Wednesday, September 24, 2008

EBCT scan

Well, I finally got an EBCT scan last week and the Agatston score came out as seven.

This is a bummer of a result for several reasons. The most obvious is that it's not zero, however inconclusive you might consider zero to be!

Second is that it's an isolated score, so there is no way I can tell if it's the start of an exponential rise to serious problems in 5 years time or the tail end of a fall from a higher number 5 years ago...

Third, I'm going to have to get another scan done in 12 months time to get a trend analysis. It makes me a little envious of Stephan and checking out his HbA1c reading of 5.8%. Measuring you post prandial glucose is a lot less expensive and a lot quicker than waiting a year for another EBCT scan!

While I wait, am I going to do anything different diet/exercise wise?

Probably not. Just about the only changes I'm thinking of will be to make sure I get my egg yolks every morning and not skip them on work days (which are now three days a week plus the weekend rota). I might get to paddle my kayak a little more frequently and I'll certainly continue my relaxed driving style. Apart from those, there are not a lot of changes to make. If I did alter much it would leave me wondering which alteration had affected the number in either direction in a year's time.

On the plus side the scan has dropped in price from £450 to £400. Still not cheap, but then when I think of how much our practice charges for me to do a canine dental the cost drops in to perspective!

The other plus is that if you are going to have a non zero score, having one below 10 is probably better than having one over 100...


Another up side to life is that our chicken house is about finished (been my main free time occupation for this last week) and just needs waterproofing, so it's time to start on the enclosure at the bottom of the garden! Chickens arrive in about 2 weeks time.

Oh, and the senior cardiologist in the imaging department was waaaaaay in to metabolic syndrome and the junior chap, who chatted to me after the scan, was well on his way. I had a coffee in their canteen and it's not hard to see why. Just imagine the worst possible aisles in the supermarket transported to a hospital basement! The coffee was as OK as coffee ever is.


. said...

So what's the range? You mention 100 as being bad. So 7 should be good, right? (Regardless of where you started from)

gunther gatherer said...


That score is still extremely low, seeing how any score of any relevance would be around 80.

Have any indigenous or high-fat eating people had the EBCT scan? I'd be interested in knowing what an average range is like.

And why would increased exercise, such as kayaking, etc. reduce your score in the future?

It still looks like you're at extremely low risk. Zero is weird thing to work for, isn't it!

Thackray said...


We have had 20 – 50 chickens here for about ten years. We only keep them for eggs.


Friendly good layer - Buff Orpingtons (not dual purpose although advertised as such).

Most friendly and interesting bantams – Silkies and Sultans.

Best bantam layer (good sized egg with high percentage of yolk) - White Crested Black Polish bantam. High egg volume per size of bird and rather friendly.

A neighbor swears by New Hampshire Reds – lots of large brown eggs, matures quickly. May not be available in England as they originated here in the States.

Unfortunately I can’t free-range my chickens due to traffic, hawks, foxes and severe winters here in Western Pennsylvania, USA. Here in the States, chicken feed is based on corn which is high in PUFA. We supplement with dried coconut flakes (they love coconut!).

I’d like to isolate a few hens and try a mixture of defatted corn germ meal (left after oil is extracted), alfalfa, dried coconut meat, a small amount of flax seed meal and crushed oyster shells. I wonder if chickens would eat other saturated fats like tallow and suet? They fight over the coconut!

Enjoy your blog!

Philip Thackray

mtflight said...

Hey Peter!

Well we've all read somewhere that everyone on autopsy has some degree of plaque. Yet not everyone dies from it. Would be interesting what the Masai score, as well as the Kitavans, and Inuits etc. Even the French vs the UK would be interesting, French vs. US, etc.

According to Hof and Kondos, Am. J Cardiol 2001;87:1335-1339

50th percentile for mein in age group 50-54 is a score of 15. So you're ahead of the game. 25th percentile is 4. 75th percentile is 215 and 90th percentile is 332.

So I'd say you're doing pretty good. Will be interesting to see what happens to the number. I had one done for $199 last month.

There's a free e-book by Dr. Davis at that has a lot of information about the scores and what they mean, etc.

So I think you're doing well--certainly ahead of the curve.

Neil said...

Which machine was it Peter? I understand there are different 'slicers' from what I have read in Dr Davis blog.

7 sounds brilliant, congratulations are warranted I feel


mtflight said...

Let me guess it was a 64 slicer...?

gunther gatherer said...


Can you tell me where you got your scan done for so cheap? I will be in the states around christmas, and that price is too good to pass up.


Stephan Guyenet said...


7 is low! As you said, it could be the remains of regressing plaque from years ago. It may be worthwhile to look into the data on vitamin K2 MK-4 a bit; it seems to have strong control over coronary calcium. I'll be interested to see what the score is next year! I'd like to get a heart scan at some point. My grad student stipend isn't going to pay that bill right now though.

mtflight said...

hey gunther gatherer,

I know two places in Texas with good prices. Center for Preventive Medicine in McKinney (Dallas TX) is where I went ( <-generic website.

And the other is the San Antonio HEARTSAN hospital. They are $150 but I saw a coupon for $50 off on their website a few months ago, so it comes out to $100 if they still have it/honor it.

Thackray said...


How about this form of K2:

Philip Thackray

Stephan Guyenet said...


No one really knows how well MK-7 stacks up to MK-4 in the long term. MK-7 has been shown to have some of the same benefits on bone health as MK-4.

However, there are several reasons why I think MK-4 is probably superior. First, it's the form mammals produce for themselves and their offspring (found in milk). Second, I can't imagine how hunter-gatherers would have consistently gotten MK-7, which is a product of bacterial fermentation. I know some HGs fermented food, but I don't think all of them did. Whereas they would have a had a constant source of MK-4 from organ meats, insects and other animal foods. MK-4 is Weston Price's "activator X".

So the question is not settled, but on a strictly hypothetical basis I'd go for MK-4 over MK-7. Advocates of MK-7 say it has a longer serum half-life, which seems to be true, but that doesn't necessarily make it superior.

Anonymous said...


(or anyone else who might know the answer)

I remember you mentioned that saturated fat increases insulin resistance --- is this a reason to avoid sat. fats? Or is this observed in the presence of carbohydrates? You may have answered this question already - but I cannot for the life of me find it on your blog. Thanks in advance.

Ray Sawhill said...

Some links you may enjoy, although you're probably 'way ahead of me on all this ...

Thackray said...


Thank you for your input.


See Peter’s posts titled Physiological Insulin Resistance – there are five of them. My take is – enjoy your fats, limit your carbohydrates.

Philip Thackray

Brad Reid said...


I wonder if the HGs might have harvested some fermented product by consuming the stomach and intestinal contents of freshly slain grazing herbivores?

I really don't know but it makes me think of the great novelist, Wilbur Smith, in a novel on ancient Egypt and the people slaying hippos and then harvesting the viscera first as the great culinary prize for their strenuous efforts.

And, then another anecdote I recall but can't seem to clearly remember, that the idea of cheese and/or perhaps yoghurt, first came to us from man eating the fermented product content contained in the stomach of some grazing beast... goats or camels. Again, the specifics are lost to me... sorry.

I see truth in the idea that when the HGs finally tracked down and killed a large grazing herbivore, that they were likely gutting the animal very quickly and likely consuming its organs and associated fats first, perhaps even while the animal lay in shock in the moments before its death. This would have been the "easy pickens" as all it would take was a single cut to gain access... eating muscle tissue would require more time and a whole lot more work.

I can imagine the digestive organs WITH their contents were all utilized.


Cheers! Brad

Mark said...

Most 50 year olds don't have a young child to take care of.

So you are doing great at 7, considering some sleepless nights and stress.


Unknown said...

Hello, me again...
Congratulations on the test results..

I found some new weird JK-bits. Strangely, he says it's absolutely normal for a woman to be amenorrheic while on OD, more precisely to lose period temporary for a number of years (if in her 20's) and get it back when older.
(Typically there is also a social theory connected to that: no more than 2 children per family, etc.)

I'll try some translation:
"In the peak period of human development women used to start to menstruate around age 60, ovulated once a year, and if didn't get pregnant menstruated also once a year. This is how it shall be, yet through introducing products inedible in their raw state --what the Bible names as the original sin-- it is how it is, it is wrong."

Anyone knows what the science behind is? Is that really a healthy state?


. said...

mtflight - May I ask what your score is (okay if you'd rather not say, but I'm always looking for extra data). Unfortunately in NZ where I live such a test is not available (I checked), so I have to go with the balance of probabilities (and other people's data!)

Stan Bleszynski said...

This a question for Peter and Stephan,

Different subject:

Have you seen this paper on ALA to DHA and EPA conversion?

They claim that ALA from flax seeds is as effective as fish oil, while some previous studies questioned it's effectiveness. If you have an access to the full text of the paper, could you comment on that? Thanks,

Stan (Heretic)

Peter said...

Just a quick reply to Stan before my first consult after the theatre list...

The study abstract says nothing. The important thing is a biologically significant rise, not a statistically significant one. No way to tell what the rise was from the abstract, agree we need to see the full study.


mtflight said...

for Chainey: zero. It was a 64 slice EBCT.

Stephan Guyenet said...

Stan and Peter,

Just peeked at the full text. The abstract is really incomplete!

First of all, they gave flax at doses up to 3X the fish oil. Despite that, after 12 weeks they saw no increase in total erythrocyte n-3 with flax, while they did with fish oil. The flax actually caused a decrease in erythrocyte DHA, while the fish oil caused an increase. The flax did cause an increase in EPA and DPA.

Well that pretty much removes any reservations I had about trashing flax oil as a supplement.

Peter said...

Hi Stephan,

The phraseology of the abstract made me very suspicious. You get to smell when a study is "off". How do these people sleep at night?

But be kind to flax oil, it does make excellent traditional paint/varnish thinners. Drink it if you like drinking paint thinners I guess. Fine for Dr Ornish!


Peter said...


Yes, zero would be nice. Kayaking is mostly because I've been eyeing up some of the weirs in Newbury and it's time I did a bit more stuff which wasn't just chicken houses or allotment work. Got to have some fun. I doubt the amount I'll do would alter my insulin resistance much. Some up hill cycling might do more. Always worth having!


We've got some sort of random mix coming including Rhode Island Reds but others too. They'll be 10 weeks old. I've got a decent crop of potatoes, broad beans and weeds available. We'll go to commercial food if we have to... Egg shells for the calcium (lots of these at the moment. I'm feeling remarkably good now I'm back on to a regular six egg yolks per day. Three whole eggs per day doesn't hack it).


Envy you score. A single lesion gets me the marks. I'm wondering what my score was when I lived on rice stir fried in corn or sunflower oil plus some veggies and a bit of meat, and I was falling asleep every night in the aftermath...

Hi Neil and Alex,

The scanner was a C-150 EBT machine. I think it's a 64 slice machine judging by the Xray dose they talk about on their web site, but I didn't ask!

Stephan and Mark

I'm suspicious of old bad eating habits and a year of severe sleep deprivation (we had a VERY bad first year sleep wise until we taught Squiggs to get himself to sleep without me carrying him for an hour from 2-3am to the tune of Rico's Sanctuary Medicines or Violent Silences, to be repeated at 5-6 after spending 8-11 getting him to sleep. Boy did we learn slowly. Much better now!


The lack of cycling was what happened to us and I've heard of at least one other person to whom this has happened. I think it rings true. I'm not sure why it happens hormone wise but we did buy a number of pregnancy test kits in the early days of LC! Not an issue now but we do eat more carbs than back in the very early days.

BTW there was one anecdote on the AHOA discussion group of reversal of menopause on the OD. Now how do you square that circle? Personally I class the menopause as a carb or insulin related phenomenon. Modern explanations of its "benefits" miss the point that it may be a pathological process similar to, but milder than, the premature menopause which can occasionally happen as a cause of intractable infertility in even very young women.


Thackray said...


You probably know this but you must crush the egg shells up beyond recognition or the chickens will learn to eat their own shells. We have shell eating problems even without feeding egg shells. If you have a rogue egg eating chicken you may need to de-beak her! Another hint is to track when the hens tend to lay and gather the eggs as soon as possible. The ultimate home solution is a nesting box with an egg guard. When the hen lays her egg it rolls into a protected area. I think these would be easy to “do it yourself”.

I think they will eat suet and tallow (we feed coconut as I said above). This would help the saturated fat content of the egg and chicken fat.

We love having available fresh eggs that are under our control. And Linda is so fond of the chickens - that’s why we only have egg layers!!!

Enjoy your chickens!

Philip Thackray

Unknown said...


Thanks, yeah I think that too... Carbs to low, protein to high -> cortisol issues? I've read about many low-carb people experiencing thyroid burnout. There is a trend with OD (especially for those less active) to go something crazy like: carbs- 1g/kg, protein-0.5g/kg (fats according to energy demands), providing that protein is the highest quality. Quite controversial, might be hazardous, but trying it now, we'll see.

Regarding menopause: yup, read JK reporting postmenopausal women going back to having cycles and in general - slowed ageing process. Nice.

Unknown said...

Regarding saturated fat and insulin resistance...Bix at has just put up a post titled "Meals High In Saturated Fat Increase Insulin Resistance," in reference to a Sept 2008 study that can be found here:

I'm not equipped to make heads or tails of it--and perhaps unbeknownst to me, Peter has already done so here. (I searched the archives and did not see the study.) Does this study or Bix's interpretation warrant comment?

I worry about saturated fat because I do not follow a strictly high-fat or low-carb diet (though I am basically a low-carb eater), and it seems some have suggested the combination of saturated fat and glucose can be dual burden on the system. I try to follow a paleo-diet, though I make exceptions for dairy and sometimes earthy things like sweet potatoes. For example, I might lather a sweet potato in this ruinous? Another saturated fat + glucose combo in a typical day could be several servings of heavy whipping cream with half an apple. I know this is not very hyperlipid of me, but I seem to feel better with some variation in my diet...Perhaps this will change in due time.

Sue said...

Regarding the study - Meals high in Saturated Fat increase insulin resistance. From what I am reading that is a good thing when you are a low-carber.

From Peter's post:
What is happening? Well, the first thing is that LC eating rapidly induces insulin resistance. This is a completely and utterly normal physiological response to carbohydrate restriction. Carbohydrate restriction drops insulin levels. Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non esterified fatty acids. These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles. There are a couple of nice summaries by Brand Miller (from back in the days when she used her brain for thinking) here and here and Wolever has some grasp of the problem too.

This is patently logical as muscle runs well on lipids and so glucose can be left for tissues such as brain, which really need it. Neuronal tissue varies in its use of insulin to uptake glucose but doesn't accumulate lipid in the way muscle does, so physiological insulin resistance is not an issue for brain cells.

However, while muscles are in "refusal mode" for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion. This is fine if you stick to LC in your eating. It also means that if you take an oral glucose tolerance test you will fail and be labelled diabetic. In fact, even a single high fat meal can do this, extending insulin resistance in to the next day. Here's a reference for this.

. said...

Thanks mtflight. You are my new guru. (Sorry Peter, it's been fun, but at a rating of SEVEN ... well, you could keel over any minute)

Unknown said...

re Sue @ 1:43 AM:

I am indeed a low-carber; between following a paleo-diet and an intermittent fasting practice, there are days when I eat far fewer than 40-50grams of carbs. What concerns me, however, is that I do occasionally eat carb-rich foods--a sweet potato, an apple, even lentils on a rare occasion.

You quoted Peter as follows: "while muscles are in 'refusal mode' for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion. This is fine if you stick to LC in your eating." My concern is that I do "stick to LC" in my eating, but unlike Peter and others, not exclusively...So I'm left wondering if a sort of high-fat, high-sat fat, diet coupled with non-low-carb moments is a particularly bad combo.

I am not well-versed enough in this material (or nomenclature, of course) to articulate any technical considerations beyond noting that I have been lead to believe, by everything I've read up until this point, that periodically spiking my blood glucose out of all proportion
can be quite damaging. Perhaps I am missing something...I am eager to learn more and will certainly make time to read over old posts here.

mtflight said...

I'm thinking from a paleolithic standpoint, carbohydrates were seasonal, and this insulin resistance in the muscle would be appropriate when carbs were not available for weeks or months at a time.

If it's a day to day thing, it may be different--I don't know.

I would guess HbA1c would be much higher if this were a real problem.
For example, infortunately from time to time against my better judgement, I go "off the deep end" and have something like pizza or dessert, and not just one portion. My HbA1c was a 4.8 when I had it tested in February (asking for the test from an endocrinologist was like pulling teeth).

Peter said...

OK Chainey,

We both know what this means. Would you prefer me to use HFCS or sunflower oil?


Peter said...

Hi P,

Sue sums it up nicely (thanks). Most of the posts are under "physiological insulin resistance" in the labels section. The blog is getting a bit unwieldy in terms of size and no one likes to just repeat stuff, so things get buried in the past. I think this is a problem intrinsic to the blogging format.

The link from Fanatic Cook is interesting enough for a post on its own. Bix has such fantastic links and understands so little about the significance of anything. BTW Anna, of this blog, has had the honour of being banned from commenting on Bix's blog. That says a lot to me about Bix!


Dr. B G said...


A few sips of that gluten-loaded beer yrs ago...??

If any consolation, my cat and I probably have higher scores than yours, respectively, being only grain-free a few short months ago (yeah I'm slow) *grin*

But I've quit wheat, beer, all grains except oatbran/rice, most fruit, smoking, cigars (never inhaled), most carbs (except Anna's delicious butter chocolate chip cookies *THANKXXX!*), sleep deprivation (by virtue that my kids are no longer breast feeding and sleep in their own room -- GOOD LUCK TO YOU AND MR. CHOCO-GRABBING BABY CUTIE-PIE! *haa*), synthetic progesterone (Mirena -- gave me asthma curiously and other fun things).... so we'll see... won't turn 40 for a while (suspense)...

Not too much frostbite surfing? That would affect my favorite blog on earth. I'd have to entertain myself with Bix.

Chainey -- you kill me, don't stop

MTFlight -- good job!

Anna said...

dr. b g, then I guess you don't want the coconut flour cinnamon walnut coffee cake recipe, either? It as a big hit with the moms at my 10 yo son's birthday bash at the beach yesterday.

mtflight said...


I'm thinking you're coming down from a higher score in the past.

Anna did you say "coconut flour cinnamon walnut coffee cake recipe"? (drooling)

I tried making a pizza dough out of coconut flour, but it turned out like white sand with some water--just crumbled.

Do share :-)

Sue said...

Anna, sounds divine - can we have the recipe??

Sue said...

Mtflight, re the coconut flour pizza base - do you have eggs in it - I think that's needed to hold it together.

Peter said...

Hi G,

Woo hoo, welcome to wheat free! The list of things we don't eat always looks a bit daunting when you write it down, but I don't seem to feel deprived on what I eat. My wife is as anti bread now as she was deprived when she gave it up in the first place.

I know JK has seen prolonged reproductive years (not everyone wants this!) but I think Barry Groves suggest that this really needs the OD from before puberty for it to be a common occurrence... So wait and see and plan well!

Surfing was mid summer and even in the UK 4mm of wet suit is all you need. The sun came out one day! Next session will be Christmas in Norfolk (got 6 days off so will take the kayak) which may be a little cooler...

Fantastic to see Dr D talking omnivory. Logic and facts. Great! Of course my transient post scan cardiologist assures me scores never drop. Maybe, maybe not...


Dr. B G said...

Anna -- you said beach? bash? And coconut flour cinnamon walnut coffee cake? I'll ditto MTflight's DROOLS!!

I used to make sticky cinnamon buns (which of course made my BGs high)...going wheat-free makes me miss them (sort of). I've been putting 2 tsp of cinnamon in my coffee and cream -- but if I'm casein-sensitive (like my little sister recently discovered too in addition to wheat) I'll probably need to quit that too.

Then I'll really be in desparate need for your recipe for that coffee cake. YES YES YES !! Please share your recipe *grin*

The eggs make a huge difference in binding everything up nicely -- ok now I've made your cookie recipe 3 x -- WOW they are soooo so good!! The forced modification to dump what ever I could get left over at the bottom of the bins at Whole Foods wasn't too bad either. The garbanzo bean flour may be hard on the stomach for some people. Wouldn't you agree, beans generally should be soaked then cooked the heck outta em? My kids asked to take your cookies to school for lunch -- they were a definite hit! THANK YOU!!

RE ovulation -- I might need to get my hands on Ray Peats book on Progesterone. Any thoughts on it?

What if I've been on synthetic OC hormones since my 20s -- so nearly 15 yrs except for 5 yrs pregnant and lactating... would that delay menopause significantly (other than being completely JACKED on these hormones)? some studies say not by much -- that atresia still just happens -- pre-programmed. I wonder what JK or BG says? Or Peat?

I agree I'm scared -- my sisters and I have the 'superfertility' gene. We alone could populate a small 3rd world country. Thanks for the warning, I think. *hee* You know being at home with babies, blogs 'n books aint a bad idea, right? I need to get a gig like yours -- retire early, renovate, work intermittently and... SURF!


Anna said...

Oh jeeze, me and my big mouth!

I hesitate to post the recipe verbatim because it is copyright protected and I haven't made substantial enough tweaks of my own (only adding cinnamon to the batter as well as the nut topping). Hope you understand. I'll be working on some tweaks, though. Actually, I've been hired to write a paleo-oriented cookbook, so I'll be in the kitchen a lot the next few months - new adventure for me). I might need some recipe testers :-).

The Coffee Cake Recipe is in Bruce Fife's Cooking With Coconut Flour, pg 100. Good book, get it - it's cheap on Amazon. The readers of this blog (maybe not Bruce; coconut flour is high fiber :-) will probably get good use of it. Most of the sweet recipes have lower sugar version; probably possible to go yet lower. And must have lots of eggs on hand, you'll need them as a binder. The 8x8 inch coffee cake batter takes 9!

I haven't tried all the recipes (but I can say the ginger cookies were awful, especially when compared directly to conventional homemade gingersnaps made the same day). The pancakes were good, though.

mtflight said...

Cabbage anyone?

Back in May, I was talking to a friend over lunch about the EBTC scan I wanted to have done, and he said he should have one done too. I sent him a few links, including a link to heartscanblog (which I think he didn't read, more to follow).

So I got mine done in September.

From the little bit that I do know,

This is a guy who mentions having sponsored some research on transfats (years ago) and thus doing everything to ban them in his household for his wife and kids.

He did mention he had high triglycerides, but he would not look like a typical metabolic syndrome person. Tennis player, physically active in normal shape (not overweight but not lean).

I told him triglycerides were diet related (carbs), he said he thought it was stress. Stress obviously a key word, but he was no longer a stressed person as far as I know, very happy go lucky pleasant fellow.

Ate very well, but did eat some bread with the meal. No sugary soda (probably goes for sugar-free), rather a glass of red wine.

Non-smoker (non transfat eater)

Probably believed butter is harmful, but his cholesterol numbers were good, no statin (age 59-60, but looking younger, good color). Supposedly they use olive oil a lot.

So last I heard, two weeks ago he was having bypass surgery, quadruple. Then a second and third surgery to correct internal bleeding from a graft.

Recovery I hear, has been slow. He choked on a sandwich last week and ended up in the ER once more. But he's hanging in there.

So apparently he had his heartscan, then was immediately scheduled for an angiogram ( high score? -- I don't know what it was). The angiogram was not good one would assume--and surgery was scheduled ASAP.

I'm obviously not going to ask too many questions, yet, as apparently he doesn't like visitors for more than 10 minutes.

Moral of the story: a 7 is nothing!

Peter said...

Hi Alex,

Hmmm a classic, as described by Dr Davis... I guess three ops is seriously expensive. But yes, cabbage is the worry after an episode like that. You just have to sigh when you realise how common this scenario probably is.

I hope the guy does OK, but none of that sounds too encouraging.

BTW did I get a wrong Gmail address? Do you still have the Yerushalmy and Hilleboe paper? I would seriously like a copy. You can use the addy on my profile, it's getting used for more and more stuff so I check it pretty often.



mtflight said...

Peter, you've got mail!

Yeah I hope he recovers ok. Certainly is a lot of trauma--and the guy was so healthy! I really want to know what the score was, but I haven't heard back (I sent him an e-mail a few days ago).

I'm trying to be tactful, but also want to know.


altavista said...

Peter, did you do a follow-up to this? Or like a good doctor, left it at "one and done" ? :)

This cracked me up:

Peter said...

I've thought about in on a few occasions but it's a combination of finances vs what might I do differently cf what I do now that has me never getting around to it... Nice case report!


altavista said...

It's an interesting exercise, if you find it 500 now, what do you do. You must change something. I bet you would get more of your ketones from fasting and move to France.

Peter said...

I could live with that but my wife doesn't do heat. I do!