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Hello everyone.

Greetings from Dallas, where it has turned hot, but not dead-of-summer hot. No more storms.

One thing of note that did happen since last week’s Arrow was that Amazon restored Dr. Marik’s account. His book on cancer treatment can now be purchased there, though it can still be had for free in digital form from the FLCCC Alliance for the book.

Not really a lot of issues brought up in the comments or the poll responses. Most people who weighed in, felt about the same as I do about the so-called food deserts. Which a number of people commented on.

There was a comment from this week and an email from a couple of weeks ago I do want to discuss.

Comments, Poll Responses, and Emails

A Physician Encounter

From the comments last week:

Had I read this 15 or 20 years ago, I wouldn’t have believed it. But I’ve heard far too many similar stories since that time to doubt this one. I just hope MD remains healthy for a long, long time, so she can treat me, and I won’t have to go through anything like this.

A couple of things amaze me about this comment. I’m not all that bothered that the guy got his dander up about the Fauci dig. I would probably have defended a colleague I thought well of. But interviewing him via phone from another room?!?! Then standing in the doorway five feet away?!?! If this were during Covid, he was obviously worried about getting Covid. And since he worked at the CDC and worshipped Fauci, he must have been vaccinated; if the vaxx works, what did he have to fear? If he was any good at all as a doc, he should have known that SARS-CoV-2 is an aerosol, so standing five feet away wasn’t going to prevent his getting it. Nor was being in a room across the hall.

When MD and I spent a few days during the waning days of Covid in our old stomping grounds of Santa Fe, New Mexico, where we had lived part time for about eight years, we had a waiter at an outside dining area who made sure to stay about six feet away from us while taking our order. But he was a waiter. Who expects him to know about aerosols? This other guy was a physician who was well enough educated to be employed by the CDC. And he didn’t know? That’s beyond the pale.

Plus, as part of their profession, physicians take care of sick people. When MD and I ran our primary care clinics and it was flu season or a time when something else bad was going around, we examined patients. As did all the other doctors who worked with us. We got in their faces and had them say AHH, as we checked their throats and listened to their chests and palpated their necks for lymph nodes. God only knows how many bugs we breathed in, but that’s part of the job when you sign up to be a doctor. We didn’t speak to them from the doorway. Or wear masks. We dug in and did our duty. The patients were there for help, and we provided it.

The other thing I can’t understand is why the guy wouldn’t order a fasting insulin. He said he wouldn’t know how to interpret it or treat it. Which also amazes me since insulin is kind of the master metabolic hormone (actually glucagon is probably more important, but we’ll leave that discussion for another day). And there isn’t any way to treat it other than with diet. (And besides, on a keto diet, it should have been low, not elevated, so he was probably on pretty safe footing re having to know what to do about an elevated insulin.)

Like the commenter, that would have been my one and only interaction with this guy. I would have found another doc pronto.

A Weight-Loss Dilemma

I received an email from a female reader a couple of weeks ago that I meant to bring up last week, but ran out of time. She describes a problem that I figure is fairly common among those wanting to lose weight.

I could write an entire book on this subject (entire books have been so written), but I’m going to try not to get carried away.

There are two components to this sad story: a physiological one and a psychological one. Let’s look first at the physiological.

The final bolded statement above tells the physiological tale. “How I can I weigh 223lbs at over 40% body fat and still be hungry all the time just amazes me.”

It’s perfect demonstration of the carbohydrate-insulin model, which is also described as fat trapping. The hypothalamus senses the nutrient content of the blood circulating through it. If the blood is low in nutrients—fat and/or glucose—the hypothalamus generates the hunger signal. When people are hungry, they are driven to eat. (More about this in the part about the psychology.)

When people have insulin resistance and chronically elevated insulin levels, they end up not only sending more nutrients (fat and glucose) into the fat cells for storage, they also end up not being able to access this stored energy when needed. Under normal physiological circumstances, as the nutrient level in the blood begins to fall, fat would be released from the fat cells to top off the blood’s levels, so to speak. But chronically elevated insulin prevents this. So, the hypothalamus kicks in the hunger signal, eating follows, blood nutrient levels go up, and the entire process repeats itself.

What ends up happening is that more and more fat accumulates in the fat cells, but remains entrapped there by the chronically elevated insulin levels. The lack of nutrients in the blood signal to the hypothalamus that fuel levels are low, so it kicks in and generates a hunger response.

Physiologically, the only way to deal with this is to overcome the insulin resistance by diet. No drugs can do it. If you cut the carbs, you will reduce insulin resistance, and restore the system to its natural operating state. The energy stored in the fat cells will move into the blood as needed, and the hypothalamus won’t get the low-fuel signal. Hunger will abate.

This correspondent wrote that she is following a keto diet. And engaging in CrossFit.That she’s doing time restricted eating. That she is not drinking alcohol. That she is water fasting for 36 hours weekly. And yet she’s still hungry. The driving question, here, is why? Why would a person still be fat-trapping, still have elevated insulin, still be insulin resistant? It could be reproductive hormonal imbalance in a menopausal female. Some hormonal syndrome of exogenous insulin production? Those possibilities deserve to be explored. It’s a conundrum. The inability to lose is easily explained by simply eating too many low-carb calories, but the burning question is why? Why is a person driven to continue to eat, when their nutritional needs are already met? We’ll look at that now. Is there a thyroid issue. We don’t know. Based on the info available, I’m kind of in the dark. But what we do know is that she did well on a low-carb diet at one time, but since has found it too restrictive.

Now for the psychological implications.

I have gained enormous insight from the work of William Glasser, M.D., a long-time practicing psychiatrist who died about ten years ago. During his many years of working with patients, Dr. Glasser determined that people tended to spend all kinds of time and effort worrying about and trying to fix things they could not control, while at the same time abandoning control of things over which they have complete control.

After dealing with a lot of patients over the course of a lot of years, I’ve concluded that Dr. Glasser is absolutely right. I’ve had patients whose spouses have dumped them, whose adult kids have gone off the deep end, whose jobs have been lost, whose loved ones are terminally ill, and on and on. There really isn’t a lot—if anything—they can do about these situations. They have zero control, but they spend vast amounts of time and psychic energy worrying about them.

And they relinquish control over things they have total control over.

Here’s an example I’ve encountered countless times.

A lady who has been doing well on a low-carb diet misses an appointment or two. She finally comes in a couple of months later after having regained ten of the pounds she had lost. She wants to get back on the program.

I ask her what happened.

She tells me about how her mother was diagnosed with cancer and had to be hospitalized for a week because she almost died. This all came out of nowhere, and my patient, who had a wonderful relationship with her mother, was devastated.

In describing all this, she says the words I’ve heard over and over and over from people in such situations. “With all that was going on with Mom, I couldn’t even think about my diet.”

If we look at this rationally, we understand that this lady had absolutely no control over her mother’s condition. Her mother was in the hands of the medical system, which was deploying all the things it deploys when people come down with cancer. My patient was in no position to make decisions about her mother’s treatment. That was between her mother and her own doctors. So, my patient had no control over the situation whatsoever. Yet she spent countless hours stressing over it all, despite the fact that her stressing didn’t accomplish anything.

And at the same time, she totally abrogated control over the one thing over which she had total and complete control: what she put in her mouth.

That’s a fact we all have to come to grips with. No matter what else is going on in our lives, we have complete, total, 100 percent control over what goes in our mouths.

How many times have I heard people say about eating some nasty, carb-laden, ultra-processed desert: I just couldn’t help myself.

Uh, yes, you could. Especially since it came after a dinner you ate. You weren’t even hungry.

Don’t get me wrong. I, myself, have succumbed to this temptation way more times than I would like to admit to. But not nearly as many times as I would have had I not heard Dr. Glasser’s words ringing in my ears. “You have complete control over this.”

Dr. Glasser was smart enough to know that it requires more than will power to resist situations like this, so he laid out a plan to help deal with it.

This is what I wrote about it in my first book Thin So Fast:

Let me give you an example of this from my own life.

I love donuts. I probably haven’t eaten one in five years, but I love them. And they’re just about one of the worst foods you could ever eat. Dough made from refined flour cooked in nasty fats with a sugar glaze on them.

Drug salesmen would come into our clinic all the time to detail new drugs. Many of them would bring fresh donuts. The staff loved the donut-bringers, so they would make sure we—the doctors—got to see them.

If I walked into the break room to grab some coffee between patients and there was a box of fresh donuts sitting on the table, I was a goner. Until I read Dr. Glasser. After that, I would go in the break room, see the donuts, lust after them mightily, and quickly walk out. Had I stayed and debated over the donuts, with their delicious smell wafting through the room, I would have succumbed. But by quickly walking out and focusing on the next patient (or whatever), I was saved.

Dr. Glasser wrote a terrific book on this subject titled Take Effective Control of Your Life. It is the book I bought and studied. But it is out of print today. You can find used copies on Amazon or other online booksellers. He republished it in 1985 in a book titled Control Theory, which, sadly, is also out of print. He did a bit more refining of his theory and published it under yet a third title, Choice Theory, which is in print, but which I have not read, so can’t comment on. I’ve never read anything by Dr. Glasser (and I’ve read a lot) that I didn’t profit from, so I suspect Choice Theory is very good. I just can’t say for sure first hand.

I would put Take Effective Control of Your Life in the list of top ten books I’ve read in terms of having a positive effect on my own life and way of thinking. It has forced me to think about whether what I’m stressed over is something I can control or something I can’t. By bringing that to my consciousness, I can decide how to react.

Now, having said all this, what would I do with a patient in the same situation as this correspondent?

We’ve all heard the standard advice given by doctors who don’t know any better: Eat less and move more.

As a practical suggestion, it doesn’t work at all.

But if applied drastically, it works very well. Look at the concentration camps in WWII, for example. The Nazi’s underfed those interred there and worked them like dogs. And, as I’m sure you’ve seen from many old photos, there was no obesity. Which proves that eating less and moving more can be a successful strategy, but only if done to the extreme.

A casual stroll around the block a couple of times a week, and cutting back here and there just won’t do it. That doesn’t sound like what this correspondent was doing — CrossFit, done regularly, isn’t a stroll around the block. It’s cardio and it’s lifting and it’s a great full body workout. But it takes a committed effort to lose weight. And most of the heavy lifting is done by the diet, not the exercise.

I don’t really buy into the notion that I’ve been told by many patients: I just can’t lose weight. Anyone can lose weight. It just takes the right diet and self control. The right diet—which in most cases is a low-carb diet—makes the self control part a lot easier.

But for patients who, for whatever reason, are maybe eating the right foods (as it sounds like this correspondent was doing) but simply eating far too much of them to lose weight because they fall prey to their appetites, perhaps there is a place for the GLP-1 receptor agonist drugs. These drugs primarily act as appetite suppressors. And people lose a lot of weight on them. Which proves that if you limit your food consumption, you will lose weight.

About the only reason I would ever prescribe these drugs would be if a patient refused to acknowledge that he/she really does have complete control over whatever goes into his/her mouth. In that one instance, it might make some sense to try them. It would be better for the patient to lose the weight rather than continue to indulge in overeating. But I would try everything in my power, explore every other avenue, to force myself to change my diet or my habits before I would opt for these drugs. Especially since there is already massive litigation mounting against the companies making these drugs. There would be minimal litigation if the side effects weren’t so bad.

Which is why I would think twice before using them. Especially if I used them only because I couldn’t control my appetite. If these drugs apply an external governor on my appetite, what’s going to happen when I go off of them. If I haven’t learned to deal with it, I’ll quickly go back to my old appetite and, ultimately, my old weight. Plus some.

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The More Things Change…

As the French say, Plus ça change, plus c'est la même chose. The more things change, the more they stay the same.

And so it is with how obesity is now viewed by the medical profession and Big Pharma.

When I first started in practice, the common knowledge at the time was that obesity was the driving force behind all of the so-called diseases of civilization: heart disease, type II diabetes, dyslipidemia, high blood pressure, etc. Which seemed to make sense, because all these disorders were vastly more prevalent in obese people than in normal weight ones.

Here is a graphic from an old paper showing what I mean.

As I’ve written about before, I dug into my med school biochemistry text to try to figure out what drove fat storage. It was pretty obvious that it was insulin. I then tracked through all the actions of insulin and realized that it was involved in all of the pathways mentioned above. It caused fluid retention and, consequently, high blood pressure. It stored fat, and kept it stored. It stimulated the production of cholesterol and drove triglycerides up. I made a drawing of all the pathways I came up with. I’ve put this up in an earlier version of The Arrow, but here it is again.

At the time I was doing all this, I was primarily using my textbooks and other textbooks I had purchased. I hadn’t really gotten into the medical literature yet, because it was difficult to do. This was before computerization—at least before I had a computer. When I finally did start getting into the actual scientific literature, I had to schlep to the medical school library, track down the various journals in the stacks, and make copies at ten cents a page.

Once I figured out how to use the system to retrieve papers, I began haunting the medical library. There was no system available like PubMed now (at least no system I knew of at that time), so the only way I could track down papers was to go from a particular article I found then start finding the articles from the citations at the end. As you might imagine, it was a cumbersome process, but it was the only one I had.

I had concluded that excess insulin was the primary culprit underlying all these issues, so I was out to find evidence to confirm (or deny) what I had decided.

I ended up finding a great paper titled “The Deadly Quartet,” which laid out everything much as I had suspected. This is the paper from which I got the graphic above showing obesity as the cause of all the problems. The article had a revised version that was in keeping with what I had figured out shown below:

It wasn’t too many years before this became the current paradigm for the metabolic syndrome as a consequence of insulin resistance and hyperinsulinemia. I used a crude drawing of an iceberg with all the diseases sticking out of the water and insulin beneath the surface. I also used this graphic when I gave talks about insulin resistance. It’s a nice way to make people understand the power of excess insulin and now these much improved graphics are all over the place. Here’s one from Dr. Sigurdsson’s blog from a few years back:

This has been pretty much what the mainstream accepted as the underlying cause of all the widespread health problems. Obesity was just one of the issues driven by hyperinsulinemia, not the cause of them.

But now…

Well, there is now a drug that treats obesity. At least for a while. The GLP-1 receptor agonists make people lose their appetite and eat less. Eating less, means fewer carbs, which also means insulin goes down. When insulin goes down, good things happen.

But now, thanks to these drugs, the idea of an underlying cause of obesity has gone away. Now we’re back to obesity being the driving force behind all the other diseases.

Dr. Leana Wen (remember her as the Karen scold during the Covid vaccine days—at least until her own kid got a vaccine injury) wrote an article for the Washington Post headlined “How ‘obesity first’ health care is transforming medicine.” She writes:

She’s goes on:

So thanks to the new injectable weight loss drugs, obesity has once again become the cause of all these other disorders instead of just one of the many consequences of insulin resistance.

And since these drugs end up blunting the appetite, the resulting decrease in consumption will end up lowering insulin levels, which will be the driving force in improving lipids, stabilizing blood sugar, reducing high blood pressure and all the rest.

The goal in all this is, of course, to set up these expensive drugs to be paid for by insurance, both public and private. And all of our premiums will go up.

No one will stay on these medications for life. People are dropping off due to side effects right now. So all this money will end up in the coffers of Big Pharma, while the taxpayers and those of us purchasing insurance privately will foot the bill. And the people who took the drugs will end up even more obese than when they started thanks to the muscle loss they will experience. I predict it will all come to a bad end.

Dr. Peter McCullough interviews Dr. Joel Kahn

Peter McCullough’s Substack is one I read religiously. And his book Courage to Face Covid-19 was the best book I read on Covid, written during the pandemic. Imagine my surprise when I came across one of his recent posts, which was a video of an interview with noted plant-based-diet advocate Joel Kahn. As it turns out, Dr. Kahn was Dr. McCullough’s attending physician during the latter’s cardiology fellowship. So it makes sense that they’re friends. And makes sense that Dr. McCullough would have Dr. Kahn on his podcast.

I watched the interview and took copious notes, but I’m running out of space here and have more stuff I want to go over.

Why don’t you watch the interview. Next week I will refute most of the claims Dr. Kahn has made and show why I believe he is wrong. I’m going to reach out to Dr. McCullough—we’re both here in Dallas—and see if he will interview me, so I can argue for the superiority of the low-carb/ketogenic diet.

I will go through all my arguments here next week irrespective of whether Dr. McCullough invites me on or not.

Ultra-Processed Food. Another RCT

As I’ve discussed, both the medical literature and the popular press are crawling with articles about how bad ultra-processed foods (UPF) are for health. But despite this vast press coverage (both medical and corporate media), there has been only one randomized controlled trial looking to see if UPF live up to their negative billing.

Kevin Hall from the NIH performed a one month study during which he put 20 subjects on a diet devoid of UPF or one crawling with UPF. The subjects acted as their own control. They spent two weeks on one diet, then two weeks on the other.

At the end, it turned out that those on the UPF diet consumed ~500 kcal more than those on the unprocessed food diet, which is a huge difference. Here is a graphic of the study outcome.

Many were critical of the study because a) it wasn’t long enough, and b) there was no washout period between the two diets. In other words, subjects went right from one diet to the other. Which means there could have been carryover effects from one diet bleeding into the other.

I’ve heard Kevin Hall speak about it, and he said he thought the whole UPF deal was BS, so he threw together a quick study to prove it. As it ended up, the outcome really surprised him. He is in the process of recruiting subjects for a new study that I’m quite sure will have a washout period between the diets.

A new study has come out from Japan, but with some differences. In the Japanese study the subjects were on the different diets for a one-week period instead of a two weeks as in the Hall study. And there was a two-week washout period between diets. This study, however, had only nine subjects, so it doesn’t have quite the power that the Hall study did.

Here is the layout from the paper.

The meals in this study were designed to be equal in terms of caloric content and macronutrient distribution. In other words, the fat, protein, and carb content were the same in both diets—the only difference was all the additives that made one a UPF diet.

Those subjects on the UPF diet ended up consuming a whopping 813.5 kcal difference per day! Which is really incredible.

I hope these two studies fire up enough researchers to duplicate them with more subjects and a washout period.

I, like Kevin Hall, didn’t really buy into the UPF premise, but after these two studies, I’m beginning to. MD and I have tried to completely ditch UPF foods from our diet. It’s difficult if you buy anything other than just meat and vegetables.

I used to look only at the macronutrient composition if I was evaluating a packaged food. I ignored all the small text below describing the flavorings, preservatives, emulsifiers, etc. No longer. We try to buy as clean as we can, but it’s difficult.

I would encourage you to do the same.

Odds and Ends

• Chinese newest nuclear submarine sinks in the harbor dealing a major setback to China’s priority weapons program.

• Take this interesting and fun quiz to see what country would suit you best to live in given multiple attributes you find important. Japan, a country I’ve never visited was ranked number one for me, followed closely by Italy, where I’ve been many times. [Which disappointed the Bride who was hoping for Scotalnd!]

• The dark secrets of the world's billion dollar chocolate industry. It’s more cloak and dagger than one would expect.

• Ketogenic diet improves fertility in patients with polycystic ovary syndrome: a brief report. Just another one of the many benefits of a ketogenic diet.

• Weight Watcher’s CEO, who brought the company into the weight-loss drug biz, resigns after stock price tumbles by 90 percent over the last year.

• Be careful of your olive oil choices. According to Bloomberg, adulteration is widespread, and that’s not to mention lampante, a grade listed as unfit for human consumption.

• White substance sprinkled on the heads and necks of mummies—some of which are 3,600 years old—turns out to be the world’s oldest preserved cheese.

• Montana man faces sentencing for cloning giant central-Asian sheep to breed large sheep for captive trophy hunts in Texas. Strange story.

• Analysis of gruesome battle site indicates an army wielding fearsome weapons invaded the German northlands 3200 years ago.

• Would you like to run a bookstore in Scotland for a day? Or two? Or three? Or more? And have a place to stay? If so, this might be the deal for you. [The Bride is intrigued.]

• Downpours due to Helene have taken the biggest known deposit of high-purity quartz offline, leaving the global tech supply chain potentially starved of an ingredient vital for making microchips.

• This is pretty cool. Check out what the weather was on the day you were born in the place you were born. Can be used to check out the weather any day, any where.

• Cenotes in the Yucatán Peninsula are time capsules preserving remnants of Maya culture and fossils of extinct megafauna. I’ve always wanted to SCUBA dive in a cenote; this is probably as close as I’ll get. I’ve seen them, but never been in one.

• 'Ghost Ship of the Pacific' is found on California ocean bed 82 years after becoming only American vessel to be captured by Japanese in WW2.

• A junk dealer in Pompeii keeps a Picasso painting in his living room for 50 years without knowing it.

• A graphic guide to cemetery symbolism. I’ve seen most of these many times in cemeteries and never knew what they meant. In fact, I just thought they were design elements. Nice to know they have specific meanings.

• Almost 3 out of 4 employees are contemplating quitting since Amazon had mandated a back-to-the-office work policy. The Millennials were having too much fun working from home. Serves Amazon right for promoting the lockdowns.

• We get 24 hours in a day. How do we spend this time? How does our time use change as we get older and priorities shift?

• What reports got wrong about China’s ‘sunken nuclear submarine.’ (See first entry above for standard media report.)

• Sad tale about how many students at elite universities are unable to muster the attention required to read a complete book. Cell phones? Video games? Who knows why?

Newsletter Recommendations

Video of the Week

This week’s VOTW honors Dame Maggie Smith, who died last week. Here she is with Carol Burnett, with whom I have a special relationship. I grew up with her as my folks loved her, and it seemed to me she was on TV constantly. These days she owes me about a dozen golf balls. I play a lot in Montecito on a golf course that abuts her house. She lives off of a par 5 that has a lake on one side and her house on the other. The fairway slopes toward the lake, so when I hit my second shot, I try to keep it to the right side of the fairway, so it won’t roll into the lake. About half the time, it seems, I hit it a little too much to the right, and it ends up in Carol’s back yard. But I don’t begrudge her given all the pleasure I’ve gotten from watching her.

On another note, Carol Burnett is really a sweet person. Montecito is crawling with celebs, and everyone pretty much leaves them alone. I’ve seen Carol Burnett swarmed on twice by middle-aged women who were all over her about her show. She was absolutely as gracious as she could be.

Enjoy both Carol and Maggie when both were in their primes.

Next week I’ll discuss the McCullough interview with Joel Kahn and go over a study making the case that many elderly people diagnosed with dementia may have nothing but a statin side effect. And I’ll cover a bunch of other issues that strike my fancy between now and then.

Time for the poll, so you can grade my performance this week.

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

Please help me out by clicking the Like button, assuming, of course, that you like it.

This newsletter is for informational and educational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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