The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.

In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[53]
Don’t think that “Mediterranean diet” means gorging on pasta and pizza, though. People in Mediterranean countries traditionally eat small portions of grains – for example, a side dish of 1/2 to 1 cup of pasta, instead of the full platter of pasta Americans are used to. Fill the rest of your plate with vegetables to fill you up without many calories.
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Since avocados are packed with nutrients and healthy fats that can stimulate weight loss, it’s no surprise that avocado oil acts in a similar fashion. When Penn State University researchers compared those who consumed avocado oil with those who consumed a flax-safflower oil blend, they found that those who used just three tablespoons of avocado oil daily lost nearly two percent of their belly fat in just one month.
This was simply the best response to this article. The doctor who wrote it has no idea of the life changing benefits of keto. Bravo to you for speaking up. Congratulations on reversing your diabetes. I dont have diabetes and am not obese but I switched to keto to live a longer healthier life. I’ve never felt better. Must mention that I am 32. I want to prevent disease. Let the food be the medicine.
What the expert says: ‘This is something that is used for athletes as part of their training. While it can lead to weight loss, carbohydrates are an energy source for the body, and restricting them can lead to headaches, fatigue and difficulty concentrating. You would be better to find the level of carbohydrates your body needs by eating normal portion sizes and a balance of all food groups.’
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[34] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[35] On the other hand, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism.[9] A person with a disorder of fatty acid oxidation is unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[36]
“During physiological ketosis ketonemia reaches maximum levels of 7/8 mmol/L with no change in pH while in uncontrolled diabetic ketoacidosis it can exceed 20 mmol/L with a concomitant lowering of blood pH. Blood levels of ketone bodies in healthy people do not exceed 8 mmol/L precisely because the central nervous system (CNS) efficiently uses these molecules for energy in place of glucose,” researchers summarize.
The Mediterranean Diet was identified in the 1960s as research continued to show populations from Mediterranean regions, particularly Southern Italy, the isle of Crete, and Greece, were considerably healthier, with less incidence of disease and longer lifespans than seen in other regions. Studies indicated that the way these populations ate seemed to be the common denominator and through research, the Mediterranean diet was formally born.

The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]


Kamut is an ancient grain native to the Middle East that is an excellent source of heart-healthy omega-3 fatty acids, protein, and fiber, while simultaneously being low in calories. In fact, a half-cup serving of the stuff has 30 percent more protein than regular wheat and just 140 calories. What’s more? A study published in the European Journal of Clinical Nutrition found that eating Kamut reduces cholesterol, blood sugar, and cytokines (which cause inflammation throughout the body). Kamut’s ability to stabilize blood sugar and reduce inflammation make it a great weight loss staple, especially if it is used in place of nutritionally lacking refined grains.
We really do only want to try and share the knowledge we have through seeing thousands of different patients with complex issues over decades with all of you. Physicians jump at the chance to have a CDE see their patients in their practice or in the hospital because they know our value. They know how thorough we are when assessing their patients and often find issues that may have been overlooked for years. It’s all we do all day, so it’s our specialty…diabetes. We live and breathe it and are very passionate about helping people overcome their hurdles. I do hope sharing some of my personal experience with all of you will help, but I am here if you all have more questions anytime!
While it’s true that low-carb diets do raise the so-called bad LDL-cholesterol in some people, it’s important to note that LDL-C, when influenced by diet, has never been shown to have any effect on cardiovascular risk. Large clinical trials and observational studies show that one’s level of LDL-C and the lowering of LDL-C through diet is not reliably linked to cardiovascular outcomes.21, 22, 23
My husband and I have lost weight after just 2 weeks on this. Not a lot, but enough to lose a belt loop. I've been menopausal for years, along with having an underactive thyroid, and losing weight has been almost impossible for me for the last few years. I'm unable to exercise much due to torn ligaments in my foot. Following this weight loss solution really helped. I'm going to get the other book with more recipes. Cutting out breads and sugar really did make a difference!

A computer program such as KetoCalculator may be used to help generate recipes.[46] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower and green beans are all equivalent. Fresh, canned or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[36]
In regard to serum measurements, the mean fasting glucose decreased by 17% from 9.08 ± 4.09 mmol/L at baseline to 7.57 ± 2.63 mmol/L at week 16 (p = 0.04) (Table ​(Table4).4). Serum sodium and chloride levels increased significantly, but only by 1% and 3%, respectively. Uric acid level decreased by 10% (p = 0.01). Serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001). Increases occurred in both high-density lipoprotein (HDL) cholesterol (8%) and low-density lipoprotein (LDL) cholesterol (10%) but these changes were of borderline statistical significance (p = 0.08 and p = 0.1, respectively). The following blood tests did not change significantly: total cholesterol, potassium, bicarbonate, urea nitrogen, creatinine, calcium, thyroid-stimulating hormone, and hemoglobin.
Now, about that whole low-fat and low-sugar thing. It can be tricky come dessert time, but Gorin has a hack for surviving that as well: "One way to feel like you’re getting the dessert that you crave while still following the diet is to eat a fruit-based 'nice cream,' like my chocolate-banana recipe. By combining frozen bananas and unsweetened cocoa powder, you'll wind up with a treat that resembles the texture of ice cream yet contains no added sugar and also counts toward your daily fruit servings."

Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can’t sit still for too long. His favorite book is The 4-Hour Workweek and artist is Infected Mushroom.


You are so biased against Keto, this can be noticed very quickly because almost every positive thing you say about Keto, you immediately follow with a “but…” negative statement. And most of your negatives are simply saying it’s hard to maintain. You completely exaggerate the negatives “If you have one bad day and your body is kicked out of Ketosis, you immediately gain all of your weight back”. That is simply not true; if someone is on a Keto diet for 3 months, they will not gain that weight back in a day. Also, their body will be back into Ketosis the next morning. You say that the ADA doesn’t recommend 60-70 grams per meal, but it does (coincidentally I just left their website before coming here). I don’t claim to be a Diabetes expert; I admit that. But your bias is leaning heavily against Keto. “Moderation” is not your goal if you have diabetes. When you compare HbA1C levels, for example, you compare them with someone in Keto at less than 20 g of Carbs per day as compared to someone at a 70-90 gram of carbs per day diet. You should be fair and compare them with someone on a 200 g of Carbs diet. If you want to get rid of the effects of Diabetes, get on a Keto Diet, period. It MAY get rid of the effects completely, but in the very least it WILL reduce your Insulin needs to very low and you’ll have little-to-no side effects other than a relatively restrictive diet (most diets are WAY more restrictive than Keto). You back up everything with “science” and misleading numbers/arguments without providing any real evidence.
The MIND diet, or Mediterranean-DASH Intervention for Neurodegenerative Delay, is a sort of hybrid between the DASH diet and the Mediterranean diet. It features foods meant to slow the progression or development of Alzheimer’s disease, the most common form of dementia and an incurable neurodegenerative condition that more than 5 million Americans are living with, according to the Alzheimer’s Association. (12) Some research backs up this notion, including a study published in September 2016 in Alzheimer’s Dementia that found a link between following the MIND Diet and a reduced risk of the disease. (13)
The low glycaemic index treatment (LGIT)[48] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[3] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
"Those with type 1 diabetes should avoid a ketogenic diet," warns Joseph Galati, MD, a hepatologist at the Liver Specialists of Texas in Houston, "Many patients with type 1 diabetes have some degree of renal impairment, and handling the build-up of ketones and acids in the body may cause too much stress on the kidneys. Of course, any pregnant women with diabetes, especially those requiring insulin should avoid such an extreme diet given the low glucose levels will be a constant [health] threat."
"These diets are so restrictive that of course you're going to lose weight fast because you're not eating enough calories to sustain basic activities of your body, let alone any exercise. That's nothing that any person can sustain for the long term," Hogan said. "The weight's going to come back if you do lose any weight, and then it's going to be harder to lose weight in the future."

“The alkaline diet often has a focus on eating lots of fresh produce and unprocessed foods, which could be a good thing,” says Hultin. “However, keep in mind that this is not an evidence-based therapeutic diet. When people take it too far — for instance, drinking baking soda — or become too restrictive or obsessive over food choices, it can definitely turn negative.”
You’re a diabetic counselor and are talking about being worried about not being able to eat birthday cake? Hell I’ve been on keto since July 2016 and haven’t felt any urge to go back, simply because I feel so much better. Also the diet is really not all that restrictive, you can make desserts using stevia/erythritrol, coconut/almond flour, etc. I had ketogenic pizza the other night and it turned out great. Lots of great resources out there for food options. I’m not diabetic myself, but I used to be prone to hypoglycemia and keto has eliminated the issue since I’m not dependent on glucose. There are a lot of wrong ways to do keto though, and doing the diet correctly has a moderate learning curve.
What the diet advocate says: Controversial Canadian psychologist Jordan Peterson is a fan, crediting the diet for curing his daughter’s various ailments, from juvenile arthritis to depression. But it was popularised by Shawn Baker, author of the aptly titled ‘The Carnivore Diet’ – in which he describes the diet as ‘a revolutionary, paradigm-breaking nutritional strategy that takes contemporary dietary theory and dumps it on its head’.
DASH stands for "dietary approach to stop hypertension" and was created by the National Institutes of Health (NIH) as a way to help reverse national trends of obesity and heart disease. Scientists combed through decades of research to come up with an expert-backed list of diet tips, along with a prescription for exercise. And it worked: The DASH diet has topped nearly every diet list for nearly a decade. Doctors particularly recommend it for people looking to lower high blood pressure, reverse diabetes, and lower their risk of heart disease. (Here's the basic list of DASH diet-approved foods.)
It appears that a ketogenic diet is generally safe when implemented correctly. One must be careful to obtain all the necessary nutrients by eating a variety of foods, such as non-starchy vegetables, seeds, and nuts, and also consume adequate protein and essential fatty acids. Provided that the need for vitamins, minerals, amino acids and fatty acids is met, there is no reason to suspect that the ketogenic diet is unsafe.

He also told me that I was in horrible shape, that I would need a lot of medication, and that because I was T2, insulin would do nothing for me. I still remember walking out of the building after. I felt like shooting myself. My brother had just gone blind from retinopathy 2 months earlier. There was no hope for me. High numbers were inevitable. Complications were inevitable.
I suffered through a year on 20 grams of carbs per day and it was the worst year of my life. Yep, I lost weight, but at my current weight of 130 lbs and eating 30 carbs per meal and remaining in a prediabetes state for 15 years, I am healthy AND happy now. None of us know the long term effects of most of what is offered to us…medications, diet drinks, processed foods, restrictive diets. The point I was trying to make was eating healthier, more natural foods will be better in the long run, I believe we all have the common sense to agree on that, even if we can’t agree on how many carbs we will eat!

It’s only dangerous to not get enough carbs at each meal if one is taking too much meds or insulin for the amount of carbs they are eating! Restricting carbohydrates doesn’t lead to hypoglycemia unawareness, but having lots of lows and lots of highs will (and decreasing insulin and carbs leads to way fewer highs and fewer lows, or at least it can). On the other hand, being in ketosis does make low blood sugars less negative as an experience. I still feel my lows just fine, but they are less of an emergency because my brain still works (feeding on ketones) and by body doesn’t freak out and release tons of adrenaline that then makes me want to eat a house. Mind you, I still wake up and know immediately if I’m low, I know from experience and how it feels in my head and body but without the crazy shakes. This is not unawareness but it is less reactive.
During the 14 days of Phase 1, you will learn how to satisfy your hunger and, as a result, feel fuller longer. To regulate your blood sugar and help curb your cravings, avoid fruit and whole grains, which have a lot of natural sugar, and alcohol, which also contain sugars. That said, you can enjoy 2-3 servings of low-fat dairy per day. This would include 1 cup of skim milk or low-fat yogurt. Avoid regular or even fat-free cheese because they are often high in sodium.
1- Eliminate fast foods. For many of us living in America, this is one of the tougher adjustments and may take some time. To start with, try swapping a fast-food meal with a homemade one. For example, if it’s chicken wings you crave, make them Greek-style like in this recipe! Or if it’s sweet potato fries (my personal guilty pleasure), try baking them in olive oil with a sprinkle of Mediterranean spices like in this recipe. And So on!
I can tell how passionate you are about this subject. As you can see on one of my reply’s above, CDE’s do not recommend the same number of carbs for every person we see; we use an individualized approach. It varies depending on the person’s height, bone structure/muscle mass, amount of weight they may need to lose (or gain) and the amount of exercise they may or may not do per day/week.

Meat products make up a big part of the keto diet, but experts stress the importance of choosing quality. "Since the keto diet is based a lot on animal proteins, it's important to buy organic poultry and grass-fed, organic beef," says Aimee Aristotelous, RD. "Not only do organic selections help with limiting environmental toxins, but grass-fed options of red meats even change the composition of fats." The result, she explains, is that your body is able to better absorb those healthy fats.


The Keto diet versus Plate Method study triggered some challenges and a bit of criticism. In an editorial, Andrew Reynolds, PhD, a postdoctoral research fellow at the University of Otago, New Zealand, suggests that the much better results in those on the ketogenic diet may be due not to the diet itself but to the lifestyle changes and ongoing support that keto diet group received.5

Aude, Y., A. S, Agatston, F. Lopez-Jimenez, et al. “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat: A Randomized Trial.” JAMA Internal Medicine 164, no. 19 (2004): 2141–46. doi: 10.1001/archinte.164.19.2141. jamanetwork.com/journals/jamainternalmedicine/article-abstract/217514.
After seeing thousands of patients now for years and from personal experience, I still believe it comes down to staying away from processed foods and cooking at home whenever possible. Eating a variety of fresh fruits, vegetables, proteins, and fiber. Also, cutting out any sugary liquid calories; staying away from sodas, juices and the infamous sweet tea! Keeping stress levels under control and incorporating exercise into your routine will also be key to breaking through challenging times when you are having trouble with continued weight loss.

I think the larger question is why we are seeing such a sudden rash of anti-keto stories. So many of them quote no experts sources and do not provide citations for their claims. Skeptics with little acquaintance with the diet are quoted exclusively instead. From a journalistic perspective, this lack of balance of viewpoints and the failure to back up claims with evidence falls below basic reporting standards. Offenders on this list include even the Harvard School of Public Health, which recently published more than one  unsourced, one-sided article on the keto diet (This is in addition to the Lancet Public Health article cited above, by Harvard researchers, which suggests that a low-carb diet kills you). These stories could reflect lazy reporting or they could very well be scare tactics to steer people away from the keto diet.  Why would reporters or scientists at Harvard be doing such a thing? That’s material for another post. Stay tuned.


Incidentally , there’s a very informative article on the bbc website about one of the last remaining hunter/gather societies left in the world, living in Tanzania. They have amazing gut health and no t2d. Would you like to guess at the type of diet they follow? This would be the caveman diet that the writer mentions, and yes these people might not live as long as us but the cause of death is never a lack of motivation to stay on a keto diet.

Milk is limited. There are no long-term risks to eating Mediterranean, says Cohen. But you may be put off if you’re big on eating a lot of milk and rely on it to get all the calcium you need. You’ll get to eat cheese and yogurt, but in smaller amounts. "To get enough calcium in the diet without milk, one would need to eat enough yogurt and cheese, or seek nondairy calcium sources," says Cohen. If needed, drink skim milk. Otherwise, nondairy calcium sources include fortified almond milk, sardines, kale, and tofu made with calcium sulfate. (30)
Choice #1: Lathero Dish (seasonal vegetables or beans cooked with olive oil, herbs, and tomato sauce accompanied by bread and cheese). This is what you will have 3-4 times a week. Typically this is green beans, peas, spanakorizo (spinach-rice) and cauliflower cooked in this way. This is accompanied by a slice of bread and feta. Click for lathera recipes. Please note that one serving consists of 3-4 servings of vegetables.
Moreover, the ketogenic diet also reliably raise the “good” HDL-cholesterol, while also improving most other cardiovascular markers, including blood pressure, as this study shows.24 Thus, the overall effect on cholesterol and other markers for heart disease is positive. In some lean hyper-responders, a keto diet will increase LDL particle number, and this effect needs further investigation.

Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
I know a few people who struggle with keeping on the low carb diet and staying in ketosis. They introduced me to a exogenous drink called keto/os that is a natural energy drink that contains ketones. It gets you into ketosis within an hour!!! This can be tested in the blood and they showed me the results and it works!!! Not only that but it dropped their blood sugars as well. I am now on the product myself for other reasons but just thought I would share it. Let me know if you want more info.
Wolfrum said he and his colleagues don't want to stop people from changing their diet if that's what's necessary to reach a healthy weight, but they think it's important for people to know that "the [final] verdict on the ketogenic diet is not out yet." There's still more research to be done to fully understand the long-term effects of a high-fat, low-carb diet. In the meantime, said Wolfrum, "more balanced food intake is probably the healthiest way to live."
7. I should mention ALL my health markers have DRASTICALLY improved including cholesterol and inflammation markers? My fatty liver is resolving and my cardio markers are perfect! The study where you cited there were not significant changed in diabetes markers in two months, well it takes longer! Check it out at 6 and 8 months. Most people will show a VERY different story than what you are reporting!
That’s why the Bulletproof Diet uses cyclical nutritional ketosis, and why on days when I eat carbohydrates, I always have Brain Octane Oil so my cells have a steady supply of ketones. This builds metabolic flexibility: you can eat fat and carbs and your body will use them both, which is the goal. You want to be resilient and full of energy no matter what, and that means you want cells strong enough to burn whatever you give them.
That makes a lot of sense. Keeping up insulin pathways when you aren’t eating carbs would be like keeping the lights on when it’s daytime outside — it’s a waste of energy. You aren’t using insulin on keto, so your body probably downregulates your insulin pathways. As a refresher, insulin is a hormone produced by your pancreas that tells your cells to absorb glucose to use as fuel. When you eat carbs, insulin production begins. In the absence of carbs, there’s less need for insulin.
Similar to the CICO diet, the Body Reset has gained popularity via social media, and there isn’t any definitive research that suggests the approach is safe and effective. Celebrity trainer Harley Pasternak created the plan, which is essentially a three-phase liquid diet comprised of smoothies and moderate exercise. While U.S. News notes you may lose weight on the diet, it may be tough to stick with, and isn’t safe for people with diabetes and heart disease. (38)
The DASH diet isn't just for healthy living anymore--now it's for healthy weight loss, too. Using the newest DASH diet research, bestselling author, foremost DASH dietitian and leading nutrition expert Marla Heller hascreated the most effective diet for quick-and lasting-weight loss. This is the only book to bring you the latest updates for the DASH diet, integrated with the latest weight loss research, which work synergistically to maximize results. This effective and easy program includes menu plans, recipes, shoppinglists, and more. Everything you need to lose weight and get healthy!
Popularized by the documentary Forks Over Knives, the Ornish diet is a low-fat, plant-based diet plan based on whole grains, vegetables, fruits, and legumes. It's based on a lacto-ovo style of vegetarianism, allowing only egg whites and nonfat dairy products. It's packed with vitamins, fiber, and lots of filling plants to keep you satiated. Some studies have shown it can reverse heart disease and have beneficial effects on other chronic health conditions. (BTW, there is a difference between a vegan diet and a plant-based diet.)
And it’s not just this study, either. Several other studies have found  that keto leaves rodents unable to process carbs,[7] leads to insulin resistance,[8] and, more long-term, causes non-alcoholic fatty liver disease, which is when your liver accumulates lots of fat and begins to shut down.[9][10] Triglycerides and inflammation go way up, too.[11]
Keto breath, on the other hand, is less of a side-effect and more of a harmless inconvenience (your breath literally smells like nail polish remover). Basically, when your body breaks down all that extra fat on the keto diet, it produces ketones—one of which is the chemical acetone, Keatley previously told WomensHealthMag.com. (Yes, the same stuff that's in nail polish remover.)
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