#187 - Sam Apple: The Warburg Effect—Otto Warburg's cancer metabolism theory

Sam Apple is the author of the book Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection, published in May 2021. In this episode, Sam describes the fascinating life story of Otto Warburg, a Nobel Prize-winning scientist who, despite being both Jewish and gay, survived Nazi Germany because of his valuable research on cellular metabolism and cancer. Sam describes Warburg's observation that cancer cells consume large amounts of glucose anaerobically – a phenomenon subsequently known as the "Warburg Effect" – and relates how Warburg's seminal work on this topic was largely forgotten after the discovery of oncogenes, only to regain relevance decades later within the field of cancer biology. Sam sheds light on the current debate around Warburg's interpretation of the causes of cancer, and Peter gives his personal take on the matter. Finally, Peter and Sam tie it all together with a discussion about cancer prevention, the role of hyperinsulinemia, and the link between dietary sugar and cancer. We discuss: <ul> <li>Sam's interest in Otto Warburg and work as a writer [2:30]; </li> <li>Otto Warburg's dedication to science and his complicated life in Germany [14:00]; </li> <li>Warburg's interest in cancer and early discoveries about cellular consumption of oxygen [23:00]; </li> <li>The role models who fueled Warburg's desire to make a great discovery [34:15]; </li> <li>How Warburg described the primary and secondary causes of cancer [42:15]; </li> <li>Warburg's Nobel Prize in 1931 [45:45]; </li> <li>Warburg's life and work during WWII in Nazi Germany [46:30]; </li> <li>Warburg's research in hydrogen transfers and coenzymes—his best science? [59:45]; </li> <li>Warburg's decision to stay in Germany after WWII [1:03:30]; </li> <li>Discovery of oncogenes in the 1970s and the decline in interest in Warburg's ideas [1:07:30]; </li> <li>The renaissance of Warburg's ideas on cancer metabolism and a new explanation for the Warburg Effect [1:13:45]; </li> <li>The argument against the Warburg Effect as a primary cause of cancer and the potential role hyperinsulinemia [1:21:15]; </li> <li>Identifying primary and secondary causes of cancer for the purpose of prevention [1:27:00]; </li> <li>The link between sugar, fructose, and cancer [1:35:30]; </li> <li>Sam's reflections on the work that went into Ravenous [1:39:45]; </li> <li>More</li> </ul> <div><a href="https://peterattiamd.com/samapple/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211212-pod-samapple&utm_content=211212-pod-samapple-podfeed"> View the Show Notes Page for This Episode</a> <a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211212-pod-samapple&utm_content=211212-pod-samapple-podfeed"> Become a Member to Receive Exclusive Content</a> <a href="https://peterattiamd.com/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211212-pod-samapple&utm_content=211212-pod-samapple-podfeed"> Learn More About Peter Attia</a> <a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211212-pod-samapple&utm_content=211212-pod-samapple-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a> Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> & <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></div>

Actionable Insights

1. Aggressive Cancer Prevention Strategy

To prevent cancer, adopt an aggressive strategy by avoiding hyperinsulinemia and any signs of metabolic ill health, while also doing everything imaginable to reduce the burden of DNA insult. This approach aims to confine oneself to a “double negative” box against cancer.

2. Prioritize Hyperinsulinemia Reduction

Focus on preventing hyperinsulinemia as a key strategy for cancer prevention, as it is believed to simultaneously drive obesity and cancer cell proliferation. Addressing this metabolic disruption is considered fundamental for making progress in prevention.

3. Limit Fructose Intake

Reduce consumption of fructose, as research suggests it can drive certain cancers, particularly in the colon, even independent of its effects on insulin. Fructose metabolism can turn on the Warburg effect and lower ATP, leading to increased glucose flow into cells.

4. Improve Writing Through Revision

Recognize that good writing is a result of extensive revision, as first drafts often come out poorly. Spend significant time going over and over your work, making correction after correction, to improve clarity and conciseness.

5. Seek Trusted Private Feedback

Before finalizing a project, share your work with a handful of trusted friends or an editor to receive valuable feedback in a private setting. This allows for critical assessment and improvement without the discomfort of public judgment.

6. Adopt Warburg’s Chemical-Free Lifestyle

Consider adopting a lifestyle similar to Otto Warburg, who became an “organic farmer” with his own garden and well, and had only one person cook for him. This was based on his hypothesis that chemicals in food and the environment poison mitochondria and cause cancer.

7. Cultivate Scientific Humility

Cultivate humility in your work, remembering that science is constantly evolving and not everything is definitively proven, even when strongly believed. This mindset helps avoid being overly attached to one’s own ideas and encourages openness to new evidence.

8. Find Central Character for Stories

When approaching a complex topic like science, identify a central character to anchor the narrative. This storytelling technique helps make the subject accessible and provides a clear way to structure the story.