The Keto Diet: A Low-Carb Approach To Fat Loss

The Keto Diet: A Low-Carb Approach To Fat Loss


The idea of the ketone diet is to get your body into a process called Ketosis where you stop burning carbohydrates as fuel… Learn more about how it works, variations, etc.

Along with the Atkins diet and the South Beach diet, individuals who are interested in low carbohydrate approaches to dieting will likely want to look into the Keto Diet. Popular among many who are trying to maintain blood sugar levels and lose body fat, the main premise of this diet is, ‘eat fat to lose fat’.

So How Does It Work?

The idea of the ketone diet is to get your body into a process called Ketosis where you stop burning carbohydrates as fuel and instead turn to the burning of what are known as ketones. This will occur when you bring your carbohydrate levels to around 50 grams per day or lower.

Many keto activists advise that number to be 30 grams of carbohydrates but most individuals can still maintain ketosis while consuming the 50 grams and this allows for a little more leeway in the diet since you can increase the consumption of vegetables and a variety of flavoring’s that contain a few grams of carbohydrates.

A TKD is one where you will eat carbohydrates right before and right after your workouts.


Usually people who are involved with exercise will follow either a TKD (targeted keto diet) or a CKD (cyclical keto diet).


A TKD is one where you will eat carbohydrates right before and right after your workouts. This is the best bet for those who are involved in more intense activities and require some carbohydrates to fuel them and who are not as interested in doing carb loads and depletion workouts.


A CKD on the other hand is a diet where you will eat a minimum amount of carbohydrates per day (that 30-50 gram number) and then on the weekend (or at a time that is appropriate for you) do a large ‘carb-up’ phase where you will eat a large amount of carbohydrates in an effort to refill your muscle glycogen stores so you can continue to workout the coming week.

Normally right before the carb-up phase you will do a depletion workout where you try and get your muscles to completely eliminate their glycogen supply. Then when you do the ‘carb-up’ phase, you cut almost all the fat out of the diet so you are now just consuming protein and carbohydrates.

Setting Up The Diet

To set the diet up, first you take your lean body weight and multiply it by one. This will be the total number of grams of protein you are required to eat per day. After you get this number, multiple it by 4 (how many calories are in one gram of protein) to get your total calories coming from protein.

Now the rest of your daily requirement will come from fat calories. You don’t really need to calculate carbohydrate grams specifically because by default you will likely reach your 30-50 grams per day simply by including green vegetables and the incidental carbs that come from your fat and protein sources.

To figure out how many fat grams specifically you want, you would take the total number of calories it takes to maintain your body weight (normally around 14-16 calories per pound of body weight). Subtract your protein calories from that number and then divide by 9 (number of calories per gram of fat). This should give you how many total fat grams you need to eat per day.

Divide these numbers by however many meals you wish to eat per day to get the basic layout for your diet. Be sure to consume plenty of green leafy vegetables for antioxidant and vitamin protection and you are good to go.

Weekend Carb Load

Now this brings us to the weekend carb load period and usually the ‘fun’ part for most individuals. You are now able to eat large quantities of carbohydrate containing foods, cereal, bagels, rice chips, candy, pasta and so on are all good options here.

Since you won’t be eating very much fat at all, there is less likely of a chance that these carbohydrates will get turned into body fat as they will be going towards filling up your muscle glycogen stores once again.

Most people will choose to begin their carb-up on Friday night and end it before bed on Saturday. This is usually most convenient as it’s when you are off of work and can relax and enjoy the process. If you aren’t overly concerned with fat loss and are just using this diet as a way to maintain blood sugar levels, you can likely eat whatever carbohydrate foods you like during this period. If you are worried about fat gain though, then you need the math.

Try and aim to keep your protein the same at one gram per pound of body weight and then take in 10-12 grams of carbohydrates for every kilogram of body weight. Start taking these carbohydrates (usually the first bit in liquid form) right after your last workout on Friday night. This is when your body is primed and ready to uptake the carbohydrates and it will be most beneficial for you.

During weekend carb loading, you are able to eat large quantities of carbohydrate containing foods, cereal, bagels, rice chips, candy, pasta and so on.

Note that you can have some fat here, since it will be hard to consume many of the foods you really want to eat without being allowed any (pizza for instance) but do your best to keep your fat grams around your body weight in kilograms (so if you weigh 80 kg’s, eat no more than 80 grams of fat).

On a second note, some individuals find they like to eat a little fruit along with protein before their final workout on Friday night as this will help restore their liver glycogen levels and give them the energy they need to push through that workout. Plus, by refilling the liver glycogen you will help put your body into a slightly more anabolic state so you don’t see as much energy breakdown.

Pros & Cons

Overall this seems to be a very good diet for most people as far as fat loss is concerned. Some do deal with negative side effects while in ketosis but most people will find that although it’s really hard the first two weeks, after that period their body begins to adapt and it gets much easier. Furthermore, one of the biggest benefits of being in ketosis is appetite blunting therefore it can actually be an ideal program for someone on a diet.

The only draw back you will see is for those who do have high activities or are involved in lots of sprinting type exercise. Although a few will find they feel fine, even have more energy on a high fat/moderate protein diet, most of the time carbohydrates are the best source of fuel for these activities. That isn’t that big of a problem though, it just means that that person should instead look into doing a TKD instead of a CKD.


In part two of this article, we’ll go over how you should set up a TKD for those who want to keep their carbohydrate intake slightly higher on a daily basis so as to allow for more intense training levels.

To sum up, for fat loss, this diet would rate 4 out of 5.

For muscle gain though, it is slightly harder to put on muscle since usually a large amount of insulin is needed to put the body in an anabolic state, so it would be more along the lines of 2 out of 5 (TKD though could bump that higher).


Gastric Sleeve Surgery – The Expert’s Guide

Table Of Contents
  • History
  • Benefits
  • Surgery Day
  • Recovery
  • Diet
  • Vitamins & Supplements
  • Complications
  • Can it be Stretched?
  • Expected Weight Loss
  • Emotional & Mindset Changes
  • Books & Tools For Success

Gastric sleeve surgery, also known as the sleeve gastrectomy, has become a popular choice for patients seeking excellent weight loss in a straightforward procedure that doesn’t require the maintenance and long-term complication rates of a Lap Band.


On January 1st, 2010 United Healthcare added gastric sleeve surgery to their list of covered surgeries for weight loss. Over the following two years, almost every other major insurance company followed suit. From 2010 to the 2015 gastric sleeves became the fastest growing bariatric surgery procedure.


It’s very difficult to get insurance companies to approve new procedures. So why would they approve gastric sleeve surgery?

  1. The evidence showed significant weight loss with low complication rates.
  2. Surgeons were already performing the procedure and insurance was paying!

Stomach after sleeve gastrectomy surgery.Number 2 deserves some explanation.

Super Obese individuals (people with a Body Mass Index over 45) have an increased risk during any surgery. And the longer the time under anesthesia, the greater the risk. Gastric bypass surgery can last over 2 hours. Duodenal switch surgery often takes over 4 hours. That’s a long time to be under anesthesia.

So surgeons started breaking the procedure up into two stages. The first stage was to reduce the size of the stomach. The second stage would be done a year later after the patient lost some weight. The second stage of the procedure would include bypassing some of the intestines to reduce calorie absorption.

So surgeons started coding the first part of the procedure as the first half of a duodenal switch. Insurance was paying.

When patients came back a year later, they had lost so much weight that a second procedure wasn’t necessary.

Studies like this one started to emerge (Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2). Complication rates were low and weight loss was as good, if not better, than gastric bypass. And because the surgery took less time and was less complicated to perform, surgeons liked it.

Patient Feedback

Patients also liked the procedure. After surgery and often for months after the procedure patients noticed they weren’t hungry. Some patients had to remind themselves to eat.

Soon patients were asking their doctors about gastric sleeve surgery.

Later, research showed that the hunger producing hormone ghrelin was significantly lowered in gastric sleeve patients. It’s believed that the area of the stomach removed during gastric sleeve surgery produces much of the hormone ghrelin. While gastric bypass patients experienced less hunger, it seemed to be more pronounced in gastric sleeve patients.

Potential Benefits to Patients

Gastric sleeve surgery has the benefits below:

  1. May reduce hunger.
    1. The hunger inducing hormone ghrelin is reduced by removing a portion of the stomach largely responsible for its production.
    2. Reduction of hunger occurs in most patients but not all.
  2. Shorter operating time compared to gastric bypass.
  3. Does not re-route intestines.
  4. No dumping syndrome.
    1. While dumping syndrome can be a tool to reinforce good eating habits, it’s very unpleasant.
    2. The pylorus remains intact and sugars have time to digest since the intestines remain untouched.
  5. No adjustments are needed. The Lap Band requires regular adjustments (doctor visits).
  6. No foreign objects are left in the body. The Lap Band leaves a silicone band around the upper portion of your stomach.
  7. Weight loss occurs over 18 months.
    1. Gastric bypass weight loss is very quick. The majority of weight loss occurs in the first year.
    2. Lap Band is gradual and requires major lifestyle changes for success. The majority of weight loss occurs over 3 years.

Why Your Surgeon Prefers Sleeve Gastrectomy Over Lap Bands

Guess what? Your surgeon may prefer gastric sleeve or bypass over Lap Bands. Surgeons want you to be successful. Most surgeons care about getting you healthy. But, they also know that you’re a future referral source. You are a future success story.

Surgeon getting ready to perform gastric sleeve.If your surgeon has been performing bariatric surgery for long enough he or she has seen patients that lose little or no weight with a Lap Band.

This doesn’t mean the band isn’t working. It just means that certain patients cannot implement the lifestyle changes (3 small meals a day, high protein, exercise, low carbs, etc.) that are needed to be a success with the Lap Band.

The failure to lose weight is significantly less with gastric bypass or gastric sleeve surgery. Granted, after the weight comes off, it’s up to the patient to keep it off.

For a surgeon that is trying to help, it’s difficult to identify patients that are truly dedicated to implementing exercise and healthy, nutrient dense foods into their diet.

It’s a much better bet and ‘safer’ to recommend bypass or sleeve.

Surgery Day

So you want to know what to expect on the day of surgery? Expect to be scared, nervous, and expect everything to go well.

Again, gastric sleeve surgery is a very straightforward procedure with low complication rates. When serious comGoing into the operating room.plications do happen, they usually occur the first few days after surgery. So rest easy for your procedure.

You’ll likely be scheduled for an early morning surgery. However, this depends on the surgeon’s and hospital’s schedule.

Prior to surgery you will have followed your two week pre-op diet. You should know what to bring to the hospital. And you’ll know that you can’t eat anything after midnight the night before. Don’t cheat! Surgeries get cancelled all the time because people eat or drink prior to surgery. And if you vomit during your procedure you can get pulmonary aspiration. This is when the contents of your stomach regurgitate and get stuck in your airways. This can be fatal or cause aspiration pneumonia.

Don’t chew gum, drink water, chew tobacco, or take any medications not approved by your surgeon. These may cause your surgery to be cancelled.

You’ll check into pre-op and meet your nurse and your Anesthesiologist. You’ll change into your hospital gown, removing any jewelry, watches, etc.. You’ll then sign the needed consents and get an IV. You’ll be given medication to help you relax. Your circulating nurse (the nurse that will be with you in the OR) will come meet you and wheel you back to the OR. Then you’ll be asked to breath in from a face mask and count backwards.

When you wake up you’ll be in recovery and your family will be invited in shortly thereafter. Once cleared, you’ll be wheeled up to your room where the TV and your pain pump will be your new best friend for the night.

Typically, within the first 5 hours after surgery, you’ll be asked to get up and take a few steps. This helps reduce the risk of blood clots and help alleviate some of the shoulder pain associated with the CO2 left in your abdomen from the surgery.


Recovery from gastric sleeve surgery is painful for some and ‘not too bad’ for others. Each person experiences pain differently and different pain medications work better than others for different individuals.

Some sleeve procedures are outpatient (you can leave the same day as your procedure) and many require 1 or 2 days in the hospital to recover. Some surgeons prefer 3 days while others are comfortable letting you leave the day after surgery.

As always, it’s important that you follow the doctors orders.

Below are some general guidelines after you are discharged from the hospital. You should have more specific guidelines to follow in your discharge instructions or post-op manual.

  1. Sip your liquids constantly.
    1. It’s easy to become dehydrated. You aren’t getting any liquids from food your first week post-op. Sip slowly, but makes sure you drink plenty.
  2. Bowel movements
    1. Bowel movements may be difficult or painful. This is normal.
    2. However, don’t hesitate to call your surgeon if you are having issues.
    3. Constipation is normal the first week post-operative. Your pain medications can increase constipation.
  3. Medications
    1. Don’t be a tough guy. Take your pain medication when you need them.
    2. You may receive a prescription for Protonix to decrease the acidity in your stomach. This helps with heartburn and may reduce pressure on your healing pouch.
    3. Unless otherwise advised by your surgeon, you can resume taking your medications. All non-time-released medications will likely need to be crushed. Any medication that is time-released should be switched, if possible, to non-time released. Do not crush time-released medications. Ask your doctor about your diabetes medication.
  4. Activity
    1. Walk, walk, walk.
      1. Walk as much as you can. This helps the healing process and starts you on the path to include exercise daily.
    2. Don’t lift anything heavy. This can put undue pressure on your stitches and torso which will be sore.
    3. You will feel fatigued and tired for up to a month after surgery.
      1. This is due to the reduced calorie consumption. Your body is adjusting.
  5. Showering & Bathing
    1. Don’t bathe or sit in a hot tub for the first 3 weeks after surgery.
    2. Showering is typically OK.
  6. Going back to work.
    1. You can typically return in 2 to 4 weeks depending on the physicality of your job.
    2. Most people return after 4 to 6 weeks at full strength.

When to call the ER?

  • Fever over 101.5 with shaking or the chills.
  • Pain that increases over time.
  • Redness, warmth or pus draining from incision sites.
  • Persistent nausea.
  • Inability to swallow liquids.

Remember, don’t hesitate to call your surgeons office if you are worried that something is wrong. You’re not bothering them.

This article walks you through the details of recovery from gastric sleeve surgery.

Pre and Post-op Diet

Your diet is going to change after gastric sleeve surgery.

Food journal.In fact, your diet has to change 2 weeks prior to surgery. So if you’re planning on having a ‘last meal,’ you’ll want to do it before you start the pre-op diet.

Pre-Op Diet

Your pre-op diet will start 2 weeks before your surgery date. The pre-op diet is important because it helps to reduce the size of your liver prior to surgery. This makes surgery easier for your surgeon and reduces your intra-operative risks.

Details on a typical pre-op diet can be found here.

Post-Op Diet

They say it takes tasting a food 20 times to develop a liking for it. Keep that in mind as you struggle through the first few months of adopting a new diet after surgery. With a small stomach, it’s utterly important that the food you do eat is nutrient dense. This means you should be eating foods like vegetables, lean protein sources and whole grains.

Most doctors recommend you eat a good portion of your calories via lean meat. However, it should be noted that there are some very successful vegetarians that have had gastric sleeve surgery.

Dr. Garth Davis at The Davis Clinic in Houston is a bariatric surgeon and a vegetarian. Many of his patients have become vegetarians with great success.

Your post-op diet greatly depends on how far out you are from surgery. The stages below are typical recommendations after gastric sleeve surgery. For a more detailed look what you can and can’t eat after surgery, we recommend this article.

Stage 1 – The first week after surgery

  • Clear liquids only. These include:
    • Water
    • Decaf Tea
    • Sugar-free Posicles
    • Broth

Stage 2 – Week 2

  • Full liquid diet with protein shakes.

Stage 3 – Week 3

  • Soft-pureed foods. These include:
    • Soups
    • Scrambled Eggs
    • Cottage Cheese

Stage 4 – Week 4

  • Soft foods.
    • Boiled chicken.
    • Fish
    • Cereal
    • Mashed potatoes.

Stage 5 – Week 5 and beyond

  • Introducing real foods.
    • Introduce small amounts of foods.
    • Chew well and eat slowly.
    • Eat 3 small meals a day.
    • Eat a small, healthy, nutrient dense food as a snack if needed.
    • Get your protein but don’t forget vegetables and fruit.

Daily Vitamins & Supplements

Bariatric vitamins.You’ll need to ensure you are getting enough vitamins after gastric sleeve surgery. This is also true for gastric bypass (slightly more supplements are required) and true for Lap Band patients (less vitamins are required).

Below is a list of typical vitamins and protein supplements for a gastric sleeve patients.

Multivitamin with Minerals – You’ll want to use chewable vitamins for the first month after surgery. Follow the directions. You may need to take one in the morning and one at night (depending on the brand).

Below are a few options for good bariatric multivitamins:

  • Bariatric Advantage
  • Bariatric Fusion

A decent option for a non-bariatric specific multivitamin is below:

  • Centrum Adult Daily Chewable – you can find this at your local pharmacy (Walgreens, etc.).

Iron – Iron may be recommended. It’s important to talk to your doctor and follow his or her recommednation.

  • Check with your surgeon when to start iron post-operatively.
  • Take on an empty stomach.
  • Ferrous Fumarate 29mg – NOT the more typical ferrous sulfate (ferrous sulfate is not absorbed well after bariatric surgery).
  • Do not take with your Calcium Citrate.

Calcium Citrate – Taken 3 times daily.

  • Begin 1 month after surgery.
  • Liquid or chewable form and should be taken in 500 mg doses with at least one hour in between doses.
  • Do NOT take Calcium at the same time as Iron.
  • Wait at least 2 hours between taking your multivitamin/iron and your calcium.
  • 1500 to 2000 mg daily.

Vitamin B12 – May be recommended. Check with your doctor.

  • Typically taken once per week.
  • 5000 to 7500 mcg.
  • Available in sublingual (under the tongue), injection, or nasal spray.
  • Should NOT be taken in pill form after surgery.

Protein Supplements

Protein is important after gastric sleeve surgery. It’s recommended that you get at least 60 grams of protein per day after surgery. You can opt for protein supplements from Wal-Mart or other retailers. However, most physicians prefer a bariatric specific protein supplement. Below are some common options for bariatric protein supplements.

  • Bariatric Advantage
  • Bariatric Fusion
  • Unjury


You should have a good understanding of possible complications during and after your surgery. The most worrisome complication from gastric sleeve surgery is a staple line leak.

Staple line leaks can occur during or after surgery. During surgery, they are typically noticed and fixed before completing the surgery – no big deal. However, if they go unnoticed, you will start to get sick shortly after surgery.

Staple line leaks typically occur during the first month after surgery. They can be triggered by eating improper foods (always follow your post-op diet) or from the tissues of your stomach not healing. This, in turn, leads to the staples detaching from the thin, devascularized tissue which then leads to a leak.

A staple line leak leads to a major infection as your stomach juices enter your abdomen. The signs and symptoms are tachycardia (rapid heart beat), fever, chest pain, and pain in your belly.

Most staple line leaks occur within 14 days of surgery. See your doctor immediately if any of these symptoms are present.

The risk of death from gastric sleeve surgery is low. The chart below shows the risk of the more serious complications with gastric sleeve surgery.

Graph showing rate of serious complication after sleeve gastrectomy.

This article is a full list of the most common complications along with their signs and symptoms.

Can It Be Stretched?

You can stretch your stomach after gastric sleeve surgery. The inside of your stomach is lined with rugae. These are folds of tissue that expand and contract in relation to the amount of food that enters your stomach.

Stretching rubber bands.When they expand, your stomach sends a signal to your brain that you are full. When they contract, they push the food into your intestines for further processing. Once the stomach is empty, a hormone called ghrelin is released that triggers hunger again.

These signals can get skewed when your stomach is constantly stretched from too much food. This article details how this happens and why it’s important to get back on track quickly after binging.

Below are a few tips to reduce the risk of stretching your stomach.

  • Drink water an hour before and an hour after you eat. This gives your body time to digest the food and make room for fluids and vice versa. Don’t eat and drink at the same time.
  • Don’t drink carbonated beverages. The carbonation can put unneeded pressure on your stomach.
  • Eat small, healthy snacks if you get hungry in-between meals.
  • Plan your meals. Focus on small portions of nutrient dense foods. Nutrient dense foods keep you full longer and give you the nutrients that you need.

Remember, if you overeat once, you haven’t ruined your new stomach. Get back on track as quickly as possible.

Expected Weight Loss

On average, gastric sleeve patients will lose about 60% of their excess weight. Excess weight does not mean total weight. If you weigh 300 lbs, you will not weigh 120 lbs after surgery. To calculate your expected weight after surgery, use our calculator.

You should know that you can lose more or less than 60%. There are many examples of people that have implemented exercise (marathons even) into their daily lives and have far exceeded the 60% mark. Some people who revert back to poor eating habits lose less than 60%.

The key to success (exceeding the 60%) is implementing the changes needed to keep the weight off. Below is a list of the mean average excess weight loss 5 years after surgery.

62.7% Year 1
64.7% Year 2
64.0% Year 3
57.3% Year 4
60% Year 5

Hitting Weight Plateaus

Gastric sleeve surgery will make you lose weight fast. However, similar to any diet, you’ll hit a wall (plateau) at some point. This means you’ll lose weight, and you’ll lose it fast, and then all of the sudden you’ll stop losing.

When the weight loss stops, often only 6 months after surgery, patients freak out (that’s the technical term).

Why does it happen?

Your body is constantly seeking something called homeostasis. Homeostasis is a process that maintains the human body’s internal environment in response to changes in external conditions.

So when food decreases significantly (external condition), your body adjusts internally to create stability (stable weight). So, to counteract the lack of food in your environment, the body slows down your basal metabolic rate – your metabolism slows down and you hit a wall. You haven’t changed your eating or exercise habits and you hit a wall before you reach your target weight.

How do you get past a plateau?

To get past a weight loss plateau, you need to add a new external change. This is typically done by increasing exercise. But what if you are already spending as much time in the gym as possible? You need to look for other ways. Simply adding a couple of 30 second planks morning and night may be all you need. Can you take an extra walk before bed? Are you taking the stairs at work?

It may be worthwhile to meet with a personal trainer and have them design a workout plan that you can maintain. Their plan should be more intense than your current workout.

You may need consider adding a small healthy snack in between meals to speed up your metabolism.

Have your bariatric dietitian review your weight loss. Download an app like Baritastic and start tracking all of your food intake. Share your food logs with your dietitian and ask him/her to review it and look for areas to improve.

Emotional & Mindset Changes

This topic is often passed over for topics with clinical studies backing them up. However, it’s important to know that emotional changes do happen after surgery. And you should be prepared for them.

Immediately after surgery, you will start to lose weight very quickly. Drastic weight loss leads to changes in hormone production. Changing levels of estrogen and testosterone results in mood swings. Let your family know that this is probable, particularly in the first 2 months after surgery.

On top of the mood swings, you will be tired. Tired and moody people tend to be less than pleasant. Have faith, this goes away. And not everyone experiences mood swings.

Personality Changes

Happy and sad face.One other interesting, admittedly anecdotal change is related to personality. ObesityCoverage has a podcast where we interview patients after surgery. You can listen to it here on iTunes and here on Stitcher Radio. About 50% of our interviewees have mentioned that they noticed a change in their personality starting a few months after surgery.

What kind of changes? After weight loss surgery patients tend to be less of a pushover. Is this a result of the required therapy/counseling sessions pre and post-operatively? Is it because of a new self-confidence? Or is it because weight loss surgery requires you to take a hard and honest look at yourself (everything from diet habits, lifestyle habits and relationships)? It’s probably a mix of all of those.

Regardless what causes it, all of our interviewees have said the changes are a good thing.

Relationship Changes

If you read enough about weight loss surgery, you’ll notice a fairly high incidence of divorce. There are no clinical studies to back this up, so don’t assume this is going to happen to you. However, you should know that there are many stories of divorce after gastric sleeve surgery.

From interviewing a number of patients (this podcast is about divorce after surgery) who have had weight loss surgery and subsequently found their marriage failing, below are some important takeaways.

  1. Your partner may become insecure as you start to lose weight and gain self-confidence.
  2. You may be less tolerant of certain behaviors from your spouse. Excessive drinking, smoking, anger, passive aggressive behavior, are examples of this.
  3. You may find that your husband doesn’t share the same desire to eat and live a healthy life. This can be fine if you find friends to help support you.

As a result of your therapy sessions, you may find yourself taking a close look at your friends. The people you surround yourself with should make you a better person and help you reach your health and work goals. This doesn’t mean that you need to get rid of all of your friends. But it does mean you should try to surround yourself with people that want to make you better.

Gastric Sleeve Maintenance

Gastric sleeve surgery doesn’t require regular band fills like the Lap Band does. But it does require maintenance. There are no tune-ups with a gastric sleeve. Once it’s done, it’s done. However, you do have to ensure you are doing the right things to create lasting weight loss.

Diet Maintenance

It’s utterly important that you follow the new diet guidelines for the rest of your life. Falling back into old habits is easy. You can regain weight after gastric sleeve surgery.

Exercise Maintenance

You must ensure that you continue to workout at a minimum of 3 times per week. It’s preferable to workout 5 to 7 days a week for 30 minutes. Exercise can be walks, runs, fitness videos, etc. The goal is to get moving and increase your heart rate. In turn, you’ll burn calories.

Mood Maintenance

Maintaining a positive attitude 100% of the time is impossible. Everyone has bad days. For people with food addictions, a state of depression can trigger food cravings. When you’re depressed, food becomes comfort. Being healthy becomes secondary to finding immediate comfort.

On a daily basis you should take notice of your mood. Are you motivated? Have you been spending time with friends? Are you abnormally tired?

Losing the battle with food often starts with a sad or angry mood. Ensure you pay attention to your mood and actively manage it by implementing healthy activities to improve your well-being.

While you will have bad days, don’t let those bad days become bad weeks or months. If you have a bad day and seek comfort from food, it’s ok. Tomorrow is a new day. Don’t let overeating become a vicious cycle that leads to a stretched stomach and weight gain.

Recommended Books

Gastric sleeve surgery is a big change. Learning as much as you can, implementing what you’ve learned, and then continuing your education is one of the best ways to reinforce your new healthy lifestyle.

The books below offer advice and guidance. Some are specific to gastric sleeve surgery while others are geared towards healthy eating and living. Putting these on your nightstand is an excellent way to reference and reinforce healthy habits both before and after surgery.

Wheat Belly, by William Davis

Most surgeons recommend a high-protein, low carbohydrate diet after weight loss surgery. This book is written by a cardiologist and while not specific to weight loss surgery it outlines why wheat may in fact be adding to our obesity.

My takeaway from this book was to eat more veggies, fruits, and lean protein sources. Reduce unhealthy carbohydrates (bread, pastas) wherever possible.

It’s a good, easy to understand read. The science seems a little anecdotal, but many people have had great results reducing or eliminating wheat from their diets (also anecdotal).

Eating Well After Weight Loss Surgery, by Pat Levine and Michelle Bontempo-Saray

If you love good food and like to cook, you’re going to need new recipes after surgery. Part of success after weight loss surgery is getting your friends and family to support your journey. It’s much easier to get your family to eat healthy when you make delicious and healthy meals.

And if you don’t have a family to cook for, most of the meals in this book are great as leftovers.

Ultimate Gastric Sleeve Success, by Dr. Duc Vuong

This book is written by a bariatric surgeon and I like his no-nonsense attitude. The real benefit of this book is the way he teaches you to appreciate food again. We have to retrain our taste buds to appreciate healthy eating. Dr. Vuong’s book is a short but highly recommended read.

For more books about weight loss surgery, we recommend this article.

Tools For Success

There is a lot of information available online. There are apps to track your food, books to help you get and stay healthy. Below is a list of our 5 favorite tools for success.

  1. Different tools.Join a Forum
    1. It’s important to find friends, ask questions, and stay motivated.
    2. Our favorite forums are ObesityHelp, BariatricPal and Thinner Times
    3. This article discusses the forums and includes many others.
  2. Join a Facebook Group
    1. Facebook makes it easy and private to share your success with a real face (profile). There are some very active groups. And you must request to join them.
    2. Your current friends won’t know you’re part of the group and they won’t see your posts (they’re private).
    3. My favorite for gastric sleeve surgery is the Gastric Sleeve and Bariatric Surgery Support Group.
  3. Download the Baritastic App
    1. This is our app and we love it. We’re also always improving it.
    2. Track exercise, nutrition, water and more.
  4. Local Support Groups
    1. Don’t forget to attend these each month.
    2. Your surgeon will offer these either through the hospital or at his/her clinic. They are invaluable for making friends and staying committed.
    3. If you can’t find a support group in your area, check the OAC’s list of local support groups here
  5. Document your progress in a public place.
    1. When you let your friends, family, and strangers know that you’ve had or will have bariatric surgery, you add a level of accountability.
    2. You can do this in a forum, Facebook group, or on our site here.
    3. Feedback on your journey will help you stay motivated and encourage you to become a superstar.


Gastric sleeve surgery is a long journey. On average, it takes close to two years to reach your target weight.

It takes changing an entire lifetime of unhealthy habits to keep the weight off. It’s not the easy way out. It takes dedication, perseverance and daily work (forever). Keep learning, reinforcing good habits, and celebrating your small victories.

The farther you get from surgery, the less you will think of yourself as a sleeve patient and the more you’ll consider yourself someone that chooses to be ‘healthy.’

Remember gastric sleeve is a tool. It helps you lose weight so you can implement the healthy changes that will forever change your life.

Pic of boy with cerebral palsy going shopping goes viral

A picture of little Leon's beaming smile went viral

A picture of little Leon’s beaming smile went viral Credit: MEN SYNDICATION

To some the weekly shop is a chore, a boring necessity of life.

But a little boy with cerebral palsy has enjoyed his first ever trip around a supermarket in a trolley – and a photograph of his beaming delight on Facebook has gone viral.

Leon with mum Jodie
Leon with mum Jodie Credit: MEN SYNDICATION

Leon Hart is four, he doesn’t speak and can’t walk unaided. The condition, which seizes his muscles and means he can’t sit up in a supermarket trolley, resulted from him being starved of oxygen after complications at birth.

Mum Jodie Torevell, 28, always shops online as a result – until she spotted a specially-adapted trolley during a trip to Asda in Wythenshawe.

Her subsequent post on Facebook has been widely shared, with the public applauding Asda and wishing delighted Leon all the best for future trips around the aisles.

Jodie, a mum-of-six from Newall Green, said:

He cannot sit up unaided and that’s why he could never go into a shopping trolley. He would always just fall to the side. There has been lots of online shopping over the four years because of it.

I saw the trolley in a corner locked up near to where all the other trollies were and I presumed it is new because I haven’t seen it before.

It’s specially-adapted to hold his body up. I have seen them in America but haven’t come across them over here.

He loved going around – he absolutely loved it. He was so happy and chuffed to be able to do what he sees others do. It’s a minor thing to many, but to him it’s massive. It really made his day.

– Mum, Jodie Torevell

Leon, who goes to the Lancasterian School in Didsbury, was diagnosed with cerebral palsy spastic quadriplegia at the age of nine months.

Jodie said:

He was very poorly and was on life support for 10 days. They did not think that he would survive and it all stemmed from complications with his birth. All four of his limbs are affected, although he can use his left arm.

Everybody who meets him says he is the happiest kid you will ever meet. I want to say a big thanks to Asda because I haven’t seen this before. He sees other children doing things and wants to do the same.

15 women with endometriosis share the one thing they wish everyone knew about their struggle

Endometriosis is a daily battle most don’t even know a person is fighting.

According to the Endometriosis Foundation of America, the condition occurs when “tissue similar to the endometrium (the lining of the uterus) is found outside the uterus on other parts of the body.” It’s more common than you think — in the U.S. alone, endometriosis affects 1 in 10 girls. Approximately 176 million women worldwide struggle with the disorder.

The pain of endo is more than physical symptoms like fatigue, pain, and bleeding. In addition to the constant barrage of “you don’t look sick” comments, it can be a struggle to find a treatment, or doctor, that is the most effective. Women’s health concerns are treated less aggressively then men’s, despite the fact that women deal with more severe pain.

To bring visibility to this invisible illness, Revelist asked 14 women to share the one thing they wish others knew about their struggle with endometriosis. Here’s what they had to say:

1. Jaimarie Gold, Los Angeles, CA

Jaimarie Gold endometriosis
photo: Courtesy of Jaimarie Gold

“I wish people knew [endometriosis] is so incredibly common and so often misdiagnosed. It is not just a heavy period; it can affect many different areas of your body and it does!”

“The most important thing with endo is having the right doctor that listens and truly knows about the disease because only then can they help.”

2. Katie Awdas, 30, Prestwich, England

“Each day is different. One day I may be able to do everything a ‘normal’ person can and the next I can be in bed on five types of painkillers and unable to move.”

3. Debbie, 27, Stockholm, Sweden

“I wish people knew how much I struggle with just the day-to-day interactions. My pain is manageable, but it’s always there. Whenever I get a stab of it I hide it because I don’t want to seem dramatic, but it’s hard when it feels like I’m about to pass out.”

4. Lottie L’Amour, 29, London, England

Lottie L'Amour photo

“I wish that people realized how much energy it takes to do things when you have a bad attack.”

“When my Endo is bad, it affects my legs, my sleeping patterns, my mood, my stomach and my back. Dealing with the constant pain is tiring and doing simple things like showering and even eating takes up so much energy it can leave me bed bound all day. It’s not as simple as just taking pain killers and getting on with things either — most pain solutions don’t work for everyone and it takes a lifetime of trial and error to see what works best to take the edge off for you.”

“Friends and work colleagues can struggle to comprehend why you need yet another bed day — I wish they could feel how it feels for just one day, I’m sure they’d never complain again!”

5. Sinead Kelly, 29, Scotland

“I wish people knew the severity and the suffering we go through.

“Because it’s an invisible illness, it’s so difficult to make people understand! ‘You look fine’ is something we hear all the time, even though inside we are struggling.”

“I try to explain to family members, friends, work colleagues when I’m in pain and the reaction is usually, ‘Aww, that’s a shame.’ We don’t want sympathy, we want support.”

“Having someone there supporting you, checking on you, helping out when you’re having a flare is so important! Without that the other symptoms start to sneak in — anxiety, depression, etc.”

“Every day is a real struggle, but because I ‘look fine’ I just have to get on with it and feel like I can’t ask for help when I need it. It’s a very lonely and isolating disease. Endometriosis is not just bad periods, it’s a life altering agonizing condition that needs more awareness!”

6. Raina, 34, Portland, Oregon

“It would be nice if [endometriosis] was taken more seriously by people like employers because it can be hard to say, ‘I’m in crippling pain over this,’ and be taken seriously.”

“I think because most people either don’t know what it is, or know but realize so many of us have it, it can be hard for them to empathize.”

7. Abby Norman, 25, Maine

“Here’s what endometriosis is not: it’s not a ‘career woman’s disease,’ it’s not a ‘white woman’s disease,’ it’s not even strictly a women’s disease, because it’s not only found in the reproductive system.”

“Lesions have been found in brains, livers, and lungs. Men undergoing treatment for prostate cancer have had endometrial lesions as a direct result of estrogen therapy. What we don’t know about endometriosis greatly outweighs what we do know.”

“And if we want to understand the disease, understand how to better diagnose and treat it, we need to talk about it more inclusively. And not just for the sake of inclusivity, either: if we want to see more research being funded, if we want the scientific and medical communities to take interest, we can no longer frame it simply as a female problem. Historically, that hasn’t been enough.”

“While endometriosis certainly does have a life-altering impact on millions of women, that fact alone hasn’t been enough to generate interest in finding a cure, or even a cause. We need to find a way to discuss endometriosis in a way that makes it of immediate interest to (largely male-dominated) research and medical communities: because so far, women’s suffering just hasn’t been enough.”

8. Victoria Justice, 28, Bristol, England

“The one thing I wish people knew about endo, is that endo is only the beginning (no pun intended).”

“Getting a diagnosis took me 10 years; and then the treatment started. Mine revolved around a highly addictive dependency forming drug called tramadol, which is an opioid. The same family as — yep — heroine.”

“I had no idea that a drug, handed over by my doctors, would end up outstripping endo in the ‘you’re ruining my life’ stakes. Four years and 4 stone, a few ruined relationships and friendships later, I’m starting to learn that every medicine has a price.”

“I want more young women with endo to know it’s fine to take whatever you’re prescribed; but do your research. Some things are worse than endo. It’s truly a daily life life changer; it’s a marathon not a race, so be ready to change your mind.”

“Oh and never ask a woman if she’s pregnant; if you can’t tell for absolute sure keep your mouth shut.”

9. Claire Barker, 28, Hertfordshire, England

“The one thing I wish people understood about battling endometriosis is that it isn’t ‘just period pain.'”

“Through this disease I have lived with nausea, headaches, diarrhea, breathlessness, exhaustion, and severe pain throughout my body from my arms and back to my legs. It’s also made me depressed and anxious. Living with these symptoms has negatively impacted on every part of my life.”

10. Char, 41, Manitoba, Canada

“I wish people knew that you don’t always have to feel symptoms if you have endo.”

“I’ve always had a short cycle — 25 days — but never had real pain until after my first child. It took a long time to get pregnant with him and with my third, (though not with my second, presumably because I had her 6 months after my first and pregnancy helps endo). Anyway, it didn’t really occur to me that there was anything wrong until I was trying for number three, when things started to get really painful and I experienced random bleeding.”

Also, having a frozen pelvis is rare. Though in my case it has as much to do with scar tissue from C-sections as endo, they are linked. [My] doctor went looking for what she thought was a cyst after my third child and said, ‘It looks as though someone stirred up your insides and then dumped crazy glue on the lot.'”

woman in pain

11. Maggie Owsley, 33, Oakland, CA

“I wish people knew it is a very isolating chronic illness, not only because it is ‘women’s health’ which is already stigmatized, but chances are the person with endo has spent a long time dealing with it in private.”

“It’s also isolating because the pain varies from person to person and it’s hard to share that and feel understood/heard about that.”

12. Danielle Markes, 21, Northeastern U.S.

“I wish people knew how serious endometriosis is.”

“Many people mistakenly believe that endometriosis is just “bad period cramps”, and they treat you like a delusional teenager that just had her first period and is freaking out because she doesn’t know how to deal with it.”

“Endometriosis is a chronic condition that has robbed me of so much happiness. I’ve cancelled so many plans and disappointed so many people because of this disease. I’ve disappointed my managers at work because I have to keep calling off due to the crippling pain that leaves me unable to do anything but stay in bed, occasionally leaning over to vomit into a bucket.”

“I’ve disappointed partners after telling them I can’t have sex tonight because the jarring will cause the pain to get worse and make me bleed profusely…I’ve disappointed myself because the stigma of female reproductive health issues has made me feel like this is all my fault and I’m just overreacting for no reason.”

“If you had a broken bone, cancer, or a head injury, people would understand how much you’re suffering. They’d show empathy and want to help you. But when your condition is something that only female bodied individuals experience, and something that can’t be clearly seen you get treated like you’re just making it up and trying to get attention.”

“You get treated like a burden when you seek medical intervention, and so many young women live through their teen years thinking that the pain is normal because they were born in a body with ovaries and a uterus. It’s not fair, and it needs to be addressed. Endometriosis is serious and has ruined countless lives.”

13. Janessa, 23, Salt Lake City, Utah

“I wish people understood how much further it goes than ‘period pain.'”

“It truly causes chaos in your immune function, and for many like me, every day is a battle with the pain. And side effects from treatments that rarely help. We are a resilient bunch.”

14. Amanda Palumbo, 23, Toronto, Canada

“I wish people knew that not all pain can be seen. Just because I look like a normal person doesn’t mean my pain isn’t real.”

15. Dawn Slusher, 44, Virginia

“I wish people realized that the disease affects each individual person differently, even if they have the same stages and severe/advanced cases.”

“I now realize through research and experience that one woman can have advanced disease as bad as mine and not be in much pain and she can function without difficulty, while another may have only a few lesions and be debilitated.”

“Or, two women can have the same stage of disease with advanced and aggressive lesions throughout and one woman may be able to function while the other cannot.  It has absolutely nothing to do with how hard either of them are trying.”

“This is not a race and we are not in competition with each other to see who can be the superhero and who are the weak ‘losers.’ There’s no such thing as either one with this disease.”

“We are all ‘endosister’ warriors who are doing the best that we can and each of our experiences deserves recognition and respect. For some, just getting out of bed to go to the bathroom can be the equivalent of running a marathon for another woman.”

Obama Administration Set to Remove Barrier to Marijuana Research

he Obama administration is planning to remove a major roadblock to marijuana research, officials said Wednesday, potentially spurring broad scientific study of a drug that is being used to treat dozens of diseases in states across the nation despite little rigorous evidence of its effectiveness.

The new policy is expected to sharply increase the supply of marijuana available to researchers.

And in taking this step, the Obama administration is further relaxing the nation’s stance on marijuana. President Obama has said he views it as no more dangerous than alcohol, and the Justice Department has not stood in the way of states that have legalized the drug.

For years, the University of Mississippi has been the only institution authorized to grow the drug for use in medical studies. This restriction has so limited the supply of marijuana federally approved for research purposes that scientists said it could often take years to obtain it and in some cases it was impossible to get. But soon the Drug Enforcement Administration will allow other universities to apply to grow marijuana, three government officials said.

While 25 states have approved the medical use of marijuana for a growing list of conditions, including Parkinson’s, Crohn’s disease, Tourette’s syndrome, Alzheimer’s, lupus and rheumatoid arthritis, the research to back up many of those treatments is thin. The new policy could begin to change that.

“It will create a supply of research-grade marijuana that is diverse, but more importantly, it will be competitive and you will have growers motivated to meet the demand of researchers,” said John Hudak, a senior fellow at the Brookings Institution.

The new policy will be published as soon as Thursday in the federal register, according to the three officials, who have seen the policy but spoke on condition of anonymity because they were not authorized to discuss it.

It is unclear how many additional universities would receive licenses to grow marijuana, but the new policy does not set a cap on the number who could qualify. Any institution that has an approved research protocol and the security measures needed to store dangerous drugs can apply.

Researchers will still have to receive approval from federal agencies to conduct medical studies of marijuana, including from the D.E.A. and the Food and Drug Administration. Those whose projects are funded by the National Institute on Drug Abuse will also need its consent.

But drug policy advocates, experts and researchers predicted that increasing the number of institutions growing marijuana will have a significant practical effect. The University of Mississippi’s monopoly on that role has been a barrier.

“It’s clear that this was a significant hurdle in limiting the quantity of clinical research taking place in the U.S.,” said Paul Armentano, the deputy director of the National Organization for the Reform of Marijuana Laws.

Researchers often had difficulty getting some kinds of marijuana, including ones with large amounts of THC, the main ingredient in the drug that gets people high. Under the University of Mississippi monopoly, Mr. Hudak of Brookings said: “If you were a researcher who thought a product with high THC would help someone with a painful cancer, you were out of luck. You couldn’t access high THC marijuana in the same way you could buy it in a market in Colorado,” where it is legal.

As recently as June, Dr. Steven W. Gust, a special assistant to the director of National Institute on Drug Abuse, had disagreed with critics who say the monopoly has stifled research. “In the past, NIDA has been able to provide marijuana for every federally qualified research project,” he said recently in an emailed response to questions.

Earlier this year, the D.E.A. had suggested that it would possibly remove marijuana from the list of the most restricted and dangerous drugs by end of June. But this week, the agency did not take such a step.

Dr. Orrin Devinsky of the Comprehensive Epilepsy Center at New York University Langone Medical Center called it “deeply disappointing” that the agency had not done so. He said the scientific data overwhelmingly indicated it should not be listed as such a dangerous drug.

The federal government still classifies marijuana as a highly addictive drug without medical value, as it has for 46 years. The D.E.A. did not say when it will answer two petitions demanding a change of that policy, filed separately in 2009 and 2011.

Others were relieved that the D.E.A. had moved to allow more institutions to grow marijuana for research, but not taken it off the list of the most dangerous drugs.

“They’re looking at the science, taking a nuanced view,” said Kevin A. Sabet, a former Obama administration drug-policy adviser and president of the group Smart Approaches to Marijuana. “It’s a good day for science.”


Drinking Tequila Could Help You Lose Weight

While it’s widely known that throwing back booze racks up a ton of empty calories, a new study has found a link between tequila and weight loss. This is huge news for agave-spirit lovers—and virtually anyone who plans on drinking over the holidays. 

According to the American Chemical Society, which researched the effects of tequila on blood glucose levels last year, sugars found in the plant that makes tequila can help lower your blood sugar. The sugars that naturally occurs in the agave plant are called agavins—not to be confused with agave syrup—and are non-digestible, so they won’t raise your blood sugar.

During the study, researchers found that mice who’d been given a standard diet, and then drank water with agavins added, ended up eating less overall and had lower blood sugar levels than the others who hadn’t consumed agavins. What’s more, the mice consuming agavins also produced a hormone called GLP-1, which keeps the stomach full longer and produces insulin, leading researchers to believe that agavins could be beneficial for people with type 2 diabetes or struggling with weight-loss issues.

We’re not saying you should start shaking up party-size batches of sugary margaritas or palomas, but a round of tequila shots might start sounding more and more enticing now that we know this potential weight-loss link.

It’s Not Fibromyalgia

I stood in my closet this morning, looking around as though I’d never been there. I couldn’t remember what I was doing, why, or what I should do next. So I stood still, waiting for it to come to me. Moments before I had been violently panting like a wild animal, bent over in pain and hugging my own body. I’d simply gone upstairs to get dressed for the day, but just as it does every day of my life in varying degrees, my illness reminded me who was in charge.

Tears welled up. That happens a lot, too. I don’t always have words any more when I want to express what I’m feeling so my soul expresses it for me. I forget. A lot.

If you have been told you have Fibromyalgia or Chronic Fatigue Syndrome, this could change your life. #Fibromyalgia #CFS

It’s Not Fibromyalgia

I was first diagnosed with Fibromyalgia in my early 30s by a young doctor who had clearly just learned the word on a sleepover at Junior Doctor Camp.

“You will grow weaker and weaker until finally your muscles atrophy. Your life span will be drastically shortened, and you’ll live out your final years wheelchair bound.”

Over the years I would experience sporadic periods of improvement and so I’d decided that Fibromyalgia was a bullshit diagnosis, and I damn sure didn’t have it.

Then I’d get really sick again.

My Symptoms

My arms and legs go numb, almost always both at the same time but sometimes not. Either way, I fall down, bump into things, lose my balance. I can’t always tell where my foot is hitting, and when that happens you would think that our floors are made of chewed up bubble gum.

My joints stiffen so severely that my ankles don’t want to bend and my elbows always feel like someone hit them with a hammer while I slept.

I move like Frankenstein, only not as gracefully.

My muscles ache down to the bone in a way that feels like I am always battling influenza. It never stops. Ever.

But, by far the worst thing I’ve been living with for so long is extreme fatigue. I’ve thought so often about what word I could possibly use to describe what it feels like, and I’ve always come up empty. All I can tell you is the kind of fatigue I live with every day is what I believe it must feel like to die. When it’s very bad, doctors notice a palsy that comes over my face, and I have trouble even standing. I can’t rest enough to recover. I say it’s like someone is embalming me.

That can happen whether I am sitting in a chair with my feet up, or it can happen after I’ve played with my grandmonkeys. It doesn’t matter what I do. It’s always there.

I’ve said to every doctor I’ve seen, “I know that I will not live much longer. I’m dying.” I’ve known that for a long time. In years past I’d have bursts of weeks or months of energy that would allow me to behave normally. But, I always knew I was dying. In the past three years I’ve really felt my life slipping away. There have been almost no bursts of energy or good days – just me waiting to go to sleep and not wake up.

I figured that in my autopsy results they’d discover what was really wrong with me and “the world” would know I wasn’t crazy. Well, at least as it pertains to my health.

Across decades I’ve been seen by new doctors, and with each came mounds of new medical bills. “You are presenting like you have MS,” they’d all say, and then after the same battery of tests came the same diagnosis.

Fibromyalgia and Chronic Fatigue Syndrome.

Fibromyalgia or toxic mold poisoning? -

“I don’t believe that either of those is a diagnosis,” I’d say to them. “You are labeling me with those words because I am a woman, and because you don’t know what else to do with me.”

Want to piss off a doctor? Tell them you think they don’t know what they’re talking about. One particularly cocky son-of-a-bitch said to me, “You seem like you’d rather I’d have said you have MS.”

I know people who suffer unspeakably with Multiple Sclerosis. It’s vicious. But, yes. Sometimes I’d have taken the diagnosis of that horrific disease if only to have a “real thing” that explains why I so often can’t walk the ten feet from my recliner to the closest bathroom without holding onto something. People believe you when you say you have MS. They understand (as best they can), that you’re not well and that you’re not a liar who is seeking attention.

It’s not the same mindset with regard to Fibro and CFS.

I remember someone I deeply respect who suddenly made a proclamation on Facebook about women and Fibromyalgia. Go on a diet, get some exercise and grow up pretty much sums up the sentiment. There was no way I could tell people how sick I’ve been for fear they’d think of me as someone who wasn’t trying hard enough to be healthy, or worse, have them think it was all in my head.

Vapors or Fibromyalgia? What's the difference?

Just to be sure, I went to see a psychiatrist. “Sher, you aren’t crazy. This isn’t in your head,” he said. To his credit he also said, “I could prescribe Lyrica for you, but if I do that it’s the same as saying I believe what you’ve been told about what’s going on and I don’t. You have to keep pushing until you get to the person who can help you.”

Well-meaning close friends and not so well-meaning relatives had more to say when I would take them into my confidence about how unwell I was. To be fair, there is only one person who knows how bad I am. Some people in my life know a little, and some a little more, but no one knows the extent of just how damn bad it’s been beyond my partner.

What People Say to Me

You need to cut out gluten. You need to cut out sugar. You need to push through it. You need to exercise. You should pray. You need to try harder to force yourself to do things that are uncomfortable. My friend knows someone who knows someone who has Fibromyalgia and they are living their life, not laying around letting it happen.

And the worst things that have been said? The things that I can’t get out of my head and that bring me to tears even as I write?

“Are you planning on being sick next month?”

“Seriously? Don’t tell me you’re sick again. Really? It’s funny how you’re sick when I need something from you.”

Finally, a Diagnosis

An acquaintance dropped me a note one day that encouraged me to see a infectious disease doc here in the Midwest. A close family member of hers was made healthier by this man and she felt I should at least see him. It took months to get in, and I was profoundly skeptical.

The day came and I brought my partner with me to help me express what was happening, ask smart questions, and remember it all. When you lose your words and you forget things the way I do, you stop going to appointments alone. You stop going anywhere alone.

When he walked in, I knew right away something was different. He told me he was allowing two hours for our visit. I’d never had more than minutes with any doctor. He asked me questions about my current life, and my past. In many cases, before I could answer he’d tell me what he suspected my answer was going to be. He was always right.

He explained his research into Fibromyalgia and Chronic Fatigue Syndrome and how it had become his driving passion for many, many years. He spoke to us about his research, the two papers he’d published and the third on which he was currently working.

“I am 95% positive, Sher, that when we test your urine you will be positive for mycotoxins – black mold.”

In my life, no doctor has made such a bold statement. No physician of any kind had ever before been so confident to use such language BEFORE tests.

“It’s with good reason that you tell me you know you are dying. That’s exactly what is happening. The mycotoxins are killing you at a cellular level.”

And, then he said two little sentences that changed everything.

“I can help you. I will help you.”

I cried, and when at the end of our time together he got up to leave he opened his arms wide to me. “Around here, we give hugs.”

I came home and prayed that I’d be positive for black mold. There’s a prayer I never imagined.

When the tests came back, about two weeks, I received a copy of my results. There it was in black and white. Black mold. Mycotoxins. “You have a black mold factory living in your sinus cavity, Sher,” doctor said.

(Here is the info regarding Dr. Brewer’s peer-reviewed, published research into Mycotoxins, along with answers to your most frequently asked questions.)

It could have begun as a very young girl in the South. It could have happened all the years I lived in Kentucky. It could have been in Germany. It definitely could have been made worse again by all the flooding and old homes in Southeast Kansas.

“You don’t have to be living in a home with black mold on the walls to have this happen to you,” he said.

That’s been several weeks ago now, and every day I take the treatment he’s prescribed. It amounts to inhaling a drug to kill the mold. There is no way to know how long it will take, but I don’t care. If it takes a year I’ll do it every day and wait for this to be over. The only side effects I’m currently having are that I’m so nauseous almost all the time now, and the fatigue has gotten even worse… if you can imagine such a thing.

I’m waiting on a call from his nurse right now about those things, but I’ve told myself the nausea is from the treatment running down my throat to my stomach. And the worsening fatigue? Well, I used to tell my babies that when your body is working hard to make you well, you have to rest because it takes so much energy for healing. There is a war inside my body now and I’m just going to have to do the best I can to wait it out.

At least we know what the hell this invisible, torturous monster is and there is hope now. I want to be healthy again. I want to take my grandmonkeys on outings. I want to run. I want to drink coffee in Portland, and sleep in a treehouse in New England, and drink great wine with friends in Chicago, and eat the best pizza in New York, and zipline in some place lush and warm. I want to be me again.

I have two incredibly loving and supportive children and a man in my corner who says things like, “I’d rather have life with you – even when you’re not well – than life without you. No question.”

Can’t quit now. I’m three feet from sunshine.

If you’re wondering about black mold poisoning, I’ll leave you with the following information:

Black Mold Symptoms

Please note that this is an exhaustive list. You do not have to have every single symptom to have a mold related illness.

  • Abdominal pain
  • Aches and pains
  • Aggression and other personality changes
  • Anxiety
  • Bleeding gums
  • Bleeding in the brain
  • Bleeding tendency
  • Blood not clotting properly
  • Blurry vision and vision worsening
  • Bone marrow disruption
  • Brain fog
  • Burning sensation in the mouth
  • Chest pain
  • Chronic fatigue
  • Cold or flu type symptoms or recurring colds
  • Coma
  • Confusion
  • Coughing
  • Crawling skin
  • Damage to heart
  • Death
  • Depression
  • Dermatitis
  • Diarrhea
  • Difficulty breathing
  • Difficulty concentrating and paying attention
  • Disorientation
  • Dizziness
  • Drowsiness
  • Eye damage
  • Eye inflammation and soreness
  • Fever
  • Hair loss
  • Hallucinations
  • Headaches
  • Hearing loss
  • Heart inflammation
  • Hemorrhage – internal bleeding
  • Immunosuppression
  • Impaired learning ability
  • Infections reoccurring
  • Irregular heartbeat
  • Itchy nose
  • Jaundice (yellowing of the eyes & skin)
  • Joint pain
  • Joint stiffness
  • Liver disease
  • Low blood pressure
  • Malaise
  • Memory loss and memory problems
  • Muscle pain
  • Nausea
  • Nose bleeds
  • Numbness
  • Pulmonary edema
  • Pulmonary hemorrhage
  • Red or bloodshot eyes
  • Runny nose
  • Seizure
  • Sexual dysfunction
  • Shaking
  • Shock
  • Shortened attention span
  • Slowed reflexes
  • Sore throat
  • Stuffy, blocked nose
  • Tingling
  • Trembling
  • Vomiting
  • Vomiting up blood
  • Weakness
  • Weight loss, anorexia
  • Wheezing

My hope is that you feel better very soon. Please know that while I cannot respond to every comment, I do read them all and my heart hurts for each of you who are suffering.


American Idol's Jax Reveals She's Battling Thyroid Cancer: 'I Don't Think I Have Ever Experienced Anything Scarier'

by Melody Chiu

Jax left everything she had on the American Idol stage each week when she competed on the show’s fourteenth season, but for the last few months, the singer has been secretly battling cancer.

In a new interview with My Central Jersey, Jax reveals she was shockingly diagnosed with thyroid cancer in April shortly after performing at a show.

“It was very unexpected,” she says. “When you’re 20 years old, you have this ‘Superman’ entitlement mentality. Like you’re indestructible. Thank God I have people in my life that were there to help me deal with this when my reality finally clicked for me. I’m a tough guy, but I don’t think I have ever experienced anything scarier.”

In the days leading up to her diagnosis, the Idol contestant was “waking up in a very dark place every day,” she says. “Stress has always been a weight in my life, but over the course of a few weeks something felt different. While grocery shopping with my parents, I felt a small lump on my throat.”

After visiting the doctor, she was diagnosed with Hashimoto’s Disease and was found to have 18 tumors on her thyroid. Twelve of the tumors tested positive for cancer.

The star had her thyroid taken out and has been undergoing radiation treatment in New York. And though she’s spent most of the summer at home, the singer is planning to participate in the 2016 TCS NYC Marathon in November to help raise funds for Tuesday’s Children, an organization that supports youth and families affected by terrorism or traumatic loss.

“The work, pressure, & travel in music is not always so forgiving on the mind and heart. It absolutely takes its toll on your body,” Jax captioned an Instagram post on Monday. “Sometimes I think the universe is yelling at me to slow down and I just blatantly ignore it.”

This article originally appeared on

My Son Was Just Diagnosed with Autism. Thank God I’m Bipolar.

Kevin Hall understands the pros and cons of being labeled. And he knows that what really matters is doing your best.

By Kevin Hall Leave a Comment

Until just the other day, my wife and I consistently beat ourselves black and blue as parents. We figured that we weren’t doing (X, Y, Z) quite right. We thought maybe we were feeding our oldest son (a, b, c) when it should have been (e, f, g.)
From now on, our son will be “a boy with autism” instead of just a boy.

As it turns out, our eleven-year-old boy isn’t wired for social cues and empathy. We’ve known this intuitively for much of his life, we’ve heard it anecdotally from school teachers and principals. But I’ve been very reluctant to seek a diagnosis for him. I was branded bipolar by the medical model at age nineteen. It has left debilitating scars even if it has saved my life.

With our son’s brand-new diagnosis of autism comes understanding, explanation, and a world of forgiveness. All because of a simple word. But what has actually changed?

side portrait of a father and son : Stock PhotoAbsolutely nothing. He is the same boy. We are the same parents. We love him.

Absolutely everything. He is doing his best, with the wiring and tools he has. Sometimes his behavior doesn’t fit the world around him very well.

I can now see that my son has been doing an incredible job at school socially, given that he’s had to construct an intellectual model of social interactions and expectations. He doesn’t receive all the subtly coded non-verbal information that the rest of us do.

I can see that my wife and I have been good parents, that we might do well to ignore much of mainstream media parenting advice that never would have worked for him (other than the love bit.)

It didn’t always seem to them like I was doing my best. The label helped a lot though. We could describe some of my antics or apathy as disorder—not intentional disaster.

I can see that my son may have a life ahead of him on the razor’s edge of labels. There will be solidarity with an in-group, acceptance, and practical tools, while at the same time he is set apart from neuro-typical. (On this topic, I cannot recommend enough Andrew Solomon’s Far from the Tree.)

From now on, our son will be “a boy with autism” instead of just a boy. He will become aware that while he wants nothing more than to be “just another boy,” it will often serve him better to be a boy with a label.

As a manic depressive father, I am grateful that I have twenty-five years of experience walking this knife-edge of identities. As his life gets more complicated, I may be able to help my son navigate ambiguous terrain better than I otherwise would have. I hope so.

A while ago I was enjoying the podcast of a conversation between Alanis Morissette and another guest. Things got a little heated. They chose to agree to disagree about whether it was right to say that everybody was “doing their best.” They did this so that they could move the podcast along. Alanis was advocating the perspective that people were always doing their best, that some behaviors betrayed less-than-optimal natures or nurtures, or trauma, or all three.

I’ve lived with manic depression since I was in college. My family has had to support me through some rough patches. It didn’t always seem to them like I was doing my best. The label helped a lot though. We could describe some of my antics or apathy as disorder—not intentional disaster.

I’ve only ever yelled at my sister once as an adult, when she said, “I know you want to not have to be responsible for that time ….” I jumped down her throat and screamed that I wanted nothing in the world more than to have been able to be responsible for that time.

We agreed to disagree.

For a thrilling way to bracket one end of the “doing their best debate”, check out neuroscientist Sam Harris’s position that free will itself is illusory. From that starting point, you can’t even ask the question whether someone is doing their best.

At the other end of the spectrum is the Western capitalist ethos, which tries to suggest you always get what you deserve. We admire so many of its tenets that we sometimes forget they don’t apply to all walks of life.

Where do you stand on the “Everybody is doing their best” spectrum?

Why you shouldn't exercise to lose weight, explained with 60+ studies

Welcome to Show Me the Evidence, where we go beyond the frenzy of daily headlines to take a deeper look at the state of science around the most pressing health questions of the day.

“I’m going to make you work hard,” a blonde and perfectly muscled fitness instructor screamed at me in a recent spinning class, “so you can have that second drink at happy hour!”

At the end of the 45-minute workout, my body was dripping with sweat. I felt like I had worked really, really hard. And according to my bike, I had burned more than 700 calories. Surely I had earned an extra margarita.

The spinning instructor was echoing a message we’ve been getting for years: As long as you get on that bike or treadmill, you can keep indulging — and still lose weight. It’s been reinforced by fitness gurus, celebrities, food and beverage companies like PepsiCo and Coca-Cola, and even public-health officials, doctors, and the first lady of the United States. Countless gym memberships, fitness tracking devices, sports drinks, and workout videos have been sold on this promise.

There’s just one problem: This message is not only wrong, it’s leading us astray in our fight against obesity.

To find out why, I read through more than 60 studies on exercise and weight loss. I also spoke to nine leading exercise, nutrition, and obesity researchers. Here’s what I learned.

1) An evolutionary clue to how our bodies burn calories

When anthropologist Herman Pontzer set off from Hunter College in New York to Tanzania to study one of the few remaining hunter-gatherer tribes on the planet, he expected to find a group of calorie burning machines.

Unlike Westerners, who increasingly spend their waking hours glued to chairs, the Hadza are on the move most of the time. Men typically go off and hunt — chasing and killing animals, climbing trees in search of wild honey. Women forage for plants, dig up tubers, and comb bushes for berries. “They’re on the high end of physical activity for any population that’s been looked at ever,” Pontzer said.

Table of contents

1) An evolutionary clue to how our bodies burn calories
2) Exercise is excellent for health
3) Exercise alone is almost useless for weight loss
4) Exercise accounts for a small portion of daily calorie burn
5) It’s hard to create a significant calorie deficit through exercise
6) Exercise can undermine weight loss in other, subtle ways
7) Exercise may cause physiological changes that help us conserve energy
8) Energy expenditure might have an upper limit
9) The government and the food industry are doling out unscientific advice
10) So what actually works for weight loss?

By studying the Hadza’s lifestyle, Pontzer thought he would find evidence to back the conventional wisdom about why obesity has become such a big problem worldwide. Many have argued that one of the reasons we’ve collectively put on so much weight over the past 50 years is that we’re much less active than our ancestors.

Surely, Ponzer thought, the Hadza would be burning lots more calories on average than today’s typical Westerner; surely they’d show how sluggish our bodies have become.

On several trips in 2009 and 2010, he and his colleagues headed into the middle of the savanna, packing up a Land Rover with camping supplies, computers, solar panels, liquid nitrogen to freeze urine samples, and respirometry units to measure respiration.

In the dry, open terrain, they found study subjects among several Hadza families. For 11 days, they tracked the movements and energy burn of 13 men and 17 women ages 18 to 75, using a technique called doubly-labeled water — the best known way to measure the carbon dioxide we expel as we burn energy.

When they crunched the numbers, the results were astonishing.

“We were really surprised when the energy expenditure among the Hadza was no higher than it is for people in the US and Europe,” says Pontzer, who published the findings in 2012 in the journal PLoS One. While the hunter-gatherers were physically active and lean, they actually burned the same amount of calories every day as the average American or European, even after the researchers controlled for body size.

Pontzer’s study was preliminary and imperfect. It involved only 30 participants from one small community.

But it raised a tantalizing question: How could the hunting, foraging Hadza possibly burn the same amount of energy as indolent Westerners?

hunter gatherer Javier Zarracina/Vox

As Pontzer pondered his findings, he began to piece together an explanation.

First, scientists have shown that energy expenditure — or calories burned every day — includes not only movement, but all the energy needed to run the thousands of functions that keep us alive. (Researchers have long known this, but few had considered its significance in the context of the global obesity epidemic.)

Calorie burn also seems to be a trait humans have evolved over time that has little to do with lifestyle. Maybe, Pontzer thought, the Hadza were using the same amount of energy as Westerners because their bodies were conserving energy on other tasks.

Or maybe the Hadza were resting more when they weren’t hunter-gathering to make up for all their physical labor, which would also lower their overall energy expenditure.

This science is still evolving. But it has profound implications for how we think about how deeply hardwired energy expenditure is and the extent to which we can hack it with more exercise.

If the “calories out” variable can’t be controlled very well, what might account then for the difference in the Hadza’s weights?

“The Hadza are burning the same energy, but they’re not as obese [as Westerners],” Pontzer said. “They don’t overeat so they don’t become obese.”

This fundamental concept is part of a growing body of evidence that helps explain a phenomenon researchers have been documenting for years: that it’s extremely difficult for people to lose weight once they’ve gained it by simply exercising more.

2) Exercise is excellent for health

Before we dive into why exercise isn’t that helpful for slimming, let’s make one thing clear: No matter how working out impacts your waistline, it does your body and mind good.

A Cochrane Review of the best-available research found that, while exercise led to only modest weight loss, study participants who exercised more (even without changing their diets) saw a range of health benefits, including reducing their blood pressure and triglycerides in their blood. Exercise reduces the risk of Type 2 diabetes, stroke, and heart attack.

A number of other studies have also shown that people who exercise are at a lower risk of developing cognitive impairment from Alzheimer’s and dementia. They also score higher on cognitive ability tests — among many, many other benefits.

If you’ve lost weight, exercise can also help weight maintenance when it’s used along with watching calorie intake. Exercise, in summary, is like a wonder drug for many, many health outcomes.

3) Exercise alone is almost useless for weight loss

exercise weight loss bike

The benefits of exercise are real. And stories about people who have lost a tremendous amount of weight by hitting the treadmill abound. But the bulk of the evidence tells a less impressive story.

Consider this review of exercise intervention studies, published in 2001: It found that after 20 weeks, weight loss was less than expected, and that “the amount of exercise energy expenditure had no correlation with weight loss in these longer studies.”

To explore the effects of more exercise on weight, researchers have followed everybody from people training for marathons to sedentary young twins, and post-menopausal overweight and obese women who ramp up their physical activity through running, cycling, or personal training sessions. Most people in these studies typically only lost a few pounds at best, even under highly controlled scenarios where their diets were kept constant.

Other meta-analyses, which looked at a bunch of exercise studies, have come to similarly lackluster conclusions about exercise for losing weight. This Cochrane Review of all the best-available evidence on exercise for weight loss found that physical activity alone led to only modest reductions. Ditto for another review published in 1999.

University of Alabama obesity researcher David Allison sums up the research this way: Adding physical activity has a very modest effect on weight loss — “a lesser effect than you’d mathematically predict,” he said.

We’ve long thought of weight loss in simple “calories in, calories out” terms. In a much-cited 1958 study, researcher Max Wishnofsky outlined a rule that many organizations — from the Mayo Clinic to Livestrong — still use to predict weight loss: A pound of human fat represents about 3,500 calories; therefore cutting 500 calories per day, through diet or physical activity, results in about a pound of weight loss per week. Similarly, adding 500 calories a day results in a weight gain of about the same.

Today, researchers view this rule as overly simplistic. They now think of human energy balance as “a dynamic and adaptable system,” as one study describes. When you alter one component — cutting the number of calories you eat in a day to lose weight, doing more exercise than usual — this sets off a cascade of changes in the body that affect how many calories you use up, and in turn, your body weight.

4) Exercise accounts for a small portion of daily calorie burn

One very underappreciated fact about exercise is that, even when you work out, those extra calories burned only account for a tiny part of your total energy expenditure.

“In reality,” said Alexxai Kravitz, a neuroscientist and obesity researcher at the National Institutes of Health, “it’s only around 10 to 30 percent [of total energy expenditure] depending on the person (and excluding professional athletes that workout as a job).”

total energy expenditure Javier Zarracina/Vox
Components of total energy expenditure for an average young adult woman and man.

There are three main components to energy expenditure, Kravitz explained: 1) basal metabolic rate, or the energy used for basic functioning when the body is at rest; 2) the energy used to break down food; and 3) the energy used in physical activity.

We have very little control over our basal metabolic rate, but it’s our biggest energy hog. “It’s generally accepted that for most people, the basal metabolic rate accounts for 60 to 80 percent of total energy expenditure,” Kravitz said. Digesting food accounts for about 10 percent.

That leaves only 10 to 30 percent for physical activity, of which exercise is only a subset. (You can read more about this concept here and here.)

“It’s not nothing, but it’s not nearly equal to food intake — which accounts for 100 percent of the energy intake of the body,” Kravitz said. “This is why it’s not so surprising that exercise leads to [statistically] significant, but small, changes in weight.”

5) It’s hard to create a significant calorie deficit through exercise

Using the National Institutes of Health Body Weight Planner — which gives a more realistic estimation for weight loss than the old 3,500 calorie rule — mathematician and obesity researcher Kevin Hall created this model to show why adding a regular exercise program is unlikely to lead to significant weight loss.

body weight planner Javier Zarracina/Vox
National Institutes of Health Body Weight Planner.

If a hypothetical 200-pound man added 60 minutes of medium intensity running four days per week while keeping his calorie intake the same, and he did this for 30 days, he’d lose five pounds. “If this person decided to increase food intake or relax more to recover from the added exercise, then even less weight would be lost,” Hall added. (More on these “compensatory mechanisms” later.)

So if one is overweight or obese, and presumably trying to lose dozens of pounds, it would take an incredible amount of time, will, and effort to make a real impact through exercise.

6) Exercise can undermine weight loss in other, subtle ways

How much we move is connected to how much we eat. As Hall put it, “I don’t think anybody believes calories in and calories out are independent of each other.” And exercise, of course, has a way of making us hungryso hungry that we might consume more calories than we just burned off.

One 2009 study shows that people seemed to increase their food intake after exercise — either because they thought they burned off a lot of calories or because they were hungrier. Another review of studies from 2012 found people generally overestimated how much energy exercise burned and ate more when they worked out.

“You work hard on that machine for an hour, and that work can be erased with five minutes of eating afterward”

“You work hard on that machine for an hour, and that work can be erased with five minutes of eating afterward,” Hall added. A single slice of pizza, for example, could undo the calories burned in an hour’s workout. So could a cafe mocha or an ice cream cone.

There’s also evidence to suggest that some people simply slow down after a workout, using less energy on their non-gym activities. They might decide to lay down for a rest, fidget less because they’re tired, or take the elevator instead of the stairs.

These changes are usually called “compensatory behaviors” — and they simply refer to adjustments we may unconsciously make after working out to offset the calories burned.

7) Exercise may cause physiological changes that help us conserve energy

The most intriguing theories about why exercise isn’t great for weight loss describe changes in how our bodies regulate energy after exercise.

Researchers have discovered a phenomenon called “metabolic compensation.”

“The more you stress your body, we think there are changes physiologically — compensatory mechanisms that change given the level of exercise you’re pushing yourself at,” said Loyola University exercise physiologist Lara Dugas. In other words, our bodies may actively fight our efforts to lose weight.

This effect has been well documented, though it may not be the same for everyone.

For one fascinating study, published in the journal Obesity Research in 1994, researchers subjected seven pairs of sedentary young identical twins to a 93-day period of intense exercise. For two hours a day, nearly every day, they’d hit a stationary bike.

The twins were also housed as in-patients in a research lab under 24-hour supervision and fed by watchful nutritionists who measured their every calorie to make sure their energy intake remained constant.

Despite going from being mostly sedentary to spending a couple of hours exercising almost every day, the participants only lost about 11 pounds on average, ranging from as little as 2 pounds to just over 17 pounds, almost all due to fat loss. The participants also burned 22 percent fewer calories through exercise than the researchers calculated prior to the study starting.

By way of explanation, the researchers wrote that either subjects’ basal metabolic rates slowed down or they were expending less energy outside of their two-hour daily exercise block.

Dugas called this phenomenon “part of a survival mechanism”: The body could be conserving energy to try to hang on to stored fat for future energy needs. Again, researchers don’t yet know why this happens, and how long the effects persist in people.

“We know with confidence that some metabolic adaptions occur under some circumstances,” said David Allison, “and we know with confidence some behavioral compensations occur under some circumstances. We don’t know how much compensation occurs, under which circumstances, and for whom.”

8) Energy expenditure might have an upper limit

Another hypothesis about why it’s hard to lose weight through exercise alone is that energy expenditure plateaus at a certain point. In another Pontzer paper, published in 2016 in the journal Current Biology, he and his colleagues found evidence of an upper limit.

They cast a wide geographic net, recruiting 332 adults from Ghana, South Africa, Seychelles, Jamaica, and the United States. Tracking the study participants for eight days, they gathered data on physical activity and energy burned using accelerometers. They classified people into three types: the sedentary folks, the moderately active (who exercised two or three times per week), and the super active (who exercised about every day). Importantly, these were people who were already doing a certain amount of activity, not people who were randomized to working out at various levels.

Here, physical activity accounted for only 7 to 9 percent of the variation in calories burned among the groups. Moderately active people burned more energy than people who were sedentary (about 200 calories more each day), but above that, the energy used up seemed to hit a wall.

“After adjusting for body size and composition,” the researchers concluded in the study, “total energy expenditure was positively correlated with physical activity, but the relationship was markedly stronger over the lower range of physical activity.”

In other words, after a certain amount of exercise, you don’t keep burning calories at the same rate: Total energy expenditure may eventually plateau.

additive model

In the traditional “additive” or “linear” model of total energy expenditure, how many calories one burns is a simple linear function of physical activity.

“That plateau is really different than the standard way of thinking about energy expenditure,” Pontzer said. “What the World Health Organization and the people who build the Fitbit would tell you is that the more active you are, the more calories you burn per day. Period, full stop.”

In the “constrained” model of total energy expenditure, the body adapts to increased physical activity by reducing energy spent on other physiological activities.

Based on the research, Pontzer has proposed a new model that upends the the old “calories in, calories out” approach to exercise, where the body burns more calories with more physical activity in a linear relationship (also known as the “additive” model of energy expenditure).

He calls this the “constrained model” of energy expenditure, which shows that the effect of more physical activity on the human body is not linear. In light of our evolutionary history — when food sources were less reliable — he argues that the body sets a limit on how much energy it is willing to expend, regardless of how active we are.

“The overarching idea,” Pontzer explained, “is that the body is trying to defend a particular energy expenditure level no matter how active you get.”

This is still just a hypothesis. He and others will need to gather more evidence to validate it, and reconcile contradictory evidence showing that people can burn more energy as they add physical activity. So for now, it’s a fascinating possibility, among all the others, that may help explain why joining a gym as a sole strategy to lose weight is often an exercise in futility.

9) The government and the food industry are doling out unscientific advice

Since 1980, the obesity prevalence has doubled worldwide with about 13 percent of the global population now registering as obese, according to the World Health Organization. In the United States, nearly 70 percent of the population is either overweight or obese.

A lack of exercise and too many calories have been depicted as equal causes of the crisis. But as researchers put it in an article in BMJ, “You cannot outrun a bad diet.”

Since at least the 1950s, Americans have been told that we can. This Public Health Reports paper outlines the dozens of government departments and organizations — from the American Heart Association to the US Department of Agriculture — whose campaigns suggested more physical activity (alone or in addition to diet) to reverse weight gain.

Unfortunately, we are losing the obesity battle because we are eating more than ever. But the exercise myth is still regularly deployed by the food and beverage industry — which are increasingly under fire for selling us too many unhealthy products.

“Physical activity is vital to the health and well-being of consumers,” Coca-Cola says. The company has been aligning itself with exercise since the 1920s, and was recently exposed by the New York Times for funding obesity researchers who emphasize a lack of physical activity as the cause of the the epidemic.

Physical activity and diet should never be given equal weight in the obesity debate

It’s just one of many food companies that’s encouraging us to get more exercise (and keep buying their products while while we’re at it): PepsiCo, Cargill, and Mondelez have all emphasized physical activity as a cause of obesity.

The exercise myth for weight loss also still appears in high-profile initiatives like the first lady’s Let’s Move! campaign — largely because of the food industry’s lobbying efforts, according to Marion Nestle, New York University nutrition professor. The White House’s exercise focus to end childhood obesity, Nestle said, was “a strategic decision to make the message positive and doable and, at the same time, keep the food industry off its back.”

But this focus on calories-out, or the calories we can potentially burn in exercise, is “an inadequate and a potentially dangerous approach, because it is liable to encourage people to ignore or underestimate the greater impact of energy-in,” an obesity doctor and professor wrote in the journal Public Health Nutrition.

In other words, we can lose sight of the fact that it’s mostly too much food that’s making us fat.

“There are all kinds of reasons to exercise that are good for your health,” says Diana Thomas, a Montclair State University obesity researcher. “However, if you’re trying to lose weight, the biggest problem I see is food. We need to cut back the food we’re eating.”

The evidence is now clear: Exercise is excellent for health, but it’s not important for weight loss. The two things should never be given equal weight in the obesity debate.

10) So what actually works for weight loss?

At the individual level, some very good research on what works for weight loss comes from the National Weight Control Registry, a study that has parsed the traits, habits, and behaviors of adults who have lost at least 30 pounds and kept it off for a minimum of one year. They currently have more than 10,000 members enrolled in the study, and these folks respond to annual questionnaires about how they’ve managed to keep their weight down.

The researchers behind the study found that people who have had success losing weight share a few things in common: They weigh themselves at least once a week. They restrict their calorie intake, stay away from high-fat foods, and watch their portion sizes. They also exercise regularly.

But note: These folks use physical activity in addition to calorie counting and other behavioral changes. Every reliable expert I’ve ever spoken to on weight loss says the most important thing a person can do is to limit calories in a way they like and can sustain, and focus on eating healthfully.

In general, diet with exercise can work better than calorie cutting alone, but with only marginal additional weight-loss benefits. Consider this chart from a randomized trial that was done on a group of overweight folks: The group that restricted calories lost about the same amount of weight as the group that dieted and exercised, though the exercisers didn’t cut as many calories:

diets compared
The calorie restriction groups lost more weight than the group who both dieted and exercised.

If you embark on a weight-loss journey that involves both adding exercise and cutting calories, Montclair’s Diana Thomas warned not to count those calories burned in physical activity toward extra eating.

“Pretend you didn’t exercise at all,” she said. “You will most likely compensate anyway so think of exercising just for health improvement but not for weight loss.”