Greetings friends.

I received a lot of questions this week from the various ways folks have of contacting me. I always figure if I get a question or two on the same subject, there are probably many more readers who would like to know the same answers, but for whatever reason were reluctant to write.

Let’s get to some of them.

Poll Responses, Comments, and Emails

Tom Seyfried and the Metabolic Theory of Cancer

I’ve had a number of people ask me if I knew of Thomas Seyfried and his theory on the metabolic basis of cancer. The answer is yes to both. Tom is a friend of mine; I’m well aware of his theories (he’s not the only one who believes in the metabolic theory of cancer, and, yes, I have written about it. )

I had many readers come out of the woodwork telling me which posts contain my writings on the subject. The problem I have in finding these posts is that since I started writing The Arrow in January 2021, I have used three different platforms, with about a third of the time spent on each one.

The reason I’ve jumped around so much is that each one of the platforms had issues I hated dealing with. So, in my quest for constant improvement, I left one platform for another. In each case, there was a tradeoff. I would get the feature I wanted from the new platform, but would then discover that the new platform didn’t include something I had taken for granted from the old. But it was such a pain moving, that I had no intention of going back. Now I’m using a platform I like a lot, but the developers are constantly creating new features. Unfortunately for me, most of them are features I neither want nor would use. (The one feature I really want and keep begging for is the ability to embed videos. So far, my pleas have fallen on deaf ears. But hope springs eternal.)

One of my self-imposed tasks for this summer is to corral all these issues of , in one spot, so folks could scroll through them. And to figure out how they could be searched. But we’re coming up on July, and I haven’t done a thing. For first one reason, then the next, this summer has gotten away from me. And it’s not because I’m playing a lot of golf. I’ve played less golf over the last couple of months than I have in ages. I’ve just got a lot of other issues I’m dealing with, all of which are time consuming. I may have to end up just paying someone to do this for me. Although I have done nothing as of yet, my goal is still to have it done by the end of the summer.

According to a bunch of readers (and thank you to each of them) here are the issues of The Arrow containing my thoughts on the metabolic theory of cancer. As it turned out, all of these were during the Substack period. Just click on the link at the bottom of each box below.

Many, many thanks once again to those of you who rooted these out for me.

The Stearic Acid Experiment

I had a number of people comment on my suggestions on stearic acid. Here is my favorite:

As I mentioned in my post about stearic acid, I used it in a mug of bone broth that was very hot. One teaspoon staying melted nicely; two teaspoons gave me the granular experience similar to the reader’s with coffee, though not quite as bad. I had the same experience with the coffee, which might be a consequence of the acidity of the coffee. I’ve been drinking the broth as part of my ketogenic diet—one mug twice per day—so it works for me. Has anyone else had any experience with any other hot liquids? If so, let me know through the poll or the comments.

I hadn’t looked up the stearic acid content of beef in a long time. Turns out it is lower than I remember its being. Figures vary by source, but it looks like an average steak provides somewhere in the neighborhood of 2-5 gm, depending on the cut of meat. I hadn’t looked it up in a good while, but I had remembered it being more than that.

If I eat a steak (or other comparable chunk of meat), then have two mugs of broth with a teaspoon of stearic acid in each, I’ll be getting almost the 18 g used in the article last week. Just the beef alone and the other bits of stearic acid I may get from here or there will leave me far short of the 18 g the researchers showed drove mitochondrial fusion.

Unfortunately, there are no tests I know of that measure mitochondrial fusion other than the ones done academically, so you can’t ask your doc for a test. The paper under discussion last week used 18 g of stearic acid, so that’s why I’m using that as my guideline.

I just noticed that a day or two ago, Nick Norwitz put up a video on this same mitochondrial fusion study. So if you want a brief review, you can watch it below:

Inability to Lose Weight

Yes, I have thoughts, but I had to have my own great awakening to understand. And although I can’t give advice to particular people about their particular issues I can make some general comments.

The first is that in menopause metabolism definitely changes. I don’t know this personally, but I certainly watched my lovely Bride, despite her medical and nutritional knowledge, fight the same kind of frustrating menopausal battle as the reader had done. One comment is that it is counterproductive to over train. Exercise is a two edged sword; and one of the edges is that it is inflammatory. And much of the benefit of exercising (especially weight training) occurs during rest days. Particularly for middle-aged and older everyday athletes.

MD (now age 71) works out religiously with her MPC cross-training-style program, incorporating cardio, flexibility, and strength training into the sessions; she does a hard workout three days a week and always takes at least two full rest days, and tries for ‘active recovery’ type work—yoga, walking—on the other two. She’s been at it for 4 years now, rarely if ever missing a workout, and only in the last year is she finally feeling like she’s getting back closer to her old shape and fitness. For women at menopause especially, high intensity interval training like this is beneficial.

If you want to delve into the hard science of menopause and women’s struggles against it, I would heartily recommend the new book by our good friend Amy Alkon called Going Menopostal. The culmination of eight long years of slogging through the stage of life and the medical literature and trying to make sense out of what is often a wilderness of mirrors, Amy’s book is a blue print for how to talk to your doctor, how to insist on proper science based testing and treatment, and what that testing and treatment is. And her writing is fast-paced, humorous, sometimes irreverent, and always deeply researched. If you or someone you love is wandering in the menopausal misinformation doldrums, run grab a copy. It’s a great read.

From a male perspective, I have been at the same weight for years. I’ve vacillated around 205-210 pounds forever. If I dieted, I dropped a couple of pounds; if I said to hell with it, I’m going to eat what I want (which was'n’t often), I would gain a couple of pounds. But mainly I stayed right about 207.

Then I decided to seriously try a hardcore ketogenic diet last December, mainly to see what happened if I didn’t consume all the candies, cookies, fruit cake, etc. that I usually gulped down in the days around Christmas aided and abetted by the notion that it was just once a year. I figured I would stick with it till the middle of January or so, just to see what, if anything, might happen.

What happened was that I lost a fair amount of weight. I can’t say how much, because I didn’t weigh myself. I could tell by my belt notches. When I finally did weigh myself—on a very accurate balance scale (the one we used in our medical clinic)—my weight was 185 pounds. I hadn’t weighed 185 pounds in years. The Bride says that’s what I weighed when we met in 1979.

I remained on the diet, but loosened up a little. From December to March, I probably didn’t eat ten grams of carbs per day. Mainly I ate meat and cheese. After March, I loosened up a bit, but still stayed on a ketogenic diet. I was happy with my weight and didn’t want to lose any more. I plugged along eating mainly meat, but with more vegetables thrown in. During the first three months or so, I didn’t imbibe any booze. Once I hit 185, I started drinking a little alcohol. Just a wee dram here and there, as MD would say. I would nurse maybe a third or a half a shot of Jameson (my whiskey of choice) for an hour. Sometimes I wouldn’t even make it through the wee dram. Sometimes I wouldn’t have any booze.

My point is, I wasn’t drinking to anywhere near excess. Far, far from it.

I had so many people telling me how good I looked that I decided to weigh again. (The reason I wasn’t weighing more often is that our clinic scale is kind of buried away in the garage, and it’s a pain to get to it.) To my astonishment, I weighed in at 172! I had lost 35 pounds since the middle of December. I would have bet people money that I hadn’t dropped below 180 pounds, but I definitely had.

When I started the ketogenic diet, I had to use some restraint. I was used to coming to the table famished and eating all I wanted. I ate the meat and cheese, but it left me feeling not completely satisfied. I mean I didn’t feel like I was going to keel over from starvation or anything, but I was still a bit hungry and focused on food.

As time passed, these feelings of hunger gave way to feelings of contentment with the food I had eaten. I no longer left my meal feeling hungry.

My only issue was that I couldn’t get my ketone levels to stay where I wanted them to be.

I read that doing a three-day water fast would jump start the process of ketogenesis and my ketones would get into the range I wanted them to be. So I set myself to doing a three-day fast, which was the hardest part of the whole experience. I hadn’t really focused on food for several months, and then I was focusing on it a lot. But I forged ahead, and, indeed, my ketones went up. Somewhere along the way, my highest ketone level was 5.0.

As soon as I started back on my regular ketogenic diet, my ketones dropped back down to ~1.5-2.0.

I remained on the same diet for another month or so, then decided to try another three-day fast just for grins. Unlike my first three-day fast, this second time around was absolutely painless.

I thought I might do it again a month or so later to see if it were still easy, but my encounter with the scales coming in at 172 put the kibosh on that. I certainly didn’t want to lose anymore. In fact, I wanted to gain a bit. Which is where I am now: In the regaining phase. I haven’t weighed again, but I can tell I’m up a little. And I’m eating more. Still ketogenic, but just more food.

The amazing thing to me is how easy this all was. Other than the first week or so, when I was still focused on food, and the first three-day fast, which made me focus on food again, there was nothing to it. I simply coasted along and didn’t think much about it. I was certainly surprised when I weighed in at 185, and stunned when the scales showed 172. But at no time during the process, except for the first week and the first three-day fast, was I focused on food or even tempted.

I’m not saying that every individual would have my response to a strict ketogenic diet. But it certainly surprised me when I had the response. I didn’t expect it at all.

What I am saying is that if you’re having a tough time losing weight, try a strict ketogenic diet not for a day or two or even a week or two. Give it a try for at least a month to let your body slide into weight loss mode. Once there—if your experience is anything like mine—autopilot will take over, and you’ll cruise to your goal, or beyond, as I did.

I hate to make analogies like this, but I’m going to in this case. Your body is like a computer. It remembers the time you intermittently fasted for three days. It remembers the week you spent on the Ornish diet. It remembers the time you went full carnivore over a long weekend. If you just try some particular diet for a few days, your body says, been there, done that. Don’t worry, he/she will be face down in the Mac-n-cheese in a few days. All of that is programed into you. When you outlast your body’s memory card, then you’re on your way to some real weight loss.

It certainly worked for me.

I can’t leave this section without a trenchant observation from one of the commenters.

Last week I posed a link to one of my talks, which is what this reader is referring to. Here is the link again. That was me at ~207 in 2020. I clipped one photo out, but you can go through the video if you want and find many others.

It just so happens that MD has a photo she took a few days ago when our two eldest sons, our grandson Will, and I just finished a round of golf. We were the big winners that day, thus the need for a celebratory photo.

You’ll notice that I now have the smallest belly of the group despite obviously being the oldest.

Consequences of Health Care Fraud

A little over a week ago, there was the largest coordinated enforcement over health care fraud in U.S. history.

SOURCE

It appears that the U.S. Government is fairly easy to defraud, especially where Medicare, Medicaid, and health care in general are concerned. The big problem, in my view, anyway, is the governmental response to the fraud when they finally catch it.

I’m all for throwing the book at the miscreants who do the defrauding, which sounds like what’s going to happen with these crooks. But all too often, along with penalties inflicted on the crooks, Uncle Sam tries to fix the system to make it more difficult to defraud and in the process usually makes it more difficult to navigate and less user friendly for both doctors and patients.

When MD and I had our primary care clinics in Little Rock, we were able to draw blood and send out labwork, and we had an X-ray machine. We charged patients from a big book of standard costs provided by Blue Cross/Blue Shield titled (as I recall) Usual and Customary Charges. These books were sent to us annually and showed the usual and customary charges in our area for about anything you wanted to do. The charges would be different (higher, no doubt) in Los Angeles or New York as they would have their own Blue Cross/Blue Shield book.

As physicians, we could charge whatever we wanted, but insurance would pay only for the charges listed in the book. We, and all the physicians we knew, just set charges to whatever the book said.

For X-rays and labwork there was one charge. If you did a chest x-ray, you charged whatever the book said for a chest x-ray. Same with labwork. If you ordered a CBC (complete blood count), you charged the book charges. It made things easier for everyone.

Then the crooks realized they could really screw Uncle Sam with labs and x-rays. They set up these large clinics and ran patients through them, getting x-rays and every lab test known to man irrespective of what was wrong with the patients. They defrauded the heck out of the government on Medicare and Medicaid charges, which went by the book, too.

When these slime balls got caught, they ended up getting fined and sent to jail. But the government decided to make the fraud more difficult to perpetrate, but did so at the expense of both the patients and the doctors.

They discouraged in-house labs. Except for simple things, like a hematocrit or a white blood cell count or a strep test, we didn’t really do in-house labs; we sent most of our labs to a national reference lab. Like the Blue Cross/Blue Shield books, we had a list of charges for all the labs we might ever want to have done. We negotiated with the reference labs for those particular labs we did a lot of. Since we did so many, we got a better price than some doc who did five labs per day. For the more esoteric labs, we were charged the same as everyone else.

When we went to put a bill together for a patient, we just looked in the Blue Cross/Blue Shield book and charged whatever it said. The patient got one bill.

In an effort to prevent fraud, the government made it mandatory to have the lab bill the patient directly for what was called the technical component of the lab. Which was basically what the lab charged for putting the blood, or whatever, through their machine and getting a number, which was sent to us.

In our clinic, a doctor interpreted the lab. So we charged the patient the professional fee for interpreting the lab. The patient ended up getting a bill from us for the professional fee and another bill from the lab for the technical fee. It was confusing for the patients and a pain in the rear for the staff. Going back to our CBC, let’s say the BC/BS book said reasonable and customary charges for a CBC are $30. In the old days, we would simply bill the patient $30, and that was the end of it as far as the patient was concerned.

After all the anti-fraud measures, we would charge the patient $15 for the professional fee for reading the lab, then the patient would get a $15 bill from the lab. They would then call the clinic and say, Hey, I was double billed for the CBC. Our staff would have to explain the situation, which took time away from other duties.

It finally became such a hassle that many doctors’ offices simply quit sending labwork from their own clinics, and instead gave the patient a lab request form. The patient then went to a branch of the reference lab and had the lab drawn. The results were sent to the doctor for evaluation.

So the patient instead of just going to the clinic, getting labs drawn there, getting charged once, now had to go to the clinic, get a lab slip, go to the lab, which might be halfway across town, get the lab drawn, then go back to the doctor, get billed for the lab, then get another bill from the lab for the technical fee.

It went from a pretty simple operation to a much more complex one in an effort to deter fraudsters.

The same thing happened to in-office x-rays. If you go to see a doc today, and you need an x-ray, it’s off to another building somewhere else to get it.

Next time you’re running all over town to get labs and x-rays, thank the fraudsters and thank Uncle Sam for screwing the system up in an effort to make it more difficult for the fraudsters to defraud.

Most doctors (most people, too) are on the up and up. There will always be a few bad apples around irrespective of the profession involved. In my view, the government should run a tighter investigative ship and increase the penalties for fraud. It should he a lot easier to find the bad guys now with algorithms and AI. Go after them, and they let patients go to their doctor without having to run all over hell and gone, just to get a few labs and maybe an x-ray.

Odds and Ends

• Want to take a dip in the River Seine? It reopens to public swimming for first time in a century. If I were there, I would jump in.

• Satellites are booming, but Earth’s orbit is filling up with dangerous space junk. It's a looming crisis, and the dawn of a new industry.

• A better solution for consumers in Zohran Mamdani’s socialist New York. Walmart beats a government grocery store.

• Photos show the kick off of the Running of the Bulls in Pamplona, Spain. I’ve run with them twice. The last time in 2000 with MD and youngest son. I’d love to go back. Great festival. Great food.

• If you want a taste of what the ancient Egyptian diet was like, look no more. Here is how you can make their bread and beer.

• The company behind resurrecting the dire wolf turns it attention to the extinct moa. Imagine a flock of 12-foot tall, hairy, flightless birds. What could possibly go wrong? Did these people never see Jurassic Park?

• Meet the first Barbie with Type 1 diabetes. Beyond the pink CGM, I can see the other - accessories now: the pink insulin pump or the tiny pink syringes and insulin vials? What’s next?

• Rodeo bull Sauce Boss becomes latest animal escape artist. The article is a prime example of a writer’s desperate efforts not to repeat a noun, as laid out so beautifully in the writing lessons of James Kirkpatrick in writing about bananas: beware the oblong yellow fruit. Sometimes a banana is just best called a banana and a bull a bull. And BS just BS.

• Evidence that Ancient Neanderthals beat Kettle and Fire to the punch with bone broth by about 125million . Organic, too. And NBS.

• Explosion of colorful street art revives an Italian 'ghost town'. And landed it squarely at the top of cool places I’d like to visit.

• There are vents on the seafloor hot enough to melt lead. And we're blaming 'human-caused' warming on the projected 0.5 degree rise in ocean temps?

• The almost lost art of Disney animation is kept alive by 4 people. Complete with cool video. If you’re a fan of animation art (as I am) you’ll love this one.

• Snakes on a plane - the Bride's worst nightmare. But with a happy ending, and as it turns out, romance on short order was the snake captor’s specialty.

• Follow the (social) science. New study defines six traits that add up to 'cool' across cultures. Are you cool? Or too cool for school? Find out.

• How do airplane toilets work? Beyond pushing the little FLUSH button, I mean.The engineer in me was intrigued.

• Does Minnesota really have 10,000 lakes? And who counted them?

• One woman collected 15,485 egg cups over five decades. Eggs-actly why would you want to do such a thing? And more to the point, where would you put them??

• Astronomers detect the third interstellar object - comet 3I/ATLAS coming to us from outside our solar system. In other words, as the Bride would say, a true 'Outlander'.

• How art affects the brain. As an artist, that title is catnip to me. But if, as they argue, no artwork is completed by the artist until the viewer sees it, then should we all get a cut of Picasso's net worth? Add a word; take a third, so they say in the music trade.

• Examination of ancient DNA unlocks the secret to ancient Rome’s culinary secret sauce: garum.

Newsletter Recommendations

Get Shorty (or Shorty’s right hand man)

I’ve got a great newsletter recommendation for you today. MD and I have a good friend of many years who had the enviable career, spanning three and a half decades, of being the research assistant and man on the ground for the noted fiction author Elmore Leonard. He penned a zillion books, many of them made into movies or television shows: Get Shorty and Justified are ones you’re probably familiar with. He’d been writing westerns and decided to branch out into the detective realm in places outside his native Detroit, but felt he was too old to ‘learn a new town’.

So he hired Gregg Sutter, our friend, to be his eyes and ears, his feet on the ground, his window into the new towns, to bring back to him all the local color, the local characters, the connections, the flavor and essence of wherever his next novel would be set. And so there is no one who knows more about the process of what it takes to bring an entertaining novel to life, from a career spent in the inner circle of a master of the art.

My folks lived in a suburb of Detroit in their later years. Gregg lived in Los Angeles, where he spent a lot of time doing research for Elmore. MD an I spent a fair amount of time in Michigan visiting my parents. At one point all the stars aligned. MD and I and Gregg were all in Michigan along with Elmore. Gregg set up a dinner for us all at a restaurant in Birmingham, which is close to Elmore’s house, where we all met up for drinks before heading to the restaurant. After dinner, we went back to Elmore’s for a nightcap. It was a wonderful experience, but it had a bizarre outcome.

The morning after the dinner, Gregg called me and asked me if I had had a box of blue ball point pens sent to Elmore. I said, No, why on earth would I have done that? Gregg said he didn’t know who had sent them or why, but Elmore was convinced we had as some sort of practical joke. He probably went to his grave thinking so. Weird.

Gregg has recently launched a new Substack in which he shares stories, insights, interviews, photos, and much more gleaned from his time as Elmore “Dutch” Leonard’s man on the beat. They’re great reads and watches, and if you’re a fan of detective mysteries, westerns, or noir, I encourage you to give The Gregg Sutter Files a try.

Video of the Week

MD ran across this soul/rock/blues duo called Sons of Legion on Instagram a week or two ago. They are just a pair of guys who happened to run into each other a while back and jammed. And their jamming clicked for them. So they began to write and perform their songs. No record label, no manager, no agent. Just two guys making music and putting it out there on social media. And from zero they built a large following and landed multiple (I think more than a dozen) of their tunes on the iTunes charts. I really like their sound and I really love it when somebody from completely out of nowhere bursts forth on nothing but talent and determination and drive. Hope you enjoy.

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.

Thanks for reading all the way to the end. Really, thanks. If you got something out of it, please consider becoming a paid subscriber if you aren’t yet. I would really appreciate it.

Finally, don’t forget to take a look at what our kind sponsors have to offer. Dry Farm Wines, HLTH Code, Precision Health Reports, and Jaquish Biomedical.

And don’t forget my newest affiliate sponsor Lumen. Highly recommended to determine whether you’re burning fat or burning carbs.