The Arrow #143

Hello everyone.

Greetings from Dallas.

Here at Casa Eades we’re in a flurry of activity getting all our stuff together for our upcoming trip to Australia. Both MD and I are speaking at Low Carb Down Under 2023 in Sydney. I’m giving a couple of talks and MD is giving one. When I pulled up the site to get the link and read through it, I discovered that there will be an Ask Mike Anything session. God help me. And MD has a session for her Caddo Bend fans Down Under. All this, and we’re barely recovered from our jet lag after being in Scotland and Ireland for two weeks.

We’re really looking forward to the conference, where we’ll get to meet some old friends and a lot of other docs whom we’ve watched on video, but never seen in the flesh.

Tickets are still available for Low Carb Sydney. And for the livestream of the meeting. You can find them on the website here. Or by clicking the graphic above. Hope to see some of you there. It’s stacking up to be a great conference.

Because I slacked off a bit last week, the vast majority of this week’s Arrow will be devoted to medicine and nutrition. Before I get to that, however, I’d like to add one little video to last week’s material.

The Constitution

Last week I wrote a bit about how I revered the U.S. Constitution, including the Bill of Rights. And how I was worried it was being dismantled bit by bit what with all the government-driven censorship and canceling.

In one of the comments to last week’s Arrow, a reader wrote:

The reader goes on to say he feels, like I do, that our Constitution is being nibbled away piecemeal. But I want to address what he wrote above. Below is a totally non-partisan description of why the Constitution of the United States, though copied by many other countries, works differently here. Though it is under attack right now, and some politicians would love to see it weakened, my hope is that it will weather the storm.

Watch this brilliant, short description of why our Constitution works the way it does.

I find it most interesting that the twits at YouTube feel compelled to add a Context block under the video in much the same way they do when someone discusses the Covid vaccines in any way other than that they’re “safe and efficacious.” I looked up a few Ruth Bader Ginsburg videos on YouTube, and none had Context blocks. So…

Okay. On to other things.

Low-Carb, Thermodynamics, and Mass Balance

Now there is a section title to make eyes glaze over if there ever was one. I’ll try to make it at least moderately interesting.

Most of you probably saw my video of my talk back in January of this year on the mass balance equation. (If not, and if you’re interested, here is the link.) In the talk, I discussed a reason that people lose weight on low-carb diets that really no one in academia has ever mentioned. I wrote about it in The Arrow earlier this year.

Not long after my talk was made public on YouTube I got an email from Richard Feinman, a professor of biochemistry at the SUNY Downstate Medical Center, telling me he had been thinking along the same lines and was glad I had given the talk. Richard and I have been friends for years and years, so I was glad to hear from him. And glad he approved of the talk.

Then a few weeks ago I get another email from him telling me I’m wrong. We had a brief back and forth about it, then he said he was in the process of writing a Substack about it. Which, in due course, he did. You can read it in the link below.

Before I get into his criticism of my talk and forget to do so, I want to highly recommend Richard’s book Nutrition in Crisis. It’s an update of his first book The World Turned Upside Down published in 2014, which I purchased and read when it first came out. Here is the proof in case anyone doubts me.

My copy has a blue cover. Not a yellow one. Nutrition in Crisis is a terrific primer on nutrition, biochemistry, thermodynamics, and the sorry state of nutritional research today. Richard is a terrific writer and very witty. You will not be bored reading his book, even the biochemistry parts. There are many parts that are laugh-out-loud funny. At least to me. But, as you’ve probably figured out by now, I’m a little off as to what trips my sense of humor. If my copy were here, I would provide you with some hilarious quotes, but, alas, it is in Montecito.

Let’s first talk about some basics, then we can get into Dr. Feinman’s critique.

As I’m sure most of you are aware, there is a huge schism in the nutritional community about what causes obesity and why we are in the middle of an obesity epidemic. At this stage of the game, at least, the two are the calories in vs calories out (CICO) folks and the carbohydrate-insulin model (CIM) followers.

Those who are all in on CICO believe we gain or lose weight based on how many calories we consume versus how many we burn off regardless of what the composition of those calories might be. If we take in more than we burn, well, we gain weight.

The CIM is a little more complex. I’ll get to it in a bit, but before I do let’s take a look at the most important differentiating issue between the two.

I wrote about the arrow of causality a few months ago, but I’ll give a brief recap here. The main goal of science is to determine what causes what. Does A cause B? Scientists set up hypotheses to test whether A causes B, then test them with randomized, controlled trials. By randomizing the subjects, all kinds of confounding variables can be removed, so the results end up showing whether A causes B.

Those who believe in CICO, also called the Energy Balance Model (EBM) have a tough row to hoe here. Why? Because all they’re saying is that if you eat too much and don’t exercise enough, you’re going to gain weight. What’s the problem with that?

It’s like going to your favorite local restaurant you go to every Saturday night only to find it completely packed. You’ve always been able to get a table with a minimal wait, but tonight the hostess tells you the wait will be over an hour. You ask her why the restaurant is so crowded, and she tells you, “Oh, it’s because a lot more people are coming in than are leaving.”

You say, Whisky, Tango, Foxtrot! That’s obvious. Why are so many more people coming in? Did a concert just let out? Was there some kind of athletic event that just ended? Did you run a big promotion on your new menu? Was there an article in the paper today about your restaurant? Telling me that more people are coming in than going out tells me nothing. It’s simply a keen grasp of the obvious.

It’s the same with CICO aka the EBM. We know more energy is coming in than going out. The question is, Why?

If you look at the graphic below, you can see what the CICO situation looks like.

Let’s look at this based on what we already know. This hypothesis (which, in my view isn’t really a valid hypothesis, but let’s humor them and call it that) proposes that we overeat and under exercise, so therefore we’re all fat.

They say we overeat because there are is a lot of good food available. So we eat it. Fifty years ago, before the obesity epidemic kicked in, we had good food available to us as well, but we apparently didn’t eat as much as we do now.

Same with exercise. Fifty years ago we didn’t see everyone exercising like they do today. There weren’t 24 Hour Fitnesses or CrossFit boxes on every corner. The roads weren’t crawling with joggers and walkers. The fitness craze was just kicking off. I would wager that the exercise per capita level was significantly lower then than it is now.

But the caloric intake today is much higher than it was fifty years ago. In the terms we discussed above, a lot more people are coming into the restaurant. Why? That’s what the CICO hypothesis is missing. People are definitely eating more, but why? That’s the question.

You might say, Well, they are hungrier today. Okay, I’ll buy that. But, again, why are they hungrier today than they were fifty years ago?

The CIM at least has a reasonable hypothesis.

The graphic below is from a recent paper by Dr. David Ludwig (as is the one above).

Let’s walk through this diagram. It starts at the upper right when we eat a high-GI (glycemic index) diet. Unlike Dr. Ludwig, I’m not a big believer in the GI. Too many variables for my taste. So let’s say we’re eating a high-carbohydrate diet. Why? Well, there is a reason.

In the mid-to-late 1970s, the McGovern committee decided on the basis of literally zero evidence that fat in the diet caused heart disease. Based on this totally baseless notion, the nutritional guidelines were set. When set, Big Food complied. Mainly because the law said that anyone the government fed—prisons, schools, the military, etc—had to be fed according to these low-fat, high-carb guidelines. (I discussed this with Bill O’Reilly years ago—at that time I think the government was feeding something like 53 million people per day.)

So, the amount of carbohydrate in the average American diet went up significantly, which ties to the start of the obesity epidemic.

Returning to the graphic above, we ARE, on average, eating a higher carbohydrate diet than we were five decades ago. That is our starting point.

The greater carb consumption drives the pancreas to produce more insulin. Since insulin is a fat-storage hormone, it makes sense that more insulin will store more fat.

Now we come to the crux of the hypothesis. I’ve put it in a red box.

If fat and glucose are removed from the circulation and stored in adipose tissue under the influence of excess insulin—as they are—then the hypothalamus, the part of the brain that is the fuel gauge, so to speak, reads the tank as getting empty. The same hypothalamus then triggers the hunger response, which drives the urge to eat. And at the same time ratchets back the energy expenditure.

So that is a real hypothesis that can be tested with RCTs. Ludwig and his group have done many of the RCTs along the different points on this pathway, and, so far, the hypothesis seems to hold up.

Plus, there are all the Public Health Collaboration collection of RCTs showing that low-carb diets overwhelmingly crush low-fat, low-calorie diets in terms of weight loss.

In his Substack post, Dr. Feinman writes:

For years Dr. Feinman has studied thermodynamics as applied to low-carb diets and has published a number of peer-reviewed papers on the subject. He believes—and I think he is correct—that the metabolic paths followed by the various nutrients we consume vary in the energy they release.

Let’s just look at one example to keep from getting way too far into the thermodynamic weeds on this. The energy content of protein is 4 kcal per gram. That 4 kcal per gram is in the bonds between the various atoms that make up the amino acids that make the protein. When these bonds are broken, the energy is released for the body to use to create other bonds to make other molecules.

Although theoretically you have 4 kcal per gram, how that is dealt with by your body is a function of which path it takes. If you consume protein, and the amino acids are reconfigured to make muscle, that has a certain energy cost. If you consume protein and some of the amino acids are converted to glucose via gluconeogenesis, there is another energy cost. In other words, you are not going to be able to extract precisely 4 kcal out of a gram of protein. Some escapes as heat.

If you read Dr. Feinman’s papers, you’ll see that he has basically followed the various pathways by which macronutrients are metabolized after their consumption. He makes the case that a high-carb diet will net out more energy ending up being stored than a low-carb diet of the same number of calories.

For instance, your body can make fat out of glucose, but it can’t make glucose out of fat. You need a certain amount of glucose to keep things running properly, so if you don’t get that glucose from carbs because you are on a low-carb diet, then the body has to make them. Which is more costly energy-wise than just bringing them in through your mouth. You’ve first got to break down protein and convert it to glucose via gluconeogenesis, which has an energy cost.

If you’re getting plenty of glucose via carbs in your diet, you use them or store them as glycogen, which can be retrieved at less energy cost than making them from protein.

It’s a complex system, but just understand that it requires more energy by and large to metabolize a low-carb diet than it does a high-carb diet. Therefore you can consume more low-carb food kcal-wise than you can high-carb food and maintain your weight. Or even lose.

Dr. Feinman’s criticism of the mass balance equation as I presented it is here:

He’s basically making the same criticism that a handful of very smart people did right after my talk was posted on YouTube.

They said, You’re simply trading MIMO (mass in versus mass out) for CICO. You’re still not showing causality.

And they—and Dr. Feinman—are correct. MIMO does not show causality, but it is a vastly more accurate way to look at it, in my opinion. If for no other reason than the units are the same.

Here is the mass balance equation:

Change in mass = mass in - mass out.  

All the units are the same. You’ve got grams, kilograms, or pounds on both sides of the equal sign.

When you lay out the energy balance equation, you don’t have the same units.

Change in mass = energy in (kcal) - energy out (kcal)

Here you’ve got mass or weight on the left side and energy, which weighs nothing on the right hand side.

You might as well say change in weight = heat in minus heat out. Heat does’t weight anything. The equation is meaningless.

Other than the folks who attended LowCarbUSA in San Diego last month or those who purchased the videos of the talks, no one has seen my second talk on the mass balance equation.

(In case you’re wondering, I don’t know when or if they are ever going to remove the videos of these talks from behind a paywall.)

In the talk, I brought up the idea of causality and made the case that I thought science would make faster progress determining more accurately how the whole process works by using the more accurate mass balance equation instead of fiddling around with CICO.

It is much more accurate in predicting weight loss (or gain) than is the energy balance equation. And explains much better the findings in all the many weight loss studies.

If researchers looked at mass in vs mass out, I think their metabolic chamber studies would be more accurate and more predictable than trying to fiddle with calories in vs calories out, which are difficult to measure. And then trying to determine energy expenditure, which is horribly difficult at best, would be a thing of the past.

Okay, enough on this.

I do want to give you something to think about. I’ve dealt with kcals my entire career, but I learned something I just could not get my head around while I was doing research for the latest talk I did.

I went back and looked at some of Atwater’s work instead of just reading about it. In doing so, I came across this statement of his back in the late 1800s. This is an excerpt from a book he wrote explaining his work. In his day, Calories (with a capital C) meant 1,000 little c calories or one kcal.

As you can see, his definition of a Calorie (or kcal) is essentially the same as it is today: the amount of energy required to raise a kilogram (or liter) of water one degree Celsius.

But look at the part I underlined in red. One Calorie (or one kcal) is the amount of energy required to life one ton (2,000 pounds) 1.53 feet off the ground. In other words, the number of kcal in a measly teaspoon of sugar (5g) is enough to lift 2,000 pounds 7.65 feet off the ground. I thought there had to be some mistake, so I looked it up. And, sure enough, one kcal equals 1.53 foot-tons.

That was stunning to me.

If you think about how many kcal you burn in a day, say 2,500, that means you burn enough kcal to lift a ton of weight (that’s a small car) 3,825 ft (or well over half a mile) in the air! In just one day.

That’s how much energy it takes to just get you through the day.

Incredible!

David Diamond, Statins, and the Low-Carb Diet

I said last week’s Arrow was going to be video intensive, because I intended to put up a couple of videos, then ran out of time and space.

For those of you who don’t know him, Dr. David Diamond is a neuroscience researcher and professor from the University of South Florida. Years ago he discovered he had extremely elevated triglyceride levels (~775 mg/dl) along with low HDL levels. His doctor was alarmed, but David decided he could treat his problem with exercise and a low-fat diet. All he ended up doing was getting fatter and making his triglycerides worse.

Finally, his doctor told him he was a heart attack waiting to happen and encouraged him to go on medication. Before he went on the drugs, he decided to dig in and use his own research abilities to see if there were any other treatment strategies he might deploy.

This video (below) is his story. And what he learned about triglycerides, LDL, and HDL. And how he treated his own problem.

Dr. Diamond is an excellent speaker, so I’m sure you will get a lot out of this video. Especially if your doctor is badgering you about taking a statin.

Enjoy!

Okay, let’s jump from one video to the next.

Carbosis

Dr. Mercola must have been busy the last couple of weeks. I’ve had a handful of people send me this video by Denise Minger from several years ago that Dr. Mercola had apparently posted on his site. It is about the almost miraculous results some people achieve by following a very low-fat, high-carbohydrate rice diet. The video has been around for five or six years, so I don’t know why Dr. Mercola decided to show it now.

Give it a watch, then we can discuss.

When this video first came out, Peter Dobromylskyj did a long blog post on it. He described how “carbosis,” as Denise calls it (as a play on ketosis), could bring about weight loss. He described in detail how it would work via his Protons theory of localized mitochondrial insulin resistance. I’ve discussed his theory, of which I am a believer, in a talk I gave several years ago. You can give it a watch if you’re interested in the nuts and bolts.

You can read Peter’s blog post to see his hypothesis as to how his Protons theory would work with an extremely low-fat, extremely high-carb diet. But I just want to bring up his conclusions about this diet versus a low-carb diet. Which are on the money.

  [Image from Peter’s blog post]

I agree completely. You may end up with some good results on the Rice Diet, but odds are against it.

As I wrote above, I intended to write this last week and include Denise’s video, but ran out of time. I’m glad I did when I looked at my emails this past Monday morning.

Zoë Harcombe had done an entire post on the Kempner Rice Diet. Apparently, she had been getting deluged by people who saw the video on Mercola. At least that’s what I assume.

Just to show you how effective this diet could be, here are a couple of photos from one of Kempner’s papers.

There are several more photos in the paper linked above. As you can see, some subjects lost a tremendous amount of weight. But how many? And at what cost?

Zoë’s post is behind a paywall, but I would encourage you to subscribe. She does a masterful job every week—her posts come out on Monday—describing some aspect of nutritional science in great detail. And if you ever get the chance to watch one of her talks, don’t miss it. They are second to none.

I’m going to post just one little bit from her post on the Kempner diet. As you might imagine, an extremely low-calorie, high-carb diet would be difficult to remain on for any length of time. These diets would bump insulin due to the sugar—there was plenty—along with the rest of the carbs, which would tend to move the nutrients from the blood to the adipose cells. And there weren’t many kcals, to boot. So it must have been a tough go hunger-wise.

It must have required incredible will power to stay on such a diet.

Perhaps they had a little help.

According to Zoë (and Zoë is nothing if not meticulously accurate)…

There you have it. The cat-o-nine-tails diet.

Read Zoë’s post. It’s terrific.

I just discovered that Amazon Prime is going to start charging $2.99 for ad-free versions of Prime videos you’re already paying for if you have Prime, which I do. I just learned about this treachery from The Hustle, a daily newsletter filled with all kinds of info. You can subscribe here. It’s absolutely free. It’s the first thing I read every day. I’ve been meaning to write about how Amazon is the in-the-US version of China. I just have’t gotten around to it yet.

Avoid the Semaglutide Drugs

A friend sent me a great article on Wegovy and Ozempic. I think it’s great because the writer pretty much feels the same way I do about it.

The title of the article is Ozempic Is A Permanent Treatment To A Preventable Problem That Already Has A Cure. The subtitle is “In desperation, Americans are getting hooked on a lucrative drug that conveniently capitalizes on the obesity epidemic.”

Very true.

As discussed many times in these pages, the muscle loss is the biggest issue I have with these drugs. Other, of course, than the studies show those who go off of them gain their weight back as fast as they lost it.

Once you get past age 30, your muscle is your life’s blood. But it begins to fade away if you don’t do something to help keep it around.

What can you do?

Two things.

Eat a lot of protein and do strength training. That’s about it.

Unfortunately, it is much easier to lose muscle than it is to get it back. If you take these drugs, you will lose a lot of muscle. When you quit taking the drugs, you will regain your lost weight. But, and this is a very important but, you won’t regain what you lost in the same proportion as you lost it.

You will regain primarily fat and very little muscle.

I can’t say this strongly enough. You’ve got to do everything you can to maintain, or even increase, your muscle mass.

A number of doctors are advocating staying on these drugs forever. Obesity is a chronic condition, they say. It’s like diabetes or high blood pressure. You don’t just treat those for a few months, then stop the meds. Why do that with these truly effective anti-obesity medications? You need to take them for life.

Well, problem is, no one knows what the long-term effects of those drugs are. They may be fine for the long term, but my suggestion would be to let someone else be the guinea pig on that one.

But whether you take these drugs for the long term or short term, you are going to lose muscle. Which you do not want to do.

The headline of the article mentions a cure that is already available. What is it?

You can read more on this subject on the Substack of Lee Fang. See below.

My advice, for what it’s worth, is to avoid these drugs until we know a lot more about them.

Fauci Gets In Deeper

If you’ve read all about this already, you can skip on down. I read the mainstream press and all the alternative sites and Substacks. None of what I’m about to tell you is in the mainstream media.

One thing that did make its way into the mainstream press—not the headlines, but a few pages in—was the discovery that the CIA had determined that the odds were likely that SARS-CoV-2 escaped from the Wuhan lab. Then someone paid the CIA agents who made this determination to keep silent about. You can read about it in depth here.

Now as it turns out, Anthony Fauci visited the CIA without a record of his doing so.

The Daily Mail reported 

I read multiple reports on this over the past few days. It may be nothing, but I wouldn’t put anything past The Fauc given his behavior during the pandemic.

Here is the most concise one I’ve come across. From The Scroll.

More to come on this, I’m sure.

Those Who Don’t Know History Get Slapped By It

I just can’t resist this one.

Back when the Freedom Convoy in Canada when all the truckers who refused to get vaccinated showed up in Ottawa, the local mainstream news media showed photos of all kinds of protest signs bearing swastikas, implying that the truckers were somehow neo-Nazis. The truth was that the swastika signs were meant to signify not the beliefs of the truckers and their supporters, but the administration of Justin Trudeau., which the truckers thought was acting in a fascist way.

Occasionally, I’ll still read something every now and then about the neo-Nazi trucker convoy in Canada.

Well, karma struck a couple of days ago. And struck hard.

Ukraine’s Volodymyr Zelensky was there in parliament along with the speaker and Justin Trudeau himself. The speaker (now resigned), one Anthony Rota, invited Yaroslav Hunka, a former member of the 14th Waffen Grenadier Division of the SS (1st Galician) to be honored. Why? Because he fought against the Russians in WWII.

No one stopped to think about who fought against the Russians in WWII, before inviting this guy. It’s like with Trump: Orange Man bad. Anyone against him is good. So now it is Russians are bad, so anyone who fought against them is good. Even a Nazi. Though they didn’t know that, because no one had stopped to think about actual history for even a moment because: Russia bad. No one apparently remembered that Germany was Russia’s enemy in WWII.

The old guy stood up and everyone stood and applauded like trained seals. Had they had even a smidgen of knowledge of WWII history, they might have thought twice. It was hilarious and a brutal humiliation.

As much as I’m enjoying the fallout from it, I’ve got to say that Ukraine suffered mightily under Stalin prior to WWII. They endured what is called the Holodomor, the great Ukrainian famine in the early 1930s, during which millions of Ukrainians starved. As a consequence, I’m sure many Ukrainians feared and hated Stalin more than they did Hitler. Many signed up for the German army just to fight Stalin and, it was hoped, pry Ukraine free from Russia. In fact, the unit Hunka was in was also called 1st Division of the Ukrainian National Army. After what Stalin did to them, I couldn’t blame them.

Perhaps Yaroslav Hunka was one of those. I have no idea. I went to Wikipedia on the off chance I might learn something about him, and came across this:

Because one of their own is being humiliated, Wikipedia is contemplating removing Yaroslav Hunka’s page. I don’t know how long it has been up there, but it contains quite a history. Strange that no one bothered to look before inviting the guy.

Many, many applauding seals with red faces, and I’m eating it with a spoon.

Video of the Day

Here is a great video I came across on Twitter. In fact, I posted it on my own account. I love videos like these and haven’t posted one in a while.

This video was shot in Lyon, France in 1896. AI was used to colorize and smooth out the jerkiness inherent in old videos. Notice that there is no obesity in sight. Enjoy!

Here is the Twitter link for details.

Give a quick click to the Like button if you enjoyed the post.

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

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