MKD @ 127.0.0.1 2x💉 🍉

Speaker 🎙️@mozTechSpeakers • Security 🤓 • ❤️ ✈️🚞🚝 • Gamer 🎮 • ❤️ to 🔨things to 👷 again • He / him

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

Mastodon account - @[email protected]

When the time comes!!!

[TheLiverDoc™ @theliverdoc]

Do make this your #mustread

I was interviewed as an international expert and my work on alternative medicines featured for @SciDevNet by @lolacometa on this very important global problem.

Other experts featured include Mario Chávez (of Mexican College of Rheumatology), Fernando Bessone (liver toxicity, of LATIN-DILI) and María Victoria Urrea (of INVIMA).

In this investigative health feature about so-called "natural" products across Latin America (with comparisons from India) — supplements and herbal remedies sold as natural, curative, or preventive, the central finding is that many of these products are not really natural at all: they are frequently adulterated with hidden pharmaceutical drugs, contaminated, or unlabeled, and they are causing real, sometimes fatal, harm to people who trust the word "natural" to mean "safe."

The piece is anchored by a human tragedy: Patricia Vela's father in Mexico died after months of taking AK-Forte (secretly containing diclofenac, dexamethasone, and methocarbamol), which caused multi-organ damage. A second case involves a Peruvian woman left incontinent after coffee enemas promoted on social media caused severe inflammation of the rectum and anal canal.

Regulation is weak and inconsistent - like India's Ayush. Because these aren't classified as medicines, pre-market safety and efficacy testing isn't required, good manufacturing practices are voluntary or loosely enforced, and pharmacovigilance is almost nonexistent.

Be better informed and do not fall for alternative medicine claims.

Please read: https://t.co/6sx4D9T8wI

[TheLiverDoc™ @theliverdoc]

Dear friends, if you were unable to read the review/interview of my book and work with The Indian Express, here is it is!
Please take a moment out of your time and read this beautifully written reflection on my book, The Liver Doctor: Stories of Love, Loss and Regeneration.

[Sparsh Agarwal @sparshselim]

The Age of AI demands planetary-scale Carbon Dioxide removal.

@AltCarbonIndia is using volcanic rock dust to geochemically pull carbon out of the atmosphere — and we just proved it works at scale. The world's largest issuance of carbon credits through Enhanced Rock Weathering.

~10,000 tonnes of CO₂ removed. Enough to offset a small AI data centre.

India has a history of scientific breakthroughs that stun the world — across medicine, space exploration, energy, & financial inclusion.🇮🇳

Climate Change is the most significant existential threat to our species. It demands Himalayan Ambitions.

We're moving mountains to make that happen. Literally.

[Telangana Weatherman @balaji25_t]

People, please try to understand the meaning of these terms in the forecasts which I share

👉 ISOLATED STORMS - Rains in 0-25% of areas
👉 SCATTERED STORMS - Rains in 25-50% of areas
👉 FAIRLY WIDESPREAD STORMS - Rains in 50-75% of areas in the forecast
👉 WIDESPREAD STORMS - Rains in 75-100% of areas

Without understanding these meaning in the forecast, please don't put replies that it's not raining in my area, your forecast is wrong

[TheLiverDoc™ @theliverdoc]

Dear friends, here is the full interview/podcast I had with India Today for Doctor vs. Internet.
https://t.co/YhoIXw6B0b
Please watch and let me know your thoughts. This had nothing to do with my recent debut book release and discussion, but was more of a surprise hot seat and roasting session. It was taken in good spirits and the outcome is there for all to see. This is ballistic, #mustwatch.
Hope we all learn some good take-aways from this.

In this episode we cover:
✅ Is Ayurveda scientific? The truth about the ₹3,992 crore Ayush ministry budget
✅ Fatty liver disease — causes, grades, reversal, and what your ultrasound actually means
✅ Alcohol and liver damage — why WHO says there is NO safe level
✅ Vitamin D, Omega-3, Biotin, Ashwagandha — take it or trash it?
✅ Protein powders — which ones are safe and which cause liver failure
✅ GLP-1 drugs (Ozempic/Semaglutide) and liver disease
✅ Poop transplant (FMT) — the groundbreaking treatment saving dying patients
✅ Why Huberman and wellness influencers are dangerous
✅ Doctor mental health, burnout, and the hidden cost of practising medicine in India
✅ How to keep your liver healthy for the next 20 years
And why Liver Doc refuses to debate Fittr Jitendra Chouksey and Dr. Pal.

[Telangana Weatherman @balaji25_t]

Do's and Don'ts during HEATWAVE

STAY ALERT, STAY SAFE ⚠️🙏

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@theliverdoc @HarperCollinsIN Doc, schedule for Hyderabad.

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@ivanburazin Reach destination by evening/night. Have little food, shower and off to sleep. Helps a lot, wake up and get going.

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@nixxin Try uncensored models. They work a lot faster and also don’t break down for long, complex tasks.

[TheLiverDoc™ @theliverdoc]

Very happy to share our paper which took a long time to prepare. This is the largest single center series on adult patients with DENGUE infection which provide new insights on related liver clinical outcomes published in @PLOSONE
https://t.co/QBf78H0daZ

Here is what we found, in plain language:

The first evidence of the "Obesity Paradox" in a tropical virus: We first demonstrate that having a fatty liver (steatotic liver disease) paradoxically gives patients a survival advantage when infected with a tropical virus like Dengue.

Liver based outcomes: Unlike earlier research that often grouped all liver issues together, this study specifically separated patient outcomes into three distinct categories: pre-existing chronic liver disease (CLD), non-CLD steatotic liver involvement, and no liver involvement.

Development of a new clinical tool: We created the Dengue Severity Risk Score (DeSRS), a novel and simple scoring system that predicts mortality risk using only four basic parameters routinely available at a patient's bedside.

Chronic liver disease is extremely dangerous: While a simple fatty liver was protective, having long-term, severe liver damage (like cirrhosis) was very dangerous. Patients whose livers were already dysfunctional before they got Dengue had a drastically higher risk of dying.

A standard protein test is the best warning sign: Measuring "albumin"—a common protein found in the blood—was the single most powerful way to predict if a patient was going to survive. Low levels of albumin strongly signaled that the patient was in severe danger.

Standard ICU scores need updating for Dengue: The standard scoring system doctors use in the ICU for serious infections (called SOFA) does not work very well for Dengue patients. A different system, called SAPS-3, is much more accurate at predicting who will survive and should be the preferred tool.

A specific "Red Flag" number: If a routine blood test shows that a liver enzyme called "AST" has spiked over 1,000, it is an absolute emergency. More than half of the patients who hit this number did not survive, meaning anyone reaching this level needs immediate intensive care.

Disease severity, not chronological age, drives outcomes. This means an 80-year-old with classical dengue and normal albumin doesn't need automatic intensive monitoring, and a 30-year-old with hypoalbuminemia and NLR 8 does.

We discovered four patient phenotypes with very different fates: Mild-Classical (3% mortality), Thrombocytopenic-Leak (5% mortality), Inflammatory-Systemic (11% mortality, defined by NLR ≥8), and Fulminant (100% mortality). The inflammatory cluster is the one most likely to benefit from immunomodulation.

Things are getting worse over time. Severe dengue more than doubled (19% → 47%) and mortality quadrupled (1.6% → 6.8%) from 2021 to 2024

The DeSRS bedside score [severe dengue {2} + albumin<3.5 {4} + NLR≥4.8 {2} + De Ritis≥2 {2}] have a 17-fold mortality gradient from low-risk (1.8%) to very-high-risk (≥6 points: 30.6%) using only four routinely available parameters. Needs external validation, but it's deployable today.

The forgotten complications worth screening for: secondary hemophagocytic disorder (ferritin >3,535 ng/mL is your trigger), acute kidney injury (creatinine >1.5: 26% mortality), and dialysis requirement (universally fatal in this cohort).

Bottom line: in a hospitalized dengue patient, three numbers tell you most of what you need — albumin, NLR, and AST. Add the dengue classification and the De Ritis ratio and you have the score. The presence of a fatty liver report shouldn't worry you; the presence of decompensated cirrhosis should.

Many thanks to my research team for their painstaking data collection work!

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@LisaForteUK Sorry for your loss, it’s always hard loosing a parent 💙.

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@tweepul @gauravsabnis @Loquacious_Lion Felt summer and cold winters in EU travels. Netherlands summers does seem mild but there are not. Sweden, Brno winters are chilly asf. Forgot hand warmers and couldn’t feel them within 10-15 while travelling 😅.

[TheLiverDoc™ @theliverdoc]

The longevity supplement industry is a $70+ billion scam. Here's what decades of published data actually show extends human life. and what doesn't.

The "anti-aging" supplement market is built on mouse data, not human data.
The global anti-aging and longevity wellness industry was valued at over $77 billion in 2024 (Global Market Insights). Not a single pill sold in it has been shown to extend human lifespan in a randomized controlled trial.

NMN: promising in mice, unproven in people.
Animal studies show NMN raises NAD+ and extends lifespan. The best human trial so far (Yi et al., GeroScience 2023) showed NMN safely raised blood NAD+ levels but did not produce a statistically significant improvement on the 6-minute walk test versus placebo. No human trial has tested whether NMN extends life, prevents disease, or slows aging.

Resveratrol is the cautionary tale of modern longevity science.
GSK bought Sirtris (by David Sinclair) the company built around resveratrol and sirtuin activation, for $720 million in 2008. Independent labs at Pfizer and Amgen later challenged the original in vitro assays (from David Sinclair) that launched the field. GSK shut the program down in 2013. No resveratrol-based drug has ever been approved.

"NAD+ boosters" sell a half-truth.
Yes, NAD+ declines with age. No, artificially raising blood NAD+ has not been shown in any rigorous human trial to extend life, prevent major disease, or slow biological aging. The marketing skipped the hard part.

Collagen, multivitamins, turmeric, ashwagandha, sea moss, apple-cider-vinegar gummies: no mortality data.
No randomized trial has shown any of these reduce death, dementia, heart disease, or cancer. Supplements survive regulatory scrutiny only because in India and the US, they are treated as food, not medicine, and require no efficacy proof.

Every "longevity influencer" has something to sell. Check who owns stock, who endorses which brand, who profits from the supplement they just recommended. Skepticism of the person is as important as skepticism of the product.
🫀
Now, what actually extends human lifespan, with hard data:
Your aerobic fitness (VO2max) is the strongest modifiable predictor of longevity known. In 122,007 adults (Mandsager et al., JAMA Network Open 2018), low cardiorespiratory fitness carried death risk comparable to or greater than smoking, coronary artery disease, or diabetes. Each 1 ml/kg/min gain in VO2max translated to roughly 45 additional days of life in a 46-year follow-up (Clausen et al., JACC 2018).

Muscle strength independently predicts survival.
The PURE study of ~140,000 adults across 17 countries (Leong et al., Lancet 2015) found every 5 kg drop in grip strength = 16% higher all-cause death. Grip strength was a stronger predictor of mortality than systolic blood pressure. Resistance training 2–3×/week is not optional after 40.

The Mediterranean diet has the strongest trial evidence of any eating pattern.
The "revived" PREDIMED trial (Estruch et al., NEJM 2018, n=7,447) showed a Mediterranean diet with extra-virgin olive oil or nuts cut major cardiovascular events by ~30% compared with a low-fat diet. No supplement has ever matched this in a trial.

Sleep 7–9 hours. Get snoring evaluated.
In the Wisconsin Sleep Cohort (Young et al., Sleep 2008), untreated severe obstructive sleep apnea tripled all-cause mortality, rising to 3.8× when CPAP users were excluded. A CPAP machine has more mortality evidence behind it than every bottle in your supplement cabinet combined.

Social connection is a medical variable, not a mood. A meta-analysis of 148 studies and 308,849 people (Holt-Lunstad et al.) found strong social ties were associated with 50% higher odds of survival - an effect size comparable to established mortality risk factors. The 2023 US Surgeon General's Advisory called loneliness a public health threat.

Don't smoke. Lose the alcohol. Keep blood pressure, LDL/ApoB, and HbA1c under control. Unglamorous, unpatentable, and responsible for almost all of the life-expectancy gains of the past century. No longevity clinic will ever market these to you because there is no margin in them.

The one newer intervention with genuinely surprising data: the shingles vaccine. A natural-experiment study in Wales (Eyting et al., Nature 2025) found the live shingles vaccine was associated with a ~20% reduction in 7-year dementia risk. A separate analysis of the recombinant vaccine (Taquet et al., Nature Medicine 2024) showed a 17% increase in dementia-free time. If you are 50+, ask your doctor.

The honest summary.
A multi-billion-dollar industry is selling hope in capsule form. The real longevity protocol is boring, mostly free, and unpatentable: move hard, lift heavy, eat real food, sleep well, stay connected, skip the bottle, take your vaccines. If someone tells you otherwise, check what they're selling.

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@gethackteam There are still some phpBB forums out there even today 😁

[TheLiverDoc™ @theliverdoc]

Coffee is one of the only drinks with strong evidence that benefits the liver. Here's what decades of research actually says about how to drink it right:

Coffee genuinely lowers liver disease risk.
Meta-analyses show regular drinkers have about 35% lower risk of significant liver fibrosis and nearly 50% lower risk of liver cancer compared with non-drinkers.

Aim for 2–3 cups a day, minimum.
The effect is dose-dependent. The Hepatology socities such as AASLD and EASL says 3 or more cups daily is reasonable for liver benefit, if you tolerate it.

Caffeinated works better than decaf.
But decaf still helps.
Caffeine blocks adenosine receptors that drive liver scarring. Decaf lowers chronic liver disease risk too, just by a smaller margin (UK Biobank, n=494,585).

The target dose: ~300 mg caffeine/day, or 3 cups.
Fibrosis protection kicks in around the 75th percentile of intake, roughly 308 mg caffeine, or 2.25 cup equivalents, per day - the AASLD 2023 advises 3+ cups for liver benefit.

What a "cup" actually means
One standard cup = 240 ml (8 oz), not a 60 ml tiny Indian "cup." A 240 ml filter coffee has ~95–165 mg caffeine. A single espresso shot (30 ml) has only ~60–75 mg.

Coffee-to-water ratio: 1:15 to 1:17.
For filter/drip/pour-over: 15 g of ground coffee to 250 ml water. This is the standard brewing ratio and gives clean extraction of chlorogenic acids and caffeine.

Choose medium roast, not dark.
Medium roast has significantly higher chlorogenic acid (CGAs) content than dark roast. Dark roasting thermally degrades CGAs, the main antioxidant doing liver work.

Arabica beats Robusta.
Arabica beans are richer in CGAs and polyphenols, the antioxidants doing most of the liver-protective work.

A note here:
Arabica for polyphenols, Robusta for caffeine.
Arabica (1.5% caffeine) has more CGAs and polyphenols. Robusta (2.7% caffeine) has more caffeine but a cruder phenolic profile. A 70:30 Arabica-Robusta blend is a reasonable compromise.

Water temperature: 92–96°C.
Just off a rolling boil. Too hot (>96°C) burns the grounds and extracts bitter compounds; too cool (<90°C) under-extracts CGAs and caffeine.

Grind size matters.
Medium grind (table-salt texture) for filter/drip. Coarse for French press. Fine for espresso. Brew time: 3–4 minutes for pour-over, 4 minutes for French press, 25–30 seconds for espresso.

Filtered coffee is the safest daily choice.
Paper filters trap cafestol and kahweol, naturally present plant diterpenes that raise LDL cholesterol if consumed daily in large amounts. Pour-over (V60, Kalita, Melitta) or drip machines with paper filters give you CGAs and caffeine without the cholesterol penalty.

Espresso and French press: fine, but not unlimited.
They retain more polyphenols but also more diterpenes (so more chances of increased lipids). Great occasionally; don't make them your 5-cups-a-day default if you have high cholesterol or heart disease.

South Indian filter coffee: acceptable, with caveats. The metal filter does not remove diterpenes as well as paper, so limit to 1–2 cups/day if you have dyslipidemia. The decoction itself is rich in CGAs. Use less sugar. Skip condensed milk.

BUT ULTIMATE: Drink it black. Or close to it.
Sugar, syrups, flavored creamers and whipped cream cancel the liver benefit, especially if you already have fatty liver, diabetes, or obesity. Skim milk or unsweetened plant milk is fine.

Instant coffee: still works.
UK Biobank (n=494,585) showed instant coffee drinkers had similar reductions in chronic liver disease as ground coffee drinkers. Not as potent, but far better than no coffee.

Cold brew: underrated for the liver.
Medium roast + coarse grind + 6–7 hours at room temperature extracts CGAs and caffeine efficiently with lower bitterness. pH and CGA content are comparable to hot brew.

Timing.
Spread across the day. one at breakfast, one mid-morning, one early afternoon. Stop by 2 pm if you have insomnia.

It helps across almost every major liver disease.
Evidence supports benefit in fatty liver (MASLD), alcohol-related liver disease, hepatitis B and C, cirrhosis, and liver cancer.

The mechanism isn't magic, it's chemistry.
Chlorogenic acid cuts oxidative stress and liver fat. Caffeine inhibits stellate cell activation (that promotes scarring or fibrosis). Melanoidins and polyphenols reduce inflammation.

Who should go easy.
Pregnancy, children, those with uncontrolled heart rate and rhythmn issues (arrhythmias), panic disorder, or insomnia.

And no, coffee does not undo a bad diet or bad choice - such as alcohol, herbal supplement or that Ayurvedic "liver tonic."

Sources: Modi et al., Hepatology 2010; Kennedy et al., BMC Public Health 2021 (UK Biobank); Fuller & Rao, Sci Rep 2017; AASLD MASLD Clinical Care Pathway 2023; EASL 2016 CPG, Frontiers in Nutrition 2026 (Italian coffee cohort).

[TheLiverDoc™ @theliverdoc]

The liver's best friend is the muscle. Your liver listens to your muscles. Every type of movement has a different dose and a different benefit, all backed by trials. Here's the playbook, for you to include in your routine, whichever helps you maintain consistency.

Brisk walking
The most accessible liver medicine there is. 150 min/week cuts liver fat by ≥30% on MRI, and every extra 1,000 daily steps lowers your risk of developing fatty liver by ~12% (UK Biobank Study, 91,000 people).

Moderate-intensity cardio (MICT)
Steady jogging, cycling, or swimming at a "can talk, can't sing" pace. 30–45 min, 3–5 days a week for 12 weeks reduces liver fat by 2–4% (absolute) and drops liver inflammation (enzyme levels) significantly - even without weight loss.

High-intensity interval training (HIIT)
Short hard bursts - e.g., 4 minutes at 85–95% max heart rate, 3 min easy, repeated 4 times. In 12 weeks it cuts liver fat by 16–37%, improves heart function, and matches steady cardio in half the time.

Sprint interval training (SIT)
Even shorter, even harder - sessions under 15 minutes. 6 weeks reduces intrahepatic triglycerides by 12% and visceral fat by 17% in men with fatty liver (MASLD). Biggest liver benefit for the smallest time spent.

Resistance / strength training
Weights or bodyweight - squats, presses, rows, pulldowns. 3 sets, 3 times a week, 40–45 min. Reduces liver fat independent of weight loss, uniquely lowers liver enzyme, and is the single most important exercise for cirrhosis patients to prevent muscle loss (sarcopenia).

Combined aerobic + resistance
The gold standard. Network meta-analyses rank this combination as #1 for improving triglycerides, LDL, and total cholesterol in patients with fatty liver (MASLD) - better than either alone. If you only pick one strategy, pick this one.

Yoga (Hatha / Surya Namaskar) - these are not classical Yoga, but modernized versions.
For example: Surya Namaskar was developed into its current 12-posture sequence in the early 20th century, largely by the Raja of Aundh and later popularized by T. Krishnamacharya. T. Krishnamacharya also modernized classical Hatha Yoga into its globally known "dynamic" form. Classical Yoga is not useful for liver health as it is not aerobic. Plus classical Yoga is pseudoscientific in its principles of practice.

That said, 8-12 weeks of Asanas like Surya Namaskar, Ardha Matsyendrasana, Paschimottanasana, Naukasana - 3 sessions/week improves liver tests, insulin resistance, and fatty liver grade - especially in patients with type 2 diabetes plus fatty liver disease.

Pilates and core work
8 weeks of Pilates reduces body weight, body fat, liver enzymes, and liver fat on ultrasound. A joint-friendly option for people who can't run or lift heavy.

Tai Chi / Qigong
Low-impact mind-body movement, 30–60 min, 3 times a week. Improves glucose control, insulin sensitivity, and balance/ stability, muscle tone. Gentle enough for older patients, those with early decompensated cirrhosis, or people with poor cardiorespiratory fitness.

Exercise in cirrhosis
Even advanced liver disease responds well to exercise treatment! Combined aerobic + resistance training cuts serious events (death, major complications) from 12.3% to 5.6% in randomized trials, and prevents the muscle wasting that drives death events in cirrhosis patients.

So make physical activity your number one preference to maintain liver health and reduce liver disease.

[TheLiverDoc™ @theliverdoc]

Today is World Liver Day 2026.
Here are 8 things your liver actually wants you to know.

1
There is no such thing as a "liver detox."
Your liver runs phase I and II detoxification 24/7 on its own.
No juice cleanse, no milk thistle, no herbal detox speeds this up.

In fact several have caused liver injury - the opposite of the claim.

2
Alcohol has no safe dose.
Liver harm begins from the first drink.
The old "moderate drinking is protective" myth came from flawed studies contaminated by abstainer bias - now debunked by Mendelian randomization.

Zero ml is best.

3
"Natural" supplements are now a leading cause of acute liver failure.
Ashwagandha. Green tea extract. Garcinia. Kratom. High-dose turmeric. Giloy/Tinospora.
They dominate drug-induced liver injury registries across India, the US, and Europe.

Natural ≠ safe.

4
Coffee is genuinely liver-protective.
2–3 cups/day (caffeinated or decaf) lowers the risk of fibrosis, cirrhosis, and liver cancer.

One of the very few dietary interventions with real, replicated evidence.

5
Fatty liver (MASLD) now affects ~1 in 3 adults worldwide.
A 7–10% body-weight loss:
• clears Liver fat
• reduces inflammation
• can regress early fibrosis

No approved drug currently beats this. Your plate and feet are the first-line therapy.

6
Sugar-sweetened drinks independently cause fatty liver.
Fructose is metabolized almost entirely by the liver - straight into fat.
One daily soda raises MASLD risk even after adjusting for total calories.
Lesser is better.

7
Get vaccinated against hepatitis B. Get screened for HBV and HCV at least once in your lifetime.
HBV vaccine prevents >95% of chronic infection, cirrhosis, and liver cancer.
Hepatitis C is curable in 8-12 weeks with >95% success - but most carriers don't know they have it.

8
Exercise protects the liver independent of weight loss.
150 min/week moderate OR 75 min vigorous activity reduces liver fat and stiffness - even when the scale doesn't move.

Movement is "medicine".

🫂

PS: we also need a liver emoji

[MKD @ 127.0.0.1 2x💉 🍉 @decode_dev]

@nixxin Would suggest @regolo_ai. Multi-model and works with OpenCode.

[TheLiverDoc™ @theliverdoc]

Whey protein does not damage kidneys.

[TheLiverDoc™ @theliverdoc]

It is COVID only. We have collective and selective amnesia about that little f*cker.