Recovery line · rev 7.18

Durable Day-Sheet · rev 7.18

rev 7.18 · zero doses changed from 7.16. Codifies the 7/18 botanical re-audit + the 7/19 Perplexity refinements — reasoning, reconciliation, and precision. The supplement layer is your call (the team is consulted only for clinical facts they hold and prescribed-med changes). The schedule below is 7.16’s. Prior context: that rev moved doses — mushroom ladder now live (Erinamax + Lion's Mane ×2), L-theanine restructured to 1,100 across the day, Synapsa consolidated, Magtein dual-form, omeprazole finished. Telmisartan holds at 40 (step gated on the 8/1 draw). The old single-variable "freeze" is retired as a hard rule — the principle stands, multi-variable changes are a judgment call now. CGM card →

What changed — rev 7.18 (7/19): reasoning re-audit + framing · zero doses

🧭 Framing recalibrated + Schrader precision (7/19 Perplexity pass). The reflexive “your decision” gate on supplement decisions is removed — the supplement layer is your call; the team is consulted only for clinical facts they hold (labs, healing, imaging) and prescribed-med changes. And Schrader/Meier 2009 is recharacterized as a distinct, mass-mediated mechanism (alpha dysfunction secondary to beta-cell loss after 50% resection), not corroboration of Kumar’s mass-independent Frey finding — Kumar carries the demotion. Everything below still holds; zero doses.
🩸 C-peptide reconciled 2.1 → 1.4. The 2.1 cited throughout was the June 2025 value; the current figure is 1.4 ng/mL (fasting, June 11 2026, ref 1.1–4.4) — still in range, nearer the floor. The draw was one week pre-Frey and a single fasting C-peptide is glucose-dependent, so read it as “still retained, nearer the floor,” not a precise delta.
🔬 Anatomy argument demoted. A Frey-specific study (Kumar 2018, PMID 30029953) found beta-cell function unchanged at 3 months but alpha-cell function deteriorated post-op — spared mass ≠ preserved function. Demoted to directionally reassuring, not dispositive; the 180-day zero-confirmed-hypo record carries the falsification, not anatomy.
📏 C-peptide measurement rule. A single fasting C-peptide entangles secretory mass and demand, and a sensitizer can move it either way — never adjudicate a glucose-active agent on C-peptide alone; track fasting insulin + HOMA-IR alongside. “Restore toward 2.1” is retired — the ceiling is protecting residual function.
🧪 R-ALA: IAS contingency. Alpha-lipoic acid carries one documented hypoglycemia mechanism — insulin autoimmune syndrome (Hirata), sulfhydryl-triggered, with high, not suppressed, C-peptide/insulin. Rare, HLA-linked, and you tolerated ALA >1 yr without it, so a contingency (draw anti-insulin antibodies if an unexplained symptomatic low with high C-peptide occurs), not a new hold. The iron gate never addressed it.
🌿 Gymnema & berberine re-scoped (NOT-LIVE, post-8/1, your call). The hypoglycemia caution was over-imported from total-pancreatectomy/insulin-dependent “brittle T3c” literature and doesn’t fit this phenotype. Gymnema returns as a candidate because its removal rationale evaporated (not for systemic benefit); berberine has the strongest independent systemic case and its gates are BP/anemia, not hypoglycemia. Chromium stays out; Panax held on evidence weakness + species mismatch.
🔬 8/1 draw gains fasting insulin + HOMA-IR + a first post-Frey C-peptide. The .md is the source of truth; this sheet is a rendering of it.

Prior — rev 7.16 (7/18): doses moved

🍄 Mushroom ladder live — Erinamax 500 mg (6 AM) · Lion’s Mane 500 mg ×2 (6:30 AM + 3 PM). L-theanine 600 → 1,100 mg/day across 7 doses · Synapsa 320 → 360 mg single AM cap · Magtein dual-form (667 cap / 833 powder ×3) · Vitamin E ≤400 → 200 IU.
Omeprazole discontinued — one 40 mg bottle, finished as prescribed; the 40→20 taper floated earlier was never prescribed, now removed.
The “freeze” retired as a hard rule (principle stays as guidance) · 4 PM-pressor analysis removed everywhere.

Berberine — held on BP/anemia, not glucose (re-audit)

The re-audit’s verdict first: berberine is the strongest independent systemic case of the held agents — lipid, AMPK, gut-microbiome, anti-inflammatory, all documented separately from any glucose effect. Its hold is hemodynamic and anemia-driven, not hypoglycemia. The gates (lipid panel · ABPM · Hgb ≥10 · ARB stability · probiotics established) are all BP/anemia/attribution gates — so the reintroduction question is “when is the BP and anemia picture characterized,” never “is this too glucose-lowering.” rev 7.18: ≥72 h from any telmisartan change — berberine has its own BP-lowering, so keep it clear of the ABPM/telmisartan-step read.

The hemodynamic gate, concretely. 39 Apple Health readings (Jul 4–8): fasted 138/68, postprandial 115–128 / 50–62. Berberine lowers BP ~3–5 mmHg, and your diastolic margin to your own stop rule is five points. Both doses bracket dinner — the one postprandial window with no reading — so ABPM comes first.

The probiotic-timing gate. Broad-spectrum antimicrobial at SIBO-range dosing (500 mg BID–TID is the SIBO protocol); its <1% bioavailability is why it stays luminal and remodels the microbiome. You cannot time-separate from a mechanism — so it waits until ProBiota/MegaSpore attribution closes.

And the endpoint has to exist. There is no lipid panel anywhere in your record — berberine’s best-evidenced systemic indication is completely uncharacterized in you, so the 8/1 lipid draw is what gives the reintroduction something to read. The old Adderall/berberine CYP2D6 worry was never binding (a hepatic in-vitro finding at concentrations oral berberine never reaches); it was never held on glucose or on that. BP card →

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/berberine interaction was never binding — and matters even less now. With Adderall back to the full 70 mg (IR at 6:30 AM + 4:00 PM), d-amphetamine covers 6:30 AM → midnight continuously; no waking hour separates it from the 6:15/7:45 PM berberine slots. That never mattered: the CYP2D6 interaction is a hepatic in-vitro finding at concentrations oral berberine never reaches systemically. Berberine stays held on hemodynamics, not this. BP card →

Gymnema — removal rationale largely superseded (re-audit)

The re-audit’s verdict first: the hypoglycemia-risk logic that removed gymnema was over-imported from total-pancreatectomy/insulin-dependent “brittle T3c” literature that doesn’t fit this phenotype (retained C-peptide, non-insulin, 180 days zero confirmed hypos, endo endorsement). The glucagon-impairment premise it rested on is UNMEASURABLE, with the behavioral record running against it. So gymnema is now a post-8/1 single-variable candidate — but it returns on “the reason to hold it evaporated,” not on systemic benefit: its non-glycemic effects (appetite, modest lipid) are weak and downstream of the glucose action.

The one caveat that survives — independent of the glucose logic — is nutritional: gymnema’s primary consumer effect is sweet-taste/appetite suppression, and at 25 days post-Frey with Hgb 8.3, total protein 5.5, and HMB running for anti-catabolism, an intake-reducing agent worked against the recovery objective. A recovery-window concern, not a hypoglycemia one — and it softens as protein/recovery normalizes.

Why chromium is not in the same boat. Chromium is also gate-free in reasoning, but for the opposite reason: gymnema’s removal premise is now defunct; chromium’s efficacy evidence is self-contradictory across equal-sized RCTs. Different failure modes — not an inconsistency. Chromium stays out; gymnema comes back to the candidate list.

What the original removal got right, narrowly: gymnema was the weakest-evidenced compound in a stack held to NSF/USP/iTested/ISO-17025 (small T2D trials at A1c 8–9%, none in T3c), so it should return as a clean single variable with a real endpoint — 2 weeks paired CGM (once validated) + fructosamine — not on faith. Removal was free and reversible; reinstatement is a decision, not a default.

1 · Nutrition. Its primary consumer effect is sweet-taste suppression and appetite reduction. You are 25 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 1.4 (residual beta cells; alpha mass largely spared, body/tail — though rev 7.18 notes alpha-cell function can worsen post-Frey). 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. rev 7.18: the re-audit finds this removal rationale over-imported from brittle-T3c literature that doesn’t match you — gymnema is now a post-8/1 single-variable candidate, your decision. See the change list above.

Cascade ahead

~7/21 · ProBiota HistaminX — Meal 1. Deferred past the omeprazole stop (7/14), so tolerance reads across the acid rebound, not into it. The one addition standing before 8/1. Single-variable.

~post-8/1 · SPM Pro-Resolve — Dinner, fat-anchored. Slid past the 8/1 draw.

~8/5 · MegaSporeBiotic — Dinner. After ProBiota tolerance and the 8/1 draw.

~8/1 · Telmisartan → 80 mg (gated, not dated) — steps only if the 8/1 draw clears: Hgb ≥10, Na workup + UACR back and clean, postprandial margin intact. Dose it in the evening then. Draw not clean → keep holding.

— · R-ALA (OptimALA) — un-dated. Gated on Ret-He + TSAT — NOT ferritin alone. correction: this sheet previously read "ferritin + iron saturation," which the master regimen explicitly contradicts — ferritin is an acute-phase reactant ~4 weeks post-op and will falsely reassure. It is also a fasted 6 AM dose into a duodenum that bled, during acid rebound. The meter-validation gate is CLEARED (FDA K181070: BG5S + EGS-2003 = Hct 20–60%; in range at 25.2). Iron is now the ONLY measurement gate — draw requested 7/22–26. Honest note: human evidence that oral ALA meaningfully chelates iron is thin; the real cost of going early is attribution, not safety.

🍄 Lion's Mane / Erinamax — LIVE (~7/19) · ~8/8 · Turkey Tail · ~8/19 · Cordyceps — mushroom track. 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." The meter is IN RANGE and the protocol is UNBLOCKED — run it now, not at Hgb 10. FDA K181070 (BG5S + EGS-2003, glucose dehydrogenase) labels Hct 20–60%; you are at 25.2. This sheet's old "delay until Hgb ≥10, or source a meter validated to ≤20%" escape hatch was already satisfied — you own one. Run the 5-day rehabilitation protocol now — 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; spacing additions out keeps reactions attributable — a guideline now, not a hard rule.

Still open — none of it blocks this sheet