Ruth

Satiety achieved by eating what we need and by turning off the appetite in brain. How? . . .

[Afshine Emrani MD FACC @afshineemrani]

I'm a cardiologist. After 40, stop guessing about your health. These numbers tell you whether you're building a long, vibrant life — or quietly declining without knowing it.

I run these on myself. I run them on every patient I care about. Most are cheap bloodwork. All are available now. And together, they paint a picture no standard annual physical will ever give you. Print this. Bring it to your next appointment. Your 60-year-old self will thank you.
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𝗙𝗮𝘀𝘁𝗶𝗻𝗴 𝗜𝗻𝘀𝘂𝗹𝗶𝗻
Target: below 5 μIU/mL. Ideal: 3-4.
This is the 10-year warning bell your standard panel completely misses. Your glucose and A1c can look "normal" for a decade while your pancreas is working overtime to keep them there. Fasting insulin catches insulin resistance 5-10 years before your A1c moves. By the time A1c rises, the damage is already extensive.

𝗛𝗢𝗠𝗔-𝗜𝗥
Target: below 1.0.
Calculated from fasting insulin and fasting glucose. The single best measure of insulin sensitivity. Above 1.0 and your metabolism is already under strain. Above 2.5 and you're insulin resistant — even if every other number looks fine.

𝗛𝗯𝗔𝟭𝗰
Target: below 5.4%.
Not below 5.7% — that's the threshold where medicine calls you "prediabetic." By then you've been metabolically compromised for years. Optimal is below 5.4%. Blood sugar mastery is longevity mastery.

𝗧𝗿𝗶𝗴𝗹𝘆𝗰𝗲𝗿𝗶𝗱𝗲 : 𝗛𝗗𝗟 𝗥𝗮𝘁𝗶𝗼
Target: below 2. Ideal: below 1.
Your metabolic health crystal ball. This ratio predicts insulin resistance, cardiovascular risk, and metabolic syndrome better than any single lipid number alone. A ratio above 3.5 is a red flag regardless of what your total cholesterol says.

𝗔𝗽𝗼𝗕
Target: below 80 mg/dL for moderate risk. Below 60 for high risk.
I've written about this extensively. ApoB counts every atherogenic particle hitting your artery walls. A 2024 analysis found 54% of patients had dangerous levels that standard LDL testing completely missed. If you only know your LDL, you're driving with one eye closed.

𝗟𝗽(𝗮)
Test once in your lifetime.
100% genetic. 1 in 5 Americans are elevated. Triples heart attack risk independently of everything else on this list. Diet and exercise cannot lower it. The 2026 ACC/AHA guidelines now recommend everyone be tested. Most never have been.

𝗵𝘀-𝗖𝗥𝗣
Target: below 1.0 mg/L.
You can have perfect cholesterol and inflamed arteries silently preparing to rupture. hs-CRP measures the fire behind the plaque. The JUPITER trial proved that finding and treating inflammation saves lives — even when lipids look fine. If this number is elevated, your mouth, your gut, your metabolic health, and your visceral fat are the first places to investigate.

𝗩𝗶𝘁𝗮𝗺𝗶𝗻 𝗗
Target: 50-80 ng/mL.
Not the bare minimum of 30 your doctor accepts. Suboptimal vitamin D is linked to higher inflammation, weaker immunity, increased cardiovascular events, worse mood, and poorer outcomes across nearly every disease I treat. Supplement D3 with K2 — without K2, calcium deposits in your arteries instead of your bones.

𝗧𝗲𝘀𝘁𝗼𝘀𝘁𝗲𝗿𝗼𝗻𝗲 (𝗧𝗼𝘁𝗮𝗹 + 𝗙𝗿𝗲𝗲)
Men: optimal range 600-1000+ ng/dL total.
Declining testosterone is an independent predictor of cardiovascular death in men. It's tied to insulin resistance, arterial stiffness, visceral fat accumulation, and systemic inflammation. DHEA-S drops 10-20% every decade after 30. Tracking these isn't about vanity — it's evaluating your body's systemic resilience.

𝗕𝗹𝗼𝗼𝗱 𝗣𝗿𝗲𝘀𝘀𝘂𝗿𝗲
Target: below 120/80. Aim closer to 110/70.
Every point above optimal is cumulative arterial damage. Buy a home cuff. Measure morning and evening, seated quietly for five minutes, arm at heart level. White-coat readings in the office miss what's really happening. The smartest $40 investment in cardiac self-care.

𝗩𝗢𝟮 𝗠𝗮𝘅
Men over 40: above 40 mL/kg/min. Women over 40: above 35.
Cardiorespiratory fitness is the single strongest predictor of all-cause mortality — stronger than smoking, diabetes, or heart disease as individual risk factors. A landmark study in JAMA found that extreme fitness was associated with the lowest mortality with no upper limit of benefit. You can estimate VO2 max with a timed mile, a rower test, or a wearable. Get faster every year.

𝗡𝘂𝗺𝗯𝗲𝗿 𝗼𝗳 𝗠𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀
Target: as few as possible.
Every medication you're on should be earning its place. I just wrote about five commonly prescribed drugs that do more harm than good with long-term use. Bring your full medication list to every appointment. Ask: "Do I still need this?" Deprescribing is one of the most powerful and underused tools in medicine.
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Thirteen numbers. Most available through cheap bloodwork and simple tests. Get them once or twice a year. Here's what I want you to understand: these numbers don't just tell you where you are. They tell you where you're heading. A fasting insulin of 8 today becomes diabetes in five years. An ApoB of 120 today becomes a heart attack in ten. An hs-CRP of 3 today means your arteries are inflamed right now — regardless of how healthy you feel. The standard annual physical checks a fraction of these. It was designed to find disease that's already there. This panel finds the disease that's coming — years before it arrives.

What gets measured gets improved. Optimize with the foundation I write about every week on this platform:
Zone 2 cardio plus resistance training 3-4 times per week. High-protein whole-food nutrition. Sleep 7-9 hours — non-negotiable. Morning sunlight. Stress management. And the targeted supplements I've covered in detail — creatine, magnesium, CoQ10, D3+K2, glycine, omega-3, psyllium husk.
The breakthroughs coming in the next decade — gene editing for cholesterol, cellular reprogramming, senolytics that clear senescent "zombie" cells driving inflammation and aging, GLP-1 drugs rewriting metabolic medicine — will be most powerful for people who've already built the metabolic foundation to receive them.

The future of medicine is personalized. But it starts with knowing your numbers today. Print this list. Book the bloodwork. Own the data. Prevention isn't passive. It's the most aggressive thing you can do for the decades ahead.

[Sama Hoole @SamaHoole]

Every winter, millions of songbirds flee the northern cold for the olive groves of southern Spain. Robins, warblers, greenfinches: the birds Britain puts on Christmas cards. A great many are about to be processed. Here is how.

- Super-intensive olive farms now harvest at night, when the cool air keeps the oil's delicate aromas intact
- The harvesters work under banks of floodlights, which dazzle the roosting birds and pin them in the branches
- The birds do not flee. They sit there, blinded, and get hoovered straight into the machine along with the olives
- In Andalusia alone, researchers put the toll at around 2.6 million songbirds a year. Robins, warblers, greenfinches, wagtails
- Andalusia moved to curb the night shift. Portugal, Italy and France carry on, where nobody is rude enough to count

Olive oil sells itself as the wholesome fat, the Mediterranean secret the experts wave through without a flicker. The secret, it turns out, is a faint top note of British songbird, harvested fresh from the dark while it slept.

[Ruth @RuthBowyer1]

@SamaHoole @edgema I often wonder if genetic inheritance gets aligned with inherited eating habits.
2 very different things.

[Ruth @RuthBowyer1]

@SamaHoole Not sure. More disruption for UK.
Does anyone know what any contenders for the position stand for? Particularly AB.

[Sama Hoole @SamaHoole]

In 1967 India ran one of the most inconvenient heart studies of the century, almost by accident, and the field has been quietly looking away from it ever since.

Dr S.L. Malhotra had a researcher's dream sitting in front of him: the Indian railway workforce, well over a million people. Same employer. Same medical cover. Comparable pay and hours. Scattered the length of a subcontinent. Strip all of that out and one great variable remained. Diet, which in India meant geography.

In the north, in Punjab and Rajasthan and UP, the railwaymen ate the way their grandparents had. Ghee. Milk fat. Curd. As much as nineteen times more fat than their southern colleagues, and nearly all of it the saturated animal fat that Ancel Keys was at that very moment teaching the West to dread.

In the south the plate was rice, sambar, and seed oils, groundnut and sesame, with far less fat overall. By the brand-new rules being drafted in America, the southerners were the ones doing everything right.

Then Malhotra counted the bodies.

Heart disease deaths in the south: 135 per hundred thousand. In the ghee-soaked north: 20. Seven times the disease in the men eating the wholesome seed oils. Among the railway sweepers, the leanest and hardest-working of the lot, the gap yawned open to fifteenfold.

He chased down every other explanation within reach. Smoking ran the wrong way, the north smoked more. Activity gave no clean signal. Wealth made things worse if anything, executives dropping dead while the sweepers carried on. The one thing that tracked the dying was the fat in the pan.

It was published. Peer-reviewed. British Heart Journal, 1967.

It landed in the exact decade the West was pouring concrete around the opposite belief. Heart associations were prescribing vegetable oils. Factories were tooling up to turn them out by the tanker. A study showing the seed-oil eaters dying seven times faster was not a study anyone with a budget wished to repeat.

So nobody did. Almost sixty years on, the finding still stands, unrefuted and unloved.

It has never once troubled a dietary guideline.

[Ruth @RuthBowyer1]

@dr_balbin @protokolsuyu @SamaHoole Sorry, sill question.

[Ruth @RuthBowyer1]

@dr_balbin @protokolsuyu @SamaHoole Do you?

[Ruth @RuthBowyer1]

@dr_balbin @protokolsuyu @SamaHoole No, I don't. A sort of spiritual mix of things. As a child the lovely story of Christ was the norm. I still go along with those words. Someone wrote them. But the old testament and the Abrahamic religions revolt me.

[Ruth @RuthBowyer1]

@dr_balbin @protokolsuyu @SamaHoole Sorry, but any religion which follows that vindictive God has thrown out any reason. Pork or not. Whatever made the universe isn't concerned with a few on our planet.

[Ruth @RuthBowyer1]

@MRKOWALCZYK7 @SamaHoole Use the butter you ate yesterday?

[Ruth @RuthBowyer1]

@protokolsuyu @dr_balbin @SamaHoole Eh?

[Sama Hoole @SamaHoole]

They want to sell you meat grown in a steel tank, and they want you to believe it is the natural, clean, future-facing choice.

Here is what growing meat in a tank actually involves. You take animal cells, usually an immortalised line, which is a polite way of saying cells that divide forever in a way ordinary cells are not meant to. You feed them a broth of sugars, amino acids and growth factors inside a bioreactor that has to be kept cleaner than a hospital, because there is no immune system in the tank and a single stray bacterium turns the whole batch to soup. You do this at enormous cost, with enormous energy use, to produce a pale slurry that then has to be flavoured, coloured and bound into something a person will eat.

Meanwhile, a cow stands in a field. It runs on grass and rain. It carries its own immune system, it reproduces itself for free, it improves the soil it stands on, and it produces meat with no bioreactor, no growth factors, and no venture capital.

One of these is being marketed as the high-tech solution to the other.

They have it exactly backwards. The cow is the technology. It has been refined over forty million years and it still runs on weather.

The tank is the primitive option. It just has a better pitch deck.

[Ruth @RuthBowyer1]

White (refined) flour was used by the ancient Egyptians. It was reserved for the elite.

I wonder what ailments
They suffered from, apart from inbreeding.

The industrial era (19th C) brought in steel rollers so white flour available for the masses.

[Ruth @RuthBowyer1]

@SamaHoole @Andrews86495144 I wonder how much food we export?

[Sama Hoole @SamaHoole]

Quiet question. Who owns Britain now?

In 2023, around half of all UK farm sales went to non-farming buyers. The figure has been climbing since 2018, only easing in 2025 as the inheritance tax shock froze the market.

The new owners include:

Aviva Investors and Par Equity, who acquired 6,300 hectares of Aberdeenshire moorland at Glen Dye to plant trees and restore peatland against Aviva's own net zero target.

Brewdog, which bought the 9,300-acre Kinrara estate in the Cairngorms for £8.85 million, killed more than half its 100,000 planted saplings in year one, collected £690,986 in Scottish Forestry public grants, then sold the estate to Oxygen Conservation in October 2025 for the same price it paid.

Oxygen Conservation itself, which now controls over 20,000 hectares across 12 UK properties and plans to build a £1 billion offset portfolio before flipping the lot by 2030.

Multiple anonymous shell companies registered in Jersey and the British Virgin Islands, hoovering up upland sheep farms in Cumbria, Northumberland, the Borders, and the Highlands. Beneficial owners undisclosed. The UK has not produced a public register of agricultural land ownership. Successive governments have promised one. None have delivered.

The local livestock farmer cannot compete. A Welsh hill farm grossed £25,700 in 2023-24. A corporate carbon buyer can outbid them every time and write the cheque from petty cash.

The farmer is outbid. The farm is consolidated. The village empties. The press release talks about nature recovery.

The trees, in many cases, are already dead.

[Ruth @RuthBowyer1]

@JeremyClarkson @giveashitnature Maybe give it more time?

[Ruth @RuthBowyer1]

@SamaHoole Glad you mentioned that. Once every so often sounds good

[Ruth @RuthBowyer1]

Think it adds fat and flavour to meat which hasn't enough of its own. Much meat reared to meet lean requirements of the diet era.

[BB5 🇵🇹 ✨ @BullBoss5]

@SamaHoole Never cooked my steaks in butter. I don’t use anything, just a hot pan and the Maillard reaction. Does butter actually add something?

[Sama Hoole @SamaHoole]

Standard oncology advice to cancer patients: "Eat whatever you can keep down. Calories matter most. Don't worry about what's in it."

So cancer patients are blessed with:

- Ensure shakes (corn syrup solids, seed oils, maltodextrin)
- Hospital trays of refined carbs and margarine
- "Easy" comfort foods (crackers, pasta, white bread, jelly)
- Sugary drinks to "keep weight on"

Cancer cells preferentially run on glucose. They thrive in inflamed environments. Omega-6 from seed oils is one of the most inflammatory fuels in the food supply.

The advice is to feed the patient exactly what the tumour wants, in industrial quantities, while the chemo tries to kill it from the other side.

The metabolic literature on cancer has been growing for decades. Otto Warburg won the Nobel Prize in 1931 for the foundational observation. Modern research has built on it consistently.

Yet the nutritional protocol on the ward looks like the menu at a primary school in 1995.

The disconnect between what oncology knows about cancer metabolism and what oncology hands the patient on a tray is criminal.

A cancer diagnosis deserves better than a vanilla Ensure and a slice of toast.