Lies I Taught in Medical School

1. Mainstream medicine misunderstands chronic diseases' root causes

I did everything right and (almost) died anyway.

Flawed medical education. The author, a medical school professor, realized that much of what he taught about chronic diseases was wrong. The medical establishment often treats symptoms rather than addressing underlying causes, leading to ineffective treatments and worsening health outcomes.

Metabolic connection overlooked. Most chronic diseases share a common root in metabolic dysfunction, yet this connection is often ignored in medical education and practice. Conditions like obesity, diabetes, heart disease, and even some cancers are interrelated through metabolic pathways.

Paradigm shift needed. To truly improve health outcomes, a fundamental shift in understanding and treating chronic diseases is necessary. This involves:

• Recognizing the role of diet and lifestyle in disease development
• Focusing on prevention rather than just treatment
• Addressing root causes instead of merely managing symptoms
• Integrating knowledge about metabolic health across medical specialties

2. Metabolic dysfunction drives major chronic illnesses and aging

Metabolic dysfunction is the root of our major chronic diseases, including aging and ultimately death itself.

Central role of metabolism. Metabolism isn't just about digesting food; it's the foundation of cellular health and function. Disruptions in metabolic processes can lead to a cascade of health problems affecting multiple organ systems.

Insulin resistance as a key factor. Many chronic diseases are linked to insulin resistance, where cells become less responsive to insulin. This can lead to:

• Elevated blood sugar levels
• Increased inflammation
• Abnormal fat storage
• Disrupted cellular energy production

Chronic diseases as metabolic disorders. Conditions previously thought to be separate are now being recognized as different manifestations of underlying metabolic dysfunction:

• Type 2 diabetes
• Cardiovascular disease
• Non-alcoholic fatty liver disease
• Some forms of cancer
• Neurodegenerative diseases like Alzheimer's

3. Sugar and refined carbs are more harmful than previously thought

Refined carbohydrates drive insulin resistance and mTOR, which drives inflammation and most major chronic diseases as well as aging in general.

Sugar's toxic effects. Far from being merely empty calories, sugar and refined carbohydrates actively harm the body. They cause:

• Rapid spikes in blood glucose and insulin
• Increased inflammation
• Accumulation of visceral fat
• Disruption of gut microbiome
• Acceleration of cellular aging processes

Fructose as a major culprit. While glucose can be used by all cells, fructose is metabolized primarily in the liver. Excessive fructose consumption can lead to:

• Non-alcoholic fatty liver disease
• Increased uric acid production
• Impaired insulin sensitivity
• Elevated triglycerides

Hidden sources of sugar. Many processed foods contain hidden sugars, often under different names. Awareness and reduction of these sources is crucial for metabolic health:

• High-fructose corn syrup
• Fruit juice concentrates
• "Natural" sweeteners like agave nectar
• Processed grains that rapidly convert to sugar in the body

4. Cholesterol isn't the primary culprit in heart disease

Statins are a good choice to prevent heart disease.

Challenging the lipid hypothesis. The long-held belief that dietary cholesterol and saturated fat cause heart disease is being questioned. Evidence suggests that:

• Many heart attack patients have normal cholesterol levels
• Lowering cholesterol with statins often doesn't prevent heart attacks
• Inflammation and metabolic dysfunction play a larger role than previously thought

Insulin resistance and heart health. Insulin resistance may be a more significant risk factor for heart disease than high cholesterol. It contributes to:

• Increased inflammation in blood vessels
• Abnormal fat deposition in arteries
• Elevated blood pressure
• Disrupted blood clotting mechanisms

Rethinking heart disease prevention. Instead of focusing solely on lowering cholesterol, a more effective approach may include:

• Improving insulin sensitivity through diet and lifestyle changes
• Reducing inflammation through anti-inflammatory foods and stress management
• Addressing other metabolic risk factors like high blood pressure and obesity

5. Cancer may be a metabolic disease, not just a genetic one

Cancer is the uncontrolled proliferation of cells.

Challenging the somatic mutation theory. The prevailing view that cancer is primarily caused by genetic mutations is being questioned. An alternative hypothesis suggests that:

• Metabolic dysfunction may precede and drive genetic changes in cancer cells
• Cancer cells exhibit altered metabolism, favoring glucose fermentation over normal respiration
• Targeting cancer metabolism may offer new treatment approaches

The Warburg effect. Cancer cells often display a metabolic shift known as the Warburg effect:

• Increased glucose uptake and fermentation, even in the presence of oxygen
• Reliance on glutamine as an alternative fuel source
• Altered lipid metabolism to support rapid cell division

Metabolic approaches to cancer. Emerging research is exploring how targeting cancer metabolism could complement or enhance traditional treatments:

• Ketogenic diets to starve cancer cells of glucose
• Fasting or fasting-mimicking diets to enhance chemotherapy effects
• Drugs that interfere with cancer-specific metabolic pathways

6. Alzheimer's could be "type 3 diabetes" with metabolic origins

Alzheimer's disease is a progressive, untreatable disease caused by beta-amyloid accumulation.

Metabolic roots of neurodegeneration. Growing evidence suggests that Alzheimer's disease may have strong links to metabolic dysfunction, leading some researchers to call it "type 3 diabetes." This connection is supported by:

• Insulin resistance in the brain of Alzheimer's patients
• Impaired glucose metabolism in affected brain regions
• Correlation between type 2 diabetes and increased Alzheimer's risk

Beyond amyloid plaques. While amyloid plaques are a hallmark of Alzheimer's, targeting them alone has not led to effective treatments. A broader approach considers:

• Mitochondrial dysfunction and energy metabolism in neurons
• Inflammation and oxidative stress in the brain
• Vascular health and blood-brain barrier integrity

Potential metabolic interventions. Strategies targeting metabolic health show promise in Alzheimer's prevention and treatment:

• Ketogenic diets to provide alternative brain fuel
• Intermittent fasting to promote neuronal repair mechanisms
• Exercise to improve brain insulin sensitivity and blood flow
• Addressing cardiovascular risk factors to protect brain health

7. Mental health is closely linked to metabolic health

Metabolism has little effect on mental health.

Metabolic underpinnings of mental disorders. Emerging research suggests that many mental health conditions have strong metabolic components:

• Depression and anxiety are associated with insulin resistance
• Bipolar disorder shows altered brain energy metabolism
• Schizophrenia is linked to disrupted glucose regulation

Inflammation and mental health. Chronic low-grade inflammation, often driven by metabolic dysfunction, may contribute to mental health disorders through:

• Alterations in neurotransmitter production and function
• Disruption of the gut-brain axis
• Impaired neuroplasticity and neurogenesis

Metabolic approaches to mental health. Targeting metabolic health may offer new avenues for treating and preventing mental health disorders:

• Ketogenic diets show promise in treating drug-resistant epilepsy and some mood disorders
• Intermittent fasting may improve symptoms of depression and anxiety
• Exercise and stress reduction techniques can improve both metabolic and mental health
• Addressing gut health and the microbiome may influence mood and cognition

8. Aging is not inevitable wear-and-tear, but a programmed process

Aging is the inevitable result of accumulated wear and tear.

Challenging the wear-and-tear hypothesis. The traditional view of aging as a result of accumulated damage is being replaced by the idea that aging is a regulated process:

• Some organisms show negligible senescence, remaining youthful indefinitely
• Certain genes and pathways can dramatically extend lifespan in model organisms
• Cellular reprogramming can reverse age-related changes in cells and tissues

Hallmarks of aging. Researchers have identified several interconnected hallmarks of the aging process:

• Genomic instability
• Telomere attrition
• Epigenetic alterations
• Loss of proteostasis
• Deregulated nutrient sensing
• Mitochondrial dysfunction
• Cellular senescence
• Stem cell exhaustion
• Altered intercellular communication

Interventions to slow aging. Understanding aging as a programmed process opens up new possibilities for intervention:

• Caloric restriction and fasting mimetics
• Exercise and physical activity
• Targeting senescent cells (senolytics)
• Improving mitochondrial function
• Enhancing cellular stress resistance

9. mTOR protein regulates growth, aging, and disease

Drugs targeting cancer genes don't appear to work, except for one or two examples.

mTOR as a master regulator. The mechanistic target of rapamycin (mTOR) protein plays a central role in cellular metabolism, growth, and aging:

• Integrates signals from nutrients, growth factors, and energy status
• Controls protein synthesis, autophagy, and cell growth
• Overactivation is linked to many age-related diseases

Balancing growth and maintenance. mTOR activation promotes growth but can accelerate aging when chronically elevated:

• Necessary for development and wound healing
• Excessive activation can lead to cellular senescence and reduced autophagy
• Periodic inhibition may promote longevity and health

Targeting mTOR for health and longevity. Interventions that modulate mTOR activity show promise in treating various diseases and extending healthspan:

• Rapamycin and rapalogs as potential anti-aging drugs
• Intermittent fasting and caloric restriction as natural mTOR inhibitors
• Exercise-induced mTOR modulation for metabolic health
• Potential applications in cancer, neurodegenerative diseases, and metabolic disorders

10. Fasting and ketogenic diets offer powerful health benefits

Food really is the new medicine. Sometimes, however, the best, most nourishing food you can give your body . . . is none.

Beyond calorie restriction. Fasting and ketogenic diets provide benefits beyond simple calorie reduction:

• Promote metabolic flexibility and insulin sensitivity
• Enhance autophagy and cellular repair mechanisms
• Reduce inflammation and oxidative stress
• May improve cognitive function and neuroplasticity

Types of fasting. Various fasting protocols can be tailored to individual needs and preferences:

• Intermittent fasting (time-restricted eating)
• Alternate-day fasting
• Extended fasting (24 hours or more)
• Fasting-mimicking diets

Ketogenic diet benefits. A well-formulated ketogenic diet can provide numerous health benefits:

• Improved blood sugar control and insulin sensitivity
• Enhanced fat burning and weight loss
• Potential neuroprotective effects
• May help manage certain neurological and metabolic disorders

Cautions and considerations. While powerful, these approaches aren't suitable for everyone:

• Should be implemented under medical supervision, especially for those with health conditions
• Nutrient adequacy must be ensured, particularly with long-term ketogenic diets
• Individual responses can vary, and some may experience side effects

11. Simple lifestyle changes can prevent and reverse chronic diseases

You cannot delay. In the words of entrepreneur Seth Godin, if you wait until you are ready, you are almost sure to be too late.

Nutrition as medicine. Dietary changes can have profound effects on health and disease risk:

• Minimize refined carbohydrates and added sugars
• Emphasize whole, nutrient-dense foods
• Consider time-restricted eating or intermittent fasting
• Experiment with ketogenic or low-carb approaches under guidance

Movement and exercise. Regular physical activity is crucial for metabolic health:

• Aim for a mix of aerobic exercise and strength training
• Incorporate movement throughout the day
• Consider high-intensity interval training for metabolic benefits

Stress management and sleep. Chronic

Last updated: August 27, 2024