Troy Marcus

Just a Conservative in the medical field. Gods grace shed on thee. Emergency Medicine PA-C

[Squat University @SquatUniversity]

POV: you start doing reverse planks every day, and now your pelvic tilt is finally going away, your stomach looks flatter and you finally feel what targeting your deep core feels like too...

[Eric Smith @Eric_Smith08]

Amazon Prime costs $139/year.

Most members use 2 features: free shipping and Prime Video.

That's a $139 subscription doing the job of a $5.99 delivery fee.

J.P. Morgan estimates the actual value of Prime benefits at approximately $1,430/year more
than 10x the membership cost. But most of that value sits unclaimed behind tabs, menus,
and pages 200 million members have never opened.

And 4 of those benefits expire monthly. If you don't claim them by the end of the month,
they're gone. Amazon resets the clock. You paid for them. You lost them.

Amazon is counting on you not knowing.

Here are the 12 Prime benefits most members have never activated including the 4 that
vanish every 30 days 🧵

[Troy Marcus @troygem]

@Floridagirl0850 you must not have heard of direct primary care. We can probably do all of this for roughly the same price depending on the particulars.
i’m in the 850.
https://t.co/DJJUZxwxI4

[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.

[Andrew D. Huberman, Ph.D. @hubermanlab]

PEPTIDES MASTERCLASS. A must listen if you’re peptide curious, peptide skeptical, bullish on peptides, or anti. The science, the uses, sourcing, concerns, and much more. @AbudBakri thank you for such an informative discussion.

[Troy Marcus @troygem]

@RussellShaw_MLS @CoffeeBlackMD @DocAbirHealth This is what I do in Direct Primary care. Monthly membership. Visits are scheduled in one hour blocks of time. Personalized comprehensive primary care that is more than just a referral office.

[Anuj @anujcodes_21]

🚨 Anthropic just showed a 24-minute workshop on how to actually do prompts for Claude.

Taught by the people who built it.

Free. No registration. No paywall.

I've seen $300 courses that don't cover what they teach in the first 8 minutes.

Watch it and bookmark it now.

[Elie Jarrouge, MD @ElieJarrougeMD]

A bodybuilder tells you he eats 400g of carbs a day and he’s shredded and metabolically healthy.

So carbs can’t be the problem, right?

He’s missing something fundamental about his own metabolism that doesn’t apply to you.

🧵

[Manisha Mishra @manishamishra24]

A man spends 50 years teaching at MIT.

He knows his time is running out.

So he records one last lecture — everything he knows, distilled into a single hour.

He died 5 months later.

This is that lecture.

The most important hour you'll watch this week. 👇
Bookmark it for later

[CyrilXBT @cyrilXBT]

Anthropic pays engineers $750,000 a year to understand how AI models actually work.

Stanford just put the same knowledge on YouTube.

2 hours. Completely free.

This is the lecture that teaches you what most AI courses skip entirely.

Not how to use the tools.

Why they work the way they do.

The engineers who understand the why build things the people who only know the how cannot even conceive of.

The gap between those two groups is $750,000 a year.

You can close most of it in an afternoon.

Bookmark this before you scroll past it.

Watch it this weekend.

Not eventually.

This weekend.

[10Δ @_10delta_]

3 weeks ago I argued the US goal in Iran is to seize the global oil spigot. Venezuela in January -> Iran in February.

Neutralize every supply channel outside the dollar system within 90 days. Achieve a compliant successor government and complete energy dominance.

The oil thesis was the obvious layer. However, when you zoom out & view the last four years as a single sequence rather than isolated geopolitical events, the architecture of the grander US plan becomes visible.

1st was Europe, which laid the groundwork.

The Ukraine conflict provided the justification for sanctions that collapsed Russian pipeline gas from 150 billion cubic meters to 40.

Then Nordstream was destroyed, which rewired the entire European energy system permanently. The US went from supplying 28% of Europe's LNG in 2021 to 58% by 2025, exporting a record 111 million MTs, the 1st country in history to break 100 MT.

Europe was transformed from a customer with options into a captive market now purchasing its survival in USD.

2nd was Syria.

The fall of Assad severed the critical node connecting China's Belt & Road Initiative to the Mediterranean.

The trilateral railway linking Iran, Iraq & Syria, designed to bypass Western maritime chokepoints, was completely destroyed.

This isolated Iran geographically & cleared the path for what came next.

3rd was Venezuela.

In January the US effectively took control of the world's largest heavy crude reserves. The US Gulf Coast has the most advanced refining complex on earth, specifically built for heavy sour crude. Phillips 66, Valero & the rest are now positioned to process hundreds of thousands of barrels of Venezuelan crude daily.

The US captured a massive strategic reserve & solidified its position as the dominant exporter of refined petroleum products, an industry worth $110 billion in 2025 alone.

Venezuela & Iran were the two major oil supply channels that existed outside the dollar system. Both produce heavy crude sold primarily to China & evaded US financial supervision. Both now being neutralized within 90 days, which leads us to..

4th is Iran & the Middle East energy shock.

Israel struck Iran's South Pars gas field, the world's largest natural gas reservoir. Iran retaliated against Qatar's Ras Laffan, the single largest LNG facility on earth, responsible for a fifth of global supply. QatarEnergy's own assessment is that 17% of export capacity is gone and recovery will take up to 5 years. The Strait of Hormuz is closed. European gas prices spiked 70%. Asian spot prices doubled.

The only remaining scaled supplier? The United States.

If Iran falls & a successor government is installed that the US controls or influences (the Delcy model described weeks ago) then roughly 40 to 45 million barrels per day of global production out of 103 million is effectively under US control. OPEC becomes irrelevant because the US coalition is now the marginal producer. Now add the gas dimension & it goes beyond oil.

This war is solidifying the petrodollar system as it evolves into a hybrid petro/LNG-dollar. The old system was built on Saudi crude priced in USD. The new system is built on American crude plus American gas from the Gulf Coast, with no alternative supplier of comparable scale. The dependency is deeper because LNG infrastructure requires long term contracts & regasification terminals that lock buyers into supply relationships for decades. Europe & the Pacific allies (Japan, South Korea, Taiwan, etc.) cannot pivot away as there is nowhere left to pivot to. They're now locked into the US energy system.

The market confirms this. DXY went from 96 to 101. Gold down ~20% from its January all time high. Bitcoin down 20% on the year. Brent above $100. European & Asian institutions are liquidating precious metals and crypto to buy dollars because they need dollars to buy the only remaining scaled energy supply. The world is selling its gold to buy American energy in American currency. The dollar is now being weaponized through energy dependency.

The structural repricing is happening regardless of how the conflict resolves.

But the US grand strategy goes deeper..

Artificial intelligence is a physical industry. It runs on power and chips. Data centers require massive uninterrupted baseload electricity, primarily provided by natural gas. Semiconductor fabrication requires helium & rare earths.

By choking the Strait of Hormuz & crippling Middle Eastern LNG & helium production, the US is systematically degrading China's ability to power its data centers & fabricate semiconductors at scale.

The US is energy self sufficient, especially with newly captured Venezuelan reserves & expanding Gulf Coast capacity running on domestic gas.

On the other hand, China is import dependent & every joule it imports effectively now transits chokepoints the US Navy controls..

Iran was the Belt & Road's overland energy bypass, the corridor that allowed China to mitigate the Malacca Trap. With Iran neutralized that corridor is severed. China faces a world where its compute infrastructure competes for scraps on a depleted global LNG market, while American data centers run at full capacity on domestic energy.

Russia is next in the sequence. A post-war Iran reopening under US influence competes directly with Russia for the same refineries in China & India at lower cost. Iran's production costs are lower. Russia loses its last structural advantage in heavy crude & its economic lifeline. Additionally, under the Iran war cover, Ukraine has been opportunistically destroying Russian energy infrastructure & all signs point towards Russia being at the end of the line. The message from Washington becomes very simple: we dismantled two regimes in three months, your economy is about to get crushed, sign the Ukraine deal.

Then Trump sits down with Xi holding every card. Complete energy dominance. The hybrid petro/LNG-dollar fortified, Iran cleared, Russia cornered, & China facing the Malacca Trap fully closed with no remaining energy bypass.

Israel & the GCC are absorbing the kinetic cost of a conflict whose primary beneficiary, counter to the mainstream narrative, is actually America (First). Qatar offline for 5 years reprices the entire global gas market in favor of US exporters for the remainder of the decade. The Gulf states face years of rebuilding. Europe faces its 2nd energy crisis in four years.

Sure, the average American might face temporary moderate inflation & higher gas prices. But if you are the architect of the US empire & you view the rise of China & Chinese ASI as an existential winner takes all scenario, the collateral damage is acceptable cost.

Whoever controls the energy corridors controls the monetary system. Whoever controls the monetary system & the energy supply simultaneously controls the compute infrastructure that determines which civilization builds ASI first.

The US is seizing all 3.

[Troy Marcus @troygem]

@JimDrumheller @megbasham Jim’s profile page says it all. Gross

[Troy Marcus @troygem]

@Sunny333333333 @TheCoachMelShow @JohnMappin The letter states that there is a messaging problem by Israel, not an intention or action problem by Israel. Charlie was not in disagreement with Israel’s actions. He was making the case that they needed to make a better case to The American population for what they were doing.

[Melody Jennings @TheCoachMelShow]

@JohnMappin What Charlie’s actually said in May 2025…in writing.

[Troy Marcus @troygem]

@JacobEdwardInc If your engaged with your children and your home is sound. It's easier than you think.

[Melissa Tate @TheRightMelissa]

@IanCarrollShow There are ZERO Christian citizens in QATAR:

Tucker didn’t mention:
❌Christians r not allowed to be citizens in Qatar
❌Public display of crosses or Bibles is illegal & punishable w/ 7 years in prison

Why did Tucker omit these important details?

[Boring_Business @BoringBiz_]

This 40 minute lecture from Peter Thiel at Stanford will teach you more about business competition than a 2 year MBA program

[Mr PitBull Stories @MrPitbull07]

I drive Uber. Night shift mostly. Last week picked up an old man at 11 PM. He got in and said: "I need you to drive me to five places tonight. I'll pay you $500. Cash. But you can't ask why until we're done." Handed me five addresses. First stop: a house in the suburbs. He sat in the car. Stared at it for ten minutes. Crying silently. "Okay. Next one." I drove.

Second stop: elementary school. Empty. Dark. He got out. Walked to the playground. Sat on a swing. Stayed there twenty minutes. Came back to the car. "I taught here. 43 years. Best job I ever had." Third stop: diner. He went inside. Ordered coffee. Sat alone in a booth. Didn't drink it. Just sat. Looking around. Fifteen minutes. Came back. "My wife and I had our first date here. 1967." Fourth stop: cemetery.

He got out at the cemetery. Walked to a grave. Stood there. Talking to it. Couldn't hear what he said. Thirty minutes. When he came back his eyes were red. "My wife. Three years today." Fifth stop: hospital. He asked me to park. Wait. "This is the last one." He looked at me. "Now I'll tell you why. I have stage four cancer. Weeks left. Maybe days. Tonight I wanted to see my whole life. One last time. Before I can't anymore."

I started crying. Right there. "The house - that's where I raised my kids. The school - where I found my purpose. The diner - where I fell in love. The cemetery - where I said goodbye. And here. The hospital. Where I'm checking in tonight. Hospice floor. I'm not going home." He handed me $500. "Thank you for driving me through my life. You're the last stranger who'll ever be kind to me. I wanted it to be gentle. You made it gentle."

I refused the money. "I can't take this." He insisted. "Please. I have nobody to leave it to. My kids don't talk to me. I have no friends left. You gave me three hours of kindness. That's worth more than $500 to me." He got out. Grabbed his small suitcase. Turned back. "What's your name?" "Marcus." "Thank you, Marcus. For being the last good thing." He walked into the hospital. I sat in my car. Sobbing. For an hour.

Couldn't stop thinking about him. Went back next day. Asked for him. "Mr. Patterson. Room 412." Brought flowers. Knocked. He was in bed. Smiled when he saw me. "Marcus. You came back." "Couldn't leave it like that. Are you okay?" "Dying. But I got to see my life last night. So yes. I'm okay." We talked for two hours. About his wife. His students. The kids who stopped calling. The life he lived.

I visited every day for two weeks. Brought coffee. Read him the news. Sat in silence sometimes. He told me everything. The regrets. The joys. The moments he'd relive. "I thought I'd die alone," he said one day. "But you're here. A stranger who became family in my last days. That's a gift." I held his hand. "You're not dying alone. Not anymore." He cried. "Thank you for seeing me. When I was invisible."

Mr. Patterson died on a Tuesday. 3:17 AM. I was there. Holding his hand. His last words: "Tell people. Tell them to look at strangers. Really look. Everyone's dying. Some faster than others. But we're all heading somewhere. Be kind on the way. You were kind. You saved my last days." He closed his eyes. Heart monitor flatlined. I stayed another hour. Couldn't let go. He died with someone. That mattered.

His funeral had six people. Me. Three nurses. A lawyer. One former student who saw the obituary. That's it. A man who taught for 43 years. Loved a woman for 52. Lived 81 years. Six people. I spoke. "Mr. Patterson taught me something in his last two weeks.

Every stranger is someone's whole world. Every Uber passenger has a story. Every person you pass is living and dying and hoping someone sees them. He paid me $500 to drive him through his life. But he gave me something worth more. The knowledge that kindness to strangers isn't extra. It's everything. Because we're all strangers. Until someone stops. Looks. Listens. Stays." I keep the $500 in my glove box. Never spent it. It's a reminder.