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Hello everyone.

Greetings from Montecito, where I’m knee deep in family, including a grandson who wants to play golf at every opportunity. So, I’m getting plenty of sunshine. The rest of the time it’s been one family event after another. Last night I went bowling, for God’s sake. I haven’t done that probably since the last time they were all here. I suck at bowling, and every time I try it, I always tell myself, Hey, it should really be pretty easy to break 200. All you need to do is get out and practice. Then I say, What are you thinking, you’re already underwater with all you have to do. The competitive mind is something to behold sometimes.

Let’s take a look at what’s on the minds of some of The Arrow readers.

Poll and Comment Responses

Virtual Colonoscopy

I got a number of questions and comments on virtual colonoscopy, which means plenty of people are interested. Let me expand a bit.

I contacted my former partner, who had run an EBT scanning center for a long time. Here is what he had to say.

• The virtual procedure can be performed via CT or MRI.

• The CT might be marginally more accurate but the MRI is excellent and certainly "accurate enough" to provide reliable diagnosis.

• As you know - but patients do not - accuracy can be highly dependent on which device is used.

• The biggie is that the MRI has zero radiation.

• Even the fastest CT will result in a pretty significant dose; something your readers need to consider.

• Both are expensive and not covered by Medicare or most plans if any.

• As always, the place to have it done is a clinic where they do a ton of them.

A reader wrote telling me Medicare doesn’t cover virtual colonoscopies. Apparently that is true, so that’s a decision you’ll have to consider.

One of the advantages of the virtual colonoscopy is that you don’t have to be sedated. It can be a little uncomfortable because of the gas pumped in to expand the colon for clearer visibility, but that’s about it. Nothing you need to be put to sleep for. Consequently, you can drive home after.

Usually people are sedated for a colonoscopy, which means they can’t drive afterward and need someone to go with them to get them home.

A couple of people asked me if I had ever had a colonoscopy. Yes, I did. About 20 years ago. It was no big deal, other than the abuse I took from the nurse and a doctor friend. There are advantages to being a doctor, and there are disadvantages. Sometimes you just want to be the patient and be coddled. But that won’t happen if you know the staff.

In my case, my best friend, who was a great family practice doc, badgered me relentlessly to get a colonoscopy. Finally, I said, Okay, screw it, schedule the frigging thing.

Then, the day before, I did the prep, which was dreadful. And, unfortunately, is required for a virtual colonoscopy as well. You drink this stuff that tastes like cherry-flavored (in my case) lighter fluid. It doesn’t taste bad, but it has a heavy, oily consistency to it. And your drink about a gallon of it, as I recall. The fluid by design doesn’t absorb from your GI tract like other liquids, so it moves on down the tract pushing everything in there ahead of it. You end up spending a lot of time on the toilet.

And because I found it more palatable taken cold, I drank it with ice. The cold fluid ended up chilling me a bit, so I was lying in bed under the covers between trips to the can. As I lay there huddled beneath the blankets, my imagination started to run wild. I had visions of a giant cancer gnawing away at the inside of my colon—one that looked like an apple core on barium enema. I had operated on a number of colon cancer patients, so I knew just what such a cancer looked like. It didn’t take long before I became overwhelmed with paranoia.

Bright and early the next morning MD took me to the hospital where the event was to take place. To my horror, the nurse turned out to be the wife of one of my poker playing buddies. She put me through the paces of getting ready for the big event, which including starting an IV for the sedative.

I asked her if a colonoscopy was painful, she said it probably wasn’t, but that most patients prefer to be sedated. I told her to keep the juice at hand just in case, but that I wanted to watch the whole thing unless it really did become painful. At which point, she could inject the sedative through the IV.

So I watched the entire procedure, which was not painful at all. But I was a bit angst ridden based on all my ruminations during the prep. The procedure was shown on a video screen that I could watch as it happened. All I could see was what the scope that was snaking through my colon saw. Each time it came to a curve in my colon, I kept thinking that at any moment the cancer would loom into view.

Fortunately, my colon was clean as a whistle. There was only one thing out of the ordinary, which was, believe it or not, a watermelon seed in there that had not been flushed out with the prep.

I didn’t think much about it till the next time I went to my friend’s office. The receptionist, whom I knew well as I did all the folks who worked there, says, Hey Doc, I hear you’ve been eating a lot of watermelon lately. It became an ongoing joke every time I visited my friend.

My doctor friend had once asked me if I had any cancer in my family. I told him my grandmother had died of some kind of abdominal cancer, probably gall bladder cancer. And I told him her mother had died of colon cancer. Thus his constant badgering me to get a colonoscopy.

But he, himself, came to a bad end for not following his own advice about diet.

I visited him at his office early in December, and every flat surface had a plate of cookies, a pie, a fruitcake, cup cakes, and on and on—all of which his patients had brought him. I said, Jesus, Allen, what are you going to do with all this crap?

He said, I’ve got to eat a little bit of all of it, so I can tell them how good it was. He then said, but I know I’ve got to cut the carbs, and I will as soon as Christmas is over. I’ve decided that carbs are an addiction, and I’m going to go through a Twelve Step Program to shed myself of them.

Then he informed me he had been diagnosed with sleep apnea and had been using a CPAP machine when he slept.

I couldn’t believe it. He had a little bit of a belly, but he wasn’t that much overweight. And he had sleep apnea. I told him, Look, I am going to ride your ass relentlessly after the first of the year, just like you rode mine about the effing colonoscopy. He said he hoped that I would.

We parted, and that was the last time I saw him alive.

A few days after that, my assistant called me in the evening and said she had just driven by his house and there were all kinds of emergency equipment outside. I knew if he, or his wife, or one of his kids had to be taken anywhere, it would have been to a specific hospital. So MD and I headed there at warp speed.

As it turned out, he had come home from making his rounds at the hospital and had been helping put up the Christmas tree. His wife had taken their two twin boys, aged 9, up to get them off to bed. My friend flopped down on the couch to snooze till his wife came back down, and he had an arrhythmia and died.

Probably occurred due to lack of oxygen to his heart as a consequence of his sleep apnea. When oxygen levels in the heart fall, it can trigger an aberrant beat. And if it’s the wrong one, you can easily die. He was 44.

A low-carb diet will improve sleep apnea almost immediately. Had he started on his diet the last time I saw him, he might still be alive. The take home message here is to take sleep apnea very seriously. There are vastly worse consequences than simply being tired the next day.

More on sleep apnea next week.

After that downer, let’s get back to the virtual colonoscopy situation.

Below are a couple of videos of what a virtual colonoscopy looks like to the radiologist reading it.

Here is a video that shows a fly through, which is what radiologists call traveling through the colon digitally. This video was from ~12 years ago, and technology has much improved since then. You can see the kind of detail visible inside and outside of the colon with a virtual colonoscopy.

Here is another short one just showing what can be visualized and measured.

The one other nice thing about a virtual colonoscopy is that it is digital, so if later the radiologists wants to go back and look at something in more detail, he/she can find it easily and magnify it.

When you get a regular colonoscopy, the gastroenterologist runs the tube through your colon videoing everything along the way, which is what I watched on the screen during mine. But if he/she fails to turn the colonoscope around one little bump or wrinkle, that area can never be seen without redoing the colonoscopy. All that’s there to see is what’s on the video made during the procedure. With a digital image you can go back and recheck at will because it’s all there.

Variable Resistance Band Workouts

This poll respondent wrote about a couple of different issues. I’ll address the variable resistance first, then maybe the other if I have time.

If you want to read countless studies about variable resistance as compared to strength training, read Weight Lifting Is a Waste of Time, which details many studies comparing variable resistance training to lifting weights. The author, John Jaquish, has a PhD in biomedical engineering, describes numerous studies comparing variable training with weight lifting. In the book, he examined studies looking at three groups of people. One group was composed of sedentary people, another one of weekend athletes, and the final group was elite athletes.

Subjects in each of these groups were randomized into either variable resistance training or standard weight-lifting training. In all cases, the subjects in the variable resistance training cohort were able to lift more weight at the end of the study period than those who lifted weights. There are a multitude of such studies in the back of the book lasting varying lengths of time.

I think just about any exercise is good. But for the time spent compared to the outcome, I think variable resistance training is superior. And is less likely to get you injured. Plus it’s vastly less expensive if you use the X3 Bands or other similar system. It costs a few hundred bucks and you can hide it under the bed (where I keep mine). Or, you can do like my kid, and drop $4,000 on an entire weight rack set up that takes up the end of his garage.

I’m sure there may be some advantages to using free weights, but when you tally up the cost, the room required, the portability (I can take mine on a plane—try that with free weights), and the ease of use, I think the bands are an all around win.

As this reader mentioned, body weight exercises such as pushups, pull ups (these may require extra equipment), sit ups, etc. are fine too. Portable, cheap, etc., etc., etc. But they don’t really provide variable resistance, so I’m not sure you’ll get the same outcome with the same amount of time spent as you would with the bands.

Dietary Protein

A reader writes:

There are two times in life when you need a lot of protein: During growth when you are increasing in size, and during the later years when you are trying to desperately hang on to your waning lean body mass.

Problem is, when you’re young, you don’t really give a flip about what you eat. You feel invulnerable. Consequently, you just eat a lot. And the young growing body is able to extract the protein out of whatever you eat and use it for growth.

Not so when you get older. It becomes a battle then against time. Ideally, people getting older should eat double the 0.8g/k body weight. I always recommend 1.6g/k minimum (which calculates out to ~ 0.73 g protein per pound of body weight).

The best quality protein comes from foods of animal origin. As a rule of thumb, you can figure that an ounce of animal protein contains about 7 g protein (quality protein), so for every 100 pounds of body weight, you should be consuming about 70 g of protein, which would be a 10-ounce steak. Now this doesn’t have to be eaten all at once, though I don’t have any problem gobbling a 10-ounce steak at a sitting (or a 16-ounce one, for that matter).

The big issue is that people who are older now have gotten older during the days when everything they heard for years was about the dangers of cholesterol and saturated fat. Even looking at a 10-ounce beef steak could cause a heart attack. I’m kidding, of course, but people were (wrongly) scared to death of red meat.

Young people don’t care, because they think they’ll live forever. Not so those who are in their 50s, 60s, 70s, 80s and beyond. All the people in these age groups have seen friends and relatives die of all kinds of issues, so they know they’re not immortal.

And if you’re in one of these age groups and have been harangued by the media and even doctors, who should know better, about red meat, cholesterol, LDL levels, heart disease and all the rest, it gives pause when you’re told to eat red meat. Or almost any kind of animal protein other than fish.

I still come across articles by cardiologist who advocate against a lot of red meat because it is high in saturated fat and can clog your arteries. And even when the cardiologists’ own trade journal, the Journal of the American College of Cardiology has absolved saturated fat. It says it right there at the top of the study.

That says no arbitrary upper level, which means just that. But a lot of folks haven’t gotten the message. Those are the ones also recommending less protein, because they know most people think of protein as animal protein, so they don’t want folks eating too much of that, God forbid.

And as to dietary cholesterol… Ancel Keys, the father of the lipid hypothesis of heart disease, said dietary cholesterol doesn’t matter. You make plenty of it in your body. If you eat a lot, you make less, and vice versa. His primary concern was saturated fat, which concern has now been undone.

Getting back to the comment above, increasing protein while decreasing carbs should resolve the “stubborn belly fat in the elderly.” Eating more protein burns more calories while reducing carbs lowers your insulin. That’s a good one-two punch, but it’s going to take more time to get rid of than it would if you were 20. There’s a fair bit of evidence that HIIT (High Intensity Interval Training) helps reduce belly fat, so maybe adding that piece to more protein and fewer carbs would be the tri-fecta.

Berenson, Missouri Ozarks, and HITT

Here is a poll response that covered a lot of ground.

I, too, was reared in the Missouri Ozarks. I would love to know where this respondent grew up. Hell, we may be kin.

I don’t know the answer to the question about HIIT as compared to doing the bands in slow motion. I do know that although mild to moderate exercise does a little bit for you, you’ve got to really raise your heart rate and your breaths per minute to get substantial benefit. And as you begin to get in shape, you have to keep increasing the load, so that you continue to breathe hard with a high heart rate. I suspect the findings in this study have to do with increased blood flow to the hippocampus.

Sachs Interview Again

The person who wrote about the variable resistance exercise in the earlier poll response I wrote about started his response by disagreeing with the Jeffrey Sachs interview I posted.

This respondent hit on the head the one major thing I disagreed with Sachs about. I don’t believe any kind of diplomacy can ever—at least not in my lifetime—bring about a two state solution. I think there will be turmoil there for a long, long time.

My belief, and I have no way other than to consult an alternate universe to verify it, is that had Ukraine backed away from NATO, there would have been no war. And I think our (the US’s) intelligence community (IC) does act as Sachs portrayed. None of the various agencies that make up the intelligence community have had a knot jerked in their tails since the Church hearings in 1974, which brought about many changes, including the firing of James Angleton, who had been there from the start. From 1974 till now is 50 years that they’ve run amok without much oversight.

The IC saw how their wings got clipped in 1974 and haven’t wanted another such clipping. As Charles Schumer commented about Trump’s messing with them, “They have six ways from Sunday to get you.” Someone needs to bring them to heel. In 1974 it was the Democrats who did it. Who will do it now?

And finally, a serious testimonial.

Loved The Arrow

Every week I get a handful of poll responses saying stuff along the lines of Good job this week. Really enjoyed this week’s Arrow. Loved all the topics this week. One of my favorite newsletters. And I love reading all those attaboys from the bottom of my heart. It offsets those who write, You suck. I don’t get that all that often, but every now and then I do.

So this week I was delighted to get the best testimonial ever.

This one really warmed my heart. And it didn’t take me all that long to write.

Just kidding. It’s legit. Whoever wrote it has my profound thanks for the kind words.

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Are Carbohydrates Essential For Life?

A reader sent me a video of Dr. Mercola interviewing Dr. Cate Shanahan. He had it cued up to run right at the point at which Dr. Mercola was launching into one of the bizarrest claims I’ve ever heard anyone who supposedly understood basic nutrition make. Here is the video all cued up for you right at the spot.

I haven’t watched any of the video before the spot it’s queued to, so I don’t know what either of them have to say about seed oils. But Dr. Mercola’s description of what Dr. Tim Noakes told him in an interview is astonishing. Not what Tim Noakes told him, but Mercola’s response to it.

I had to watch those few minutes several times to make sure I wasn’t misunderstanding Dr. Mercola. What he said was so ignorant, that I thought I must have misheard what he said. But no, he said it. Watch it yourself if you don’t believe me.

He said he was interviewing Tim Noakes (whom I know fairly well) when he (Tim) made the comment that carbohydrates are not a requirement for human nutrition. Mercola said he (Mercola) nearly fell down when he heard those words. He admitted that they were technically true, and that humans could indeed live without carbohydrates, but not for long.

He then blathered on for a minute or so about the various amino acids in collagen, but then ended up saying that what Tim Noakes said was scientific fraud. And that it should be unlawful for experts to even say such a thing. You can watch those few minutes and see for yourself.

He talks about how you will deplete your muscle mass if you don’t eat carbs, because carbs are essential, and if you don’t eat them, they can come only from cannibalizing your muscle. He says “if you don’t get enough carbohydrates into your body, you are in for trouble.”

It’s insane. You can get along just fine without a single carb. Not so with fat; especially not so with protein.

Carbs are nothing but a fuel. They convert to glucose or are broken down into glucose and absorbed. If you have a lot of glucose in your blood, your body springs into action and burns it preferentially and stores whatever isn’t needed at the moment into glycogen, which is stored in primarily in the liver and muscles. Although I haven’t specifically heard him say this—maybe he does later in the video; I couldn’t watch the rest of it out of fear of damaging my own brain—but he’s the kind of person who would probably say carbs are preferentially burned because they give you quick energy. I suspect glucose is burned first because too much of it gives you glucose toxicity and runs up your insulin. (Go to PubMed and look up glucose toxicity or glucotoxicity and see how many papers you’ll find.)

Excess glucose corrodes the arteries and causes a host of ill effects. It’s quite toxic, for instance, to the glomeruli (the filtering units of the kidney). I’m pretty sure the body evolved to burn it quickly. Not because it’s a source of quick energy, but because it’s toxic. Any glucose that isn’t burned or stored as glycogen is converted to fat, and a saturated fat, at that.

So the body deals with it by burning it or converting it to a less harmful substance.

The whole system operates under the control of insulin. If we eat a lot of carbs, blood sugar rises as does insulin. Insulin drives the carbs into the cells to be burned, and it drives the liver to convert what can’t be stored to fat. Unlike the adipose tissue on your body, which can expand to store a lot of energy, the glycogen storage depots are limited.

If you don’t eat carbs, and your blood sugar starts to drop, your insulin will fall as well. When insulin falls, the body switches to fat burning mode. It burns fat to fuel most everything, and the stored glycogen is able to meet the body’s minimal need for glucose.

During starvation or on ketogenic diet, the insulin is low, so the body burns fat. It converts some of that fat to ketones, which are an alternate fuel that replaces the need for glucose in many tissues, so glucose can be spared for those few tissues that require it.

No one really knows how much glucose ketones can replace, because it has been deemed unethical to get glucose levels low enough to really find out. George Cahill at Harvard did a number of fasting studies back in the 1960s when that sort of stuff could be gotten away with and found that in some of his subjects who had fasted for months blood sugar levels were 25mg/dl. An unadapted person whose blood sugar fell to that level would be almost instantly comatose. But these fasting subjects were wide awake and didn’t notice anything out of sorts. The majority of their glucose needs had been supplied by ketones.

If insulin is high, you can’t make ketones, so you have to use glucose.

If you are on a low-carb or ketogenic diet, you will be taking in minimal carbs. You will be consuming a fair amount of protein and fat. As mentioned above, the dietary fat—in the presence of low-insulin levels—will convert to ketones to replace the glucose. What little glucose you’ll need could be pulled from muscle protein, but there are other sources as well. Dietary protein can be converted to glucose. All of our cells contain little storage vesicles in them filled with bits and pieces of protein structures that have been broken down and stored there. One of the things that ketones stimulate is a dumping of these vesicles, which does a couple of things. First, the junk protein can be converted to glucose. And second, it’s good to clean all this junk out of your cells. They function much better without a lot of vesicles in them filled with protein debris.

Dr. Mercola has fallen under the influence of someone who has persuaded him that the Randle cycle, which we discussed here a few months ago, won’t let you burn carbs if you have too much fat. And vice versa. Too much glucose impairs fat burning.

What he obviously doesn’t understand is that it is flipping back and forth all the time depending upon what the body needs at any precise time. It’s a really complex system of checks and balances. If you want to see how it works in all its complexity, take a gander at the video below. I might have put this up when I discussed the Randle cycle before, but I can’t remember. This guy does a great job of really getting into the weeds and showing graphically where all the control points are. Which reside primarily in an enzyme complex within the mitochondria called the pyruvate dehydrogenase complex.

It kind of gives me hives to watch this, because it is so much like a med school lecture. I enjoy watching these lectures now. But in med school we had to learn all the enzymes and what stimulates of inhibits them. Made for some long nights and a lot of flashcards.

If you watch the video, you can see how cleverly the body allocates fuels. Just about everything we burn ultimately converts to pyruvate. Depending upon many feedback mechanisms (explained in the video) allows the body to burn what it needs to burn when it needs it.

A reader sent me a link to a video by Dr. Ben Bikman that I hadn’t seen. It is all about the Randle cycle, but it considers it from a different perspective than I did a few months ago. Then I discussed the work of Robert Wolfe, who basically discovered the Randle cycle works almost opposite of the way Philip Randle thought it did.

Ben’s video is great and it discusses some, but not all, of the control points seen in the video above. It’s a great overview. If you watch just one of these videos, you’ll probably get more out of Dr. Bikman’s. If you want the med school version, watch the first one. I would encourage you to watch both.

Odds and Ends

• Thanks to an alert reader, I found out that the whale attack on the boat I posted about here last week was likely not really an attack. And the whale probably wasn’t angry. And that I know very little about whales.

• How a 'light bulb moment' in an Arkansas barn made Ryan Crouser a shot put juggernaut.

• Scientists say A23a, the world’s largest iceberg, which is more than twice the size of Greater London, has been captured on top of a huge rotating cylinder of water.

• Researchers at Washington University School of Medicine have developed what may be an entirely new class of antibiotics, which has been shown to be effective against “flesh-eating” bacteria, in mice, at least.

• What kind of fare do you get served in a nice restaurant located above the Arctic Circle?

• What happens when tigers try to sneak up on small bears?

• Children of freed spies learned they were Russian on flight to Moscow. Helluva thing to learn all of a sudden. Kids didn’t speak Russian, knew nothing about their home country. Thought they were Argentinian.

• America isn’t ready for the wars of the future, but, sadly, they’re already here.

• It really does physically hurt to think, which is doubtless why so many people refuse to do it. Instead they indulge in passive entertainment or letting others think for them.

• A new report from the Met Office admits that storms were much worse in the past.

• Old footage of chimpanzees in captivity uttering the word "mama" suggest our closest living relatives could have the neural building blocks for speech after all.

• Researchers from MIT were able to order and receive all the genetic material necessary to recreate the 1918 pandemic influenza virus and the toxin ricin.

• A minute-by-minute account of how Israel assassinated Ismail Haniyeh in Tehran, which is obviously swarming with Mossad spies. It’s no wonder the Iranians are paranoid.

• How movie watching is changing. Looks like the trend was accelerated by the pandemic.

• Dolce & Gabbana introduced a new alcohol-free fragrance mist for dogs that is now available for preorder for $108. May make them smell better to humans, but will the dogs like it? Plus, I’ve paid less than $108 for an actual dog.

• Carvings at Göbekli Tepe may be the world’s oldest calendar.

• What insanity will PETA think of next? They put a chicken with an AR-15 on billboard threatening to kill people who eat meat. In Casper, WY of all places.

• Why Dairy Queen, by law, can’t call its ice-cream-like product ice cream, but has to call it soft serve instead. Take a look at the list of ingredients, which don’t include enough milk fat.

• Paper straws often touted as better than plastic, but there’s a big problem: as it turns out many paper straws are toxic.

• Trees don’t like to suck in wildfire smoke anymore than humans do. And like humans, trees can hold their breath to avoid doing so.

Newsletter Recommendations

MD’s weekly Substack OutlanderMD will be discussing tracheal injuries and how they would be dealt with in the 18th century…and how they are dealt with now.

Books & Biceps is written by meatheads who like to read for other meatheads who like to read. I read it every week to keep up with what the meatheads are reading.

Video of the Week

Well, since this was a sort of abbreviated version of The Arrow, I’m going to compensate by making the Video of the Week a little longer. This video shows how butter is made in the old fashioned way in France. A friend of mine sent this to me (h/t to Richard Nikoley) and it is a treat to watch. Our kids found a terrific butter made in Belgium and sold in our local grocery store in Montecito. It comes wrapped in white paper just like the butter in this video. It is so good, I can eat it by the slice. That’s the way you want your butter. Just to be able to eat it with nothing else. I can’t wait till the next time we go to France as I am dying to try the butter in the video.

Time for the poll, so you can grade my performance this week, abbreviated though it was.

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

Please help me out by clicking the Like button, assuming, of course, that you like it.

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

Thanks for reading all the way to the end. Really, thanks. If you got something out of it, please consider becoming a paid subscriber if you aren’t yet. I would really appreciate it.

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