The Arrow #148

Hello friends.

This issue of The Arrow is longer than usual. I’m compensating by sending it out earlier than usual.

A lot of stuff this week including a great new study that confirmed what I already pretty much knew. But nice to have it confirmed officially. Before we get to that, though, I’ve got a few personal details to write about. For those of you who are interested in those sorts of details. The rest can skip on down.

Let’s roll.

Weird Personal History

Have you ever had someone from your past—even a brief acquaintance—pop up in the news? If so, you’ll know what a strange feeling that is. I just experienced it.

Ten or fifteen years ago MD and I used to attend a party in Santa Monica on the first Friday of every month. The event was held at the house of a big time Hollywood screenwriter who shall remain nameless. I suspect most of you have seen one or more of his movies. We cadged our first invitation through our good friend Amy Alkon, The Advice Goddess. Once we started going, we had such a good time and met so many interesting people that we never wanted to miss a First Friday. If we were in town, we were there.

The invitees were a mixture of writers—both fiction and non-fiction (which is how we got an invite)—people in law enforcement (which was strange), various columnists, libertarians, TV and movie celebs (not a lot of those, but a few), and a handful of other diverse characters. One of the regulars was Andrew Breitbart (RIP), who was a terrific personality. A few months before he died, I spent about 40 minutes with him one-on-one talking about diet and nutrition.

On a good day, it took MD and me about an hour and a half to drive down there from our place in Montecito. But LA traffic can be brutal, especially at that time of day, and could take as long as two or more hours. Since we enjoyed these get togethers so much, we didn’t want to be late. We always left in plenty of time to get there circa the 7 PM starting time.

One day we left at our normal time, and for whatever reason there was practically zero traffic, and we got there 30-40 minutes early. We decided to go on in and then went down to the deck overlooking the Pacific and grabbed a drink from the bartender just getting set up. While we were sitting there all alone sipping our wine, this sort of nebbish bespectacled guy with red hair and a red beard walks out on the deck. He grabs something to drink and makes a beeline for us.

I had never seen the guy at one of the parties before and never saw him at one after. He walks up to us, sticks out his hand, and introduces himself as Charles Johnson. We did the normal chit chat and what do you do and what do we do kind of thing. He told us he was a political consultant and an author. He told us he had just had his first book published, which was a book on Calvin Coolidge, a US President about whom I knew almost nothing. Which I told Charles. He asked for our address and told us he would send us a copy.

In due course, all the party regulars began to show up, and we all ended up mingling.

About a week later, I get a package in the mail. It is the aforementioned book. It was titled Why Coolidge Matters: Leadership Lessons from America s Most Underrated President. I read it. And it was a really good book. I learned a lot. Plus after reading it I wished we could have another Calvin Coolidge at some point.

As I recall, I dropped Charles a quick note thanking him for the book, and kept waiting to run into him again at one of the parties. But I never did. In fact, I never saw him again. Or heard of him.

Until last week, when I come upon an article on MSN titled “Far Right Billionaire Peter Thiel Revealed As FBI Informant.” What?!?! In the first place, I don’t consider Peter Thiel as being far right. Second, he doesn’t seem like the type who would be an FBI informant. I read on in the article, and come across this paragraph:

So, I go to the link above, and there is a photo of Charles C. Johnson, who looks much like the guy I remember. But I’m not sure because the guy I remember had kind of reddish hair. I go to the Insider to read the original article and see if there is a photo. Sure enough, there is. And it is the same red-haired Charles Johnson I remember.

Wow! Since these are notoriously left wing publications, I’m not sure I buy everything they say about him. Based on my one and only meeting with Charles, I would have described him as being just the kind of guy who would write a book about Calvin Coolidge. Who knew?

Protein Power History

I had a weird confluence of events a couple of days ago. As those of you who have been readers for a while may remember, MD and I moved a ton of stored junk out of a storage unit and parked it on our driveway. MD worked like crazy to get most of it—that we paid for years and years to store—ground up and carted off. The few boxes remaining were those she wanted me to go through.

Which I finally started to do a couple of days ago. The first box I grabbed and started rooting through was the box containing the early manuscripts of Protein Power. After I was about halfway through the box, MD came out and said, “What are you doing?” I said, “I’m going through these boxes you’ve been hounding me about.” She basically called me a moron and told me those weren’t the boxes she wanted me to go through. She had already gone through those boxes, and their contents were keepers, slated to go back into storage. It was a whole different stack of boxes she wanted me to go through. The whole situation was eerily reminiscent of that great scene in Butch Cassidy and the Sundance Kid.

Anyway, despite attacking the wrong pile of boxes, I struck gold. It’s always nice to kind of unearth a time capsule years after events have taken place. Here is a photo of some early notes I had written down late at night on the structure of the book that became Protein Power.

For those of you who can’t (or won’t) read a doctor’s handwriting here is what I wrote way back in 1990. [The bride would object. She’s a rare exception to that truism; she has lovely handwriting.] I had already had plenty of experience taking care of people with lipid issues, which, at the time, were always referred to as ‘cholesterol’ issues. These are proposed bits aimed at the reader of the as yet non-existent book.

I don’t have a copy of Protein Power at hand as I write these words, but as I recall, the above pretty much made it into the book.

I especially like the words at the very top. I have no recollection of writing these late-at-night notes, but apparently I thought they were pretty good at the time. It was a habit of mine at the time when I couldn’t sleep to get up and write by hand. Now, I just lay in bed and type on my iPad. Back then I had only a desktop, so it was much easier not to mention convenient late at night to write on a tablet. A paper tablet. By hand. With a pen.

I don’t know if the book was as good as I hoped it would be when I enthusiastically wrote the words at the top. But it certainly sold well enough. It ended up staying on the New York Times Bestseller List for 63 weeks. Which one would think would make me happy, but it could have been so much better.

Let me explain.

But first, let’s take a look at the New York Times Best Seller List.

As it so happened, the NYT Best Seller List was the subject of my favorite daily newsletter The Hustle on Monday of this week. I was able to learn a lot I hadn’t previously known about this mysterious list as a consequence. For authors the NYT List is the place you fervently want to be because the books on this list get put at the front of all the big chain bookstores and even small bookstores. If you go into a Barnes & Noble (about the only big chain bookstore still in existence) today, you’ll find all the NYT bestselling books up front and heavily discounted. Authors love discounted books, because authors get paid a royalty on the cover price of the book, not the price it actually sold for. So the bigger the discount, the more sales, the higher the royalty checks.

How does a book get on the NYT list? It’s a major secret in publishing, and no one—other than those in the bowels of the NYT book section—knows. And, not surprisingly, they aren’t talking. According to The Hustle article, only 0.00208 percent of books ever make it to the NYT list.

The article goes on to discuss the secret formula the NYT uses to figure out who gets on the list. Unfortunately, they are unable to give any specific information other than the NYT uses sales from some specific bookstores throughout the country. And, although they didn’t mention it, I would suppose these days Amazon sales would count.

In other words, you can buy your way on to the list if you can afford it. Or if you’ve got inside info on how to game the system.

The article says that most first authors have to do something to get on the list or have a lucky break.

At the time we wrote Protein Power, we were spending a lot of time with Barry Sears, the author of The Zone. We often found ourselves together on the speaking circuit, so MD and I became good friends with Barry. Although our book had been mostly written and submitted to my original publisher in manuscript form, there were delays, and we ended up changing publishers and that’s a whole other story. At any rate, his book came out before ours, and his sales kind of idled until he got a lucky break. He got on an extremely popular talk radio show in LA, and the host was taken with him. Barry was just supposed to have a short segment, but the host kept him on for the entire two hours (as I recall; the time might have been a bit different). That one gig threw him onto the LA Times bestseller list. Then he ended up on a best seller list in San Francisco. Then went from there and ended up as a mega best seller.

Our book came out six months or a year later, and the same thing happened to us. Sales of Protein Power languished. We were all over the place on a book tour promoting it, but it just didn’t catch fire. As part of our book tour, we gave a bunch of public educational talks. After one of them, a guy approached us and asked us to go to dinner with him. We had nothing better to do other than go to dinner by ourselves and head to the hotel, so we said, Sure, why not?

At dinner he told us he was the talking head for a number of infomercials, and he thought our book would be a great product for one. He threw around all these huge numbers of money various people had made on infomercials, all of which both MD and I thought were BS. We told him we would think about it.

He kept after us and told us he had persuaded a big infomercial company to take a look at us and our book. They paid to fly us to Portland, Maine (of all places) to give us the once over. It was in the middle of the winter and freezing-ass cold in Portland. We discovered there are a million infomercial companies in Portland and environs because, I suppose, people have nothing else to do there for about eight months of the year. So there are a lot of infomercial companies and call centers.

After much back and forth and haggling, we decide to license our likenesses and intellectual property (IP), i.e., our knowledge, to this infomercial company. Life then becomes intense. We are back and forth between Little Rock and Portland every time we turn around it seems. We have to go to brainstorm with their creative team on how to exactly promote our IP. Then we have to go to work on a show. Then we have to go to film the thing. Then we have to write all the supporting material — workbooks and the like.

All the while, Protein Power sales were not setting the world on fire.

And this is the point at which I really get pissed and vent my spleen at publishers in general and our own publisher, Bantam Books, in particular.

The experience I’m going to relate has convinced MD and me that publishers are in the business of printing books, not selling them. They have a sales force, but they just can’t seem to sell books. If they get an author who is a known name—a celeb, for instance—they pay big bucks, because they know the big name author will sell him- or herself. If a book is terrific, but the author is a no-name person, then the publisher gives it a bit of a push by sending the author on a rinky dink book tour, and that’s about it. If the book doesn’t sell, then, in the publisher’s eyes at least, the author(s) are un-promotable. If the book sells well, then they pat themselves on the back for having done a helluva job.

The normal life of a book goes through a few phases. First, the hardcover comes out. When hardcover sales begin to flag, then they come out with a less expensive trade paperback, which is the same size as the hardback, but has a soft cover. And is about half the price of the hardback. When those sales start to fall off, then it’s time for what is called the mass market paperback, which is the small format you see on book racks. (This scenario was all before digital books even existed, so now you’d throw Kindle into the mix right from the get go.)

The bone-headed, obnoxious, indescribably stupid behavior of the chief pinhead at our publishing house.

If for some reason you think I might be annoyed at our publisher, you would be correct. One of my favorite books of all time was written by an Italian professor and titled The Basic Laws of Human Stupidity. The book lays out all the laws of human stupidity and basically defines it as doing something that hurts or damages both the stupid person and someone else.

This applied in spades to the president of Bantam and his underlings. He made a stupid, stupid, stupid decision that cost both Bantam and MD and me a lot of money. And, I’m sure, to this day, he thinks he is a genius, which is what’s truly pathetic.

Here’s what happened.

While MD and I were working on getting the infomercial filmed and produced, sales of Protein Power were headed into the summer—a bad time for books on diet and nutrition. The idiots at Bantam were starting to talk about bringing the book out in paperback in the fall. I told them we were going to be doing an infomercial that would put our faces and the name of the book on TV stations all over the country. It would be free advertising for them and for us. I begged them not to go the paperback route until we had a least given the infomercial a try.

They relented and said they would push it off for a bit. We went ahead and finished all the work on the show—which you wouldn’t think would take forever, but always does. When we finally had it in the can, we talked the infomercial people into burning us a copy on VHS tape (DVDs weren’t even around yet), which we planned to show to the folks at Bantam, so they could see we really were working on this project. The way they had been acting made me think they might have been thinking we were BS-ing them just to keep the book out in hardback.

When I got my hands on the tape, I sent it to them. The entire program was 30 minutes long, and it featured MD and me in a talk show/interview setting with the guy who had brought us to the table doing the interviewing. The infomercial company was trying to decide what to call the program and our nutritional regimen. They were worried that with a book out there, people might see the show and then buy the book instead of the much higher priced informational product we had been working on with them.

Someone at the company had good sense and said, Look, people who buy through infomercials are not book buyers. And people who buy books probably don’t buy much through infomercials. Protein Power is a great name. Let’s go with it. That’s the difference between people who have business brains and publishers.

When Bantam got the VHS I sent them, instead of being ecstatic, they were disappointed, angry even. Somehow they expected MD and I would be waving around a copy of Protein Power during the show. I don’t know how or why they would think some other company was going to spend the thousands of dollars they paid to schlep us back and forth to Portland, Maine, put us up, and front the money to make a video and then buy the TV time to promote Bantam’s book, but they did. And when the show didn’t have us specifically showing the book, even though it was us on the set, our names in the news, and the name of the show and the product was the Protein Power Plan, they thought they had been ill used by our (and our agent’s) begging them to hold off on the paperback.

So, despite our protestations, the head honcho at Bantam makes the call to put the book into paperback. And not just any paperback, but the mass market paperback. I was absolutely livid. And I pretty much let everyone know it.

The problem is that all these idiots in publishing are English majors. They don’t have MBA’s. These folks work their way up from a lowly assistant editor to editor, to senior editor, to publisher (a title in a publishing company), and finally to an executive position. They are still English majors, not business people.

And, worst of all, they live and work in New York. Both MD and I love New York and have spent a ton of time there and have a lot of friends there. But people in the publishing business in New York think anyone who is not from New York or who doesn’t have a degree from Harvard is not worth listening to. Especially not a rube from Little Rock, Arkansas. They sometimes just have this supercilious aura about them that makes the redneck in me want to smash them in the face.

The infomercial was going to roll out in July. The pinheads at Bantam told me the paperback wasn’t going to be out until late January/early February. So I figured we would have six or seven months of hardcover sales driven by the infomercial, assuming, of course, that the infomercial was a success. If it didn’t sell, then the company would not spend the money to run it and would be looking for another product. They had warned me this might happen, which worried me about Bantam. Because had they held off on the paperback, then the infomercial flopped, we would have really been humiliated.

As it turned out, the infomercial was a huge success. It did way, way better right out of the gate than anyone at the infomercial company expected. MD and I had decided to move our clinic from Little Rock to Boulder, Colorado. So while that move was in flux, we did some traveling. We ended up all over the place, and everywhere we went, we, like all authors, went into bookstores looking for our book. When we found one or more copies of Protein Power, we always turned them face out. Again, as all authors do.

Problem was, we didn’t find a lot of copies of the book. When we would ask the people at the store about it as if we were customers, they would look it up. Then they would say, Oh, it’s coming out in paperback next year. Would you like us to order you a copy?

After having this happen over and over, I checked with our agent and discovered that once the book company announces that the paperback is coming out, that’s a sign to the bookstores that the hardcover isn’t selling well. So the people at the bookstores pack them up and ship them back. Most books at bookstores are bought on consignment. So if they haven’t sold within a certain period, the bookstores can simply send them back to the publisher for full credit.

So, instead of getting a ton of hardcover sales before the paperback came out, we got almost no hardcover sales because the stores had already sent them back. The infomercial company is by this time running about a million dollars a month in television media buys promoting us and the name Protein Power, and there are no books in the store thanks to a stupid decision made by the jerk who ran Bantam.

Just dandy.

Then late January of the next year comes around and the bookstores are full of Protein Power paperback books and the book almost immediately hits the NY Times list and stays there for 63 weeks.

So, all’s well that ends well, right?

Not exactly.

Let me explain the economics.

At that time, the cover price of the hardcover version of Protein Power was $22.95. The cover price of the paperback was $4.99.

Here is how the royalty system works, which is pretty typical. On the first 10,000 books that go out in a given format, say hardcover, the royalty is 10 percent of the cover price. After the first 10,000 sales, the royalty jumps to 15 percent of the cover price. Same thing happens with the paperback.

It doesn’t cost as much to print a hardcover book with a book jacket as you might think. At that time, it was probably about $2.50 all in depending upon the print run. It cost a little less than a buck to print a paper back.

So, our royalty on the first 10,000 copies of the Protein Power hardcover was 10% times 10,000 times $22.95, which comes out to be $22,950. Any books sold beyond that—and very, very few books sell over 10,000 copies—would have netted us $3.44 apiece. So, another 10,000 sold would have given us $34,400.

The paperback is a different deal. The first 10,000 sold netted us $4,990. Any books sold after that would have paid us about 75 cents, apiece.

Given the massive promotional power of the infomercial that was running 24 hours per day, we sold about 4 million copies of Protein Power. Mainly in paperback format.

Would you rather have 4 million times 75 cents or 4 million times $3.44? It’s an easy question.

Plus, how many book sales did we lose during the six or seven months there were no books on the shelves?

You can probably see why I was annoyed, to put it mildly.

We probably wouldn’t have sold 4 million hardcover books, but you never know. And we don’t know, because there were no hardcover books available. The infomercial product was selling for ~$150, so at $22.95, the hardcover book would have been a bargain.

The worst part of the whole thing—actually, there were two; I’ll get to the other in a bit—was that when the paperback hit the Times list, our idiot of an editor called to congratulate us and tell us we shouldn’t have worried. That the head of Bantam was a genius. And that he made the right decision to put the book in paperback when he did as evidenced by the fact that it immediately hit the list.

I was speechless. And Jesus wept.

How much did the dipshit who was the head of Bantam cost us? And how much did he cost Bantam in hardcover revenue. It beggars belief. Truly stupid as defined in the book mentioned above.

We loved our first editor on the book. The one who bought it and nurtured it to completion. But she ran afoul of the same guy in the company, and they ditched her. We’re still friends. She was replaced by a young woman who thought her mission in life was to make Protein Power a better book by getting rid of the paleopathology and Egyptian mummy chapter. I told her she was crazy and that everywhere we went people told us that chapter was what they found so persuasive. She would not relent. She kept saying It’s a distraction to your message.

We fought over it constantly. Finally, we compromised and moved it to the back of the book as an epilogue. Which I wasn’t happy about, but I was so beaten down by fighting with her in particular and Bantam in general that I gave in. Though not completely. The chapter is still in the book. And I’m sure she’s still somewhere making someone else’s life miserable.

One last coda to the Protein Power story prompted by another thing I found in the box I shouldn’t have been searching through.

When I was in college, I worked for the US Forest Service in the Toiyabe National Forest (now called the Humbolt-Toiyabe National Forest) during the summer. I was on the trail crew, which was composed of another guy and me and four horses. We would ride our horses up the eastern side of the Sierra Nevada mountains into Yosemite, which is National Park territory. We would then ride through Yosemite to the next trail coming back down into Toiyabe territory. We would repair all the trails going both ways. We would be out 7-10 days at a time, which required us to use pack animals (thus four horses) to haul our food, cookware, sleeping bags, tent, shovels, and all the rest of the tools we needed to clear trails.

It sounds like a romantic job, but it was the job where I lost all my fondness for horses. They are a major pain in the rear when you have to deal with them all day long every day.

My partner in all this was a guy who was a year older than I was. And he loved to read western novels. I wasn’t a big western reader, but he told me I really needed to read two in particular. The first one was The Big Sky and the second in the series was The Way West. Both were by A. B. Guthrie, Jr., whom I had never heard of. The Big Sky was written in 1947 and The Way West came out a few years later and won the Pulitzer Prize for fiction.

My partner lent me his copies, and I read them during the summer, often astride a horse. We had one spell of continuing rain, so we holed up in our tent in a clearing. Our horses and pack horses were hobbled, so they stayed fairly close. So for two days, all I did was read all day long in a tent with occasional trips outside to check horses.

I don’t know if it was situational or what, but I fell in love with those two books. I read them over and over again. Especially The Big Sky, the protagonist of which was a mountain man named Boone Caudill. The book starts out with him as a kid running away from his brutal father and heading west. Great, great book.

One of my good friends, who was also a doctor—he was in MD’s med school class—loved to read westerns. When I learned this, I told him about the two books I thought were fabulous and had read repeatedly. He bought copies and read them. This was during the writing of Protein Power, and he faxed me the two pages below, which I found in the Protein Power box. I had, of course, forgotten all about this passage as I was not into diet and nutrition when I read these books. This is from The Big Sky:

If you like this kind of book, then get copies of The Big Sky and The Way West. They are terrific. They are both still in print, which says something, and are available at Amazon. In my library packed away in storage, I have first editions of each signed by Guthrie. One even has a long inscription by him. He didn’t sign them for me—I sought them out in the collectors’ market. The books are that good.

How Real Investigative Reporters Work

Remember the major NY Times screw up on the hospital that was supposedly blown to bits by Israel, killing 500 Palestinians in the process? And how they continued to change the headline as more info came in. But still always with 500 dead victims.

H/T to The Free Press for the image above.

David Zweig, who writes one of my favorite Substacks set out to find out how all these journalists came up with the death count of 500.

Much of his reporting (which I pay for gladly) is behind a paywall, but this one is public. Give it a read. Shows the lengths good journalists go to before making claims.

The situation reminds me of Jack London during the Russo-Japanese war in 1906. The Japanese crushed the Russians both on land and on sea. And Jack London was there to report on it.

I read a great biography of him written back in the late 1990s that described how he was one of the very few reporters who actually went to the fronts of various battles and reported on them. Most of the other reporters served their time in the bar waiting for others who had been to the front to come in and tell their tales. Then these barstool reporters would wire stories to their various papers pretending them to be eyewitness reports of the various battles. Jack London’s were the real thing.

Given how numerous reporters from all kinds of media botched the story of the hospital in Gaza, I guess things haven’t changed a lot.

Has The Cochrane Report Lost Credibility?

For years the Cochrane reports have been the go-to source for physicians and scientists wanting to get the real truth about various drugs and other treatments for all sorts of medical conditions. The administrators of Cochrane sought out and recruited experts in the field who were also excellent researchers and interpreters of the research of others. These folks would sort through all the research that had been done on a given subject, put the data through a wringer, and distill all the results into a report representing the most scientific state of the art possible at the time. For years, Cochrane has been the gold standard of scientific reporting.

Then, a few years ago, trouble started brewing. There was dissension among the leadership. Some long term staff left. Some scientists who had been there from the start resigned. Now Cochrane has lost some of its luster.

And I suspect it’s going to lose a whole lot more of its luster given its latest report.

According to another of my favorite reporters, Maryanne Demasi, there is more trouble brewing. The latest Cochrane report basically says the Covid mRNA vaccines are pretty much harmless, i.e., they’re safe. And, at least according to the report, reasonably effective.

In my opinion, any fool can look at nothing but the VAERS data and realize there is something way different about these so-called vaccines as compared to most other vaccines that have been in use for decades.

Other doctors and scientists feel the same way, and they are pushing back hard on Cochrane to revise their report. One can’t help but wonder if it’s a follow-the-money issue.

You can read about it below in full.

Fat and Carbs: A Deadly Duo

I want to discuss a couple of old studies I turned up while preparing for my talk in Australia. These studies together show how the combination of dietary fat and dietary carbohydrate has a huge additive effect on insulin. Dietary fat by itself doesn’t do much to insulin levels. It sends them up a tiny bit, but not enough to worry about.

As you might imagine, dietary carbs send insulin levels skywards pretty quickly.

But if you ingest the combination, insulin goes through the roof. Much more than just the combination of the rises driven by carbs or fat individually. The whole here is truly greater than the sum of the parts.

Just about every processed food you can think of contains this concentrated combination of fat and carbs. Which is one reason processed foods are so bad. They drive insulin levels to the moon.

I can’t remember for sure who alerted me to an important fact about all this that I want to pass on to you. I’m pretty sure it was Gabor Erdosi. He asked ‘Can you name a food in nature that contains a lot of both fat and carbohydrate?’

It’s easy to name any number of foods found in nature that are high in carbs. Same with fats. But can you name any that are high in both? Think about it and let me know in the comments if you come up with one. I’m not saying it can’t be done; I’m just saying such foods, if they exist, are rare in nature.

Now think about the fact that many of us (well not us, as in most readers of this newsletter, but our less nutritionally informed brethren) get most of our caloric intake in the form of the fat/carb combo. Our taste buds love the combination. Think donuts. Think potatoes and butter. Think ice cream. Think almost any kind of processed food that isn’t pure carb.

We love this taste combination, yet it doesn’t occur in nature.

I first learned of this weird effect on insulin from an old paper by Kerin O’Dea, an Australian researcher. We wrote about her in Protein Power. She did a handful of studies on Australian Aborigines who had moved into the city, changed from their traditional diet, and become overweight, diabetic, and hypertensive. She put these folks back on their traditional lower carb whole food diet, and, surprise, surprise, all the excess weight, blood sugar, and blood pressure problems resolved.

Just about the time Protein Power was published, I read another study of hers I hadn’t seen before, which made me wonder how many other studies of hers I would like to read. Remember, back in those days you couldn’t just pull up PubMed like you can today and search for anything and everything. But I could go to the medical librarian at the med school library in Little Rock and request a search. Which I did. And in the list of her papers, which wasn’t nearly as long as it is now, was one I found of great interest.

The paper, titled Effect of co-ingestion of fat on the metabolic responses to slowly and rapidly absorbed carbohydrates, was published in 1984. In it, she describes a study she did on seven young, healthy, normal weight males and females.

She kept them on a weight-maintenance diet containing at least 250 g of carb per day during the study period. On study days, the subjects fasted for 12 hours, then were given one of the following diets:

• 438g of potato (almost a pound)

• 438g of potato plus 37.5g of fat (as 45g of butter)

• 121g of lentils

• 121g of lentils plus 37.5g fat (also as 45g of butter)

The potato was a rapidly absorbable carbohydrate while the lentils were a slowly absorbable carbohydrate.

She measured glucose, insulin, and glucose-dependent insulinotropic peptide (GIP), which we will get to later.

What she discovered should be of great interest to those of you who have ever worn a continuous glucose monitor (CGM).

She found that both the lentils and the potato consumed with butter provoked a much lower glucose response than just the potato and lentils alone. In other words, consuming fat along with the highly and not so highly absorbable carbs diminished the glucose response.

If you look at the insulin response these blood sugar elevations generated, you will see that the lentils with fat drove the insulin levels higher, while the potato without fat did the same thing. In the paper, the authors say the differences are not significant.

Here are the charts from the paper:

Another chart from the same paper shows the difference in GIP, which is substantial.

As you can see, the addition of fat to the carbohydrate drives the GIP way, way up. So, what is GIP and why does it matter?

GIP is a sort of hormone released in the upper part of the small bowel from cells called K cells. These K cells release GIP in response to food coming down the path. The GIP alerts the pancreas to release both insulin and glucagon in advance of the absorption of sugar into the blood. This augmented release of insulin is called the incretin effect. GIP and GLP-1 (glucagon-like peptide-1) are incretins.

Back in the 1960s researchers at the University of Colorado medical school discovered the incretin effect, which is quite dramatic.

They gave subjects what amounted to a glucose tolerance test by having them drink a glucose solution then measuring their blood sugar rise over time. They then duplicated the blood sugar rise by giving the same subjects a glucose infusion intravenously. They infused the glucose in an amount that created a duplicate of the glucose rise experienced when the subjects consumed the glucose orally.

At the same time the researchers measured the glucose, they also measured the insulin response. In doing so, they discovered that the insulin response to oral glucose was vastly higher than the response to the same level of glucose provided intravenously. Consequently, it was pretty obvious that there was some kind of signal triggered by food going through the GI tract that goosed insulin output. In other words, it wasn’t just the glucose in the blood.

Subsequent investigation discovered the so-called entero-insular hormones GIP and GLP-1, also called incretins.

The difference in insulin stimulated by incretins (mainly GIP) versus glucose in the blood is called the incretin effect. It is substantial. Here it is shown graphically in a slide from a talk I gave.

The green line on the bottom represents the insulin response to IV blood glucose while the blue line at the top shows the insulin response to the same glucose level generated by glucose taken orally. The difference in red is the incretin effect, which is dramatic.

One of the main driving forces in terms of generating GIP and increasing the incretin effect is the degree to which a given food has been processed. Below is another slide from one of my talks showing the difference.

Golay and Reaven did a study in 1986 in which they gave subjects 50g of carbohydrate as white beans either whole or ground up. They called the whole beans undamaged carbs (UC) and the partially ground ones damaged carbs (DC). As you can see, the blood glucose curves varied very little. Both the UC and DC beans would have had the same glycemic index. In other words, they both caused essentially the same rise in blood glucose. But, thanks to GIP and the incretin effect, the DC beans provoked a substantially higher insulin response.

Over the years, many, many studies have been done looking at this incretin effect, and they have all shown it to be dramatically increased as a function of food processing. Minimal processing produces a minimal incretin effect while ultra-processing stimulates a vastly larger effect.

The take home message from this is that if you are going to eat carbs, eat them minimally processed.

Now that you know what GIP is, let’s take another look at the GIP chart from the first study above. I’ll paste it here again, so you don’t have to scroll back up.

In this chart you can see the huge increase in the release of GIP after combining either lentils or potato with fat (butter). Remember in the charts above that the insulin release driven by this combo was about the same as that from eating the potato or the lentil alone. What happened? Why is there no difference in insulin?

This puzzled me, too, when I first saw this study. Then it dawned on me what had happened.

The subjects in this study were young (aged ~23), healthy, and not overweight (BMI ~22). Youth and health covers a multitude of sins. We haven’t discussed metabolic flexibility in The Arrow yet, but we will. The short definition is that metabolic flexibility means your body can deal with and metabolize everything your mouth can throw at it without serious consequences. As you lose metabolic flexibility with age and with years of dietary indiscretion, you no longer have the ability to deal with various foods as easily as you did when you were younger.

One of the things I heard over and over from overweight patients was the complaint along the lines of “my daughter (or son) can eat anything and never gain weight, but all I have to do is look at food and the pounds pile on.” I would always ask these patients if they were the same way at their daughter’s (or son’s) age. They would think for a minute, then say something along the lines of, “Well, yes, come to think of it, I was.”

By the time they had come to see me, they had lost their metabolic flexibility. As will their kids in due course if they follow the same abysmal diet.

I decided to look for a study of overweight or obese people to see if they responded differently than the young, normal weight subjects in the study above.

This study by Creutzfeldt et al fits the bill. The paper titled The Incretin Concept Today is a review paper describing several studies on incretins. One of these studies demonstrates the difference in response of obese people as compared to the normal weight ones discussed above.

The researchers recruited six obese males and put them on a total fast for three weeks, during which time they lost an average of almost 24 pounds. They tested them before and after the three weeks of fasting using a combination of IV glucose and a nasty drink containing 150g of corn oil (fat) to see what their glucose, insulin, and GIP responses would be to glucose and fat alone and in combo before and after substantial weight loss.

Here are the impressive findings:

The filled in black circles represent the responses to the oral fat drink. The black triangles the IV glucose. And the open circles as the glucose plus oral fat drink.

As you can see from the graph in the upper left, the oral fat drink didn’t do much to glucose, which is what you would expect from pure fat. An infusion of a fair amount of IV glucose does send the blood glucose curve to the moon. But when the oral fat is added, you can see that the glucose comes down, which makes the situation—at least blood sugar-wise—look a lot better.

The second chart down on the left shows what happens to insulin levels. Again, nothing much with the fat drink alone. A bump with the glucose infusion alone. And a huge rise when the two are combined. The fat drink does virtually nothing. The glucose sends it up a bit. But the combo really shoots insulin up.

If you look at the third graph down on the left, you can see why. The IV glucose does nothing, because it isn’t going down the GI tract, so you would assume the GIP wouldn’t respond. And it doesn’t. But look what happens with the oral fat and with the fat plus glucose. Both are through the roof. No wonder insulin is so high.

This is broken metabolism.

If you look at the graphs on the right side, you can see how all of them are improved simply by the loss of ~24 pounds and fasting. The good news is that even though these subjects need to lose a lot more than 24 pounds to become anywhere near normal weight, just this amount of weight loss and change of diet brought about significant changes in how their metabolism works in a mere three weeks.

The take home message from all this is to avoid highly processed foods and as much as possible avoid foods with the combination of fat and carbs. Just avoiding processed foods will eliminate a lot of the carb-fat combo. And bear in mind that we evolved eating the foods that were at hand millennia ago. Most of what we ate was protein plus fat. And apart from the occasional honey find, little concentrated carb. But there were no foods that were a combination of a lot of fat and a lot of carbs. Is it any wonder that now when fat-carb foods provide most of our calories, we are in a metabolic mess?

One way of dealing with this is the ketogenic diet, which keeps carbs at a minimum while increasing fat and protein.

A terrific new study just came out that shows many of the benefits of a ketogenic diet.

I just did a word count on this issue of The Arrow and discovered it is at 8,319 right up to the word “at” before the number. That’s way longer than the average Arrow, so I guess I’m making up for the last few while we were traveling and time constraints made them shorter. I don’t want to test your patience, so I’ll just hit one high point in this new study and save the rest for a longer discussion next week.

Before we get to it, though, I want to put up my quote of the week, a new feature.

Quote of the Week

This one from Curtis Yarvin, who writes the Gray Mirror Substack.

Lessons From New Ketogenic-Diet Study

I have had discussions and collegial arguments with my good friend Steve Phinney over how long it takes to recover low-carb adaptation after a carb blow out. Both of us know it takes a long time—many months in some cases—for low-carb adaptation to be complete. You can get many of the benefits from the restriction of carbs pretty quickly, but to get them all, it takes a bit of time sticking with the program.

When people first begin a low-carb diet, they typically complain of fatigue. Here is what is happening.

At least in my view.

All of our metabolic processes are catalyzed by enzymes. These enzymes are protein structures coded for in our genes. We have a lot of genes that code for many, many proteins, but we don’t trigger them unless we need them.

When you are on a typical high-carb American diet, you have the enzymes in place to deal with the metabolism of that diet. When you suddenly switch one day to a ketogenic or other low-carb diet, many of the enzymes you have on board no longer have much to do. And you need new enzymes to deal with your new diet.

Since the manufacture of these enzymes is substrate driven, it takes a bit to crank them out. During this time, you feel fatigued because things aren’t working exactly as they used to. And it takes a while to get the new enzymes generated and functional. Once in place and operating, the new ketogenic dieters feel much more energetic and way better than they did before.

Which is why MD and I never recommend patients start exercising when they first start a ketogenic diet. They will be too tired. But as soon as the new bunch of enzymes kick in, they will feel vastly more energetic and usually (it has been our experience) will start to exercise on their own without prompting.

Given this situation, if one goes off the ketogenic diet for a carb blowout, how long does it take to get back into the ketogenic flow?

That’s what Steve and I have argued about. Unless I’m misinterpreting his argument, he says it takes a long time to get back. I maintain that it shouldn’t take that long the next time as all the ketogenic enzymes should still be in place.

A new study just came out done by Isabella Cooper and colleagues in the UK looking at many aspects of the ketogenic diet.

The researchers recruited ten lean, metabolically fit, pre-menopausal women with an average age of 32 who had been on a ketogenic diet for over a year. (The average time spent on the ketogenic diet by the subjects was 3.9 years.)

The study involved three 21-day phases. On the first phase, the subjects stayed on their normal ketogenic diet and remained in nutritional ketosis as measured by beta-hydroxybutyrate blood levels.

During the second 21-day phase, the subjects were instructed to go on the standard UK diet (the study was performed in the UK), “which recommend [s] the daily consumption of at least 267g of carbohydrate per day for women.”

(As an aside, I find it hilarious that the standard UK diet is referred to as SuK, which one assumes must be pronounced as “suck.” It’s like the standard American diet termed SAD, which is an apt commentary on it in a word.)

After the 21 days on the SuK diet, the subjects went back on their ketogenic diet for another 21-day phase of study.

During the three phases of this study, the researchers analyzed many variables. And we’ll go over them in next week’s Arrow, but suffice it to say the ketogenic diet performed remarkably well in all aspects.

The one I want to hit this week is how quickly the subjects sprang back into ketosis once they went from the SuK 21-day phase (which was three weeks, so not just a single carb blowout) back into Phase-3, returning to their ketogenic diet.

As we all know, beta-hydroxybutyrate (BHB) is the ketone body that dominates during nutritional ketosis. You can see from the graphic above that these women got back into ketosis pretty quickly after their 21 days on the SuK diet. The measurements were done on the last day of the various phases, so we really can’t see how quickly they got back into full BHB ketosis, but we know they did by the end of their 21-day, Phase-3 period.

The caveat I have here is that these women had been in ketosis for an average of almost four years before they started this study. It is clear they quickly bounced back from their 21-day SuK diet divergence. What I don’t know is if this rapid return to ketosis would take place in someone who had just been on a ketogenic diet long enough to reach the 2-4 mmol/L level of ketosis, then went on the SuK diet for 21 days. Would that person bounce back as quickly? Based on this study, we don’t know.

I’ve worried a bit about reporting this part of the study because I don’t want to encourage people to go off their ketogenic diet with the promise that they can just jump back on and be right in the groove again. But, I’ve seen a number of people who have gone off, and because they thought they would have to start over from scratch, decided not to do so. It is those people this is aimed at.

If you do go off your ketogenic diet, just hop back on and, based on my interpretation of this study, you should be back in the swing of it in short order. And however long it takes, you’ll be better off for not being on a SuK-y SAD diet.

Next week, I’ll go over the rest of the findings in this fantastic study.

Video of the Week

Have you ever wondered about the difference between a violin and a fiddle? Watch the video below, and wonder no more.

Okay, I’m almost out of here. Gotta have a poll, though.

You can always just skip the poll, click the Like button below, and move on.

Okay, finally at the end. I’ll be back next Thursday with more on the ketogenic diet study and a lot of other stuff. Cheers until then.

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