The Arrow #111

Hello everyone.

Greetings from Dallas.

After MD did her book gig in Hot Springs last Thursday, we headed up to Fayetteville for a surprise birthday party for our middle son. The entire fam gathered there for it: all the kids, spouses, and grandchildren. It’s nice to have them all under the same roof every now and then.

The whole gang traipsed to an Arkansas Razorback basketball game on Saturday, only to see the Hogs lay down.

What a lackluster game. I’ve been to two Razorback games over the past six months. The football Razorbacks against Alabama and the BB Razorbacks playing Mississippi State. The Hogs lost both of them. Maybe they should pay MD and me not to go.

Lackluster though the game was, it was also deafening. Thank God I brought my trusty ear plugs. The decibels at one point on the big board display read 105!

Mass Balance and Weight Loss

I just took a look at the stats from last week’s Arrow and discovered that only 6 percent of readers clicked on the link to my talk in Boca Raton a few weeks ago. That doesn’t mean that 6 percent of people actually watched the thing, but that 6 percent clicked on the link. Which means that 94 percent of readers have no idea what the talk was about.

I was planning on discussing it in a little more length this week after everyone had had the chance to watch it. Since so few watched it, I’ll summarize, so the subject will make sense.

I started out discussing the two competing theories of why we gain weight: the calories in vs calories out model (CICO) and the carbohydrate-insulin-model (CIM). In brief, those invested in CICO believe weight loss or gain is simply a matter of whether one consumes more of fewer calories than one burns. If you eat more calories than you burn off metabolically and by movement (exercise), then you’ll gain weight. By this theory, the only way to lose weight is to eat less and move more, i.e., reduce the calories coming in and increase the calories being burned. As a corollary to this, CICOers believe people overeat due to a variety of reasons, and this overeating (more calories in than out) leads to obesity. Believers in CICO always invoke the First Law of Thermodynamics to bolster their belief.

The First Law of Thermodynamics is the conservation of energy law, which says energy can neither be created nor destroyed, so any energy you bring into your body—calories—must be dealt with. It can’t just disappear. It either has to be dissipated via metabolic processes and exercise or you will gain weight.

The Carbohydrate-Insulin Model posits that calories coming in are not just neutral energy, but instead provoke metabolic hormonal responses that, in turn, drive the urge to eat and store calories. The CIM proposes that people have varying degrees of carbohydrate tolerance, and that in those who are intolerant, carbs provoke a greater and more long-lasting insulin response. The continuously elevated insulin levels in those people end up driving insulin resistance and hyperinsulinemia. Since insulin is the metabolic hormone that both drives fat into the fat cells and keeps it there, those people who have too much insulin tend to increase their mass of fat tissue.

When these people eat, the digested food enters the bloodstream, and the appetite centers of the brain signal that they are full. But, because their insulin levels are elevated, the fat in the blood is driven into the fat cells quickly, leaving fewer nutrients in the blood to trigger the “full” signal in the brain. Instead, the brain gets a signal that nutrients are depleted, so it sends the hunger signal driving the urge to eat. Which starts a sort of vicious cycle. More hunger = more carb intake = more insulin = more fat storage = less nutrient supply in the blood. The brain then hits the You-need-to-eat switch and the cycle continues on and on.

The battle between these two modes of thought are being fought in the academic literature. Metabolic chambers and/or doubly labeled water are the battlefields.

There has been an ongoing series of studies comparing diets high in carbohydrate to those lower in carbohydrate or even ketogenic containing the same number of calories. For years these kinds of studies were done by randomizing subjects into one of two diets—high-carb, low-fat, or high-fat, low-carb—giving them instructions as to how to follow their assigned diet, then have them return at intervals for follow up and weighing. The vast majority of these studies ended up showing those dieters on the low-carb diets to have lost the most weight.

When these diets were iso-caloric (each containing the same number of calories), and the subjects on the low-carb diets lost more, the notion arose that there was a “metabolic advantage” in the restriction of carbohydrates. In other words, subjects restricting carbs ended up somehow burning more calories than those on a high-er carb diet. Otherwise how could people lose more weight consuming the same number of calories?

CIMers believed that by reducing insulin levels, more fat was released into the blood, which signaled to the brain that the dieter was not faced with starvation, but instead had calories to burn. So the body did. No real need to conserve. And having plenty of calories to burn or nutrients floating around quells hunger signals as well.

Over the years there have been a number of overfeeding studies during which subjects are expected to eat vastly more calories than required to maintain their weight. In all of these studies, subjects never gained the amount of weight predicted by their increased caloric intake. They did gain some weight, but they ratcheted up their metabolic rate to burn off a lot more calories than they would if they had been on lower calorie diets.

This is the process CIMers believe happens with low-carb diets. The increased flow of fat from the fat cells into the blood induced by falling insulin levels signals fullness or more than fullness to the brain, which, in turn, gives the signal to waste calories. Thus those subjects on low-carb diets lose more on the same amount of caloric intake than do those on high-carb diets.

Of course, this doesn’t fly with the CICOers, because, to them, it’s simply a matter of calories in have to balance calories out, so if these two groups of subjects have a difference in weight loss, then it has to be because the diets weren’t followed properly. The subjects didn’t eat the same amount. The low-carb subjects ate less. It was impossible to have a difference in weight if the caloric intake was really equal, because, you know, the First Law of Thermodynamics.

The CIMers said, What we need to do to resolve this is to use subjects as their own controls, put them in a metabolic chamber, and measure their energy output. If their energy output is greater on a ketogenic diet than on an iso-caloric low-fat, high-carb diet, then we’ll admit defeat. We’re comparing the same subjects to themselves on different diets, and we’re doing it under strict control, so we’ll know calories are the same. And we’ll have them in a metabolic chamber, so we can really determine the energy expenditure.

They did this study and published it in 2016.

As it turned out, the subjects while on the ketogenic diet did demonstrate increased energy expenditure to the tune of 57 kcal/day and an increased sleeping energy expenditure as measured in the metabolic chamber. And they had 151 kcal/day increased energy expenditure as measured by doubly-labeled water (a complex, but accurate process for measuring energy expenditure in free-living people).

But the researchers wrote these increases in energy expenditure off as artifacts of the study process. Even more surprising, they pooh poohed the increase energy expenditure as measured by double labeled water as not as accurate as the metabolic chamber findings. I was surprised by this because I’ve seen multiple talks by the same folks detailing how doubly-labeled water is the “gold standard” for measuring energy expenditure.

These same researchers gave press conferences in which they said the CICO had been proven by this experiment. Here’s an off the cuff commentary by the lead author (a CICOer of the deepest dye) when the paper was in prepublication.

If you read the conclusions, written by the above author, here’s what you find:

Conclusion: The isocaloric KD [ketogenic diet] was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology.

If you look at the paper linked above, you can see for yourself what the weight loss and fat loss looked like.

The CICOers claimed victory, but because there really was more energy expenditure there was bound to be a rematch. And there has been. Several, in fact. The first one, the one above, was funded by the CIMers, but the work was done by an über CICOer. The rest have been funded through the CICOers and done by the CICOers. With each one, the energy expenditure difference by those on the low-carb arm get closer and closer to zero.

In the real world, however, when put into practice in actual free-living humans, the low-carb diet reigns supreme. A non-profit in the UK called the Public Health Collaboration has looked at all the studies over the past couple of decades comparing low-carb to low-fat diets. Many of these studies compare calorically-restricted low-fat diets to non-calorically-restricted low-carb diets. So far, the PCH has found 67 studies that meet their criteria for inclusion, and in almost all of them the low-carb diet triumphs over the low-fat, high-carb diet.

Apparently when the CICOers run studies looking for a difference in energy expenditure, the results are small, and getting progressively smaller with each new study. Yet, in RCTs with people going on either low-carb or low-fat, high-carb diets, those on the low-carb diets almost always lose more weight.

What gives?

Well, that was basically the topic of my presentation. I offered an other rationale as to why dieters lost more on low-carb diets than on low-fat ones.

When you look at the energy balance equation as presented by both CICOers and CIMers, here’s what you see.

Δwt = energy in - energy out

A change in weight equals energy (calories) taken in minus energy out.

If you burn off more calories than you consume, you lose weight. If you take in more calories than you burn off, you gain weight.

Problem is, there is a major fallacy with this equation that virtually everyone in the weight-loss arena believes in.

To understand what this fallacy is, let’s define a few terms.

First, what is a calorie. Or, as I should write it, a Calorie.

A calorie (so-called little “c” calorie) is defined as the amount of heat required to raise one cc of water (or 1 gram) one degree Celsius. But that is a tiny amount of heat that would require huge numbers to represent what goes on metabolically.

A Calorie (a big “C” calorie) is the calorie we’re all used to using. It is the amount of heat required to raise one liter of water (or 1 kilogram) one degree Celsius. In other words, a Calorie is 1000 times the heat of a calorie. It is also called a kcal, which means a thousand little calories.

What about Calories in food? How do we determine those?

Scientists take a food—could be a carrot or a piece of carrot cake—and put it into a device called a bomb calorimeter. Inside the bomb calorimeter, the food is incinerated. The amount of heat released determines the caloric content. Remember, calories are a measure of heat.

Back in the late 1800s, a scientist named Wilber Olin Atwater constructed a metabolic chamber and measured the heat released from both animals and humans on various diets. He worked for years to determine how many Calories could be extracted from different foods and different macronutrients. He measured the heat lost and the remnants of foods in feces and urine. The end result of all of this thousands of measurements led him to posit that carbohydrates contained 4 Calories (kcal) per gram, protein 4 Calories per gram, and fat 9 Calories per gram.

Since then those numbers have been refined, but the more accurate numbers are so close that everyone continues to use the 4, 4, and 9 numbers Atwater calculated.

Now here is where it gets interesting.

Energy Balance Versus Mass Balance

In my talk, I described a thought experiment. Let’s say you have a stainless steel water container that holds one liter of water. You put one liter of boiling water in this container and put a tight lid on it.

The 1 liter of boiling water in the container weighs exactly 1 kg. Since it is boiling, the temperature is 100 Celsius. So, the water contains 100 Calories (kcal).

You put it on one of those accurate kitchen scales on which you first weighed the empty container and set that weight as zero. So now the what you’re weighing is the one liter of water, which weighs one kilogram.

The room temperature is 20 degrees Celsius (68 F). You go away for four or five hours and come back. Now the water in the container has assumed room temperature of 20 degrees Celsius. So, the water has lost 80 Calories of heat.

But the weight hasn’t changed. It still weighs one kg, just like it did when it contained 100 Calories.

Calories don’t weigh. They are a measure of heat. Heat does’t weigh.

Now let’s look at our energy balance equation again.

Δwt = energy in - energy out (Δ = difference)

In the case of our water container, we have 100 Calories of energy in and 80 Calories of energy out as it returned to room temperature. But there is no change in weight. Because Calories have no weight.

So that makes the energy balance equation that everyone uses a fallacy.

The more accurate way to state the equation would be

Δwt = wt in - wt out

But let’s call it mass instead of weight. There is a technical difference between mass and weight, but for our purposes, they are both the same.

Δmass = mass in - mass out

That’s the conservation of mass equation, which is a vastly more accurate way to measure weight (mass) gain or loss than the energy balance equation that everyone uses. And which is a fallacy because you’ve got mass on one side and energy on the other.

Okay, so mass comes in as food, but how does it go out? How do we get rid of it?

When we eat food, we eat chemical structures made of basically carbon, hydrogen, and oxygen. Both carbs and fats are made only of carbon, hydrogen, and oxygen. Protein has some added nitrogen and sulfur.

The various bonds between the various carbons, hydrogens, and oxygens contain energy. When our metabolic machinery breaks these bonds via the process of digestion, energy is released and captured to drive the process of life.

One of the interesting facts about all this is that all of our energy comes from the sun. The sun powers the growth of plants through the process of photosynthesis. The sun provides the energy for the growing plants to bond carbon, hydrogen, oxygen and nitrogen together to make the body of the plant. When herbivores eat these plants, they, like we, tear apart these bonds and use the energy released to fuel their growth, which involves creating the bonds that make their bodies. When we humans eat herbivores or if we eat plants, we are eating energy that originated from the sun. So, technically, when we eat, we are eating the sun.

Cool, right?

Okay, back to the mass in vs mass out.

When we eat, we bring mass in.

How do we get rid of it?

Via our breath mainly. We break apart the carbon, hydrogen, and oxygen bonds for energy and release the mass of the actual atoms as carbon dioxide and water vapor in our breath and as water in our urine.

If you don’t watch any other part of my presentation, at least watch these next few minutes. I’ve got it queued up for you. Feel free to watch beyond this, but at least watch the little three minute video here.

Interesting, no?

The guy on the video wrote an article a few years back in the British Medical Journal that launched me on this journey. He is an Australian physicist who travels all over doing this demonstration for schools to show where fat goes when people lose it.

But, in my view, he missed the big picture.

If you watch his entire video and/or read his article, he says the way to lose weight is to eat less and move more. And we all know how well that advice has worked over the years.

He thinks low-carb diets are a fad, especially low-carb ketogenic diets. Don’t fall for fad diets, he says, just eat less. And move more.

Which makes a sort of sense. Think about the mass balance equation:

Δmass = mass in - mass out

If you want to change your mass in a downward direction, you’ve got to either decrease the mass coming in or increase the mass going out. Preferably both to maximize weight loss.

So, if you eat less food, you take in less mass. That’s part one. If you exercise (move more), you’ll burn more fat and breathe harder, which will remove more CO2 and H2O than if you were just sitting watching TV.

Makes sense, right?

But we all know from experience that if we eat less and move more, we get hungry. And hunger can be held at bay for a while, but it is such a strong survival urge that we ultimately succumb. Which is why Eat Less, Move More has become kind of a joke in the weight loss community. It just doesn’t work.

And it doesn’t work because when we talk about eating less—certainly when the guy in the video talks about eating less—we mean eating fewer calories.

Now, here is where my insight on all this came in.

Here is a slide from the presentation showing Calories as defined by Atwater.

And here is what happened when I flipped them to be grams per Calorie instead of Calories per gram.

As you can see, on a gram/Calorie basis, carbohydrates are more than twice as heavy as fat. In other words, you can get over twice as many Calories from a given weight of fat than you can from the same weight of carbs.

In other words, you can eat less (mass) while keeping the caloric intake the same. So you don’t have to starve.

Which is one of the reasons low-carb diets work so well. And why almost all the studies comparing low-carb to low-fat diets for weight loss show a greater weight loss with low-carb. People are getting plenty of calories in their low-carb diets while keeping the mass of the carbon, hydrogen, and oxygen atoms they need to get rid of vastly lower.

Here is a slide showing the difference in mass of food intake over a year on an all-fat vs an all-carb diet of 3,000 Calories per day.

I go through all the calculations in the presentation, but the end result is that you consume 338 fewer pounds of food on a 3,000 kcal/day all-fat diet than you would on a 3,000 kcal/day all carb diet.

So, you really are eating less. But getting plenty of calories at the same time, which keeps hunger at bay.

No wonder people always lose more on low-carb diets. I can’t believe this escaped the notice of the guy doing the video. It seems so simple.

The diet above—all fat vs all carb—is not totally realistic. In the presentation I show the calculations for a more standard low-carb diet vs a more standard low-fat diet of the same number of calories. And the calculations don’t include the mass of ketones that are released in both breath and urine, which increase the mass out, especially in ketogenic diets.

Whoa there, you may be thinking. When I eat a big steak that’s full of fat, it weighs a helluva lot more than if I eat a giant piece of cake or a half a dozen donuts that have the same number of calories. So how can the steak be less mass?

Well, we’re talking about the mass of atoms that make up the fat, protein, and carbohydrate in foods. Most foods have a water component. We humans are about 70 percent water plus or minus a bit. Steaks are a tiny bit less, but they still contain a lot of water, which doesn’t count because it contains no calories and passes right through as urine.

This is a new paradigm, which in my view destroys the calories in calories out theory.

But what about CIM?

The Arrow of Causality

A physician practicing back in the 1950s named Alfred Pennington wrote about the idea that a defect in metabolism could drive people to eat more and gain weight. Pennington is an interesting guy because he learned about the low-carb diet from another physician named Blake Donaldson, who had learned about it directly from the arctic explorer Vilhjalmar Stefansson. Pennington in turn taught it to Robert Atkins of The Atkins Diet fame.

As we discussed above, the CICOers believe that a plentiful food environment drives people to overeat. The overeating ends up making them gain weight.

Pennington came upon the idea during his study of obesity that a defect in metabolism—carb intolerance leading to insulin resistance—might cause excess weight gain. Then the excess adipose tissue itself might increase hunger, which drives people to eat, which makes them even more obese.

This is what happens to teenagers when they hit their growth spurt. As anyone who has had teenagers in the house knows, they are constantly hungry and constantly tired. They eat more and move less than any other group of humans, yet they don’t get fat. They are growing, so their growth drives them to eat more and move less. That’s the arrow of causality in that case.

When Gary Taubes was doing the research for his great book Good Calories, Bad Calories he read all Pennington’s papers. And he—Gary—resurrected in his book the notion of the arrow of causality.

Gary and I have been friends going on 20 years now, and I have read every book he’s ever written in manuscript form. And added my suggestions. (As he will at some point do with our Protein Power 2.0 book) In one of the books—and I can’t now remember which; there have been so many—he came up with the metaphor of a busy restaurant, which I thought was brilliant. Then he told me his editor wanted to cut it out. I told Gary he should keep it in, and if he didn’t, that I was going to use it. Now, I can’t remember if it made it into the book or not, but I’m going to use it anyway.

Imagine you go out to a restaurant for a nice dinner, and you get there only to find the place chaotic with an hour wait for a table. There are people everywhere. And you ask the maître d’, what’s going on? Why are you so busy tonight?

The maître d’ responds: Well, a lot more people are coming into the restaurant than are going out.

You are stunned. You know the maître d’, so you say to him, Do you think I’m an effing moron? Of course more people are coming in than going out. That’s why the place is packed. My question is why are more people coming in tonight? Did a concert just let out? Is a sporting event just over? Did you run a special in the paper today? Did you run an ad on the radio? Why? Why are all these people here?

What you’re wanting to know is the arrow of causality. Just telling you more people are coming in than leaving tells you nothing about why.

It’s the same with CICO. It tells you nothing. People are gaining weight because they’re eating more calories than they’re expending. The question is why?

Since I started writing The Arrow over two years ago, I’ve put up a bunch of videos of films made back in the late 1800s/early 1900s. Very few people were obese then. When you watch these videos, the people look like stick figures compared to films of people out on the street today. People today are obviously eating more than they are burning. But why?

I talked about one hypothesis in a talk I gave a few years ago. It involves the vast increase in the amount of vegetable oils everyone is eating now.

So, how does the mass balance equation fit in with this arrow of causality?

Who knows for sure? The presentation I made a few weeks ago is the first time a bunch of people have even heard of it. As more see it, I’m sure possibilities will arise for discussion.

As I mentioned in the talk, whenever someone asks me about a weird herb or supplement I’ve never heard of, I immediately look it up on PubMed. And despite the fact that I’ve never heard of it, there are often 50-100 or more papers about it. When I looked up the mass balance equation on PubMed, I was astonished to find only one paper on it. And it was a paper steeped in deep mathematical analysis. Since I’ve been thinking about this over the past year and a half or so, there have been three more papers published on it. One more by the author who published the first one and one by him and another researcher. And one more by the other researcher. And that’s it.

Strange since the whole thing seems so intuitively obvious once you see it.

As Dr. Pennington said when he figured out the whole arrow of causality thing, “the concept…dawned on me with such clarity that I felt stupid for not having seen it before.” Which is precisely how I feel.

I’ve communicated with the two authors of the papers above, and hope to hob nob with them soon. The author of the deeply mathematical paper has offered to walk me through the math, so I’ll have to brush up on my old engineering math studies.

As far as the arrow of causality is concerned, I think that people going on a low-carb diet get a double dose of good. Limiting carbs reduces the mass that has to be gotten rid of, which is kind of step one. And limiting the carbs also reduces the amount of insulin produced and, in time, gets rid of insulin resistance and hyperinsulinemia. Consequently fat can easily flow out of the adipose cells and provide energy instead of being trapped away, which signals to the brain that there is plenty of sustenance on board. The brain ratchets down hunger, so there is no strong compulsion to eat. Quite the opposite of the vicious cycle of eat less move more, it’s a beneficial cycle.

One is getting plenty of calories, which is what is required to maintain life, but in the form of a lot less mass, which is what weight is made of.

And, as I’ve said all along, the low-carb diet is the diet we cut our teeth on evolutionarily. A low-carb, high-fat diet.

As Blake Donaldson, the doc mentioned above in the lineage of Pennington famously said:

During the millions of years that our ancestors lived by hunting, every weakling who could not maintain perfect health on fresh fat meat and water was bred out.

That pretty much sums it up. A low-mass, low-carb diet that provides plenty of Calories and keeps insulin low.

Mask Hysteria

I wrote last week or the week before about the Cochrane report showing that masks don’t do anything to prevent contracting or disseminating Covid.

People find this really difficult to believe, because it just makes intuitive sense that if you cover your mouth and nose, there has got to be some barrier to the virus. Even if it’s only a little. Wearing a mask, so many people believe, will in at least a tiny way prevent the spread of the disease.

What these people don’t understand is the size differential between pores in a mask and an aerosol virus.

As MD says, wearing a mask is like erecting a chainlink fence to keep out mosquitoes. How about two or three or even four chainlink fences put up side by side? Even four won’t deter a mosquito. The holes in the chain link fence are vastly larger than even the largest mosquito, so it just won’t work.

Yet people just can’t grasp it.

My friend Maryanne Demasi did an interview with Tom Jefferson, the lead author of the Cochrane review that makes for an interesting read.

The whole thing is enlightening and fun to read.

Some tidbits I particularly enjoyed.

Maryanne comments that the recent Cochrane review has really caused an uproar in the ongoing mask debate.

TJ [Tom Jefferson]: Well, it’s an update from our November 2020 review and the evidence really didn't change from 2020 to 2023. There’s still no evidence that masks are effective during a pandemic.

MD [Maryanne Demasi]: And yet, most governments around the world implemented mask mandates during the pandemic…

TJ: Yes, well, governments completely failed to do the right thing and demand better evidence. At the beginning of the pandemic, there were some voices who said masks did not work and then suddenly the narrative changed. 

Remember Fauci and his ‘masks won’t help’, then his 180-degree reversal.

Down the way, Maryanne mentions that TJ is an expert. He interjects:

TJ: …please do not call me an expert. I'm a guy who has worked in the field for some time. That has to be the message. I don't work with models, I don’t make predictions. I don't hassle people or chase them on social media. I don’t call them names… I'm a scientist. I work with data.

David Sackett, the founder of Evidence Based Medicine, once wrote a very famous article for The BMJ saying that ‘experts’ are part of the problem. You just have to look at the so-called ‘experts’ that have been advising government.

Well, we’ve certainly had our share of “experts from the CDC who blew this one.

MD: May I just ask a finer point on masks… it's not that masks don’t work, it’s just that there is no evidence they do work…is that right?

TJ: There's no evidence that they do work, that’s right. It’s possible they could work in some settings….we’d know if we’d done trials. All you needed was for Tedros [from WHO] to declare it’s a pandemic and they could have randomised half of the United Kingdom, or half of Italy, to masks and the other half to no masks. But they didn’t. Instead, they ran around like headless chickens.

The more I read what this guy has to say, the more I like him.

Maryanne asks him about layering protection and N95 masks. He calls it the Swiss Cheese model.

Just go to the link above and read the whole thing. It’ll take you five minutes. Jefferson reminds me of Johan Giesecke from Sweden. We need many more like him.

What I’ve particularly enjoyed is the anguished hysteria the Cochrane report has prompted among the ever-masked.

When it came out, I tweeted about it. Immediately someone replied to my tweet with this comment:

He obviously doesn’t understand how the scientific literature works. It is always loaded with weasel words in case it turns out to be wrong. Since, according to Tom Jefferson above, some involved with Cochrane were worried about the response to the findings and even delayed the report as a consequence, you would imagine they would totally lard it with weasel words. Which threw this mask lover a rope to save him from having to confront reality.

Jeff Childers wrote today about a Slate article with kind of a contradictory headline/subheadline.

The headline not-so-subtly implies that only a fool might believe that masks aren’t valuable. To Mask of Not to Mask? Somehow in the minds of morons everywhere that might “somehow” still be a question. But certainly not to us elites here at Slate.

Then they follow up with the sub head saying “The latest, highest quality evidence does not show masks” work.

Totally weird. Not that masks don’t work, but that they would put those two contradictory statements one after the other.

Some of the quotes in the article are great. They are the typical hit job you see when a prestigious source comes out with a conclusion the author of the piece disagrees with.

First, Slate lauded the Cochrane group and its reports in general, going on at length about their strict methodology and the lengths to which they go to prevent bias from creeping in.

Then, the attack begins. The Cochrane report shows that there is no evidence that mask wearing prevents the spread of Covid. The authors don’t state with absolutely, 100 percent positive, declarations that masks don’t work. They simply report that of the many studies available comparing masking to non-masking, the preponderance of evidence shows that there is no, well, evidence that masks work to prevent Covid.

Now comes Slate:

But as the saying goes, absence of evidence is not evidence of absence. The review doesn’t show that masks definitely do not reduce the spread of COVID—only that studies to date have not proven that they do.

“Only that studies to date have not proven that they do.” Somewhere, someday there might be a study that shows masks do work. So let’s all wear them just in case.

Then they go on to try to discredit the lead author.

[T]here’s been some consternation about the predispositions of the review authors. Tom Jefferson, a senior associate tutor at Oxford University, has spearheaded Cochrane Reviews of interventions to reduce the spread of respiratory viruses since 2006. But Jefferson has raised some eyebrows, as he has publicly expressed skepticism about masks.

According to the interview with Tom Jefferson above, they held this report off forever before publishing. If Jefferson was in possession of this information, and as lead author, I’m sure he was, he knew the results. So why wouldn’t he “express skepticism about masks”?

Then they go on to nitpick some of the studies and what others have said about some of the studies.

Then they break out the old canard mouthed by mask proponents everywhere:

[M]ask proponents insist that in the face of uncertainty, it’s better to be safe than sorry. Even if you’re not worried about your own risk, masking protects other people who are more vulnerable. Why not, they ask, since the downsides of masking are negligible?

Because the downsides are not negligible. Especially for children.

And finally, they come to a reasonable conclusion:

Ultimately, the decision about whether to mask comes down to personal feelings about risk tolerance, collective action, and the effects of masks—or COVID itself—on quality of life. People disagree on all three counts, so it’s unlikely we will ever come to a consensus. It doesn’t look like “the science” is going to be a tiebreaker anytime soon. More than showing whether or not masks work, the Cochrane Review finds that the kind of evidence gathered so far can’t really answer the question. Maybe that’s a good reason to let people decide for themselves

I agree 100 percent!

Problem is, the elitist pricks at Slate and other online and hard copy opinion sources are the very ones who demanded mask mandates for everyone. They were not willing to “let people decide for themselves.” They wanted to use the force of the government to decide for them in favor of wearing masks.’

Never forget the videos of people being physically attacked in grocery stores, restaurants, and even gas stations for not wearing masks. Those attackers have the same mindset as the writers for Slate. We know best, and you had better obey.

It’s funny how when the data comes out showing them to be wrong, it becomes a personal choice issue.

Funny thing about that.

But, unfortunately, some of those in power aren’t so willing to let people decide for themselves as are the lefties at Slate. Rochelle Walensky, Director of the CDC, said just yesterday when asked about Cochrane

Our masking guidance doesn’t really change with time — what it changes with is disease. So, when there is a lot of diseases in the community, we recommend that those communities and those schools mask. When there’s less disease in the community, we recommend that those masks can come off.

Jesus wept.

The depth of her dumbth is unfathomable.

I wish I had a video of her saying this, but I couldn’t find one.

I did find this one though. Someone must have laced Fauci’s coffee with truth serum or something.

This is Fauci, back in the day, on why it is necessary and prudent to be careful during vaccine rollouts.

As you have seen, this all went by the wayside during the mRNA vaccine rollouts. He certainly changed his tune.

Bootleg Ozempic

Bari Weis’s Free Press has an article today about how people are going nuts to get semaglutide, the generic name of Ozempic and Wegovy. Apparently is can be compounded by compounding pharmacies and sold for significantly less than the two aforementioned drugs.

According to the article, a preloaded injection pen of Ozempic (a month’s worth) costs about $1,000 before insurance kicks in. Which it might do for Ozempic, if it is prescribed for treatment of diabetes. If for weight loss, it’s out of your hip pocket. You might be able to get your doc to prescribe Ozempic if your blood sugar is a little up. It was tested and approved for diabetes, so if prescribed for that, depending upon your insurance, you could get reimbursed. Not so for Wegovy. It is the same drug—semaglutide—but in a double dose that was tested for obesity. If you’re getting Wegovy, your insurance company will know it’s for weight loss and will probably not pay for it. Unless you’ve got one helluva policy.

For those who don’t have a helluva policy or deep pockets, bargain semaglutide can be found more cheaply at compounding pharmacies. Some of which, apparently, are affiliated with physicians who will write prescriptions. (Even from a compounding pharmacy, semaglutide requires a prescription.)

According to the article

Healthcare lawyer Harry Nelson says there are “well over 100” businesses across the U.S. now peddling off-brand semaglutide. Most get the Novo Nordisk knockoff from compounding pharmacies—places that mix and combine active ingredients to create custom formulations. A quick online search pulls up promises for same-day prescriptions with no office visits needed. While none of this is illegal, medical experts question the ethics of the off-label boom.

Medical spas, which sell Botox and fillers but are overseen by a physician, typically prescribe off-label semaglutide after a weight-loss consultation. Clients pay about $300–$600 a month for an off-brand prescription, and within a week the drug arrives at patients’ homes, usually in the form of a vial and a syringe.

And because many of these visits are done online, it’s easy to get around the guidelines.

Heather McKerrow, an Atlanta-based licensed physician assistant who helps run a new chain of telehealth clinics called RegenMD, says she’s turned a small army of users on to the drug, including her mom, her stepmother, her nanny, her housekeeper, six of her best friends, her neighbor, her hairdresser, and “a guy that sells diamonds that is our jeweler.”

“I’ve got 60-year-old women saying it saved their marriage—like literally they’re having sex with their husband again for the first time in years,” McKerrow told me.

Ayla Humphrey, a 27-year-old influencer in Atlanta, said the off-label semaglutide she obtained from RegenMD helped her fit back into her clothes after a breast augmentation, followed by a family tragedy, landed her on the couch for weeks.

“The thought of food repulsed me,” Humphrey told me about the effects of the drug. “I’d have two or three bites of chips and salsa and be like, ‘I don’t want any more.’ ”

You can read about it all in the article linked above.

I’m just here to urge a bit of caution. I suspect the compounding pharmacies do a decent job of putting together the non-branded semaglutide, so I’m not so worried about that. What I am worried about is the last paragraph in the quoted piece above. The bit about how food repulsed her. And how just a few bites of chips and salsa, and she was full. That’s what worries me.

I wrote about the studies on Ozempic and Wegovy in an earlier edition of The Arrow. In that edition, I wrote about playing a round of golf with an A-list Hollywood celeb, who told me all about Ozempic. He said the same thing. I’m never hungry. I almost never think about food or eating.

Here is my issue with that.

When you get to be over about 25 years old, things change physiologically. Prior to that, your muscle mass was maintained by your array of growth hormones. You could snatch a bit of protein here and there, and your metabolic hormonal system would make best use of it and be sure you maintained muscle mass and even increased it. But not so when you drift past the 25 year mark.

From then on, maintaining your muscle mass becomes driven by a host of different systems, all of which revolve around mTOR, which is a signaling mechanism for muscle growth. The essential amino acid leucine, found primarily in foods of animal origin, triggers mTOR. Insulin and IGF-1, both growth hormones play a role in stimulating muscle growth. Energy in in the form of calories stimulates AMPK, yet another system that regulates muscle growth, and, finally, yet another system is triggered by resistance exercise. All of these are required to have the body build new muscle. Especially the leucine.

You’ve got to have at least 30-40 grams of animal protein at a sitting to ensure getting enough leucine to fire off mTOR and keep it active for 4-6 hours. You don’t want it active all the time—you want to pulse it.

If you don’t eat, not only won’t you build muscle, you won’t maintain what you have. When you lose muscle with age, it’s called sarcopenia. When you replace it with fat, it’s called sarcobesity, which is the worst case of all. I think a lot of people are setting themselves up for sarcobesity when they take these drugs and don’t eat.

It sounds like an easy way to lose weight, but it comes at great peril. If you do decide to take one of these meds, please keep your protein intake up. Do it in three meals per day with protein skewed to the morning meal and the evening meal. Remember weight loss is a mass related phenomenon, not a calorie one. You can keep calories up while keeping mass intake down by focusing on fats and protein. Do some resistance training and eat your protein after, not before. If you can keep protein and calories up and do some resistance training, you should maintain your muscle mass at the very least.

Remember how I wrote about the article on Ozempic face a week or two ago. The facial muscles are the first to go. The above linked article discusses that phenomenon, too. Ozempic face is sarcobesity of the face. Or, at the very least, sarcopenia of the face. You don’t want it.

When I wrote about the studies on both drugs linked above, I posted the graphs showing how when patients stop the medication most, if not all, of the lost weight comes back. I’m not naive enough to believe people are going to take that seriously. Most will think, Well, it won’t come back for me. Once I lose, I’ll keep it off. Just be forewarned.

If you do decide to go this route, think protein, protein, protein.

Or just go on a low-carb diet instead.

Video of the Week

I’m depressed thinking about all the people who will go on these drugs, lose weight quickly, then gain it all back. And end up with more fat and less muscle.

When I get down, I love to listen to singer, songwriter Iris DeMent. She’s a good Arkansas girl with a beautiful, sweet, crystalline voice that I love to listen to. If she knew my politics, she probably wouldn’t walk across the street to pee on me if I were on fire. But I never let politics stand in the way of art and music. Here she is singing one of her own songs, which is one of my favorites.


Well, that’s about it for today. Not as many topics, as usual. But more in-depth coverage of the mass balance equation.

I’ll be back next Thursday. Keep in good cheer till then.

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