UC professors are begging to bring back the SAT. They dropped it in 2020 for “equity.” Now their new students can’t do middle-school math. One in eight freshmen at UC San Diego place below middle-school level. Professors are reteaching fractions in engineering classes. High school 4.0s mean nothing when the kid can’t add ½ + ⅓. This is what happens when you replace standards with slogans. China doesn’t do equity cosplay. T hey run the gaokao and produce the talent. We lower the bar and wonder why we’re falling behind. Stop the BS. Reinstate the tests. Competence is not oppression.

The US Senate passed the Lindsey Graham Sanctioning Russia and Iran Act by a vote of 86-11. The core provision authorizes the President to impose targeted tariffs of up to 100% on imports from the five largest buyers of Russian crude oil or natural gas. The bill also extends Iran sanctions, keeping restrictions on Iran's energy and arms sectors from expiring by renewing the 1996 Iran Sanctions Act through 2031. I miss Lindsey Graham so much. Your spirit lives on, SIR!

(9/8) — THE THREE PATIENTS WHO CHANGED HOW I THINK I want to close with something I left out of the thread, because the science above is abstract until it happens to a person in front of you. The first was a man in his fifties who did everything right. Marathon runner. Perfect cholesterol. Never smoked. He had a heart attack in my hospital and looked at me and asked, "What did I miss?" We tested his Lp(a) afterward. Sky high — genetic, unchangeable by anything he ate or ran, and never once measured in five decades of medical care. He didn't miss anything. We did. That test costs almost nothing and one in five people are elevated. He is the reason I now tell everyone to get it once. The second was a woman in her forties, exhausted for years. Hair thinning, brain fog, no energy. Told repeatedly she wasn't anemic and was probably just stressed. Her ferritin had been low the entire time — and hemoglobin drops last, because your body drains its stores first to protect it. She wasn't anemic. She was profoundly iron-deficient. Those are different conditions, and one of them was being ignored because the flagged number looked fine. She got her life back in four months. And the third was a man who did everything wrong for thirty years and then stopped. Sixty-one, calcium score in the hundreds, terrified. He thought it was a verdict. It wasn't. We drove his ApoB into the fifties, treated the inflammation, fixed his sleep apnea, and put him in a gym. Two years later his repeat imaging showed the soft plaque shrinking and stabilizing into scar. He is seventy now and hiking with his grandchildren. That's what all of this is actually about. Not enzymes and vectors and neural implants — though those are coming, and faster than anyone in my field is prepared for. It's about the fact that the gap between what medicine already knows and what your doctor has time to tell you in seven minutes is where most preventable suffering lives. Closing that gap is the entire reason I write. I published the full manual today — the complete version, far deeper than this thread. The science of what's actually arriving, the traps that will cost you money and possibly your health, and the full protocol: exercise, nutrition, sleep, stress, supplements, the exact labs to demand, and the words to say to your doctor when they push back. Read it here: It's free. No paywall. No supplement line. No affiliate links. Nothing to sell you — just a cardiologist writing what I'd want my own mother, my own father, and my own children to know, including the inconvenient parts and the parts my profession gets wrong. Subscribe and you'll get all of it: cardiology, cancer screening, hormones and midlife, metabolic health, bone and muscle, and the frontier research most people don't hear about until it's already standard of care. And send this to the person who just got a scan and doesn't know what to do next, or the one who was told "everything looks normal" and had no idea what to ask. Those four words have cost more lives than almost anything else in medicine.

Many of the loser children of my wealthy friends who see no way to emulate the success of their parents, have gravitated toward Mamdani-ism and found community and a sense of purpose by rejecting capitalism as a way to cope with their own failure. Please note they have nor however rejected their trust funds or living subsidies while pursuing their “passions” in NGOs, dabbling in the arts or trying to invest their parents money in “VC”.

Hasan Piker urges his audience to assassinate senators: “If you cared about Medicare fraud, you would kill Rick Scott.” In a sane world, campaigning with him would be disqualifying. Apparently just not in Michigan.

I'm a cardiologist. Curcumin may be one of the most legitimately promising anti-inflammatory compounds available — and the exact form that works best is the one with documented cases of liver injury. That tension is the whole story, and almost nobody tells it honestly. Let me give you both halves. First, why the form matters more than the compound. Standard turmeric and cheap curcumin are almost pharmacologically useless. Absorption is dismal, the liver metabolizes it within minutes, and blood levels barely register. Most people taking turmeric capsules are essentially taking an expensive yellow placebo. Phytosomal curcumin — curcumin bound to phospholipids, the best-studied being Meriva — changes that completely. A randomized crossover trial in the Journal of Natural Products found 29-fold higher total absorption compared to standard curcuminoids. That single fact explains why decades of curcumin research looked underwhelming. We were testing a molecule that never reached the bloodstream. What the absorbed form actually does. It works upstream, at the genetic level, by downregulating NF-κB — the master switch controlling inflammatory gene expression. Downstream of that: reduced TNF-alpha, IL-6, and COX-2. TNF-alpha is the one I find most interesting. It's a central driver of "inflammaging" — the chronic low-grade inflammation that accelerates biological aging. It's the same target as the TNF-inhibitor drugs used in rheumatoid arthritis, which observational data has linked to substantially lower Alzheimer's risk. Lowering TNF-alpha through a supplement is not the same as a biologic drug. But the pathway is real, and it's the right pathway. The human evidence that impressed me most. This isn't cell culture. In a multicenter randomized trial, 52 biopsy-proven MASH patients received Meriva 2g/day or placebo for 72 weeks. Biopsy-proven. Seventy-two weeks. That's a serious trial design for a supplement. Additional randomized trials in NAFLD have shown reductions in ALT, AST, cholesterol, triglycerides, waist circumference, and liver volume. As a cardiologist, that matters — fatty liver and cardiovascular disease share the same metabolic root, and ALT is one of the most underread markers on a standard panel. Now the part the enthusiasts leave out. The NIH's LiverTox database documents several dozen cases of clinically apparent acute liver injury attributed to turmeric products — and it specifically implicates the high-bioavailability forms. There was an outbreak of acute hepatitis with jaundice in Italy traced to enhanced-absorption curcumin. Sit with the irony: the reason these formulations work is the same reason they can hurt you. You made a poorly absorbed compound highly absorbed. You did not merely increase the benefit. You increased the dose the liver actually sees. A genetic susceptibility has been identified — an HLA variant that appears to predispose certain people. Most will never have a problem. Some will. And a note on piperine. Many products add black pepper extract to boost absorption. It works — by inhibiting the liver enzymes that clear the compound. That same mechanism affects how your liver clears your other medications. If you take anything metabolized hepatically, this matters. Meriva achieves its absorption through phospholipids rather than enzyme blockade, which is one argument in its favor. So where do I land? This is one of the few natural compounds with genuine randomized human data hitting a mechanism that matters. I take it seriously. But treat it like a drug, because pharmacologically that is what an enhanced-absorption formulation is. Get a baseline ALT and AST before starting, and recheck at 8-12 weeks. That single step converts an unmonitored risk into a managed one, and virtually nobody does it. Skip it entirely if you have existing liver disease, gallbladder disease, or bile duct obstruction. Curcumin stimulates gallbladder contraction and can worsen biliary colic. Be cautious if you're on blood thinners — it has antiplatelet effects. And stop immediately for dark urine, yellowing eyes, right upper quadrant pain, or unexplained fatigue. The lesson underneath this is bigger than curcumin. We've been trained to believe "natural" means "safe," so we skip the monitoring we'd never skip with a prescription. But a supplement engineered for 29-fold absorption isn't a spice anymore. It's pharmacology in a capsule with no oversight. The compound may genuinely help you. Just check your liver while it does.

People ask me almost every day, "What magnesium should I take?" The truth is that there is no single "best" magnesium—only the one that best matches your body's needs. Magnesium isn't one supplement. It's a family of compounds, and each one behaves differently. Choosing the wrong form can leave you disappointed, while choosing the right one can improve sleep, calm anxiety, support heart health, boost energy, relieve constipation, reduce muscle cramps, or even sharpen cognitive function. That's why understanding the different forms matters. Magnesium glycinate is my favorite all-around choice for most people because it's well absorbed and gentle on the stomach, but it isn't the answer for every situation. Citrate, malate, threonate, taurate, chloride, and oxide each have unique strengths and specific uses. Spend two minutes learning the differences, and you'll likely make a better decision than the vast majority of people buying magnesium off the shelf. Your body deserves more than guesswork.

BONUS POST (13/12) — THE FIVE TESTS THAT AREN'T BLOOD, AND MAY MATTER MORE Everything above happens in a tube. These happen outside it — and for predicting how long you'll live, several of them beat anything on your lab report. VO2 max. Cardiorespiratory fitness may be the single strongest predictor of all-cause mortality we've ever measured. The Cleveland Clinic study of 122,000 adults found the least fit had 4-5x the death risk of the fittest — with no upper limit of benefit. Being in the bottom quartile for your age carries mortality risk comparable to smoking. Men over 40 should target above 40 ml/kg/min, women above 35. Measure it once a year. Coronary calcium score. Cheap, ten minutes, low radiation. It looks directly at your arteries instead of estimating risk from a calculator. But know the trap: zero calcium does not mean zero plaque. In the PROMISE trial, 25% of people who had a major cardiac event had a score of zero — because soft, rupture-prone plaque is invisible to it. Zero score plus real risk factors? Ask about CT angiography with AI plaque analysis. Grip strength. Thirty seconds, a $30 dynamometer, and it predicts all-cause mortality, cardiovascular death, and cognitive decline. It's a proxy for total-body muscle and neurological integrity. Track it yearly — the direction is what matters. A sleep study. If you snore or wake unrefreshed, get tested. Untreated sleep apnea drives hypertension, atrial fibrillation, insulin resistance, inflammation, and low testosterone. Treating it can improve nearly every marker in this thread at once. And the free one: home blood pressure. A $40 cuff. Morning and evening, seated quietly five minutes, arm at heart level, back supported. Office readings mislead in both directions — white coat hypertension and masked hypertension are both real, and both are missed by a single hurried reading. One more, calculated for free: PhenoAge biological age uses nine markers you probably already have — albumin, creatinine, glucose, CRP, lymphocyte %, MCV, RDW, alkaline phosphatase, and white count. Plug them into a free online calculator with your real age. The gap between the two numbers is the most honest scorecard you'll ever get. Your birth year is fixed. Your biological age is not. I wrote the complete guide to all of this — every test, every target, how to prepare, how to read your results, how to build the panel by budget, and the exact words to say when your doctor pushes back. It's free. No paywall. Nothing to sell you. Subscribe there and you'll get everything I write — cardiology, hormones, metabolic health, cancer screening, bone, longevity, and the frontier research most people never hear about until it's already standard of care. Written the way I'd want it written for my own family, including the inconvenient parts and the parts my profession gets wrong. And send this to the person who was just told "everything looks normal" and didn't know what to ask next. That sentence has cost more lives than almost anything else in medicine.

BONUS POST (13/12) — THE FIVE TESTS THAT AREN'T BLOOD, AND MAY MATTER MORE Everything above happens in a tube. These happen outside it — and for predicting how long you'll live, several of them beat anything on your lab report. VO2 max. Cardiorespiratory fitness may be the single strongest predictor of all-cause mortality we've ever measured. The Cleveland Clinic study of 122,000 adults found the least fit had 4-5x the death risk of the fittest — with no upper limit of benefit. Being in the bottom quartile for your age carries mortality risk comparable to smoking. Men over 40 should target above 40 ml/kg/min, women above 35. Measure it once a year. Coronary calcium score. Cheap, ten minutes, low radiation. It looks directly at your arteries instead of estimating risk from a calculator. But know the trap: zero calcium does not mean zero plaque. In the PROMISE trial, 25% of people who had a major cardiac event had a score of zero — because soft, rupture-prone plaque is invisible to it. Zero score plus real risk factors? Ask about CT angiography with AI plaque analysis. Grip strength. Thirty seconds, a $30 dynamometer, and it predicts all-cause mortality, cardiovascular death, and cognitive decline. It's a proxy for total-body muscle and neurological integrity. Track it yearly — the direction is what matters. A sleep study. If you snore or wake unrefreshed, get tested. Untreated sleep apnea drives hypertension, atrial fibrillation, insulin resistance, inflammation, and low testosterone. Treating it can improve nearly every marker in this thread at once. And the free one: home blood pressure. A $40 cuff. Morning and evening, seated quietly five minutes, arm at heart level, back supported. Office readings mislead in both directions — white coat hypertension and masked hypertension are both real, and both are missed by a single hurried reading. One more, calculated for free: PhenoAge biological age uses nine markers you probably already have — albumin, creatinine, glucose, CRP, lymphocyte %, MCV, RDW, alkaline phosphatase, and white count. Plug them into a free online calculator with your real age. The gap between the two numbers is the most honest scorecard you'll ever get. Your birth year is fixed. Your biological age is not. I wrote the complete guide to all of this — every test, every target, how to prepare, how to read your results, how to build the panel by budget, and the exact words to say when your doctor pushes back. It's free. No paywall. Nothing to sell you. Subscribe there and you'll get everything I write — cardiology, hormones, metabolic health, cancer screening, bone, longevity, and the frontier research most people never hear about until it's already standard of care. Written the way I'd want it written for my own family, including the inconvenient parts and the parts my profession gets wrong. And send this to the person who was just told "everything looks normal" and didn't know what to ask next. That sentence has cost more lives than almost anything else in medicine.