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Hello everyone.

Greetings from Dallas, where it is sunny but freezing cold, and has been for days. It’s making me itch to get back to Montecito. Just talked with our kid there. It’s 66F and partly cloudy.

A New Beginning

At least I fervently hope so. A couple of days ago, Robert F. Kennedy, Jr. was sworn in as the new Secretary of Health and Human Services. I am praying he will do as promised, and my hopes won’t be dashed as they have been many times before by politicians.

Before we get into what he wants to do, let’s take a look again at this grim graphic from the NY Times.

I posted a clearer version of this same graphic last week (I think), but that one didn’t include Russia and Saudi Arabia. Saudi Arabia (and I’m sure other rich Middle-Eastern countries) aren’t spending the same amount the US is, but their longevity is tracking about the same. I have a couple of doctor friends who have an obesity practice in Dubai. They told me that obesity and diabetes are epidemic there among the upper classes. They told me the men aren’t bothered by obesity in themselves at first, but send their wives to the weight-loss doctor. But when the men begin to become impotent, it changes their perspective considerably, and they come to the clinic as well.

I suspect that given enough time and US influence all the lines above will converge.

But let’s hope not.

I listened to every word of Bobby Kennedy’s talk to the folks at HSS a couple of days ago. I tracked it down, so you can watch and listen as well.

I was worried that after all the BS he’d had to deal with to get through the confirmation process he might soften. But he didn’t. Thank God! Now if he will but carry through.

I tried to find a complete transcript, but I couldn’t. Here are the most important parts, at least to me. They are brief, but at least he said them.

One of the things he said that jumped out at me the most was the following.

Compare that with the last administration. There are still countless FOIA requests that haven’t been fulfilled.

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Now, of course, what got the most scrutiny and pushback from the responses I’ve seen, was his comment on the childhood vaccine schedule. If you go back and listen to his words (or read them above), he said “Some of the possible factors we will investigate were formerly taboo or insufficiently scrutinized. A childhood vaccine schedule,…”

This one line caused massive panty wadding throughout the tribe of vaccinators. During Kennedy’s confirmation hearings, he basically said everything was on the table, including the childhood vaccine schedule (pdf). Which set the vaccinators baying, with Paul Offit at the head of the pack, howling that RFK had “preconceived notions” above vaccines, which was in conflict with what he actually said during his hearings.

What RFK said was “I support vaccines. I support the vaccine schedule. I support good science” The catch is the “good science” part. Vaccines are not good science. They’ve never gone through placebo-controlled studies, yet we give them willy nilly to all of our children. I suspect that will change under his watch. At least I hope so.

One good sign is that a bunch of people have already been let go. And, of course, the squeals of outrage are off the chart. Jim Jones, a deputy commissioner at the FDA, resigned a few days ago in protest of the firing of 89 people from the FDA’s human foods program.

From an industry online journal:

Cry me a river.

What were all these people doing before? Why hadn’t they already jumped on implementing an agenda to make our food safer? That’s what they were being paid to do.

I’m glad Jim Jones cut and ran, too. He oversees it all, and what has he done? Anyway, it’s a new beginning, and I’m eager to see it bear fruit. Fingers crossed.

Yet Another Study On Ultra-Processed Food

Perhaps they can use the salaries saved from all the canned employees mentioned above to fund a real study on ultra-processed foods (UPF). All of the studies done so far have been less than optimal. As far as I can tell, there have been only two real RCT studies done—one at the NIH, the other in Japan—both of which fall far short of proving anything. And Kevin Hall’s group, who did the first study, is doing another, but based on what I’ve read about it, it is more Mickey Mouse than the first.

The first Kevin Hall study used the subjects as their own control—which is a valid way of doing such studies—but kept them on one of two diets, one filled with UPF, the other without, for only two weeks each. And with no washout period in between.

It takes about six weeks on a diet to adapt to it. We don’t know if those on the two weeks of UPF wouldn’t have adapted to it in a few more weeks and stopped their weight gain. In which case, it would be difficult to attribute weight gain to UPF. Also, if UPF do indeed cause subjects to gain weight, we don’t know how long that effect lasts. So stopping the UPF diet on Sunday and starting the non-UPF diet on Monday may involve a carry-over effect from the two weeks before. If so, then the data from those immediately switching to the non-UPF diet might show less weight loss than if they had simply started the diet without the two-week, high-UPF lead in. It’s confounded.

All good studies of this type have a washout period of several weeks to all the subjects to let them kind of re-equilibrate before starting on the new leg of the study. Kevin Hall said there was no washout because there were so few subjects (another downside) and he was afraid a number of them wouldn’t return for the next two week part of the study if there were a two or three week pause in between. And, as he has said numerous times, he thought the whole UPF thing was BS, so he didn’t think the study would show much anyway. So why bother?

Now, he’s got a second chance to do another study, and on this one, which is underway, he is doing different diets for only one week, instead of two, and there is no washout period in between.

The Japanese study did have a two-week washout period, but the actual study periods were only one week long, which is way too short. Consuming a different diet can make you gain or lose weight in the first week or so before you accommodate. This is why the study periods need to be longer than one or two weeks.

The problem with these kinds of studies is funding. In-patient studies are expensive, and it’s difficult to find funding sources. Who would fund such a study? Certainly not anyone from Big Food. Or Big Pharm.They are the ones trying to cram UPF down our throats—they certainly don’t want to lose that gravy train. Some small food company that doesn’t use UPF wouldn’t have the financial clout to do it. The NIH would be able to, but it’s political. Maybe with Bobby as the head of HHS, he’ll help underwrite such funding. He should since that’s one of his causes.

A study should be pretty easy to do. MD and I now go through the grocery aisles looking for food that isn’t UPF, and it can hardly be found. Cream and half and half that doesn’t contain gums. Various sauces that aren’t full of gums, emulsifiers, and flavorings. My favorite hot sauce was Cholula, until I discovered it contains xanthan gum. Found another called Frank’s Original that is devoid of anything bad. Same with a bunch of soups and other canned and packaged foods. Even ice creams come in pure versions along side those crawling with gums and emulsifiers. One of the things that might have to be done is to bake the bread with non-enriched wheat flour. (Well, I don’t eat much bread but some do.) But all in all, it shouldn’t be a major undertaking to come up with an average American diet with and without UPF and do a trial.

My worry is that Kevin Hall is a total CICO fanatic, and since he’s more or less the head of nutritional studies at the NIH, I hope he doesn’t BS RFK or Jay Bhattacharya into doing yet another crappy study that really doesn’t prove anything.

The latest study I came across is enlightening, but doesn’t prove causality. Nevertheless, it is just another data point showing that UPF are not good for us. There are a ton of observational studies (pdf) showing UPF are associated with obesity, but those studies don’t prove causality. None of them—at least none that I’ve seen—show a negative correlation. But it takes properly designed, randomized controlled trials to do that. But until we get them, these observational studies are all we have.

The latest one I’ve seen was published in JAMA Network titled “Ultraprocessed Food Consumption and Obesity Development in Canadian Children.” This study looked at UPF consumption in three-year-old children and compared it to their obesity rates when they turned five. The authors used the NOVA system, which I’m not all that crazy about, to determine UPF consumption.

It does provide nice graphics, making it easier for parents to decide what their kids ate.

At multiple locations in Canada, parents completed food frequency questionnaires asking how often their three-year-old kid ate any of 112 individual items, each of which was assigned a processing level using the NOVA system. Based on this data, the researchers could derive a UPF score.

From the graphic above, you can see the progression. The tomato is obviously unprocessed. As you go from left to right, you can see products with progressively more processing. The marinara sauce on the far right contains sugar and a host of preservatives, etc.

When the kids came back for their five year visits, they were weighed and measured. Then researchers compared their rates of obesity to what they ate UPF-wise at three and, presumably, what they continued to eat until age five.

Here’s what they found.

First, which kind of goes along with all the other data out there, the kids were eating a lot of UPF at age three. Probably more than the graphic below indicates simply because people tend to underestimate the quantities of what they think are bad foods. Most parents won’t say, Oh, yeah, Little Johnny (or Joanie) eats a lot of candy and donuts and sweetened cereal. So these figures have to be taken with a big grain of salt.

But given the fact that parents will underreport the consumption of bad foods by their kids, because it’s a reflection on the parents, the figures are dreadful.

As you can see, processed and ultra-processed foods made up over 60 percent of the diets of these three-year-old children. UPF alone made up ~45 percent. Which is pretty consistent with the data on adults, who consume more than 50 percent of their calories (probably more) at home and away from home dining. Again, based on food frequency questionnaires, which are highly inaccurate. I suspect it’s more in the 65-75 percent range.

But what did it do to the weights of the kids when they turned five?

Strangely, if affected boys much more than girls. I pulled the graphic below from a Medscape article about this same study.

I have no idea why the males were affected much more than the females. The data from the food frequency questionnaires shows the little girls ate a tiny fraction less of the processed and ultra-processed foods than the little boys, but not enough, I wouldn’t think, to show this disparity in weight gain.

The doc who wrote the Medscape article makes a good point, but I’m not sure he described it well. It’s always something that needs consideration.

What he’s discussing is the fact that UPF drive more food intake. Both the Kevin Hall study and the Japanese study show that subjects on the UPF arm of the trials consumed significantly more calories than those on the non-UPF arm. Significantly more calories, in fact. The subjects in the Hall study threw back a little over 500 calories per day while eating UPF as compared to non-UPF. Those on the Japanese study ate over 800 calories more per day more than when on no UPF.

My perspective on UPF right now is that they are specifically formulated to make those who eat them want to eat more and do so. By adding artificial or natural flavorings, food technologists can make the foods vastly more tasty and, I hesitate to use this word, addictive. It’s like the old Lay’s Potato Chips campaign slogan: “Betcha can’t eat just one.”

It’s easy to understand this by using a simple thought experiment. Let’s say you have a subject in a nutritional study using a shake as the only food. These kinds of studies are done all the time. Food technicians mix up shakes with different macronutrient composition but with the same taste. You don’t really know what your getting macronutrient-wise, because it all tastes the same.

Let’s say you are going to be a subject in a study during which you suck down these shakes for three weeks. Then you have three weeks off and come back and suck down shakes again for three weeks. The researchers monitor how much of each shake you drank.

Both of the shakes have exactly the same macronutrient composition. Let’s say it is 20 percent protein, 40 percent fat, and 40 percent carbs, by calories. The only difference is that one of the shakes is kind of bland, while the other tastes delicious and has a great, creamy mouthfeel.

Which one do you think you would drink the most of during the experiment? I know I would drink more of the great tasting one. I would drink the bland one when I was hungry just to get some calories. But I would drink the delicious one not only to get the calories, but because it was enjoyable. And I’m sure I would drink a lot more of it, because I would be getting both calories AND pleasure.

That’s what the doc quoted above is talking about. If you used me as a subject in the above thought experiment, you’d find—I’m absolutely certain—that I would have consumed many more calories of the tasty shake than I would have of the bland one. Which would have demonstrated that making it delicious makes me consume more of it.

But if the researchers running this imaginary study would have adjusted for energy intake, there would have been no difference.

It isn’t that UPF, which for the most part contain no calories, increases weight gain per each unit of food containing them. The UPF, in my opinion, drive us to eat more of a given food than we would if this same food did not contain UPF additives. Measuring it as a function of total caloric intake is worthless.

Indiscriminate Antibiotic Use

I’ve come a long way since the first few medical conferences I attended years ago. Young doctors love to go to these big conferences because a) they learn a lot, and b) they walk away with a lot of swag. But to get the swag requires giving up your name and address (now I’m sure it’s your email address).

When you would go into one of the Big Pharma booths, you could get all kinds of stuff. But many of them asked you to fill out a survey. One of the questions on the survey was to determine how aggressive you were at prescribing new drugs. These surveys always asked something along the lines of: When prescribing medicines, a) Do you prescribe the newest drugs available? b) Do you wait until the drugs have been available for a year before prescribing? c) Do you wait several years before prescribing? or d) do you prefer to prescribe drugs that have been in use for decades?

I was Doctor Aggressive. I always answered a). That was until I saw a few really bad drug reactions—one of which was MD’s sister. I had prescribed her a brand new non-steroidal anti-inflammatory drug called Zomax. Zomax was the latest drug on the scene in that NSAID category and was getting rave reviews. She had broke out in hives and we had to administer epinephrine! Not long after MD’s sister’s bad reaction, it was removed from the market never to be heard of again.

Before granting approval, the FDA requires pharmaceutical companies to spend tens of millions of dollars to develop and test new drugs. But the tests required can’t possibly ensure that once the drug is out and being used by millions of people side effects won’t appear that were missed because of the relatively small number of subjects tested. When it does happen, the FDA demands the drug be yanked, and the drug company doubtless gets sued by those who were harmed by it. A recent Yale study showed that one third of drugs receiving FDA approval end up getting yanked due to side effects once introduced to a larger body of patients.

(For what it’s worth, this is the only bit of sympathy I have for Big Pharma. They lose a ton of money on drugs that don’t make it through the approval process, and they really lose a ton when one makes it through then has to be withdrawn.)

The bad reaction to Zomax that MD’s sister experienced had an impact on me. After a couple of other similar events with other new drugs, I decided to move out of the a) category in the surveys and into the b). It wasn’t too long before I was in category c): a drug had to be around a few years before I would prescribe it. Unless, of course, it was a new drug category for a problem never before treatable. Zovirax, for example, the first drug developed to treat herpes infections was one I would prescribe simply because there was no other choice.

As I’ve gotten older, and I hope wiser, I’ve really edged into category d). If I’m going to prescribe a drug—or take one—it has to have been around a long time and must have developed over time a good safety profile.

Heather Heying, who is married to Bret Weinstein, related a bad-drug-reaction horror story in her Substack a couple of days ago that I thought would be illuminating to discuss.

The drug in question is Cipro (ciprofloxacin) which is in the drug category called fluoroquinolones.

Cipro came out not long after I went into practice, and I prescribed my fair share of it. The drug detail folks who haunt doctor’s offices were always in there pushing it and providing samples. It was thought to be a safe broad-spectrum antibiotic that treated a lot of different infections. It was also quite expensive. Not so much anymore as it has gone off patent.

One of the things no one (even the manufacturer) knew at the time was that it could cause disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and even the central nervous system. Which is a good reason to wait a while before prescribing or taking Cipro or other fluoroquinalones. Here is a graphic from a paper on the long-term damages that fluoroquinalones can cause.

I had a friend who was put on one of these drugs a few years ago and experienced a problem with his knee. Heather Heying’s case was worse.

She starts her story by talking about her younger days as a PhD student and researcher in various far flung places.

Later on, she gets more specific about her traveling pharmacy.

She describes what happened to her a decade ago.

She ended up rupturing her Achille’s tendon, which is a serious injury. For any professional athlete, an Achille’s rupture is a season-ending injury, even if it occurs on the first day.

She describes her long, excruciating journey to recovery, which still isn’t over ten years after her injury. It’s well worth reading as a cautionary tale.

The moral of the story is to not take medications for minor issues. Hold off till you really get sick before succumbing to being medicated. Many disorders simply do well with a little tincture of time. The body has spectacular healing properties. Give them a chance to work.

Doctors prescribe way too many antibiotics, analgesiacs, NSAIDS, and other drugs when the tincture of time could do was well. Problem is, physicians feel like they need to do something for the patient to feel the visit was worth the time and money.

When MD and I opened our first urgent care clinic (long before urgent care clinics were on every corner), we offered a different kind of service than people were used to receiving. We tried to do things differently. One of the things we started doing early on was having our nurses during their down time call all the patients to see how they were doing. We had them make the call two days after the visit.

One of the most common complaints we received took the form of “The doctor didn’t do anything.”

If you have a viral upper respiratory infection, i.e., a cold, the best thing to do is rest and keep fluid intake up. The problem is self limited. Telling someone they should rest and drink fluids is the perfect treatment. But, as we learned, people thought they were short changed because they didn’t get medicated.

Here is what happens in this situation. The patients take a few days to get better. When they’re still sick a couple of days later, they go to another doctor. That doctor gives them an antibiotic. Their own immune system has just about fought off the infection, so when they take the antibiotic, they get well in a day. They then think the second doctor is a genius and the first one an idiot.

Consequently, most doctors, who are aware of this, end up giving people an antibiotic at the first visit. Which doesn’t really help the patient. And ends up worsening antibiotic resistance.

I ended up cobbling together a kind of cough medicine that I had to write out for the pharmacists that involved three medicines that have been around forever. One was an expectorant, the other was a drug that opens airways a bit, and the third was a small dose of a steroid. It worked like a charm. Kept people feeling better and breathing easier.

The moral is to be careful what you take. Ask questions. Ask about possible side effects. Ask if you would do just as well without the medications. Take the prescription, but hold off for a bit before you take the meds. You’ll have the script if you need it in case you don’t get better in a couple of days. Or if your snot changes colors, or if you begin hacking up yellow crap you have it; take it.

Take some responsibility for your own health. You’ll be all the better for it. Doctors always ask you if you’re allergic to any drugs. If I get asked, my answer is always fluoroquinalones.

Now, it should go without saying, that if you are in an emergency situation, you need to follow instructions pretty much to the letter. What I’m talking about is these little annoying colds, flus, and other URIs that plague us all a time or two a year.

The Great Flu Epidemic

I’ve heard and read all over the place that we are in the midst of a flu epidemic. I haven’t paid much attention to it, because I don’t myself know anyone who is sick. And flu is very contagious.

Then I read a recent post by a woman who writes a Substack called Your Local Epidemiologist. I’ve subscribed to her for several years just so I can keep up with someone who advocates every vaccine that has ever been produced. If there is a vaccine out there, according to Your Local Epidemiologist, you need it. And she can tell you why you need it.

A few days ago, she posted this graphic showing the flu epidemic spreading across the country.

This graphic is posted under the title of Your national disease report: Hello, flu. You can see the epidemic threshold she has identified with the horizontal dotted line. According to this chart, we are way, way above where we’ve been flu-wise for years. And we’re still heading up.

The flu, or influenza, is a pretty serious viral infection. It’s fairly contagious (has been for centuries) and often makes people extremely ill. They have high fevers, chills, body aches, head aches, and are pretty much bedridden for a few days. The real influenza is that bad. Those of you who have had it understand.

Unfortunately, the “flu” has come to mean any kind of little upper respiratory infection. People who have colds call it the flu, but the real flu is a far cry from the common cold.

Since the woman writing this Substack is a working epidemiologist, I figured she knew what influenza was, so assumed her graphic was legit. I doubted that she just made it up. But if it were true, I figured I would know a bunch of people with the flu. And that the hospitals would be overrun. The flu plays hell with elderly people, so many of them take no chances when they come down with influenza.

I was taken by her graphic, but then I read what she had written right above it.

A fever, cough, or a runny nose. That’s pretty much the definition of the common cold, not influenza. Fever, cough, and a runny nose, an influenza-like illness, is not influenza. The flu is bad; those are simply symptoms of a cold.

She does go on to say

I knew vaccines would enter the picture somewhere along the way. In my view, and in the view of many others now that it’s becoming more socially acceptable to discuss the downsides of vaccines, the flu vaccine is worse than useless.

Masks don’t do squat. That has been shown pretty conclusively. Ventilation is good.

And in one of the rare instances in which MD and I disagree, I don’t think Tamiflu works for crap. She thinks it’s wonderful. Take your choice. Dueling doctors. [The Bride adds: it doesn’t hurt if you think you really have the actual flu!]

If all these people are dying with the flu, it has escaped me. I don’t know a single person who has had the real, honest-to-God flu. Maybe you have.

My Continuing Ketone Journey

A year or so ago, I wore a continuous glucose monitor for a month, during which I ate my regular diet. My blood glucose levels stayed in the 80-90 mg/dl range almost all the time. Even if I tested my blood sugar a bit with some extra carbs, it never went much above 100.

Now I’m on a strict ketogenic diet and have been for a couple of months, and my blood sugar is over 90-100 almost every time I test it. This has been driving me crazy. It just shouldn’t be.

My ketone levels are pretty good most of the time. I’ve been running between 1.2 to 3.5 mmol. Never under 1 and usually closer to 3, but I’m going nuts trying to figure out why my blood sugar is running way higher than during my usual low-carbohydrate diet.

When I decided to kick off this quest, I did a water fast for 3 days. Which was not fun. I am not a good faster, but I stuck with it. I ended up with some really low glucose levels and pretty decent ketone levels. My lowest blood sugar was 52 mg/dl, but the very next one was 106 (while fasting!). My ketones were a low of 1.2 and a high of 4.2.

I switched over to real foods, but extremely low-carb. I haven’t eaten over 20 grams of carbs a day at any time. Most meals are mainly fat. I’m kind of forcing the fat. Tonight, for example, I ate a couple of small pieces of rare top sirloin streak, a good sized piece of baked Halloumi cheese, a tiny (and I mean tiny) bit of sautéed kale cooked in bacon grease, and a half of a small avocado with mayonnaise.

I’ve heard countless people say that dietary protein drives glucose production. It does indeed…if you need glucose. Gluconeogenesis is an on-demand function. You don’t just make glucose because you’ve eaten protein. If you are deficient in glucose, you will convert some protein to glucose. But, according to every source I’ve read, you won’t make glucose if you don’t need it.

I decided to use a little AI to see if anything new had been published about protein driving gluconeogenesis when blood sugar wasn’t needed. Both Elon’s Grok and my favorite, Perplexity, have been upgraded to do deep searches that can take a few minutes. I put the question to both, and ended up getting fed the same studies I had already read. All of which said protein wouldn’t drive gluconeogenesis if it wasn’t needed.

Something wasn’t coming together, so I decided to think about it to see if I could come up with some rationale for what was happening to my blood sugar.

Before I got too deeply into it, I forked over $150 for the keto book of all keto books. I could have gotten it for $120 at Amazon, but I chose instead to get it from Academic Press, because they had on offer a combo deal to get both the softcover version and the Kindle version for $150.

It’s a great book, but it didn’t answer my questions.

As I started thinking about it deeply, a few possibilities bubbled up into my brain. As a result, I’ve come up with a few theories that I’m going to test.

Let’s take a deeper look.