The Arrow #265 - Pyramid & Polypharmacy II

Greetings, one and all, on another beautiful, sunny winter’s day! 

Several of you commented that I needed to amend last Arrow’s list of all the groups of unfortunate people (apart from the 30 million school kids) who are fed daily by law according to the Nutritional Guidelines to include those in hospitals and nursing homes. Mea culpa for not specifically mentioning those two important groups, because if you’re looking for people who need protein and good fats the most, the injured, sick, and elderly top the list.

I had occasion about a year ago to see a hospital’s ‘obey the food pyramid’ requirement in action when I went to visit a friend (a long-time low-carb follower) who had gone into the hospital for a procedure that required a couple of days in house. I was there when the pleasant person from dietetics delivered him the day’s menu from which he could check off what offerings he wanted for his dinner. The fare was, as you might imagine, very carb heavy – rolls (with margarine not butter), starchy sides like mashed potatoes, potato salad, or mac’n’cheese, the ever present lime or orange hospital Jell-O and vanilla pudding out of a can. UGH!

As I recall he selected a protein – it think it was broiled salmon, which he later told me wasn’t bad for hospital food – with steamed carrots, green beans, a mixed green salad, and a half pint of 2% milk (the highest fat version on offer). I was still there chatting when his tray of food arrived, along with a slip of paper detailing what he’d ordered and giving him a pretty pie chart showing the macronutrient breakdown, which as I recall contained about 5% of calories as carbohydrate. Proving, of course, that with careful selection, you can cobble together a low-carb meal in such an institution in a pinch, though I’m sure the head of some nameless dietitian in food services exploded into a thousand little pieces when he/she saw the macro numbers. Fortunately, I don’t think he was in there long enough for anyone to come by to scold, nag, or try to educate him over his ‘misguided’ choices.

And another example from about 2012 when MD’s sister was in the hospital having been just diagnosed with metastatic lung cancer was even more appalling. She’d been admitted in a crisis of confusion from brain mets and not being able to swallow from the obstruction caused by large cancerous lymph nodes in her chest cavity. She couldn’t eat, so the doctors placed a feeding line in her subclavian vein and started her on TPN (total parenteral nutrition, which consists of mainly sugar and bad fat). Meanwhile, the oncologist blasted her with chemo, and in a few days it shrank her nodes enough to let her swallow, so they started her on real food — typical hospital food, which was mainly carbs. But they left the TPN line in, so she was getting IV carbs and awful fats and eating plenty of carbs from her tray of food.

And SURPRISE! Her blood glucose began to rise. They were checking it at all hours of the day and night (MD was by this point staying in the hospital room with her sleeping on the couch, or trying to) and finally one morning the nurse announced that they were going to start her sister on insulin to bring her blood sugar down. At this point, MD intervened and called her sister’s oncologist (a med school classmate, as it turned out) and said basically WTF?! You’re pumping her subclavian vein full of sugar and bad fats, and she’s eating plenty of food, but mostly things that turn to sugar, and your solution, instead of taking out the TPN line and changing what’s on her tray is to start her on insulin?? To his credit, he rectified the situation without insulin. But what of all those patients who don’t have a physician knowledgeable in nutrition on the couch?

So, yes, yes, yes we must include those important vulnerable groups in hospitals and nursing homes among the millions fed by the government’s Nutritional Guidelines for better or worse.

Granted, these new 2025-2030 Guidelines are a vast upgrade over what they replaced, at least in their verbiage and imagery – eat real food, eat more meat, drink full fat milk, don’t be afraid of butter, tallow, or lard as stable cooking fats. All of that is right in line with what we and so many others (Nina Teicholz’s Nutrition Coalition, especially) have been advocating for them to say for decades.

(And on that topic, if you have never treated yourself to a read of Nina’s fabulous best-selling book The Big Fat Surprise, run don’t walk and do so. It’s a critical and seminal component of any serious low-carber’s research library. I can’t recommend it highly enough. And if you have read it, you’ll love her Unsettled Science substack, too.)

The content of the new Guidelines is unarguably better than either Michelle Obama’s My Plate or the 6-11-servings-of-bread-and-cereal-grains original Food Pyramid. And average Americans who make their own choices about what to eat may wind up getting a more nutritious, more healthful diet if they follow the new images and the sentiments espoused out loud by the HHS Secretary and head of the USFDA.

But the fly in the ointment here (as mentioned in Arrow #264) I spoke out about decades ago when I appeared on the O’Reilly Factor. Millions of people are fed according to the directives in the Nutritional Guidelines. (You can watch the whole interview or skip to my salient comment about this point at about 3:25 into the video.)

The problem is that for all their good words about whole foods and protein, they kept the idiotic and utterly baseless 10% limit on saturated fat. And that hard number is precisely what all these government-funded institutions are going to have to—and likely will—abide by. The Whole Milk in Schools work around to exempt the sat fat of dairy products from that meager daily sat fat total won’t help our soldiers and sailors, prisoners, hospital patients, or nursing home residents because it only applies to the school lunch program.

And I have to wonder how on earth all these mess halls and cafeterias are going to follow the spirit of their words (eat more meat, fish, poultry, and full fat dairy) without exceeding the letter of their law (less than 10% of calories as saturated fat)? And I suspect it’s that hard number the institutional meal plan developers will shoot for. Particularly since, despite the American College of Cardiology, itself, exonerating saturated fat as a driver of cardiovascular disease, most dietitians have the anti-sat-fat bias embedded in the very fiber of their being and think the HHS Secretary is a nut job crack pot. This 10% directive gives them cover to keep scraping all the fat out of institutional meals and completely ignore the broader message.

So… Why?

So now the question that really puzzles me is the ‘why’ of it. How did the decision to preserve the 10% limit come to pass when there’s really no credible science to back keeping it and lots of science saying better to remove it. So who benefits from maintaining this artificial (and hair-brained) saturated fat limit? Certainly not the citizens of America. Not really even the dairy or beef industry – cream is more valuable to be skimmed and sold at a higher price on its own than mixed into full fat milk and ranchers have been struggling for years to keep ‘lean beef’ on the menu, so that’s nothing new for them. I can’t for the life of me see how it helps or enriches anybody.

Maybe, as Nina has suggested, it’s nothing more than face-saving on the part of powerful long-time low-fat advocates, who are still embedded within the regulatory agencies and on these powerful committees – nutritional heavyweights such as Alice Lichtenstein from Tufts, Marion Nestle from NYU, and Walter Willett from Harvard, who apparently all lobbied to keep the 10% cap on sat fat in place. Maybe it was a bone thrown to these anti-sat-fat luminaries to get them to go along with and approve the rest of the 2025-2030 recommendations, so as not to throw out the baby with the bath water.

Or maybe in the darkest, most dystopian interpretation I can come up with it’s political pressure from the Medical-Pharmaceutical industrial complex to keep chronic illnesses rising and pharma and hospital care dollars flowing through the revolving door where politics and industry intersect. I’m not sure I’d have entertained such a notion pre-Covid, but after living through that web of deceit, it’s hard to predict how low they can go.

There’s a Pill for That

I saw a headline this week again in MedScape that further exemplifies what we discussed in the last issue of the Arrow, mainstream medicine’s answer to every physical malady: another medication. This one linked to an article involving how to handle early stage kidney disease.

The article concerned the release of new therapeutic guidelines from the US Department of Veteran’s Affairs for management of early stage kidney disease in a primary care setting, advocating the addition of GLP-1 Receptor Agonists (the mainstream’s new darling drug for just about everything) to other drugs already in use to slow the progression of renal disease, improve cardiovascular outcomes, and reduce mortality.

Long time Arrow readers won’t likely be too surprised to discover that the mainstream’s treatment and prevention focus is squarely on a parade of drugs, not diet or lifestyle.

The VA’s recommendations suggest primary care docs should prescribe GLP-1 RAs to reduce blood sugar, in addition to statins for reducing cardiovascular risk (of course, always, but ignoring the evidence that they may raise risk for developing diabetes) , angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to lower blood pressure, and SGLT2 inhibitors to lower blood glucose by causing the body to waste it in urine, all to treat mild or early stage kidney disease, which they say may affect 14% of the population. The article admits that anyone with metabolic syndrome might be at risk, so this much larger group should be screened for early signs of kidney disease and if present it should be hopped on with a full house of drugs.

The far and away most common causes for developing kidney disease are diabetes and hypertension. Diabetes, because the glomerulus (the individual filtering units that make up the working kidney) are damaged by elevated levels of blood glucose — which calls into question the wisdom of putting these people on a drug (SGLT2 inhibitors) that actually sends glucose through the filter on purpose. And hypertension because it puts undue stress on the arterioles, narrowing the vessels and impairing renal blood flow.

You’ll immediately recognize both of these maladies – diabetes and hypertension – as components of insulin resistance / metabolic syndrome. And because you are an astute reader of the Arrow, you’ll already know that the low-carb/ketogenic diet is (without much argument) the most effective treatment for both of them, without a doubt for diabetes and in probably 80-85% of cases of hypertension.

So if diabetes and hypertension are the biggest drivers of chronic kidney disease (CKD) and if reducing the risk, morbidity, and mortality associated with CKD is your aim, why in the name of all that’s holy would you not seek first to actually resolve those underlying causes?

But nowhere in the VA’s primary care recommendations does it say: ‘Before you do anything, address the underlying metabolic syndrome with a sound, whole food low carb/ketogenic diet.’ It should, but it doesn’t.

To be fair, I feel sure the VA recommendation’s authors don’t believe diet will work. And certainly the low-protein, low-fat, low-salt, high-carb, plant-based diet they’d likely recommend won’t. And I’m equally sure they would equate ‘low-carb/ketogenic diet’ with high protein, which they fear in regard to the kidney. And it certainly could be that, high protein, I mean. But it doesn’t have to be. Just adequate daily intake of quality protein without much starch or sugar will do the trick. The metabolic heavy lifting of a ketogenic diet is carried mostly by the higher fat intake, which may be in the neighborhood of 70% of calories.

Of course the mainstream would be queasily quaking in their boots about putting someone with mild signs of kidney disease on a diet so high in fat, fearing it would cause the very cardiovascular disease they’re aiming to prevent with their statins and other meds on the one hand and croaking their kidneys with all the protein on the other. And neither is going to happen.

(Jesus putteth his palm to his forehead.)

The Vampire Myth of Kidney Damage

The myth that protein damages the kidneys is one I have longed termed ‘a vampire myth’ because no matter how many scientific stakes you drive through its black heart, it lives on. The belief that protein damages the kidneys arose back in the 1920s-30s from studies at the University of Michigan where researchers administered high doses of single amino acids intravenously to animals and humans and noted acute increases in renal blood flow and filtration and transient appearance of albumin (protein) in the urine. This effect was misinterpreted to mean the kidney was being damaged, when it was only a transient physiologic response to a single high dose amino acid. The same has never been shown to occur from dietary protein intake in people with normal kidney function.

I always turn to the example of the bodybuilder community, a group of people eating far in excess of the protein intake recommended (sometimes exceeding 300 or 400 g of protein a day) and yet we don’t see long lines of Mr. Americas loitering out front of dialysis centers. If protein hurt the kidneys, there would surely be more CKD among body builders than the rest of us, and yet there are no such reports. In fact studies specifically looking at that have documented no decline in kidney function in this group, so long as there was not any underlying CKD to begin with. Once the kidneys have been damaged sufficiently, however, protein does become an issue to wrestle with – getting enough and not too much.

Body builders notwithstanding, there have been a number of studies examining the effect of a low-carb ketogenic diet on kidney function and to the great surprise of an author of one such study, the renal function of the subjects with polycystic kidney disease put on the ketogenic diet not only didn’t deteriorate, it improved. And it’s not just in one study. See here, here, and here for a few examples.

So, IMH (but educated) O, if the most ancient and sacred directive for a healer is to ‘First Do No Harm’ and if your objective is the improved overall health of your patient and if you’re dealing with a relentlessly progressive disease that can be brought to heel and even reversed by instituting a particular dietary structure that directly addresses not the symptoms but the underlying cause of the disease, why wouldn’t that be your first impulse? It should be.

The Arrow is a reader supported publication. You can subscribe for free, but if you would like to support my work, the best way of doing that is to take out a premium subscription. At just $6 per month, it’s cheaper than some Starbucks Caramel Double Pump Vente latte or whatever. And a lot better for you. It will run your IQ up instead of your insulin.

Odds and Ends

• Men, they say, are from Mars and women from Venus. And maybe it's so; apparently there's a clear male/female disparity on New Years' Resolutions. Based on a YouGov survey, here's the gender divide.

• Metal detector finds silver Scottish coin from 1130 AD, from the time of the reign of David I. Just reading about it flames my love of rare coins, metal detecting, and treasure hunting. So...catnip!

• Cowboys still exist. But this one, like Paladin, one of the Western tv heroes of my misspent youth, travels from town to town to solve people’s problems, but in this case, however, it's 'have lariat will travel'. (IYKYK)

• If in the bleak midwinter you find yourself craving some sunshine, here are some of the sunniest cities in the US. They oddly left off Boulder, CO and Santa Fe, NM two places where the Bride and I have lived. At 80% and 75-80% sunny days respectively, they both should qualify for the list and are lovelier vacation spots than some that made it.

• Here's a weird one -- Victorian era shoes have been washing up on a beach in Wales for years. Wonder where they might have come from?

• Ever wonder where your prescription drugs are made? (If you take prescription drugs, that is.) You can find out here.

• 11 movies considered the greatest of all time. I've seen about half, heard of all but one. Not sure what they base their decision on, and not sure I concur with them. You?

• Arguably among the most awe-inspiring and beautiful waterfalls in the world, Niagara Falls has become a cliche destination for honeymooners, and the Bride and I couldn't resist the impulse to go there on our own now 45 years ago. In November. It was cold! Here are some of the most beautiful falls in the US. 

• Mattel introduces the newest Barbie: Autistic Barbie, complete with noise cancelling headphones and a fidget spinner. But I had to wonder, since autism is hugely more common in boys than girls, shouldn't it have more correctly been Autistic Ken?

• Destinations where the sun don't shine. If endless polar night is your thing, this is for you. Great location for vampire vacations, I guess. The Bride says 'Don't buy a ticket there for me. At least not during winter.' 

• In every language there are nonsensical idiomatic phrases that don't at all mean what they sound like. Take one of my favorites: 'In bucco al lupo!' meaning 'In the wolf's mouth' which is the Italian way of saying 'Good luck!' 'Break a leg!' (OK, that's another one in English). Here are a bunch more from around the world that you might find intriguing.

Newsletter Recommendations

Video of the Week

The chorus the Bride sings with (SB Choral Society) is back at rehearsals after the new year, hard at work on their March concert which in honor of the 250th Birthday of our Nation will explore the choral tradition in the United States since its founding and focus exclusively on choral works written or arranged by American composers. Among them will be a couple of works by LA-based composer Shawn Kirschner, including this one below that will close out the program (sung here by the Concordia University Choir). “Cornerstone” draws on the American Spiritual legacy. MD describes it as a ‘feel good, stand up and shout AMEN’ piece, which is exactly what you want to leave an audience with at a concert’s end. And a feeling we could all probably use about now. 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 soon.

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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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