The Arrow #135

Hello friends,

Greetings from Montecito.

I’ve been searching for an email a reader sent me. I planned to use it to kick off a section of this Arrow about a problem a lot of people seem to have. When I went back to look for it, I searched and searched before I found it. Along the way, I realized that I am woefully behind in answering emails. And I mean woefully behind.

Now that I’ve switched to Substack, readers emails go to a different email account than they did with my first email provider. A lot of people have the other email address, so write to me there. Those who respond to a particular Arrow go to a different email address. And I have three other email addresses I have to keep up with. And throw in the comments to the Arrow… so, as I say woefully behind.

Anyway, if you’ve emailed me in the last month and haven’t heard back, this is why. I’m doing the best I can, I just can’t keep up. And have a life. And work on PP 2.0. And my talk coming up at LowCarbUSA in San Diego. A lot going on. I’ll try to do better when things get back to normal.

Insulin Sensitivity, Ketosis, and Aging

Below is that elusive email I finally found, pretty much intact, from a gentleman who wrote me after the section I wrote on the Krauss paper a few weeks ago. I figure for everyone who writes with these kinds of questions, there are a lot of others out there who have the same questions, but don’t write.

This email addresses many issues people experience with low-carb dieting. After reading the email carefully, I bolded a few issues for discussion.

The first point the author of the email makes is one we all have to live with. We get older every day. And every day after about age 30, things begin to deteriorate slowly, but inexorably. Pick just about any bodily system you can think of, and I can guarantee you that it worked better at age 25 than it does at 65. As awful as it sounds, the truth is that all of our bodily systems have—for lack of a better term—a rate of decay over time.

You don’t notice it at age 40, although it has been going on for ~10 years by then. Why? Because you have plenty of capacity in whatever organ you want to focus on. You get in trouble only when the rate-of-decay curve intersects and dips below the functional capacity of the organ in question. As long as you have plenty of capacity, then you don’t notice much—if any—change. But it is taking place.

So, first, no diet works as well when you’re older as it did when you were younger.

We’ll get to the why in a bit, but first I want to go through the rest of the email.

Next is a subtle key to what happens to many, many people on low-carb diets. In the first paragraph, our email author tells us he was unsuccessful on his low-carb diet, and attributed that lack of success to his aging. Which is indeed part of it. But the first bolded line in the next paragraph tells me a lot.

He wrote that he gave the diet “a much more stringent than usual trial.” Which implies that previous trials were not as stringent. And I’m not sure that the “more stringent than usual trial” was all that stringent.

One of the things I’ve picked up from discussions with many, many patients and from monitoring my own behavior and watching that of others I know well is that most people do a kind of half-assed low-carb diet the second or third or whatever time around.

Typically, when folks go on a low-carb diet (or probably any diet) the first time, they follow the instructions to the letter. And they usually achieve pretty good results. They lose weight effortlessly and then, when they hit their goal weight, they assume the diet is over. Then it’s back to eating all the foods they’ve missed while on the diet. Inexorably the weight comes back on.

When you get right down to it, there are only a handful of ways to lose weight. You can cut calories, you can cut fat, or you can cut carbohydrates. Any diet you might consider falls into one of these broad categories.

If you go on a calorically restricted diet, you usually get hungry. And the battle with hunger is almost always one you are going to eventually lose. If you cut fat, you end up loading up on carbs, which sort of defeats the purpose. Believe me, you can eat a lot of carbs while keeping your fat intake low. There is almost no off switch for carbs, especially processed carbs. In my view, the best option is some version of the low-carb diet. When you cut carbs, you lower your insulin levels, which basically opens the fat cells so stored fat can come out and be burned. High-fat, protein-rich foods are highly satiating, so the foods you are allowed to eat in unlimited quantities will, unlike carbs, quickly kill your hunger. And doing well on a low-carb diet is more or less printed into our genes, as we as humans existed—of necessity—on such a diet for millennia.

The data shows the low-carb diet to be the best way to lose weight. The Public Health Collaboration, a UK non-profit, has been tallying all the diet studies comparing low-fat, high-carb diets (and low-calorie diets) to low-carb diets over the past couple of decades. You can take a look at the data yourself. Of all the 67 studies they’ve evaluated, the low-carb diet beat the low-fat (low-cal) diet in terms of weight loss in 58 of them. In only 7 studies did subjects lose more weight on low-fat diets. If you evaluate these 67 studies in terms of statistical significance (wee ps, if you’re into that), it turns out that 36/67 studies show a statistically significant difference in weight loss in subjects on low-carb diets and a 0/67 for the low-fat diet.

(Disclosure: The Public Health Collaboration promotes low-carb diets. But I know some of the folks who run it, and they weren’t always low-carbers. The data changed their minds.)

Let’s assume for purposes of discussion that the low-carb diet is the best diet for weight loss for the greatest number of people. When people follow the low-carb diet and lose weight, what do they do when they reach their goal? Do they eat more meat, eggs, and cheese? Or do they eat more carbs? I think everyone knows the answer to that one.

If they gain their lost weight back, then it’s pretty obvious they have an issue with carbohydrates.

And, in fact, people do. It’s been known for years that people become more glucose intolerant as they age. There is a brand new paper just out last month that shows this phenomenon nicely. I haven’t had the time to dig into the paper like I would like to do, but I did give it a brief look. The graphics say it all. Here is what happens to blood sugar and insulin as we age.

The solid line shows what happens to normal weight people over time, while the broken line shows the results for overweight subjects. The gray clouds show the distribution of subjects. The dotted horizontal line on the fasting glucose graphic shows the demarcation between normal blood sugar and the pre-diabetic range.

As you can see, even normal weight subjects approach the pre-diabetic range as they age.

Getting back to what happens when people go on low-carb diets the second or more time around… They almost never do it as strictly as they did when they first did it. And they’ve learned all kinds of ways to cheat.

In my experience, the three non-meat foods people tend to load up on when they follow a low-carb diet are cheese, nuts, and nut butters. These foods—especially nuts, in my case—are really easy to eat way too much of while still keeping the carb count down. (Although even nuts eaten in quantity can pack enough carb to be an issue at times.) These are the first foods I query my patients about who are having difficultly losing weight. And I usually find that one or more of these are the problem.

The other issues is low-carb junk food. By which I mean stuff like brownies, cookies, candies, and other crap that is made low-carb by replacing sugar with sugar alcohols and wheat flour with almond flour. As an occasional treat, it may not be problematic, but this low carb junk is not something you can chow down on daily without consequence. And though it may be low in carbs, it is not usually low in calories, still highly processed, and likely contains a lot of bad oils. And if you’ve seen my talk on bad oils, you’ll know why these are problematic. I think saturated fats are actually healthful, not harmful. I also suspect some of the obesity epidemic can be laid at the doorstep of our trying to cut too much saturated fat from the diet.

I have to admit that I’ve fallen victim to a half-assed low-carb diet. When I don’t watch what I eat, I end up gaining weight just like everyone else. Whenever I go on a “soft” version of the low-carb diet, I don’t see much change. When I decide to do it right, I lose the pounds fairly quickly.

The take home message is to not write off the low-carb diet if you’re just trying a semi-sort-of low-carb diet. You’ve got to really get serious to get serious results. And the older you get the more serious you have to be.

Our email author brings up the notion that with age and years of following a low-carb diet, it’s easy to fall out of ketosis.

I have a different view.

Ketones and ketosis

There are three ketones (ketone bodies is the technical term, but no one much uses it any longer) your body makes: acetone, acetoacetate, and beta-hydroxybutyrate.

Here are a couple of graphics to help explain how ketosis works.

As you can see from the above, Acetyl CoA is kind of the end product of all food metabolism. Once food is broken down into Acetyl CoA, it can go in a number of directions, including into the production of ketones.

Here is the pathway for the formation of the three ketones I mentioned above.

Remember step #4 in this graphic. It’s quite interesting, and we’ll get to it in a bit.

Now let’s take a look at a famous graphic from a paper by George Cahill. This picture has been reproduced in countless textbooks and other papers.

The graphic shows what happens over time during starvation. (And as a paper by Robert Wolfe demonstrated later, what happens during a low-carb diet.)

It’s somewhat difficult to see, but between day zero and day one, the first ketones released are acetone and acetoacetone. Over time beta-hydroxybutyrate (BHB) kicks in and ultimately becomes the most prevalent ketone in long-term starvation and the low-carb diet. Acetone pretty much goes away.

Most people check for ketone levels with Ketostix, which are readily available and inexpensive. Problem is, Ketostix check for acetone, not BHB. So if you’re a few weeks into a low-carb diet, you’re going to have a helluva time getting your Ketostix to turn purple. Even though you may be in serious ketosis.

I can’t tell you how many patients MD and I have had who were overwhelmed with despair because they couldn’t get their frigging Ketostix to turn purple.

Ketostix are easy to use. All you have to do is pee on them. Or dip them into your pee.

There are test kits for BHB, but they are expensive, require you to prick your finger, and use an expensive strip (more expensive than Ketostix) for every test. The kits I like best are made by Keto-Mojo, a company with which I have no financial affiliation, though I’ve met and spoken to them at medical conferences. You can get their kits through Amazon or through their website.

If you’ve followed a low-carb diet for a while and you want to know whether or not you are in ketosis, get one of the kits. Just don’t go crazy with it, or you’ll burn up your food budget buying strips.

Okay, now to the interesting bit I mentioned above. The graphic above showed how ketones are synthesized starting from Acetyl CoA. During this process an NAD+ is generated. Below is a graphic showing the process of ketone metabolism, i.e., how ketones are used to produce ATP (energy).

If you look at step 1 above, you’ll see that when BHB is converted to acetoacetate in the first step of its ultimate conversion back to Acetyl CoA and on through the Krebs cycle (also called the tricarboxylic acid cycle (TCA)) to ATP, it consumes the NAD+ it threw off in step 4 of the ketone formation graphic. So, if BHB is completely metabolized, there is no net change in NAD+.

But, if BHB is released in the urine, as it often is in ketosis, then there is no consumption of NAD+. Which means there is a net increase in NAD+.

NAD+ is a wonderful substance with all kinds of great properties. You can read about it here. Unfortunately, it declines with age. It’s an expensive supplement to purchase, but you can get it for free simply by being in ketosis. Even when you’re old.

Steady State

Our email author wrote that people on low-carb diets, which generally stimulate fat burning, quit losing “when they eventually become firmly metabolically accustomed to the practice.”

He is kind of correct on this.

Think of any kind of machine. When it is running at a steady state, it uses a minimal amount of fuel. Throw it out of the steady state, and fuel consumption goes up. If you run your car at a steady 65 mph, you’re going to burn less fuel in a given time than you would if your speeds are all over the place but end up averaging the same 65 mph. Sometimes 85 mph and sometimes 45 mph. That isn’t a steady state.

It’s the same with your body.

If you eat the same thing every day at the same time everyday, you’re going to be operating metabolically at a steady state.

You need to shake things up.

Vary the times you eat, the amount you eat, and what you eat.

Our emailer went to a once per day schedule of eating whatever he wants. And, according to his report, he’s losing weight. That’s what intermittent fasting is all about. It kind of shakes things up. And lets your metabolic system parameters sort of settle back to baseline.

But if you eat the same thing each day at the same time, you’ll end up in a steady state. And will probably gain weight or stop losing at some point.

Okay, on to something really interesting.

Clearance

You’ve probably never heard anything about clearance and diet, but it’s important.

First, a definition.

In physiological terms, clearance means removing something from the blood. Probably the most common kind of clearance known to most doctors is the clearance of creatinine. Creatinine is a waste product from muscle breakdown and is excreted via the kidneys. A lab test called a creatinine clearance is a common lab value when looking for kidney issues. It’s a measure of how much creatinine is cleared from the blood by the kidneys. If there is too little, it could be a sign that the kidneys are damaged.

Just about everything is cleared from your blood over time. And it’s important to ongoing good health that it is. Take this extreme example:

Imagine you are walking on a path in the forest, and you make a turn around a dense bush and run right into a huge bear. Your body will be instantly flooded with all the fight or flight hormones. We all know what it feels like to be scared shitless all of a sudden—it’s not pleasant. But then you notice that it’s a stuffed bear, not a real one. Over the next couple of minutes the fight or flight hormones go away and your heart rate, breathing, skin color and all the rest return to normal.

Where did the fight or flight hormones that appeared almost instantly go? They were cleared from your blood by your liver and other organs.

The same thing happens when you release any kind of hormone for any reason. The hormone in question does its job, then is cleared from your circulation. If it weren’t, you could be in big trouble.

Take insulin, for example. If you eat a cookie, your insulin is going to go up in an effort to keep your blood sugar normal. It drives the sugar from the cookie into your cells for storage, then is cleared from the blood. If it weren’t cleared, it would continue to act and drive your blood sugar so low you might lose consciousness.

Most substances are cleared by the liver, which is one of its main jobs. Some are cleared by the kidneys, and some things by both.

Not long after I came to understand insulin and insulin resistance and how diet figured into the picture, I concluded that somehow insulin got cleared from the blood after it had done its thing. At the time, there was no online PubMed to search for such things. In fact, there was no online. To find something, you had to have a hard-copy medical research paper in hand to get you started. You would look at the citations at the end of the paper, then start tracking those down that had some relevance to whatever you wanted to know. You would seek out those papers, then rinse and repeat until you had your own little research paper library.

At that time, there were few papers on insulin resistance and/or hyperinsulinemia. In fact, when I decided to start checking insulin levels on my patients, the nationwide reference lab didn’t have the capability to check for insulin. I had to badger them for months before they finally came up with a methodology, which, as you might imagine, was expensive.

During all this, I started thinking about how insulin might be cleared from the blood. It had to be. But I couldn’t find any papers on it.

But I figured the liver had to play a good-sized role in insulin’s clearance, so I began thinking about how to make the liver work better. I couldn’t really come up with a plan for making the liver work better, but I did figure out how to keep it from working worse.

As I mentioned earlier in this section, the function and capacity of all organs degrade over time. The liver has a finite capacity to do what it does, and if part of that capacity is in use, then there is less left for other things.

One of the liver’s primary jobs is detoxification. Humans consume all kinds of things that need to be detoxified. Alcohol, caffeine, various drugs, to name a few. And these things occupy the liver’s gradually diminishing capacity to do what it does.

Most people—myself included—could drink as much coffee as they wanted when young and never have a problem going to sleep. As they get older, they discover they can’t. The 50-year-old liver isn’t up to the task the way the 20-year-old liver was.

As people age, they are more apt to be taking prescription medicines for one reason or another. Or even OTC meds for aches and pains. Throw in a few cups of coffee and a cocktail or two in the evening, and the ol’ liver is under some strain.

Even though I couldn’t find any papers on insulin clearance, I knew it had to exist. And I reasoned that all the meds, booze, coffee, etc. older people were taking had to make it tougher on the liver to clear insulin.

So, when people had difficulty losing, I started trying to get them to cut back on coffee, booze (which, if it is pure spirits, contains zero carbs), and at least OTC meds in an effort to give their livers a break. It seemed to work.

I discovered that espresso has only about half the caffeine of regular coffee, so MD and I started drinking that ourselves. (This was way before the existence of Starbucks.) Caffeine is water soluble, meaning it gets pulled out of the coffee grounds by water. Making drip coffee keeps the grounds in contact with the water for a longer period, and so increases the caffeine in the coffee. ‘Percolated or French pressed coffee is even higher for the same reason - longer contact leaches out more caffeine from the grounds.

In making espresso, the steam under pressure does not suck up as much caffeine as does water. But it does pull out more of the oils—kind of like fracking—than drip coffee does. It makes the resulting espresso more intense than drip coffee, but it isn’t because of the caffeine—it’s because of the greater concentration of flavorful oils.

I can’t tell you how many people have told me that they can’t drink espresso because all that caffeine makes them wired. The mind is a funny thing.

If you like to drink coffee, as I do, then switch to espresso. You’ll get half the caffeine as compared to drip coffee. If you don’t like the intensity, then drink it as MD and I do. As an Americano. That is a shot of espresso and hot water. They rarely have drip coffee makers in Italy, so that’s how they make coffee for Americans. I’ve promoted Americanos so much in various publications that I finally decided to make a how-to video years ago. You can watch it below.

Don’t be too critical. It was my first effort. In fact, it was my only effort. I’ve never made another video. I’ve had talks and interviews taped, but never a straight-to-camera video.

The upshot of all this is that if you want to clear your insulin and help your weight come off faster, don’t occupy your liver’s clearing capacity. Cut your caffeine consumption, your booze consumption, and get rid of whatever meds you can get rid of.

Now, I have been recommending this to patients for years. In getting ready to write this section, I took a run through PubMed to see if anyone had written anything on insulin clearance. Imagine my surprise to find a burgeoning literature on the subject. There are now over 7,000 papers on insulin clearance!

I haven’t had time to read them all. In fact, I just found them yesterday, so I spent a bit of time last night skimming a few. And, as I thought long ago, insulin is cleared primarily in the liver with a bit being cleared in the kidneys and a bit in the adipose tissue and muscle.

Here is the graphic that shows it more clearly.

Just to walk you through it, the beta cells in the pancreas release insulin which is sent to the liver by the portal vein. This is important because most people believe insulin is released into the circulating blood. It isn’t. The GI tract and all the organs therein, including the pancreas, release their products into a big vein that goes into the liver before going anywhere else. This means the liver gets to fiddle with it and fine tune it. The liver is the grand director of all metabolism, so that makes sense.

The liver ends up degrading (or clearing) from 50-70 percent (papers vary) of the insulin coming through. It releases what’s left into the blood, where the other organs shown above deal with the rest as needed.

So the liver is extremely important in determining the fate of insulin.

And, as I reasoned long ago, it’s going to do a better job when it is working at full speed without a major limitation on its capacity.

Let’s look at a couple of scenarios.

First, imagine you’re young, and you eat some sugary treat. Your blood sugar goes up; your pancreas dumps a bunch of insulin; your young liver, which is working fine, clears enough insulin so that what gets into the blood is just enough to lower your blood sugar quickly to normal levels. Then the liver, kidneys, muscle and adipose tissue clear any excess insulin. Everything returns to normal.

Now you’re older, and you eat the same treat. Your blood sugar goes up; your pancreas dumps the insulin into the portal vein; but your older liver with caffeine, alcohol, Advil, and God knows what else to deal with can’t clear the insulin it should. Blood levels go up and maybe push sugar too low, making you hungry and driving you to eat more. (A falling blood sugar is the most powerful motivator to eat.) Chronically elevated insulin levels then down regulate the insulin receptors, which then require even more insulin to do the job. And hyperinsulinemia sets in.

There are two and only two steps you can take to stop or reverse this. The first one is not to eat the sugary treat. The second is to keep your liver in the best working order you can given your age.

In scanning a handful of these papers on insulin clearance last night, I noticed that obesity and diabetes both reduced clearance of insulin by the liver. And that’s not to mention fatty infiltration of the liver, aka NAFLD, which really puts the kibosh on clearance . So…

Let’s look at something a little different. How about the government equivalent of a fatty liver.

The Main Industry of Washington, DC

Tucker Carlson released a Twitter video yesterday that was part of his interview with Devon Archer, the former partner of Hunter Biden. Archer appeared Monday in closed testimony in front of a congressional committee. He was supposed to be the secret weapon against Joe Biden.

As I watched the Tucker video, I realized that neither Hunter, nor Joe will be indicted. Why? Because it’s all business as usual in Washington, DC. The main business of Washington, DC is selling influence. Both sides do it, so one side can’t very well blow it all up.

Senators and congressmen make a salary of about $160,000 per year. They get a few perks, housing allowances, travel expenses, etc., nothing close to what it would take to make someone rich. Yet they all come out fabulously wealthy. How does that happen?

In great measure because of the administrative state.

I’ve had bitter experience with the administrative state. It’s a story I might tell later, but not now. But it was brutal. And I escaped after spending a mere $500K to do so.

I don’t want to go into all the details now, but I got caught up in a dragnet of companies one of the regulatory agencies decided it didn’t like. I ended up getting a demand to produce answers to a host of when-did-you-stop-beating-your-wife type questions. Which I answered. Our son at the time worked for a giant, international legal firm, and he told me I really needed a lawyer to deal with this. They set me up with the person they thought was best in this field.

When I met with him, he told me that we needed to go through a specific process to get this all dealt with. I said, Screw it, let’s just sue them. We didn’t do anything wrong. He then told me that we couldn’t sue them.

When I asked why, he said that we had to try to deal with them. If the terms they brought after their investigation were unsatisfactory to us, and we couldn’t come to terms, we could have a hearing in an administrative court in the agency involved.

I said, Okay, let’s just tell them we don’t want to settle and take it to the court. He told me we had to first go through the process, which was already chewing up giant chunks of money on legal fees. Then we could tell them to shove it and have a hearing. But he warned me that we would lose at the hearing because all the judges worked for the agency and simply rubber stamped whatever the agency wanted.

I asked about an appeal.

He said, Sure. But the appeal is heard by another agency judge, and you’ll lose that one, too.

When I asked if there was any appeal to that. He said, Yes, we can appeal it to the commissioners of the agency. All these agencies are run by commissioners who are political appointees. He said the commissioners are not likely to overturn two agency courts.

Only after going through all this could we actually sue them. And at that time, the ball would finally be in our court, because we could find a federal court that had a history of being hard on that particular agency, and file our suit there.

I asked him how much all that would cost. He told me the last time he took a client all the way through the process cost $1.5M. A million and a half dollars just to get to the point where we could sue them. God only knows how much more that trial would cost.

Then I came up with the bright idea to just kill the company. Bankrupt it or just let it die. Then they would have no assets to get, so they would probably leave us alone.

Nope, our lawyer said. Even though all your corporate documents are in order and you are operating as a legitimate corporation, the agency can go right through all that and get all your personal assets. A creditor can’t. The government prevents creditors from going after your personal assets, but not regulatory agencies. Congress has granted them wide leeway. An expression I got very tired of hearing.

We didn’t have the money to go the take-it-to-federal-court route, so we decided to settle the thing. As it went on, we brought more and more proof to light that we hadn’t done anything wrong. The agency ended up telling us they were letting us off the hook, but to not do it again. Our lawyer, who was dumbfounded as he had never seen them let anyone off, told us it was obvious they didn’t have anything on us and didn’t want it to go to trial. These agencies hate, hate, hate to lose.

So, after all the dust settled, we had spent $500K on legal expenses and travel to Washington, DC. Just our photocopying bill for documents they demanded was $50,000, if you can believe that.

Anyway, it made me realize how someone can just be working along and have one of these agencies decide to intervene, for no real reason, and get ruined. It is not what you think of as The American Way.

And you can see why I don’t like the Administrative State.

If you watch just the first few minutes of Tucker’s interview, you can see how Washington works. I’ve experienced it first hand.

I can’t really queue it to the spot, because it’s on Twitter. And you’ll have to go to the link below the graphic. But just watch the first three minutes or so, and you’ll understand. It’s the part where Tucker talks about what Washington, DC does.

https://twitter.com/TuckerCarlson/status/1686799149109256192

The whole system is a morass of regulation and regulators. All created so that congress doesn’t have to be the bad guy and tell people no.

An entire industry has grown up in Washington, DC in which people who have influence use it to help businesses keep from getting regulated out of business. Or let foreign countries—some of which are hostile to us—do things they shouldn’t be doing.

People who work in these regulatory agencies quit and start firms that end up helping people keep from getting regulated. They go back to their former co-workers at the regulatory agency in question and lobby them to let whatever their client wants to go through. The folks who work at the agencies know that when they’ve put in enough time to know enough people and how the system works, that they too can retire and go out and work the system.

Problem is, people who don’t have the funds to pay these companies to keep them from getting regulated, or who don’t think they have anything to fear—me, for example—can get totally screwed.

And it’s all unconstitutional.

It’s not a trial by jury. Yet you’re giving up money or assets or whatever without due process.

But since everyone in both parties is involved with this, I don’t see anything coming of it. Granted most of these influence operations don’t go as high as the Vice President of the United States, but still I doubt anything will happen.

Fortunately, after many years, the US Supreme Court is taking this up in the fall. We might see the end of it. I certainly hope so.

Okay, back to science…

Statins, Diabetes, and Insulin Resistance

A paper is making its rounds right now that I can use to explain a lot of diverse issues in the journal publication business.

The article “Assessing the Link Between Statins and Insulin Intolerance: A Systematic Review” pretty much lives up its title. It does do a pretty good review of the literature on statins, diabetes, and insulin intolerance.

Everyone has known for a long time that taking statins increases one’s chance of developing diabetes. Which has always seemed strange to me. Not the fact that statins cause diabetes in some, but that these drugs are given to prevent heart disease, when diabetes itself is a huge risk factor for heart disease.

Since type 2 diabetes is pretty much always found in association with insulin resistance and hyperinsulinemia, it stands to reason that statins may well induce insulin intolerance. Which is also a risk factor for heart disease.

This is a paper that tells me everything I want to hear. Like everyone’s, my confirmation bias is strong.

Consequently, when I see something I agree with completely, I try to be as rigorous as possible in looking for mistakes. Or irregularities.

One of the first things I do is look at the authors and what institution they work for. If it’s a major university or think tank, I feel more comfortable. No one with a position in a great learning institution wants to be fingered for fraud. Though it does happen. The president of Stanford just resigned after being outed for work that was dodgy.

If it is an institution in China, I am totally skeptical. The Chinese government rewards researchers well who get articles published in the any of the major journals. And, as has been demonstrated at the Wuhan Institute of Virology, all of their standards are not always up to snuff. And having dealt with personnel in Chinese factories who will screw you in a heartbeat, I almost never take Chinese papers at face value. Whatever they say—even if it agrees with me 100 percent—has to be confirmed by another more reputable source for me to believe it.

Now if the authors are Chinese, and they work in an institution outside of China, I don’t have a problem.

This paper under discussion was written by a group of people who work at the California Institute of Behavioral Neuroscience & Psychology, an impressive sounding institution, but one I had never heard of. So, I found their website and took a look. You can, too.

When I first clicked the site link, I got this page.

I clicked on the link and got a 17 page booklet in pdf describing how to write research papers.

When I got past this link, I reached their website home page.

As far as I can tell, the CIBNP is an online school where people can learn to write research papers. You can click on and look around. Most people learn this in PhD programs. I suspect it is for independent researchers or for people who want to add a few papers to their CVs. I’m not sure. The details on the courses I looked at seem pretty comprehensive.

The papers they teach people to write are review papers. The scientific literature is cluttered with them.

A review paper is a paper that is a summary of the medical literature on a particular subject. In the case of this paper, the authors dug out a bunch of papers on statins, diabetes, and insulin sensitivity. They then summarize their findings. There is no original research that’s gone on.

If you read the Materials & Methods section, you can see the search criteria they use. That’s what makes or breaks a paper like this in terms of how trustworthy it is. If you set the search terms and the inclusions and exclusions, you can reach almost any outcome you want.

In this case, I went over the papers they selected on statins and a decrease in insulin sensitivity. There were only three listed. Two from Finland (here and here) and one from South Korea. These are all RCTs and show statins do cause a decrease in insulin sensitivity. Going through the citations listed at the ends of these papers, I found a few others. But they may have missed the mark based on the selection criteria of the authors.

All in all, it’s an interesting paper to read. Nothing groundbreaking, and it looks at both sides of the subject. Plus gives statins a little too much credit for saving lives.

I found it interesting because of the institute from which it came. If you roam through the site, you’ll find a video by a guy extolling the virtues of the various courses. One of the things he says is that you can work with other students and get your name on several papers. Which is what I expect happened here. I don’t know for sure, but I wouldn’t be surprised.

I was surprised to find an online school for this sort of thing. It’s just what we need when the number of scientific papers published is already hitting astronomical heights.

Okay, on to something fun

The Video of the Week

I had never seen anything like this, but apparently it’s a big deal in Japan. It certainly seems like it would take a bunch of coordination and hours of training to be able to pull it off. Here it is. Precision walking.

Okay. That’s about it for today. Keep in good cheer, and I’ll be back next Thursday.

Thanks for reading all the way to the end.

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