are can ever use sugar, but think of it as a conned condiment like -- condiment. certainly don't create it because drinking sure seems to

cause the worst metabolic effects in terms of quickly hitting your liver and causing the insulin-resistance phenomenon. >> and people need to be very careful, ideally don't eat a whole lott of foods with labels. there's no labels on broccoli or roastedou chicken. you have to be careful9 with the added sugar. that'sat true. but just watch the word carbohydrate. there are carbohydrates in pasta. there are carbohydrates in bread. but then there are different types of carbohydrates. i mean, there are a -- carbohydrate meaning they've never been rationalized and put back together. like whole grain bread. but wheatog berries are whoaciag they're intact. so i think for people -- i mean, sugar's a cash high day. and i think people --

carbohydrate. and i thinknk people hear carbohydrates, and, you know, i'm not on a keto diet personally, but, you know, there's no root vegetables or potatoes or certain things that have nutrients in them. so there'srb different carbohydrates 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. you know, it's very clear that, you know, more refined carbohydrates, you know, cause a more profound insulin spike and are worse for you with. think about food, i said the whole thing's about sugar, but fruit does have some -- and most scientist es 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 glucose to, you know, 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, what they call the glycemic effect, you know, how much of glucose -- and some people, you know, metabolically, if you're healthy and don't have insulin resistance, they don't have to worry. but there are many societies in human history that have eaten a lot of carbohydrates and been metabolically healthy. it's e really only, i think, after the introduction of sugar, first and foremost, that you started to see at lot of these problems. once you have these metabolic problems, i think you want to

avoid is most, certainly, processed carbohydrates. but each individual, you can get a pretty good sense of what's working for you. you know, looking at, you know, your weight. so i don't think it has to be a one size fits all, but i think think the a common sense thing -- is less carbohydrates because it keeps insulin lower, and when your insulin's lore -- lore, part of what it does is traps fat inside your fat cells, so your insulin's lower, you know, the analogy of a wallet. fat from, you know, the -- it flows back out, you burn it. but if you have elevated insulin all the time, the fat is getting locked in, and it's just a natural sort of logical response rto keep insulin lower to sortf restore the metabolism of your

whole body. i'm only talking about cancer, but there's even more evidence for insulin -- in other conditions. >> well, you know, years ago i i did some volunteer work at a breast health center with one of the local hospitals, and the women would come in for treatment, and we would all recommend a very low-sugar diet because simplistically, it was sad, sugar's a cancer feeder. not everybody agreed with that at the time, but i think pretty much everybody agrees with that now.he so if you have, you know, again, i know you were working primarily on prevention. so eat a healthy diet if you want to avoid any kind of metabolic disease, of course. and cancer. so healthy fats, you know, enough omega-3 fatty acids in relationship with mega 6s and the healthy fats and whatever

kind of protein you with eat. but the big thing is you recommend limiting the, obviously, sugar, sugary drinks particularly and staying low on the carbohydrates. and if you have cancer, that's probably even more so important. so that's 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, we didn't really talk about otto's partner and what he did,we 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, you know, the fat city liver disease, you know -- fatty liver disease,

non-alcoholic fatty liver disease, that's all sugar. so the sugar, metabolically speaking, is a nightmare. we already talked about fiber mitigates the glucose rise in fruit, we did talk about that. is insulin the culprit or the elevated sugar causing insulin to rise? ing what about igf-1? >> yeah, the igf-1 story, insulin growth factor back to 1 and that, certainly, that's another hormone that's part of the story. there's a lot of nuance to that science, but elevated insulin seems to also increase the igf-1 signaling. so i sort of lump them together for the sake of simplicity the, but i think it does sort of, the igf f 1 issue follows the elevated insulins. soso one of the interesting this about, you know, when i started

writing this book, i thought te whole damaging effect of sucrose, the sugar, was just on insulin resistance and elevated insulin. but there's some evidence that some cancers, colon in particular, consuming the -- consumes the sucrose directly. so the case against sugar continues to build even on the time i i was working on the boo. >> well, a fascinating book, and we could talk for probably a couple more hours on this. but hopefully everybody has, listening, has, you know, a reason to go purchase your book, read this incredible and -- incredible story and how his work from this very difficult, brilliant man is front and center again and what that means to us. so i, so basically, sam, i want to thank you so much -- >> oh, thank you. >> -- for your comments here today. it's been wonderful.

and as well, i want to thank all of you who are listening today. so this program will be on the commonwealth club's web site soon. again, that's commonwealth club.org. and now, this meeting of the common if wealth club of california -- commonwealth club of california commemorating its # 18th year of enlightened discussions is adjourned. ♪ ♪ra >> if you're enjoying booktv, then sign up for our newsletter using the qr code on the screen to receive the schedule of upcoming programs, author discussions, book festivals and more. booktv, every sunday on c-span2 or anytime online at booktv.org. television for serious readers. ♪ ♪ >> c-span now is a free mobile app featuring your unfiltered view of what's happening in washington live and on demand.

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