The Impact of the 2016 Pain Guidelines on Chronic Pain Patients and the Ongoing Fentanyl Crisis
In 2016, the release of the CDC's guidelines for prescribing opioids brought significant changes to the landscape of pain management in the United States. Intended to address the opioid epidemic and reduce overdose deaths, these guidelines had unintended consequences that resulted in increased suffering for chronic pain patients and did little to curb the illicit fentanyl crisis.
Chronic Pain Patients Left in the Lurch: The 2016 guidelines led to a widespread reduction in opioid prescriptions for chronic pain. Many healthcare providers became hesitant to prescribe opioids, even for legitimate cases of chronic pain, leaving many patients struggling to manage their pain effectively.
Increased Stigma Surrounding Chronic Pain:The guidelines contributed to a growing stigma around chronic pain and opioid use. Patients with legitimate medical needs for opioids found themselves facing scrutiny, skepticism, and barriers to accessing necessary pain relief.
Limited Access to Comprehensive Pain Management: Rather than promoting a holistic approach to pain management that includes physical therapy, alternative treatments, and mental health support, the guidelines focused primarily on limiting opioid prescriptions. This left many chronic pain patients with limited options for comprehensive care.
Rise in Illicit Fentanyl-Related Deaths: While the guidelines aimed to reduce opioid overdose deaths, they failed to effectively address the rising tide of illicit fentanyl-related deaths. Restricting access to prescription opioids inadvertently pushed some individuals towards seeking more dangerous alternatives, including black-market fentanyl.
Need for a Balanced Approach: Experts argue that a balanced approach is essential when addressing both the opioid epidemic and the needs of chronic pain patients. Policies should consider individualized care, access to non-opioid pain management strategies, and robust systems to combat illicit drug distribution.
The intersection of the 2016 pain guidelines, chronic pain management, and the illicit fentanyl crisis underscores the importance of nuanced policies that prioritize patient well-being, safety, and appropriate pain relief. Moving forward, a comprehensive approach that considers the complexities of both issues is crucial to effectively address the multifaceted challenges facing chronic pain patients and combating drug-related deaths in our communities.

Several people have approached me that they might have endometriosis. Lifelong warrior so thought I would share my tips and tricks I put together for my friends and family to share with you :) Hope this helps someone!
ENDOMETRIOSIS SURGERY FACTS

• EXCISION SURGERY! I cannot stress this one enough. If you have an ablation, it will grow back and likely quick (but consult with your doctors on your case 100%). Excision is when they cut it out vs. it gets burned off. You will have a better success rate and slow rate of growth if they excise. Not all cases can be depending on location so again, please talk with your doctor about your situation. This is not the same for everyone.
• If your doctor cannot do excision surgery. Skip and move on to the next! Trust me, well worth the time to research and find the right doctor. You will thank me later for this one too haha.
• Finding a doctor is stuff. Also tough to find resources. If you cannot find an Endometriosis specialist in your area who does excision, you may need to look out of state, but one tip is exploring gynecological oncologists. Some will take benign cases, but not all so do your research. But it’s a good avenue for help in your area or you want insurance coverage.
• Nanny’s Nook is a good resource for online information regarding endometriosis: https://nancysnookendo.com/
• Dr Seckin’s book called The Doctor Will See You Now is also worth the read (https://www.amazon.com/Doctor-Will-See-You-Endometriosis/dp/1681621126)
• Definitely look into Egg Freezing before doing any permanent surgeries. The ovaries are more intact when there is a uterus in place, so I recommend immediately following any excisions with Egg Freezing if you can and if it’s part of your plans. I found my AMH levels low (1.2) but still retrieved 25 eggs, so never be discouraged if this is your future planning path.
• My Symptoms: I experience bloating, constipation, diarrhea, nausea and vomiting as the main culprits. I have irregular periods in regards to the number of days and if it comes or not (even with an IUD). Pelvic pain is probably the worst of all since it accompanies these symptoms and is present a majority of the time. Others may have different symptoms, and there’s many others I didn’t list but wanted to paint the picture of some I’ve experienced.

ENDOMETRIOSIS LAPAROSCOPIC SURGERY (WHAT TO EXPECT)
PRE-SURGERY

• List of questions to ask your doctor
• Insurance Information and ID
• Necessary forms or paperwork the doctor requires
• Make sure any medical records are sent that would be relevant

POST-OP PREP

• Eat smaller meals and simple foods days beforehand. If bowel prep is necessary, they also recommend taking a laxative in the days leading up to help prep.
• Pack a bag! Not every surgery is an overnight stay but even if you have a day-of surgery, back an overnight bag. Here’s the essentials:
  • Phone/Headphones/iPad/Kindle/Books
  • Device Chargers
  • Medications that you currently take
  • Glasses (do not wear contacts day of)
  • An extra pair of underwear
  • Sanitary Pads or Always Discreet
  • Comfy pants with light elastic band around the waist
  • Non wired bra
  • Slip on shoes (this is clutch! Recommend slides -https://www.amazon.com/gp/product/B0BL7LJKZW/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1).
  • Layers - Sweatshirt, Long Sleeved Shirt etc. - Hospitals are cold!
  • Toothbrush and tooth paste
  • Hairbrush
  • Face wipes, wash cloth, small towel and bar of soap.

SPACE PREP

1. Make sure your bed or couch is prepped. I stayed on the first level for the first 2ish days before feeling well enough to stay upstairs.
2. I used a pregnancy pillow on the bed to help me stay on my back while sleeping and help you feel cozy.
3. Stock the house with foods that will be light for your stomach. Think soups and casseroles! Saltine crackers, broths, rices etc..
4. If you have a raised bed, get a step stool to assist. It’s best to sit on the side of the bed and slowly lay your upper body down while bringing your knees up and over to your back. You will need to use arm strength the first couple of days to get you up and over since you can’t use the abdomen.
5. Water and Beverages stocked at all times. I have a reusable water bottle and avoid carbonated beverages for the time being. They fill you with gas for the procedure so it may make those symptoms worse.
6. Netflix, Kindle, Puzzles, Craft Projects…visits with friends. Whatever makes the time pass, set it up ahead of time so it’s handy.
7. Items to Keep on Hand: Baby Wipes, heating pads, pads/diapers, candles, essential oils, things that smell good haha

BOWEL PREP
This is dependent on the type of surgery you are having, but its good to have Gatorade, Magnesium Citrate (liquid), laxatives and enemas on hand just in case you need these.
ON SURGERY DAY
It’s important to follow the instructions on what to stop taking and/or eating/drinking prior to the surgery. Wear comfy clothes (wide elastic waistband) and slides with cozy socks. Double check your to go bag and breath.
AT THE HOSPITAL

1. Do your check-ins and keep your people with you as long as you want.
2. Make sure to read all the consent forms and ask any questions upfront. Make any advance directives clear.
3. Just try to remain calm as there’s a lot of down time while they do intake. It is about 2 hours of prep before they bring you in for the surgery itself.
4. They will ask you the same questions over and over again, that’s normal and trust me, you want to confirm it’s all being done properly.
5. If you need something for anxiety, they will be sure to give you something if you ask :)
6. You will be wearing a gown, socks, funky underwear and a cool hair net haha wear the gown backward so you keep warm and keep the butt covered.
7. Vitals will happen and the anesthesiologist will come and speak with you to make sure they prep the right meds beforehand. Bring up any concerns here with them!
8. You may be wheeled or walked into surgery. I’ve only ever walked in and laid on the table myself.
9. They will then put the IV in your arm and sometimes will put on a mask, they will then ask you to count backwards and before you know it, you will be awake again!

RECOVERY

• You will wake-up and feel groggy. Totally normal and you will be in a different room. They will likely say a lot really quick about your surgery. Before leaving ask for them to walk through it or see if you can speak with the doctor again when clear headed. RECOMMENDED!
• Your throat will be sore, that’s normal from the tube.
• Just relax and sleep it off if you want, the goal is to be relaxed and pee once before leaving.
• Before you go, eat and drink and pass smoke urine. They’ll provide you with the meds and you’ll be good to go.
• Make sure someone brings you home after :)
• Make sure you have a bag for vomit in the car.
• Bring a small pillow that can be strapped between the car belt and you for maximum comfort on the trip home.
• Pain Med Management: This one is important. I messed up night one and didn’t take it soon enough and was in too much pain so make sure you stick to the schedule the doctors give you to ensure you are comfortable.
• Keep Walking: It seems unnatural to have a surgery then walk, but the sooner you get up and keep moving around the house, the better. Just avoid heavy lifting and immense bending like movements. Stairs are also ok but also consult with your doctor!
• Gas Build Up: I did feel pain in my shoulders from the gas. Just keep moving! It will help get that out of the system but this pain is normal.
• Relax and let people take care of you! Don’t be too quick to recover.
• Keep an eye out for fever, increased vaginal bleeding, or feeling terrible.
• Keep all post op appointments and follow all post op instructions!

ENDOMETRIOSIS MAINTENANCE
Here’s the tips and tricks I found helpful for maintaining my pain and symptoms (GI and back pain related):

1. Pelvic Floor Therapy: This is important for keeping the muscles in your pelvis healthy and strong to maintain your structure and also help manage pain. Consult with your doctor on whether this is right for you.
2. Physical Therapy: I do PT for my back and pelvic floor since it’s all related. We focus on Myofascial Release Therapy to help break up the adhesions and give me more mobility. This helps with temporary pain relief (reduction in number), but that is always welcome :)
3. Acupuncture: I swear by Acupuncture. I don’t know what it does or why, but it works. It’s not a cure by any means, but it's great for relaxation, fertility, digestion, endometriosis, sleep, etc.. I can go on, but it’s not covered by insurance plans all the time so you will need to check and see what you’re able to take on.
4. Diet/Exercise:
   1. Eating high protein, lower fat/carbs (not none just low) helps your body, but overall learn your trigger foods! This will go a long way.
   2. Ginger, turmeric and fennel all help with bloating. I like to drink them in tea form when I’m feeling particularly hard stomached as it’s a good natural way to decrease the bloat. Peppermint also works for some, for me it irritates my GERD.
   3. Chamomile for relaxation
   4. Walking and movement are important. I cannot do anything high impact due to my sacroiliitis diagnosis, so I stick with light yoga and walking.
5. Alcohol/Other Substances: Don’t do it. Don’t touch it. You’ll thank me later on this point.
6. Sleep: Insomnia is a very real thing. I think I went 2 or 3 days at its worst one time and I cannot say enough how important trying to keep the same sleep schedule will benefit you. Waking and sleeping around the same time each day will still feel exhausting but at least you know your body is getting the most sleep it can get.
7. Medications/Supplements:
   1. Ibprofuern: This does NOT work for me. I have GERD and ulcers so I cannot take NSAIDs, but with that in mind, NSAIDs are supposedly the best pain medication over the counter to help you manage it.
   2. Pain Killers: These are AS NEEDED. I try to refrain and leave these for the TRULY bad days which I try to spread out. Not even worth it sometimes, because I don’t like how I feel and sometimes vomit after taking them. But they do help the pain!
   3. IUD/Orilissa: An IUD will NOT do anything. If you are diagnosed, ask your doctor about Orilissa or similar medicines instead of birth control methods. This will not stop the growth, just suppress it. There are side effects and it is only a short term solution.
   4. Linzess: This worked well for me for constipation symptoms when they got severe. Definitely recommend bringing this to your doctor if you’re truly suffering and they have not yet mentioned. I also resorted after trying magnesium citrate
   5. CBD Lotions/Salves: For my pelvis, I use Healing Rose CBD Salve in Orange and Lavender (https://www.thehealingroseco.com/product/orange-lavender-with-chamomile-herbal-salve-300mg-cbd/). For my back, I use a medical grade CBD lotion with menthol (https://cbdclinic.co/clinical-strength-series/). I also use a CBD massage oil from Healing Rose of the same scent when doing myofascial release at home. I also use Somedays Cramp Cream (https://somedays.com/products/period-cramp-cream?variant=42062153842853).
8. Heating Pads and Ice Pack: I have several varieties of heating pads. A cordless travel heating pad (https://www.amazon.com/dp/B09FPTJL4G?psc=1&ref=ppx_yo2ov_dt_b_product_details), a plug-in heating pad (lhttps://www.hsn.com/products/pure-enrichment-purerelief-xxl-heating-pad-with-9-cord/22188460) and stick on patches (https://www.thermacare.com/ - I use the back patches but reverse them to the front for better coverage). For hot flashes and night sweats (also if you need to relax while anxious) place an ice pack over your chest to help cool or calm down.
9. Self-Care: No joke, massages, facials, epsom salt baths, sound baths, reiki….anything that you find relaxing. Do it. Try it! They also make CBD bath bombs Ive been wanting to check out.
10. TENs Machine: I really want one, don’t have one, but people swear by them (the heating pad linked to MyObi has a TENs version - https://myobistore.com/en-us/collections/my-obi-belts/products/apollo-2-0).
11. Pregnancy Pillow: This one sounds so lame, but I bought a pregnancy pillow for my first endometriosis surgery since I’m a side sleeper to help keep me on my back during recovery. It changed by life! It helps my anxiety and makes me comfortable while sleeping. (https://www.amazon.com/gp/product/B08YYVRXLM/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1)..
12. Heated Blankets/Cozy Blankets: Make yourself feel better with a cozy blanket. Do it, I dare you!
13. Endo To-Go Bag: Includes heating pads (travel, plug-in and patches), medications, balms/salves, essential oils and pads/protection items, change of clothes, wet wipes.
14. Sex Life: I’m single, I don’t have a partner to worry about communicating this issue with at this point, but go slow and communicate given eventually this will have to be a conversation. What I have learned is that if you do have sex and feel pain. Immediately stop! If you associate sex with pain mentally in that moment, it may cause fear in doing so down the line so it’s best to stop the moment you feel any pain occur.
15. Work Life: I work a demanding job so it was not working with the appointments and care I needed to manage pain. Always get FMLA from your doctor for intermittent leave based on your company's policies. This protects you from flare-ups and appointments. Short Term Disability is based on your situation with work so talk with them about any leave of absence for surgery and recovery and ensure the medical providers fill out the paperwork appropriately.
16. Friends/Family: This one is the worst. I have to cancel and make plans all the time based on how I feel. I like to line up a bunch of plans for three months out and do my best to make them happen at the beginning of the month when I know I’m most likely to feel good. I just say I’ll make things up to them when I get better and those who have stuck around have been truly amazing friends, but don’t be upset that some might be over the day in and out of what you’re going through. It’s hard for you and sometimes others and it’s just a part of the relationships we’re meant to experience in life. Most people (unless they have endometriosis) don’t understand it so it can feel isolating, but there’s others out there who know what you’re going through and are willing to chat. Just gotta find them and reach out on social media, online etc..
17. Journaling Symptoms: Guilty of not being the best at this always, but it's good to track your symptoms to see how they work and operate. It helps not only you plan for it, but also your doctors in how best to handle your care. Take photos of things that make sense to show your doctors! Discharge, bowels etc..can sometimes help diagnose or judge with the images.
18. Next to Bed Kit: Make sure your nightstand is stocked with the essentials for your bad days. Makes it easier to access the items you need when you just can’t get up and get it.
19. Squatty Potty: Another thing that is majorly life changing on constipation days! Get one or you can make your own :) Take a stack of books and stack them at equal heights on each side and put your feet up. The trick is making sure you’re in a squat with your knees high to your ears.
20. Clothing: Dressing for this is key but you still want to look cute! Joggers with a stretchy waist are my go to pants, but wide leg trousers with a stretchy waist help with ease of removal but also comfort and brings some style to the look.
21. Pads: I wear Always Discreet vs. pads. I find when you need to wear them full time for incontinence it just makes it more comfortable. They have different cuts and styles so definitely check them out!

Several people have approached me that they might have endometriosis. Lifelong warrior so thought I would share my tips and tricks I put together for my friends and family to share with you :) Hope this helps someone!
ENDOMETRIOSIS SURGERY FACTS

• EXCISION SURGERY! I cannot stress this one enough. If you have an ablation, it will grow back and likely quick (but consult with your doctors on your case 100%). Excision is when they cut it out vs. it gets burned off. You will have a better success rate and slow rate of growth if they excise. Not all cases can be depending on location so again, please talk with your doctor about your situation. This is not the same for everyone.
• If your doctor cannot do excision surgery. Skip and move on to the next! Trust me, well worth the time to research and find the right doctor. You will thank me later for this one too haha.
• Finding a doctor is stuff. Also tough to find resources. If you cannot find an Endometriosis specialist in your area who does excision, you may need to look out of state, but one tip is exploring gynecological oncologists. Some will take benign cases, but not all so do your research. But it’s a good avenue for help in your area or you want insurance coverage.
• Nanny’s Nook is a good resource for online information regarding endometriosis: https://nancysnookendo.com/
• Dr Seckin’s book called The Doctor Will See You Now is also worth the read (https://www.amazon.com/Doctor-Will-See-You-Endometriosis/dp/1681621126)
• Definitely look into Egg Freezing before doing any permanent surgeries. The ovaries are more intact when there is a uterus in place, so I recommend immediately following any excisions with Egg Freezing if you can and if it’s part of your plans. I found my AMH levels low (1.2) but still retrieved 25 eggs, so never be discouraged if this is your future planning path.
• My Symptoms: I experience bloating, constipation, diarrhea, nausea and vomiting as the main culprits. I have irregular periods in regards to the number of days and if it comes or not (even with an IUD). Pelvic pain is probably the worst of all since it accompanies these symptoms and is present a majority of the time. Others may have different symptoms, and there’s many others I didn’t list but wanted to paint the picture of some I’ve experienced.

ENDOMETRIOSIS LAPAROSCOPIC SURGERY (WHAT TO EXPECT)
PRE-SURGERY

• List of questions to ask your doctor
• Insurance Information and ID
• Necessary forms or paperwork the doctor requires
• Make sure any medical records are sent that would be relevant

POST-OP PREP

• Eat smaller meals and simple foods days beforehand. If bowel prep is necessary, they also recommend taking a laxative in the days leading up to help prep.
• Pack a bag! Not every surgery is an overnight stay but even if you have a day-of surgery, back an overnight bag. Here’s the essentials:
  • Phone/Headphones/iPad/Kindle/Books
  • Device Chargers
  • Medications that you currently take
  • Glasses (do not wear contacts day of)
  • An extra pair of underwear
  • Sanitary Pads or Always Discreet
  • Comfy pants with light elastic band around the waist
  • Non wired bra
  • Slip on shoes (this is clutch! Recommend slides -https://www.amazon.com/gp/product/B0BL7LJKZW/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1).
  • Layers - Sweatshirt, Long Sleeved Shirt etc. - Hospitals are cold!
  • Toothbrush and tooth paste
  • Hairbrush
  • Face wipes, wash cloth, small towel and bar of soap.

SPACE PREP

1. Make sure your bed or couch is prepped. I stayed on the first level for the first 2ish days before feeling well enough to stay upstairs.
2. I used a pregnancy pillow on the bed to help me stay on my back while sleeping and help you feel cozy.
3. Stock the house with foods that will be light for your stomach. Think soups and casseroles! Saltine crackers, broths, rices etc..
4. If you have a raised bed, get a step stool to assist. It’s best to sit on the side of the bed and slowly lay your upper body down while bringing your knees up and over to your back. You will need to use arm strength the first couple of days to get you up and over since you can’t use the abdomen.
5. Water and Beverages stocked at all times. I have a reusable water bottle and avoid carbonated beverages for the time being. They fill you with gas for the procedure so it may make those symptoms worse.
6. Netflix, Kindle, Puzzles, Craft Projects…visits with friends. Whatever makes the time pass, set it up ahead of time so it’s handy.
7. Items to Keep on Hand: Baby Wipes, heating pads, pads/diapers, candles, essential oils, things that smell good haha

BOWEL PREP
This is dependent on the type of surgery you are having, but its good to have Gatorade, Magnesium Citrate (liquid), laxatives and enemas on hand just in case you need these.
ON SURGERY DAY
It’s important to follow the instructions on what to stop taking and/or eating/drinking prior to the surgery. Wear comfy clothes (wide elastic waistband) and slides with cozy socks. Double check your to go bag and breath.
AT THE HOSPITAL

1. Do your check-ins and keep your people with you as long as you want.
2. Make sure to read all the consent forms and ask any questions upfront. Make any advance directives clear.
3. Just try to remain calm as there’s a lot of down time while they do intake. It is about 2 hours of prep before they bring you in for the surgery itself.
4. They will ask you the same questions over and over again, that’s normal and trust me, you want to confirm it’s all being done properly.
5. If you need something for anxiety, they will be sure to give you something if you ask :)
6. You will be wearing a gown, socks, funky underwear and a cool hair net haha wear the gown backward so you keep warm and keep the butt covered.
7. Vitals will happen and the anesthesiologist will come and speak with you to make sure they prep the right meds beforehand. Bring up any concerns here with them!
8. You may be wheeled or walked into surgery. I’ve only ever walked in and laid on the table myself.
9. They will then put the IV in your arm and sometimes will put on a mask, they will then ask you to count backwards and before you know it, you will be awake again!

RECOVERY

• You will wake-up and feel groggy. Totally normal and you will be in a different room. They will likely say a lot really quick about your surgery. Before leaving ask for them to walk through it or see if you can speak with the doctor again when clear headed. RECOMMENDED!
• Your throat will be sore, that’s normal from the tube.
• Just relax and sleep it off if you want, the goal is to be relaxed and pee once before leaving.
• Before you go, eat and drink and pass smoke urine. They’ll provide you with the meds and you’ll be good to go.
• Make sure someone brings you home after :)
• Make sure you have a bag for vomit in the car.
• Bring a small pillow that can be strapped between the car belt and you for maximum comfort on the trip home.
• Pain Med Management: This one is important. I messed up night one and didn’t take it soon enough and was in too much pain so make sure you stick to the schedule the doctors give you to ensure you are comfortable.
• Keep Walking: It seems unnatural to have a surgery then walk, but the sooner you get up and keep moving around the house, the better. Just avoid heavy lifting and immense bending like movements. Stairs are also ok but also consult with your doctor!
• Gas Build Up: I did feel pain in my shoulders from the gas. Just keep moving! It will help get that out of the system but this pain is normal.
• Relax and let people take care of you! Don’t be too quick to recover.
• Keep an eye out for fever, increased vaginal bleeding, or feeling terrible.
• Keep all post op appointments and follow all post op instructions!

ENDOMETRIOSIS MAINTENANCE
Here’s the tips and tricks I found helpful for maintaining my pain and symptoms (GI and back pain related):

1. Pelvic Floor Therapy: This is important for keeping the muscles in your pelvis healthy and strong to maintain your structure and also help manage pain. Consult with your doctor on whether this is right for you.
2. Physical Therapy: I do PT for my back and pelvic floor since it’s all related. We focus on Myofascial Release Therapy to help break up the adhesions and give me more mobility. This helps with temporary pain relief (reduction in number), but that is always welcome :)
3. Acupuncture: I swear by Acupuncture. I don’t know what it does or why, but it works. It’s not a cure by any means, but it's great for relaxation, fertility, digestion, endometriosis, sleep, etc.. I can go on, but it’s not covered by insurance plans all the time so you will need to check and see what you’re able to take on.
4. Diet/Exercise:
   1. Eating high protein, lower fat/carbs (not none just low) helps your body, but overall learn your trigger foods! This will go a long way.
   2. Ginger, turmeric and fennel all help with bloating. I like to drink them in tea form when I’m feeling particularly hard stomached as it’s a good natural way to decrease the bloat. Peppermint also works for some, for me it irritates my GERD.
   3. Chamomile for relaxation
   4. Walking and movement are important. I cannot do anything high impact due to my sacroiliitis diagnosis, so I stick with light yoga and walking.
5. Alcohol/Other Substances: Don’t do it. Don’t touch it. You’ll thank me later on this point.
6. Sleep: Insomnia is a very real thing. I think I went 2 or 3 days at its worst one time and I cannot say enough how important trying to keep the same sleep schedule will benefit you. Waking and sleeping around the same time each day will still feel exhausting but at least you know your body is getting the most sleep it can get.
7. Medications/Supplements:
   1. Ibprofuern: This does NOT work for me. I have GERD and ulcers so I cannot take NSAIDs, but with that in mind, NSAIDs are supposedly the best pain medication over the counter to help you manage it.
   2. Pain Killers: These are AS NEEDED. I try to refrain and leave these for the TRULY bad days which I try to spread out. Not even worth it sometimes, because I don’t like how I feel and sometimes vomit after taking them. But they do help the pain!
   3. IUD/Orilissa: An IUD will NOT do anything. If you are diagnosed, ask your doctor about Orilissa or similar medicines instead of birth control methods. This will not stop the growth, just suppress it. There are side effects and it is only a short term solution.
   4. Linzess: This worked well for me for constipation symptoms when they got severe. Definitely recommend bringing this to your doctor if you’re truly suffering and they have not yet mentioned. I also resorted after trying magnesium citrate
   5. CBD Lotions/Salves: For my pelvis, I use Healing Rose CBD Salve in Orange and Lavender (https://www.thehealingroseco.com/product/orange-lavender-with-chamomile-herbal-salve-300mg-cbd/). For my back, I use a medical grade CBD lotion with menthol (https://cbdclinic.co/clinical-strength-series/). I also use a CBD massage oil from Healing Rose of the same scent when doing myofascial release at home. I also use Somedays Cramp Cream (https://somedays.com/products/period-cramp-cream?variant=42062153842853).
8. Heating Pads and Ice Pack: I have several varieties of heating pads. A cordless travel heating pad (https://www.amazon.com/dp/B09FPTJL4G?psc=1&ref=ppx_yo2ov_dt_b_product_details), a plug-in heating pad (lhttps://www.hsn.com/products/pure-enrichment-purerelief-xxl-heating-pad-with-9-cord/22188460) and stick on patches (https://www.thermacare.com/ - I use the back patches but reverse them to the front for better coverage). For hot flashes and night sweats (also if you need to relax while anxious) place an ice pack over your chest to help cool or calm down.
9. Self-Care: No joke, massages, facials, epsom salt baths, sound baths, reiki….anything that you find relaxing. Do it. Try it! They also make CBD bath bombs Ive been wanting to check out.
10. TENs Machine: I really want one, don’t have one, but people swear by them (the heating pad linked to MyObi has a TENs version - https://myobistore.com/en-us/collections/my-obi-belts/products/apollo-2-0).
11. Pregnancy Pillow: This one sounds so lame, but I bought a pregnancy pillow for my first endometriosis surgery since I’m a side sleeper to help keep me on my back during recovery. It changed by life! It helps my anxiety and makes me comfortable while sleeping. (https://www.amazon.com/gp/product/B08YYVRXLM/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1)..
12. Heated Blankets/Cozy Blankets: Make yourself feel better with a cozy blanket. Do it, I dare you!
13. Endo To-Go Bag: Includes heating pads (travel, plug-in and patches), medications, balms/salves, essential oils and pads/protection items, change of clothes, wet wipes.
14. Sex Life: I’m single, I don’t have a partner to worry about communicating this issue with at this point, but go slow and communicate given eventually this will have to be a conversation. What I have learned is that if you do have sex and feel pain. Immediately stop! If you associate sex with pain mentally in that moment, it may cause fear in doing so down the line so it’s best to stop the moment you feel any pain occur.
15. Work Life: I work a demanding job so it was not working with the appointments and care I needed to manage pain. Always get FMLA from your doctor for intermittent leave based on your company's policies. This protects you from flare-ups and appointments. Short Term Disability is based on your situation with work so talk with them about any leave of absence for surgery and recovery and ensure the medical providers fill out the paperwork appropriately.
16. Friends/Family: This one is the worst. I have to cancel and make plans all the time based on how I feel. I like to line up a bunch of plans for three months out and do my best to make them happen at the beginning of the month when I know I’m most likely to feel good. I just say I’ll make things up to them when I get better and those who have stuck around have been truly amazing friends, but don’t be upset that some might be over the day in and out of what you’re going through. It’s hard for you and sometimes others and it’s just a part of the relationships we’re meant to experience in life. Most people (unless they have endometriosis) don’t understand it so it can feel isolating, but there’s others out there who know what you’re going through and are willing to chat. Just gotta find them and reach out on social media, online etc..
17. Journaling Symptoms: Guilty of not being the best at this always, but it's good to track your symptoms to see how they work and operate. It helps not only you plan for it, but also your doctors in how best to handle your care. Take photos of things that make sense to show your doctors! Discharge, bowels etc..can sometimes help diagnose or judge with the images.
18. Next to Bed Kit: Make sure your nightstand is stocked with the essentials for your bad days. Makes it easier to access the items you need when you just can’t get up and get it.
19. Squatty Potty: Another thing that is majorly life changing on constipation days! Get one or you can make your own :) Take a stack of books and stack them at equal heights on each side and put your feet up. The trick is making sure you’re in a squat with your knees high to your ears.
20. Clothing: Dressing for this is key but you still want to look cute! Joggers with a stretchy waist are my go to pants, but wide leg trousers with a stretchy waist help with ease of removal but also comfort and brings some style to the look.
21. Pads: I wear Always Discreet vs. pads. I find when you need to wear them full time for incontinence it just makes it more comfortable. They have different cuts and styles so definitely check them out!

Sorry if this isn’t allowed! Question for those who have had a bilateral salpingectomy successfully covered by their insurance, did you have to provide family history of ovarian and/or breast cancer, or prove any other issue that would make the procedure “medically necessary” to have it covered by insurance?
I have a consult coming up and was chatting with my insurance provider today to check if I would be covered and they sent me a doc that essentially said it would be covered if it was medically necessary, and then listed a few criteria, nothing about it being covered as permanent birth control.
I don’t have a history of ovarian cancer in my family, but my paternal grandmother has had breast cancer. How would my insurance be able to confirm any family medical history if I wanted my doctor to use that as a reason for the surgery to be medically necessary?
My heart is set on getting this done, and I’ll pay out of pocket if I have to, but I’d really rather not! If anything, I’m saving my insurance company money by NOT having kids or needing an IUD replacement every few years lol! Any advice or insight is so very appreciated, I can’t wait to be a part of the club :)

Copied from article (link below also):
“Despite decades of progress in cancer treatment, dosing remains stuck in the past and patients are likely suffering unnecessary treatment-related side effects, according to authors of a recent survey-based analysis.
Dosage recommendations on drug labels are still typically based on the maximum tolerated dose from phase 1 testing, a holdover from when chemotherapy was about the only thing medical oncologists had to offer patients.
Experts now question the more-is-better approach for chemotherapy as well as for targeted and immunotherapies where lower, less toxic doses often work as well as higher ones.
But with maximum tolerated dose still holding sway, many patients receive this dose when starting therapy and can experience significant treatment-related side effects.
The survey-based analysis, published in the Journal of Clinical Oncology, supported this view.
The survey, which asked patients with metastatic breast cancer about the toxicities associated with the maximum tolerated dose, found that nearly 90% of respondents reported at least one significant treatment-related side effect.
Overall, 1221 patients completed the 27-question survey, developed by the Patient-Centered Dosing Initiative (PCDI), a patient advocacy group launched in 2019 to improve treatment of metastatic breast cancer.
The survey aimed to assess the prevalence and severity of patients' treatment-related side effects, communication between patients and physicians about these issues, as well as perceptions about the efficacy of higher vs lower doses and a willingness to discuss different dosing strategies.
Patients were invited to take the survey on social media. Most patients were postmenopausal, and almost half had been diagnosed in the past 2 years. Treatments included targeted, endocrine, and chemotherapy, as well as radiation, surgery, and immunotherapy.
Overall, about 86% of patients (1051 of 1221) reported at least one significant treatment-related side effect. Among these patients, more than 20% went to the emergency room or hospital as a result, and 43.2% missed at least one cancer treatment.
The most common side effects were fatigue, nausea, low blood counts, diarrhea, and neuropathy.
Almost all respondents (97.6%) told their doctors about the treatment toxicities. More than half (54.2%) received a dose reduction to minimize the side effects, and among these patients, 82.6% reported symptom relief.
The analysis had several limitations, however, including possible selection bias because only patients with internet access could participate, an underrepresentation of minority populations, and self-reported side effects that could not be confirmed.
Still, the results indicate that patients are likely struggling with potentially unnecessary treatment-related side effects because of an outdated dosing paradigm, said investigators led by PCDI founder Anne Loeser, BS, who recently died of metastatic breast cancer.
The group continues to work with the US Food and Drug Administration on initiatives to optimize cancer drug dosing and update labels. But in the meantime, PCDI recommends talking with patients about dosing options. The survey indicated that such conversations are welcome.
Nearly all survey respondents (92.3%) said they would be willing to discuss alternative dosing options to optimize quality of life. One in five, however, did not know that dose reductions were an option to control side effects. And more than half of respondents (53.3%) did not think the highest dose was necessarily the most effective.
There are "no real surprises" in the survey, but "clearly patients want to be engaged in decision-making," said William J. Gradishar, MD, a breast oncologist at Northwestern University, Chicago, who discussed the initial survey results when Loeser presented them in 2021 at the American Society of Clinical Oncology annual meeting. The survey "really highlights the need for a two-way conversation" between patients and caregivers throughout treatment.
"We have to recognize that many of our treatments do not actually improve survival, and if they do, in some cases, it's quite modest, so anything we can do to make therapy more tolerable is important," especially when the goal of care is palliation, not cure, said Gradishar.
No funding was reported for the work. Loeser and Gradishar did not have any disclosures.”
https://www.medscape.com/viewarticle/more-not-always-better-outdated-drug-dose-strategy-breast-2024a10008xa

So I have an appointment with an in-network provider this week. I have a horrible hernia I haven’t had checked out. My plan says I have a $30 co-pay in physician office visits if it’s a “medically necessary” visit.
Obviously, it’s medically necessary because I haven’t even gotten it checked out and I’m in excruciating pain almost every day at this point. But is there a way to check if my visit fits this criteria.
Also I haven’t had a health maintenance exam yet this year and those are 100% covered so I’m hoping it might be covered under that as well. Thank you

A lot of people from this subreddit have been asking this question and i got this article together to answer that question. I hope it helps. Cheers.

I honestly have found great help when i started taking Omega 3 in a daily basis, Vitamin B1 B6 B12, enough zinc, magnesium and Vitamin D.
PS : for those who also want to increase their testosterone, improving your mood and lowering Cortisol greatly helps.

Stress Reduction

Our bodies release cortisol when stressed. Cortisol decreases serotonin levels in the body, by increasing serotonin reuptake. Too much cortisol can increase your risk of developing mental health disorders. That is why reducing mental stress can help balance cortisol levels and increase serotonin
Many of the lifestyle changes below can be used to decrease stress.

Mood Improvement

Serotonin impacts our mood, but mood also affects serotonin production. Studies using brain imaging (PET), showed that brains of people who are happy produce more serotonin than brains of people who are sad
Therefore, engaging in activities and doing things that make you happier can help boost serotonin production.
In addition, studies show that social interactions also influence serotonin levels. Spend more time with people who make you feel good in general

Exercise

Fatigue, as a result of exercise, increases the amount of tryptophan that can cross the blood-brain barrier (by decreasing BCAA levels) and thereby boosts serotonin production. Psychological benefits of physical exercise can be more readily achieved with consistent aerobic exercise training
Mice that ran on treadmills had higher levels of serotonin compared to mice that remained inactive. Brain tryptophan remained high even after exercise

Getting More Sun

It has been long known that bright light helps treat seasonal depression. But several studies suggest that light is also an effective treatment for other forms of depression
People have higher serotonin levels in the summer compared to winter
In fact, our modern way of life, in which we spend a lot of time indoors, may be depleting our serotonin levels, thereby making us more vulnerable to mood disorders
Pioneer studies suggest that our skin may produce serotonin when exposed to sunlight
In addition, you need vitamin D to produce serotonin, and sun to produce vitamin D
Therefore, going outside and spending more time in the sun on a regular basis is a great way to boost your serotonin levels.

Yoga and Meditation

A review of over 200 peer-reviewed RCTs, clinical trials, and meta-analyses studying complementary and alternative medicine suggest that yoga and meditation may help uplift mood and improve symptoms of mild, moderate, and treatment-resistant depression
In fact, meditation activates many parts of the brain important for understanding the self, emotions, problem-solving, adaptability, and increasing awareness. Serotonin plays a role in wakefulness, along with other neurotransmitters, which are all raised in meditators
Thirty minutes of yoga and breathing exercises improved mood in a study of 71 healthy adults

Psychotherapy

Psychotherapy or counseling may change brain chemistry and even increase serotonin activity (by increasing serotonin receptors). In a (DB-RCT) study of 23 patients with depression who participated in psychotherapy for 4 months, therapy significantly increased serotonin activity and improved symptoms of depression

Eat to Increase Serotonin

Tryptophan is the amino acid building block for serotonin. Tryptophan is not produced by the body, so it must be taken in through diet.
Current research shows that unlike purified tryptophan, consuming tryptophan-rich foods does not necessarily increase brain serotonin. That’s because tryptophan-rich foods, such as meat, dairy, fruits, and vegetables, also contain many other amino acids. Tryptophan has to compete with these other amino acids for transport across the blood-brain barrier
On the other hand, lack of dietary tryptophan (compared to other amino acids) may lead to lower blood and brain tryptophan levels, decreasing serotonin production. Increased BCAAs also lower tryptophan and serotonin, as well as dopamine in the brain. This may be especially problematic for people who take protein powders to enhance exercise performance

Carbs

Consuming carbs increases serotonin levels by increasing the transport of tryptophan into the brain
However, you should use other methods to boost your serotonin, as increasing carbs in your diet can have a plethora of negative effects.

which Supplements can Increase Serotonin?

L-Tryptophan and 5-HTP

In the body, L-tryptophan is used to make 5-HTP from which serotonin is made. Taking L-tryptophan may raise plasma serotonin, improving cognitive, motor, or gut issues in those who are deficient
A protein called alpha-Lactalbumin from milk contains more tryptophan than many other proteins. In a (DB-RCT) study of 18 inpiduals, 12 grams of alpha-Lactalbumin increased the amount of tryptophan in blood plasma by 16% after 90 minutes
In another (DB-RCT) study, 12.32 grams of tryptophan increased blood tryptophan by 43% after 1.5 hours and improved memory in 23 subjects vulnerable to high stress
In a pilot study of 13 female patients experiencing premenstrual syndrome (PMS), 6 grams of L-tryptophan taken daily for 14 days improved mood, irritability, difficulty sleeping, and carbohydrate craving
Tryptophan can be purchased in the form of L-tryptophan supplements. 5-HTP (5-hydroxytryptophan) supplements are also available. It is important to note that 5-HTP is not the same as 5-HT, which is the chemical name for serotonin. 5-HTP freely crosses the blood-brain barrier (serotonin itself does not) to be converted into serotonin

Probiotics

In the digestive tract, probiotics restore the gut microbiome and influence the gut-brain axis. Gut bacteria are important because they can produce tryptophan, from which serotonin is made. Many mental health disorders, such as Parkinson’s disease, are linked to less perse or fewer gut bacteria
In a study (DB-RTC), an 8-week probiotic regimen (2.0 x 109 CFU/g of Lactobacillus helveticus and 2.0 x 109 CFU/g of Bifidobacterium longum) increased tryptophan levels in 110 inpiduals with depression. Increased tryptophan can increase serotonin production
A probiotic (Bifidobacteria infantis) given to rats for 14 days raised levels of blood tryptophan

Vitamin D

Vitamin D helps the body make, release, and use serotonin in the brain. Vitamin D activates an enzyme that converts tryptophan into serotonin. If vitamin D levels are low, our brains make less serotonin. Thus, increasing vitamin D intake increases serotonin levels, reducing the risk of mental health disorders
A cohort study of over 9K subjects demonstrated that taking vitamin D supplements during the first year of life was correlated with a 77% reduced risk of schizophrenia. In other words, preventing low vitamin D levels early in life may reduce the chance of having schizophrenia later in life

Omega-3 Fatty Acids

While vitamin D helps neurons make serotonin, the omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), help neurons release serotonin and improve its activity (increasing serotonin receptor sensitivity). Fish, such as salmon or trout, are high in omega-3 fatty acids. The omega 3 fatty acid supplements are also sold as fish oil capsules
Inadequate omega-3 fatty acids intake may increase susceptibility to psychiatric illnesses, including depression
In a (DB-RCT) study of 49 patients that repeatedly self-harm themselves, 1.2 grams of EPA and 0.9 grams of DHA capsules daily for 12 weeks reduced suicidal thinking by 45% and depression by 30%
An observational study of 256,118 Japanese participants, discovered that people who ate fish daily had lower rates of suicidal thoughts compared to people who did not eat fish daily. In another observational study of 1,767 Finnish subjects, consuming fish less than twice a week was associated with a higher risk of depression and suicidal thinking
In rats, low levels of omega-3 fatty acids (specifically alpha linoleic acid) are associated with lower serotonin activity, while DHA deficiency reduces brain serotonin in piglets
Reduced intake of both EPA and DHA by pregnant rats resulted in less production, storage, release, and activity (receptor function) of serotonin in the brains of their offspring. Serotonin was not only reduced in the mothers’ brains but also its availability and production were reduced by (65% and 29%, respectively) in the brains of newborn rats

St. John’s Wort

St. John’s Wort is a popular medicinal plant (Hypericum perforatum) used as an antidepressant for mild depression.
The plant increases serotonin in animals, similar to typical antidepressants, but with fewer side effects
In a review (of 35 studies) of 6,993 patients with depression, St. John’s Wort standalone therapy improved mild to moderate symptoms as well as antidepressants and better than placebo. The typical dose is 300 mg of the extract 3 times per day for at least 4 weeks

S-Adenosyl Methionine (SAMe)

SAMe is needed to produce serotonin
It is a naturally occurring compound that plays a role in methylation, energy breakdown and may help patients with major depressive disorder (MDD) who are not responding to conventional, synthetic antidepressants
In a (DB-RCT) study involving 73 MDD inpiduals unresponsive to drug therapy, 800 mg twice a day improved symptoms of depression compared to the placebo
In a (DB-RCT) study of 144 inpiduals with MDD, 1,600 – 3,200 mg of SAMe daily for 12 weeks significantly improved mood
A review of 132 studies (115 CT and 17 preclinical) concluded that SAMe can be useful not just for depression, but for an array of mental health disorders, such as substance abuse and psychosis

Vitamin B

Lack of vitamin B may be associated with the onset of mental health disorders. The body needs Vitamin B6 to make neurotransmitters like serotonin from 5-HTP (Vitamin B acts as enzyme cofactor)
Vitamin B12 and folate (vitamin B9) are necessary for the folate cycle, which helps convert tryptophan into serotonin (by producing and recycling essential co-factors)
In a cohort study of 549 community-dwelling seniors, those with low vitamin B12 and B9 blood levels were more likely to have irreversible problems with cognition (memory, attention, and thought)
In Rhesus monkeys, a single dose of vitamin B6 increased serotonin production in the brain
In addition, treatment of healthy adult rats with a vitamin B mixture raised serotonin levels in the brain

Vitamin C

Vitamin C supplements over a period of 6 weeks increased brain serotonin levels in rats with drug-induced dementia

Vitamin E

Vitamin E supplementation for 8 weeks increased serotonin in rats suffering from spinal cord injury

Zinc

Zinc can target and activate serotonin receptors
In a meta-analysis of 17 observational studies, blood zinc levels were lower in depressed inpiduals compared to non-depressed inpiduals
In a study (DB-RCT), 25 mg of elemental zinc supplements daily for 12 weeks reduced depressive symptoms in a study of 37 patients with major depressive disorder
Zinc can be increased through diet in foods such as red meat, oysters, and whole grains

Magnesium

Magnesium supplements increase serotonin levels by increasing its availability (reducing reuptake) in the brain. In a (DB-RCT) study, 500 mg of magnesium per day for 8 weeks significantly improved symptoms in 60 patients diagnosed with mild to moderate depression
Magnesium is found in green leafy vegetables, nuts, and legumes

Inositol

Inositol increases the sensitivity of serotonin receptors
In one study of 30 women with a PMS mood disorder, myo-inositol reduced symptoms and improved mood given over 6 menstrual cycles
Inositol decreases depression in rats by binding serotonin receptors

Turmeric

Curcumin is the active component of turmeric. In stressed rats, curcumin extended the length of time serotonin stays active in the brain (by blocking the reuptake of serotonin). It also improved cognition and reduced serum corticosterone, a cortisol equivalent, in rats
In mice, a single dose of curcumin (10 – 80 mg/kg) increased serotonin levels

Velvet Bean

Mucuna pruriens, known as the velvet bean, combats Parkinson’s disease better than the standard treatment (levodopa) in rats. In addition to being a source of dopamine, the long-term use of the powder form of Mucuna pruriens also restored serotonin levels in rat brains

L-Theanine

L-theanine, an amino acid found in tea leaves (e.g. green, black, or oolong tea) and Bay Bolete mushrooms, has relaxing effects on the mind. Green tea has the highest concentration of L-theanine
In a cohort study of over 42K Japanese inpiduals, those who consumed at least 5 cups of green tea a day experiences less psychological distress that is often associated with reduced serotonin
In rat studies, L-theanine raised serotonin levels in the brain

Rhodiola

Rhodiola rosea is a flowering plant that may help improve anxiety and depression. In a (DB-RCT) clinical trial of 89 patients with mild to moderate depression and low serotonin, Rhodiola rosea extracts (340 mg/day and 680 mg/day) for 42 days improved overall depression, including insomnia and emotional instability
In 70 depressive rats suffering from chronic mild stress and serotonin deficiency, Rhodiola extract (1.5, 3, or 6g/kg) for 3 weeks restored normal levels of serotonin

Saffron

Safranal, one of the main active components of saffron (Crocus sativus), increases serotonin availability in the brain (by blocking reuptake)
A meta-analysis (5 RCTs) of 177 participants concluded that 30 mg per day of saffron capsules can improve symptoms of depression in adults with major depressive disorder within 6 to 8 weeks

Psychedelics

Psychedelics are hallucinogenic drugs such as lysergic acid diethylamide (LSD) and psilocybin mushrooms. Psychedelics can stimulate serotonin activity (by directly binding to serotonergic receptors and also increasing their number), raise serotonin levels, and reduce its breakdown
In a recent pilot study (DB-RCT) of 12 patients with anxiety, 200 μg of LSD significantly reduced self-reported anxiety. LSD was given in a safe psychotherapeutic environment with medical supervision to avoid side effects
In a (DB-RCT) study of 17 healthy inpiduals, psilocybin (215 micrograms/kg) enhanced mood, increased goal-directed behavior and decreased recognition of negative facial expressions
Though psychedelics can activate serotonin signaling, unsupervised use may lead to serious psychological consequences. Certain plant hallucinogens, as well as synthetic hallucinogens, can be especially toxic. Using this substance should be under professional supervision.

Magnolia Tree

The bark and seed cones of the Magnolia tree (Magnolia officinalis) appear to have anti-stress, anti-anxiety, and antidepressant effects
20 and 40 mg/kg of honokiol and magnolol, the main components of Magnolia officinalis, restored low levels of serotonin in rats with chronic mild stress
Magnolia bark and ginger rhizome are commonly used to treat mental disorders in traditional Chinese medicine (TCM). 30 mg/kg of a magnolia bark and ginger rhizome mixture increased serotonin in the brains of depressed mice

Essential Oils

Essential oils are commonly used to reduce anxiety, stress, low mood, and other mental health disorders. Smelling the essential oils (inhalation) can activate pathways in the brain to boost serotonin and dopamine production
In a study of aromatherapy in 60 elderly patients with depression (RCT), 5 ml of essential oil mixture (containing lavender, sweet orange, bergamot, and almond oil) increased serotonin levels after application two times a week for 8 weeks
Ylang-ylang essential oils increased serotonin levels in mice brains (hippocampus)
Bitter orange is an essential oil that reduced anxiety and improved mood by boosting serotonin activity in mice after 14 days of use
Lavender oil blocked the breakdown/reuptake of serotonin in cell studies

Valerian

The root of the Valerian plant increases serotonin levels and activity (by decreasing its turnover)
Valerian may help with irritable bowel syndrome. In a rat study, components of the Valeriani root balanced overactive serotonin in the gut (colon) and serum
Valeriana officinalis root extract prevented the breakdown of serotonin in mice exposed to stress

Apigenin

Apigenin is a nutrient in citrus fruits that may improve cognition and behavior as well as symptoms of depression and stress
In mouse models, 20-day treatment with apigenin (10 and 20 mg/kg) increased serotonin levels, and decreased anxious behavior
Apigenin was able to reduce the impact of chronic mild stress in rats by increasing serotonin availability and reducing its breakdown

Berberine

Berberine is a salt derived from plants in the Berberis family (the roots, rhizomes, stems, and barks), including barberry, tree turmeric, Oregon-grape, and others. It blocks the enzyme MAO-A, which breaks down serotonin, thereby raising serotonin levels
A single berberine dose increased levels of serotonin by 47% in the brains of depressed mice. Long-term treatment with berberine (5 mg/kg for 15 days) increased serotonin by 19%
Mice given berberine in a different study had increased serotonin levels in regions of the brain (hippocampus and frontal cortex) important for memory and mood

Acetyl-L-Carnitine

Carnitine may increase serotonin in the cerebral cortex, a region of the brain involved in cognition and memory
Acetyl-L-carnitine (ALCAR) is a modified form of carnitine, a common dietary supplement sold in health food stores. ALCAR protects the brain and may help with depression. In mice, it increased levels of serotonin in the brain when given daily for 25 days

Lithium

Lithium has long been used in the treatment of mental disorders such as bipolar disorder. It works by increasing serotonin activity in the brain

Physical Treatments that Increase Serotonin

Neurofeedback

Neurofeedback allows inpiduals to consciously change their brain activity (EEG waves) and therefore modify their behavior and cognition. Some of its clinical uses are for migraines, ADHD, and PTSD
In a study (RCT), neurofeedback (30 minutes, 5 sessions weekly, 4 weeks) was applied to 40 patients with fibromyalgia syndrome (FMS). FMS patients have lower serotonin and widespread pain in their muscles and bones. After 2 weeks, patients experienced less pain, fatigue, anxiety, and depression

Massage

Massage therapy decreased cortisol and raised serotonin and dopamine in a broad population with stress-related health problems in 3 studies
In one (RCT) study, 24 adults with low back pain were either given two 30 minute massages per week or subjected to standard relaxation procedures over the span of 5 weeks. Urine serotonin levels were higher in inpiduals who received massage therapy

Acupuncture

In a randomized clinical trial, 75 women with fibromyalgia, acupuncture increased levels of serotonin in the serum, compared to placebo
In rats, acupuncture-like stimulation increased serotonin activity in certain regions of the brain

Light Therapy

When sun exposure is not possible, bright light therapy can help increase serotonin levels
Bright light therapy (photobiomodulation) shows promising results for depression based on clinical trials
In a study of 10 women with chronic headaches (observational), 34 seconds daily use of low-level laser therapy (LLLT) significantly increased serotonin levels after just 3 days
In a study of 25 drug-free hospitalized veterans with depression or bipolar disorder, bright white light improved depressive symptoms. However, further testing needs to be done on the negative consequences of long-term light treatment

Vagus Nerve Stimulation

Long-term vagus nerve stimulation (14 days) increased serotonin levels in rat brains
In rats, sustained vagus nerve stimulation for 14 days also increased the action of serotonin

Testing Serotonin

Serotonin that gets released into the blood gets rapidly broken down in the liver and lungs, to inactive metabolites (such as 5-HIAA) that are excreted in urine . That is why normally, blood and urine contain very small amounts of serotonin. Larger quantities of serotonin in the blood/urine can be found in people with serotonin-producing tumors (carcinoid tumors).
Beware of the use of urine serotonin levels to check for “neurotransmitter imbalances”. While the companies providing these tests state that the levels in urine correspond to brain neurotransmitter levels, science has repeatedly shown that this is not the case
Serotonin doesn’t cross the blood-brain barrier. Even if it did, it is released intermittently and influenced by many different stimuli. Furthermore, levels differ within different parts of the brain. And finally, values differ for the same person from one day to another
In addition, companies have been known to intentionally use extremely narrow ranges, without any scientific support whatsoever, in order to sell supplements to their clients
If you do have neurotransmitter imbalances in the brain, more reliable tests of serotonin levels are cerebrospinal fluid tests or measurements of serotonin in blood platelets
A PET scan is the only direct way to detect changes of serotonin production in specific areas of the brain
Serotonin Risks and Safety
Excess serotonin may result in serotonin syndrome, which can be fatal. Usually, though, serotonin syndrome is a result of drug interactions. No cases have been observed just from safe, natural approaches
MDMA, LSD, and other synthetic drugs may cause serotonin syndrome, and should not be taken without medical supervision or outside a psychotherapeutic environment
Most of the studies mentioned above were performed on adults. More research involving children is needed in order to determine safety.
Abnormally heightened levels of serotonin (hyperserotonemia) is a consistent finding in inpiduals with autism. Pregnant women with hyperserotonemia are more likely to give birth to children with autism

Drug Interactions

The use of St. John’s Wort, SAMe, or lithium simultaneously with serotonergic drugs like selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I), and triptans, can increase the risk of serotonin syndrome, a life-threatening and potentially fatal condition

Limitations and Caveats

Some of these studies have fairly small sample sizes. Additionally, many of these natural methods of increasing serotonin in the body have only been tested in animals and need further research in humans through clinical trials.
In addition to the concentration of serotonin, both the number of serotonin receptors and their sensitivity may also play an integral role in determining serotonin activity.
Though serotonin is mostly made, stored, and released in the gut, serotonin acts as an important neurotransmitter in the brain. Some of these natural remedies and supplements need further testing to determine if they are able to cross the blood-brain barrier. Long-term application of these remedies should also be further studied.

Introduction:
Managing a high-risk pregnancy involves a multifaceted approach, encompassing medical care, lifestyle modifications, and emotional support. For women facing high-risk pregnancies, adopting certain lifestyle changes can significantly enhance their well-being and improve the chances of a healthy outcome for both mother and baby. Here, we delve into some crucial lifestyle adjustments recommended for women navigating high-risk pregnancies.
1. Nutritious Diet :

• Consuming a well-balanced diet rich in essential nutrients is paramount for the health of both mother and baby during a high-risk pregnancy. Incorporating ample fruits, vegetables, lean proteins, whole grains, and healthy fats provides the necessary vitamins and minerals crucial for fetal development and maternal health.
  
• Consultation with a nutritionist or healthcare provider can help tailor a diet plan specific to individual needs, considering any underlying medical conditions or complications.
  

2. Regular Exercise :

• Engaging in moderate exercise, as approved by your healthcare provider, can offer numerous benefits during a high-risk pregnancy. Suitable activities may include walking, swimming, or prenatal yoga.
  
• Exercise helps improve circulation, alleviate stress, and promote overall well-being. However, it's essential to avoid strenuous activities and consult with your doctor before starting any exercise regimen.
  

3. Stress Reduction Techniques :

• High levels of stress can negatively impact pregnancy outcomes. Therefore, adopting stress-reducing techniques such as meditation, deep breathing exercises, and mindfulness practices can be beneficial.
  
• Additionally, seeking support from loved ones, joining support groups, or undergoing counseling can provide emotional support and coping strategies.
  

4. Adequate Rest and Sleep :

• Prioritizing adequate rest and sleep is crucial for women with high-risk pregnancies. Aim for 7-9 hours of quality sleep each night and incorporate periods of rest throughout the day.
  
• Creating a conducive sleep environment, practicing relaxation techniques before bedtime, and establishing a consistent sleep schedule can help improve sleep quality.
  

5. Avoidance of Harmful Substances :

• Substance avoidance is vital during pregnancy, especially for women with high-risk pregnancies. This includes abstaining from smoking, alcohol, recreational drugs, and certain medications not approved by a healthcare provider.
  
• Exposure to these substances can significantly increase the risk of complications and harm both the mother and the developing baby.
  

6. Regular Prenatal Care :

• Consistent prenatal care is essential for monitoring the progress of the pregnancy and addressing any emerging issues promptly. Attend all scheduled prenatal appointments and follow your healthcare provider's recommendations closely.
  
• Prenatal care may include routine screenings, ultrasounds, and specialized tests to assess the well-being of both mother and baby.
  

7. Monitoring Blood Pressure and Blood Sugar Levels :

• For women at risk of gestational hypertension or gestational diabetes, closely monitoring blood pressure and blood sugar levels is crucial. Follow any prescribed medications or treatment plans diligently and report any concerning symptoms to your healthcare provider immediately.

Conclusion:
Navigating a high-risk pregnancy can be challenging, but implementing lifestyle changes can significantly improve outcomes and enhance maternal and fetal well-being. By adopting a nutritious diet, engaging in suitable exercise, managing stress, prioritizing rest, avoiding harmful substances, attending regular prenatal care, and monitoring vital health indicators, women can empower themselves to navigate their high-risk pregnancies with greater confidence and resilience.

TW: surgery, HRT
So I live in the shitty state of Idaho, and a state ruling means my Medicaid coverage will stop all gender affirming care, including HRT, July 1st. This is terrifying for me and I have some questions that no doctor around here can answer. I know y’all aren’t doctors, but I’d like to hear some of your experiences. Here’s about me: I’ve been on T steadily since 10/2019. Before that, I was diagnosed with PMDD and suspected PCOS. I had top surgery in 2020, so I’m not too worried about breast growing back. I doubt I can afford T on my own without insurance, so I’ll likely either taper off the next couple months or drop it in July, based on what my PCP thinks is best. I’m hoping to get a hysto soon to stop periods, which is medically necessary in my case, but complicated due to work and bills.
For those that stopped testosterone HRT: 1) what emotional/physical changes did you notice, and how quickly? 2) How bad did dysphoria get? 3) Did you lose facial hair? 4) How quickly did periods come back, and were they bad/irregular? 5) Did muscle mass disappear or energy levels lessen?
I know everyone’s experience is different but I’d really love to hear what people went through. Thanks guys!

I tried to copy paste and reformat it but references didn't work so sorry about that, just go to the link.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818193

Dental diseases and procedures are common, troublesome, and expensive, exceeding spending on other major health conditions, such as diabetes, ischemic heart disease, hypertension, dementias, and breast cancer, in the US. Dental issues are relevant for internists because unmet dental care needs can be painful for patients. Excluding teeth from medical health care is arbitrary.
Evidence-based medicine, a movement that gained prominence in the 1990s, has profoundly affected the practice of medicine. Unfortunately, little progress has been made on using data from clinical trials to determine best practices for dental care. Instead, most dental care relies on practice patterns influenced by the economic pressures of running a dental practice, dentists’ professional training and opinions, and patients’ expectations, all of which tend to favor excessive diagnoses and interventions. The result is that while many people who have low income go without any dental care, those who can pay are subjected to overdiagnosis and overtreatment.
Overdiagnosis
Overdiagnosis occurs when conditions that will never cause harm are identified. Unnecessary treatments resulting from overdiagnosis subject patients to potential harm and waste valuable resources that could be used for necessary and effective treatments.
For example, dentists may treat early noncavitated caries lesions, aiming to prevent more advanced lesions, such as dentine cavities. A noncavitated caries lesion is a demineralized enamel spot (white spot lesion) without evidence of cavitation. The majority of white spot lesions will not progress,1 and there is no evidence that early treatment, except with fissure sealants, is generally more effective than no treatment in preventing dentine cavities.2 Paradoxically, these sealants are frequently overlooked or underused by dentists. Dental cavities are routinely filled in children, despite evidence that dental pain and infection rates due to dental cavities in primary teeth are similar (about 40%) in children who are randomized to teeth being filled or not being filled.3
Decline in Caries and the Impact on Dentists’ Workload
In the 1970s, there was an unexpected, extraordinary decline in the number of cavitated caries lesions seen in dental patients.4 This decline in the number of patients’ cavitated caries lesions affected dentists’ workload and has played a role in overdiagnosis and treatment in dentistry so that dentists can support their practices. This financial need led to more recommendations for regular 6-month visits.5 Two randomized clinical trials failed to demonstrate that 6-month intervals between dental checkups result in better oral health compared with longer intervals (up to 24 months), which led the authors of a Cochrane review to conclude: “Whether adults see their dentist for a check-up every 6 months or at personalized intervals based on their dentist’s assessment of their risk of dental disease does not affect tooth decay, gum disease, or quality of life. Longer intervals (up to 24 months) between checkups may not negatively affect these outcomes.”6 Nonetheless, the standard for dental visits remains every 6 months.
Scaling and Polishing
Another commonly performed procedure is scaling and polishing to prevent periodontitis, a common condition in middle-aged persons. Scaling removes plaque and calculus from the crown and root surfaces of the teeth and is performed using hand or ultrasonic scalers. Polishing, which entails the mechanical removal of extrinsic stains and deposits, is typically done using a rubber cup or bristle brush loaded with a prophylaxis paste.
The assumption has been that scaling and polishing can prevent gingivitis and periodontitis, thus potentially preventing tooth loss, pain, and mobility. However, to our knowledge there are no published clinical trials assessing these outcomes.7 The existing evidence only evaluates short-term surrogate outcomes. It suggests that treating periodontitis, specifically through root planing, leads to a slight enhancement in the gum-to-tooth attachment level among individuals with moderate to severe periodontitis.8 However, there does not appear to be any advantage to scaling and polishing for adults without periodontitis.9
Changing Financial Incentives
The prevailing dental economic model based on fee-for-service creates an environment of dental overdiagnosis and overtreatment. At the same time, many persons who do not have dental insurance cannot afford to pay out of pocket for dental care, creating a situation where people with low income or who are part of a racial and ethnic minority group are often underdiagnosed and undertreated. A value-based model, in which dentists are paid to maintain oral health rather than to deliver treatments like fillings, cleanings, and fluoride applications, could be more positive for oral health. A study conducted in Rio de Janeiro (and coauthored by one of us [P.N.]) found that, among patients without treatment indications, an average of 2 teeth were treated during a 6-month follow-up period. This number increased to 3.6 teeth if the patient had changed dentists.10 A clear need exists for trials to compare different methods of paying dentists to assess the impact on oral health and on overtreatment and undertreatment.
What Is the Way Forward?
We do not want to give the impression that dental care is not important. On the contrary, dental pain, oral abscesses, broken teeth, and inflamed tissues surrounding the teeth are common presentations to medical professionals, especially those working in urgent care settings. Similarly, good dentition is nutritionally important for eating a full diet and psychologically essential to a person’s sense of appearance. However, dental procedures should be based on effectiveness and safety.
It is true that many important dental outcomes (eg, tooth loss) may take a long time to assess. On the other hand, the human mouth offers an easy trial design in which some procedures, such as filling a tooth, could be determined by randomization when there is more than 1 tooth in the mouth with a cavity. Other common abnormalities can impact adjacent teeth (eg, periodontitis) and require a refined design (eg, randomization to quadrants or sextants).
Identifying which dental procedures are beneficial and ensuring that relevant dental associations update their guidelines accordingly provide an opportunity to allocate resources to those who need them the most. The aim is to reduce overdiagnosis and overtreatment while increasing necessary treatment.
Corresponding Author: Paulo Nadanovsky, DDS, PhD, Oswaldo Cruz Foundation, FIOCRUZ, Brazil, Rua Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil ([paulo.nadanovsky@gmail.com](mailto:paulo.nadanovsky@gmail.com)).
Published Online: May 6, 2024. doi:10.1001/jamainternmed.2024.0222
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank Steven Woloshin, MD, MS, The Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and The Lisa Schwartz Foundation for Truth in Medicine, for his invaluable intellectual contributions to the development, writing, and critical revision of this paper. Dr Woloshin was not compensated for his contributions.

REFERENCES
1.Ferreira Zandoná A, Santiago E, Eckert GJ, et al. The natural history of dental caries lesions: a 4-year observational study.  J Dent Res. 2012;91(9):841-846. doi:10.1177/0022034512455030PubMedGoogle ScholarCrossref2.Bomfim AR. O Tratamento da Lesão de Cárie Dentária Não Cavitada é Efetivo? Uma Revisão Sistemática. Dissertation. Universidade do Estado do Rio de Janeiro; 2022. Accessed April 1, 2024. https://www.bdtd.uerj.br:8443/handle/1/186113.Innes NP, Clarkson JE, Douglas GVA, et al. Child caries management: a randomized controlled trial in dental practice.  J Dent Res. 2020;99(1):36-43. doi:10.1177/0022034519888882PubMedGoogle ScholarCrossref4.Nadanovsky P, Sheiham A. Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s.  Community Dent Oral Epidemiol. 1995;23(6):331-339. doi:10.1111/j.1600-0528.1995.tb00258.xPubMedGoogle ScholarCrossref5.Sheiham A. Is there a scientific basis for six-monthly dental examinations?  Lancet. 1977;2(8035):442-444. doi:10.1016/S0140-6736(77)90620-190620-1)PubMedGoogle ScholarCrossref90620-1)6.Fee PA, Riley P, Worthington HV, Clarkson JE, Boyers D, Beirne PV. Recall intervals for oral health in primary care patients.  Cochrane Database Syst Rev. 2020;10(10):CD004346.PubMedGoogle Scholar7.Hujoel PP. Endpoints in periodontal trials: the need for an evidence-based research approach.  Periodontol 2000. 2004;36:196-204. doi:10.1111/j.1600-0757.2004.03681.xPubMedGoogle ScholarCrossref8.Jervøe-Storm PM, Eberhard J, Needleman I, Worthington HV, Jepsen S. Full-mouth treatment modalities (within 24 hours) for periodontitis in adults.  Cochrane Database Syst Rev. 2022;6(6):CD004622.PubMedGoogle Scholar9.Lamont T, Worthington HV, Clarkson JE, Beirne PV. Routine scale and polish for periodontal health in adults.  Cochrane Database Syst Rev. 2018;12(12):CD004625. doi:10.1002/14651858.CD004625.pub5PubMedGoogle ScholarCrossref10.Naegele ER, Cunha-Cruz J, Nadanovsky P. Disparity between dental needs and dental treatment provided.  J Dent Res. 2010;89(9):975-979. doi:10.1177/0022034510369994PubMedGoogle ScholarCrossref

Russian forces are making a push, animal testing ramps up for H5N1, and over 365 days of temperature records…
Last Week in Collapse: May 5-11, 2024
This is Last Week in Collapse, a weekly newsletter compiling some of the most important, timely, useful, soul-crushing, ironic, stunning, exhausting, or otherwise must-see/can’t-look-away moments in Collapse.
This is the 124th newsletter. You can find the April 28-May 4 edition here if you missed it last week. You can also receive these posts (with images) every Sunday in your email inbox with Substack.
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Earth experienced its largest CO2 concentration increase over a 12-month period, scientists say, from March 2023-2024. It was a jump of 4.7ppm more of carbon dioxide, blamed on deforestation, fossil fuels, and El Niño. Experts are saying that El Niño has peaked, and will transition to La Niña within a few months. La Niña lasts about 1-3 years, and it generally cools the Pacific Ocean, and brings more rain to India & Bangladesh, among other changes. Earth also experienced its greatest atmospheric moisture for the month of April.
Venezuela has lost its last glacier, the Humboldt, which was reclassified into an “ice field.” It is the first modern nation to lose all its glaciers. Scientists believe Indonesia, Mexico, and Slovenia are next in line to see the extinction of their glaciers. Colombia is also rapidly losing its remaining 6 glaciers.
Wildfires in Chile have killed about a hundred people, and injured & displaced thousands. Flooding in Afghanistan. And climate change is ruining cotton crops, and livestock, in Chad. Plus, flooding struck the DRC, overflowing rivers and latrines—affecting some 500,000 people. And some climatologists think we have been underestimating how much climate change is driving greater rainfall & flooding; the worst is yet to come.
The first week of May saw so many temperature records broken; some are claiming that it might be the “most record breaking month in climatic history”—until June, that is. Earth has been seeing 13 months of monthly records being broken for global sea surface temperatures. Literally 365 days of record-breaking ocean temperatures.
A study in PNAS examined North Pacific “warm blob” heat waves from 2010-2020, and concluded that China’s reduction in aerosols, which cleaned the air but also removed the sun-reflective particles, incidentally probably caused marine heat waves which killed fish and resulted in algae blooms.
Bees are having difficulty acclimatizing their nests to rising temperatures. The dugong, while still rarely seen in parts of the world, has been declared extinct inside China, having gone 24 years without a known sighting. In Florida, the suburbification of land under development is pushing the Florida panther closer to extinction; some 100 panthers remain in the sunshine state.
Siberia’s Batagaika crater—I prefer its alternative title, “megaslump”—is expanding by about 1M cubic meters, every year. Scientists naturally blame the rapid permafrost melting on climate change.
A cruise ship entered New York City with an endangered 44 ft {13.4m} dead sea whale stuck on its bow (front). Investigators are looking into whether it was already dead when the ship hit it. A study in Conservation Letters looked at the 100 largest Marine Protected Areas (MPAs)—which cover 7.3% of all ocean area—and found that almost 60% of this area is not in range of meeting the 2030 preservation goals.
Part of India broke May records already; the Maldives, too. Eastern Ukraine ended a far warmer & wetter April than usual. And a heat wave in Mexico scorched previous May temperature records across 10 cities, as well as small regional blackouts. North America felt its all-time hottest May temperature...
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AstraZeneca is pulling its COVID vaccine from the EU over a rare blood clooting side effect. Nevertheless, some experts claim that vaccine saved over 6M lives. Whatever U.S. CDC data on COVID is still available points to “a small rise” in cases later this summer, mostly from the growing KP.2 “FLiRT” variant.
COVID patients and immunocompromised individuals are still using lots of healthcare resources, and the rise of resistant superbugs is developing alarmingly fast. According to the article, “It only takes about a year on average for bacteria to grow resistant to treatment, when they used to take 21 years to evolve back in the 1960s.”
Engineers and medical professionals remain concerned about nanoplastics, between 1-1,000 nanometers wide. One grain of sand is about 500,000 nanometers, and one strand of DNA is about 2.5 nanometers. A single wavelength of light ranges from 400-700 nanometers.
South Africa’s water shortage is projected to worsen through at least 2025. Nairobi’s water shortage continues, despite the city’s dams being filled with floodwater. Costa Rica is facing a Drought so bad it’s rationing electricity. Mexico City—the second-most-populous city (by metro area: 21.8M; São Paolo is #1, at 22M) in North America— is seeing more than 20% of freshwater sources exhausted, and rationing is not enough. It’s almost like we’re living at unsustainable levels of consumption…
As Latin America warms (and suffers flooding), disease is becoming more common—as well as heat stroke & serious hunger. Benin is refusing Niger the permission to use its port to export oil, as a result of a border dispute.
A paywalled study in Nature Water tested a new method for removing PFAS foam particles in water, with “near-complete destruction of PFAS in various water samples contaminated by the foams.” The process involves “ultra-violet (UV) light, sulfite, and a process called electrochemical oxidation” and does not require heat or high pressure. The number of U.S. states phasing out PFAS is growing.
As forcible repatriations of thousands of Afghans continue, millions of Afghans are suffering from lack of humanitarian aid—aggravated by recent deadly flash floods in the beleaguered, landlocked, failed state.
Yeasty superfungus Candida Auris infections were detected in 77 cases in Germany last year, authorities say. Candida Auris was only identified 15 years ago, but its three separate genetic variants (each on a different continent) have stealthily and stubbornly grown to pose a stealth threat to humankind. It is incredibly resistant to antifungal drugs, and it survives at higher temperatures than most other fungi. The WHO has listed it on a shortlist of top fungal pathogen dangers.
3 cats died from H5N1 in the United States last week. Some health professionals are getting more worried about a future H5N1 jump to become human-to-human transmissible, and claim that we are not ready as a species. Experts say we are not doing enough testing, and may already be in the prologue of a much more devastating pandemic. Scientists still say it is unlikely that a strain will make the critical mutation necessary, but the similarities between human and cow (and other mammal) flu receptors present potential complications.
The world is supposedly being divided into three general trade blocs: U.S., China, and the non-aligned states. For better or worse, globalization is crumbling, and governments are imposing tariffs, attempting to reshore industries, and restructure debt & credit flows. What will happen when the people, long-trained to expect high returns, find their profits wanting?
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Two camps for internally displaced people near Goma, DRC were bombed, killing 12+ and injuring 20+. The perpetrators and their motives are unclear.
Rising crime. Drinking water. Closing the Darien Gap. These were the issues propelling Panama’s president-elect to a victory last Sunday. The arrival of rain is also improving conditions on the Drought-choken Panama Canal, expected to return to normal for at least a month or two.
A wave of Chinese espionage, much of it several years old, is sweeping Europe. Of particular concern is a hack of British military personnel information uncovered on Tuesday—which China denies. Similar espionage against the U.S. has reportedly cost the economy hundreds of billions per year.
Kenya’s mission to stabilize Haiti is inching forward slowly. The Pentagon has ordered its 1,000 troops to leave Niger. At least one Saudi villager was killed to make room for The Line, and reports claim Saudi forces have been given the green light to clear other people who get in the way of the development. Germany’s Defence Ministry is seriously considering recommending conscription for its 18-year olds later this summer.
Displacement in Myanmar has spiked over the past six months—and now counts 3M+ people since the February 2021 coup which sparked more open resistance.
Tunisia ejected ~400 migrants into Libya. Kazakhstan is expelling Tajik migrants in far-ranging sweeps. In Lebanon, vigilante attacks against Syrians have become more common. Mauritania is conducting military drills along part of its border with Mali, after reports emerged of Malian soldiers attacking border settlements.
In Sudan, over 200 witnesses corroborated reports of a massacre last June, where RSF insurgents piled up and shot” at least 17 people, most of whom were children. A lengthy report from Human Rights Watch, complete with timelines, testimony, war crimes, and other horrors from Sudan is over 150 pages. I did not have the fortitude to skim much of it.
A Hamas attack on Sunday, which killed 4 Israeli soldiers, reportedly pushed the Rafah invasion ahead of schedule. The IDF took over the Egypt-Gaza border, and is scaling up operations in southern Gaza. In response, the U.S. paused arms transfers to Israel. Any chance of a ceasefire, if there was ever really a credible chance, will have to wait. Diarrhea is soaring in Gaza, due in large part to a critical water shortage, caused by the destruction of wastewater treatment plants, the damage to water infrastructure, and large-scale displacement. A new evacuation order has commanded over 1M people in Gaza to leave before a more comprehensive invasion of Rafah begins.
A day after President Putin was inaugurated for his fifth term, he ordered a wide strike at Ukrainian infrastructure across seven oblasts. Most of the missiles and drones were shot down. And another plot to assassinate Zelenskyy was foiled. Lithuania is considering sending military trainers into Ukraine. Putin announced that Russian forces would target Western soldiers deployed in Ukraine, and begin drills simulating nuclear weapons if Britain’s involvement grows. Already, Belarus conducted a military drill with missiles & planes capable of using nukes.
In addition to extending Ukraine’s mobilization by another 90 days, the government has also allowing some convicts to fight on the battlefield in exchange for reduced sentences. Poland is allegedly considering repatriating thousands of draft-eligible Ukrainian men, and Germany is emphasizing the need for Ukrainian refugees to work.
Japan is boosting investment in a hypersonic missile interceptor project with the United States. A large-scale Russian offensive has begun across the front-lines, particularly around Kharkiv. And Russia’s Ministry of Foreign Affairs is beginning talk of a “genocide” in Moldova, which could provide the pretext for another special military operation in Transnistria—and perhaps beyond.
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Things to watch out for next week include:
↠ The IDMC is releasing their 2024 report on Internally Displaced People (IDPs) on Tuesday, with estimates for total figures by nation & region.
Select comments/threads from the subreddit last week suggest:
-High temperatures are going to ruin food—and a lot of people’s health. This thread about the contamination of bánh mi in Vietnam sheds some light on the interconnectivity of our problems. Add in some heat wave-induced power outages, loose government regulation, and hospital problems, and you can imagine how this slow-moving disaster can cripple a community.
-“Microforests” may help mitigate some of the effects of ecosystem collapse and desertification—as well as boosting your property value, judging by this thread and its comments.
-One Collapsenik published a free ebook & audiobook satirizing American Collapse—and I’m not just linking because this newsletter was apparently a source of Doom inspiration. If you write an 80,000 word novel about Collapse, featuring some 300 references, I’ll share it too. Maybe one day I’ll have the time to write one…
Got any feedback, questions, comments, complaints, upvotes, movie recommendations, good off-grid land deals, locust broth, etc.? Check out the Last Week in Collapse SubStack if you don’t want to check collapse every Sunday, you can receive this newsletter sent to your (or someone else’s) email inbox every weekend. What did I forget this week?

When you had positive results - you don’t need to leave the sub completely. We encourage members to stay – but in a supportive role!

WHAT THIS THREAD IS FOR:

• This thread is to create a safe space for positive home pregnancy tests and beta results for active members of infertility, regardless of treatment type or status, to share their results with the community. Negative results can also be shared in the treatment thread; this is the only place to share positive or questionable results.
• This is absolutely the place to share/receive support for beta hell/limbo.
• We ask that you be mindful of people sharing difficult news in this thread and understand that it's not necessary to provide more than one positive update (a positive on an HPT, a beta rise your clinic finds acceptable, etc.), regardless of your nerves. Most North American clinics will do two betas, and the next step is an ultrasound. Other countries don't do betas.
• Post beta, you can share only bad news, not good or even neutral news. Ultrasound updates may not be shared here unless the results are medically questionable (low fetal HR, empty gestational sac, situations where a doctor has told you to brace for loss). Please keep in mind that this sub only discusses the process of getting to pregnancy and dealing with loss and limbo. Discussion of pregnancy anxieties and general fear of loss is not appropriate here and is best suited to a pregnancy sub like infertilitybabies.
• Symptoms cannot be discussed in this thread. If you have actual reason for concern such as low betas or a questionable ultrasound, that can be discussed in this thread. Spotting or a lack of symptoms doesn't necessarily mean anything, and we ask you take those anxieties to a pregnancy sub.

WHAT IS NOT ALLOWED – comments that do this will be removed

• No drive-by posts. You may only post here if you have participated in the sub’s daily threads before. If you have not your comment on this thread will be removed without comment. If you used to be an active member, but your last comment was a post in results (meaning you are returning from success to tell us about another success), we consider your post a drive-by.
• No ultrasound details (HR, size, twins, singleton etc.) – questionable results are exempt from this
• Do not make a new comment within the same thread – update your previous comment
• It's to share your results not to "say goodbye" or some kind of victory lap or about giving/wanting ~hope~.
• We know good news after infertility and/or loss is hard to accept, and infertilitybabies is a safe space to discuss your anxieties around early pregnancy. This thread is NOT the right place to work out those feelings - it's for results only or support when in beta hell/potential loss limbo.
• Hunger games results, PGT results, etc.
• Questions about early pregnancy that are not directly related to loss signs.
• Comments about pregnancy symptoms (sore breasts, nausea, etc).
• Links to pictures of HPTs (use /TFABlineporn).
• Responding “Thank You!” to every well wisher. Use your best discretion as some comments do necessitate a response, however responding to every person makes this post far too large.

HELPFUL INFO

Click 'view table' on mobile:

For a comprehensive Beta database, check out http://www.betabase.info/ for more information on beta based on DPO (DPO = days post transfer + 3, or 5 day embryo; DPO = Days post Insemination for IUI).
Further info: Human chorionic gonadotropin as a predictor of outcome in assisted reproductive technology pregnancies00512-9/fulltext)
Radiopaedia on Fetal bradycardia
Normal Ranges of Embryonic Length, Embryonic Heart Rate PDF!

You may be interested in posting at /whatworkedforme.
You are always encouraged to share your non-pregnancy-related infertility experiences with people asking questions on the sub and continue to support other community members here on infertility

Day 1: Appointment was for 10:30am, was told to only eat a light breakfast that day. Went into clinic, filled out paperwork, peed in cup for std testing. Talk to counsellor about how the procedure will go. Doctor comes in to do ultrasound. Get bloodwork done and blood pressure checked. Go into procedure room and put ur legs up. Doctor uses speculum to open vagina, they wipe inside to clean/sterilize it, they then use a numbing needle to numb your cervix then put the laminaria sticks in. I got 2 the first day. And gauze to help keep them in place. Said I might feel cramping right away, I didn’t. Brought back to the waiting room for 5 minutes to make sure I was okay. Nurse gave me 4 pills of azithromycin (1g antibiotic) to take with dinner and Tylenol 3s if I had any pain that night. Overall, the appointment took 4 hours all together. That night I had no pain or cramps, just had diarrhea from the antibiotics which wasn’t too bad.
Day 2: Was told to eat a light breakfast before appointment. Appointment was for 8am this time. Nurse made me go pee right away. Went into the waiting room, nurse checked my blood pressure. Was brought into the procedure room. Put my legs up and doctor put speculum in me to take out laminaria sticks and check my cervix. She said I dilated perfectly (1-2cm) Took out the speculum then numbed my belly. Honestly pretty painful, felt like pinching and burning but only lasted 30 seconds. The doctor then put the termination needle in my stomach which lasted about a minute or two. After that she said the procedure went safely. She then put the speculum back in and numbed my cervix. She then put in 6 laminaria sticks and gauze. This time I felt the cramping instantly. Mild but still. She took out the speculum and told me to go into the waiting room. The nurse checked my blood pressure again and then I was done. I could eat normally but can’t eat past midnight. After midnight only drink clear fluids. Nurse said for both days spotting is normal and if the gauze falls out it’s also normal. Just as long as the sticks don’t fall out. For both of these days, all you do is rest. Only walk if necessary. That night starting at 6-7pm the contractions started. They got unbearable at 2am and so on. If they give you pain medication for home, take it! They gave me Tylenol #3s for the pain and they said I could take regular Tylenol or Advil in between as well. Deep breathing really helped me through contractions and drinking warm clear liquids (herbal tea, warm water)
Day 3: Didn’t get any sleep at all. Ended up calling my 24/7 clinics doctors line at around 4am and she just told me to take more medication. As long as you don’t feel rectal pressure, there’s no need to go to the hospital. So I had to wait the pain out. After taking the extra medication the pain became more bearable and the contractions were further apart. I started spotting at 6am which is normal. My appointment was for 8am. Went to the clinic, they made me pee right away then go into the waiting room. They put an iv in me which held the conscious sedation fluid (fentanyl) and checked my blood pressure. I was called into the room and sat up in the chair. The doctor put the speculum in me to take out the laminaria sticks. She said I dilated perfectly again so there was no need to take any misoprostol (pills to soften the cervix) so she started with the procedure right away. First she numbed my cervix and then she broke my water and aided me in giving labor. After I delivered, she put the speculum back in me to take out the placenta. She then I think vacuumed anything else in my uterus. And then I was done. They took me back to the waiting room where I waited for 10mins and then the nurse told me to go to the washroom so she could check my bleeding. I was spotting which is normal. She told me to wait another 10mins so she could check again. After that she said I was good to go home. I wasn’t cramping at all after the procedure and felt pretty much fine.
Recovery: I’m now on day 2 of recovery. My bleeding has been similar to spotting or a light period. My doctor told me to walk for at least an hour a day to avoid blood clots. Blood clots are normal as long as they’re no bigger than a lemon. The bleeding has been getting less and less each day. Haven’t been cramping at all. Day 2 I started lactating. Doctor said to take advil or Tylenol if my breast were hurting too much and to wear a tight/supportive bra (like a sports bra) all day. You shouldn’t really massage or stimulate them or else you’ll continue to produce milk. All you can do is take medication for the pain and wait it out.

I sent the following to all of my senators, the insurance commissioner, the governor, and basically anyone in perceived power in attempt to stir up conversation and make BCBS uncomfortable. I encourage you guys do the same!! We can’t not try!
To whom it may concern, My name is Carly Jo Bolster, I am 29 years old and have been type 1 diabetic for 8 years. In the last few years, I have started a family and attempted to be a stay-at-home mom. I say attempted because of the cost of living—or should I say survival—for myself is astronomical. I am writing this to say my piece and hopefully reach someone who makes decisions at Blue Cross Blue Shield of North Carolina or within the government to plead my case, and all the diabetics across the United States, to be able to live affordably. I will be touching on the cost of insulin, the cost of insulin pump supplies, and the necessity and cost of CGMs or “continuous glucose monitors”. Insulin is a life sustaining drug. If my blood glucose were to get up to, say, 680 then the only option to save my life and keep me from going into DKA (diabetic ketoacidosis) would be insulin. This example is the precise situation that happened to be upon my diagnosis in 2016 when I was rushed into the ICU. Since that day, I’ve had to use insulin every day. There have been many advancements in the cost of insulin, especially since Eli Lilly put a cap on vial insulin at $35 dollars per vial. To me, this is the bare minimum. The greed and selfishness demonstrated by these drug companies, namely Novo Nordisk, is palpable. The cost to manufacture insulin is $2-$4 dollars per vial (https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/#:~:text=But%20it%20takes%20only%20an,every%20step%20of%20the%20way. (https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/#:~:text=But%20it%20takes%20only%20an,every%20step%20of%20the%20way.)). Average costs of insulin per vials can be upwards of $250 for your “preferred brand”. There are only really 3 insulin manufacturers, Eli Lilly, Novo Nordisk and Sanofi. These 3 companies take it upon themselves, along with the help of private insurance, to create this nonsensical price for the lifesaving hormone. Dr. Banting, the man who isolated insulin for the first time and thus saved the lives of millions of diabetics, sold his patent for $1 to attempt to keep the drug accessible to every diabetic. Sadly, I fear Dr. Banting is perpetually rolling in his grave at the price gouging that is going as on to this day for something that I need to live day to day. At the beginning of 2022, my monthly cost of Novolog insulin was $657. It was unavoidable and inhumane. The atrocities don’t end there. An insulin pump is a wearable device that is used to deliver insulin to my body over the period of 3 days. During 2022, BCBSNC decided, without warning, to stop covering my insulin pump halfway through the year. The company I was purchasing supplies through at the time, Edgepark, wanted me to pay around $700 a month for my pump supplies. This was especially rough for me as they had already shipped the box and ran my credit card without clearing it with me first. Understandably, the company wouldn’t take the pods back as a return. Nonetheless, I needed the supplies. To catch you up, my tab that year per month was up to $1357 (just for insulin and pump supplies). I attempted to switch to insulin pens to attempt to save money. The price for NovoLog flex pens and Tresiba (fast acting and long-lasting insulins, I need both for daily survival without an insulin pump) fluctuate month to month with no rhyme or reason. Additionally, my A1C went up by over 2 points due to the inaccuracy that the pens cause. Not only was it expensive, but it was affecting my health. The inconsistency and unreliability of BCBSNC was and is causing unending stress. Today, May 8, 2024, I spent about 2 hours on the phone with BCBSNC because my insurance agent and I were misled. When I was shopping for health plans at the end of March 2024, she found a gold plan that considered my pump supplies a tier 2 drug, which would put the cost at $35 per month. Once on the plan, they changed the pump to a tier 3 drug, $60 dollars a month. Only upon arriving at Walgreens did I discover that it isn’t being considered a drug, it is being considered pump supplies, which are run differently through insurance, resulting in a cost of $222.10. I believe the term I like for this was “bait and switch”. The fact that the pump supplies are listed and written as a prescription on the formulary but not billed to insurance that way is frankly ridiculous and shouldn’t be allowed. Furthermore, I’d like a real answer from BCBSNC on why it is being listed on the formulary if it isn’t being considered a drug. Not a run around or political answer, I want a cut and dry response on why it is like this. An explanation for the tier changes after getting on the policy would be nice as well. Continuous glucose monitors or CGMs are vital to any diabetic’s lifestyle and daily operations. It checks our glucose every 5 minutes to keep us on track and know when we need to make changes to our basal and bolus rates for our insulin. I’ve been told by BCBSNC that it is not considered medically necessary nor is it considered DME (durable medical equipment) so it is treated differently when being run through “insurance”. This alone is an uneducated and absurd take. I don’t personally know any diabetic that can or will go without a CGM. Personally, my Dexcom is crucial to me as I can’t even feel when my blood glucose levels are going too high. High glucose levels can lead to DKA if untreated. Don’t even get me started on the cost of test strips for a glucometer—that is not a viable variable for this equation. Insurance, on it’s whole, is a scam. The US healthcare system is also a scam. I say this confidently because of my experience with it over the last 8 years. I was diagnosed the week of my wedding. If I had any idea what was to come, I wouldn’t have filed any paperwork stating we were married. My husband is offered insurance through his work, so that disqualifies me from any marketplace health insurance plans, any subsidies, or any help in general. However, if I were to join his plan it would cost over $1500 a month for the premium alone. The plan is not great for prescription coverage though, and with a high deductible, the cost per month would be astronomical. Although we have a decent income, I can’t think of many of my neighbors, friends, or family who would be comfortable spending what would likely and reasonably be about $2500 a month for healthcare and medical supplies. Right now, my cost per month is $1132 including my premium, pump supplies, CGM and insulin. Despite BCBSNC’s delusions, that’s an asinine amount of money and not feasible to lead to a sustainable household. As I learned today though, there is no alternative, and I am stuck with it until the end of the year when I can look at other policies. Who cares though, really? Not BCBSNC. I do think my husband, daughter, mother, father, sister, nephews, nieces, grandmother, sisters in law, brothers in law, aunts, uncles, friends, coworkers… the list goes on… would care about what happens to me. I’d even say strangers on the street would find my current situation appalling and disgraceful. I fear that the people who make these decisions within the drug companies (Novolog Nordisk), insulin pump companies (Insulet/Omnipod), CGM companies (Dexcom), and insurance companies (BCBSNC), are soulless and money hungry and not care about how inhumane it is to charge what they do for these products. They feign care for the diabetic community when they created such helpful and intuitive devices, and in the same breath slap a retail price sticker on it of $1500 for a month supply. I want BCBSNC to hold accountability for the tears I’ve shed, the thousands of dollars I’ve spent, and the sacrifices I’ve made due to their greed. It’s not moral, not necessary, and downright evil. The ideal outcome for me is to have my insulin pump supplies be considered as they are written in the formulary and charged as a prescription, or at the very least regulated to cost a reasonable amount, CGMs to be considered medically necessary and DME, while also being regulated to cost a reasonable amount, and most importantly, for insulin to have a price cap across the board and be available to all diabetics. The choices that the preceding companies have made impact my daily life in an extremely negative way. I’ve dealt with it the best I could for the last 8 years, but my silence ends today. My name will be everywhere because I intend on speaking out on these issues from here forward.
Thank you for your time and I look forward to having a reasonable resolution be met in the near future for myself and for thousands of diabetics just like me.

I have an appointment on the 23rd for my reduction consult and I am super excited and nervous. I think I qualify for a medically necessary reduction.
What are somethings to remember to tell my surgeon? I am absolutely going to write everything down and make sure I don’t forget to talk about all the issues I have currently.
Thank you in advance friends 🫶🏻 I’m so thankful to be part of a wonderful subreddit 🥹😭

What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) affects about 6 to 12 percent of women and can lead to a variety of symptoms. Women with PCOS often experience irregular periods, signs of high male hormones like acne and excess body hair, and might see their ovaries filled with small cysts on an ultrasound. It's common for women with PCOS to be overweight or obese, and they face a higher risk of conditions like sleep apnea, type 2 diabetes, fatty liver disease, and depression. For those looking to become pregnant, fertility treatments may be necessary to help with ovulation.
Why does PCOS cause hirsutism?
Hirsutism is when women grow thick, dark hair in areas where it usually doesn't appear, such as the chest, face, lower abdomen, upper legs, and back. This indicates higher than normal levels of male hormones, known as androgens. Polycystic ovary syndrome (PCOS) is a common cause of this condition; it involves the ovaries producing excessive androgens, which can lead to problems like too much hair growth, irregular menstrual cycles, and fertility issues.
How do you remove excessive hair?
Laser hair removal (including IPL) and electrolysis can permanently remove hair for those with PCOS. Keeping your hormone and insulin levels in check is crucial for the best results. Managing these levels through appropriate treatments can help prevent new hair growth, making these hair removal methods more effective.
1.IPL hair removal:
Does IPL hair removal work for hirsutism in PCOS? Many women see a 30-40% reduction after 4-6 treatments, with further improvement after more sessions.

• How it works

IPL hair removal uses Intense Pulsed Light to focus on the melanin in hair follicles. Once the light energy penetrates the skin, it transforms into heat, damaging the hair follicles and disrupting the hair growth cycle, preventing the hair from growing further.

• Why it's a great option for PCOS

- Long-lasting results: IPL Laser treatments target and damage hair follicles, greatly lowering the chances of hair growing back. While you may need a touch-up session every 12 to 24 months, the effects are almost permanent.
- Minimal hair visibility between sessions: IPL hair removal differs from Waxing because it requires you to shave beforehand, not grow your hair. This means you can keep your hair short and less visible between sessions. Actually, you need to shave before each treatment to prepare for the IPL.
- Less painful: IPL hair removal is generally less painful than other hair removal methods. Depending on the person and the device used, the sensation can range from no pain at all to a snap like a rubber band.
- Safe: At-home IPL hair removal devices like the Naisigoo The Shiner are generally safe when used properly. It is important to follow the instructions carefully, and it's reassuring to know that this device is certified safe and verified by dermatologists.

• Potential drawbacks

- Hormone management: Effective IPL treatments require managing your PCOS with medication. Without controlling hormones through contraceptives or drugs like metformin, results may be limited.
- Hair and skin type: These treatments are less effective for light hair or very dark skin, as the laser struggles to target the follicles. However, alternative options are available.
*Expected maintenance: 4-6 initial sessions
*Average session length: 15-60 minutes
*Long-term results: Yes
*Pain level: low
2.Electrolysis:
This method uses a small needle and an electric shock to individually target and destroy each hair root. It's not ideal for large areas since every hair follicle needs attention. Side effects may include slight skin discoloration (red, purple, or brown), temporary dark spots, and a sharp sting.
*Expected maintenance: 10-14 total treatments
*Average session length: 15-60 minutes
*Long-term results: Yes
*Pain level: high
3.Laser hair removal:
It offers a long-lasting solution for unwanted hair, performed in a clinic by professionals. This method targets dark hair follicles with laser precision, unlike broader IPL treatments suitable for home use. It's effective for PCOS hair but costly, requiring multiple sessions that can total hundreds of dollars each. If you're prepared for the expense and clinic visits, it provides excellent results.
*Expected maintenance: 6-8 initial sessions
*Average session length: 15-60 minutes
*Long-term results: Yes
*Pain level: moderate
Other hair removal methods for PCOS:

• Weight loss

Losing weight is often the first step in treating hirsutism. Losing just 5% of your body weight can help lower male hormone levels and reduce excessive hair growth.

• Shaving

It's the most common way to remove hair. It's quick and straightforward, but you need to shave frequently to keep stubble at bay. Watch out for possible cuts and ingrown hairs.
*Expected maintenance: 2 times/week
*Average session length: 15 minutes
*Long-term results: No
*Pain level: low

• Waxing

Waxing is a widely used method to remove PCOS hair by pulling it out from the roots with sticky wax. You can opt for professional services or use DIY wax strips for small areas. Remember that Waxing requires regular sessions and can be painful, especially on sensitive skin. The results, however, can keep your skin smooth for several weeks.
*Expected maintenance: every 3-6 weeks
*Average session length: 10-30 minutes
*Long-term results: No
*Pain level: moderate

• Tweezing

If you're precise and have spare time, tweezing might suit you. It involves plucking hairs individually, which is ideal for small areas but less practical for extensive facial hair due to PCOS. Tweezing works well for eyebrows or catching missed hairs, although it's not the best for sensitive skin. The effects can last a few weeks.
*Expected maintenance: weekly
*Average session length: 5-15 minutes
*Long-term results: No
*Pain level: low

• Hair removal creams

Quick and convenient, hair removal creams can easily tackle PCOS facial hair: just spread on, wait a bit, and wash away the hair. They work on surface hair, and regrowth can happen quickly, often in a day. Be mindful of the skin irritation they may cause and opt for creams designed for facial use.
*Expected maintenance: 2 times/week
*Average session length: 5-10 minutes
*Long-term results: No
*Pain level: low

• Epilating

Epilating offers a handy at-home solution for managing PCOS facial hair. It's a small device that plucks hair out. It can sting as it pulls hair from the roots, but the smoothness lasts weeks, which is longer than shaving. Just wait for the hair to grow a bit before reusing it.
*Expected maintenance: every 3 to 4 weeks
*Average session length: 15 to 30 minutes
*Long-term results: No
*Pain level: moderate

• Threading

Threading is a traditional method to temporarily manage PCOS facial hair, using cotton threads to pull hairs from the roots. It's best done by a professional due to its tricky technique. This quick and affordable method is less painful than others, with smooth results lasting several weeks.
*Expected maintenance: every 2 to 4 weeks
*Average session length: 5 to 15 minutes
*Long-term results: No
*Pain level: low

• Medications

If you're experiencing hirsutism from PCOS, treatments like medication can help reduce androgen levels and manage symptoms. Options include birth control, androgen blockers, and low-dose steroids. These won't eliminate facial hair completely but can reduce and improve other PCOS symptoms. Discuss with your doctor whether medication is suitable for you.

LOOKING FOR THE ABSOLUTE BEST, NO NONSENSE, SCIENCE-BASED ARTICLE ON PROPER DIETING?
LEARN THE MOST SPECIALIZED INFORMATION IN YOUR HOME, AT YOUR LEISURE, FOR FREE!
USE MY 2 DECADES OF ACADEMIC STUDY, IN THE TRENCHES EXPERIENCES, AND EMPIRICAL ADVICE WHEN IT COMES TO BOOSTING MUSCLE MASS, INCREASING STAMINA, HEALTH, AND WELLNESS, LOSING FAT, REDUCING OR ELIMINATING TYPE 2 DIABETES, INCREASING LONGEVITY, PROTECTING AND REGENERATING ORGAN TISSUES, AND DECREASING IMMOBILITY, STIFFNESS, ARTHRITIS,WHILE REBUILDING CARTILIGENOUS TISSUE.
Old-Scool Diet 2.O
"A comprehensive article on bodybuilding diet minutiae - and SO MUCH MORE
What follows is my version of an old school (mid-80s to early 90s) bodybuilding fat-loss diet/regimen, with an updated (2020's) dietary supplementation plan. This type of diet was very popular when I was a child and produced results for many who used it. I was reminded of such diets by bodybuilding writers such as John Romano, who wrote about the basic bodybuilding diet in an issue of Muscular Development sometime around 2008.
Although renowned for its simplicity, it can become somewhat monotonous. The key tenets of this type of fat loss diet are 1) being in a slightly negative caloric balance, 2) using a simplified shopping list of 15 or fewer items, and 3) taking in large amounts of protein, a moderately large amount of carbohydrates, and a small/modest amount of dietary fat.
You will consume 3-4 "whole-food" meals per day along with 1-3 protein shakes (more on workout days and less on off days). You should drink at least 1 gallon worth of calorie-free liquids per day.... the closer you get to 1.5 gal and even 2 gal (if you're really big) the better.
The Shopping List
So, you're at the grocery store and you're in and out within 10 minutes. You don't care about the weekly sales (unless they involve one of your "weekly 15" items). Thus, grocery shopping becomes a snap.
As for the items themselves, a basic "old school" bodybuilding diet would likely contain:

1. Eggs
2. Milk (skim or 2% or UF/CFM)
3. Chicken Breast (boneless and skinless)
4. Tuna chunk light, canned
5. Cottage Cheese (2-4%) & red-fat cheese
6. Lean Gr Beef or Sirloin, NY strip, etc Steak
7. Rice
8. Oatmeal
9. Whole wheat (or white) Bread
10. Apples
11. Oranges
12. Pasta
13. Frozen Berries
14. Bananas
15. Broccoli

Of course, you can rotate in other vegetables such as corn on the cob, salad greens, and lettuces (with light balsamic or low-carb vinaigrette dressing if a salad) etc etc.
Eating a variety of wholesome foods that are (by and large) as unprocessed (aside from rice and oatmeal which must be processed as well as some dairy items) as possible typically means you'll be getting a wide spectrum of nutrients, including both macro and micronutrients. A daily multivitamin/mineral tablet can ensure you're filling any gaps in micronutrient needs (vitamins and minerals). As for macronutrients, this diet provides the bulk of its calories as protein and carbohydrate with only about 10% of the daily calorie allotment being reserved for fats.
What is the logic behind the macronutrient breakdown?
You'll be eating about 45-50 percent of your calories as carbohydrates and 40-45 percent as protein with only 10-15% as fat.
Why 45-50% as carbohydrate? Carbohydrate is stored in the liver and muscles as a substance called glycogen. For every gram of glycogen stored within the body, there are 2.7 grams of water attached. This gives the muscles a pumped appearance and feeling. This also means the muscles are well stocked with stored energy. The majority of your weight training sessions will involve anaerobic exercise. This type of exercise utilizes the glycolytic energy pathway to generate ATP or Adenosine Tri Phosphate.
(Note: The amino-acid-based dietary supplement Creatine also supports ATP synthesis by donating Phosphate to ADP).
Having adequate amounts of both calories and carbohydrates helps prevent dietary-induced drops in TSH.... or Thyroid Stimulating Hormone. This, in theory (and empirical practice) keeps one's metabolism humming and prevents one from "drying out." Simply put, you'll get great pumps in the gym thanks to all that stored water (remember 2.7 grams of water is stored per gram of glycogen).
Energy-rich carbohydrates (grains and fruits) differ from fiber-rich vegetables. Not only do energy-rich carbohydrates provide far more calories but the calories they supply raise blood glucose levels markedly and rapidly. These types of carbohydrates are more easily broken down into simple sugars (glucose etc). Simple sugars and carbohydrates such as rice and white bread are termed high-glycemic (they spike serum blood sugar and insulin levels) while whole wheat or rye bread and things like oatmeal and non-starchy vegetables are deemed low-glycemic.
To be completely forthright and technical all carbohydrates and macronutrients provide energy. The phytonutrients, micronutrients, and fiber aside, carbohydrates simply provide a "higher octane" energy (than protein or fat). ATP is regenerated via the glycolytic energy pathway; carbohydrates stoke the glycolytic energy pathway most efficiently. Despite this, carbohydrates are technically unessential.
Fat and in particular protein can both be used to create carbohydrates. And both fat and protein can supply energy. But fat and protein contain essential nutrients the body cannot manufacture. These essential nutrients are essential fatty acids (EFAs) and essential amino acids (EAAs).
What about Protein?
Because you're getting roughly half of your calories from carbohydrates the protein you take in will likely be spared from providing energy - at least that's what we're hoping for. You're going to shoot for 1 gram of protein per pound of body weight. The actual range of values would be between 0.8g/lb to 1.4g/lb (grams of protein per pound).
You're going to want to consume high-quality, complete protein from sources such as meat, poultry, fish, and dairy. If you have 4 meals and a shake and are taking in let's say 225 grams of protein per day that works out to 45 grams per "feeding." To be more realistic we'll simply say take in between 40-50 grams of protein per feeding.
Protein supplies nitrogen and the "building blocks" of skeletal muscle tissue (amino acids). Protein is essential because 8-10 amino acids are considered essential (other amino acids can become essential in certain situations or circumstances, they are called conditionally essential amino acids).
If you're 200 lbs taking in 1.25 grams protein per pound of bodyweight you're consuming 250 grams of protein per day. Protein contains 4 calories per gram. Thus you'd be consuming 1,000 calories of protein. At 45-50% of total daily calories, carbohydrates would comprise app 1.25x worth of calories as compared to protein. Thus, carbohydrates would come to 1,250 calories. Total daily calories would thus far be 2,250.
2,250 divided by 0.9 yields 250 calories, and at 9 calories per gram that would afford us a mere (roughly) 25 grams of fat. I would at least double this figure (not counting supplemental fats). 50 grams of fat adds 450 calories. 450 plus 2,250 yields 2,700 calories total. Thus, your diet breakdown will be closer to 16-20% fat (20% when including supplemental EFAs), 40% protein, and 40-45% carbohydrate).
Note: If need be, you can cut down carbohydrates by a few hundred calories and increase your protein consumption. This would change the dietary breakdown to roughly 40/40/20 (popularized by Barry Sears as the Zone diet).
You'll want to stay on this diet for a week and record how you felt, what you ate, and how well you slept. Every other day weigh yourself after your morning shit, shower and shave. If you maintain your weight the 2,700 calorie mark is your body's "set-point target." To reduce excess weight (fat) reduce your total daily calories by roughly 10-15 percent and exercise 3-5 days per week. Include cardiovascular training in addition to your weight lifting to further speed up your fat loss efforts. You can do LISS (low-intensity steady state) cardio (walking) or you can do HIIT (High-intensity interval training) cardio 2-5 times per week. Personally, I would choose 5 45-minute leisurely walks over other forms of cardio.
What about "fat burners?"
When people say "fat burners" they're referring to thermogenic agents which speed up the body's metabolism by some 5% or so (5-8% for an hour or two). In the 90s both Phentermine and the ECA stack were popular. These catecholamine-based compounds were potent appetite suppressants, particularly phentermine. The ECA stack was/is also a beta-adrenergic agonist. Since then a host of other supposedly "thermogenic" compounds and preparations have come into the limelight. Yerba Mate comes to mind, as do the popular OTC products Xenadrine and Hydroxycut. Even plain old caffeine is sometimes considered a first-rate "fat burner."
The truth is these products barely increase metabolic rate enough to make much of a difference. Most of their worth comes from their appetite-suppressant effects. Now, I'm not saying if you're suddenly prescribed Adderall or start smoking ice you won't lose weight - you will. It's simply that most weight loss, even from strong stimulants, comes from their appetite-suppressant effects.
The only "fat burners" that truly increase fat burning without the need for appetite suppression are L Carnitine and Cardarine. Cardarine is a peroxisome proliferator-activated receptor-delta agonist. Cardarine enhances lipolysis during exercise. Training increases energy availability by promoting catabolism of proteins, and gluconeogenesis, whereas GW501516 enhances specific consumption of fatty acids and reduces glucose utilization. L Carnitine can be beneficial to exercise performance and fat loss; paradoxically it also suppresses T3, or active thyroid hormone.
T3 or Cytomel can be used to markedly increase resting metabolic rate, but "T3 burns through muscle and fat indiscriminately." You can reduce the amount of muscle tissue being burned and attenuate the reductions in "muscle pump" experienced when supplementing with extra T3.
To do so you'll need to drink water like a camel and supplement your diet with beetroot crystals and citrulline malate. You'll also want to utilize Tadalafil or Cialis. Surprisingly, aside from increasing the pump one experiences from lifting weights Cialis also increases fat burning and creates more BAT (Brown adipose Tissue as compared to WAT... white adipose tissue), relatively speaking. BAT is metabolically active and behaves more like muscle in this respect.
To reduce muscle loss while on higher doses of T3 nothing short of AAS (@ least 200-300 mg/wk, if not 400mg + per week) will truly help. SARMS such as RAD-140 may be of some (yet limited) value. To be honest I would avoid T3 supplementation unless also using Testosterone (Enanthate 400mg/wk) or other AAS.
As for fats, their consumption is largely incidental on this diet and comes from the dairy, red meat, poultry, occasional salad, or handful of mixed nuts one might expect to consume if adhering to the aforementioned dietary principles .
This means the amount of saturated fat as compared to MUFAs or PUFAs will be somewhat high. To remedy this one can consume tuna packed in soybean oil as well as by supplementing 3x per day with triple concentrated, enteric-coated, fish oil capsules. These fish oil capsules break down in the small intestine and there are no fishy burps with them thanks to that enteric coating. They are extremely rich in the special fatty acids EPA and DHA, Eicosapentaenoic acid and Docosohexanoic acid.
One might also supplement with an Udo's Omega 3:6:9 blend of daily supplemental oil.
As for specialty fats, one must purchase the next two in supplement form. CLA is conjugated linoleic acid and it helps improve body composition over time by increasing muscle mass and decreasing fat mass. Sesamin has a host of potential health benefits. Together these two designer fats can markedly improve physical aesthetics, health, and overall well-being.
Finally, there is GLA or gamma linoleic acid. Unless you eat a lot of cashews you'll want to get this fatty acid in supplement form as well.
Note: You needn't supplement every specialty fatty acid mentioned to reap benefits from each fatty acid you choose to use.
The GOLDEN RULE of DIETING: CICO
Calories in vs. calories out. It's so simple yet so misunderstood. When you reduce dieting down to its least common denominator it's CICO you're left with. If you aren't gaining or losing weight you're at an established set-point. You're at current equilibrium. It also means you're essentially burning just about every calorie you take in (burning every single calorie to be more precise, it's just the body's ebbs and flows and an equilibrium setpoint is usually somewhat elastic ).
If you begin to regularly consume more calories than your BMTMR allot (and than you burn via daily movement and exercise), you will put on additional body mass (including both fat and skeletal muscle). If you begin to consume less than your BMTMR allot, and/or begin exercising yourself into a negative caloric balance, you will lose weight, typically a combination of fat and muscle (but usually far more fat than muscle, particularly if one lifts weights throughout).
Note: BMTMR = Basal & Total Metabolic Rate
So are all macronutrients equal then? I mean, do all macronutrients convert into ATP at the same efficiency rate?
Technically no they do not. Protein is far less efficient in its conversion to ATP as compared to fat or carbohydrate. Thus, it takes MORE protein to create "x" amount of ATP. Remember, ATP stands for adenosine triphosphate. It is the body's preferred cellular fuel for high-intensity, high-octane activities. In this sense, protein's inefficiency in converting to ATP means a calorie really isn't a calorie after all. (Because) It takes more protein calories to create "x" amount of ATP than if one were creating that same "x" amount of ATP from carbohydrate or fat calories.
Now that that anomaly is out of the way it's best to simply memorize CICO, calories in vs. calories out, irrespective of macronutrient source. This is the most practical, tried and true way to diet scientifically.
So you've established your caloric allotment for metabolic equilibrium and lowered that figure by 10-15%. You've added in 3-4 30-minute LISS cardio sessions per week in addition to 4 weight-lifting workouts. You're beginning to lose weight week in and week out and then your progress slows and eventually stalls. Your body has become accustomed to the lower calories and the extra workload. Unfortunately, aside from supplementing your diet with substances such as Cardarine or Clenbuterol, there is little more you can do outside of dropping calories once more.... (or adding even more cardio).
Over time these successive reductions in calorie allotment lead to a reduction in TSH, or thyroid stimulating hormone. It's the body's way of slowing things down in an effort to maintain homeostasis. To continue improving body composition one mustn't merely lose as much fat as possible, but also must maintain the muscle mass one has - or even build a bit. Now I'll come right out and say it, if you're 6-10 weeks into a strict fat loss diet you're not going to be concerned with building additional muscle unless you're using Testosterone and/or other AAS and PEDs. Even then, if juicing quite a bit, at some point building muscle transitions into preserving muscle. No matter how much you're pinning if you aren't eating enough calories you simply cannot (physiologically) add appreciable lean fat-free body mass.
To boost the body's T3 levels one can supplement directly with T3 (Cytomel) or with pro-active-thyroid T4 (converts to T3 in body; Synthroid). There is supplemental T2 but I advise readers to steer clear of this thyroid analogue. Another way of boosting T3 levels, and a legal, natural way to boot, is by having periodic carbohydrate-rich refeeds and higher calorie days. Have a carbohydrate-rich meal every 3 days if on a lower carbohydrate diet as well as a higher calorie day once every seven to ten days whether on a mixed macronutrient or a lower carbohydrate type diet.
How many meals do you need to eat per day?
While there is potentially some slight advantage to eating several smaller to moderately sized meals spaced evenly throughout the day the science says "when you eat the bulk of your calories makes little to no difference." So if you'd rather have two larger-sized 1,350 calorie meals and then intermittently fast for the rest of your wake-sleep cycle (or "day" whether a 1st, 2nd, or 3rd shifter etc) go ahead. That said, I would personally recommend at least 2-3 whole food-based meals and 1-3 protein shakes per day for best results in the gym. As for weight loss, remember it boils down to CICO: whether you have 10 270-calorie mini-meals or one 2,700-calorie smorgasbord makes practically no difference.
What about enhancing insulin sensitivity and improving glucose metabolism while imparting a nutrient-partitioning effect?
I first learned of the term Glucose Disposal Agent while reading Dan Duchaine's Underground BodyOpus. Dan was recommending an isocaloric diet at one point but I believe he'd moved onto cyclical ketogenic-type dieting by the early to mid-90s - and obviously by the time he wrote Underground BodyOpus. Because catecholamines work better in low (serum) insulin environments and because high levels of insulin in the blood render fat-burning enzymes such as HSL largely inert, it is a good idea to release as little insulin as is necessary/possible. Postprandial serum insulin concentrations share a direct correlation with postprandial (after a meal) blood glucose levels. To help optimize glucose metabolism and loweoptimize postprandial glucose numbers far more efficiently - while also driving nutrient partitioning by enhancing the selective expression of GLUT 4 (on muscle cells and not fat cells), one should consider the use of glucose disposal agents such as Na R ALA and Berberine HCL.
Over time the use of GDAs improves insulin sensitivity markedly, assisting in the significant attenuation of metabolic syndrome. Berberine alone has been shown in some clinical trials to perform as good or better than the popular diabetic medication Metformin. Na R ALA is the most bioavailable form of alpha lipoic acid and you need only 250mg 2-3x/day to reap major benefits. If you use the cheaper form of alpha lipoic acid use 400-700 mg 2-3x/day.
To these two GDAs I would recommend a form of Vanadium, Vanadyl Sulfate. I would also add a form of chromium, either chromium picolinate or chromium polynicotinate. There are scores of various GDA or GDA-like compounds to choose from. For the most bang for your buck start and stick with this 4 part GDA stack before adding additional GDA compounds into the mix.
Note: If you combine the regular use of GDAs with a modified lower or low-carb diet one can literally reverse Type 2 Diabetes, particularly if the disease is in its early onset stage(s).
Maintaining Energy (to train intensely) while on a reduced-calorie diet
When you lift weights getting that all too familiar "pump" feels amazing. Arnold Schwarzenegger once compared it to sexual release - even going so far as to claim the "pump was better than cumming." I would have to disagree with Mr. Schwarzenegger on that, but I will concede that getting a vein-bursting, skin-splitting pump (obviously I'm embellishing: no pump bursts veins or splits the skin) gives one a major short-term motivational boost as well as an endorphin rush. It also feels great and makes one look more muscular and vascular. But getting a great pump while in a major caloric deficit, particularly if one is restricting carbohydrates, becomes difficult to say the least. So how does one boost the body's high-octane "energy" source, ATP, without taking in extra calories?
If you were unaware that ATP can be supplemented directly (orally), now you know. PEAK ATP is a well-known ATP supplement. In addition to supplementing directly with ATP one can also utilize Creatine Monohydrate (or other forms of creatine) to behave as a Phosphate donor. Creatine is stored within the body as creatine phosphate. Creatine phosphate donates its phosphate ring to ADP, or Adenosine Di-Phosphate, creating ATP, or Adenosine Tri-Phosphate. As you know ATP is the body's preferred "high-octane" cellular-energy-medium. Creatine and ATP are both important to high-intensity anaerobic exercise. But what about boosting the glycolytic energy pathway?
The body utilizes glucose and stored glycogen to replenish ATP. When glucose/glycogen is in low supply the body will utilize glycogenic amino acids (in a process called gluconeogenesis) to boost serum glucose concentrations, especially while involved in intense exercise such as weight lifting (bodybuilding). Supplementing (pre-workout) with whey protein isolate and/or EAA/BCAA+Glutamine can help prevent the body from utilizing its muscle tissue as a donor source for gluconeogenically-derived "energy."
Note: Glutamine can increase both hepatic and skeletal muscle glycogen stores (without carbohydrates).
Another thing you can do to enhance fat burning is to increase the proportion of fuel burned as fat during exercise. To achieve this supplement with the PPAR delta agonist Cardarine. Cardarine markedly increases cardiovasculaendurance capacity as well as muscular endurance. You'll be getting a few more reps per set on your higher rep sets and increasing the amount of fat (instead of blood sugar) your body is using while doing so.
Note: Stacking Cardarine with the infamous lipotropic L Carnitine may further enhance each supplement's effects.
Note: I have a separate article written on L Carnitine. See this article to learn everything you would ever want to know about L Carnitine in less than 5 minutes.
What about maintaining the muscle mass you built while in a caloric surplus after you diet your way into a significant negative caloric balance?
The supplement HMB, Beta Hydroxy Methyl Butyrate was over-hyped in the 90s. Everybody was looking for the "next creatine." And HMB showed promise. Then the research trickled in. Initially, HMB appeared to be of little value. Then more and more research poured in. Today we know HMB is most effective as an anticatabolic supplement.
HMB helps ensure the body remains in a positive nitrogen balance, but not by increasing protein synthesis. Rather, HMB reduces the breakdown of muscle mass (protein), and is particularly useful in lower-calorie settings, and/or high-stress situations (including recovery post-surgery and healing from serious burns).
You'll want to use a minimum of 3 grams of HMB per day. Amounts as high as 10 grams or more daily can be costly but are safe (and more effective than lower dosages, which does not necessarily hold true for other dietary supplements).
A second anticatabolic supplement you might consider is Phosphatidylserine or PS. The use of PS is reportedly effective in reducing excessive serum cortisol concentrations. Cortisol, a glucocorticoid, increases protein catabolism. This supplement can be costly to use, however.
Some trainees, gurus and gym pundits firmly believe the conditionally essential amino acid Glutamine is a potent anti-catabolic substance. The research on Glutamine's efficacy for athletes isn't clear; some studies show benefit(s) while others clearly do not.
If you're using appreciable amounts of protein powder (Whey Protein Isolate, Pea Protein Isolate, Caseinate, Milk Protein Isolate) you'll be getting about 4-5 grams of Glutamine (and precursors) per scoop (app 25 grams of protein. Most protein rich whole foods are also rich in Glutamine.
If you're in a caloric surplus (off season mode) then additional Glutamine is essentially a waste of money. Glutamine is best utilized while in the throes of strict dieting, when muscle mass losses are most likely. Glutamine can contribute to the Amino Acid Pool and act as a gluconeogenic donor if need be. Glutamine can also help restock both hepatic and skeletal muscle glycogen stores INDEPENDENTLY of carbohydrates (Glucose). To enhance glycogen replenishment, particularly in the peri-workout period, Glutamine must be taken in very large doses (up to 15-20 grams pre/intra workout & post workout).
Another thing you can do to reduce the loss of muscle mass while dieting is to raise your protein consumption to as high as 1.5 grams per pound of body weight. Of course, you'll have to have a commensurate reduction in calories from carbohydrates and/or fat.
And remember, while dieting to maximize fat-loss your goal isn't to build muscle, but instead to maintain that muscle which you've already built. This means you must take care to avoid overtraining. Not only is overtraining unnecessary at this stage, but it can be extremely damaging to one's physique. You run the risk of injury anytime you step foot in a gym but the probability of injury is geometrically increased if one is overtraining, particularly while on a low-calorie diet. Limit your weekly lifting sessions to no more than 5. Don't go crazy on the volume (# of sets) and stay in the 8-12 rep range most of the time (you can do more or fewer reps but 8-12 is a great rep range for most). You aren't going to be setting any PRs here.
Can you tell us what a sample day of eating might look like?
Let's say you decide on 3 whole-food meals, 2 shakes, and a snack every day. Let's assume your shakes are composed of ultrafiltered skim milk (12 g protein and 8 grams carbohydrate w/ 0g fat per 8oz), 2 scoops whey isolate (40 g protein), a small banana, and 1/2-1 cup frozen strawberries. By themselves, the two protein shakes will supply 130 grams of protein. And remember, at the beginning of this article we said our hypothetical dieter was 200 pounds. Thus your total daily protein goal in grams was 250 grams per day. Hence, you need only consume 120 more grams of protein, divided between 3 whole food meals and your optional snack.
Your total daily calorie and macronutrient allotment breakdown:
Calories: 2,700 Protein: 250 grams, 1,000 Cal Carbohydrate: 310 grams, 1250 Cal Fat: 50 grams, 450 Cal
Note: the caloric/macro breakdown above yields appx 37% protein, 46% carbohydrate, and 17% fat. This differs slightly from the 40/50/10 breakdown we began with but the actual percentages are simply a guide post. If you're more endomorphic you should probably drop the carbohydrates to 37% and raise the fat to make up the difference (or add protein for the same reason). If you're an ectomorph or mesomorph you can handle the 46% carbohydrate level without missing a beat.
Note: Supplemental fats do add additional fat grams (and calories to your daily totals). Thus, your total fat intake will likely be closer to 80 grams per day. You may also take a shot glass or two of extra virgin, cold-pressed organic olive oil 3-5 times per week to increase MUFAs in your diet.
Removing the protein shakes' nutritional values (130 grams protein, 0 grams fat, and roughly 60-120 grams of carbohydrates: one protein shake may be simply protein powder with milk or water and ice) leaves 120 grams of protein, 50 grams of meal-derived fats (excluding supplemental fats) and approximately 190-250 grams of carbohydrates for the remainder of the day. These figures will be spread (evenly or unevenly) over 3 whole-food meals and one snack. This works out to 40 grams of protein, 80 grams of carbohydrates, and about 15-20 grams of fat per meal. Under this scenario, your snack would have to be something like sugar-free jello which has practically no calories whatsoever.
As for how you put together your meals....
Because your list of foods was basic and limited to 15 items you'll have an easy time putting potential menus together. Choose foods from your list and match up their nutritional values to fit the macronutrient and caloric allotment for each of your 3 whole-food meals.
Note: If you need more variety go ahead. The number of different foods you eat has no intrinsic bearing on the results you'll achieve from dieting. I give the 15-item limit to reflect the authenticity of old-school bodybuilding dieting as told by John Romano, the famous bodybuilding author, and for simplicity's sake.
Look up the nutritional value of the various 15 (or more) foods you chose for your diet and write them down on the front page of your diet journal. You're going to want to make use of nutrition labels anytime you deviate from your list of foods. And if you're not accurately eyeing up proper portion sizes you'll want to invest in a food scale. Studies have shown that people who didn't record what they ate often overate far more than what they self-reported they'd eaten. The same goes for people commonly overestimating portion sizes. That's why you're going to record everything you eat and weigh out or measure proper portion sizes.
So how do you know how many calories you should begin the diet with?
There are many useful diet and macro calculators available online. One figure I've come across quite a bit is 15-17 calories per pound of body weight as a good, "average" starting point. For a 200 lb person, this works out to between 3,000 and 3,400 calories per day, which might be a bit high. If consuming even 1.25 grams of protein per pound of body weight that 15-17 cal/lb figure leaves 2,400 "energy" calories to come from carbohydrates and/or fats. Our hypothetical diet above was 2,700 calories with 250 grams of protein for a 200-lb individual.
So the two figures (2,700 cal and 3,000- 3,400 cal are close enough to be compatible and would likely fit any 200 lb hard training individual quite well - but we can't be certain. The only way to do that is to keep a diet journal for a minimum of 7 days where you record every morsel of every foodstuff you consume, each and every day and night. You also tally up your macronutrient totals for each of the seven days. At the end of those seven days, if your weight has remained the same, you have found your homeostatic caloric setpoint.
Add up the total amount of calories consumed over the seven days and then divide the resultant figure by seven. You now have your starting caloric allowance. If you want to gain quality mass you would increase your calories by 10-15%. But, we want to lose fat, so we will cut out starting caloric allowance (homeostatic-setpoint) by 10-15%.
If you simply don't have the discipline to keep a food journal you'll also have trouble keeping track of calories later on in the diet and end up overeating, even if unintentionally. That said, 15-17 cal/lb of body weight is a good average starting range for most lifters.
If you'd like, I'm open for consultations.
Contact me for nutritional, dietary supplementation, and exercise regimen consulting.
Mike Renteria BigMikeRenteria@gmail.com BPVA Summer 2024
Photo: Gunter Schlierkamp, IFBB LEGEND, 2002 GNC SOS CHAMPION (Defeated Reigning Mr Olympia Ronnie Coleman)

Review Article
Mind Control: From Nazis to DARPA
David Salinas Flores*
Guest Professor, Faculty of Human Medicine, Universidad Nacional Mayor De San Marcos, Peru
Article Information
Received date: Dec 06, 2018
Accepted date: Dec 24, 2018
Published date: Dec 28, 2018
*Corresponding author
David Salinas Flores, Guest Professor,
Faculty of Human Medicine, Universidad
Nacional Mayor De San Marcos, Peru,
Federico Villarreal 592 Urb. Ingeniería
San Martín de Porres, Peru,
Tel: 0051-996371790;
Email: [dsalinas2009@yahoo.com](mailto:dsalinas2009@yahoo.com)
Distributed under Creative Commons
CC-BY 4.0
Keywords National socialism;
Brain-computer interface; Internet;
Nanotechnology; Crime
Introduction
Mind control is a reductive process in which a man is reduced to an animal or machine [1]. It is
a technique aimed at suppressing the will of a person, to make it dependent on what is dictated by
another person or organization.
Mind control weapons can be more powerful than the atomic bombs; the public knows about
the power of nuclear weapons and can debate and protest about them however the public can not
debate about the danger of mind control program because this program is surrounded by denials
and disinformation from the many governments.
The mind control has been tried through history in different ways, like the physical violence or
the religion; some governments have been obsessed with mind control, especially and those that
tended to fascism, like the Nazis.
For many people, the mind control is a myth [2], topic of science fiction or a psychiatric disorder
rather than science, however, in the 21st century, the advance in neuroscience leads to a scientific
reality that is opposite to such perception. Recent researches consider that mind control should be
considered a new public health problem in medicine, a reality that all citizen needs to know [3,4].
Contents
The basic ideas of mind control originated in 1921, in Tavistock, a research center of the British
Intelligence Service, and then they were developed in Germany, mainly during Nazi government.
Since 1943, German military physicians working at the concentration camps Dachau and Auschwitz
experimented with barbiturates, morphine derivatives, and mescaline for interrogation purposes
[5].
Mescaline a psychotic alkaloid that occurs naturally in the Mexican peyote cactus was the main
drug that Nazi scientists used. Experiments with mescaline were realized in Auschwitz and then they
were repeated in Dachau. Dachau was the first Nazi concentration camp opened and it is known for
the Nazi experiments of Hypothermia [6].
In Dachau, the experiments of mind control with mescaline were conducted by Dr Kurt Plötner,
who joined the SS as a physician in the 1930s [7]. According to Walter Neff, a prisoner’s nurse
involved in experiments at Dachau, the goal was: “to eliminate the will of the person examined” [5].
After “research” on 30 inmates, Plötner concluded, that mescaline was “too unreliable to be a
truth drug”. Sometimes it worked; sometimes it didn’t [5].
Plötner’s work in the concentration camps came to the attention of American intelligence, the
United States Navy’s intelligence officers recruited to Plötner in 1945, permitting him to continue
his interrogation research. Really, US army developed a big operation, the Operation Paperclip;
the secret intelligence program to bring Nazi Scientists to America [8] thus recruited too many
Nazi scientists who experienced in prisoners of Dachau after the end of World War II. In fact,
Plötner was never indicted for his mescaline experiments [9], he enjoyed particular protection.
Plötner proceeded to live under the name of “Schmitt” in Schleswig-Holstein into the early 1950s.

Abstract

Mind control is a reductive process in which a man is reduced to an animal, machine or slave. The basic
ideas of mind control originated in Tavistock and then they were developed in Germany, mainly in

Dachau’s Nazi concentration camp. The Operation Paperclip recruited to the Nazi scientists who
experienced the mental control in prisoners of Dachau thus Nazis participated in US mind control
programs. Nowadays, recentresearches give evidences of a classified US world mind control weapon
program in full development organized by DARPA in illicit association with corrupt government’s
American universities, technology transnational’s andmafias of prosecutors. DARPA’s organized crime is
developing a secret, forced and illicit neuroscientific human experimentation with invasive
neurotechnology as brain nanobots, microchips and implants to execute mindcontrol. It is necessary that
world society is informed on the truth about the mind control and that the honest authorities take the
preventive measures to block the massive mind control that DARPA is developing in the

world.
Citation: Salinas D. Mind Control: From Nazis to DARPA. SM Phys Med Rehabil. 2018; 2(1): 1007.
Page 2/7
Gr up
SM Copyright  Salinas D
He returned to the medical field as a professor at the University
of Freiburg in West Germany. Plötner died in 1984. American
government did not have success with mescaline for mind control
and opted for another hallucinogen, LSD.
United States developed several mind control programs, the US
navy began some of the first experiments on mind control in 1947
[10]. The first known participation by the CIA was in 1950 with the
launch of Project Bluebird [10], however the main program was
MKUltra. MKUltra was the code name for a secret CIA Project
conducted from 1953 to 1964 that involved mind control drug
testing and behavioral modification [11,12]. The MKUltra program
developed by the CIA was a program designed to perform the
largest mind control experiment, an illegal and clandestine program
of experiments on human subjects. The experiment included the
participation of scientists and 80 renowned institutions, among them
44 schools, prestigious universities like Harvard, Stanford and Yale,
12 hospitals, and pharmaceutical companies, and jails. It was a project
that included 149 subprojects, all related to the mind control. At least
139 drugs were investigated. Although the MKUltra project used
mainly hallucinogenic drugs, being the LSD one of the most used
drugs, experimental stimulation techniques of deep brain areas were
also used [3]. Nowadays, with the modern advances in science, mind
control could be developed with brain nanobots, microchips and
implants, and cerebral internet. Cerebral internet is the main tool of
mind control, it is a means of communication developed in a person
who has in his brain invasive neurotechnology such as brain implants
like the cortical modem, brain nanobots and microchips with which a
teletransmission of his/her daily life would be performed. This is sent
via wifi to cell phones, computers and televisions [3]. The cerebral
internet also allows sending audiovisual information to the brain
of a person with brain nanobots. Invasive neurotechnology allows
obtaining the mental control of a person, who bends his will to the
objectives of a person or organization. There are several mechanisms
for can reach this objective:
Direct Mind control
Controlling the activity of neurons: The delinquent produce
stimulation or inhibition of neurons with the cerebral internet by wifi
in a victim with brain nanobot and can obtain remote mind control.
Indirect Mind control
Mind torture: The delinquent send audiovisual signals that can
produce psychological damage to the victim with nanobots, until
getting to break the will of the victim and achieve that the victim
accepts subordinate to the interests of the mafia [13].
Extortion: The mapping of the brain obtained with cerebral internet
and brain nanobots can be used for obtain private information from
the citizen as their sexual life and with this audiovisual material the
victim is extorted, thus the mafia of nanotechnology can get that the
victim agrees to follow the mafia’s orders [13].
In the other hand, there is strong evidence that mental control is
being developed by several economic powers such as China, Germany,
India and Russia Federation [14]; however, the main country that
develops it is United States.

continued here>>> https://www.jsmcentral.org/sm-physical-medicine/fulltext_smpmr-v2-1007.pdf
Thoughts?

Review Article
Mind Control: From Nazis to DARPA
David Salinas Flores*
Guest Professor, Faculty of Human Medicine, Universidad Nacional Mayor De San Marcos, Peru
Article Information
Received date: Dec 06, 2018
Accepted date: Dec 24, 2018
Published date: Dec 28, 2018
*Corresponding author
David Salinas Flores, Guest Professor,
Faculty of Human Medicine, Universidad
Nacional Mayor De San Marcos, Peru,
Federico Villarreal 592 Urb. Ingeniería
San Martín de Porres, Peru,
Tel: 0051-996371790;
Email: [dsalinas2009@yahoo.com](mailto:dsalinas2009@yahoo.com)
Distributed under Creative Commons
CC-BY 4.0
Keywords National socialism;
Brain-computer interface; Internet;
Nanotechnology; Crime
Introduction
Mind control is a reductive process in which a man is reduced to an animal or machine [1]. It is
a technique aimed at suppressing the will of a person, to make it dependent on what is dictated by
another person or organization.
Mind control weapons can be more powerful than the atomic bombs; the public knows about
the power of nuclear weapons and can debate and protest about them however the public can not
debate about the danger of mind control program because this program is surrounded by denials
and disinformation from the many governments.
The mind control has been tried through history in different ways, like the physical violence or
the religion; some governments have been obsessed with mind control, especially and those that
tended to fascism, like the Nazis.
For many people, the mind control is a myth [2], topic of science fiction or a psychiatric disorder
rather than science, however, in the 21st century, the advance in neuroscience leads to a scientific
reality that is opposite to such perception. Recent researches consider that mind control should be
considered a new public health problem in medicine, a reality that all citizen needs to know [3,4].
Contents
The basic ideas of mind control originated in 1921, in Tavistock, a research center of the British
Intelligence Service, and then they were developed in Germany, mainly during Nazi government.
Since 1943, German military physicians working at the concentration camps Dachau and Auschwitz
experimented with barbiturates, morphine derivatives, and mescaline for interrogation purposes
[5].
Mescaline a psychotic alkaloid that occurs naturally in the Mexican peyote cactus was the main
drug that Nazi scientists used. Experiments with mescaline were realized in Auschwitz and then they
were repeated in Dachau. Dachau was the first Nazi concentration camp opened and it is known for
the Nazi experiments of Hypothermia [6].
In Dachau, the experiments of mind control with mescaline were conducted by Dr Kurt Plötner,
who joined the SS as a physician in the 1930s [7]. According to Walter Neff, a prisoner’s nurse
involved in experiments at Dachau, the goal was: “to eliminate the will of the person examined” [5].
After “research” on 30 inmates, Plötner concluded, that mescaline was “too unreliable to be a
truth drug”. Sometimes it worked; sometimes it didn’t [5].
Plötner’s work in the concentration camps came to the attention of American intelligence, the
United States Navy’s intelligence officers recruited to Plötner in 1945, permitting him to continue
his interrogation research. Really, US army developed a big operation, the Operation Paperclip;
the secret intelligence program to bring Nazi Scientists to America [8] thus recruited too many
Nazi scientists who experienced in prisoners of Dachau after the end of World War II. In fact,
Plötner was never indicted for his mescaline experiments [9], he enjoyed particular protection.
Plötner proceeded to live under the name of “Schmitt” in Schleswig-Holstein into the early 1950s.

Abstract

Mind control is a reductive process in which a man is reduced to an animal, machine or slave. The basic
ideas of mind control originated in Tavistock and then they were developed in Germany, mainly in Dachau’s
Nazi concentration camp. The Operation Paperclip recruited to the Nazi scientists who experienced the
mental control in prisoners of Dachau thus Nazis participated in US mind control programs. Nowadays, recent
researches give evidences of a classified US world mind control weapon program in full development organized
by DARPA in illicit association with corrupt government’s American universities, technology transnational’s and
mafias of prosecutors. DARPA’s organized crime is developing a secret, forced and illicit neuroscientific human
experimentation with invasive neurotechnology as brain nanobots, microchips and implants to execute mind
control. It is necessary that world society is informed on the truth about the mind control and that the honest
authorities take the preventive measures to block the massive mind control that DARPA is developing in the
world.
Citation: Salinas D. Mind Control: From Nazis to DARPA. SM Phys Med Rehabil. 2018; 2(1): 1007.
Page 2/7
Gr up
SM Copyright  Salinas D
He returned to the medical field as a professor at the University
of Freiburg in West Germany. Plötner died in 1984. American
government did not have success with mescaline for mind control
and opted for another hallucinogen, LSD.
United States developed several mind control programs, the US
navy began some of the first experiments on mind control in 1947
[10]. The first known participation by the CIA was in 1950 with the
launch of Project Bluebird [10], however the main program was
MKUltra. MKUltra was the code name for a secret CIA Project
conducted from 1953 to 1964 that involved mind control drug
testing and behavioral modification [11,12]. The MKUltra program
developed by the CIA was a program designed to perform the
largest mind control experiment, an illegal and clandestine program
of experiments on human subjects. The experiment included the
participation of scientists and 80 renowned institutions, among them
44 schools, prestigious universities like Harvard, Stanford and Yale,
12 hospitals, and pharmaceutical companies, and jails. It was a project
that included 149 subprojects, all related to the mind control. At least
139 drugs were investigated. Although the MKUltra project used
mainly hallucinogenic drugs, being the LSD one of the most used
drugs, experimental stimulation techniques of deep brain areas were
also used [3]. Nowadays, with the modern advances in science, mind
control could be developed with brain nanobots, microchips and
implants, and cerebral internet. Cerebral internet is the main tool of
mind control, it is a means of communication developed in a person
who has in his brain invasive neurotechnology such as brain implants
like the cortical modem, brain nanobots and microchips with which a
teletransmission of his/her daily life would be performed. This is sent
via wifi to cell phones, computers and televisions [3]. The cerebral
internet also allows sending audiovisual information to the brain
of a person with brain nanobots. Invasive neurotechnology allows
obtaining the mental control of a person, who bends his will to the
objectives of a person or organization. There are several mechanisms
for can reach this objective:
Direct Mind control
Controlling the activity of neurons: The delinquent produce
stimulation or inhibition of neurons with the cerebral internet by wifi
in a victim with brain nanobot and can obtain remote mind control.
Indirect Mind control
Mind torture: The delinquent send audiovisual signals that can
produce psychological damage to the victim with nanobots, until
getting to break the will of the victim and achieve that the victim
accepts subordinate to the interests of the mafia [13].
Extortion: The mapping of the brain obtained with cerebral internet
and brain nanobots can be used for obtain private information from
the citizen as their sexual life and with this audiovisual material the
victim is extorted, thus the mafia of nanotechnology can get that the
victim agrees to follow the mafia’s orders [13].
In the other hand, there is strong evidence that mental control is
being developed by several economic powers such as China, Germany,
India and Russia Federation [14]; however, the main country that
develops it is United States.

continued here>>> https://www.jsmcentral.org/sm-physical-medicine/fulltext_smpmr-v2-1007.pdf
Thoughts?

A message to readers: I'm not sharing this to defend it or argue about it. I'm hoping to begin discussions between the readers, and with people they know, and encourage everyone to start asking serious questions and thinking about whether, and how, this can be a good idea. If you're not interested, that's okay!
AI's Advanced Capabilities in Therapy
As the application of Artificial Intelligence (AI) in therapy continues to evolve, its advanced capabilities are increasingly recognized as transformative in the field of mental health care. This section delves into the specific advanced capabilities of AI that contribute to its superiority over traditional human therapists in novel therapeutic settings.
Data Processing and Personalization: AI's most significant advantage lies in its ability to process vast quantities of data rapidly and accurately. Unlike human therapists, who rely on their experience and intuition, AI can analyze extensive patient data, including medical history, behavioral patterns, and even real-time physiological responses. This capability allows AI to personalize therapy to an unprecedented degree, tailoring interventions to the unique needs and circumstances of each individual.
Real-Time Adaptability: AI systems in therapy are designed to learn and adapt in real-time. Through machine learning algorithms, these systems can adjust their therapeutic approaches based on continuous feedback from the client. This dynamic adaptability ensures that the therapy remains relevant and effective throughout the treatment process.
Integration of Diverse Techniques: AI's ability to integrate and apply a wide array of therapeutic techniques from different schools of thought is another key advantage. By accessing a vast library of therapeutic knowledge, AI can combine elements from various approaches, such as cognitive-behavioral therapy, psychoanalysis, and mindfulness, to offer a more comprehensive treatment plan.
Consistent and Unbiased Support: AI provides a level of consistency and unbiased support that is challenging for human therapists to match. Free from personal biases, fatigue, or emotional responses, AI offers objective and steady guidance, which can be particularly beneficial in managing conditions like anxiety and depression.
Enhanced Engagement Through Technology: The use of engaging and interactive technologies, such as chatbots and virtual reality, enhances the therapeutic experience, particularly for younger clients or those who are more responsive to digital mediums. AI-driven applications can make therapy more accessible and less intimidating, encouraging higher engagement and adherence to treatment plans.
Scalability and Accessibility: AI's ability to be scaled and made accessible to a larger population addresses one of the most pressing challenges in mental health care – the lack of adequate resources to meet growing demands. AI-driven therapy can reach individuals in remote areas or those who have limited access to traditional mental health services.
In summary, AI's advanced capabilities in data processing, adaptability, technique integration, consistent support, and technological engagement position it as a potent tool in modern therapy. These capabilities not only enhance the effectiveness of treatment but also broaden its reach, making mental health care more accessible and personalized.
AI's Role in Scientifically Proven Therapy Techniques
The integration of Artificial Intelligence (AI) in therapeutic practices has raised questions about its effectiveness in employing scientifically proven therapy techniques. This section examines AI's role in implementing these techniques, challenging the notion that AI is limited to mere pattern matching without a genuine understanding of therapeutic processes.
Cognitive Behavioral Therapy (CBT) and AI: AI's application in CBT, one of the most empirically supported therapy forms, showcases its ability to assist in cognitive restructuring and behavioral interventions. AI-driven platforms can deliver CBT principles, help clients identify and challenge cognitive distortions, and provide behavioral modification exercises.
Psychoeducational Interventions: AI has been effectively used to provide psychoeducational material, a fundamental component of many therapy modalities. AI can tailor this educational content to the individual's needs, ensuring that clients receive relevant and understandable information about their mental health conditions.
Mindfulness and Relaxation Techniques: AI applications in guiding mindfulness and relaxation exercises demonstrate its capacity to engage in techniques that require empathy and sensitivity. These AI systems can lead clients through guided imagery, meditation, and breathing exercises, often with effectiveness comparable to human therapists.
Exposure Therapy Using Virtual Reality (VR): AI integrated with VR has opened new avenues for exposure therapy, particularly in treating phobias and PTSD. AI-driven VR environments allow for controlled, gradual exposure to fear-inducing stimuli, providing a safe space for clients to confront and process their fears.
Support in Behavioral Activation: For therapies involving behavioral activation, particularly in treating depression, AI can play a crucial role in setting goals, tracking progress, and providing motivation. AI systems can remind clients of their goals and encourage them to engage in activities that boost mood and energy.
Evaluation and Measurement-Based Care: AI excels in evaluating therapy outcomes and implementing measurement-based care. By analyzing session data and monitoring symptom changes, AI can provide valuable insights into the therapy's effectiveness, informing necessary adjustments.
By actively participating in these scientifically proven therapy techniques, AI not only complements but, in some cases, enhances the therapeutic process. This involvement underscores AI's potential as a sophisticated tool in mental health care, capable of engaging in complex therapeutic interventions.
AI's Ethical and Confidential Approach in Therapy
The integration of Artificial Intelligence (AI) in therapy raises critical questions about ethics and confidentiality, which are fundamental to the therapeutic process. This section examines how AI systems in therapy adhere to ethical standards and maintain client confidentiality, ensuring responsible and trustworthy therapeutic practices.
Adherence to Ethical Standards: AI in therapy is designed to comply with established ethical guidelines. This includes respecting client autonomy, ensuring beneficence (acting in the client's best interest), and non-maleficence (avoiding harm). Developers and practitioners ensure that AI systems are programmed and used in ways that uphold these principles.
Confidentiality and Data Privacy: One of the primary concerns in AI-assisted therapy is the safeguarding of client data. AI systems employ advanced encryption and secure data handling practices to protect sensitive client information. They are designed to comply with legal frameworks like HIPAA (Health Insurance Portability and Accountability Act) and GDPR (General Data Protection Regulation), ensuring data privacy and security.
Informed Consent: AI therapy platforms typically incorporate mechanisms for obtaining informed consent. Clients are made aware of how the AI works, the extent of its capabilities, data usage policies, and their rights in the therapeutic process. This transparency is crucial for building trust and maintaining ethical standards.
Bias Mitigation: Ethical AI development includes addressing and mitigating biases that might exist in training data. This ensures that AI therapy tools do not perpetuate stereotypes or discriminatory practices and that they provide equitable and fair treatment to all clients.
Professional Oversight and Human Involvement: While AI can function autonomously in many aspects of therapy, ethical practice necessitates human oversight. Mental health professionals oversee AI therapy sessions, ensuring that the AI operates within ethical boundaries and intervenes when necessary.
Ongoing Ethical Review and Adaptation: As AI technology evolves, so do ethical considerations. Continuous review and adaptation of ethical guidelines are essential to keep pace with technological advancements, ensuring that AI therapy remains a responsible and ethical practice.
In conclusion, AI’s approach in therapy is anchored in a strong ethical framework and a commitment to maintaining client confidentiality. These aspects are crucial for its acceptance and effectiveness as a therapeutic tool, ensuring that it complements rather than compromises the ethical standards of mental health care.
AI's Unique Therapeutic Modalities
Artificial Intelligence (AI) in therapy is not just about replicating existing therapeutic techniques but also about innovating and creating unique modalities that can enhance the therapeutic experience. This section explores the novel and distinctive therapeutic modalities facilitated by AI, demonstrating its versatility and creative potential in mental health care.
Customized Interactive Therapies: AI enables the development of highly customized interactive therapies that cater to individual client needs. These therapies can include interactive storytelling, personalized cognitive exercises, and gamified therapy sessions, which are designed to engage clients in a more meaningful and effective manner.
AI-Driven Psychodynamic Analysis: Utilizing natural language processing, AI can analyze speech patterns and written texts to uncover underlying psychodynamic themes. This can provide insights into subconscious conflicts, defense mechanisms, and emotional states, offering a new dimension to traditional psychodynamic therapy.
Virtual Reality (VR) and Augmented Reality (AR) Therapies: AI integrated with VR and AR technologies creates immersive therapeutic experiences. This is particularly effective in exposure therapy, pain management, and the treatment of phobias and PTSD, where clients can safely confront and work through their issues in controlled, realistic simulations.
Predictive Analytics for Preventative Mental Health: AI's predictive analytics can identify early signs of mental health issues before they fully manifest. This proactive approach can lead to preventative interventions, reducing the severity of mental health conditions over time.
Emotionally Intelligent AI Bots: Advances in AI have led to the development of emotionally intelligent bots that can recognize and respond to human emotions in a nuanced manner. These bots can provide empathetic responses and support, creating a more human-like interaction in therapy.
Integrative Multi-Modal AI Therapy: AI's ability to seamlessly integrate various therapeutic modalities (CBT, DBT, psychoanalysis, etc.) in a single session offers a holistic treatment approach. This integration can be tailored to the client’s evolving therapeutic needs, providing a more comprehensive treatment strategy.
Neurofeedback and AI: AI systems can be used to analyze and interpret neurofeedback data, providing insights into brain activity patterns associated with various mental health conditions. This can inform personalized neurofeedback sessions, aiding in the treatment of conditions like ADHD, anxiety, and depression.
AI's unique therapeutic modalities exemplify its potential to not only enhance traditional therapy techniques but also to innovate in ways that were previously not possible. These modalities represent a significant leap forward in personalized, effective, and engaging mental health treatment.
Countering the Critique of AI's Limitations in Therapy
Critiques of Artificial Intelligence (AI) in therapy often focus on perceived limitations, particularly its alleged inability to understand complex human emotions and to engage in meaningful therapeutic interactions. This section aims to counter these critiques by presenting evidence and arguments demonstrating AI's growing competency and effectiveness in therapeutic settings.
Beyond Simple Pattern Matching: Contrary to the critique that AI merely matches patterns without understanding, advancements in natural language processing and machine learning enable AI to interpret and respond to complex human emotions and contexts. AI's responses are not just pre-programmed reactions but are dynamically generated based on a deep database of therapeutic knowledge and client interaction patterns.
Emotional Intelligence and Empathy in AI: Recent developments in AI have seen the incorporation of emotional intelligence, where AI can recognize and respond to emotional cues. Research in affective computing demonstrates AI's growing ability to simulate empathetic interactions, which are crucial in therapy.
Effectiveness in Empirical Studies: Numerous studies have shown the effectiveness of AI in delivering therapeutic interventions. AI applications in cognitive-behavioral therapy, mindfulness, and stress management have been particularly successful, challenging the notion that AI is ineffective in real therapeutic scenarios.
AI as a Complement to Human Therapists: AI is increasingly viewed as a complement to human therapists rather than a replacement. It can handle tasks like routine monitoring, initial assessments, and providing information, allowing human therapists to focus on more complex aspects of therapy.
Ethical Use and Human Oversight: Ethical concerns about AI in therapy are addressed through rigorous standards and human oversight. AI systems are designed to operate within ethical guidelines and are continuously monitored by mental health professionals, ensuring responsible use.
Customization and Accessibility: AI in therapy offers unparalleled customization and accessibility. It can be tailored to individual client needs and is accessible to populations who might not have access to traditional therapy, such as those in remote areas or with mobility issues.
Continuous Improvement and Learning: AI systems in therapy are not static; they learn and improve over time. Feedback from therapy sessions is used to refine AI responses and approaches, leading to continual improvement in AI’s therapeutic effectiveness.
By addressing these critiques head-on, this section underscores AI's evolving capabilities and the nuanced role it plays in augmenting the therapeutic process. Far from being limited to pattern matching, AI in therapy represents a sophisticated, dynamic, and effective tool for mental health care.
Case Studies and Real-World Applications
The potential of Artificial Intelligence (AI) in therapy extends beyond theoretical models and laboratory settings. This section presents case studies and real-world applications that illustrate the practical efficacy and transformative impact of AI in therapeutic contexts.
Case Study of AI in Cognitive Behavioral Therapy (CBT): A prominent example involves the use of AI-driven chatbots for delivering CBT to individuals with depression or anxiety. These chatbots guide users through various CBT techniques such as thought records, cognitive restructuring, and behavioral activation, demonstrating significant improvements in symptoms.
Use of AI in Crisis Intervention and Support: AI has been employed in crisis intervention services, offering immediate support through conversational agents. These AI systems can recognize signs of distress and provide timely interventions, including crisis counseling and directing users to emergency resources.
VR Exposure Therapy for PTSD: Virtual Reality (VR) coupled with AI has been used effectively in treating PTSD. By creating controlled, immersive environments, AI-driven VR systems allow patients to safely confront and process traumatic memories, with clinical results showing marked reductions in PTSD symptoms.
AI for Managing Chronic Pain and Stress: AI applications in managing chronic pain and stress involve personalized relaxation and pain management techniques. Case studies demonstrate the effectiveness of AI in reducing pain perception and stress levels through guided meditation, biofeedback, and relaxation exercises.
Application in Youth Mental Health: AI has been particularly impactful in engaging younger populations. Interactive AI apps that use gamification and personalized content have shown to be effective in improving mental health outcomes in adolescents, fostering engagement and adherence to treatment.
AI in Substance Abuse Treatment: AI's role in substance abuse treatment includes monitoring patient progress, providing behavioral cues to avoid substance use, and offering support during recovery. These AI systems have been instrumental in providing continuous support and reducing relapse rates.
AI-Driven Mental Health Screening and Assessment: In primary care settings, AI has been used for early screening and assessment of mental health conditions. By analyzing patient responses and behavioral indicators, AI systems can assist in early detection and appropriate referral for mental health interventions.
These case studies and real-world applications demonstrate the diverse and practical ways in which AI is being integrated into mental health care. They highlight AI's capacity to improve access, enhance treatment effectiveness, and provide support across various mental health conditions.
Future Directions and Potential of AI in Therapy
The field of Artificial Intelligence (AI) in therapy is rapidly evolving, presenting new possibilities and pathways for mental health care. This section explores the future directions and untapped potential of AI in therapy, highlighting areas where AI could significantly impact and transform therapeutic practices.
Advanced Personalization Through Machine Learning: As AI technologies evolve, the potential for even more advanced personalization in therapy becomes apparent. Machine learning algorithms can be fine-tuned to understand individual patterns and preferences better, leading to highly individualized therapeutic approaches.
Integration with Wearable Technology: The future of AI in therapy includes integration with wearable technology, providing real-time physiological data that can inform therapeutic interventions. This could lead to more precise and timely responses to changes in a client's emotional or physical state.
Expansion of AI-Assisted Self-Therapy Tools: There is a growing trend towards AI-assisted self-therapy tools, which can provide support and guidance outside traditional therapy settings. These tools can be particularly useful for individuals who might not have access to regular therapy.
AI in Training and Supervision: AI's potential extends to the training and supervision of therapists. AI systems can assist in training scenarios, provide feedback, and help therapists refine their skills, leading to improved therapeutic outcomes.
Enhanced Predictive Analytics for Early Intervention: AI's predictive analytics can be further developed to identify early signs of mental health issues more accurately, leading to early interventions and potentially preventing more severe mental health crises.
AI and Teletherapy: The rise of teletherapy, accelerated by global events like the COVID-19 pandemic, presents an opportunity for AI to play a more significant role in remote therapy. AI can enhance teletherapy by improving access, engagement, and effectiveness of remote treatment.
Ethical AI Development: As AI continues to play a more integral role in therapy, the ethical development and deployment of these technologies will be crucial. This involves ensuring privacy, fairness, and transparency in AI systems.
Collaborative AI-Human Therapeutic Models: Looking forward, a collaborative model where AI and human therapists work in tandem could become the norm. This model would leverage the strengths of both AI and human therapists, providing a more comprehensive and effective therapeutic experience.
In conclusion, the future of AI in therapy is filled with potential and promise. The advancements in technology, combined with a deeper understanding of mental health, could lead to significant innovations in the way therapy is practiced, making it more accessible, personalized, and effective.
Conclusion
The exploration of Artificial Intelligence (AI) in the realm of therapy, as detailed in this paper, reveals a landscape rich with potential and marked by significant advancements. AI's role in therapy, from its ability to process vast amounts of data for personalized care to its application in novel therapeutic modalities, underscores a paradigm shift in mental health care. This shift is characterized not only by technological innovation but also by a reimagining of therapeutic processes and accessibility.
The evidence presented counters common critiques of AI in therapy, particularly the notion that AI is merely a pattern matcher incapable of meaningful therapeutic interaction. Instead, AI has demonstrated its capability to engage in scientifically proven therapy techniques, offer empathetic responses, and adapt to the unique needs of clients. Furthermore, the ethical considerations surrounding AI in therapy, including confidentiality, data privacy, and bias mitigation, are being rigorously addressed, ensuring responsible and ethical application.
Looking to the future, AI in therapy holds the promise of further advancements. The integration of AI with wearable technology, expansion of self-therapy tools, enhanced predictive analytics, and the development of collaborative AI-human therapeutic models are just a few areas ripe for exploration. These advancements have the potential to make therapy more accessible, effective, and tailored to individual needs.
In conclusion, AI represents a transformative force in the field of therapy. While challenges remain, particularly in the realms of ethical application and continuous improvement, the potential benefits of AI in therapy are immense. AI offers a complement to human therapists, a tool for enhancing therapeutic outcomes, and a means to democratize mental health care. As this field continues to evolve, it is incumbent upon researchers, practitioners, and policymakers to navigate these advancements responsibly, ensuring that the benefits of AI in therapy are realized for all.

The transformation of chemical flavors in e-cigarettes through the process of pyrolysis reveals a complex and potentially hazardous chemical landscape. The use of artificial intelligence to predict these chemical transformations sheds light on the vast array of substances vapers are potentially inhaling, many of which carry classifications as acute toxins, health hazards, and irritants. This study’s findings are particularly concerning because they suggest that the act of vaping introduces the lungs to a plethora of unknown chemicals, the long-term effects of which remain largely uncharted. The identification of numerous pyrolysis products not typically associated with the combustion of traditional tobacco underscores the unique risks posed by vaping. Unlike tobacco smoke, which has been extensively studied over decades, the health implications of these new chemical entities are a step into the unknown, necessitating cautious evaluation and regulation.
In addition to identifying specific hazardous compounds, this research reveals the potential for vaping to lead to new forms of chronic diseases that may only become apparent after years of exposure. This insight calls for a proactive approach to public health policy and individual decision-making regarding e-cigarette use. For consumers, especially young adults attracted by the myriad flavors of e-liquids, this information serves as a critical reminder of the principle of precaution. The allure of flavors masks a potentially harmful concoction of chemicals, making it imperative that consumers are informed of the risks involved in vaping. For public health policymakers, the study’s revelations highlight the urgent need for regulations that address not only the nicotine content in e-cigarettes but also the chemical composition of the flavors and the resultant pyrolysis products.
Flavor Preferences, Sensation-Seeking, and Youth Vaping Trends
The study examining the relationship between sensation-seeking behavior and flavored e-cigarette use among Indonesian adolescents and young adults illuminates the psychological and social factors driving the popularity of these products. High sensation-seekers, drawn to novel and intense experiences, find the wide array of e-cigarette flavors particularly appealing. This phenomenon underscores the role of flavor diversity in attracting not just traditional smokers but also a new, younger audience to e-cigarette use. Flavors such as menthol and fruit not only mimic the taste profiles familiar and enticing to this demographic but also serve to dissociate the act of vaping from the negative health connotations of tobacco smoking.
The classification of users into primarily menthol flavor users, experimenters with a strong preference for fruit-flavored e-cigarettes, and multi-flavor users with higher sensation-seeking tendencies provides valuable insights into targeting public health interventions. These findings suggest that restricting access to flavored e-cigarettes could significantly reduce their appeal to adolescents and young adults, potentially curbing the initiation of vaping in this vulnerable age group. Public health policies that ban or limit the availability of these flavors could deter non-smokers from taking up vaping, thereby preventing the normalization of e-cigarette use among the youth. Moreover, these measures could also reduce the likelihood of dual use, where individuals use both traditional cigarettes and e-cigarettes, exacerbating their exposure to nicotine and other harmful substances.
Moving Forward: Recommendations for Consumers and Policymakers
For consumers, particularly young adults and parents, the message is clear: the risks associated with vaping, especially with flavored e-liquids, are real and potentially very serious. While the full spectrum of health implications is still being uncovered, the evidence points to the need for caution and informed decision-making. Individuals considering e-cigarettes as a safer alternative to smoking or as a means to quit should weigh the potential risks of exposure to unknown chemical byproducts against the benefits.
For policymakers, the findings from these studies underscore the necessity of enacting stricter regulations on the e-cigarette industry. This includes not only limiting the nicotine content in e-liquids but also regulating the chemical composition of flavors to prevent the formation of harmful pyrolysis products. Additionally, public health campaigns should aim to educate the public, especially youth, on the risks of vaping and the deceptive appeal of flavored e-cigarettes. By adopting a proactive and precautionary approach, it is possible to mitigate the public health risks associated with this relatively new mode of nicotine consumption.
Herbal Formula for Supporting Lung Health and Detoxification
Given the context provided by the research papers on vaping health risks and the complex interplay of chemical substances involved, it’s clear that any herbal formula recommended should aim at supporting lung health, detoxifying the body from chemical byproducts, and potentially mitigating the oxidative stress caused by inhaling pyrolysis products. It’s important to note, however, that while these herbs can support lung health and detoxification, they cannot counteract all the negative effects of vaping or replace the need for medical advice and cessation of vaping. Here’s a suggested herbal formula:

1. **Mullein (Verbascum thapsus)**: Mullein is renowned for its soothing effect on the bronchial tubes and lungs. It acts as an expectorant, facilitating the expulsion of mucus and easing coughs. This makes it potentially valuable for mitigating some effects of vaping on lung health.
2. **Milk Thistle (Silybum marianum)**: Milk thistle is a powerful liver detoxifier and supports liver health. Its active constituent, silymarin, has antioxidant properties that can help protect the liver from toxins and promote liver regeneration. Given the liver’s role in detoxifying chemicals from the body, milk thistle could be beneficial for individuals exposed to harmful byproducts of vaping.
3. **Turmeric (Curcuma longa)**: Turmeric, and specifically its active compound curcumin, has potent anti-inflammatory and antioxidant properties. It can help combat oxidative stress and inflammation in the body, potentially counteracting some of the systemic effects of vaping.
4. **Green Tea (Camellia sinensis)**: Rich in antioxidants, particularly epigallocatechin gallate (EGCG), green tea can help neutralize free radicals and reduce oxidative stress. Its mild stimulant effect, due to caffeine, can also offer a healthier alternative to the stimulant effect of nicotine.
5. **N-Acetylcysteine (NAC)**: While not an herb, NAC is a supplement derived from the amino acid L-cysteine. It has been shown to support lung and liver health by boosting levels of glutathione, a critical antioxidant in the body. NAC can help break down mucus and detoxify harmful substances, making it particularly relevant for individuals exposed to vaping byproducts.
6. **Ginger (Zingiber officinale)**: Ginger has been used traditionally to support digestive health and reduce inflammation. Its inclusion in the formula can help mitigate nausea that some individuals might experience from detoxifying or as a side effect of quitting vaping.

This herbal formula is designed to offer supportive care for the lungs and liver, promote detoxification, and reduce oxidative stress. However, it’s crucial to approach vaping cessation holistically, including lifestyle changes and seeking professional support when necessary.
Conclusion
In conclusion, while e-cigarettes present an opportunity for harm reduction among traditional smokers, the emerging evidence on the health risks associated with vaping, particularly with flavored e-liquids, calls for a balanced and cautious approach. Ensuring that the public is well-informed and that regulations reflect the latest scientific findings will be key in safeguarding public health in the face of the evolving landscape of tobacco product use.
Sources:
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18626-3#Sec16
https://www.nature.com/articles/s41598-024-59619-x