Shocking Truth About Cancer: Fix Your Diet & Lifestyle To Starve It For Longevity | Thomas Seyfried

almost 30 years ago I started medical school in Edinburgh in Scotland and I still remember sitting in the anatomy theater being told by one of our professors that one in four of us at some point in our lives were going to get cancer and I remember being shocked this was back in 1995 I looked around thinking wow one in four now I know as things stand today that rate has gone up to one in two of us are going to get cancer at some point in our lives so Professor Seafood you've been studying cancer for decades now in your view what's going on well thanks um well you know in any kind of uh a disastrous situation um there's never one thing that could be responsible uh for the rise in in a particular disease I I think that um there are many factors that come together uh to account in part for this worldwide epidemic of cancer where most people uh that study epidemiology have now uh consider the view that it's just a matter of time before cancer overtakes heart disease as the number one killer of people in various countries so what's going on uh when you consider that are ancestral uh groups of people um cancer was extremely rare in uh in tribes and and and different populations that live by their standard ways uh ways that were common to those folks for for centuries all of a sudden now we have this explosion within the last say 50 or 70 years an explosion of of Cancer and a lot of it has to do with our Western Civilization diet and lifestyle we have more contaminants in the atmosphere we have less exercise and we have far more foods that are poorly nutritious and provide uh high amounts of carbohydrates I I think you put all this together because there's a direct correlation between the Obesity epidemic and cancer a correlation between the Obesity epidemic cancer and type 2 diabetes you put all this together Alzheimer's disease all these chronic diseases are on a increased trajectory so clearly it's linked to a change in diet and lifestyle over the last uh 50 to 70 years where we're really starting to see this this increase even even when we said the anti-smoking campaign here in the United States in the in the in the 1990s you know smoking was a major cause of lung cancer and other cancers but now with the uh reduction of smoking we're still seeing this Relentless increase and obesity now is replacing smoking is the num as a number one or a major risk factor for the development of cancer so I think it's a lot of factors coming together uh increasing our susceptibility to developing tumors in various uh organ systems yes really interesting one of the ways in which we get trained as Western Medical Doctors of course is that these different diagnoses these different illnesses are completely different diseases right we say things like oh you know this increases your risk of type 2 diabetes and if you have type 2 diabetes it increases your risk of another condition called Alzheimer's disease and what's really interesting hearing you talk about what's happened in the last well my question was the last 20 30 years but you broadened it out to 50 to 70 years is that it's not just cancer that's going up as you say we know that chronic disease is going up type 2 diabetes is going up Alzheimer's is going up cancer is going up and I know you have very much been trying to get the message across to people for many decades now that cancer is a metabolic disease so clearly these things are not quite a separate as they might initially seem that's absolutely right and and um metabolic homeostasis uh which is the uh absolute functioning of our cells in the appropriate way organ cells it's called metabolic homeostasis when you're basically a very healthy person you're in metabolic homeostasis so what's happening is our bodies are falling out of metabolic homeostasis as the result of a variety of insults from uh from largely from from the environment diet and lifestyle and these kinds of things but when you look back and say what is what is uh what is responsible for maintaining what in metabolic homeostasis and it comes back to our mitochondria within the cells um the organelle that uh ultimately is responsible for the metabolic homeostasis within individual cells and within the body as a whole so this organelle when it becomes corrupted or dysfunctional can manifest can Manifest this problem in in many different ways cardiovascular disease type 2 diabetes cancer uh Alzheimer's disease depending on the on the tissue and the cells of the individual and cancer we we know for sure that um every major cancer that I have studied has defects the number structure and function of the of the mitochondria and this then causes the cells to fall back on a on a primitive form of energy which is fermentation and that leads to dysregulated cell growth so we have I I have a very clear idea of the origin of cancer and how to manage it um the ramifications of these two say other chronic diseases we always find a mitochondrial connection it may not be always the same as what we see in cancer yeah well let's just go initially to something you you you mentioned at the start of this conversation which is when we look at these kind of indigenous populations we don't see cancer now some people may be thinking okay but how much are we you know examining these people how much are we scanning these people so do we know for sure that actually they don't have rates of cancer or is it just that we haven't found it so I wonder if you could just address that right at the top yeah well that's a good question but um when when we read the the work of um the humanitarian physician Albert Schweitzer uh he he definitely knew what cancer was he examined 40 000 Africans and living in their natural ways looking for cancer and he didn't find it so uh so he absolutely knew in other cases with the in Inuits of Alaska and the Arctic Circle some um British Physicians reported that cancer was very very rare but I don't think it was done as comprehensively as what Albert Schweitzer did in the African populations but others have looked as well and they kind of con uh concur what Schweitzer had seen in general uh human populations that lived according to traditional ways had a much lower incidence of cancer than those same populations that shifted to diet lifestyle for example the Inuits I I had the opportunity to visit the medical school at Thunder Bay Canada uh where they uh they uh service the the medical problems of the Canadian Inuit population and the Inuits now are are raked with uh diabetes cancer dementia uh which their ancestral populations never had so um clearly it's the change in diet and lifestyle that's largely responsible for the onset of these chronic diseases including cancer I've heard you say in a previous interview that our bodies are actually very resistant to cancer and I've been thinking about that a lot over the past few days that despite all the insults that are coming into our bodies especially these days although the rates are high you could make the case that the rate should be even higher so I guess when you say our bodies are incredibly resistant to cancer what do you kind of mean by that well I I think um uh when we live traditional lives like the Primitive folks and traditional ancestral groups not getting cancer or having very low uh rates of cancer um I think when we have the right diet and lifestyle I I think it becomes much more difficult for cancer uh to develop and a kind of an example of this was the there was a study done some years ago um with with uh I think they were macaque some sort of a monkey from South America or one of these places and they rubbed carcinogen they 20 methyl chlanthrines is a known carcinogen and and they rubbed it on the arms of these monkeys uh for 10 years inject them with it and everything else and they didn't get a single case of cancer uh from from these and they concluded that well these monkeys are not good models for cancer um but the monkeys were eating their their diet they were living in their natural environment um and they were quite resistant the con the the alternative experiment which was never done is why don't we give these monkeys uh High carbohydrate diets uh really changed their diet and lifestyle and then do these kinds of experiments and and I think that members of our ancestral groups uh uh having the correct exercise diet and lifestyle even even when exposed to carcinogens would have a much lower risk so when you take folks that are now uh not exercising getting obese uh you have you have them exposed to a variety of chemicals within the Food Systems the type of poor nutrition I think you even though we have a lot of resistance in our body to cancer right we're really we're really bashing down those walls of resistance by the diet Lifestyles that we're taking yeah I really like that example because I think it goes Beyond cancer for me into all these chronic diseases we can scare ourselves these days if we go online if we read about the toxins the pollutants the air pollution the diesel fumes that you know it can be really really scary to think well what can I do I'm going to be exposed to so much of this but what you just explained there is really the approach I take with myself and with my patients which is very much okay well what can you do okay what are the things you have control over what can you do in your own house and the more good things you can do the more of a buffer you create the more strong these foundations become to then resist the attack and the onslaught from the modern worlds as someone who's been studying cancer for decades now do you think that's a kind of fair analogy oh I think it's a really good analogy I I think I I think uh but it's hard you know it is hard uh uh we we are confronted now um with food sources in abundance uh our our exercise levels are far far lower than they than they were uh when we evolved as a species um you know this this whole way we live sitting in traffic in front of computers um with minimal exercise chowing down on on on poorly nutritious High carbohydrate Foods I mean over years you know little kids kids can do this uh because your body is strong and healthy but man you do that for 30 years and it just it just you know it crushes you down yeah um and so it's it's a combination of all these exposures and the lifestyle that we have and it's it cuts across um racial and and different groups I mean clearly it's it's a common it once that Western diet lifestyle enters into a population all of a sudden you see the onset of these chronic diseases it's very clear so so that never existed yeah previous so you can know you know what it is but what in the diet and lifestyle specifically is responsible for one of these chronic diseases you know as you said they're they're all Linked In One Way or Another and that one and that linkage in my mind has to do with the way we generate energy within ourselves and um uh the consequences of what happens uh to the body through this chronic assault year in and year out decade in decade out yeah we're going to get into the details here because I think it's really important and I think certainly for long time listeners of my podcast I think I hope there's there's a real awareness that actually the way we live our lives the choices we make the the behaviors we engage with each and every day over time they build up and they increase our risk or decrease our risk of getting sick in the future but we haven't spoken about cancer that much on the show so far which is one of the reasons why I wanted to speak to you and I think you've already so far spoken about Concepts that people are familiar with but possibly not familiar with when looking at cancer what I mean by that is just as type 2 diabetes doesn't happen overnight you don't just wake up one morning go to the doctor get your hba1c at 6.8 and go oh wow what I don't know what happened I I've just got type 2 diabetes no things were going on in your life for maybe five to ten years that was building up building up building up and now you've crossed that threshold can we say cancer adopts a a similar kind of model that you know you get the diagnosis at some point but things have been building up for a period of time I wonder if you could just expand on that and help us understand how one actually develops it in the first place yeah well you're right about that I mean it doesn't happen you don't you don't wake you don't go to sleep uh looking healthy at night wake up with a big tumor on on your lung or your kidney or something like this I mean the these these things when you have something that can be obvious now and detected uh um by um you know uh pathology pathological report or non-invasive Imaging I mean there's got to be a large number of dysregulated cells in that mass uh before you actually uh see it uh with with some diagnostic tool um but you know when I when I wrote my book on cancer Albert sent Yorkie uh who was a Nobel Prize recipient did work on vitamin C he called he called this cancer thing the uh an oncogenic Paradox how is it possible that so many different provocative agents uh could could elicit this a dysregulated group of cells in a particular organ or um part of the body in a in a common way what is the common pathophysiological connection uh among all the provocative agents like we know carcinogens they call chemicals that cause cancer as carcinogen this is a chemical that has been been determined to uh cause cancer so we refer to these chemicals as carcinogens we also know that we have certain viral infections like hepatitis C papilloma viruses and some of these other kinds of cars uh carcinogenic viruses they produce cancer we also know radiation can produce cancer we also know that chronic inflammation can produce cancer we know that intermittent hypoxia can produce cancer in certain cells what is the common pathophysiological mechanism by which all this happens we know that there are certain uh inherited genes in our body these are called secondary risk they're not primary risk factors but they in the right environment they they will list said cancer like the leaf Frau many syndrome you have the bracha 1 mutations for breast cancer so a woman might get breast cancer for her having a bracket one mutation they might get breast cancer from a clogged milk duct they may get cancer from systemic inflammation but when you look at it under the microscope the pathological report they say oh you have breast cancer so what was the origin why one woman why all these women that would have various guides they might all have different provocative agents that elicited uh the the common patent what the common pathophysiological mechanism mechanism is to all cancers is a chronic disruption of energy metabolism in the mitochondria of the cell followed by a compensatory fermentation now let me break that down because this is what Otto Warburg initially said he just didn't connect all the dots like we have he he said cancer elicits from chronic damage to the ability of a cell to generate energy from oxygen so we know that all of the cells in our body use oxygen to generate ATP which is the currency of energy in our body adenosine triphosphate okay so you and I are breathing we're talking uh because the air that we breathe in has oxygen in it oxygen serves as a the acceptor of electrons which allows the mitochondria to produce a vast amounts of of energy and the waste products are CO2 and water of oxidative phosphorylation all of our cells in our body the majority of cells except red blood cells are using this process so that we can remain alive what happens in the cancer cell over time that organelle that process becomes corrupted or deficient in some way but the but as warrenberg said if you disrupt oxidative phosphorylation or energy through oxygen too acutely the cell will die and you'll never get a cancer from a dead cell so whatever causes the cancer whatever the provocative agent does it doesn't do it acutely it does it chronically and by chronic disruption of oxidative phosphorylation it allows the cell to to replace oxidative phosphorylation with the ancient Pathways of fermentation the fermentation Pathways is energy without oxygen and all the cells on our planet existed uh in using fermentation before oxygen came into the atmosphere and that was about 2.5 billion years ago so the cancer cell adapts to a fermentation metabolism as a way to compensate for the chronic disruption of oxidative phosphorylation interestingly enough that same organelle the mitochondria controls the cell cycle it allows the cell to remain in a quiescent differentiated State and as that organelle becomes corrupted over time the transition to fermentation causes the cell to lapse into the default state which is proliferation so in this in this all of the cells on our planet uh were highly proliferative disregulated cell growth before oxygen came into the atmosphere to form metazones and more complicated complex uh organisms so the cancer cell is doing nothing more than falling back on Ancient pathway living in the living as if it were in the absence of oxygen and that's what cancer cells do they can absolutely survive without oxygen they don't use oxygen anymore so they're living without oxygen anaerobosis says Warburg called it their life without oxygen even when oxygen is present the cancer cell is the cancer cell is still fermenting so now you know what this cell is yeah it's so interesting so let's just unpack a little bit of what you just said first of all you said that I guess or my interpretation is that there are infinite numbers of insults that we can have on the human body and with respect to cancer it can be from pollution from radiation from you know whatever it might be we can have these insults but whatever those insults are for us to get a diagnosis of cancer there is a specific abnormality in mitochondrial function which occurs and at that point the cancer cell is no longer utilizing oxygen to make energy it's doing it using fermentation products and you're saying that so so if we go down that logic is it fair to say then that cancer is not really the diagnosis cancer is a symptom it's a symptom of problems in the mitochondria yes exactly you're actually right and then Warburg had said this and at that time he only knew about glucose fermentation lactic acid fermentation because ATP synthesis through oxidative phosphorylation is highly highly efficient so you can generate 30 32 to 36 ATP molecules for one mole of oxygen consumed but fermentation is a very inefficient system so what is the raw material to generate fermentation yes glucose but uh but the glucose can only generate a couple of ATP relative to the vast number from oxidative phosphorylation so in order to make up the difference in energy you have to take in massive amounts of glucose to in order to replace the energy that you would have gotten from uh that the cell would have received from oxidative phosphorylation so consequently the Transporters for the the sugar glucose are massively upregulated on the surface of cancer cells and this is one of the reasons why you can Tech tumors using position of pet scanning positron emission tomography you can you can you can see cancer because it's sucking down so much so much uh glucose um but what we have found and Warburg did not know um we have also discovered that these same tumor cells also ferment the amino acid glutamine so they can they can use glutamine in the absence of oxygen in a fermentation mechanism so the two fuels the glucose and the glutamine are the two predominantly the predominant fuels for fermentation so uh once you know this once you know that these tumor cells are dependent on uh non-oxidative energy which is called fermentation energy without oxygen what what generates listen without energy nothing can grow period energy is absolutely essential for life so if the cancer cell is using a different type of energy metabolism what is it it's fermentation wow okay great what are the fuels that are driving the fermentation well one of them is glucose as Warburg said and the other one is glutamine as we have now found as the second major fermentable fuel in these tumor cells and these two fuels work together driving all of the necessary processes for Rapid development rapid proliferation and for um it's the constant dysregulated dysregulated growth DNA RNA protein synthesis the glutamine has the nitrogen and carbons to make new DNA and RNA the glucose has the carbons the fatty acids and proteins and these two fuels are driving the Beast and once you understand then the other thing you need to know is that they can only use fermentable fuels fatty acids and Ketone bodies are non-fermentable fuels they're not they cannot be used by tumor cells but they're they can be used by normal cells that have normal mitochondria so the solution to the cancer problem is simultaneously targeting the ferment fermentation metabolism of the cells which is the glucose and glutamine but by transitioning the body over over to Ketone bodies which allows the normal cells in the brain and all the organs to to function and fatty acids for the liver through our cells can't use fatty acids and Ketone bodies so the solution is a cancer problem is very simple you have to simultaneously Target the fermentation while transitioning the body over to fuels that cannot be fermented and this now puts massive pressure and kills the tumor cells without toxicity wow I mean it's so clear when you when you say it like that because like if you were not MediCal right if you knew nothing about cancer and the pathophysiology but you knew that Hey listen a cancer cell cannot use oxygen even if oxygen is around it doesn't use oxygen to generate energy it can only use glucose and glutamine right if that's all you knew you told a child that I reckon a child will say okay well let's not give the body any more glucose or glutamine if that's what cancer cell feeds on let's stop it right now that may be overly simplistic but it kind of sounds like that's the conclusion from what you're saying yeah well I think the you can't stop the glutamine because uh it's a non-essential amino acid and it's the most abundant amino acid in our body it plays in a more a massively important role in our gut our immune system the urea cycle so glutamine is is they call it a non-essential amino acid but for cancer it's an absolutely essential amino acid you can use diet and lifestyle to lower blood sugar for sure but you need drugs uh that will interrupt the glutamine pathway the glutamanolysis pathway essentially so we use a combat a combination of of diet and uh repurposed drugs uh in the what we developed called The Press pulse therapeutic strategy for managing cancer where we can we bring the body into a state of very low glucose High ketones and then we hit the surviving tumor cells with uh drugs that Target that can Target and disrupt the the glutamine pathway but we do it over very we pulse it we don't do it too aggressively knowing knowing the value of glutamine for the normal physiological function of our body you can't go after glutamine uh aggressively because you're going to harm the body so you have to know the biology you have to really understand biology evolutionary biology to manage cancer and once you understand that like you said it's quite it's not that complicated uh once you break down uh the issues so so um once you understand the issues and dissect them I mean yeah there's you have to know about energy metabolism and you have to know about a variety of these things for sure but once you know that then the the path to resolution the path to long-term management without toxicity becomes obvious you mentioned oxygen making energy in the presence of oxygen or making energy well in the presence of oxygen but without utilizing oxygen and I think a lot of the public have heard about aerobic exercise and anaerobic exercise so they understand I think a lot of people that will remember from biology class at school that when your body's utilizing oxygen you can do certain forms of exercise but if you push up the intensity and let's say you're playing football or doing lots of high intensity Sprints that at some point you go to anaerobic where actually you're generating energy no longer using oxygen or not exclusively using oxygen for people who are thinking about that can you help us understand like is is there a similarity there between what you're saying about cancer and the difference between aerobic and anaerobic exercise yeah well I think that's a that's really a an important point with the sprinting you build up lactic acid because the uh the muscles are working at such an incredible speed uh that the amount of oxygen delivered to the tissue in the blood is not is not uh enough to keep the muscles uh working through an aerobic mechanism but the muscle can generate tremendous energy using anaerobic uh short periods of time for short periods of time your muscles can burn energy uh through anaerobic mechanisms which is which is taking in a massive amounts of glucose and getting energy now as soon as the muscle stops Contracting you're breathing oxygen so that the the muscle can recover uh ATP synthesis through oxidative uh phosphorylation but when they were in that sprinting condition uh they were dumping out lactic acid which and this was the how they found the Quarry cycle Sol and Gertie story that received the Nobel Prize when the muscles were dumping out massive lactic acid into the bloodstream from this very active activity the lactic acid would go to the liver and the liver would conjugate the lactic acid back into a glucose two lactic acids were reconfigured into glucose molecule to replenish the the blood sugars now muscle is very interesting because it's it muscles conserves IT muscle does not share glucose with other organs this is a very interesting thing information is not enough to make change in your life you have to take action so to help you take action after watching this video I've created a free nutrition guide for you this contains the five most important practices I've seen in over two decades of seeing patients they work for you no matter what your dietary preference there's a step-by-step action plan to help you implement those changes in your life if you want to receive that free guide right now just click on the link in the description box below and it's an evolutionary can serve that adaptation so muscle stores energy in the form of glycogen you have glycogen in your muscles and that energy that can be broken down very quickly for Rapid for rapid rapid energy but muscle does not share a glucose with any other organ for from Mostly and that's because when a lion would chase us we better damn well have enough energy in our muscles to run away because if you're sharing if you're sharing your energy with some other organ you're not going to be able to run as fast when the lion chases you so um uh so clearly the conservation of energy within muscles is an evolutionary adaptation for survival liver on the other hand will store glycogen and that glycogen in the liver can be shared in fact it's shared majority mostly with the brain and uh as we stop eating blood sugar goes down glycogen is mobilized largely from from liver uh which can then subserve the function of the brain brain Burns a lot of a lot of glucose on the other hand if the glycogen stores that's why it takes about 36 hours after you stop eating for the glycogen stores and the liver to be depleted and then all of a sudden we then mobilize energy out of the adipocytes in our body and the adipocytes release the fatty acids back into the bloodstream those fatty acids go to the liver and the liver makes Ketone bodies water-solubles break down products of the fat which can then provide the brain the energy for the brain so we are an unbelievably uh sophisticated machine that we have these different organs and different populations of cells that can be flexible and how they generate and use energy the cancer cell on the other hand is trapped it's linked only into a fermentation energy so knowing that this cell is massively Limited in its capability of survive rival we now have strategies we can take advantage of knowing how the Body Works to eliminate and kill cancer cells without toxicity once you understand evolutionary biology and systems physiology you now know the strategies for managing cancer through the lens of evolution you mentioned before oxygen came into the atmosphere and before we evolved into being multicellular those single cells would generate energy through the process of fermentation which is what cancer cells do yeah so is the cancer cell then moving towards a more primitive form of energy production yeah you're actually right I mean we can't we can't say the cells before oxygen came into the atmosphere as cancer cells because cancer cells develop from cells that were differentiated they were they were a part of the Society of cells however they share a common uh energy mechanism they ferment um and fermentation before oxygen came into the atmosphere was the way the way all cells uh uh gut energy was a fermentation mechanism and they would ferment um whatever carbohydrate or whatever amino acid would be in the environment and interestingly enough it was called the alpha period of of life on Earth as saint gergy called it all of the cells at that time had dysregulated cell growth they were unbridled proliferation and they would proliferate like crazy until the fermentation fuels in the environment dissipated and then they would die uh cancer cells are the same they they will survive as long as there are fermentable fuels in their micro environment and when you remove the fermentable fuels in their micro environment they die very quickly just like cells did in the old days the the old days let's put it this way in in the time before oxygen so but their behavior is very very similar and and when you say cancer cells look very primitive like when you uh when you look at cancer under a microscope I mean it's just a massive pile of cells in all different dysmorphic stages um they look very primitive they look they look uh very uh undifferentiated compared to the normal cells of the organ from which they arose but the commonality is that the cancer cell is surviving on fermentation um because it's oxidative phosphorylation is defective the cells before oxygen came into the atmosphere had no mitochondria were a fusion between two different organelles two different organisms uh an organism that could capture the oxygen and use it for energy so we had this symbiotic and that led to the formation of metazoans which are multicellular organisms of which we are all medicines multicellular couldn't have multicellularity until you were able to capture the energy from oxygen in the in the fusion hybridization between these organ between these different organisms so the cancer cell is simply using the heirlooms of energy Metabolism from the past to grow in a disregulated way and and that dysregulated growth will continue as long as the cancer cell has access to fermentable Fuels in the micro environment so our way of managing cancer is simply to restrict the availability of the fermentable fuels in the micro environment using both diet and specific drugs uh and then using the normal cells of our body to out-compete and digest and destroy the cancer cells it's under believable when you really understand the mechanisms and the strategies involved you can get very excited about it well it's absolutely fascinating to hear it how we've evolved how we get energy and then what happens to that cancer cell and how it reverts back to actually maybe the oldest form the oldest way that we have the generating energy the cancer cell is utilizing that so that's that's really really interesting I want to talk a little bit about genes and genetics because we hear a lot of things like in the media let's say over the last 10 years there's been a growing awareness of Brecken one and bracket 2 and how that potentially can increase the risk of things like breast cancer or ovarian cancer by 50 to 80 depending on which study you read now I'd love to know your thoughts on that but I'd also love to know just more broadly about this relationship between genes and cancer I have heard prominent oncologists in the UK professors say things like we are born with the genetic codes for cancer within our cells but they're kept locked in place by suppressor genes and then something happens whether it be from you know carcinogens in the diets or the environments or whatever we're exposed to and then what happens is that genetic material becomes rearranged and once it becomes rearranged those cells no longer stop growing and they become cancerous and they spread so that's a Viewpoint I've heard what is your view on that and I guess more broadly where do genes fit into this whole conversation around cancer yeah uh well of course that's the basis for the somatic mutation Theory here in the United States National Cancer Institute on their website they say cancer is a genetic disease caused by mutations in specific genes uh tumor suppressor genes and proto-onco genes and these kinds of things and this leads to a dysregulated uh cell growth and this is the dominant consistent view we have right now the somatic mutation Theory uh where uh the mutations arise randomly in a population of cells which then leads to uh disorder of the cell cycle and and the proliferation but you have two different kinds of genes you have those inherited in the germline and you have those that are acquired through various insults in in the environment when you mentioned about brachial one the high the that's a inherited mutation uh that contributes to a greater risk for breast cancer and when you look at what does the bracha 1 mutation do it disrupts oxidative phosphorylation in the mitochondria the most the most uh prominent inherited mutation is the p53 mutation in the leaf from many uh disorder syndrome the leaf around many were about 80 percent you have about 80 to 85 percent penetrance of that Gene leading to ovarian cancer breast cancer brain cancer is a variety of cancers that are linked to the leaf from any believe from many encodes a protein in the electron transport chain of the mitochondria cytochrome C oxidase II so what you do what these inherited mutations are doing we went through all the inherited mutations and all of the inherited mutations risk factors uh damage mitochondria in a particular way uh putting them on the path to destabilized energy metabolism in a consequent fermentation metabolism so so the inherited mutations are we call secondary risk factors not primary risk actors because in order for an inherited mutation to be a primary cause of a disease like like uh the pre-senaline mutation and Alzheimer's disease that's a hundred percent associated with the development of Alzheimer's disease there is no cancer Gene linked uh a germline linked mutation that is in what is 100 associated with the onset of a particular cancer so we call those secondary risk factors just like being exposed to a carcinogen if you inherit a mutation in bracha one or one of these your your risk for the development of cancer is certainly higher but it's not 100 100 percent now the in somatic mutations this is where the cancer this is where a cell in the body will randomly accumulate mutations uh some of which will then lead to destabilized growth okay so where the somatic mutations come from and they come from destabilized energy metabolism in the mitochondria how does that happened so Ros reactive oxygen species are a byproduct of dysfunctional oxidative phosphorylation so the oxygen that the tumor cell is taking in is not being used efficiently for ATP synthesis but rather is throwing out these radicals these reactive oxygen species what do they do they cause mutations in the DNA they lead to the mutations in the DNA so the mutations that we see in cancer are largely Downstream epiphenomena of the damage to oxidative phosphorylation forcing the cell into a fermentation metabolism leading to acidification of the micro environment which further damages the nuclear genome so that most of what we see in cancer the genetic mutations are largely Downstream epiphenomena of the damage to oxidative phosphorylation so they're not effects they're not causes they're effects of this whole process okay so let's just get this really clear so because a lot of people will have absorbed the idea that cancer is genetic and of course you know that there's been a there's been a conversation online for I would say at least 10 years about what a woman might want to do if they have one of these brachi mutations and I think there's some very prominent examples of women having prophylactic operations removing both breasts to try and ensure that they don't get breast cancer in the future and I definitely want to get your perspective on that and your view on on these kind of procedures but the big picture I'm getting from what you're saying is that look these genes may increase the likelihoods that you are going to develop cancer but they're not 100 they're not deterministic genes fully so yeah yeah their risk we call them risk fat it's a risk factor right it's a risk factor but if you make uh significant modifications to your diet your lifestyle your environments the amount of stress you're under or all kinds of things that you try your best to to significantly change your environment you can then also significantly decrease your risk of developing that cancer even if you have the gene yes you are absolutely correct so you have you have I guess at least two choices if you are detected to have uh the braco one let's just use that but there are there are several other genes that this would also apply to but the brachial one you rest because you some women uh have done prophylactic removal of breasts and ovaries and things like this to reduce their risk for getting cancers in those organ systems or recognizing that they would have this risk factor how would they reduce the probability of that inherited mutation causing cancer and you're absolutely right Cancer Cannot occur if the mitochondria in the cell remain healthy and how do you keep mitochondria in your cell healthy by exercise and enhancing ketogenesis how do you do that well you can do water only fasting you can do a variety of of of diets that will reduce glucose and Elevate ketones ketones are a super fuel for mitochondria they reduce reactive oxygen species the damaging the damaging byproducts of respiration so ketones can significantly reduce damage to mitochondria allowing that organelle to function in a highly precise manner for long periods of time so yes diet and exercise in the right Foods in the right context could take the risk of a hair mutation that we would say 50 percent chance of getting a a cancer with that mutation you could reduce that down massively I don't know to what extent because the studies haven't been done in the correct population but but we do know that we can significantly just as you said you can significantly reduce your risk knowing that and you can't get cancer without uh you get cancer from damaged respiration protect the mitochondria and the risk will go down look I'm all for informed consent like real informed consent so you tell a patient you know what all the options are and of course a patient is entitled to do what they want right then they're entitled to do what they want with their own body but what I'm passionate about why I work so hard on this show each week is to help give people information so actually they're empowered to know well actually there are some options here there are some options now someone may say I don't want to take that option fine informed consent to me means or one part of it is giving people all the options so if you have been diagnosed with epilepsy as well as the anti-epileptic drugs if there's good evidence as there clearly is that ketogenic diets can be of use and in some people can be transformative surely you should also be told that at the same time now you may go but I don't want to do a ketogenic diet it's too difficult it doesn't fit my life fine you're entitled to make that decision but you kind of need to be given that choice if we're going to be evidence-based if we're truly practicing informed consent rights yeah absolutely I was on on those decision committees when I was a member of the epilepsy Society of America I was the society's representative to the corporations on this whole thing and you know um the ketogenic diet developed from um Wilder in 1921 one only when he realized that many of these intractable seizures could be modified significantly with water only fasting but water only fasting is only good for a certain period of time and you have to eat something so uh what he found was that when you water only fast blood sugar goes down ketones go up is there a diet that can do what water only fasting could do and that was the the ketogenic diet it was managing a lot of different in children it works in adults but it's the the children the problem is with kids is that when they have a a blown seizure or they have absent seizures or whatever it disturbs the parents tremendously and the parents have control over the child's diet at what they're doing so in order to avoid seeing your child writhing on the floor and foaming they would say okay you're going to stay strict on this diet because I don't want to see who sees in the 1930s certain drugs became available that would also stop seizures and obviously it was much easier to take the drug than to adhere to a kind of a rigid buy it the problem with these drugs is long term they have very adverse consequences and then in the 1990s mid 1990s Jim Abrams uh of a movie producer from Hollywood his son Charlie uh had this terminal kind of epilepsy where he was actually dying and then he contacted Folks at the Johns Hopkins Medical School in Baltimore the late John Freeman who was one of the few guys left that that liked to study uh ketogenic diets and they rescued Charlie uh from his condition they made a movie out of it first Do no harm was the movie by Merrell with Meryl Streep uh a friend of Jim Abrams uh made this movie which then brought tremendous attention back to this ketogenic diet uh uh because uh it had been it had fallen by the wayside when I was at Yale University in in New Haven Connecticut I wanted to do a project on ketogenic diet internal support and the people in the neurology department in the medical school in general said ah ketogenic diets nobody's interested in that stuff anymore so my grant was just like oh no no more so when one of my students came to me in the late 90s when I was here at Boston College and said hey there's a there's a meeting in wash in Seattle Washington on ketogenic diet spearheaded by Jim Abrams because his son Charlie uh did so well in this ketogenic diet he wanted to bring the concept to the world that this ketogenic diet should be resurrected as a non-toxic management for epileptic seizures so I told my seizure that nobody's interested in ketogenic diets so please send me anyway so I sent her out there that means she came back oh my God you can't believe how powerful the diet is everybody's so excited about this diet for epilepsy so we started working on ketogenic diets because we had the best animal models of epilepsy just like humans with Epson seizures and all this kind of stuff and we started to see wow this this diet does work on the animal models as well and I said we published all these papers and everything and um I said wow what's the mechanism of action I know you got to lower glucose and Elevate ketones well we were doing research on cancer at the same time looking at angiogenesis which is the the vascularization of the tumor cells so we put the the when we put the epileptic mice on on calorie restricted diets that lowered blood sugar elevated ketones we knew from from Warburg yesterday I said what the hell Warburg he said you lower blood you're lower blood sugar you can manage cancer so we started to put uh move the diets that we were using to manage epilepsy in the mice onto our cancer models which are the best model that we spontaneous models of cancer in the mice and lo and behold we said holy crap this these uh calorie restricted diets knocked the hell out of angiogenic when everybody's getting excited about angiogenesis you can you can completely manage angiogenesis with these diets and you know Napoleon Ferrar and all these other guys that were making all these anti-angiogetic immunotherapies and and stuff and a lot of them don't work and they cause the cancers to be worse but when you when you start using metabolic therapy so after we saw that and not only that we started killing these cancer cells through a variety of different mechanisms okay uh and then we said oh we should be shifting shifting our power away from the we use we actually had two uh parallel programs uh metabolic management of epilepsy and metabolic management of cancer but of course uh folks from England and the United States got together and they wrote up a clinical trial they said well we can't believe uh epilepsy managing epileptic seizures with ketogenic diets there's no clinical trials um uh well Dr cross from England and uh our group here at Johns Hopkins got together and they wrote up a really nice publication showing a clinical trial that ketogenic diet absolutely can manage a variety of epileptic seizures in children so you'd say to yourself well hey like you said well then we should use this but no there will only measure or they'll only do ketogenic diet for managing seizures only after your expensive drugs don't work then you'll do that but we've all argued that you should be doing metabolic therapy for epilepsy first if the if that doesn't work maybe you can consider low-dose drugs no but they still they still have it reversed in the cancer field the stuff right now what I'm saying is predominantly unknown people have no clue that you can manage cancer in a very similar kind of way obviously with certain certain uh differences but now that's the the situation so so the argument is well we can't use metabolic therapy for cancer because there's no clinical trials to prove it does despite the fact that the science is Rock Solid to support why you should do that so that's the conundrum that we have right now is that no one on the planet has yet and we can't do a clinical trial yet because the people needed to do that aren't trained and you need to know what to do and how to do it and we're working on that right now so as soon as we have our treatment protocol we'll be able to move into the cancer field with the same with it with the same uh uh uh uh intensity as we did in the epilepsy field to manage to manage the epileptic seizure so it's a it's an evolving situation with parallel studies uh knowing how the brain works on the different the ketosis issue and all of these different kinds of things coming together to know how to enhance the health and vitality of your normal cells without harming the body I know I said an awful lot in a very short period of time no it's I mean you're clearly very passionate about this and and with good reason how long have you been studying cancer for now oh well I studied cancer for probably 40 years but it was not not in the way to manage the disease uh I studied cancer like 90 of the people studying cancer we do research on some aspect of cancer like I was doing glycolipids we were looking at you know all the different abnormalities and glycolipids and cancer cells so it had nothing to do uh with actual uh design to manage the disease of course everybody in their papers everybody many many people put it oh this information could potentially be important at some future point or whatever um but it wasn't a direct it wasn't a direct assault uh on the management of the disease uh where you could actually cons where you can actually see even observable outcome in someone that would be riddled with a stage four cancer uh okay how would understanding the glycolipid dysregulation and that's and that person with the stage 4 for cancer in a very short period time lead to a management strategy and the answer was none so and that's the majority of people signaling Cascades and looking at this and looking at that I mean you can do that for the next 150 200 years and you're not going to have any impact in the clinic so the idea is how are you going to imp how are you going to make your research impactful to the person dealing with the stage four cancer today we've used the word cancer a lot during this conversation so far and of course there are lots of different types of cancer you know you can differentiate them depending on location in the body brain pancreas prostate uh of course the different pathological types of cancers as well so when we say cancer do we need to be a bit more specific about what we're talking about or would you state based upon your research that actually all of them are fundamentally the same there is a problem with respiration there's a problem with generating energy in the mitochondria like just help us understand that if you will yeah well that's really so important because we were all led to believe and we still are pounded by information saying you're we have a therapy for your specific kind of cancer you hear this all the time like breast cancer is different from colon cancer different from brain cancer different from bladder cancer different from the leukemias you hear you hear this all the time and and that's based again on the somatic mutation theory of cancer when you start to look at the mutations in all these different cancers they're all quite different from each other they're different from each other within the same within the same type of cancer within the same tumor you'll find all kinds of different mutations but all of the cells now what I what I did I I went back and I said well if um if all all the cancers that we know are fermenting uh to get energy that says there's some commonality between them so in order to in order to justify that I had to go back and go through historical records on ultra um um uh histology my the the the um you know the way electron microscopy Ultra structure of the cells in a cancer so I would look at lung cancer breast cancer colon cancer pancreatic cancer bladder cancer blood cancers and I was looking for a commonality and that commonality uh was abnormalities in the number structure and function of mitochondria in all the major Cancers and and that's what I found and in the in the concepts of evolutionary biology structure determines function this is a a a a a well-established concept structure determines function if the structure of the organelle that generates energy through oxygen is abnormal the function of that organelle will be diminished in some significant way leading to an alternative energy which would be fermentation so when I went back and looked at all of the major cancers I found abnormalities in all of these different Cancers and then that would lead to the explanation that they would all need to have fermentation in one way or another and that leads to the the concept that if they do ferment there's only two fuels that they can ferment which is glucose and glutamine and we know every major cancer is dependent on glucose and glutamine fermentation so it comes right back to the yes they look different under the microscope they look different in their genomic profiles but metabolically they're all very very similar and will respond quite effectively to a singular strategy of metabolic therapy the ketogenic diets or certainly the presence of ketones in the body is now you know the research is accelerating so fast we're seeing benefits potential benefits of ketones in neurodegenerative disease in Alzheimer's in mental illness in cancer of course in weight loss and it's really interesting isn't it that how can this one fuel source or potentially this one diet ketosis and of course there's many ways to get into nutritional ketosis but it's it's very interesting to me how this could potentially have a wide variety of different benefits for a wide variety of seemingly different conditions now let's look at this methodically so yeah you're right you're absolutely right I mean okay let's go back to our um Paleolithic ancestors all right so uh our uh for uh thousands and thousands of years um we were in a state of ketosis uh mainly because food was not available carbohydrates were certainly very limited to seasonal uh situations so our ancestors we were always in a state of therapeutic ketosis we we know that in the Aboriginal populations Not only was cancer rare diabetes was rare uh cardiovascular disease was rare Alzheimer's was never heard of or rarely discussed or rarely identified um uh as some all of these things that we see now you've just uh mentioned or are linked to mitochondrial uh function so uh ketones as I said as as my late good friend um uh Richard Veach from the national uh uh NIH ketones are a super fuel uh they allow the health and vitality of our mitochondria they allow our mitochondria to remain very very healthy so when you when you talk about um you know all of these different linkages for all these different diseases they all comes back to energy metabolism and we didn't have uh uh all of these chronic diseases when we were existing in the Paleolithic period we had other things that would kill us like uh infections bacterial in fact we didn't have antibiotics uh a Falls uh arthritis you would have a variety of things that would limit your capability of longer term survival but cancer dementia cardiovascular disease all of these kinds of things uh we're not there yeah so or very very rare so you're when you say ketogenic diet it's actually you got to be very careful because it's not necessarily a ketogenic diet it's the state of being in therapeutic ketosis is is at a ketogenic diet can put you in therapeutic ketosis but many of these so-called ketogenic diets are not done correctly people go out eat too much of it they don't do it the right way it's nutritionally imbalanced I mean but uh but the bottom line the the underlying theme Here is nutritional ketosis prevents chronic diseases that's a really interesting point there right so if we're going to talk about as I hope we get to during this conversation nutrition and cancer and the link between it and you've covered bits of it throughout this conversation so far a lot of people will talk about so this there's there's lots of n equals one studies there's lots of anecdotes of people uh saying that I got a cancer diagnosis and it caused me to stop and look at everything in my life and I changed dramatically My Lifestyle I started to meditate I loaded stress I stopped traveling all the time for work I went on a keto diet for example and you know my cancer never came back right or whatever it might be you hear that a lot with uh a ketogenic diet and of course that can be practiced in many different ways but you also hear people saying that if they radically change their diet to plant-based diets right there's many case studies out there that I've heard or certainly people reporting now it's really interesting to me so I'm trying to put it all together and go well okay what Thomas just said was that it's not necessarily A ketogenic diet it's the state of ketosis so I guess what I'm trying to get to a plant-rich diet will have lots of polyphenols right within it and I know there's been quite a few studies showing the benefits of polyphenols in terms of their role the signaling molecules and what they can do for cancer risk given what you know about cancer how do you put these two things together where some people say they revolutionize their health with a keto diet other people will say that they've done it with a plant-based diet how does that sit with you when you think about cancer just taking a quick break to give a shout out to Vivo barefoot shoes now I've been a huge fan of Vivo barefoots for over 10 years now well before they started supporting my podcast they are the only shoes that I wear then they really have had a huge impact on my own life and the lives of many of my patients you see when people start wearing Minimalist Shoes like vivos you can see improvements in things like back pain hip pain knee pain foot pain even things like plantar fasciitis can often get better and scientific research shows us that just wearing vivos for about four months or so improves the strength in your feet by over 60 percent which is absolutely incredible one thing people don't realize about these shoes is just how flexible they are which allows your feet to do what your feet naturally want to do rather than the shoe dictating your foot's movements Vivo Barefoot are giving my audience a 15 off one-time code when you make your first order and they make it really easy for you to give them a try they give a 100 day trial for new customers so if you don't like them you just send them back for a full refund I'm a huge fan I really hope you take advantage of this offer to get your 15 off codes all you need to do is go to vivobeath.com forward slash live more or click on the link in the description box below yeah well I think those are important points and you know we don't have answers uh to all of that yet I I know Kelly Turner wrote a book on called radical remission and um uh in her book on these cancers that you've just mentioned like some people just do something different and cancer goes away she she kind of cataloged all the different kinds of things that were linked to rat so-called radical remissions and and a large amount of it had to do with a dramatic change in diet and lifestyle uh whether whether you were a carnivore going through a vegan or a vegan going through a carnivore it seemed it seemed as though there were Radical changes in diet and lifestyle that were um uh linked to these uh these remissions uh you have to you have to realize um the cancer the cancer cell is a cell uh hovering near death all the time because it can't get energy efficiently so it has to depend upon the fermentation fuels in the micro environment and ever whenever you change the whole physiology of your body you are creating all the we evolved as a species to survive under incredible uh stresses in our environment whether it's cold hot food absence food abundance or whatever it was uh Rick Potts of the Smithsonian institution described it uh as our flexibility in uh survival cancer cells can't do that they they're very limited so when you have these radical changes in your body going from one state to another sometimes this just the tumor cells just simply cannot handle the change in some people making these radical changes so you don't have a a very uh a good clinical trial or a sophisticated educated approach to say you know what is responsible for the elimination of your cancer by by this radical change all we know is the tumor cells up and died and they disappeared and you're now healthy um in the movie that's coming out the documentary film called cancer Revolution um by Brad and Maggie Jones Brad is a professional documentary filmmaker and his wife Maggie who contacted me she had a stage four breast cancer that metastasized to her brain uh she went on one of these radical keto changes and she her cancer disappeared and she's still doing very very well but they've collected a lot of these n of ones a lot of these people that you just mentioned and put them in the movie um and they're all the faces are there and I must have I promise Divine one after another after another and she's collecting more and more of these individuals that had stage four cancers of a broad range lung cancer brain cancer colon cancer breast cancer and they're all alive yeah now what is it what is it about this and there's no there's no comprehensive clinical trials on this because how would you design such a clinical trial to look at some sort of a radical change in your diet lifestyle um there's a lot of variables that have not yet been pinned down that we should need to focus on and this this is the whole thing with using ketogenic diets for managing cancer what kind of ketogenic diet that's why we developed the glucose Ketone index calculator we published this and what it does is allows any patient healthy or sick to know whether they're going to be in a state of maximal metabolic homeostasis and it's a meter you can buy it on Amazon the keto Mojo meter and it's a you take a a blood a drop of blood and you can measure with one stick your blood sugar in with another stick your blood ketones and if you can get the ratio down to 2.0 or below you are going to be in a state of metabolic homeostasis and that that really puts tremendous pressure on cancer cells diabetes all of these Variety in other words you're bringing yourself back to a state of metabolicomius with a quantitative measure to let you know when you're there okay I want to talk about that I just want to finish off um from the previous question about keto diets plant-based diet diets another way I was thinking about it as you were talking is that if we if we develop cancer based upon everything we've said so far I think it's fair to say that there's something going on you have been receiving a variety of inputs whether out of choice or not out of choice whether you're aware of or whether you're not aware of but whatever's happened your current environment has resulted in you developing cancer right we don't know maybe what exactly it was but it was multiple signals from your environment and lifestyle so if you then undergo radical environmental and lifestyle change I'm not saying no matter what but you know if you're significantly making changes so the environment in which the human body is now existing is fundamentally different well it kind of stands to reason that in some cases depending on how advanced that cancer is depending on the type it stands to reason that yeah in some people the environment has shifted and you're no longer getting the inputs so cancer cells are no longer sort of growing and proliferating right does it does that sound like a reasonably correct you're absolutely correct yeah so especially if you catch it like early yeah well when you're many people not all people many people are first diagnosed with cancer they never knew the goal gee I just diagnosed with cancer how do you feel I feel great uh it's at that stage uh where the body is pretty healthy other than you have a growing tumor somewhere where you can do this radical change and blast out these uh marginalized and blast out these cancer cells the problem the problem is many cancer many folks develop who are diagnosed with cancer immediately without any alternative thinking or recognize they go in for toxic poisons and radiation and and and what happens is that undermines the health Vitality of the rest of the cells in the body making them less capable of challenging the Vitality of these of the the existence of these tumor cells so then well I get so many people contacting me who have failed every kind of a cancer treatment and the cancer is still growing and now they want to do one of these metabolic therapies and their bodies are raked uh you know they're they're emaciated they they have all kinds of adverse effects and all kinds of stuff and now you're going to ask your body to go through this uh tough uh radical change uh to try to eliminate they should have been doing that at the very beginning not to say it can't happen uh because when you have sometimes you get a stage four diagnosis you're still in pretty good health oh I got stage four diagnosis okay well great now you do metabolic therapy to pound out those cancer cells not to say that we can't use radiation and chemo uh but they would be used in a very strategic way in very low doses at the right time at the at the right setting but not uh massive poisoning at the beginning of this disease that is such a key point because I really think that that message has to come through loud and clear which you'll not necessarily saying that we shouldn't be using some of these modern advances like chemotherapy or radiotherapy what I think you're saying is you've just pointed out there is essentially that look let's get involved with the metabolic side of things right at the start you know and I'm guessing you're going to say that in some people that may be sufficient in others it's going to reduce the size it's going to allow some cancer cells to die off so you can be a bit more targeted and use lower doses of chemotherapy or radiotherapy rights absolutely absolutely we have seen that ourselves you know uh you shrink the tumor down and make it extremely vulnerable now you can come in with say uh one of these therapies um modern more modern therapies at a lower dose in a more strategic way to finish off the cancer survivors that the metabolic therapy wasn't able to kill because one thing is going to be in common when you Pare down the cancer cells are all kinds of as you said they're all genetically different from each other they're all fermenting but they're all genetically different from each other but when you pair them down the survivors of metabolic therapy will have something in common and and that that common commonality uh makes them extremely vulnerable now to some sort of targeted therapy because all your all the cells are going to have the same Target uh so that's the stress so in other words we need we have a lot of tools for managing cancer it's just that we haven't been using them in the correct way or understanding the concepts of evolutionary biology to enhance that success of the of the treatments that we already have yeah we kind of need to embrace this approach more not going either or it's like well why can't you do both why can't why can't we do it but but we're not but going back to what I said at the start that I was in I started medical school in 1995 right we were taught how to diagnose and we were taught to treat with Pharmaceuticals yeah end off right that is literally what we were taught and again that can be very useful for certain conditions but there's a big piece missing there right so the training needs to evolve and I I honestly don't feel that has evolved even now you know almost 30 years on well you're you're 100 correct and and uh what we know we base it on on the science I mean I I do the experiments here in the lab I I I have the best animal models for cancer so we know what it's doses timing and scheduling this is not what we call sexy science this is just knowing how to how to manipulate the tools that you have to the maximum efficiency and then we can translate that directly to patients in the clinic when I have all these my physician colleagues they they're coming to me and they're saying wow you can't believe how powerful this stuff is uh when you do it the right way our group in Istanbul Turkey are using uh metabolic therapy with conventional uh uh treatments and they're using far lower Doses and and the outcomes are so much better so this is an evolving uh process right now but I agree 100 we have to do we have to know the tools that we have what will work the best and how to how to blend the system um but that we're not doing that yeah uh we're not doing that at all I have all this information I publish all these papers we do all this kind of stuff and then when the cancer patient goes to their oncologist now there's no evidence to support that if it were really true I would have learned it in medical school well we'll get into that because I've got a few things to share about that let's go to that glucose Ketone meter that you mentioned that sounded really interesting right so you're measuring the ratio between glucose in your Bloods and ketones is that right yes now if you were to take you live in I think Boston if you were to go out into the center of Boston and pick the first 10 people who passed you on an average streets downtown on a Saturday afternoon right what do you think the glucose Ketone ratios would be in that population typically I know exactly what they would be because we we've done these okay okay not to guys walking through the streets but to the students tonight they're at the University here so we can where all of us we test uh it's about 50 to 60 sometimes 70. hold on so 50 is that to one so it's basically yeah so so it's um you would have glucose levels um well you can do normally uh your glucose levels would be uh let's say 100 milligrams per decaliter what does that come out to be you have to divide that by 18 and that gives you the millimolar uh ratio was at 4.5 or something like this um you know four point and the Ketone value in millimolar would be 0.1 so you divide the uh 4.5 by 0.1 or one of these kinds of things okay uh you you come up with a value about 50 I I have all the the numbers about 40 to 50 times higher based upon yeah yeah yeah okay so then you stop eating like for how like when we did the water only fasting here with the students um it takes about four days and then you start to see the ketones rise and the glucose drops so uh because you stop eating once you stop eating you're not bringing glucose back into your system the only way you're going to get glucose now is through the process of gluconeogenesis where your body will make glucose from breaking down uh proteins and also you mobilize the fats and most of these are called triglycerides so the two glycerol backbones could be conjugated to make one glucose molecule but the majority of the fats are going to be used to make Ketone bodies so the ketones are going to gradually increase in your bloodstream and their glucose gradually goes down and you come to a ratio where the ketones and the glucose are about the same similar millimolar or in your blood or the ketones are higher in millimolar than the glucose therefore you get numbers below one and that becomes super healthy so you did you say before you want to get to two or below for killing cancer for killing cancer cells for sure um but for just General Health yeah you can get down to five or even like my good friend Dom D'Agostino from University of South Florida he's always in ketosis right he's always in this kind of estate uh he's like one of these Paleolithic guys you know he likes to eat the alligators and squirrels I mean it was one of these kinds of guys he's always like living he's like living the Paleo I really like Dom's work and I I'm I hope they're going to try and get him on the show later in the year and and he sheds well we'll get this maybe later but he did share one of his colleagues I think in a was it a mouse model where they had GBM glioblastoma yeah it was your model yeah and actually um by using ketosis yeah and radiotherapy there was like full remission I think from record which is uh it's hyperbaric oxygen hyperbaric oxygen we use hyperbaric oxygen as an alternative to radiation because uh both radiation and hyperbaric oxygen kill cancer cells by increasing reactive oxygen species so Ros so if I can kill but the hyperbaric oxygen doesn't work until it doesn't work well until you bring your blood sugar down and your ketones up so once you put the pressure on the cancer cells then you put patients in hyperbaric chambers once they're in a state of ketosis and then you start killing cancer cells by the same mechanism that radiation does but without harming the rest of the body that's why it's beautiful yeah so so that's the glucose Keystone Mesa for a second right so the average person on the street who's maybe not paying attention to their diets may have a 50 to 1 ratio right yeah you're saying that if you have cancer and you want to kill cancer cells you want to get down to at least two to one ideally lower right yeah 2.0 or below 2.0 or below so that's a huge change now yeah I don't know if you know this or not but someone let's say like many people these days to try and put their type 2 diabetes into remission are following low carb diets uh on it and I guess you know low carb can mean so many different things but to many people it's when they keep their carbohydrate intake under 50 grams of carbs per day some people would use that as their definition but of course I'm aware there's a huge variety there if someone was having around 50 grams of carbs a day and on a low carb diet what might you imagine their glucose to Ketone ratio to be well it's certainly going to be lower than what than it was before you could use this meter this we published the calculation and the the company that makes keto Mojo put a chip in the meter so you just push the button it gives you the ratio right off the bat so patients can can always monitor uh their gki we call it glucose Ketone index their GK do you do it yourself oh yeah I do it occasionally I I'll I'll uh some guy will tell me oh I got this keto drink so I'll I'll not eat for about 18 to 20 hours I'll take my my gki find out what it is stop eating free and then chug his little little drink do some exercise come back and measure it again and determine whether or not I'm in going in the right direction and sometimes it does it does work and do you have a feeling because I guess we can talk about treatment and we could talk about prevention right so if you have cancer already we know that there's been a variety of signals to your body and for whatever reason now cancer cells are starting to proliferate so at that point you're saying no matter I think you're saying no matter what the cancer is or the site of it one of the things you want to be thinking about is trying to reduce these fermentable fuel sources to the cancer which are glucose and glutamine and it's easier with diet at least to try and remove that glucose by going into ketosis so far so good yeah you're absolutely right and and what what uh George Cahill who was the head of the Johnson diabetes center passed away a few years ago he found that the patients who did water only fasting to 14 to 20 days the blood glutamine would go down as well so so if you want to push it that way and I have I know personally several people who have completely eliminated their cancer by just doing water only fasting yeah uh now people when you tell cancer patients oh you got to do you don't don't eat any food for 21 days or so they'll think you're nuts so that's why the the keto like a carnivore only diets uh very low in carbohydrates vegan diets are a little bit harder because the plants we have but we have to use a lot of energy to to burn the plants up we didn't evolve to eat we were not born born we did not involve to eat only plants we evolved we're omnivores we can eat everything but you're right so the gki values will tell whatever person whether you're a vegan a carnivore or whatever it it cuts across all diets it cuts across everything because it tells you right off the bat whether I'm in a Zone to kill cancer cells regardless what they always ask me can I eat this can I eat that I don't know I said what does it do to your gki yeah this is interesting right because we've all got different bodies we've got different microbiomes right we all we're seeing that with personalized nutrition now that someone can have a banana and their blood sugar can go into their diabetic range someone else could have a banana and have a pretty stable blood sugar right so right I love things that cut through the nutrition was because ultimately it's like well what's going to work for you do we know yet and I I think I'm gonna buy one of these glucose Keystone meters straight after this conversation I just want I'd love to know what I'm in yeah in fact I I made the meter for glioblastoma patients with brain cancer because they they needed more than anyone but now I get all these Health gurus out there these guys that are running health clinics and everything and they're saying oh I got a gki like you know it's like so uh obviously it's cutting across the the populations what do you want your gki at you know we're it's hard to say all I know is that uh when you don't feel well and you feel kind of iffy don't eat for don't eat for a couple of bad whatever was bothering you seems to go away on your body when you're having you start getting super healthy um but if I were to have cancer having written the protocol to treat cancer prices with my colleague Thomas durye and we're working on the treatment protocols right now you know the first thing you're going to do is you're going to you're going to you take stop taking carb I'll get your GK High down and people say oh I don't care how hard it is that you'll get it closer to a 2.0 or below below one you're going to start killing cancer cells so what we do because it's such a hard thing what we do is we we we take zero carb diets for about 10 days to see where your gkis and you can start to see it stair step down in the right direction and then from there you can step off into water only fasting because the trauma of doing water only fasting the difficulty of your physiology to do that like as as opposed to going cold turkey okay you're going to eat a big meal today and now for the next five days you're not going to eat anything the body goes through it's almost like trying to break a a a alcohol nicotine addiction yeah the body the brain is addicted to glucose it's a it's like a it's like a an addictive agent so you have to lower that addiction slowly with a zero carb diet you're still eating but you're not getting carbs and then once you're down to a gki of about five or seven you jump now into water only fasting once you're in that zone of water only fasting now and you can keep a low gki that's when we come in with the battery of drugs these uh um these repurposed drugs that hammer a hammer the glutamine and further lower the glucose these tumor cells are toast they can't handle this kind of a dramatic change in your body they up and die and not only that the the body cells compete directly with the tumor cells starving with even further and not only that it's called autolytic cannibalism your body actually goes after the tumor cells and uses them for the fuel for the rest of the cells that are healthy it's unbelievable you have to this is evolutionary biology in action it is absolutely amazing to hear this it's even more amazing to see it in action some people uh Thomas are gonna say this is pretty controversial right you're you're talking about stuff that we've got no evidence for right you're talking about water really fast no no I I know you have I'm just trying to I'm trying to think about what would your critics say now some people will say you need um people are going to lose weight right and you need proper weight to fight off this cancer and to deal with the toxic effects of the chemo right so for anyone who is thinking that and I'm sure this has been leveled at you before what would you say to them well this is again uh an extremely important important Point um uh you know when you say weight loss why why there's two reasons why you would lose weight with a cancer what is the cachexia which is the signaling from the cancer cells to the muscles to dissolve the muscle to get glutamine for the cancer so um and the other reason for weight because the treatment you're going to be giving this poor person is so poisonous they have a fatigue diarrhea nausea vomiting all this kind of stuff this is this is makes you lose weight you're not hungry anymore you're you're so we want you to take as much carbohydrate back into your body to keep the weight on so cachexic weight loss and poisonous weight loss from poison um this is called pathological weight loss you're you're sick as opposed to therapeutic weight loss when you stop eating your body gets super healthy it doesn't you're not poisoning the body you're making it stronger and healthier so that's why depending on the weight of the patient at the time we start the or my colleagues will start the treatment we have to design the kind of treatment that would be appropriate for that individual's body weight if you have a some guy walking into the into the the clinic that weighs 300 pounds and you're worried about him uh losing weight from the treatment I mean this is absurd this kind of this guy with that amount of body weight can blast the hell out of his cancer so just because he has so much energy stored in his body that tumor cells won't be able to use the fats that he mobilizes so you have to use it you have to understand the difference between therapeutic weight loss versus pathological weight loss and the medical establishment hasn't come to recognize these differences yet so they don't they think weight loss is bad uh yeah because you're poisoning somebody you know oh um that you're gonna you're gonna lose weight because you're poison you don't have to poison the the thing of it is is that once you do metabolic therapy the amount of drugs that you would need to kill off the tumor cells now become so much less so you really you're really dealing with an altogether different physiological state but getting back to your really important point is when the cancer patient goes into the clinic they should be at least told that there are alternative options to the treatment plan that we have been indoctrinated to use so I think and that's where we have this problem there is uh one size fits all you you're either you either do it my way or the highway and so many cancer patients email me and say I asked my oncologist if he could help me do metabolic therapy and he says there's no evidence to support that and I say well you got to read the scientific literature and you have to understand the science and then you'll know that it works and what's more important you're 100 correct many can cancer patients would love to be participants in their health care they want to know that they're that their actions are also helping them survive and the traditional Cancer Treatments we have today takes that completely out of their hands they just sit there get radiation chemo and whatever they're going to give this patient with the patient absolutely doing nothing yeah I mean there's so much to unpack there I'm loving my conversation with you I think this is so important we get this message out but one of the frustrations will be I'm sure for some of the listeners or viewers on the back of this as they'll hear this information and maybe they have cancer or a family member has and they may go to their oncologist and have this conversation and chances are this will be shut down and it will be like look I don't know about that stuff I mean four years ago a really close friend of mine his son I think at the age of maybe six or seven was diagnosed with an optical pathway glioma and of course very scary to you know for your child to have this tumor inside your brain and you know initially they started I think down the conventional routes I think initially um he had a course of chemotherapy but as my friends started to read up and you know he went all in spent hours a day researching the papers experts like yourself listening and he thought wait a minute I'm not sure about this I'm not sure I like what's been offered versus what I think we can do he has basically for four years there has been no increase in size at all and he's done it all and to be fair I feel that he's done it all a huge amount of stress he's taken on to you know seven days a week obsessively research the literature trying to get help it's not getting help from his oncologist you know he told me recently he said one of the first things his oncologist said to him was oh you're gonna do the the no sugar thing don't worry in four weeks you'll be back eating McDonald's they all are that's the first thing which is a pretty um I just don't know why or how a doctor would say that what what even if that's what the doctor believes I'm not convinced that that has any benefit at all uh to saying that uh to a parent of a child with a tumor I mean what would you say to that well it speaks to a profound lack of knowledge on the part of the oncology community and it's not just where you are I see it all the time here in the states as well um at the Mayo Clinic uh which is supposed to be you know a top-notch medical center and for certain uh aspects of medicine they they are but when it comes to cancer um they they're clueless uh one of one of the people who emailed me said they went to the Mayo Clinic with glioblastoma and one of the neuro oncologists there said sugar has nothing to do with glioblastoma and I said that we were the first to publish a direct association between glioblastoma and the mouse and how fast the tumor uh how that the sugar and how fast sugar could make a tumor grow and then that was replicated in humans with glioblastoma hyperglycemia is an accelerant to Rapid tumor growth and it's been repeated dozens of times and now it's been shown for almost every major cancer that the higher the blood sugar the faster the tumor grows the lower the blood sugar the slower this has been now repeated and yet for a person treating patients to say that sugar has nothing to do with glioblastoma speaks to a profound lack of knowledge on the part of not only that person but the entire establishment another person you might want to talk to is Pablo Kelly from Devon England um Pablo uh chose no radiation chemo or steroids to manage his glioblastoma he's still alive eight eight almost nine years August will be nine I'm just I'm just and just explained to people how bad the prognosis is when you have a diagnosis or when you have glioblastoma it's a brain tumor it killed John McCain of our country Ted Kennedy it killed the President Biden's son Beau Biden I did the studies for for many many decades on glioblastoma the issue is why is survival for glioblastoma so poor there's been not a single major advance in a hundred years and I keep pointing this out in 1925 survival was 8 to 14 months in 2023 survival is 8 to 17 months so I mean you're talking about no progress in a hundred years and what we have found what I have found in my research is not only is the tumor very bad it grows it grows rapidly um radiation uh treatment frees up massive amounts of glucose and glutamine in the micro environment when you irradiate somebody's brain tumor the head swells uh the radiation forces blood sugar into the into the stratosphere and not only that they give you high dose steroids to reduce the inflammation from the radiation which raises blood sugar even higher so you're you're actually contributing a micro environment rich in the two fermentable fuels that drive the rapid growth of the cancer I have published this over and over again and I said as long as you continue to continue to irradiate the person's brain you're never going to achieve a level of success that you would expect now Pablo Kelly rejected radiation he rejected temazol he rejected it all and went from metabolic therapy alone people say oh he's only an N of one yeah and N of one he could be that he could be the the rule rather than the exception but to stop the radiation of the brain by by Uncle by radiation oncologists is an absolute essential a part for encrypt to if you want to keep people alive longer you have to stop irradiating their tumors and we have a treatment protocol that will that will hopefully do this but I tell you when you're when you're indoctrinated and wrapped into a into this constant system it's very hard to break the habits of what you're doing yeah I think that's the problem you know I I genuinely believe that all doctors nurses Healthcare professionals are doing the best for their patients based upon what they've been taught based on what they know based upon the current Paradigm it and I know you've been shouting from the routers trying to shake up this Paradigm and go you know the other the other thing to really think about here is that and I always say this when we're talking about nutrition changes is that look like there's there's very little downside here right improving your diet whatever that means depending on what you're doing whether it's cancer or anything else there's no downside here right rarely you know well you know that's that's an interesting point you'll hear some of the people in the oncology center said oh that ketogenic diet is very dangerous you're going to get cardiovascular disease or something like this and and I I said what you got a brain tumor you got a glial blastoma you're worried and and the the issue is relative you're exactly right downside do you think a a metabolic therapy has more downside than toxic radiation and poisonous chemicals yeah I mean give me a break and also what you were saying Thomas before is that you could do them both you could use the metabolic therapy to reduce the cancer size improve the health of other cells and then use small targeted doses which have less side effects so it's not either or so public Kelly you're saying what's has been a life of what eight nine years is that right yes yeah yeah and he he was given nine months a nine months to live wow and and he said no it's all over the English newspapers there was many why did you say he was Devin Devin Devin I might try and get hold of him oh god oh he's a he's a character he he can tell you what he did oh yeah now since got married he has two children uh he would have never had any of this so uh um if he had followed uh standard standard of care would have killed him uh a long time ago so he was bold he was bold though he he really fought against uh using the standard of care despite all the the dire prognosis that he was given Thomas one thing I I really want to make sure we make clear right you'd have mentioned how hyperglycemia so elevated blood sugar levels is an accelerant for tumor growth right and that fits with everything we've been talking about so far metabolic dysfunction a problem in the mitochondria you know what happens when a cancer cell is there it no longer uh is using oxygen appropriately it's getting its fuel from fermentable sources which is glucose and glutamine yeah so it makes sense when you have a diagnosis of cancer you may want to reduce sugar reduce glucose maybe go into ketosis but if we shift our lens to prevention right of course there are many things that can cause cancer you know we've already mentioned that diet lack of exercise um environmental pollutants carcinogens whatever it might be can we say that sugar is causing cancer because I think that's that's why we really need to be very careful with our messaging right what what's there's something to do with our diet as a therapeutic intervention if we have been diagnosed but what if you are I don't know in your 30s and 40s and and pretty well and you listen to my podcast you try and stay healthy try and make small changes you know what's the relationship there between sugar and cancer well I I think we can never call Sugar a carcinogen we cannot we cannot yeah no sugar is not a carcinogen okay but sugar uh creates a systemic inflammation in the body over time uh C-reactive protein goes up now how do we know this obesity the Obesity epidemic which is now becoming worldwide in in industrialized societies the Obesity epidemic is the result of of the storage you get fat by storing carbo hydrates you don't get fat by eating carbs that's why you lose weight with a ketogenic diet you can't you can't store fat you store carbs as fat you don't store fat as fat people this is another tremendous Mis uh conception misunderstanding so we have an obesity epidemic obesity has now replaced smoking as a major risk factor for cancer how do you get obese by consuming too much carbohydrate in the diet especially poorly nutritious carbohydrates not complex carbohydrates that you see in certain plants and in certain grains but you get it from consuming those foods that have minimal nutritional value with high levels of processed carbohydrates ifrop those corn syrup and all these kinds of things they are provocative just becoming obese elevating blood sugar elevated blood sugar is an accelerant to Growing tumor so so clearly all of these things come together and it's basically diet and lifestyle yeah we also would like to prevent cancer but when we have fast food stores on every corner we have Coca-Cola we have everything that's in our environment that makes us feel good we evolved as a species to love sweets our brains are geared to love sweets and we have sweets everywhere so it's again it's my moderation we try to do what we can do to moderate our consumption of Highly processed carbohydrates and that will reduce the risk for can not only cancer but a lot of these diseases as well I think you know the the truth as I say at least is that many people are really struggling right they do have they either live in a food desert where they can't get access to decent Foods they're in poverty that they've had a problematic relationship with food so I I think on an individual level I think that it's complex as to why so many people are overweight certainly that's my experience as a clinician um but I think we can say as a society we're not really putting this front and center if if Government for example really wanted to address frankly Beyond reducing a risk of cancer reducing our risk of obesity and type 2 diabetes you know they could uh put in place a lot more policies for example I don't know make sure that there's uh affordable healthy food for all of the population make sure the food and hospitals and schools is healthy and health promoting rather than health decimating we'll be back to the conversation in just a moment now many of us struggle to find time to eat all of these incredible Whole Foods that's why I'm a big fan of good quality Whole Food supplements like this one that's been in my own life for over three years now it contains over 75 Whole Food Source ingredients vitamins minerals pre and probiotics and can help us support our energy focused digestion and our immune system 81 are giving my audience a fantastic offer one year supply of vitamin D and five free travel packs with your first order you can see all details at drink81.com forward slash live more or just click on the link below and now back to the conversation right so I just want to clarify that because I'm sure you would agree oh you're 100 but you know it's an industrial thing uh the Food Industries are extremely powerful uh they control Politics as well as the pharmaceutical Industries yeah so you have massively powerful Industries uh that um thrive on on on the health health problems of the of the country and you're right about food deserts and people are stressed out and food makes them feel better and a lot of that food is full of carbohydrates that puts them at risk for all these different diseases but the governments could do a better job but you know who are the governments they're the congressmen Senators uh these guys and they get money from these different Industries to run their campaigns and and they're not going to come out and all of a sudden shout that we have to reduce uh carbohydrates in the diet to make our our population healthier and the drug companies are making money hand over fist yeah on on all these crazy drugs that they're given to people but I think it falls on our shoulders ourselves now now I can I can you're right I can speak from a different perspective than the poor guy who's living hand to mouth and his his food can only be cheap Foods that's poorly nutritious he can't afford the garden variety of stuff that's more generally more expensive grass-fed beef and all this kind of stuff I mean so you're caught in a you're caught in a between a rock and a hard place yeah so um yeah so these are difficult problems yeah you need to be addressed and see things I just wanted to finish up on that um as you mentioned earlier on in this conversation you can put on weight on a ketogenic diet if you eat too much right so I think processed carbs are absolutely uh we're eating too much of them but but I think people are losing weight on a whole variety of different diets you know I guess it's for me it's a question of what what is the whole food-based diet because I'm I'm interested in weight loss and health promotion you can technically eat 500 calories of garbage each day and lose weight but I'm you know if you have a whole food based diet it's a case of What can you do consistently that's going to help you eat the right amounts well this is very your point there's some recently within the last month I think some guy lost 50 pounds eating only McDonald's food and and you say wow how is that possible he ate he would order something and eat only half of it he he in other words he did calorie restriction he lost weight by just like said eating eating food but I only had half the amount that he normally would eat he lost weight he he got he he felt good but the other there was another guy who ate as much as you could get super sized meals this was about 10 or 12 years ago and that guy within a month got cardiovascular disease obesity and every all the other so again it's the amount and types of food that uh you are addressing you keep your body in a in a state and I think the key point there to conclude is look obesity is a massive risk factor for cancer right that's not trying to shame anyone that's not trying to have a go at anyone it's just trying to look at the science and and share it I think a lot of people do not know that yeah I agree by you stating that you have informed whoever is listening that obesity is a major risk factor for cancer so um and I think a lot of people aren't aware of that and I think uh that by that statement getting out in the world uh makes people think twice uh about their uh weight condition Professor it's been a real Joy uh talking to you I know you've been in this field for for many decades now and you're you're still banging the drum you're trying to get people to see that there's a metabolic cause to cancer and that maybe we need to you know re-look at how we view cancer and how we treat cancer there's plenty more we haven't got to maybe I can tempt you to a for a part two at some point in the future I'm pretty sure my audience are going to love this conversation but just to finish off then for people who've heard that and are inspired to go okay I'm with you I can see how poor metabolism metabolic dysfunction mitochondrial dysfunction is gonna increase my risk of getting cancer what can I do right now I don't have cancer but I want to reduce my risk of getting in the future I wonder if you could share some of your top tips for people as to what they can actually practically do well I think exercise is absolutely essential um keeping your because at bringing oxygen into your blood having a good blood flow increases uh physiological function if you can reduce the amounts of high carbohydrate foods that you eat with exercise and occasionally look at your gki your glucose Ketone index uh you're going to ward off not only cancer but probably type 2 diabetes cardiovascular disease and even dementia so uh all of these things are linked to a common problem in in Disturbed metabolic homeostasis so um so I think there are definitely things people can do and it's hard when you're sitting in traffic uh traffic jams and then you have to rush up and sit in front of your computer or in an office somewhere so all of these things are not consistent with our evolutionary origins but I think if people become aware of these things at least they can in their own lives try to adjust adjust their uh their their situation to to to recognize this and sleep chronic stress these sort of things well that's another thing too sleeping you know good sleep yeah right who wouldn't like to have that yeah stress what do you do for stress you know I mean we're all stressed out people were used to smoke like crazy to reduce stress now they stopped smoking and now they got fat and now they got this they're back in the same spot for a different reason so uh you know it's just it's just um but but the but the point is is that all of these things really do make a real difference at reducing your risk of cancer in the future yeah absolutely absolutely and maybe this is just a little teaser for the next time we talk you mentioned earlier on the intermittent hypoxia is one of the things that can drive the mitochondrial dysfunction I wanted to really explain what you meant by that did you mean obstructive sleep apnea things like that because you also because you then mentioned exercise as being a way of delivering more oxygen right you don't know that's what Warburg even showed that it was intermittent hypoxia that he thought was responsible for the majority of cancers we've expanded upon that and we've shown the mechanisms by which that can happen so yeah that's another story I'm mean we've done we've done a lot of research and and we recognize these things and and intermittent hypoxia can be prevented by by uh oxygenation and exercise and eating the right Foods so again you're coming back to a similar kind of thing well we'll get to that in our next conversation hopefully but just to finish off then are you hopeful are you hopeful that we can do something different to make an impact in our rates of cancer oh absolutely I mean absolutely and Warburg even said that we could reduce 80 percent of our Cancers and I believe that if we but now we we have a plan we know what's going on we have an understanding of the mechanism by which cancer occurs and we really understand how we can manage it the problem is getting that to be adapted in the uh in the clinics and and the education that requires uh in the medical schools uh to train the physician that diet lifestyle issues are really important for managing uh chronic diseases and here is the strategy and and protocols for doing that and that's I think will be the future well Professor thank you for your tireless work thank you for giving up some time thank you for coming on the show yeah very nice thank you very much for having me if you enjoyed that conversation I think you are really going to enjoy this one about the four common causes of decreased longevity and what we can do about it today we're at a point where not only is life expectancy flattened but in many parts of the developed world it's actually declining a little bit and more importantly quality at the end of life is going down the question is why

Channel: Dr Rangan Chatterjee

Views: 385,736

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: MakS2iRkj1Q

Length: 112min 45sec (6765 seconds)

Published: Wed Sep 20 2023