Live Longer World Podcast Episode #22 has been released!

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My guest today is Sam Apple. He is the author of Ravenous: Otto Warburg, The Nazis, and the Search for the Cancer-Diet Connection.

Otto Warburg was a Nobel-Prize winning German scientist during the era of Hitler and the Nazi’s and he was the first person to put the metabolic story of cancer on the map. The famous “Warburg Effect” that shows how cancer cells have an increase in glucose uptake even in the presence of oxygen, is named after him.

It was a fascinating conversation talking about how the story of cancer research has evolved - how cancer cells eat to the discovery of oncogenes to coming full circle and making the connection between the two, and what the debate still holds in the story. We also talk about how cancer cells take up a lot of glucose, feed on sugar, and the connection between obesity and cancer. I hope you enjoy the conversation!

[If you are a premium subscriber, you can also read the transcript of the episode below]

Best, Aastha

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Time Stamps:

0:00 Cancer as a disease of modern societies

1:27 Otto Warburg & the Cancer-Metabolic Connection

2:27 Warburg’s research on respiration

4:02 Why was cancer skyrocketing in Western societies?

9:17 Warburg Effect: Warburg’s research on cancer cells

15:00 Why do cancer cells take up so much glucose?

17:44 Cancer-Diet Connection

21:44 Cancer, Ketogenic diets & Fasting

23:43 Hibernation of the metabolic story of cancer

27:20 Hitler’s connection with cancer

30:07 Warburg’s arrogance

31:51 Why does cancer need glucose?

38:46 Warburg’s stigma: connecting with Nazi’s

40:51 Is insulin responsible for cancer?

48:00 Science is not immune from politics

50:24 Prostate cancer & obesity

52:13 Pendulum swing in cancer research

54:40 Mitochondria & Cancer Connection

57:07 Nazi’s fixation on cancer

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Premium Subscriber Transcript:

Aastha: Your book Ravenous is fascinating on many levels, because it talks about the story of Otto Warburg, but it also talks about Nazi, Germany and science during that time and the beginnings of the cancer-diet connection, just the metabolic story of cancer. I'm curious before we dive into all of that, how did you get interested in studying Otto Warburg or writing about him?

Sam Apple: Sure. I was a nonfiction journalist, an author and writing about different themes and I became interested in nutrition really. I can't even say exactly how it started, but I was reading and getting older and growing more concerned about my own health. I wasn't in great shape in my early 30's, but I came across the works of Gary Taubes who has been a big influence on me and he wrote a lot of articles, challenging the conventional wisdom. What I saw right away is whether a lot of people disagree with Taubes. I think he gives most of the story right, but I saw right away that whether or not you agreed with Taubes, it was very clear that the science was not as clear as one had thought.

I grew up following nutrition advice to drink only pure milk and eat pasta all the time. The thought that everything I had been told was untrue, it was pretty shocking to me. I remained curious, continued to read, began to write a little bit, but I only decided to write about Otto Warburg because I was really fascinated to discover that cancer could be thought of as a metabolic disease as well.

Obviously diabetes is metabolic and it made sense to me that heart disease was related to that and obesity. I learned cancer as a part of that story as well, I was truly shocked because I had always thought of it as a separate realm. You get an unlucky mutation and it's got nothing to do with what you eat or your metabolism. That really surprised me. As a journalist and a storyteller, I was thinking, is there a way to write about it? I came across the name, Otto Warburg, and looked him up and immediately saw that he had this incredible story of survival in Nazi Germany. My first book was about the Holocaust to some extent, so it sort of combined all my interest into one story.

Aastha: That's fascinating. I think a lot of people aren't aware of the metabolic story of cancer. It'd be cool to just start from the beginning. Warburg’s childhood in Germany, he obviously grew up around a lot of prominent scientists like Einstein, his dad himself, Emil Warburg was a very prominent physicist. What do you think? Do we know much about Warburg's childhood because I don't think you touched on it as much in the book about just how he was as a child growing up. Was he super, was he doing scientific experiments all the time as well? What was his education like?

Sam: That's a good question. You’re one of the few people who's pointed out that I didn't say much about that. I was always frustrated that I couldn't find more about his early childhood. I know that he was at these German schools that were extremely strict and very advanced and he had to learn Latin and Greek and he had a very formal education and I did find one teacher's report that said he was sort of a troublemaker. It was clear that he was very smart, but I don't know that he was identified as an absolute genius, but clearly very smart in elementary school. As he got older, he began to distinguish himself, and by the time he was in his late teens, I think it was pretty clear that he was brilliant.

The fascinating thing about his childhood is as you already alluded to, he grew up with a father who was a distinguished physicist and a close friend of Einstein and Fritz Haber and Max Planck, some of the greatest scientists who have ever lived would be in and out of his house and were really changing the world, changing our conception of the universe. He grew up really thinking of himself as part of that community and thinking about what incredible breakthrough he would make when he was old enough.

Aastha: It sounds like he grew up just loving science and obsessed with science and perhaps that was also because maybe he wanted to compete with his father. You speak about how he was in competition with his dad and he didn't really have the best relationship with him. What was their relationship like?

Sam: It was definitely competitive. It was loving and respectful. I don't think he hated his father, but he felt competitive and wanted to emulate him and ultimately surpass him. His nature was a bit of an egomaniac and narcissist and he couldn't stand anybody, including his own father, I think to be more famous than he was. His father taught him to be a great scientist. There really was respect, and one line that I loved is that one of his father's messages that the true measure of a man is the accuracy of his measurements, and that's the way like only a German scientist could put. The science that Warburg explored was in a different realm in biology, but he was always thinking through the lens of a physicist. That influence stayed with him throughout his life, and ultimately his discoveries were related to energy in the biological sense.

Aastha: Let's talk about that then. What was Warburg's initial research, because he started with, as you said, biology and perhaps studying respiration before he started studying more on the cancer side of things?

Sam: His initial research was in the realm of respiration and remained a mystery how cells breed. The example that I give in the book is we understand, of course, if you set a piece of bread on the counter, it's not going to burn, and yet somehow when we swallow it, it does burn in our bodies and yet we don't fortunately have the heat of a flame in there. There has to be some processing. Now we know how enzymes speed up reactions and make all this possible, but none of that was understood at the time. It was really mysterious. Warburg was working on that problem and studying sea urchin eggs, single cells from sea urchins that would grow and multiply. He was curious how they get the energy to grow.

One of his first famous studies, he just measured how much oxygen those sea urchin eggs were taking up as they grew and divided. He saw that the oxygen was increasing. He began to see the relationship between increased oxygen consumption and growth and that played heavily into his thinking when he turned his attention to cancer cells, which was a very similar question, what do they need to grow? What are their energy needs? It looks like even when he was studying sea urchin eggs, he already had cancer in the back of his mind. He understood that this was sort of a first step.

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