In this episode, I’m speaking with Dr. Robert Lufkin, a physician and medical school professor at UCLA and the University of Southern California, about his new, provocatively titled book Lies I Taught In Medical School.
Our conversation touches on some of the most impactful topics in medicine, including his nuanced views of chronic disease treatment and why scientific research, although incredibly useful, should not always be trusted.
I really enjoyed speaking with Dr. Lufkin, and I think you’ll love this episode!
Table of Contents
In this podcast, Dr. Lufkin and I discuss:
- Whether he believes the conventional medical system is intentionally lying, as the name of his book suggests, or if there’s a more nuanced meaning
- 2 recently revealed nutritional lies spread by the Harvard Department of Nutrition
- Dr. Lufkin’s impressive career in the medical establishment and why this sets him up to make highly informed and unique criticisms of medical science
- The marked differences between acute and chronic disease…and why the conventional approach is currently failing those with chronic diagnoses
- One sad and deceptive example of research publication bias often used by pharmaceutical companies that contorts the actual usefulness – and safety – of many drugs
- The subtleties of heart disease, LDL cholesterol, metabolic dysfunction, and what the research really tells us about statin drugs
- The unfortunate disconnection between many doctors and research findings…and the role of the media in muddying the waters
- Lies told about Alzheimer’s disease and Dr. Lufkin’s current opinion on the primary reason why dementia develops
- An FDA-approved “magic drug” currently being studied for its positive effects on heart disease, cancer, metabolic disease, and Alzheimer’s, and why lifestyle changes are still superior to its effects
- How to know who to trust and take advice from when it comes to the complex issues of health and medicine
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Transcript
Ari Whitten: Dr. Lufkin, welcome to the show. Such a pleasure to have you on.
Dr. Rob Lufkin: Hey, Ari. Thank you so much for having me. I’m a huge fan of your podcast and also your many books that you’ve written, so it’s a real honor and a pleasure to be here today.
Lies I Taught in Medical School
Ari: Yes. Well, I have some great news for everybody listening. Dr. Lufkin just wrote a wonderful book. It came out yesterday. I already have my copy of it. I pre-ordered it, so it arrived to my house on the day that it was published. I actually bought it. Oftentimes, friends and colleagues send me books for free wanting to help promote it. In this case, I purchased this myself, and I’ve been reading it since I got it yesterday, and there is a ton of great information in this. The book is called, for everybody listening, Lies I Taught in Medical School, and obviously this implies Dr. Lufkin is an educator of medical students in medical school.
This book has a very provocative title, and I want to start our conversation by talking about the title of this book because you use the word lies, and the word lies is a pretty provocative word, and it suggests, I think, not just ignorance, so not just information that’s incorrect due to lack of knowledge, but sort of a deliberate attempt to mislead people. Even though you have evidence to the contrary, even though you know better, you are deliberately lying to people with the intention to deceive.
Let me ask, I’m sure you probably put some thought into that and maybe even second-guessed whether you want to do this because you maybe worried about maybe people interpreting it the wrong way or being upset about it. It is provocative. Let me start there. Why did you choose to title it, and what do you mean by these lies? What are you referring to?
Dr. Rob: Part of it is it is a provocative title, and it’s intentionally so. Some would even say clickbait, but it falls in a long line of books titled very similarly. Ken Berry’s famous book, Lies My Doctor Told Me, and it goes on and on and on. Many people riff on that various thing. I guess I want to go on record and say I don’t believe that most people, including most healthcare practitioners, intend to harm people. I don’t think by lies these are intentional lies, as you say. I think there are strong pernicious incentives, both conscious and unconscious, including financial incentives that shape our behaviors as educators that we wind up doing things that may be incorrect or may not be in the patient’s best interest.
I always refer back to one of the greatest physicians who ever lived, Sir William Osler, who famously made one of the greatest quotes about medical education when he was addressing a group of graduating medical students who just completed medical school. They were about to become doctors, and he said, “Gentlemen, I have a confession to make. 50% of what we’ve just taught you is incorrect. Unfortunately, we don’t know which half it is.”
That speaks to the real nature of science, certainly, but medicine in particular, in that the knowledge is continually evolving. If we don’t look critically at what we’ve been taught, and we don’t fully accept the fact that much of what we’ve been taught is going to be changing and will be wrong and will be a lie in a sense, we’re not being honest with the way the science works or the way that health care works.
Ari: I think there’s like a couple of layers to dig into there. Maybe more than a couple, maybe arguably a few dozen layers. One element is, as you said, just the evolution of knowledge itself and lots of things that were once thought to be a certain way that we now know are not that way or– the science evolves in many ways. It wasn’t that long ago that people thought the appendix, it was taught to medical students, it was taught to people in health science, that the appendix was this useless remnant of evolution that served no functional purpose in the body. Then it was discovered, actually, it’s a storehouse for the microbiome when you have different toxins or things that function as antibiotics that wipe out the microbiome. It can be repopulated because of the appendix.
There’s all kinds of new discoveries happening all the time. It wasn’t that long ago that we sequenced the human genome. We obviously went into that whole project with what turned out to be an enormous misconception of what we thought we would discover by sequencing the human genome. we thought we’d find a gene for this disease and a gene for that disease and that it would be this really easy story of just manipulating this or that gene to solve so many illnesses. Of course, it’s much more complex than that.
One thing is, as you said, this sort of evolution of knowledge, which is ongoing. The other aspect is corruption, is fraud, is deliberate lying. I think even further, it can be, to your point, that, most doctors are well-meaning people who actually want to help and are not trying to lie. It is also possible that there can be lies and well-meaning people who are not trying to deceive putting forth the same information, meaning lies can come from the top, from people who are trying to deceive, be interpreted as so.
Meaning, let’s say, hopefully something we’ll talk about, pharmaceutical companies and pharmaceutical company-funded research, coming to a certain conclusion, pharmaceutical reps, teaching doctors, a certain thing that is maybe a lie at that level, is genuinely a lie, an attempt to mislead. It is taken in by well-meaning people who just want to serve and help people, who believe it’s truth, and then who continue to push that information as though it’s truth and have no intention to lie, but they are, in effect, part of the lie. Do you follow what I’m saying here?
Dr. Rob: Yes, absolutely. In the book, we look at some actual lies where famously the Harvard Department of Nutrition, people there were paid to write articles saying that fat was harmful and caused heart disease and minimize sugar and the effects of sugar on heart disease, and they were paid for by the Sugar Foundation. This was only discovered in the 21st century from records, and it turns out they were paid large amounts of money. They wrote articles that they knew were incorrect or at least were slanted according to that, and they never declared it, which is scientific fraud, and it’s now come out in paper.
It goes all the way from that to more unconscious bias or, subtly, we’re manipulated by the system. We don’t have five minutes to see the patient. We don’t have time to explain about how diet can reverse your diabetes. Instead, we just give you insulin and Metformin and send you on your way, and you’re happy, and the system works, but people get sicker and sicker.
The issue with the modern medicine approach
Ari: Yes. I want to quote something you wrote in the first chapter of your book. You said, “First, I must make clear where I stand. I am the establishment. I’m not a renegade, rogue, maverick, or conspiracy theorist. It’s crucial that you understand this as I lay out the evidence of fraud, deception, incompetence, and ignorance.” Take people through what you mean by that, and how would you distinguish yourself from the proverbial conspiracy theorist who– because some people in evidence-based circles, as soon as there is an attack on anything within the realm of “evidence-based” medicine and the pharmaceutical sort of medical complex, anybody making any attack on that, there are certain people, typically MDs and people in other evidence-based circles, who will reflexively respond to anybody making any attack by saying, “You’re a conspiracy theorist.”
What are the distinctions that you would make between someone like yourself who’s bringing criticisms to the forefront, but you’re simultaneously saying, “Hey, I’m not a conspiracy theorist. Let me show you where I land on this spectrum. I’m not like those crazy people over there, but I’m also not just like, let’s say,” and I’m using my own words here. I want to be clear about that. “I’m not just like one of the sheeple or the obedient followers of whatever the perceived authority is who just does what they’re told. I’m thinking about things more critically. I’m evaluating the evidence, and I’m coming to the conclusion that there is fraud and incompetence and lies going on here.” What distinctions do you bring to that?
Dr. Rob: Yes, that’s a great point. Some people say, “Wow, are you a whack job?” Something like that. Actually, I may be a whack job, but I’m actually part of the medical establishment. I’ve spent my entire career essentially as a professor at two leading medical schools in California. As part of that, I not only practice medicine, but I do research. I’ve personally written or co-authored over 200 peer-reviewed scientific papers that are published in scientific journals. I’ve written 10 textbooks that are available in six languages on medicine.
I have a laboratory that’s received millions of dollars in grants from the NIH and the federal government to do research. I’ve received in similar amounts of money from drug companies and device makers. I really am the establishment, and I was only dragged kicking and screaming into this viewpoint out of something happened to me personally. Otherwise, I was going on fine, and I was completely unaware of some of these deeply disturbing things.
Maybe before I go into this, I want to just say for the record that I believe in Western medicine. I think Western medicine has transformed humanity in the 20th century with public health and infectious disease control. Our lives are truly transformed, and the really successful pills and surgeries that were developed then are still lifesaving. In fact, today if I walk outside and I get hit by a bus, I’ll always think about my lifestyle, but in the moment, to save my life, I want to have a blood transfusion, I want to have my spleen removed, I want to have different things done that will acutely save my life.
I think the problem is, and what this book hopes to point out, is that in the 21st century, we’re dealing with different types of diseases. That the set of chronic diseases which were present in the 20th century have now reached epidemic proportion, unprecedented in the history of the world, even corrected for population. When Western medicine tries to apply the same things that worked so well in the 20th century, pills and surgery, when they apply these same things to these chronic diseases, as it turns out, they may be able to treat the symptoms and maybe even be lifesaving in the acute moment, but for the most part, they don’t do anything to the overall root cause, so to speak, of these diseases, which continue to get worse and worse and worse. That’s the point of the book.
The fascinating part is that there is no pill or surgery for these chronic diseases to get to the root cause, unfortunately. Even more empowering is the fact that lifestyle can do it, and the same lifestyle choices we make can benefit and even reverse everything from obesity to hypertension to cancer to Alzheimer’s disease to heart attack to mental illness. Even ultimately, we talk about in the book, the last chapter is longevity, because once you start changing all those things, a funny thing happens. People start living longer, they live healthier, and that’s something we also have to think about and examine what we’re going to do with that, what we’re going to do with another 50 years of our lives after age 60.
Ari: With regards to the general population getting sicker and more chronically diseased, there are some people, again, within very evidence-based circles who argue that this is largely, and this is not an argument I agree with for a variety of reasons, but they argue that this is just a function of more of the population living to older ages. In other words, it’s not that we’re actually any sicker than we used to be. Actually, it’s that we’re living long enough now, thanks to modern medicine, to get these diseases. That’s the only reason we appear to have a higher prevalence of many diseases. What do you think of that argument?
Dr. Rob: The demographics don’t support it, and I’m really an evidence-based person. I have no axe to grind or no agenda. I’ll just follow the evidence and whatever the papers and science. I try to be open-minded in everything. As much as longevity is exploding, it hasn’t exploded to the extent that a huge number of people are living longer. In other words, the people who are getting these diseases, and by obesity, most adults are now obese or overweight, regardless of their age. 50% of people have hypertension, and it goes on and on. There are 30-year-olds now getting colon cancer when before they didn’t get them until their 50s, and we now have to increase our screening. I would disagree with that argument just because the evidence doesn’t support it, in my opinion.
The little-known fact about drug research
Ari: Yes, agreed. Okay. There was something else you wrote, and you mentioned something along these lines a minute ago. This is a quote from your book. You said, “My laboratory received millions of dollars in grants from drug companies. I wrote papers for drug evaluations that the drug companies wouldn’t let me publish unless they were positive.”
This is another aspect, I would say, of the lie that I was hoping we could touch on, and it relates to what is also called the file drawer effect in publishing research, which is describing how the overall body of evidence on a topic is corrupted or is misleading, gives a false impression of the reality by virtue of the fact that many of the studies that didn’t arrive at a positive result that said, “This drug doesn’t work or this drug is unsafe,” never see the light of day. They don’t get published in the journals.
The studies that end up in the journals getting published and put on PubMed and Google Scholar and all these places where people actually see them and where people go to evaluate, “What is the body of evidence, let me gather all these studies and come to a conclusion about the efficacy and safety of these drugs,” the lie in a way is so deep that we can’t even fully grasp the extent of the lie because part of it is what we are unable to even see, the information that we don’t have access to, meaning we’re given this false impression of efficacy and safety because so much of the research that was done that didn’t show that kind of efficacy and safety isn’t even accessible for us to see.
Dr. Rob: Absolutely. What you’re describing is something that’s baked into the system so that it defeats the– like you say, if you just look at the papers and you go, “Well, here are a bunch of papers that show this result and there are no papers that are against it,” one would expect that result is positive. As you say, the system at a very basic level, if it excludes the negative papers by one way or another, it’s going to corrupt the knowledge and that’s absolutely what happened.
When I started doing papers, we would have contracts from drug companies to run a study on a given drug, a clinical study, and they wouldn’t say they wouldn’t publish it, but they said they have rights of publication rights. In other words, they get to review the paper and then approve it for publication or not approve it. Simple, benign sounding thing, but guess what? Only the positive ones got approved and the negative ones, “Well, we’re still evaluating it,” and that thing.
We see it in other things too, the food pyramid, which famously influenced our dietary patterns for a couple of decades, not only in the US, but around the world. The food pyramid, Nina Teicholz and others have famously revealed the ties to the authors of this food pyramid to basically big food, which are the junk food makers. Most of them are strongly conflicted with these relationships with junk food. If you look at the food pyramid, it sort of makes sense. The bottom line of the food pyramid is what you’re supposed to eat the most of is all junk food. It’s basically cereals and grains and refined carbohydrates, which is junk food, really.
Ari: Yes. There’s another layer to the story. There’s a wonderful author who’s also done a couple of great TED Talks named Ben Goldacre. He’s an MD and he wrote the book Bad Pharma. One of the things that he talks about, I think in one of his TED Talks that he gave several years ago, is he shows based on an evaluation they did of large bodies of published research on drugs in particular, they found that research that is funded or that is funded or conducted by the drug companies themselves, which is a very widespread practice, is 400% more likely to arrive at a positive result than the same study that was done by independent researchers.
There’s almost these two layers that are baked into it. One is the file drawer effect, where studies with negative findings never see the light of day. The other one is drug companies funding research on their own drugs, which are basically, essentially, this is hinting at scientific fraud, this is basically showing they’re designing the studies in subtle ways that are making them much more likely to arrive at flattering results to their product, showing that they’re either more effective or safer or both than a similar study done by independent researchers.
What this points to, and it brings me no pleasure to point this out, but it really points to, I think, a sad reality that our entire body of evidence, or a large portion of our entire body of evidence, and so much of what’s done in medical science, has to be taken with a grain of salt. Can’t be just simply looked at and trusted as objectively true, because there’s so many layers of corruption baked into the system.
Dr. Rob: Yes, certainly what you said about the drug companies and publications, but even our respected scientific organizations that represent they’re the mouthpiece of science for a given disease group, the American Diabetes Association. Type 2 diabetes is rampant, and type 2 diabetes leads to many, many other diseases. All the ones I mentioned, in fact, are driven by type 2 diabetes.
Type 2 diabetes, interestingly, can be reversed by diet in almost all patients. Yet the American Diabetes Association, who purports to want to help diabetic patients and make them better, publishes on their website recipes for diets that make the diabetes worse, containing high sugar and refined things. There was one that just came out, and right at the bottom of the diet, which was high sugar, and they just said cover it with insulin, was one of their sponsors, one of their leading sponsors. It was called DaVita Corporation.
All you have to do is follow the sponsors back, and DaVita Corporation is a large renal dialysis company, basically. What’s the number one cause of renal failure and dialysis worldwide? Type 2 diabetes. You could see there are these conflicting motivations.
It even can go to an institutional level. I go to a hospital, I won’t name the name, but you go to the hospital and you say, “Hey, we have a program. Your hospital is full of diabetics. People are suffering from this disease. We can reverse the diabetes, not by putting them on insulin and metformin,” which actually doesn’t, for many of the complications, the insulin makes it worse, or at least doesn’t slow them down for many of them, as studies have shown.
You go to the hospital and you say, “Well, we have a program. We can reverse type 2 diabetes in your patients by a program of carbohydrate restriction and coaching and all this.” They go, “Wow, let’s see. Our operating rooms pay for the hospital. The number one surgical because of amputations is type 2 diabetes. Our dialysis units pay for the hospital. Renal transplants,” the number one because of renal transplants, as we said, was type 2 diabetes. It goes on.
Alzheimer’s disease is called type 3 diabetes because of the association with all these things. Retinal blindness. It just goes on and on. Heart attack, stroke, cancer. They’re all linked to diabetes. There are all sorts of pernicious influences that we’re fighting against. That’s an upstream battle that color the lens through which we see things. Our colleagues in health care see it as well. It’s really challenging.
Ari: I want to talk about some of the specific lies that you mention in the book. You have many chapters on specific diseases. On hypertension, on diabetes, on obesity, on heart disease, on Alzheimer’s. There’s also one on longevity and aging more broadly. I’m probably missing a few in there. Cancer is one of the ones I’m missing. You’re probably thinking of a couple others. Fatty liver disease. Anything else? What else am I missing?
Dr. Rob: Mental illness, which was something I didn’t expect that lifestyle and junk food would literally make people have mental illness. We talk about that in the book.
The lies we are told about cardiovascular disease and statins
Ari: I want to go to cardiovascular disease first because I think this is obviously such a big one. It’s the number one killer in our society. I think in the entire world more broadly when we look at mortality in all countries combined. Certainly in the United States it is. The lie that you wrote at the beginning of the chapter is, “Statins are a good choice to prevent heart disease.”
I want to dig into this because I know firsthand that this is a controversial one. I have many friends, actually, somebody who’s a big brother, mentor figure to me was just asking me a few days ago saying his doctor was recommending him to go on statins. I was telling him about my interpretation of some of the research, which aligns very much with yours. Yet what I see as the landscape that we have here is, and maybe you can add to this because I think you’ve probably dug into this much more than I have, but I see a landscape of, on the one hand, the conventional medical establishment being very insistent about this link between cholesterol and LDL and various sub-particles having a very strong and clear association with being a causal factor in heart disease.
On the other hand, the other extreme is I see a lot of online influencers, and particularly I would say those who align more generally with maybe more your diet recommendations that tend to be more low-carbers, people saying to eat a more low-carb, ketogenic, higher fat diet, who oftentimes, not always, but oftentimes basically say this whole thing about cholesterol and LDL causing heart disease is a big bunch of nonsense and it’s totally not true. Actually, the opposite is true. Here’s a study showing a direct correlation between higher cholesterol levels and lower rates of mortality, and so on.
Then the evidence-based people are very angry at those people who are questioning the whole cholesterol-heart disease link and questioning the value of statin drugs, and there’s this sort of battle going on between those people. Then I also have friends who are physicians and more natural health-minded who will say, “Well, yes, there is this relationship between cholesterol and LDL and heart disease, but we should focus more on lifestyle, and only in the last resort, maybe we use statin drugs.” Do you think that’s a good representation of the different camps that are out there?
Dr. Rob: Yes. Yes, I think so. I’m the first to say, I don’t think anybody really understands the whole picture of heart disease and the mechanisms for it. I think statins are very popular. They’re one of the most prescribed drugs because up until recently, they were the only drug that would have any effect on heart disease by influencing LDL cholesterol. I think LDL cholesterol and statins have an association with lower heart disease that may be doing an effect in anti-inflammation rather than LDL cholesterol because, as you know most patients who come in with a heart attack don’t have elevated cholesterol.
Then the famous meta-studies are now, at least some of them, showing that all-cause mortality, when you lower cholesterol, the heart rate death drops 1%. Wait a minute, I’ll take that 1%. It’s still the number one because of death. Why not do it? The other causes of death go up, things like traffic accidents, suicide, other things that aren’t necessarily related to heart attack but could be influenced by cholesterol manipulation. The brain is mostly cholesterol and this sort of thing.
Ari: Just to be clear, and sorry to interrupt, but the implication there is that maybe lowering cholesterol levels below what the body is trying to have them at, in those cases, is impairing brain function in a certain way that translates into potentially higher rates of death from other things.
Dr. Rob: That’s one interpretation. I sort of agree. Like most other markers there’s a u-shaped graph for cholesterol. Maybe too much is too bad and too low is too bad. Some people are saying the lower the better. I don’t agree with that just because cholesterol has so many other functions in the body and we’re still not sure of its role in atherogenesis. It may be an innocent bystander in the blood vessels and all.
Ari: It would seem to anybody, and unfortunately conventional medicine doesn’t view things through this lens, but to anybody viewing things through the lens of evolution, which is in my opinion the only way to view human health and biology that makes any sense, it would seem that it wouldn’t make much sense for LDL levels to have evolved to be kept on average at a certain range over millions of years, and for presumably this to be ubiquitous across all mammals, if it was just inherently harmful and it was better to not have any or to have much lower levels. You understand what I’m saying? It wouldn’t have made sense for evolution to keep it around if it was only doing harm.
Dr. Rob: Totally. Even if it is harmful, if we look at the hazard ratio or the relative contribution of the risk. Elevated LDL cholesterol is a relatively small risk for heart attack. Much bigger risk is smoking cigarettes or the biggest one is elevated triglycerides and lowered HDL, which are metabolic markers and fasting insulin and glucose. Basically, metabolic health is much more closely tied to heart attacks. I’m much more likely to die of a heart attack from eating donuts than I am from eating steaks or eggs. What I’m saying is the fat is not the problem in my opinion, it’s the carbohydrates, the effect on insulin, the effect on mTOR and those factors.
Relative risk and absolute risk reduction
Ari: You mentioned in passing there something about taking statins leading to a 1% reduction in risk of cardiovascular disease. This is an important thing to dig into, and I’m familiar with what you’re referring to there, which is absolute risk reduction, and I’ve seen some of the research on statins where they talk about a 1.3% reduction in absolute risk of heart disease.
What most people don’t know, and I think this is an important topic for you to address, and this is a statistical concept. This is how I think many people use statistics and pharmaceutical companies use statistics to deceive, to lie. That is this distinction between absolute risk reduction and relative risk reduction. Because frequently you’ll see studies, and if someone wants to Google right now, you what percentage do statins reduce my risk of heart attacks by?
They will find studies that say 27% and 35% and 43% and things like that. People can Google that right now and see that, and they’ll say, “What is this Dr. Lufkin guy talking about 1%? I see studies right here in Google that say, 37% reduction. 1%? This guy’s a crackpot. He’s misrepresenting the research.” Take people through this distinction between absolute and relative risk reduction.
Dr. Rob: Yes, it’s, as you say, sort of statistical alchemy. Lipitor is one of the original statins to come out, and when they came out, they had full-page ads in the medical journals and, of course, now in all journals, and they say, “Lipitor reduces the risk of heart attack by 30%.” They put it in their ads. What they were doing is that is the relative risk reduction compared to those on Lipitor versus off Lipitor. If you look at the absolute risk reduction, it’s only 1%. It’s the absolute risk reduction is what matters.
The problem is most physicians are not aware of that and people who read the articles are busy. Just like you said, they see 30% risk reduction for statin. Why wouldn’t I take it? Then you have doctors saying, “Well, we should put it in the water supply.” Even if it’s a 1% reduction, “Hey, you just said this is the number one killer for all of us. Statistically, we’re likely to die of that. I’ll take 1%. Why not take the 1%?” The reason is the side effects. We talked about the alcoholics mortality, but also lots of side effects like muscle pain and a number of different things. Brain fog that people have.
Ari: I think there’s some research showing increased risk of diabetes as well, right?
Dr. Rob: Yes. Yes, that just came out. Of course, when the drug companies report the risk, they report the absolute risk, not the relative risk, to minimize the side effects with that. It’s really challenging. The other alchemy they do is, muscle pain is a big problem with statins. Instead of having muscle pain as one side effect, they divide it into muscle cramps, muscle tenderness, muscle weakness, muscle stretching. There are several-
Ari: Each one is presented as being very rare.
Dr. Rob: Yes, so it’s sort of 10%, they each have 1%. They’re 10 items with 1% essentially. I think the benefits are exaggerated through the relative versus absolute risk, and the side effects are minimized through a number of things. Then we have the specter of the all-cause mortality not even changing, where it may be that the people who lower their LDL are at risk for other types of deaths that people who don’t take statins experience. The answer is really not in.
Doctors are forced to follow the rules
The problem is mainstream medicine, doctors have to follow the rules and they have to follow practice guidelines. If they deviate from certain recommendations about a statin, they’ll get dinged by their provider company and they may get fined, they may get reported, there may be disciplinary action. It’s very difficult to do that. One thing I found that may help some people that if they want to get off statins is as long as you don’t have a high risk profile, in other words, you haven’t had a previous heart attack, which makes things more complicated.
If you’ve never had a heart attack and it’s just for elevated LDL cholesterol, if you get what’s called a CT calcium score, it’s a CT scan, you can order it yourself. You don’t need a doctor to do it. It measures the calcification in the coronary arteries. Zero is best. It means no calcification. The calcification means plaque is there. Even the American College of Cardiology now allows, through practice guidelines, if you have a zero calcium score, you can go off statins safely and still be following medical recommendations. That’s what some people are doing, at least, as a way to get off statins without refusing care from their doctor.
Ari: Yes. The issue of the statistics that we were just talking about with absolute versus relative risk reduction made me think of Mark Twain’s quote, “There’s three kinds of lies. Lies, damn lies, and statistics.”
Dr. Rob: Absolutely.
Ari: The other layer to this story of statins is I’ve read a lot of research. With this, the presentation of all these numbers, these very impressive sounding numbers of relative risk reduction, I think just to ground this distinction in practical numbers so people can get what absolute risk reduction means, it’s like heart disease kills one out of five of us in the United States. We could say it’s a 20% risk of dying from heart disease. If you can take a drug that gives you an absolute risk reduction of about 1%, that means that you have a 19% dying instead of a 20% chance of dying from that disease.
Then you add to that picture, as you were saying, what is the risk of side effects? What is the risk that this drug will simultaneously increase problems in other ways, increase my risk of diabetes and other complications? That makes the situation even more complex at that point. Yet, we have so much studies that you can find very easily on the internet with a simple search that will tell you 35-40% reduction, which sounds very impressive.
Also, many doctors are very impressed by those studies. Many doctors, because of seeing so many studies like that, are under the impression that there is a really huge reduction in the risk of dying from heart disease. This is presented also to the patients, not only through doctors, but also through messaging, through news articles, through online TV advertising. The US and New Zealand are the only two countries in the world that allow direct pharmaceutical to consumer advertising. What ends up happening is that the whole population becomes convinced that there is this really huge magnitude of effect size. I’ve seen this quantified in research where they’ve shown that people overestimate the efficacy of statins in reducing their risk of heart disease.
When you poll, when you ask questions to people who are on statins, who were recently prescribed them, the doctors talked to them about statins and how much they reduce their risk of heart disease. People are taking the statins, you ask them questions about how much they think taking those drugs will reduce the risk of heart disease. What this study found is that on average, people overestimate the magnitude of effect size by over a hundred orders of magnitude or something to that effect. Something like astronomical, that people just have a wildly disproportionate sense of how effective these drugs are that is totally disconnected to the reality of the actual evidence showing what is objectively quite minuscule effects in terms of absolute risk reduction.
Dr. Rob: Yes. That’s a great point. I’d also like to shift some of the, not blame, but at least responsibility on not just the medical system, but also the patients to some extent. Because I, as a patient, know that when I go into the doctor’s office, I would much rather have a pill, let’s say you just take this pill once a day, and it will take care of your problems, rather than a recommendation for lifestyle change. Because lifestyle change means I have to change who I am, whereas a pill is no investment at all. It’s a few seconds a day, or even surgery, I just have to take a few days off work, but I don’t have to change who I am.
These lifestyle changes to really move the needle on diabetes risk and these other things, there really isn’t a pill for them. It means lifestyle. It means changing our behaviors, changing what we eat, who we are, and even that education may not even be enough just because of the whole addiction issue that we’re driven by our childhood traumas and things that are making us eat the junk food, and it’s not enough to know that junk food is going to not let me see my grandkids, but I still eat it.
The population are indoctrinated to follow the narrative
Ari: Yes, 100%. I think to even go more upstream of that is the fact that, especially in the United States, we’re all indoctrinated into a sort of collective cultural narrative from the time we’re kids. Without even realizing it or choosing it, we’re indoctrinated into this cultural narrative of, doctors will have the answers, pharmaceutical companies are looking for the cure, so once I do have some kind of problem, some symptom, some disease, what I do is go to a doctor, they deliver the cure in a pill form, in a drug, and that’s the answer.
That’s how we’re all taught to think about our health from the time we’re kids, and so most of us are not taught to think, my health is a product of my lifestyle choices for decades, that’s the root cause of my problems, when I have symptoms, what I need to do is alter my lifestyle and address those root causes. They think, I go to a doctor, doctor gives me pill, I can carry on living my lifestyle as normal, take the drug, the drug cures me.
Dr. Rob: Yes, and that’s absolutely true, and the other thing is that the whole model of I go to the doctor and I don’t have the disease until the doctor tells me I have the disease, what was a real wake-up call for me for literally all these chronic diseases, we’re realizing that they begin not when the doctor tells me I have diabetes or I have Alzheimer’s or I have something else, but they start years to decades before that, and that’s the time to start prevention, and if we wait until the doctor tells us that we have one of these things, we’re at a real disadvantage as far as treatment, aside from the fact that the pills and surgery won’t work to reverse it, we’ve already lost years of time that we could have changed the course of our lives.
The lies we are told about Alzheimer’s
Ari: Yes, 100%. I would love to dig into so much more here. I don’t think we’re going to have time to get through all my lists of questions, but I’d like to go into Alzheimer’s next, and the lie that you wrote on Alzheimer’s is, “Alzheimer’s disease is a progressive untreatable disease caused by beta-amyloid accumulation.” Why is that a lie? What’s untrue about that story?
Dr. Rob: Well, Alzheimer’s is interesting because unlike all the other chronic diseases that we talk about in the book, Alzheimer’s is the single one of them that there currently is no pharmacological treatment available, or surgery, for that matter, so there is no pill or surgery for Alzheimer’s disease, and if you think about it, Alzheimer’s disease represents the ultimate failure of the healthcare research establishment, because it’s literally been decades of time and unlimited financial resources to find something that will work for this, and the model that has been followed is this beta-amyloid hypothesis, and we talk about in the book how that’s flawed, all the way from fraud in scientific articles now that we retracted on it, but to the point where not all patients with Alzheimer’s have beta-amyloid abnormal levels and not all people with abnormal beta-amyloid levels even get Alzheimer’s disease, so there’s a disconnect there.
In the book I reference a lot of the work of Dr. Dale Bredesen and others who look at Alzheimer’s disease as a multifactorial disease that stems from things like toxicity and mold and lime and mercury and lead to metabolic abnormalities, glucose, type 3 diabetes, and there’s strong evidence for, throughout the book we talk about a metabolically healthy state and how to get there, and it turns out the ketogenic diet is one way to turn down the mTOR and turn off the glucose and everything, but it’s fascinating that the ketogenic diet when applied to Alzheimer’s patients actually, for some, not all of them, but makes the brain fog go away and the memory come back.
It also does that for mental illness and schizophrenia. Again, some, not all, but it does the same thing for cancer, for heart disease, for obesity, for hypertension, for diabetes. It’s fascinating how changing the metabolism for all these diseases across the spectrum will have that effect, but to your point with Alzheimer’s, I think at its base is metabolic effects with other. By metabolism, I mean inflammation and insulin resistance, and APOE4 is the classic allele for Alzheimer’s disease.
It’s really not an Alzheimer’s disease allele at all, it’s an inflammation allele, and its survival advantage was most, APOE4 used to be the most common human allele up until recently in history, and it was because we were constantly being infected with brain parasites, and having a brain that turns on the inflammation really rapidly, which APOE4 does, would protect us against these, and that’s the theory, at least for the survival advantage, but it’s not just the brain, APOE4 is associated with cardiovascular disease and atherosclerosis, turning up the inflammation in the blood vessels, too, so I think it’s not the beta-amyloid, I think it’s these other factors.
Ari: It’s interesting, I think, and you correct me if I’m misrepresenting you in any way, but I think for almost everything or for actually everything that you mention in the book, from Alzheimer’s to heart disease to hypertension to cancer to what else is there, fatty liver disease, obesity, diabetes, all roads sort of lead back to Rome, Rome being nutrition and lifestyle, and at the crux of that, would you agree with that?
Dr. Rob: Yes. I think they lead back to nutrition and lifestyle, but it’s not the complete answer. We can’t ignore the patient who has lead toxicity and then gets dementia, and is called Alzheimer’s disease, or the cancer patient who smokes cigarettes, or now obesity is overcoming tobacco as a leading environmental cause of cancer, and that’s a metabolic factor, but there are environmental factors that can affect each one of these, smoking and cardiovascular disease, but at the basic root cause, there’s one theme that just blew me away in writing this book, that this particular metabolically healthy lifestyle slows down or even reverses every single one of these diseases to the point where the last chapter, I didn’t intend to write a book about longevity, but when you slow down these diseases and reverse these chronic diseases, longevity happens. The same metabolically healthy diet, same thing turning down mTOR with lifestyle, and maybe even rapamycin, it has dramatic, so far the most impressive lifestyle prolongation effects in animal models of anything we’ve seen.
mTOR
Ari: Basically, doing those nutrition and lifestyle, and to the point that you were just making also environmental modifications, slows down the rate of biological aging at the cellular level, and that this translates into reduced development of many of these diseases, and in many cases, the reversal of many of these diseases.
Dr. Rob: Well, that’s the leading theory on aging that we just wear out, that my shirt wears out, my shoes wear out, my car wears out, that’s what aging is, we wear out. There’s a lot of evidence to show, wrinkles, gray hair, everything, that’s aging. The funny thing is, or the interesting thing is that I hadn’t been aware of before is that the chronic diseases that determine our longevity, and it’s a short list, as you said, there’s only five of them there statistically that are most causes for how long we live, those diseases aren’t really wear and tear diseases. In other words, when I die of a heart attack, it’s not like my heart wears out or my body wears out, it’s a specific hyperfunction of the blood vessels, this proliferation of atheroma.
Similarly, cancer, it’s not like the cells just wear out, instead, the cells go on overdrive, this proliferation. Same thing with Alzheimer’s, you could make the argument, it’s inflammation, it’s turned on, all this hyperfunction. There’s a theory, and we talk about it in the book about mTOR, which is a primordial metabolic switch that normally it’s switched on by things like insulin and glucose, and it’s good, it makes us grow, it’s an anabolic switch. When insulin and growth factors are not present, it turns down, and then it allows autophagy and repair of the cells. There’s a theory that while aging is due to wear and tear, that longevity itself is due to hyperfunction and overactivation of mTOR, and that’s why–
Ari: You mean reduced longevity is due to this?
Dr. Rob: I’m sorry, reduced longevity is hyperfunction–
Ari: You said longevity is due to like activation of mTOR.
Dr. Rob: Reduced longevity is due to hyperfunction of mTOR, and lengthened longevity, prolonged lifespan is due to turning mTOR down. The shining example of that is the one drug that specifically turns mTOR into that off position. Rapamycin is the leading pharmaceutical intervention for lifespan prolongation in animals, and indeed humans are using an off-label now for hopeful that they’ll see similar effects.
Ari: An interesting fun fact first. Rapamycin was given that name because it comes from the island of Rapa Nui, which is Easter Island, actually a place that I’ve been, very beautiful place. I think it’s a compound produced by a fungi or a bacteria there?
Dr. Rob: It’s a bacteria, yes. There’s a great radio lab that tells the story about it, but Easter Island was isolated until the 1960s by thousands of miles. In the 1960s, they were going to put an airport in, and suddenly Montreal wanted to send some scientists there to collect the dirt to get these unusual organisms before they were contaminated by the rest of the world. They brought back the soil in the ’60s and then discovered this bacterium that initially was an antifungal thing. It was for athlete’s foot. Then later on, now it’s FDA approved for cancer, for heart disease. It’s being used for Alzheimer’s disease. Wrinkles, gray hair, skin, hearing loss, menopause, it slows down. It’s just like almost every single phenotype of aging, and not only that, the diseases of aging as well. It’s remarkable.
Ari: My understanding of where it is currently is that, and do you have to go, are you okay to go a few more minutes here?
Dr. Rob: Yes, sure, yes.
Rapamycin
Ari: Okay. My understanding is where it’s at currently is they’re still in long-term testing to evaluate the long-term safety of taking it for lifespan extension.
Dr. Rob: Yes, rapamycin was first FDA approved at the turn of the century. It’s been around for 20-some years, so tens of thousands or maybe a million people that are taking it for all sorts of applications for FDA. There are FDA indications for all those things. It does appear to be very safe. People taking it off-label for longevity, it’s very difficult to determine human longevity just because of the lifespan. In the animal models, like the mouse longevity studies, it gives a significant increase in their lifespan, as it does in yeast and fireflies and roundworms, and dogs even, there’s evidence for that.
Ari: Is this something you take yourself?
Dr. Rob: Yes. Back to our other conversation, we all want a pill. Well, here’s a pill for longevity. Well, not really. We understand how rapamycin turns mTOR down, but mTOR itself is a very important longevity signaling molecule, but so were the SIRT2 and so is AMP kinase, and they all interact together. It appears that as powerful as rapamycin is, when you combine it with something like acarbose, which is another diabetic drug that blocks glucose absorption in the gut. You actually get synergistic effects on longevity in the animal models greater than rapamycin or acarbose by itself. There’s a lot of things we don’t know.
With that in mind, I would never take rapamycin without first doing everything I can in my lifestyle, having a metabolically healthy lifestyle with diet, sleep, exercise, and stress reduction, because only then will you truly get the benefits. Maybe the pill will add something, but the real secret, the real message is lifestyle, I believe.
Ari: Yes, I certainly agree with that. To be honest, I was a little bit depressed that the conversation went in the direction of emphasizing rapamycin, and leaving people with the impression, oh, well, after all the earlier discussion actually there is a magic pill and it’s this thing. I personally am quite skeptical of the research on rapamycin. I would put it this way, after roughly 75 years of pharmaceutical companies with trillions of dollars behind them and a mountain of research, where we have so much knowledge about the mechanisms of disease, and with trillions of dollars, they have created millions of drug candidates that are designed to interfere with this or that mechanism.
As it stands right now, we don’t have a single drug, not a single one of those millions of drug candidates, about 20,000 of which are FDA approved. Not one has been shown that we can give it to healthy humans, non-diseased humans, where it will make them healthier and extend their lifespan, and where the benefits outweigh the harms. As it stands currently, we don’t have a single one that fits that criteria. Some people are suggesting rapamycin may be it. I know lots of people, lots of researchers, and I would put myself in this camp as well, are skeptical as to whether it will ultimately turn out that the benefits outweigh the harms. Of course, I, too, like magic pills that with no effort we can take and get a big benefit from, and they have no risk of harm.
Dr. Rob: Well, the number one killer, as we talked about, is a heart attack. The number one treatment for a heart attack is to put a stent in, which opens up the blood vessel. Most people sadly believe, they get the stent, wow, they cured my heart attack. I dodged that bullet. Now I can go on with my life. Of course, nothing could be farther from the truth. That surgery, like most surgeries for chronic disease, may save your life in the moment, but it doesn’t change your lifespan. You’ll still die of a heart attack later on. It doesn’t change the underlying disease. The blood vessels continue to clot off, and the stents continue to clot off, unless you coat them with rapamycin. When you coat the stents with rapamycin, they no longer clot off. That’s one of the FDA indications for rapamycin.
Similarly on cancer, there are eight FDA indications for rapamycin for cancer, things like metastatic renal cell cancer, the number one kidney cancer that’s metastasized. There, you could say the rapamycin helps the person with the heart attack and the stent, maybe live longer because the stent doesn’t clot off as fast, maybe.
Ari: Well, I think there’s another layer to the story given to talk a bit more about rapamycin. Given the mechanism of action, that it’s something that activates AMPK, and basically suppresses mTOR, something that has that mechanism, and there’s lots of other things. There’s other drugs. I believe metformin also does that to some extent, and there’s natural compounds that also do that to some extent.
In a population that is very mTOR dominant due to chronic excess of energy consumption and obesity, and being in a state of having excess body fat, having insulin resistance, and that metabolic type where you have this excess of mTOR, and you’re not in a proper see-saw of mTOR and AMPK, you’re spending way too much time in mTOR dominance and not enough in AMPK, we could expect that a drug that maybe shifts that scenario to a better balance would have benefits in that demographic, especially which happens to be the majority of the US population.
I would expect logically that in a demographic of people like me, people who are very fit, exercising people who are also very lean, who do plenty of exercise, who have proper feeding and fasting windows, who go long periods where they’re maybe doing physical activity and not eating, where you do suppress mTOR heavily and you spend a lot of time in AMPK, I would expect a drug that works on those mechanisms to have way, way less benefit in the population that already has good mTOR-AMPK balance, and probably have maybe a strong benefit in people who are out of balance in that equation. Is that something you’d agree with?
Dr. Rob: Yes, I would totally agree with that. It goes back to I think lifestyle is really important, and people with the worst lifestyle are going to have the best benefit from minimal interventions, whether it’s dropping the carbs or the seed oils or the grains or exercising more and everything. The people that are finely tuned will have less benefit from it. One thing that was sort of a wake-up call to me, too, talking about with aging and mTOR being turned on, I always thought diabetes was a switch. You either turn it on and turn it off. You either have it or you don’t. There’s interesting studies about non-diabetic Americans in looking at their A1C levels, which is the marker for glycation damage and diabetes.
Their A1C levels with aging in these non-diabetics gets higher and higher and higher and higher like that. Now, I think of diabetes sort of like gray hair. In other words, if I don’t dive something else first, I think most people, if not maybe even all people, are on the road to insulin resistance and inflammation. Both those things turn mTOR into this fully on state. To your point, lifestyle may be able to reduce it, but I think it gets worse and worse the older you get. Hopefully, we’ll understand this better someday, and come up with some good recommendations for people.
The lies we are told about environment and lifestyle
Ari: Yes. The last thing I want to say, and I want to thank you for emphasizing the role of lifestyle in all of this, as well as environment and nutrition. I think of those sort of all under the umbrella of lifestyle. It’s interesting I’ve interviewed so many physicians, and it’s especially interesting in light of this whole discussion in your book, what is being taught in medical school, because we now have the evidence to basically show that 8 out of 10 people are dying from diseases of civilization, which are diseases of lifestyle.
The other aspect to, I think, this equation, what’s being taught in medical school, and you’re talking about a lot of the lies that are being taught, but another part of this discussion is what is not being taught in medical school. Because 8 out of 10 of what’s killing us, 8 out of 10 people are dying from diseases of lifestyle, and yet physicians, MDs, receive virtually zero education in nutrition and lifestyle.
I wish that I had a more powerful way of saying that, because that is such an absurd situation that I feel like words don’t even do justice to the absurdity of that situation. I think this is another huge aspect to this, like why is it the case that physicians are not being educated in the thing that kills 8 out of 10 people?
Dr. Rob: Back to what we said, the funding sources, junk foods have a big incentive to have people eat a lot of junk foods, like in the food pyramid, or they have a lot of incentives to make it okay to be fat. I don’t believe in fat shaming. I think it’s horrible. It’s unacceptable, but normalization of fat is something that benefits– It’s okay to be fat. Don’t worry about it. I think that’s something, too. There are all sorts of effects from– These pernicious influences continue all the way down the line.
I think even society, within the zeitgeist, if I go to my daughter’s elementary school, and somebody walks up and hands a kid a cigarette, the room will collapse on them and pull them out. If that same kid gets handed a bowl of sugar-frosted flakes with chocolate milk on it, everyone will smile and nod, not realizing what, in my opinion at least, is a really harmful beginning of life of junk food that’s going to result in increased risk for all these chronic diseases we talk about.
Ari: Yes, well said. Dr. Lufkin, I would love to have you on for two more hours. I have a long list of other questions that we didn’t get to. There’s certainly lots more in your book that is worth discussing. I strongly recommend everybody listening, go get yourself a copy of this. Understand this situation. We talked about many of the layers to this story here in this conversation about, I think, why you need to understand that not all information that you get can be trusted. You have to be skeptical. You have to think critically. You have to evaluate the evidence in depth.
Also this is a really hard thing to do, particularly for people without a background in science and a background in health science, medical science. This is a big ask of people to try to think critically through the evidence, to evaluate the evidence, to know who to trust. I’m curious, Dr. Lufkin, before we finally wrap up, if you have any thoughts on that issue. How can people know who to trust and who to take advice from, given that there’s so much complexity to this story, that so many people are in possession of bad information, and there may be even corruption and scientific fraud, and bad actors and people who are deliberately lying, or well-meaning people who are unintentionally giving bad information? How do you think people should navigate this, and how should they go about getting good information?
Dr. Rob: Yes, describing it like that, it’s very difficult and very intimidating. I think one rule, Ari, that helps me is to look at the funding sources, like we talked about before with, who funded the paper, who’s paying for the ads on the American Diabetes Association, who funded the American Heart Association so that now they advertise vegetable oil as heart healthy for everybody, who in American Dietetic Association of dieticians, why do they have Coca-Cola as one of their main sponsors at their meetings and all the junk food, how does that translate into now dietary recommendations that we all get? That’s a start, but I think it’s a challenge, and something we have to keep looking for answers for.
Ari: Yes, and hopefully find people who seem to be, you never know, but find people who seem to be honest actors, high integrity, who are experts, who are trying to, as I think you are, and I certainly try to be myself as well, of course. Hopefully that shows people who sift through the evidence and try to make sense of it, and sort out fact from fiction, sort out BS, and sort out fraudulent and corrupted science from good science, and do all of that hard work. Hopefully, if you find maybe a handful of experts with honesty and high integrity who seem to be doing the work on that front end, really people who you can trust, authorities you can trust, I think, hopefully, that’s a pretty good solution as well.
Dr. Rob: Yes, absolutely.
Ari: Dr. Lufkin, as I said, lots more that we could talk about. Everybody listening, go out and get yourself this book, lots more to dig into here. It’s called Lies I Taught in Medical School: How Conventional Medicine Is Making You Sicker and What You Can Do to Save Your Own Life.
Dr. Lufkin, thank you so much for the work that you are doing. If there’s anything that you want to say to people to wrap up, you have the floor, and then let people know as well where they can find you, where they can follow your work, or anywhere else you want to send them.
Dr. Rob: Yes, just one last question people ask me, if you’re writing this book, aren’t you getting depressed with this situation and all those things? Actually, no. I find it inspiring because I think we’re entering a new era of health care, where a new era where the patient is in control. In other words, as a patient, I no longer just passively receive information, pills, and surgery from my doctor, whoever he or she is. Instead, I become the CEO of my own body. Through lifestyle choices, I realize that now I have agency. I can determine what happens to me.
The great thing about lifestyle is it’s something we truly do control. Every morning when we wake up, I get to decide when I eat, what I eat, what exercise, what sleep, as much as we can. I think that’s very empowering. I think, hopefully, this will translate into a new area of understanding chronic disease and prevention and all the stuff you mentioned. Thanks so much, Ari. These are some of the best questions I’ve ever had. I really appreciate your thoughtful ideas. It was great chatting with you.
Ari: Hey, awesome. Thank you so much. I really enjoyed this conversation as well. Thank you again for the work you’re doing. Everybody listening, go on Amazon or Barnes & Noble, wherever you buy books, go grab yourself this book. Dr. Lufkin, anywhere else you want to send people before we sign off?
Dr. Rob: Yes, you can get it at the public library, too, and your independent bookstores. My website is robertlufkinmd.com. You can download a free chapter of the book there. See if you like it. I’m also active on social media and follow me if you want.
Ari: Awesome. Thank you so much again, Dr. Lufkin.
Dr. Rob: Thanks, Ari.
Show Notes
00:00 – Intro
00:58 – Guest Intro
02:24 – Lies I Taught in Medical School
10:16 – The issue with the modern medicine approach
17:19 – The little-known fact about drug research
27:18 – The lies we are told about cardiovascular disease and statins
34:12 – Relative risk and absolute risk reduction
38:38 – Doctors are forced to follow the rules
44:44 – The population are indoctrinated to follow the narrative
46:44 – The lies we are told about Alzheimer’s
52:17 – mTOR
56:24 – Rapamycin
1:05:03 – The lies we are told about environment and lifestyle
Links
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