Jim

One Year. One Heart. 1,405 Miles. A year ago I sat in a cardiologist’s office, fresh off an atrial-flutter ablation, wondering if my heart would ever let me chase big things again. A new SLAP tear in my shoulder killed swimming and biking. Six years earlier, running injuries had pushed me into Ironman; now the idea of pounding pavement felt like a bad sequel. But six Ironman seasons had taught me a better script: long, slow, mostly Z2 hours. Instead of quitting, I set three goals: Marathon PR First 50 K Stretch: first 50-mile ultra Today the goals are checked. • Flying Pig Marathon weekend Four Way Challenge: 1-mile, 5 K, 10 K, then a 13-minute PR in the marathon. • Kettle Moraine 50 K: brutal Wisconsin trails, 8 h 12 min. • Des Plaines 50 K: flat, fast, 6 h 08 min. • Tunnel Hill 50 Miler: rails-to-trails, 11 h 49 min, middle-of-pack on controlled effort. Totals: 288 hours, 1,405 miles, 80 % Z1/Z2. No heroics—just steady, grateful forward motion. I started at the back of every pack. I finished in the middle. My heart never skipped a beat it wasn’t supposed to. Grateful doesn’t cover it. This year wasn’t about proving anything to anyone else; it was about proving to the guy in the recovery room that the story doesn’t end in the EP lab. If you’re wondering whether you can run your first race—run slow, run long, enjoy the process. Onward. @Alan_Couzens @feelthebyrn1 @johngoldman

@zoeharcombe My preference is LMNT.

Almost every time I go swimming, at least one person doing lengths has a tall bottle at the end of their lane. The liquid is not clear, so it's not water. Every few lengths, they stop to drink. It baffles me...

@hjluks The pressure from patients is enormous to order these, it can be quite difficult to explain the inherent dangers.

The irony I find myself returning to is that MRI technology has not made us better diagnosticians. It has, in many cases, made us worse ones, because the image is so concrete and the language of the report so authoritative that it takes deliberate effort to resist anchoring to it. When the MRI arrives before the history is fully taken, the finding shapes what questions get asked and which ones don't. Bias abounds throughout the encounter. The encounter organizes itself around what the scanner found rather than what the patient experienced, and that is very difficult to undo once it has happened. Don't look at the scans first... the basics matter. Take a history... confirm it with an exam, then see if the MRI findings make sense in the same context.

@nullhypeai @elonmusk Makes me wonder if all of these companies are firing all of their coders only to find out ai won’t be so cost effective going forward.

The ELO is real. The pricing is the more interesting number. Grok Imagine launched at $4.20/min with audio included, versus Veo 3.1 at $12/min and Sora 2 Pro at $30/min. That's a 7x undercut on the premium tier. xAI burned $7.8B in cash in the first 9 months of 2025 on $500M in projected annual revenue. This is the classic infra price-war playbook: buy leaderboard position with capital, establish developer lock-in, reprice later. The technical win is real. Whether the unit economics survive the next 18 months is a different question.

Grok

@WallStreetApes @GuntherEagleman It’s really a sugar delivery company.

Starbucks employee in America records herself making drinks people actually order This one drink has 12 pumps of white mocha and a bunch of other extra add ins I added up all the add ins, did the math and found that this one drink contains over 210 grams of sugar and 1,200+ calories There are people who order these kinds of drinks every day Make America Healthy Again

@CoffeeBlackMD @BodyRecompExprt IM or SQ?

@BodyRecompExprt That's too aggressive for me. 2mg 3x per week of prop is usually fine.

I often consult with women dealing with low testosterone and a low sexual desire. Total testosterone in these lady's is often 30ng/dL or less and "rock solid normal range" I often hear something like this, "I love my husband, and he wants more sex than I do, and I want none," and they genuinely feel bad about this. They may not admit this to their husbands, idk, but they tell me the truth. A low dose of testosterone per week will nudge this testosterone back up into a range where they again find interest in sex. They are not "sex maniacs" but are also not apathetic towards it any longer. It can take a bit of time to move, and I never expect overnight changes. This small dose of testosterone does not cause masculinization, but also needs to be watched closely until satisfactorily stabilized. These women are NOT "witholding sex" they have no interest in sex. This is an important point. It's like they aren't refusing to eat pizza, but rather eating pizza simply doesn't come to mind.

@mattvanswol Yes! My wife is such a good cook, we can rarely find a restaurant good enough to go out to and fortunately she really enjoys cooking.

Surprised my wife last night with two dinner reservations for Valentine’s Day. Both places were super fancy, at least $100/plate. Told her to pick which one she wanted. She turned them both down. She said, “Going out to eat just sucks now…” Anyone else experiencing this?

@Alan_Couzens It would be interesting to see how high the Fatmax goes for these various groups.

How to interpret the curve: If we take a random sample of ~100 athletes... 1/ Poor Metabolic Health (~20/100) Approx 20 out of 100 athletes in my sample see their fat max below 60% Max HR - for many, this will be reached at a walk. These are typically sedentary or very low volume athletes (<7hrs/wk) or athletes with very crappy diets. 2/ Low Volume OR Fast Twitch Dominant (~30/100) Approx 30/100 athletes will see their fat max between 60-70% Max HR - for some a brisk walk, for others a light jog. These athletes are typically training in the 7-15hr range. 3/ High Volume/Slow Twitch Dominant (~30/100) Another ~30/100 athletes will see their fat max between 70-80% Max HR. These will generally be in high volume training ~15-20hrs/wk or will be natural "slow-twitchers" 4/ Very Competitive/Elite (~15/100) ~15 out of 100 athletes (in my sample) are very high level Ironman type athletes (training 20-30hrs/wk) whose max fat ox continues to quite high heart rates of 80-90% MHR (& high pace/power) - i.e. fat burning persists into higher training zones approaching threshold. 5/ Ketogenic Athletes (~5/100) ~5 athletes will hold their fat max all the way to the end of the test. This will often because they lack sufficient glycogen to achieve a true max.

@DrJMarine Thanks for posting this! This is indeed very well written!

Brilliant essay and reflection – one of the most thought-provoking I have ever read on a medical topic. The immediate subject is screening mammography, but it touches on the entire modern preventive medical ecosystem and shifting public sentiments in covid's wake. The quality of the writing alone makes it well worth the read. 1/8

@MoMoPerry @tabletmag Well done. This is so hard to explain to women with questions.

For @tabletmag, I wrote about mammograms, the epistemic ruins of public health, and the implications of unplugging from the consensus-making machine. tabletmag.com/sections/scien…

@bigfatsurprise Yes, his articles on Keto were well written as well as his articles on the numerous weaknesses of observational dietary studies. Formative in my development of a keener eye towards the claims of researchers, dietary and otherwise.

Peter Attia once promoted low-carb, yes. In fact, 15y ago, he faced his own stubborn weight problem despite swimming 3-4 hours/day—a huge amount of exercise. Then he gave up sugars, starches, and finally went full keto. A high-fat diet, He lowered his protein. His calories increased by more than 1000/day (!). Says he lost 40 lbs fat, went from a body fat of 20% to “close to what it was in high school,” which he says was 4%. He recounts this in a talk he gave in 2011: youtube.com/watch?v=lVm7iD… Yet years later, in his book, he says, “Calories Matter” and doesn't single out carbs as a particular problem. It’s a reversal that allowed him to stay inside the orthodoxy. But it does not reflect his experience, or at least part of his experience. Gary Taubes wrote this up, coincidentally, in late Dec substack.com/home/post/p-18…

@tyromper I feel you brother! I have found the videos that accompany this plan to be amazingly helpful. I follow it on @YouVersion bible.com/reading-plans/…

Thoughts & prayers as I enter LEVITICUS tonight on my quest to read the Bible cover to cover this year. After reading Genesis & Exodus it's wild how something written thousands of years ago can speak directly TO ME TODAY. The Bible truly is THE LIVING WORD. 🙏

@alisa_childers Well said!

The reason so many people are not impressed or moved by the comments of Bethel's Bill Johnson and Kris Vallaton is because it's not just fake prophecy and sexual abuse that need to be dealt with. It's the whole movement. The culture. The theology. I just met with several ladies who escaped a NAR church. They are gutted. Their lives are wrecked and they are hanging on to faith by a thread. Some have PTSD. And none of them were given fake prophecies or endured SA. I believe the vast majority of people abused by NAR churches (of which Bethel is the flagship) are in the same boat. To watch these leaders "repent" for a narrow sliver of what was exposed feels like a gut punch. Even if Bethel repents in dust and ashes for covering for fake prophets and sexual abuse...even if Johnson and Vallaton step down and the younger leaders take over...they will still be teaching the same theology. I am praying for Bethel to do the right thing. Their leaders are disqualified. Their ministry school teaches superstition and pagan practices. My sincere prayer is that all the true Christians in this movement (I have no doubt there is a great many) will leave and find biblically sound churches and begin to heal. Lord, please purify your church. Luke 12:2 "There is nothing hidden that won't be revealed."

@theamelia__ 34 years for my wife and I. Every year is better!

@pureMetatron Yes! C64 with floppy drive. This was my second computer, an upgrade!

Starting my morning with a bit of Commodore 64 today. Did you have this machine back in the day?

@SandyofCthulhu I spent so many hours playing Doom. Thank you Sir!

When I was at id Software, John Carmack rarely had gameplay suggestions. He might say something like, "I just incorporated variable lighting. Use it somehow." That sort of thing. But on Doom E3M6 (Mount Erebus) he had a specific idea. He came to me and said, "For the secret level entrance, what if you have to go way up on a ledge, then face into the wall and fire a rocket to blow yourself backwards into a little walled enclosure where the secret exit was?" I thought this was brilliant, because it was before John Romero had invented the rocket jump, so I thought there was no other way in. Also the dumb clipping rules meant you could actually walk up to the side of the enclosure and still "reach" it to click the button, so you didn't even have to rocket into it. But if YOU used the rocket to enter it the proper way, my hat's off to you. Ah well. It's still kind of cool.

@DrEenfeldt This is common sense, practical, and works! Translating this into action is challenging and Hava is the way.

How do you lose weight? What's the most effective way to eat? 250,000 days of eating show the way: – More protein (20% or more, higher=more effective) – More fiber – Lower energy density (calories per gram of food) – Less hyper-palatable foods (combinations of sugar, salt, fat, starch) How about low carb? It tracks with most of the factors above, and it certainly helps. Check out the data below.

@exQUIZitely Those were the days…..

Some of you will be old enough to remember this. Defragging - and it actually did serve a purpose. It was essential for optimizing slow, mechanical hard drives by rearranging scattered data into contiguous blocks. By doing so increased data load times (since the physical head of the hard drive didn't have to move that much). However, what I remember most was the almost hypnotical satisfaction of seeing all those little blocks flashing, being organized, and just "knowing" that it was good for my computer. In times when you fiddled around with autoxec.bat and config.sys, when every little Kilobyte of RAM mattered, and when hard drives were measured in Megabytes, not Terrabytes, the weekly routine of defragging almost felt like cleaning up your room.

@JohnGoldman @code_musings @tim_roozendaal When I’m not in Topo’s, I’m in Hoka Gaviota’s

@code_musings @tim_roozendaal ASICS Novablast 5 wide ASICS glide ride wide ASICS magic speed wide NB More wide Nike Pegasus wide

First impressions of the New Balance 1080v15: Oehlala 💃🏻 This gets me excited. It's a smooth, soft but responsive ride. The upper feels a little more spacious compared to the v14. This shoe is still not suited for heel strikers, but it felt really smooth with a midfoot strike. You can really feel the weight difference (±40 decrease). I'm definitely getting a pair, as I really liked the v14 and am curious to see how this is going to feel after some longer runs.

@drjohnm One reason is the need to build them into our EMR's to facilitate their use.

Just a PSA about treating high cholesterol: I recently helped two young women who were told to take meds for high cholesterol calculate their 10-year ASCVD risk Both had 10-year risk less than 3%. Why aren't primary care clinicians using a risk equation?

@Brady_H The only thing harder than getting unwell patients to reduce eating unhealthy foods is getting them to exercise. When I have been successful getting them to eliminate sugars and eat Whole Foods sometimes they feel well enough to also exercise.

This administration is myopic about food at the neglect of physical activity. Don’t get me wrong, this is a great change—altering the food environment and what we tell people to eat is a must. But *nothing* will move the lever on population health as much as getting people to move more. We are not talking about it enough.