 So, my talk is going to be in a few different parts, but basically start by outlining why modern sports result in an evolutionary mismatch, that's both in terms of energy expenditure and energy intake, and then connect this through various parts of what we're asking the gut to do. Gastrointestinal symptoms in athletes, everything from nausea, vomiting, to abdominal pain and diarrhea are very common. Most studies show about 70% of athletes experience them at one point and another, particularly runners. And as ancestrally minded athletes frequently struggle to balance a lot of these things, those are the kind of guys that we tend to work with, and I think it's worth thinking about the fact that modern sport and nutrient requirements probably aren't ancestral and we're often sacrificing long-term health for short-term performance and we need to take that into consideration. So just to start by talking about ancestral movement and energy requirements, the pads are probably the best well-described, and I often wonder if there's like a Heisenberg uncertainty principle thing where we turn up with our heart rate monitors and accelerometers and then by just measuring them we've changed what they do, but we get a rough idea. They seem to spend two to three hours per day doing moderate to vigorous activity, and that's less vigorous than you might think it's sort of being sort of the threshold for moderate to vigorous is just spending time, the equivalent of walking more than 100 steps per minute, so that's probably average walking, maybe brisk walking for some people. They seem to cover about three and a half to seven miles per day based on their tasks, and though this is significantly more active than the average Westerner, the calorie requirements are constrained across populations, so a number of studies have basically shown that even though these hunter-gatherer and subsistence farming populations are much more active than we are, they still only expend about two to three thousand calories per day just like we do. So there's a couple of studies here. On the left this is basically just a scatterplot of fat-free mass versus total energy expenditure. The grey is a Western society and then the red and blue are hunter-gatherer and subsistence farmers, and what you basically see is that it's the same as your fat-free mass increases your total energy expenditure increases pretty much linearly, and the reason why this happens here on the right you'll see this is the total amount of energy that we're expending. So the bottom bar is the thermal effect of food, so just the energy we expend metabolising our food, then this is our resting metabolic rate which a lot of would be taken up by our fat-free mass, and then on top this is what we can adjust based on our activity levels. And there's two parts to this. So we can increase this by doing some exercise, so we can increase our caloric output, but at the same time once we get to a certain threshold we start to decrease this other activity component which is non-exercise activity thermogenesis. So it's basically sitting there, tapping your foot, you know, sort of all these extra movements that we kind of do without thinking about them, and the more energy you expend doing physical activity or exercise, the less of that you do, it's a compensatory mechanism. However, up to a certain point you won't always be able to compensate, and as an example here is just a training plan for a reasonably competitive Ironman triathlete, and you don't need to read all of the different subsections, but what you're seeing is basically two to three hours per day of vigorous exercise. That's compared to zero to 30 minutes of vigorous exercise that you might do as a hunter-gatherer, and they need, on average, just to stay calorically balanced, at least 45 calories per gram of fat-free mass per day. So somebody like me doing endurance exercise at a training program like this, I'd probably need six, 7,000 calories a day. So that's two to three times what a normal hunter-gatherer might be expected to put into their gut and process, and that's a lot of food. When we're doing that, we often need to resort to certain processing methods just to get those calories in, and that might be causing part of our problems. So there's a number of pitfalls for the potential ancestral athlete, and these are the kind of guys that we tend to see in our practice. They know they should be eating real food, but they want to be competitive at modern sports, so they're often training for two to three hours a day, and their calorie requirements are significantly greater than ancestral populations, just like we talked about. At the same time, I think there's some harm that's been caused by people in our kind of field, because we put a lot of information out there, and these guys consume a lot of information. So they think or have heard that carbs cause diabetes, protein causes cancer, intermittent fasting and time-restricted eating are essential for health, and there might also be some calorie phobia there, which is often very common in endurance athletes. So while you're trying to train two to three hours a day, you think pretty much every micronutrient at a certain point might be detrimental to you, and you just can't get all those calories in, and then what happens is this. So these are the labs from just one of our clients. He's a 30s male. He's an obstacle course racer. He came to us with fatigue and various gastrointestinal symptoms, and you'll see that his free T3 and total T3 are low, and his testosterone at the top is an output for a Dutch, but basically his testosterone was almost unreadable on this test, and if we measured it in blood, it would be super low, and this is really not uncommon. And we sort of jokingly say, the first time I saw this guy's labs, and the first thing I said was he really needs some carbs, because he's trying to be a low-carb athlete whilst trying to do obstacle course racing. This doesn't really work out so well. So we can go into the literature to kind of look at what's happening here, and this is a really nice study of army rangers. So the army rangers in training, and they did two different periods. This is basically their calorie intake over time, so they cycled them more or less calories, and at the same time, these guys are rucking all day, they're psychologically stressed, and they're sleep deprived. So it sounds a lot like the modern guy who has a family trying to train for Ironman and has a 9-5 job, and in the two different trials what they did is the second time they added a big refeeding window. And then what you see is that cortisol goes up, TSH goes up, so thyroid hormone signaling is messed up, IGF-1 comes down and T3 goes down. So basically all hormonal signaling falls apart because we're exposed to these multiple stresses, and this is pretty much what many ancestral athletes are trying to do and what they're getting all the time. So how does this connect to symptoms in the gut, which is where I talked about initially, and there are multiple potential causes of gastrointestinal symptoms in athletes, and I think there's the direct effect of exercise on gut function, which I'll talk about. There's the total amount of food that these guys have to eat if they're staying on top of their calorie needs, or there's just a caloric deficit if they simply can't eat enough. We know that symptoms increase with increasing intensity and duration of exercise, and they're also worse in people that have symptoms of some kind of gastrointestinal symptoms at rest. And like I said earlier, this is the most common issue that we see and we've now worked with and seen the blood test just like I showed you of well over a thousand athletes at this point. So we know that gastrointestinal symptoms are associated with poor fueling, and this is a really nice kind of example. This is taken from the questionnaire, it's called the LEAFQ, the Low Energy Availability in Females, and they did this in elite athletes before the Rio Olympics, and Low Energy Availability using this questionnaire was the best predictor of injury risk during the Olympics, and they have a whole section dedicated to gastrointestinal symptoms, so they directly correlate with an excess caloric deficit. Then going to some data that we have, so Chris, who's the CEO of our company, has built some machine learning models to predict various issues that we see in athletes based on just subjective health questionnaires, and I've just extracted some of the data, the responses of the athletes who've done this questionnaire online, and so over 6,000 people, it's actually more than 10,000 people now, but 50% have somewhat or more gas, this is in the last week, 40% somewhat or more bloating, and then between constipation and diarrhea, at least 70% of the athletes have constipation or diarrhea within the last few days, so this is really, really common. So if we think about how the gut responds to exercise, on the left you'll see a graph, this is just blood flow to the gut, and this is somebody cycling at 70% of VO2 max, so this is something that every endurance athlete would be used to, and basically within 10 minutes you see a significant drop of blood flow to the gut, and then by 30 minutes, and beyond you've lost about 80% of blood flow to the gut, and this is not even at that intense exercise. At the same time we see reduced motility, so you're stopping things moving through, reduced nutrient absorption, so we can't absorb what we're eating, and then there's also a direct injury to the gut lining with very intense exercise. So, lots of blood flow to the gut, just like I said, it starts in the first 10 minutes, then increases over time. The intensity of the exercise is really important, if you do a maximum effort, so five minutes of running, rowing, cycling, some kind of endurance exercise all out, so this would be kind of at VO2 max of five minutes. At that point you've lost almost all blood flow to the gut, and this increases with increasing ambient temperature and with dehydration. So at the same time that that's happening, you're not gonna be able to absorb anything that you put into the gut, which we often try and do while we're doing these types of exercise, so we lose the ability to absorb both carbohydrates. You can see this by giving an athlete some glucose source during exercise, and you'll see their hydrogen increase, just like you would in somebody with a SIBO positive breath test, so they're not able to absorb the carbohydrates and then they get fermented by the gut bacteria instead. They've also shown reduced amino acid absorption. This is for the bros, you wanna make sure they get their protein shakes and immediately after their weight session, and actually if you've done a really hard session of weights, you've got to reduce the ability to absorb the amino acids from your protein shake, and then what happens then is you've got two different effects, so either they can be fermented by the gut bacteria and then you get gas and bloating, or the carbohydrate or the protein can sit in the gut, draw in water, and that's when you get the osmotic effects, things like diarrhea. In terms of actual direct injury to the gut, we know that we lose some of the integrity of the gut lining with increasing intensity and duration of exercise, so again here, they're cycling at 70% of VO2 max, so a very standard endurance session, and so this is just over time, and this is on the Y-axis there, is the level of something called intestinal fatty acid binding protein. You don't need to know what it is, you just need to know that it's inside the cells of the gut and if it's in your blood, that means that those cells broke open and died essentially, and this increases over time, and it's part of a normal response to exercise and we adapt to it, but we need to know that transiently this could certainly be causing issues and we'll also cause issues if we do this more and more over time. So if we're damaging the lining of the gut, particularly with long or intense exercise, we're seeing an increase in intestinal permeability, increase in something called endotoxemia, so that's just toxins from the gut bacteria passing across the wall of the gut and into the bloodstream, and we also see things go in the other direction, so we see blood ending up in our stool and the same thing happens as exercise intensity and duration increases, we see an increased likelihood of blood in the stool, so if they look at people running a 100 mile ultramarathon, about 90% of those guys when they're tested have some blood in their stool afterwards, so almost everybody is starting to bleed into the gut. So just some data here, so on the left, that's having people cycle at different percentages of VO2 max and then this is a lactulose mannitol test, so it's not perfect, but it gives you a rough idea of intestinal permeability and that increases with increasing exercise intensity. And then on the right hand side, that's the fecal occult blood, the blood ending up in the stool that I mentioned, so this is after the Marine Corps Marathon, they took about 130 people, they looked in the stool before and afterwards and about 30% of people had no blood in the stool before and ended up with blood in the stool afterwards, so that's sort of 20 to 25%, which is quite significant just after a normal marathon. Interestingly, they did mention in the paper that gastrointestinal bleeding appeared to be independent of age, race time, abdominal symptoms or recent ingestion of steak. I think that was that they didn't want the iron in the steak looking like blood in the stool rather than they thought that steak was actually causing bleeding into the gut, but they didn't specify. So if we think a little bit more about endotoxins, so these are within the outer wall of gram-negative bacteria and when they get across the gut wall, they result in a systemic inflammatory response. We know that endotoxins increase in the blood after exercise, however, a number of people have thought about this and there's no real commercial test if you're interested in it. There are things you can do to test endotoxin antibody levels. The problem is that these tests sold to kind of give us an idea of gut permeability. However, we increase our endotoxin antibodies as athletes because we know that endotoxins are gonna increase after exercise. So they're gonna be higher in athletes and we also know that they decrease immediately after exercise because they've been bound to all the endotoxin that's come across and then been cleared. So this is again just some data showing that, measuring antibodies to endotoxins in athletes and endotoxins increase by about double after intense exercise and at the same time the antibodies to them decrease by about 50%. So there are, people are selling tests for endotoxin antibodies, but they're really not telling you what they think they're telling you, especially in athletes. So this is just a quick summary of what kind of happens there. Here you have endotoxins at the top. They're decreasing, they can actively decrease the integrity of the gut barrier, the junctions between the cells of the epithelium. You can also activate the immune system which can then cause changes in sodium and potassium transport and then that can result in more water ending up back in the gut and that sort of contribute to some of the things like the diarrhea that we mentioned earlier. So it can affect multiple levels and this can sort of continue in a feed forward cycle if you're not allowing the gut to rest properly or not looking after it properly. So intestinal permeability, increased endotoxin exposure, inflammation and that can directly affect the gut permeability too. Some people have theorized that part of this, this cycle of inflammation, the systemic endotoxins is one of the reasons why athletes are at an increased risk of certain arrhythmias, particularly AFib, if they have a long history of exercise. And there's also potential, some studies that suggest maybe an increased risk of coronary artery atherosclerosis in very high volume athletes and this might be one of the reasons why. So if we then start to think about how fueling might affect the gut, we know that inflammation directly affects the gut microbiota and I apologize, this is the only mouse study that I'm showing. But they've sort of dissected some of these pathways out and they show if you can create some kind of inflammation in the gut, that changes the way that the gut microbiota metabolizes a certain product. So in this case, they're talking about formates and what happens is you then allow certain bacteria, you foster a greater number of certain bacteria. So in this one they were looking at E. coli which we know is one of the most common bacteria in terms of exposure to endotoxins. But other interesting things happen. So if you have an inflamed epithelium, you reduce the ability to do the beet oxidation of fatty acids. So you have actually more oxygen within the gut lining and then that changes the bacteria that can survive within the gut because we know some of them are obligate anaerobes, which means that then they don't like the presence of oxygen. So particularly things like bifidobacteria might decrease in the setting of an inflamed gut. Continuing on, thinking about fueling strategies affecting the gut. And this is really interesting data looking at CGM, so continuous glucose monitoring. This is in 10 athletes who are exercising at least an hour a day. And this is just sort of the total curve of their glucose. And this, the green areas, what we might consider just a normal range for blood glucose. And you'll see these four athletes here. Away from meals, they're spending more than 50% of their time above six millimoles of blood glucose, which is over 110 milligrams per deciliter. So these guys are essentially pre-diabetic despite all the exercise that they do. And also despite not eating that many carbohydrates. So the pink crosses here are the amount of the upper limit of carbohydrates they'd be recommended to eat and it's like four to six hundred. So it's quite a lot. And even they're not even eating quite that much, but these guys are insulin resistant to some degree. And there's a number of different reasons why we might become insulin resistant. And at least part of that could be the fueling strategies that we're using. So here, this is just data looking at the number of parameters that people have with the metabolic syndrome, which we know is insulin resistance is essentially pathonomonic of metabolic syndrome. And the more positive parameters you have a metabolic syndrome, the more endotoxin you have circulating around. So that again feeds back to the integrity of the gut. This is interesting data from the Institute of Systems Biology. And they looked at the number of sugar sweetened beverages that people are eating every day and then the diversity of the gut microbiota. Now I'm not gonna stand here and tell you that more diversity is better because we don't really know that. However, you can see the microbiota definitely changes the more sugar that people are drinking. And when we think about sugar sweetened beverages off as, you know, we think about soda. This is sort of what we associated with. However, it's also this, which we're told, on the one hand, the things on the left cause diabetes and, you know, they're a public health hazard on the right. These are the things that we need as athletes to consume so that we can go faster. However, in some people, they certainly seem to be causing issues. If we go to the other end of the spectrum, we might think, okay, that's fine. We'll cut out all carbs. What if I go low carb? And this again coming back to the endotoxin story, when you're trying to look at the amount of endotoxin that's coming across the gut after a meal in people and here in the black lines, you have normal people and in the white bars, that's the greater increase you see in people with type diabetes. The way that you stimulate endotoxin, crossing the gut into the bloodstream is to have people drink heavy cream. So in people with the right setting with, you know, where the gut isn't healthy, there's ongoing information, maybe they're stressing it too much with the exercise that they're doing and various other things. Throwing down a bulletproof coffee is probably gonna be causing an increase in these endotoxins coming across the gut. So even then, even the low carbers, you know, could be causing damage. It's worth talking about the fact that low carb does not equal no carb, especially when you're trying to fuel elite athletics. So there's a couple of examples here. I don't know if Ben came into the room. He's probably not here, but when he took part in the fast study a couple of years ago, so he was on a ketogenic diet for over a year whilst training for Ironman. And even though he was eating more than 100 grams of carbohydrates today, he was in ketosis pretty much continuously and he failed pretty spectacularly. His thyroid and sex hormones were pretty much in his boots. And you can go and find him and ask about that. He's talked about it pretty extensively. The other example below is Sammy Incanon who some people will know as the CEO of Verta. This is some data that he published online. The carbohydrate intake or the calorie intake he had over an eight day mountain bike race. I'll just highlight one particular day here where he ate 370 grams of carbohydrates yet was still over one millimolar in terms of ketones. So you can eat a significant number of carbohydrates if you're doing that volume of training and still being ketosis. And it's when you try and restrict the carbohydrates that you then start to see issues. So low carb definitely doesn't equal no carb. And when we're trying to think about performance I like this quote from Bill Rogers that more marathons are won or lost in the porter toilets than at the dinner table. However, I do have my one caveat which is that what happens at the dinner table definitely influences what happens in the porter toilets. So this can maybe bring us on to some of the strategies that we like to use with people. And the most important thing is just to eat enough food and the most common advice that we give to the people we work with is just to eat more food. And it's worth remembering that carbohydrates are ergogenic for almost every sport. So if people want some kind of recommendation if you're doing glycolytic sports, high rep weight training, at least one gram per pound of body weight around workouts. If you're doing very low rep weight training you probably don't need as much. If you're doing endurance athletics then at least double that if not more. And it's actually really useful to add carbohydrates back to the diet and people who are restricting them if they're not eating enough calories because they do seem to stimulate hunger. So you can get people to eat more. The corollary of that is when you go on a low carb diet and you try and do endurance athletics you're just not hungry so you automatically eat less. It's worth mentioning that real food is less calorie dense. So if I was gonna eat two grams per pound of carbohydrates from sweet potatoes I have to eat six pounds of sweet potatoes. That's a lot of sweet potatoes. So you really need to work harder eating and sometimes you just need to eat some ice cream. And it can be paleo ice cream but sometimes if we're trying to balance performance versus long-term health and performance is the important thing. Sometimes you just need to get in those calories however you can. In terms of race strategies there's an interesting review paper that came out that basically said that fiber, fat, protein and carbohydrates have all been associated with the greater risk of developing gastrointestinal symptoms during exercise. So that basically means if you eat food during exercise you're more likely to get symptoms. So then one obvious strategy might be to try reduce our reliance on intra-race workout or nutrition and equally that means that we might not always need to go straight to the protein shake or whatever post-workout meal immediately after as we can wait half an hour an hour and let things settle down. So becoming fat adapted is obviously gonna be potentially beneficial. So restricting carbohydrates for periods of time during the training cycle. Fasted workouts can certainly be beneficial as long as you are then making sure you can make up the calories later on. And the sleep low approach again, so that might require some glycolytic activity in the evening, some sprints, some circuit training, deplete glycogen in the muscles, then eat low carb overnight. The next morning do some kind of aerobic type work so you're training in a glycogen depleted state and then after that you eat a meal that has some carbohydrates in it. So it allows you to work on all parts of the system. It is important if you're doing a particularly long event to have a small amount of carbohydrate in protein and that's because it actually maintains a small amount of blood flow to the gut and stops some of those issues that I mentioned earlier. So up to 45 grams per hour if people have, you know, wanna take some kind of amino acids or carbohydrate drink. Theoretically they always talk about 90 grams per hour being the limit. However, particularly in people who are susceptible to gastrointestinal systems, pressu, above 45 grams an hour seems to be about the limit. So 150 to 250 calories per hour, amino acids, fat if you can tolerate it and you're sort of a low carb or keto athlete, including MCTs and then some kind of carb source and that can be pretty much whatever you like and we have a lot of people who do real food stuff based on nut butters and honey and berries or Pema Can or whatever works well for you. I've added keto nesters because particularly for longer endurance events they seem to be, estrogenic seems to increase performance by about one to 2%. And also there's some interesting thoughts on the fact that a beta hydroxybutyrate which obviously you get large increases of when you take a ketone ester can replace butyrate as helping the integrity of the gut lining. So you might also be helping in the integrity of the gut whilst also improving your performance. So I'm hypothesizing that but maybe. Also maintaining hydration is important because dehydration exacerbates all of the negative effects that I've already talked about. However, it's important just to drink to thirst and this is still a debate that's going on whether you should sort of anticipate how dehydrated you will be and drink too much or drink more than you think you need. However, that never really seems to be beneficial and if you go to some of the really interesting studies looking at elite long distance endurance guys so ultramarathans and Ironman athletes, the guys who go fastest lose a lot of water. They're almost 10 to 20% body weight by the end so they seem to be really well adapted to lose water and still perform well. So just drinking to thirst is enough and also electrolytes very important as part of that so magnesium, sodium, potassium and particularly in lower carb athletes that seems to be something that's worth focusing on. So you can also train your gut and the gut does adapt to exercise over time. So in studies where they've given people a certain type of food during exercise as they train more with that strategy the symptoms decrease and the microbiota also adapt to the type of exercise that you're doing which is interesting of nothing else. So this is data from a paper by Lauren Peterson from last year and you see she looked at various categories of cyclists and if you see the amount of training that they did so from six to 10 hours per week up to more than 20 hours per week they had more prevotella species in their gut and so in athletes this seems to be part of a beneficial adaptation. However, certain prevotella species also seem to be associated with disease in other settings. So again, it's very specific to exercise. Very similar in pro cyclists they saw a lot of methanol brevibacter smithii various versus in amateur athletes they saw a lot less of it. And again, if you're sort of plugged into gut health and SIBO and all that kind of stuff you might think of this as a methane producer associated with constipation. And yes, it's actually part of slowing down the transition of food through the gut which then helps these athletes metabolize carbohydrates better but then equally we know a lot of elite athletes who can't go to the bathroom unless they're exercising. So there's kind of an interplay there that they then later become constipated because of the microbiota that they're developing or at least that's potentially part of it. So we know that we should also manage any inflammation and training stress just because of some of the factors that I mentioned earlier. There are a number of potential dietary triggers so we often use elimination diets it could be low FODMAP, low Fiber or AIP and there's definitely some case reports published in the literature that show low FODMAP diets can improve symptoms in athletes. Also other things that end up in process foods like emulsifiers can certainly affect the integrity of the gut lining or at least they can in preclinical studies. So they were thinking about definitely investigate symptoms at rest. And I think a good test might be the degree of sensitivity to gels and carbohydrates during exercise. If you're really sensitive to those things they really cause symptoms that's likely there might be something else going on that's worth looking into. And then adapting your training approach is also important. So we often work with people to move towards more of a polarized approach. So that's spending a lot of time at a very low intensity aerobic type work and then just shorter periods doing sprinting or higher intensity work. And what this does is this minimizes the amount of time that you spend around your lactate threshold high periods near the top of VO2 max. And that's when you're actually getting probably some of the least training benefit but the worst in terms of stress on the gut. So it sort of minimized the time there and also removing unnecessary volume becomes really important. And if we then try and think about the long-term effects on our health there's a lot of data to show the more exercise we do the better our long-term health. However, there's certainly a threshold where we then start to see increases particularly in certain cardiac problems. And when people are doing things like marathons, obstacle course races, triathlons, particularly Ironman, CrossFit we certainly seem to be reaching that threshold pretty quickly. So if you are trying to train for performance or longevity versus performance then the best evidence that we have suggests you're doing about an hour a day of some kind of vigorous activity but what we think is vigorous might not be, it doesn't need to be as vigorous as you might think so that's weight training, body weight stuff running or cycling at a fairly sedate pace. Brisk walking is enough. Daryl Edwards is here so I can't not mention primal play. And then if you're trying to put together a training program think what do I need to add for a performance in my given sport what can I take away that's unnecessary. And also if I want to do a lot more than that if I want to do a lot more than an hour a day why do you want to do that? And I think there's a big sort of psychological component to that that you often need to think about. Just a couple of other things to consider is probably not gonna be breaking news everybody here that should avoid NSAIDs things like a leave and ibuprofen because they can definitely affect the gut. Probiotics have an uncertain place so in some studies they've shown giving certain lactobacillus species as a probiotic actually increases endotoxins circulating in the blood after exercise even though those bacteria don't actually the probiotics don't have any endotoxins themselves. There's a lot of various different nutrients that you can try but if you're not taking away the root causes then that's not really gonna have that much of a benefit. And it's also worth mentioning that the more you believe that a supplement will work the more likely it is to work but that doesn't mean it was actually the supplement that worked. And so one of the best things that you can do is be mindful of subjective symptoms. And this just very very quickly here where I mentioned earlier we've developed some machine learning models to predict common issues in our athletes based just on subjective data. So we're asking about GI symptoms, sex drive, mental health, hunger in society all that kind of stuff. And we can predict low testosterone with a 97% sensitivity and 100% specificity. So very very it's very very easy to see changes in biochemistry based just on how we're feeling so actually being mindful of what's going on can be really important. I just quickly wanted to mention the guy I talked about back at the beginning. We did do a gut protocol on him based on some other tests we did, some stool tests. He has a smarter training program, more calories, more carbs. He completed a spartan beast recently so that's 11 hours of obstacle course racing in a row. That's crazy. He qualified for the Spartan World Championships and at the same time his thyroid numbers worked much better in his testosterone as up near 700 and when I saw this I said I hope he's celebrating with a big fat erection. I wasn't gonna say that. So on that note, just like to thank everybody that I work with and thank you for your attention and I'll gladly take any questions. You mentioned Ponzer at the beginning. I mentioned Ponzer? Ponzer? Uh-huh. Do I spell it or do I pronounce it incorrectly? Do you do research on Ponzer? Ponzer, yeah, yeah. So this is a very, I think a very basic change in paradigm as far as how much athletes spend in terms of calories and so what you showed is exactly I think strengthening his point of view that instead of adding more calorie or spending more calories actually the maintenance, the calories that you normally spend on the maintenance of the body are going to the locomotion, let's say, in this case. Now, but you didn't discuss the implication of that as far as the quantity of food that you eat because if you cannot spend more than 3,500 calories you can't go by the old paradigm that people spend 6,000 or 7,000 calories in a race. So do they spend 7,000 or do they spend 3,500? Are there any doubly labeled water studies of like marathon runners or Ironman runners? Yes, so I think those studies have been done and they are, so they're not expending as much as we think they're expending. However, you do end up sort of breaking that. You do end up breaking that line so you don't have that constrained model as much but you have to work really hard to get to that point but a lot of people are doing that and I think the most important, the point that you made which I didn't make was that you're losing those calories that you would be spending on repair other hormonal processes that are really important and we've sort of come up with this idea that there's actually, there's a buffer between the amount of calories that you can eat and lose weight and the amount of calories you can eat and gain weight and it's not like a simple line. So often we'll tell people to eat as much as they can without gaining weight because then you're eating to that buffer which then allow, then you have those extra calories to go and do all those processes and it's not based on a paper but people start to feel immediately better and they're not gaining weight because they're eating more but they're then able to do all those other sort of reparative processes. Thanks, really great talk, I'm thoroughly enjoyable but your comments about erections and brolifters has provoked the inevitable what about women question? Because I've read a lot of the literature on female athlete triad syndrome defined as like the loss of estrogen progesterin and menstrual cycle in the context of endurance athletes not eating enough food, no hypochloric diets but I've not seen any work looking at the parallel forms in women of what you've described that research on men's testosterone and thyroid function dropping in response to ketogenic diets in the context of endurance. I've managed to do that experiment on myself. So five years ago, four years ago, six days a week high intensity cross training in the context of a ketogenic diet and my thyroid and testosterone levels tanked but not my estrogen and progesterin. So I just wonder like why that sort of research is not being done? Do we just have this sort of norm that women are just jogging and there isn't enough women, there aren't enough women doing that kind of training for it to be interesting for anybody. So that particular example hasn't been like brought up in the research and I apologize, I actually had a female client but I had so many slides that I just, I picked one and because I had some good before and after numbers but so it used to be called female athlete triad. So actually most of the research focuses on caloric deficits in females. However, less so with just pure carbohydrate restriction like a ketogenic style diet. However, we see just as many females exactly the same and it's not necessarily that something with thyroid or specific hormone imbalances that's almost as common, it's at least 50-50. So we see that very frequently and I'm not surprised you managed to do that and I think you can make it work and there's certainly a lot of people making it work but again, you have to work really hard because the ketogenic diet makes you less hungry plus all those calories you're expending to whatever training you're doing. So if you want to stay keto or low carb, you need to work really hard to get those calories in. I'm not sure I got what you were talking about when you had the slide about things to consider and you mentioned I think like glycine and colostrum and some supplements. Yeah. Glutamine. So all of those ones that are there, glutamines, incarnation, colostrum have been shown to reduce gut permeability after exercise in athletes. So there's certainly things that you can try if this is something that affects you and there's some evidence to support them. However, like I said, if you're doing this stuff that's causing these issues, the best thing to do is to do less of them or to restructure everything else rather than rely on supplements to fix it. All right, while you're all sitting there, nobody's asking any more questions. I am president of a society called Physicians for Ancestral Health. Please come and talk to me about it. We're a group of ancestrally minded and ancestrally curious physicians. We have lots of online interactions with people of various expertise. We have a podcast highlighting members, physicians who are out there trying to work these ancestral principles into their work with patients, medical patients. We also have a yearly retreat next year. It's at the end of January in Scottsdale where non-physicians are welcome too. Trying to plug our work, get more people interested, expand our network of ancestrally minded doctors. So if you know anybody or you're interested, please come and find me. Thank you.