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Hello everyone.

Greetings from somewhere between Montecito and San Diego.

Yes, MD is driving, and I’m working on The Arrow. I’ve been in slide-making hell this week in preparation for my talk and still haven’t finished with them. Fortunately, I don’t speak until late Saturday afternoon, so I’ve got some time to put on the finishing touches.

This should be a great conference, but it’s a little late to plan a trip to San Diego. But you can still livestream the whole thing, which is almost better than being there. It’s going on right now, so hurry if you want to catch today’s talks. I’m pretty sure if you livestream, you’ll have access to whatever you missed.

I’ve been saying for the past two weeks that The Arrow was going to be abbreviated, yet it’s come through with the typical word count. This one really is going to be abbreviated. But I still hope to provide you with value.

There weren’t a lot of questions in the poll responses. I had many people tell me they loved the butter video. I’ve been hanging onto it for a few weeks now, because I thought it was too long for one of my videos of the week. Shows what I know.

I had a handful of people ask me about the butter from Belgium that we get locally. We get it in our local Safeway affiliated store. Photo below.

It’s terrific. If I’m feeling a bit hungry, I’ll just slice a little piece off and eat it by itself. It’s that good. And kills the hunger.

I got a number of complaints that I had not cued up the Mercola video to the spot where he talks about carbs being a conditionally essential nutrient. I would have sworn I did, but when I went back and checked I hadn’t.

So if you didn’t watch it because you didn’t want to wade through the entire hour plus thing to get to the one part I commented on, I don’t blame you. I’ve put it up again below cued to the spot. I double checked this time.

And about a thousand people (it seems) let me know my protein calculation was incorrect. I wrote it as 7.3 g/lb body weight. My decimal place was incorrect. It was a typo. It should be 0.73 g/lb.

I apologize for any confusion I might have created. I’ve made those corrections in the web version of last week’s Arrow. The video is cued to the correct spot and the 0.73 g/lb has replaced the typo. So if you want to revisit in context, check out last week’s Arrow.

Virtual Colonoscopy

I received an email from a professor of radiology at one of the University of California medical schools telling me that virtual colonoscopies will be paid for by Medicare (and maybe other insurance companies) starting in 2025.

I would rather pay for a virtual colonoscopy than get a regular one free. But that’s just me.

The psychology of the whole pay versus free phenomenon is something I think about a lot.

When we used to have our urgent care centers, we would occasionally see a patient visiting from a country with government-paid healthcare. These people would be outraged that they were expected to pay for medical services. They understood that was the way it worked in the US, but they weren’t happy about it. And they usually didn’t hesitate to let me know. They would always tell me about how wonderful their healthcare system was. I always wanted to ask them how long they had to wait to get scheduled for elective surgery, but I didn’t.

Getting stuff free warps our judgement about value. I’m as bad as anyone else.

I live in two locales where I’m not a practicing part of the local medical community. I haven’t had any bloodwork done in at least ten years. The last time I gave blood—a few weeks ago—I ended up getting back a total cholesterol reading of 188 mg/dl and a hemoglobin, which was 16.4 mg/dl. But that’s it. I could use an online lab service and check everything I would like to have checked for ~$150. But I know I could get it done free if I just went to the doctor. But I don’t have a doctor. MD is my doctor and I am hers. Fortunately, we’ve rarely have anything that we can’t deal with taking care of each other. But we have no access to a lab any more.

I could go out and find a doctor. Get an appointment, show up, get a physical and get all the labs I wanted to get checked sent off. All for free. But I don’t because it’s too much of a pain in the ass to go through all that. I would rather just spend the 150 bucks and get it done without the hassle.

But I don’t. Because I could get it free. (Cue endless feedback loop.)

As I said, the way we look at free is interesting psychology.

Despite all this, if I thought I needed a colonoscopy, I would pay for a virtual one rather than get a standard one free. At least that’s what I think as I sit here now not needing one.

One last thing before we move on. A number of people asked me about the ad for Hungry Root that appeared in last week’s Arrow. One or two asked me what I was thinking in promoting a vegetarian outfit.

Here’s the deal.

One of the reasons I changed platforms was that this one would find advertisers for me. I have no clue about how to find an advertiser on my own, so this seemed perfect.

I’ve been inundated with companies wanting to advertise in The Arrow, but I’ve turned them down right and left because I didn’t think they would have anything my readers might be interested in. Then comes Hungry Root, which is a home delivery service for fresh food. It is NOT purely vegan or vegetarian, though those options are available. They will put together the raw, fresh foods for low-carb, ketogenic, and/or Paleo diets and deliver them to your door.

I signed up for three ads. I’ve got one today for Hims, which is for people who would like to regrow hair. And I’ve got one coming next week with Dr. Grundy, who is sort of a low-carb doc. I’ve already signed up for these, so I’ll see how they work. I didn’t realize until I ran the Hungry Root one how much space they occupied, but I’m committed for this week and next. They pay me by the click, so by all means click if you’re at all interested. But don’t if you’re not.

Life-Threatening Emergencies

Back when I did a lot of Emergency Room work and even when I was working in one of our urgent care centers, I had a thought process I ran through every time I saw a patient. During the evaluation, I always went through the same questions in my mind: Is this life threatening, is it chronic, or is it self-limiting?

Of course, if someone came in with a gunshot wound, or a having a heart attack, or some kind of major trauma, I didn’t go through the process. I dealt with the problem.

But most things aren’t that cut and dried.

Many people show up complaining of vague symptoms, and those are the ones you worry about. In my first run through with them, I always wanted to make sure whatever they were experiencing wasn’t something that was going to kill them.

For instance, someone might come in complaining of a bit of cough, a slight fever, and just feeling like crap. Almost always this turns out to be a viral upper respiratory infection. But it could also be the early stages of a pneumonia. And pneumonia can be a literal killer. And a quick one. I don’t have the stats off the top of my head, but you wouldn’t believe how many formerly healthy people die of pneumonia. So I would always want to rule out pneumonia.

I read an awful press report a few days ago about doctors in Texas sending women home from the ER with signs of a miscarriage. These women in the article ended up having ectopic pregnancies, which is a life threatening condition requiring immediate attention.

The thrust of the article was that doctors didn’t want to run afoul of the new strict abortion laws the state instituted after Roe v Wade was overturned by the Supreme Court, so they simply sent these women away. I find this difficult to believe.

First, the new law does not preclude abortion when the mother’s life is threatened, as it is with an ectopic pregnancy. Plus the fetus isn’t even viable.

I suspect what really happened was that the doctors involved truly believed the women were having miscarriages. There isn’t a lot you can do about a miscarriage other than let nature take its course. You could do a D&C, but that would be an abortion. And maybe these women wanted to try to save their babies. Who knows?

What I do know is that all doctors working in those circumstances know about the dangers of ectopic pregnancies. I suspect this was a ploy on the part of the mainstream media to decry the Supreme Court ruling. Interestingly, despite some states imposing fairly draconian rules against abortion, the abortion rate is up by ~11 percent as compared to before the SCOTUS ruling.

I do know that if these women had come to me complaining of lower abdominal pain and knew they were pregnant, they would have been in ultrasound ASAP. Positive pregnancy test plus ultrasound showing no fetus in the uterus = ectopic pregnancy.

My doctor friend I wrote about last week with sleep apnea who died at age 44 had a sign next to his office door that he saw every time he walked out to see a patient. The sign said “Always think ectopic.”

Ectopic pregnancies are life threatening and pretty easy to diagnose…if you think of them.

Electroconvulsive Therapy (ECT)

A couple of days ago I got an email from one of the many online journals I subscribe to with the following subject line: “ECT works, now scientists believe they know how.”

Since I spend so much time reading about the electron transport chain (ETC), I misread ECT for ETC and clicked on the link. Once I got there, I realized the article was about electroconvulsive therapy aka shock therapy, not the electron transport chain. But I read the article anyway, because I’ve had experience with electroconvulsive therapy that I thought might be of interest.

When I was in my last year of engineering school, I got kind of tired of engineering. I still had a bunch of electives to take, so I decided to do something completely different. I went to the drama department and signed up for a bunch of acting classes. And I ended up in the school play in the Spring.

The play was One Flew Over the Cuckoo’s Nest, and I was Dr. Spivey, the doc who headed up the psych ward. As those of you who have seen the movie or read the book know, much of the plot revolves around shock therapy, which, as portrayed, is more or less of a death sentence. At least a brain death sentence.

In our play, the zapping was pretty dramatic. I’ve never seen the movie, so I don’t know how it was portrayed there. But our production was replete with flashing lights, jerking victims, and howling screams of anguish.

I came away from the experience with two things. The first was a total misunderstanding and fear of shock therapy. And second was my name in the Los Angeles Times. My school had a great engineering program, but it also had a drama department of renown (then, at least). Our play got reviewed by the LA Times and I was mentioned. I still remember the line: “…and Michael Eades as the engaging Dr. Spivey.”

About eight years later, I find myself on the psych ward at Fort Roots Hospital in North Little Rock, Arkansas as a junior medical student. Ft. Roots is an old military base beautifully located on a bluff above the Arkansas River. It has been converted to an inpatient and outpatient psychiatric hospital for veterans. And it was where I did my psychiatric training in medical school.

One day the psychiatrist who ran the thing tells me that I need to go over and observe some shock therapy, so I’ll know what’s involved. I about halfway thought he was kidding. I was several weeks into my psychiatric training and no one had ever said anything about shock therapy. In fact, I truly thought it was something from a much less enlightened time that had been dug up and used in the book and play. I had no idea people still got shock therapy. I was a bit apprehensive, to say the least.

So I schleped over to the place where it was done having no idea what to expect. I assumed it was going to be a harrowing experience.

I get there and find a bunch of elderly vets sitting around in the waiting room. I head into the back and meet the psychiatrist who is running the operation. And I wait.

Pretty soon an old guy kind of hobbles in and climbs up on the sort of exam table. A nurse starts an IV. They push some drugs through his IV line, and he starts to doze off. They put a device in his mouth to keep him from biting himself or breaking a tooth. After the electrodes are attached, they blast him with electricity. He kind of twitches a tiny bit, which led me to believe they gave him some kind of muscle relaxant. I can’t remember how long they kept the power going, but it wasn’t all that long. A minute or so, as I recall.

They take the electrodes off, the guy lays there for a bit, then comes to. After a few minutes, they ask if he’s ready to go. He says yes, and gets up and walks out.

I ask the psychiatrist if these guys are afraid to do it. He said, No, they love it. It makes them feel so much better, they’re eager to do it.

I stayed around about half a day while the crew worked with a half dozen people, all of whom hopped right on the bed to get it done. And all with the same minor tremor-like seizure. And that was it.

Here is a video I found on YouTube that pretty much encapsulates how I remember the experience.

From the article:

As it turns out, ECT treats a number of disorders that are refractive to drug treatment. Plus, if the psychiatrist I worked with that day is correct, it just makes people feel a whole lot better.

I’m glad I got confused by the ECT and ended up reading the article.

The whole first day of this conference has been devoted to the positive impact of the ketogenic diet on depression and other neuropsychiatric disorders. In short it’s proving to be very effective. I’ll report in more specifics on some of the interesting studies in the next week or two.

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Since due to time constraints this week, I haven’t been able to do my typical deep dive on some nutritional or metabolic issue. Instead I’m going to provide you with a terrific video of someone who has done an enormously deep dive on the subject of lipids and statins.

Dr. David Diamond, Lipids, and Statins

I’ve known David for several years now, and I’m always amazed at the presentations he gives. He is a neuroscientist, not a lipidologist, but he knows vastly more about lipids than just about any lipidologist.

Self preservation drove him to use his scientific skills to dig deep into the medical literature on lipids to try to find out the solution to his own problem. On a routine lab test he was found to have hugely elevated lipids. He got all the advice on taking statins, eating low-fat, blah, blah, blah. And he tried some of it, but nothing really worked. So, in an effort to save his own life, he began to comb the literature, and what he discovered amazed him.

I’m sure it will amaze you as well. You’ll learn a vast amount about lipids, disease, the drug companies, and what the literature really says in this terrific video.

Enjoy.

Let’s move on from lies my cardiologist told me to more about protein.

Dr. Ben Bikman and Understanding Anabolic Resistance

I've gone on and on in the pages of this newsletter about the importance of dietary protein and about how vital it is to longevity to maintain lean body mass. We’ve discussed consuming larger amounts of protein and doing resistance training to prevent the inexorable loss of muscle mass with aging.

I’ve never really given this problem a name, but in his new video below Dr. Bikman calls it anabolic resistance, which is the perfect term. Anabolism is building up while catabolism is breaking down. Catabolism is our fate if we do nothing. Anabolism comes easily when we are young, but as we age, catabolism charges to the fore. We can maintain our muscle mass and even build more, althoug it takes effort. But if we don’t put out the effort to overcome the anabolic resistance age thrusts upon us, we’ll fall prey to all kinds of catabolic forces. And not the good ones, the ones that help us lose fat. Instead we are beset by all the forces that make us lose muscle and bone.

You will have read in these pages pretty much everything you’ll hear in this video, but it is still a most worthwhile watch. You’ll consolidate what you already know and doubtless pick up a new thing or two.

The one difference you might notice is that Ben discusses mTORC1(pronounced M TORK 1), which is the complex that drive muscle synthesis. I’ve written about it as mTOR. They are the same thing, so don’t let that confuse you. The true name is mammalian (or sometimes mechanistic) target of rapamycin complex 1. Easy to see why they abbreviate it.

So, you have three tasks. Watch this video. Eat quality protein ~0.7 g/lb body weight, and do resistance training to failure.

Okay, I’ve written about half of what I usually write weekly, so this truly is an abbreviated edition. But I’ve got to get back to slide making. Next week I should be back in harness.

Odds and Ends

• One industry is defying America’s slowing job market. And it speaks volumes about the health of Americans.

• When researchers tried to train AI using AI-generated material, the whole enterprise devolved into gibberish. There’s a message in there somewhere.

• Nearly 80% of Americans now consider fast food a 'luxury' due to high prices.

• Typical. Salvage company invests resources to find a long lost Spanish shipwreck. Government of Columbia swoops in to claim it.

• Darwin award candidate. Let the herd be thinned. Unfortunately, it looks like it wasn’t and these genes will be passed on.

• I ate horse meat decades ago at a restaurant in Switzerland. It was pretty good. Next up on the menu: horse milk ice cream.

• French road drivable for only 2 hours per day—then it gets swallowed by the sea. Better not have a breakdown, or you could end up 13 feet under.

• Four consecutive bipartisan defense strategy commissions have found America’s one-war military is no match for reality.

• The law of unintended consequences strikes again. Biomass power station produced four times emissions of UK coal plant.

• Water-powered, electronics-free wound dressings that electrically stimulate wounds for rapid wound closure - 30% faster. Press report. Scientific paper. Reminds me of a terrific book I read years ago. Maybe it’s all coming true.

• What caused a plane to fall from the sky in Brazil? It was in what’s called a flat spin. First thing you’re supposed to do if your plane goes into a flat spin is cut the power. From the sound in the multiple videos I’ve seen, it sounds like full power was on.

• The British Veterinary Association (BVA) has ended its opposition to (nutritionally-sound) vegan diets for dogs. Sounds like the BVA is populated with a pack of sniveling cowards and idiots. Pity the poor dogs.

• Have you gotten one of those texts telling you the USPS is trying to make a delivery to you? Me, too. USPS text scammers duped the wrong person’s wife, so he hacked their operation and handed the details to the feds.

• Fasting-style diet seems to result in dynamic changes to human brains. Interesting study, but a) it’s from China, and b) uses fMRI, which showed a dead salmon to have thoughts about pictures shown to it. Sounds fishy.

• Why I was sentenced to 7 months in jail for posting a meme. A sad story of government and prosecutors run amok. This isn’t in the UK, but in the US.

• You think TikTok influencers can only be young, attractive people? You would be wrong. Meet the Granfluencers who have millions of followers.

• Study shows using tablets as "e-babysitters" for toddlers could lead to more tantrums, which in turn can have harried parents trying to calm a child by handing them a tablet.

• The disintegration of the turbine blade and resultant pollution that forced the closure of Nantucket’s beaches should scuttle the offshore wind scam.

• The rise in neotoddlerism. How society encourages activists to behave like infants.

• Rarely seen Titanic artifacts kept in secret warehouse in Atlanta, Georgia.

• New poll shows cigarette smoking rate in U.S. ties an 80-year low. Smoking is a major risk factor for heart disease, yet heart disease rates still high. And at a time during which many people are on statins. What does that say about the efficacy of statins?

Newsletter Recommendations

As always I must commend the Bride’s Substack, OutlanderMD. It usually goes out on Sunday, which barring calamity it will again this week, covering the murder of Malva Christie in Episode 607. This week marks her 20th essay on the science and medicine of her favorite tv series. She says it is designed to help Outlander fans get through the Droughtlander (the period between the release of a new season) and to enlighten their understanding of the medical and scientific interludes therein. Give it a read. You’re sure to enjoy.

I haven’t had time this week to evaluate a lot of newsletters, so I’m sticking with an oldie. Books & Biceps is what strength trainers read when they’re not reading about strength training. I read it every week. You should, too.

Video of the Week

This VOTW is going to be a little departure from normal. I usually put something clever, musical, or funny in this space, but not today. Since I shorted you on nutritional material above, I’m going to make up for it a bit here.

The mainstream media has been in love with calorie counting since Bing was a pup. I can’t remember when they weren’t falling all over themselves talking about calories. Well, my friends, it’s starting to change. There is no more staid and venerable mainstream media than The Economist. And that rag has bolted from the caloric theory. And I mean bolted in a big way. Those in control have come up with a short video all about the caloric theory, which they don’t call All about the caloric theory. What they call it is “Why calories are a con.”

A major about face, if you ask me.

Enjoy.

Time for the poll, so you can grade my performance this week. Don’t be too harsh because it’s shorter than usual. Give a brother a break.

That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday with a more standard length post.

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.

Finally, don’t forget to take a look at what our kind sponsors have to offer. Dry Farm Wines, HLTH Code, Precision Health Reports, and The Morning Brew (free)

And don’t forget my newest affiliate sponsor Jaquish Biomedical. Highly recommended to increase your lean body mass.