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- The Arrow #280 RFK Jr, Fauci, Diet & Set Point, Repurposed Drugs, Bison.
The Arrow #280 RFK Jr, Fauci, Diet & Set Point, Repurposed Drugs, Bison.
Greetings everyone.
The publication of The Arrow has been a bit erratic as of late. The reason is that I’ve been caught in the maw of the medical-industrial complex, and I’m trying to escape. It has nothing to do with bladder cancer returning. It’s a problem related to my right kidney…maybe. I don’t want to go into it all now, but I’ll let everyone know when I do escape. It has been – and continues to be – a real time gobbler.
I got a lot of unexpected feedback on the last Arrow. I figured many would castigate me for being a grammar Nazi, but I got just the opposite. People responded to the poll, to the comments, and even via email about their own grammatical pet peeves. Good to know I’m not alone.
Plus, the same sharp-eyed reader who noticed I mentioned that Tim Noakes was one of the authors on a paper I wrote about a couple of weeks ago (it wasn’t he – my error), discovered I had failed to include a link to one of the subjects I wrote about.
In the last Arrow, I discussed an excellent post by Michael Heumer, a professor of philosophy at the University of Colorado, on how AI would probably not take over the world. I neglected to provide the link to the post. Here it is for those who are interested.
As mentioned above, the last Arrow provoked a number of poll responses and comments to my explanation as to why I hate it when people use “I” instead of “me” when in the objective sense. Apparently a lot of people are annoyed with that misuse and a number of other misuses as well.
Several pointed out their annoyance with the all-too-common interjection of the word “like” multiple times in every sentence. Instead of saying “Um,” which is also annoying, way too many people use the word “like.”
I don’t know how it all started, but it appeared about 30 years or so ago. Right about the same time it became trendy to use the word “me” in the subjective. As in “Me and Bill are going to the store.” That grammatical aberration even made it into MD’s beloved Outlander show. One of the characters leading a group of fighters said “Me and the boys are…” That would never, ever have been mouthed in that era.
MD grew up as the English Teacher’s Daughter, so never would such a construction escape her lips. Although MD and I schooled our kids constantly in proper grammar, God only knows what they said when they were away from us. But it ultimately paid off as you’ll see in the Video of the Week. When friends of our kids were visiting or we were driving them to school along with our own kids, they would say something along the lines of “Me and Ted (our oldest) are going to the [wherever] tomorrow.” I would say, “Who?” The friend would say “Me and Ted.” I would say, “Who?” Finally, Ted would whisper to the friend, “Say Ted and I.”
As mentioned above, another annoyance was the constant use of “like.”
We might be picking the kids and friends up from a movie. After my asking about the movie, a friend would say, “It was, like, great!” I would reply, “Was it really great, or was it like great?” Huh? Then one of our kids would say, “Dad (or MD) hates it when we say “like.””
I figured it would all die out. Using “me” in the subjective sense isn’t as pervasive (at least among the people I’m around), but “like” is now on steroids.
Tachylikea
Tachy is a medical term meaning rapid. A fast heart beat is called tachycardia. Rapid breathing is called tachypnea. Using “like” in rapid fire in conversation, I call tachylikea. And it is omnipresent in everyday speech these days.
A hilarious example recently appeared in the Wall Street Journal's “Notable & Quotable” section. It was a transcript of Michelle Goldberg (a New York Times columnist) on a podcast discussing Graham Platner, the Maine Democrat candidate for the Senate who just dropped out. I’ve read her stuff in the Times. She is a good writer. But here is what her non-Times-writing-every-day patois sounds like when transcribed as she says it.
You know, like when I was at one of his events and there was this trans woman who was talking about, you know, being really terrified about this, like, you know, barrage of legislation and saying: Are you going to stand up for me? And him, you know, up there again with his gravelly voice saying that, you know, like, well, you know, like, yes, like the one thing that I can do as—I think he called himself like a “cease man,” which I thought was cute. Like he was trying to, like he was—here’s what I thought was cute about it, was that he didn’t have the pronunciation right, like he was kind of trying—but do you know what I mean?
So he says, you know, that I can sort of be the—again, this is months ago—that, you know, like I can be like the shield between, you know, for the more vulnerable people. And so again, I just think that what they are, what people are connecting to is feeling like nobody is protecting them. And he seems like he will be unrestrained in trying to protect them.
Tachylikea in spades.
I’m sure the writers at the WSJ aren’t particularly fond of Michelle Goldberg. There is no better way to humiliate someone than to precisely record what they say, including all the “ums,” “ahs,” and “you knows.” While we’re at it, “you know” uttered after every other sentence is also another annoyance of mine.
Her comment is almost non-readable in the sense that it’s difficult to even know what she’s saying. When I try to reproduce it with my voice using all the pauses and likes, it does make sense. Sort of. It shows how spoken English is going to hell, while written English, as Michelle Goldberg herself would write it, maintains its integrity.
I have a niece, whom I love dearly. I haven’t seen her in the flesh for a few years, but she now holds a nice position in an internationally renowned scientific institute. When she was in her late teens/early twenties, she was babbling to me about something using “like” as every fourth word.
I said to her, “If you couldn’t use the word “like,” you would be struck mute. Just try it.”
She started to say something, then backed off. She tried again without using “like,” but couldn’t. Then she said, “Uncle Mike…” without saying anything else. I said, “See what I mean?”
RFK, Jr.
My prediction about Robert F. Kennedy quitting as head of HHS was a total bust. There are no signs of his leaving. For which I am enormously thankful. I just hope he can overcome all the factions allied against him to be able to generate some meaningful reform.
Dr. Fauci’s Hour Has Come
One thing I did get right was that the duplicitous Dr. Fauci was going to get his public comeuppance. Senator Rand Paul (R-KY) has been on Anthony Fauci’s case from the get go, and now will get to rake him (Fauci) over the coals in a public hearing on July 29. It will be a precarious outing for the Fauch. He will have to tread most carefully. But he's a wily, long-term bureaucrat skilled in deflecting blame. My bet is that he’ll show up with an attorney or two (or three), with whom he discusses every answer before responding. I’ll be watching.
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Maintenance and the Set Point
One of my favorite quotes comes from Mark Twain:
“Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times.”
Twain’s quote came to mind every time I looked at the dietary history of most of the new patients I was preparing to meeting with.
One of the questions we asked our patients to answer when first coming to see us was to describe their dietary history. MD and I were interested in knowing what nutritional approaches our new patients had taken previously and what were the outcomes. Most would list multiple weight-loss programs they had tried. And most had success with these varying approaches.
A typical patient might write down the following list:
Weight Watchers Lost 40 pounds
Nutrisystem Lost 35 pounds
Jenny Craig Lost 45 pounds
Optifast Lost 48 pounds
The patient had been successful, yet here s/he was at our clinic.
What I never saw was a patient with the following dietary history:
Jenny Craig Lost 40 pounds
Jenny Craig Lost 40 pounds
Jenny Craig Lost 45 pounds
Jenny Craig lost 45 pounds
I always found this intriguing because the patients in question had found success with one program, but never went back to it again.
If I had some sort of serious legal issue, and I found an attorney who solved it for me, I would go back to that same attorney again should the same issue arise. But, based on my experience, those who successfully lost weight using some formalized program almost never went back to that program when they regained their weight.
When I was doing my initial visit with a patient and going over the history, I would always ask about the many successful weight-loss programs tried. I always got back the same answer. “The program didn’t work. I gained all my weight back.”
It was at this point that I went into my discussion about all of these programs (including my own – at least the first part) were tools to get people to lose weight relatively quickly. But the real work didn’t begin until the weight was lost.
I would use blood pressure medications as an example. If you have really high blood pressure and it comes down after a week or so on the medication, you wouldn’t say, Okay, my blood pressure is normal. I can quit taking the meds now. Any sane person would understand that there is an underlying reason blood pressure was way too high, and that the meds lowered it. And that (absent any other changes) going off the medications would result in the blood pressure screaming back up.
Few seem to follow this reasoning where dieting is concerned.
But it is the same.
If you’ve got a metabolic problem that’s been solved by a change in diet, then, just like with the high blood pressure, the problem will recur when you go off the diet.
Somehow people just can’t get their heads around this concept.
Knowing my predilection toward a low-carb diet, you may be wondering why I would think any of the diets my patients were on would solve their overweight, diabetic, metabolic problems.
It’s easy.
All of the diets mentioned above do one thing: they bring about a reduction in insulin levels.
Even higher carb diets – as long as calories are low – will reduce insulin levels.
There was a great study published in the (AJCN) back in 1996 demonstrating the reduction in insulin levels nicely. The study was done in a metabolic ward in Switzerland (in collaboration with Stanford University) where all food was provided. This was not a study in which subjects were told what to eat, then sent home to do it. Subjects in those studies are prone to cheating. Not so much in hospital metabolic wards where subjects are under supervision and have their meals specially prepared and delivered.
In this study, the subjects went on one of two diets, both of which were very low in calories (1,000 kcal/day). One diet was relatively low-carb, while the other was higher-carb. Both groups consumed the same amount of protein – what varied was the amount of fat versus carbohydrate.
One group got 15 percent of calories as carbohydrate (which calculates out to around 37 grams of carb per day.) The other group were treated to 45 percent of their calories as carbohydrate, i.e., 115 grams per day.
Below is the macronutrient breakdown of the two diets.

This paper is interesting for a number of reasons. The first is the title: “Similar weight loss with low- or high-carbohydrate diets.” The study was published in 1996, a time when the cholesterol-causes-heart-disease-hysteria was at its highest. Also a time during which high-carb diets were being recommended by almost everyone to lower cholesterol levels and, it was hoped, to prevent heart disease.
I wrote my first book Thin So Fast in 1989. Atkins had been semi-resurrected and was back in sort of vogue. Protein Power hit the bookstores in December 1995. MD and I had been touring all over the country giving talks and making various media appearances. The low-carbohydrate diet, long disdained as simply The Atkins Diet, was making a comeback.
I suspect the publishers of the AJCN did not want to be seen as promoting the ‘deadly’ low-carb diet, so they settled on the”similar weight loss…” title. Every single parameter tested in the study was more improved in the group on the low-carb diet than in those on the high-carb diet. All except weight loss. But even that was more in the low-carb arm. It just didn’t reach statistical significance. In other words, its wee-p wasn’t wee enough.
The article could have easily and legitimately been something along the lines of “Low-carbohydrate diet brings about large decrease in insulin levels.”
If you look at the charts showing the changes, you’ll notice that everything got better in the low-carb diet group.


Second, and not to belabor the point, even the authors begrudgingly admit that everything – except weight loss – got better in the low-carb arm:
Indeed, if anything, consumption of the kind of low-fat, high-carbohydrate diets for weight maintenance advocated by the National Cholesterol Education Program seems to minimize the fall in plasma insulin and triacylglycerol concentrations. This is most likely related to previous results showing that both plasma insulin and triacylglycerol concentrations increase in proportion to dietary carbohydrate consumption.
When people consume their regular diets, they usually consume more energy than they need. The carbs and the fat are used for energy in that sequence, while the protein is used to replenish protein structures within the body. In other words, the protein is not burned as a fuel.
When subjects go on 1,000 kcal/day diets in a metabolic ward, they are consuming way fewer calories than they need. So, they end up using everything – protein as well as carbs and fats – for energy. What this means is that these very-low-calorie diets generally produce the same amount of weight loss irrespective of macronutrient composition.
Third, in this study, the most significant change of all is the reduction in insulin levels in those on the low-carb arm. If you calculate it out, you’ll find that those on the low-carb diet reduced their insulin levels by a little over 46 percent, whereas those in the low-fat group reduced their insulin levels by a little over 8 percent.
Quite a difference.
The study gives us a couple of pieces of important info.
First, a low-calorie, high-carb, low-fat diet will reduce insulin levels. Not by a huge amount, but these diets will lower insulin levels some. Which is why low-fat diets and low-calorie diets bring about weight loss. Both lower insulin levels.
Second, restricting carbs really does a smack down on insulin levels and insulin resistance. See the red underlining in the graphic above showing the changes in insulin levels.
Converting from European units to those commonly used in the United States, we find that insulin levels dropped from 17.8 µIU/mL (US values) to 9.6 µIU/mL in the low-carb group. In the low-fat group, insulin levels went down from 16 µIU/mL to 14.7.
I had my good friend Perplexity dot ai calculate the HOMA-IR numbers for me for both groups. Here they are.

There is no absolute consensus on the cut-offs for a definite HOMA-IR number (which is a measurement involving insulin and glucose) that defines insulin resistance. But most of the papers I’ve seen set it at 2.5. With the lower the better.
As you can see, those subjects who followed the low-carb diet reduced their HOMA-IR below the cut-off for insulin resistance, while those who were on the higher-carb diet did not come close to the 2.5. Their HOMA-IR decreased, but not enough.
The point of all this is that pretty much any diet that reduces food intake sufficiently is going to reduce insulin levels to some extent. Even a high-carb diet will if the amount of food is restricted enough, as it was at 1000 Calories in this study.
There should be no doubt in anyone’s mind that a low-carb diet is the best diet out there for rapid weight loss for the majority of people. (There is certainly no doubt in my mind.) But some folks prefer other diets. And as I discovered when taking dietary histories, many people lost a lot of weight on low-fat, low-calorie diets.
It’s not so much the weight-loss diet that counts as it is the follow up. That’s where most people crater in their weight-loss efforts.
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Weight loss is easy. Maintenance, not so much.
Most of the people who came to see MD and me in our clinic had, like Mark Twain with his quitting smoking, lost a lot of weight many times. They just couldn’t keep it off.
Obesity is a metabolic issue. If an insulin-reducing diet solves it, then remaining on such a diet should keep it in check.
It won’t really work with a low-fat, low-calorie diet simply because people can’t stay on those diets at sufficiently reduced calories for the long term. Hunger ultimately wins out.
The nice thing about low-carb diets is that you don’t ever have to be hungry. There are all kinds of foods that don’t end up raising insulin much, if at all. And typically those foods are ones that are filling. They don’t really satisfy a sweet tooth, but they do overcome hunger.
Hunger for sweets or high-carb foods in general isn’t necessarily a real hunger. It’s more of a craving or addiction. And feeding it feeds the addiction. You’ve got to feed the hunger, but starve the addiction, because that’s the only way you’ll get rid of it. (See the Tim Noakes video below.)
One of the concepts that has bounced around the medical literature, but has never been confirmed is the idea of a set point. Despite my always looking to science for answers, there is really none where the set point is concerned. At least none I’m aware of.
But I am firmly convinced that it does exist. Years ago, there were a number of over feeding studies, mainly done in prisons. Prisoners were overfed, and they gained weight. When they went back to their normal diets, they lost back pretty much to their previous weights.
All of us who have dieted to lose weight have seen the opposite happen. We diet, we lose, then we gain back to our previous weight. Sometimes plus some.
After my cancer got clobbered, and my appetite returned, I gained from my nadir of 152 pounds to 182 pounds in 44 days. Right now I’m at 192, and I want to stay there. My weight before I got sick waffled between 205 to 208 pounds. I’m having to watch what I eat now to stay at 192.
My body really wants to get back to 205 or so, but I’m working on not letting it do so. Unless, of course, it all comes on as muscle, then I’d be OK with that. And I’m working hard to bring that about.
Along with believing in the set point, I also believe it can be changed. But it takes effort. Not so much physical effort, though that does help a bit, but mental effort. Mental effort to stave off your brain’s call for the wrong foods.
Once you reach a lower weight, it takes work to maintain it. Really much more so than it does to lose it in the first place. The weight-loss phase is limited in time. Maintenance is much tougher because, ideally, it is forever.
You’ve just got to look at it the same way I described the blood pressure medicine above. If you’ve got a weight problem, you’ve got a metabolic problem. If the metabolic problem is solved by diet, then going off the diet and back to your old way of eating simply invites the metabolic issue back.
I wish there were an easier way to deal with it, but there isn’t.
The only saving grace is that once you’ve maintained your lower weight for a while (different periods for different people), you will establish a new lower set point. Which will make keeping weight off much easier. But it takes time and work to get there.
Which is partly why obesity rates are as high as they are. Sure, we’ve had changes in our national diet since the obesity epidemic kicked off in the early 1980s. But we’ve still got access to decent food that won’t worsen our problem. We just have to be choosy.
Sure, there is a lot of ultra-processed crap out there, but we don’t have to eat it. The science is still out on whether or not UPFs make us fat. It’s not known if it is the processing or the fact that UPFs are filled with easy to absorb carbohydrates. Because usually UPFs contain both.
Gary Taubes wrote an article in The Atlantic about this very thing recently.
To the staunchest anti-UPF crusaders, though, ultra-processing may also represent an outgrowth of a deeper problem. The nutritional epidemiologists and other scholars who have led this push in public health are out to challenge an entire system of beliefs, propagated by nutritionists for a century or more, about what makes a food unhealthy in the first place. When they swap in ultra-processed for junk, they are shifting the focus from the nutrient content of a processed food—whatever fats, salt, carbs, and sugary sweeteners it might contain—to how it’s made, where it’s made, and even why it’s made.
Going by this logic, even basic intuitions about what is good or bad to eat may be twisted into strange new shapes. Keebler’s Soft Batch cookies might be labeled harmful on account of their industrial ingredients—preservatives, emulsifiers, and hydrogenated oils—although your grandma’s home-baked snickerdoodles could be equally sugar-rich and considered benign. Store-bought whole-grain rye bread, with preservatives added to prolong its shelf life, could be viewed as toxic, but home-baked white bread is thought of as just a wholesome treat.
(Although nowadays I would suspect grandma might even make her home-baked snickerdoodles with some kind of vegetable oil, all in the name of heart health.)
Gary uses another similar example in a blog post he wrote a few weeks ago.
The UPF concept has remained controversial for all the reasons I discuss in The Atlantic. It is by no means universally accepted by nutritionists, largely because it proposes this radical redefinition of what constitutes healthy or unhealthy food.
Thus, a sugar-rich fruit food like a Medjool date is benign because it is unprocessed and can be eaten straight off the tree. A nori seaweed snack of the kind that us health-conscious parents tried to get our kids to eat is an ultra-processed food and should be avoided because of the industrial ingredients needed to preserve it and sell it in sheets that are remarkably resistant to crumbling in the packages. So should our kids eat the unprocessed dates, each of which has the sugar content of about two dozen M&Ms (we’ll get to those shortly), while shunning the seaweed snacks that are essentially sugar-free but ultra-processed?
That’s an extreme example, but extreme examples are good for thought experiments. If our kids are predisposed to be fat and diabetic (we’ll get to that, too), I’d hazard the guess that the seaweed is the far better choice, and I’d bet that most proponents of the UPF concept would agree.
In today’s current dietary climate, UPFs are having a tough time. Over 90 percent of the food sold by Big Food manufacturers is UPF. And most are filled with easily-absorbed carbohydrates, the very kind that run up insulin the most.
If you eat real foods and avoid UPFs (except, of course, nori seaweed snacks and others like them), you’ll be ahead of the game. As long as the real foods don’t contain a lot of real sugar and real carbohydrates.
It's a tough order, but there is no other way.
Except maybe by going for one of the GLP-1RA drugs. But all those do is stave off hunger – at a price. A price both in money and in side effects. All of the studies show that after quitting the drugs, the lost weight comes back on with a vengeance. So weight lost with these drugs is just like weight lost with all the other diets I mentioned above.
To paraphrase Mark Twain: Weight loss is easy: I’ve lost hundreds of pounds.
It’s the keeping it off that’s the problem.
And unless you want to be on these drugs forever, you’ll gain the weight back. All the studies have shown that. I can sort of make a case for these GLP-1RA drugs in folks who have unrestrained hunger. In most cases, they help. But they don’t help forever.
Another writer for The Atlantic discusses his experience going on and then off the GLP-1RA drugs.
And then, in March of this year, and not without some anxiety over how my life might change, I stopped taking Ozempic. I just felt very strongly that this was the right time to quit. I had been successful, losing nearly ninety pounds in eleven months; when I looked in the mirror, the face staring back at me looked much as it had before I’d put on all that weight, aside from a few gray hairs. Yet I still had a little more weight to lose, and maybe some part of me wanted to lose it on my own. It’s hard to say. I started taking semaglutide because it felt like the right thing to do. When my gut said it was time to give it up, I felt like I should listen.
My appetite took weeks to return, but when it came roaring back it seemed to happen all at once. This started as I was recovering from a bout of flu that had kept me from eating much of anything at all. For a week I nibbled and pecked at the odd piece of food, then on a whim I ordered a bulgogi pizza. After eating most of it in one sitting, I tried telling myself this was only because I’d been eating so little. But as days passed, then weeks, I had to admit that my appetite was still unusually strong, which is another way of saying it had returned to normal. [My bold]
To give a counter example, at least in the early days, one of my favorite Substack writers, eugyppius, wrote about his experience with a gray-market form of the drug.
I started reading eugyppius during the COVID days. He is a German academic who taught in the US for a decade then went back. He wrote about the insanity of the COVID years and how crazy the whole COVID era was. Once COVID faded from the news, he began writing about German politics, which I find fascinating. So I continued reading him. A day or two ago, he wrote about using an off-channel version of a GLP-1RA drug he was able to get his hands on.
A few years before this latest post, he used to be a serious runner. After laying off for a while, he started gaining weight. He writes (mistakenly – see Tim Noakes below) about how he needs carbs to fuel his running. Once he starts trying his contraband GLP-1ra shots, he notices a real difference in all sorts of aspects.
Here is what he had to report about it.
So, at the most prosaic level, you think less about food when you’re on these drugs, and this even at the very small subclinical dose I’m taking right now. I’d never realised how much space eating had occupied in my brain before. Suddenly a great part of my attention has been freed up for other things. Sometimes it can even be an effort to eat enough, which is slightly annoying, but this is mostly a matter of getting the dose right. (I had a rough first week but it’s mostly all worked out now.) I’m losing weight at the pace I wanted to, which is not very remarkable because I’m tracking all of my macros and calories like I always used to. The only difference is that I’m never really hungry and confining myself to my set food schedule requires no effort at all.
But, as I said, the food thing is the most prosaic part. It turns out that dialing down appetite has vastly broader psychological effects. In general I feel incredibly focussed all the time – much as I do after my first cup of coffee in the morning, but this lasts all day. Alcohol is much less interesting to me, and the same goes for nicotine. For years I’ve relied on oral nicotine pouches to keep my writing energy up late into the afternoon, but suddenly I’ve lost almost all interest in this particular stimulant; I have all the focus I need already. Also too I spend vastly less time dicking around on X, YouTube and other social media sites. I still have to use these platforms because they’re part of my routine as a blogger, but the stuff the algorithm feeds me just doesn’t hold my interest anymore. Oh, and perhaps most unexpectedly, I’m shopping less. Looking at my bank receipts, I can see I’m buying less at the grocery store, buying less from Amazon, buying less of everything. As I’ve discovered, none of this is unique to me. Many others in the peptidesphere report similar experiences.
You might ask at this point what I am still doing, or what I am doing more of, now that my doubtful grey-market pharmaceuticals have suppressed the less convenient aspects of my baser nature. The answer is that I’m doing more of the stuff I always theoretically wanted to do but got sidetracked trying to do before. Because things moving on screens has lost its attraction, I’m reading a lot more, and with luck this reading will supply material for interesting blog posts before long. I’m running more of course, which was the whole point, and a funny thing about that is that even harder workouts and longer runs don’t require the level of resolve that they used to. (Also too, though, the temptation to overdo it when running feels good and everything is going well is also gone.) Beyond that I realise from surveying my stupid fitness tracker data that I’m taking longer and more frequent walks.
He goes on to discuss in true eugyppius fashion how this all comports with his ideas of evolution and the development of early humans.
What I quoted above is behind a paywall, but the first part isn't. Here is the link to his post. I wouldn’t normally make someone’s post that is behind a paywall available to the public, but Alex Berenson already did it with this eugyppius post, so…
It’s all incredibly interesting, as is most of eugyppius’s writing is, but I fear he’s in for a disappointment. I can pretty much assure him that once he goes off the meds, his old urges will return. As they always do.
Medicare Approval
A big push is underway for these Ozempic-like drugs because Medicare just approved them. Here is a full-page ad that appeared in the Wall Street Journal a few days ago.

Although it is approved for Medicare, according to an article in the WSJ, it’s apparently not all that easy to get.
In my view, it’s much better to adopt the practice of an old acquaintance I ran into years ago who told me about her meditating in, as she called it, her Garden of Self Loathing. I wrote a blog post about it. The blog post is almost 20 years old, but every word holds true. And I love it because it has one of my favorite photos of me and two of my grandchildren back when they were governable. In fact, I like it so much I’ll just put it below. Neither the grandkids nor I now look like we did back then. More’s the pity.

I strongly encourage you to read the post. I go back and read it when my own will power falters. Think about your loved ones.
One more example that might help those of you (us) struggling.
Tim Noakes
My friend Tim Noakes is a physician from South Africa. He’s mainly known for his research on endurance exercise. He was one of those who recommended carb loading way back in the day. He suddenly got religion when he, himself, a veteran distance runner developed type 2 diabetes. He discovered the secret of carb restriction and insulin lowering. And he hasn’t looked back.
What makes him unusual is that despite his entire career being devoted to endurance exercise and carb loading to improve endurance, he publicly announced that he was wrong. The German theoretical physicist Max Planck famously said that “science progresses one funeral at a time.” That’s a paraphrase. The exact quote was longer because, well, Planck was a German.
His point was that most scientists hang onto their theories till they die. The scientists, not the theories. It’s unusual to find scientists reverse their opinions on theories they have spent their professional careers promoting.
That’s just one of the things that makes Tim Noakes so different from other famous researchers.
Here is a terrific video of a recent interview with him. In it he discusses his own low-carb diet and how he goes about following it. Tim and the woman I wrote about in the blog mentioned above are two of my heroes. I think of them when my will power wavers.
Here is the link to the latest research Tim and his group have published. Below is a graphic from the talk above (which is not in the paper). He explains the implications and importance of all this in the video. It is a major, major scientific insight.

The Oncologists Are Getting Worried
Those of you who read my post about it know I kept my bladder cancer at bay using repurposed drugs. On my initial evaluation, I had muscle invasive cancer all over my bladder. When I went off the drugs, my tumor burden, according to the extremely accurate Signatera test, was 3.00. As I was awaiting my appointment at MD Anderson, which took almost four months, my tumor burden increased monthly from 3 to 10.32 to 49.17 to 94.64.
God only knows what my Signatera test would have shown had I gotten it right at the start. I didn’t know the test existed. Nor, apparently, did my urologist at the time. It would have been nice to have known the tumor burden from the start. I would guess it would have been huge then.
At any rate, the repurposed drugs (and serial TURBT surveillance resections) kept it controlled until I went off of the drugs. Which I wish I hadn’t. But that’s all water under the bridge.
The point is that the drugs did keep my cancer pretty much beaten down as proven by what happened after I laid off of them.
The oncology community is feeling a bit of pressure from the anecdotal reports of people who have had the same experience I had. Or have even had their cancers knocked out. (And to be fair, I question now what might have happened with mine had I kept taking the repurposed regimen in August. In another few months would it have been zero? That which is not seen…)
The American Society of Clinical Oncology (ASCO) has issued a warning about the use of these repurposed drugs.
The American Society of Clinical Oncology (ASCO) cautions that ivermectin and fenbendazole should not be used to treat cancer, nor as an adjunct to established cancer therapies, outside the regulatory safeguards of a well-designed clinical trial. The current lack of established clinical benefit, coupled with the potential for toxicity and harmful drug interactions, presents an unacceptable risk to patients.
This was the focus of a new ASCO Clinical Notice published to help oncologists and their teams manage increasing reports of patients using these agents. [Link in the original]
They go on to say
To date, “there is no robust, peer-reviewed clinical evidence demonstrating that either ivermectin or fenbendazole is safe or effective for treating any human malignancy. Well-designed comparative clinical trials with human participants would be needed to establish the benefit-to-harm profile and utility, if any, of ivermectin and fenbendazole in the cancer setting,” the notice stated.
And as always, they make the point the fenbendazole is not licensed for human use.
There are a number of clinical studies going on right now evaluating these drugs as anti-cancer agents. But the problem is — for the oncologists, anyway — that these drugs are dirt cheap. They are a little more expensive now than when I first started using them, but, compared to chemotherapeutic drugs they are almost free. The repurposed drugs cost well under $1,000 for the entire course of my therapy. Whereas the billed cost was ~ $60,000 per pop for the immunotherapy I got. I got four doses altogether. So the repurposed drugs cost was almost non-existent as compared to the immunotherapy.
If these drugs were not effective, the oncologists would not be worried. It’s been my experience throughout my career that when doctors see their income threatened, they always couch their response in terms of what might be harmful to patients. They would never, ever say it was because of monetary issues.
MD and I learned this first hand. When we set up our first urgent care center (it was one of the first in the country and the very first in Little Rock), many of the local primary care doctors complained that patients would be harmed. All of these doctors took patients by appointment, which were sometimes more than a week booked out. If you’re sick now, you don’t want to wait a week to see a doctor. Since we took them as walk ins, they could be seen immediately. And their regular docs lost the revenue.
The whole reason we started our clinic in the first place was that I was doing a lot of emergency room work while MD was finishing medical school and her internship. During my many, many shifts, it didn’t take me long to realize that about 90 percent of what came into emergency rooms were not emergencies. People were using the ERs because they couldn’t get in to see their own docs.
So, MD and I started what we called a free-standing emergency clinic. We dealt with whatever walked through the door. Now these clinics are called urgent care centers and they are all over the country. Not so back in the very early 1980s. When we came on the scene, the local docs got worried. And they couched their financial worries in terms of their fear that patients would not be well taken care of.
As it turned out, MD and I ended up with the largest primary care practice in town. We had almost as many patient charts as there were people in Little Rock.
Them Bulls’ll Hook Ya
One of the greatest scenes in all of TV mini-series history is the one below from Lonesome Dove. If you haven’t read the book Lonesome Dove, you have really missed out on one of the great American novels. If you haven’t seen the mini-series from years ago you really should. It was, in my view, the best acting job of Robert Duvall’s career.
Below is a short scene from the mini-series. Gus, played by Robert Duvall, realizes that the old west as he has lived it is coming to an end. He and Pea Eye, one of the other characters, come upon a small heard of bison, or buffalo, as they call them.
Gus wants to chase them just for the hell of it. Pea Eye is not so sure. The entire short little scene is terrific. Both in the book and in the series. I found a not very good quality version of it. See below.
Pea Eye is right about the damage a bison can inflict. The video below — which has been all over the internet — made me think of the Lonesome Dove scene above.
I don’t know what got this bison so riled up, but there is no doubt that something did. Who knows what goes through a bison’s mind? It’s clear to see that this one was mightily pissed. And huge. And fast.
Fortunately, the bison was content just to flip grandpa through the air and not to gore him. For which I’m sure grandpa was thankful as well.
Whenever I see videos like this, I always wonder what people are thinking when they get too close to wild animals. In Estes Park, Colorado, where elk wander all over the town at certain times of the year, I saw a set of parents trying to get their kid (who appeared to be four or five) to get up close to a big bull elk so they could get a photo. The elk was enormous, and he was hovering over several does. The kid didn’t want to get close. He had much better sense than either of his parents. The elk looked to me like he was ready to savage the kid if he got too close. The parents were clueless. The kid did not get harmed, but he sensibly refused to get as close to the elk as his idiotic parents wanted him to.
I tracked down the story of the grandpa who got hooked by the bull above. As it turns out, he had multiple fractures of his leg, but was otherwise okay. And has a helluva story to tell with video included.
Pea Eye was right. Them bulls will hook you.
Odds and Ends
Why is the placement of buttons and zippers gendered? An interesting historical tidbit.
I admit to being an ice cream junkie. I don't eat it much anymore, but it's my favorite treat. So if I'm ever in any of these spots I'll head to one of these 16 Ice Cream Shops with Seriously Unique Flavors.
What happened to Rover and Fido?? I'll admit that one of our son's dogs is, indeed, named Lucy. And my sister's dog is Daisy, and her daughter's dog, Bella. So maybe there's something to this list of the top 10 dog names in the US.
I love beautiful tapestries. MD especially does. We have a lovely example in storage now. It used to hang in a place of honor in our main staircase at a house we no longer own. I miss it. Have seen the Bayeaux tapestry at the Louvre and it's amazing. Now, you can explore it scene by scene virtually. Take a look.
When you can't see the forest for the trees, it could be because there are an estimated 3.4 trillion of them on planet Earth. Who counted them all and how?
In Through the Looking Glass Humpty Dumpty wisely told Alice (and us) that words are our slaves. He said, 'When I use a word, it means whatever I choose it to mean. Neither more nor less.' Ole Hump wouldn't therefore have needed to look up a definition, but you might. So here are the most searched-for word definitions in the US, state-by-state. Hard to believe most of them needed looking up.
Sneezes vary, from the Cannon Blast that can be heard in the next county (the Bride and I both cop to this one) to the uberly stifled ahmn-hmn-hmn of our D-I-L that turns the release inward on itself and completely obviates the whole reason for doing it, which is to expel some irritant. As it turns out science suggests a mousy silent held in sneeze is potentially dangerous. Here's why.
And riffing on the subject of sneezes, ever wonder why bright sunlight causes some people to sneeze? Hint: it’s genetic!
Video of the Week
The VOTW is a little different than the others in that this one stars me…sort of.
My sister-in-law in South Carolina had the below video feed come up on her Instagram account. She sent it to me.
Somehow, someone got a video of a lecture I gave somewhere (I don’t recognize it) and did a voice over via AI. It is definitely not my voice. And I have never been filmed talking about how we’re all getting screwed by companies shorting us on various products. Note what “I” said about razors.
I’ve got to admit that it’s kind of disturbing to see oneself misused in this way. But it had a hilarious and gratifying end result. I sent the video around on our family chat group. Our youngest kid’s response was priceless.

The difference between “less” and “fewer” is something we quizzed the kids on all the time. “Less” is used when describing something that can’t really be counted. “Fewer” is used to describe things than can be counted. Let’s use “money” for example. You really can’t count money. You can have more of it, or less of it. As in I have less money in the bank than I used to.
But if you’re talking about dollar bills, which can be counted, you use “fewer.” As in, I have fewer dollar bills in my wallet than I did last week.
Sand is another. There is less sand on the beach than there was last summer. You can’t count sand. But there are fewer grains of sand (which, theoretically, could be counted) than there were last summer.
We quizzed our kids on these things randomly and especially on road trips. It’s extremely gratifying to see that the lessons took. Especially since I didn’t notice it myself on my first time watching the video. I think I was just too flabbergasted by it.
Time for the poll, so you can grade my performance this week.
How did I do on this week's Arrow? |
That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday.
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