The Arrow #192

Hello friends.

Greetings from Dallas, where it has gone from brutally hot and humid to overcast, rainy, and, mercifully, not so hot.

Before I get to our regularly scheduled program, I need to bring up a poll response I intended to discuss last week, but it somehow escaped me. So, let’s start off with the various responses.

Comments, Poll Responses, and Emails

HOMA Insulin Resistance Calculations

A couple of weeks ago a reader wrote me about Dr. Mercola’s video in which he reported a blood sugar level of 2. I couldn’t figure out how he could have a blood sugar of 2 other than if he were talking about 2 mmol/l, the system used in most of the rest of the world to describe lab values. 2 mmol/l calculates to about 36 mg/dl, using US units. Which I opined would be unbelievably low.

The reader then wrote the following:

Ok, this is embarrassing. Last week when I asked about Mercola's "fasting glucose"< 2, I was going too fast. I meant his fasting INSULIN < 2. Apologies as you spilled a bunch of words on the wrong Q. Still curious how he gets there on so much carb, though. Thanks!

That explains a lot.

Another reader chimed in on the subject:

On the linked video, Mercola did not claim his fasting glucose was less than 2, as a reader suggested. What he reported (at timestamp 29:25) was that his fasting insulin was 1.2 mU/L, and Shanahan mentioned his HOMA-IR was 0.2. Using these two values, Mercola’s fasting glucose can be calculated to be 69 mg/dL using the HOMA-IR Calculator from Omnicalculator.com. This might be a point worth clarifying for accuracy.

I thought I would be forever shed of the Mercola-Shanahan video, but it keeps jumping up to haunt me. Here is the link. I’ve cued it to start at 29:25, which the reader above has correctly determined.

I figured this would be a nice time to explain the HOMA test for insulin resistance. HOMA, which stands for Homeostatic Model Assessment for Insulin Resistance, is a quick and easy test to get a feel for the insulin-resistance status of those who take the test. All you need is a fasting blood glucose level and a fasting insulin level. Once you have those figures, you just plug them into the equation below:

(Fasting blood sugar in mg/dL + fasting insulin in mU/L)/405 = HOMA score

(If you live in a place that uses mmol/L instead of mg/dL for glucose, divide the blood glucose + insulin by 22.5 instead of 405)

If Dr. Mercola’s HOMA is 0.2 and his fasting insulin is 1.2 mU/L, as he reports, then we can calculate his fasting blood sugar to be ~68 mg/Dl. Here is how I calculated it: (0.2(405)/1.2=67.5).

All of those figures are great. I’m not sure how long they will stay that way if he continues to eat 500g of carbohydrate per day, but I wish him well. It would be interesting to see what his HgbA1c is. That is a measurement of average glucose throughout the day over about a three to four month period. If he is throwing back 500g of carbs, he is going to have spikes, which would be included in his HgbA1c.

The last time I checked a fasting blood sugar and a fasting insulin level, my insulin was 6 mU/L and my blood sugar was 100 mg/dL. The 100 mg/dL is not unusual in a person on a long-term low-carb diet. As I’ve discussed a few months ago, when one is low-carb adapted, the muscles contain plenty of fat to burn, and it makes blood sugar more difficult to absorb, so sugars sometimes run a little higher. But my HgbA1c was 5, which is at the low end of normal at the lab we used.

It’s interesting that a lot of docs now are checking fasting insulin levels. I think I was the first in the country to do it other that at academic research settings. Back in the early 1980s I concluded that insulin-resistance was a driving force for all kinds of issues. I asked our lab, which was a large, national reference lab, to give me a price for a fasting insulin level. The person I spoke with said they didn’t do fasting insulin levels. When I asked why, she said because no one has ever asked for one. I asked if they could do it. She said she would check and get back to me.

She did, and she said they could, but that it would be expensive and we would have to guarantee them a certain number of tests per year. I ended up agreeing to the deal, and I think the tests came out at about $30 apiece. But that was almost 40 years ago. I ended up doing enough of them that eventually the price dropped to $16.

Since the lab was doing them as a favor to me (we had four very busy clinics, so sent them a lot of lab work), they had no range for what was normal. I went back and looked at all the academic papers I had in which the authors reported insulin levels and discovered all the young, healthy controls had insulin levels under about 8 mU/L, so I set anything up to 8 as my normal. Now normal is considered anything up to 12 mU/L, at least that’s what it was in the last lab we used.

In my opinion, a much better test is an insulin challenge test. They take a long time to do and require constant supervision, so in today’s corporate medicine get ‘em in/get ‘em out way of practicing, very few docs do them.

Here is the way they work.

You start an IV on the patient. You pull some blood from the IV and test for blood sugar to get a baseline. Then you infuse a bolus of regular insulin at a dose of 0.1 units of regular insulin per 7 kg of body weight. Then you check blood sugar levels at 15, 30, and 60 minutes. Then at two hours. You have to have someone observe the patient the entire time in case blood sugar falls too low and symptoms occur. If so, then you infuse a bit of glucose into the IV, which solves the problem immediately.

Most overweight insulin-resistant people won’t show much of a drop in their blood sugar levels despite the insulin infusion. After they’ve been on a low-carb diet for a few weeks, their blood sugar will fall significantly with this test. They won’t experience symptoms of hypoglycemia. Their blood sugars are usually pretty high when they start and don’t budge much with the first challenge. Later we considered them insulin sensitive if their blood sugars dropped to half of what they were at the start of the test, with a minimum of 40 mg/dL.

In my view, it’s much better test than HOMA, which is really just an estimate and can be gamed. Fast for a day before taking it, and both your blood sugar and insulin will be low, which will result in a low HOMA score.

Artery-Clogging Plaque?

A commenter wonders about the difference between stable and unstable plaque.

If I understand you correctly, stable plaque isn't something to worry about. But isn't one danger of plaque that it builds up over time and eventually clogs the entire artery? Thus if you continued to get more and more "stable plaque," couldn't this create problems eventually if it were to fill the entire artery?

Many people think of plaque-filled arteries as being like clogged pipes. The plaque continues to grow until it occupies the entire lumen or opening through the artery. When it does grow big enough to occlude the artery and shuts off blood flow to heart tissue downstream, then that downstream tissue dies, an event we call a heart attack. That description makes a nice story and sounds plausible, but that’s not what really happens.

The plaque forms beneath the inner lining of the artery. As it grows, it can make a sort of bulge of the artery that intrudes a bit into the lumen, but the artery itself can expand and make a larger opening for the blood to flow through. As long as there exists a large enough channel to accommodate enough blood flow to the downstream tissues there isn’t a problem.

The plaque itself, which lies beneath the inner layer of the artery lining can be thought of almost as a large pimple or boil, composed of all kinds of sticky material. (How this happens would take a book to explain. Fortunately, Malcolm Kendrick wrote an easy-to-read book that explains it all nicely titled The Clot Thickens, which I highly recommend.)

If you think of this soft, goo-filled plaque as being kind of like an inflamed pimple, you can kind of get the idea. If the plaque bursts open and releases this inflammatory junk into the blood coursing through the artery, all hell breaks loose. The immune cells in the blood try to patch the leak. They recruit platelets, which accumulate and can form a sort of clot/scab. If this clot/scab breaks loose and floats downstream, that is what causes the occlusion.

Now if the body begins to repair this soft or unstable plaque by beating down the inflammation and shoring up the plaque with calcium, the soft plaque becomes hard or stable plaque, which is vastly less prone to rupture.

In the study of the Masai autopsies by George Mann I wrote about last week, the coronary arteries involved had plenty of hard plaque, but the opening through the arteries, the lumen, were wide open. Which is why the Masai did not experience heart disease (ie heart attack) despite having plenty of plaque.

You can stabilize plaque in a couple of ways. One way, strangely enough, is with statins. Apparently statins do stabilize plaque, probably by reducing a bit of the inflammation. Which is doubtless why those study subjects on statins experienced fewer fatal and non-fatal heart attacks as compared to those control subjects who didn’t take statins. But, on the whole, they didn’t live any longer. Which means the statins caused enough of them to die from some other cause to cancel out the modest benefit of reducing the number of heart attacks.

People get coronary calcium scans (CAC), find out they’ve got a lot of plaque, get put on a statin, and come back in a year or two for a repeat scan and discover that their scores worsened. So clearly they aren’t a certain cure for plaque.

Another way I believe plaque can be stabilized is with a low-carb diet. I discovered this from a long-time commenter on my blog. He was a real fan until he wasn’t. He commented positively about everything, then one day, he turned on me. After that, he had nothing positive to say and everything was a critique. I ended up reaching out to him to ask him why the change of heart.

He wrote back and said he had trusted me, and I had let him down. He wrote that he had gotten a bad CAC score and, based on the recommendations I had made on my blog and in our books, he went on a low-carb diet in an effort to lower his CAC score. When he went back a year later for a repeat, his score had gone up. And he was pissed.

I asked him to send me his score, which he did. I interpreted it as per the technique I wrote about last week and found him to be in the quartile who had the least risk. He was not placated. He went back to a low-fat diet, and I haven’t heard from him since. I suspect I never will.

I had a few other similar experiences—not of someone being an asshole, but of people who had their CAC scores go up a bit after switching to a low-carb diet. I had one patient who is a close friend of mine end up with a hugely elevated CAC score. I was a little worried about recommending a low-carb diet to him, so before I did, I reached out to Bill Davis, who before he got all into Wheat Belly and anti-gluten, wrote a book on calcium scanning and plaque reversal.

I told him about the dilemma with my friend. He told me that after he started putting his patients (all of them heart patients as he is a cardiologist) on low-carb diets, his life had changed. He said he got to spend his nights at home instead of at the hospital because he didn’t see heart attacks any longer. He said he still saw horrible CAC scores and still saw terrible lipid levels, but that he didn’t see heart attacks.

That conversation along with my experience with the new way of calculating risk combined with the aggregate experience MD and I had with patients, made me comfortable using a low-carb diet in folks with high CAC scores. MD and I treated many, many patients over the years with low-carb diets. Most of them were middle-aged folks with bad lipid levels, high blood pressure, and even diabetes. Patients stayed with our program for many months. If you take the number of patients we had times the amount of time they spent with us, it turns out to be many thousands of patient-weeks. And these were patient weeks of people who were at high risk for heart disease given their age and co-morbidities. Yet we never had one of our active patients who had a heart attack.

More on Statins

I received the next couple of responses from readers. They go along with the many stories I’ve heard from my own patients who have been put on statins.

Hate to beat a dead horse (statins), but check out the former rugby player who was told he had terminal nuero issues, so he quit statins, and guess what - he recovered. Paul Gill from Leeds UK. If this link doesn't work google his story. Big question is with the platoon of physicians, why did not one of them say: maybe it's the statins? Ugh! https://www.yorkshirepost.co.uk/health/former-rugby-player-from-yorkshire-diagnosed-with-mnd-discovers-symptoms-were-caused-by-statin-pills-4509761

This one via email.

As a Statin side-effected individual, I feel the need to share some acquired insight on Statin drugs for the benefit of your subscribers.

Statins are a category of CoA Reductase inhibitors that essentially "Gird" the Mevalonate pathway to inhibit the production of an enzyme needed to produce cholesterol. This pathway is also an essential avenue for the production of Heme-A, Dolichols, and Ubiquinol; all of which are necessary to good health, and all of which are likewise inhibited.

At least one of the drugs used to achieve this effect, Lipitor, is able to cross the blood/brain barrier and enter the brain itself. The brain is, in its makeup, essentially a trove of cholesterol, and who knows what the effect of this pharmaceutical exchange in this environment might be?

CoA reductase inhibitors can also interfere with transporter pathway slc01b1.

Having SLCO1B1 decreased function means that you may have reduced transport of certain medications into the liver for processing and removal from the body. This may lead to higher than normal medication (Statin) levels in the body.

I can tell you from first-hand experience how potentially destructive Statins an be, as I was placed on a Lipitor regimen in early 2000 after my PCP at the time found my total cholesterol was dangerously high at 220. I was a typical medical "lemming", and I took the medication as prescribed. In two months I was in pain from head to toe, had difficulty walking and was only comfortable in a recliner. Prior to this I went to the gym three times a week, played frisbee golf and volleyball, and Kayaked on a lake near my home in Colleyville, Texas. After some months of follow-up, I went to a physician, a family friend, who picked up a tome she referred to as the Physicians’ Desk Reference, and looking up the Statin drug, Lipitor, began to read aloud all the problems I was experiencing. I stopped the drugs and found a website hosted by Dr. Duane Gravline, a NASA physician who had also been side-effected (https://spacedoc.com/). The rest of this story is a journey of self-education and partial recovery which I won't relate here. Suffice to say I am now an adamantly vocal critic of cholesterol management. I recommend Dr Graveline's website category "Spacedoc Forum" to any and all.

I communicated with Dr. Graveline years ago. He is no longer with us. He died ~ten years or so ago. He went on statins while in NASA and got complete amnesia. He recovered when he went off the drug, but the docs at NASA put him on a lower dose, after which the symptoms returned. He ended up devoting most of his time to his spacedoc writings. He had kind of a checkered past, but he was definitely injured by statins and wanted to get his story out.

I’m posting the correspondence from these two people just to demonstrate that statins are not without issues. In some cases, very serious issues. Although many people take them and seem to experience no problems, on the whole, they are not benign drugs. At least not in my opinion.

Especially since they are given to lower LDL levels to prevent heart disease, and LDL has never been shown to cause heart disease.

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Ultra-Processed Food, the Media, & Politics

Yes, I’m going to semi-sort-of venture into politics a bit just because what’s happening is so insane.

First, let’s talk about ultra-processed food (UPF). UPF is defined as food made with ingredients not found in a typical kitchen. If you look at the label, and you see a list of ingredients for, say, bread, and the ingredient list is as long as your arm, you know it is UPF. What are the ingredients required to make basic bread? Flour, yeast, a touch of salt, and water. So why the 15 other ingredients?

For whatever reason, UPF has captured the imagination of the media and the research community. Just to give you an idea of the interest in UPF in academia and research, I just checked the number of citations on PubMed using the search terms “ultra-processed food” and “low carbohydrate diet.”

Before I show you the results, I need to tell you that there have been many, many studies—hundreds, in fact—looking at the efficacy of the low-carb diet. It has been compared to all types of other diets. It has been shown in RCTs to be effective for weight loss, diabetes treatment, lowering high blood pressure, changing body composition, reducing inflammation, treating GERD, and a host of other health issues. If the low-carb diet were a pill, whoever invented it would rule the world.

UPF, on the other hand, have been tested in exactly one RTC. And that RTC was a mickey mouse one done over two two-week stretches with no washout period in between.

But now look at the differences in research interest. Below are screenshots of of the little graphs on PubMed that shows how many papers were published in any given year. First, let’s compare the number of papers on UPF to the low-carb diet in 2001. Here is the one for UPF.

UPF published papers

Then low-carb:

Low carbohydrate diet published papers

As you can see, even back in 2001 there were half again as many papers published on UPF as there were on low-carb diets.

Let’s look at 2024 so far.

UPF published papers

And low-carb:

Low carb diet published papers

As you can see, there are three times as many papers published on UPF so far in 2024 than there are papers published on the low-carbohydrate diet.

And out of all these papers on UPF there is only one RCT. It shows you the panache UPF has among researchers.

It’s the same with the mainstream media. Below is a slide I made for my talk in San Diego last month. I grabbed just a few of the many headlines from various mainstream sources about UPF.

I could have had ten of these slides if I had wanted to. Everywhere you look there are (were) articles about ultra-processed foods. And all of them fingered UPF as a very bad actor.

You couldn’t find the number of headlines I stuck on the one slide above about the benefits of the low-carb diet if you looked for a year. If you did find an article about the low-carb diet, it would probably be about how low-carb diets are bad for the planet because they are beef-heavy. Or some such BS.

That’s the first part of this discussion. Articles on UPF are ubiquitous and they are always without exception fingered as being bad, bad, bad.

Here comes part 2.

I saw this diagram from an Elon Musk tweet a couple of days ago that I think is brilliant because it simply captures the state of society currently.

The thing in the top box above could be anything. But these days it’s not judged on accuracy or benefit or by any other factor than how it plays politically.

Let me show you what I mean using UPF in part 3 here.

As everyone knows who has been paying the least bit of attention to politics, Robert F. Kennedy, Jr. seems to have thrown his lot in with the Trump campaign. Only time will tell if this is a legitimate throwing in, or if they’ll be on the outs in a week. But right now, RFK Jr. appears to be on the Trump train.

If you look at the diagram above, you could certainly say that RFK Jr. has “done a thing.” If you are on Team Trump, you think “it’s fine,” but if you’re on the other side, you’ve decided RFK Jr. is a “BASTARD.” Even if you liked him before. But that’s politics these days.

But this has deeper implications. It cascades down to what the mainstream media pushes as news.

It’s a well-known fact that RFK, Jr. has it in for UPF. He rants about them all the time and has for a long spell. The mainstream media apparently hates UPF, because they write article after article on how terrible they are.

In January last year, Time published a long article headlined “Why Ultra-Processed Foods Are So Bad for You.” The piece starts off with a laundry list of reasons UPF should be avoided.

A growing number of recent studies have raised health concerns about a certain type of food that most Americans eat: ultra-processed foods. One such study, published in November 2022 in the American Journal of Preventive Medicine, concluded that these foods likely contributed to about 10% of deaths among people 30 to 69 years old in Brazil in 2019. Other studies—including one published in Neurology in July 2022 finding that a 10% increase in ultra-processed food consumption raises the risk of dementia—have linked the food category to severe health outcomes.

These studies are all observational studies that don’t show causality. The one and only RCT, a crappy one at that, shows only the people in the UPF group consumed a greater number of calories than those in the control group. No mention of dementia or early death.

As the article continues, it makes it pretty clear that UPF are best avoided if good health is your goal. There is nothing special about this article. It just pretty much echoes all the others out there on the same subject. UPF = bad.

Then comes the RFK, Jr. ship-jumping and all has changed. Since RFK, Jr, has made UPF one of his causes, then they can’t be all that bad.

Time, the same Time that published the article quoted above, comes out within a few days with a new article on UPF with a little different take on the subject.

After they got some blowback, they decided to temper their headline a bit, and changed it to the headline below to make it seem Time wasn’t as directly involved. It was simply one dietitian speaking up. Same article, though. You can read it here.

My bet is that we’ll be seeing a whole lot fewer articles on how bad UPFs are as long as RFK, Jr. and Trump are a duo. Too bad since I really do believe UPF are deleterious for health. I’m eagerly awaiting the results of the study I’m pretty sure Kevin Hall is doing now. Should be a lot better controlled than the last one, which was really just a pilot study.

I find stuff like this fascinating. There was no change whatsoever in UPF. The only change is the political affiliation of someone who happens to rail against them. See Elon’s graphic above.

Polypharmacy

In my weekly troll through the medical literature, I came upon a study in JAMA that confirmed my worst fears. People are taking more and more medicines, and not just because they’re getting older. Older people are taking more medicines than they used to.

According to this study, which evaluated the medications of almost 15,000 people aged 65, the average number of daily medications jumped from 3 in 1999-2000 to 4.3 in 2017-2020. That’s an average. That means for everyone of these folks not taking any meds, there are others taking 9 meds!

Taking numerous meds is called polypharmacy. Taking more than 10 drugs is called hyperpolypharmacy, and that has doubled. Doubled!

When I pulled the pdf, which is available at the link above, I found that the most prescribed medicines were cardiovascular medicines, which I can only guess are statins.

Here is a little secret for you. If you don’t want to be prescribed a lot of medicines, don’t go to the doctor. I’m not being facetious here. When people go to the doctor, they want to get something out of it.

When MD and I ran our walk-in primary care centers, the precursors to today’s urgent care clinics, we had our nurses call back all of our patients two days after their visit to see how they were doing. One of the most common complaints we got from people who weren’t better was that the doctor that saw them didn’t do anything (ie, didn’t test them sufficiently, didn’t give them a prescription for whatever it was that ailed them.)

Many, many times the best thing you can do as a doctor is let the tincture of time do the healing. Most things people come in with—at least to an urgent care kind of clinic—are self limiting. They will get better over time. If I went to a doctor, which I never do, because I sleep with one every night, I would be ecstatic if he/she told me you’ve just got a cold. It will get better. Yahoo, I don’t have cancer, I would say.

Most people aren’t like that. They want to be treated somehow. So most docs learn to treat them. Which is how so many people end up on a lot of medications.

MD and I are rapidly approaching senility, [the Bride disagrees vehemently!], and neither one of us takes any medications. Other than a few supplements here and there. (Well, she takes HRT and a f ew more natural supplements than I do.) And I take them only when I remember them (senile after all). I would venture to say that most people don’t need most of the medications they are taking.

The first part of my medical practice I spent putting patients on medications for whatever ailed them. The last part of my practice I spent working with them to get off of medications. That’s not to say that all meds aren’t necessary. Some are. Vitally so. But as a doctor you need to be judicious. Treat when absolutely necessary. We always felt the first step was to get the patient on a decent low carb diet, get them stable on it, then see what (if anything) was left to treat.

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Case History

I keep getting asked by a commenter if I’m ever going to talk about sleep apnea as I promised to do when I wrote about my doctor friend’s death at age 44 from the condition.

I’ve got a case history for you of a talented musician who was involved with the Santa Barbara Choral Society, of which MD is a member. This guy has a fabulous tenor voice and can play about a thousand different instruments. He has three kids and a wife who is a professional ballerina. And he was about 90 pounds overweight.

He put up post on Facebook asking if anyone knew of a sleep doctor because his wife told him he was snoring all night, and he was tired all the time. He thought he might have sleep apnea. MD saw his post and reached out to him telling him he needed to take sleep apnea very seriously. She told him about our friend who died at age 44 as a consequence of sleep apnea.

When you don’t breathe because you have sleep apnea, the oxygen concentration in your blood falls. The electric conductivity of your heart depends upon sufficient oxygen in the blood, and when oxygen is low, aberrant conductivity can be a consequence. If the impaired conductivity is in a part of the cardiac conductivity network that has a major influence over how the heart beats, the heart can go into ventricular fibrillation, which is ultimately fatal if not corrected.

I had learned that, but I thought it was a rare occurrence. Then my best friend died from it, which made me realize after I researched it more that it wasn’t all that out of the ordinary. Until my friend’s death, I had had only one encounter with someone who had serious sleep apnea. I was in a cab in New York on my way to La Guardia airport and the cabby kept falling asleep at every intersection. He would come to a stop for a red light, then the light would turn green, and the cab didn’t move. I figured out what was going on and had to push him on the shoulder at every red light to get him going. It was stunning to me that he could fall into a deep sleep that quickly. (That’s called narcolepsy.)

After MD reached out to her musician friend, he thanked her and told her he was looking for a sleep specialist. MD told him he needed to go on a serious low-carb diet ASAP. A low-carb diet will vastly improve sleep apnea even before much if any weight is lost. She encouraged him to get started.

Here is her text message to him:

As a physician who over the last 40 years has treated lots of people with sleep apnea and obesity and metabolic syndrome (and your friend) I am begging you DO NOT IGNORE THIS! Immediately, this afternoon, tonight, tomorrow morning, switch to a ketogenic very low carb diet (meat, fish, poultry, game, eggs, dairy, greens and green veg, a few nuts and seeds, little starch and no sugar.) We had a friend (one of my husband's best friends) who had sleep apnea, not all that overweight, and who 'after Christmas' was going to get serious about his low carb diet (he knew well what it would accomplish) laid down for a nap while his wife and twin boys were decorating the Christmas tree and dropped off, suffered a heart arrhythmia, and died. He was 44. He left twins just about to turn 9. Do it today! Please! And call or DM me if you have any questions.

MD is a helluva coach. And she is relentless. She was all over him with texts and suggestions.

He texted back after about five days with

Going strong and am very low carb. 5 days in and for the most part I've already slept better and have a lot more energy during the day.

These things don’t format that well, so I’m just going to post the texts as they came across.

It went on like this week by week. Here is the guy’s FB post on August 1 of this year.

He’s still got a ways to go, but if you look at his photo on the right, below, before he started, you can see the tremendous change.

This is all it takes. The commitment to do it and the follow through. And MD on your case, maybe.

BTW, he gave us permission to use his story. If you go to his FB page, you can see the changes as they happen and get to hear some great music as well. And if you’re in the SB area, check out the Santa Barbara Folk Orchestra, which he founded and directs. If there’s a concert, you’ll be in for a great time.

I fell in love with Dry Farm Wines all over again a couple of weeks ago in San Diego. They were pouring freely at the low-carb conference, and I drank a gracious plenty. And felt no ill effects from it the next day. I did it three days straight. I love wine, but wine doesn’t love me. If I drink even a tiny bit too much, I pay for it dearly that night and the next morning. I’m pretty sure it’s the additives the various wineries put in their wines to enhance the taste that does the job on me. Dry Farm Wines seeks out pure, lower alcohol wines with no additives from wineries all over the world. They aren’t the cheapest wines in the world, but they aren’t that expensive either. They could sell you a $15 bottle, but then you’d have to drink it. If you like wine, but it doesn’t like you, or if you’re in ketosis and want to stay that way, do yourself a favor and give Dry Farm Wines a try. Click here to get your first bottle for a penny.

RQ and You

As you may have noticed, there is an ad for Lumen above. I’m not 100 percent sure how it works, but I am close to 100 percent. I’m pretty sure it is a respiratory quotient calculator.

What is respiratory quotient, also called RQ in the biz? It is truly a measure of whether or not the person being tested is burning fat or carbohydrate.

Here is how it works.

Glucose is C6H12O6. In other words, it is made of six carbons, twelve hydrogens, and six oxygens. Here is what it looks like.

Let’s now look at a fat. Palmitic acid, for example, like glucose is composed of carbon, hydrogen, and oxygen. Palmitic acid is the most common saturated fat found in mammals, and it’s chemical makeup is C16H32O2.

It looks like this:

If you look closely at the composition of both, you’ll notice that both have twice as many hydrogens as carbons. The glucose has as many oxygens as it does carbons, but the palmitic acid has only two oxygens to go with its 16 carbons.

When we burn or oxidize either of these compounds, we break the chemical bonds where the energy is stored and release it to be used to fuel all of our biochemical processes. When the glucose and fat are reduced to carbons, oxygens, and hydrogens, we get rid of those atoms as water, H20, and carbon dioxide, CO2. All of the hydrogens leave as water. All of the carbons leave as part of carbon dioxide. And the oxygens go out with both.

Since we breathe out the carbon dioxide, all of the carbon leaves that way as does some of the oxygen. As should be apparent from the difference in chemical structure of fat and glucose, burning glucose releases a lot more oxygen than burning fat. Remember, there are six oxygens on a 6-carbon glucose molecule, but only two oxygens on a 16-carbon fat. Thus we release less oxygen when we burn fat than when we burn glucose.

If you take the oxygen that comes in when we breathe and compare it to the oxygen that we breathe out when we’re oxidizing pure glucose, it turns out to be 1 to 1. we breathe out as much as we take in.

If we’re burning pure fat, we breathe out 70 percent of the oxygen we take in.

The way this is measure is called the respiratory quotient, RQ, and it is the oxygen we breath out divided by what we breathe in.

So if we have an equal amount going out as we do coming in, our RQ is 1. But if we have only 70 percent going out as compared to what’s coming in, our RQ will be 0.7.

Units that measure RQ can then tell us if we’re burning fat or carbohydrate by what the reading is. If the unit reads out 1, we’re burning pure carb. If it reads out 0.7, then we’re burning pretty much pure fat. Anything in between means we’re burning both. You can tell by how close the number is to 1 or 0.7 where you are on the fat-burning spectrum.

I’m pretty sure that’s how the Lumen product above works.

Odds and Ends

Newsletter Recommendations

Video of the Week

It just so happens that today is Farrokh Bulsara’s birthday He was born 78 year ago today in Zanzibar, an island off the east coast of Africa. He drifted through life pursuing multiple occupations ranging from graphics design to baggage handling at a major airport. After a few years of dead end jobs, young Farrokh finally stumbled into his true calling. He had always wanted to be in a band, so he talked his way into a failed, struggling band called Smile, talked the other members into renaming the band Queen. And he changed his name to Freddie Mercury. The rest is history.

I always wonder if the members of the struggling members of Smile realized how lucky they were that Freddie stumbled into their band.

Here are a couple of my favorites. Enjoy.

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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, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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