Each week Dr. Carl Seger listens to your favorite podcasts to summarize the data and give you our precision medicine take. Here's this week's take:
Who: Tara Brach
What: Part 1: Forgiveness Three Blessings in the Spiritual Life
- Work on shifting from the egoic state to a quality of presence in belonging and interconnectedness with all of life. When something negative happens in life we respond by blaming others or ourselves. We reinforce the identity of the victim. The other way to respond is to evolve, adapt and expand with use of love, kindness and compassion. This is the shift from flight-fright-freeze to attending and befriending.
- In order to achieve forgiveness we have to ask: “How am I creating separation from myself and from others?” It’s the chronic judgements and resentment we carry with us. It’s the little things that accumulate to stop the flow of appreciation. These continuous negative thoughts can make you stagnant. Do a forgiveness scan by practicing where and when you pause and reflect. This can be done daily.
- When we’ve been hurt, we are afraid to forgive. We fear it will happen again, that things will get worse, or that we will lose control. Forgiving isn’t approving or forgetting boundaries. It’s a way of releasing our heart so it’s not caught in blame. This allows our heart to be open to decide what will or will not work. When we let go of blame we are able to act with more clarity. “You're not building scabs that cover up your heart.”
- What motivates us to let go of blame and resentment? For most people, we aren’t motivated, because it is work. Then, we realize it is what keeps us from love. Blame and judgment keep us from experiencing our potential to love without holding back.
- Anger has a place of belonging, but we must work to recognize the feeling beneath it. The very same process that is used to release our own armor is what we must go through with society. It is a process of letting go of the armor. This is the great awakening. Sometimes it’s a process that requires a therapist. You can’t will forgiveness into being, but you can be willing to forgive. The energy we need to bring peace into the world is becoming more willing to build intention to forgive.
How: Whatever we practice grows stronger. For most, we are not motivated to forgive because we know it will require work. However, if forgiveness is not practiced, then anger, resentment, and shame grow stronger. If there is someone or something in your life that requires forgiveness, build a daily forgiveness scan practice. Focus on letting go of blame, anger, and fear. Instead, respond with love, kindness, and compassion, knowing that this is the desired response.
Who: The DRIVE with Peter Attia, MD
What: #216: Metabolomics, NAD+, and cancer metabolism | Josh Rabinowitz
- Metabolomics studies metabolites within an organism, tissue or cell. Glucose is the most popular metabolite studied because of its effect on the development of type 2 diabetes (T2D). Glucose is the primary fuel source for cancer cells. Our bodies are built to have the most circulating glucose in our system that we can handle at one time. Evolution didn’t build in wiggle room for glucose to rise much more than what we already have circulating. This leads to a broader set of derangements for glucose to be chronically elevated, like in the case of T2D. The problem arises when the liver assumes the high glucose level is the correct level and continues to maintain it. Some research shows that making room for glucose to be burned by controlling the amount of fat burned can help to manage some of this imbalance of elevated glucose in the body for people with T2D. If you turn off lipolysis (fat metabolism), you turn on glucose consumption. Lactate is another fuel source that can suppress glucose metabolism. Lactate is the fastest nutrient because there are MCT transporters that distribute lactate everywhere in the body. In contrast, glucose is heavily regulated to keep stores for possible times of famine. Fasting lactate levels (like glucose) vary based on metabolic fitness. If lactate is high, it means the lactate clearance system isn’t working efficiently and circulating lactate is an intermediary in glucose catabolism. For this reason, lactate dysregulation might be an earlier telling factor of metabolic dysfunction than glucose.
- NAD is a longevity nutrient that is produced via the Krebs Cycle. NAD is prepared to pick up electrons to make NADH. If NADH is too high, it leads to the buildup of free radicals which slows down metabolism. Supplementing with NAD has become more popular recently with new research showing that as we age, NAD levels decline. The hypothesis is that by restoring NAD levels in older organisms, they should feel like new organisms again. However, according to Josh’s findings, this decline is much more subtle than we previously thought, in the range of 10 percent, but maybe cell type dependent. NAD has no known oral absorption route. The best way to get NAD into your system is intravenous. Either way, NAD will be broken down. However, by way of IV, it is only broken down partially, which means that some pieces of NAD may be taken up in cells and can potentially boost NAD levels. IV may not be the most efficient for distribution, but it is more effective than oral absorption because it bypasses the liver. NR and NMN are precursors for NAD. These are popular for oral supplementation, which can have a more significant benefit than supplementing NAD itself. When these precursors are digested, they are broken down into smaller pieces which can boost NAD. Prescription niacin can also do the same thing. NR + NMN delays absorption of niacin, which can reduce the flushed feeling you get from niacin supplementation. However, the dosing is much less, which may also be the reason.
- Cancer metabolism is fueled by glucose. However, there is no way to eliminate glucose because our bodies will always have stores of glucose, even in starvation. It is not easy to cut off cancer fuel supply without vital fuel supplies (brain, organs, etc.). The composition of the microbiome can be predictive of whether immunotherapy will work. Chemotherapy can lower glucose levels in tumors and, in combination with a low glucose diet, there has been success in improving the treatment.
- Pancreatic cancer is the most lethal, with a 95% mortality. It is the 4th leading cause of cancer deaths in the US in both men and women. Pancreatic cancer is difficult because it is in a problematic location within the body to contain cancer cells and is a massive protein-producing organ. Cancers turn this process down, slowing down metabolism and slowing down the breakdown of cancer cells. Other epithelial cancers like lung cancer might also respond to a metabolic approach, like chemotherapy with diet change, as well as cancers with mutational burdens.
- Nutrition in cancer treatment can be a helpful piece of the puzzle: reducing insulin, optimizing the fats in the diet, dietary fiber and even nutritional supplements. Relying simply on cycling between fasting and feeding isn’t as effective as we thought. Josh poses the idea that cycling carbohydrates, fats and proteins can also benefit treatment outcomes. All of this has been studied in animals, and the transition to studying in humans is a few years away due to the nature of the challenges of adherence for humans. While finding the perfect diet to go with immunotherapy treatment is a top goal, Peter and Josh both acknowledge that no matter what it is, it has to be clinically actionable. Patients would need to be able to adhere to it simply without having a robust knowledge of nutrition. Josh is adamant that nutrition and lifestyle changes are significant for immunotherapy treatment to be successful. Still, it is unrealistic and infeasible to ask people to completely give up the joys of food and eating to treat their cancer.
How: We can use this information to better understand how our body utilizes fuel sources and when there may be a breakdown of function somewhere along the way. We can use the information provided on NAD supplementation to better guide patients on supplement recommendations. Additionally, we can use the information provided to take a holistic approach in guiding some nutrition strategies to help support their treatment of cancer for any patients we may assist through this in their journey.
Who: Andrew Huberman Ph.D., Professor of Neurobiology and Ophthalmology at Stanford School of Medicine
What Dr. Emily Balcetis: Tools for Setting & Achieving Goals
1. How we visualize problems can predict whether or not we will be successful at overcoming them. Knowing this, we can strategize to set and meet goals. For example, whether we imagine success at the top of a mountain or as something closer in the distance strongly dictates whether we achieve the goal with more or less energy. These strategies can be applied to all types of goals including performance, relationship, vocational goals, etc. Positive self talk, motivational sticky notes and reminders are all common and powerful tactics. However, these methods are effortful and take a lot of time to maintain, leading to burnout before meeting goals. Strategies that don’t take as much effort and are automated include tapping into our visual system and utilizing mental illusions to take a new approach and improve motivation.
2. Studies started in the 1940’s looking at the science behind motivation using rats. They found that toward the end of a race, rats moved faster to get to the finish line, even though they were hungry and had to expend more energy. These results showed that proximity to a goal increases motivation and effort. This study spurred a wave of research in humans. It was discovered that humans also tend to work harder when they are closer to achieving a goal, a finding that was named the Goal Gradient Hypothesis. Researchers then asked, “could we induce the experience of the finish line?” We find that if we focus on shorter distance goals, breaking up work into smaller pieces or focusing on getting to closer goals, that we can effectively increase motivation states with the illusion of proximity. Examples of this strategy are focusing on short distances, like running to a certain light post, then reframing a new goal, which eventually amounts to longer distances. Another example is choosing to eat healthy foods today instead of thinking about a 3-6 month restriction diet. Those who employ these strategies tend to be more successful at actualizing their goal.
3. For many, it may not be the finish line, but the starting line that can be hard to find. Vision boards or dream boards are a strategy to make a visual representation of something you want to accomplish. This is a great thought exercise for determining long term goals. However, for some, just identifying the actual goal is satisfying and they may not try to actually reach it. Some studies have shown that systolic blood pressure decreases after identifying a goal or making a vision board, potentially correlating to a dip in motivation. The process of achieving a goal should not stop with identifying what the goal is. We need to simultaneously think of a couple more components. First, ask “how am I going to get there?”. Often we set our timelines and focus too far in the future. Rather, we should focus on what we are going to accomplish in the next day or the next 2 weeks. Think of the big picture but by breaking it down into smaller pieces or steps. Second, think about the obstacles that stand in your way of success. This may seem counterintuitive, but having a back-up plan and knowing how to bail out of a problem can provide relief. We don’t do our best thinking in crisis mode, so it's best to plan ahead.
4. Vision is our dominant sense, therefore, people prioritize what they see over any other senses. Vision is a tool that we can add to our kit for accomplishing goals. By changing to a more narrow visual aperture, we can change our sense and perception of time. Some studies have shown how states of the body can relate to their physical experiences. For example, those who are overweight, chronically tired or older have the sense that distances look longer. Just the thought of exercise for those who are physically unfit looks and feels much harder than for those who are fit. In another double blind study, some participants were given KoolAid with real sugar and others were given KoolAid sweetened with Splenda. They were then asked to estimate distance and those who had been given the sugar perceived their space as more constricted and distances were closer. However, a narrowed focus of attention can work for everyone. By inducing the same visual illusion the same positive consequences can be attained.
How: Set small attainable goals that make you feel they are in sight. Reset new goals often to keep propelling you forward. Vision boards are useful for identifying goals, but simultaneously breaking down the goal into small steps leads to success. Think ahead about obstacles that could derail your plans and have a plan B. Tools like the “Reporter” App or the “1 Second Everyday” App help you to record your progress so you can assess if you're on track.