The Arrow #109

Hello friends.

Greetings from Dallas.

Dallas where there is a slight dusting of snow, and almost every service is shut down.

Consequently, I’m going to start today’s Arrow with a rant. If for no other reason, just to get it out of my system.

But before I do, I want to thank Ivor Cummins for featuring last week’s Arrow in one of his famous videos.

Here it is.

I love Ivor’s videos. If you don’t subscribe to his YouTube channel, you should. And to his website. Along with his Twitter feed. Ivor is one of the folks who have been right about the Covid debacle right from the get go. And he hasn’t been afraid to talk about it, which, given the situation, takes a lot of courage.

In the video above, Ivor reminded me about something else I intended to write about in describing how I analyzed the Covid situation to come to my own determination about what was going on. The situation in Sweden. One of my favorite videos was of Johan Gieseke, the former head epidemiologist for the Swedish government. Watch this short clip of him talking about why Sweden didn’t go whole hog on the lockdowns. I’ve queued it to the best part.

As he says, “people aren’t stupid…” If you tell them the risks, they’ll make the proper decisions for their own health. If only the rest of the countries had trusted in the good sense of their own citizens, the outcome would have been much different. There would probably have been the same level of fatalities, but no devastating, economy-destroying lockdowns.

Here are two more Gieseke interviews here and here from a reporter on Lockdown TV (which says it all). The guy interviewing him is a Brit, who appears to be all in on the lockdowns. Gieseke tells him, let’s talk again in a year to see what the outcome is. They have another interview a year later, and he tries to get Gieseke to admit he was wrong. Which he does, to a certain extent. But Gieseke still says time will tell. Gieseke understands how viral illnesses work. Here is the difference between the death rate in Sweden, where schools stayed open and businesses—even pubs and restaurants—continued to function and the death rate in the UK, where the lockdowns were disastrous. To what end? The graph tells the story. Sweden in blue; UK in red.

As I watched Ivor’s video, I kept thinking of other things that made me wary about the vaccines that I should have expanded on. I did mention about the difference between the relative risk and the absolute risk. Pfizer used relative risk, which always looks much more impressive, while being of really no value. I went into it in depth in earlier versions of The Arrow, but barely mentioned it last week.

I came across a nice explanation in a tweet from one of my followers. She was replying to Scott Adams about his mea culpa. Take a look at the short video to see the finagling Pfizer did to come up with the 95% efficacy rate:

Cassandra Drew @CassandraDrew10

@ScottAdamsSays Some of us did our due diligence. We weren't right by accident. Did you bother to read the vaccine trials? Did you bother to question the efficacy numbers? Some of us did.

Rant

Okay, on to the rant about Texas drivers.

Before I took up golf, skiing was my sport of choice. While our kids were in school, our family spent every spring break on a ski trip. We’ve skied in Taos, New Mexico, Sun Valley, Idaho, and a bunch of places in Colorado. When MD and I moved our practice from Little Rock to Boulder, CO, we skied a ton. We discovered that in Colorado when you’re buying ski equipment, people don’t ask you what your level of expertise is like they do everywhere else. In Colorado they ask you how many days you ski per year. MD and I, finally freed from having to arrange our ski trips around kid vacations—they were all gone by then—we skied a lot.

The point of all this is that when you ski, you end up driving in a lot of snowy, icy conditions to get to and from where all the skiing is. And, at least in my experience, driving in the snow just isn’t all that bad. You just have to go a little slower and test here and there for how icy the roads are. And adjust your driving accordingly. MD and I lived for several years in Boulder in a house in the foothills. We had to navigate a 5.2 mile road down (or up) a hill daily during all kinds of weather, including massive snowfalls. And most everyone who lives there does the same.

We lived in Incline Village on Lake Tahoe for over 20 years, and it was nothing to have huge snows there. People chugged along as if it were nothing. As long as they could get on the road.

But people in the South are absolutely terrified of driving in the snow. Even a little dusting of snow. I’m sitting here in Dallas awaiting two important deliveries, and none of the delivery services are running. Do you suppose UPS, FedEx, and Amazon shut down in Minnesota when it snows? They certainly didn’t in Colorado. But they do here.

Even the frigging mailman has taken a powder. Whatever happened to this obviously long out-of-date saying?

Neither snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds.

I drove to the grocery store yesterday and the roads had a little snow and ice on them, but nothing bad. Almost no one was out. Yet all the checkers and stockers were at work at the store. Somehow they managed to get there. But not FedEx?!?!

Just so you’ll know I’m not exaggerating about how light the snow is, here’s a photo I just took from out our front door.

Yet people here are terrified to get out and drive in it. We have a Ring doorbell, so that when we’re out of town, we get a live video of anyone who walks up to our door. It’s nice because we can tell if we get a delivery. And can then text our long-suffering and very kind neighbor to grab our package and keep it for us till we get back. Having a Ring doorbell ends up getting you on a neighborhood list of others who have Ring doorbells, and these folks can text out notices about porch pirates and burglaries. Today I get the message below:

See what I mean? People here are scared witless about driving in a tiny bit of snow. It was the same in Little Rock, but I understood it better there. Little Rock is a hilly, hilly place. It’s hard to find a level road. And, of course, snow and ice on hills can be treacherous. But Dallas is pancake flat. I just don’t get it.

And I really don’t understand the delivery services taking a powder. Or the guy who delivers my Wall Street Journal, which has been MIA the last couple of days.

There doesn’t even have to be snow to engender a full-blown panic. MD and I had to get something from our bank a couple of days ago before a single snowflake fell. But snow was predicted. We get there, walk to the door, and there is a sign that says, We are closed for inclement weather. Please use the ATM. WTF!!!!

I’m sure I’ll get savage in emails and in the comments section about my heartlessness, so go for it. It was therapeutic for me to vent about it.

On to other things.

Speaking of the comments…

Russia v Ukraine

I received a bunch of emails and comments taking me to task for taking the side of the mask mandaters, pussy hat wearers, lockdowners, and 'it’s The Sciencers on the Russia versus Ukraine issue. And for listening to my pony-tailed guy instead of Doug Macgregor on what’s going on.

I found the most recent Doug Macgregor interview I could find and watched it. He said basically the same thing he said right when the war started. And I’ll paraphrase him here:

It’ll be over in a few weeks. Russia’s advanced, skilled military is going to move in a slaughter them. The US is foolish for wasting money helping Ukraine. Had we not, Ukraine would have negotiated a settlement. Probably would have given Russia the areas it wanted, which are mainly populated by ethnic Russians anyway. All we—the US gov’t—has done is prolonged the inevitable, spent billions of dollars of US money that could have been better spent in the US (by maybe protecting our own borders), and ended up killing God only knows how many Ukrainians and Russians in the process.

In the end, Russia will win, tens of thousands more will die unnecessarily, billions of US dollars will have been spent propping up a corrupt regime (Ukraine wins no awards for lack of corruption), and we will be humiliated. And that’s the best-case scenario. Worst-case scenario is that we’ll be dragged into a nuclear conflict resulting in WWIII.

So says Col Doug Macgregor.

Well, I have a different take. And it isn’t motivated by politics. It’s motivated by reality. At least reality as I see it. I know we all have different realities, but I have to go with my own.

My view of Russia was altered when I read a piece by Andrew Bacevich years ago titled The Unmaking of a Company Man. Bacevich was a career officer in the US Army when the Berlin Wall fell and the USSR disintegrated. He got his first up close and personal view of the capabilities of the USSR while he was in Germany and wrote about it. His essay, which was the introduction of his book on the subject is well worth the short time it takes to read it. When Bacevich saw the shoddy state of the USSR military, the scales fell from his eyes. He realized that Eisenhower had been right in his speech warning Americans to beware the growing military-industrial complex.

The next step in my Russian education was from a book my long-time accountant gave me a few years ago. The author, a client of my accountant’s, was the only person (to date—and probably ever) to sue Putin and win. And get paid the money due from it. My accountant traveled to Russia to do a forensic audit to find out just how badly his client had been screwed by Putin. His audit was the basis for the author’s recovery.

Welcome to Putingrad, the book that came out of this experience, is an inside look at the corruption going on at all levels of the Russian government. And it all flows downhill. A big portion of the entire military budget goes to graft. The first in line takes a big chunk—which is why all of Putin’s close advisers all have beautiful apartments in Moscow (which are almost impossible to obtain) and immense dachas out of town.

What’s left after their share passes down to the next level, at which point another chunk is taken out for a lesser Moscow apartment and smaller dacha. And so it goes down the line with each more minor administrator taking his little bit until what’s left actually goes into the purchase and/or development of military equipment and training.

Within the last year or so, I read a long article by Mark Hertling, who was the Commanding General of U.S. Army Europe and Seventh Army and in the command of all U.S. Army forces stationed in various countries throughout Europe. I’m assuming he is at least as qualified as Doug Macgregor to comment on the situation. He had multiple occasions to visit his Russian counterparts during his years in command. He found the Russian soldiers to be ill-trained and their equipment to be shoddy. But he found just the opposite with the Ukrainians. Their military leaders had turned their formerly rag-tag military into a crack fighting force.

These three sources gave me a pretty good picture of the Russian military. Combined with my knowledge that the vast country of Russia with ~140M people had an economy smaller than that of Italy, population ~ 60M, I was even more convinced of the inadequacy of the Russian army.

(As an aside, speaking of the Italians… Mussolini thought of his reign as the Third Rome (much like the Third Reich), which led Hitler to comment “Mussolini might be a Roman, but his people are Italians.” Which I’ve always found to be hilarious. And I love the Italians more than any other Europeans. But they are Italians. It’s almost incomprehensible that their economy is larger than Russia’s.)

Getting back to the Russian military…

When I read about the 40-mile-long caravan of Russian military vehicles that entered Ukraine early on and ran out of gas four days in, it confirmed what I had read. And then when all the accompanying military in these stalled vehicles ran out of food a few days later and ended up walking back to Belarus, it really hammered it home.

Now they’re refitting ancient tanks to take into battle. Tanks that have some serious issues with ammo storage.

The Russians have a supposedly vast armory of nuclear weapons. Do they? Are they in working order? If they were to fire one off, would it a) hit its target? Or b) detonate when it did?

I believe my pony tail guy has a better grasp of what’s happening than a lot of the former military folks do who hit the conservative talk show circuits. Here is a recent video of him making a long presentation to a group in Ames, Iowa about a month ago. I’ve got it teed up to where he starts talking about the war. It is well worth watching. He talks about a lot more than the war later on, but the first 15 minutes or so is about the war.

Peter Zeihan is a funny guy. The folks in Ames, Iowa seem either not able to understand his humor or have no sense of humor. I haven’t spent a lot of time in Iowa, so I can’t really tell which.

I finally finished his book night before last. It is phenomenal. It is the best book I’ve read in ages, and it has my full-throated recommendation. His basic hypothesis is that the pax Americana, which has been in effect since the end of WWII, is coming to a close. If true, then what he says will happen when the dominos start to fall is pretty dreadful. Not so much for those of us in the US, but for most everyone else except for a few lucky countries.

Zeihan says that from here on out, most of our wars will be proxy wars just like the one we’re involved in now in Ukraine. The US will provide money, equipment, and intelligence. Everything but American boots on the ground. Since WWII, we’ve been directly involved, i.e., soldiers and casualties, in Korea, Viet Nam, Iraq (twice), and Afghanistan. Maybe a few others I might be forgetting. The only real proxy war we fought was against the USSR in Afghanistan back in the 1980s. In that war, we funded the Mujahideen, one of whom was Osama Bin Laden. The USSR ended up basically running out of money and retreating. Although their withdrawal was humiliating for them, it was accomplished in a tightly controlled and efficient manner by Col-Gen Boris Gromov. Unlike our totally humiliating throw-down-your-guns-and-run withdrawal in which we left tens of billions of dollars worth of equipment, the USSR managed to get all theirs out.

That proxy war worked for us. It probably ended up putting paid to the USSR a decade or so later.

This proxy war I’m not so sure about. Russia is corrupt to the bone. But Ukraine isn’t far behind. I’m not sure that it is in the US’s best interest to engage in battle there. I’ve wondered from the start if the whole thing can be laid at the feet of the mask mandater, vaccine mandater, pussy hat wearing, lockdown crowd, all of whom are Donald Trump loathers to their very cores. Since he allegedly beat Hillary Clinton with help from Putin, the so-called Russian hoax, maybe their hatred for Russia and Putin have driven them to this. They are the ones running the administration that jumped head first into this proxy war.

I am pretty sure had Trump still been president this war would not have happened. But without an alternative universe, we’ll never know. I have no idea how it will turn out, but my bet is that Ukraine will over perform while Russia will underperform. Especially if we keep throwing money at the former.

The Cochrane Report on Masks

For those who don’t know, the Cochrane Collaboration is named after Archie Cochrane, a British epidemiologist who beat the drum loudly for evidence-based medical thinking. Not just doing what had been done forever, but doing what the best medical evidence available recommends. The Cochrane Collaboration is a prestigious and highly respected international medical research organization founded in 1993 to conduct systematic reviews of all the pertinent medical literature and extract the best recommendations based on the most current research on any given disease or intervention.

Since the Cochrane Collaboration is free from pharmaceutical or other industry funding, and since it involves the collaboration of many, many experts on a given subject, its results are considered the gold standard of current evidence.

The only real blemish on the record of the Cochrane Collaboration was when an internal dispute ended up with the group basically kicking out one of the founding members, Dr. Peter Gøtzsche. Dr. Gøtzsche is a Danish physician, who accused members of Cochrane of basically selling out where psychotropic drugs are concerned. Many of you have probably heard of Dr. Gøtzsche due to his many books, the most famous of which is Deadly Medicines and Organized Crime.

I know Dr. Gøtzsche. I have heard him speak numerous times, and have spent time with him. He’s an irascible guy, so I can see how he would get under the skin of anyone who disagreed with him. I suspect the folks at Cochrane were glad to see the back of him and vice versa.

The medical profession—at least those who keep up—pretty much relies on the findings of the Cochrane Collaboration to define what is the current best evidence for treatment. That doesn’t mean it will be the very best treatment, just that it’s deemed the best based on the currently available studies.

Having provided all this prologue, I’m happy to report that the Cochrane Collaboration has released its latest report advising that masking with medical/ surgical masks provides no protection against Covid, influenza, or other aerosol viral diseases.

We included 12 trials (10 cluster‐RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks… 9 trials, 276,917 participants; moderate‐certainty evidence.

Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks… trials, 13,919 participants; moderate‐certainty evidence.

Harms were rarely measured and poorly reported (very low‐certainty evidence).

I’ve removed all the statistical numbers and separated the sentences for easier reading. You can see the original here.

I know, I know, you’re saying to yourselves, yea, but what about N95 masks. Those do work.

Well, not so fast. Here’s what the folks at Cochrane discovered about those:

We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness… 3 trials, 7779 participants; very low‐certainty evidence.

N95/P2 respirators compared with medical/surgical masks may be effective for ILI… 8407 participants; low‐certainty evidence. Evidence is limited by imprecision and heterogeneity for these subjective outcomes.

The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection…; 5 trials, 8407 participants; (moderate‐certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings.

Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low‐certainty evidence). 

One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non‐inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID‐19 patients.

Again, I removed the statistical figures and separated some of the sentences for easier reading. All the numbers are in the original.

The authors of this report summarize as follows:

The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.

It’s hard to be clearer than that. “No clear reduction…” and “no clear differences…” are pretty firm statements that masks don’t work. Especially coming from Cochrane.

I wonder how the we’re-all-going-to-die-if-we-don’t-wear-masks brigade is going to respond to this?

PP 2.0 Response

Thanks very much to all of you who emailed me about what you would like to see in Protein Power 2.0. The information has been extremely helpful.

For those of you who are new subscribers, please email me at mreades@proteinpower.com telling me what you would like to see in our new book. Please put PP 2.0 in the subject line, so I can easily find them among the tons of emails I get every day.

Some of the issues people have brought up, I’ll deal with in this newsletter. In fact, I’ve got one today about protein that I’ll go over.

Protein and Amino Acids

A reader posted the comment below to last week’s Arrow:

I have been taking amino acid supplements for a couple of years now. Perfect amino and optimal amino are the two brands I’ve used. Both are what they call MAP formulas (master amino profile), optimal ratios for utilization.

Just curious if you are aware or have an opinion on these?

I’m almost 61 years old and use them in conjunction with my workouts hoping to get optimal protein while keeping my muscle as long as possible....

I do indeed have an opinion on these kinds of amino acid supplements.

Let’s briefly review what proteins and amino acids are.

Amino acids are the molecules that combine to form protein. Two or more amino acids hooked together by peptide bonds are called peptides. A polypeptide is a chain of many amino acids hooked together forming part of (or the whole of) a protein.

Amino acids are the basic building blocks of protein. For years it was said there are 20 amino acids in the human body. Recently there has been talk of maybe two more. But for our purposes, let’s say there are 20. That’s what you’ll find in any textbook you consult.

Like many molecules in the body, some amino acids can be synthesized from other molecules. And some can’t. Those that can’t must be obtained via diet. Those that can’t be synthesized are called essential amino acids. There are 9 of them out of the 20. (Some recent textbooks say there are 10 essential amino acids, out of which 6 are truly essential. The other 4 are essential in that under normal circumstances the body can produce an amount of them, but not enough to meet the body’s needs. These are called conditionally essential amino acids.)

Just to keep it simple, we’ll stick with the 9 essential amino acids out of the total of 20.

We get our food in the form of three macronutrients: fat, protein, and carbohydrate. For the most part, fat and/or carbohydrate provide calories. We use them for energy to fuel our cells. The body can use protein for energy if that’s all it has, i.e., no carbs or fat, but it prefers to use protein to build and repair.

Most of the body’s structure is built on a protein frame. Muscles are primarily protein as are hair, skin, and nails, bones, blood, and organs. All the enzymes that catalyze all the zillions of reactions taking place every second are made of protein. The vitreous and aqueous humors in the eye are protein structures. The liver makes and releases the protein albumen, which circulates in the blood and keeps the fluid inside the blood vessels instead of letting it leak out. I could go on and on, but I’m sure you get the picture. Protein is essential to life.

Fat and carbohydrates are not. When you starve to death, you die of protein malnutrition. Not carb or fat malnutrition. (There are some so-called essential fats, but the requirements for these are so low that virtually no one ever experiences a deficiency.)

So, protein builds and repairs while carbs and/or fat are fuels.

The human body has many redundancies built into it in an effort to keep us ticking along under a multitude of stressful circumstances. Since diets are so varied, almost everything can convert to something else.

Fat can be broken down to release the glycerol, which converts to glucose. Fat can convert to ketones. Some amino acids can even convert to ketones. Carbs can convert to fat. Some amino acids can convert to carbs, and carbs can convert to some amino acids. In fact, your muscle mass is the primary reservoir for glucose. All day long, your body is silently converting all these molecules to meet its specific needs at the moment.

Everything, it seems, is interconvertible. Except for the essential amino acids. Those must come from the diet. You get them from eating protein. High quality protein, which comes basically from foods of animal origin, contains plenty of essential amino acids. Eggs, meat, and dairy products are great sources. Plant foods, not so much. Which is why vegans must mix plants with different amino acid profiles (or supplement) to prevent deficiencies.

Amino acids fall into three different groups: those that can convert only to carbs, those that can convert only to ketones, and those that can do both.

The pure ketogenic amino acids are leucine and lysine. The ones that swing both ways are phenylalanine, isoleucine, tyrosine, threonine, and tryptophan. All the other amino acids are purely glucogenic, i.e., convert to glucose only.

Because the majority of the amino acids (all but two) can convert to glucose, a myth has taken root in the minds of many that eating protein causes blood sugar to go up.

I’ll address that myth in a bit, but first let’s look at the amino acid supplements the commenter above asked about.

Here is the website for the product Perfect Amino.

If you scroll through, you’ll come upon a section titled WHAT’S THE DIFFERENCE IN PROTEIN SOURCES? all in caps, so you’ll be sure not to miss it. In that section, the graphic below appears:

Notice that the chart is divided horizontally into ANABOLIC (building) and CATABOLIC (breaking down). It purports to show which protein-containing foods fall into either the anabolic or catabolic sections. In other words, which foods will make you build muscle and which foods convert to sugars (or fats).

Now, take a look at the far right part of the chart that says BCAAs.

BCAAs are branched-chain amino acids, a description based on their particular structure. There are three of them, all essential amino acids: leucine, isoleucine, and valine. BCAAs are considered anabolic amino acids. Body builders add them to all their food and shakes.

This chart, however, shows them as being converted to sugar. Yet Leucine is a purely ketogenic amino acid; isoleucine can convert to both glucose or ketones; and valine can convert only to glucose. So, two out of the three BCAAs can convert to glucose if needed. What I find strange is that if you look at the ingredients making up the Perfect Amino Acid supplement, you find that the first three ingredients are Leucine, isoleucine, and valine. The three BCAAs the graph above implies will turn to sugar.

The other strange thing you might notice about a “perfect” amino acid supplement is that it contains only 8 of the 9 essential amino acids. Histidine is MIA. So, it’s not really “perfect.”

Just as a comparison, let’s look at the amounts of these amino acids you would get in 3.5 ounces of steak. (I happened to have the nutritional breakdown of steak up on a tab, and the portion size is 100 g, which is 3.5 ounces. Also, ground beef or other less expensive cuts would have roughly the same nutritional value.)

• Leucine 2.54 g

• Valine 1.46

• Isoleucine 1.38

• Lycene 2.84

• Phenylalanine 1.18

• Threonine 1.39

• Methionine 0.78

• Tryptophan .33

Which all add up to 11.9 grams of these amino acids. The total weight of a full dose of the Perfect Amino Acid Blend as shown on the nutritional label is 5 g. And it doesn’t include the other essential amino acid histidine, of which there is 1.1 grams in the steak. (The lower amounts of methionine and tryptophan shown above are still > 100% of the US RDI. I seriously doubt there are greater amounts in the Perfect Amino Acid supplement.)

The 3.5 ounces of steak contains 27.9 gm of protein (which includes the essential amino acids listed above along with histidine). You can buy 3.5 ounces of red meat (which will have roughly the same amounts of the various amino acids) for not a lot of money. It costs $43.95 per month to purchase the supplements. You get 5g per day times 30 days, which totals to 150 grams of a not complete protein. You would get the same amount of complete protein with 3.5 ounces of red meat per day for five days. Or a little over a pound. Right now ground beef runs $5.19 per pound (the national average price for ground beef).

Maybe it’s just me, but I would put the $43.95 each month toward meat, dairy, and eggs instead of an incomplete essential amino acid supplement.

Okay, let’s look at protein and blood sugar.

As I wrote above, somehow this myth has taken hold that if you eat protein it will run your blood sugar up. It’s what I call a vampire myth. No matter how many times it gets a stake rammed through its heart, it continues to live on.

Like all such myths, there is a bit of truth to it, which is doubtless what keeps it alive.

Gluconeogenesis is the process whereby the liver converts protein to glucose. Gluconeogenesis is regulated by insulin and glucagon. Insulin shuts it down; glucagon drives it. Since type 1 diabetics produce no (or insufficient) insulin, they are unable to shut off the liver, which is being driven by glucagon to make sugar. In those subjects, protein will convert to glucose. But not in people who are not type 1 diabetics.

When I first started treating patients with low-carb, high-fat diets (which also typically involve more protein), I heard people say too much protein will convert to glucose. Metabolically it didn’t make sense to me, but it did make me wonder.

As it happened, I serendipitously stumbled onto a paper that made me realize it didn’t work that way in non-type 1 diabetic people. Back then I had to schlep to the medical library to pull papers, and it was a tedious task. I would write all the citations for the papers I wanted on blank business card stock. I would then arrange these alphabetically as that was how the journal stacks were arranged in the medical library. I would then grab a cart and start down the aisles pulling first one bound journal then the next. (Most medical/scientific journals were bound in annual volumes about the size of a volume of the Encyclopedia Britannica.) I would stack them on the push cart as I went, then take them to the copy room. It cost me a dime a page to make copies.

Now I can just go online, go to the journal site, pull up the article I want in pdf and Bob’s your uncle. No schlepping to the library, no ten cents per copy, no getting pissed because someone else had checked out the journal I wanted.

But the disadvantage is that now I seldom stumble on terrific articles I otherwise wouldn’t have found. Back then, when I pulled one of the annual volumes of, say, The Lancet off the shelves, I had to flip through it to find the specific article I was looking for. While flipping, I would invariably come across another article of interest that I had no idea existed. That doesn’t happen now. More’s the pity.

I would come across so many of these articles that I had to be selective of which ones I took, or my printing bill would start to compete with our mortgage in price. I’m still pissed about one I decided not to print. It was in an old journal—I can’t now remember which—and was an observational study a dentist did in northern Canada. He plotted the amount of tooth decay in his Inuit patients as a function of how far they lived from a trading post. Those who lived further way, had less decay. I thought at the time that that made perfect sense, because the trading post was where the carbs were in northern Canada. The paper didn’t tell me anything I didn’t already know, so I didn’t print it. I’ve kicked my own butt ever since, because it would really make a great presentation slide. But, alas, I was never able to find it again.

Anyway, while I was looking for some article in an ancient journal, I came across a great article from 1936 titled The Glycemic Response to Isoglucogenic Quantities of Protein and Carbohydrates. To say the least, it was an amazing paper.

This study was done not all that long after insulin had entered the scene. But docs still didn’t know there was a difference between type 1 and type 2 diabetic subjects. They didn’t know they were two separate diseases. Instead they thought diabetes was a single disease and whether or not the patients had to go on insulin was just a measure of severity of the disease.

Because they had seen protein drive sugar up in type one diabetics, they thought somehow protein converted into sugar at a high rate. Here is what they wrote:

It is a fact that during the metabolism of protein there occurs a yield of glucose which approximates 50 per cent of the weight of the ingested protein. Janney working with isolated proteins found that the glucose liberated varied from 48 per cent to 80 percent. It is reasonable to state that 50 percent represents a good average figure in calculating diets in which the total intake of protein is made up of a mixture of many single proteins.

I love the confidence with which they assert “It is a fact that during metabolism of protein there occurs a yield of glucose…” It is not a fact. Not at all.

Despite their being in possession of this “fact,” they decided to put it to the test.

They recruited 15 diabetic patients (all of them what we would diagnose now as type 2 diabetics) and “three normal fourth year medical students” for the study. All the subjects in the study—both diabetics and “normal” medical students—were to consume 2g per kg body weight in the form of beef at breakfast after an overnight fast. A few days later, they were to all consume a breakfast containing 1 g per kg body weight of carbohydrate.

Since in the researchers minds it was a fact that half the protein would be converted to carbs, they figured the blood sugar curves would be the same for both breakfasts.

As they wrote:

It is assumed that protein yields, during metabolism, glucose equal to 50 per cent of its weight.

They were in for a big, big surprise.

Here is what they found with one of their medical students.

You can see how his blood sugar went up quickly when he ate the carbs, whereas when he ate one and a third pounds of beef, his blood sugar stayed flat.

The researchers couldn’t understand this, so they looked at his blood urea nitrogen, which they thought represented his protein being converted to glucose. It did indeed show a rise, but this wasn’t glucose driven. It was a function of the nitrogen in the protein. The test still is within the normal range. A BUN on a high-protein diet ranges from 10-20 mg/dl.

Here is one of the diabetic subjects. Blood sugar skyrockets after various carb doses, but stays steady as a rock after slightly more than a pound of lean beef.

So, even in type 2 diabetics, protein consumption doesn’t appear to run blood sugar up.

Below in yet another diabetic subject, blood sugar screams upward after carb intake, but no real change after eating well over a pound of lean beef.

Below is a tabulation of various parameters in most of the diabetic subjects on the two diets. I don’t know why they didn’t include them all, but they didn’t.

If you look at the data I surrounded with the red box, you can see that only one diabetic subject had a slight bit of sugar in the urine after consuming meat. The rest lost no sugar in their urine. All had major sugar spilling after the carb consumption.

The green box shows blood sugar. It went up minimally in those eating meat and by a huge amount when they ate carbs.

The blue rectangle shows the amounts of all the foods the subjects consumed. You can see the huge amounts of meat each subject ate with very little affect on blood sugar.

This obviously is an ancient study. What might we find if we used newer techniques? There is a much newer study that does just that. But before we get to it… I just noticed the above study was published in the Journal of Clinical Investigation. That journal has been one of the best about digitalizing their older studies, but I didn’t figure they went back to the 1930s. But when I looked it up, I found that they go way back. And they had this one available. Here it is if you want to read the entire thing.

In 2013 a group of researchers from France came up with what I would consider the definitive study of the protein to glucose question.

One of the techniques available today to study these kinds of issues is by using a procedure called isotopic labeling. Isotopes, which are atoms with differing numbers of neutrons, can be incorporated into different foods. Then the ultimate fate of these foods can be determined by identifying these isotopes in, say, blood, for instance.

In this study, researchers fasted healthy subjects overnight then infused them with labeled glucose. Two hours later, the subjects each ate four eggs that had been doubly labeled with nitrogen and carbon isotopes. The subjects were monitored over the next 8 hours to see where the doubly-labeled egg protein ended up.

The only food the subjects consumed over the 8 hours was the four eggs at the start, so the situation was optimal for protein to glucose conversion. Here is the description of what happened graphically:

Here it is in the researchers words.

After the ingestion of a lipid-protein meal (four eggs), 18% of AAs [amino acids] were deaminated, producing carbon skeletons that were entirely oxidized within 8 h of the meal. EGP [endogenous glucose production, i.e., glucose generated in the liver] did not increase after the meal but remained stable for 6 h and then fell. Of the 50 g glucose produced over the 8-h period, 4 g originated from dietary AAs, indicating that under our experimental conditions, dietary protein-derived AAs contributed to only 8% of EGP.

In non-scientific language this says that 18 percent of the amino acids from the eggs were broken down and burned for energy. So, under fasting conditions, protein will be burned for energy. Because the body needs a constant level of glucose, and none was coming in from the eggs, the liver had to make glucose, which it did. And it made it from glycogen, which is stored glucose. It made about a quarter of a cup (50 grams) over the eight hour period. Because of the isotopic labeling, the researchers were able to determine that of the 50 grams of glucose made in the liver, only ~4 grams (3.8 to be exact) came from protein. And this during a time that would be optimal to find increased production of glucose from protein.

You don’t have to worry about protein converting to glucose. Unless, of course, you have type 1 diabetes. If you don’t, you don’t need to stress over it.

It’s a pull phenomenon, not a push phenomenon.

The protein doesn’t push glucose formation. Even if you don’t have a lot of glucose around—you’ve been fasting—dietary protein won’t push much glucose. Certainly not enough to run your blood sugar high.

If you need it, though, your body will convert protein to glucose. It will pull what it needs for the conversion.

Okay, we’re reaching Tolstoy-ian length here. And I’ve still got a ton to write about. I’ll push it to next week. That is a push phenomenon.

I’ll leave you with a great video.

Video of the Week

Here it is. The Eye of the Pfizer. I’m always incredibly impressed with how creative and talented so many people are.

That’s it for now.

Keep in good cheer, and I’ll see you next week.

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