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Ruh-roh. (Photo Credit: We Love Costa Rica)

Following our Paleolithic ancestors, our Neolithic ancestors lost an average of six inches in height. Most people now have those last 5-10 pounds that seem impossible lose. The causes for both, surprisingly, may be the same.

Robb Wolf can explain. Robb, a former research biochemist, has functioned as a review editor for the Journal of Nutrition and Metabolism and is co-owner of NorCal Strength & Conditioning, one of the Men’s Health “top 30 gyms in America.” He’s also a former California State Powerlifting Champion with a competition 565 lb. squat, 345 lb. bench, 565 lb. deadlift…

I have known of Robb for several years, but I only met him through a friend a week ago. Several weeks earlier, that same friend had sent me a copy of Robb’s book, The Paleo Solution, which I ended up devouring in a few sittings. The chapters on digestion and improving digestion were particularly fascinating to me, and, for that reason, this post is a book excerpt. It details a particular problem and specific solutions. Enjoy.

Enter Robb Wolf.

A Common Problem

Below I describe several people who at first glance appear different, but in fact they all share a common problem. They had significant health issues with no apparent cause or solution and assumed they had no treatment options, as their doctors were stumped and could offer few solutions.

For you, this chapter may represent the “missing link” in your quest for improved performance and health.

Alex, Age Five

I first learned of Alex from my friend Kelly. She related a story of a little boy who was very sick, underweight, and suffering from constant digestive problems. If you like kids and other small, scurrying critters, Alex’s features and symptoms were literally heartbreaking. He had painfully skinny arms and legs, attached seemingly at random to a torso dominated by a prominently distended belly. At night Alex thrashed and turned in his bed, wracked by diffuse pain in his arms, legs and, especially, his belly. Alex had severe lethargy and a “failure to thrive.” His doctors ran extensive tests but found nothing conclusive. They recommended a bland diet of toast, rice puddings, and yogurt, but with no benefit to the little guy.

Kelly contacted me on behalf of the family and asked if I had any ideas that might help Alex. I made a few specific recommendations, which the parents enacted immediately. Within ten days, Alex’s perpetually distended belly was flat and normal. He gained six pounds in a little over two weeks and was noticeably more muscular in the arms and legs. His sleep shifted from the thrashing, restless bouts that left him listless and tired, to the sleep all kids should have: restful, unbroken, and filled with dreams. Alex’s energy improved to such a degree that the other kids and parents could hardly imagine he was the same kid. He was healthy and happy, all because of a simple adjustment he and his family made to his eating.

Sally, Age Sixty-One

Sally was referred to us by her family physician. Sally’s doctor had worked with her on a variety of issues: low thyroid, osteoporosis, gall bladder problems, depression, and high blood pressure. It was an impressive and ever-growing list of ailments that both Sally and her doctor attributed to “normal” aging. Her doc was pretty forward thinking, however, in that she recommended that Sally perform “weight bearing exercise” to help slow the progression of the osteoporosis and muscle wasting that been accelerating in the past four to five years.

When this recommendation brought Sally to us, she was a bit reluctant to get started with a strength-training program and was very reluctant to modify or change her nutrition. We were gentle but persistent.

Our recommendations focused on specific changes to her nutrition and lifestyle. Within two months Sally was off her thyroid medications, her gall bladder issues were gone, she was four pants sizes smaller, while her symptoms of depression had disappeared. After six months of training with us and following our nutrition recommendations, it was discovered that she was no longer osteoporotic.

Of all the improvements, Sally’s doctor was most impressed with the increased bone density. She asked Sally what she had modified to affect this change. When Sally told her doctor how she had changed her nutrition, her doctor pondered things for a moment, then said, “Well, it must be something else! Food can’t do all that.”

Jorge, Age Forty

Jorge started working with us primarily to lose weight. At five feet nine inches and 325 pounds, Jorge was heading down a path of significant illness stemming from type 2 diabetes and obesity. Compounding Jorge’s situation was a condition neither he nor his doctors could figure out. Nearly every time Jorge ate, he would break out in a rash and his tongue would swell. Like really swell. Jorge had to keep an epi-pen on his person at all times, similar to someone who has a severe allergy to bee stings or peanuts.

Jorge is a practicing attorney and several times a week he would dash out of the courtroom on a mad trip to the emergency room, where he would receive antihistamines to bring his tongue swelling under control. His doctors were (again) stumped. His blood work did not show a specific allergy, nor did he appear to have a full-blown autoimmune disease. Certain immune cells were obviously overactive, but in an atypical fashion that left the allergists and rheumatologists scratching their heads.

We recommended a nutritional change for Jorge, which he fought tooth and nail. God has never made a person more appropriate to be an argumentative lawyer! Part begging, part threatening, we finally won Jorge over and told him, “Just do this for a month. If it does not work, what have you lost? If it does work, what will you have gained?”

Jorge gave things a shot and his tongue swelling disappeared. Now a year later, Jorge is down to 255 pounds and making headway toward his goal of a lean, strong 225 pounds. Thankfully, Jorge now argues for us instead of against us! Not to beat up on the physicians too much, but when Jorge told his docs what he changed, they too did not believe the cause and effect staring them straight in the face.

So, What Did We Do?

It will come as a surprise for most people that the underlying cause of all the issues described above, in these very different people, was the same thing—a common component in nearly everyone’s diet. Gluten.

Gluten is a protein found in wheat, rye oats, and barley. Other grains such as corn and rice have similar, but less problematic proteins (we will talk about that later).

OK, calm down, I get it. Bread, pasta, and cookies are yummy. They are also likely killing you. The other sections of this book I’m willing to give you a “pass” on understanding the technical points. Most people kinda get the insulin/high-carb issue. People are slowly realizing there are “good fats.” So, I’ll not hold you responsible for that material. However, I insist you read this grain issue, ponder it, and then do what I recommend.

We are going to learn the whole story about gluten, grains, and their roles in disease. I’ll then give you quantifiable measures for determining how much healthier you are without them. Then it’s all up to you. If you want to be healthy, you will find some level of compliance that works for you.

We have all seen pictures or videos of smokers dying from lung cancer yet still smoking through tracheotomy holes in their throats. Amazing, right? How can people do that? Well, gluten consumption is on par with a pack-a-day smoking habit.

Like most things, we need to start at the beginning.

Grains Anatomy

When I say “grain,” I am talking about one of many domesticated grasses in the gramineae family. This includes staples such as wheat, rye, oats, barley, millet, rice, and sorghum. These plants are derivatives or descendants from wild grasses that have been managed and bred for 2,000–5,000 years. All grains have the following anatomy:

The bran is the outer covering of a whole, unprocessed grain. It contains vitamins, minerals, and a host of proteins and antinutrients designed to prevent the predation, or eating, of the grain. When you see brown rice, the bran is the flakey outer covering of the rice.

The endosperm is mainly starch with a bit of protein. This is the energy supply of a growing grain embryo. When you see white rice, this is the endosperm with bran and germ removed.

The germ is the actual reproductive portion of the grain. This is where the embryo resides.

In the wild, the cereal grain is distributed by the wind, and when conditions are right, the germ (embryo) begins the process of growth using the endosperm for energy. It may come as a surprise, but plants are not benign, altruistic organisms just waiting to send their next generation of young into our mouths in the form of sushi rice or French bread. Grains, like all critters on this planet, face the challenge of surviving long enough to reproduce. This is particularly problematic for grains in that their most nutrient-dense portion (the part we eat) happens to be the reproductive structure.

Sidebar: Oats, Quinoa, and False Friends

Hey Robb, I appreciate your concern, but my dietician told me Oats are gluten-free, so no need to worry about my morning bowl of oatmeal? Yep, I love oatmeal too, but it contains similar proteins to gluten. Cereal grains tend to have proteins that are high in the amino acid proline. These prolamines (proline rich proteins) are tough to digest, and thus remain intact despite the best efforts of the digestive process to break them down. The result is gut irritation, increased systemic inflammation, and the potential for autoimmune disease.

Corn has a similar prolamine called zein. Now you can heed or disregard this information as you please, but grains are a significant problem for most people. Upon removal of these grains, you will notice that you feel better. With reintroduction of grains…well, you feel worse. Keep in mind this inflammation is also a factor in losing weight and looking good, so don’t dismiss this if your primary goal is a tight tush. What I’m asking you to do is take 30 days and eat more fruits and veggies instead of the grains. See how you do. Not so hard, right? And just to head you off at the pass, let’s tackle two other grain related topics: “Whole grains” and Quinoa.

When we factor in their anti-nutrient properties, and potential to wreck havoc on our GI tract, grains are not a sound decision for health or longevity. For the purposes of our discussion, consider dairy and legumes in the same category.

[Note from Tim: Many of you know that I consume some legumes and beans. Normal cooking will reduce anti-nutrients in both, but, when possible, I also soak them overnight beforehand in water with a tablespoon of baking soda. Soaking for 24 hours at room temperature has been shown to remove 66% of the trypsin (protease) inhibitor activity in mung bean, 93% in lentil (this is what I eat most often), 59% in chickpea, and 100% in broad bean. Remember also to distinguish “in vitro” (e.g. red blood cells in a petri dish) vs. “in vivo” (e.g. after normal digestion) studies.]

Quinoa pops up frequently and the refrain goes like this, “Robb! Have you tried this stuff Quinoa (the pronunciation varies depending on how big a hippy you are). It’s NOT a grain! It’s fine, right?”

Well, you’ve likely heard the expression, “If it looks like a duck and quacks like a duck…” Quinoa is botanically not a grain, but because it has evolved in a similar biological niche, Quinoa has similar properties to grains, including chemical defense systems that irritate the gut. In the case of Quinoa, it contains soap-like molecules called saponins. Unlike gluten, which attaches to a carrier molecule in the intestines, saponins simply punch holes in the membranes of the microvilli cells. Yes, that’s bad. Saponins are so irritating to the immune system that they are used in vaccine research to help the body mount a powerful immune response. The bottom line is if you think grains or grain-like items like Quinoa are healthy or benign, you are not considering the full picture.

One for Me and One for You

Some plants, like blueberries or similar fruits, have evolved a strategy of “give a little to get a little.” Critters (us included) eat these fruits, then pass the seeds in a convenient, warm fertilized package that all but guarantees the next generation. Sewage systems aside, this is a reasonable trade off. The critter that eats the blueberries gets a little nutrition in exchange for spreading the blueberry seeds for subsequent generations of blueberries.

Other plants take a different approach and try to dissuade all predation by shrouding themselves in nasty substances that are either irritants or outright poisons. Consider poison oak or poison ivy. These plants have developed chemical warfare capabilities and use oils that have a tendency to work their way through the skin of animals that come in contact with the leaves. This oil sets off an alarm that irritates the immune system. Lymphocytes and other white blood cells attack the oil and in the process release pro-inflammatory chemicals that lead to a rash. Keep this idea in mind as we talk about grains, as it will help you to wrap your mind around what is happening when we eat this “staple” food.

If we compare grains to the strategies listed above, “give a little, get a little,” like the blueberry, or “bugger off,” like the poison oak, we see that grains are much more like poison oak. If a critter eats a grain, that’s it for the grain. That does not mean that the grain goes down without a fight! Grains are remarkably well equipped for chemical warfare.

Grains contain a variety of proteins, some of which are called lectins (not to be confused with the hormone leptin). In simple terms, lectins stick to specific molecules and thus play “recognition” roles in biological systems.

For our purposes, we will look at wheat germ agglutinin (WGA), which is one of the nastier lectins, but also one of the better studied. Keep in mind, WGA (or similar molecules) are found in all grains, but it’s my opinion (and that of many other researchers) that wheat, rye, and barley, which are the gluten-containing grains, are likely the worst of the bunch with regard to health. Millet is similar to oats, in that it contains a protein only a few amino acids different from gliadin (the main problem in gluten), and it is therefore problematic for digestion. Be careful with “gluten-free” snack foods that seem too good to be true, millet-based or otherwise. Corn and rice can also be problematic, but they are safer if consumed infrequently (we will look at this later). WGA and similar lectins are problematic for several reasons:

  1. Lectins are not broken down in the normal digestive process. This leaves large, intact proteins in the gut. If you recall, most proteins are broken down in the digestive process, but the structure of some grain proteins makes them very difficult to digest (for the geeks: these proteins are high in the amino acid proline). Grains also contain protease inhibitors (dairy and some other foods also contain these), which further block the digestion of dangerous lectins. This lack of adequate protein digestion leads to serious problems, as you will see.

  2. The lectins attach to receptors in the intestinal lumen and are transported intact through the intestinal lining. Remember how amino acids and sugars are transported out of the intestines during digestion? Certain lectins “fool” transport molecules in an effort to gain entry into our bodies intact.

  3. These large, intact protein molecules are easily mistaken by the body as foreign invaders like bacteria, viruses, or parasites. It’s perhaps unpleasant to think about, but the intestines are not the nicest place to hang out. This area is a major source of infection by bacteria and viruses, and the immune system lies primed, waiting to pounce on any invading pathogen. Not only does WGA enter the system intact, it damages the intestinal lining, allowing other proteins to enter the system. Why is this a problem? Our immune system mounts an attack on these foreign proteins and makes antibodies against them. These antibodies are very specific to the shapes of these foreign proteins. Unfortunately, these proteins also tend to look like proteins in our body.

Brother from a Different Mother—Molecular Mimicry

Proteins are made of molecules called amino acids (AA). Let’s imagine for a minute these amino acids are represented by Legos, with different shapes and colors denoting different amino acids. Imagine a string of Legos with a specific sequence; let’s say its five to ten Legos long. Now imagine another, identical set of Legos attached on top of many more Legos. The top five to ten of the long piece is identical to the short piece.

Let’s assume the short piece is WGA and the long piece is a protein in the beta cells of your pancreas where insulin is made. If the WGA is attacked by the immune system and an antibody is made against it (because the body thinks WGA is a bacteria or virus), that antibody will not only attach to WGA, it can also attach to the protein in your pancreas. When that WGA antibody attaches to your pancreas, it precipitates a wholesale immune response—attacking that tissue. Your pancreas is damaged, or destroyed, and you become type 1 diabetic. If that protein happened to be in the myelin sheath of your brain, you would develop multiple sclerosis.

Most people are familiar with a condition called celiac, which is an autoimmune disease caused by gluten, a protein found in wheat, rye, barley, and millet. It is clearly understood that celiac is an autoimmune disease caused by lectins. It is also clear that other autoimmune diseases such as rheumatoid arthritis, lupus, Sjögren’s, multiple sclerosis, and a host of other autoimmune conditions occur at much higher rates in celiac patients. However, this association, for whatever reason, was largely dismissed as an anomaly until researchers recently made the connection between the development of celiac and other autoimmune diseases.

We now understood that WGA and other lectins have a significant effect on the enzyme transglutaminase (TG). Transglutaminase is an enzyme that modifies every protein we make in our body. How many proteins does TG modify folks? That’s right, all of them. Heart, brain, kidney, reproductive organs—all of them. So, if lectins can cause problems with TG, and if TG modifies every protein in our body, how many things can lectins cause problems with? I hope this is obvious—lectins can and do affect every organ system. Reproductive issues, vitiligo (a skin condition where the individual loses pigmentation in the skin) Huntington’s, narcolepsy—we have found literally hundreds of conditions in which lectins appear to be the causative factor. Not only do we have science to support this, we have observed clinical resolution of these conditions upon the removal of grains, legumes, and dairy. I hate to do this to you, but we have to go back into the intestines.

Really? Digestion? Again?

When food is emptied from the stomach into the small intestines, it is mixed with bile salts that are produced in the liver and stored in the gall bladder. Remember, bile salts are much like soap and are critical for our digestion and absorption of fats. In addition to bile from the gall bladder, the pancreas releases digestive enzymes that are critical to digestion. And lest you forget, much of the digestive process happens at the tiny structures in our intestines—the villi and microvilli. Now let’s see how lectins interact with the intestinal lining to produce autoimmunity.

Lectins such as WGA bind to a receptor in the microvilli, allowing WGA to be transported into the body. This is the mechanism of the autoimmune cascade I described above. If the gut wall (microvilli) becomes damaged, the entire contents of the intestines can now make its way into your system. Yes, that’s as bad as it sounds. You are not only in a position to create antibodies against WGA, which leads to autoimmunity, but you now have the potential to develop multiple allergies due to a permeable gut lining and inadequately digested food. This is how you can develop allergies to chicken, beef, apples, or other normally benign foods.

Additionally, if your gut is damaged, you expose yourself to a host of chemicals that would normally remain in the intestines. This can lead to conditions such as multiple chemical sensitivity syndrome, which is regarded more as a psychiatric problem than legitimate medical condition.

Let me be crystal clear about this: Anything that damages the gut lining (including bacterial, viral, and parasitic infections, as well as alcohol, grains, legumes, and dairy) can predispose one to autoimmunity, multiple chemical sensitivities, and allergies to otherwise benign foods.

As my Brazilian Jiu-Jitsu coach says, “This no opinion is, this fact is.”

“If the gut wall (microvilli) becomes damaged, the entire contents of the intestines can now make its way into your system.” [Note from Tim: this is where the “feces in the bloodstream” post title comes from]

Full of Bile

While this digestive disaster is taking place, there are several other problems brewing. As you recall, the function of the gall bladder is to release bile salts into a meal as it is emptied into the duodenum from the stomach. When the intestinal wall is damaged, the chemical messenger, cholecystokinin (CCK), is not released. CCK usually sends the “on” switch to the gall bladder and the secretion of pancreatic digestive enzymes. When this signal is blocked, we do not properly digest our foods, particularly fat and protein. The lack of bile release allows cholesterol crystals to form in the gall bladder, which leads to gall stones. The standard medical practice of removing the gall bladder is effectively killing the “canary in the coal mine.” Gall stones are a symptom of a problem, an alarm. Instead of treating the cause (remove grains) we cut out the gall bladder. People who have had gall bladder removal are almost certainly undiagnosed celiacs and likely have a number of other progressive diseases. In my experience, these individuals are plagued with digestive problems, culminating in dysphagia, or difficulty swallowing.

The disruption of CCK and related hormones (PYY, adiponectin) in the signaling cascade of digestion is a really big deal. Not only is the digestive process severely damaged, much of our satiety signaling is taken offline as well. We cannot properly digest our food, we are always “hungry,” and the very food we crave, refined grains and sugary junk, happens to be the cause of the problem.

It Gets Better

Another piece of the chemical defense system used against us by grains is a group of enzymes called protease inhibitors. Protease inhibitors prevent the breakdown of proteins. This means that when you consume grains you do not effectively digest the protein in your meal. Protease inhibitors also stymie the digestion of lectins such as WGA, making these already difficult-to-digest items virtually indestructible. This leaves more large proteins in the intestinal contents, which increases our likelihood of developing autoimmunity, allergies, or chemical sensitivities.

Osteoporotic Much?

If you do not have a bellyache thinking about grains by now, let’s look at one more player: antinutrients such as phytates. Phytates are important for seeds and grains because they tightly bind to metal ions (like magnesium, zinc, iron, calcium, and copper), which are crucial for the growth and development of the grain. If the metal ions are not tightly bound by the phytates, the process of germination can happen prematurely and this can spell disaster for the grain.

When we consume grains, the phytates are still active and powerfully bind to calcium, magnesium, zinc, and iron. This means the calcium, magnesium, zinc, and iron are unavailable for absorption. Because of the action of antinutrients such as phytates combined with the gut damaging characteristics of lectins and protease inhibitors, our Neolithic ancestors lost an average of six inches in height vs. our Paleolithic ancestors due to the Neolithic diet of grains and legumes. Are you concerned about osteoporosis or iron deficiency anemia? Do you suffer from fatigue or heart problems that might be caused by magnesium deficiency? Have you diligently consumed a “smart” diet of whole grains, legumes, and low-fat dairy as per the recommendations of your dietician and doctor? Do you see how ridiculous that suggestion is in light of what you now know about grains, legumes, and dairy?

Thank You Sir, May I Have Another!

Here is a recap of how grains cause malabsorption issues and how that affects our health and well-being:

  1. Damage to the gut lining. If the gut is damaged, you do not absorb nutrients. We need healthy villi and microvilli to absorb our nutrients, be they protein, carbohydrates, fats, vitamins, or minerals.

  2. Damage to the gall bladder and bile production. If you do not absorb fats and fat soluble nutrients such as vitamins A, D, K, and other nutrients, you will have problems utilizing any minerals you do absorb, to say nothing of the nutrient deficiencies from inadequate essential fats.

  3. Phytates tightly bind to metal ions and make them unavailable for absorption. Analytical chemists actually use purified phytates in experiments where it is necessary to quantify the amounts of metal ions like calcium, zinc, or iron in a sample because the phytates bind to these metals tighter than just about any other molecule. The same thing happens when you eat phytates, and this is not a good thing for bone health or iron status.

  4. Open door for autoimmunity and cancer. Once the gut lining is damaged, we are at exceptionally high risk of autoimmune disease, such as Hashimoto’s thyroiditis, and several types of cancer, including non-Hodgkin’s lymphoma. The pancreas is assailed by grain-induced inflammation due to CCK problems and elevated insulin levels. This inflammation is a potential cause of pancreatic cancer and pancreatitis (inflammation of the pancreas).

Why does all this happen? Because grains are pissed that you want to eat them and they are willing, and able, to fight back.

Here is a short list of the problems associated with leaky gut and the autoimmune response:

• Infertility

• Type 1 diabetes

• Multiple sclerosis

• Rheumatoid Arthritis

• Lupus

• Vitiligo

• Narcolepsy

• Schizophrenia

• Autism

• Depression

• Huntington’s

• Non-Hodgkin’s lymphoma

• Hypothyroidism

• Porphyria

But I’m Not Sick

Some of you, however, may think you have no issues here. You have eaten grains, legumes, and dairy your whole life and are “fine.” Well, maybe. But I suspect that is not the case. I’ll bet that if you completely remove these Neolithic foods from your diet for one month, you will notice a dramatic improvement in how you feel and perform. Why? Because if you are consuming these foods, I’ll wager you have gut irritation and other systemic inflammation issues.

A recent study looking at children with type 1 diabetes (an autoimmune condition) found that a significant number of them had overt gut pathology, i.e., celiac. Some had a positive antibody test for celiac, but a number of kids were negative on both the WGA antibody test (a common blood test for celiac) and on an intestinal biopsy. So doctors would think there was no gluten influence in their condition. Interestingly, however, nearly all the kids showed antibodies in the deep tissues of the microvilli to . . . transglutaminase.

The study authors suspected most of the kids would at some point develop what is commonly described as celiac. What this tells us is gut damage can be fairly benign (few symptoms) but still lead to autoimmunity. Once initiated, autoimmunity can and does progress to other problems. Your doctor or dietician will likely dismiss this information, especially if you are “negative” for any of the standard blood work or lab tests for celiac. They are foolish in this regard, but hey, it’s only your health.

Trust your medical professionals, they always know best. Or, try a simple experiment: Follow a Paleo diet, and assess how you feel and perform. I know, I can hear the MDs now, that it’s “just anecdotal.” If you are going to save your ass you are not likely to get much support in this matter unless you have a forward-thinking and aggressive primary physician.

What is the ultimate gold standard in all this? How do you know for sure you do or do not have an issue with these foods? The answer seems obvious: remove the potentially offending foods! Reintroduce them after thirty to sixty days. See what happens. Now there is a caveat to this. You only need to be exposed to things like gluten once every ten to fifteen days to keep the gut damaged. This can bedevil people as they “cut back on gluten” but do not notice an improvement in their overall health. I’m sorry but there is not a pink “participant” ribbon given out for doing this “almost correctly.” You need to be 100 percent compliant for thirty days, then see how you do with reintroduction.

Now, I’ll be honest, the reintroduction is for you, not me. If I did a phone consult with you, I’d ask, “How did you do when you had that piece of bread?” I know exactly how you did—I’ve seen this scenario thousands of times, but you are the one who needs convincing. When you reintroduce gluten you will not feel good. Sorry kiddo, it’s just the way it works. Now it’s up to you to decide if health and a long life are worth forgoing some of these foods more often than not.

Does all this seem hard to believe? Well, remember how I described the effects of poison oak on your skin? It’s a similar deal here with gut irritation and lectin exposure. If you want to get the full power of this program, you need to actually give it a shot. Worst-case scenario: You spend a month without some foods you like. Best-case scenario: You discover you are able to live healthier and better than you ever thought possible.

But I Like Bread and Pasta!

Yes, I like that stuff too, but they make me sick. I suspect it makes you sick, as well. Not only do grains make you sick by raising insulin levels, messing up your fatty acid ratios (n-3/n-6), and irritating your gut, but they are also addictive. Grains, particularly the gluten-containing grains, contain molecules that fit into the opiate receptors in our brain. You know, the same receptors that work with heroin, morphine, and Vicodin? Most people can take or leave stuff like corn tortillas and rice. Suggest that people should perhaps forgo bread and pasta for their health and they will bury a butter knife in your forehead before you can say “whole wheat!” Sorry folks, I don’t make these rules, I just have the lovely task of educating you about them.

Why I had to focus on gluten-free living, exercise, and trying to get you healthy, I will never know. I should have just peddled hookers, cocaine, and pastries! So much easier.

Instead, here’s a one week food plan. There are hundreds of great options, but this is a simple menu to get you started:

Week 1

BREAKFAST: 2–4 poached eggs, almonds, small piece fruit or berries

LUNCH: Chicken fajita salad

SNACK: 2 oz chicken, apple, few avocado slices

DINNER: Grilled salmon, roasted green beans, side salad

BREAKFAST: Leftover salmon, walnuts

LUNCH: Lettuce, tomato, onion, and condiments of your choice over 1–2 burger patties, orange, almonds

SNACK: Jerky, macadamia nuts

DINNER: Rotisserie chicken, steamed broccoli, side salad

BREAKFAST: Leftover chicken w/salsa, ½ avocado

LUNCH: Tuna and cabbage salad

SNACK: Remainder of tuna and cabbage salad

DINNER: Crock-Pot pork loin, tomato sauce, zucchini, chopped cauliflower, basil. Make a large portion, leftovers will be used for several meals!

BREAKFAST: Slice of ham, 2–3 scrambled eggs, fruit

LUNCH: Leftover pork loin

SNACK: 2 hard-boiled eggs, almonds

DINNER: Stir-fry beef salad. Serve over bed of greens with balsamic vinegar

BREAKFAST: Sausage stir-fry breakfast

LUNCH: Easy ceviche

SNACK: 2 oz chicken, apple

DINNER: Spaghetti squash (Note from Tim: this is delicious) or kelp-noodle spaghetti: cook either choice with marinara sauce, ground meat, olive oil

BREAKFAST: Chicken apple hash

LUNCH: 5–6 oz deli turkey, ½ lb steamed broccoli, drizzle with olive oil

SNACK: 2–3 oz turkey, carrot sticks, almonds

DINNER: Indian-style coleslaw, leftover pork loin, side salad with olive oil

BREAKFAST: Western omelet, sweet potato hash

LUNCH: Lamb patties, tomato, lettuce, strawberries

SNACK: Turkey, avocado

DINNER: Halibut, roasted asparagus, berries with balsamic vinegar

For full 30-day meal plans, recipes, and more, this is the resource.

Afterword: Holy religious war, Batman! Hundreds of strong comments below, including a few very smart contributions from MDs, nurses, etc.. Robb has also answered some of the most common questions in the comments.

The Tim Ferriss Show is one of the most popular podcasts in the world with over 400 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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1,393 Replies to “How to Keep Feces Out of Your Bloodstream (or Lose 10 Pounds in 14 Days)”

  1. Great Stuff!! I seem to remember reading that antibodies from gluten can take up to 90 days to clear your system. My doc had me give it up for 3 months min before he’d ask me if I felt better. When it make a huge difference, he asked me to give up grains when I tested hyper thyroid.

  2. After reading most of this I’m certain that a regular diet consisting of cigarettes, coffee, bourbon and chocolate is the plan to stick with. And an occasional apple or banana. (kidding of course…maybe) 😉

  3. This is fascinating stuff – what is difficult I find is to convince people this is really that bad from them. At a molecular level these sound intense and in cases the results are pretty dire for some. However I have had people point to plenty of people who have lived long lives (80-90+) without any of the modern day ‘diet fads’ as they refer to them as. I’m not saying this isn’t true but sometimes I wonder if we over analyse things so much that we lose perspective. I love eating healthy insofar as possible and do also have my moments. But being an Indian vegetarian I don’t see what the hell I’d have to eat if I cut out so many grains from my diet. Any alternatives for that would be very welcome as I have cut down wheat intake at home (Indian flat bread known as roti) and am trying to get my parents to do the same. Thank you!

  4. Hi Tim!

    I read several articles about gluten sensitivity and got myself tested, but am negative on Transglutaminase antibodies.

    My question is why earlier generations as well as populations in developing countries didn’t/don’t show all these lifestyle diseases as mentioned above though bread/wheat/rice is/was their main food? And why does not everyone develop these diseases though we follow a similar diet?

    I think the theory is interesting, but it might be only one contributing factor.

  5. Ahhhh! After I’m finished slapping my specialists and GPs, I’ll hit them in the face with my computer screen, this article zoomed with full brightness. I keep telling them what grains do to me. I show them my rheumatic, Reynauded, chilblained hands, and all the other symptoms. I tell them the symptoms disappear whenever I quit grains. They tell me to eat rice, say it’s weird anyone would react to lectins. I want to cry that they can legally treat people.

    Two article criticisms:

    1. “literally heartbreaking”. No.

    2. Nuts are recommended in the food plan. And tomatoes. These are high in lectins. They do me as much misery as corn chips and buckwheat. You may be inadvertantly steering readers right into a small room with the monster you just warned them is outside.

    Otherwise, thank you. x 1000. Now, please please please write an article on healing intestinal permeability. It’s become clear my physicians aren’t going to help, and I need my health back so I can start living a real life before my youth is a pale, sickly memory.

  6. Definitely something to this! I’ve been on the 4Hr Body diet for some time now. No tremendous weight loss but I found that my body does not like glutens. At the end of my cheat day I feel tired and terrible and I don’t really go that much overboard. As important as eliminating glutens is to eliminate all chemical additives. As a result I no longer have sweet cravings.

  7. Why no mention of sprouted grains? When you soak beans or grains, aren’t you effectively starting the germination process, and that’s what breaks down these harmful proteins? I want to know if I’m wasting money buying more expensive sprouted breads and delicious english muffins.

    Also, what’s up with canned beans? They are soaking in water already. Does that count?

  8. Thank you so much for writing this Rob and for posting Tim…the more attention to it, the better.

    Anyone with time for a personal case study, pretty pretty please??

    The short version:

    After years and years of health problems (largely digestion related, depression, inability to lose weight…eventually with inflamed joints and chronic sinusitis and candidiasis as well), many doctors, antibiotics, workout plans, allergy tests, adrenal tests, thyroid tests (all golden perfect), sinus surgery…I finally saw a naturopath.

    I took out gluten, dairy, sugar, soy, alcohol, caffeine, etc. strictly for 3 months and after that, stuck to it at about 95% for 4 years. I had minor improvements, but definitely no dramatic results.

    The depression, brain fog, fatigue and weight are still a problem…so about 8 months ago, I became stricter with it. I took out all grains and also had to take out nuts because I found they made me puffy and uncomfortable. I also had a hair analysis test done to find out how my vitamins, minerals, metabolic state was doing. As a result, I am taking supplements to balance out what was completely out of whack.

    I sleep 8-10 hours every night, meditate, drink tons of water and work out 6 days a week (typical work out would be running stairs for an hour at Red Rocks in Denver, yoga, cycling or hiking for an hour or two). I only eat free range, grass fed organic proteins. No processed food. I believe in being balanced/healthy not just physically, but emotionally, mentally, spiritually and socially too.

    This was 8 months ago. The first three months of that, I slept for about 15 hours a day. Now I’m back to 8-10, but all of these problems still persist.

    I know it would be a million times worse if I incorporated any of this back into my diet and I won’t and I do feel strange for getting so personal on a blog post.

    But anyone out there with any ideas? Rob? Tim?

  9. I like the article, thank you very much for it. But there is something that always bothers me. Every new thing in health and eating is plagued with all the theory as to how this is healthy and so on. Now it may very well be that this is correct. Being a Physicist myself, I have doubts about those theoretical explanations. What I would REALLY like to see would be a study where they let people eat different diets and monitor how they feel. With many people. Robb is right when he thinks someone will say this is anecdotal. Because it is. I read an interview with (supposedly) one of the first doctors to shed some light on this issue, and he thought that this problem may only concern 5% of the population, that the rest would be hype.

    Furthermore, all the other stuff you should take care of not eat confuses me. Tony Robbins is a big fan of eating alkaline things. Doesn’t that mean eating less meat? Yes, both diets agree on vegetables, and that seems for me the only thing to be sure about: eating veggies is healthy.

    To make my point clear: Please, please, stop holding up all that theory. It may be right, it may be updated in a few years or completely rewritten while the results may still be true. What counts, are the results. Please quote studies that look at results of different diets in many people. How come I have not come across a single article covering that? I would love to hear about that.

  10. Hey guys/Tim,

    Real stupid question from a n00b, but does this post imply that people using the “Slow Carb Diet” should avoid gluten even on cheat days? The article says that you only need to eat gluten once every 15 days to trigger the autoimmune response, but I go to town on grain-based foods once every 7 days on my cheat day. Obviously, eating a bunch of grain products on cheat days is fun, but it’s not worth it if I’m screwing up my metabolic system.

    1. I hope not, I’ve been eating gluten pretty much every day for years (seitan, excellent protein source) EXCEPT on cheat days – on which I have a 5-7 course lunch including cheese and multiple desserts 🙂

  11. Irritating and condescending. “Sorry kiddo….”

    “I know exactly how you did…I’ve seen this a thousand times…”

    “Sorry folks, I don’t make these rules…”

    “OK, clam down….”

  12. Don’t ditch bean! As it comes to lentils and beans, lectin is in ton’s of stuff and lectins have healthy properties when in proper amount. Thing is you can easily and completely denature most of the lectins in lentils and beans by cooking them, either for 15 minutes at 100*C or for 2 hours at 80*C. The left over Lectins are quite healthy in smaller amounts.

  13. I love and trust U, Timothy Ferris! Whenever I hear something new related to health, I always research what U have to say on the topic…Ur opinion comforts me, because I know how much time U spend on getting the facts and the science behind any given topic!!!

  14. I started feeling better when I stopped eating bread, due to swallowing problems. (Something to do with my skeleton, and jumping off motorbikes at high speed, Osteopath is sorting that out)

    I noticed I was feeling better. For the last two years, I’ve been eating big amounts of pasta, (easy to swallow) three or four times a week, and feeling pretty rough. Weak, irritable, unmotivated, tired, and so on.

    So after reading this, I stopped the pasta for a week.

    Had one meal, and felt not good the next day.

    Stopped again for ten days, had a pasta meal, and felt bad.

    Stopped again for over two weeks.

    Last night I had pasta for last meal of the day.

    Today, I though I was dying………

    That’s it, no more Gluten.

    Thank you Mr Wolf, Thank you Mr Ferriss.

  15. I’ve found ‘dry-fasting’ to be the most effective way to rest the digestive system and give it a chance to heal itself. Meaning, if we go without food or water regularly, 12-20hours daily and 3-5 days monthly, the body becomes more ‘fat adapted’. As we become more adept at shifting our energy processes from glucose to ketones, the desire for carbs and sugars fades away. It’s only our inability to ‘shift gears’, from processing sugars to processing fats, that causes the discomforts that make it challenging to go without food at all. Going ‘dry’, in a ‘hard fast’ entails no physical contact at all with water, and no ingestion of anything into the alimentary canal; and in a ‘soft fast’ contact externally with bathing and tooth brushing is done but it slows the ketogenic process down some. The idea that we must eat and drink daily is a myth, with many now documenting 10+ days ‘Dry’ with only healing results, and yet we will never hear about this from the Government/Corporations that profit from our overconsumption that makes us sick and fills their coffers. There are no profits and no taxes to be made from informing people that they’d be healthier if they ate and drank less often… Also, no profit motive to inspire scientific testing of the benefits to humans and laws preventing the testing on animals. Animals can’t volunteer, so severe calorie reduction below 30% of normal isn’t allowed by law in the US at least. The Russians have done the most study of ‘medical starvation’, as many there experienced it by circumstance and not by choice.

  16. Wold you have advice for someone who is hypoglycemic? I would love to try the above, but it will not carry me through the night.

  17. People should look up the earth’s Blue Zones. Some meat is eaten, but rarely and on special occations. Common for all Blue Zones is high intake of plant-based foods, fruits, vegetables, beans, herbs, etc.

  18. Tim: for slo-carb, you don’t have a problem with legumes, in fact it seems to be the main source of carbohydrates. What’s your take on Robb’s position?

    Robb: Judging by the suggested meal plan, there is not a significant amount of carbohydrates (at least in comparison with other diets that allow oats and legumes), are you suggesting that we do not need nearly as many carbs as we typically eat? If so, what’s your response to metabolic damage (and/or leptin levels) for cutting carbs down to that small of an amount?

    Thanks guys!

  19. No way! I’m eating that much meat or follow a strict meal plan.

    Something I take for breakfast that my bowels seem to love is chia seed pudding. I don’t care if it has phytic acids. My bowels rule, and they seem happy when I eat this. They say pasta and bread are painful, and oats are even worse. Indeed.

    I may do the grain fasting for one month. I have done the same with milk, and now I don’t have milk or yogurts at least most of the time, still occasional milk in desserts and a little butter. I just don’t like the way I digest it so I don’t feel deprived and very little amounts. Not perfect. But sustainable forever for me.

    I’m always going for a balance between what my mouth wants and how my bowels respond otherwise. Cravings alert!!!

    It seems my bowels can tolerate some grains better than others. But they are much happier digesting carrots. They love some fermented foods and are not kin on chickpeas even soaked. Still looking for a trick to make them more digestible.

    I’ll never eat a perfect diet because I know the cost of going the perfect route. My diet is “mouth and bowels” driven. In other words, tasty and highly digestible most of the time. I can see you cringe and say “but it must perfect”. That’s OK. I respect your knowledge and passion as well as my body’s wisdom. There are just too many doctors with conflicting theories. I have learned to trust myself and my body in this cacophony.

    That being said, your results for osteoporosis are astounding. One of my very dear friends has had it for ten years, and she’s not even 40. Alas, no doctor seems to be able to help. I’m going to share your article with her. Thanks a million for that.

  20. Hi Tim and Robb

    Fascinating stuff. I could give up grains. I notice I feel bulky after bread or Muesli.

    Legumes are trickier. I have 2 cans of butter beans a day. I’m veggie so need protein that isn’t meat. Can you advise?

  21. It is difficult to believe that people are commenting on this after SIX years (myself now included.) I am a 22 year old Type 1 diabetic who was vegan for two years (2012-2014.) I feel much better now that I am consuming meats. Eating is more convenient and my blood sugar is now more stable. Hair growth, nail growth, muscle mass, and menstruation are now much more normalized. While I do feel bad for the animals that are slaughtered in order to feed myself, I now realize that flesh consumption is a way of life. Animals eat one another all of the time.

    On another note: Why does everyone argue through comments here? The main point of all of this is to eat naturally/when hungry and to avoid toxins found in wheat products, legumes, and dairy. This is feasible on any sort of diet and is ideal for optimal health. Please reply if you agree. (Sorry to be late to the conversation.)

    1. The main point wasn’t to eat naturally! It was to avoid gluten even if you don’t have Celiac disease. It’s medical hogwash. Bad science. And as a diabetic, I can assure you you can eat a vegan diet and be fine if you watch your carbohydrates. Well, type 2. Type 1 requires insulin as your body doesn’t produce it.

  22. Awesomely funny and relevant view on this subject!

    “Because grains are pissed that you want to eat them and they are willing, and able, to fight back”

    …and some really intense discussions under here 😛

  23. First off, I think the jury is out for claiming Paleolithic ancestors are 6 inches taller than Neolithic people. Even if they did, to blame this on grain is questionable. I can understand some of the cases and the reasoning to cut the portion of grain intakes, but to make this a case against the whole categories of food source is absurd. Plus, if all of us do that, I assure you the world will running out of food in no time. For anyone interested, watch Michael Pollan’s documentary Cooked on Netflix. He has something to say about Paleo diet and the concept of gluten free.

  24. “Yep, I love oatmeal too, but it contains similar proteins to gluten. Cereal grains tend to have proteins that are high in the amino acid proline. These prolamines (proline rich proteins) are tough to digest, and thus remain intact despite the best efforts of the digestive process to break them down. The result is gut irritation, increased systemic inflammation, and the potential for autoimmune disease.”

    Proline in oats? This is the same proline that is found in collagen/bone broths? Does this not mean those things would have negative consequences too?

  25. So I’m having blueberry yogurt added to my pancake mix for… you got it blueberry pancakes while reading this article. My past reaction to the Q; Is it gluten free? Was here we go again w/ first world issues… Truth is I never knew what the point of a GF diet was and being relativity fit I dismissed looking into it BUT now this article is knocking me all up side my I’m into health&nutrition head.

    Thanks Time to know the facts … but 1st my pancakes getting cold

  26. I am thrilled that I came across this article. I had a bout of candida in my gut which took two years to diagnose, 5 doctors, 20 appointments, tons of blood work and $4000 later, my latest PA found it in a simple allergy test.

    So I went strict Paleo and did a 60 day candida diet. I I have never felt better. More energy, better sleep, flatter tummy, no headaches, more energy, better memory, no stuttering, no brain fog. Candida even made me stutter! Very odd indeed. I was literally sick for 2 years and I was about to give up. It was not a good place to be.

    I am now pregnant. I have had a severe gag reflex and could not stomach much meat so Paleo went out the window. All I have craved were carbs. So I thought ha, maybe I need to try and eat bread, crackers and maybe a little dairy to help sustain my blood sugar (which I read was good). So my diet consisted of cottage cheese for a week, bread, crackers, beans and fruit, no meat. 3 weeks later, I have had severe blood sugar issues, haven’t been able to sleep, bloating like crazy, hazy brain, a cold sore on my lips and hives on my face.

    So I can attest to the Paleo life that’s for sure. It works for me and I’m getting back on track. I believe that we all have the privilege to consciously choose what we eat and figure out what works best for us without judging and condemning others on their ways of eating.

    We may know what’s best for us and maybe we can even be an example of what’s possible for others. It’s not our job or responsibility to change what other people do or choose in their life because unless we want change, we can’t force it upon others and nor should we.

    However, what I know, after this awful month of “trying” to listen to what my body was craving has absolutely steered me in the wrong direction. And I know it’s a necessity for me to eliminate grains, dairy, beans and gluten once again. I have realized for me it’s all or nothing and I can’t just be pick and choose when I can eat Paleo. I have to eat Paleo and follow the regime ALL the time.

    Good luck on your journeys everyone!

  27. Yet another person who thinks we should severely limit our diet. I eat the dreaded bread, dairy, legumes, gluten, etc., and I’ve been healthy as a horse my whole life. LMAO

  28. Coeliac disease is an inflammatory reaction to gluten. If you don’t have it, and very, very, very few do, gluten is harmless. This is snake oil being sold as science. People, do a little bit of research before you believe guru led BS. If you want to lose weight you simply burn more calories than you consume: everything else is shear, utter BS and a waste of time. Was I rude? Or just bluntly truthful?

  29. Dear Tim,

    Many thanks for this blog post, and for everything you do to make life better for so many people.

    Just wondered if you had heard of Dr Steven Gundry? Check out his latest book The Plant Paradox . He would be a great guest on your show. Lectins are his big enemy number 1 for gut health…and they are hiding in all nightshade (including tomatoes)…

  30. Quick question: how about beer? How does this compare to eating barley/wheat directly? I’m wondering about the chemistry when yeast breaks down the sugars. But again, I have no idea.

    Please help!

  31. Ok so on the side note from Tim he mentions cooking and soaking the beans/legumes can dramatically decrease the composition of such reducing the effects explained by the article and Robb Wolf (great last name by the way). The question than becomes to achieve these results explained by Mr. Ferris does anyone know if they have to be whole beans, or when I buy say a can of black beans (already in whater) that process is already in affect? Minus the baking soda?

    Would love to hear some info…. you see I am originally from Brasil and black beans are a staple! Completely eliminating such would be a hard task… But if there’s a better way to consume it, why not?!?!?

  32. Hi, fantastically detailed article, I can’t help but draw parallels to content in the SCD book – refraining from posting link here – is called ‘Breaking the Vicious Cycle’ . I also personally know one person who followed th(e similar) steps to save his health

  33. Tim, as always informative, comprehensive and helpful blog. The way you write about each subject helps me, and I am sure other people, to get it. Thank you.

    How about nuts? I have read that nuts have the same lining as grains and need to be sprouted before consumption.

  34. You left out a very very important thing here… on your example of a diet to eat you’ve included nightshade vegetables. Surely surely you realize that nightshades are absolutely poisonous to those of us already plagued with the rheumatoid arthritis . Tomatoes potatoes… etc… but when I excluded these I almost immediately felt so much better. Pain level went down . Beans, nuts,…

    and dairy , eggs, cheeses, were equal poisonous.

    It’s very very complicated , you go have to do your own research but it’s so much easier w our cell phones in our hands than it was pre search engine days👏

  35. Dear Tim

    I have had lumps and pustules around my neck and jawline for many years. Others suggest by their own struggle with adult acne that I am gluten intolerant. Since ditching gluten two weeks ago I no longer have ibs at least these last weeks. But the spots persist. Could it be that my body is still eliminating toxins from the gluten? Do you believe there is a link? And in another note what about tapioca? Thank you so much for the scientific breakdown above

  36. I ingested a lot of wheat germ containing WGA approx 6g a day for 3/4days, and could feel the effects on my mood, memory, and it was causing head aches. I’ve stopped now and only the headaches remain 3 days later. How do I get the WGA out of my brain and body?

  37. Tim – Love your work, listen often to the podcast, bought Four-Hour Body. Would love to hear more women interviewed on the podcast. I appreciated the tips “for the ladies” in your books, and your open-mindedness. Best…

  38. Thank you for the great article. I have made all of the lifestyle changes cutting out gluten, sugar and dairy for three years now. What I am beginning to notice is that I am stuffy and congested after eating rice and potatoes in particular. After reading this, I can now understand why especially since my body is still trying to heal from leaky gut.


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Ketosis and Athletic Performance: More Than Fat Loss

The above video is a presentation by Peter Attia, M.D.

His talk is somewhat technical, but I always write blog posts hoping 20,000 people will *love* them, not that 1,000,000 will *like* them.

In this presentation, you will learn (in my words, not Pete’s):

– More about nutrition than most MDs learn in med school.

– How ketosis-adapted performance can aid fat loss and high-altitude resilience.

– Why the calorie estimates on treadmills and stationary bikes are complete BS.

– The three primary systems of energy production and basic organic chemistry, both of which aid understanding of all athletics.

Even if you struggle a little with vocabulary, the first 30 minutes are well worth watching a few times.

This talk made me immediately want to jump back on the Cyclical (or “Cyclic”) Ketogenic Diet (CKD), which was conceptually introduced to me in 1996-1998 by the writing of Lyle McDonald, Dr. Mauro Di Pasquale, and the late Dan Duchaine. It’s incredible for simultaneous fat loss and lean muscle gain, though perhaps needlessly complicated for non-athletes.

I usually limited the carb-reloading period to 12-18 hours after a glycogen depletion workout on Saturdays, though I experimented with moderate Wed night carb-ups while training for sports like kickboxing.

If you’ve experimented with ketosis, what was your approach and experience? Pros and cons?

For additional reading, I suggest the following posts by Dr. Attia:

Odds and Ends:

This week, I’m using my birthday to change the world with @charitywater. Please click here to take a look. You could do the same.

The Tim Ferriss Show is one of the most popular podcasts in the world with over 400 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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219 Replies to “Ketosis and Athletic Performance: More Than Fat Loss”

  1. I was diagnosed with Anklyosing Spondilytis in January. I immediately began experimenting with my diet based on anecdotal success stories I read online. After many months of experimentation I settled on a diet that consists entirely of meet and green vegetables with a small amount of cheese, beer, and wine. The diet has reduced my inflammation levels from 7x the normal value to currently about 1.5x the normal value. So still a little ways to go but it has made an enormous difference.

  2. Started the Keto Diet after hearing it from a friend. On a 5’7″ frame I went from 260lbs to 238lbs in 8wks, with zero exercise. Strictly limited myself to <50g carbs per day while maintaining 1800 calories.

    Now I've joined a gym and I'm excited to try this out with exercise. Going to start slow and steady…

    1. I train in mixed martial arts and have competed in Kickboxing while in ketosis. I can honestly say that if a dedication to getting enough calories is there, my performance has improved in every athletic marker: aerobic fitness, anaerobic fitness etc. I think it has improved because my system is generally less stressed from carbs which I am clearly intolerant to. It takes some adaption time-the benefits of ketosis for me have emerged over a stretch of a year but they are well worth it for me.

  3. Thanks for the post and all of your amazing work. I follow Peter closely now and his work at NUSI. What is terrific, I became aware of him through your podcast last year. I have been CKD for several years and for the last 4 months have been Keto, my experince has been life altering…the cognitive buzz and empowered flow state, is extraordinary. The other significant addition I highly recommend is cold water therapy, and of course without saying, the most important addition to performance…daily meditation practice. Thank you Tim, I owe most of all my performance enhancements to you! Your work has changed my life and I have changed the lives of many others! I am in your legion of learners and teachers, your legacy lives!

  4. I tried It a few years ago and I had the most energy I had ever had in my life. But it was a bittersweet experience because it made me gain weight. I was eating a lot of heavy cream and eating when I wasn’t hungry if my ketones got too low. I used the urine strips. I fell off the wagon and my energy went back to shit which really sucks because I’m only 34!! With no kids!! Now I’m excited to try it again for the THIRD TIME. wish me luck 😉😉

  5. I did keto for 10 days, it did bring my blood pressure down to 118/70, but I know it’s not a diet for life. But if I look back to the time before I relied on driving a car everywhere and to using the computer, 1995, I was very slim and had a six pack, I did eat rubbish all the time, drank plenty of beer, but I was not sitting at a PC for many hours at a time.

    Well fast forward to 2015, and I am still on the computer! But also 20 kilos heavier and wider…..the car and the computer are the problem! Anyone care to argue?…..please do.

  6. I have been in Ketosis for about 3.5 months now. I tried a 5 day fast but I could barely get past day 3. I wasn’t even hungry, my mind was playing tricks on me… But, I noticed that even after some beer binges with friends, the next day my Ketonix shows that I’m still blowing enough Acetone to show that I’m still in Ketosis…

  7. I personally like and continue apply many of John Kiefers readings regardless of misuse of a multitude of citations. Application has been my personal experiences and others I train. Carb Back-Loading supports solid glycogen replenishment and the following the ultra low carb regiment majority of the day allows me to push my HR, helps my CNS recover, and not gain much if any fat. I do like movements that keep my HR <60% such as Ido Portal Movement Method to tax every muscle group without taxing my CNS much. HIIT, CrossFit, and other like concepts will require carbs however if you sustain consistent intake of dietary fats and protein through gluconeogenesis the body should have plenty of available glucose as solid energy source for workouts. Carb Back-Loading works very well for sustaining muscle volume and lean muscle tissue without much if any fat tissue accumulation if any.

  8. My biggest struggle is afternoon munchies. If I feel like I’m dragging and low on energy, I used to turn to the carbs and sugar. So that was my biggest road block. I’m still learning, though. I use a ketone supplement (beta hyroxybutyrate) that really helps with the cravings and energy. I also would like to see more resources on what to buy at the store. I need to get more keto-friendly foods that I like and know I would eat,

  9. I’m an ultrarunner and a HW developer so I jumped right into ketosis two years ago. A diet with so many ways to monitor progress was really appealing to me. I certainly had plenty of issues staying in ketosis when something as simple as an avocado can knock you out. I just finished building a portable breath meter that monitors acetone and generates a ketone mmol/L value. [Moderator: link removed]

  10. I struggle with fueling around ultra marathons while on ketosis. Pre-race would you want to carb up a bit? In race how what is an ideal low carb fuel. I would prefer to use real food over products. Post race would you rather be in ketosis for recovery or replace all that spent glycogen?

    My current solution is to use vegetables for carb loading pre/post race meals in the slow carb fashion. Also using chia as my primary in race food due it’s weight, fiber and fat ratio. Still need a lot of electrolytes so Sucees tabs typical 1-2 an hour.

    I monitor my blood glucose and ketones daily. It surprises me to hear that people are using piss stix as indicators as that is a very limited tell as to what is going on.

  11. Thanks Tim for sharing this useful presentation and your experiments in general. For over 14 months I´ve lived in ketosis without any cheat days and have never felt so good before. Besides loosing fat, I am more energetic and sportive which directly influenced my business and private life. I was not aware that glucose had been influencing my mood so much. Tell me please, do you think one can live all her life in ketosis without any harms?

  12. Hey TIm, my wife is trying the slow-carb diet and struggling a lot with cravings (pizza, donuts, etc.) Is there anything that you’ve found that helps?

  13. I know this is an old thread, but I figured it’s worth a shot anyway. I’ve been out if the gym for roughly 10 months, so I’m effectively starting from scratch. I’ll be picking up where I left off using the 5/5 method 3 days a week (push, pull, legs) as described by Tim in either geek to freak or Occam’s protocol, I can’t remember. I’ve also become really excited to try a keto diet for the first time. Basically what I’m looking for is the 20 pound recomposition described in 4 Hour Body, and I’ve got 6 weeks to do as much damage as possible. A couple of questions here:

    Any problem getting into ketosis for the first time at the same time as starting a gym regimen, besides what I’m guessing is a certain induction flu?

    Any suggestions about post workout meals in this situation? Maintain very low carb and focus on caloric surplus?

    I’m sure I had more questions, buy this is a good start. Thanks in advance for any help.

  14. I’ve been doing a standard keto diet for about 4 months now with great results. What I want to know now is whether this can be coupled with Occam’s protocol to maximize muscle gain and minimize fat gain

  15. Thank for this lost Tim. After 30 years of a typical bodybuilder diet ( cycling starchy carbs, med to high protein ) I finally utilized an Intermittent Fasting approach ( 50% fat, 25% carbs, 25% protein ).. I was amazed at how easy it was.. I def noticed better natural energy & focus.. In 8 weeks I gained 3 lbs. on the scale while losing 2 inches off my waist. My testosterone level increase by 200 to 822.. Amazing to me for a 50 year young guy that is lifelong drug, hormone & ped free.. I have become hooked on the benefits of a personalized IF program.. And now have all my clients utilizing it.. And I just signed with a publisher to write a book about it..

    1. That’s a huge hormonal improvement for any adult age. While your book is forthcoming, will you share the length (hours) of your intermittent fasts?

  16. Actually carb refeeds are starting to appear in the research pointless and counter-productive (see Dr. Jacob Wilson’s work on this). It is a misunderstanding of how ketosis works – a primary adaptation is novel/upregulated gluconeogenic pathways. The great misunderstanding – one is NOT glycogen depleted when one is in ketosis. Volek and Phinny, among others, have shown this. Eric Westmann has the numbers – a 170 pound man can make 800 cals of glucose a day in ketosis, mostly from non-protein substrate. While your glyocgen might not be topped off, it is never empty either except in very specific sport situations – high volumes of high VO2 max work at high cal/min rates. A keto athlete might be in a better glyocgen state most of the time compared to a high carb athlete because glucose efficiency outstrips lowered storage of glycogen. My 45 year old wife competes in Figure in year round ketosis with no carb refeeds. Maintains 12% BF off season comfortably on 150g fat, 30g carbs, 135g protein and at 124 pounds benched 140 in a bench-only powerlifting competition to win overall. She can do 10 bodyweight pullups and do dips with a 45 pound plate on a belt. No need for carbs.

  17. I’ve been in ketosis for 4 months and lost 35 lbs and I’m feeling great. I listened to all the relevant podcasts with Dr. Peter Attia and Dom D’agostino, and those were all super helpful. Just today I discovered that Dr. Attia and Gary Taubes are no longer on the NuSI website, and that a NuSI study did not support one of their hypotheses. I’d love to know the latest on what the study showed, etc.

  18. Hi guys, Is it possible to gain a decent amount of muscle on the cyclical ketogenic diet whilst weight training as I am struggling to find any research on the topic?

  19. Listening to your podcasts, I twice heard that you are having gut flora problems after antibiotics. I won’t go into how I know this, but you should try 1/2 raw milk (you can get safe stuff at health food stores in California no problem) 1/2 fresh squeezed grape juice to make a quart. Drink it all right away as it begins to curdle immediately. Try it for a week. If your measurements don’t change or you don’t feel a difference, call me an asshole, but you have nothing to lose. I hope it helps!

  20. The ketogenic diet really does work. Thank you for posting this. I chanced on this video on your blog just in time. I started my nutritional transformation in early 2017 with the ketogenic diet and a daily exercise habit. I was a bit of a couch potato and never really got into sports. I had exercised sporadically in the past.. weights and cardio at the gym, doing different traditional forms of yoga (hatha, Iyengar, Sivananda) and dance workouts. This time, I started jogging at 4:30am every morning and doing bodyweight exercises in the evening. I cut sugar out completely (including natural sugars) and followed keto as sincerely as possible. Imagine my surprise when I started losing fat and visibly gaining muscle within weeks. I am 34-year-old woman weighing 61kg when I started. It’s under 2 months and my weight has dropped to 54kg. Even more surprising was the fat loss. My body fat percentage was upwards of 27 when I started. last week, it was 20.5. My goal is 18% body fat by end of May 2017 and I am more and more sure of reaching it.

    I dropped dress sizes too. I have gone from a medium size to a Large, XL and even XXL in my late 20s. The XXL phase was the most depressing. My waist was about 38 then. After getting on the ketogenic diet, for the first time in life, I am a US XS (that’s extra small!). I am studying nutrition too and as of now, the Keto diet looks pretty balanced (the only thing I miss is fruit). Once I reach my weight loss (50-53kg) and fitness (<18% body fat) goals, I will switch to a Paleo-keto diet.

  21. Haha, this post is old and no one will see this comment, but it was fun to hear Dom D’Agostino asking Dr. Attia about exogenous ketones. We all know what Dom has shown regarding the power of exogenous ketones, and how spot on both guys have proven to be as far as disease prevention and treatment with keto as an adjunct. But more to the point, I truly believe that almost anyone would find the extreme restrictiveness of keto to be almost irrelevant if they first experienced the effects on energy/fatigue. It also seems, as someone who has struggled with binge eating, that the hunger alleviation of keto confers a massive advantage to someone struggling with weight-loss and is almost completely ignored when different diets are compared in studies.

  22. Informative video and love the link to the cycling of the Keto Diet. I’ve been looking at ways to incorporate ketosis while gaining muscle and not gaining any fat for my bulking periods. Tim has created great articles and parts in the 4-Hour Body of how to get down to roughly 8% body fat but at least from my knowledge hasn’t touch on how to naturally (without steroids) get down below 5% body fat. I would love for Tim to post or have someone on the podcast about this but does anyone else have any suggestions that worked for them?

  23. Have you heard of the pesKETOrian diet? Probably not, because I just invented it. It’s a keto diet only I just eat fish for proteins. A few exceptions: grass fed butter, heavy crean, and pasture raised eggs.

    Can you please ask Dr. Attia if this is genius as I suspect, or if I’m wasting my time?

    Mark Cafiero

  24. I’ve read about CKD, it is a solution to long-term Ketogenic Diet success. It allows the practitioner to break ketosis from time to time, therefore enjoying carbs, while resetting the metabolism. CKD is a very challenging type of ketogenic diet, which is why it is not recommended for beginners.

  25. [Moderator: Twitter link removed.] During a routine physical, my doc announced to me that I was pre-diabetic. I commented something like “wow, I’m not even overweight!”. He grabbed my stomach fat and said, “See this? This is a gut. Lose it or else you will become full-blown type II diabetic”. I started the keto diet that day. Today, 6 years later, I’m running faster skiing better than I did in college, and my life is changed. Still keto and I enjoy a cheat on major holidays and some birthdays only. IF almost every day. Life: changed.

  26. Hi Tim! I love your podcast and have learned much from it. Thanks for that, your TED talks, and 5 bullet Friday. Random place to post this, but seems as relevant as any: I would love to see (hear) you interview this scientist: [Moderator: link to Lisa Mosconi’s website removed.], not least because menopause is hardly considered a cool topic and I would like to see that changed by an arbiter of cool such as yourself, but also because I know you are fascinated by neuroscience and diet and her work combines these…could be an epic conversation.

  27. Did keto for a few months. Lost 20 pounds; bad cholesterol shot up. Used it like a blunt tool for weight loss; would do it again if I could keep the cholesterol down.

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2009 Langhe Nebbiolo Bricco Maiolica

( £12.50 by the case, 13%, Lea & Sandeman )

If the price of Barolo and Barbaresco leaves you spluttering into your pasta, some of the regional wines made from the Nebbiolo grape can be good value alternatives, enabling you to enjoy this most brilliant (and temperamental) of Italian varieties without raiding your savings account. This is very elegant and comparatively forward, showing considerable finesse and poise, medium-weight tannins, a core of sweet and savoury tobacco and red cherry fruit, fresh acidity and a fine tapering finish.

Similar Wines: £10-£20, 91-95, Italy, Red, Nebbiolo

2008 Cave de Beblenheim Grafenreben Riesling d'Alsace

( £8.82, 12%, Waitrose )

It’s easy to forget about Alsace Riesling in the rush to buy examples of the grape from Germany and Australia, but they can be some of France’s best whites, especially if they are made in a dry style, like this one. The wine is fresh and delicate, with lovely lime-like flavours, some stony minerality, a hint of the complex bitterness that is so typical of the region and a fine, lingering finish.

Similar Wines: £5-£10, 86-90, Germany, White, Riesling


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If class size doesn’t matter, why do the charter schools list it as a key selling point?

July 18, 2013

Classroom in Edgewood ISD, San Antonio, Texas, in 2010. Photo by Bob Daemmrich

Classroom in Edgewood ISD, San Antonio, Texas, in 2010. Republican legislators want more classrooms like this one, crowded, to save money paying teachers and heating the rooms. Or maybe they have a real reason — it can’t be a good one. What’s the ratio, three kids to one desk? Did one kid fail to shower this morning.  Texas Tribune photo, by Bob Daemmrich

Steven Zimmer, a member of the board of the under-assault Los Angeles Unified School District, lays it on the line:  Class size is important, and legislative efforts to expand class size in public schools are intended to sabotage public schooling — and that action harms students.

Description of the video at YouTube from the OTL Campaign:

Small class size isn’t about protecting teachers’ jobs or making their work easier — it’s about providing every student with quality attention in the classroom. Steve Zimmer, Board Member of the Los Angeles Unified School District and a former teacher, asks why we tolerate or dismiss crowded public school classrooms when charters and private schools use small class sizes as a selling point?

 J. D. Crowe cartoon from the Mobile, Alabama, Press-Register.

“OK, Class . . . How many of you are students adn how many are teacher consultants?” J. D. Crowe cartoon from the Mobile, Alabama, Press-Register, August 18, 2009.

“It could be worse — this could be a public school classroom during budget cuts.” Cartoon by Mike Keefe, Denver Post, March 18, 2011

War on Teachers and Education, Part 2: Ben Austin of Parent Revolution attacked Prof. Ravitch

June 10, 2013

Ben Austin is the head of Parent Revolution, the group trying to push teachers out of management of schools in California.  After Prof. Diane Ravitch noted problems with his group’s actions at Weigand Avenue Elementary in Los Angeles, on her blog, he responded with an “open-letter” carried by Huffington Post.

Other than the link to Dr. Ravitch’s post (“now infamous blog post,” as Austin calls it), all links are added here.

Dear Professor Diane Ravitch:

Parents, educators, and education advocates have a lot in common when it comes to a kids-first first agenda. But we can never seize that common ground if those with whom we disagree are deemed to be “evil” and sentenced to Hell, as you did last week in your now infamous blog post.

If we can’t start from that basic premise, then we are no more mature than the children we endeavor to serve. We cannot purport to encourage tolerance and discourage bullying on the schoolyard if the adults in charge of the schoolyard can’t adhere to those same basic principles.

For the past year, the organization for which I serve as executive director – Parent Revolution – has been working with parents from the Watts neighborhood community school Weigand Avenue Elementary to help turnaround their failing school. Although there appear to be some areas of improvement at the school, Weigand is currently ranked 15th worst of nearly 500 elementary schools in the Los Angeles Unified School District (LAUSD), and has been on a continual overall downward slide for the past 3-4 years under its current school leadership.

Four years is a long time for parents to wait for improvements in a failing school, despite even the best of intentions from dedicated professionals like Weigand’s current principal. Unfortunately, the current principal was unable to make the progress needed to turnaround the school.

In 2011 many of these same parents petitioned along with Weigand’s teachers to oust their failed principal, but had no real power to force change, and the principal retained her job. Every teacher who signed that 2011 petition is now gone, and the school has gotten even worse since then.

Many of the kids have now “graduated” without having learned basic skills. Currently, more than half of kids at Weigand cannot read, write, or do math at grade level.

So this year, the parents organized again – but this time using California’s landmark Parent Trigger law, which gives parents trapped in a failing school the power to force leadership or staffing changes at the school, or convert it to a non-profit charter school.

After the parents submitted petitions representing a majority of parents at the school demanding a leadership change, the district complied with the law, verified the parents’ legal majority, and in August Weigand will open up as a newly transformed school with new leadership.

Recently, in a debate about whether these parents should have the power to demand a new principal for their failing public school, you labeled me “loathsome” for siding with the parents. You declared that everyone who supports these parents “deserves a special place in Hell.”

Let me tell you about Hell.

I grew up in Greenwich Village and Venice Beach, the son of two writers. My parents published a number of books, but our family struggled financially.

In many ways, I grew up lucky. I grew up with parents who valued education and loved me. They helped me get a scholarship to a private high school in Los Angeles. That scholarship may have saved my life.

My dad was an alcoholic. A few weeks before my junior year in high school, he committed suicide. I vividly remember going to the first day of school after my dad’s death, soon after his funeral. As a kid, my overriding emotion that day was embarrassment. I (wrongly) assumed that all the wealthy kids at my school had near perfect home lives, and I was embarrassed about mine. I didn’t want them to know about my dad, but it was such a small school that I knew that everyone would.

That’s what I remember as a boy. But looking back as an adult, I see that same day through a different lens. I can see the role that educators and others played to get me through this Hell.

I see how my teachers and my principal sat down with me that first day of school to talk. They told me they believed in me. They told me they would help me. Some even told me they loved me.

They told me I could make it. And I did. I graduated from high school, then Berkeley, then Georgetown Law School. I worked in the Clinton White House as well as on five Democratic presidential campaigns. I served as deputy mayor in Los Angeles, and sat as a member of the California State Board of Education.

I was lucky. But my younger brother wasn’t so lucky.

He went to a different school. His principal told him that he would never amount to anything. So he dropped out of school in 9th Grade. He fell down, and with no one at his school to help pick him up (and no dad), he lost a decade of his life.

Astonishingly, he did end up getting back up. Years later, he earned his GED, went to college, then business school and now is an awesome dad with a wonderful family. But his story is not the typical story of a 9th grade drop out.

When I see kids attending schools like Weigand, I see kids who are going through a whole lot more at home than I could have ever imagined as a boy, but who don’t have a safe place where somebody believes in them, supports them and loves them. Many kids drop out like my brother, but rarely share his happy ending.

So forgive me if I take it personally when parents trapped in a failing school ask for the same kind of support for their children that saved me as a child, and that I now expect from my daughters’ neighborhood public school as a father.

Your opposition to the Weigand parents is especially puzzling given the logic of your prior critique of Parent Trigger as a conspiracy to trick parents into converting their school into a charter school. The Weigand parents did not want a charter school, or new teachers, or even a new union contract. They wanted a change in leadership after 4 years of failure.

Weigand has exposed you as being opposed not just to charter schools, but to pure parent power.

To be clear, the reason that we have never personally attacked you, the principal, or any other opponent of parent power, is because our goal isn’t a political victory. It is a victory for our kids, and we can’t achieve that goal without ultimately working together.

Just last year, I wrote about you in the Huffington Post: “Diane Ravitch is a talented academic who has devoted her life to this issue. She clearly cares about kids and the future of public education in America.” I believed it then and still believe it now, despite your mean-spirited attacks against me and the committed parents and staff with whom I work. Instead of puerile name-calling and ugly personal attacks, let’s commit to a debate about a kids-first agenda and the future of public education that is worthy of our children.

Your intelligence and unique perspective have the potential to enrich this debate. But we must stipulate that this debate will not occur in Hell, Heaven, or in some imaginary world where one side has all the answers and holds all the moral authority.

Let us debate about the future of American public education on Planet Earth, where ideas and civility matter.

Ben Austin
Executive Director
Parent Revolution

Why didn’t he respond on Ravitch’s blog?  I don’t know for sure, but as deliverd on HuffPo, this letter is a poison-the-well tactic:  Austin didn’t respond to Ravitch’s criticism directly.  Instead, he attacked Ravitch’s tone, making Ravitch out to be a rude person — but he did so to a different audience, one that had no background in the controversy.  Had he responded at her blog, he wouldn’t have the chance to introduce the audience of not-closely-watching-this-issue people to his biases first.  So this letter increases my skepticism of the good faith claims of Parent Revolution and Ben Austin.

Ben Austin’s group, Parent Revolution’s website lists a string of successes.  Each of those successes is a political victory over teachers and educators.  So far, there is not a single school turnaround success Ben Austin’s group can point out for us.  They claim they worked for a year with parents to turn around Weigand Avenue elementary.  As a political organizer, education administrator, civics wonk and teacher, I wonder why Austin’s group didn’t work with the teachers, too or instead.  The work described was not to turn around Weigand, but rather to wrest control from people who, by all accounts I’ve seen, were making solid progress in a tough situation.  I have not found evidence of a working PTA, which suggests the parents could not and would not organize a toss-the-principal campaign on their own. (If you have information on a working PTA, please note it in comments.)

Austin’s group is no fly-by-night neighborhood parents’ group.  Austin has no children at Weigand, nor do any of the other full-time staffers on the group’s payroll.  The Hechinger Report notes:

Parent Revolution, whose backers include the Gates, Walton Family and Wasserman foundations, now has a budget that has climbed close to $5.5 million and a staff of about 45, including its California and national teams, Phelps said.

I’m mystified by Austin’s story of his family life.  It explains some of his drive, perhaps, but it’s totally at odds with his group’s continuing attacks on the teachers and principals who, he claims, were heroes in his own life.  He also calls out the principal of his brother’s school as a villain.  But he offers not a hint of any rational way to tell who are the heroes and who are the villains in these dramas.

Plus, he almost completely brushes off the concerns raised by Ravitch and the Los Angeles Times.  The woman fired by Austin’s outside agitator-style actions looks a heroine in every portrait I’ve seen. The Parent Revolution targeting of Irma Cobian is covered in a smokescreen for no apparent reason.  Austin managed to can the one person who could save the life of a kid like Ben Austin.

Is there an explanation?

Please continue to Part 3.

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text: WHATEVER IS - IS BEST I know as my life grows older, And mine eyes have clearer sight, That under each rank wrong somewhere There lies the root of Right; That each sorrow has its purpose, By the sorrowing oft unguessed; But as sure as the sun brings morning, Whatever is - is best. I know that each sinful action, As sure as the night brings shade, Is somewhere, sometime punished, Tho' the hour be long delayed. I know the soul is aided Sometimes by the heart's unrest And to grow means often to suffer-- But whatever is - is best. I know there are no errors, In the great Eternal plan, And all things work together For the final good of man. And I know when my soul speeds onward, In its grand Eternal quest, I shall say as I look back earthward, Whatever is - is best. - Ella Wheeler Wilcox


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Picking Women’s Shoes

In the event that you feel that your shoes have nothing to do with your wellbeing, you are committing an error.

On the off chance that you generally wear agreeable, level shoes, you don't have a great deal to stress over with respect to your feet. In any case, in the event that you adore heels, you could be doing your whole body an injury. Rather than surrendering the high heels that you like, consider concocting a superior method to wear them and after that an approach to spoil your feet so you don't have any long-haul issues related with women’s shoes that you cherish to such an extent.

To start with, you need to comprehend what some women casual shoes can do to your feet. High heels that are even an inch high can make harm your feet that you cannot right over the long haul. These push the foot into an unnatural position and that makes strain and harms the toes and the tendons in your feet. It can likewise make you hurt your spine. When you wear heels for women’s shoes, you are tossing your focal point of gravity forward, and your back takes the strain of this to hold you upstanding. In the event that you have back issues, it could be your decision of footwear that is a piece of the issue.

That being stated, you can comprehend why high obeyed women casual shoes are not the best decision. There is extremely no real way to wear them that does not cause this strain on your body. In any case, that does not imply that you need to surrender them. You need to constrain when you wear them. On the off chance that you wear them to work, kick them off while you are sitting at your work area. Put them on when you arrive and take them off before you leave. In the event that you want to wear them out on the end of, as far as possible when you wear them amid the week. The key is control with successive breaks for your feet.

When you are not wearing your foot sole areas for women casual shoes, wear the most agreeable shoes that you can discover. On the off chance that you have issues with your curves, ensure you get women’s shoes that are made to help your curves. Wear agreeable shoes at home on the off chance that you can, and have great tennis shoes and other agreeable alternatives for being outside, doing errands, and whatever other time when you need shoes on your feet. In spite of the fact that these shoes can not fix harm, they can offer your feet the reprieve that they require when you feel that high rear areas are important to your closet generally.

You can likewise settle on better decisions for women casual shoes when you are purchasing heels. Despite the fact that any rear area can cause harm, you can run with a lower heel for more solace and fewer feet issues. Additionally get shoes that don't tie your toes and that have a pad against your feet instead of something hard and unforgiving. Women’s shoes don't need to hurt you to look great. Likewise make sure to locate some incredible looking pads that can make you look similarly in the same class as foot sole areas can, regardless of whether they are not your first decision. Your feet will compensate you with less torment and better stance all through life. Visit Tiosebon/Konhill shoes and select your casual shoes now.

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TJ_IT_GADGET P-32 Presentation Clicker – TT

Presentation Clicker

  • Plug and Play USB Receiver – Quick and easy to setup on any PC
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  • Built In Rechargeable Lithium Battery
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Packaging: Zip Pouch


text:
Supraspinatus Segmentation from Shoulder Ultrasound Images Using a Multilayer Self-shrinking Snake

You Wei Wang, Chung Chien Lee, Chung Ming Lo

Research output: Contribution to journalArticle

Objective: Over people’s lifetimes, the prevalence of shoulder pain exceeds 70%. In particular, 70% of shoulder pain is caused by rotator cuff lesions which are located in the supraspinatus area. The automatic and quantitative segmentation of the supraspinatus area can provide a more-objective and accurate assessment of rotator cuff lesions. Methods: In this study, 108 shoulder ultrasound images comprised the image database to evaluate the proposed segmentation method, and a multilayer selfshrinking snake (S3), based on a multilayer segmentation framework, was used to achieve optimal segmentation. Using a rough initial contour that enclosed the supraspinatus area, the modified snake was shrunken with an iteration procedure according to boundary conditions that included the elasticity, curvature, gradient, and distance. Results: In the performance evaluation, the S3 achieved an F-measure of 0.85. Conclusions: The success of the S3 could provide more-objective location information to physicians diagnosing rotator cuff lesions.

Original languageEnglish
JournalIEEE Access
Publication statusAccepted/In press - Jan 1 2018

  • Elasticity
  • Image segmentation
  • Lesions
  • Nonhomogeneous media
  • Pain
  • rotator cuff
  • segmentation
  • Shoulder
  • shoulder pain
  • snake
  • Ultrasonic imaging
  • ultrasound

ASJC Scopus subject areas

  • Computer Science(all)
  • Materials Science(all)
  • Engineering(all)

Cite this


text:
Beatit Test (Video)

There was never time to take to the workshop a very interesting product offered by the American company TNR. We have met this product many times in recording studios and always somewhere in the back of the head was the thought to bring you, expensive drummers and dear drummers, this interesting idea to increase the potential of the drum kit sound.

Read the Full Review Here


text:
Sports Personality

Hunter Mahan
Hunter Mahan is the 21st most popular contemporary golfer and the 18th most famous. Hunter Mahan is described by fans as: Determined, Talented, Genuine, Focused and Polite.

What America thinks of Hunter Mahan

  • Ratings 13%Positive opinion
  • 4%Negative opinion
  • 11%Neutral opinion
  • 28%Have heard of

7381 interviews - YouGov Ratings data collected between May 2019 and May 2020Find out more