The Arrow #117

Hello everyone.

Greetings from Montecito.

Based on the number of hostile emails I got last week, a bunch of people were upset that I put up a paywall. Especially without any warning. (Although in my defense I did say the plan was to go to a paid subscription model shortly after I shifted over to Substack.)

Part of that was my fault, and part is Substack’s fault. Or maybe it’s all my fault for not knowing how to properly use Substack.

Substack is a bare bones platform. It doesn’t give writers a lot of choices as to how their publications look, which is why most Substack posts look similar. Or, perhaps I just don’t know how to make optimal use of what the platform has to offer. Admittedly, I spend vastly more time writing on Substack than I do futzing around in the backend trying to figure out how it all works and trying to make it look exactly what the way I would like it to look.

Which is a long way of saying I didn’t realize how abrupt the paywall appeared last week to those who weren’t expecting it.

I, myself, pay to subscribe to numerous Substacks along with other non-Substack online publications. I’ve set myself a limit of $250 per month. So when I come across a new one I want to subscribe to, I have to figure out which one I want to swap for it. I do this both for monetary and time reasons. If I subscribed to everything I wanted to subscribe to, I would quickly blow past my budget in time and dollars. And, since I barely have time to read the ones I do subscribe to, I would not have time to read them all and still do all the things I need to do.

Many of the subscriptions I read involve Covid and the pandemic. I don’t know what these writers are going to do once the rona and the pandemic fallout are all way in the rearview mirror. But the closer we get to that time, the more I’ll be freed up to switch to non-Covid reading.

I spend a vast amount of time reading all this material and a vast amount of time writing about it in this newsletter. So much time, in fact, that I cut into the time I could be using for other endeavors. And since I need to make a living like everyone else does, my choices are to quit writing The Arrow (or at least quit spending so much time on it) and use the time saved to devote to other things. Or keep writing The Arrow and charge for it.

It comes out weekly, which means 4.3 times per month. At $6 per month ($5 per month with an annual subscription) that doesn’t even equate to a Starbucks drip coffee per week, so I didn’t think that was an outrageous ask for the time I put in.

Allow me to digress for a sec and tell you a story (probably apocryphal) about Picasso. And don’t think I’m comparing myself to Picasso here, because I’m not. But the principle is the same. Someone sees Picasso in a restaurant and asks him for a quick portrait. Picasso grabs a napkin and quickly sketches out a few lines that precisely capture the essence of the guy asking for the portrait. The guy asks Picasso how much for the portrait. Picasso says $10,000. The guy is gobsmacked. He says, but, but, but it only took you a few seconds to draw it. Picasso replied, Yes, but it took me many many years of practice to be able to do it in a few seconds. That’s what you’re paying for.

I’ve spent many years in training and many more in practice. And many, many, many hours parsing the medical literature. What you’re getting when you pay for The Arrow is the result of all that time and experience, not just the many hours it takes me to write it. And, what’s more, MD and I discuss all these medical issues I write about, and she’s spent years in training and in practice as well. If that’s not worth a buck and a half a week to you, I completely understand. But you need to understand it from my perspective as well.

Since it was so abrupt last week, I’ve gone ahead and made last week’s Arrow available in full online. You can find the link here.

But I am putting a paywall on this one, so unless you enjoy it, don’t do as many others who emailed me last week did and read all the front-end drivel (as one reader called it) only to run into a paywall before the good stuff.

To compensate, I’ll keep the “drivel” to a minimum. Which more’s the pity since I have a hilarious story to relate about how I was scammed (or potentially scammed) when I had a power outage for over a day a few days ago.

Which brings me to a poll. I love to read Glenn Greenwald (I’m a paid subscriber), because he is and has always been a major proponent of freedom of speech and freedom of the press. He wrote a recent column about the serious health issues his family has been dealing with. He wrote:

Until I read this just a few days ago, it never occurred to me that people might not like to read about the personal lives of those whose writings they enjoy. I’m just the opposite. I love reading about personal anecdotes from writers whose works I always read. It personalizes them to me and makes their non-personal writings more entertaining, because I feel a deeper connection.

I usually start The Arrow with a bunch of kind of personal stuff—up to and including bitching about the weather—because, although I’ve never met most of you, I feel like I’m writing to friends. And it gets my writing wheels moving. And then I go on from there. What I wrote above did not get my writing wheels rolling, so I’m struggling a bit here. But I am curious to see how you feel about reading about the personal lives of those you read for information. And so I ask:

Okay, on to some important Covid issues. Even if you are done with Covid, as I pretty much am, these are worth reading.

Covid Roundup

Excess deaths due to vaccines

One of the issues I’ve stayed away from is the whole idea that the post-pandemic excess deaths most countries are experiencing are caused by vaccines.

Based on a lot of study, I believe the mRNA Covid vaccines are harmful and should never have been brought to market and inflicted upon a frightened public. But based on many years of living with myself, I know my confirmation bias is strong. Consequently, I fight it all the time.

As I mentioned above, I read a lot of Substacks and other publications. Many of these were started when the Covid situation began heating up. And most of the writers of these publications feel as I do about the vaccines. I have a lot of other issues I can write about while many of these other folks are stuck in the Covid lane.

They are always publishing studies showing the vaccines are terrible and cause huge numbers of adverse events up to and including deaths, the most adverse event of all. I always wonder when I read the writings of these folks—most of them physicians or PhDs—whether they would even write about a study showing the vaccines were beneficial were such a study to be published. Or would they simply ignore it because it didn’t comport with their opinion that the vaccines are harmful.

I’ll admit that I haven’t scanned the medical literature myself looking for papers hailing the vaccines as being wonder drugs. I read the Pfizer study documents myself, and it would be difficult to find more positive findings in other independent studies. I find most of the negative studies in the posts of all these other writers. I go through them and only report the ones here that I think are well done and have merit.

Virtually everyone writing about the excess deaths issue either directly or indirectly blames them on the vaccines. There are undoubtably excess deaths in virtually all countries in which the vaccination rates are high, but that doesn’t “prove” the vaccines caused the excess deaths. I would say the vast majority of those highly-vaccinated countries also were pretty authoritarian in terms of lockdowns and mandates of one kind or another. Which makes it difficult to tease out exactly what is causing the excess death rates. Vaccines? Inability to get medical care during the lockdowns? Depression? Increased obesity? Diabetes? Drug and alcohol abuse?

Are they a consequence of the vaccines or issues related to the steps taken by the various governments in terms of lockdowns, mandates, etc. Or some combination?

Since I don’t really know the answer, I haven’t wanted to jump into that fray and make all kinds of bold pronouncements only to have to eat my words later.

One of the authorities I rely on to keep me on the straight and narrow is William “Matt” Briggs, who goes by the tongue-in-cheek title of “Statistician to the Stars” on his blog. He publishes there almost daily and has written several books, including the highly influential Uncertainty, which is not an easy read, despite being overloaded with information. Or maybe because it is overloaded with information.

One of the best pieces of advice I’ve received from him in conversation, in his blog, in his books, and in his talks is the following.

Yet people continue to believe in modeling to predict climate change and Covid trajectories and countless other issues. My youngest son, who has obviously been reared well, sent me this graphic a few days ago.

Briggs has also been looking at whether or not vaccines could be causing the excess deaths we are experiencing in the United States. There is no one I would rely on more than he to ferret this out.

Briggs is not a fan of the vaccines, so he didn’t go into this exercise wanting to exonerate them in terms of their causing excess deaths, but that’s more or less what he ended up doing in an incredibly in-depth and complex post. It took me a long time to read and fully understand. I see his point.

This comports with the golf club membership observation I made a year or so ago. I’m involved with a couple of golf clubs with memberships totaling ~1,300 that skew older and almost all of whom are vaccinated. I know, or know of, most members. No increase in deaths among the membership. At least not that I’ve heard about, and I’m sure I would have heard about it. Especially if they were Sudden Adult Death Syndrome victims.

Virtually all of the Covid writers I follow attribute the increase in excess deaths to the vaccine. I could give you an array of different posts from different authors showing the increase in excess deaths correlated with the numbers vaccinated. But that’s all it would be: a correlation. No one I’ve read (other than Briggs) has gone to the trouble to try to tease out all the different possible causes of these excess deaths. They simply blame them on the vaccines.

I’m hoping the vaccines aren’t the cause, because I have many friends and loved ones who have been vaccinated. So far, no one has had an issue, knock on wood.

Before I leave this section, I want to vent about the censorship efforts of Big Tech, which really agitates me.

In yesterday’s Coffee & Covid column, Jeff Childers wrote about an article in Victoria, Australia’s Umbrella News about “How the ‘Hermit Kingdom’ Became the World’s Control Group for the Largest Vaccination Trial Ever.”

Instead of quoting from the article, which I don’t have available for reasons I’ll explain in a bit, I am going to quote Childers.

(Image from Childers’s article)

Okay, there are a lot, more than a lot, of adverse events. But these aren’t excess deaths…yet. And they may never be. VAERS and other such reporting systems all over the world show vast numbers of adverse events from the mRNA Covid vaccines, so, in my opinion, these aren’t all that exceptional. Other than the fact the remote area was closed down and there were very few cases of Covid. So these adverse events were as a direct result of the vaccine and not the vaccine given to a lot of people who already had the virus.

What really pisses me off about this article is the fact that Big Tech definitely does not want me to read it.

When I pulled it up on Childers’s site yesterday, I was able to read it. I didn’t save the tab because I already had a ton of tabs up and I figured I could go back and get it from the site. I tried to pull it up and I got some bizarre notice telling me the site was dangerous. Gave me the chance to go to it anyway, which I tried. Nothing happened the link wasn’t live. I was using Chrome, so I went to another Browser. Brave. Same thing. I couldn’t get to the site. Then I tried Safari, with the same results.

Then I cut off everything but the https://umbrellanews.com.au/ part of the link to see if I could get to the site itself. And indeed I could. Here is the page that popped up:

Great, thinks I. I’ve fooled them. I click on the “Read More” button, and get thrown into the same zoo of bizarre sites. You try it. Maybe it’s just me, but I went to the link on Childers’s site yesterday, and it took me right to the article. Which he posted because when he tried to search by title, Google “embargoed” his search.

This is Big Tech at its worst. It’s really despicable. Someone really doesn’t want us to read this article.

The only bright spot in all this is that in fiddling around with this, I came upon what has got to be the worst haircut in the history of haircuts. You can find it if you go to the abbreviated link I posted above and then click the 2nd button on the lower left. Or, better yet, I’ll take a screenshot and post it at the risk of offending maybe a substantial chunk of the Australian population. Maybe this kind of haircut is all the rage down under. I doubt it, but who knows.

I just grabbed a screenshot. It’s not an Australian pictured. It’s an Estonian. At least I won’t have all of Australia after me in case this is the latest style. And I doubt that I have a lot of readers in Estonia, so I’m probably safe.

By the way, I could read this article just fine. And others as well. It is only the one about vaccine adverse events that I couldn’t retrieve from the website. Curious.

Myocarditis from the Vaccine vs from Covid-19 Infection

It’s pretty well known that a significant number of people, especially young males, develop myocarditis after taking the mRNA Covid vaccine. When people express hesitance about taking the vaccine due to the risk of myocarditis, they are often told by their doctors and the various public health sites that they are as much, if not more, at risk for myocarditis from getting Covid as they are from getting vaccinated.

Peter McCullough posted on a study that looked at autopsies of people who had died from Covid or had had Covid previously and died from something else later.

He writes:

The study involved 50 different hospitals from Saudi Arabia to the Cleveland Clinic and looked at 548 hearts at autopsy. The median age of the deceased was 69 years old.

As reported in the abstract:

The study concluded

Based on this study, it doesn’t look like those prodding people to get the vaccine by telling them they are just as likely, if not more so, to get myocarditis from coming down with Covid as they are getting it from the vaccine were dead wrong. Especially when you consider the Cleveland Clinic finding I wrote about a month or so ago showing those with the most vaccinations and boosters had the highest incidence of Covid.

As an addendum to all this, today’s Wall Street Journal has an article by a doctor who is a director of breast imaging at Memorial Sloan Kettering Cancer Center. She describes the idiocy of the entire response to Covid. Here’s how she starts her story:

This beggars belief. The Pfizer scientific team that has withheld data and oversaw a truly shitty study, the same Pfizer scientific team that wants to jab babies, tells her she should take a lesser dose, and she and the dimwits at the hospital and pharmacies go ahead and give her the full dose. And she “reluctantly received the full doses.” All she had to do was take a half dose. She almost deserves what she got as a consequence of her own blind stupidity.

She gets Covid, which wasn’t nearly as bad as the vaccine. And after all this, she writes

The third booster, which implies she took the first two along with the two Pfizer shots. Jesus wept.

You can read the rest of this short article here to see just how screwed up this whole situation has been. And continues to be as long as autocrats are in power.

Is Your LDL-cholesterol Level Real or Calculated?

I received a notice a while back that a link in one of my blog posts was broken. When I went to the post in question to check on it, I discovered it was about the difference between measured and calculated LDL-cholesterol levels. I suspect that not many people know the LDL level they get on a lab test is not really measured, but is calculated.

In looking for the missing link, I discovered—I think—it was a paper no longer readily available. But with the help of a friend, I was able to track it down, assuming that was the paper. And I learned a lesson about linking in blogs. I had written

Now I know to write something that identifies the actual paper. Maybe a title or a citation. It’s frustrating when journals change their online architecture and links no longer work, and you can’t go back and find the actual paper. I’m assuming I found the paper I originally linked to, but I don’t know for sure.

In terms of lipid measuring, it’s pretty easy to measure HDL. Its name is high density lipoprotein so it settles to the bottom when centrifuged (if that’s how they measure it). Total cholesterol is easy to measure. And triglycerides are easy to measure. What’s not so easy to measure—at least not inexpensively—are VLDL (very low density lipoprotein) and IDL (intermediate density lipoprotein).

Total cholesterol is made up of all the subfractions, so

Total cholesterol = HDL +LDL + VLDL +IDL.

Back in 1972 William Friedewald and his team fiddled with this equation and discovered that VLDL + IDL could be approximated by the triglyceride level divided by 5. Which ended up creating the following equation.

Total cholesterol = HDL +LDL +triglycerides/5

If you solve for LDL, the difficult one to measure, you end up with this equation.

LDL = Total cholesterol - HDL - triglycerides/5

Which is called the Friedewald equation and is used in just about every lab to calculate LDL levels.

When Friedewald et al looked at tons of data, they discovered that when triglyceride levels were over 400 mg/dL, the equation didn’t work. You may have gotten a lab test back at some point that said, “LDL: unable to calculate due to high triglyceride levels.” Or something to that effect.

MD and I have taken care of thousands of patients following low-carb diets, and we noticed that the vast majority had improved lipid levels once they had been on the diet for six weeks (which was when we did routine blood draw follow ups). We noticed, however, that a few patients had their LDL levels increase.

The other thing we found uniformly was that on low-carb diets our patients’ triglyceride levels plummeted. Many fell to down below 50 mg/DL.

I began to wonder if the Friedewald equation was as inaccurate under a specific triglyceride level as it was over 400 mg/dL. So, I hit the medical literature, and, sure enough, there were a couple of papers showing that low triglyceride levels would make the LDL calculation come out significantly higher than it really was. To the tune of 20-30 mg/dL in many cases.

Here is a case report by another group showing what we have seen many, many times. This report is by the lab involved in Taiwan, mentioned in the case report below. [my parens below]

I say the family physician was an idiot because I don’t believe you should put someone on an expensive (at that time) medicine for a lifetime based on one lab measurement. Even if you’ve bought into the entire lipid hypothesis.

Anyway, the patient goes to Taiwan and ends up getting another measurement, which turns out to be pretty much the same.

Pretty much the same values as the lab in the US.

Like this patient’s family doctor, the docs in Taiwan had swallowed the lipid hypothesis hook, line, and sinker.

According to the NCEP ATP II guideline, the patient had 2 CHD risk factors, ie, male older than 45 years and an LDL-C (calc.) level of greater than 160 mg/dL. After subtracting out the negative risk factor, an HDL-C level of more than 60 mg/dL, the patient still had one risk factor. Does this patient need treatment for elevated CH and LDL-C levels?

Remember, the guidelines were written by academic physicians with all the academic merit badges, who were on the payroll of the various statin manufacturers. I’m sure all these folks believed in their heart of hearts that this was valid advice, but then I always return to my favorite quote from Upton Sinclair…

Unlike this patient’s family doctor, the docs in Taiwan actually thought about his situation.

So, thanks to some actual thinking on the part of the docs in Taiwan, the patient avoided going on a statin for the rest of his life.

If your lab test comes back showing an elevated LDL-cholesterol level and your triglycerides are low (say, under a 150 mg/dL), tell your doc you want to have your LDL measured directly instead of calculated.

Okay. Last time for this.

LowcarbUSA San Diego Conference

As you can see, it will all take place in sunny San Diego Aug 17-20.

Here is the specific info for those who might be interested. I just discovered that if you sign up on or before March 31 and use the code MarchMadness, you’ll get a 30 percent discount on the ticket price. This is the last time you’ll see this reminder as the discount expires at the end of day tomorrow.

MD and I met a bunch of folks who are Arrow readers at the Boca Raton conference in mid-January of this year. We would love to meet a bunch more in San Diego.

Weight-Loss Drug Gold Rush

What with the financial success of Ozempic, Wegovy, and Mounjaro, I figured it wouldn’t be long before a horde of boffins hidden away in their labs would be focusing their efforts on the next big drug.

Sure enough, I get this alert from a medical research site I subscribe to with the breathless headline “Obesity treatment could offer dramatic weight loss without surgery or nausea”

As it is turning out, a lot of people on the GLP-1 receptor agonists—Ozempic, Wegovy, Mounjaro—experience a lot of nausea and even vomiting. But the drugs do work…as long as you take them. As I wrote several months ago, studies on people who quit taking them show a dramatic regain of weight.

The new drug under development is dubbed GEP44. According to the researchers working on it, this drug produces similar, if not better, weight loss than the three drugs mentioned above that are racking up hundreds of millions in sales. And brings about this weight loss without the nausea and vomiting induced in many people by these other drugs.

How does it work?

Whereas the above mentioned drugs in use now affect the GLP-1 receptors, the new drug going through testing acts on both the GLP-1 receptors and the receptors for peptide YY (PYY), another hormone that signals fullness, curbs appetite, and normalizes blood sugar. The thinking is apparently that since both of these gut hormones are affected, maybe they will offset one another and the nausea and vomiting could be prevented.

And apparently it has in animal models.

But there is still a long way to go before this drug hits the market. Since it isn’t a Covid vaccine, it will take a few years to wend its way through the approval process. Even though obesity is probably a bigger threat to the health of more people than Covid, sadly there will be no Operation Warp Speed for this drug.

Maybe not so sadly.

In reading more about this drug, I came across this:

It all sounds nice in theory, but I have a few problems with it.

First, cutting back on eating while increasing energy expenditure (kind of the Holy Grail of dieting) is okay for young people with weight problems, but not so great for those of us who are a bit older.

As I’ve mentioned multiple times in this newsletter, muscle mass is extremely important as you age. A loss of muscle mass leads to sarcopenia (less than adequate muscle mass), which leads to frailty. No one wants to be frail. It isn’t a good look, and, more importantly, it isn’t healthy.

Although I’ve never read a paper documenting this, I’ve read a number of times that a substantial portion of deaths in the over 65 age group come about on account of frailty. And it does make sense.

If you don’t eat much, you don’t get enough protein. And it takes a pretty good amount to stimulate the muscle building process. I would say at least 1.5 g per kg of body weight, which calculates to a minimum of 0.7 g/lb body weight.

It takes that much in middle aged and older people to stimulate the pathways that build muscle. You need to have 30-40 g of protein from animal sources to get the 2-3 g of the amino acid leucine you need to trip the protein building switch. You can’t get that from 30-40 g of plant protein.

When you sleep at night, your body recycles about 300 g of protein. It breaks down damaged protein structures, strips them of their amino acids, and uses them to rebuild new protein structures, i.e., muscle, enzymes, hair, skin, nails, connective tissue and many other components that keep you going. If you short yourself on protein, you will gradually lose your muscle mass, because it is the main reservoir for protein.

Do you know what your muscle mass is the other main reservoir for?

Believe it or not, blood sugar.

Which is why when I read in the above quoted except that these drugs also work to “reduce blood sugar by pulling glucose into muscle tissue, where it can be used as fuel.”

The process of gluconeogenesis is that process whereby protein (muscle) is converted to glucose. Unless you’re eating a lot of carbs, and those are the source of the glucose pulled into muscle, you don’t want to be making glucose from your muscle because you’re not getting enough to eat. It’s not so bad to make it from dietary protein, but you’ve got to eat protein to make it available.

What you want to lose while dieting or taking a weight-loss drug is fat. Body fat. If you just don’t eat very much because the drugs depress your appetite, you’ll lose weight. But it’s not really the kind of weight you want to lose.

It’s critical in middle age and later—assuming you want to be active and enjoy life—to consume enough protein to ensure you’re maintaining muscle mass. As we age, it is ever more and more difficult to get muscle mass back once we lose it.

Now that there has been an explosion in sales of these new weight-loss drugs, there will soon be a plethora of them hitting the market. Just like statins. Once the drugs were proven money makers, one new one will come out after another.

As an aside, our clinic in Little Rock was the largest site in the world (studied the most patients ) for one of the studies of orlistat, aka Xenical, which is now sold over the counter as Alli. It is a drug that blocks fat absorption from the GI tract. When the folks at Hoffman LaRouche approached us about doing the study, they told us during the dog and pony show that when their research scientists discovered the drug, they thought they had stumbled onto a real gold mine. Everyone knows, said they, that fat causes cholesterol to go up, so they reckoned they might have a new kind of cholesterol-lowering drug on their hands. When they tested it, however, it didn’t do squat. They could have saved their money if they had only asked me first.

Once all these new weight-loss drugs hit the market, don’t be beguiled by dreams of easy weight loss. You may get it, but it will be followed by easy weight regain. And you’ll end up in a worse place in terms of muscle loss and will have paid a fortune to get there.

I know no one wants to hear this, but the best way to lose weight is with a good quality low-carb/ketogenic diet that provides plenty of protein, which you really need, and not a lot of carb, which you don’t need at all.

Okay, well, I’m not going to put the paywall up this week after all. I intended to write a lot more, but a huge fiasco—of my own making—has loomed up to seriously hamstring me this week in terms of my research materials. If the poll at the top tells me people want to hear about my personal ups and downs, then next week I’ll spill the beans on what a hash I’ve made of my many hours of work gathering the publications I’m using to write about the ketogenic diet and cancer. If no one cares, then I won’t relay it. I’ll simply cry myself to sleep over it and get it fixed by next week, when we’ll return to the ketogenic diet and cancer. Among other things.

Video of the Week

This week the video is of Voctave, an internationally famous acapella choral singing group.

MD (and her chorus in SB) will be singing backup with them tomorrow night as Voctave will be here headlining in a concert at the Santa Barbara Choral Society’s annual gala. On the program with be this song (with the 60 voice chorus playing the part of the virtual choir, but live in the flesh.)

So, in her honor, here is Voctave. Enjoy!

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

Before you go, take a look at what our sponsors have to offer. Dry Farm Wines, HLTH Code, and Precision Health Reports.