Dr. Hanno Pijl - Optimizing Hormones through Hormesis

Dr. Hanno Pijl
Leiden University Medical Center

Hanno Pijl is an internist-endocrinologist at the Leiden University Medical Center (LUMC). He is a professor of Diabetology at the same institution since 2007. He practices internal medicine and co-authored over 250 papers in peer-reviewed scientific journals, primarily related to obesity and type 2 diabetes. He has been a member of the Dutch Health Council (standing committee on nutrition) from 2008-2016. He is former president (2014-2017) of the Dutch Obesity Partnership, an umbrella organization connecting all stakeholders involved in obesity care in the Netherlands. He currently co-chairs the Dutch Innovation Center for Lifestyle Medicine (www.nilg.eu), a joint effort of LUMC and the Dutch Organisation of Applied Science (TNO) focusing on lifestyle interventions in health care.

TRANSCRIPT

Dr. Pompa:
Hey, Dr. Pijl, thank you for being here. I’m going to call you Dr. Hanno because when I see the last name, I’m like surely I’m going to mess that up 10 times. So, the J being silent. Well, you know, I have to say I fell in love with your message. We were at the UAC. Dr. Valter Longo had the UAC conference on fasting, the summit there and you spoke and I just thought, “Oh gosh, he has to speak this at our next seminar,” because it tied in so many of the topics that we’re going to be discussing. It tied in cancer, but it tied in the whole principle about fasting and some of the discoveries that you have, our doctors need to hear this message, but with that said, so, thank you for being here and I want to discuss some of these topics here today.

Dr. Hanno Pilj:
My pleasure. Thank you for inviting me.

Dr. Pompa:
Yeah. So, you’re from, I guess I don’t know where you grew up your whole life. I mean, tell our viewers a little bit of background about yourself. Just how you got into this topic and from where you are now.

Dr. Hanno Pilj:
Well, I’m a doctor. I’m an internist, in fact, an endocrinologist. So, I treat people with any hormonal disease, but particularly, I’m particularly interested in diabetes. So, I treat many patients with diabetes and in fact, my interest in fasting originates from my interest in aging. So, very much interested in why we age and how we age and this is because diabetes is an aging associated disease. So, then I discovered that calories, a long time ago, that calorie restriction is in fact a very effective way to postpone and even prevent chronic disease and extend lifespan. So, from that, I became interested in fasting as an extreme form of calorie restriction and then I discovered that it’s a very effective way and periodic fasting is a very effective way to do the same as chronic calorie restriction in terms of extending lifespan and preventing chronic disease. So, that’s where my interest, and preventing diabetes in particular. That’s why my clinical interest come from.

Dr. Pompa:
Yeah and I think you and I both read all the studies on caloric restriction. Really, the only thing that actually holds up under the scrutiny of actually extending life, however, clinically, I think we both face that longterm caloric restriction leads to new problems, right? Leads to lower immunity, it leads to a metabolism that can slow and lower, right? We both discovered short bursts of caloric restrictions, the magic. Explain that for our viewers.

Dr. Hanno Pilj:
Well, I think chronic caloric restriction, first of all, is not a feasible intervention for people to do. I mean, no one can chemically restrict calories enough to have a significant effect on disease and a part from that, you’re right, chronic calorie restriction actually leads to problems. Now, periodic fasting has a very powerful effect on our metabolism. We know more and more and so, what happens is that in fact our cells, our healthy cells sense that there’s a shortage of energy and a shortage locks and then they go into a mode of, they shift away from growth and proliferation towards maintenance and repair. So, what happens is there is a process called autophagy, which is activated and autophagy is nothing more than cells eating up their debris, the damaged cell structures and they’re using those structures as energy and also, to a certain extent is building blocks. So, they actually clean up themselves. So, that’s one thing and the other thing is that there’s a process called hormesis, which is basically a very evolutionary conserved mechanism of cells protecting themselves against all kinds of toxins and this process is activated as well by periodic fasting.

Now, if you do that for a couple of days and then start eating again, the cleaning process has very longterm effects on cell physiology. So, if you do, if you fast periodically, there is a very powerful effect on health actually.

Dr. Pompa:
Yeah. We found it clinically, you know? No doubt about it. We have, our doctors have clients, patients with diabetes, obviously cancer and we realized these pulses of either partial fast and Valter Longo’s case, fasting, mimicking diets or even just water fasting, drive the ontology and drive this hormesis. You know, talking to me a little bit more about that because a lot of people, that’s probably the first time they’ve heard the term hormesis, which is this adaptation process and it’s really, I find very few people actually speak about it and I can’t wait to hear more at the seminar about it because it is part of this driving factor-

Dr. Hanno Pilj:
It is.

Dr. Pompa:
Of these times of feast and famine that I like to call diet variation works and you said something. I believe that it’s in our DNA, that we actually need these times and we actually gain such hormone. You said you deal a lot with hormone cases. So do I. It causes a hormone optimization because of hormesis. Explain that to people.

Dr. Hanno Pilj:
Well, hormesis is a phenomenon that is meant to help organisms to survive periods of stress.

Dr. Pompa:
Yeah.

Dr. Hanno Pilj:
If you fast, that’s obviously stressful for an organism. Now, we know very well that mild stress induces this process called hormesis, which is meant to actually resist that stress, but the interesting thing is that it doesn’t resist the stress in this case. So, the fasting only, but it protects against all kinds of other toxins as well. Now, obviously, if you fast too long, you’re going to get problems. So, hormesis is meant to survive relatively short periods of mild stress and it’s a very well conserved mechanism and in fact, the molecular biology has been figured out quite well. It involves IGF, it involves insulin, it involves MTORE, all kinds of molecules are involved there and it’s also every organism that we know of has this same mechanism. So, humans, well-

Dr. Pompa:
You and I align on something that I think very few people do. I think people stand in their camps on certain diets. Vegans, vegetarians, paleo people, high protein, whatever it is and you and I, I think we have an approach where we look at cultures and go, you know, I don’t really see someone locked into one diet. I see people that were forced in and out of different diets and that forcing in and out of different diets, it stimulates this hormesis adaptation principle, right? So, speak a little bit about that.

Dr. Hanno Pilj:
Yeah. Well, I think we have evolved as humans, as omnivores and if you look back in our history, there have been humans that basically survived and thrived on plant based diets, but then there’s also human populations that primarily eat meat and then there’s one other very important characteristic, which is that we never had food every day. So, whether you were a plant eater or a meat eater or a mixed eater, well, usually it was mixed by the way. We are really true omnivores, but in no case, we had food always. So, I think we are truly made to have less food and fast once in a while. This is how our organism evolved. Just like any other animal in nature and plant-

Dr. Pompa:
Yeah.

Dr. Hanno Pilj:
Same thing. So, I think it’s a part of our, it’s a very important thing for our physiology to do this.

Dr. Pompa:
Yeah. I think we don’t even understand some of the healing yet. You know, clinically because I teach a growing group of doctors some of these principles, you know, we see gut healing, which is so difficult. You can’t just give people bacteria and probiotic and fix their gut, but we see these diet shifts, feast famine cycles actually really has a much greater impact and you’re going to learn that at the seminar. We’re going to be teaching all about that, but you know, I think some of the newer studies and I don’t know if you’ve found anything on this, but some of these diet shifts are changing the microbiome in ways that we didn’t anticipate. Do you know anything about that?

Dr. Hanno Pilj:
No, not enough. No. I didn’t work on that myself yet, but we are going to study the microbiome of people with type two diabetes and we’re going to treat them by periodic modified fasting. The Longo diet. So, the fasting mimicking diet and we’re going to treat people with type two diabetes for one year, five days a month, give them a modified or a fasting mimicking diet and look, one of the things that we’re looking at is their microbiome. So, I’m very curious because I’m sure that it will have profound effects on the microbiome.

Dr. Pompa:
Yeah. I mean, we’ve seen it clinically and that’s what I’m excited about the studies. I didn’t know where you are on that and really nobody’s doing that, but clinically, we see these microbiome shifts even with dietary changes, you know? If they go into [crosstalk 00:11:33] to a plant based diet, out back and we see these amazing shifts that are occurring. It has to do with this hormesis concept that like you said, not many people really understand, but it must have something to do with the adaptation.

Dr. Hanno Pilj:
Yeah. I agree.

Dr. Pompa:
Yeah, whether the body’s using the microbiome to adapt, right? With a communication with the immune system or cells or the forced adaptations affected the microbiome. I don’t know.

Dr. Hanno Pilj:
Yeah, no-

Dr. Pompa:
Interesting topic.

Dr. Hanno Pilj:
Yeah, it is and you’re right. It has a profound effect on our immune system as well. Valter Longo is working on that a lot actually and it has a very beneficial effect on immune cells.

Dr. Pompa:
Yeah and with diabetes, a lot of the docs there, you know, I think we all see so much diabetes and would love to hear more about that at the seminar and what about some of the work with cancer? You spoke a little bit about that when I heard you speak. How does this play into that?

Dr. Hanno Pilj:
What we do here is we’re one of the first here in Leiden to look at the impact of fasting mimicking diet in women with breast cancer who get chemotherapy and so, what we do is we give them three days ahead of their chemo cycles and during the chemo itself, the day of the chemo itself, we give them a fasting mimicking diet and we look at the two things, the primary outcome measure is side effects and we expect much less side effects because the healthy cells of these women we propose are shifting towards maintenance and repair and they are activating their hormesis. So, we expect them to be more resistant to the toxic effects of the chemo-

Dr. Pompa:
Right.

Dr. Hanno Pilj:
One thing and the other thing we look at is tumor response to the chemotherapy because the interesting thing is that tumors are muted, tumor cells are mutated obviously and they cannot make that shift towards maintenance and repair. They are just, their metabolism goes on and on and they feel, they sense this energy deficit and building blocks, deficit of building blocks, they sense that they are extra sensitive to that. So, we expect them to, we expect the tumor response to be more profound to chemotherapy and I may be able, I’m not sure, but I may be able to show you some data on the conference and they appear very positive.

Dr. Pompa:
Yeah. I was excited when I saw the data presented at the seminar that you and I were at. You know, I think one of the things that ran through my mind was it’s a shame that the average person, the general public doesn’t know this research is being done, right? They’re getting hammered with chemo that has a negative effect on the cells, the good cells and of course, it has a negative effect on the bad cells or at least an affect on the bad cells, but people don’t realize that something as simple as fasting can change that paradigm greatly and that’s what these early studies is showing. I have a simple saying, bad cells don’t adapt, right? These cancer cells, they can’t make the adaptation-

Dr. Hanno Pilj:
Exactly.

Dr. Pompa:
You know, and good healthy cells do and the fasting cells, when fasting, it makes the healthier cells healthier and it inhibits the bad cells, therefore chemo would have a more positive effect. Well, listen, I so appreciate you coming all the way the ocean.

Dr. Hanno Pilj:
My pleasure.

Dr. Pompa:
Where are you from exactly over there?

Dr. Hanno Pilj:
I’m from, you want to know the city where I grew up?

Dr. Pompa:
Yep.

Dr. Hanno Pilj:
I’m from Arnhem, which is in the eastern part of the Netherlands. So, then I moved from Arnhem to Rotterdam, you’ve probably heard of Rotterdam, which is one of the biggest ports in Europe.

Dr. Pompa:
Yep.

Dr. Hanno Pilj:
And I studied in Rotterdam and then moved, well, I was back in Arnhem for a couple of years, two years or two and a half years and then moved to Leiden and so, Leiden is, Leiden where I’m now and working now here for 30 years and it’s in between Amsterdam and the Hague. It’s very close to Amsterdam.

Dr. Pompa:
Yeah.

Dr. Hanno Pilj:
Very close-

Dr. Pompa:
Again, that’s the closest I’ve been to you. I’ve been to Amsterdam and yeah-

Dr. Hanno Pilj:
Okay-

Dr. Pompa:
Love that area, by the way. I want to spend more time there. Now, I have a reason. I can come see your work.

Dr. Hanno Pilj:
Yeah.

Dr. Pompa:
I do have to ask one question. I mean, very traditional scientist and practitioner, how did you stumble upon, I mean, you said the anti-aging component, the diabetes, but still, you’re a rare bird in that you stumbled upon this. Was there one thing that did that?

Dr. Hanno Pilj:
No. I actually, I have been interested in nutrition and the health effects of nutrition for a very long time. I even considered studying nutrition when I left high school, but then decided to go to medicine instead and then it was a little bit in the background for a couple of years, but then I think 15 or 20 years ago, I read this book by oh, now I forgot his name. It’s called Guns, Germs and Steel, about the impact, basically the impact of agriculture on our evolution and it answers the question why Europeans have been so predominant in the world for many years. It’s a very interesting book and it, so, that’s the nutrition again and then somehow and I’m not sure why, there was no specific, I can’t remember any specific case or something that I became interested in fasting or calorie-

Dr. Pompa:
Yeah.

Dr. Hanno Pilj:
It stems from my interest in nutrition in general.

Dr. Pompa:
Yeah and when you deal with the nutrition, there’s nothing more powerful than fasting and folks, you need to come to the seminar because Dr. Hanno has so many principles. When I heard you speak, honestly, I was like, “People have to hear this. More people have to hear this,” and I don’t know how often you get to the US to speak, but how often have you been?

Dr. Hanno Pilj:
Well, a couple of times a year.

Dr. Pompa:
Yeah. Well, I’m glad we’re one of them this year Dr. Hanno because you are. You’re a wealth of knowledge. Docs, you need to hear this and for the first time, we actually have in our seminar and by the way you can sign up for the seminar right here on this page. So, make that happen. This time we actually have a day for where the public is going to be there.

Dr. Hanno Pilj:
Wow.

Dr. Pompa:
So, because of the topic, you know? I think people need to hear some of this information, but I can’t wait. You’re going to bring information nobody has brought and it’s so aligns with what I’ve been teaching, what we’ve discovered clinically. So, to hear the science line up, it makes me come out of my chair. I can’t wait to hear your talk. I really can’t. So, thank you for flying all the way across and making that happen for everybody. So, we’ll see you at the seminar. Thanks doc.

Dr. Hanno Pilj:
Okay, thank you. Bye, bye.

Dr. Pompa:
Yeah, bye.