The Arrow #101

Hello everyone.

Greetings from Montecito.

Note: I’m getting the ‘this is too long to be sent as an email’ message. So if you don’t get it in full, click on the view online link in the upper right and read it there.

Also, in the early days of The Arrow, I asked people to send me typos, of which there are always a generous supply. Many folks sent them to me, but then I discovered I couldn’t change them in the online version. That’s not the case with Substack. I can change them. So if you would be so kind as to send them my way, I’ll make the corrections.

It’s been a whirlwind of activity for MD and me over the past week. We flew from Dallas to Santa Barbara on Tuesday. We’ll stay here till after Christmas. I had a golf tournament in Los Angeles yesterday, and MD had rehearsal last night for the Santa Barbara Choral Society’s Christmas concert, which goes off this coming weekend. She has been rehearsing over Zoom from Dallas, but she needed to get back for live rehearsals during concert week, which is pretty intense.

I drove down to LA with our son, who was also in the tournament, and who, unlike me, actually won some money. Which, of course, meant that he, unlike me, played well.

We played at the Wilshire Country Club. I’ve had a few opportunities to play there over the years, but never could correlate my schedule with the invites. It is a beautiful place chopped out of the middle of Los Angeles. God only knows what the property would be worth were it sold to developers.

It’s been around since 1919 and is kind of the old LA money club. Howard Hughes was a member, and, according to what folks told me, used to land his plane on the 9th fairway, which his house sits right next to. Moron that I am, it didn’t occur to me to take a photo of it when I was right there in front of it.

It was a cool, clear LA day. And when it is cool and clear in LA, it is a great place to be. When it’s smoggy—much less now than it used to be—it’s awful. I did take one photo showing the setting.

I just wish my play had lived up to the beauty of the place. MD always whines that she has to endure all of my golf rounds as I’m compelled to relate them to her hole by hole. Mercifully, I won’t give a hole-by-hole replay here, but just so you can experience my anguish, I’ll tell you about the hole in the photo above. It is a par 3. My tee shot went right and I ended up in the last bunker on the right. I came out with a nice sand shot, but the greens were lightning fast, so my ball rolled across and down into the gully on the left. I hit a nice chip back up, then almost holed it with my putt for bogey. But missed and took a double bogey. Which negated the birdie I had just made.

Vax Brain?!?!

My son drove us down for the tournament. In terms of the number of cars on the road, the traffic wasn’t all that bad on the way down to LA. We should have gotten down there in plenty of time, but we ended up being late to the pre-tournament lunch. Given the traffic count, we should have flown. But the traffic that we encountered was dominated by idiot drivers.

When you drive from Montecito to Los Angeles, which is basically a straight shot down the 101, you always come upon a jerk or two who drive in the left lane at 65 mph forcing everyone to go around. When traffic is mild, as it was yesterday, you can usually drive at between 80-85 mph and be right in the flow of traffic. But you run into few folks who poke along in the left lane and screw up the nice laminar flow of the traffic. Yesterday the freeway was clotted with people poking along. They were in all the lanes. We just couldn’t get up a nice head of speed for any length of time.

Usually, driving in LA is like fighting in the UFC. It’s combat. Drivers are constantly zipping in front of you from out of nowhere and everyone flies. Which is why I love the Tesla. It allows me to zip in and out faster than most everyone else, other than other Tesla owners. Yesterday, it was as if everyone was on drugs. Poking along at (sometimes) 50 mph. ON THE 101. It was like no one cared whether they got wherever they were going on time or not.

I commented on it, and my kid replied, “They’ve all got vax brain. The traffic has become like this in the last couple of months, and it’s terrible to drive anywhere in SoCal.”

I wrote it off as a coincidence even though it was much the same driving back home.

Then I get up this morning to make a quick run through my emails, and I come across a post by Erik Hoel, who goes into a discussion about how college students had become so blasé about their studies and even attending classes. He said a number of professors he knows had complained to him about it. He posted a few tweets as examples.

It could be that all these teachers are awful, and the kids just don’t want to show up in class. Or it could be that there is a syllabus for the class, and the prof’s told the students that everything that would be on the test was in the syllabus. Which, of course, is an invitation for non-attendance. But based on their comments on Twitter, this is a new thing.

Erik guesses it might be due to the students spending so much time gaming in virtual reality.

Or it could be vax brain. Just as most of the people on the road yesterday just didn’t seem to give a flip, maybe the poor students are experiencing the same. If it’s not worth the effort to drive competitively in LA, perhaps it’s not worth the effort to go to class.

Maybe the fact that everyone seems braindead is why they’re all turning to ChatGTP to do their thinking for them.

What is ChatGTP and Is It Reliable?

I had never heard of ChatGTP until I read about it on Tyler Cowan’s blog a couple of days ago.

In discussing how busy Twitter has become recently, Cowan writes

Well, I’m on Twitter a lot, and somehow I missed the big news. I guess I’m following all the wrong people, because I haven’t seen anything about ChatGPT.

I did a search on it and came up with this site that describes it pretty well.

AI technology that is setting the world on fire?!?! At least the Twitter world, or the parts of it I haven’t been inhabiting.

How could I resist? I immediately signed up. But not without some misgivings. Not only did I have to provide my email address, I had to provide my phone number as well and receive a code by text, which I had to enter to complete my registration. That was almost a bridge too far, but my curiosity got the better of me, so I forged ahead.

I read through all the instructions and the sample questions. The answers provided to those sample questions were pretty articulate. The feedback from users was great. So I decided to test the program’s ability to synthesize information based on its alleged ability to quickly tear through all the digital information out there and come up with comprehensive in-depth answers.

Here are screenshots of the questions I posed and the answers ChatGPT provided.

The answers to my questions lead me to believe ChatGTP is not as reliable as it might be. Given all the information out there, it is pretty clear the folks doing the programming give vastly more weight to some sources than others. I won’t be using it to look up the answers to any important questions.

The last question I asked brings me to my next topic.

The Best Book Yet on Covid

I’ve tried to keep up with all the new books about Covid that are hitting the shelves right and left. I read and reported on the books about the development of the mRNA vaccines and realized they were basically flacking for the various vaccine manufacturing companies. And I’ve mentioned a few of the books on the various aspects of the pandemic. I haven’t read all of the new books out, but of the ones I have read, the one by Dr. Peter McCullough and John Leake is by far the best. I read it almost at a sitting.

The Courage to Face Covid-19 is both infuriating and intensely sad. The subtitle says it all: Preventing Hospitalization and Death While Battling the Bio-Pharmaceutical Complex. The book reads like a thriller, which is no accident since the writer, John Leake, is a true-crime reporter. It is the story of Dr. Peter McCullough’s transformation from staid, mainstream physician and researcher with hundreds of papers to his name to a renegade in the war against Covid.

At the start of the pandemic, Dr. McCullough was the Vice Chief of Internal Medicine and Program Director of Cardiology at the Baylor University Medical Center in Dallas. Along with being board-certified in both internal medicine and cardiology, he was a Professor of Medicine at Texas A&M University, President of the Cardiorenal Society of America, and the Editor-in-Chief or Senior Associate Editor of three major academic journals. In addition to his academic credentials, he had authored or co-authored over 600 peer-reviewed journal articles.

His specialization was cardiovascular medicine with a focus on the interaction between the heart and kidneys. Two key components of his work were Epidemiology and Pharmacology—that is, understanding the prevalence and risk factors for diseases, and understanding how to evaluate the efficacy and safety of drugs for treating them. Over the years he had organized and supervised several clinical trials, and he had chaired or served on data safety monitoring boards for over two dozen randomized trials.

As mainstream as mainstream can be. But along with all these credentials, Dr. McCullough was a doctor. And it is a doctor’s primary job to treat people who are ill. When MD and I were working at our primary care clinics, we never knew what was going to come through the door. It could be some guy who fell off a ladder while cutting branches off a tree with a chainsaw and tumbled to the ground with the chainsaw on top of him and still running. (I got that one and spent over two hours sewing him back together.) Or could be a kid with a Lego block impacted in his nose. (MD got that one.) As the saying goes, it was just one damn thing after another.

But several times a year, we would be swarmed on by very sick people, all with the same symptoms. Our clinic flow would go from 40 patients per day to 80 or 90 per day, all with identical complaints. We would treat these patients symptomatically until we finally landed on the treatment that worked best. Once we figured it out, we could deal successfully with whatever the bug was that was going around. But it took a little trial and error at first. [The bride reminds me that this was in the days before there were rapid tests for both types of flu and so many other ailments. You often just had to figure it out by your wits and their symptoms.] And we never, ever just told patients to go home, drink fluids, take aspirin or Tylenol, and come back to see us if it didn’t get better. We would at least treat the symptoms to give them some relief. And these patients weren’t facing a disease with the potential to kill them. They just had the current upper-respiratory bug that was going around, which, when you think about it is what Covid has now become.

When Covid struck, McCullough’s chief of cardiology asked him, “What are we going to do to fight this monster? If our nurses get wiped out, we’re done for.”

This is the real jumping off point in the book. The story races along from there. McCullough finds disparate doctors around the world who are successfully treating Covid on an outpatient basis and saving people from hospitalization. The standard of care was—and still is, based on the quote above from ChatGPT— to tell the patients to go home, rest, drink a lot of fluids, take OTC meds for the aches and pains. If they developed difficulty breathing, they were told to come back to the hospital, where they would be given oxygen and ultimately be put on a ventilator. Which, unfortunately, killed most of them.

After his own elderly father contracted Covid, McCullough kept him alive with the treatment regimen he had cobbled together. That was the defining moment for him. He became hell bent on developing treatment protocol based on the success of other doctors who had been feeling their way along with their own patients. (This is how medicine usually works. See one, do one, teach one is how it’s put during your training.) Dr. Zelenko in New York was successfully treating patients based on information he learned from other doctors who were also experimenting. He went public with his findings, which made their way to President Trump, who mentioned chloroquine and hydroxychloroquine as possibilities in the fight against Covid. Per Trump…

Which, given the legacy media’s hatred of Donald Trump, was immediately attacked from all angles. Fauci, Gates, everyone piled on.

As an aside, at the time, I thought it was a good idea without really knowing anything about either of those drugs, having never prescribed them myself. What made me think they might be useful is a report I read in the medical news somewhere (which, of course, I can’t lay my hands on right now) about Italian rheumatologists. Hydroxychloroquine is often used to treat lupus and other auto-immune disorders. As you’ll no doubt recall, Italy was the first country really devastated by Covid. They were desperately trying to figure out how best to treat the virus that was overwhelming their hospitals, especially in the north of Italy. The little medical piece I read said that a medical journalist surveyed a large number of Italian rheumatologists (the docs who care for patients with these disorders) and discovered that none of their patients who were on long-term hydroxychloroquine had contracted Covid.

Why would this journalist even think about doing such a survey? Probably because he came across the same paper I did and wrote about in The Arrow months ago from Virology Journal in 2005 showing chloroquine (a drug similar to hydroxychloroquine) was a potent inhibitor of SARS coronavirus infection and spread. This study was performed by researchers at the CDC, the same CDC that was now badmouthing Trump for recommending it. And the same CDC, btw quoted by the ChatGTP bots saying there was no evidence of any effective treatment.

Despite the constant harangues and backlash from the press, Fauci, and others, Trump pressed on and ordered HHS to immediately make available 29 million doses of the drug they had on hand to pharmacies nationwide. Then one weaselly little twerp named Rick Bright overrode Trump’s order and prevented the drug’s release. Here he is on video discussing his treachery.

I encourage you to watch this video to see someone who singlehandedly prevented the distribution of a treatment that might have helped millions, many of whom may have died as a result. He weaseled it around in a manner he admits he is very proud of so that the drugs could be used only in hospitalized patients, which would severely limit their use. Which is insane, because the drugs were to be used early on to keep Covid patients out of the hospital. Once the infection is well entrenched, the drug will be far less effective. When you see his smarmy countenance you will be absolutely incensed to think of all the people his decision might have killed.

The above is just the tip of the iceberg. The entire book is about Dr. McCullough’s awakening to what was going on. And his sacrifice of his job, all his titles, and even his medical credentials to fight against this idiocy. It is a real page turner. You will not be disappointed. But you will be infuriated to think of all the people who died unnecessarily and without their families at their bedsides or their gravesides.

It’s really too bad Trump didn’t come out telling people not to use hydroxychloroquine and/or ivermectin. Then the mainstream media might have dug up the same virology journal article I did from 2005 and used it to tarnish Trump. How many thousands of lives would have been saved? It is sad to even contemplate. And now all these folks want amnesty for have gotten it all wrong.

For all of us who were correct from the beginning, the counter narrative will now probably become, You just lucked out with this one. The bad cat came out with this today. Kind of sums it all up.

On a different but related note, does anyone happen to know John Leake, the writer of the book on Peter McCullough? I found what is probably an old email address of his online and emailed him, but haven’t heard back. He (and Dr. McCullough) live in Dallas, and I would love to meet up with him. If you happen to know him or his email address, send him or it my way or introduce us.

Ketogenic Diet Beneficial for Vascular Disease

Welp, we have all heard for years and years and years that high-fat diets are bad for the heart and the arteries. And we’ve heard it from all kinds of people with various degrees of education including those at the highest levels of academia. It has always amazed me how so many people can not think clearly where diet is involved.

If you ask most nutritionists—at least back in the day when I did so—what they thought about a common meal of a double-patty cheeseburger, an order of fries, and a soft drink, almost all would respond that it wasn’t a very good diet. A lot of calories and a lot of fat. If, without asking that setup question first, you asked about a diet consisting of a double-patty cheeseburger without the bun—just meat and cheese—no fries, and an unsweetened ice tea, they might well respond that it was one of those dangerous low-carb diets that could croak your kidneys and clog your arteries. They never, ever said the full burger with bun, the fries, and the soft drink would damage your kidneys. But ditch the bun, eschew the fries, and switch to ice tea, and you’re in real trouble.

Having lived with this for years, imagine my surprise when I happened upon the mention of a paper titled Fat not so bad? The role of ketone bodies and ketogenic diet in the treatment of endothelial dysfunction and hypertension. As we all know, ketogenic diets are high-fat, very-low carbohydrate diets, and—wonder of wonders—here is a paper saying all that fat was good for arterial function and high blood pressure.

I had to get my hands on it.

I trolled through all my usual sources and came up empty handed. So I wrote to the author who is an academician in Poland. She replied quickly and sent me a draft copy of the article and a couple of days later the journal-formatted pdf version, which I stuck in my dropbox for you to download if you wish. Just click on the link above.

Once I got the paper and started reading it, I was disappointed because it wasn’t original research. I was a little misled by the abstract, which I read on PubMed, which had I skipped on down I would have discovered was a review paper. Sometimes researchers do literature searches and gather all the papers they can find on a given subject, then summarize them. Which is what these folks did.

Here are the search terms they used:

They ended up with 82 papers, a number of which I had never seen. Several of which enlightened me a lot. And depressed me as well.

The paper mainly discusses the effect ketones have on the endothelium. The endothelium is the single cell layer lining the inside of all the blood vessels in the body. These cells in aggregate weigh a little over two pounds and cover an area of somewhere between 4,000 to 7,000 square meters. For those of you who think in square feet, 4,000 square meters is equivalent to a 43,055 square feet. Which amazes me, because one of the numbers drilled indelibly into my head in engineering school is that an acre is 43,560 square feet. So, in the smallest of adults, there is about an acre of surface area of endothelium. In the 7,000 meter sized person, that area is a bit shy of two acres. That’s a lot of surface area.

The little over two pounds the endothelium weighs is close to the little over three pounds the average liver weighs. The liver is the main organ in charge of metabolism in the body. And the endothelium weighs almost as much. And probably does as much as the liver. Even though it’s only one cell thick, it acts as a major organ. But unlike the liver, it can’t be transplanted. So you really need to take care of it.

One of the tasks allotted to the endothelium is traffic directing for blood flow. It sends the blood where it’s needed most and away from where it isn’t needed as much. I learned about this back in my SCUBA instructing and commercial diving days. Leap in the water and head to depth where it’s really cold, and you have to urinate like crazy. Your endothelium shunts the blood away from your surface more into the interior of your body. Since you have more blood flowing in your core than normal, the sensors in your kidneys read it as fluid overload and start getting rid of it.

Directing blood flow is only one of the many tasks of the endothelium. Here is a diagram from the paper showing many of the tasks of the endothelium and how ketones positively affect them:

Fig. 4. Possible effects of the KD to combat hypertension and other obesity-related cardiovascular conditions. Ketogenic diet feeding pattern results in metabolic shift by increasing fatty acids and reducing glucose levels. Elevated fatty acids induce mild ketosis and mediate the reduction of inflammatory responses, reduction of blood insulin level and attenuated endothelial activation. Ketogenic diets also increase the activity of uncoupling proteins, leading to the reduction of ROS and stimulating mitochondrial biogenesis thus leading to enhanced energy reserves at the molecular level and results in changes the physiological parameters of multiple metabolic disorders. Abbreviations: IL – interleukin, eNOS – endothelial nitric oxide synthase, ROS – reactive oxygen species, TNFα – tumor necrosis factor alpha, UCPs – uncoupling proteins.

I could spend two full issues of The Arrow going over all these pathways. We are hitting a lot of them in PP 2.0, but as you can see just from this bit, ketones make a lot of good things happen.

One of the things I hadn’t known, but learned from this paper was that ketones markedly improve congestive heart failure, which is a brutal disorder. The authors discussed a study published in Circulation in 2019 that I somehow missed.

Before I get to the study, let’s discuss congestive heart failure, or just heart failure, for those who don’t know what it is.

As I’m sure everyone knows, the heart contracts to pump blood throughout the body. It does so by an electrical impulse-driven, coordinated squeezing of the heart muscle. I don’t know how many of you have ever milked a cow, but it’s the same kind of action. With milking, you start squeezing at the top, nearest the udder and then tighten your fingers from the index finger toward the little finger to force the milk out the opening. The heart squeezes in a similar way from the bottom up, forcing the blood out through the aorta and pulmonary arteries.

Basically, one side of the heart receives oxygenated blood from the lungs and pumps it out to the rest of the body. The other side of the heart receives blood from the body with most of the oxygen removed and pumps it through the lungs for oxygenation. If all is working well, the body always has nice, oxygenated blood at its disposal.

If you start doing something strenuous, the heart starts beating faster and you start breathing harder. The lungs pull in more oxygen and your heart, by beating faster, sends more blood to the lungs to accept this oxygen.

Now imagine yourself working out or running so hard your lungs and heart are both going for all their worth, but can’t keep up with your body’s demand for oxygen. You can’t get your breath and your heart is pounding, and you have to stop for rest so your lungs and your heart can catch up with your oxygen debt.

That’s how people with heart failure feel while they’re just sitting around. They are already resting, and they can’t get enough oxygen. As you might imagine, it’s a miserable feeling. Especially since you can’t do anything about it. Other than breathe oxygen from a cylinder. It is really death impending. Or at least feels like it.

Why does this happen?

In the case of intense exercise, the lungs and the heart are working at capacity given the level of conditioning. Once that capacity is exceeded, the oxygen deficit begins to accrue.

In the case of heart failure, the lungs may be working fine. In fact, they probably are. But the heart muscle has been damaged to the point that it can’t effectively pump the blood from the heart to the lungs. If the lungs don’t get the blood, they can’t oxygenate it. If the blood isn’t well oxygenated, then the body begins to develop an oxygen deficit that is no different from that driven by heavy exercise.

The heart’s function is measured by what is termed the ejection fraction, which means the amount of the volume of blood in the heart chamber that is pumped with each beat. A normal ejection fraction is anywhere from around 50 to 75 percent, with higher being better. Borderline is 40 to 50 percent. Once you go below that, you’re into heart failure territory.

Typically the decrease in ejection fraction comes about as a consequence of damage to the heart muscle. Usually as occasioned by a heart attack. Each time a segment of the heart gets damaged because of decreased or interrupted blood flow, the viable muscle gets replaced by scar tissue. The scar tissue basically holds the heart together, but has no muscular pumping capacity. Enough injury from one big heart attack or multiple smaller ones can destroy enough heart muscle to compromise the ejection fraction. If it gets low enough, heart failure ensues.

The researchers in the Circulation paper above studied 16 patients with average ejection fractions of 37 percent. They infused these patients with enough beta-hydroxybutyrate (BHB), the most common ketone, to raise their blood levels from ~0.4 mM, which is pretty standard for people on a typical diet, to 3.3 mM, which is about the level of nutritional ketosis found after adaptation to a ketogenic diet.

This level of BHB increased their ejection fraction by 8 percent, bumping them up almost to the lower end of normal. It jacked their cardiac output by 2 liters/min, a 40 percent increase, which is huge.

At the same time—and this is important—it did so without increasing the oxygen consumption of their hearts.

Why is this important? Because people who have heart failure can increase the activity of their hearts by beating faster. But that requires more oxygen to fuel their heart muscle, which adds to the growing oxygen deficit. These study patients increased their cardiac output without increasing their hearts’ requirements for oxygen.

This is truly amazing.

As I wrote above, it both excites and depresses me. It excites me for all the obvious reasons. It depresses me because MD’s dad, whom I loved as my own, died at age 58 with heart failure. His ejection fraction was 29 percent. He ate a standard diet. I didn’t know better. Had I known what I know after reading this paper, we could have boosted his ejection fraction to the upper 30 percent level. That, combined with some additional oxygen, could have kept him around a lot longer. He was a helluva guy. A civil engineer like me. And interested in everything.

Before he was an engineer, he had a booming plumbing business that he quit to go to college. I went through an idiotic phase early in my marriage to MD where I wanted to be able to do all my own home repairs myself. Her dad asked me why I didn’t just work one of my doctor hours and pay a plumber to work three of his. I insisted on doing my own. So, he would come to help. We made a good pair. Along with dealing with heart failure, he had crippling rheumatoid arthritis, so he couldn’t do much of anything. But he knew everything. I was just the opposite. I could do anything, but knew nothing.

He would sit in his wheel chair and try to talk me through sweating copper pipes while I was lying on the floor scrooched under the kitchen sink. He would just shake his head and laugh as I continually screwed up. But, by God, under his tutelage, I finally learned to sweat copper pipes and a lot more to boot.

He finally just gave up because it was so miserable living without being able to get what he considered a decent breath. I miss him greatly, and it saddens me to learn I could have kept him going longer.

On a final note, I looked up endothelium in Wikipedia hoping I would find what I found. Sure enough, there it was:

Jesus wept.

Tweet of the Week

How true, how true. Mimetic. Not rational.

Okay.

I’ve gone on enough.

I meant to get to the movie Died Suddenly. But if I do, this will be of epic length, and I need MD to vet it before she goes to rehearsal tonight. I’ll do it next week. I promise.

I also intended to get into my thoughts on Elon Musk and Twitter. Such thoughts are not all positive. In fact, I’m kind of disappointed.

And I want to delve into the situation with Russia and Ukraine. I’ll hit all these next week along with a further deep dive into the virtues of a ketogenic diet.

Until then, keep in good cheer.

And don’t forget to take a look at what our sponsors have to offer. Dry Farm Wines, HLTH Code, and Precision Health Reports.