Stay Off My Operating Table

Dr. Robert Lufkin Challenges Medical Dogma About Metabolic Health and Longevity #154

• Dr. Philip Ovadia • Episode 154

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When Dr. Robert Lufkin confronted his own health concerns, he uncovered truths that shook the foundations of his medical beliefs. Join us as he shares his transformative journey from traditional physician to a revolutionary thinker in the realm of metabolic health and longevity. Our conversation with Dr. Lufkin dives into the heart of his upcoming book, "Lies I Taught in Medical School," where he unveils the limitations and misconceptions of established medical practices, urging us to question what we've been taught for the sake of better health outcomes.

In a fascinating exploration of metabolic health, we discuss how it's intricately linked to both common diseases and the aging process at a cellular level. We discuss the government's Interventions Testing Program, groundbreaking research on potential life-extending substances like rapamycin and acarbose in mice, and the exciting implications for human health. 

Dr. Lufkin also addresses critiques of longevity research models and the synergy of lifestyle tweaks and pharmacological interventions that could revolutionize our approach to living longer, healthier lives.

We wrap up with a provocative look at how our perspectives on health and medical practices are shifting. We dissect the impact of modern dietary patterns on our well-being, scrutinize the stark contrast between historical diets and the rise of processed foods. Our dialogue underscores the importance of personal responsibility in managing health and the need for a dynamic, self-improving medical system.

Key topics covered: 
00:02:00 - Dr. Lufkin's background and personal health journey 
00:15:00 - The concept of metabolic health and its importance 
00:27:00 - Longevity research and the role of rapamycin 
00:35:00 - Challenging conventional medical education 
00:42:00 - The relationship between metabolism and longevity

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Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Any use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

Speaker 1:

welcome. It's the stay off my operating table podcast with dr philip ovadia. We are joined today by dr robert lufkin. Um phil, how'd you meet this guy?

Speaker 2:

and then let's get this thing started yeah, definitely so, uh, trying to remember exactly how we met uh. But I've certainly known Rob now for a number of years and been fortunate to meet up with him a bunch and even share some steak with him, and I've really been impressed with what he's doing. Rob's background in a lot of ways mirrors mine. Rob is a radiologist and was a professor, has been a professor at a number of pretty high ranking medical schools, we'll say, and some prestigious institutions, but has come to realize, maybe that everything he learned and was teaching might not be exactly correct. So Rob has an upcoming book that I'm very excited for, called Lies I Taught in Medical School and really excited to kind of jump into the conversation Before we get to the book, rob, maybe you can give everyone a little bit more of your background and how, maybe what started to enlighten you and open your eyes up to some of these lies that you had been teaching.

Speaker 3:

Oh, thanks Phil and thanks Jack. Let me just say from the beginning, phil was my inspiration with this book. When he wrote this, I got inspired to write my book and it's a great book. I highly recommend it. It tells his journey and actually he introduced me to a writer who helped him write his book, joshua Lissick, who helped me write my book, and he really made my book what it is. So kudos to him and thanks to Phil for making all that happen. But it's a pleasure to be on the program today.

Speaker 3:

I guess my background is I'm not. First of all, I'm not a medical conspiracy theorist or anything. Oh, I am. As Phil mentioned, I spent my whole career basically doing medical school stuff.

Speaker 3:

I was, like, I say, a professor in a medical school where I still am and what that meant was I got to teach medicine. My specialty is and was radiology, although now I'm focused on metabolic health and longevity, out of self-interest largely. But as a professor I got to not only practice medicine, but also I got to teach residents and learn from residents and students in training. But I also did all the things that conventional medical academicians did. So I wrote like 200 peer reviewed papers, many textbooks and I had my laboratory received millions of dollars in funding from the federal government, from drug companies, from medical equipment manufacturers, so I was, basically I was and am the medical establishment.

Speaker 3:

But I had a everything was going well until recently. A few years ago I had a wake up call, kind of like Phil had a similar thing, or our other friends in this space are sometimes called to question their own beliefs when things happen to themselves that made them really examine things. So for me, I was diagnosed with four conditions that I went to my doctors for and I was prescribed medicines. I was told I'd be on them for life and the medicines would take care of the diseases and don't worry about it and go on. And that was kind of the wake-up call for me.

Speaker 1:

Can you share what those were?

Speaker 3:

Sure, yeah, they were. First of all it was arthritis, a type of arthritis called gout, and then hypertension, which you know almost half of adults have today. It's very common adults have today, it's very common. And then I had prediabetes, which is elevated blood sugar, blood glucose, and then I had dyslipidemia, sort of abnormal blood lipids, and for each of those I was prescribed something and for the most part the doc said you know, hey, your arthritis is really not linked to your hypertension, so don't worry about it, they're separate things, we treat them separately and all. And as I began to dive deeper into them I realized that it was a large body of work that was done. I read Phil's book and other books in the area and then went back to the basic research and there was a lot of stuff that was happening in our understanding of these chronic diseases, that that that changed thing that changed my thinking. And Well, wait a minute.

Speaker 1:

Why, why, why did you not just take the, the standard path? I mean, it's one thing for Joe Sixpack like me to say, ah God, that sounds crazy, I'm going to try something else, but you're a medical professor, why did you not? What caused you to question?

Speaker 3:

it? Well, that's a great question. I mean there are two opposing forces, one, I have to say. I want to go on record that I believe the Western healthcare system is the best in the world for many, many things. Look at infectious diseases and public health. In the 20th century, amazing, magical things were done. If I walk outside and I get hit by a bus, probably my lifestyle is going to be a lower priority and although it will help how I recover from that but my immediate survival will depend on getting a blood transfusion, getting my phones you know things fixed like that. So we're really good at trauma care.

Speaker 1:

That's one thing we're really good at.

Speaker 3:

Acute things and the only problem is that when we try and apply surgery and pills to these chronic diseases, like the ones I had and several other ones that statistically we're most likely to die of, it doesn't work. And we have pills and surgery and they control, in many cases just the symptoms, and yet the underlying disease continues to move on. So that was the fact. And the other factor that made me question it was I was, you know, I had two kids that were still in elementary school. I knew enough about medicine, I knew enough about those diseases that I realized that, you know, that wasn't going to end well. So, kind of out of self-preservation, out of self-interest, I began to question things and said you know, is there a better way?

Speaker 2:

So, a related question there. Rob, you know, as you said, you're kind of deep in the system, you know, and you're very much, you know, interacting with your colleagues, your teaching, your future colleagues, and so what do you think keeps physicians from asking these questions more? Why are we in such an environment where it's unusual for guys like you and guys like me to really question the mainstream narrative and we're looked at as kind of crazy or certainly unusual, I'll say maybe less judgmental way? We're in the very much minority in that we're questioning these things. So what do you see about the system that really keeps more doctors from questioning these things?

Speaker 3:

Well, first of all, again, I want to say that I believe in human nature. I believe that, for the most part, people who go into healthcare and people in general, don't wake up wanting to hurt someone or don't want to do something that's consciously going to harm someone. However, I think, all the way from our medical education to the scientific organizations we have, to the food pyramid, to the food pyramid, to the things that we're exposed to, there are conscious and unconscious, pernicious financial and other incentives that drive people to make the wrong choices, which I believe to this day, are still harming people with the advice that's being given by, you know, mainstream authorities in medical care.

Speaker 1:

Yeah.

Speaker 2:

Yeah, that's a pretty, I guess, bold statement. Let's dig into that some more. You know what do you think some of these incentives are that you've seen in practice? Certainly, I've seen in practice, but let's unpack that some for the audience.

Speaker 3:

Yeah, I mean if the looking at diabetes, the American Diabetic Association, which is the mainline A-list medical organization for diabetes and diabetes, recommendations that people all over the world go there for advice.

Speaker 3:

If you turn to their website, they recommend eating. They have recipes there that include food with sugar in them and they just recommend just covering it with insulin, which I believe is not healthy advice, because there are studies we talk about in the book and elsewhere where it's shown that even tightly controlling blood glucose with insulin doesn't affect many of the downstream consequences of diabetes. Diabetes, as you know, is the number one cause of surgical amputations, number one cause of renal transplants, dialysis, blindness, main driver for cardiovascular disease, main driver for cancer, Type 3 diabetes is Alzheimer's disease and mental health all these factors. So the American Diabetic Association is giving recommendations that actually don't benefit the patients and, in my opinion, a much better advice is to adopt a diet, avoid the one macronutrient that drives insulin significantly and that's carbohydrates, and thereby lowering the carbohydrate, lowering the insulin levels and reversing insulin resistance and hopefully winding back the need for exogenous insulin and even other drugs.

Speaker 1:

Let me ask you to comment on something you know. Phil and I've been doing this for what Gosh? We're coming up on three years. I think Phil and I've gotten such an education, but I've never heard anybody summarize everything that I've learned as well as Dr Casey Means did just here in the last week or so. I saw she posted this the stark economic reality. I'm quoting her now the stark economic reality is that nearly every institution that touches our health, from medical schools to insurance companies, to hospitals to pharma makes money on managing diseases, not curing patients. This is the highest level of why so many aspects of American society is set up to create illness. There is no incentive to change it. Our current system incentivizes invasive therapies, prescriptions and endless specialist visits over disease prevention and reversal strategies. Here's the money quote A healthy patient is not profitable at all.

Speaker 3:

Yeah, no, shout out to Casey. I'm going over to her house on Saturday. We're celebrating. She's having a book launch party for her new book that's coming out on the 15th. It'll probably be out when the podcast is out, but highly recommend it. She wrote it with her brother, kali, and it speaks to those issues that you mentioned. So it's critical If you go to a large hospital system and say I have a program that will reverse type 2 diabetes. We've shown it. We have the evidence and controlled trial, the hospital has to, you know, think of the economics. Wow, our number one surgical amputations are, you know, are diabetes. Our number one renal transplant patients are diabetes, you know, are diabetes, are number one renal transplant patients are diabetes, you know, diabetics, and and also there are a lot of effects that that go into that and and plus, the healthcare system isn't set up for lifestyle changes, you know, and a doctor's visit, whether it's seven minutes or 15 minutes, you really can't explain lifestyle.

Speaker 1:

It requires a different, you know, different calculus, different approach to it so I don't know that we got the, the, the, the closing chapter of your health journey. I'm assuming that what happened was things got fixed and yeah.

Speaker 3:

Yeah. So the journey for me was and it's just like you say. You know, you learn so many things and I'm continually learning things all along.

Speaker 3:

It caused me to rethink my entire framework about health, wellness, about all these diseases and that was the basis for this book also help help me to understand what lifestyle changes I could make that would dramatically affect my metabolic health and, in doing so, would unwind these diseases, to the point where, when I went back to the doctor's office, they couldn't believe it. They said, uh, you know, the labs are wrong, let's retake them, etc. But long story story short, got off the medications, as many, many people do when they make these changes in their lives, and so it was a happy ending for me, but it made me think that so many of my colleagues are not aware of that and even more so many patients are not aware of that. That kind of like Phil, I wanted to get this message out to more and more people, and so, you know, I just wanted to add my voice to the choir of of people that are getting this message out, and you know, maybe you know, each person will will attract a different audience slightly.

Speaker 2:

And you know, one of the unique aspects maybe that you've talked more about and gotten into is this concept of longevity. So let's, let's kind of talk a little bit about that. You know, obviously I mean at its base, longevity means living longer and you know it would seem to be kind of a simple concept. You know, don't get sick, don't die and you'll live longer. And you know it would seem to be kind of a simple concept, you know, don't get sick, don't die and you'll live longer. But we know that there's more to that. And talk about maybe what's a little bit different about the longevity space as compared to, maybe, the metabolic health space and they're certainly not exclusive of each other in any way but what that focus kind of entails.

Speaker 3:

Yeah, there's a revolution going on in our understanding of longevity, perhaps even more than our knowledge of metabolic health. Things are happening very fast. Lifespans are increasing. People are going to be living into their hundreds at least past 100, much more frequently, so it's a really exciting time. I noticed that I was amazed by the fact that improving my metabolic health, or one's metabolic health, not only affected obesity, diabetes, hypertension, cardiovascular disease, you know, cancer, alzheimer's disease, mental health, but at the end of the day, the same factors, the same lifestyle maneuvers seem to affect basic cellular mechanisms like mTOR that are known, have known effects on longevity and prolonging life, at least in the animal models, and there's strong suggestive evidence in humans as well. So I think the fascinating part is adopting a metabolically healthy lifestyle will not only decrease the diseases that we get that will determine our longevity, but will also increase the quality of our life and improve our longevity as well. For example, there's a there's you may have talked about this on your program the, the sort of the ultimate longevity government program is called the ITP or the interventions testing program. It's, yeah, it's. It's a wonderful program. The problem with testing longevity in humans is we live too long. You know humans used to be 70. Now it's you. Now in Japan it's 89 or something for women and it's just getting longer and longer, which is actually a good thing, because worldwide the fertility rates are going down and down and down. So the population is actually decreasing in many countries like Europe and continents like Europe or China. So increasing longevity has a potential to offset the decreasing population, but that's a whole other discussion. But with longevity, yeah, the drugs that affect longevity in this ITP, it's a great model.

Speaker 3:

The federal government started it as a way to look at longevity in this ITP. It's a great model. The federal government started it as a way to look at longevity in an animal model. So they picked the mouse. The mouse only lives three years, so you can actually give an intervention to a population of mice or half a population of mice the other half are controls and then see what happens to their lifespan after three years and if they live longer, then it's a positive effect. And the great thing about this program it's the National Institutes of Aging, so it's run by the government and we can actually, as citizens, can write in and suggest things. So, not surprisingly, in the last 20 years they've run it on things like CoQ10. They've run it on statins. They've run it on things like CoQ10. They've run it on statins. They've done NAD supplements, curcumin, green tea extract, methylene blue, all kinds of stuff.

Speaker 3:

But by far the most powerful pharmacologic intervention on the animal models in mice and everything else has been rapamycin, which turns this switching molecule, mtor, into a metabolically favorable state, turns off inflammation, turns down insulin, turns up autophagy and repair. But interestingly, if you take rapamycin and add a drug to it called a carbose, which is a uh, which is another diabetic drug which has a small effect in the itp in prolonging life, a carbose actually blocks it's. It's a diabetic drug that's used to block uh, carbohydrate or glucose, absorption from the gut and it doesn't really go in the body, just stays in, stays in the gut. But if you block carbohydrate absorption it helps diabetics because they get fewer glucose spikes. But in the animal model it actually causes longevity. But when you combine it with rapamycin it actually dramatically improves longevity, longer than either rapamycin or a carbose individually.

Speaker 3:

The point is we're just beginning to scratch the surface on how our metabolism is related to our longevity and how these drugs can affect things, and it's really an exciting time. And as powerful as these drugs are and I take rapamycin myself, I take A-carbos but as powerful as they are, I don't want to fall into that trap that modern medicine has fallen into, or that I just want to take a pill and then I'm going to live longer. I think, while these drugs are useful, they should never be taken without a lifestyle plan, because if you don't do the lifestyle, you're probably missing out on much, much more powerful effects than any single drug can do. And you know, honestly, we're just scratching the surface on how these drugs even work. Mtor wasn't discovered until the end of the 20th century. It's arguably the single most important biological nutritional switching molecule known all the way from yeast to humans. It's just amazing.

Speaker 1:

I want to follow up with the lies. Follow up with the lies. But before we get to that, I want to ask you about have you read Brett Weinstein's article All Our Mice Are Broken. Are you familiar with it?

Speaker 3:

I'm familiar with it. I haven't read it, but I've heard people talk about issues with mice models?

Speaker 1:

Yeah, for sure, all right. Well, if you haven't read it then there's no point in commenting on it, but I commend that article to you. In regards to the mouse testing, weiss makes a point that these tests might not be as robust as we are often led to believe, and it's because of the mice that they're testing.

Speaker 3:

Yeah, and if I can. Yeah, go ahead.

Speaker 2:

Well, I was just going to say I think it kind of brings up that bigger question, because what was kind of alluded to in that article, and maybe what we see in the human lab all around us, is how much of longevity is really curing or improving the smoldering metabolic issues that most of us are walking around with, versus truly things that can take a, you know, a truly healthy person and make them live longer, rather than all we're really doing is just, you know, the people or the mice weren't really that healthy to start with and what these medications are doing is addressing those underlying kind of subclinical problems.

Speaker 3:

Yeah, that's a great great question and I think longevity is, it's a multi-stage thing. I think even if we reverse these longevity diseases of longevity, we'll get to 100 or 120 max. Now, right now I'll take that, but I think there's another revolution in longevity which is going to go beyond that, that you know, with partial epigenetic programming and some other things. But right now we're just talking about that short thing. And to your point about the mouse models, jack, I agree, they're flawed and the ITP goes to great lengths to try, and they don't use lab mice.

Speaker 3:

In other words, they use genetically heterogeneous mice, which doesn't solve the problems, but they make an attempt. They run it in several labs around the country, so it's not just one lab but still it's mouse models. So the question then becomes is there any evidence for humans or this rapamycin? If it's such a longevity metabolic molecule, what does it do to humans? Well, if you look at the human, at the phenotypes of aging, um, when you put rapamycin on skin, there was a actually prospective human control trial for for eight months of rapamycin once a day cream versus a blinded placebo. They did skin punch by the end of these brave people.

Speaker 3:

They were able to show significant, you know, basal collagen enhancement, the skin got younger and all that. But then basically you can go down other things like periodontal disease Again, this is in the animal model. It reverses periodontal disease Again, this is in the animal model. It reverses periodontal disease, which is aging With hair color. It reverses to grayness, menopause it slows down menopause again in the mouse model. It does a number of things. But yeah, that too. But all these things are phenotypes of aging, right? Nobody dies of menopause, nobody dies of wrinkles.

Speaker 3:

So what about the diseases that are going to kill? You know, you, me and most of our listeners? It's a short list, right? The diseases that determine our longevity? You know, nobody dies of old age, right? When we die, for most people, in fact, in the US, you're not supposed to put old age as a cause of death on the death certificate. You have to list some specific things. So the list is pretty short cardiovascular disease, cancer, and then it goes down to Alzheimer's and a few other things in there.

Speaker 3:

So what evidence do we have that rapamycin has any effect on these chronic diseases? Well, as Phil knows, with cardiovascular disease, when you put a stent in the heart, a lot of people think well, I'm cured of my heart attack, everything's good, I go back. Of course you're not. You may not even change your life expectancy from it, but instead the disease continues on in the other blood vessels and even in the stent itself will eventually clot off. Well, there's now an FDA-approved indication. The mainline drug for coating stents is with rapamycin, because when you coat them with rapamycin the atherosclerosis basically doesn't recur or recurs at a much lower rate in the stent. And there's FDA approval for a couple of formulations of that. So that's atherosclerosis.

Speaker 3:

What about cancer? That's a completely separate thing, right? Um? Well, as it turns out, if the um, if there's a human model for cancer, that's a. That's a very powerful one. It's something I didn't know. I'm sure Phil does. But what's the most common cause of death in heart transplants in the first five years? I would have thought, well, it's transplant rejection. But it's actually a malignancy. Uh, you know, a cancer. Because by having the immune suppression of things go on with that, they have a higher rate of cancer. So you have a population of humans with a high cancer rate and and they also. Rapamycin is one of the mainline drugs for transplant rejection. It's not the only one, but anyway there's a population you can take heart transplants patients. Some of them are on rapamycin, some of them are on other immunosuppressants and what you look at is-.

Speaker 1:

Okay, well, rapamycin is an immunosuppressant.

Speaker 3:

Oh yeah, rapamycin's first FDA indication in the year 2000, essentially 99, was for renal transplant, immune suppression, and that's a great point. If it's given single dose, daily dose, it will have that effect. It's one of the best ones we have. The longevity dose of rapamycin is once a week, which in human studies with Joan Manick and others has shown that it actually improves immune function, as evidenced by reaction to vaccines and some viral testing. So once a week rapamycin is what people take for the off-label longevity effects. Daily rapamycin is what people take for immunosuppression.

Speaker 2:

Yeah, it's an interesting you know medicine because, as you mentioned, you know, at certain doses it suppresses the immune system and at other doses it seems to actually enhance the immune system and so the immune system.

Speaker 2:

And so you know rapamycin and mTOR. You know, and to, I guess, back up a little bit, you know the mTOR stands for mechanistic target of rapamycin, so the protein was discovered after the medication, basically, as this is what rapamycin acts on, and mTOR itself is a, I would say, somewhat controversial molecule when it comes to, you know, nutrition and guidance. And there's some data to suggest, for instance, that mTOR might play a role in the development of cardiovascular disease. And then that leads people, with looking at some scientific evidence, to say, well, eating red meat increases mTOR, although that's not a clear relationship. Eating fish also might increase mTOR, or does increase mTOR, and yet we think fish are beneficial for the heart and red meat is harmful for the heart. So there's a lot that goes into it there. But yeah, it's just very interesting to think about some of these things from a longevity standpoint versus the the, you know, kind of just treating the disease, uh, standpoint um, yeah, because longevity is the greatest risk factor for for all the chronic diseases.

Speaker 3:

Like a 70 year old non-smoker has a greater risk for lung cancer than a 30 year old who smokes four packs a day. You know, you just, they all, they all take off after that point. So you know anything we could do to turn down inflammation, to turn down insulin resistance, to to lower those and whatever longevity is. Um, however we approach it, um, it's going to be beneficial if we can, on all the chronic diseases, if we reverse aging or slow it down.

Speaker 1:

Well, let's talk about lies lies you taught in medical school. Give us a big one.

Speaker 3:

Well, first of all, let me start with it.

Speaker 1:

Disclaimer already Disclaimer yeah.

Speaker 3:

People say, wait, how can you teach lies in medical school? And to that I refer you, to one of the greatest physicians who ever lived, sir William Osler. He had one of the greatest quotes about medical education when he was addressing a graduating class of medical students who were on that day about to become doctors after finishing medical school, and he famously said to them, gentlemen, and back then most of them were gentlemen. He said, gentlemen, gentlemen, and back then most of them were gentlemen. He said, gentlemen, we have a confession to make 50% of what we've just taught you is wrong and furthermore, we can't tell you which half it is because we don't know.

Speaker 3:

And that speaks to the nature of science and medicine in particular, in that our knowledge is constantly evolving and that you know, whatever we learn in medical school, whatever we're teaching, it's constantly evolving and we have to be open-minded to it and rethink, re-look at you know, critical, controlled studies and re-evaluate our knowledge. So it's kind of set in the context of that. I was copying Ken Berry's great book Lives, my Doctor Told Me and many other similar titles like that. But it's the idea that our knowledge is fluid, and even the knowledge we're talking about today, talking about today. You know I'm open-minded, you know I'm I'm ready to hopefully I try to, you know accept new things as they come out and be, you know and be critical, but accept new things.

Speaker 1:

Okay, okay. So now tell us one of the big lies.

Speaker 3:

Well, I mean, there there are about 12 lies in the book. The first chapter is sort of that metabolism doesn't matter. When I went to medical school, metabolism was kind of it was a backwater how you digest food, and that was it. But today, with what Phil's taught and other people are taught, I now believe that metabolism, our mitochondria and our energy pathways and mTOR are truly fundamental to every chronic disease that we get and, for most of us, our longevity itself.

Speaker 1:

Yeah, I've kind of come to the conclusion after my extensive research. Listening to smart people talk, that's what my research has been but I've come to the conclusion that metabolic health is life period when your metabolism begins breaking down. That's that's when your body quits converting food into energy. That's when you die. And it could I think it could be said that in the absence of metabolism, you also have the absence of life, and it's not that metabolism is a signifier that life exists, and it's not that metabolism is a signifier that life exists. It is what allows these bodies, these brains, hunk of meat on the side of the road.

Speaker 3:

Absolutely. I couldn't agree more. And that speaks to the fact that this molecule, mtor, is conserved biologically over billions of years. It's present in yeast all the way to human beings. Like what? What is so fundamental that you need the same molecule? That's really not changed much between them. It does the same thing and it's about switching between inflammation and nutrition. It detects the presence of food and then it tells the cell to grow when food is present and it tells the cell not to grow and turn on autophagy and repair when food is not present. And that's what our lifestyle effects do on mTOR and many other molecules. But it's just to affect these. And some of the drugs too, like rapamycin, have that same effect. But yeah, it's amazing that they do.

Speaker 3:

One thing you said about life kind of wearing out that was one of my later lies about longevity, and the longevity lie, if you want I can segue into that is that we die because our bodies just wear out. Longevity, death or aging, is the inevitable effect of wear and tear on our bodies. Right, my shirt wears out, my car wears out, my shoes wear out, everything wears out. My body wears out. Is that what causes longevity? Is that what determines longevity? And I think there's a.

Speaker 3:

Misha Blaglosconi is a brilliant researcher back in New York who studies longevity and he has a new model for longevity and he's a physician and a scientist who pointed out that well, actually, when people die, it's not like things wear out. When somebody has a heart attack, it's not that their heart wears out. Or when somebody has cancer, it's not that their body wears out. Actually, the cardiovascular disease is hyperfunction, it's proliferation of atherosclerosis, or with cancer there's uncontrolled cell growth. Even with Alzheimer's disease there is cell proliferation and immune inflammation in the brain, kind of a hyper reactive state. So he advanced a theory that aging may be due to wearing out. But longevity, which is determined by the chronic diseases we've been talking about, is not determined by wearing out but it's determined by hyperfunction. In other words, it means that advantageous systems in our body for hyperfunction, for cell growth, for in a child allows our bones to grow and our epiphyses to close and our brain to mature and all the cells to grow, those systems when turned on in an older patient, when we can't, our bones can't grow anymore, that instead they drive hyperfunction which manifests as cardiovascular disease, cancer hyperfunction which manifests as cardiovascular disease, cancer, alzheimer's disease and these other things.

Speaker 3:

And his theory is the hyperfunction switch is mTOR. You know when you turn mTOR on it's cell growth You're hitting the accelerator to grow when food's present. That's why fasting, you know, you turn mTOR off. There's no food, you turn on autophagy and these healthy things.

Speaker 3:

And he's one of the advocates, proponents, of rapamycin for longevity. But he's a very deep thinker about longevity and his idea is really novel about how things that were beneficial to us as young organisms actually drive our death and determine our longevity as older organisms. And his shortcut is through lifestyle choices we make, turning our metabolism in a certain way to a ketogenic diet, to insulin very low, will turn mTOR down. Or even rapamycin, acarbose, these other things will turn mTOR down into this slow repair state and that's what mTOR does with. I mean, that's what rapamycin does, presumably with cancer. It basically stops growth. So it's cytostatic, unlike cytotoxic drugs, like chemotherapy agents. When you give rapamycin for drugs for cancer and there are nine fda indications for rapamycin as a cancer treatment it it basically stops the cells from growing, which is which can be very beneficial interesting you're.

Speaker 1:

Would you say that guy's name again? I want to make sure he shows up in the show notes.

Speaker 3:

Yeah, misha Blaglaskony, mikhail Blaglaskony, blaglasklony and if you just look up rapamycin and Misha, he, he was. He was literally the person who wrote about it and started humans taking it as a um, as a longevity uh, longevity supplement.

Speaker 1:

Okay, we will make sure that ends up in the show notes. Phil, I know you're sitting over there stuff going.

Speaker 2:

Yeah, yeah, definitely geeking out on all of this, but, you know, kind of keeping it high level. I guess the question I have next is you know, it's great to talk about problems, but let's talk about solutions. You know, how do we stop teaching the lies? How do we, what do you think needs to happen to really allow medicine to get back to what it used to be an innovative, you know, self-correcting. An innovative, self-correcting learning over time.

Speaker 2:

I mean, I think back to, and we've never really talked about the history of heart disease on this show, which is interesting, since I'm a heart surgeon. But it was only 70 years ago that the first human heart surgeries were performed. And 75 years ago it was largely accepted that if you, you know, opened up the chest and touched the human heart, the person would die, like instantly, like you cannot operate on the heart. It is a total no-go zone, and you know, and 70 so years ago, you know, there were a couple of surgeons who were brave enough to try this and to undertake this problem. And here we are. You know, heart surgery is one of the most common surgeries performed today. So how do we get back to that self-correcting environment where medicine can start to you know correct the lies that we know are out there.

Speaker 3:

Yeah, that's a great question. Well, you know, getting the message out, certainly through the work you're doing and you know other people in this space, is really important. I think there needs to be an awareness that we're truly entering a new phase of healthcare where me as a patient changes. In other words, I used to go into the doctor's office and they would give me a pill or surgery. I'd go home and do it and that was it. It was very simple. I think nowadays we're beginning to understand how important lifestyle is and I'm realizing that I am the CEO of my life and as much as you know, as much as you or I know about medicine over decades of studying it, Jack here actually knows more about his own personal life experiences and life, life traumas and everything he brings to it, so that it really needs to be. He has agency as a patient, or I have agency as a patient because now I can, you know, the doctor works for me. Doctors won't make me healthy.

Speaker 3:

They will make me less sick and if I want to be healthy, I get to choose my lifestyle and every morning, when I get up, I decide you know what I'm going to eat, when I'm going to eat, you know what my sleep, what my diet, what my exercise and, probably most important of all, what my mindset is, the way I look at the world, the way I see things. Is it a place of abundance? Is it a place of abundance, is it a place of love? Or, you know, is it a place of stress and hassle? You know, do I look forward to the day? Do I have purpose in my life? You know, am I working towards a goal that is going to make you know mankind better, or my family better? Or you know, help people in general, family better, or you know, help people in general? I think it's a new awareness that is coming and I can see it happening, but it's a challenge and it's going to take time.

Speaker 1:

So you're basically advocating for taking personal responsibility for your own health. That's a kind of radical proposition there own health.

Speaker 3:

That's a kind of radical proposition there. Well, as we know in the last 30 years by the failure of the healthcare system in these chronic diseases, that the healthcare system really you know there is no treatment for type 2 diabetes. You know that the healthcare system gives you give insulin and we know long-term that people still get the side effects of diabetes from the insulin. So the insulin saves them from dying. You know, similarly, if we put a stent in somebody's heart or do a bypass, we're going to save them on the moment from dying on the table, but their heart disease will continue unless they change their lifestyle. And that's true with Alzheimer's disease and everything else. And I think the notion of prevention is great but people are busy. It's like I got 10 other things I don't want to worry about Alzheimer's disease in 20 years. I think we need to reframe our thinking, as I certainly did, is that these diseases it's not an on and off switch like type two diabetes. When my hemoglobin A1C hits 6.5, the doctor says, okay, you're a diabetic now. Now I can start charging for stuff and doing that. Or when I have a heart attack, or when I forget my keys or don't recognize my kids, then I have Alzheimer's. But I think what we're now learning is all these diseases begin years, if not decades, beforehand, and the time to work on them, the time to improve our lifestyle and reduce the risk of these diseases, is then Not when the doctor diagnoses it. When you walk in the doctor's office you're late and it makes it much, much harder to reverse it, to wind things down. So we're all facing the diseases.

Speaker 3:

I think all these diseases are inevitable if we live long enough. You know type 2 diabetes, the A1C goes up with age. In non-diabetic adults the A1C goes up and if you live long enough it's like gray hair. If you don't get something else, you will be diabetic, just like men with prostate cancer. If you live long enough, you will get prostate cancer. You know it may not kill you, it may not be significant, but all these diseases should be on our radar and maybe you know we're all at different risks. Some people are greater risk for Alzheimer's. Some people are greater risk for cardiovascular things. You know other types of conditions. But we need to pay attention and the great thing about lifestyle is when we improve our metabolic health, we're decreasing our risk for all those diseases, or at least the list we've talked about.

Speaker 1:

Yeah, let me ask both of you guys to comment on something. I was with a bunch of friends a couple of days ago and somebody asked the question what was your favorite cereal when you were a kid? And um, you know, the list of things that were people's favorite cereals was absolutely terrifying. Um, but I had my own, and it got me to thinking about the fact that when I was a kid, everybody ate breakfast cereals Everybody they were. You know, they were high carbohydrate, lots of sugar.

Speaker 1:

But if I go back and I look at my high school yearbook, of the 275 people in my high school graduating class, there were two who you could qualify as overweight, two Less than 1%, and I don't mean obese, I mean just kind of chubby. Something happened in the last 40 years that is not just carbohydrates, not just sugar, because we were pounding down the sugar stuff and the wheat-based stuff. What happened? And I realize you guys may not have the answer, but this morning, as I was thinking about that conversation, I thought wait a minute. I've been terrified of sugar, I've been avoiding wheat and yet as a kid, we all ate it all the time.

Speaker 3:

Yeah, that's a great, great observation and people have pointed that out. You know, when you look at the sugar consumption over time or red meat consumption, it doesn't really track with these things or saturated fat. The one thing that I've been drawn to and I've included it in my personal dietary choices, is the use is avoiding industrial oils which are pro-inflammatories, called seed oils, or American Heart Association recommends them for a heart healthy diet, which I disagree with. But their use took off along with junk food in general, took off 30 years ago, you know, with high fructose corn syrup and seed oils and grains make up a lot of junk food as well. But I don't know, phil, it's your show, what do you think?

Speaker 2:

Yeah, so I certainly you know. I think the vegetable and seed oils have played a large part in this, and I do think it is an amount issue too, because, yes, you know we all ate, um you know, uh, high carbohydrate cereals, um, as as youngsters, uh, but you know we weren't eating uh high carbohydrate meals eight times a day like we are today. Uh, the constant snacks and everything is processed in high carbohydrate. You had the cereal, um, oh, by the way, you had the cereal with real milk, not skim milk.

Speaker 2:

Um and then you know, uh, but dinner was your, you know your meat and veg and you know, maybe you had some potato and you didn't have dessert and you weren't snacking every three hours and we weren't just kind of drowning in, uh, the carbohydrates and in the processed, uh uh, foods, uh. So I think I think it is multifactorial, um, but I also think, you know, a very important part of the conversation is um you, once you're metabolically broken, it is clear that carbohydrates are, you know, problematic and um, uh, and that's a different situation than when you're a you know young kid who wasn't exposed from birth, uh, to these, uh, you know other toxic, uh, other toxic substances in our food supply. That's kind of what I point to ultimately.

Speaker 1:

So, robert, let me ask you with this it sounds to me like pretty significant shift in your thinking, in your approach. How has that affected you personally in your professional life?

Speaker 3:

Well, I think a couple of things. One just personally the longevity thing. Longevity thing, um, the idea that you know people are people, are going to live a long time and along a healthy time. It's changed my perspective on the, the time frame, on things I want to do, and I mean I still have young children so I still have, you know, college to pay for and stuff like that. But but it's changed my thinking of framing the way I look at the world and the way I look at life.

Speaker 3:

And there are things we need to look at in our second 50 years that we don't look at in our first 50 years that are very different. The medical system's not set up for people in their 80s or their 90s or their 100s or their 120s. They're sort of freaks or aberrations. But increasingly that's going to be the population and we need to change our thinking there. Such things as like radiation doses you know we're calculating how much radiation to be exposed to based on living 60 years of age. You know, Well, if I'm going to live to 120, I don't necessarily I, maybe, I, maybe, I. I don't want to follow the the recommendations of radiation dose because it's cumulative over your lifetime, you know for exposure to things. So that's just one example.

Speaker 3:

But as far as um, as far as my professions, I've been greeted courteously. Intelligent people can agree to disagree. Not everybody agrees with what I say, but people have been open-minded to it Because what I try to do in the book it's not my idea. I didn't think any of this up. I'm basically I'm just reading the literature, the way I interpret it, and I include the references in there in the book. Some say too many, but they're all reference peer-reviewed articles, so I'm open-minded. If Coca-Cola, there's a study tomorrow that says that Coca-Cola is healthy and will make me live longer, I'm going to go back to ordering drinking Diet Cokes every day, which I no longer do, and I've lost Coke as a sponsor for my podcast.

Speaker 2:

I'm sure you have too, Phil. I don't see a Coca-Cola patch on your arm or anything. Very good, Well, yeah, the book is, and I'm happy to have a pre-copy here of Lies I Taught in Medical School. I highly recommend it. As we're recording this, it's available for pre-order I think by the time this episode is out. It should be. It's released, so definitely recommend it. Where else can people connect with you, Rob?

Speaker 3:

My website is robertlufkin L-U-F-K-I-N. Mdcom and I'm active on social media. You can find the links there and if you want a chapter, you can download a chapter of the book, a free chapter on my website, to see if you like the writing style or whatever.

Speaker 1:

All right. Well, Dr Robert Lufkin has been our guest here. Interesting story. I'm fascinated to talk to somebody who's made this shift in their professional perspective and still been able to continue teaching. I guess the one thing I haven't asked you that I'd love to hear about is how are the medical students responding? Have you seen a shift?

Speaker 3:

Yeah, well, I'm mainly teaching. It's medical school, but I'm teaching postgraduate people now. But I am seeing. You know Nick Norowitz is a friend of a friend of ours.

Speaker 1:

Speaking of bizarre studies.

Speaker 3:

Yeah, and you know he's a voice out there putting CGMs on his classmates, and we're seeing more and more people like him, which I think is, you know, a guiding light and it's the future. So I'm optimistic.

Speaker 1:

I guess we're going to have to link to our interview with Nick Norwitz as well. Phil, we'll make sure we do that, all right? Well, thanks for being with us today. Dr Robert Lufkin, we'll make sure all this information is available in the show notes For Dr Philip Ovedia. This has been the Stay Off my Operating Table podcast. Thanks for joining us and we will talk to you next time.

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Dr. Philip Ovadia

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Jack Heald

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