Dr Louise Newson: This is a great conversation with Dr Robert Lufkin, who is a US doctor, and he's written a book about lies he learned at medical school. He talks about things he learned in medical school aren't quite what he knows now. And we know this because evidence is changing all the time, but he talks a lot about chronic diseases and the underlying cause being related to inflammation, something I'm very fond of. So thinking about how we as individuals can reduce inflammation through our lifestyle and hormones, of course, really important. So it's a very riveting conversation for you to enjoy and to learn from. So, Rob, I've been stalking you for a little while, and I read your book quite soon after it came out. And to be honest, so many pages I've turned down and I've gone back and read and re-read it. And it resonated so much with the way that my mind, my brain has changed over the last 30 years of being a doctor. And when I came out of medical school, I thought I knew everything and I thought everything I learned at medical school would just put me in good stead until the time I retired. And it's changed, every day I learn new things from my patients and every day I learn new things from reading different articles and scientific evidence and literature and reading books like this as well. So your book is called Lies I Taught in Medical School: How Conventional Medicine is Making You Sicker and What You Can do to Save Your Life. So it's pretty powerful cover here. So can you just explain a bit about your background and then why you wrote this book, which is a New York Times bestseller, I'd like to add. So congratulations for that.

Dr Robert Lufkin: I'm a practising physician. I'm also a medical school professor. So in addition to seeing patients, I also get to do research and write papers and also help educate healthcare professionals in learning about the world of medicine. And I've done that essentially my entire career and how I got to this particular point is I was, I was minding my own business as a medical school professor when I suddenly came down with four chronic diseases and I went to my doctors and they said, oh, don't worry, here's a pill. We're gonna give you a pill for each one of those. So I was given four prescriptions for medications and I said, hey, what about lifestyle? I hear about that, does that work? And they go, nah, that really doesn't work. You're gonna be on these pills for the rest of your life so get used to it. And at that point my daughters were in elementary school and I knew enough about chronic disease that I was, that I knew it wasn't going to end well. And so it forced me to, to begin to question my own beliefs, what I'd been teaching and what many of my colleagues are still teaching. And I realised there's been a revolution in our understanding about these diseases and the mechanisms for them, and that lifestyle actually does matter. And I was able to make a few changes in my own lifestyle. And long story short, I went back to the doctors. They couldn't believe it. They thought the labs were broken, but they eventually took me off all medications. The diseases are reversed. So now I've made it my mission to help others take back their health and hopefully not make the same mistakes that I did. And that's why I've written the book.

Dr Louise Newson: It's so interesting, isn't it? Because I trained, as you know, as a general physician and I did lots of different jobs rotating through hospital specialties. So, you know renal medicine, cardiology, respiratory, rheumatology. And it was really exciting as a junior doctor to make a diagnosis. We'd run loads of tests with people, scans were just sort of coming in. They were harder to get, but we were doing scans. Once we had a diagnosis, the first thing we did was think about which treatment, and it was always prescribing treatment. And in hospital, as you know, there's layers and layers of treatment. And this was, you know in the 90s, we often didn't really involve our patients, we'd just write on the drug chart, and then they would just have the drugs, they'd then go home with the drugs. The GP would carry on the prescription. And it was almost like I felt I was doing the best thing for the patient at that time. And I didn't even think about how could we even prevent that disease happening in the first place? What's making it happen? And, you know, like you over the last few decades, the incidence of chronic diseases, we've just watched getting higher. People are becoming sicker, despite all these medicines, despite it being, you know in the 21st century. I feel like we haven't really made the advances that we should have done to keep people well.

Dr Robert Lufkin: Yeah, yeah, totally. I mean, some of your audience may be thinking, wait a minute, you're being critical of Western medicine or allopathic medicine, but you're part of the problem, right? You were in medical school, you were teaching that, you're the problem. And my book is very critical of western medicine and what we're talking about, it is gonna be critical of Western medicine. But I think in the 20th century where you and I grew up, and essentially, Western medicine was magical. It transformed the lives of humanity, truly around the world, through the pills and surgeries that were developed, made the world a better place. I mean, largely through public health measures, certainly. But indeed, it really transformed and elevated the life of everyone around the word. And even today, you know, if I get hit by a car, I'm gonna wanna have you know, that blood transfusion. I'm going to want my, my ruptured spleen removed. I'm gonna want my bone set. So Western medicine still has a role to play. But I think the problem is in the 21st century, we're now facing this literal tsunami of what you and I are talking about are chronic diseases that while they were present in the 20th century, they're now in biblical numbers, never before seen in history. By some estimates, occupying up to 80% of healthcare resources. And this list, it's really wide ranging, goes all the way from obesity, diabetes, hypertension, cardiovascular disease, cancer, Alzheimer's disease, and mental illness, just to name a few. And these seem like very separate diseases, but they share a common cause. But the problem is when Western medicine takes the same pills and surgeries, hey, they worked in the 20th century and applies them to these chronic diseases now, they do help in the acute case and they may be life-saving, but the problem is in most cases, they don't get to the root cause and these diseases continue to progress. They're sort of a bandaid over the symptoms and that's really the problem. And that's what the book is set out to address, and I think that's what you're talking about as well.

Dr Louise Newson: It's almost got worse because medicine is very siloed. You know, I really trained with some amazing people to be a general physician. And I had a lot of interest in all the organs, whereas now it becomes, everyone becomes specialised a lot younger. It's a lot narrower, people thinking of one organ. But as you know, I've got a pathology degree as well. And It's really interesting. I love doing pathology because the study of disease makes you think in a molecular way, a lot differently to the way you're trained as a medical doctor. And one of the essays that I wrote for my final degree was about atheroma, so the furring of the arteries, being a pre-malignant disease, as in something associated with cancer. Which people listening might think, how has arteries, you know, diseases of the lining of the blood vessels associated with cancer? And I wrote a three-hour essay on this. And I was trying to find if I had my exam paper anywhere, because I'd love to reread it now. This was in 1992, I wrote this essay. And I loved it because I wrote a lot about inflammation, so the cause of atheroma, this furring of the arteries. And I wrote about inflammation and the cause of cancer and why cancer develops. But it's going back to the basics. And this is what your book does because it sets out all these chronic diseases like heart disease and osteoporosis and like you say even mental health, non-alcoholic fatty liver disease. And to specialist people, they would think they're all very separate conditions. But once you get down to the root cause, thinking about in a cellular level, what's going wrong in the body, it makes sense to fix that, rather than wait for all the diseases to happen, and then, like you say, medicalise them all.

Dr Robert Lufkin: Yeah, that's such a great point. And it was really a wake-up call for me to realise that the same lifestyle changes that work for obesity and hypertension also work for cancer risk and Alzheimer's disease and mental illness, and it's correcting the same, at the root metabolic dysfunction that drives all of these. So it's almost like one, one size fits all. And the other, the other big wake recall for me was that the diseases didn't start when the doctor diagnoses them, you know, as a doctor that's what I used to think, you know, and our healthcare system is certainly set up that way. You know, you don't have diabetes until your glucose or your, your haemoglobin, once it crosses a certain threshold. And then you have diabetes, and then the insurance or the payers will start to cover that disease. And you know before that, a week before, you didn't have it. And I now realise, at least for these chronic diseases that we're talking about, they don't begin when the doctor diagnoses them, they begin actually days to weeks to decades before the doctor diagnosis them. And if we wait, until the doctor says, oops, you've got diabetes or oh you forgot your keys, you have Alzheimer's. If we wait for the doctor to diagnose them, we'd miss a tremendous opportunity for what you mentioned was prevention. And that's why even, I have friends who go, hey, I'm perfectly healthy. I don't have a single disease. Well, we're all on the path to getting the diseases because the list, those chronic diseases that we're talking about, statistically, those are the diseases that you and I and most of our listeners will die of. And we all die of something, right? As Jim Morrison said, nobody gets out alive. So they are in our future, but why have the heart attack at 50? Why not have it at 105? Why get the Alzheimer's at 60? Why not get it at 95? Let's push them back as far as we can. And that's,that's why I believe even quote unquote "healthy" people should think about their lifestyle because you can do things now that will keep you healthy longer just by doing these simple things.

Dr Louise Newson: I totally agree and it's so important because, you know, our healthcare system sadly is failing like a lot of healthcare systems and it is very reactive. My husband said to me, he works in the NHS and he said we haven't got time to think about preventing disease. We are just there to fight and help and treat diseases. It's different for him. He's a surgeon so obviously he can make a huge difference to people. But actually I feel very strongly as a patient we should be advocates for ourselves. We should be working as hard as possible to help our physicians. And the problem is, I think the way the healthcare systems are set up, it's almost waiting for the inevitable to be happening. And then it's like, oh, it is not my fault now because I've got diabetes or hypertension or whatever. But we need to be thinking really holistically, and we need be helping as physicians our patients to understand this because lifestyle to a lot of people seems really scary, but actually thinking about inflammatory diets, thinking about the inflammatory lifestyles, there's quite a lot we can do to change our habits quite early on, isn't it? Which makes a big difference because if we can think about keeping well in our 20s and 30s, it's a lot easier to have good habits then than waiting until we're in our 50s and then suddenly realising we have to change what we eat or stop drinking or smoking or whatever.

Dr Robert Lufkin: Yeah, totally. I mean, even though I'm a doctor, one of the wake-up calls I realised was that, even though, I'm the doctor, I now realise that doctors really don't make us healthy, right? It's not a healthcare system, it's the sick care system because for the most part, doctors are too busy dealing with disease and illnesses. Like your husband, the surgeon, he's busy operating on things and taking care of diseases. But if I wanna be healthy, the doctor's not gonna do it for me, doctors can't make me healthy, doctors just make me less sick. And if I want to be healthy, me, I as a patient, that's on me and that's, no doctor can do lifestyle for me, that's a choice, you know I make every day when I get up, when I eat, you know when I'm gonna exercise, when to go to the gym, all those things. But it's really empowering for the patient too as well I think.

Dr Louise Newson: Absolutely. And I can see that with younger generations, actually, my oldest daughters are 22 and 21 and they go and exercise far more than I did as a medical student. They don't smoke. One of them doesn't drink at all. The other one doesn't drink that much. And, you know, they're constantly looking at things. But my oldest daughter has really bad chronic migraine and she's been under so many different neurologists and we've seen so many different consultants. She's a trombone player, so she was getting reflux as well. So she saw a gastroenterologist who gave her medication. Her neurologist wanted to give her some medication with lots of side effects for her migraines. And then she saw a respiratory person who wanted to her other medication for her lungs. And now she's not on any medication because she's changed a lot with her lifestyle and various other supplements and various things that she does. But it would have been very easy for her, like you say, to be medicalised on a PPI, you know, a proton pump inhibitor to stop reflux. The gastroenterologist said when she was 20, that's fine, she can be on it for life. And I sat there like thinking, oh my goodness, I wouldn't want really my children to be on something for life unless they really needed it. Just felt like a bit of a crutch almost. And, you know looking at her gut microbiome, looking at, you know, what she eats, all sorts of things. Her posture, her exercise, her mental health, all of those things are so important, but it's a lot quicker, isn't it? You can get through loads of patients if you're just giving them all medication.

Dr Robert Lufkin: Yeah, I mean, and it's not all the fault of the system or the fault of doctors. I mean the system is built into doing it the way it is, but I think part of it is patients have some responsibility for it because I know as a patient, I'm basically lazy. I would much rather, if I have a symptom, all things being equal, assuming that they're equal. I would much rather get a pill that I only have to take once a day or even a surgery that I take a week off from work and then I'm back to normal. I'd rather do that than get a lecture about how I have to change my lifestyle and actually change who I am at the root cause. And no question, everyone would rather have the pill or the surgery. But the problem is it's a false equivalency. In other words, in most cases, the pills and surgery are not as good as the lifestyle changes in, you know, like with type 2 diabetes, you can, you could go on, you know, insulin and metformin and these things, and you won't die of hyperglycemia, but your diabetes becomes a chronic progressive disease going on to, you know, amputation, blindness, renal failure. But when you, when you reverse it with lifestyle, the disease stops. Essentially, it goes into remission and it's no longer a chronic progressive disease. So it's not really a fair equivalency. I don't think that's being presented to patients nearly enough.

Dr Louise Newson: Every medication has a side effect, it has a risk. And I didn't really think so much about those when I was younger. You know, I've prescribed a lot of antidepressants, for example, but we know they're associated with osteoporosis, increased incidence of dementia, you know, and side effects. People often have side effects with them. And I'm not saying they're wrong. For some people, they are really important, but to be just handed them out as readily as possible and looking at some of the figures for the amount of medical treatments that are prescribed for chronic diseases in your country, in the US, but also in the UK, we're catching up. So by the time we're in our 60s and 70s, many people are on six, seven different medications and like you say, they'll be on them forever, won't they?

Dr Robert Lufkin: Yeah, yeah, that's definitely a thing. I mean, the numbers are just staggering. I mean in the United States, most people are overweight or obese. Most people have hypertension or are being treated for hypertension. Most adults, when I say people, I mean adults. Children are affected too. One third of adolescents in our country now have diabetes or pre-diabetes. And it goes on and on. These chronic diseases are affecting everyone, up to where 90% of adults in America have at least one symptom of metabolic dysfunction. And as you say, most people take many, many pills for many of these conditions.

Dr Louise Newson: One of the things that I obviously spend a lot of my time thinking about is natural hormones and, you know, we know that estradiol, progesterone, testosterone for men and women work on the inflammatory cells. They help reduce inflammation. They help mitochondria to, to work and function properly. They are really important actually in improving metabolism. We know that people that have replacement hormones have a lower instance of cardiovascular disease, diabetes, osteoporosis, and dementia, depression, non-alcoholic fatty liver disease. The list goes on and on. And it's, you know, if it was a new drug that was a public health medicine that I had just said, look, Rob, I've got this one treatment that we can give to people, or three, because there's three hormones, but even if you look at estradiol and then testosterone for men to make it even simpler. It has all these disease-modifying effects, but most people can't access it because it's cheap, it's not pharma, it's not patented, you know, so there's a big resistance globally for people to have hormones back, although we've got good evidence how important they are to reduce incidence of inflammatory disease.

Dr Robert Lufkin: Yeah, that's such an important area. I couldn't agree with you more, Luis, on that. Yeah, absolutely.

Dr Louise Newson: So, but I think this is where like my work, your work to educate people as in patients, but also healthcare professionals is really important. And I think as a healthcare professional, you want to keep that professional curiosity. And somehow that seems to have gone in some people. I feel like often people are on a bit of a treadmill and they do something because they've always done it, because they'd been told that it's the right thing to do. I'm very challenging because I like to challenge myself, but I think it's a good thing to challenge guidelines, challenge scientific literature, challenge what others have done, because we're learning and changing all the time. And I feel sad that some doctors, clinicians are sort of stuck in a rut. They don't want to be challenged or think differently somehow.

Dr Robert Lufkin: Yeah, and I would suggest those challenges are becoming even greater now. As we accelerate into the age of artificial intelligence, we're now having science being developed by artificial intelligence so that the pace of discovery is increasing. I'm certainly feeling it, and each week there's new information, And you know, some optimists are even saying that, you know, we're accelerating so fast that within the next 10 years, we'll have as many scientific discoveries in the next ten years as in the last hundred years. And it's really a unique time in human history where with artificial intelligence and quantum computing, we're approaching a singularity in many ways, as many authors talk about.

Dr Louise Newson: It's interesting, isn't it? Because on one hand we're really advancing and it's wonderful, but the other hand, I look back to when I was growing up in the 1970s and people weren't overweight, people weren't obese, people were healthy, you know, they weren't all going to the gyms like people do now, but they were doing a lot more physical exercise just day to day with gardening and being outside and walking and, and whatever. And I look and think what a shame because they had, they got it right, really. They didn't have these inflammatory diets. They didn't have all the drugs because they weren't all available then. So something has really changed over the last 30, 40 years. So, and they, it was quite a simplistic life back then.

Dr Robert Lufkin: Yeah, yeah. It's fascinating to speculate. I mean, nobody really knows the answer, but you can, as you say, you can plot the graph of obesity. You can plot the graph diabetes and these other chronic diseases. And going back to the 80s and 90s, there's a hockey stick kind of sharp uptake in these diseases. Fatty liver disease, non-alcoholic fatty liver disease didn't exist before the 1980s. Now in the United States, it's the number one cause of liver failure, liver transplants and all, and it has nothing to do with alcohol, it's fructose. But overall, there's so many possibilities of what this could be. Certainly the lifestyle factors that you and I talked about are first and foremost there, but many people are suggesting all kinds of different things.

Dr Louise Newson: So there's a lot more we need to do. Before I end the podcast, I always ask for three take-home tips. I want to ask you three things that you think will make the biggest difference to the future generation of doctors, because as doctors, we do have a responsibility for our patients, their families, and so forth. So what three things do you think are so important for the new generation of doctor to learn?

Dr Robert Lufkin: First of all, to embrace an understanding of metabolic health and these root causes, mitochondrial health. We're talking about doing mitochondrial transplants now. Who knew for longevity and stuff? Embracing metabolic health and understanding that embracing lifestyle and what patients can do as far as prevention and really becoming aware of that and you know, and accepting that knowledge is changing rapidly and whatever we know today, whatever we believe to be true today, you know, a large percentage of that is going to be proven wrong, just because our models of the world are getting, you know are continually improving. One last chip, not only for medical students and, but for everybody, especially people as they get older and older is to lift weights. It's something I never even thought of, I never considered. It wasn't a part of medical school unless you were an orthopaedic surgeon. Nobody lifted weights. But I think now, everybody should do it. It's the secret longevity trick. If our nursing homes had weight rooms, there'd be a lot fewer people in nursing homes.

Dr Louise Newson: Yeah, that's a great tip. I do a lot of yoga, but I have been starting to do weights as well, just to join in. So, it's so important, but thank you so much for sharing your knowledge and wisdom. It's been great. Thanks Rob.

Dr Robert Lufkin: Thanks so much, Louise. I appreciate it. It's been a wonderful conversation.