The Arrow #156

Hello everyone.

Greetings from Dallas.

Or at least greetings from on the way to Dallas. I’m writing much of this from 35,000 ft on the way back.

I just noticed that this is The Arrow #156, which makes the newsletter three years old. Not a missed Thursday in three years. I didn’t imagine when I started this project that it would assume the life that it has. But at least I’ve proven to myself that I can stick with something for at least three years. For all of you who have been along for the ride since the first issue named the No Name Newsletter, thanks for hanging in there. I really appreciate it. Here is the header for that first effort.

Took me till the sixth week of writing the thing before I came up with a name.

Those of you who have been here from the start probably remember my endless dithering over what to call what has become The Arrow. For those readers who came in after the thing was already named, here is what I wrote in No Name Newsletter #4, when I was getting close. Actually, when the deal was sealed. In my mind, anyway.

Arrow in the Blue is the title of the first volume of Koestler's autobiography. He wrote a handful of biographical books about various periods of his life, which was nothing if not exciting. But Arrow in the Blue was his first shot at a chronological autobiography starting at the day of his birth, September 5, 1905. Why did he call it Arrow in the Blue? I don't recall his saying why in the book, but here is a journalistic piece about him that offers an explanation.

I like the title for reasons having nothing to do with Koestler. When I told my wife this story, she shuddered and said it's a wonder that men survive little boyhood.

As I wrote in a recent blog post, I grew up in the Ozarks in southwest Missouri. Not far, in fact, from where the Netflix show of the same name is set. I spent a lot of time at my grandparents farm, which had no running water and no indoor plumbing, which didn't bother me a lot as a kid. I had the run of the place and spent a ton of time roaming through the freshly plowed fields looking for arrowheads and just playing by myself without much supervision. My first sibling wasn't born until I was almost seven, so I had no playmates at the farm until several years after.

Once when I was nine or ten I got a bow and arrow set for Christmas. I took it to the farm to shoot it at whatever lent itself to being shot at. One afternoon I was out in my favorite arrowhead hunting field, and it occurred to me that it would be fun to see how high the arrows would go were I to shoot them straight up in the air. I figured they would come down close, so I wouldn't risk losing them. I aimed straight up, drew the bow to its limit, and loosed an arrow. An arrow in the blue, so to speak.

As I watched, the arrow went up and sort of melded with the blue sky. It went high enough that it briefly went out of my field of vision. Then it dawned on me that I couldn't see where it was going to come down. And that it might well come down right in the middle of my skull. My first impulse was to run, but I quickly realized that I didn't have time and that given the fact that I probably didn't shoot it exactly straight up and there was wind, I could easily run right into the arrow's downward path. While I was thinking all this through, the arrow came down 20 or 30 feet away.

I had survived my first encounter with what could have been certain death.

You would think I would have had sense enough to quit, but such was not the case. I got such a high from the risk that I repeated the exercise a dozen or so times. I kept thinking I could improve my vision by continuing to do watch the arrows ascend, so that I would end up being able to easily avoid them. As is evidenced by the fact that you're reading these words, my idiocy didn't bring about my demise. But it could have.

Perhaps that experience of shooting my own arrows into the blue is what attracts me to that as a title. [Links in the original]

Now you know.

Okay, on to something important.

Weight, Willpower, and the New Year

Since it’s the time for resolutions, I suspect many of you may have resolved to lose weight in 2024. If so, you aren’t the only ones. And Big Pharma has taken note.

I subscribe to a bunch of online periodicals written for physicians. Most of these are summaries of all that is new in medicine. And since most of them are paid for by Big Pharma, they always detail the latest drugs to hit the market.

Over the last month or so, I’ve noticed a troubling trend. Along with all the notices of new drugs—with major emphasis on the GLP-1 agonists—there have been countless pieces about how it is impossible for people to lose weight by making lifestyle changes. It’s just not possible, they all say. Willpower won’t hack it.

The obvious motivation behind all this is pharmaceutical marketing. Big Pharma does not want you to think you have control over your own life. And it’s not just Big Pharma.

I just read a quote from our CICO friend Kevin Hall (I’ve been frantically searching for it without success) that goes something like this: We can’t fight our physiology. I can want to hold my breath, but I can do so only for a minute or so, then I have to breathe. I don’t have a choice. My physiology overcomes my willpower. It’s the same with hunger. I can fight it for just so long, then I have to give in. My physiology overcomes my willpower.

Here is a recent quote from Oprah Winfrey in People.

"I had the biggest aha along with many people in that audience," she recalls of the discussion, which posted online in September. "I realized I’d been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control."

She adds, "Obesity is a disease. It’s not about willpower — it's about the brain."

I don’t know this for a fact, but I would be willing to bet that the magazine People receives plenty of advertising money from Big Pharma. (I don’t read it, so if any of you who do know better, let me know.)

And this is exactly what Big Pharma wants you to think. “It’s about the brain.” Willpower is useless. Obesity is a disease that is beyond your control. Obesity is a chronic disease just like diabetes or high blood pressure. If you have those chronic diseases, you treat them with drugs. Forever. Same with obesity.

That is the message you’re going to be hearing over and over and over. You’ll hear it so much, you’ll start believing it. And when you do, you may well sign up for weekly injections of one of the new GLP-1 agonists.

When you do, you will be exposing yourself to an increased risk of pancreatitis, gastroparesis (a sort of paralysis of the GI tract), and GI obstruction. As well as perhaps some episodes of suicidal ideation and/or depression.

If you’re like the average person who signs on to these drugs, you’ll end up going off of them after about a year, which is what happens to most people. Why? Probably because that’s when they quit working.

The graphic below shows the weight changes over time with tirzepatide, the most potent of the new injectable weight loss drugs.

As I discussed a couple of weeks ago, this chart represents what happened to two groups of subjects. Both groups were on the drug until week 36. Then half were randomized to either continue on the drug or get a placebo injection. Those who got the placebo (represented by the blue line) started to regain their lost weight, while those who continued on the drug did not.

You can see that by the one year mark (52 weeks) the weight loss with the drug has decreased and shortly after it basically flatlines. And it even looks like it may start back up again at the far right. Which was a good time for the company to stop the trial.

If you look at the actual weights of the subjects involved, they are nowhere near their goal weights when the weight loss flatlines. I can tell you from taking care of many, many patients over many, many years, when the weight loss stops, so does whatever the regimen is. Which is why the study linked above showed most stopped their injectable drug after a year.

Now, let’s go back up and explore some of the statements quoted above.

First, Kevin Hall. Kevin is the most vociferous promoter of the calories-in-calories-out theory of weight gain and loss. He believes the cause of obesity is that we live in a crappy, junk food environment. On that, I agree. There is crap everywhere you look. But that doesn’t mean you have to eat it.

He said he could try to overcome physiology by holding his breath, but ultimately he would have to breathe. True. But you get in serious trouble quickly if you don’t breathe. In about 3-4 minutes, in fact. He tries to equate that with hunger. But it doesn’t work, because most of us could go without food for a month, and it wouldn’t kill us.

If you go back and reread the Oprah quote. She says it’s a disease. It’s in the brain. Willpower has nothing to do with it.

Well, willpower worked for her before. She lost 67 pounds of fat doing Optifast. And she looked great. But, unfortunately, she did what most people do who lose a lot of weight. She said, Oh, great, I’ve reached my goal. Diet’s over. I can eat all those foods I’ve been missing. And you know what the outcome of that strategy is. (To be fair, the Optifast program, itself, set her up for failure by putting her right back on a diet of low-fat, no-fat carbs (baked potatoes) as her transition to food.)

What about the argument that obesity is a chronic disease just like type 2 diabetes and/or high blood pressure?

Well, type 2 diabetes can, in most cases, be fixed with the right kind of diet. Same with high blood pressure, though not to the same extent as with type 2 diabetes. About 20-25 percent of high blood pressure is refractory to dietary reduction. But most can be reversed with the proper diet.

Same with obesity.

And all it takes is a bit of willpower.

Almost 40 years ago to the day, I stumbled onto one of the most important books I’ve ever read. It was by a psychiatrist named William Glasser, who ended up developing an entire school of psychiatry called Reality Therapy based on his Control Theory. I’m not sure if the book I ended up reading was one of his first or not, but it made a huge impression on me.

The book is titled Take Effective Control of Your Life and it is, I’m sure, out of print now, so if you want a copy, you’ll have to find a used one. It was reprinted later in paperback under the title Control Theory: A New Explanation of How We Control Our Lives. You can find used copies on Amazon or from online used book sellers.

I happened to be in a bookstore when the book first came out in early January 1984. I flipped through it and bought it. When I did, I didn’t realize what an impact it was going to have on me.

One of the main points Dr. Glasser makes is that we all spend way too much time worrying about things we can’t control and way too little time worrying about things we can control.

It seems pretty obvious, but it hit me right in the face. It was obvious, but I just hadn’t thought about it.

I can’t tell you how many patients I’ve had who were doing fine, losing weight, watching their blood sugars and lipids improve and feeling great then vanished from the practice for a month or two. They would come back in, having regained a bunch of weight, and they all had a variation of the same story.

My mother came down with cancer, my daughter had a bad pregnancy, my husband (wife) left me, my house got damaged in a storm, and on and on. And they would all follow up with some variant of “I just couldn’t think about my diet while all that was going on.”

All of those things, terrible though they are, are, for the most part, out of our control. The woman whose mother had cancer could not do anything to treat the cancer. Yet she was worried sick. As we all would be should a loved one come down with a terminal disease. You can’t help stressing over it. But there is nothing you can do anything about other than be supportive and lend a hand.

But all these people had complete, total, 100 percent control over what they put in their mouths. They were overcome with worry about things they couldn’t control, but completely gave up control over something they had total control over.

Once I had read Dr. Glasser’s book, I noticed this over and over and over and over.

Granted, it’s almost impossible not to worry and stress over bad things that are going on in your life even if you have no control over them. But why give up the control you do have just because you’re stressing about something you can’t control?

But what’s even worse is giving up control over what’s in your total control without being stressed over something you can’t control.

According to Kevin Hall, if you live in an area where there are a lot of fast food places and markets where junk food is easily obtainable, you’re sunk. But does that mean you just give up and go face down in it?

That’s what he thinks. Because all this crap food is around, we all just give in and eat it. And because it’s all so calorically dense and filled with ingredients that make us want more, when we do eat it, we eat too much, get too many calories, and, consequently, get fat. It’s not our fault. It’s the food manufacturer’s fault. It’s our brain, Oprah would say.

Well, it’s not. It’s all in your control.

And the book above made me aware of that. It’s never completely out of my awareness.

Okay, but what about this situation, you might say: You’re at work and you’re kind of hungry and some vendor brings in donuts. (This happens all the time in doctor’s offices with drug reps—they often come bearing sweets.)

You’re hungry, your stomach growls, the donuts are hot, and you can see and smell them. And even almost taste them. How can you resist?

Well, the other part of Dr. Glasser’s book tells how.

There are basically four components to any behavior: the doing component, the feeling component, the thinking component, and the physiological component. Of the four, we have complete control only over the doing component, and partial control over the thinking component. We have no control over the other two whatsoever. (Dr. Glasser touches on diet only peripherally in his book, so this is my interpretation as to how these components and our control over them apply to eating.)

If we haven't eaten for a time and we see or smell food that appeals to us, we feel hungry—the feeling component. We can't help it that we feel hungry, it's beyond our control. Our mouths water and our stomachs growl: the physiological component. We can't keep our salivary glands from working, and we can't do anything about our intestinal muscles that are becoming active.

We have no control over these physiological processes. We look at the food and smell the aroma, and we imagine how good it will taste: the thinking component. As long as we are hungry and in the presence of this wonderful food, we will probably think about it. Who wouldn’t?

We can, however, force ourselves to think of other things, but more than likely, our thoughts will occasionally revert back to the food.

We can partially control our thinking. The stronger-willed of us more than others. Finally, we might sit down and eat the food: the doing component. This act, we can completely control. We can eat or not, as we please. Unlike the workings of our salivary glands, or our feelings of hunger, we have total, 100-percent control over whether or not we eat.

But… Although many of us allow the uncontrollable components of behavior to direct the controllable component, it can work in the reverse direction.

If we commandeer the doing component, over which we have total control, the other involuntary components will fall into step.

In our example with the donuts, if we walk away from the food and involve ourselves in a different activity, one unrelated to food or eating, slowly our feelings, physiology, and thinking will change and adapt themselves to our new activity.

We have controlled what we can and as a result, have ended up indirectly controlling those components that we can't control directly.

If you are now, or have ever been, overweight (and this includes me), you have let the components of behavior over which you have no control coerce your doing or controllable component into submission. You have been confronted with greasy, carbohydrate-laden, unhealthful, but unfortunately, very tasty foods, and you have let the feeling and physiological components of behavior bias your thinking component.

Then all three put your doing component to the sword, and you ate that which in your heart you knew you shouldn't. If you were like most victims, you probably said that you "couldn't help it." But you could, and you can now. Take charge of your actions.

You have total control of them. Grab a foothold of control. Everything else will fall in line.

Or, you can get expensive weight-loss injections that reduce your appetite and almost ensure you will be protein deficient and lose muscle mass. And you will quit after a year, long before you reach your goal weight, and your appetite will come back, and you will regain your lost weight, but probably as fat, not muscle.

When our genes were laid down, we were in an era in which food was controlled by availability. We had external controls on what we ate. Our Paleolithic ancestors had external controls. They could eat only that which they could catch or gather. Those who didn’t do well with basically a fairly low-carb, fat and protein dominant diet were bred out. We are the heirs to those genes.

Where they had external controls (availability), we have to muster internal controls (willpower). And it often takes effort.

I’m sure everyone reading these words has overcome adversity in some way. And accomplished tasks requiring effort and denial. Whether it is graduating from college, dealing with major problems at work, raising a family, or whatever—they all take effort. So does good health.

One of my favorite sayings (and I have no idea who said it first, or I would give credit) is that the only time you can coast is when you’re going down hill.

So, come resolution time remember, control what you have control over. One day at a time, one meal at a time, and if necessary one bite at a time.

The Arrow is a reader-supported publication. It costs a coffee per week to subscribe. And I’m not talking some fancy, high-end, high-carb, Venti Caramel Frappuccino with Extra Caramel Drizzle and Whipped Cream Starbucks crap; I’m talking a Joes’ Diner drip coffee. To receive new posts and support my work, consider becoming a free or paid subscriber.

How Did We Get Here In the First Place?

In another issue of The Arrow, I wrote about how many food manufacturers complain they are losing sales due to the huge number of people on Wegovy, Ozempic, and Mounjaro. These are companies that primarily produce snack foods. Snack food companies are having a harder time of it now, because taking the shots reduces the appetite across the board. And junk food makers are hurting.

A nanosecond of contemplation tells us why those people who are taking the shots gained their weight in the first place. They obviously consumed a lot of snack foods. Which is not unusual. A statistic that’s been kicking around for a while is that ~68 percent of calories in the typical American diet are snack foods, which are primarily carbs and (bad) fat. And as we’ve discussed in these pages ad nauseam, the fat-carb combo—which is found nowhere in nature other than milk, the very food designed to promote growth—runs insulin levels out the wazoo. High insulin increases fat storage, and as President Biden would say, “Oh, you know the thing.”

Now with the holiday season here (or almost over) come a bunch of articles about people wanting to go off Wegovy, Ozempic, and Mounjaro (here and here are a couple), because they want to go face first into the junk food that is a traditional part of this time of year. But while on the shots, they just don’t have the appetite for it.

It doesn’t take a lot of deep cogitation to imagine what’s going to happen to these folks when they finally go off the shots. Appetite for crap will return, and so will their lost body weight. But on a smaller muscular infrastructure, which will make them prone to gain even more.

I’ll say it again, in my view, there is only one way to achieve permanent weight loss, and that is through a lifestyle change. Primarily with diet. The right diet.

Speaking of diet…

Beef Diet Trumps Plant Diet for Muscle

A new study out of Maastricht University Medical Center in the Netherlands titled Higher Muscle Protein Synthesis Rates Following Ingestion of an Omnivorous Meal Compared with an Isocaloric and Isonitrogenous Vegan Meal in Healthy, Older Adults shows that beef, when consumed as part of a mixed meal, stimulates more muscle protein synthesis (MPS) than does an equal amount of protein from plants.

How much more? How about 47 percent more.

For this randomized controlled trial researchers recruited 16 healthy, older adults (ages 65-85 years), in Maastricht, the Netherlands. On one of the test days, subjects consumed an omnivorous meal made up of 3.5 ounces of lean, ground beef along with potatoes, string beans, applesauce, and herb butter. The beef protein was the primary protein source in the omnivorous arm of the study.

On another test day, after a wash out period, subjects chowed down on a whole food vegan meal of equal caloric and protein content made of quinoa, soybeans, chickpeas and broad beans.

Both meals contained ~ 36 grams of protein, which more or less hits the trigger for MPS in elderly people.

Here are the meals. [The bride says the one on the left looks like a dog’s breakfast.]

Based on data from prior research, the authors noted

Beef is protein-dense and shows rapid and complete digestibility upon ingestion. Due to these properties, ingestion of cooked beef is followed by rapid amino acid absorption, with more than 60% of the beef-derived amino acids being released in the circulation during the early postprandial phase. However, consuming cooked beef as part of a complex meal will likely lower gastric emptying rate and attenuate beef protein digestion and amino acid absorption. Despite lower protein digestibility of plant-based protein sources, domestic processing (i.e., cooking) of plant-based whole-foods can increase protein digestibility and improve the postprandial availability of plant-derived amino acids in the circulation. With the increasing interest in more plant-based diets and/or a strict vegetarian or vegan lifestyle, it is of importance to assess potential differences between the muscle protein synthetic responses following the ingestion of complete omnivorous and vegan meals. This may be of particular relevance for older adults, as age-related muscle loss is partly attributed to the development of anabolic resistance to feeding.

All of which tells me they hadn’t made a deep dive study into protein, or they could have predicted the outcome of this study before they ever did it.

From another report on this study

All participants refrained from sports and strenuous physical activities, as well as alcohol consumption, for two days prior to each of the two experimental trial days. Researchers compared post-meal plasma amino acid profiles and muscle protein synthesis rates, using blood and muscle biopsies that were collected frequently for six hours following meal ingestion. In addition to observing the 47% increased muscle protein synthesis rate over a 6-hour postprandial period, researchers noted plasma EAA [essential amino acid] concentrations were 127% higher following the lean beef meal, despite the vegan meal not presenting any selective amino acid deficiencies.

To be perfectly honest, I was surprised there was this much MPS with this small a dose of beef. Three and a half ounces of beef just isn’t all that much. I could almost inhale that much in a large breath. And yet it did the trick.

The graphics below show the difference in essential amino acids after the two diets and the difference in leucine, the main amino acid the mTOR signaling complex keys on to turn on MPS.

Plant protein is by and large deficient in leucine, so it’s no surprise that it is elevated in the beef diet.

And here we see the difference in MPS driven by the beef diet vs the plant diet.

Both of these diets were pretty closely matched in terms of calories and macronutrients. I didn’t show the glucose and insulin curves, but they were essentially the same for both.

I would love to see a study in which plant foods were increased to the point at which they stimulated as much MPS as 3.5 ounces of beef. Were that study done, I seriously doubt the glucose and insulin curves would be the same.

Remember, this study was of older people (avg age ~72), so the same amount of beef would doubtless stimulate even greater MPS in those younger.

So, if you’re losing muscle mass, you need to ask yourself, Where’s the beef?

I wish someone would do a study showing what happens with even more protein than that provided by 3.5 ounces of beef.

Oh, wait, someone did.

Dietary Protein: The More the Merrier

I’m just going to tease you with this study now. I just came across it and haven’t had time to give it a deep read. But based on the way it was done, it looks great.

The study titled The anabolic response to protein ingestion during recovery from exercise has no upper limit in magnitude and duration in vivo in humans was done at Maastricht University by some of the same researchers as the previous study shows that ingestion of a larger amount of protein has a more prolonged anabolic (muscle building) response than does ingestion of a smaller amount.

Unlike the study above, this one was done using healthy younger people. And unlike the study above this one involved exercise. But there is no reason to believe that the same wouldn’t apply to more elderly subjects. Quite frankly, I was surprised that the elderly subjects responded as well as they did, given that they were forbidden to exercise in an effort not to confound the study.

I’ll go more into detail on this incredibly interesting study next week. Meanwhile eat your beef and do a little resistance training. Building your lean body mass is like putting money in the metabolic bank. It will be there when you need it.

Francis Collins Spills the Beans

This is an incredible short video of a statement by Francis Collins (a little over a minute). Remember, Francis Collins was the white-haired, mustachioed director of the National Institute of Health during the start of the Covid pandemic response. He is the one who wrote the email below to Fauci.

The “fringe epidemiologists” were Jay Bhattacharya from Stanford, Martin Kuldorff from Harvard, and Sunetra Gupta from Oxford University.

Just remember this is from the horse’s mouth on how public health works. Remember it well the next time something like Covid comes around.

Their calculus is garnering all the reward for them. “We stopped the disease.”

And no consideration of the risk for you. Losing your business. Dying from the treatment. Failure of kids’ learning. Doesn’t matter.

You heard it straight from the top.


Video of the Week

After all that, we need some fun. The best Go Pro videos from 2023.


Okay, that’s about it. Happy New Year in advance. Have a safe one. Keep in good cheer, and I’ll be back next year.

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