The Arrow #181

Hello everyone.

Greetings from Montecito where the weather has been picture book perfect. June is a funny month in the Santa Barbara/Montecito area, when the weather usually presents as what the locals call June gloom. From sunrise until about noon, you would swear a pouring rain is imminent. Then, suddenly, the sky clears, and the day is beautiful. This past week, I’ve awakened every day at about sunrise to be greeted with a clear, cloudless day that continues till sunset. A slight breeze, comfortable, but not enough to interfere with the flight of a golf ball, makes the 80F weather just right. I hope it lasts.

Today is Summer Solstice. You can read about it all here. And if you’re really into it, you can watch this live stream of people celebrating it at Stonehenge. On a less important note, today is the day after my birthday, which has now been conscripted into a national holiday called Juneteenth. If I were a federal employee, I would have my birthday off for the rest of my life.

I apologize for the mess up last week about the poll. Somehow I managed to delete it while removing some excess space above it. Now it’s on my checklist of things to look for before hitting send.

I tried to remedy the situation by editing the online version. It seemed to work. I rated myself and added a comment. Then I went to the dashboard to see if it came through okay, and was greeted with this.

I could not find the comment I left. So, if any of you tried to comment on last week’s actual Arrow #180 poll, your commentary has disappeared. When I discovered this, I sent out the Arrow #180 addendum with the poll only.

The reason I went to this effort (and added another email to your stack) is that I get a wealth of information about what you readers are looking for from your comments on the poll. Otherwise, I’m just writing about what I want to write about, which may or may not be what everyone wants to read about. And after I tried out the idea of answering a bunch of questions from the poll responses, I wanted to see what everyone thought about it. Thus the extra email with a working poll.

As it turns out, it was the right thing to do. I got a ton of responses from folks telling me they enjoyed the commentary on other people’s poll questions. And I got a bunch of new ones to comment on this week.

Before I get to those responses, I’ve got to bring up an issue I get at least two emails and a couple of poll responses each and every week about. People write me or respond to the poll that they aren’t getting The Arrow (or haven’t gotten the last issue of The Arrow) via email.

I have no way of responding to the poll responses as they are anonymous, but when I get emails about this, I always check the subscription list to see if the emailer’s email address is there and is active.

I then ask the correspondent to check his/her spam folder, and in almost 100 percent of cases, that’s where their missing Arrow resides.

I have no idea why a given email diverts to the spam folder one week while it has never gone there before. I, myself, subscribe to The Arrow, just so I can make sure it actually goes out. Over the past 180 weeks my own issue of The Arrow has ended up in my spam folder twice. The last time, I marked it not as spam, and it hasn’t happened since.

So, if you don’t get yours, check your spam folder first. If it’s there, mark it as not spam and you should be okay.

I queried the folks who run the platform and they responded with a) make sure folks are really subscribed, b) check the spam folders. These will deal with most of the issues.

Then there is this:

If they’re using a corporate email, their organization may have strict spam filters in place and possibly blocked the mailing. You can reach out to our support team to confirm if this is the issue. If so, the subscriber’s firewall administrator will need to change the firewall rules for them to be able to receive your mail on a regular basis.

I know a lot of people use their work emails, because after every issue of The Arrow that goes out, I get about ten bounce back replies from people telling me they are out of the office. So, if you are corporate, check the above.

Okay, on to the polls.

Poll Responses


I receive emails, comments, and poll responses about this topic frequently, so let me delve into it.

There are basically two types of constipation. One is an imagined constipation. This is the constipation people experience when they don’t go as often as they think they should. They really have no symptoms, but they stress because they haven’t gone for a day or two or three.

The older generations, for whatever reason, used to obsess over bowel movement frequency. I was victimized by this obsession as a child, myself. I spent my younger years in the care of my grandmother, who, at that stage of her life, was bowel obsessed. If I got a sniffle or a sore throat or just about any symptom out of the ordinary, she assumed it was because my bowels were backed up. She would then hog me down and give me an enema. Or equally as awful, ply me with castor oil. (Even the smell of which still nauseates me.) It didn’t take me long to realize that if I told her I had just gone, I could avoid all this.

I often wondered why people of her generation were so bowel focused. Then read one of the great books of all time: The Road to Wellville by TC Boyle. Do not watch the movie. It sucks. The book is fabulous, however. A must read. It is a novelistic take on the vegetarian movement back in the early 1900s (by a fantastic writer) and the obsession people then had with their bowels. Dr. John Harvey Kellogg, who is featured in the novel, and whom I looked up and read about in detail, was a total whack job. Yet his sanitarium in Battle Creek, Michigan was the place the elite of the day went to cure their ills. Kellogg believed that retention of the colon’s contents was a toxic condition. I’ve been unable to determine whether or not he went so far as to actually surgically remove large parts of some of his patients’ colons to “cure” them, but it wouldn’t surprise me. He and one of his competitors named C.W. Post (a patient of Kellogg’s) started the breakfast cereal movement that keeps the supermarket shelves filled, even today, with crap.

All this hype took place during the era in which my grandmother (whose father was a doctor) grew up, so she—and others of that generation—believed in the nonsense that too much in the colon for too long was deadly. And they passed it along to their kids and grandkids.

As far as I know, there is no optimal number of bowel movements one should have per day or per week. There is great individual variation. I’ve had patients who go at least once per day and sometimes twice. And I’ve had patients who go once a week. I haven’t seen any studies on longevity as a function of bowel movement frequency, but I doubt they would show any difference. One paper I did come across in looking for the makeup of human feces said the average number of bowel movements was around 1.2 per day. But that is an average. Not necessarily optimal. And I’m absolutely positive that average would change if only people who were on low-carb diets were queried.

When most folks switch to low-carb/ketogenic diets, their BM frequency decreases to some extent.


Because these diets typically contain more animal-based foods and less fiber than the ones they had been consuming. Meat is a complete food. Meat is composed of what you are composed of, so when you eat meat, there isn’t a lot of indigestible waste.

Carnivores don’t go as often as herbivores. And when they do go, their feces are not as large.

When you go more carnivore by adopting a low-carb/ketogenic diet, you will go less frequently and get rid of a smaller amount.

This isn’t constipation. This is normal.

Typical human feces are composed of about 75% water and 25% solid matter. The solid matter is broken down as follows:

  • Dead bacteria (around 30%)

  • Indigestible food matter like cellulose (around 30%)

  • Cholesterol and other fats (10-20%)

  • Inorganic substances like calcium phosphate and iron phosphate (10-20%)

  • Protein (2-3%)

    And the remaining small percentage from:

  • Cell debris from the intestinal lining

  • Bile pigments like bilirubin

  • Dead white blood cells

These figures are based on a standard diet. So let’s go through and see what changes we might find in the feces of someone on a low-carb diet.

Water may be a little lower. One of the things I’ve discovered about a low-carb diet is that for some reason people don’t seem to be as thirsty as they are on regular diets. Which may be one of the reasons blood pressure goes down.

A lower insulin level allows the release of excess sodium and fluid. Consequently, on such a diet you need a bit more salt and to make a conscious effort to drink more fluids so you don’t become fluid depleted.

I’m not sure what a low-carb diet does to the number of bacteria in the colon. I know it quickly changes the make-up of the bacterial profile, but I’ve never seen data showing what it does to overall bacterial mass. Maybe there is a paper out there on this, but if so, I’ve never seen it. So let’s assume the bacterial mass doesn’t change with a low-carb diet.

The indigestible food matter will definitely decrease on a low-carb diet. Meat is made of what you’re made of, so there isn’t a lot of indigestible waste.

Cholesterol and fats may go up a bit on a low-carb diet simply because meat is richer in those. There is no cholesterol in plants.

The other components are probably about the same on low-carb as on a regular diet. There is probably a little more protein in the stools of one on a low-carb diet, just as there is in the feces of carnivores. At least I would assume so.

The main differences in the feces of low-carbers vs regular dieters would be a decrease in water and a decrease in the indigestible stuff, i.e., fiber, and maybe a bit more fat/cholesterol.

If you aren’t going as often as you think you should be, you can increase your fluid intake. And when I say fluid intake, I mean your non-biologically-active fluid intake.

What do I mean by that?

Coffee is a diuretic. You drink a cup of coffee and you pee out more fluids than you consumed. You go negative fluid-wise. Same with alcohol. Same with any caffeinated beverages. If you drink Diet Coke, you probably don’t pee out as much as you would with coffee, but you do get rid of some. In other words, you don’t get the full measure of the fluid that you would had you consumed the same amount of just plain water.

I, myself, drink a lot of coffee. I’m not always successful, but I try to drink a glass of water between each cup to keep my own fluid intake up.

One of the things I’ll do, especially in the winter, is drink bouillon. It keeps my salt intake up and provides non-diuretic fluid.

If you keep fluid intake up, then there will be more water in the stool, making it bulkier and easier to get rid of. One of the jobs of the colon is to extract fluid from the mass going through it. When the contents of the small intestine dump into the colon, they are liquid. As these contents move on through the colon, the colon removes the fluids and you end up with what you see in the toilet.

If you are a bit dehydrated, the colon removes even more fluid. And you can get hard stools that can be painful to expel. So drink more water.

Another thing you can do is eat more fat. Most of the fat you eat is removed as it goes down the GI tract because it is fuel for the body. But not all is absorbed. A small percentage makes its way into the colon. So the more you eat, the more that ends up in the colon. And more fat in the colon ends up greasing the skids, so to speak, for an easier exit.

You can take a magnesium supplement. Remember, milk of magnesia? It’s designed to provoke bowel movements. It contains a lot of magnesium. You can do the same with supplements and not have to chug MofM. Take the supplements at bedtime. (Magnesium supplements work for high blood pressure, too. And they help relax your muscles and may help you sleep.)

How about fiber?

If you’re consuming low-carb fruits and vegetables as part of your low-carb/ketogenic diet, you should get plenty of fiber, because almost all of those are high in fiber. If you’re on a primarily meat diet, you won’t get as much as you would if you’d added veggies. But you’ll get more fat.

Fiber works by irritating the GI tract. This irritation induces the GI tract to produce mucus to protect itself, and the mucus then makes the resultant stool more slippery and easier to expel. I wrote about this in a blog post long ago. Give it a read to get a different take on fiber.

Just for comparison’s sake, I did a quick run through on the literature on carnivore crap (I had to use the alliteration), also called scat. Here is what I found. As compared to that of herbivores, carnivore scat contains

  • Higher levels of bone fragments, teeth, hair, and feathers from consumed prey animals

  • Higher concentrations of calcium and phosphorus from digested bones

  • Lower levels of plant fibers and cellulose compared to herbivores

  • More protein and fat residues from animal tissues

  • Often have a white, grayish or crumbly texture from bone fragments

Since those of us consuming a low-carb diet probably do not have bone fragments, teeth, hair, and feathers in our own scat, it stands to reason it would be less bulky than even carnivore scat.

As you can see, carnivore poop has lower levels of plant fibers, i.e., fiber and more protein and fat than that of herbivores. Ours should be somewhat similar since we basically have a carnivore’s digestive tract.

Here in Montecito, we have a number of wild large carnivores. There are bears, mountain lions, bobcats, coyotes by the zillions, and foxes. Plus probably a bunch of smaller ones. A couple of days ago, a carnivore took a dump on the gravel pathway behind our place. Admittedly, I am not an expert in carnivore scat, but I can tell from all the fur in it that it is obviously is not herbivore. I took the photo below.

Ignore the pebbles. I’m sure they are stuck there from the gravel pathway. Some birds have gravel in their gullets, but since I don’t see any feathers in the scat, I doubt these came from a consumed bird of some sort.

To gauge the size, I put it on an 8X5 piece of note paper. As you can see, it’s not all that bulky. Remove all the hair, and there wouldn’t be a lot of organic matter there.

The take home message is that you shouldn’t expect large, bulky stools while on a low-carb/ketogenic diet, especially if you are consuming a fair amount of meat.

So adjust your defecation schedule (and expectations) accordingly.

The second kind of constipation is more problematic. It could come from reduced GI motility, which could be the consequence of a number of issues. It could be from extra dry stools, which means you need to consume more fluids, magnesium, and fat… see above discussion. Or it could be from other bowel issues that should be explored with your doctor.

Okay, enough about this. Let’s move on.

Visceral Fat

I got the following thoughtful question through a poll response.

In looking at the pictures of visceral fat in your post, it looks to me like there is some visceral fat in the picture of the normal scan. Plus I’ve heard that fat inside the belly protects the organs. Is that true? If it is true and there is fat inside the abdomen, why wouldn’t it be attacked by the immune system like you say the visceral fat is.

That is a good question. And it has a good answer.

It is true that fat pads the organs, sort of in a protective way. It is also true that there is some fat always inside the abdominal cavity, which by its definition is visceral fat.

So why doesn’t this fat induce the immune response I wrote about last week? Why doesn’t it act like a big splinter in the abdominal area?

Visceral fat is not problematic as long as the fat cells themselves are normal sized. But when they become enlarged, as they do when more fat is shifted away from the subcutaneous fat stores that have reached capacity into the viscera, pathology is in the offing.

Like all cells, fat cells need nourishment. This nourishment is delivered through the capillaries, the tiniest blood vessels in the body. In normal visceral fat, the capillaries are insinuated throughout, bringing nourishment as needed. But when the fat cells enlarge as they accept more and more fat, they outgrow the reach of their capillaries.

Fat cells size can increase by a large factor, and when they grow too large in size, their blood supply basically gets cut off. It is comparable to building a subdivision of homes without putting any roads into it. All the houses are there, but people can’t get to them.

Same with overgrown or hypertrophic fat cells.

When these hypertrophic cells can’t get nourishment because they’ve grown away from their blood supply, they become hypoxic (low on oxygen) and panic sets in. When cells panic, they send out all kinds of signals for help.

They send out signals to increase angiogenesis (the development of new blood vessels) and panic signals in general. These panic signals attract macrophages, which burrow into the fat cell mass and begin sending their own signals for help. And the entire inflammatory cascade begins.

But it all starts because the fat cells outgrow their blood supply.

The normal sized fat cells get plenty of blood, so there is no panic. Which is why the normal-sized fat cells making up the visceral fat you see in the normal examples from last week are not problematic. It becomes a problem only if you run out of subcutaneous fat storage space and the elevated insulin starts pushing fat into the normal-sized visceral fat cells and makes them hypertrophic.

I hope this answers the question.

High Blood Pressure

I sometimes wonder if readers of The Arrow confab with one another, because I seem to get similar questions over a similar time period.

I received a couple of emails along with a poll response or two asking what I thought about Dr. Malcolm Kendrick’s take on elevated blood pressure. One of the questioners asked about a British GP named Dr James le Fanu, whom I don’t know anything about. But I do know Dr. Kendrick, and we’ve discussed the blood pressure issue. In short, I am in total agreement with him, at least per our one on one discussion.

I looked to see if he had written anything on the issue, and, sure enough, he wrote a relatively recent blog post on it (given the date of the post, this would have been about the time we had our discussion at a meeting in Santa Cruz, CA). And he wrote a post about six years before that, which basically says the same thing.

We both believe we need to treat exceptionally high blood pressure. That’s a no brainer. It’s the borderline BP that’s at issue. I don’t need to rewrite everything he has written, so you can read it in his blog posts linked above.

I will reproduce his recommendations, because they are my recommendations to my patients. (They are in green font, because this platform won’t let me put a list inside a quote box.)

What I do recommend to patients is:

  • Go on a high fat, low carb diet

  • Use relaxation techniques: mindfulness, yoga, whatever floats your boat

  • Take exercise

  • Get out in the sun – this stimulates NO synthesis

  • Try L-arginine and L-citrulline

  • Increase magnesium consumption

This will often do the trick.

I’ve made all these recommendations to my own patients except for the arginine and citrulline. I’ve never used those. Not that I have anything against them—I’ve just never used them, so have no first hand experience with patients.

The rest are my standard recommendations. As you might recall, a few weeks ago I wrote that my go to medications for anyone I had to put on BP meds were the ACE inhibitor class of drugs. I was glad to see that in his blog post Dr. Kendrick concurred. Specific medications didn’t come up when we had our high blood pressure conversation back when.

If you must take medication, I was a very strong supporter of ACE-inhibitors, in that they blocked angiotensin II, and increased NO synthesis. Both good things. However, some research has come out recently, suggesting they may increase the risk of lung cancer. Not by a great deal, but there you go. Best to take nothing at all, if you possibly can. [My bold]

The line bolded above could be my motto as far as all drugs are concerned.

But I just came across a recent study showing omega-3 fats are helpful for reducing high blood pressure. The Journal of the American Heart Association just published a meta-analysis of randomized controlled trials looking at the effect of omega-3 fats on high blood pressure. Here is the conclusion of the authors:

This dose‐response meta‐analysis demonstrates that the optimal combined intake of omega‐3 fatty acids for BP lowering is likely between 2 g/d and 3 g/d. Doses of omega‐3 fatty acid intake above the recommended 3 g/d may be associated with additional benefits in lowering BP among groups at high risk for cardiovascular diseases.

Here is a graphic showing the findings in terms of both systolic and diastolic blood pressure change as function of omega-3 intake. (Systolic pressure is the one on top; diastolic is the pressure on the bottom of the BP reading. A BP of 130/80 for instance (pronounced 130 over 80) would mean the systolic pressure is 130 and the diastolic 80)

The dark solid line shows the average response. The X-axis shows the grams of omega-3 while the Y-axis shows the change in either systolic or diastolic blood pressure. As you can see, along the average response line the blood-pressure-lowering effect is maximal at about the 3 g per day level. But it obviously varies by subject.

The paper contains a number of graphics of the response to omega-3 fats as a function of different conditions. Here is one showing the effect on subjects that have systolic pressures under 130 vs those with pressures at or above 130.

As you can see, those with BPs equal to or greater than 130 have a different dose response. In those folks, the higher the omega-3 intake, the greater the reduction.

MD and I did not have the advantage of having this knowledge while we were taking care of thousands of patients, but we did advise them to take omega-3 fats to improve the O-6/O-3 ratio. Perhaps we inadvertently treated our patients with mildly elevated blood pressures. We used ProOmega fish oil capsules. We also used krill oil capsules, which patients tolerated much better. Krill are tiny shrimp-like creatures and their oil is an omega-3 oil that is in the form of phospholipids that are much more like the lipids in the human cell membrane and so they incorporate better and may be more easily absorbed. But I haven’t seen a paper like the one described above that looked specifically at krill oil in terms of blood pressure. The omega-3 fats come in lower doses in krill oil, but there are other benefits. If you look up krill oil, you’ll find a ton of research showing a plethora of benefits. I’m just not sure if lowering BP is one of them.

For those who have marginally high blood pressure, according to this paper, adding 2-3 grams of fish oil daily to your diet may well help. Whatever fish oil capsules you get—even if you get ProOmega, which is a high quality fish oil—you should keep it in the fridge. Due to its many double bonds, fish oil can go bad in a hurry. It lasts much, much longer if you refrigerate it.

Whenever I get a new bottle of fish oil capsules, I always bite into the first one. If the capsules are fresh, they are almost tasteless. If they have begun to go rancid, you can tell at once. Throw them away or return them.

If you want to support my work, take out a premium subscription (just $6 per month)—it’s cheaper than some trashy Starbucks Vente latte gingerbread whatever. And a lot better for you. It will run your IQ up instead of your insulin.

Diet Sustainability

Over the past few weeks, I’ve received probably 15 poll responses and a few emails from people giving me their medical histories. About two thirds of them have one story, while the other third have a different story.

The two thirds complain about how they hate having to follow their low-carb/ketogenic diet (carnivore-intermittent fasting in one case), but they do it because that’s the price they pay for continuing to lose weight. They’ve tried a lot of other strategies, but this is the one that works for them.

The other third are from people who tell me they lose and feel better when they’re on a low-carb/ketogenic diet, but they just “can’t sustain it.”

One person said, “In this day and age, a ketogenic diet is simply non-sustainable.”

Which means, of course, that this person doesn’t want to sustain it. But that’s actually a mischaracterization. What he/she really means is that he/she doesn’t want to make the effort to. (Or possibly that he/she assumes that the Earth can’t sustain having people on a ketogenic diet, which as I’ve written about before is nonsense, but a topic for another discussion.)

As I’ve mentioned several times, I absolutely hate the band workout I do. I dread it. But I do it, not because I want to, but because I have to in order to get stronger and build, or at the very least maintain, muscle mass. I don’t have any other option. I can either do strength training, or I can lose muscle mass.

There is no easy way to do strength training. I have to constantly go up on reps or on band size. Neither is easy. I could do a band workout that might be fun. I could use the weenie band and do a few reps without breaking a sweat and then tell myself I had a helluva workout. Might make my psyche feel better. I certainly wouldn’t dread it like I do my regular workouts. But it wouldn’t do squat for my lean body mass.

I’m not trying here to come off holier than thou. I’m just saying I have a choice. I can be miserable for a half hour three times a week and maintain or build muscle mass and strength. Or I can blow it off and just live with the loss of muscle mass consequences. It’s a choice. And I choose the be-miserable-for-30-minutes choice most of the time.

It’s the same with diet. If you’re on a diet that is doing right by you, you’ve got to stick with it. I occasionally miss a workout. You can be on a ketogenic diet and go face down in donuts at some point. If I miss a workout, I don’t say, Oh, well, there goes my training regimen. I can just accept I missed it and make sure I don’t miss the next one.

Same with diet. Just because you have a blowout, doesn’t mean you can’t climb right back on that dietary horse.

I screwed up last night. So did MD, and she’s almost always more diligent than I am.

Here’s what happened.

A golfing buddy of mine and his newish girlfriend took MD and me to dinner for my birthday last night. MD had salmon and I had a giant pork chop. Both came with sides. We both had Brussels sprouts and asparagus. Very few carbs. Then the dessert menu came around, and I didn’t see anything I liked. (Actually, I saw a half dozen things I loved, but almost never eat because they are loaded with carbs. And much though I like them, they aren’t worth the carb load.) So, I said, No, dessert for me. I’m stuffed.

My buddy’s girlfriend ordered the flourless chocolate cake. And MD orders an affogato, which is an Italian dessert in which a dollop of ice cream is dropped into a cup of espresso. I hadn’t seen it on the menu, so when she ordered it, I ordered one, too. As did my friend.

I figured what’s the carb price? maybe 10 grams of carb. I probably had 5 grams with dinner, so no biggie.

After what seemed like an eternity, the waiter finally shows up with the desserts. They are like reverse affogatos. In this restaurant they come as a giant bowl of ice cream along with a little (and I mean little) shot of hot espresso to pour over the mound of ice cream.

It was not what we expected, but we both manned up (she, I suppose, womaned up?) and ate them. But we knew it was just a blip on our long dietary history. We didn’t say, We blew our diet. We simply chalked it up to experience and moved on. Back to our regular diet today, which, if you’re interested, was a bowl of high-protein yogurt we’re working to develop as a product. Two eggs and two pieces of bacon. A chicken thigh for lunch, eaten before the very computer I’m writing these words on. And we’ll have steak for dinner tonight. So, really, no harm, no foul, from the reverse affogato last night.

If people have serious health and weight issues, they’ve got to commit to a plan. Whatever plan it is, I guarantee it’s not going to be as enjoyable as eating everything they want to eat anytime they want to eat it. There will be sacrifice involved. The low-carb/ketogenic diet sustained our ancient ancestors for millennia. And based on anthropological studies, they were more robust than we are. They had better teeth, increased cortical bone density, greater stature, and were all around in better health than their agricultural followers.

Their diet was sustainable simply because it was the only diet they had. I’m sure had ancient man been given a jelly-filled donut, he would have wolfed it down and asked for more. But, fortunately for him, such evil treats weren’t available then.

Our ancestors didn’t have to make a choice because they had no choice to make other than eat what was available or starve. Unfortunately for us, we do have a choice. Too many choices, in fact. So we have to decide between health and taste. (Not that steaks aren’t tasty; they are indeed, but I’m talking high-carb indulgence foods here.)

I dip into the tasty treats occasionally (as I did last night), but I don’t make a habit of it. I stay pretty much on the straight and narrow most of the time. And that’s what I encourage you to do, too.

Nick Norwitz recently posted a video about myths surrounding the ketogenic diet. One of them is that it isn’t sustainable. He has a nice commentary on that. But before we get to it, I would like to address one other issue that no one has written me about, but that I’ve seen in action all too many times.

I have a belief that there are no junk foods. There is only food and junk.

Many people try to make their low-carb or ketogenic diet as much like the diet that got them in trouble as they can. They eat low-carb brownies. Low-carb cookies and cakes. All kinds of crap that is made to look and (sort of) taste like the real thing but without all the carbs.

These items, for the most part, are often filled with bad oils and other vile ingredients to make them taste like the high-carb foods they are trying to replace. Eating something like this once in a while won’t kill you, but eating them all the time can be problematic.

I did toy with this earlier in my low-carb life, but I decided I would rather eat the real thing once in a while than the fake stuff all the time.

If you’re going to do a low-carb/ketogenic diet, go with real foods. Embrace what the diet has to offer. You can have meat, eggs, butter, and an entire cornucopia of low-carb fruits and veggies. Adhere most of the time, do a little fasting here and there. Mix things up a bit. And occasionally—very occasionally—have a treat. I don’t mean every other day occasionally. Indulge infrequently.

Here’s what Nick has to say about diet sustainability. I’ve got it keyed to the spot.

Mercola Situation

Here is a poll response I got on Mercola.

Lots of great medical stuff.  Please don't waist any time on Mercola.

This reader won’t be disappointed. Despite my many inquiries, I haven’t been able to find out anything about the situation. Most of my contacts are academics, and most of them have no truck with Mercola. So it’s not surprising they don’t know what’s going on.

I’ll keep an ear to the ground, but as of now, I know nothing more than what I’ve read here, here, here, and here. These are all the articles I’ve been able to find, and I kind of feel bad about even posting them, because I have no other knowledge. So,I’m out of the Dr. Mercola saga until I can get some real info.

If anyone out there is in the know, drop me a line. No hearsay. I need something solid before I’ll write about it.

More on Parasites

I received a few responses about parasites. Here is one from the latest poll.

I would differ that today we don’t have parasites in our bodies. Both my husband and I have had live blood analysis tests done in the past year two times, and we both observed the parasites in our blood with our own eyes. It’s extremely common. Highly recommend you have a live blood analysis. Many parasites are floating around the rest of our bodies as well, most likely. 

I think this reader has been had. In the first place, parasites don’t usually float around in the body. They have a target organ. The liver flukes of schistosomiasis, for example, end up in the liver. It’s an awful disease. But you don’t find the flukes sporting about in the blood. And if they were, you would know it.

Malaria ends up in the red blood cells, but if you have malaria, you generally know it, because you run high fevers, feel like crap, and are anemic.

Other parasites end up in the GI tract or in the lungs or other organs. I can’t think of one that would be free floating in the blood and be able to be picked up on any scan.

MD and I have a friend who is kind of woo woo. He, like my grandmother, is focused on his bowels. He went to a place on one of his travels where he found an enema center (I can’t even imagine). He went through the process, and, according to him, the folks at the center ran the results of his colon cleansing through a clear pipe so that he could see watch it along with the ‘tech.’ As he watched the crap run through, the ‘tech’ pointed out all the yeast to him. He told us he saw it with his own eyes.

Problem is, yeast are microscopic. They can’t be seen with the naked eye. Only with a microscope. Whatever the highly trained ‘tech’ pointed out as yeast couldn’t possible have been yeast. I have no clue what they were, but I know they weren’t yeast. They were probably pieces of colonic contents that looked like what a hugely magnified yeast would look like. But they weren’t yeast.

And I would be willing to bet that what this reader had identified to her as parasites were nothing of the sort. People typically are not crawling with parasites without knowing it.

All these poll responses are anonymous, so I have no way of contacting the person who posted this. I would very much love to know what the person who diagnosed all the parasites recommended as treatment.

Okay, one more.

Efficacy of Flu Shots

Here is a question from one of the poll responses

Loved it, as always! I commented on yesterday's newsletter....would love your analysis of the efficacy of flu shots. Thanks!

I looked into this several years ago. From the papers I read then, the data suggests that those taking the flu shot do not get the real flu as frequently as those who don’t get the shot. But they do get more non-flu upper respiratory infections.

Like all vaccines, the flu shots are not tested against a placebo, they are tested against an earlier version of the vaccine. So there is really no way to tell whether or not there is a risk-reward benefit from the shots. You basically take them on faith.

I’ve had exactly one flu shot in my life. We offered them at our clinic, and MD and I both took one. Once.

MD had one other one in the 70s when the swine flu scare came through. Her father was immunosuppressed and his doctor insisted that the whole family get vaccinated against it, so she agreed to take it. And promptly got sicker than three bejesuses with fever and flu like symptoms. And that’s it.

Quote of the Week

This isn’t a regular weekly thing, but I couldn’t let this one pass without posting it. Senator Rand Paul is pissed because he wants the justice department to open an investigation on Anthony Fauci for lying to congress. Which is a crime.

“If you happened to walk in the Capitol on Jan. 6, [2021], you might get 10 years in prison, but if you’re responsible for funding research that led to a pandemic and killed 15 million people, and then you lied about it to Congress, then nothing happens to you.”

In my view, he is right. Fauci along with a bunch of his compatriots should face the music. And I don’t mean a Micky Mouse senate or house hearing. Those are all for show. I mean a real investigation. And real consequences depending on the findings.

Does Fake Meat Lead to Early Death?

I’ve got to debunk a story that I really wish I didn’t have to. Recently the New York Post published a story titled “Vegan processed foods linked to heart disease, early death: study” that I would like to go over just to show what to look for in articles like this one.

I’ve got to admit, at first blush I was ready to believe this, because it tickled my confirmation bias. But instead of just looking at the headline, I read the thing and pulled the study.

Let’s take a look.

The NY Post article starts out thus:

This is not ha-pea news for vegans.

While experts extol the health and environmental benefits of a diet free of animal products, new research suggests that consuming ultra-processed vegan food can increase the risk of heart death.

Ultra-processed foods include packaged goods, drinks, cereals and ready-to-eat products that contain colors, emulsifiers, flavors and other additives. UPFs are typically high in sugar, saturated fat, and salt and devoid of vitamins and fiber. [My bold]

As you can see from the weasel words I’ve bolded in the above, we’re probably dealing with an observational study. The article continues

Researchers from the University of São Paulo and Imperial College London assessed the diets of more than 118,000 Brits aged 40 to 69 years old.

They found that a plant-based eating plan promotes overall heart health, but only when that diet features fresh plant-based foods such as fruits and vegetables, whole grains and legumes.

Researchers found that for every 10% increase in plant-based foods, the risk of death from heart disease fell by 20%.

Yet, when the increase in plant-based foods came from UPFs, it was linked to a 12% rise in heart disease-related deaths.

If you go on and read the entire article, you’ll find that the authors start to back off of their staunch opening as the article progresses. Most writers of these sorts of pieces know that almost everyone will read the headline, and a lot of people will read the first few paragraphs, but then readership really starts to fall off. They know if they make the case they want to make—which is often not the case the scientific article itself is making—they can put the opposing argument at the end. Most people will never get that far.

Those that don’t, end up taking away the message the author wants them to take away. In this case, that consuming ultra-processed plant based foods will lead you to an early death.

Those who do read the article to the end—the vast minority of people—come away thinking the author wrote a balanced article.

Almost no one will take the time to pull the paper about which the article was written and read it.

I did, and you can find the study here.

The first thing I noticed was that one of the authors is Carlos Monteiro, who is the guy spearheading the movement against ultra-processed foods. He’s the one who came up with the NOVA classification, which I think kind of sucks. You’ve got to figure that he’s got some skin in the game here as this paper is showing exactly what he wants it to show.

Where did the data come from?

Data from the UK Biobank participants (40–69 y) who completed at least two 24-h dietary recalls between 2009 and 2012 (n = 126,842; median follow-up: 9 y), with subsequent data linkage to hospital and mortality records, were used. Food groups were classified as either plant-sourced or non-plant/animal-sourced foods. These groups were further divided into non-UPF and UPF, and expressed as a percentage of total energy intake. [My bold]

As you can see from the bold above, these subjects completed “at least two 24-h dietary recalls between 2009 and 2012.” Which means they were asked to remember what they had eaten the 24 hours before the survey. Can you provide an accurate account of exactly what you ate yesterday?

And they took this information—inaccurate though it was—and extrapolated it over an entire year. Let me ask you this, is whatever you ate yesterday representative of what you’ve eaten over the past 12 months?

This is where they got the data. Then they took this data, shabby though it was, and compared it to hospital records for these people. The authors then compared the death and disease records from the hospital to the pathetic 24-hr dietary recall data and ran it through a statistical program to come up with their numbers.

How accurate do you believe these numbers are?

Not very, I would say.

Then when you look at the results, you can see that the whole affair is a loser. It does nothing to add to the mass of knowledge on the subject. It’s a waste of time, funding, paper, etc.

Here are the results from the paper.

See the numbers on the lines I’ve underlined in red. A 5% increased risk (1.03-1.07) and a 12% higher mortality (1.05-1.20) are meaningless. Any observational study you see with numbers in parenthesis that are less than at least 2 are totally meaningless. Even if the numbers are 2 or greater, odds are the numbers are meaningless. But at least it will make you look twice at the study. And think it might merit further investigation.

These tiny numbers mean nothing. This study proves nothing other than the ability of researchers to bilk the funding agencies. I would be ashamed to have my name on such a paper unless the conclusion was that we looked, but we couldn’t find anything.

No one believes more than I that ultra-processed food are not optimal for health, so I was willing to believe when I saw the NY Post article. But it didn’t take me long to realize the study was worthless. It doesn’t prove UPF are bad; it doesn’t prove they’re good; it’s simply a waste of effort and resources.

So don’t get gulled by stories like this one without doing your homework.

Odds and Ends

Newsletter Recommendations

I’ve gone on too long tonight and don’t have any groundbreaking new newsletters for you, but as always, there is OutlanderMD. This week upcoming the bride tackles the delicate issue of ‘exposure’ of infants and the folklore deception of ‘changelings’.

Take a look if that strikes your fancy.

Video of the Week

I have a great video of the week this week along with a bit of Eades family lore. One of our grandsons has been accepted to a college near Santa Barbara, so he’s out here to visit the campus. In talking to him, I brought up the movie Animal House. Blank look on his face. I said, You’ve never seen Animal House? It’s a classic. Or it was when it came out in 1978.

This got us to talking about older movies, and I asked him if he had ever seen the movie Deliverance. He said he hadn’t, so I had to tell him the family story.

The movie, which I’d seen in the theater years before, showed up on TV sometime in the mid-to-late 1980s. At least at a time we had a VHS recorder, so I recorded it. MD and I had already both seen it, but we recorded it for one scene. It’s the dueling banjos scene.

There are so any little bits of genius in that one short scene that our entire family watched over and over. It starts out with one of the characters commenting on one of the hillbilly’s hats. He says, “I like the way you wear that hat.” The hillbilly stares at him for a long time, then says, “You don’t know nothin.”

Since that time, if anyone in our family appears in a hat that isn’t a golf hat, the comment is always, “I like the way you wear that hat.”

If anyone says anything the least bit strange, the response is always, “You don’t know nothin.”

As the clip goes on, Burt Reynolds asks the hillbilly where the folks live who can drive them to where they want to go. The hillbilly waves his arm and says, “Back off over that way.” To this day, whenever anyone in our family asks where something is, the answer is usually, “Back off over that way.”

Our youngest son, who is the father of the grandson here with us now, had seen only this one short clip we had all laughed about countless times. One night MD and I were headed out for some event and left our youngest at home with his best friend. They were about 13 years old or so. As we left, we asked them what they were planning on doing. Our son said they were going to watch Deliverance.

When MD and I got home, our kid was asleep and his friend, who had come to watch the movie, was gone.

The next morning, we were up drinking coffee and reading the paper when the youngest kid comes boiling into the kitchen. He doesn’t say good morning or any kind of greeting. He simply snarls out, “I thought you said that movie was funny.”

I said, No, that short clip we all watched a thousand times is kind of funny, but the movie is terrifying. That’s why I wondered why you chose it to watch.

It had scared the bejesus out of both of them. His friend so much that he called his mother to come get him.

I’m laughing so hard as I write this that I’m almost in tears. It may be one of those things where you just had to be there, but I thought it was hilarious.

Anyway, the movie was made in 1972 and it was outstanding. Here is the scene we all watched so many times. It doesn’t have the “I like the way you wear that hat” part in it; that comes right before this clip starts.

The scene brilliantly sets the stage for what is to come. If you haven’t seen it, rent or purchase Deliverance. It is a true classic.

Time for the poll, so you can grade my performance this week.

How did I do on this week's Arrow?

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That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday.

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This newsletter is for informational and educational purposes only. It is not, nor is it intended to be substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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