Preventative Medicine, Diet & Lifestyle vs. Pharmaceuticals in Health & Disease, Lies Taught in Medical Schools | Robert Lufkin | #157

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.

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* 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 pyr