I have this thing.  Maybe it’s genetic, I don’t know.  I sometimes become intensely interested in certain things, foods, people, microcosms.   I can eat the same meals, order the same kind of coffee, read the same book, watch the same movie a zillion times.  It’s not so much that I get stuck in a loop as that I enjoy things more with repetition. 

When I was about ten years old, this intense focus landed on an unlikely candidate:  Amelia Earhart.  I spent a whole summer  with my sister and my best friend researching and writing little books about Amelia.  We spent days in the library when we could have been swimming at the Boulevard Pool.  We discussed the details of Amelia’s life with the same fascination star-gazers usually reserve for celebrity gossip mags.  We were endlessly intrigued by her life story, particulary her marriage to George Palmer Putnam, which we judged to be loveless. 

Recently, my odd propensity for intensity has landed on a new subject:  Otto Warburg.  Warburg was a Nobel prize winner who was born in Germary in 1883. As a German biochemist living in the mid 20^th century, he got to hang around with some pretty impressive company:  people like Albert Szent-Gyorgyi and Hans Krebs, the guys who figured out the Krebs cycle (a cellular process, the memorization of which torments med students to this day).  Otto’s career in science went on hold when he joined the cavalry in WW I.    He loved anything equestrian (he never married and had no discernible love-life).   His devotion to the cavalry made his family worry that he might remain in the army permanently.   He was persuaded to return to research by a friend of his father’s who knew a bit about science:  Albert Einstein..   

It was a lucky thing that Warburg traded horses for the laboratory.  He made a major discovery, known to this day as the Warburg Effect.  To understand this discovery, you first need to know that all bodily cells make their own energy; in other words, they self-create the fuel they need to stay alive and to do their particular work.  This fuel is called ATP.

 You probably recall that cells have a kind of gel inside called cytoplasm.  Within this cytoplasm are small organelles…tiny factories that have special jobs.  Normally, cells make a bit of ATP by burning up some glucose, or blood sugar, in the cytoplasm.  That process throws off a molecule called pyruvate which is then taken up by  mitochondria (which are organelles).   Once in the mitochondria, a complex process turns the pyruvate into lots more ATP.   Warburg’s fascinating discovery was the following:  cancer cells aren’t able to make fuel by this normal pathway.  In cancer cells, the mitochondria are not working and cannot process pyruvate.  Thus, cancer cells are left having to make all of their fuel from glucose in the cytoplasm.  This takes a lot of glucose.   Essentially, cancer cells are obligate sugar burners.

This is not the case for normal cells.  Normal cells can burn other fuels, in particular ; chemicals which are made from the breakdown of fat.  We all know about this because we all know about the Atkins diet.  When sugar in the diet is reduced to nothing and most of what is consumed is fat and protein, the body soon begins to run on ketones.  It does just fine on this fuel.   Many of us believe that we will die unless we have glucose, but there are only a couple of areas in the body that must use glucose as fuel.  Enough glucose to feed these areas can be created within the body.  We don’t have to consume it.   For proof, we can look at the native diets of people like the Inuit, who survived in excellent health on little more than fish, meat and blubber and the Masai, who eat mostly meat, blood and milk.

Warburg first articulated his hypothesis in the 1920s and the Warburg Effect has been widely accepted for many decades.  The PET scan, which is a test which identifies active cancer cells, is based on the fact that tumor cells use up glucose so avidly that they can be spotted this way.  On the other hand, one aspect of Warburg’s work has remained highly controversial. 

Warburg believed that cancer itself was caused by the damaged mitochondria.  As we all know, cancer cells have many mutations and appear damaged.  It was Warburg’s belief that this DNA damage occurred as the result of the switch to an unnatural cellular fuel production method.  As the years progressed, most cancer scientist’s research came to believe that damage to DNA came first and the damage went onto cause the mitochondrial problems Warburg observed. 

Warburg was aware of the slipping acceptance for his hypothesis about the cause of cancer.  He never wavered in the belief that he was correct.  As he said at a meeting of Nobel laureates in 1996, “"the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar."  Further, Warburg felt that the refusal to accept his hypothesis was delaying research into treatments which might work on restoring mitochondrial function and thus cure, prevent or slow down cancer.   He himself became obsessed with dietary carcinogens as he became older and insisted on eating only organic foods.

So why am I so interested in Warburg?  You guessed it!  The sugar connection!!  Since it is my belief that ancient diets which are low in glucose-producing foods (starches and sugars) are the best for health, Warburg’s work makes a nice fit.  In doing some research on suggested diet for a patient who recently developed cancer, I came across Warburg.   I was hooked.  Two questions immediately came to mind:

1. Can consuming a very low glucose-producing diet slow down cancer?  If cancer cells can’t burn alternate fuels, this would seem to make sense.

2. Does continuing to eat a low glucose-producing diet perhaps inhibit small cancer “areas” that we may develop from time to time?  If that were true, would we see less cancer in those who eat such diets?

Interestingly, Warburg’s hypothesis is getting a new look.  The treatment of cancer with agents that might restore mitochondrial function or block the abnormal sugar burning process are now being investigated.  Here is one such attempt, reported yesterday in Science Daily.   This drug works by “choking off the sugar supply” to tumors.

But can we do something similar with diet?  To find out, I wrote to Dr. Thomas Seyfried, a Professor of Biology at Boston College.  Dr. Seyfried is among those who believe that cancer is a metabolic disease, as Warburg did.  He is conducting research on very low carb, ketogenic diets in the management of brain tumors.  In other words, he is trying to starve the tumors by forcing them to burn fuels that they cannot use.  Seyfried says that it is the number of calories (very low) and not the composition which is most important. The research is not yet advanced enough to draw conclusions, but Dr. Seyfried believes that such an approach may work.  When combined with other agents, it may work even better. 

As to the answer to question two, one can only speculate.  We know that animals that are calorie restricted have slower aging, less cancer and chronic disease.  Might this be related to a lower sugar environment?  So, I guess you know what I think.