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Hello everyone.

We’re still kicking around in Boulder, but will be on our way soon. It’s been a nice long visit with some great friends of ours. Friends of ours who are avid readers of The Arrow, and who long ago jumped on the NBS bandwagon and have felt much better since doing so. Since going NBS, they told me that one of the most difficult items to find on grocery shelves is NBS dressings; most are clotted with all kinds of gums and emulsifiers. So they set about making their own.

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A few nights ago, Doug made an NBS blue cheese dressing for a wedge salad that was the best I’ve ever had. In fact, it was the best any of us had ever had. Here is a photo of my chopped wedge right before I tore into it.

Two things you probably discerned right off the bat glancing at the above photo. First, I love a lot of pepper. And, second, I was not cut out for a career as a food stylist. The photo looks pretty much ho hum, but the salad and dressing were spectacular.

Just the night before, we had all gone out to one of our favorite steak houses in Boulder, and all of us got a half wedge as a starter. All I can say is that to paraphrase Mark Twain, the high-end steakhouse wedge dressing ain’t shucks to the homemade NBS one we had the next night.

Here is the recipe.

NBS Blue Cheese Dressing
Makes about 2 cups
Note: Be sure all ingredients used are NBS* (no bad sh*t). I have listed the brands we have used. There are others out there; just check the ingredients list to be sure there aren’t any gels, gums, chemical emulsifiers, artificial flavorings and dyes, starches, ingredients with unpronounceable names.

INGREDIENTS 

• ¾ cup avocado mayonnaise (Primal Kitchen, Chosen Foods)

• ½ cup sour cream (Good Culture, Daisy)

• ½ cup buttermilk (Kalona SuperNatural, Organic Valley)

• 2 teaspoons distilled vinegar (Heinz, Whole Foods 365)

• 1 teaspoon Worcestershire sauce (Lee & Perrins)

• 1-1/2 teaspoons garlic granules (Simply Organic, Whole Foods 365)

• 1 teaspoon Himalayan pink salt (Wild Himalayan)

• ¼ teaspoon freshly ground black pepper (Whole Foods 365)

• ½ cup crumbled blue cheese (DaneKo, Bristol Farms)

DIRECTIONS

1. In a large bowl, whisk together all the ingredients except the blue cheese until smooth and well blended.

2. Gently fold in the blue cheese crumbles until distributed throughout but avoid over mixing.

3. Cover and refrigerate until ready to use.We had so many memorable NBS meals that I would be remiss if I didn’t provide recipes, so I’ll add them over the next few weeks.

Here is one more. This one is MD’s Caesar salad dressing that drives everyone who has eaten it to beg for the recipe. It’s NBS as well.

Hail of a Caesar Dressing
Makes about 4 servings

INGREDIENTS

• Juice of 1 lemon

• 1 clove garlic, minced finely or pressed or 1 teaspoon minced jarred garlic (Garland Foods, Iberia)

• 4 anchovy fillets or about 1 teaspoon anchovy paste (Rizzoli)

• 1-1/2 tablespoons homemade or avocado mayonnaise (Primal Kitchen, Chosen Foods)

• 1 teaspoon Dijon-style mustard (Whole Foods 365, Inglehoffer)

• 1 tablespoon Worcestershire sauce (Lee & Perrins)
  

DIRECTIONS

1. Put the juice of the lemon into a shallow bowl.

2. Add the garlic and anchovy fillets and mash with two forks until you’ve got a smooth paste (or use anchovy paste).

3. Add remaining ingredients and mix until blended thoroughly.

After eating completely NBS every meal for almost two weeks, a real challenge usually on the road—the one exception being the steakhouse meal mentioned above—I am mystified as to why food manufacturers put all the BS in their foods. Anti-oxidants, I can understand; they’re often needed to increase shelf life. But all the gums, emulsifiers, and other crap—why those? I’ve always assumed it was because the artificial flavors along with the other additives induced people to eat more.

I’m beginning to think they put all the crap in there because it saves them money. If they want to thicken, say, a soup, adding gums is doubtless a lot cheaper than adding cream. And probably also more shelf stable.

I can tell you for a fact that after almost two weeks of every meal being NBS, I personally think I would eat more of the NBS than the BS versions. I inhaled the chopped wedge shown above in its entirety, whereas I left about a third of the steakhouse chopped wedge on my plate.

What Is the Definition of Ultra-Processed Food?

What with all the hullabaloo about ultra-processed foods (UPF), you would think they would be strictly defined. And you would be wrong.

A new paper came out a couple of days ago purporting to be another RCT on UPF. It caught the attention of one of the members of the academic low-carb email list I’m a part of and created a bit of a stir. As it turned out, most of the members of the group made the point that it’s impossible to do a valid study on UPF if UPF can’t be defined.

I agree 100 percent.

As far as I know, there has been only one official definition of UPF and that is the NOVA classification, which I think falls way short of the mark.

First articulated by Brazilian professor Carlos Augusto Monteiro in 2009, the NOVA classification, in my humble opinion, falls way short of the mark. Let’s take a quick look at a graphic describing it, and I’ll show you what I mean.

There are other explanations that are more detailed, but this will give you an idea.

In Group 1, for example, grains are listed. Most grains humans can’t eat without some sort of processing. Go out in a wheat field, strip off a bunch of the wheat grains, plop them in your mouth and start chewing. I did this once as a kid while riding in the back of my grandfather’s pickup. I can tell you that if you chew them long enough, you’ll end up with a white, gelatinous glob in your mouth that won’t break down no matter how long you chew it.

If you have to process wheat (and other grains) before you can extract energy from them, why are they on the lowest end of the processing gradient?

Even then, they can be processed more or less. They still end up as wheat or other grains, but the degree of processing they go through makes a difference. The more finely grains are ground—and they are still nothing but wheat—the greater the insulin response when you eat them due to the incretin effect.

(Note: I’ve given a few talks on the incretin effect. Here is probably the most comprehensive one.)

The incretin effect doesn’t necessarily affect the glycemic index of a food, but it does affect—sometimes hugely—the degree of insulin response to a given food. The more mechanically refined foods are in general, the greater the disruption of their original architecture, the greater the incretin response and the higher the resultant insulin response.

The NOVA classification doesn’t really look at the mechanical processing of foods, which, in my view, at least, is incredibly important. And should be included in any legit classification of UPF.

In Group 2 of the NOVA classification above, we can see that sugar, honey, and maple syrup are listed. These, along with the others listed, are considered “processed culinary ingredients,” even though I would not consider many of them processed. Honey, maple syrup, and salt, for example, are eaten pretty much as they’re found. Maybe maple syrup not so much, but I have never been involved in making or collecting it. My friend, Perplexity, tells me the sap is boiled down and concentrated such that 40 gallons of maple tree sap is reduced to 1 gallon of maple syrup.

Sugar is clearly processed from sugar beets or sugar cane. No one goes around eating sugar beets as a sweet, though I have chewed on sugar cane as a kid, and it was pretty good.

How about salt? It isn’t processed; it’s mined or collected from the sea. How is it a “processed culinary ingredient.” Now granted some types of salt have anti-caking ingredients added or iodine added, so that’s processing. But Celtic sea salt or Himalayan pink are pretty purely as they come.

And what about cream, butter, and lard (or, one supposes, tallow)? I suppose the case could be made for butter being somewhat processed, but not the others. They come as they come, except for the brands that add gellan gum to diluted cream to thicken it. That’s processed for sure.

Just from going through the first two groups, it’s easy to see the NOVA classification is far from perfect in determining what is and what isn’t UPF.

Conceivably, you could make a pancake, put some butter and honey on it, and that wouldn’t be considered a UPF. But in my mind it would be due to the fine grinding of the pancake flour. The whole pancake, butter, and honey conglomeration would send insulin skyrocketing in the vast majority of people. And since insulin resistance and the consequent hyperinsulinemia are real problems, were I creating a UPF classification system, I would test a lot of foods and put them in declining order as to how much insulin secretion they prompted, with the highest being the most UPF and working down from there. Doing that would at least include the consequences of the mechanical processing of foods that the NOVA system ignores. And we haven’t even mentioned the issue of ‘enriching’ that flour with lots of niacin and other vitamins.

RFK, Jr. is making a push against Big Food, and many companies have capitulated by agreeing to remove dyes over the next few years. I would prefer to have my foods without dyes, but I’m not sure how much of an insulin response those dyes would provoke. Allergies perhaps. Behavioral changes in some kids.

I agree with the folks on the low-carb email chain that it is going to be impossible to do any studies examining the effects of UPF without a firm definition of what a UPF really is.

I suspect we can all use the Judge Potter Stewart method of judging what is and what isn’t UPF. Stewart, a Supreme Court Judge, when asked what his standards were to determine what is or isn’t hard-core porn replied, “I know it when I see it.” I would bet most of us can pretty well determine what UPF is because we know it when we see it.

But that is no standard for selecting foods to be a part of an RCT. So, I think it will be a while before we come up with a definitive answer as to whether UPF cause all the problems now attributed to them.

In situations like this, I default to the Geoffrey Rose method of looking at things. Rose was a British epidemiologist who wrote a paper in 1981 titled “Strategy of prevention: lessons from cardiovascular disease.”

At the very end of his paper, Rose wrote about what conscientious docs should do when treating patients. I’ll give you some advanced warning. At the time Rose wrote this, it was almost uniformly believed among the medical tribe that saturated fat caused heart disease, and that increasing consumption of polyunsaturated fats prevented it. That situation has flipped now, but you’ll get the gist of what he’s saying.

His first paragraph above basically says that removing foods, habits, etc. that weren’t part of our evolutionary heritage shouldn’t cause harm. The second paragraph says we should be very careful in adding new agents to the mix, as we’re not sure if they will be proven safe over time.

UPF of the we’ll-know-it-when-we-see-it type has not been with us for very long, so restricting it from our diets ought not hurt us.

Once researchers do come up with a definition of UPF that makes sense, we still won’t have any valid studies on what it does or doesn’t do to us for a good while. But for me, based on taste and how I feel—granted both are subjective—I’m avoiding it as much as I possibly can. And, as per Geoffrey Rose, I would recommend you follow suit. (But ignore his advice on sat fats!)

Alpha-Gal Syndrome

One of the things I’m pretty anal about is saving tabs for articles I want to write about or think about or put in one of the various ways I have of saving such info. Somehow, though, I fell down on the job with this one.

I am absolutely certain I read an article recently by someone who wrote that he/she hoped the hot weather would increase the habitat of the lone star tick, so that more people would come down with Alpha-gal syndrome, eat less beef (and other animal food), all of which would reduce climate change.

I’ve looked and looked for the article, and I do not have it. I even went to AI to see if it could find it for me. And it couldn’t. Maybe I dreamt it.

Anyway, I thought most readers would be interested in Alpha-gal syndrome (AGS) as it is increasing, albeit slowly. Since first learning about it a few years ago, I assumed AGS was limited to the US, but apparently not. It has now been diagnosed on every continent except Antarctica, though it is heavily concentrated in the Southeastern US when the lone star tick resides.

Alpha-gal syndrome (AGS) is a potentially life-threatening allergy to a sugar molecule called galactose-α-1,3-galactose (alpha-gal), found in most mammalian meats (e.g., beef, pork, lamb) but not in humans. The condition is triggered primarily by bites from certain tick species, especially the lone star tick in the United States. When a tick bites and injects saliva into a human host, it can introduce alpha-gal into the bloodstream, prompting the immune system to produce antibodies against it. Later, ingestion of red meat or exposure to products containing alpha-gal can provoke allergic reactions that range from mild hives to life-threatening anaphylaxis.

You may have already read about this syndrome, which, if you’re a beef eater like I am, could give you nightmares.

Could it really be possible that you could go out for a walk in the park, pick up a tick, then end up being unable to eat meat for the rest of your life? I suppose it is theoretically possible, but highly unlikely.

The majority of people bitten by a tick do not develop AGS. Current thinking is that recurrent or multiple tick exposures, rather than a single bite, are more likely to cause sensitization and full-blown AGS.

Research suggest that regions with frequent tick bites may see 15%-35% of people develop alpha-gal sensitization (meaning detectable immune response), but only a small fraction go on to experience true allergic symptoms—estimated at less than 10% among tick-exposed populations.

For the average person bitten once, the probability of developing symptomatic AGS appears to be extremely low, though exact odds have not been determined. Most cases are associated with multiple or repeated tick exposures.

According to the CDC (if they can be believed), approximately 110,000 suspected cases of AGS were documented between 2010 and 2022 in the US, with actual numbers likely higher due to under diagnosis and lack of mandatory reporting.

In my opinion, the numbers might be considerably higher as most people experience mild, short-lived cases and the vast majority of people have no idea AGS even exists.

Here is what happens.

When a tick bites, it can inject saliva containing the alpha-gal molecule (a type of carbohydrate present in most mammals) into a victim's bloodstream. In some individuals, this triggers the immune system to produce IgE antibodies directed against alpha-gal. When these individuals later eat mammalian meat or products containing alpha-gal, they may experience allergic reactions that range from mild to severe.

The exact mechanisms explaining why only certain people develop AGS after a single tick bite are not fully understood. Most evidence I’ve come across suggests that repeated tick exposures increase the risk, but clinical reports do confirm that a single tick bite is potentially sufficient to trigger the immune response in susceptible individuals.

Here is the habitat of the lone star tick in the United States per CDC surveillance data. It’s habitat has broadened over the years.

AGS is a weird syndrome in that we don’t really know for sure who is predisposed to it, other than those who have been the victim of many tick bites, and even that is not a uniform feature. Many people have been bitten by ticks frequently, yet never develop AGS.

Aside from a high frequency of tick bites, some of the predisposing factors are:

• Being a person prone to allergies.

• Having certain genetic factors.

• Age. Older people are more likely to develop AGS. Maybe because they’ve had time to collect many tick bites.

• Other factors hypothesized to play a role include alcohol use, physical activity during allergen exposure, concurrent infections (e.g., parasites), pet ownership, and use of certain medications, though supportive evidence for these is less robust.

As you can probably tell from the uncertainty about all the above, there isn’t a lot known about AGS. I’m sure as time goes on and more and more people develop the syndrome, more money will flow into AGS research.

For now, just be aware of what it is. And carefully examine yourself for ticks if you’ve been outdoors in tick-infested areas. When I was a child, my parents looked me over for ticks every night before I went to bed. It’s good idea for everyone.

It apparently takes a while for the ticks to really get connected and start to feed. So, if you’re careful, you won’t likely be a victim of AGS. Just beware that it does exist and be careful.

More on the Sugar Diet

Nick Norwitz put up yet another video about the sugar diet…sort of. He put himself on a protein restricted (to 9%) 4:1 ketogenic diet for three weeks after being on a 18% protein diet the previous two weeks.

He had to bump his 4:1 keto calories to maintain weight on a 9% protein diet.

His caloric intake went up, his metabolic rate increased, and he ended up losing a bit over 6 pounds from his already lean frame over the three weeks on the study diet.

I discovered the same exact thing when I started on my strict keto diet back in December. I couldn’t eat enough to keep from losing weight.

As Nick says, the folks on the sugar diet lose weight when they restrict protein, and the subjects in the Nature Metabolism paper lost weight on a balanced (carbs and fat) diet when they restricted protein, and he (and I) lost weight while restricting protein.

This goes against everything I’ve ever learned, but I can’t fight the data. Other than, of course, saying there is not enough of it. But it is a fascinating idea.

Nick discovered that the people who did the original Nature Metabolism study, which was done on fit people, did another study in which the subjects were obese. The paper is in peer-review right now, but the lead author gave Nick the news that it works in obese people, too.

I find all this mind boggling (other than the the 4:1 keto diet, which I would have expected), and I can assure you I will stay on top of it. All we need are a bunch of new studies. I sure hope someone is going to get the funding to do them.

A Public Service Announcement

I’m going to put up a video I put up four+ years ago. It came up in conversation with our friends in Boulder, and it made me realize just how important it is. I’m going to start putting it up annually, so new readers can benefit.

The video is now about nine years old, but the advice still holds.

The guy presenting is Doug McDuff, who has been an emergency room physician for years. He is also a proponent of slow-motion/slow burn type strength training.

His talk is about a couple of things. The first and longest part is his description of what has happened to the whole medical edifice that has gotten us to the place we’re now in. He does it from a free market perspective, so if you don’t want to hear about that, skip forward to 48.55 on the video.

Doug has a list of the top dozen things you can do to avoid entering the belly of the beast, which is his term for the medical situation as it exists today. I have spent many, many days and nights working in ERs, and I agree with him across the board. Except maybe for the part about the lottery. I’ve never had a patient who won the lottery, so I can’t comment.

Here is his talk.

Go to 48:55 to get to his dirty dozen that will keep you out of the belly of the beast.

Odds and Ends

• The world's first speeding ticket was issued for going 8 miles an hour! My, my how times have changed.

• 5 Reasons European bread might be better for you. From the writers of the NY Times, so maybe eat with a grain of salt. “All the news that fits, they print.”

• Medieval walled cities you can explore on foot. If those walls could talk, what tales they'd tell. 

• You've heard the slogan Don't Mess with Texas. But you might be surprised how the phrase came to be.  

• They're painful to stand on, as any parent or grandparent can attest, but did you ever wonder what LEGO stands for?

• Paleontologists discover a new species of Plesiosaur from 180 million years ago. Now if they could just find Nessie.

• Hyper-realistic reconstruction of a pair of Stone Age sisters. This kind of thing is catnip to the sculptor in me. 

• Ever wonder why cartoon characters wear gloves?

• Sounds like a tabloid headline, but it's not. Flesh-eating bacteria kill 8 and sicken dozens more along the Southern gulf coast. Bathers and raw oyster eaters beware!

• Study shows music therapy rivals opioids for chronic pain relief.

• Nine historic hotels that are a destination all by themselves. I would have added the Grove Park Inn to the list and made it an even 10, but that's just me. 

• In a growing trend, a new start up business lets people sell tickets to their wedding. To strangers. Who would want to go? And why? I’d be more likely to pay not to have to go, myself.

• The vegetable that panics in the dark and cries out for help. Proving what I have always said regarding vegans ‘Just because you can’t hear the carrots scream when you tear them from the soil doesn’t mean they don’t.’

• On this very day in the year I was born (I was a mewling 2 month old and unaware of it at the time) Thor Heyerdahl completed his incredible 4,300 mile ocean voyage on the wooden raft Kon Tiki.

• Get down, get down! Researcher determines these avian head-bangers have over 30 dance moves. Probably more than most humans.

• Replacement windows to the soul. For millennia, artisans have been trying to capture the mystique of the human eye.

• Scientists are turning rhino horns radioactive to curb poaching.

• Imaging reveals 2,500-year-old Siberian 'ice mummy' had intricate tattoo.

Newsletter Recommendations

Video of the Week

Beyond the shadow of a doubt my favorite modern composer is Morten Lauridsen. Long time readers will recall I’ve written about his luminescent works before in these pages and that the Bride and I had the good fortune of spending time with him in Italy in 2016, when he joined the Santa Barbara Choral Society for their international performance tour. And of the many works of his that I love, one of my absolute favorites is a short piece from his Les Chanson de Roses called Dirait-on. MD has sung it many, many times at home and abroad on their tours. I don’t have access to a recording of her chorus singing it here in Colorado, but here is a good one from another chorus. Enjoy!

And just for grins, take a listen to this version, sung by All the King’s Men of the King’s College Choir. I’d never heard it done before by an all male chorus, and it’s quite a different feel, but equally beautiful. Let me know in the comments which version you prefer.

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. And share it with your like-minded friends.

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

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