The Arrow #218

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Hello everyone.

Greetings from Dallas, where it is overcast, cold and windy.

Got some strange poll responses on last week’s Arrow that I want to pass along, mainly because I don’t understand them.

The first was short:

Too much AI talk.

I went back and looked. There was not a single word of AI talk in the entire post. Now if you’re talking about the Odds and Ends section, there were a couple of links out of the 20 total that were about AI. But nothing in the post. Maybe this reader reads only the Odds and Ends. If not, I’m baffled.

Next comes a really bewildering one.

Arcane insulin sleuthing story was excessive. Nitpicking it seemed.

Nitpicking?!?! It was just about the entire point of that section of last week’s Arrow. I was trying to show how you must check out the references in any scientific paper that don’t seem to correspond with what your own experience is. You can’t just accept what authors present without going back and making sure the reference they cited actually backed up the point they made. Last week’s was a case in point. The reference cited basically refuted what the original authors posited.

That’s not excessive and nitpicking. At least not in my book. It’s how you’re supposed to do it. Take nothing at face value. If you do, it will end up biting you in the rear.

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Book Blurbs

Okay, it’s time for a little book writing inside baseball. I’ll try to make this short, because it won’t affect many readers. But those who are authors or who are planning on writing a book will find it interesting. In my case, I find it wonderful.

A few weeks ago, it was announced that Simon & Schuster would no longer demand that their authors collect book blurbs. For those who don’t know, book blurbs are those little quotes from other authors or famous people you find on the covers of books recommending said books.

I, for one, couldn’t be happier. I get it from both sides, blurber and blurb requester, so the end of book blurbs is a godsend.

Once you’ve written a book and turned it in to your publisher, the marketing push starts, so they’ll be ready to hit the ground running when the book is ready to ship. One of the first things publishers do is make the book cover. In fact, they usually do that while the book is still being written. So while you’re in the throes of writing the book, they begin to badger you for book blurbs.

You’re supposed to go out and get any one you know who is authoritative or famous to give you a cover quote. Which, if you’re writing a controversial book is difficult. No one who is authoritative wants to blurb a book that probably goes against their own beliefs or the mainstream beliefs. And most first time authors don’t know anyone famous.

Plus, the book isn’t even finished when the publisher starts pushing you for blurbs, so you can’t even send out a copy of the book for your prospective blurbers to read.

When I wrote my first book Thin So Fast in 1988, it was highly controversial, to say the least. Some people got wind of what it was about and went berserk. Before I knew what hit me, Harvard professors were writing to my publisher telling them that if they were to publish my book, they would be responsible for thousands of deaths. My publisher was concerned, to say the least. I got them calmed down, but they insisted I get a blurb from an authoritative source.

At the time, MD and I were members of the American Society of Bariatric Physicians (ASBP), which has now morphed into The Obesity Society. We attended all the meetings, which all revolved—at that time—around the low-fat diet. I knew a few of the members causally, but I knew they would be totally scandalized if they knew what I was writing or even how I took care of patients.

One of the talks at the most recent meeting was by Michael Steelman, M.D.,a physician from Oklahoma City, which was the next big (small) city going west from Little Rock. He was also a past board member of the ASBP. I inferred from his talk (which I remember nothing about today) that he might be more open than most to the idea of a low-carb diet as a part of the extremely popular (at that time) protein-sparing modified fast (PSMF). I took a deep breath and approached him. He said he would be happy to read what I had written so far and, if he liked it, he would blurb it.

He did. Thank God. And here is his blurb on the back of the book.

I have never failed to thank him whenever our paths have crossed since. And if I’m giving a talk, and he happens to be in the audience, I always single him out with a public thanks.

As I’ve continued to write books, I’ve learned more and more about the blurb business. In many cases, authors write their own blurbs and simply ask the permission of the supposed blurber to use it. Most of them say Yes. No one wants to have to write a book blurb—it’s a major pain.

When our friend Barry Sears wrote his second book after his mega-bestseller The Zone, he asked me for a book blurb. MD and I struggled to come up with something perfect.

A few months later, we came out with Protein Power and asked Barry to blurb it for us. He told me to just put something together and send it to him. We were under the gun, so we wrote the blurb, but couldn’t get in touch with him. (This, of course, was before texting and all the other immediate ways to get in touch with people.) I sent it off to the publisher as we wrote it. When Barry finally got back to me, I told him what I had done.

He just laughed and said, “Great. What did I say?” If you don’t know Barry, he is a really funny guy.

Since that time, we haven’t had trouble getting cover blurbs, but it is still a real pain in the butt. You hate to ask, because you’re essentially asking someone to read your book, which is asking for a real time commitment in manuscript form especially.

MD and I are barraged for requests for blurbs. Neither of us will blurb if we haven’t read the book. So agreeing to a blurb, means we’ll have to spend a lot of time reading a book we might otherwise not read. Or saying no, which I hate to do, because I know how much it means.

So, for many reasons, I am deliriously happy that book blurbs may be going away.

Say It Ain’t So, Bobby

That was my first reaction when I heard about the editorial RFK, Jr. wrote for Fox News about the measles vaccine and the unvaccinated child dying in Texas. It appeared at first blush that he was backing off on his stance on the idea that vaccines should be scientifically vetted before being foisted on an unwitting public.

But then I read the piece more carefully and realize he was being extremely precise, lawyerly, if you will, in his choice of words. During his interrogation by members of the senate, he did the same thing. He played to the preconceived beliefs. He told them he had no intentions of abandoning vaccination programs; he just wanted to make sure the vaccines were thoroughly tested.

Of course, the dolts questioning him ‘knew’ the vaccines had been thoroughly tested, so most of them gave him a pass. One exception was Mitch McConnell, whom I can’t wait to see the back of. He also ‘knew’ about vaccine science. The turtle refused to vote for RFK, Jr’s confirmation because, as he said:

In my lifetime, I’ve watched vaccines save millions of lives from devastating diseases across America and around the world. I will not condone the relitigation of proven cures, and neither will millions of Americans who credit their survival and quality of life to scientific miracles…

The turtle wouldn’t know a proven cure if it walked up and bit him. I have no way of knowing, but I would hazard a guess that ol’ Mitch might have a hand or two in Big Pharma’s pocket. It’s even more turtles all the way down.

As I’ve discussed many times (and won’t go into it here) vaccines have never been properly tested. They have not by any stretch been thoroughly tested.

RFK, Jr was very careful in what he wrote in his Fox News opinion piece.

As the Secretary of the U.S. Department of Health and Human Services, I am deeply concerned about the recent measles outbreak. …Tragically, this outbreak has claimed the life of a school-aged child, the first measles-related fatality in the United States in over a decade.

Nothing but the facts here. He’s concerned. And the death of a school-aged child is a tragedy. No one can argue with that.

What no one knows—and I’m here in Texas and reading everything I can find—is what the state of this little girl’s health was before she came down with measles. Is it like dying with Covid instead of from Covid? There has been no mention of her overall health status, which leads me to believe she may have had some co-morbidities. But that’s just a guess.

He continues:

The current Texas outbreak has predominantly affected children, with 116 of the 146 cases occurring in individuals under 18 years of age. The DSHS reports that 79 of the confirmed cases involved individuals who had not received the measles, mumps, and rubella (MMR) vaccine, while 62 cases had unknown vaccine status. At least five had received an MMR vaccine. [My bold]

Again, just a recitation of the facts. Plus the line at the end of the paragraph letting people know that the MMR vaccine does not protect everyone.

In the next paragraph, he states that he will direct the CDC and other federal agencies to work closely with the Texas agencies to contain the outbreak.

In the next paragraph, he does what he did to his senate inquisitors.

As healthcare providers, community leaders, and policymakers, we have a shared responsibility to protect public health. This includes ensuring that accurate information about vaccine safety and efficacy is disseminated. We must engage with communities to understand their concerns, provide culturally competent education, and make vaccines readily accessible for all those who want them.

After the first boilerplate sentence, he basically says we’ve got to provide people with accurate info about vaccine safety and efficacy. That’s what I’ve been trying to do in as I’ve learned more and more. Of course, most of those reading that are becalmed because they believe that vaccines are safe and efficacious, but that’s far from the truth.

The last bolded line in the quote above says it all. We want to make vaccines readily available for all those who want them. Not mandated for everyone. Not forced on people who don’t want them. But for those who do. He’s said that from the start. Anyone who wants a vaccine should be able to get it. But those who don’t wish to be vaccinated shouldn’t be forced.

He then goes on to provide some nutritional advice to those who are already infected with the measles.

It is also our responsibility to provide up-to-date guidance on available therapeutic medications. While there is no approved antiviral for those who may be infected, CDC has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection. Studies have found that vitamin A can dramatically reduce measles mortality. [My bold]

He tells people getting vaccinated is a personal choice.

Parents play a pivotal role in safeguarding their children’s health. All parents should consult with their healthcare providers to understand their options to get the MMR vaccine. The decision to vaccinate is a personal one. Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons. [My bold]

In the paragraph above, he does a couple of things. The decision to vaccinate should be a personal choice, not foisted on individuals by government or their workplace. It is true that vaccines protect individual children from the measles, but at what cost? That’s the part of the equation we don’t know, simply because the studies haven’t been done. And he’s correct that vaccines do contribute to community immunity. But, again, at what cost?

Let me interject my own thoughts here. If the measles vaccines (or any vaccine, for that matter) had been thoroughly tested and found to prevent the measles without a host of other adverse events that might affect a person for a lifetime, I would be all for them. But, unfortunately, we don’t have that comfort as the tests have never been done. All we know for sure is that the vaccine almost totally eliminates (not fully—see the five cases mentioned above who were vaccinated) the measles, which is a pretty benign childhood disease for the vast majority of children.

RFK, Jr. goes on to discuss the history of measles deaths.

Tens of thousands died with, or of, measles annually in 19th Century America. By 1960 -- before the vaccine’s introduction -- improvements in sanitation and nutrition had eliminated 98% of measles deaths. Good nutrition remains a best defense against most chronic and infectious illnesses. Vitamins A, C, and D, and foods rich in vitamins B12, C, and E should be part of a balanced diet.

That is the rest of what he says about treatment. The last few paragraphs are the normal political blah, blah, blah about how we’re all working together tirelessly to deal with the situation.

As you can see, RFK, Jr. did not sell out. He remained true to his beliefs and expressed them well.

I came across the chart below pulled from the CDC and the VAERS data. It tells an interesting story.

I did not create this chart, but it was created by someone I trust to pull the data. I refuse to go on government sites. I end up going crazy. I can search the medical literature all day long and enjoy doing it. But I would rather suffer some awful personal debasement than go on the CDC website. I wish I could afford a research assistant who loved crawling government websites as much as I do delving into the medical literature. Unfortunately, MD is not that person. She hates doing both.

I asked AI to tell me how many kids were vaccinated in the US for measles and came up with the answer below, which looks about right.

During the 2019-2020 school year, 95.2% of eligible kindergarten students in the US were vaccinated against measles, according to the CDC. That percentage has dropped to 92.7% in the 2023–2024 school year, leaving approximately 280,000 kindergartners at risk during the 2023–2024 school year.

If instead of using total deaths as the chart above does, you used per capita deaths, it would look much different. There are about 13 times more kids who are vaccinated than there are those who aren’t. If you apply that to the stats above, it makes the deaths in red much lower than those in blue (non-vaccinated).

But then if you consider the stats that only about two percent of people with adverse reactions report to VAERS, then the picture changes again. But then VAERS, as I understand it, takes these reports, but doesn’t check them for accuracy. So the ball might bounce back the other way.

All we know for sure is that some kids who aren’t vaccinated for measles end up dying. And some kids who are vaccinated end up dying. We don’t know the prior health status of any of them. My guess is that almost all who die are not normal, healthy kids who come down with measles.

This is why we desperately need placebo-controlled trials. Only those will give us the data we need to confidently determine what’s best for our children. I hope RFK, Jr. doggedly pursues it to that end.

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CICO Crazy

The calories-in, calories-out kids really outdid themselves recently. It’s almost unbelievable how stupid this latest stunt is, but given the source, maybe not.

Back in 1958 a doc named Max Wishnofsky published a paper in the American Journal of Clinical Nutrition describing the process he used to determine that a pound of body fat contained 3,500 calories. He went on to say that if one wanted to lose a pound per week, all one had to do was cut one’s intake of calories by 500 per day, and, bingo, a pound of fat gone in a week.

This might work for a week or two, but then it wouldn’t. The body works to achieve homeostasis, so if you cut calories, you end up not moving as much. By the same token, it you indulge in serious exercise, you end up eating more to compensate. It’s really difficult to simply cut 500 calories from your diet and keep all your other activities the same, especially including NEAT (non-exercise activity thermogenesis), which are the bouncing of your legs, wiggling, restlessness in your sleep, etc. NEAT activities burn calories, but if you cut calories, most people end up with reduced NEAT.

And, speaking of exercise, it really doesn’t burn as many calories as most people think. I took at look at what a 176 pound person would burn running a 5K race at a pretty good clip. (I used 176 pounds because that made it easier for me to look up the caloric expenditure in the tables in the standard exercise physiology textbook (titled appropriately enough Exercise Physiology) by McArdle, Katch and Katch, which uses a 176 pound subject.)

This same textbook tells us that a 176 pound 5Ker running a 7-minute mile burns 17.9 calories per minute. (Running 7-minute miles is moving considerably faster than the average jogger.) The tables show that “lying at ease,” basically the resting metabolic rate of our 176 pound runner, burns 1.8 calories per minute. When we subtract the 1.8 calories burned at rest from the 17.9 total calories burned, we find that our runner burns 16.1 extra calories per minute while flying along at a 7-minute- per-mile pace.

At that pace it takes 21 minutes and 45 seconds to run a 5K race. Multiply 16.1 calories per minute times 21.75 minutes and you come up with 350 calories, the total calories burned above and beyond what this same person would burn just sitting quietly watching TV.

This 350 calories may seem like a lot until you consider that it could be replaced by one standard order of McDonald’s French fries that serve up 340 calories. Were you the runner who just sped through a 5k race in a little over 21 minutes (a very good time), do you think you might be hungry? Do you think you might eat a little more than had you been sitting listening to music for those 21 minutes? Do you think a standard order of fries from McDonald’s would replenish you?

I doubt it.

That’s the fallacy of burning off your excess fat. The exercise itself increases hunger. We’ve all heard the command: Go out and work up an appetite. It’s true.

Now with that long meandering introduction describing how the body adjusts for caloric intake all the time, making the counting of calories more or less a fool’s errand, let’s look at the craziness.

STAT, which is an online periodical (massively supported, I’m sure by Big Pharma)for those in the healthcare business, came out with an article titled “Do calorie counts on menus really change how people eat?” The subheadline tells the tale: “Calorie labels on menus have a small but meaningful impact on people’s choices, review finds”

Here is how the article kicks off:

Some people might prefer not to know exactly how many calories are in a Starbucks Frappucino or Bloomin’ Onion from Outback Steakhouse. Nevertheless, the Food and Drug Administration has required that the information be displayed on chain restaurant menus in the U.S. since 2018, and a similar rule was introduced in the U.K. in 2022.

But do calorie counts really change the way people eat? Evidence suggests they have a small but tangible impact, according to a new systematic review from the Cochrane Collaboration. [My bold]

The Cochrane review found that subjects who pay attention to the calorie labels end up consuming an average of 1.8 percent fewer calories than those who pay no attention to the labels. As the STAT article informs, that is the difference between a 600-calorie meal and a 589-calorie meal.

That’s not much. But small daily changes “can have meaningful effects if sustained long-term,” Gareth Hollands, a co-author of the review and researcher at University College London, said in a press briefing. He cited a U.K. government report that found 90% of people between ages 20 and 40 in England gain up to 9 kilograms (roughly 20 pounds) over the course of a decade.

Cutting 24 calories a day would prevent that increase, Hollands said. “Many of us are able to benefit from some help to maintain weight by cutting small numbers of extra daily calories that explain a lot of population weight gain.”

Yes, that difference might add up to or subtract from the 20 pounds many people gain over the course of a decade, but do you really think it would? Given the homeostatic capabilities of the human body, do you really think that if you ate whatever you wanted, but meticulously sliced 24 calories of your diet each day by, say, not eating one third of a piece of white bread, you would lose or gain 20 pounds in a year?

I don’t think so.

The process is not that exact. I don’t care what you weigh right now or what your body composition is, if you eat a bunch of extra calories, you’ll burn most of them off. If you restrict a lot of calories, you’ll slow down and your NEAT will drop.

So how is fiddling with a minuscule portion of calories going to make a huge difference?

In my view, it is not.

But, if the truth be known, I don’t think this study even tells us that people consume 24 fewer calories when they see food labels versus when they don’t. This is a big mishmash of a study that, in my view, isn’t worth the paper it is written on. (You can read the original paper here. The STAT article said the newest data was added to this paper, but they did not link to the current paper.)

It is one of those meta-analyses of other studies, but not even really that. Most meta-analyses carefully select similar studies to group together to see if more info can be extracted from the larger combined database. In this case, all kinds of disparate studies were evaluated. Some were randomized-controlled studies, but many others weren’t.

My eyes glazed over as I tried to read the methods of all the studies. There were some RTCs in which subjects were given foods that were either labeled or not, and the amount consumed measured. Others were far, far less exacting.

When you cram the whole thing together, I think it takes a lot of wish power to come up with a difference of 24 calories per day. And a lot of I-don’t-know-what-to-assume that will represent a 20 pound weight loss over ten years.

Why I Don’t Trust Scientific Studies from China

As I’ve written before, I take every study coming out of China—and there are a ton of them—with a major grain of salt. Over half of Chinese scientists working in China have admitted to committing fraud in a study.

This is reminiscent of all the medical school deans who tell 1st year medical students on their first day that they will learn a lot of facts over the next four years, but half of them will turn out to be false twenty years later. The problem is, we don’t know which half those are right now.

Same with these studies out of China. If over half of them have someone on board who has admitted to scientific fraud, how can we know which studies are clean? We can’t.

I just came across another report from Nature on the institutions that have had the greatest number of retractions due to scientific fraud, and, as you might imagine, most of them are from China.

I’m keeping this list at hand, so I can check the institution that any Chinese study came out of. If it’s one of these, my index of suspicion will skyrocket. If it doesn’t come from one of these, maybe the odds will be less than 50 percent that it’s fraudulent.

It’s a real shame, because a lot of really good studies come out of China. And when I say really good, I mean really good if they are valid. But just like the med students who don’t know which half of the stuff they’ll learn in medical school will turn out to be false down the road, I’m never really sure if what I’m reading is on the up and up.

Post-Ingestion Feedback

Post-ingestion feedback is what food technologist look at in terms of how a particular food makes people feel after they eat it.

We’ve all had the experience of eating something we thought was really tasty, but afterwards felt kind of punk. That’s post-ingestion feedback telling us there was probably something in the food we shouldn’t have been eating.

I’ll give you an example.

I love ice cream. But I eat it only occasionally. And I haven’t eaten so much as a molecule since mid-December when I started my strict keto, no Christmas junk, just to see if I could do it. I just intended to do it through the first of the year, but I lost so much weight, I didn’t want to quit. So I’m still at it. In fact, here are my blood glucose and ketone readings from this morning. I thought the readout included the date, but I can see it doesn’t. Only the time.

Back to the ice cream.

Since I love it so much, my beloved wife—who is one helluva good cook in terms of figuring out recipes—decided to make me a low-carb version. Which she did. And which I loved. She used a little sugar—not much, maybe two teaspoons a serving, which is about 40 percent of the sugar in regular ice cream. I would gladly make up for it by not eating something else carb-y during the rest of the day.

The magic ingredient was something called Cremodan 30, which is an ice cream stabilizer she found on Amazon. It gave the ice cream great mouthfeel, and it was creamy as could be. This, of course, was years ago, long before our current mission to never eat anything unless it contains no bad shit (NBS).

The homemade ice cream was fabulous going down, but it did not generate a positive post-ingestion feedback. I felt kind of gassy and just not all that good. It wasn’t disabling or anything, but it just left me feeling a bit yuk.

Moments ago, I looked up Cremodan 30 to find the ingredients. Here they are:

Mono and diglycerides, locust bean gum, sodium alginate, guar gum, and dextrose powder

Is it any wonder I felt like crap? It was full of gums and emulsifiers. Emulsifiers make fat and water play well together. But they can also emulsify the lining of your gut.

I looked on Amazon for the product, but it is not there. And there are questions from people online wondering where it went. I’m not reading anything sinister in this, but I can’t find it. And if I did, I would never use it again.

My go-to ice cream is Häagen-Dazs vanilla, should I ever eat ice cream again. It has no gums, not anything but all the stuff you would find in homemade ice cream. And it does not give me bad post-ingestion feedback.

I asked MD how much Cremodan-30 she used to make a quart of ice cream, and she told me a teaspoon. You read these things listed near the back of the ingredients list on commercial products and assume they are there in minuscule amounts. But a teaspoon isn’t all that tiny, even spread over a quart.

If you’re getting negative post-ingestive feedback after eating something, it’s probably a pretty good indicator that whatever you ate might not be right for you.

Yesterday the Wall Street Journal published an article about the looming dangers of emulsifiers.

The WSJ has this annoying habit of changing the headlines of their articles when they go online. You can see the above headline. In the online article, which is exactly the same (replete with the same pictures), it has a different headline.

From one who has written a lot of them, headlines are a bear to write. So why do it twice for the same article. There has to be a rationale, but whatever it is escapes me. Here is the full-text of the article, should you want to read it.

Recent studies have found that consuming common emulsifiers is linked to a higher risk of heart disease, Type 2 diabetes and some cancers. Other research seems to show why: The substances change the gut microbiome in a way that can cause inflammation.

Emulsifiers may partly explain why diets high in ultra-processed foods are associated with health problems. Ultra-processed foods, which include everything from energy bars and chips to deli meat and many soups, are facing increased scrutiny by the Trump administration. Robert F. Kennedy Jr., the new head of the Department of Health and Human Services, has said that the Food and Drug Administration will investigate food additives. Kennedy has often blamed the substances for chronic diseases in the U.S.

The new research on emulsifiers is upending what scientists thought they knew about them. Many common emulsifiers were considered safe because they aren’t readily absorbed by the body. But now researchers understand that this very quality enables emulsifiers to disrupt the microbiome.

Emulsifiers are harder to avoid than some other food additives, like artificial sweeteners and colors, because they are difficult to taste and see and their use is so widespread. The ingredients are cheap and increase stability and shelf life. [My bold]

Emulsifiers are commonly found in so-called junk foods, but they are also found in foods thought my many to be healthful, such as yogurts, whole grains products, and even ‘allegedly’ wholesome breakfast cereals. But the list doesn’t stop there.

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