Penn Jillette interviews water fast guru Dr. Michael Klaper. Woo ensues.

I’ve self-identified as a skeptic for a while now, and, even though I agree with a lot of points made by Sharon Hill I’m not quite ready to turn in my skeptic card just yet. I could get there though. Be that as it may, if there’s one thing they say that’s true, it’s never meet your heroes. they’ll always disappoint. For instance, I used to think of Penn Jillette as a prominent skeptic, and for a while he sure did seem to be one. But then I started noticing him denying the adverse health effects of secondhand smoke (which he later admitted to have been in error), denying climate science that says that humans are a primary cause of global climate change, and in general letting his libertarian political views cloud his skepticism. Sure he was right on vaccines and a lot of other things, but, as is the case with most, if not all, humans, there were certain areas where skepticism was lacking. Most recently, to his great credit, Penn has lost over 100 lbs. Unfortunately, accompanying that weight loss appears to be credulity over certain kinds of dietary pseudoscience and bad science, as I learned when I listened to his interview on his podcast with vegan “whole food” diet maven and water fast guru Dr. Michael Klaper.

A friend emailed me links to episodes of Penn Jillette’s podcast Penn’s Sunday School, where Dr. Klaper was featured in a two part interview (episode 412 and 413) because Penn had decided to start a 21 day water fast under Dr. Klaper’s supervision. I was intrigued. I had no idea who Dr. Klaper was, and, I must admit, had not paid much attention to Penn himself in quite some time, certainly not after he had treated me so shabbily at TAM five years ago. I was, however, aware of how much better Penn now looked after having lost so much weight and that he had written a book about it. Apparently, he had enlisted the help of someone named Ray Cronise and followed a “wild potato diet.” I didn’t know the details, not having been interested, but it didn’t take much Googling to find out. Basically, Penn had lost 120 lbs in four months on what was characterized as a “vegan-inspired” diet after what sounded like a “come to Jesus” (if you’ll excuse the term) moment when he was hospitalized for hypertension. That hypertension was attributed largely to his obesity. As a result, Penn went on a mostly vegan 1,000-calorie-a-day diet from December 2014 to April 2015 and lost almost a pound a day without exercise. He continues to follow a mostly vegan diet based on Dr. Joel Fuhrman’s Nutritarian Diet, which excludes animal products, processed grains, added sugar and salt.

Of course, if you adhere to a radical 1,000 calorie a day diet, you will lose weight, a lot of weight, and you’ll lose it pretty quickly. Whether that’s a healthy way to lose that much weight is quite debatable; it probably isn’t. In any event, contrary to what diet gurus like to claim, it likely doesn’t matter much what those 1,000 calories a day consist of, given that that’s basically a starvation diet. Still, Penn’s accomplishment is impressive, although it’s more impressive that he’s so far managed to keep most of the weight off. What’s not so impressive is that he appears to have become convinced that he needs to undergo an even more radical “water fast” to complete the process of reversing his obesity-related health issues, like hypertension. Enter Dr. Michael Klaper.

Dr. Michael Klaper: Vegan and water fast guru

Before I listened to the podcast, I wanted to find out what Dr. Klaper was all about. This post, after all, is not so much about Penn other than that Penn is how I found out about Dr. Klaper. Rather, it’s about Dr. Klaper’s claims, which were laid out in detail on Penn’s podcast. Given that I had never heard of Dr. Klaper before wanted to familiarize myself with them before hearing the interview, I wandered over to Dr. Klaper’s website. It’s immediately apparent there that Dr. Klaper subscribes to the all-too-common claim that a vegan diet is better than any other and supplements that claim with a belief that undergoing fasts, in which one consumes only water, is a major part of the path to health and wellness. Actually, he goes further than that:

For more than 40 years, Dr. Michael Klaper has served as a physician, consultant and educator to thousands of clients and patients around the world on their journey to reclaiming health and optimizing well-being. As Dr. Klaper says, “I have the deepest respect and passion for the healing abilities of the human body. Each day, I witness countless ‘miracles’ when the body is provided optimal fuel: pure, whole, plant-based foods, and, when needed, a modicum of beneficial, time-tested medicines and complementary therapies such as acupuncture, massage and herbal medicine – and, at all times, generous doses of love.”

What does he mean by “pure, whole, plant-based foods”? As I learned in his interview with Penn and elsewhere on his website, he means only whole plants, no extracts. Early in his interview, he states that one’s diet should optimally be whole plant-based; in other words, no processed food, no ground flour, no oils, no nothing other than “whole plant.” To paraphrase Dr. Klaper, if it doesn’t grow out of the ground, you shouldn’t eat it. Anything else is a “treat food” that you shouldn’t touch, except maybe once a week at most. He and Penn quite properly noted that it’s quite possible to eat a vegan diet that’s bad for you (a number of snack foods, strictly speaking, can be considered vegan, and a lot of vegan meat substitutes are not good for you), but this is still the “appeal to nature” fallacy writ large. It’s a fallacy that undergirds a whole lot of what Dr. Klaper claims and undermines a lot of what he says. I also can’t help but note that Dr. Klaper is very much into the pseudoscience behind “complementary therapies,” such as acupuncture. Indeed, although he recently retired from TrueNorth Health Center, where he most recently practiced, in favor of full time production of educational materials, I can’t help but note that TrueNorth is a full-service “integrative” quackery center, complete with chiropractic, naturopathy, acupuncture, and the like and chiropractors and naturopaths to provide those services. I can’t help but note that these are modalities that Penn and Teller once termed “Bullshit!” on their show.

Dr. Michael Klaper: Borderline germ theory denialism and other dubious claims

While perusing Dr. Klaper’s Answers section on his website, I came across some seriously dubious stuff. For instance, Dr. Klaper subscribes to the myth of the “deathbed conversion” of Louis Pasteur. No, really, he does. In a section, How to Avoid Getting Sick, he writes:

Louis Pasteur finally realized the truth in Dr. Bernard’s assertion. Pasteur’s last words are reported to have been, “The terrain is all…” His lesson to us is that if we keep our mind, spirit, and body’s tissues healthy, the bacteria will be far less likely to gain a toehold (or tentacle-hold, or flagellum-hold, or whatever microbes hold on with). Take care of your precious terrain. Salud!

In fairness, some of Dr. Klaper’s recommendations on how to avoid getting sick are not unreasonable (e.g., get enough sleep, exercise), but others are not supportable (e.g., consider herbal immune support, drink enough pure water, keep your diet “clean”). However, he flirts with some serious germ theory denialism. As I’ve discussed more times than I can remember going way, way back, no, Pasteur said no such thing on his deathbed, even if Bill Maher claims that he did, falling for a longstanding myth among quacks like Kelly Brogan, who made the same claim.

I also note that it wasn’t so much Claude Bernard who was Louis Pasteur’s rival. It was Antoine Béchamp who believed that the “germ is nothing” and the “terrain is everything” with respect to infection. His idea was known as the pleomorphic theory of disease and stated that bacteria change form (i.e., demonstrate pleomorphism) in response to disease. In other words, they arise from tissues during disease states. Béchamp further postulated that bacteria arose from structures that he called microzymas, which to him referred to a class of enzymes. Béchamp postulated that microzymas are normally present in tissues and that their effects depended upon the cellular terrain. Ultimately, Pasteur’s theory won out over that of Béchamp, based on evidence, but Béchamp was influential at the time, and, given the science and technology in those days, his hypothesis was not entirely unreasonable. It was, however, superseded by Pasteur’s germ theory of disease and Koch’s later work that resulted in Koch’s postulates. Besides not fitting with the scientific evidence, Béchamp’s idea had nowhere near the explanatory and predictive power that Pasteur’s theory did. On the other hand, there is a grain of truth in Béchamp’s ideas. Specifically, it is true that the condition of the “terrain” (the body) does matter when it comes to infectious disease. Debilitated people do not resist the invasion of microorganisms as well as strong, healthy people. Of course, another thing to remember is that the “terrain” can facilitate the harmful effect of microorganisms in unexpected ways. For example, certain strains of the flu (as in 1918 and H1N1) are more virulent in the young because the young mount a more vigorous immune response. It’s true that Claude Bernard did come up with the concept of the milieu intérieur, which would later become known as homeostasis, the process by which living organisms maintain a constant internal environment that allow the cells that make them up to function. As a historical side note, he was also a vocal proponent of vivisection and vivisected the family dog, leading his wife to leave him.

More disturbingly, in his section on hepatitis C, he recommends this:

The anti-viral medication, Harvoni, has revolutionized the lives – and prognosis – of people with hepatitis C. 12 weeks of oral therapy makes the virus permanently undetectable in 95% of people and should be investigated by anyone with this condition.
Whether or not one uses Harvoni, a very promising therapy that seems to help retard or even apparently arrest the cirrhosis process was described by Dr. B. M. Berkson of New Mexico in his article, “A Triple Antioxidant Approach to the Treatment of Hepatitis C using Alpha-lipoic Acid (thioctic acid), Silymarin, Selenium, and other Fundamental Nutraceuticals,” and published in Clin Practice Alt Med 2000; 1(1):27-33. (See a 6-page PDF with this link.)

Since much of the damage done to the liver cells by the cirrhosis process involves oxidation, Dr. Berkson employed potent anti-oxidants in several patients with severe liver disease from hepatitis C – some of whom were on the liver transplant list. Apparently his program produced dramatic clinical improvements, allowing people to regain their sense of health and strength and return to their employment. There was significant normalization of previously abnormal liver function tests. The case accounts are quite inspiring to read.

I’ve discussed Dr. Burton M. Berkson in detail before in the context of cancer quackery. He and his son Dr. Arthur Berkson run a clinic in New Mexico, where they promote a protocol to treat pancreatic and other cancers using α-lipoic acid and low-dose naltrexone plus a strict dietary regimen based on no clinical trial data and several dubious testimonials. Indeed, Dr. Klaper seems to be into a lot of highly dubious advice for cancer patients, as evidenced by his article Stage 4 Breast Cancer: Constructive Actions. Among his recommendations:

  • Stop eating ALL animal flesh. He claims that eating animal flesh (meat) raises levels of IGF-1, the most potent, growth promoting molecule in biology, and thus drives cancer growth. (Hint: IGF-1 is not the most potent growth-promoting molecule in biology. It is important in the development of some cancers, but Dr. Klaper can’t seem to resist overselling it.) He also claims that cholesterol feeds breast cancer cells. While there is evidence that cholesterol might contribute to breast cancer development, the evidence that ceasing cholesterol intake after a woman has stage IV breast cancer is—shall we say?—sparse to nonexistent. Basically, Dr. Klaper is relying on cherry-picked cell culture studies here.
  • Stop eating ALL dairy products. Dr. Klaper claims that cow’s milk is loaded with estrogens that promote breast cancer growth and its proteins boost IGF-1 levels. (Again, there’s no evidence that this matters in stage IV breast cancer.)
  • Stop eating processed, packaged food products and all vegetable oils, including olive oil, and all fried food. (Again, there is no evidence that this matters in stage IV cancer.
  • Cook only with water-based methods, e.g. steaming vegetables, preparing quinoa, rice, oatmeal and other whole grains, making soups and stews, etc. (Again, I’m getting tired of pointing out that there is no good clinical evidence for this.)
  • Eat flaxseed. Dr. Klaper bases his claim on preliminary studies that looked at surrogate endpoints presented in a biased fashion by an ideologue.

You get the idea. Dr. Klaper is one of those “diet physicians” who thinks that food (or dietary changes) can do a hell of a lot more than the evidence suggests that they can.

Dr. Klaper’s vegan and water fast nonsense on Penn’s podcast

Let’s get into the dietary claims and the claims for fasting that Dr. Klaper makes. Before I do that, I can’t help but note that TrueNorth, as described by Dr. Klaper in his interview with Penn, is a converted apartment building where patients stay in individual apartments as they undergo their water fast, so that the medical staff can monitor them. This is hard core water fast woo.

One of the first claims that raised my eyebrow was his claim that “chimpanzees can’t fast” because they’re not able to metabolize their fat tissues for prolonged periods of time. While it is true that chimpanzees have a significantly lower percentage of body fat than humans on average, this claim, which was unsourced and that I could not back up, smells. My guess is that it is probable that chimpanzees can’t fast as long as humans because they don’t have as much body fat, but that’s a trivial observation that really has little relevance here. Indeed, elsewhere in the interview Dr. Klaper himself says you shouldn’t fast if you’re too skinny. What’s the difference? Of course, I could be wrong here. Maybe a primate physiologist can set me straight. However, I was unable to find anything to confirm Dr. Klaper’s claim, either on his website or on Google.

Through it all, Dr. Klaper relies on evolutionary and physiological claims that range from the dubious to the inconsistent. For example, he points out how intermittent fasting is what we’re evolved for because our ancestors on the African plains might go days between finding bushes full of berries. Of course, if this were the case, it rather goes against his claim that chimpanzees can’t fast, given how closely related humans are to chimpanzees. How does he reconcile these claims? He doesn’t. He also neglects to mention that, contrary to his claims, muscle protein is broken down throughout fasting, just not to the same degree as fat stores are utilized.

Another claim that raised my eyebrow (and caused my blood pressure to spike) also comes early in the interview. It’s in two parts. First, Dr. Klaper claims that fasts will clear up inflammation and resolve eczema and arthritis and other immune conditions. That might be possible, but think of the reason. Nutritional depletion (which is what a water-only fast will rapidly cause in a manner of days) is immunosuppressive. Indeed, malnutrition is the single most common cause of immunodeficiency worldwide. So, of course any inflammatory process mediated by the immune system causing symptoms might temporarily abate while the faster is seriously nutritionally depleted. Much later in the podcast, he even claims that not eating will result in faster wound healing, which would lead most surgeons (like me) to respond: “Bullshit!”

The second part of the claim is the doozy, though. Using a “just so story” as rationale, Dr. Klaper claims that the body, after food intake has ceased for a few days, “doesn’t know” if it will ever get any more and therefore shuts down “wasteful” processes like inflammation. Of course, this is painfully simplistic, because inflammation is an immune response and utterly necessary as part of the response to, say, infection or injury. If inflammation of arthritis is shut down, so too is inflammation necessary to fight off infection. Now here’s the kicker. Dr. Klaper says one of the most wasteful processes of all is running a malignant tumor. “If you’re starving to death,” Dr. Klaper observes, “that’s the last thing you want to spend calories on.” He then goes on to claim that fasting can shrink malignant tumors, citing—ugh—Dean Ornish. Basically, what he’s advocating here is a variation of ketogenic diet claims. (After all, fasting is the ultimate ketogenic diet, if you know what I mean.) Now, I haven’t discussed ketogenic diets in a long time, but when I did I pointed out that the evidence for them as anticancer therapy is spotty at best and utterly unconvincing at worst, and a more recent case report claiming that a ketogenic diet was a useful adjunct for neoadjuvant chemotherapy for breast cancer was similarly unconvincing. Again, as with most things in medicine, it’s complicated. There is some preclinical (i.e., animal model) evidence that calorie restriction might be useful, but almost nothing in the way of useful clinical trial data yet.

None of this stops Dr. Klaper from irresponsibly claiming that fasting cured two “nasty lymphomas,” which “melted away” on a fast. To that, I would respond: Show me. These cases, if legit, surely need to be written up as case reports. Oh, wait. I did find one of them. Not surprisingly it was a lot more than meets the eye, being a follicular lymphoma, a form of non-Hodgkin’s lymphoma that tends to be indolent. Indeed, she wasn’t even recommended chemotherapy, but rather close observation. Given that spontaneous regression can occur in 20% of follicular lymphoma cases, I remain unimpressed.

Dr. Klaper helpfully says that he doesn’t want to claim that fasting will shrink all tumors (imagine my relief), pointing out that lymphomas are “watery tumors.” (No, they’re not, at least not the sort of lymphomas that Dr. Klaper described here. That would be leukemias. Lymphomas are generally solid tumors involving the lymph nodes and other lymph-bearing tissue that present as solid masses.) He also invokes molecules called sirtuins, which are supposedly induced during fasting and turn off cancer growth. Let’s just say that the situation is way more complicated than Dr. Klaper paints it, with it not being clear whether sirtuins function as oncogenes (cancer promoting) or tumor suppressors (cancer inhibiting).

In any case, when Penn asks him why the body doesn’t just do this anyway while eating, the response is some epic handwaving in which Dr. Klaper claims that digestion is expensive and requires 80% of our energy, which is nonsense. The amount of energy required to digest food is much lower and known as the specific dynamic action (SDA) or thermic effect of food. This energy varies by food type. For example, for carbohydrates the SDA is 7%; for fats, 12%; for proteins, which take more energy to break down, 30%.

It also turns out that Dr. Klaper believes that fasting is also “detox.” (“Detox.” First, he states that humans evolved to live in a much more “Edenic” world, without artificial chemicals. (Yes, he went there, straight to the false dichotomy between “natural” and “artificial” chemicals.) It had to be “detox” woo.) Basically, he claims that, as you go through a fast, you start melting down your fat, and, as a result, all the “toxins” (“remnant chemicals”) deposited in your fat (e.g., pesticides, food dyes, evil modern “chemicals,” and the like) are released into the bloodstream, stressing out the liver, causing liver enzyme elevations as the liver struggles to detoxify them. When asked if any of these chemicals show up in any lab tests, Dr. Klaper can’t answer. He just handwaves about liver enzyme elevations that are sometimes seen during fasts. In other words, he can’t answer with specifics or science that identifies these “toxins,” just as naturopaths can’t identify the “toxins” they “detoxify.” None of this stops Dr. Klaper from likening fasts to “taking your cells to the car wash.”

There’s more woo, so much more woo in this two part interview. It all seems to be based on the claims above, though with one exceptions. In part 2, Dr. Klaper invokes the microbiome in depression, claiming that obesity and abnormalities in the microbiome cause the release of inflammatory cytokines that can cause or modulate depression. At this point, I couldn’t help but think of Dr. Kelly Brogan’s quackery with respect to depression in which she claims that she can treat “naturally” without drugs.

The bottom line

Whatever I now think of Penn, I am happy that he’s managed to lose a lot of weight and thus bring himself to a much better place, health-wise at least. However, he did it, he did it. I don’t know if, were I ever to be 100+ lbs overweight, I could manage to do the same thing. I’m only around 25 lbs overweight now, and over the last couple of years I haven’t been able to do more than lose around 5 lbs, weight that usually eventually comes back. So, I salute Penn for his achievement of losing all that weight and (thus far) keeping it off.

What I do not salute him for is for apparently falling hook, line, and sinker for a whole lot of dietary pseudoscience and promoting it on his show with a credulous interview with someone like Dr. Klaper. For one thing, astute readers will note that the multiple articles right after he lost 120 lbs state that he was off antihypertensives. In this interview, we learn that that’s not the case. He’s still on blood pressure medications and his systolic blood pressure is still around 140 (sometimes up to 160), which is on the high side. True, that’s so much better than it was before, but it’s far from perfect. One can’t help but wonder if he thinks this water fast he’s undertaking will finally get him off of all of his blood pressure medications and off his CPAP machine. Maybe it will. Yesterday, he reported that he finished his fast at 14 days:

I hope he continues to do well, but somehow I doubt he’ll stay off all of his medications. Unfortunately, Penn is still selling Dr. Klaper online:

And:

I doubt that, even if he reads this, Penn will realize that Dr. Klaper is peddling highly dubious claims (at best). Basically, the product Dr. Klaper is peddling in terms of science is a massive exaggeration based on dubious science, cherry picked cases, and bad evolutionary analogies. Worse, fasts, even when supervised by a physician, are potentially dangerous, and there’s no good evidence that avoiding all animal proteins is healthier. Moreover, water fasting is not “like a vegan diet, only better,” as I’ve seen claimed. It carries its own risks. There’s a reason why even Dr. Klaper says that it shouldn’t be attempted without medical supervision. Complications can include cardiac arrhythmias, urate nephrolithiasis (kidney stones), gout, orthostatic hypotension (low blood pressure on standing), severe normocytic, normochromic anemia, gouty arthritis, and sudden death. Worse, there’s no good reason to undergo one of these fasts, at least not from a medical perspective.

Water-only fasts are, in reality, part of an old concept dating back to the 1830s known as “natural hygiene,” which involves purging the body in order for it to “purify and repair” itself. The basic idea is that if you provide the organism with natural, unadulterated food; sunshine; clean, fresh air; pure water; appropriate physical, mental and emotional activities; and a productive lifestyle, while simultaneously eliminating all harmful factors and influences, the self-constructing, self-regulating, self-repairing qualities of the body will be given full rein. In natural hygiene, fasting is viewed this way:

A thoroughgoing rest, which includes fasting, is the most favorable condition under which an ailing body can purify and repair itself. Fasting is the total abstinence from all liquid or solid foods except distilled water. During a fast the body’s recuperative forces are marshaled and all of its energies are directed toward the recharging of the nervous system, the elimination of toxic accumulations, and the repair and rejuvenation of tissue. Stored within each organism’s tissues are nutrient reserves which it will use to carry on metabolism and repair work. Until these reserves are depleted, no destruction of healthy tissue or “starvation” can occur.

Unfortunately, this is incorrect. Muscle mass is utilized for energy and protein during a fast, just not as much after ketosis sets in. Indeed, natural hygiene is very much like naturopathy, an idea that “natural” is always better coupled with a massive misunderstanding of what actually constitutes “natural.” Dr. Klaper is a perfect example of that.