About the guest: Robert Lufkin, MD is a radiologist and professor at UCLA. His new book is called, "Lies I Taught in Medical School."
Episode summary: Nick and Dr. Lufkin talk about: the history of medicine in the United States; diet & lifestyle vs. pharmaceuticals in acute vs. chronic disease; diabetes, metabolic syndrome & insulin resistance; health institutions like the American Diabetes Association & American Heart Association, including their financial influences; carbohydrates, fats, dietary cholesterol, ketosis, and related topics in metabolism; bloodwork & choosing the right doctor; and more.
*This content is never meant to serve as medical advice.
Support M&M if you find value in this content.
Full audio only version: [Apple Podcasts] [Spotify] [Elsewhere]
Episode transcript below.
Full AI-generated transcript below. Beware of typos & mistranslations!
Robert Lufkin 2:25
Yeah, well I sincerely spent my whole My name is Robert Lufkin, I've spent my whole career in academic medicine as a professor at a couple large medical schools here in Southern California. In my being a professor I, I was fortunate to be able to not only practice medicine, but also do research and, and also teach so it's it's a great, great thing from that point of view from and and I was basically represent the medical establishment. I'm not a conspiracy theorist or anything I'm, I'm about as mainstream as they get. I mean, as example. My publications I have my my specialty is medical imaging, although, in the last 10 years, for reasons we'll probably get to, I've transitioned into metabolic health and longevity, largely out of self interest. But, but my, my academic background is in medical imaging and and like I said, doing research I, I, my laboratory took millions of dollars from or was was granted millions of dollars from the federal government from drug companies from equipment manufacturers, we did a lot of research over 200 peer reviewed publications. Doing you know, all the things I've served as president of a couple International Medical Society, so I'm really you know, I'm really mainstream medicine and, and, for the record, I believe that Western medicine is actually it unequaled in its ability to handle certain things. I'm not out to throw out Western medicine. I think, for example, if I have a you know, any number of infectious diseases, I'm gonna go to Western medicine and it's been very effective in the 20th century for eliminating public health, diseases and really improving our lifespan. Similarly, if I step out in the street, I get hit by a bus. I while lifestyle and nutrition may help me recover from that event, I will only survive that event if I have access to the latest cutting edge Western medicine, which will include blood transfusions, bone settings and you know, surgery To reconnect my, you know, whatever soft tissue damage I have. So Western medicine is really in my opinion unequaled and in its ability to do those things. And the problem is when we apply those Western medicine approaches to certain diseases that we'll be talking about later. But anyway, my background, that's my background. I still am a professor. Although my focus, like I said, is now metabolic health and, and longevity. And
Nick Jikomes 5:34
one thing that was interesting, so so your new book that's coming out, you start out with a description of of your mother. So can you kind of give give that story to people? Who is your mother? And what was she doing in terms of diet nutrition when you were growing up?
Robert Lufkin 5:51
Yeah, well, I mean, obviously, all our mothers are formatives in our formative in our lives, and our dads too. But it just so happened that my mom was a dietitian, and she was she worked in hospitals, all her life into her 80s Really, and and so what that meant to me is growing up, we were exposed to the latest, the best health care recommendations as far as nutrition, which, you know, for better or worse, at the time meant that we had a essentially a low fat high carbohydrate diet, we avoided things like butter, because of saturated fat, we thought it was harmful. And we substituted what we thought was healthy, which was margarine, which is full of trans fats and seed oils. We, you know, we avoided fat on meat, we would trim off the fat in the corner of our, our meat, and we follow the food pyramid, religiously. So the idea that that food influence our health was definitely imprinted on me. It just so happened that the wrong the wrong choices were I was subjected to many of the wrong foods growing up as many people still are. Because there's there's a lot of a lot of controversy and difference of opinions on what good diet represents today.
Nick Jikomes 7:22
Yeah, I mean, you know, people are really passionate about diet they get, there's almost a kind of religious zeal that many people have with their diet, they get really attached to certain diets. You know, you've got vegans, you've got carnivores, you've got everything in between. So as a dietitian, you're Where did your mother get her information and her training from and how does that compare to a dietitian today?
Robert Lufkin 7:45
Yeah, she well, yeah, full. Full disclosure. She I think, you know, I didn't think it at the time. But looking back, I realized that in her family, she had her brother and sister were both type one diabetics. So growing up, she was surrounded with the idea that, you know, they they should only eat certain foods because of their diabetes. So she was immersed in that and I think that influenced her her choices in her career. So she, she went to, you know, she went after college, she went to dietetics. School had training. She was certified by the American Dietetic Association. It's similar to what people have today. The same program, it's the same. It's the same American Dietetic Association that was founded, you know, at the turn of the century by, by actually a woman with very strong religious ties. But, you know, nothing against religion, but as an effect as a result of that. Some people many people believe that that this woman in the American Dietetic Association was influenced by a religious agenda by eating certain foods to not eating other types of foods, which, what was her religious
Nick Jikomes 9:05
beliefs?
Robert Lufkin 9:06
Seventh Day Adventist?
Nick Jikomes 9:08
Ah, okay, I didn't know that. And apparently, they were also influential in a lot of things, including the founding of various food companies.
Robert Lufkin 9:15
Yeah, Kellogg's cereal, yeah, and all those all those things. So there was a, there was things going on with that. And again, nothing against Seventh Day Adventists nothing against any religion at all. It's just that for my health choices, I want them to be informed by what the science says not what my particular choice of God says. You know, and that's just my belief, and everyone's entitled to their their own belief, but, I mean, that particular organization in the adventus has been very, very vocal about certain opinions about nutrition, and they've recently purchased a longtime Have any brand. Dan Buettner popularized something called Blue Zones when he wrote a book, you probably talked about this on your podcasts about certain zones around the round the world where there are a large number of people who live over 100. You know, there's centenarians, and then they analyze their lifestyle, their food choices and everything. And there's, there's some really beautiful work done with that, you know, there's there's one in the United States, which happens to be Loma Linda, where are the Adventist churches, but but then there are many other ones around the world and the I agree with many of the viewpoints of the Blue Zones, the idea of community the idea of, you know, having purpose in your life, the idea that food dramatically influences your your longevity and work and other factors as well. Even though the Blue Zones project itself has been called into, called into question when they, when they analyzed studies of centenarians, based on these were typically the other thing about the Blue Zones, these were typically lower socio economic areas, they they were, they were poor areas, which typically tend to have poor birth records. So that was a possible criticism of it. And some skeptics of some reports have come out when the birth records have improved, the centenarian numbers went away. And another report came out when they analyzed the numbers of centenarians in the population, the birth dates of centenarians versus the birth dates of the general population. They were they were looking at statistical inferences and statistical tools, the way they track kind of fraud and income fraud and financial statements. So fraud distributed,
Nick Jikomes 12:05
I'm guessing you're about to sit at the distribution of birthdays for the centenarians looked odd or not like a random sample.
Robert Lufkin 12:11
That's right. The the population is the whole birth dates are random. The centenarians birthdays were non random. In other words, they tended to do occur more on the first of the month or the end of the month, it was sort of days that people might pick if if they didn't know, but But you know, so maybe, maybe the science isn't there, but I think we can still, you know, there's good things about community and we could there's good take home messages. One concerning thing is that the BlueZone brand, which I guess is a copyrighted now or trademarked, it's a whole industry was just purchased by the Adventist organization, which again, nothing against adventus. But it is driven by a religious rather than, yeah, necessary scientific agenda. So there's going to be informing what people think is a scientific conclusion or with a religious agenda. Yeah, and
Nick Jikomes 13:10
I think one of the important things here is, it's important to understand, you know, a lot of a lot of what we're going to talk about today has to do with things like mainstream medicine or medical institutions, and the extent to which we should or should listen to them or how to look at them critically. One thing that's very important in that project, in my view, is understanding where an organization comes from, who founded it, what their prior beliefs are, the conclusions, they're coming to the table with our and looking at how those change over time. And so, you know, what you've already started to tell us is, certain organizations out there have been seated or started by people with religious beliefs, and again, nothing, nothing against religion. But another way of saying that is they were started by people who have preconceived conclusions that they are going to be interested in defending no matter what the evidence is, rather than coming out from their perspective of seeing what all the evidence is, and then tailoring their conclusions to that.
Robert Lufkin 14:05
Absolutely. Absolutely. And, and, you know, as we'll probably talk about later, it's not just the, you know, it's not just the blue zone or some of the diet that we're talking about, but also the the scientific medical societies are, you know, have similar corrupting influences as well.
Nick Jikomes 14:26
Yeah. And so, you know, since you said your mother was a dietitian, she had certain health issues in her family that probably motivated her to get really interested and diligent about her diet. She listened right to the organizations one would naturally look to these are mainstream organizations. She became a dietitian, she probably learned a lot she probably read a lot. And yet, it sounded like you more or less said that she ended up getting everything wrong, or at least many things wrong. How? How is that possible? How is it that someone can study Mainstream sources they can look to mainstream institutions. And these institutions can tell us things for decades and decades, that turn out to be so wrong in a pretty systematic way. Where does that? How can something that systematically wrong last for so many years? I
Robert Lufkin 15:19
mean, that's, that's a great question. And we're, we're still facing it today in you know, in all aspects of society, but particularly in in health care. I guess, I have to stay that I'm enough of a believer in, in human nature that I, I believe that nobody, or very few people get up wanting to harm another person. In other words, and certainly health care providers and doctors, and that, you know, they, they don't, they don't go into that business, you know, to harm people and, you know, make choices that are that are going to be unhealthy. But layered on top of that, I think, are incredible, unimaginably strong, pernicious influences, both conscious and unconscious, financial and otherwise, that manipulate our system to the point now where the mainstream health organizations and many of my colleagues still give advice that is harmful for patients and actually will make them have a greater risk for chronic diseases, if they have the chronic diseases, it will make them worse, and ultimately, likely shorten their longevity.
Nick Jikomes 16:43
So let's talk about let's just pick one chronic disease and talk about that to start with. And we can kind of use that to unpack bigger issues, I think. Let's start with type two diabetes. So you know, I've talked about this subject in different ways on the podcast a number of times with a number of different experts. Type Two btw, type two diabetes. Can you summarize briefly what that is for people? And give us a sense for how big the problem is today compared to say, when you were growing up?
Robert Lufkin 17:12
Yeah, I mean, diabetes, as a as a disease has been around for 1000s of years, it was described in, you know, ancient Roman texts and everything. And typically, there there, it's a disorder of it's thought of as a disorder of glucose metabolism. And the original type of diabetes is what's called type one diabetes. And where insulin, which is a hormone, I'm sure you've talked about with your with your guests is produced in the pancreas that regulates many things in our body, but also protects us from high levels of glucose in our bloodstream. So people with type one diabetes for somewhat unknown reasons, they may have an immune response or some some source of damage to their pancreas, they're unable to make the make insulin, and therefore they can't regulate their glucose and they will, will die of it. When glucose was introduced, in the 20th century, it was life saving for these people and really transformed the lives of these people. There was another type of diabetes that is also called diabetes. It's called type two diabetes. And though it's called diabetes, it's very different from type one, although a lot of people sort of confuse them or lump them together, because they both have the same name diabetes, and they both deal with insulin abnormalities. But where type one diabetes is a problem of too little insulin. Type Two Diabetes is a problem of the body, developing what's called insulin resistance, so it doesn't respond to the insulin and it requires greater and greater levels of insulin to manage the sugar levels. And it used to be type one diabetes was fairly uncommon, and it was used to be called adult onset diabetes, because type two diabetes, oftentimes type one diabetes, oftentimes, not always, but what would occur in childhood and then type two diabetes would be this adult onset form.
Nick Jikomes 19:32
Yeah, I mean, I remember even even in in my childhood, when I first learned about these terms, I learned it as type one is childhood diabetes. Type Two is adult diabetes. And of course, as I think you're gonna tell us, that's that's changed so drastically over time because so many people, including young people are now getting type two diabetes that that that phrasing doesn't even make sense anymore.
Robert Lufkin 19:55
Yes, something happened in the last 30 years 30 to 40 years really, and nobody really knows what it is. There's some very, you know, some very strong candidates for what it might be. But basically, our, our health began to go off the rails people began, first of all, the obesity rates began to began to skyrocket to the point today, where most people, most adults in the United States are either obese or overweight. And it didn't always used to be that way. It happened fairly recently. And that vat of course, you know, if you have any doubts that that obesity is, is not a genetic condition, and most people just, you know, look at the rates, it's exploding. If it were, you know, genes don't change, it's the same genetics, but the rates are exploding. Well, about 10 years after the the obesity rates started going through the roof like this, we're now seeing the diabetic rates going through the roof, and these are not unrelated reasons we can talk about but now, diabetes is is dramatically exploding to the point that we are in the largest epidemic of diabetes in recorded history, even corrected for population. In other words, more people have diabetes per populace per person per population, they never before in history, and the interesting thing, that type of diabetes that they have, by far 90% or more is type two diabetes, it didn't used to be that way. And it's no longer adult onset necessarily. We have children who are type two diabetics, and, and many other conditions and many other indicators like this. So we're, we're undergoing a major major revolution in diabetes, that that didn't happen before. And it's largely this, this type two diabetes. And the problem with type two diabetes is it's it's really as I mentioned, it's due to insulin resistance. But this insulin resistance and the associated inflammation associated with it, which which means metabolic abnormalities, these things also happen to drive other chronic diseases like hypertension, right? Like an arthritis called gout. Diabetics get cardiovascular disease at a much, much higher rate, that's heart attacks and strokes. Diabetics get cancer at a much, much higher rate, just like obese people do. Obesity is now replacing tobacco as the number one environmental risk factor for for cancer. And diabetes is, is also right up there. Alzheimer's disease is now referred to as type three diabetes because of the strong associations with inflammation, insulin resistance, and degenerative neural diseases, which the main one is, is Alzheimer's disease. And this actually even extends to things like mental health, psychiatric conditions, where we're seeing that the same metabolic abnormalities, also, which manifests is, as type two diabetes in some people and some people may not, it's not just type two diabetics that get these but they may not, they may not manifest as a type two diabetic, they may only get Alzheimer's, they may only get schizophrenia, they may only get something else. But the point is, all these factors seem to have common metabolic causes that unfortunately, Western medicine as we know, it now, really doesn't have a treatment for these underlying underlying the underlying causes. In other words, we have a pill or surgery, let's say if I get a heart attack, you know, God forbid you or I have a heart attack, which means we don't get blood flow to our heart, will will likely today get a stent put in our blood vessel, which is a mechanical device that opens the blood vessel and for many people, you know, they'll have the heart attack and they'll go Wow, thank God, I got the standard, save my life. I'm done. My heart disease is taken care of and they go home. And what they don't realize is the stent does nothing to change your survival from heart disease does nothing to slow down the disease and the disease actually continues in other blood vessels and even in the stent itself will eventually clot off it, this model this this misconception that we see in heart disease is also true in, I suggest in hypertension as well, I mean, my blood pressure may be elevated, I take a pill to lower it, my blood pressure is lowered, but the damage to my blood vessels continues to go on. Similarly, you know, with diabetes there, again, with type two diabetes, where people are given doses of insulin to control their insulin resistance, there have been a number of studies shown that tight regulation of the sugar, the blood glucose with insulin and type two diabetes, diabetics does nothing or does, in many cases, very little to control the downstream effects of the diabetes, which, you know, all the diseases I mentioned, plus, diabetes is the number one cause of surgical amputations today. So number one cause of renal failure and dialysis is the number one cause of blindness. You know, it goes on and on and on. And many of these complications still happen. Even when the patient is getting the insulin they go, I'm a diabetic, but it's taken care of, I've got the insulin Right, right stead they're ignoring things that they can do to actually address these basic metabolic conditions that, for a number of reasons, I don't think are, are known enough or popularized enough by Western medicine as as solutions for metabolic disease and all these conditions rather than just rather than using just band aids like pills and surgery.
Nick Jikomes 26:37
Where does type two diabetes were more generally where does insulin resistance come from? to begin with? What are some of the major lifestyle factors that drive its development?
Robert Lufkin 26:47
Yeah, that's, that's a great question. And when I talk about insulin resistance, something that that kind of blew me away that I wasn't aware of, until I really started diving into the subject is type two diabetes, as we talked about is insulin resistance. And insulin resistance is measured by a number of blood tests, but one of the most common ones is the hemoglobin a one C, you've probably talked about it with your audience. It's a it's a measure literally of glycation damage to red blood cells from from high glucose levels in your bloodstream. And once once it goes above 6.5, then the medical system diagnosis make standard diagnostic criteria for diabetes when it's below 6.5. I might be pre diabetic, but I'm not diabetic. So it's kind of an either or switch. And I used to think of diabetes and indeed, all these chronic diseases as sort of either on and off switches, either either I was diabetic, or I wasn't diabetic, or I had Alzheimer's, or I didn't have Alzheimer's and and what I've come to appreciate now, based on if, in the case of diabetes, there's a large study that came out recently where they looked at non diabetic adults, and it was based on the Framingham data, the N Haynes data, a large number of people, and they tracked this marker for diabetes, this marker of insulin resistance, this hemoglobin anyone see, and they looked at it versus the age of the person. And as people got older and older, their ha when see goes up and up and up, and up and up like that. So what does that mean? Well, when I saw that, to me, it means that, that, even though I'm not diabetic, now, insulin resistance, and type two diabetes may be something like gray hair. In other words, it's in my future, if I don't die of something else sooner, I will eventually get gray hair, you know, and, and so, and that caused me to look at the lifestyle choices I was making now. differently, because, yeah, maybe I ought to pay attention to the foods that diabetic shouldn't eat, because I'm really on the path to insulin resistance and diabetes. And
Nick Jikomes 29:18
so how do we think about the foods that diabetics should eat or stop eating to help their diabetes slash the foods we should eat or avoid to prevent ourselves from getting diabetes? If I look at, for example, the American Diabetes Association, very large, very well funded Association that's been around for decades, that's specifically focused on diabetes, you know, they tell me to eat things like whole grains and legumes and and other things. And then other people are telling me completely different things. So there's a lot of confusion out there because you get different people telling you very different things. Sometimes MCs are people at large institutions. Sometimes these are people with credentials. Sometimes it's other people. But there's a lot of mixed messaging out there. How do you think about diet and insulin resistance? Yeah,
Robert Lufkin 30:10
I mean, that's such a great point. It's so confusing for you. And I talk about this. And we focus on this, you know, all the time you imagine kind of a average person who's just trying to do their job and raise their kids. And then you get all this information about what is good and what is not good. And so we all try and simplify things. So we go to we go to organizations like the American Diabetes Association, which is the leading health care organization in the United States that is looked upon worldwide for healthy advice about diabetes. And, and as we mentioned earlier, these medical institutions, as many of them, including this one, you have to look at their influences, who is paying for their advice. And their advice is not only to eat whole grains on their website, even even to this day, they advocate recipes, which have added sugar. And yeah, we talked about, well, I don't think that's good, but they just say, Oh, just cover it with insulin. And if you look at the, if you look at who's funding the American diabetic Association, you can look in you'll see companies like DaVita, what is the Vita? It's one of the most large, largest dialysis companies that makes renal dialysis equipment, what's the number one cause of renal dialysis and renal failure in the world? Type Two Diabetes, so because the more
Nick Jikomes 31:43
the more people that are type two diabetic, the more kidney failure, you're going to see the more kidney failure, the more people that need dialysis, the more people that need dialysis, the more dialysis machines defeat is gonna sell. Yeah,
Robert Lufkin 31:56
I mean, that's a very cynical way of looking at it. But why else would would American diet Bedich Association put recipes on their website that that as we'll talk about, contain foods that will drive up your insulin and make your diabetes worse?
Nick Jikomes 32:18
Another thing another thing that's confusing to me as I think about this is why exactly is the Vita advertising with them? Are there? Are there consumers out there shopping around for different brand name, kidney dialysis machines and picking that one? No,
Robert Lufkin 32:31
they're not to be clear. They're not advertising. They're sponsoring them. So they're you if if you look on the website for I mean, the American Diabetes Association, I believe, is a nonprofit, most of these are nonprofits. So they get sponsors, not so much to run ads. But well, if you think about it, what diabetic, I'm gonna need dialysis. So I could go to the DaVita center instead of the XYZ center, perhaps, you know, I
Nick Jikomes 32:58
see. So maybe it's like, a psychological association thing that they're hoping to achieve. Yeah.
Robert Lufkin 33:03
Yeah. And that it may be it may be as benign as that, but I don't, you know, I'm, I'm suspicious, because I've tried to figure out why the American diabetic association would make such recommendations, in my opinion, that that are not Oh, healthy.
Nick Jikomes 33:20
Yeah, I mean, I've seen I've seen it, you can go online, they have essentially a big recipe page with all sorts of foods. And there's everything in there from chocolate chip cookie, chocolate chips with honey nut cheerios, or some brand new Cheerios that I'm sure they technically recommend, because it's multi grain, quote, unquote, there's added sugar inside of orange juice based drinks. There's there's a lot of really sugary stuff in there. And it is peculiar, I think, no matter who you are. It's certainly peculiar. peculiar.
Robert Lufkin 33:50
Yeah. You don't have to be a nutrition scientist or a physician to think, well, this really doesn't make sense knowing what we know about diabetes. Why are you recommending patients take this from this trusted source? And
Nick Jikomes 34:06
so with respect to sugar and carbohydrates more generally, how do you think about diabetes is, is the best approach for someone with pre diabetes or diabetes to go low carb? Is it something else? What's sort of the macronutrient framework that you use to think about diabetes?
Robert Lufkin 34:25
Yeah, I, I mean, I think there's no question. The early treatment of diabetes before insulin was to was to go on a very, very low carbohydrate diet. Why is that you know, the, the three macronutrients macronutrients, fat and protein are essential for life. In other words, we don't eat fats or proteins will will die. Interestingly, the third macronutrient is not required for life and there are populations of humans that you know survive on A little relatively little carbohydrates and and there are even diets that are extremely low carbohydrate diets. The interesting thing is, these three macronutrients affect insulin very differently, because insulin, one of its primary roles is to protect the body from damage from glucose, high glucose levels. So the number one factor, the number, the number one driver of insulin of the three macronucleus nutrients by far is carbohydrates. fat and protein have relatively little or no influence on insulin. So if you think about it, if I have, if I have a problem with insulin resistance, which is is people believe it's due to chronically higher and higher levels of insulin and inflammation that drive make the body just respond less and less to the insulin. So I require higher higher doses. It's like the boy who cried wolf, you know, you keep eating, you have to cry louder and louder. So if if so basically, the insulin, higher higher amounts of insulin are necessary to to fulfill the requirements for this type two diabetes. And so if you want to minimize the the insulin that's produced, and there, you know, there are a number of reasons why we want to reduce the amount of insulin that's produced, not just for diabetes, but for other factors like cancer and other things, then our dietary choices would be to avoid the things that drive insulin. And those are largely carbohydrates. They're two other food processes that in my opinion, can also drive insulin resistance, but the the primary effect on insulin itself, like high levels of insulin is from from the carbohydrates.
Nick Jikomes 37:00
What are those two other processes? Well, one
Robert Lufkin 37:03
of them is is another sugar, but it's an interesting sugar. It's called fructose. Fructose Is this the very sweet sugar, it's The Sweetest sugar of all, it's found in fruit fruit for us. It's also half of the sucrose molecule, which is the table sugar we eat, which is half glucose and half fructose. Fructose, interestingly, doesn't have a significant effect on insulin. So if I take insulin, my my glucose, my, I'm sorry, if I take glucose, my insulin will go up. If I take fructose, there's very little effect in this to the point that the American diabetic association for many years recommended fructose as a sugar for diabetics, because it wouldn't it wouldn't spike their insulin, which was true. What they didn't realize, though, and what what really we're just beginning to realize in the last 10 years is that fructose is actually it's in high doses is a toxin. And while glucose is metabolized by essentially most almost all the cells of the body, fructose is really only metabolized to any significant extent by our detoxification, Oregon, which is the liver, is it sort of like alcohol in that sense? Exactly. And so many of the same diseases are driven, the number one cause of liver failure, or the number one cause of fatty liver used to be alcoholic fatty liver disease, then in 1980, for reasons that, you know, are not completely clear, but they're strong suspects. In 1980, there was a new liver disease that suddenly appeared that was called non alcoholic fatty liver disease, to the point that today, 30 years later, it's totally replaced alcoholic fatty liver disease, it's the number one cause of liver failure and the number one cause of liver transplants and in some studies, 50% of adults Americans have this
Nick Jikomes 39:04
so so is the is a way to think about this that so fructose is not metabolized by all the cells of our body. So it's sort of it's not like glucose, which you know, glucose can be used by all of our cells to power, ATP synthesis and energy production. Fructose is only metabolized in the liver. So if you have a lot of fructose in your diet, you're sort of just generally stressing out the liver a little bit more.
Robert Lufkin 39:27
Yeah, and it's not all only metabolized in the liver about about 10% or a small amount is liver is digested in the is metabolized in the digestion system and in the intestines, as in you, you might think about this as well. This is sort of the normal amount that's expected to metabolize there anything above that is considered you know, one way as a toxin and that's why it goes to the liver. The liver is a detoxification organ but as it detoxifies it, it it stores fat in the liver, which causes fatty liver disease. It also drives insulin resistance, it doesn't elevate the insulin directly, but it drives inflammation which drives insulin resistance. It also affects things like urate, uric acid, which was a chemical like fructose we didn't pay much attention to for many years, it was associated with gout and things. But now we see that your eight is actually linked to fructose metabolism. And it's it's tightly linked to metabolic health. It's also linked to nitric oxide synthesis. And your eight levels of fact that and nitric oxide, of course, is an amazing molecule, they won the Nobel Prize for it. But it does three things that are fundamental it it increases blood vessels, the glyco, thelia and calyx it allows it to relax, which means it controls hypertension, you know, erectile dysfunction, but all the other all the other functions. But nitric oxide also independently drives the immune system and for immune health, and then is if that weren't enough, independent of those two things, and independent of the fact of blood vessels on the brain, it actually improves neuronal function as well. So fructose drives all these factors downstream through your aid through nitric oxide synthase, that, that have all these effects on our health.
Nick Jikomes 41:39
So one thing that was really interesting to me is I was sort of reading about the history of diabetes and insulin resistance, you know, the the discovery of insulin, the founding of the ADEA. Some of the old lifestyle interventions they used to do before we knew about insulin, up to, to the present day, and one of the founders, actually, so that so the ADA was founded by some physicians, and one of the founders actually had something he called the starch free diet. And if you go back and read it, this is all the way back from 1921. It's essentially an ultra low carb diet, you know, avoid breads, avoid sugar in any form, it says explicitly, but then just a little bit after that insulin was discovered, and then it kind of just became the thing that was used, because you could, you know, inject someone's insulin, if they were having a blood sugar episode. And that would acutely help the problem. And it sort of looked like the idea of using diet and lifestyle changes just sort of faded into the background, now that we have this medicine that could be injected to solve an acute problem. And then, you know, as you get into the 60s and 70s, the ATA starts recommending, you know, initially something like 50 60% carbohydrates in terms of your percentage of calories. And we see them, you know, following the USDA guidelines, the things that mirror the the food pyramid. I'm just wondering what your take is on that sort of evolutionary progression? What was it that caused us to go from, you know, in the early 20th century of focus on diet, focus on metric macronutrients, to then this focus on insulin, and then this focus on high carbohydrate diets? What was driving all of that was all of it just a response to what we thought was true based on the science and the research that was being conducted? Or is that one of a number of different kinds of influences?
Robert Lufkin 43:25
Yeah, that's, that's a great question. And and I want to say it's not only limited to diabetes, and insulin, there are other diseases that have sort of lifestyle dietary treatments that worked great for that when some sort of pharmacological intervention came along, and they could take a pill instead, that the, excuse me, the the effects of diet, the diets were, were fell out of use. And a great example of that is epilepsy. It used to be that the, again, since Greek and Roman times, it was known that to control seizures, what you do is you fast, and you you stop eating, or you go on a diet that simulates fasting, which is a ketogenic diet, it's called, which is no surprise, very low carbs. And it means there's very little glucose that's eaten, instead, you're eating fat and protein, and it switches the body, as you've probably talked about, into into ketosis, which is an alternative and some people argue more healthier form of metabolism. And, and for many years, up until the beginning of the 20th century, this was the treatment for epilepsy. You put people on a ketogenic diet, and their seizures go away. And then in the beginning, in early 20th century, anti seizure medicines were developed, you know, sodium valproate and other other number of medicines, and people began Hey, I'd rather take the pill, and then I can eat whatever I want. And fast forward to today, where the whole idea of treating seizures up until, let's say, 10 years ago with ketogenic diet wasn't available and, and there were and how bad it got is that there's some patients, some kids, adults who have seizures, and it doesn't their seizures don't respond to any medicines. So they're the, you know, they're non responsive to medical therapy, these patients then can undergo surgery in some cases where they'll actually resect parts of the brain that that may be causing the seizures and and there's one one story that is a he's a wealthy film maker from Los Angeles who had a child with uncontrolled seizures that they, they tried all the medicines, none of the medicines work. And I think they had surgery or they considered surgery. Nothing worked. Anyway, long story short, this individual was wealthy enough, he was able to take his child around the world looking at all different treatments. And he finally found a physician, I think somewhere somewhere on the east coast at Johns Hopkins, I think, who, who is an older guy who's still practiced ketogenic therapy for seizures. And anyway, he put the child on ketogenic therapy, and basically, the ketogenic diet, all the seizures went away. And now the this person is he made a movie about this, and he's donated, you know, millions of dollars to to advance this. So it's happened before in many different areas. Why? Why does it happen? Are you back to your question? What drives it? I think at one level, it's just a basic thing. I know I'm lazy, I'd rather take a pill than you know, that changed the way I live my life and everything else. So I think there's human nature that you know, given a short option, because if the thing about taking a pill or even surgery is, I don't have to change who I am. In other words, even a surgery, I might miss a week's worth of work, and I go to sleep for a while, but then I go back, and I still in the same way. On the other hand, to make a lifestyle change, I literally have to change the way I look at life change the way I see kind of identity transformation. Exactly. And that's much more difficult to do. It's an investment of myself, rather than just saying, Hey, I went to the doctor, they gave me a pill. It's not my problem. I took the pill, you know, so? Well, I think there's that. Yeah.
Nick Jikomes 47:42
Yeah, I think I think you're absolutely right. Like, people often feel like they're losing something, if they change their lifestyle. You know, I can think of a lot of people in my own life, that that are very much like that. It's not simply that you're asking them to give up sugary foods, or give up beer or give up, you know, whatever it may be. But there's so many memories and social context that all of those things are associated with, it's not that people are just like, I want to eat sugar period, it's that is attached to all of these things that that are, you know, really, really nice parts about life, you know, birthday parties with birthday cake, and having a drink with your friends after work. And like all of all of that sort of social emotional stuff. That psychology is bundled up with all of these foods that
Robert Lufkin 48:26
we eat even, even on a darker side, but echoing the same thing are the addictions, you know, the the addictive nature of some of these behaviors that you know, that are based on what's happened and like you say, in our life, our life experiences our childhood trauma, we've all had childhood trauma, just being a child is traumatic it, you know, it, it influences the way we look at things and then influences our choices. And that's why sometimes just telling a person, you know, you can either give up carbohydrates as a diabetic or you can take insulin, but eventually you're going to lose your toes and your kidneys and edited. And that person will still, you know, choose the latter, because they're even though they know they understand the risks of the sugar. There are other influences. That's why it's fascinating, how powerful then community becomes or coaching programs or even even there's a drug called naltrexone, which is a physical addiction drug that you give for people with physical objections. Well, there's now an off label use of it called low dose Naltrexone where it's a low dose maintenance dose but it helps people get off junk food and kind of change their lifestyle change their behavioral things that are so unhealthy and and that are harming them. So it's Yeah, many layers on this stuff.
Nick Jikomes 49:55
But yeah, I mean, when you're when you're truly addicted to something like that, it is it It is often difficult or even arguably impossible for someone to use mere willpower to come off of that, especially when they're in a social context, like our society where you know, everything from social interaction, to, you know, festivals and birthdays, and holidays, they're all They're all wrapped up in this type of food environment. We started out talking about, you know, the Seventh Day Adventists, towards the beginning, and they have religious beliefs about diet that are motivating them to pursue certain things. What do you think, you know, sort of on a higher level, given the role that religion plays in people's lives and has for many 1000s of years? Do you think it's a coincidence that most major religious traditions have a lot of taboos and strong beliefs related to things like diet and fasting? Does it require something that strong that tied to identity and culture to actually successfully motivate people to really regulate their diet in strict ways? Yeah,
Robert Lufkin 50:59
that's a great question. And well, I think, you know, as Jason Fung famously said, you know, what's the one thing that Mohammed, the Buddha, Jesus, you know, whoever, religious leaders, the one thing they all agree on, and it's not a spiritual concept of all, it's the fact that fasting is, is healthy, it's a healthy thing to do. But I think that the fact that they have those all those religious regulations about about food, reflect the knowledge that food is truly powerful, and it's one of the most powerful medicines we have. But all the all the recommendations may not be may not be beneficial anymore today, or they may be based on, you know, older concepts, like public health things with pork, and, you know, or, you know, things like that, but I it does reflect I think that, that religions as institutions understand the power of food and nutrition and the importance for our health. Yeah, it's
Nick Jikomes 52:06
sort of amazing that, you know, if you just look back at history, it's quite kind of obvious, actually, like, most successful cultures that lasted a long time, most world religions that actually, you know, have have sustained themselves. They have very clear traditions around fasting, you know, the Muslims have Ramadan, Catholics have lent. You know, many Hindus and Buddhists have, you know, it's like your entire life, you're fasting, at least from certain foods. And it's probably not a coincidence, like, none of these people knew about the gut microbiome, you know, 1000 years ago, 5000 years ago, none of them knew about the physiology of fasting, and yet they all converged on similar strategies around regulating diet.
Robert Lufkin 52:43
Yeah, I mean, you might, you might think that a lot of people with even short fasts, experience a real clarity of mind and a different a different mindset and perspective on the world. So they may have recognized this and suggested it as a tool for for, you know, if not spiritual enlightenment, at least, enhanced introspection, and, you know, self observation and everything with it that that's, that's an interesting thought, I guess.
Nick Jikomes 53:20
Going back to the ketogenic diet. So you mentioned a little bit about the history of the ketogenic diet with respect to epilepsy, it's been known for a long time that the fasting going into ketosis can be effective at helping with at least certain forms of epilepsy. What's your general view on the ketogenic diet? Today, more generally speaking, for people who are interested in weight loss, are people with metabolic syndrome, diabetes, things like that. Is the ketogenic diet viable? Is it something they should think about? Is it just a fad? Is it dangerous? What are your general thoughts there?
Robert Lufkin 53:52
Yeah. And before I get into that, I would like to make a disclaimer and he's referencing back your prior prior comment about how diet choices today and become politicized, like like everything in our lives, you know, Republicans don't speak with Democrats anymore. You know, it's like, it's just gotten so crazy and and there's there's definitely a polarization between people, let's say, who eat entire plants or eat only plants or a plant base. So sort of the vegan vegetarian side versus other groups of people who eat only animals and carnivores and all that and, and let me say that I love my vegan friends. I love my carnivore friends. I used to be a vegan for many years. I've been a carnivore for many years, I've tried it all I drank the Kool Aid. And I think, personally, I think it's possible to be very healthy or very unhealthy on either either of those extremes and anything in between. So it's not it's not one of the it's not either or on those but it's about the true choices we make within the framework of those. And and I've, you know, I think it comes down to avoiding, you know, avoiding certain types of foods. And, frankly, you know, I know from experience as a vegan, there's a lot more junk food, harmful vegan vegetarian foods, plant based foods, then there are animal based foods, they're still animal based junk foods that, in my opinion are unhealthy. But it's more of a minefield. When I'm eating plant based, I really have to pay attention. Yeah,
Nick Jikomes 55:30
I mean, because there's so many things out there that are marketed as healthy, it'll say plant based gluten free this, that or the other. It's got a bunch of vitamins that it's been fortified with. But it's filled with added sugar, and or soybean oil, and all these other things that a lot of people, I mean, people this is changing, I think, but a lot of people still don't realize that they should be looking at those things as well. And they look at the ingredients list, they think, oh, it's got low calories, and some vitamin C, B and whatever. And so it must be it must be good.
Robert Lufkin 56:00
Yeah, I mean, just it's just the nature of the beast, most junk food is heavily weighted towards plant based, but there are animal junk foods, like I said, I mean, if you look at the food pyramid, which was advanced for, you know, a couple of decades as recommendations for healthy eating for for the United States, but it was copied around the world, basically, it was amplified to everyone. Recently, it's come out the the, the people who designed the food pyramid, Nina Ty Schultz, and other people have come up with reporting that shows their their ties to big food and their financial interests that when you look at them, you realize that, wow, these the people who came up with this, this healthy eating plan, were actually strongly funded by organizations that make a lot of junk food and but on the other hand, if you look at the food pyramid, the bottom line of the food pyramid is what you're supposed to eat the most of. And then as you go up, you eat less and less and less. Well, the bottom line of the food pyramid is all junk food is basically cereals, grains, all that kind of stuff. So it makes perfect sense, when you consider who the people were who, you know, advance this agenda. Well, I want to talk a little
Nick Jikomes 57:18
bit more about how things like the USDA guidelines get set how things like the food pyramid were constructed. You just started to get into it. But you know, one way to look at the whole history of the guidelines and what some of these major institutions have said over the years as well, maybe they're just following the science are, we don't know everything we've learned a lot over the last 1020 3050 years. And our views are just slowly being updated as people pay attention to new research. An alternative view might be that, well, if we look back at the construction of the food pyramid, or the founding of these organizations, it wasn't merely that they looked at all of the research that was out there and and had a holistic view and an objective view of it. But they were actually, you know, cherry picking the information, they were influenced by their sponsors and other influences. So, you know, to what extent do you think it's, you know, the first way to view history there versus the second way? To what extent are things like the guidelines constructed from a holistic and objective and dispassionate view of the totality of the research that's out there? versus, you know, being constructed in other ways? Yeah, I
Robert Lufkin 58:30
think it's the former, I think they were filtered through the lens of, you know, one financial interests of big food, but also, they were filtered through the lens of what was thought to be the best practices for for healthy eating. And this This was driven since the 1960s, by a fear of heart disease and this fear of heart disease was based on the, in my opinion, sort of the mistaken concept that the main drivers for heart disease were dietary cholesterol and dietary saturated fats. So it began a whole industry of a low fat diet. You know, people lived I lived through a time when you know, foods were foods were made low fat and so the sort of the snack well phenomenon cookie was made low fat the fat was removed and sugar was added yogurt is made low fat, the fats removed and sugar is added. So it was replacing replacing fat in our food with what people thought was healthy was sugar. But, you know, that evidence has come forward that that, you know, many people some people knew that sugar was was a problem, you know, people Harvard Department of Nutrition were caught receiving funds from the sugar lobby that were not reported that then they they wrote articles that you know, held up this This flawed fat hypothesis. Even till even till today, we are still seeing effects of that. Gerald Raven, great scientist from Stanford, who who developed the understanding of syndrome X or metabolic syndrome, the idea that, you know that hypertension is linked to obesity is linked to dyslipidemia, and it's linked to insulin resistance. He recognized that at the end of the 20th century, the only problem was, he realized that what made metabolic syndrome, what drove metabolic syndrome was not fat in the diet, but it was actually just the opposite. It was sugar in the diet. And and so his research didn't get the attention it needed because it went against the the mainstream belief that fat is bad, you know, we're slowly unraveling that today. We know that, you know, even even the most conservative medical institutions now admit that dietary cholesterol has no effect on no significant effect on body cholesterol. So we can meet eat as many eggs as we want. In fact, I consider a hard boiled egg, one of the healthiest things we can eat, you know, it's like nature's ozempic. But so the point is that there was there was this narrative of fat being evil that that influenced the food pyramid as well as all the junk food manufacturers as well, I think.
Nick Jikomes 1:01:36
So in terms of saturated fat and cholesterol, you said dietary cholesterol doesn't really affect blood cholesterol levels. I think, you know, you're certainly not the first person to say that. A lot of people have noticed that firsthand. I eat a lot of eggs. I have a lot of dietary cholesterol, and my cholesterol levels are not high. What is your general view on saturated versus polyunsaturated fats? And what should people be thinking about there?
Robert Lufkin 1:02:02
Yeah. I mean, there's a whole whole discussion of to your question that that dietary cholesterol doesn't affect serum cholesterol. The whole question, then is does serum cholesterol matter? How important is that in our disease? But we can we can come back to that. But what was your other question about just saturated
Nick Jikomes 1:02:27
versus power? So So sort of one of the dominant narratives out there certainly among a lot of mainstream institutions is still that you should limit saturated fat intake, because saturated fat as as you can probably tell us is linked to serum levels of cholesterol. And so that's one piece of what we can talk about, but you should replace saturated fat fats with polyunsaturated fats often described as heart healthy plant based fats. Yeah.
Robert Lufkin 1:02:55
In addition to avoiding of three pillars of my diet, the first one is avoiding carbohydrates and starches, starches and sugars, and carbohydrates. The second pillar is avoiding something called seed oils, which are industrial oils, which are ultra processed oils high in Omega six that have a high, high inflammatory nature and in my opinion, can drive insulin resistance. Kate Shanahan has written a great deal about that and has a new book coming out on the on the subject. So when I was growing up, we, my mom is a dietitian, when we want to pop popcorn, instead of popping in butter, we would pop it either in margarine, or later on, we would use vegetable oil, canola oil. And, again, this, in my opinion is unhealthy. But if I go to the American Heart Association, now another, you know, a list first here, Medical Association associated with a particular disease, the American Heart Association, on their website recommends canola as a heart healthy oil. And again, you have to wonder, why, why that would be and of course, the, you look at the history of, of seed oils, they were these these industrial oils, they're, they're really not made from vegetables, which are called vegetable oils. But the industrial oils were developed famously and in the beginning of the 20th century by German scientists, naturally, they were trying to come up with a better lubricant for U boats, for their submarines. And they came up with something that was Crisco basically, it was a warm thing that people could eat. And they said, Well, why don't we feed it to people so they sold it to Procter and Gamble, Procter and Gamble granted at a Crisco, and Procter and Gamble also gave a very large grant to a fledgling Art Society, which was the American Heart Association. Kind of got them started in there. So it's it's complicated. Vegetable oils will will lower serum cholesterol in some patients. So there, you know, you could make that argument. But personally, I believe that the, the harm from inflammation and insulin resistance is much greater in the seed oils than any possible benefit. And I think that, you know, serum cholesterol, while it, you know, plays a factor in heart attacks, it's not the biggest factor and it's not the factor that we should pay be paying the most attention to. I mean, most people when they show up in emergency room, have normal serum cholesterol will show up in emergency room with a heart attack, abnormal serum cholesterol. So metabolic factors like insulin resistance markers of that a one C, inflammation, triglycerides, HDL, these reflect metabolic health. And these are have a much greater hazard ratio, which is a predictive factor for, for heart disease and, and health. And I think I think we need to pay more attention to that, you know, the take home message should be, you know, you're more likely to die from a heart attack, if you eat, you know, a lot of sugar than if you eat a lot of saturated fat. And I don't think that message is, is getting out there.
Nick Jikomes 1:06:38
In terms of total serum cholesterol levels. One, you know, if you look at, say the the relationship between total cholesterol, and all cause mortality, there's a nonlinear relationship there. At least from the data I've seen, your risk of all cause mortality can go up, if your cholesterol levels get too high, it can also go up if they get too low. So what do we know about cholesterol levels and how we think about too high too low? And where that Goldilocks zone is?
Robert Lufkin 1:07:13
Yeah, it's, it's, it's fascinating, I think, cholesterol, like, like, just almost every other metabolic marker in our body, everything else we do, there's a sweet spot, you know, and, you know, too much of it is is, is bad and has harmful effects, and too little of it is bad and has harmful effects. I, I don't think that the lower the better. And cholesterol is some people advocate is, is good. And, and as you mentioned, there are some studies, there's some very large studies now one that just came out with 60. It's a meta analysis of 60 trials of statins, which, as you know, is a drug that lowers cholesterol, and serum cholesterol. And what they what they showed was that people who took statins, in, in many of the populations, their chance of dying of a heart attack decreased. And it actually, you know, it was not a huge amount it was, it was about you know, 1% or so, which is consistent across the sentence, but hey, you know, the number one heart and number one killer for you and me, and the thing that will determine the longevity of us and most of our audience will be heart disease. So I'll take a 1% bonus anyway, just for taking a pill. The problem with statins. And the problem with with this approach is that well, first of all, Statins have a lot of side effects, and they, you know, can can have muscles side effects, brain fog, memory issues, many, many other side effects, but even more ominously, as you as you mentioned, is when we look at all cause mortality, specifically in these very, very large studies and interesting thing happens, people who take statins 1% or less had you know, lower all cause mortality from heart attacks, but they actually had increased mortality from other diseases, which meant in the, in the aggregate, there was no difference. In other words, they're all cause mortality didn't change. And then you go, well, that's weird. A tie of you know, and so when you look at the data, they go, Well, suicides you know, automobile accidents, other things. So you go, Well, how could statins cause that well, our brain is made up of cholesterol and when we have too little cholesterol, which is happening with statins for some patients, and maybe for all patients, there are effects on the brain that can that can affect the The way we think and the way we behave, and there were other there were other causes of death to that change. But the whole thing was statins is, is really is really problematic. You know, it was a great drug for many years, when people, when we built believed that cholesterol was the cause of heart disease, great, here's a drug to lower the cholesterol. Now we're understanding it's more nuanced that, you know, and maybe they're not such a, maybe they're not such a great drug. Some people are even saying that, you know, the benefit of statins isn't really the effect on LDL cholesterol. And there's been evidence to show that to that the amount you lower the LDL cholesterol doesn't affect your chance of the heart attack, you know, the people who have better heart attacks aren't necessarily the ones who lower their cholesterol the most. So some people are saying, well, what's the effect? Then they're saying, well, it's anti inflammatory, you know, possibly. So there's just so much we don't know on this, but but our, our knowledge is evolving rapidly, which is, which is exciting.
Nick Jikomes 1:11:03
So you know, a lot of the things that we've talked about, or that we could talk about that are that are related or show similar themes, or, you know, if you just look at the history of western medicine, there's a lot a recurring pattern is we develop something like a drug that that makes a particular marker interested in, go up or down? We think we know enough about the surrounding biology, that we should use that as a tool to make our marker go in the direction we want. And yet, you know, later on, at least, we realize, okay, there's a lot more to the biology than we realized at the time. So when, when do when do we know, when we know enough to use these types of innovative interventions? So for example, you know, let's just, I'm just gonna pick one example. But I could pick pretty much any drug here. We, you know, we just developed these drugs, fairly recently, they become popular very recently, for weight loss called GLP. One agonists, like ozempic. How do we like if we, if we step back, and we look at ozempic? And how the drug works and what we know about the surrounding biology? What can we point to that tells us whether or not we understand enough of the biology to mass produce a mass distribute this?
Robert Lufkin 1:12:21
That is the question is that? Let me again, say that, I don't believe there. There are situations in medicine, you know, aside from a blood transfusion, or, you know, a fracture there, I think there are diseases where a single drug can be life saving and can make a difference like type one diabetes, it's very hard to control type one diabetes, purely on dietary basis. So insulin for type one diabetics is life saving.
Nick Jikomes 1:12:51
I mean, I guess they have absolutely no ability to make insulin right. But yeah,
Robert Lufkin 1:12:56
I mean, it's a spectrum. Different people have different amounts. But But yeah, in full blown case, there may be no insulin at all. And if somebody has no insulin, they will, they will die because of blood sugar issues. And but an even more dramatic example, in the news recently was a disease that has a single genetic mutation called sickle cell anemia are largely a single, defective hemoglobin molecule. And we know it very clearly people who have this, this hemoglobin molecule defect, the red blood cells crinkle in their bloodstream, and then they get clot, they clot in their joints, they cause pain, they can cause strokes. It's, it's a terrible disease, sickle cell anemia. And and you might wonder why, why does this gene even exist in the population? You know, there's a disease gene for, for signaling the hemoglobin which carries the oxygen on our blood and causes pain and strokes and people die with it. Why doesn't the gene just die off and go away? Well, it's always interesting to ask that question for sickle cell anemia? Of course, the answer is, it provided a survival advantage for patients exposed to malaria, which, you know, used to be endemic in certain tropical zones. And when the people with sickle cell disease didn't get the malaria because the bloods with sickle and it would, they would have a much better survival. So there was that advantage. And you could ask the same thing about a bowie for, you know, as the mute mutation for Alzheimer's and heart disease, or you can ask it about, you know, other factors in there. They're fascinating stories with each one of those but but anyway, the, the, these these effects can can can be dramatic with sickle cell disease, but recently there was a As with CRISPR therapy and gene therapy, there was recently a new gene therapy product, that's if you want to call it a drug, it's a drug, but you give it once to patients with sickle cell anemia. And it basically changes their changes their DNA, so that this this is replaced in their genome so that they no longer have sickle cell anemia for their life. So it's, it's sort of it's, it's kind of a problem for the drug companies, because it's a drug that you only give once you only give one dose. And so they had to come up with the pricing to make sense. So now they charge $2 million, a dose. But, but for someone with sickle cell anemia, it's life saving. So I guess, long story, the point is, there are some medicines that actually work for, you know, certain diseases like that, that that are life saving
Nick Jikomes 1:15:56
for diseases that are more chronic, and they don't have, you know, a single gene cause or something that pin pointable. You know, we probably, I think what you would probably agree to is that, you know, we should really think more on the prevention side, and helping people live a life that's conducive to never even developing some of these things to begin with. So for something like just like metabolic syndrome, and all of the all of the things that that would cluster with that obesity, diabetes, and so forth, if you want to avoid that chronic illness in your life, what are the major things you should think about with respect to diet in particular?
Robert Lufkin 1:16:36
Yeah, great question. And let me let me reframe it a little bit, too, because my viewpoint on this changed a little bit. Because prevention is sometimes it's a tough sell for people. It's like, hey, you know, I'm going to prevent something. I'm getting it in 20 years, like, I'm busy with other stuff, you know, I got more important things right now, on the table. Well, now, I don't look at it as prevention so much, it goes back to what we were talking about earlier. In other words, the type two diabetes, the insulin resistance, maybe it's an on off switch in my doctor's office. In other words, she will tell me, you know, one day I walk in, you're now type two diabetic, and the day before, she'll say you're not based on that, that switch. But in reality, we know that type two diabetes were on a path years to even decades before the doctor diagnosis said, and what I've come to realize is that for most of these other chronic diseases, we're also on that path for Alzheimer's disease. You know, before I get to the point where I can't recognize my kids anymore, or even before I forget my keys, I'm probably on that path for years, two decades before, and there are things you can do with PET scan, you know, glucose, PET scans, or with MRIs of the hippocampus, there are markers that you can see that show that you're on that path. But it's the same thing with cardiovascular disease, you know, it doesn't happen the day you get a heart attack, although for half of people, that's the first symptom is sudden death, which is not a good way to diagnose it, but but the point is that we're really on the path for all these diseases. And in other words, if you want to live a long life lifespan, you need to pay attention to your health span. And that means looking at these diseases, as you want to call it prevention that some or just preparing for them and lowering your risk of cancer the same way, you know, you know, mental health issues, hypertension, obesity, obesity, obviously, something we can measure with a scale. So you know, we can we can track it, but it doesn't occur overnight. It's a it's a graded thing. And, you know, when do you call a person fat when you call them overweight? You know, obese versus overweight? Well, there are certain criterias. But the point is, let's not wait until we go into the doctor's office. He or she tells us we have the disease because by then we're all that is disadvantage. It's not too late. But it's it's late. So do it while it's early
Nick Jikomes 1:19:24
with respect to metabolic health and longevity? Isn't the simplest way to think about this, just not to overeat just to not eat too many calories. Should people be focused on the total number of calories they eat? Or do you think about it in a different way? Yeah,
Robert Lufkin 1:19:41
well, first of all, metabolic health is at the root cause, in my opinion of not only all those chronic diseases, but our longevity is also to the point that there are certain drugs that turn positive metabolic switches that actually dramatically increase The lifespan of model organisms like mice, and humans are taking these off label for the same, the same idea. So metabolism is super, is a super powerful switch. But yeah, our our diet is is the number one switch, we get to control, control our metabolism and even if you don't want to change what you eat there's something we can all do. And that's like you say is changed when you eat, just stop eating all the time, there's a metabolic advantage of not eating. You know, I would my mom told me to eat three meals a day with snacks in between and then you know, a couple snacks at night to you know, many small meals throughout the day. That was the teaching at one point. Now, you know, I one meal a day better.
Nick Jikomes 1:20:52
What do you eat dinner?
Robert Lufkin 1:20:55
Yeah, when my kids come home from the school, you know, than I we all eat?
Nick Jikomes 1:21:01
Why do you eat just one a day. Um,
Robert Lufkin 1:21:03
you know, everybody, first of all, everybody's different, you know, everybody looks in I, I've never felt better. I know, by eating one meal a day, I'm going to be in ketosis for most of the day, just by just by the fact that my glucose stores get consumed after about 12 hours that glycogen and everything so then I switched to ketosis, then if I if I add sort of a more of a metabolically healthy, which is more towards a ketogenic diet, then I'll be in ketosis even longer, and I believe that's healthy. So but if you don't want to, you don't want to do that. Just eat fewer times a day, just cut cut snacks after, after dinner that, you know, my, what I did my hack was I just I, since I finished dinner, I brush my teeth right away. Because again, I'm basically lazy, I knew that if I ate again, I'd have to brush my teeth again. So it's kept me from meeting and then I, you know, cut out between meals, snacks, and that that helped too. And there's one other one other trick you can do, in addition to eating, eat stopping snacking between meals or fewer meals, and that is food order. And that is if you remember the three macronutrients, right? Our foods are combinations of those three things. And the potentially the harmful one as far as insulin resistance and inflammation is glucose, and carbohydrate. So we want to protect our body from those and what we can do to protect them and slow the absorption of those things is I never eat carbohydrates, refined carbohydrates, sugar, starch, just never eat that as the first food of a meal. But if you can preload yourself with with cheese or with, you know, with fats or oils, is that
Nick Jikomes 1:22:53
because it will, it will, it will spike your blood glucose and insulin less if it comes after those things.
Robert Lufkin 1:22:58
Yeah, because you've already got stuff in your stomach. And if and if you don't believe me, there's a there's a diabetes drug called a car boasts. I know if you've talked about it with your with your audience. But it's a fascinating drug. It's there's a sort of the ultimate longevity study is one bounded by our federal government that they use mice for mice are great because they only live three years is called the interventions testing program. And they just take mice and they divide them into two groups. They give half the mice a drug. And then the other half, they just let them live their normal lives. And then at the end of their lives, they see if there's any difference in lifespan. And it's a very simple way to track if drugs can improve lifespan. And because it's run by the federal government, it's open to all of us so we can all write in suggestions. And so in the 20 years that it's been running, they've tested green tea abstract, green tea essence they've done nicotine amide and, you know, NAD supplements, they've done statins, they've done co q 10. They've done curcumin, you know, anything you can think of they've tested, but most of them didn't work and didn't have any effect at all. Which means if they fail the ITP it doesn't mean they don't work at all because Metformin had no effect but there's strong evidence that Metformin is the longevity drug, but if if they fail the ITP it just means they failed at that particular dose. But there are there are a couple of drugs that have dramatic one, of course, the biggest one is rapamycin, and it knocks it out of the park more than any other drug on longevity. And rapamycin specifically turns biological switch called mTOR into a favorable metabolic state mimicking fasting and is if your insulin was really low and turning down inflammation, but when they combined with rapamycin which they know works with another smaller, another drug, a diabetic drug called a Carbo, say carbost diabetics take and you take it with a meal and a blocks the absorption of glucose into your body. And when you take our a car boasts, it lowers your glucose spikes. But anyway, when you combine a carbost with rapamycin, you get a much more dramatic lifespan, longevity enhancement in this in this particular animal model. So now, humans are taking a carbost off label with rapamycin for as longevity effects.
Nick Jikomes 1:25:35
How long have you been on the dietary pattern you're on today? And can you say a little bit more about your your evolution there? You mentioned previously that you've tried vegan, you've tried carnivore? What was that whole journey like for you? And how did you really narrow in on where you're at today?
Robert Lufkin 1:25:53
Well, I narrowed in on where I was at today, because I talked about this in the book, I had sort of a an awakening, it was forced on me, my you know, everything was going fine. Everything was great. But like, many people in this space I came down with for chronic diseases that were unexpected. And I went to my doctor's and they said basically, they're unrelated, but here's a pill for each one of them. And, you know, you can try lifestyle, but, you know, get deal with it, you're probably you're gonna have to take this pill for the rest of your life. And I knew enough about medicine that this wasn't going to end well. You know, my kids were still in elementary school. And, you know, I didn't want to be bad guy. So I began researching it and everything and and one of the things I began understanding was there's all this research that was done that's very compelling, uncontrolled research about effects on metabolism, and how these four diseases I had, and many other chronic diseases, the drugs control the symptoms, but they didn't really address the underlying cause. And the underlying cause is really best to address with lifestyle. And so I, I dramatically changed my lifestyle. And my diet was one of the things I did at that point. And I made those changes in snacking and food order and everything to do that, what
Nick Jikomes 1:27:22
was the composition of your diet, like before he made that switch? Before
Robert Lufkin 1:27:26
that, I was kind of like, like everybody else have a sort of low fat healthy food, you know, I, for me, I was eating grains, which I don't eat anymore, I was eating a lot of seed oils, which I don't eat anymore. And I was eating, you know, a fair amount of carbs because I was avoiding the fats and a low fat diet. You know, most of the diets, if you think about the three macronutrients proteins is pretty much fixed. So it's a zero sum game, you know, you either not that all calories are equal, I'm not claiming that but zero sum in the same that you want to consume a certain number of calories. So if you increase the fat, you lower the carbs, you lower the fat, you increase the carbs. So a high fat diet is low carb diet and vice versa.
Nick Jikomes 1:28:13
Do you think grains should be minimized or avoided by most people? Or can some people do very well on them? I guess a related question to that would be like, Why are you why are you specifically avoiding grains? What is it about grains? Yeah, great question.
Robert Lufkin 1:28:30
grains. Grains have a couple problems with them. One, they have a protein called gluten in them that some people have issues with. It's called celiac disease. And it can can make them very sick and very, very sick. And so they avoid avoid that. And they avoid gluten altogether. There's growing evidence among experts that gluten as well as other proteins in these grains can have a low grade inflammatory effect with other people who maybe they don't have celiac disease, but they have low grade inflammation related to the grains and they may not be aware of it, why not? Well, low grade inflammation can result it can manifest as migraine headaches or irritable bowel disease or joint pain or almost any of the chronic diseases we mentioned. So driving this inflammation and inflammation like H A one C is one of the things that increases with age. So you know, the older you get, the more the inflammation, et cetera, et cetera. So the fact these proteins are there, and they have the potential to drive inflammation, I think they do. I, I avoid grains, including whole grains for that, but it's not only it's not only the proteins in the US, at least Many, if not most grains are bathed in glyphosate, which is a weed killer. That's, you know, outlawed in 30 countries around the world for health reasons, but not here. And then finally, grains. Typically, they have a lot of carbohydrates and starches, just by their nature. So I kind of exclude him for that way. But I, I've waited for that reason. It's interesting, though, with grains, because a lot of people, you know, wisely. So we'll say, Okay, I'm going to try this diet, and I'm gonna see how I feel, right? So of the three, the three dietary choices that I make, they have a very different timescale. So in other words, if I, if I cut out sugar and carbs, I'll feel the effect in a couple of days. So if you ask me, Is it working? Yeah, I feel better, you know, no, brain fog got it. For grains, on the other hand, because it's related to the immune system and possible inflammation proteins, experts are saying you should wait almost 90 days, so three months is that
Nick Jikomes 1:31:04
just because the inflammation and the activity of your immune system that's driving that and getting rid of it eventually, it just takes days or weeks for that to ramp up and ramp the ramp down?
Robert Lufkin 1:31:13
Yeah, presume? Presumably, yeah, it's just a much brighter window. And then, and then the worst one, of course, is seed oils, which are stored in your body fat, so that can be a year or more, much longer time timeframe. So you may not the point is you may not see immediate, subjective results with giving up grains or giving up of seed oils. But if you're having diseases or conditions that, you know, you don't know what else it is, it's one thing you can do. You can give up dairy, you know, seed oils, grains, etc.
Nick Jikomes 1:31:51
Okay, so it sounds like you, you restrict you have you have a certain pattern of eating one big meal a day, through doing some form of time restricted feeding, you're also eating a relatively high fat, low carb diet, if I'm hearing you right. On the fat side, what types of fats are you seeking out? And what types of fats are you avoiding? I know that you've already mentioned some of this, but I think it's worth reiterating. Yeah.
Robert Lufkin 1:32:15
It's fats are fats, the whole idea of what to consume with fats is is really is really confusing. For for the fats high void, or the high omega six seed oil. So I've mentioned you know, canola oil, vegetable oil in there's a list of eight, I think bitter ones, particularly you've avoided. And then what do you substitute that with, I mean, some things you need to cook, you need higher temperature. So the good oils that I would substitute would be olive oil, avocado, oil, coconut oil, those kinds of things in there. And then also, fat in meat, if you eat meat, you know, fatty meat is okay. And I get saturated fat from those as well.
Nick Jikomes 1:33:09
Is there a difference? So we're on the subject of fatty meat? How much? What kind of meat? Are you eating? Is there any type of meat you're avoiding? So for example, if you're eating red meat, are you paying attention to if it's grass fed versus corn fed or grain fed? Things like that? Yeah,
Robert Lufkin 1:33:25
it just, you go down to down the rabbit. Hole, but But it's important, you know, the Devala to follow these these things? Because, I mean, well, first of all, am I eating red meat? I mean, everybody know, red meat is associated with cancer, people who eat red meat have more cancer, right? So why would they eat red meat? Well, it's because people who had red meat are more likely to have cancer doesn't mean that the red meat causes them to have cancer. It's, it's causality versus correlation. So it's just like, people who drive pickup trucks are more likely to have cancer than people who drive Priuses. And it's not from the automobile that they drive, it's that other factors in their lifestyle, people who drive Priuses are more or less likely to smoke cigarettes and, you know, to other things that you know, or be obese even maybe, perhaps, so, we have to be very careful about, about linking causality to correlation and, and the challenge of course, with diets they're they're very few good human causal studies with diets because they're just you can't you know, it's almost impossible logistically to run them. So most diet information that humans have to base their knowledge on are epidemiological studies, which are correlations, which you know, are notoriously unreliable, so, so, do I eat red meat? Yeah, I do. I do now, meat. Meat has a lot of nutrients. It's a source of many different things. When I was a vegan, I would have to pay really close attention to make sure I was getting those other ways. With me, you could practically just eat meat, you don't need to eat anything else and you'll be, you'll be perfectly healthy. So true. I do eat red meat. As far as the question you raise is really important. It's not just important for meat eaters, but also vegetable leaders. In other words, it's not enough just the end point, but it's how they got there. In other words, meat today is fed, they don't eat grass, they corn and corn is corn is low cost because it's subsidized. That's why high fructose corn syrup is so cheap, but they're fed corn and corn is high in Omega sixes, you know, the same stuff that's in vegetable oil. And you know, these these other things. So the quality of meat, if it's corn fed meat is going to be different than grass fed meat. And so there's a whole nother level of meat, you can look for grass fed meat versus regular meat, and I would prefer that and then they have grass finished, which is they give them a little bit at the end, I think and that's good, too. So I would prefer to have grass finished and grass fed, rather than just plain one. So I do pay attention to that.
Nick Jikomes 1:36:33
I think you would probably agree that a very good way to keep track of your health. And to keep yourself honest and to evaluate, evaluate your progress. If you're you know, changing your lifestyle, changing your diet and so forth, is to get blood work done on some kind of schedule, whether that's, you know, once a year, twice a year, several times a year. There's a lot of at home blood tests now that people can use where you prick your finger, you send in a sample, that way, you don't have to go into the doctor every time you can do it from the convenience of your own home, you can do it on your own schedule. How do you feel about these at home blood testing products? How well do they work? And do you have any general guidelines for people in terms of how often? And let's just assume we're talking about middle aged people, at least? How often they should be getting that bloodwork done? Is it once a year enough? Should they be going every three months? How often do you do it? Yeah,
Robert Lufkin 1:37:26
the the Well, first of all, there's a revolution in the technology with these things. You know, Elizabeth Holmes was just a little too soon. And now companies are doing you know what different she was talking about with the Theranos things but it's become a reality. And this is going to revolutionize the way things are done. I mean, I I use a company called sai Fox out of Boston si p h o x and it's things like $300 or something but they do 16 Blood markers from a single at home blood tests. So they do you know cortisol, testosterone, ha once he fasting insulin, LDL, HDL triglycerides, you know, it's, it's really a great panel, I actually, I have it on my website, I bought a couple of 100 of them. So it's it's lower price, but check, check it against psi Fox, see what you see. But that's one thing to do. So I think how often to do it really depends on the person, you know, are you curious? Are you you know, a bio hacker mentality. First of all, if something's abnormal, then definitely you need to follow it up with your physician or, you know, stay in the loop. If something's going south, then you need to frequently check it out. If if everything's if everything's okay, and you're in a good range, then you may just want to do it once a year or something or, you know, I do it once a month or once every two months, because I'm constantly doing interventions on myself, you know, I'm doing like, different supplements. I'm doing like red light therapy. All kinds of Asana, you know, trying hyperbaric oxygen, and unfortunately, I'm doing too many things at once. So there's, it's impossible to tell if there's any effect, but I, I want to just make sure I'm not going off the rails too much. I'm not harming myself too much with any of them. But anyway, the the at home testing, I think is great there. That's just one company I happen to know. But there are many others out there and the company's you know, assuming they they're from a credible lab and they're, you know, they're tested, I think the data is reliable. For the one I use. What I do is, when I go in and get blood work drawn from a vein, I drop another vial and I run it on the at home testing kit. So I've checked the numbers against the actual blood vial ones that done it quest or LabCorp and they're they're reproducible. You know,
Nick Jikomes 1:39:55
I've actually done that too. Okay, yeah. Okay, great. Um, how should someone choose a physician? Because, you know, one of the one of the things that we talked about, or that's implicit in a lot of what we're saying is, you know, if you take the average physician out there, the average mainstream doctor who's going to be following the mainstream guidelines, the mainstream institutions, all of the stuff that can be very wrong for decades and decades at a time, how do I know? If I'm an average person? If I'm average? Joe? How do I know if my physician is the right physician for me if they are just parroting what the big organizations are saying? If I should be trusting them? How do you shop for a physician? Yeah,
Robert Lufkin 1:40:39
I think that's, that's a really important question. Because it it's key, I mean, you can have a conversation with a physician, you can tell them, you know, certain things that you you believe in all, but it's really, it's a challenge. And I think, fortunately, I think we're undergoing, you know, a paradigm shift in the way we as individuals take control of our health, it used to be that you go to the physician, they give you whatever you do it and day, with lifestyle, the physician can't fix your lifestyle, you know, the physician, and the physician can't make you healthy physician can make you less sick. And the idea that we have control of our lifestyle that we have agency is a very powerful one. And I think that more and more people are embracing that. In other words, you know, I went to medical school, I spent, you know, decades studying stuff, but you know more about your own personal life experiences, and, you know, the trauma, you've had the fractures, everything you've had, than I know, I may know about more diseases, perhaps in certain areas, but you, you're the CEO of your own health, I'm a consultant to you. And I think it's, it's an exciting time, because now as a patient, I now have agency every morning when I get up, I decide what I'm going to eat, when I'm going to eat, what my lifestyle is going to look like. And, you know, we can do the at home blood tests. And then my doctor, the doctor has limited time, you know, they have seven minutes to talk to me, you know, what are they going to do in seven minutes? You know? You know, it's, I think that your question is a good one. And I think it's, it's challenging, we need to find more and more people, we're setting up a new evolve with a new residency program, graduate medical education program for doctors out here in California and in radiology and family medicine, psychiatry, where we're hopefully going to be training the next generation of doctors with with some of these new attitudes that metabolic health does matter. It does play a foundational role in these things.
Nick Jikomes 1:42:58
We are close to time here. Do you want to give everyone just a summary of the new book, what it's about? And when it comes out? And all those things? Yeah.
Robert Lufkin 1:43:06
The new book, for lack of a better title I called it lies I taught in medical school. It's coming out on June Fourth. And it's currently available for preorder on Amazon and Barnes and Noble, your local library. If you'd like a free sample free chapter, you can go to my website and get it. It's so far we've gotten great response to it. It's been 16 weeks is the number one best seller on Amazon. It's number two longevity book. So it's gotten good. At least people seem to be interested on it. interested about it? Yeah. I
Nick Jikomes 1:43:43
mean, I read the first chapter. And and I think it seems like a great book. I like the way that you have it laid out as far as I can tell. And yeah, I mean, you're touching on a lot of important stuff, some of which we talked about today, but some of it we didn't get to. I will drop that link in the episode description for everyone. So if they want to preorder that or read the first chapter, I recommend that Dr. Lumpkin, anything that you want to reiterate from our conversation that you think maybe was unclear or any final thoughts you want to leave people with?
Robert Lufkin 1:44:15
Thanks, Nick. I think well, just read it reiterate what we just talked about that we're, I'm so excited that I believe we're entering a new era in medicine, there's so much information that's available to all of us and that we now get to take control of our own health care and with our, you know, with our health care professionals who support us, but we we have agency, we can drive things. We get to choose the lifestyle we do every day and when I wake up, I find that thought just very empowering.
Nick Jikomes 1:44:52
All right. Dr. Rob Lufkin, thank you very much for your time.
Robert Lufkin 1:44:56
Thanks so much, Nick. I appreciate you having me on the program and thanks for the work you're doing
Preventative Medicine, Diet & Lifestyle vs. Pharmaceuticals in Health & Disease, Lies Taught in Medical Schools | Robert Lufkin | #157