Hello friends. A Unforced Error I’ve got to start out this week by correcting an error I made in last week’s Arrow. A sharp-eyed reader (from France, of all places) emailed me that she couldn’t correlate what I had written with what was on the chart I showed. And she was correct. As I read what I had written, I had a difficult time figuring out how I even wrote it with the chart staring me in the face.
Sowell is also one of my intellectual heroes. I remember how sad I was when he announced he was no longer going to write his Forbes column because of his age. (When I was younger it didn't occur to me that my heroes would grow old and infirm.) But years later he is still writing books and doing interviews (with Peter Robinson in his Uncommon Knowledge podcasts), his mind still sharp at 93. It gives one hope that we won't all end up like Joe Biden.
I often times struggle to distinguish some of the information in the graphs and end up glossing over them but try to get the gist of what you are explaining. So I appreciate when you summarize the point.
I watched both videos through this time which I don’t always do, I know you can tell how many people are clicking on the links. I did immensely enjoy the Firing Line one as Dr. Sowell holds his own and knows his data to back up his points as this lady seems to want to control the direction of their discussion.
I’m hoping that Dave Feldman is familiar with the intricacies of the CAC score since he’s currently running his Lean Mass Hyper Responder experiment which could help spearhead more studies on the benefits of LDL which as a lot of us know, has been demonized unfairly. I appreciate you breaking all that down and find it fascinating and like the gut, I still think we’re in our infancy of understanding our own biology. I am currently struggling with Oxalates because I was once plant based and overloaded on them, not knowing the damage that they can cause. Being that they bind with minerals and has a specific affinity for calcium, I can’t help but wonder if they also play an important role in cardiovascular issues/disease. It’s all so fascinating and I hope we figure it out before we blow ourselves up or someone releases another, deadlier virus on society. It never used to make sense that plants could hurt us humans but after everything we’ve been thru the last few years and awakening to the propaganda that infects so many aspects of our society, why wouldn’t nutrition advice also be completely back asswards?
As always, great information. Your comments on CAC scoring reminded me of a question I’ve been wanting to ask. What are your thoughts on the thrombogenic theory of heart disease as laid out by Dr Kendrick? I think his argument makes sense but was curious about your take on it. I have established CAD but have been low carb since my CABG at 51. My inflammation markers, A1c, insulin, trigs, magnesium, vitamin D, weight are all in great ranges. My ldl particle count and NMR small are very high. I really don’t worry about LDL after my research. I do have a high Lp(a). I take a high dose fish oil to mitigate its impact.
"these calculations work only if the total calcium score is 130 or higher."
And if the calcium score (Agat.) is zero? Is there any (big) worry about unstable plaques? My original CAC was about 8-9 years ago; scanner-guy was very impressed.
Have gone carnivore (mid-Aug) and am down ~18 pounds. And my bp is down from (avg) 145/75 -- at home -- to (avg) 122/69! I quit the (20mg) lisinopril my VA doc pushes; because -- IN her office AT the VA, when I am FILLED to choking with fury and disgust and contempt -- it tends to be up around 180/95 (sometimes even 200/100) without the liso. (She often offers to send me to the ER, as it's so high. At home, a year ago, WITH the liso: (avg) ~153/73 -- she refuses to accept that, despite providing me with a bp cuff she believes is sound.)
This is the doc who keeps pushing and pushing: covid vaxxx? shingles vax? flu vax? vax vax vax? 2nd-to-last visit, when she again 'offered' the poison-vaxxx, I finally leaned in and said gently but very grimly: "not for love or money ... nor at the POINT. OF. A. GUN." (She hasn't asked since.)
and, p.s., cause I know you'll enjoy the chuckle: excellent "blogger" (more, aggregator with comments) Anonymous Conservative began spelling the covid "vaxxx" with the triple XXX in the hopes that the censoring algos will think he/we are discussing PRON, and let it go through!
Another grand one, Mike - especially so since you admitted screwing up, which always makes everything else that someone says more trustworthy. Keep these posts coming - don't know what else I'd do Friday mornings if it didn't involve this!
Just a few little ones:
vastly more expensive that a standard X-ray setup
more expensive than a standard. .
This clot can they break free
. . can then break free
It did not do that one either of the ketogenic phases
ya... "But it will take a while adhering to the plan to completely normalize, if it ever does". I am working with a few women in the 250-to-280-pound range. Definitely having challenges with them. They drop 30 to 40 pounds and get "stuck". Fasting insulin 16 and up and fasting glucose 115 and up that barely changed. I had a guy years ago at 365 drop 120 pounds in 4 months and got him off of insulin. After him I thought I had everything figured out....
Dear Mike - very interested to read this: “GIP is involved in increasing bone formation and decreasing bone resorption.” and “GIP plays a fairly major role in this.” Although you wrote that dietary fat and protein will still stimulate GIP it doesn’t appear to stimulate it as much as carbs from what I read in last week's Arrow…so can a person on a low carb diet increase GIP sufficiently to help increase their bone density if they have osteoporosis ?
I have to admit that I am not low carb. I’m “lower carb” haha. I struggle sometimes questioning how I can agree with you on many issues but not jump in wholeheartedly on that. But I’ve been a Weston Price follower for years. I think this error you explained from last week is helpful. I’ve always used lots of butter with carbs when I have them. After reading last week I thought I was completely wrong. But maybe now I’m thinking I wasn’t? Admittedly much of the tech talk/graphs goes over my head. In any case I appreciate the time you put into each issue and the book recommendations. You’re the only newsletter I pay for 😊 I have a paperback copy of your book but the font is too small 😄 I should get it on kindle. When the new one comes out.
Yikes. As I contemplate this comment and its structure, it makes me think I need my own Substack. As a new subscriber with time awake in the wee hours, I’ve been catching up and running across, in scanning, the CGM discussion in The Arrow # 149. It captured my interest immediately. What follows is a long, discursive background that will lead to a question, which will be preceded by an all-caps QUESTION, if this all gets the good doctor’s attention given the age of the post.
I’ve been a biohacker on and off for decades…. Think Polar Heart Rate Monitors and bicycling experiments on heart rate, VO2 Max, low carb vs. high carb performance, max heart rate, etc. circa 1993… For Christmas, my wife (The Enabler), got me a prescription for a CGM because I was fascinated. That’s been my current playground since Christmas.
To give the background, I consider myself well up the learning curve on the difference between CICO and CIM in terms of understanding that the CGM, for my purposes, is a tool to minimize the area under the insulin curve. That means I also understand that the measure of serum glucose is, for my purposes, a surrogate measure of the metric in which I’m interested; insulin. (In fact, I’m in a ‘double surrogate’ measurement. Interstitial fluid being the second order surrogate.) That basis of understanding has guided the interpretations of the experiments and observations I’ve undertaken.
The whole GIP discussion has spoked my wheel!
In particular, I woke one day feeling puny. Stomach upset. Headache. Probably picked up something from one of my employees. (That’s the thing about getting older. I used to have to drink to feel that way in the morning.) The plan was some fluids and acetaminophen. Sit quietly and get on with it…. Not so much. Next plan: maybe some saltine crackers and diet ginger ale. I am generally keto, although not low carb enough to keep my weight where I prefer. I can easily gain weight on 30 grams per day. I had to go get some saltines since we generally don’t have such things in the house. I read the label and decided on eight (8) saltines since that was about the 20 grams of carbs I’m currently targeting as an _absolute_ max for the day. The CGM showed my blood glucose going to 152 mg/dl over the next 30 minutes from a baseline on ingestion of 95 mg/dl. I suspect the 50+ point excursion is a function of my body seeing 20 grams of pure carbs all at once for the first time in months.
Now it’s time to experiment. After a couple of hours, I’m back at baseline. The test: maybe fat will attenuate the glucose response. Eight more crackers with 25 grams of butter. That makes each cracker about 50/50 for fat and carbs. This resulted in a much smoother curve with about ½ of the peak excursion from baseline (125 mg/dl). Bob’s your uncle! Eat carbs with fat to smooth the curve…. I’d lost the bubble. The object of the exercise is insulin response, which, from the GIP discussion, probably means I was NOT minimizing my area under the insulin curve. I was probably exacerbating the problem.
Final bit of background before the actual discussion questions.
Having been low card/keto/ketovore/carnivore, etc. for a long time, I have been red-pilled about nutrition for a LONG time. COVID added to my dislike and distrust of experts. That addition was on top of decades of reading Thomas Sowell. (I used to LOVE Firing Line as a kid.) Working for the Federals, as Judge Leander Perez would label them, in the nuclear weapons complex didn’t improve my esteem or trust for the government/expert class. When the elites in health, economics, academia, etc., etc. offer direction or opinion as to what us poor chickens should be allowed, I put my hand on my wallet. My latest shock in that long line of opinions regarding what I am capable of understanding or managing for myself was found in Gary Taubes’ excellent _Rethinking Diabetes_. In it, I learned that diabetologists were against patients having the ability to measure blood sugar quickly and accurately with a glucometer. What?
Now the discussion is that CGM’s for non-diabetics may be a mistake. Too much information. Too much understanding needed. Confusion possible. Added stress. To all of that I said horse hockey! I popped on a CGM and after long and in-depth reading/study on the Carbohydrate Insulin Model over the years, proceeded to lack a critical piece of knowledge to correctly interpret what I was seeing and how well I was performing against my clear goal to minimize insulin.
QUESTIONS: Given the complexity of the model and the understanding necessary, are CGM’s for the general populace a bad idea? How much knowledge is needed by end users to effectively use the tool?
Ben Bikman’s observation that you can’t unsee what your blood sugar does after eating certain foods is absolutely true. (I am still stunned by a 57 point increase over 8 freaking saltine crackers.) Does that information overcome the strong possibility of end users ‘gaming’ the curve with fat+carbs and creating an even larger bolus of insulin? Is my goal of area under the curve simply a second order model that isn’t germane to getting the gen pop in line with ‘Don’t drive your blood sugar to 250 with a meal and it should be back to baseline in 3 hours! Also, look for smooth curves, not spikes!”?
Re: CAC Testing-Neither the hospital nor our cardiologist was interested in providing the information required to do the calculation. We have the Agatson number but they will not provide the slice thickness or the total number. They claim it’s not material due to the high score obtained in the test.
In regard to high insulin levels after eating ice cream or gaming CGMs:
How do you think about the differences in insulin peaks from eating ice cream, for example, compared to high protein meals like a steak? My understanding is that protein is pretty insulinogenic as well.
Sowell is also one of my intellectual heroes. I remember how sad I was when he announced he was no longer going to write his Forbes column because of his age. (When I was younger it didn't occur to me that my heroes would grow old and infirm.) But years later he is still writing books and doing interviews (with Peter Robinson in his Uncommon Knowledge podcasts), his mind still sharp at 93. It gives one hope that we won't all end up like Joe Biden.
I often times struggle to distinguish some of the information in the graphs and end up glossing over them but try to get the gist of what you are explaining. So I appreciate when you summarize the point.
I watched both videos through this time which I don’t always do, I know you can tell how many people are clicking on the links. I did immensely enjoy the Firing Line one as Dr. Sowell holds his own and knows his data to back up his points as this lady seems to want to control the direction of their discussion.
I’m hoping that Dave Feldman is familiar with the intricacies of the CAC score since he’s currently running his Lean Mass Hyper Responder experiment which could help spearhead more studies on the benefits of LDL which as a lot of us know, has been demonized unfairly. I appreciate you breaking all that down and find it fascinating and like the gut, I still think we’re in our infancy of understanding our own biology. I am currently struggling with Oxalates because I was once plant based and overloaded on them, not knowing the damage that they can cause. Being that they bind with minerals and has a specific affinity for calcium, I can’t help but wonder if they also play an important role in cardiovascular issues/disease. It’s all so fascinating and I hope we figure it out before we blow ourselves up or someone releases another, deadlier virus on society. It never used to make sense that plants could hurt us humans but after everything we’ve been thru the last few years and awakening to the propaganda that infects so many aspects of our society, why wouldn’t nutrition advice also be completely back asswards?
Thanks for another excellent Arrow, but here is my yet-again nag: how is PP2 coming?
As always, great information. Your comments on CAC scoring reminded me of a question I’ve been wanting to ask. What are your thoughts on the thrombogenic theory of heart disease as laid out by Dr Kendrick? I think his argument makes sense but was curious about your take on it. I have established CAD but have been low carb since my CABG at 51. My inflammation markers, A1c, insulin, trigs, magnesium, vitamin D, weight are all in great ranges. My ldl particle count and NMR small are very high. I really don’t worry about LDL after my research. I do have a high Lp(a). I take a high dose fish oil to mitigate its impact.
"these calculations work only if the total calcium score is 130 or higher."
And if the calcium score (Agat.) is zero? Is there any (big) worry about unstable plaques? My original CAC was about 8-9 years ago; scanner-guy was very impressed.
Have gone carnivore (mid-Aug) and am down ~18 pounds. And my bp is down from (avg) 145/75 -- at home -- to (avg) 122/69! I quit the (20mg) lisinopril my VA doc pushes; because -- IN her office AT the VA, when I am FILLED to choking with fury and disgust and contempt -- it tends to be up around 180/95 (sometimes even 200/100) without the liso. (She often offers to send me to the ER, as it's so high. At home, a year ago, WITH the liso: (avg) ~153/73 -- she refuses to accept that, despite providing me with a bp cuff she believes is sound.)
This is the doc who keeps pushing and pushing: covid vaxxx? shingles vax? flu vax? vax vax vax? 2nd-to-last visit, when she again 'offered' the poison-vaxxx, I finally leaned in and said gently but very grimly: "not for love or money ... nor at the POINT. OF. A. GUN." (She hasn't asked since.)
and, p.s., cause I know you'll enjoy the chuckle: excellent "blogger" (more, aggregator with comments) Anonymous Conservative began spelling the covid "vaxxx" with the triple XXX in the hopes that the censoring algos will think he/we are discussing PRON, and let it go through!
Terrific information this week. Thomas Sowell is a national treasure.
Regarding a CAC scan, what adjustment to the risk calculation can be made if the slice size is 2mm and not 2.5 or 3?
the mouse on the left if very sick.
the mouse . . . is very sick
Another grand one, Mike - especially so since you admitted screwing up, which always makes everything else that someone says more trustworthy. Keep these posts coming - don't know what else I'd do Friday mornings if it didn't involve this!
Just a few little ones:
vastly more expensive that a standard X-ray setup
more expensive than a standard. .
This clot can they break free
. . can then break free
It did not do that one either of the ketogenic phases
.. . . do that on either of the
ya... "But it will take a while adhering to the plan to completely normalize, if it ever does". I am working with a few women in the 250-to-280-pound range. Definitely having challenges with them. They drop 30 to 40 pounds and get "stuck". Fasting insulin 16 and up and fasting glucose 115 and up that barely changed. I had a guy years ago at 365 drop 120 pounds in 4 months and got him off of insulin. After him I thought I had everything figured out....
Dear Mike - very interested to read this: “GIP is involved in increasing bone formation and decreasing bone resorption.” and “GIP plays a fairly major role in this.” Although you wrote that dietary fat and protein will still stimulate GIP it doesn’t appear to stimulate it as much as carbs from what I read in last week's Arrow…so can a person on a low carb diet increase GIP sufficiently to help increase their bone density if they have osteoporosis ?
I have to admit that I am not low carb. I’m “lower carb” haha. I struggle sometimes questioning how I can agree with you on many issues but not jump in wholeheartedly on that. But I’ve been a Weston Price follower for years. I think this error you explained from last week is helpful. I’ve always used lots of butter with carbs when I have them. After reading last week I thought I was completely wrong. But maybe now I’m thinking I wasn’t? Admittedly much of the tech talk/graphs goes over my head. In any case I appreciate the time you put into each issue and the book recommendations. You’re the only newsletter I pay for 😊 I have a paperback copy of your book but the font is too small 😄 I should get it on kindle. When the new one comes out.
Yikes. As I contemplate this comment and its structure, it makes me think I need my own Substack. As a new subscriber with time awake in the wee hours, I’ve been catching up and running across, in scanning, the CGM discussion in The Arrow # 149. It captured my interest immediately. What follows is a long, discursive background that will lead to a question, which will be preceded by an all-caps QUESTION, if this all gets the good doctor’s attention given the age of the post.
I’ve been a biohacker on and off for decades…. Think Polar Heart Rate Monitors and bicycling experiments on heart rate, VO2 Max, low carb vs. high carb performance, max heart rate, etc. circa 1993… For Christmas, my wife (The Enabler), got me a prescription for a CGM because I was fascinated. That’s been my current playground since Christmas.
To give the background, I consider myself well up the learning curve on the difference between CICO and CIM in terms of understanding that the CGM, for my purposes, is a tool to minimize the area under the insulin curve. That means I also understand that the measure of serum glucose is, for my purposes, a surrogate measure of the metric in which I’m interested; insulin. (In fact, I’m in a ‘double surrogate’ measurement. Interstitial fluid being the second order surrogate.) That basis of understanding has guided the interpretations of the experiments and observations I’ve undertaken.
The whole GIP discussion has spoked my wheel!
In particular, I woke one day feeling puny. Stomach upset. Headache. Probably picked up something from one of my employees. (That’s the thing about getting older. I used to have to drink to feel that way in the morning.) The plan was some fluids and acetaminophen. Sit quietly and get on with it…. Not so much. Next plan: maybe some saltine crackers and diet ginger ale. I am generally keto, although not low carb enough to keep my weight where I prefer. I can easily gain weight on 30 grams per day. I had to go get some saltines since we generally don’t have such things in the house. I read the label and decided on eight (8) saltines since that was about the 20 grams of carbs I’m currently targeting as an _absolute_ max for the day. The CGM showed my blood glucose going to 152 mg/dl over the next 30 minutes from a baseline on ingestion of 95 mg/dl. I suspect the 50+ point excursion is a function of my body seeing 20 grams of pure carbs all at once for the first time in months.
Now it’s time to experiment. After a couple of hours, I’m back at baseline. The test: maybe fat will attenuate the glucose response. Eight more crackers with 25 grams of butter. That makes each cracker about 50/50 for fat and carbs. This resulted in a much smoother curve with about ½ of the peak excursion from baseline (125 mg/dl). Bob’s your uncle! Eat carbs with fat to smooth the curve…. I’d lost the bubble. The object of the exercise is insulin response, which, from the GIP discussion, probably means I was NOT minimizing my area under the insulin curve. I was probably exacerbating the problem.
Final bit of background before the actual discussion questions.
Having been low card/keto/ketovore/carnivore, etc. for a long time, I have been red-pilled about nutrition for a LONG time. COVID added to my dislike and distrust of experts. That addition was on top of decades of reading Thomas Sowell. (I used to LOVE Firing Line as a kid.) Working for the Federals, as Judge Leander Perez would label them, in the nuclear weapons complex didn’t improve my esteem or trust for the government/expert class. When the elites in health, economics, academia, etc., etc. offer direction or opinion as to what us poor chickens should be allowed, I put my hand on my wallet. My latest shock in that long line of opinions regarding what I am capable of understanding or managing for myself was found in Gary Taubes’ excellent _Rethinking Diabetes_. In it, I learned that diabetologists were against patients having the ability to measure blood sugar quickly and accurately with a glucometer. What?
Now the discussion is that CGM’s for non-diabetics may be a mistake. Too much information. Too much understanding needed. Confusion possible. Added stress. To all of that I said horse hockey! I popped on a CGM and after long and in-depth reading/study on the Carbohydrate Insulin Model over the years, proceeded to lack a critical piece of knowledge to correctly interpret what I was seeing and how well I was performing against my clear goal to minimize insulin.
QUESTIONS: Given the complexity of the model and the understanding necessary, are CGM’s for the general populace a bad idea? How much knowledge is needed by end users to effectively use the tool?
Ben Bikman’s observation that you can’t unsee what your blood sugar does after eating certain foods is absolutely true. (I am still stunned by a 57 point increase over 8 freaking saltine crackers.) Does that information overcome the strong possibility of end users ‘gaming’ the curve with fat+carbs and creating an even larger bolus of insulin? Is my goal of area under the curve simply a second order model that isn’t germane to getting the gen pop in line with ‘Don’t drive your blood sugar to 250 with a meal and it should be back to baseline in 3 hours! Also, look for smooth curves, not spikes!”?
Re: CAC Testing-Neither the hospital nor our cardiologist was interested in providing the information required to do the calculation. We have the Agatson number but they will not provide the slice thickness or the total number. They claim it’s not material due to the high score obtained in the test.
I hope others have more cooperative providers.
In regard to high insulin levels after eating ice cream or gaming CGMs:
How do you think about the differences in insulin peaks from eating ice cream, for example, compared to high protein meals like a steak? My understanding is that protein is pretty insulinogenic as well.
I said magnificent but it would have been helpful if you had provided as much clarity on GLP-1 function and purpose as and you did on GIP.