A Learning a Day

“Meetings are indispensable when you don’t want to do anything.”| John Kenneth Galbraith (quoted in Poor Charlie’s Almanack)

I thought this’d be a good one as we start the week and contemplate the meetings we want to organize or attend. :-)

After 40 years of running experiments on the impact of diets on nutrition and health, Stanford University’s Christopher Gardner came to a simple conclusion – diet wars are a distraction.

I loved this distillation of the five lessons he shared –

(1) No single diet wins across the board. Low-carb, low-fat, vegan, and Mediterranean diets all produce similar average outcomes when matched for quality.

(2) Individual variation in response to diet is enormous – and mostly unexplained by genetics, insulin status, or any other single factor researchers have identified.

(3) Added sugar and refined grains are the dietary factors with the clearest, most consistent evidence for harm – and the ones most worth reducing regardless of which diet pattern you follow.

(4) The best diet for you is the one you can sustain. But that doesn’t mean the standard American diet – it means finding the highest-quality version of an eating pattern you can actually stick to long-term.

(5) There is more scientific consensus around the fundamentals of healthy eating than headlines suggest. Eat whole foods, plenty of vegetables, and legumes. Avoid added sugar and refined grains. Nearly every serious dietary framework agrees on this.

Dr Eric Topol wrote about a big milestone recently – Cardiology professional organizations have finally recognized that Apo(B) and Lp(a) should be part of the lipid panel.

After reading Dr Attia’s Outlive, I’d asked for these as part of my panel. But I’d been denied – so here’s hoping that changes. In his words – “Think of how many people would have been identified at high-risk for atherosclerosis and cardiovascular events who were missed all this time because the guidelines didn’t keep up with the body of knowledge.“

Dr Topol’s post goes on to advocate for the CHIP test as part of the lipid panel.

CHIP, which stands for clonal hematopoiesis of indeterminate potential, refers to presence of myeloid blood cells with a driver gene mutation (with a frequency of ≥ 2%) without any clinical criteria of a blood cancer. It turns out CHIP is a major biomarker, not just for blood cancer (an 11-fold risk of a blood malignancy, or absolute 0.5% risk per year), but also for heart disease, blood clot events such as stroke and pulmonary embolism, and many other chronic illnesses 

He makes the case with a simple chart that shows that the risk of heart rate with CHIP present goes up 1.8x.

You can also see the trend clearly here.

I’m hoping we’ll continue to see more testing here and will hopefully see it in the guidelines sooner than 8 years later.

Sid Sijbrandij (pronounced “see-brandy”), the co-founder of GitLab, was diagnosed with bone cancer and found himself running out of treatment options when the cancer returned in 2024.

After doctors essentially told him “good luck,” he decided to take ownership. What followed was impressive – He assembled a team, built a 1,000+ page health document modeled after the GitLab Handbook, and pursued what he calls “maximal diagnostics” – doing every test available, as often as possible.

Armed with that data, he identified experimental therapies, navigated the FDA for compassionate use access, and flew to Germany for a cutting-edge radioligand therapy that targeted his specific tumor markers. His cancer is now in remission.

He has documented his entire journey here (this story has a lot of the details too).

While Sid is undoubtedly fortunate to have incredible resources as someone whose net worth is in the hundreds of millions of dollars (or more), this is a glimpse of where cancer care is heading – personalized diagnostics, custom therapies, AI-driven drug discovery. He also highlights the aspects of the system that are broken – e.g., getting his own tissue samples and genomic data.

And, as he called out, the basics are not prohibitively expensive.

We have more agency than we think – especially with the tools available to us today.

“If you want to improve, be content to be thought foolish and stupid.” | Epictetus

Epictetus had another note that made the same point – “It is impossible to being to learn that which one thinks one already knows.”

It is easy to say “I want to learn.” It is much harder to be committed to being okay with being thought as foolish and stupid. That is a lot of discomfort to endure.

It is why learning is hard.

“In any great organization it is far, far safer to be wrong with the majority than to be right alone.” | John Kenneth Galbraith (quoted in Poor Charlie’s Almanack)

I discovered a collection of pithy and wise quotes from economist John Kenneth Galbraight.

This was one of those – so true.

There’s a short clip on the intense interaction between Maryland coach Brenda Frese and her star player Oluchi Okananwa that went viral.

After a bad third quarter stretch for Okananwa, Frese told her, “I need you to lock in. Stop being distracted. I believe in you, but you’ve got to want this moment. This is not my story.”

It sparked the turnaround she wanted and they went on to win. Both Frese and Okananwa reflected on that moment as just another day in their relationship.

The best players want their coaches to hold a high bar, and the best coaches hold a high bar.

Charlie Munger had a guiding philosophy on checklists: “No wise pilot, no matter how great his talent and experience, fails to use his checklist.”

His investing checklist reflects that same discipline:

• Risk – begin every evaluation by measuring risk, especially reputational
• Independence – only in fairy tales are emperors told they are naked. You need independence of thought to ensure you aren’t just following the crowd blindly.
• Preparation – the only way to win is to work, work, work, and hope for a few insights.
• Intellectual humility – acknowledging what you don’t know is the dawning of wisdom
• Analytical rigor – the scientific method and effective checklists minimize errors
• Allocation – proper allocation of capital is the investor’s number one job
• Patience – resist the human bias to act
• Decisiveness – when the right circumstances present themselves, act with conviction
• Change – accept unremovable complexity
• Focus – keep things simple and remember what you set out to do

Easy to say. Really hard to do.

But underneath it all, Munger’s approach distills to four things: extreme preparation (work, work, work, work), consistent discipline, patience, and decisiveness.

Applies just as much to investing as it does to life.

“We are all permeable to the influence of the group. What makes us more permeable is our insecurities. The less we are certain about our self-worth as individuals, the more we are unconsciously drawn toward fitting in and blending ourselves into the group spirit. Gaining the superficial approval of group members by displaying our conformity, we cover up our insecurities to ourselves and to others.

But this approval is fleeting; our insecurities gnaw at us, and we must continually get people’s attention to feel validated. Your goal must be to lower your permeability by raising your self-esteem.

If you feel strong and confident about what makes you unique – your tastes, your values, your own experience – you can more easily resist the group effect. Furthermore, by relying upon your work and accomplishments to anchor your self-opinion, you won’t be so tied to constantly seeking approval and attention.” | Robert Greene in “The Laws of Human Nature”

A simple, well stated truth. Applies well beyond truth to authority figures and even family.

Our insecurities never fail to show up – in what we do, in who we choose to do it with, and in the way we talk about ourselves and what we do.

Someone told us recently they were considering an electric car. Knowing we had an electric car for almost 8 years now, they asked us for our recommendation. It got me thinking about how to lay out the case.

Three things stand out.

The first is software. Electric vehicles are built technology-first, and the small stuff adds up fast. The car knows who’s driving. Mirrors, seat position, and climate are all automatic. The navigation is genuinely good. But the bigger point is that the car keeps getting better. Tesla, for example, pushes dozens of software updates. Features that didn’t exist at purchase continue to appear. When you build around software, improvement becomes continuous rather than generational.

The second is maintenance – or the near absence of it. A gas engine has nearly thousand moving parts – pistons, valves, transmission, exhaust, cooling system, fuel system. Each one is a potential failure point. An electric drivetrain has a fraction of that complexity with twenty or so parts. No oil changes, no timing belt, no catalytic converter. We’ve had ours a few years now. Maintenance has been close to nothing. That’s not anecdote – it’s physics.

The third is all about the math and this is where it gets interesting. If you take a comparable 28 MPG gas car as the benchmark (3.5 miles per kWh for the EV), here’s how the numbers look across a few places:

• Northern California (off-peak EV rate): ~7¢/mile electric vs ~17¢/mile gas. With solar covering a meaningful portion of charging, that drops closer to 4–5¢/mile.
• Texas: ~5¢/mile electric vs ~10¢/mile gas.
• Florida: ~5¢/mile electric vs ~13¢/mile gas.
• London: ~10¢/mile electric vs ~26¢/mile gas.
• Paris: ~7¢/mile electric vs ~24¢/mile gas.
• Mumbai: ~3¢/mile electric vs ~17¢/mile gas.

These figures are approximate and shift with energy markets (notwithstanding the war-driven oil shocks right now) and local taxes. The direction, though, is consistent. The gap is narrowest in Texas and widest in Europe – but across every location above, electric comes out 2–3x cheaper per mile.

In sum, you now have technology that enables a car to be personalized and to keep improving through software. It means virtually no maintenance. And, most importantly, it has a per-mile cost that’s 2–3x lower at minimum than gas, pretty much anywhere in the world.

There’s nothing like simple math to help make better decisions.