Hello friends.

Greetings from Dallas. Howling winds and torrential rains interspersed with sort of sunny days. Typical Texas weather.

There was a lot going on last week that I didn’t get the chance to comment on. That’s the problem of having a newsletter that goes out on Thursday: Some of the most important stories are dumped late Friday afternoon beyond the time the press can run with them in the hopes they will be forgotten over the weekend.

The stories I got late were for that reason. It was because I was working late on The Arrow on stories I already wanted to write about, so ran out of time to cover the ones that happened earlier.

One of the ones I intended to write about was the Presidential physical exam, which is illuminating. And it shows the higher you get, the shittier the medical care you can expect. You get pure Standard of Care (SOC), which is treatment recommended by the pharmaceutical companies.

Now you may loathe Donald Trump with every fiber of your being, but don’t skip this section on account of that. There is a lot to learn here about how you’re own doctor takes care of you.

Let’s take a look.

Presidential Physical Exam & Meds Given

I got a summary of President Trump’s physical exam from earlier in the week. I can tell you he is pretty frigging healthy, though he could be even healthier were his medical advisors not so set in their SOC ways.

Let me give you a warning. If you’ve been a long-time subscriber to The Arrow, you have read all my objections already to the kind of treatment the President is getting, so you might want to skip ahead if you already know where I’m going.

Here is a summary of his physical exam:

VITAL STATISTICS:

• Age: 78 years, 10 months

• Height: 75 inches

• Weight: 224 pounds

• Resting Heart Rate: 62 beats per minute

• Blood Pressure: 128/74 mmHg

• Pulse Oximetry: 99% on room air

• Temperature: 98.6 °F

PHYSICAL EXAMINATION AND DIAGNOSTIC SUMMARY:

Eyes: Normal visual acuity, visual fields, and eye pressure. Dilated eye exam was normal.

Head/Ears/Nose/Throat: Examination of the head, ears, nose, and throat revealed no significant abnormalities with the exception of scaring [sic] on the right ear from a gunshot wound. Hearing was normal.

Neck: The thyroid and lymph nodes were normal. A July 2024 ultrasound of the carotid arteries showed normal results, and a repeat study was not indicated.

Pulmonary: Lungs were clear on examination and a computed tomography (CT) scan of his chest showed no abnormalities.

Cardiac: Cardiac examination revealed a regular rate and rhythm with normal heart sounds. Cardiac testing, including an electrocardiogram (EKG) and echocardiogram that revealed no abnormalities. His heart function is normal, with a healthy normal ejection fraction, and blood flow to his extremities is unimpaired.

Gastrointestinal/Abdominal: The abdominal examination and ultrasound were normal. A July 2024 colonoscopy revealed diverticulosis and a benign polyp. Gastroenterology recommended a follow-up colonoscopy in three years.

Genitourinary: No abnormalities noted.

Extremities/Musculoskeletal: His joints and muscles have a full range of motion, with normal blood flow and no swelling.

Neurological: A comprehensive neurological examination revealed no abnormalities in his mental status, cranial nerves, motor and sensory function, reflexes, gait, and balance. Cognitive function, assessed using the Montreal Cognitive Assessment (MoCA), was normal with a score of 30 out of 30. The patient also completed the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) for screening of depression and anxiety, respectively, with scores within the normal range for both.

Dermatologic: The skin examination revealed some minor sun damage and a few benign lesions. No concerning lesions or growths were identified.

LABORATORY RESULTS (Normal Values Included):

Lipid Panel: 

• Total Cholesterol: 140 mg/dL (Optimal <200 mg/dL)

• Triglycerides: 56 mg/dL (Normal <150 mg/dL)

• HDL ("Good" cholesterol): 77 mg/dL (Desirable >40 mg/dL)

• LDL ("Bad" cholesterol): 51 mg/dL (Optimal <100 mg/dL)

Complete Blood Count:

• White Blood Cells: 4.4 K/μL (Normal: 4.0-11.0 K/μL)

• Hemoglobin: 14.5 g/dL (Normal: 13.8-17.2 g/dL)

• Hematocrit: 44.7% (Normal: 41-50%)

• Platelets: 229 K/μL (Normal: 150-450 K/μL)

Metabolic Panel:

• Glucose (fasting): 89.7 mg/dL (Normal: 70-99 mg/dL)

• Hemoglobin A1c: 5.2 (Normal: 4.0-5.6)

• BUN: 18.2 mg/dL (Normal: 7-20 mg/dL)

• Creatinine: 0.89 mg/dL (Normal: 0.74-1.35 mg/dL)

• ALT: 41 U/L (Normal: 7-56 U/L)

• AST: 28 U/L (Normal: 10-40 U/L)

• Vitamin B12: 486 pg/mL (Normal: 200-900 pg/mL)

• PSA: 0.10 ng/mL (Normal: <4.0 ng/mL)

• TSH: 1.42 μIU/mL (Normal: 0.4-4.0 μIU/mL)

• Urinalysis: Normal.

Now comes the part that drives me up the wall.

CURRENT MEDICATIONS:

• Rosuvastatin (cholesterol control)

• Ezetimibe (cholesterol control)

• Aspirin (cardiac prevention)

• Mometasone cream (as needed for skin condition)

Okay, here where I believe Trump’s SOC-obeying physicians have not done right by him. Before we get to the biggies, let’s look at the two medications at the bottom of the list.

Physicians have been giving elderly people a baby aspirin per day forever in an effort to protect against coagulation leading to cardiovascular disease. A few years ago a major study came out saying the practice really didn’t do much in terms of preventing heart attacks and should probably be discontinued.

Since I’m of the belief that heart disease is most likely caused by coagulation issues, I don’t mind prescribing a baby aspirin per day to elderly people. It’s cheap and probably effective. I just need to watch to make sure they aren’t having any bleeding problems.

The Mometasone cream is a corticosteroid cream that is more or less harmless. But it shouldn’t be used on the face except for brief episodes. It can discolor the skin and create other problems. I’ve seen patients who have created systemic steroid issues by overuse of “mild” steroid creams on the faces.

Were I advising Trump on this one, I would recommend Forge Skin Care for Men. It’s a beef-tallow based facial cream that truly works wonders. I had it recommended to me by a golfer friend since I have plenty of spots on my face courtesy of time in the sun on the course. I could’t believe how well it worked. I had many complements just within a couple of weeks of using it. I know this sounds like an infomercial, but, for me, it has really produced results way beyond what I expected.

Okay, now to get to the bad. Why in God’s name are they prescribing a statin to Trump? It’s a knee-jerk response from a SOC doc, who hasn’t taken the time to read the literature or even think about it. Cholesterol over 200! Time to treat.

If you’ve ever watched any of Dave Feldman’s videos on cholesterol levels. By changing what he eats, he can change his cholesterol levels almost daily. So Trump, or anyone else, goes in and gets blood drawn, then is given a statin if his cholesterol is too high. When, maybe tomorrow, he could go back in and come out with a totally different cholesterol level. He may not have gotten a prescription based on the second reading.

Cholesterol levels jump all over the place, yet the SOC docs put patients on a lifetime drug based on one reading.

On top of that, Trump is 78 years old. A number of studies have shown that the higher the cholesterol or LDL in aged people, the longer they live.

The phenomenon is called the cholesterol paradox, and it refers to the observation that in older adults, particularly those over 65-70 years, higher total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels may be associated with lower mortality risk and increased longevity.

There are probably at least a dozen or so studies describing this phenomenon, the latest of which is the “The Cholesterol Paradox in Long-Livers from a Sardinia Longevity Hot Spot (Blue Zone)” study published just this year. The study involved 168 nonagenarians from Sardinia's Blue Zone. The authors found that survival time was significantly longer in participants with LDL cholesterol above 130 mg/dL compared to those with LDL-C lower than 130 mg/dL.

The study revealed a significant reduction in mortality risk (HR 0.600, 95%CI 0.405-0.891) in participants with mild hypercholesterolemia (LDL-C ≥ 130 mg/dL) compared to those with normal cholesterol levels. The researchers concluded that their results "challenge the common view that longevity is invariably associated with low cholesterol levels"

Since there are more than a dozen studies done over the last decade or so showing this same finding, why in God’s name would they put the President of the United States on a statin for minimal cholesterol elevation. Trump’s cognitive studies all showed him to be in good mental form, but statins can reverse that. Not in everyone, but in some.

At least he was put on Crestor, which is a water soluble statin, which doesn’t have as much dementia risk as oil-soluble statins, which can cross the blood-brain barrier more easily.

And why the frigging Ezetimibe, which is a cholesterol-lowering drug that prevents absorption? It’s been known forever that the more cholesterol one eats, the less one makes. And vice versa. If you don’t eat much, your body synthesizes cholesterol. If you eat a bunch, then your body doesn’t make as much.

Even Ancel Keys knew that. Way back in 1965. Yet nimrods are prescribing drugs that try to prevent the absorption in 2025, when it does no good whatsoever.

One last issue has Trump’s medical team worried. Comparing this to previous blood pressure exams, his BP has crept up a tiny, and I mean tiny, amount. In June 2020, his blood pressure was 121/79 mmHg. At his most recent physical this month was 128/74.

“This shows that Trump's systolic blood pressure (the first number) has increased slightly over the years, from 122 in 2018 and 121 in 2020 to 128 in 2025. His diastolic pressure (the second number) has remained relatively stable, fluctuating between 74 and 79. While the current reading is still below the threshold for hypertension, it is higher than in his prior exams and falls into the "elevated" category, indicating a trend that could warrant monitoring.”

This brings me to another piece of SOC idiocy. How the decreasing limits as to what defines high blood pressure has changed over the years. I took at run at Perplexity dot ai, which is my new go-to search engine and got this chart, which is accurate as I compared it with others.

As you can clearly see, as the years have rolled by, the definition of the threshold for hypertension (high blood pressure) has gone down, down, down. Just as cholesterol has. The upper level of total cholesterol was 350 mg/dl back in my training years. Now it is 200 mg/dl.

Why do you think the thresholds for what is considered treatable hypertension came down? Do you think it could have been driven by the pharmaceutical industry coming up with more and more drugs to treat hypertension and save more lives? Or do you think it was simply to sell more drugs? The latter of which would be the cynical way to look at it.

Malcolm Kendrick is a friend of mine, and we had a long discussion about this several years back. I decided to check out his blog to see if he had written anything about what we discussed. Sure enough, I found it.

High blood pressure had been treated for years, but no one knew if the treatment was effective. It made sense that having your heart beat against a higher pressure might provoke it to give out earlier in your life than had your pressure been lower. Once Malcolm started trolling around in the literature, he discovered that despite all the BP meds given over the years, no one really knew whether they did any good. There were no studies.

As Malcolm explains:

So the study showed nothing in terms of lowering high blood pressure preventing heart disease. But there was one tiny sliver of good news.

Back to Malcolm:

Make sure to read the rest of the blog to see how the results of clinical testing and a maneuver that even Ancel Keys blew off haven’t managed to make an impact on the ever-lowering threshold for what is considered the treatable level of blood pressure.

It’s insane. And just another way Big Pharm moves drugs. So don’t feel bad when you go to your local doc and he/she pushes statins and blood pressure meds on you. You’re getting the same treatment as the President of the United States.

Kevin Hall Quits the NIH

I came across his tweet a couple of days ago and was surprised. I probably shouldn’t have been, but I was. Here’s what he wrote:

I immediately went online to see what else I could find and came across a few articles. One by CNN was the most expansive, while one from Marion Nestle was the most over the top. She starts out by worrying about what Hall’s demise might mean for her:

Which, of course, means she wants to be able to continue work that gives the same results she’s been obtaining all along. Just like Hall.

Since she and Hall are cut from the same bolt of cloth in terms of their belief in the calories in, calories out dogma, she jumps to his defense. Not only does she think his firing (or forced quitting) is a national tragedy, she’s such a fan boy that she actually told CNN this about his first published experiment on UPF:

I mentioned above the Kevin is the Head Master of the School of CICO, calories in vs calories out. There has been an ongoing battle for years now over the position of calories in the diet. Calories, as we all know, are units of energy, or, more accurately, heat.

To determine the caloric content of a food (or anything else), you put it in what’s called a bomb calorimeter, provide it with oxygen and measure how much heat is released when whatever it is burns to ash. Back in the late 1800’s Wilbur Atwater did these experiments on a wide variety of foods and verified them by detailed measurements of actual subjects in metabolic chambers. He came up with the caloric content of 4 calories (kcal) per gram of carbohydrate and protein and 9 kcal/g for fat. Scientists have used those number since as they have been reproduced many times.

Each gram of carbohydrate, fat, and/or protein that is burned in the human body for fuel basically throw off either 4 kcal/g or 9 kcal/g of heat. A group of people who have come to be called CICOers believe that’s pretty much all they do.

Giving a person a diet of donuts, chocolate milk, pancakes, hash browns, and coffee with sugar will have the same reaction in a person of the same weigh who eats a steak and a couple of eggs for breakfast with maybe some sausage thrown in and a black coffee.

Say the CICOers, it’s all a function of calories, nothing else. If both diets are the same caloric-wise, well, the people who ate them should end up at the same body weight.

There are others of us in a different group who recognize the caloric content of the food plays a role, but realize there is more than that at work. Foods of varying kinds generate hormonal effects along with caloric effects.

We all know that insulin is a fat storage hormone that is secreted when blood sugar rises. A breakfast of donuts, chocolate milk, pancakes, hash browns and coffee with sugar is going to release a lot of sugar into the blood, which will provoke a large insulin release. The insulin will drive both the sugar and the fat into the cells for storage.

The steak, eggs, and sausage breakfast, on the other hand, will barely provoke much insulin release at all.

Knowing what readers of this newsletter know about carby vs meaty foods can predict at once that the subject above eating the donuts, pancakes, chocolate milk, etc.—if followed over a long time—will end up adding a lot more body weight than will the steak and eggs guy. Even if the calories are absolutely the same.

Kevin Hill would not believe that. And if you did a study showing that carbs, in fact, do cause people to gain more weight than steaks and eggs, he would create a study, financed by the taxpayers designed to prove it wrong.

Worse yet, if you gave him money out of your own pocket to conduct such a study in a truly unbiased way, he might scuttle it.

I think Kevin, thanks to his position in the NIH, is the reason the nutritional world hasn’t moved past the Calories-In-vs-Calories-Out paradigm. He’s it’s staunchest defender and has had, until now, Uncle Sam’s money behind him.

As I was going through trying to find out everything I could about his leaving the NIH, I came across a clue. It was from an interview with Dr. Marty Makary, the new Commissioner of the Food and Drug Administration.

I tried every way I could find to spit these videos. The one I wanted was the bottom one as it is germane to the issue under discussion, the CICO model, also known as the energy balance equation. The one on the top is about the microbiome and inflammation, and it is interesting, but the bottom one tells a lot about what’s going to be happening.

As you watch Dr. Makaray in the bottom clip, you may get some insight as to why our friend Kevin Hall is moving along. It happens kind of fast, so I’ll transcribe it for you.

I would say those would not be words Kevin Hall would enjoy hearing. We should all welcome him to his brave new retirement.

Comments, Poll Responses, and Emails

I got an email on last week’s Arrow that I thought I would share. The writer is obviously not a fan of Bobby Kennedy. In his first paragraph, he does exactly what he accuses RFK, Jr. of planning to do. Picture perfect.

Our reader is going to gather all the info he believes about RFK’s beliefs about autism—whether factual or not—and present them in a way that validates his preconceived ideas about autism.

To take the reader’s side on this, I’ve got to say that RFK has been in the autism wars for years, so I do suspect he’s got preconceived ideas. But I don’t think he just started thinking about them the day before yesterday. And if it looks like vaccines are involved, he’s going to have a giant battle with Big Pharma along the way.

We’ve got to figure out what causes autism. Just blowing it off as genetics as so many have done isn’t doing anyone any good. At least we’ve got someone in there who is taking it on as a serious, major project. Everyone before took it on as a subject to sweep under the rug while more and more susceptible kids are doomed to miserable lives.

As to the tweet from Chris Palmer…Chris is on the faculty of Harvard, which is under attack from Donald Trump right now. I think he—Chris—is walking a fine line.

The Diamond Princess Redux

Remember the Diamond Princess? She was the cruise ship that basically introduced Covid to the world.

I hadn’t thought about the ship in ages, but it was much in the news when I first started writing The Arrow, so I used it often to predict what I thought was going to happen in the long run. The ship was a perfect microcosm, a laboratory for observing the spread of an infectious disease. There were enough people aboard—3711 passengers and crew—to make it statistically valid. And the passengers and crew provided a variation in ages that could make possible seeing how the infectious agent acted as a function of age.

I saw a mashup someone did of the whole US Covid ‘pandemic,’ so I wanted to go back and compare US overall stats to those from the Diamond Princess.

I had a little back and forth with Perplexity dot ai to get the overall stats of the ship, passenger count, dates, and itinerary and quarantine.

We’ve pretty much got to believe that all of the people on the Diamond Princess were exposed. SARS-CoV-2 is highly-infection aerosol, so there would have been no place on the ship to avoid it during most of the cruise and the two-week quarantine.

You can see below how the death rates and infections rates distributed among the passengers and crew. (Brought to you again by Perplexity)

As you can see, death rates and infection rates were much higher among the elderly than among the crew.

If you look at total deaths as a function of people exposed, you get 14/3711, which calculates to 0.003772568041 deaths per person on the ship. Or ~0.38 percent.

Now take a look at this mashup of guesses about mortality that was going around during Covid.

After watching the above, let’s turn to Perplexity once more for the Covid death rates for the United States.

So the overall death rate for the US is 0.37 percent, which is almost exactly what the death rate was for the Diamond Princess. We could have saved a lot of angst had we simply used the Diamond Princess to predict what the overall outcome would be. It was a large sample, larger than many in different trials that are used to give people medicines. It was the perfect opportunity blown.

Pretty Much Sure Fire Cure for GERD

I’ve been a GERD sufferer for years. I can usually keep it in check with a low-carb diet, but not always. It varies in intensity, but when I get it, I’m pretty miserable. And, of course, I end up with all the worries about Barrett’s esophagus, which is when the cells in the lower end of the esophagus change into cells more like those in the stomach. Barrett’s esophagus is a major risk factor for esophageal cancer, which is one cancer you don’t want to have.

When I was on my typical low-carb diet, I would veer from it here and there as long as my weight was about where I wanted it, but if I strayed from the diet for more than a few days, here came Mr. GERD. It was nice in a way as it was a means to keep me on the straight and narrow. I would stay on the diet for weeks and do fine, but then a trip or some kind of celebration, and here comes GERD.

I never really took any medicine for it other that Pepcid AC, which I hated to take, but which pretty much knocked it out.

One day I happened to be trolling through the medical literature and came across a Brazilian researcher who had come up with a natural formula to treat GERD that he alleged was more effective than Nexium. He had published a paper showing that his supplement—which was a combo of a number of ingredients—produced better results in patients with serious GERD than did Nexium.

I, of course, was interested. I contacted they guy, who spoke good English, and asked him all about his trial and his supplement. He had a PhD and was involved with a Brazilian university. I asked him if he would be interested in doing a joint venture on bringing it to the US. He said he would love to.

He came to visit, and we worked out the financial details and kicked off the project. Our side of the deal put up all the money; his side put up the supplement. We ended up spending a lot of money coming up with a name and getting it trademarked. And getting the patent for the US.

We got everything together and started running ads, but the product sold poorly. To make a product viable to sell at a profit through radio or TV, you have to set a price that multiplies the price of the ingredients in the product several times. The ingredients for this product were fairly expensive, and when we did our analysis of how much we had to see it for to make it profitable, it came out higher than we expected.

We sold some, but Pepcid AC was cheaper, so people weren’t motivated to buy ours for any reason other than it had all natural ingredients. Not pharmaceuticals like Pepcid AC. Over time, we built a cadre of users who loved the product, but we had to have it made in such large quantities—2,000 bottles minimum—that we ended up having it expire before we had run out of supply.

We finally got tired of losing money, so we basically let it go back to the Brazilian guy, who still I don’t think has been able to monetize it. When I ran out of my last bottle of it, I was back in my GERD-when-I-least-wanted-it situation. Which was kind of a whip to keep me on my diet.

Before I go on, let me tell you that since I’ve gone complete keto, I haven’t had a single bout of GERD. Not even anything that closely resembled it.

The GERD supplement deal went down about 16-17 years ago, and maybe about two or three years after that, I stumbled into something that stopped my GERD in its tracks. It worked instantly and worked almost as well as the hardline keto diet I’m on now.

I would have written about it earlier, but I thought it might be something unique to me. No one else in my family has GERD, so I couldn’t get them to try. I didn’t want to throw it out to readers and have them come down with awful GERD because it was something that worked only with me.

A few months ago, a friend of mine who has terrible GERD (which I did not know) was told by a friend of his how to stop it, as his friend had stopped his own GERD the same way.

There was some validation.

I cautiously asked some of my own friends if they by chance suffered from GERD. A few of them did, so I asked them to try what had worked for me. It indeed had worked in every case. So I’m ready to spread the word.

Let’s dig in.

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