Search This Blog

Wednesday 1 December 2021

My review of selenium, probiotics and vitamin D for COVID-19, meat for mental health, and LCHF for diabetes reversal in MSM

Greetings readers!

Every so often I am asked to review new or best-selling books related to diet for Newsroom and am encouraged by the Reading Room editor Steve Braunias, a very fine writer indeed, not to hold back.

Here's my "review" of two books on vegetables, which is mostly on the role of selenium, probiotics, and vitamin D in the Covid pandemic, as well as the value of meat in the preservation of mental health, and the promise of LCHF, keto and fasting diets for type 2 diabetes remission.

The more clicks and readers it gets, the more chance I'll have of presenting these types of ideas in mainstream media forums in future.

Monday 22 November 2021

The Mother of all Conspiracies; Oswald and JFK in the 21st Century.


Imagine a counterfactual America, an alternative history wherein it has always been a well-known and accepted fact that Lee Harvey Oswald, a lone-wolf Marxist, had assassinated the President of the United States for rational Marxist reasons as well as subterranean personal ones. In this America, a school shooting by a paranoid vegan only encourages logical and evidence-based discussion of gun control and mental illness, a terror attack by Islamist hijackers is unanimously attributed to its obvious perpetrators, the Moon is American, and one cannot simply say that one has won an election which one has lost. It is an America in which Dr Fauci can sleep easy, and in which, sometimes, a virus is only a virus.
There were conspiracy theorists before JFK of course, indeed Oswald had tried to kill one of them, General Edwin Walker, the only human target he missed putting one or more bullets into. Yet the creative JFK theories have had a wider appeal across American society than the paranoic blend of European antisemitism and John Birch anti-communism indulged in by Walker and his contemporaries. Robert Kennedy, as Attorney General, tried to have Walker committed after he incited the Mississippi University race riots in 1962, but libertarian psychiatrist Thomas Szasz, opposed to the coercive psychiatry that was, to be fair, something of a public menace at the time, talked him out of it. Most people knew Walker was nuts. But with JFK theory you can stay respectable enough, it’s a hobby that seems to hurt no-one. You can put your own choice of villain in the frame – the CIA, the FBI, the Mafia, LBJ, the military-industrial complex, and of course the Cubans or the KGB, though it’s strange that the Manchurian Candidate option presented in film before the assassination – because it seemed believable at the time – hasn’t survived in the modern myth, which is comprised of scenarios entirely discordant with Oswald’s personal beliefs.

We know what Oswald’s political beliefs were because he wrote them down, and expressed them relatively freely to those around him, and we know how he wanted to express those beliefs because we have a reliable witness to his development as an assassin, Marina Oswald, née Prusakova, whom he married in Minsk during his defection to the USSR. A year after Lee’s death, Marina spent several months with Priscilla MacMillan, author of Khrushchev and the Arts; the Politics of Soviet Culture 1962-1964. (MacMillan, a friend of Kennedy’s, had also interviewed Lee Oswald during his defection to the USSR, at which time he told her “I want to give the people of the United States something to think about” - she was the only person to know both the assassin and his victim). The book that resulted, Marina and Lee, did not appear till 1977.
Marina Prusakova, who was not told her father’s identity but came to assume he had died in a purge, and who was rejected by her mother and step-father, was raised for a time by her devout grandmother in an Old Regime style. She had sensibly decided, from her observations of Soviet life growing up, that politics was a sickness and that anyone interested in politics was sick, but she made a fateful exception for the young American who was interested in her. Marina may not have been “political” but she knew a thing or two, as this statement to a Warren Commission interviewer shows:

I look at America. It’s all wonderful. But you go to the damn grocery store and it’s 200 varieties of cereal and basically it’s only oats, corn – how many things? Just so someone can make an extra million off of that. It’s just so unnecessary. If that’s progress, if that’s abundance, how stupid is it of us to want it? Three hundred bags of poison, maybe only two or three good – that kind of progress…I don’t think we should strive for.

Lee Harvey Oswald’s solitary Marxism was the ideology that allowed an intelligent young man to compensate for the loss of his father and an upbringing by one of history’s more blameable mothers. It provided him with inspiration for grandiose fantasies and daring acts, as well as a feeling of intellectual importance that compensated for learning difficulties, diagnosed posthumously as dyslexia. Oswald had become seriously interested in politics at the age of 15 or 16 after he was handed a leaflet about Julius and Ethel Rosenberg, who had been executed some two years earlier for spying for the Soviet Union, on a street corner in the Bronx (the effect this interaction had on him may have influenced his later decision to hand out Fair Play for Cuba pamphlets in New Orleans; it seems to have also triggered a Walter Mitty fantasy life as an espionage hero which lasted the rest of his life). “I was looking for a key to my environment, and then I discovered socialist literature,” Oswald wrote in his diary. “I had to dig for my books in the back of dusty shelves of libraries,” although according to Priscilla McMillan, he came across more as the naïve angry young man than a perceptive Marxist in their 5-hour Moscow interview despite using “a good deal of Marxist language”. The Oswald that stalks the pages of Marina and Lee is also a familiar character to readers of criminal profiling books, a case-study of the violent malcontent male loner. An American outsider who married a Russian outsider, and who was closer to Russian-speaking outsiders than to anyone else outside his family back in the USA, Lee Oswald read Orwell and Dostoyevsky, listened to Rimsky-Korsakoff, Chaliapin, Rachmaninov, and Tchaikovsky, and in his more constructive activities was inspired by Marxist newspapers The Worker and The Militant. He is holding copies of both these papers in the famous photographs Marina took of him with his guns, one of which, with a Russian inscription on the back – “hunter of fascists – ha ha ha!” in Marina’s hand, signed by Oswald, was given to their friend George De Mohrenschildt, the edgelord of the Dallas Russian émigré scene who parodies an éminence grise role in their story. The Worker was the paper of the U.S. Communist Party, The Militant of the Trotskyist Socialist Workers Party; Oswald corresponded with both journals, in a futile attempt to establish credibility as a leader of the organized left; the March 11 1963 copy of The Militant he is holding contains a letter headed “News and Views from Dallas”, signed LH, which was the high point of his association with organised socialism in America.

Lee Oswald was a person who would lie or withhold the truth whenever possible, so that he moved in a web of misdirection, but also presumably in a state of tension lest his lies (which include a long list of needless lies on official forms) be found out. He starved himself and Marina, as his mother had starved him, and pinched pennies as she had - what conspiracy asset would have been left as bereft of financial support as the Oswalds were at times, or as dependent on the kindness of strangers, who liked Marina but rarely liked ungrateful and ungracious Lee, and sometimes feared him? He was violent and controlling towards Marina, and beat her often, but became less violent at home after his attempted assassination of General Walker altered their relationship; he was also often cruel to her, as if practicing the heartlessness essential in a great revolutionary leader, and prevented her learning English for his own reasons (so that much of the evidence in the case of Lee Harvey Oswald is the record of conversations held in Russian, remembered by someone who thought in Russian). Yet Lee, who identified as a Marxist, was never a member of the Communist party, and recognised that the USSR was less successful than the USA – his core attitude was a juvenile delinquent’s hostility to any authority he was no longer capable of idealising, and a contempt for almost all other people, but as a strongly self-entitled person of progressive views he granted, in theory, everyone else a share in what he himself felt he deserved. As a social justice warrior, he was capable of admirable performative gestures, such as sitting in the black section of a segregated courtroom when arraigned in New Orleans, without seemingly ever going out of his way to perform any act of kindness for another human being in need.

There is a Jekyll and Hyde character to Lee’s politics, in which his violent acts contradict both his written statements and his progressive activism, resembling an expressionistic caricature of 20th century Marxism. Eleven years after his murder of Joseph P. Kennedy’s son, the Symbionese Liberation Army, collectivist Marxists with better childhoods and higher education than Oswald, embarked on a crime spree which included kidnapping the granddaughter of William Randolph Hearst. Their goals, motivations and grievances were, though filtered through the kaleidoscope of LSD, aligned with Oswald’s. Both Oswald and the SLA were influenced by what Elizabeth Converse, in The War of All Against All, called “the irrational Communist belief in ultimate world victory”. At its most extreme, this belief encouraged the accelerationist heresy - the belief that as Communism was inevitable, historical upheavals within Capitalist societies brought it closer, the worse the better. The accelerationist Marxist thinks like the addict who overdoses because the sooner they reach rock bottom, the sooner they can begin recovery. Thus the Communists of Weimar Germany were taught to welcome the rise of Hitler and call the liberal democrats who opposed him “fascists”, thus Posades welcomed the possibilities of nuclear war and alien invasion, thus the apocryphal Bernie bro voted for Trump. Sigmund Freud gave us the concept of Thanatos. the organism’s compulsive drive toward dissolution back into the world; Oswald’s decisions were often thanatic – his defection to the USSR, which involved cutting his left wrist and attempting to surrender his US citizenship, his assault on the Soviet bureaucracy to get both himself and Marina back to America, the time he shot at Walker, the time he stuck a pistol in his belt and said he was going to “have a look” at Richard Nixon (defused by Marina), the similarly defused planning to hijack an airliner to Cuba, the assassination itself, his refusal to consider that he might become a target afterwards.

On the morning of the 22nd of November 1963, Lee Oswald left $170 for Marina, whom he had, up to that point seldom allowed any cash at all, as well as the wedding ring he never took off, collected his rifle, and went to work at the Elm street branch of the Texas Schoolbook Depository. There, from a window on the East side of the fifth floor, he shot dead U.S. President John F. Kennedy and wounded John Connally, the Governor of Texas; later that day Lee Oswald would kill Patrolman J.D. Tippit with the cut-off Smith and Weston .38 pistol he had mail-ordered long before the rifle, but which had arrived on the same day.
Had Lee Oswald stood trial, his guilt would have been presented as a coherent narrative, and his motivations widely discussed, as he intended. Instead, he was shot dead two days later by Jack Ruby in an act almost as impulsive and last-minute as his own. Ruby’s motives are obscure – even more unstable and violent than Oswald, he was a heavy consumer of phenmetrazine, the new amphetamine also popular with The Beatles, was only 5 blocks from the assassination when it happened, and became paranoid that Jews would be blamed for the assassination, resulting in a pogrom.

The original complaint filed by the Dallas police department on Lee Oswald, around midnight on the 22nd of November, said that Lee Oswald did, "in furtherance of an international communist conspiracy, assassinate President John F. Kennedy,” but Oswald’s murder, and the lack of evidence against anyone else he knew, meant that charge would not be tested in a court of law.

The possibility that Oswald's political convictions may have played a decisive part in his shooting John F. Kennedy was down-played in the early 1960s because President Johnson and other officials did not want the assassination to become a casus belli with the Soviet Union. And to the public, this explanation, at a moment when capitalism was riding high, appeared ludicrous. Besides, for a Marxist, killing this president appeared wildly inconsistent. Kennedy was a liberal.
- Priscilla MacMillan, JFK and Oswald: The Inconvenient Truth

It may have also have mattered that no-one wanted to revisit McCarthyism. Sen Joseph McCarthy had been defeated by censure in 1954 and died in 1957; the House Unamerican Activities Committee lingered until 1975 but by 1963 was beginning to come under siege from an emerging counterculture that would become increasingly Marxist as the 60’s turned to the 1970’s. Overseas, US foreign policy and covert interventions would ensure the abduction, torture and death of many thousands of Marxists through the next few decades, yet in the USA the few leftists who knew Oswald were not persecuted, and the journals of which he said "you can see what they want you to do by reading between the lines" were not supressed.

In December of 1963 Dylan, then in the most activist stage of his folk career, was an attendee at a dinner event in New York hosted by the Emergency Civil Liberties Committee, which had awarded him its annual Tom Paine Award.

“I’ve got to admit that the man who shot President Kennedy, Lee Oswald, I don’t know exactly where — what he thought he was doing, but I got to admit honestly that I too — I saw some of myself in him. I don’t think it would have gone — I don’t think it could go that far. But I got to stand up and say I saw things that he felt, in me — not to go that far and shoot.”

The outraged crowd then expressed its hostility to the speaker.

“You can boo but booing’s got nothing to do with it. It’s a — I just a — I’ve got to tell you, man, its Bill of Rights is free speech and I just want to admit that I accept this Tom Paine Award in behalf of James Forman of the Students Non-Violent Coordinating Committee and on behalf of the people who went to Cuba.”


Fair play for Cuba.

Perhaps the first conspiracy theory about the assassination, after the statement of the Dallas PD, was held covertly – the branch of the CIA working on mind control research must logically have begun looking for evidence of a “Manchurian Candidate” brainwashing of Oswald by the KGB. The MKULTRA program, initiated in 1953, had failed to find any reliable form of brainwashing – they had been able to produce “vegetables” among their guinea pigs but not effective agents or reliable informants. The program’s budget would be reduced in 1964, but if there was the possibility that the Soviets or Cubans had succeeded in brainwashing Oswald then it could be kept alive, and perhaps vindicated. It was probably in this spirit that MKULTRA researcher Louis Jolyon West interviewed Jack Ruby in 1964, likely with the use of hypnosis and sodium pentothal. During the visit Ruby experienced a “psychotic break”, revisiting his delusion of a Kennedy-assassination inspired pogrom. Jolyon West, who killed the elephant Tusko with LSD and other drugs in 1962 and studied hippies with MKULTRA in Haight-Ashbury in late 1967, would later testify at the trial of temporary Marxist Patty Hearst in support of her defence’s brainwashing theory.

As Jolyon West was infiltrating the hippie subculture in search of the mind-control McGuffin, David Crosby was ending his career in The Byrds on stage at the Monterey Pop festival, by introducing the song He Was a Friend of Mine, a tribute to JFK, with a categorical statement of the most enduring of the JFK theories –


When President Kennedy was killed, he was not killed by one man. He was shot from a number of different directions — by different guns. The story has been suppressed, witnesses have been killed, and this is your country.

This moment marks the overground advent of progressive conspiracy theory, with its roots in Eisenhower’s Military-Industrial Complex warning, and its motivation in opposition to the Vietnam war, and more to the point, in opposition to the drafting of young American men, who naturally adapted conspiracy theory as a defence against the mass disposal of their minds and bodies by the State – analogous to the adoption of conspiracy theory defences today by those whose autonomy and future plans have been threatened by their conscription in the war against COVID-19. It was widely rumoured that LBJ, Kennedy’s Vice President and successor, under whom America had become most stickily entangled in Vietnam, had ordered the hit, but Richard Nixon and Henry Kissinger were about to show the USA, and the world, how real political conspiracies are constructed.

It was in this environment of renewed conspiracy ferment that Kerry Thornley, who had known Oswald in the US Marines and written a book inspired by his personality, The Idle Warriors, before the assassination, initiated Operation Mindfuck, with the help of Greg Hill, Robert Shea and Robert Anton Wilson. Operation Mindfuck introduced the Illuminati, through letters and ads in Playboy and other “hip” publications, to the US counterculture, with the intent of parodying the counterculture conspiracy industry and serving up an anti-stupidity vaccine with a side-order of chaos and fun. But Thornley and his accomplices underestimated the forces they were toying with, especially the human tendency to believe in malign machinations that can explain one’s own apparent impotence, dehumanise those in control, and undermine the achievements of those who have succeeded in one’s place, the same need to feel one’s weakness justified as cursed and, if one can do nothing worse, curse back that fed the belief in witchcraft in the Middle Ages and that in modern Africa.
While the Jews and Freemasons theories of the Right did not go away, they were quaintly old-fashioned and smelled strongly of old library books by the 1970’s, unable to keep up with the actual conspiracies and political and cultural developments of the Nixon-Kissinger period. The Satanic Abuse panic of the 80’s-90’s was the most successful attempt to upgrade them – arguably this succeeded, to the extent that it disrupted civil society, because it aligned with Marxist Feminist agitation against sexual exploitation; sexual Satanism was a predictable manifestation of the Patriarchy, and vice versa. Meanwhile, Hunter S Thompson had created new myths of the operation Mindfuck type, giving adrenochrome its backstory and planting a rumour about senator Eugene Muskie, the less-progressive Democratic candidate for the 1972 Presidential race, being high on ibogaine, which destroyed his candidacy. Kenny Thornley, instead of mocking the operation Mindfuck theories – which he, glimpsing the truth about Oswald, had started - began acting as if he believed in one or the other or all of them. And a young Oliver Stone, after serving in Vietnam and disapproving of the whole thing, began thinking about the assassination of JFK, who was believed posthumously to have been opposed to the War in some way.
Stone’s 1991 film JFK marks the moment when conspiracy theory passed over from the counterculture and far-right into the mainstream; it featured an impressive cast of A-list actors who presumably approved of its message of suspicion. JFK was followed by The X-Files TV series in 1993, with its telling slogan “I want to believe”. The X-Files was ironic enough, unlike Stone’s breathless film, but this didn’t inhibit the mass distribution and discussion of its ideas. Both JFK and The X-Files posit an all-powerful, yet successfully concealed Deep State for which the elected US government is window-dressing and easily removed if it objects. All around the world, this gave an easy explanation to those who resented US cultural hegemony and military power but were not the type to organise against them. It helped that it was a seemingly playful explanation, one that didn’t insist on being taken seriously enough to really test, even as it established itself in the zeitgeist.
Prior to 2001 the Deep State conspiracy theories had to co-exist with the rest of the Fortean world represented in The X-Files. UFOs, Bigfoot, spontaneous combustion, the Bermuda triangle, vampires - by the end of the 20th century, several different species of UFO-riding aliens were abducting and probing people all around the world. But after 9/11, Islamist terrorists became the aliens and monsters we watched out for and it was the US state that began abducting and probing people everywhere; reports of UFO sightings and alien abductions went into serious decline. As the plainly venal team of Bush, Cheney and Rumsfeld openly conspired to roll back freedoms and push the world into another unwinnable war, a spontaneous conspiracy of sorts arose to undermine their casus belli by suggesting that the terror attacks had been an inside job. This also meant not admitting that a Saudi Arabian NGO could get the better of the mighty USA, so it had cross-party appeal, but the list of progressive celebrities who endorsed or indulged 9/11 conspiracy theories is almost as impressive as the cast of JFK, and included Ed Asner, Spike Lee, Woody Harrelson, Rosie O’Donnell, Marion Cottillard and Graham Nash. Spreading a rumour like “Bush did 9/11” is a way of cursing the powerful, a displacement activity born of impotence and frustration, like spreading a rumour that your local feudal tyrant worships Bahomet because you are powerless to stop him taking what he wants from you. And 20 years later, Q-Anon is simply the aggregate of all the progressive counterculture conspiracy theories, including Kerry Thornley and Hunter S Thompson’s inventions, with a modified Satanic abuse element, and with the older Jews, Freemasons and Communists theories always sneaking back in.

It all began with Oswald and the trauma he induced in the USA on
November 22 1963. As NBC News anchor David Brinkley said, as he signed off that night, Kennedy’s death was “just too much, too ugly and too fast.” In 2007 Priscilla MacMillan summed up the aftermath of the assassination in a short article for World Policy Journal titled JFK and Oswald: The Inconvenient Truth.

 Oswald's act of violence indisputably ushered in an era of unease and suspicion in American life that was not there prior to the Kennedy assassination. Oswald was not responsible for all of the damage that has befallen American society since 1963, much as he would have wished to be. Some of that damage is the result of events related only tangentially to the assassination of President Kennedy. But some of the injury can, with justice, be attributed to conspiracy theorists who have gone to superhuman lengths to avoid facing the truth. They have constructed wildly-implausible scenarios, far-out, fictitious "conspirators," and have scandalously maligned the motives of Kennedy's successor, rather than take a hard look at the man who actually did it. They have, ironically, done more to poison American political life than Lee Oswald - with the most terrible of intentions - was able to do.

Kerry Thornley thought that a little light Illuminati hoaxing would make people immune to conspiracy theories, but conspiracy theories, as The X-Files and its spin-off The Lone Gunmen have proved, are immune to spoofing; Q-Anon is a spoof of spoofs, and it has outshone them all.

If the world is ready to give Marina Oswald’s story and Priscilla MacMillan’s research and analysis the same attention it once gave to Jim Garrison’s speculations, narrative will replace montage in the JFK storytelling tradition. In the near future there will be a film, or better yet a TV series, of Marina and Lee, based on the True Crime book of that name which its viewers will queue to read. In our contemporary state of disinformation hypersensitivity, it should get a more reasoned reception from the comments section than the PBS Frontline documentary series Who Was Lee Harvey Oswald did when it rescreened in 2013. We will come to understand Lee Oswald and the ideological world he inhabited, which is closer to our own than used to be the case, because the expression of low-constraint or heretical or otherwise deviationist versions of Marxist ideas is now commonplace, because glasnost revisionism, 90 Day Fiancé, RT, and Red Scare have made Marina’s voice more relatable, and because we’re now well-used to seeing violent malcontent male loners acting out the terrorist fantasies which they developed through ideological study and travel.

Imagine a counterfactual America, an alternative history wherein it has always been a well-known and accepted fact that Lee Harvey Oswald, a lone-wolf Marxist, assassinated the 35th President of the United States.

George Henderson, Auckland, Sept 2021

The killing of Oswald by Jack Ruby was the real singularity that tipped America down the path to Q-Anon, as it removed Oswald from his own story. I've called Ruby's motives "obscure" above, but obscure as they are they are not beyond all speculation. Here's what I think.

Roy Cohn, as a patriotic American Jew trying to succeed in the system, persecuted Jewish American communists because he thought they gave a bad impression of American Jews - he more-or-less framed Ethel Rosenberg and brought about her execution. This was the injustice that led to the radicalization of the young Oswald.
The Dallas newspapers had been carrying adverts against JFK that in the opinion of many at the time amounted to hate speech, and some of these were signed by Jewish Republicans (the Republican party still being the old party of tolerance for many, I suppose). Ruby was concerned about this even before the shooting, and when he heard about it panicked that the Jews would be blamed for killing JFK (as, I suppose, they had been for killing Christ) and was compelled to kill Oswald to clear their name, as a kind of sacrificial lamb for his people.
Because this involved magical thinking, and because he may have found it embarrassing in his lucid moments, Ruby gave the more innocent explanation that he had killed Oswald to spare Jackie Kennedy the pain of a trial.
Roy Cohn would go on to become the mentor of Donald Trump, and Donald Trump would go on to become the patron and beneficiary of Q-Anon.

Friday 30 July 2021

Virta Health vs Seidelmann - of ketones and COVID-19

You would have seen this paper; senior author is Sara Seidelmann of the infamous "low carb kills" paper, the reviewers were one vegan propagandist David Jenkins (a friend of the family, so to speak) and an Iranian prof with a decent publications list in the plant-based area - neither with any infectious diseases expertise.

There were 568 COVID-19 cases and 2316 controls. Among the 568 cases, 138 individuals had moderate-to-severe COVID-19 severity whereas 430 individuals had very mild to mild COVID-19 severity. After adjusting for important confounders, participants who reported following ‘plant-based diets’ and ‘plant-based diets or pescatarian diets’ had 73% (OR 0.27, 95% CI 0.10 to 0.81) and 59% (OR 0.41, 95% CI 0.17 to 0.99) lower odds of moderate-to-severe COVID-19 severity, respectively, compared with participants who did not follow these diets. Compared with participants who reported following ‘plant-based diets’, those who reported following ‘low carbohydrate, high protein diets’ had greater odds of moderate-to-severe COVID-19 (OR 3.86, 95% CI 1.13 to 13.24). No association was observed between self-reported diets and COVID-19 infection or duration.

you'll find good criticisms in the rapid responses attached, and my PubPeer comment here.

 The methods state 
Lastly, we combined ‘low carbohydrate’ diets and ‘high protein’ diets into another category (‘low carbohydrate, high protein diet’, n=483) to evaluate whether these dietary patterns are associated with COVID-19 severity.

Why? No reason is given for combining these 2 categories. 

There was a keto option, so why didn't they add keto + low carb?

Methods state
Before analyses, we selected dietary patterns with sufficient ‘yes’ responses (‘yes’ response of at least 100 individuals). To increase precision, we analysed three dietary patterns after combining dietary patterns that are similar in terms of dietary intake.

Perhaps keto had less that 100 responses? But there was no registered protocol, those decisions were post-hoc - even if keto had fewer than 100 responses, adding it would have still increased numerical power, which was presumably the point of combining categories as they did. And there's nowhere it says how many responses, and we also have no way of knowing how similar low carb and high protein really were (everything was pretty similar really, these were for most respondents just the virtue-signaling labels they gave to their eating habits).

Anyway, there was no association once people with a negative or no PCR test were excluded.
That's not in the abstract.

But, you know, people are using the keto and LCHF diets to treat diabetes and reduce COVID19 mortality associated with type 2 diabetes, MetSyn, or obesity, so this is a nasty thing to say if it's not true. It's a bit like trying to get people to stop taking vaccines based on your bias and some shit you didn't understand.

Fortunately Vitra Health have ridden to the rescue with a survey of their own T2D population on a ketogenic diet. We know these people are actually following the diet, or adhering closely to it.

The abstract (presented at an ADA conference) is 
COVID-19 Severity in a Geographically Diverse, U.S.-based, Ambulatory Population with Type 2 Diabetes on a Medically Supervised Ketogenic Diet

Data were obtained from medical records and from surveys sent to T2D patients who self-reported COVID-19 diagnosis; 47.8% (294/614) responses and one known COVID-related death yielded a sample of 295 (50% male, 54±9 years, across 41 US states). We observed low reported rates of hospitalization (10.9%), ventilation (2.0%), and death (0.3%) relative to national reports.
Let's compare with the Seidelmann paper - 1) we know the diet is real. 2) COVID-19 is self-reported (some will have tests some not, as in Seidelmann) but - we do have people being hospitalised, unlike Seidelmann, and we even have one death, so Virta are able to capture events that people weren't able to report directly, because their model includes liaison with primary providers likely to report deaths to them. 3) the event rates are low for a population with type 2 diabetes, as shown by the comparison with this population. The populations, though much the same age, aren't identical, but the biggest difference seems to long term inclusion in the Virta Health population (note the "baseline" HbA1c data in Virta - before treatment with the ketogenic diet - is similar to the overall HbAic data in the comparator vs standard practice, but many of the Virta Health population have put their T2D in remission. At this stage, we have to say that the EFFECTS of the keto program are protective - weightloss and euglycaemia, etc. We don't have evidence that keto per se is protective apart from those factors. But that may well be hidden in the data, once the whole set is fully written up. But once again, it looks like Harvard is a bad actor, an ill informant in the nutrition-and-health space, interfering with effective treatments to preserve its own ill-gotten (by a process of bloviation if not graft) dietary hegemony.

Wednesday 7 July 2021

The Carb-Fat Food Quality Gradient - a real metabolic advantage

This post was originally published as a subscriber-only post on Patreon. You don't have encourage the speculations of the likes of me, but if you want to try, please subscribe!

By now, we've all seen them - studies that purport to show equivalent effects of LCHF and HCLF diets once diet quality is addressed and people are Eating Whole Unprocessed Foods.
The latter is a good thing, the default to go for in terms of population health; macronutrient tweaking is next-level.
But here's a question - why were almost all the original studies that validated the efficacy of LCHF diets to a skeptical medical world comparisons of ad lib low carb vs energy-restricted low fat?
To make a really low carb high fat diet (unless you want to pretend a high-protein diet is that) you're going to be using some isolated fats (cream) or refined ones (coconut oil, olive oil). There may not be sugar in your chocolate bar, but there will be cocoa butter.
This only works if in some way those isolated fats are NOT equivalent to sugar and flour.
What is the evidence for a difference?

One of the more lasting concepts in carb nutrition is the glycemic index, the average speed at which a food appears as glucose in the system. It's not perfect because sugar is only half glucose so is lower GI, but you get the idea.
High GI is worse for you.

The PURE study is good for producing null results, which makes whatever it does throw up seem a bit more reliable than most nutritional epidemiology.[1]

"In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease."

As I've said before, everything in plants that is supposed to be good for you but isn't actually a real nutrient is probably lowering GI in some way. It's the glucose (glycemic load above) but the way it arrives in your bloodstream (GI) is more pointed.

Is there equivalency for fats? Do fats that are rapidly absorbed correlate with disease?
That would be the medium chain fatty acids, MCFA.

"In comparison to triglycerides containing LCFAs, those containing MCFAs are more rapidly hydrolyzed in the intestinal tract and do not become incorporated into chylomicrons. SCFAs and MCFAs are transported by portal bloodstream to the liver, where they are readily metabolized."[2]

And perhaps also the unsaturated fatty acids, UFA.

"Although pancreatic lipase hydrolyzes fat only in the 1 and 3 positions of the molecule, it is nevertheless possible for fatty acids in the 2 position of the triacylglycerol to be hydrolyzed. This apparent violation of the specificity of pancreatic lipase occurs because of the relative instability of both the 2-monoacylglycerol and the 1,2-diacylglycerol (Crossley et al., 1959). These molecules rearrange by migration of the fatty acid in the 2 position to the 1 or 3 position, which is readily hydrolyzed by lipase (Figure 18–3). This rearrangement is more rapid when the fatty acid is either a short-chain one or an unsaturated one, and a portion of the 2-position fatty acids may be absorbed as fatty acids rather than as monoacylglycerols (Benzonana et al., 1964)."[3]

We'll call this the fat index, FI.
Are fatty acids with a high FI worse than low-FI fats?
In epidemiological studies of individual fatty acids and their associations with disease risk, the MCFAs, which are SFAs, are always more benign than the longer-chain SFAs (see table 2).[4]

"Two recent studies from the Netherlands reported largely diverging findings. In the European Prospective Investigation into Cancer and Nutrition study, intakes of 4:0-10:0 and 12:0 were inversely associated with ischemic heart disease risk, but no associations were found for 14:0, 16:0, and 18:0. However, in the Rotterdam study, only 16:0 intake was associated with higher risk of coronary heart disease." [see also table 2]

In an overfeeding experiment, the benefits of MCFA were obvious.[5]

"In conclusion, substitution of a small amount of dietary LCFAs with MCFAs rescues insulin action in conditions of lipid-induced energy excess."

This is because high-FI fatty acids are metabolized more rapidly, and, in the case of MCFAs, oxidized with less metabolic and hormonal effort than LCFA.[2,6]

In conclusion - if you eat carbs in bulk you will need to pay some attention to the speed at which your body absorbs them; this rules out eating purified carbohydrates.

If you eat fats in bulk, you need pay little attention to the speed your body absorbs them; you may want more fast-absorbing fatty acids in your food, but this does not rule out eating purified fats.

[1] Jenkins DJA, Dehghan M, Mente A, Bangdiwala SI, Rangarajan S, Srichaikul K, Mohan V, Avezum A, Díaz R, Rosengren A, Lanas F, Lopez-Jaramillo P, Li W, Oguz A, Khatib R, Poirier P, Mohammadifard N, Pepe A, Alhabib KF, Chifamba J, Yusufali AH, Iqbal R, Yeates K, Yusoff K, Ismail N, Teo K, Swaminathan S, Liu X, Zatońska K, Yusuf R, Yusuf S; PURE Study Investigators. Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality. N Engl J Med. 2021 Apr 8;384(14):1312-1322. doi: 10.1056/NEJMoa2007123. Epub 2021 Feb 24. PMID: 33626252.

[2] Schönfeld P, Wojtczak L. Short- and medium-chain fatty acids in energy metabolism: the cellular perspective. J Lipid Res. 2016;57(6):943-954. doi:10.1194/jlr.R067629

[3] Institute of Medicine (US) Committee on Military Nutrition Research; Marriott BM, editor. Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations. Washington (DC): National Academies Press (US); 1994. 18, Structured Lipids: An Overview and Comments on Performance Enhancement Potential. Available from:

[4] Zong G, Li Y, Wanders A J, Alssema M, Zock P L, Willett W C et al. Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies BMJ 2016; 355 :i5796 doi:10.1136/bmj.i5796

[5] Anne-Marie Lundsgaard, Andreas M. Fritzen, Kim A. Sjøberg, Maximilian Kleinert, Erik A. Richter, Bente Kiens. Small Amounts of Dietary Medium-Chain Fatty Acids Protect Against Insulin Resistance During Caloric Excess in Humans.
Diabetes Jan 2021, 70 (1) 91-98; DOI: 10.2337/db20-0582

[6] James P DeLany, Marlene M Windhauser, Catherine M Champagne, George A Bray, Differential oxidation of individual dietary fatty acids in humans, The American Journal of Clinical Nutrition, Volume 72, Issue 4, October 2000, Pages 905–911,

Sunday 27 June 2021

Probiotic extracts for PTSD - proof of concept for the gut-brain axis?

It is with great pleasure that I can announce results from an experiment I was actually involved with, albeit long ago.

It happened like this - having noticed that probiotics were helping with my HCV symptoms, I was theorising about the reasons for this in a Hep C forum with nurse Silvia H, who supplied a lot of my early background on immunity; this attracted the notice of Elizabeth McKenna, who was working with Beth Jones, the senior author of the present paper. Dr Jones had invented a process for producing a cell wall lysate from bacteria that, or so it was claimed, preserved the probiotic immune function to a far greater extent than other lysates and heat-killed probiotic products then available.

I knew a bit about these products because a friend with HCV swore by a product called Del Immune V, which had corrected what seemed to be autoimmune symptoms. I tried this product but to be honest was already so saturated with effective herbs and other supps that I couldn't honestly say what it did, though it did appear to be something. But by looking on the interwebs, as they then were, I could deduce a bit about such things. 

My theory was, still is, that commensal bacteria - as well as herbs like astragalus and some mushroom sp. produce polysaccharides and other PAMP signaling molecules that mimic LPS in a benign way. An agonist-antagonist relationship with PAMP receptors could explain this modified version of the effect (this is why it can be useful having a druggie on the board, pharma execs). This summary minimizes the amount of reading I did on complement and alternative complement pathways, Tregs and Th17, retinoid metabolism and immune cell differentiation, dendrite cell translocation of LPS, and other things that mercifully I only faintly remember now. Anyway, it looked as if the toll-like receptors, a major PAMP recognition pathway, were important.

Elizabeth McKenna, by now the CEO of Labyrinth holdings overseeing the patent process for Dr Jones, had the realization that TLR activity was assayable - the tests were done and, as in the current paper, there was significant activity at several PAMP receptors.

Soon after I received some test samples of the product, now called ReseT. From Reset T cells - a good concept but as it turned out a very poor name when it came to finding the product in search engines!

Anyway, at the time I still had HCV, and that was one possible use for ReseT, so I thought I should try it. Even though at the time my symptoms were under control and I had no idea if I would notice, because that's how I roll, someone has to try things and I was already implicated, as it were.

We know know that the dose I took was about twice what's optimal. It's a sublingual lactose-based pill, or was, and the effect was rapid. The pattern on the carpet in front of me softened, life softened, and I felt something very similar to the effect of valium or some other GABA agonist. Well that's quite impressive I thought, but it left me fully functional and I was on my way to a Neil Young concert.
While on the way I smoked a couple of strong joints.
Then there I was, trapped indoors with thousands of strangers in a swirling mob. 
This sort of thing is of course a recipe for social anxiety, and it's normal to negotiate this effect, which can get quite harsh, if you're a stoner who wants to be really stoned for, you know, NEIL.

But this time things were completely different - I was immune to anxiety. And I remained immune to anxiety from this cause for a long time after I stopped taking ReseT, which I didn't take regularly for long, and it's never really been all that strong ever again.

Now, the experiential effects I've described haven't been described by anyone else - that is, no-one else who's benefitted from ReseT since seems to have observed the point at which it happened in the way I did. That's Okay, I'm used to being highly observant of such things, even though it gets me laughed at sometimes. I only noticed the strong GABA effects on the first two or three occasions I took ReseT, fading as I became less prone to anxiety.

Anyway I drifted away from the probiotic problem as other work came along, and though Elizabeth McKenna kept in touch I did think the proposed mechanism, that the effect can be explained by the manipulation of oxidative stress, was putting too much onus on the immune system. and too much responsibility on bacteria.

But obviously I didn't have all the facts that the people on the ground did, and as it happens there's nothing better than a highly simplistic hypothesis - IF the evidence supports it.
If the evidence supports a simple explanation, there is no immediate requirement for terms like complex and multifactorial. To paraphrase William of Occam.

In the first of two papers, A pilot study: Innate immune modulation reduces F2-Isoprostanes and improves psychological health in a chronically stressed cohort

Seven male participants (combat veterans aged between 28 and 47 years) with PTSD completed the 70-day study.

The study design was a single-arm treatment study, wherein the effects of treatment were assessed and compared to the baseline pretreatment values (Day 1). Once the baseline samples were collected, the study participants were requested to take two 12 mg tablets, sublingually, twice daily (48 mg daily dose) for the duration of the study, and maintain their normal daily routine. Treatment sample collection and the measurements were performed on Days 15 and 70.

The graphs demonstrate after 14 days of treatment, most of the participants experienced improved psychological health that were consistent with reduced urinary levels of F2-IsoP (Figure 1A). In case of depression profiles, there was significant improvement observed by Day 15 (Figure 1D). However, with further treatment, the participants continued to exhibit improvement, with significant improvement in the metrics of life satisfaction (Figure 1B) and daytime sleepiness (Figure 1C) by Day 70. The correlation coefficients between the F2-IsoP and mental health parameter values were −0.99, 0.99, 0.95, and 0.96 for life satisfaction, sleepiness, depression, and anxiety, respectively.

To be sure, the study wasn't controlled. But a placebo effect shouldn't lower F2-IsoP that much, and I think it very unlikely that placebo effects can be maintained this consistently for 55 days, especially given the very minimal interaction between participants and clinicians during the study. But note that the antianxiety effect I noticed is probably only being experienced by one or two participants.

Anyway, placebos shouldn't affect drosophila, and there's also a fruit fly study that corroborates that ReseT is bioactive (via NF-κβ).

Treatment with Bacterial Biologics Promotes Healthy Aging and Traumatic Brain Injury Responses in Adult Drosophila, Modeling the Gut–Brain Axis and Inflammation Responses

Here we get to compare ReseT with a well-tested live bacteria that is closely related to its source, LGG.

Here, we examine the response of adult Drosophila given an inactive bacteriologic (IAB; proprietary lysate preparation of Lactobacillus bulgaricus, ReseT®) and a probiotic (Lactobacillus rhamnosus, LGG). In vitro, the IAB activates a subset of conserved Toll-like receptor (TLR) and nucleotide-binding, oligomerization domain-containing protein (NOD) receptors in human cells, and oral administration slowed the age-related decline of adult Drosophila locomotor behaviors. On average, IAB-treated flies lived significantly longer (+23%) and had lower neural aggregate profiles. Different IAB dosages also improved locomotor function and longevity profiles after traumatic brain injury (TBI) exposure. Mechanistically, short-term IAB and LGG treatment altered baseline nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κβ) signaling profiles in neural and abdominal tissues. Overall, at select dosages, IAB and LGG exposure has a positive impact on Drosophila longevity, neural aging, and mild traumatic brain injury (TBI)-related responses, with IAB showing greater benefit. This includes severe TBI (sTBI) responses, where IAB treatment was protective and LGG increased acute mortality profiles. 

Well. Interestingly there may be a "too much" point here with both interventions where they are no longer great, with a lower tolerance for the live probiotic. These are not placebos.  

Anyway L. Bulgaricus was the probiotic that Élie Metchnikoff predicted would extend life in 1907.

Just sayin'.

Tolstoy and Metchnikoff, 

Disclaimer - my work for Labyrinth in its early days was pro bono, and I've never been paid by anyone involved. I did receive two textbooks.

Sunday 30 May 2021

Bernard Shaw goes to Samoa

I’ve been lucky enough to have worked as an extra on the latest fantasy series, and this means I have finally had the time and the freedom from digital poisoning to read some of the books I have wanted to finish.

Like Thomas Mann’s Doctor Faustus. A Thomas Mann book is long and its characters and ideas only really come into focus in the second half. But when they do, wow. Hitler – what were the Germans thinking? Mann describes not the rise of the Nazis but the fall of reason and cults of irrationality that preceded it. And which could precede any form of extreme collectivism anywhere. What he describes isn’t the Popper analysis everyone bandied about cack-handed back when we thought that any reinvigorated conservative critique of progressive radicalism was an impending fascist coup. It’s something more general, something latent in our own instinct to find the self-serving pattern of submission and permission to suit any uncertain times, and also latent in the instinct of intellectuals to make all times seem so uncertain that shit like that can be made to happen in them.
I also read four plays by Ibsen, all good and Ghosts and Hedda Gabbler being perfect marvels, the best plays I can remember having read. Seeing these plays as a bourgeoise in a Victorian theatre must have felt like finding a bomb under your seat.
I was also able to start part 2 (having already read parts 1 and 3) of Michael Holroyd’s biography of Bernard Shaw, covering the years 1898-1918. Shaw, a playwright (and disciple of Ibsen), is an unsympathetic character, with his vegetarianism, chastity, self-regard and urge to pontificate on everything, but he’s also the man who was a tireless cheerleader, inventor, and, behind the scenes, a diligent planner for much of what we call progress in the Western world. Everyone being paid the same amount, men and women being treated by society as if they were physiologically and psychologically identical – these were Shaw’s ideas, expressed frequently enough during an age when they only seemed outlandish and attention-seeking to become familiar, if still attention-seeking, concepts in our own times. And so much more (renewable energy, pacifism, animal rights, the list is quite possibly endless) – Shaw was the original SJW, with the important exception that he could and did laugh at himself, and was prepared to do the grinding political work needed to make civics work well – better schools, better drains, that sort of thing. And not a typical SJW either in that he courted and tolerated opposition in order to better spread his views. Thus he debated G.K. Chesterton, in debates chaired by Hilaire Belloc in a friendly but no-holds barred fashion, for many years. 

And most importantly for our purposes, Shaw was an antivaxxer who debated the most famous vaccinationist of his days, Sir Almroth Wright, regularly for decades. Wright, in fact, sought out Shaw first for publicity purposes.
Shaw’s opposition to vaccination was in part emotional (as an anti-vivisectionist), in part mystical (as a believer in a Life Force which trumped Darwinian evolution), in part envious of the prestige belonging to the freemasonry of Medicine over that of Art.
But he also sensed the role of bunkum in medicine, the unproven theories presented as fact, the faked experiments presented as proof, the corrupting influence of money, and the hollowness of appeal to authority (when the British government wanted to promote Wright’s serum they gave him a knighthood, then used his “Sir” as a selling point).    

“Shaw’s sense of vulnerability to the power of this medical elite, replacing his fear of death, gives his satire its edge…Behind these years of correspondence and controversy with Wright, and the play [The Doctor’s Dilemma] that resulted from their association, there lay a wish to take authority from the orthodoxly educated and give it to outsiders… the medical freemasonry was a closed circle of privileged people whose mesmeric power over other human beings angered Shaw.”

Most relevantly to the present day, he saw vaccination as a shameful cover-up for poverty. No need to fix the drains, supply decent housing, or feed the poor properly if you can stop a pandemic breeding in the slums, or at least the fear of one, or at least reduce the chances of it reaching the bourgeoisie, with a cheap jab. And this point – which perhaps acknowledges that vaccination can be effective, but highlights the social cost of its success – remains valid today.

Modern medical opinion, as reported by Holroyd, seems to be, that Sir Almroth Wright’s tuberculosis serum was worthless. There is even a theory that a similar vaccine technology gave the Spanish flu what it needed to get going. I don’t have the reading or expertise to comment on that. But I do know that Wright’s certainty that women were psychologically unfit to vote was misplaced (because, as Shaw noted, and as we can clearly see today, men are not any less prone to pseudoscientific reasoning) and that his repeated opinion that “the effect of hygiene is aesthetic” was positively dangerous, even if it always gave Shaw the opening to argue the case for Art.  

Which brings us to today. Diet is an arm of hygiene just as surely as hand-washing and the avoidance of crowded indoor spaces, both effective in reducing the spread of COVID19 and other infectious diseases. We can see from China and other places that an adequate selenium level of the diet alone quite possibly reduces the case fatality rate (CFR) for COVID-19 by a factor of 4. We can see that higher vitamin D levels (a sign of good diet quality overall, and not only sunlight exposure or vitamin D intake, because vitamin C, iron and magnesium are among the factors contributing to the serum vitamin D level) are associated with a greatly reduced CFR. And that higher levels of unsaturated fat in fat stores (as in the US population) increase the risk of lung damage and death when infected with SARS-CoV-2. Unsaturated fat is the main component of margarines and the cheap oils used to cook the food of the poor; white bread helps to keep it from being burned for fuel; meanwhile the wealthy eat butter and steak, and are not so prone to the storage of excess fat, despite needing to do less work.
Most of these risk factors, as I’ve said before, are actually the unintended consequences of earlier scientific error regarding the risk of skin cancer (which unsaturated oils also promote) and heart disease (which is mainly driven by the excessive insulin response to the modern diet).

A recent example of how the pro-vax narrative ignores the effects of poverty, and hygiene including diet, appeared in the blog of David Farrier. I’ve mentioned Farrier before in this blog because he’s quite a good bellwether of right-thinking opinion, and because he’s worth reading for his own sake. He’s the creator of an entertaining film, Tickled, about the human capacity for deception, and has a pretty good take on conspiracy theory and its psychology. But it depends whose conspiracy theory, because beneath all his quirkiness Farrier is a bog-standard PMC worrywart and always defers to the interests of his class, acting, on the blog at least, as a gatekeeper who's never met an expert he didn't agree with, or at least submit to meekly.

In this article on fake news written by Farrier’s friend Byron Coley, which is otherwise an intelligent and insightful guide to the current conspiracy theory and misinformation landscape inside NZ, we get an example of misinformation by omission, regarding the measles epidemic in Samoa, in a section on some Covid grifters who ran for parliament on the New Conservative platform.

In April on Talano Sa’o, Tildsley spent an episode interviewing a man she described as “an unsung hero in Samoa” Edwin Tamasese.

During the measles pandemic — which was devastating to our people, killed around seventy of our babies — he was right in the middle of it, and he was part of sharing vitamin D, vitamin A, vitamin C, and he did what he needed to do.

Tamasese, who has no medical training, spread the false claim during the measles outbreak that authorities were “seeding” the country with measles through the emergency mass immunisation program deployed to stem the epidemic."  

So far, so bad. But the story of the Samoan measles outbreak is being manipulated here. The outbreak happened after Samoa’s regular measles vaccination program was stopped, and it was stopped after two babies died from a botched vaccination. It was the deaths of these two babies, and not the activities of anti-vax grifters, that lead to the deaths of 70 children. The Samoan health service, for reasons that are still not clear, could not run a safe vaccination program. Understandably parents chose not to take further risks, until the cost of not having vaccinated their children became obvious. Samoa has a population of 202,506, and 83 people died in the measles epidemic, among 5,700 confirmed cases. New Zealand has a population of 5 million, the same epidemic was described as the worst since 1938, with 2,194 confirmed cases, and two unborn fetuses in the second trimester died as a result of the outbreak. New Zealand many have higher vaccination rates than Samoa, at least among children, but it also has a thriving population of privileged unvaccinated kids.

This is a huge difference in impact. It is the kind of inequality of outcomes that is usually attributed to systemic racism, colonization etc. But when we see a difference so extreme that it really can be interpreted as evidence of those things by anyone with eyes to see, everyone is strangely silent.
Because systemic racism and neo-colonial exploitation could be real features of life in Samoa, if New Zealand’s experience is anything to go by. What else do we call the replacement of traditional foods with imported rubbish, under a system that promotes Western dietary values? New Zealand has a large Samoan population, and
New Zealand’s dietary guidelines are dismissive of all the traditional Pacific energy foods in favour of grains. The use of coconut is confused with coconut oil and discouraged in patronising statements like “The Heart Foundation considers that when indigenous people consume coconut flesh and milk along with fish and vegetables, and they are also physically active, the coconut consumption is unlikely to put them at risk of cardiovascular disease. They are in a very different situation from people who consume coconut oil along with a typical western diet.”
Which if true (and the claim is still untested, as Shaw would have recognized, but
likely to be untrue) would be true of any food supplying energy. Is it also saying that coconut is unhealthy for a sedentary population? That’s also unlikely to be true.
Traditional diets, and decent diets aligned with them, have long been disrupted in the Islands by Western-trained medical freemasons and commercial traders of imported goods, often
working hand-in-hand. If you want to call it structural racism I won’t stop you. But weird how silent the usual suspects are.

Would the grifter’s supplements have saved lives? A silver bullet nutritional approach to systemic deprivation is rarely highly effective, but according to the
Cochrane Collaboration, the ultimate in evidence-based medicine “Vitamin A reduces the risk of death from measles by 87% for children younger than 2 years”.
Yet the Samoan authorities were telling parents to ignore the grifters. Did they throw the babies out with the bathwater, or were they also supplying the vitamins to the unvaccinated, preferably before they got measles?

I don’t know the answers. But I do read the papers, watch the TV news, and look at stories on the internet. If I don’t know then it’s likely that very few people know. They only know what they’re told, and the narrative is owned by people who won’t tell you these important things. It’s still owned by Sir Almroth Wright. There’s an alternative narrative, of course, but you certainly can’t trust the people who own that.

Which leaves it up to the people who claim to be investigative – including your David Farriers and Byron Coleys – to find out the truth for us, even if this does rattle their class interests.
Summary:  I'm always hopeful that my blog posts may attract people not familiar with my preoccupations and body-of-knowledge, such as it is. So to avoid confusion, here is a summing up:
Vaccines, which have been improved since Sir Almroth Wright's day, are a huge contributor to population health. You shouldn't have needed me to tell you that. However:  There was no Covid vax for a year and most people will still have no Covid vax this time next year. Over 3 million people have died. The drugs are not that effective at preventing this.  Look at environmental factors. The strong associations that exist - selenium, vitamin D and unsaturated/saturated fatty acid ratios - should have been exhaustively tested by now. But instead fuck all has happened. Why? Who is in charge of deciding what to test and how, and why have they not heard of Austin Bradford Hill?

There was no measles vax in Samoa due to a vaccine disaster. Such accidents are always possible, and antivaxers, paradoxically, will always be with us. Why were nutritional interventions - including those with known value - neglected and, indeed, scorned?
And were the other effective hygiene interventions - lockdown, masks, hand sanitizer, social distancing, quarantine - used to control spread, and if so, at what stage of the epidemic? They certainly weren't being used in the NZ outbreak.

The pertussis vax in DPT is also ineffective at preventing outbreaks and needs more frequent boosters than most people can manage. Again, 
lockdown, masks, hand sanitizer, social distancing, quarantine could be used to control spread, for which to work diagnostic criteria need to be more pragmatic and affordable, and environmental factors should be researched.

It's also relevant that the DPT vaccine is too dangerous to use in sub-Saharan Africa (due to local infectious disease risks that would not be at all relevant in the Pacific). Think of something else there. Why does the development of a vaccine prevent research into alternatives? They will often still be needed.

Sunday 16 May 2021

Is cannabis protective against an adverse effect of the modern diet? Cannabinoid signaling in the omega 3/6 hypothesis of obesity and mood disorders.

(this post originally appeared for subscribers on my Patreon blog in Dec 2020, and is now unlocked. If you want to support my blogging habit and see these posts before they happen, subscribe here!
The rest of you, enjoy.)

It’s pretty well accepted that cannabis is an appetite stimulant in the normal dose range. In fact, it’s pretty much been the unofficial standard-of-care drug for the treatment of appetite loss during illness or chemotherapy for a long time.
So we’d expect people smoking cannabis to have higher rates of obesity and type 2 diabetes, because of the munchies.
Yet it’s been a consistent epidemiological finding that the opposite is true – and the explanation that’s been proposed may give us an insight into why cannabis has become the modern panacea, a drug that has been proposed to treat almost everything and why its legalisation, especially for medical use, is being welcomed by such a large chunk of the population.

How consistent is the association between cannabis use and obesity? In a meta-analysis of BMI data:
“Nine studies were included that reported BMI of users and nonusers and met selection criteria, and an additional two studies were identified that reported lower BMI in Cannabis users, but did not provide numerical data. Of these studies, all reported lower values of BMI in Cannabis users, and only one of these did not reach statistical significance. A second study did not report statistical analysis of the BMI data. Of those studies reporting significant negative correlations, two reported that longer duration of Cannabis use was associated with reduced BMI.”(Clark 2018)

That’s a convincing association as far as it goes, but is there a mechanism that explains it?

In another paper, we read that “Suppressing hyperactive endocannabinoid tone is a critical target for reducing obesity.”(Alvheim 2012) The endocannabinoids, 2-arachidonoylglycerol (2-AG) and anandamide (AEA), promote both appetite and the growth and expansion of fat cells.(Naughton 2013, Banni 2010, Madsen 2012) This is a useful adaptation to store energy after a meal (or in the autumn, when linoleic acid, like sugar, is most easily found in nature) - but if it becomes a constant state can lead to obesity; with higher food (and especially carbohydrate) intake insulin levels also rise, ensuring more synthesis and storage of fat. When this fat exceeds the capacity of the body to store it, type 2 diabetes is one possible outcome, and at this stage it is very difficult to get the appetite to normalise; at which point removing carbohydrate from the diet seems to be the most effective way to reduce food intake without hunger.(van Zuuren 2018)

A drug that antagonises 2-AG and AEA, Rimbonabant, looked promising in animal studies but turned out to cause depression in humans.

Cannabis, of course, has similar effects to 2-AG and AEA, but the body’s response differs in an important way; we respond to the stimulation of endocannabinoid tone from THC and CBD by downregulating it, and this inhibition lasts longer than the effect of the drug does. In a sense, smoking pot inoculates us against excessive endocannabinoid signalling. This counter effect means that our cells burn more energy, rather than store it, and our appetite decreases, for quite a while after a session, even if we did have the munchies at some point.(Clark 2018) In a recent epidemiological study even historical cannabis use was associated with lower BMI and better insulin sensitivity. The rebound effect seems to last. Users probably don’t want to be saturated in cannabis all the time, but be using it intermittently to benefit.

But where does this excess endocannabinoid tone come from in the first place? 2-AG and AEA are made in the body from arachidonic acid, an omega-6 (ω-6 or n-6) fatty acid only found in animal foods – but the amount of AA in these foods is very low. Most AA in the body is synthesised from linoleic acid, the main polyunsaturated fatty acid in cheap vegetable oils (corn oil and soy oil, for example, are around 60% LA).

(Pathways for anandamide synthesis, from Naughton et al 2013)

So, what counters the obesogenic effect of anandamide and 2-AG naturally? The action of omega-6 endocannabinoids is opposed by omega 3 (ω-3, n-3) endocannabinoids, docosahexanoyl ethanolamide (DHEA) and eicosapentaenoyl ethanolamide (EPEA), which have a weaker binding affinity to CB1 and CB2 receptors.(Naughton 2013, Watkins 2014) The omega-3 cannabinoids are synthesized from DHA and EPA, the fatty acids in oily fish (pastured lamb or mutton is also a pretty good source). EPA and DHA can also be synthesized from alpha-linolenic acid (ALA), the omega-3 fatty acid found in flaxseed, canola oil and hemp oil (and present in small amounts in most green veges). However, it looks as if too high an intake of ALA also suppresses blood levels of EPA and DHA.(Gibson 2018)
(There is also an omega-9 cannabinoid, made from the main monounsaturated fat oleic acid, which counters the effects of the omega-6 series, decreasing appetite and increasing fat-burning, but this does not seem to depend on dietary intake. Oleic acid is produced in the body as well as an item of diet; it is synthesised after meals from carbohydrate and other fats, so its cannabinoid probably acts as a fullness signal).

It’s been known for a while that a higher intake of LA drives synthesis of AA and inhibits the conversion of ALA to EPA and DHA.(Gibson 2018) This is probably why fish oil became popular as a supplement, but fish oil has had relatively disappointing results in human trials. The only fish oil product approved as a drug (for cardiovascular disease) is VASCEPA, a synthetic variant of EPA which is reliably able to raise the EPA level in the bloodstream.

However, research out of Australia and France shows that saturated fat, especially dairy fat, increases the level of EPA or DHA in the bloodstream, in people fed omega 3 fatty acids from fish oil or canola oil respectively, compared with people instructed to use vegetable oils as per common governmental health advice.(Dias 2016, Dabadie 2005)  The Australians achieved a doubling of the EPA level when the other fat in the diet was more saturated. Yet the LDL (so-called “bad cholesterol”) level also increased.(Dias 2016)

Why would this be? EPA and DHA trigger the burning of fat in the liver – this is a good thing, lowering triglycerides, but it means these omega-3 fatty acids are destroyed in the process so less will reach the bloodstream in the lipoprotein (“cholesterol”) particles. Some saturated fats, especially the longer medium-chain fatty acids in dairy and coconut, also trigger fat burning and lower triglycerides – and this tends to spare some of the EPA and DHA present, so that other cells in your body can use it.(Drouin 2018)  But removing triglycerides from lipoproteins in the liver means they come out with less fat, and therefore more cholesterol. This raises your LDL-cholesterol, yet these cholesterol-rich LDL particles are less likely to harm your blood vessels than cholesterol-depleted ones.(Hirayami 2012)

It’s noticeable that the true relationship between dietary saturated fat and omega-3 is thus the opposite of that described in influential early books about omega-3 fatty acids, such as Horrobin’s “The Madness of Adam and Eve” and Allport’s “The Queen of Fats”, which painted them as enemies, based on a priori assumptions.

Our diets used to be very low in omega 6 LA. This changed for two reasons – first we were told to replace animal fat with polyunsaturated vegetable oil for cooking because this would lower cholesterol and so reduce the risk of heart disease. But human experiments have never supported this idea. In particular, a meta-analysis of those trials replacing saturated fat with oils and foods high in LA (rather than omega 3 fats) found that the risk of heart disease and death was non-significantly increased in those trials that were properly controlled.(Hamley 2017)
The second reason is that more of our animal-based food today comes from animals fattened on grains. The fat of chickens and pigs fed on corn and soy waste can be very high in LA and higher in AA compared with the fat of the same animals in the past, and even ruminant fat gets higher in LA and AA, and lower in EPA and DHA, when sheep and cattle are fattened on grains.

Guyenet and Carlson analysed all the different studies done over the years measuring the fatty acid percentages of fat stores in samples from people in the USA and found “that adipose tissue LA has increased by 136% over the last half century and that this increase is highly correlated with an increase in dietary LA intake over the same period of time”.(Guyenet 2015)

Adipose LA in Sweden, for example, is significantly lower than in the USA – Scandinavians still eat plenty of meat and dairy fat, and when they do use plant oils prefer canola, which has 1/3 the LA content of soy or corn oil, or olive oil with 1/6 as much; they are also more likely to eat oily fish than Americans. The official recommended limit of saturated intake in some Scandinavian countries is significantly higher than the 10% of energy limit recommended in the USA, UK or NZ. The Swedes enjoy lower rates of obesity, type 2 diabetes, and heart disease than we do with a saturated fat limit which they seem to ignore.

As Clark et al stated in their hypothesis paper,

“…populations with diets characterized by a high omega-6/omega-3 ratio will see significantly larger health improvements from Cannabis use than those eating diets with more moderate ratios of omega-6/omega-3 FAs. This may explain some of the inconsistencies in the data on the metabolic impact of Cannabis use; for example, Cannabis use by Swedish populations may not have the same health impacts as Cannabis use by Americans due to the different dietary backgrounds and obesity rates of these populations.
Cannabis use in the United States appears to provide significant public health benefits due to partial or complete reversal of the metabolic dysregulation caused by the strongly elevated omega-6/omega-3 ratio of the American diet

(Note: If “cannabis use… appears to provide significant public health benefits” in a preventive sense, then the distinction between medicinal and recreational uses of the drug becomes a little blurred, as some medications, such as aspirin or statins, can be legally be prescribed to perfectly healthy people for their purported preventive effects, despite there not being strong evidence for such effects outweighing harms.)

Are governments blind to the possible harms of a high omega-6 intake? The New Zealand MOH is still recommending that high-omega 6 seed oils replace animal fats and coconut oil. Why?

Some public health experts still want us to have low cholesterol levels, despite a lack of evidence that the cholesterol effect of food (as opposed to genes or drugs) has any effect on disease risk.
Some also point to epidemiology in which higher linoleic acid intakes appear to be associated with benefit.
Unfortunately, this isn’t as reliable as it might be – the only foods that supply zero LA are sugar, alcohol, and highly refined flour. The less of these foods you consume, the better – and the higher your LA intake will be. None of these studies separates out the LA consumed from seed oils, as opposed to chicken or nuts and seeds, foods which might reasonably be expected to keep you healthy for other reasons than the type of fat they contain – there is no epidemiology of seed oils. How do you even measure cooking oil accurately in a questionnaire? Those takeaway chips you ate last week – do you remember what they were fried in?

But despite only weak evidence for benefit, plenty of negative evidence, and growing evidence of harm, the push continues. In 1987 the government of Mauritius introduced a raft of health measures, most of which were sensible (smoking, exercise, blood pressure control) but also ordered that soy oil replace palm oil in the cheap “ration” oil used for cooking by most people. 5 years later public health experts applauded a decrease in saturated fat intake, a large increase in polyunsaturated fat, and lower cholesterol levels.(Uusitalo 1996) But what was the outcome 10, 20 years later? Cardiovascular mortality increased a bit, BMI increased– and the prevalence of type 2 diabetes increased from 12.8% in 1987, to 15.2% in 1992, and 17.9% in 1998.(Morrell 2019, Söderberg 2005) Mauritius is now fighting the same type 2 diabetes epidemic seen in most other countries after seed oils were introduced. Yet the government of Fiji imposed a tax on palm oil in 2015 to try to get the same outcome, citing the Mauritius experiment as if it had been successful – because no-one involved had published anything suggesting that it wasn’t.(Coriakula 2018)
But while governments and establishment public health experts may appear to be blind to this problem, behind the scenes efforts to lower the amount of omega-6 in the food supply have been going on for decades. These initiatives include the development of canola and more recently the breeding of “high-oleic” oil seeds that are much lower in omega-6. For example, recently Pic’s peanut butter and peanut oil switched to using a high-oleic peanut, and these products now contain a far lower dose of linoleic acid than most other brands.
At present high-oleic oils and nut butters cost a bit more. The linoleic acid in the food supply, found in cheap oils, margarines and mayonnaise, and deep fried food, especially chicken (the cheapest meat), is tilted towards the diets of the poor, and alongside the similarly cheap refined carbohydrates is doing them no favours, whatever diet epidemiology, which is generally done in more privileged populations, might say.

Is this theory relevant to the psychotropic uses of cannabis in modern society?
I haven’t researched this question deeply, but here are some pointers -

The omega-3/6 balance also influences inflammation and pain perception; a high omega-3 and low omega-6 diet in people with chronic headache reduced pain. The control group restricting omega-6 alone, with no extra omega 3, had a lesser reduction in pain and saw some raising of EPA in the blood, but did not experience the drop in AA that was seen in the omega-3 arm.(Ramsden 2013, Taha 2014) Of course, pain relief is an important use of cannabis.

Omega-3 fatty acids supress some effects of PTSD in animals, and Hibbeln and Gow, writing in the journal of Military Medicine, proposed that improving the omega-3/6 ratio in military rations would reduce depression, suicide, and impulsive aggression among US troops.(Hibbeln 2014) In a case-control study, low DHA status was more strongly associated with suicide in US troops than having witnessed the death or wounding of colleagues in combat (OR 1.62 vs 1.54).(Lewis 2011)

There’s an interesting study on the effect of cannabis use during CBT therapy for PTSD and substance use disorders – “results revealed a crossover lagged effect, whereby higher cannabis use was associated with greater PTSD symptom severity early in treatment, but lower weekly PTSD symptom severity later in treatment. Cross-lagged models revealed that as cannabis use increased, subsequent primary substance use decreased and vice versa”.(Ruglass 2017)

A high-dose EPA supplement in children with ADHD aged 6-18 significantly improved measures of attention and vigilance in those subjects with low EPA at baseline.(Chang) A trial of Sativex in adults with ADHD found “nominally significant” improvement in some measures tested, not contradicting the anecdotal reports from this population of cannabis users.(Cooper)

Acetaminophen (paracetamol) is a painkiller that enhances cannabinoid signalling through CB1 receptors in the pain centre of the brain.(Klinger-Gratz 2018) Paracetamol also reduces the pain of social rejection, empathy for the pain of others, and the experience of existential angst after exposure to material that provokes what psychologists call a “meaning threat”, defined as “whenever one is assaulted by thoughts and experiences that are at odds with one’s expectations and values” - represented in the experiment by the films of David Lynch played to people who hadn’t seen them before!(Mischkowski 2016, Slavich 2019, Randles 2013)

And now we’re getting into deep psychological and sociological territory indeed. Has the remodelling of diets (and reformulation of infant formulas) since the 1970s altered our social functioning? Should it join the long queue of factors proposed to account for our current malaise? Or has David Lynch just made too many films?

More research is needed.
But one thing does seem clear – for good or bad, cannabis probably is an appropriate medication for our times, and the widespread modern awareness of its efficacy may have complex roots in the recent history of our society.


Alvheim, A. R., Malde, M. K., Osei‐Hyiaman, D. , Hong, Y. H., Pawlosky, R. J., Madsen, L. , Kristiansen, K. , Frøyland, L. and Hibbeln, J. R. (2012), Dietary Linoleic Acid Elevates Endogenous 2‐AG and Anandamide and Induces Obesity. Obesity, 20: 1984-1994. doi:10.1038/oby.2012.38

Banni, S. and Di Marzo, V. (2010), Effect of dietary fat on endocannabinoids and related mediators: Consequences on energy homeostasis, inflammation and mood. Mol. Nutr. Food Res., 54: 82-92. doi:10.1002/mnfr.200900516

Chang, J.P., Su, K., Mondelli, V. et al. High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD) and low endogenous EPA levels. Transl Psychiatry 9, 303 (2019) doi:10.1038/s41398-019-0633-0

Clark TM, Jones JM, Hall AG, Tabner SA, Kmiec RL. Theoretical Explanation for Reduced Body Mass Index and Obesity Rates in Cannabis Users. Cannabis Cannabinoid Res. 2018;3(1):259–271. Published 2018 Dec 21. doi:10.1089/can.2018.0045

Cooper RE, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol. 2017 Aug;27(8):795-808. doi: 10.1016/j.euroneuro.2017.05.005. Epub 2017 May 30.

Coriakula J, Moodie M, Waqa G, Latu C, Snowdon W, Bell C. The development and implementation of a new import duty on palm oil to reduce non-communicable disease in Fiji. Global Health. 2018;14(1):91. Published 2018 Aug 29. doi:10.1186/s12992-018-0407-0

Dabadie H, Peuchant E, Bernard M, LeRuyet P, Mendy F. Moderate intake of myristic acid in sn-2 position has beneficial lipidic effects and enhances DHA of cholesteryl esters in an interventional study. J Nutr Biochem. 2005 Jun;16(6):375-82

Dias, C., Wood, L. & Garg, M. Effects of dietary saturated and n-6 polyunsaturated fatty acids on the incorporation of long-chain n-3 polyunsaturated fatty acids into blood lipids. Eur J Clin Nutr 70, 812–818 (2016) doi:10.1038/ejcn.2015.213

Drouin G, Catheline D, Sinquin A, et al. Incorporation of Dairy Lipids in the Diet Increased Long-Chain Omega-3 Fatty Acids Status in Post-weaning Rats. Front Nutr. 2018;5:42. Published 2018 May 23. doi:10.3389/fnut.2018.00042

Garg ML, Wierzbicki AA, Thomson ABR, Clandinin MT. Dietary saturated fat level alters the competition between α-linolenic and linoleic acid. Lipids 1989; 24: 334–339

Gibson RA, Musings about the role dietary fats after 40 years of fatty acid research. Prostaglandins Leukot Essent Fatty Acids. 2018 Apr;131:1-5. doi: 10.1016/j.plefa.2018.01.003. Epub 2018 Jan 6.

Guyenet SJ, Carlson SE. Increase in adipose tissue linoleic acid of US adults in the last half century. Adv Nutr. 2015;6(6):660–664. Published 2015 Nov 13. doi:10.3945/an.115.009944

Hamley, S. The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials. Nutr J 16, 30 (2017) doi:10.1186/s12937-017-0254-5

Hibbeln JR, Gow RV. The Potential for Military Diets to Reduce Depression, Suicide, and Impulsive Aggression: A Review of Current Evidence for Omega-3 and Omega-6 Fatty Acids, Military Medicine, Volume 179, Issue suppl_11, November 2014, Pages 117–128,

Hirayama S, Miida T. Small dense LDL: an emerging risk factor for cardiovascular disease. Clin Chim Acta 2012; 414: 215–224.

Klinger-Gratz PP, Ralvenius WT, Neumann E, et al. Acetaminophen Relieves Inflammatory Pain through CB1 Cannabinoid Receptors in the Rostral Ventromedial Medulla. J Neurosci. 2018;38(2):322–334. doi:10.1523/JNEUROSCI.1945-17.2017

Lewis MD, Hibbeln JR, Johnson JE, Lin YH, Hyun DY, Loewke JD. Suicide deaths of active-duty US military and omega-3 fatty-acid status: a case-control comparison. J Clin Psychiatry. 2011;72(12):1585–1590. doi:10.4088/JCP.11m06879

Madsen L, Kristiansen K. Of mice and men: Factors abrogating the antiobesity effect of omega-3 fatty acids. Adipocyte. 2012;1(3):173–176. doi:10.4161/adip.20689

Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Soc Cogn Affect Neurosci. 2016;11(9):1345–1353. doi:10.1093/scan/nsw057

Morrell, S., Taylor, R., Nand, D. et al. Changes in proportional mortality from diabetes and circulatory disease in Mauritius and Fiji: possible effects of coding and certification. BMC Public Health 19, 481 (2019) doi:10.1186/s12889-019-6748-7

Naughton SS, Mathai ML, Hryciw DH, McAinch AJ. Fatty Acid modulation of the endocannabinoid system and the effect on food intake and metabolism. Int J Endocrinol. 2013; 2013:361895. doi:10.1155/2013/361895

Ramsden CE, Faurot KR, Zamora D, et al. Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain. 2013;154(11):2441–2451. doi:10.1016/j.pain.2013.07.028

Randles D, Heine SJ, Santos N. The common pain of surrealism and death: acetaminophen reduces compensatory affirmation following meaning threats. Psychol Sci. 2013 Jun;24(6):966-73. doi: 10.1177/0956797612464786. Epub 2013 Apr 11.

Ruglass LM, Shevorykin A, Radoncic V, et al. Impact of Cannabis Use on Treatment Outcomes among Adults Receiving Cognitive-Behavioral Treatment for PTSD and Substance Use Disorders. J Clin Med. 2017;6(2):14. Published 2017 Feb 7. doi:10.3390/jcm6020014

Simopoulos AP. Dietary omega-3 fatty acid deficiency and high fructose intake in the development of metabolic syndrome, brain metabolic abnormalities, and non-alcoholic fatty liver disease. Nutrients. 2013;5(8):2901–2923. Published 2013 Jul 26. doi:10.3390/nu5082901

Slavich GM, Shields GS, Deal BD et al. Alleviating Social Pain: A Double-Blind, Randomized, Placebo-Controlled Trial of Forgiveness and Acetaminophen. Ann Behav Med. 2019 Dec; 53(12): 1045–1054.

Söderberg S, Zimmet P, Tuomilehto J, de Courten M, Dowse GK, Chitson P, Gareeboo H, Alberti KG, Shaw JE. Increasing prevalence of Type 2 diabetes mellitus in all ethnic groups in Mauritius. Diabet Med. 2005 Jan;22(1):61-8.

Taha AY, Cheon Y, Faurot KF, et al. Dietary omega-6 fatty acid lowering increases bioavailability of omega-3 polyunsaturated fatty acids in human plasma lipid pools. Prostaglandins Leukot Essent Fatty Acids. 2014;90(5):151–157. doi:10.1016/j.plefa.2014.02.003

Uusitalo U, Feskens EJM, Tuomilehto J, Dowse G, Haw U, Fareed D, et al. Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey. BMJ 1996;313:1044­6.

van Zuuren EJ, Fedorowicz Z, Kuijpers T, Pijl H, Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments, The American Journal of Clinical Nutrition, Volume 108, Issue 2, August 2018, Pages 300–331

Watkins BA, Kim J. The endocannabinoid system: directing eating behavior and macronutrient metabolism. Front Psychol. 2015;5:1506. Published 2015 Jan 6. doi:10.3389/fpsyg.2014.01506