Managing probabilities under the context of risk and as a function of time. Creating systems for metabolic recovery
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Metabolic Recovery retweeted
#POCUS image of the day: heart in a spiderweb 🕸️ - subcostal view demonstrating a circumferential pericardial effusion with septations, representing a loculated pericardial effusion.
Source: Kolli S, et al. Annals of Emergency Medicine. 2021.
#echofirst #Nephpearls #Criticalcare
Metabolic Recovery retweeted
🫀Hemodynamic stability does not necessarily mean adequate tissue perfusion.
A patient with septic shock reaches a MAP of 65 mmHg, cardiac output improves, and vasopressor requirements decrease. Yet capillary refill remains prolonged, lactate is elevated, and organ dysfunction persists.
Has resuscitation succeeded?
Dr. Carlos Sanchez-Escalante and Xavier Monnet propose a fundamental shift: perfusion assessment should focus on physiological coherence rather than normalization of isolated numbers.
The central problem is that macrocirculatory recovery does not guarantee microcirculatory recovery.
CRT provides a practical starting point. It is inexpensive, rapidly responsive, and supported by clinical evidence. However, temperature, sympathetic activity, edema, and measurement technique influence its interpretation.
Lactate remains valuable for risk assessment, but hyperlactatemia does not necessarily indicate persistent tissue hypoxia. Adrenergic stimulation, altered metabolism, and impaired clearance may sustain elevated concentrations after perfusion improves.
Treating every persistent lactate elevation with additional fluids or vasopressors risks producing congestion rather than restoring perfusion.
Venous oxygen saturation and the venoarterial CO₂ gap offer complementary information.
SvO₂ reflects the relationship between oxygen delivery and consumption, but normal values cannot exclude impaired extraction or microcirculatory shunting.
The Pv-aCO₂ gap helps assess whether blood flow is sufficient relative to metabolic CO₂ production. Neither measurement directly demonstrates microcirculatory recovery.
Peripheral perfusion index, obtained through photoplethysmography, provides continuous information about peripheral circulatory changes. Its interpretation requires attention to temperature, vascular tone, and vasopressor exposure.
When uncertainty persists, advanced assessment may incorporate cardiac output, tissue oxygenation, microcirculatory imaging, and venous congestion.
An especially relevant concept is effective tissue perfusion pressure.
MAP alone does not determine regional blood flow. Critical closing pressure, vascular tone, extravascular compression, and venous outflow influence the pressure gradient available for tissue perfusion.
Consequently, increasing arterial pressure may not improve organ perfusion, particularly when vascular resistance or venous congestion is elevated.
The authors propose a progressive approach: begin with clinical examination and basic markers, integrate complementary measurements when signals disagree, and escalate monitoring according to unresolved uncertainty and patient risk.
The objective of resuscitation is not to normalize every variable. It is to restore effective tissue perfusion without creating additional injury through unnecessary interventions.
Reference 📚
Sanchez-Escalante C, Monnet X. 2026. Critical Care Medicine.
doi.org/10.1097/CCM.00000000…
Metabolic Recovery retweeted
Imagine the surgeon doing liposuction, shaking the fat to break it down, and injecting it via an endoscope to close a fistula. This works, and the concept is known as autologous nano-fat transplantation.
This case presented by Dr Rushil Solanki at #UEGWeek shows how this is used to close a refractory fistula in a 24 year old lady with Crohn’s disease.
By injecting adipose-derived stromal cells, we can now promote tissue regeneration rather than simply closing defects.
Say hello to the era of regenerative endoscopy 👏🌟 #ESGEatUEGWeek
Metabolic Recovery retweeted
Full essay by Dr. Graham Walker:
linkedin.com/pulse/always-op…
Metabolic Recovery retweeted
A basic and fundamental teaching on the gut :
Your gut, whether you take probiotics or not, can destabilize if it runs out of the right kind of food. When this happens, certain gut bacteria begin to feed on the protective mucus layer of the intestines, thinning its barrier, which can (and does) slowly contribute to inflammation (and the laundry list of things that kick off illness). Mucus thinning is one of the main ways a leaky gut starts.
The food that prevents this from happening is fermentable fiber (part of the plant the small intestine can’t digest but the bacteria in colon can).
When these bacteria have enough of it, they make butyrate, the main fuel for the cells lining our colon and in turn will leave this mucus alone.
The foods that feed and support our gut bacteria fall into eight kinds :
pectin, beta glucans, inulin, galactooligosaccharides, resistant starches, mucilage, cellulose and polyphenols.
+ Pectin ferments quite quickly and is found mostly in fruits :
Think apples, pears, quince, plums, apricots, peaches, cherries, blackberries, raspberries, loganberries, currants and grapefruit. These have the most, along with citrus peels, carrots, sweet potatoes and beans.
+ Beta-glucans :
These are found mainly in oats and barley and also in shiitake and maitake mushrooms.
Then, things like brown seaweeds (kelp, kombu, wakame and bladderwrack) also contain a beta glucan called laminarin and then the microalga euglena contains one called paramylon. An fyi : kelp, kombu and bladderwrack are higher in iodine, so a small amount a few times a week is plenty or use another source for BG, so iodine isn’t thrown out of whack.
+ Next is Inulin :
This is found in onions, garlic, leek, asparagus, chicory root, dandelion root, burdock root and Jerusalem artichoke. This feeds our bifidobacteria in particular.
+ Then, Galactooligosaccharides :
These are found in legumes, including lentils, chickpeas, peas and white, kidney, navy, black bean and lima beans.
+ Next is Resistant starch :
This goes through our small intestine undigested and ferments in the colon, where it makes a large portion of our body's butyrate.
Think potatoes, rice and pasta (especially after they're cooked and cooled, ideally overnight in the fridge). And oats, pearled barley, rye, millet, lentils, chickpeas, peas and navy, kidney, black and lima beans.
Green bananas (just regular bananas) also have it when they are raw (in this case, cooking breaks most of it down, so they're best eaten slightly underripe)
+ Next, Mucilage :
This is a fiber that turns to gel when in water. It is found in flaxseed, chia, psyllium, okra, marshmallow root and slippery elm bark (this last one as an herb is such an absolute favorite of mine - such a huge fan of slippery elm bark. Suck on some of its bark and you will immediately feel it become gooey in your mouth. Then fill the mouth with a warm water and swallow it down. A beautiful medicine).
+ Cellulose :
This makes up the cell walls of plants. Humans ferment very little of it. A few gut bacteria (for the most part Ruminococcus species), can break some of it down.
Its main job is adding bulk and helping move the stool through.
This can be found in things like broccoli, broccoli sprouts, alfalfa sprouts, bok choy, beets, jicama, turnips, parsnips, radishes, squashes, yams, sweet potatoes, cassava, taro, sunflower seeds, whole wheat, brown rice, nuts (and vegetable skins).
+ Polyphenols
These are the pigments and tannins in plants. Bacteria in the colon turn them into compounds the body can absorb and they encourage the growth of our beneficial bacteria.
The ellagitannins in pomegranate and raspberry become urolithins.
Also, green tea, cacao, olive oil and walnuts are rich in polyphenols.
Red dragon fruit gets its color from betalains, the same pigments as beets and it also contains fiber that our gut bacteria feed on…
Continued below : 👇🏻
Metabolic Recovery retweeted
Also, here's a list of basic health-related facts that you've probably not been told.
-Sleep irregularity is consistently tied to 26–53% higher dementia risk.
-Shift work is associated with 30–33% higher overall adverse mental health outcomes.
-Brisk walking for an extra 150 minutes per week is associated with living ~4.5 years longer on average.
-Social/friendship support interventions can lower depression susceptibility by around 30% in relevant reviews.
-Being insulin resistant increases your risk for depression by 2X.
-A single bout of RT or HIIT can increase levels of anti-cancer myokines and reduce the growth of MDA-MB-231 cells in vitro in survivors of breast cancer, potentially contributing to a lower risk of recurrence.
-Vitamin E therapy prevents hyperoxaluria-induced calcium oxalate crystal deposition in the kidney by improving renal tissue antioxidant status.
-CoQ10 levels in hyperthyroid patients were found among the lowest detected in human diseases.
-Lithium appears to be protective against aluminum toxicity in neurons.
-Creatine loading can increase DHT by 56% after 7 day and 40% if 5-10 grams are used after.
-You have a higher chance of being gay if your mom was hypothyroid during pregnancy.
-40g of dark chocolate can reduce menstrual pain as effectively as 400 mg ibuprofen.
-Colostrum is 3 times more effective than the flu vaccine.
-Night-shift workers show substantially higher rates of irritable bowel syndrome.
-When it comes to exercise a 2022 study saw the lowest risk of mortality at 150-300 min/week of leisurely vigorous physical activity, 300-600 min/week of leisurely moderate physical activity or a combination of both.
-There's a chance that we could achieve a COVID mortality rate pretty close to zero if everyone had a vitamin D level >50 ng/mL. Yes, zero.
-Vitamin D, A, B9 and zinc intake were lower in regions with the highest COVID-19 incidence and mortality.
-Choline is crucial for proper brain development and gestational choline deficiency in animals leads to lifelong cognitive deficits.
-Zinc at just 25mg can reduce depression by half and lower cortisol by up to 70% at 50mg.
-In rats, taurine protects their thyroid from fluoride exposure.
-Dietary vitamin B6 and vitamin E are associated with decreased odds of periodontitis.
-1–2 mg/day of elemental lithium (as lithium orotate or from mineral water) cuts suicide rates by up to 80% in high-lithium regions and reduces dementia progression in RCTs at 5 mg/day.
-Children with autism and/or ADHD seem to have impaired B6 utilization.
-High methionine, low folate and low vitamin B6/B12 (HM-LF-LV) diet causes neurodegeneration and subsequent short-term memory loss.
-Allithiamine can not only alleviate hyperglycaemia-induced endothelial dysfunction, but also reduce the level of advanced glycation end-products (AGEs).
-Rosemary can also reduce the level of advanced glycation end-products (AGEs).
-Astragalus supports mitochondria by scavenging harmful free radicals, reducing lipid peroxidation, increasing glutathione levels and it boosts endurance by 127% in mice.
-A combination of multiple lifestyle factors (sleep, activity, diet, social connection, etc.) can be linked to 50%+ lower depression risk compared with an unfavorable profile.
-Vitamin D dose-dependently reduces symptoms of depression.
-Cannabis is cooking your brain and testicles (CBD can be helpful though).
-Beta-caryophyllene (found in cloves and black pepper) increases salivary testosterone levels by 16%.
-Taurine is an essential neuromodulator during cortical development.
-Niacinamide can reduce plaque buildup in the brain and NMN improves insulin resistance.
-Children with autism often can not utilize folate properly due to genetic impairments.
-Not consuming enough B vitamins literally shrinks parts of the brain (especially B12).
-B1 is crucial for gut motility and stimulating digestive enzymes.
-High dose inositol (12–18 g/day) has antidepressant efficacy equal to SSRIs in multiple RCTs, with almost zero side effects.
-A copper:zinc imbalance (high Cu/low Zn) is found in A LOT of cases of postpartum depression and violent behavior in teens.
-10,800 FU of nattokinase per day showed significant reductions in atherosclerosis progression.
-Patients who passed away from COVID had low iron, vitamin B12 and vitamin D while also having high HbA1c.
-200 mg of vitamin C and 500 µg of B12 per day improve blood pressure, blood flow and reduce arterial thickness.
-Vitamin C lowers cortisol by up to 40% in some cases, increases oxytocin, supports cardiovascular health, increases dopamine and lowers prolactin.
-300 mg/day of ubiquinol (active CoQ10) reduces migraine frequency by up to 50–60%.
-Thiamine (B1) at high doses (up to 1.5 grams) cuts fatigue nearly in half in patients with MS.
-The first 27 longest living humans in history are women, and 80% of people over the age of 100 are women
-Plasma donation and blood donation have been seen to decrease the amount of forever chemicals in firefighters.
-Muscle androgen receptor density predicts muscle growth from resistance training far better than circulating levels of hormones
-PQQ seems good for elderly individuals with mild cognitive impairment.
-20 g/day of creatine loading + 5 g maintenance for 8 weeks cuts pain by 50% and fatigue by 60% in several small RCTs for fibromyalgia.
-High prolactin and low thyroid hormones are common in MDD.
-300 mg/day of ubiquinol cut cardiac death by 43% and total mortality by 42% over 2 years in patients with moderate to severe heart failure.
-High doses of biotin can lower blood sugar by half in diabetics and increase testosterone quite a lot (even by 3X).
-Vitamin C therapy might in fact increase the survival rate across all types of cancers by up to 4X.
-Vitamin A improves A LOT of symptoms of autism.
-Not getting enough selenium is so problematic that people with a baseline serum selenium concentration below approximately 106 ng/mL (within the low-normal range) had significant reductions in total cancer mortality and incidence of lung, colorectal and prostate cancers when supplemented with 200 µg/day of selenium.
-Separating fats and carbs in meals can minimize the simultaneous availability of both substrates, reducing competition and potentially improving glucose clearance.
-High dose riboflavin (400mg) works for up to 70% of migraineurs within 6 weeks.
-Vitamin A is superior to steroids for masculinization before 12y.o.
-10–15 g of glycine at night can improve insulin sensitivity the next day by even up to 50%.
-Men taking 600 mg/day of CoQ10 for 12 months reported a 113.7% increase in sperm concentration and a 104.8% increase in progressive motility.
-A single 20 g dose of creatine almost completely negates the cognitive decline from 24–36 hours of sleep loss.
-I can make you insane by changing your gut microbiome.
-Morning sunlight reduces the length of hospitalization in bipolar disorder.
-Religious people live longer.
-Higher vitamin B1, B6 intakes and plasma pyridoxal-phosphate are associated with lower risk of mortality up to 10 years.
-NAC + Glycine has been shown to expand lifespan in mice by more than 20%.
-Taurine has been shown to expand lifespan by 10% in male mice and 12% in female ones.
-At the end of a chromosome, there are these protective caps called telomeres and the consumption of bee products showed an increase of over 0.25kbp in just a year.
-Urolithin A is more effective than most of the supplements promoted for "anti-ageing" purposes.
-Group sports extend life expectancy and being a cardio freak (marathon maxing for no reason (run a marathon 1/year if it's for charity for example) shortens it).
-B12 supports ptp-3 and helps maintain good cognitive function in centenarians.
-Biomarker differences between centenarians and diseased populations include:
1. Metallothionein
2. Good 03:06 ratio
3. Glutathione
4. SOD
5. IL-6 (low)
6. TNF-a (low)
7. Uric acid (low)
-People who die by su*cide (but also have traits such as hostility(*)) tend to have modestly lower serum total/LDL cholesterol.
But lowering cholesterol with statins does not increase suicidal behavior.
So the proposed theory for this association remains that neuroinflammation changes lipid metabolism and results in these lower circulating cholesterol levels.
(*) patients with borderline personality disorder often have lower baseline fasting serum cholesterol levels compared to patients with other personality disorders.
-Eating breakfast is linked to lower suic*de rates
-A meatless diet increases the frequency of depressive episodes.
-When doctors say that depression is caused by low serotonin, they probably mean that it's caused by high quinolinic acid (its production outpaces its clearance, to be exact).
-Autism spectrum disorder seems to be the outcome of mitochondrial dysfunction during neurodevelopment.
-Magnesium intake is inversely associated with coronary artery calcification, with the risk being lowest at 450 mg/d of magnesium.
-Green tea enhances the skin anti-aging effects of red light.
-Giving hospitalized COVID-19 patients 30,000 IU of vitamin D daily for 3 days reduced their risk of death by 67%.
-Taking ibuprofen for more than 60 days in a year makes men twice as likely to experience infertility.
-66.5% of bankruptcies in the US are due to medical bills.
-Mold exposure can lower the IQ of children by 10 points.
-Vitamin D deficiency is linked to 60% higher odds of depression.
-Nattokinase can reverse carotid artery plaque by 36% at 10,800FU (taken over a year).
-Bright night light exposure is independently associated with type 2 diabetes.
-SSRIs can suppress melatonin by almost 50% under normal light conditions.
-Extending sleep by just 1.2 hours "offsets" 300 extra calories.
-The more you increase sodium fluoride, the dumber kids become.
-Exercise (aerobic) is more effective than SSRIS.
-It might sound weird, but onion juice is actually effective for alopecia aerata.
-Exercising 4 hours after reading something improves retention.
-Creatine is an underrated supplement for lowering triglycerides.
-Negative air ions (think being outside in nature) reduce depression by 50%.
-Thinking that depression is a response to inflammation might be correct in a lot of cases.
-By taking 600mg of NAC twice a day during flu season you might drop your chances of getting sick by up to 50% (note, NAC taken for weeks on end will deplete copper and harm some of the biofilms of beneficial gut bacteria)
-240mg twice daily of Fernblock may reduce the risk of sunburn by 400% and UV damage by over 300%.
-Bile treatment improves psoriasis.
-Using a smartphone for 60 minutes a day lowers fertility and testosterone quite a lot.
-Vapes can contain up to 20 times more lead than cigarettes.
-Laughter reduces cortisol levels by up to 37%.
-Vitamin K is associated with a reduced risk of cardiovascular, cancer, or all-cause mortality.
-Gingerol and shogaol in ginger enhance insulin sensitivity by increasing GLUT4 expression and inhibiting intestinal glucose absorption.
-Chromium enhances insulin receptor activity by improving the binding of insulin to its receptors and supporting glucose metabolism.
-Myo-inositol acts as a second messenger in insulin signaling pathways, improving insulin receptor function and glucose uptake.
-Fiber reduces postprandial glucose spikes.
-Fasting induces FGF21.
-93% of chronic fatigue syndrome patients had mycotoxins in their urine.
-Glyphosate was found in the sperm of 60% of infertile men in France (in the US a bit over 80% of the population have traces in their bodies).
-About 90% of people with fibromyalgia show elevated levels of mold-related toxins in their blood or urine.
-A higher 4-PA/PLP ratio (the marker of vitamin B6 turnover/catabolism) might be one of the strongest independent predictors of all-cause mortality in type 2 diabetics.
-One hour of chopping wood (with an axe) raises salivary testosterone by 48.6%.
-Two quite underrated yet effective tools when it comes to dealing with a candida overgrowth are undecylenic acid and baicalein.
-Tyrosine hydroxylase (the enzyme that converts tyrosine) can't function properly without thiamine pyrophosphate (TPP) as a cofactor.
-Lactoferrin (apolactoferrin might be even more powerful) helps against Covid quite a lot and is an underatted tool for lowering VC.
-630+808nm of RLT 2x/week for 6 weeks reduced abdominal fat by 4-5 cm in all participants without diet or exercise in a study.
-Quercetin and EGCG are zinc ionophores (they facilitate the transport of zinc into cells).
Hydroxychloroquine and ivermectin are also promoted that are zinc inophones in the alternative health spaces but that's not true.
-Giving 300mg of CoQ10 in fibromyalgia patients for 40 days led to 53% decrease in total symptom score.
-Taurine enhances IRS-1 tyrosine phosphorylation and reduces serine phosphorylation.
-Cold exposure activates BAT, which increases glucose uptake and fatty acid oxidation.
-A 25-year study of nearly 30,000 Swedish women found that avoiding sun exposure was a major risk factor for all-cause mortality (similar in magnitude to smoking). -The first time skin cancer was induced in mice was with a lamp that emitted UVC.
-Testosterone increases punishment of unfair behavior.
-Low creatine in the prefrontal cortex is associated with depression.
-A zinc deficiency does in fact harm androgens quite a lot.
-EGCG before doing cardio improves IR sensitivity by activating AMPK and reducing oxidative stress, promoting GLUT4 translocation.
-HIIT increases GLUT4 translocation.
-Light walking (15 minutes) after meals enhances GLUT4 translocation and glucose uptake in skeletal muscle, independent of insulin.
-Hypothyroidism impairs the activation and retention of riboflavin (and maybe iron, vitamin B12, folate, vitamin D, magnesium and copper as well).
*Thyroid hormones are necessary to regulate the enzymatic conversion of riboflavin (vitamin B2) into its active coenzyme forms: flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD).
-Each 0.5 mEq/L lower baseline serum potassium (within the normal range (3.5–5.5 mEq/L)) was associated with a roughly 45% higher incidence for type 2 diabetes in people who were not on diuretics and had normal potassium at baseline.
-This might sound weird or dumb, but lemon peels can actually help reduce cortisol.
-When you are trying to learn something new for the first time. Write it down.
Handwriting activates far more elaborate and widespread brain connectivity patterns, specifically in the theta and alpha frequency bands, compared to typing on a keyboard.
(*) Theta waves (around 3.5–7.5 Hz) are critical for working memory, processing new information, and learning.
(**) Alpha waves (around 8–12.5 Hz) are associated with focus, attention, and long-term memory formation.
-Believe it or not, the mere presence of a smartphone, even if it is turned off and out of sight in a bag or pocket, significantly reduces a person's cognitive capacity available for complex tasks.
-People with tattoos show a 29% elevated melanoma risk and a 21% lymphoma risk.
-Testosterone's anti-anxiety and analgesic effects may be due in part to actions of its 5alpha-reduced metabolites in the hippocampus.
-Our stomach pH looks like scavengers, not carnivores (the very high acidity in humans and scavengers serves the purpose of killing the high levels of bacteria and pathogens typically found in decaying meat, which was likely an important part of the early human diet during periods of scavenging).
-The fatty acid composition of membranes MIGHT be one of the determining factors of maximum life span.
-Intermittent fasting can increase the abundance of beneficial bacteria, such as members of the Lactobacillaceae, Bacteroidaceae and Prevotellaceae, but it's far preferable to skip dinner than it is to skip breakfast (unless you have sleep issues that are related to cortisol/poor glycogen storage etc).
-Levothyroxine users (T4) had a 50% higher adjusted odds ratio for cancer at any site compared with non-users.
Now, we need to note that this was an observational study and that pre-existing thyroid conditions independently alter cancer risk.
But, it makes some sense since T4 is significantly more potent than T3 at activating the pro-oncogenic signals via the αvβ3 integrin receptor (like the ERK1/2 pathway).
Using high doses of T3 can have its own problems (especially if you use it for no real reason), but it does not seem to impact cancer risk nearly as much.
-Zinc supplementation increased the rate of wound healing by 3X in healthy young people and supplementation in a group of people aged 55-87 resulted in about 2/3 fewer infections than placebo.
-People with serum magnesium above the median had 42% lower risk of sudden cardiac death and correcting magnesium deficiency may prevent atherosclerosis.
-Subclinical atherosclerosis is linked to small intestinal bacterial overgrowth via vitamin K2-dependent mechanisms.
-SIBO-positive patients have a significantly higher prevalence of dyslipidemia (54% vs 29% in SIBO-negative) and metabolic syndrome.
-Taurine supplementation improves several cardiometabolic risk factors.
-Oral supplementation with L. reuteri (NCIMB 30242) increases vitamin D levels, reduces LDL-C by 11.64% and apoB-100 by 8.41% relative to placebo.
-Excess aldosterone can contribute to androgenetic alopecia.
-Healthy sleep (roughly 7 hours) is associated with about a 22% lower risk of depression.
-Urolithin A enhances vitamin D receptor signaling
-Melatonin and vitamin E seem quite effective for atopic dermatitis
-A high dietary intake of vitamin C (≥ 75 mg/d) was found to have a statistically significant impact on reducing the risk of AD.
-The brain consumes about 20% of the body's oxygen despite comprising only 2% of body weight, leading to high production of reactive oxygen species (ROS) during energy metabolism.
BUT, antioxidant supplements often fail in trials and supporting the Nrf2 pathway seems to be preferable.
-Decreased lipoprotein (a) and serum high-sensitivity C-reactive protein levels in male patients with atherosclerosis after supplementation with ginger.
fitandball.gumroad.com/l/bra…
Here are some facts about mental health that you might not be aware of:
-Neuroscientists often can not distinguish between people with mild/moderate TBIs and people who have been exposed to mold
-Bibliotherapy (reading) is found to be highly effective for reducing long-term depressive symptoms in adults.
-Office job workers had higher levels of anxiety and depression than those working in manufacturing jobs
-People with major depressive disorder have serum zinc concentrations averaging roughly 1.85 µmol/L lower than healthy controls.
Why?
Well in a nutshell, zinc is crucial for maintaining homeostasis in BDNF, NMDA, GPR39, microglial cells, ACTH and more.
-Believe it or not, there's some research suggesting that botox helps with depression despite it being toxic.
The main theory is that the brain relies on a bidirectional feedback loop called facial feedback.
So when you feel sad, you frown for example.
However, if your forehead muscles physically cannot frown, the feedback loop to your amygdala is interrupted, telling your brain that the distress is less severe than it thinks.
So instead of botox, pay more attention to your facial expressions and artificially manufacture more positive ones :)
-When you are depressed, it's a good idea to pay attention to your sleep and circadian health.
But in the short term, staying awake for 36 hours straight has been documented since the 1970s as one of the fastest-acting antidepressant interventions in existence.
IF you have unipolar depression. If you have bipolar depression it needs way more caution (triggers full mania in 5% of people and hypomania in 6%) because well, this works mainly by rapidly increasing dopamine, norepinephrine and BDNF by downregulating NET for example (NET is responsible for sweeping norepinephrine out of your brain's synapses).
Note: It's not a long term strategy.
For roughly 80% of responders, the antidepressant effect disappears entirely after the very next period of sleep.
-Some of the benefits SSRIs might actually come from modulating ZnT-3, which is solely responsible for packing zinc into synaptic vesicles.
So they might force more zinc out of tight intracellular storage and into the active synaptic clefts of the prefrontal cortex.
-Slow COMT + mercury exposure = cooked brain (especially in children).
Mercury is well-documented to impair catecholamine degradation by interfering with S-adenosylmethionine (the methyl donor required by COMT).
This reduces COMT activity and thus leads to accumulation of norepinephrine, epinephrine, and dopamine.
The same SAM disruption can also impair phenylethanolamine N-methyltransferase (PNMT), shifting the adrenal output toward more noradrenaline and less adrenaline.
-NAC is very effective for compulsive disorders.
In a lot, if not most, compulsive disorders and BFRBs (hair pulling etc), there is dysregulation of glutamate homeostasis in the cortico-striatal circuits.
Mainly, the projection from the prefrontal cortex to the nucleus accumbens (NAc) fires excessively and this hyperactivity drives the "urgency" and loss of top-down behavioral control, making repetitive behaviors highly compulsive.
The extra cysteine from NAC stimulates the cystine-glutamate antiporter.
This increases extracellular glutamate levels outside the synapses/binds to metabotropic glutamate receptors(*), which shut down the hyperactive release of glutamate into the synapse via a negative feedback.
(*)primarily mGluR2/3)
BUT the same reason why NAC helps with compulsive disorders is why, if you use big doses for prolonged time periods, you will end up with anhedonia if you don't have one.
The same mechanism that dampens the "pathological noise" causing cravings or tics blunts the clean glutamatergic signals required for learning and reward processing for example. This was the short answer.
-Baicalin (a flavonoid found in Chinese skullcap) increased VMAT2 levels and enhanced dopamine balance in the brain.
-Plasma zinc and erythrocyte magnesium should be considered as biological state markers and used as such in both major depression and bipolar disorder.
-Ketosis might be a good additional tool to fight addiction more easily.
A ketogenic diet increases baseline levels of adenosine in the brain.
Adenosine receptors naturally pair with dopamine receptors to form functional complexes.
When adenosine levels rise, they directly repress hyperactive dopamine signaling.
Because cocaine's behavioral effects (like rearing and hyper-ambulation) rely on massive surges of dopamine, adenosine acts as a built-in brake.
On top of that:
-Ketosis increases the production of GABA
-β-OHB blocks the overactivation of an enzyme called CaMKII-α through a process known as β-hydroxybutyrylation.
By dampening this enzyme in brain areas like the hippocampus, the diet disrupts the structural "drug memories" and behavioral conditioning that drive cocaine addiction.
-A landmark 2019 follow-up study found that 44% of participating children no longer met the diagnostic threshold for autism spectrum disorder two years after completing a specialized form of fecal microbiota transplantation.
-Drinking at moderate levels (14–21 units per week (a pint a day)) tripled the odds of right-sided hippocampal shrinkage compared to abstaining.
Higher intake (over 30 units weekly) raised this risk even further.
The main mechanisms seem to include acetaldehyde and brain iron accumulation.
At the start of the study, 83% of the children were rated as having "severe" autism.
Two years after treatment, that number dropped to 17%.
-Participants who met the RDA for zinc, copper and selenium had significantly lower odds of depression.
-Aluminum inhibits protein phosphatase 2A, which helps keep tau and neurofilaments dephosphorylated.
It also downregulates TH-immunoreactive neurons inside the substantia nigra.
-Cracking up your window while you sleep might improve your brain health more than you think.
Cognitive scores drop roughly 50% at 1,400ppm compared to the 550 ppm baseline.
-Rates of depression correlate with the geographical distribution of deuterium in the natural water in the US population.
-Consuming a modified Mediterranean ketogenic diet reverses the peripheral lipid signature of Alzheimer’s disease in humans.
-Studies from the United Kingdom and Sweden indicate that the risk of depression is increased by at least 20%, with the former (over 1 million participants) reporting an increased risk with the number of courses and agents used, that persists with a slow decline over the ten years following exposure
-Inadequate dietary omega-3 intake after birth may similarly deplete maternal tissue reserves, potentially contributing to postpartum mood changes or cognitive fatigue
-In a study of 18 patients diagnosed with schizophrenia, 15 (83.3%) had positive serum FRα autoantibodies compared to only 1 in 30 controls (3.3%)
FRα autoantibodies can interfere with how B9 is transported across the blood-brain barrier into the central nervous system.
This blockage can cause a lack of folate in the brain even when blood levels of folate appear completely normal.
Some patients in related observations showed clinical improvement after receiving high-dose folinic acid (leucovorin), which can bypass the blocked receptors.
-Kiwifruit supplementation improved vitality and mood within 4 days, peaking around 14-16 days
-Every 5-gram increase in daily fiber intake correlated with an approximate 5% drop in the risk of depression.
-Women who consumed less than the recommended amount of red meat were twice as likely to be diagnosed with a clinical depressive or anxiety disorder.
-Approximately 30% to 40% of patients with moderate/severe depression experience a meaningful improvement in symptoms with placebo and for individuals with mild-to-moderate depression, that response rate can climb to 70%
-The more vitamin D increases (up to a point), the less depression a person experiences.
-A high magnesium intake is associated with larger brain volumes.
-Glutathione levels are significantly reduced in the occipital cortex of patients with major depressive disorder (MDD).
-There's a higher abundances of certain bacteria like Firmicutes, Clostridia, Actinomyces, Bacteroides, Lachnospiraceae, Blautia, and Dorea are noticed in individuals with suicidal behaviors.
-In German rare-disease clinics, more than half of adults with unexplained symptoms had a current mental disorder and in almost 54% of those cases the mental illness alone explained the whole picture.
-Adolescents with social anxiety had a shifted microbiome (higher Prevotella, lower Parasutterella).
Transplanting that community into newborn rats produced anxiety-like behavior, social deficits, and metabolic changes in medial frontal cortex
-People with MDD often have 20–60% fewer butyrate producers.
-Stool from depressed humans, put into rodents, transfers anhedonia and anxiety-like behavior plus a twisted tryptophan metabolome
-Childhood unpredictability (chaotic routines, who shows up, what happens next) predicts depression even when ACE scores are zero.
-Ten years after clinical depression, about 10% of people are not just “not depressed”, they score above a quarter of never-depressed adults on well-being.
This means that recovery can overshoot baseline
-Suicide and depression rates climb with altitude in U.S.
-Youth cannabis use has been tied to higher later odds of schizophrenia (~+52%), recurrent MDD (~+30%), and anxiety (~+21%)
-Finnish men who sauna 4–7 times a week (vs once) had on the order of 65% lower dementia/Alzheimer risk and about 77% lower psychosis risk over decades
-One session of whole-body hyperthermia (core ~38.5 °C) produced antidepressant effects that were still visible six weeks later in a small RCT
-Antibiotics can be life-saving, but they are not Tic Tacs.
Do two or more rounds of them each year and your relative risk of depression increases by as much as 40%.
"I'll just take probiotics".
They can help but it's not how this works.
The effects of antibiotics extend far beyond simply lowering the count of good bacteria.
Classes such as fluoroquinolones and penicillins bind to and block GABA receptors in the brain for example.
-Impaired glucose metabolism is not only relevant for Alzheimer's when it comes to mental health/brain related issues but pretty much every single one because, well, the brain is a very glucose-sensitive tissue.
Areas like the hippocampus, amygdala, and prefrontal cortex rely heavily on GLUT4.
More: fitandball.gumroad.com/l/bra…
Metabolic Recovery retweeted
Someone who refuses to take accountability will turn a conversation about their betrayal into a debate about your tone, attitude, insecurities, or past trauma. Anything to avoid addressing the one thing that started the whole fucking conversation.
Metabolic Recovery retweeted
If physician associates are able to train in "medicine" and are magically able to see patients independently in two years - why does it take doctors 5 to 6 years medical degree and 10 years postgraduate training before achieving independence?
We have to decide whether we want a safe healthcare service delivered by fully trained doctors or go back to a free for all where anyone can practice medicine with a cursory level of knowledge/ training and do away with medical degrees / medical training
It's like living in a parallel universe where simultaneously you need over 15 years of training to be considered safe as a doctor but anyone else can do a simple course and get stuck in.
Allowing physician assistants to see undifferentiated patients would be irresponsible and poorly evidenced, says @TheBMA's Tom Dolphin
He warns that vague guidelines on supervision fail to address the safety concerns that have been repeatedly raised
bmj.com/content/395/bmj-2026…
Metabolic Recovery retweeted
There’s an acupuncture point on the outer ear known as the Shen Men (Spirit Gate). It is one of the most widely used auricular acupuncture / acupressure points in Chinese medicine.
Traditionally we use it to calm the Shen (Shen is the spirit and includes our consciousness, mental and emotional life and clarity) and to regulate emotional issues, to promote tranquility etc etc)
You can massage this point often for any of the following issues :
Insomnia and disturbed sleep / disturbed dreams
Anxiety
Overactive minds
Depression / low moods
Stress / nervous tension
Pains of literally any kind
Headaches + migraines
Inflammation (including a sore throat, inflamed skin and any inflammatory pain)
Palpitations that are emotion related
Fright and panic (or being easily startled)
Irritability / anger
Addiction and withdrawal
Weight loss / appetite control
Trauma and chronic stress
Menstrual cramps and pelvic pain
Menopausal hot flashes / night sweats (and their related irritability)
High blood pressure, especially stress related high BP
Nausea / vomiting
Motion sickness
Itching / hives / any allergic condition / allergies etc
This is often used as the opening point to calm the system before any other ear treatments. Often, it’s also sore (sometimes remarkably so) when a needle is put into this point.
You can massage this point for a minute or two on each ear several times a day. Ear beads can also be used on it.
This is a very good time in the Northern Hemisphere to start massaging the ear as a whole, daily, and warming it up and loosening up and just generally, gently massaging the tissue. The entire body can be treated from here and warming the ears helps the whole body work better and treats the kidney meridian / system as a whole.
Metabolic Recovery retweeted
Starting the day with a micro-meditation is one of the best and most efficient ways to be stress resilient, improve focus, and start your day with vigor. Thank you @CoachDanGo !
Metabolic Recovery retweeted
The non chalant era is over. We deeply feel, express, say no more often, prioritize ourselves and show care to our loved ones, always with class and grace.
Metabolic Recovery retweeted
Just because the whole toxic group dislikes somebody doesn’t mean that person did anything wrong.
Metabolic Recovery retweeted
A woman in her late 60s w/ a hx of UV gel manicures & prior sunburns, but no tanning bed use, presented w/ widening of a longstanding, thin tan band on the L fourth fingernail.
What’s the diagnosis❓
Metabolic Recovery retweeted
Your doctor cuts you off about 11 seconds after you start talking. Researchers literally timed it in a 2018 study. That number is why Google's new Lancet result is bigger than it looks.
In the study, 98 real urgent care patients texted with Google's AI days before their appointment. No scans, no exam, no bloodwork, just an unhurried conversation about what was wrong. That alone put the correct final diagnosis on the AI's list 90% of the time.
Sounds like magic until you learn what medicine has known for 50 years.
Back in 1975, a British team published a study in the BMJ tracking which part of a visit actually produced the right diagnosis. The physical exam? The labs? Nope. In 82% of cases, the patient's story alone got the doctor there. Everything else mostly confirmed what listening had already found.
So the playbook for accurate diagnosis has existed since 1975. Let the patient talk. Medicine just built a system where nobody has time to run it, and an 18-minute appointment with 11 seconds of uninterrupted patient talk was the result.
Google didn't build a superhuman doctor. It built the first clinician in 50 years with enough time to use the method we already proved works.
And my favorite detail buried in the study... physicians who read the AI's pre-visit summary said it changed how they treated the patient in over half of cases. Hand a doctor the full story before you walk in the room and you get different medicine.
Turns out the most advanced medical instrument Google ever shipped is a conversation that doesn't get interrupted.
Today @TheLancet published our AMIE study with @BIDMC_Medicine, the first prospective study of patient-facing conversational diagnostics in a real clinic.
AMIE is a research system people can chat with before doctors appointments. Testing AMIE outside the lab with real urgent care patients showed how technology can help gather medical histories safely. Clinicians reported that the summaries helped them prepare for visits in 75% of cases and influenced their approach to care in more than half. AMIE’s differential diagnoses also matched the doctors’ final diagnoses 90% of the time giving clinicians more time to focus on patient care.
It’s Google’s first-ever paper in The Lancet’s main journal!
Metabolic Recovery retweeted
To whom it may concern,
One of the hardest parts of practicing medicine in the current landscape is the lack of autonomy.
Having no control over one’s schedule.
Having to rush because you are overbooked.
Having no say over decisions which affect patient care.
Metabolic Recovery retweeted
When someone asks me about the last two years, but all I can think about is how much they’ve taught me about the art of letting go. Letting go of people I thought would stay, expectations I held on to, versions of myself I’ve outgrown and futures I once prayed would happen. Learning that not everything you love is meant to stay, not every ending comes with closure and not every unanswered question needs an answer. These past two years haven’t been easy, but they’ve taught me that sometimes, healing means accepting what you cannot change and finding the courage to move forward anyway. I may have lost a lot along the way, but I’ve also learned that letting go isn’t always about losing something. Sometimes, it’s about finally making peace with what was never meant to be.
Metabolic Recovery retweeted
Again for the people in the back: a patient who walks into the hospital with stable vitals and a subacute history and a hemoglobin of 4 g/dL isn't critically ill.
Hemoglobin of 3 g/dL? I'm even LESS worried.
The way you get a paucisymtomatic, hemodynamically stable, profound anemia is subacute/chronic blood loss with sodium retention (euvolemic anemia).
ICU Hot Takes:
About once a month, I get that call from the ED.
The patient has an Hb of 4 g/dL, and the hospitalist, the ED attending, or both aren't "comfortable" admitting them outside the ICU.
I get the concern. A hemoglobin of 4 gets everyone's attention.
But can we agree on something? We admit patients to the ICU based on their physiology, not a laboratory value in isolation.
In fact, when I'm told that a patient with a very low Hb is hemodynamically stable, my first thought is that the anemia probably developed gradually, even if blood loss is the cause.
Of course, a normal BP doesn't exclude ongoing bleeding or compensated shock. Context matters. But often, this is a gradual Hb drop that the body has had time to adapt to.
The Hb tells us how severe the anemia is. The patient tells us whether they need the ICU.
#FOAMcc #FOAMed
Metabolic Recovery retweeted
I hate that “being uncomfortable” is now viewed by some as an indication to use a scarce ICU bed.
It’s not about physician “comfort” it’s about patient needs. A stable persons who has gotten a transfusion doesn’t automatically need ICU level care.
Metabolic Recovery retweeted
ICU Hot Takes:
About once a month, I get that call from the ED.
The patient has an Hb of 4 g/dL, and the hospitalist, the ED attending, or both aren't "comfortable" admitting them outside the ICU.
I get the concern. A hemoglobin of 4 gets everyone's attention.
But can we agree on something? We admit patients to the ICU based on their physiology, not a laboratory value in isolation.
In fact, when I'm told that a patient with a very low Hb is hemodynamically stable, my first thought is that the anemia probably developed gradually, even if blood loss is the cause.
Of course, a normal BP doesn't exclude ongoing bleeding or compensated shock. Context matters. But often, this is a gradual Hb drop that the body has had time to adapt to.
The Hb tells us how severe the anemia is. The patient tells us whether they need the ICU.
#FOAMcc #FOAMed