Recovery line · hemodynamic + instrument correction · rev 7.10

Durable Day-Sheet · The Evening Unload

Actions are unchanged from rev 7.9. The reasons are not. The 90-day Clarity report is demoted to a weak prior — nothing here is gated on it. Every change below stands on the cuff, the 7/7 labs, pharmacokinetics, or anatomy. CGM validation card →

What changed from rev 7.9 — the evidence base, not the actions

The Clarity 90-day report no longer gates anything. Nine sensor sessions, each with its own unknown offset; ~63 manual calibrations on a factory-calibrated device; ~20% of days are warm-up or end-of-wear; the window holds two hospitalizations, a transfusion, NPO days, and three eating architectures. Hour-of-day means across that are a mixture, not a signal.
Retracted: the 5–7 PM hypo hour, the 2–6 AM minima, the "only hyperglycemic window," and "Jul 9 was your best day." Every one of those was a fine-grained read of an uncalibrated instrument. They were never load-bearing — and now they are gone.
Survives: across 180 days and two independent windows, GMI 5.7% and 5.8%, HbA1c 6.1%, C-peptide 2.1, and not one reading above 250. Under any plausible ±15 mg/dL bias you are not hyperglycemic. That is enough, and it is all that is claimed.
Gymnema — still removed, on nutritional and anatomical grounds now, not glycemic ones. See below.
Berberine — still held, on the cuff. The CGM leg of that argument is deleted; it was one of three, and the other two never needed it.
NEW · Urgent Low Soon is OFF on your G7. So is Falling Fast. That is device configuration, not measurement — immune to every objection above. The one predictive alert built for glucagon-deficient physiology is switched off. Fix it today →
NEW · Your BP stop rule is ambiguous and 7/16 is six days out. "Below 100/55" — is that and or or? Your documented postprandial is 115/50. Under or, you are already tripping it. Define it before you step up.
NEW · CGM rehabilitation protocol. Five days, ten paired fingersticks, zero calibrations. Then the sensor is an instrument again.
Unchanged: 8 PM + 8 AM BP slots · 1:30 PM extended to 7/30 · R-ALA un-dated · HMB split · Bilberry + Panax behind 8/1 · ProBiota stays at Meal 1.

Why berberine is held — rebuilt without the CGM

1 · The cuff. 39 Apple Health readings, Jul 4–8. Fasted 138/68. Postprandial 115–128 / 50–62. Berberine lowers BP ~3–5 mmHg. Your diastolic margin to your own stop rule is five points. Both doses bracket dinner — the one postprandial window with no reading at all — alongside theanine 200, taurine, Magtein, Mg, Holy Basil, on top of L-citrulline, during a telmisartan 40→80 step, at Hgb 8.3 / Hct 25.2, eleven days after syncope.

2 · Pharmacology. Broad-spectrum antimicrobial at SIBO-range dosing (500 mg BID–TID is the SIBO protocol), one day before ProBiota and three before MegaSpore. Its <1% bioavailability exists because it stays luminal; the remodeling is the mechanism. You cannot time-separate from a mechanism.

3 · It has no measurable endpoint. Not glycemic — the instrument is unvalidated. Not lipid — there is no lipid panel anywhere in your record. Berberine is currently running blind, into a hemodynamic risk window, during a five-variable week.

The Adderall rationale also inverts. With both IR doses held, XR-1 (6:30 AM) peaks ~1:30 PM and XR-2 (11:45 AM) peaks ~6:45 PM. 6:15 and 7:45 PM sit on the combined amphetamine peak of the day. And d-amphetamine t½ ≈ 10 h across two XR doses gives continuous coverage 6:30 AM → midnight — no waking hour separates them. Which is fine: that interaction (hepatic CYP2D6, in vitro, at concentrations oral berberine never reaches) was never the binding constraint. BP card →

Why gymnema is removed — rebuilt without the CGM

1 · Nutrition. Its primary consumer effect is sweet-taste suppression and appetite reduction. You are 22 days post-Frey, Hgb 8.3, total protein 5.5, globulin 1.5, albumin only just back to 4.0, running HMB specifically for anti-catabolism. An intake-reducing agent is working against your own recovery objective.

2 · Anatomy. Insulinotropic + SGLT1 inhibition, with C-peptide 2.1 (residual beta cells) and no alpha cells. Every glucose-lowering agent carries asymmetric risk in you — that follows from the necrosis, not from a sensor.

3 · Logic. It is dosed 7:45 PM to blunt "the carb load." Your 8 PM dessert is annotated light — Creon 1 cap, milk thistle. An SGLT1 inhibitor before a light dessert is doing nothing.

4 · Your own bar. Small, uncontrolled trials in T2D at A1c 8–9%. It is the weakest-evidenced compound in a stack held to NSF / USP / iTested / ISO-17025. It is also the only live compound with no entry on the gate board.

And under instrument uncertainty this argument gets stronger, not weaker: removing a glucose-active variable increases the interpretability of everything else in the cascade. Removal is free and reversible. Retention is not.

What the eating day looks like now

6:30 AM protein bite (Creon + fed Adderall anchor) · Meal 1 at noon · folded Meal 2 at 3 PM · dinner 6:30 · dessert 8 PM.

~Aug 1 is the last gate. Pending a positive Wancata check-in and draw, the 3 PM meal stays where it is and the day becomes canonical 12 PM–8 PM IF. Nothing else moves.

Single-variable rule still holds: each staged addition gets its own clean day. If a day isn't clean — new nausea, cramping, stool change, lightheadedness on standing — nothing new starts.

Telmisartan

40 → 80

Adderall

60 mg

BP log

5:55·1:30·8p

CGM gate

none

Omeprazole

→ 7/14

3 PM meal

→ 7/31

Cascade ahead — re-sequenced 7/10

~7/10 · ProBiota HistaminX — Meal 1, unchanged. The slot is clean now that berberine is out. Single-variable.

~7/11 · SPM Pro-Resolve — Dinner, fat-anchored.

~7/13 · MegaSporeBiotic — Dinner. Only after ProBiota tolerance. Spore-formers are the berberine-tolerant ones; ProBiota's vegetative strains were the vulnerable ones.

~7/14 · Omeprazole ends — rebound hypersecretion peaks over the following two weeks. This will do more to the probiotics than berberine ever would. Read tolerance across the transition, not into it.

7/16 · Telmisartan → 80 mg — only if both postprandial readings clear. 8:00 AM reading starts this day.

— · R-ALA (OptimALA) — un-dated. Gated on ferritin + iron saturation. ALA chelates iron; you are mid-erythropoiesis at Hgb 8.3. It is also a fasted 6 AM dose into a duodenum that bled twelve days ago, during acid rebound. Nothing is lost by waiting — NAC already carries the glutathione axis.

~7/19 · Lion's Mane / Erinamax · ~7/28 · Turkey Tail · ~8/5 · Cordyceps — mushroom track, unchanged. Protocol →

~8/1 · IF gate + draw — Wancata check-in. Bilberry and Panax GS15-4 both move behind this. Both are glucose-active; neither can get a clean CGM window while telmisartan-80, acid rebound, and probiotic establishment are all running.

~mid-Aug · Truvaga Plus — vagal stimulation lowers HR and BP. Correctly deferred. Morning fasted, never postprandial.

The CGM is not currently a competent gate. Four glucose-active reintroductions — R-ALA, Bilberry, Panax, Cordyceps — were each queued behind "its own CGM window." That instrument is unvalidated. Run the 5-day rehabilitation protocol first — stop calibrating, discard day 1 and day 10, ten paired fingersticks, establish the sign of the bias. CGM card → · NAC ramp: 1,200/day → +500 per clean 7-day step → 4,800; overnight bolus lands last; every addition stays ≥72 h from a step, and the 7/16 telmisartan step counts as an addition.

Still open — none of it blocks this sheet

UACR (urine albumin:creatinine). Add it to the ~Aug 1 draw. Microalbuminuria means RAS blockade is indicated regardless of what the cuff says.

Orthostatic vitals. Supine, then 1 and 3 minutes standing. Postprandial hypotension plus Type 3c is a screenable pattern and nobody has looked.

24-hour ABPM. Would settle the dose question in a day instead of two weeks. Needs an order.

Med reconciliation. The chart at both Virginia Mason and Providence says telmisartan 80 mg daily. You were taking zero, at 149/74 fasted. It was a perioperative hold nobody reconciled — not a discontinuation. Portal message to Dr. Kuhlman documents the hold and the 7/9 restart.

Ferritin + iron saturation — draw this week, do not wait for 8/1. It gates the iron-repletion decision at Hgb 8.3 / Hct 25.2, and it gates R-ALA. Iron is mucosally irritating into a healing duodenum; ALA chelates it. Two decisions, one tube.

Lipid panel + ApoB + Lp(a) — add to the 8/1 draw. There is no lipid panel anywhere in your record — not Oct '24, not Jan '26, not Mar '26, not 7/3 discharge, not 7/7. Berberine's best-evidenced indication is lipids, and that endpoint is completely uncharacterized in you. It is the only endpoint on which berberine can earn its way back.

PPI plan past 7/14. Sets the ulcer runway and the acid environment the probiotics land in. Rebound hypersecretion peaks in the two weeks after stopping.

These are a phone call, not a supplement question

Dark or tarry stool · visible blood · new dizziness · resting HR climbing · fever or rigors · any reading ≥180/120. Pause every addition and call the team. Clinical suspicion outweighs a normal WBC — your inflammatory markers run supplement-suppressed.