Recovery line · hemodynamic correction · rev 7.9

Durable Day-Sheet · The Evening Unload

The everyday sheet from 7/10 through 7/31. Gymnema is out, berberine is held, and the dinner postprandial window is finally monitored. The 3 PM meal holds until ~Aug 1, when this collapses to canonical IF.

What changed from rev 7.8

Gymnema 400 mg — removed. Zero time-above-range across 90 days of CGM. No target. An SGLT1 inhibitor with insulinotropic activity, dosed at the entrance of a 16-hour fast, in a man whose alpha cells are gone. Its second job — sweet-taste and craving suppression — runs directly against protein-priority recovery at Hgb 8.3.
Berberine 275 × 2 — held. Not on bleeding grounds. On hemodynamic grounds. It is modestly hypotensive (~3–5 mmHg), and both doses bracket the one postprandial window nothing was watching. It is also a broad-spectrum antimicrobial landing on top of the probiotic reintroduction.
New · 8:00 PM BP reading. Ninety minutes after dinner. The dinner window carries five hypotensive agents; the noon window carries none. You were monitoring the wrong meal.
New · 8:00 AM BP reading, from 7/16. Telmisartan and citrulline peak together at 7:30–8:30 AM — fasted, upright, unmonitored. That window doubles on 7/16.
1:30 PM reading extended through 7/30 — not "through 7/15." Monitoring must not stop the week the dose doubles.
R-ALA un-dated. Its only gate was "the 7-day berberine CGM window," which no longer exists. It also collided with the 7/16 telmisartan step under your own ≥72 h rule. Now gated on ferritin + iron saturation.
HMB 3 g split → 1.5 g × 2 (Meal 1 + Meal 2). GI tolerance and calcium load per sitting in a post-Frey gut. Low-stakes; confounds nothing.
Bilberry + Panax moved behind the 8/1 draw. Both glucose-active. Their CGM windows cannot read cleanly against telmisartan-80, omeprazole rebound, and probiotic establishment at once.

The finding that drove this rev

The gate board sorts every compound by bleeding risk or CGM attribution. Berberine is neither. It is a blood-pressure agent, and nothing in the protocol classified it that way.

Between 6:15 and 8:45 PM rev 7.8 stacked berberine × 2, L-theanine 200, taurine 1.3 g, Magtein 1 g, Mg 200, and Holy Basil — on top of dinner splanchnic pooling, on top of L-citrulline, on top of a >35 mmHg documented postprandial fall, while stepping telmisartan 40 → 80, at Hgb 8.3 / Hct 25.2, eleven days after syncope.

Your diastolic margin to the stop rule is five points — 50 against 55. Berberine's effect size is 3–5.

And across 90 days of CGM: 0% time high, 0% very high, GMI 5.8%, average 102. The glucose-lowering layer has no target left. Its only remaining effect is to draw down hypoglycemia margin — the one account Type 3c cannot refill. Full BP card →

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

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.

Retarget the CGM gate. Every staged item is annotated "its own CGM window." Those windows are being read for hyperglycemia, and you have none. Watch %Low and absolute minimum in the 2–6 AM band, and %Low in the 5–7 PM band. Nothing else. · 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.