jet

• Over ~12 months, a few intervention thoughts; focus on evidence and questions at the end.
• Relative had a minor heart attack; cath/angiogram team attempted a stent without prior consent; another patient learned a stent was placed without warning.
• Informed consent is an ethical and professional obligation.
• Consent is not only risks; it also includes realistic benefits and when benefits may be absent.
• Transparent benefit discussion would lead some people to decline some interventions.

Aspirin example: primary prevention drifted ahead of evidence

• Aspirin was recommended for decades for primary prevention until a large "Aspirri" trial found no longer life and substantial harms; routine primary-prevention advice shifted.
• Proving "better than nothing" requires placebo-controlled trials, not comparisons against another active agent.
• A secondary-prevention meta-analysis reviewed >250 papers and recommended lifelong aspirin after heart attack.
• Only a small subset of those trials compared aspirin to placebo.
• Surrogate outcomes are not enough; all-cause mortality is the cleanest outcome when available.
• In the placebo-controlled all-cause-mortality trials, most showed no benefit; the one with benefit used aspirin for about 4 weeks.
• Short-term post-MI clotting risk makes a short-course antiplatelet effect plausible, but that does not justify automatic lifelong use.

Surrogates vs outcomes that matter

• Blood pressure and cholesterol changes are surrogate markers; lower numbers are not automatically safer in every context.
• Evaluate interventions by outcomes that cannot be massaged: all-cause mortality.

Stents and PCSK9 inhibitors under the same standard

• Two large randomized trials with thousands comparing stenting vs no stenting show no mortality benefit and more early adverse events with stenting.
• PCSK9 inhibitors reliably lower cholesterol, but cholesterol is a surrogate; no demonstrated all-cause-mortality benefit on average.

Doctor as teacher; patient as decision-maker

• "Doctor" means teacher; the job is education plus support for the patient's choice.
• Communicate benefits and harms using absolute risk, not relative-risk spin.
• Example: 1% to 2% can be sold as "100% higher", but the absolute change is 1 percentage point.
• Focus on outcomes that matter to patients, especially mortality when data exist.

Uncertainty and population gaps

• Some clinicians reject "difficult" patients; time limits are real, but informed consent still includes evidence on risks and benefits.
• Patient-provided papers can change clinical practice.
• Many drug trials have few or no South Asians, especially women; risk calculators like "MISA" omit South Asians.
• When evidence is missing or unclear, be direct about uncertainty and let the patient decide with the best available data.

References

• [00:03] Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly — https://doi.org/10.1056/NEJMoa1805819

• Simon Thornley is an epidemiologist who uses numbers to decide what works and what does not in medicine.
• The talk collects nutrition topics from recent months: diet evidence, fasting, and major new weight-loss drugs.

Network meta-analysis for diet evidence

• Pair-wise meta-analysis compares one option against another; network meta-analysis links many options through shared comparators.
• Direct and indirect comparisons combine into a single network that ranks many diets at once.
• P-score ranks the chance that one diet beats the rest; a diet network meta-analysis puts low carbohydrate at about 0.9.
• Meta-analyses depend on inputs, yet many syntheses place keto/low carbohydrate ahead of low fat and Mediterranean patterns. Fasting and time-restricted eating
• Fasting is used as a way to rest the pancreas; solid academic evidence is scarce.
• A time-restricted eating trial with an 8-hour window (12 to 8) beats calorie restriction by about two-fold.

Carnivore diet survey paper

• Evidence in journals is sparse; a recent US paper by David S Ludwig and colleagues surveys adults on a carnivore diet.
• Recruitment runs through social media; eligibility is age ≥18 and carnivore diet duration ≥6 months.
• Mean BMI drops about 2.9 units, about 9.2 kg for a 1.78 m person.
• The survey answers include LDL rising, which supports honesty on other outcomes such as weight loss.

LDL thresholds and cardiovascular risk

• LDL cut-points sit far left on the distribution, so many people fall into the "abnormal" zone.
• Low LDL cut-points support a large market for lipid-lowering drugs.
• LDL links weakly with cardiovascular events in risk prediction; triglycerides track cardiovascular risk more strongly and move in the right direction on carnivore.

Drug effect size metrics and survival time

• Wegovy and similar drugs are promoted heavily at conferences; benefit numbers often use relative effects like 19% for all-cause mortality.
• Absolute effects matter: 0.44% absolute risk reduction maps to NNT ≈225 over 4 years to avert one death.
• Restricted mean survival time uses the area between Kaplan–Meier curves to express average survival gain as time.
• For one GLP-1 drug, 4 years of use yields about one week of average survival gain.
• For statins, 6 months to 6 years of use yields about one to three weeks of average survival gain in industry-funded trials.
• For dulaglutide, 6 years of use yields about 17 days of average survival gain; cost is about $500/month for one GLP-1 example.

Wrap-up

• Network meta-analysis helps sort nutrition evidence across many diet options.
• Early data on carnivore looks strong; LDL alarm is amplified by low thresholds.
• Restricted mean survival time makes drug benefits easier to understand as days or weeks of survival.

References

• [00:07] Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a "Carnivore Diet" — https://doi.org/10.1093/cdn/nzab133

At our grocery stores and dinner tables, even the most thoughtful consumers are overwhelmed
 by the number of considerations to weigh when choosing what to eat—especially when it comes to meat. Guided by the noble principle of least harm, many responsible citizens resolve the ethical, environmental and nutritional conundrum by quitting meat entirely. But can a healthy, resilient and conscientious food system exist without animals?

Sacred Cow probes the fundamental moral, environmental and nutritional quandaries we face in raising and eating animals. In this project, we focus our lens on the largest and perhaps most maligned of farmed animals, the cow.

COMMON ASSUMPTIONS ABOUT MEAT...

• Red meat causes cancer, obesity and heart disease. 

• We’re eating too much meat.
• Humans don’t need to consume animal products to be healthy. 

• Raising livestock is bad for the environment.

• It’s unethical to eat animals. 

• If we can produce meat in labs, then why should we eat animals? 


The connection between nutrition and ecosystem health is starting to make some headway into mainstream media. Everyone is trying to figure out how to feed the world in the most sustainable and healthy way. However, we've allowed corporate interest, big food, flawed science, click-bait media and naïve celebrities to steer us away from what a truly nutrient-dense, ethical and sustainable, and regenerative food system really is. The mantra that “all meat is bad” influences how we're training dietitians, shaping our dietary guidelines, designing school lunch policies, and funding for nutrition-related research.

As we’ve become more globalized, the entire world is now pushing towards the "heart healthy" (and highly processed) Western diet. In the process, we're destroying entire ecosystems and human health through industrial, ultra-processed food.

Sacred Cow comes at a critical point in the nutrition and sustainability story. A meat tax is a very real possibility. Well intended yet highly misguided, The EAT Lancet Global Dietary Guidelines are calling for less than 1/2 an ounce of red meat per day, for human and planetary health.

Meat is being vilified as causing cancer, heart disease and diabetes, yet there are no solid studies to back this up. Meanwhile, Silicon Valley has invested millions in highly processed meat alternatives, with the assumption that engineering our proteins in factories will be a better alternative to something nature has already figured out: grazing animals, restoring land while converting cellulose into protein.

The solution is regenerative agriculture.

The truth is, well-managed cattle are the unlikely heroes of this story. We can increase biodiversity, improve soil health, increase the water holding capacity of the land and raise high quality, nutrient-dense protein, while preserving family farming communities. Removing these animals from our food system could cause more harm than good. It’s not the cow, it’s the how.

• Meat should be traceable: farm, breed, and slaughter conditions should be known.
• Butchery should use the whole animal (nose-to-tail) so nothing is wasted.
• Local processing quality matters; farmers can control the animal’s life but often not its final day.

How industrial food became dominant

• Post–World War II agriculture scaled up through chemicals, monocultures, and efficiency goals.
• Processed food engineering amplified sugar/salt/flavor to drive repeat consumption.
• Public messaging shifted toward low-fat eating while ultra-processed foods expanded.

Health narratives around fat, meat, and processing

• Low-fat guidance did not prevent rising obesity, diabetes, and metabolic disease.
• Processed meats were framed as cancer-causing; red meat was framed as risky too.
• Nutrition guidance strongly shapes institutions (schools, healthcare) and food programs.

Plant Based identity, nutrient gaps, and personal health fallout

• Plant Based can become identity, making counter evidence hard to absorb.
• Some people do well for a time; many later develop health problems and leave the diet.
• Animal foods provide or simplify access to B12, bioavailable iron/zinc, EPA/DHA, and other nutrients.
• Supplements are a weak substitute in settings without clinicians, pharmacies, or supply chains.

Limits of observational nutrition claims

• Correlations between red meat and disease can reflect confounding behaviors (smoking, inactivity, low produce intake).
• Meat eaten within a whole-food, plant-rich pattern is not inherently harmful.
• Processed food is treated as the main driver behind modern chronic disease patterns.

Ethics conflict and activism pressure

• Activists targeted a butcher shop with protests and demanded public messaging concessions.
• The clash is shared opposition to factory farming but divergent solutions.

Alternatives to livestock: lab meat and plant-based substitutes

• Lab-grown and highly processed substitutes still depend on industrial crop inputs and fossil-fuel supply chains.
• Marketing is disguising the material inputs, processing, and ecological costs.

Regenerative grazing, soil, water, and biodiversity

• Managed grazing is rebuilding soil structure, water infiltration, and ecological function.
• Ruminants are co-creators of grassland soils via trampling, manure, and plant regrowth cycles.
• Portable infrastructure and multi-species rotations are stacking functions per acre.

Methane framing: biogenic vs fossil carbon

• Enteric methane is part of a short carbon cycle with ~10-year atmospheric lifetime.
• Fossil methane is adding ancient carbon and driving net atmospheric imbalance.

Land-use constraints and “marginal land” framing

• A large share of agricultural land is unsuitable for cropping but usable for grazing.
• Removing ruminants is creating a nutrient-dense food gap and degrading ecosystem function.

Desertification and restoration

• Poor management is accelerating erosion and water damage over decades.
• Rancher collectives are restoring grasslands and springs at very large scale.

Nutrition equity and child outcomes

• Adding small amounts of meat to children’s diets is improving school performance (45% figure).
• A proposed global dietary pattern restricting animal foods is unfair to regions needing more animal-source nutrients.

• Cancer growth follows chronic mitochondrial injury and disordered energy metabolism, not an initiating nuclear gene mutation.
• Tumor cells shift ATP production away from oxidative phosphorylation and toward substrate-level phosphorylation and fermentation.
• The somatic mutation theory dominates cancer care, and that focus blocks metabolic targeting.

Evidence base

• Nuclear–mitochondrial transfer experiments: normal nucleus placed into tumor cytoplasm yields tumor; tumor nucleus placed into normal cytoplasm yields normal growth control.
• Driver mutations can exist without forming cancer, so mutations do not explain initiation by themselves.
• Environmental exposures and inherited risk interact, so separating “genes” from environment in real people is difficult.
• Hereditary cancer syndromes align with impaired oxidative phosphorylation in a recent Oncology paper with Bob Kaplan.
• Keeping cancer as a gene-only problem leaves about 1,700 people per day dying from cancer in the US.

Fuel logic and therapeutic targets

• The two fuels driving dysregulated tumor growth are glucose and the amino acid glutamine.
• Tumor cells cannot shift to ketone bodies or fatty acids the way healthy cells can.
• Cutting fermentable fuel availability and blocking glutamine use is the direct way to stress tumor metabolism.

Metabolic therapy: baseline approach

• Nutritional ketosis and water-only fasting lower glucose, raise ketones, and reduce inflammatory drive in tumors.
• The glucose–ketone index (GKI) tracks the glucose-to-ketone ratio as a single number to monitor metabolic pressure.
• Achieving ketosis is harder in modern food environments because sugar and ultra-processed foods are engineered for craving and convenience.

Combining metabolic therapy with standard care

• Metabolic therapy is non-toxic in practice; people generally get healthier during it.
• Chemo, radiation, and immunotherapy remain options, but metabolic control first aims to shrink and de-inflame the tumor.
• After the tumor burden and inflammation drop, smaller doses of standard agents can be used with less collateral damage.
• Some immunotherapies help some people, and they also can cause hyperprogressive disease and death; metabolic therapy avoids that risk profile.

Antiparasitic drugs and cancer

• Mebendazole and fenbendazole can hit cancer metabolism because parasites and tumor cells share a survival pathway.
• The shared pathway is mitochondrial substrate-level phosphorylation, fermentation inside mitochondria.
• In pediatric high-grade glioma work, antiparasitic drugs paired with nutritional ketosis are a practical, low-cost direction.
• “Cancer is a parasite” is rejected; parasites are different organisms, even when drug targets overlap.

Obesity, inflammation, and GLP-1 drugs

• Weight alone is less informative than inflammation; some people carry weight without chronic inflammatory drive.
• Ultra-processed carbs and sugar push inflammation; removing them and using fasting or ketosis pulls it down.
• GLP-1 drugs can reduce appetite and body weight, and they do not fix the food environment that drove the problem.
• When lifestyle change fails for years, GLP-1 drugs can be a last-resort tool to break the cycle.

Industry and incentives

• Cancer care is a revenue generator, with multi-billion-dollar drug markets anchored to the genetic model.
• Drug advertising spends heavy time on fatal risks, and metabolic therapy remains underused despite low toxicity.
• A “firewall of ignorance” exists across patients and caregivers who do not read or understand the scientific literature.

Virus, vaccines, and “turbo cancer” talk

• SARS-CoV-2 infection damages mitochondria and can contribute to downstream chronic disease.
• Sorting vaccine damage from virus damage is hard when many people experienced both.
• Regardless of trigger, metabolic behavior is the same: fermentation of glucose and glutamine.
• No clinical trial targets glucose and glutamine together while maintaining nutritional ketosis.

Risk reduction starting now

• Exercise is the top lever for mitochondrial health.
• Reduce ultra-processed foods, especially addictive sugar, and favor more natural foods even when cost is higher.
• Sleep, social connection, and reducing sedentary “doom scrolling” support healthier mitochondria.
• Chronic disease occurs at younger ages, with type 2 diabetes and obesity in children as warning signals.

References

• [00:01] Cancer as a Metabolic Disease: On the Origin, Management and Prevention of Cancer — https://doi.org/10.1002/9781118310311
• [00:03] Hereditary cancer syndromes linked to oxidative phosphorylation insufficiency — https://doi.org/10.1515/oncologie-2025-0301
• [00:12] The glucose ketone index calculator: a simple tool to monitor therapeutic efficacy for metabolic management of brain cancer — https://doi.org/10.1186/s12986-015-0009-2
• [00:19] Ketogenic diet as a metabolic vehicle for enhancing the therapeutic efficacy of mebendazole and devimistat in preclinical pediatric glioma — https://doi.org/10.1101/2023.06.09.544252

• Humans do not require dietary carbohydrates to survive or thrive.
• For over two million years, humans lived as apex predators with long periods of minimal plant intake.
• Populations in Arctic regions survived ice ages with virtually no access to carbohydrate-rich plants.

Glucose Without Carbs

• The body produces necessary glucose through gluconeogenesis.
• Essential tissues like red blood cells receive glucose synthesized from protein and fat.
• There is no dietary carbohydrate that is biologically essential in the way essential amino acids and fatty acids are.

Carbohydrates and Modern Disease

• High carbohydrate intake drives chronically elevated insulin in many people.
• Persistent hyperinsulinemia contributes to insulin resistance, obesity, and metabolic syndrome.
• Reducing carbohydrates lowers insulin and allows stored body fat to be used for energy.

Fiber and Plant Foods

• Fiber is not required for bowel function when diet is based on animal foods.
• Many digestive complaints attributed to low fiber resolve when irritants are removed.

Performance and Energy

• Fat adaptation provides stable energy without blood sugar spikes and crashes.
• Ketones and fatty acids supply the majority of fuel needs in low-carbohydrate states.