Pagination Imagination

For millions of people managing type 2 diabetes, mornings begin the same way — a needle, a dose, and a quiet mental note to do it all again tomorrow.

That routine just changed.

On March 26, 2026, the U.S. Food and Drug Administration approved Awiqli (insulin icodec-abae), developed by Novo Nordisk, as the first and only once-weekly basal insulin ever approved for adults with type 2 diabetes in the United States.

This is not a minor update to an existing drug.

It is the first entirely new class of basal insulin to reach U.S. patients in more than two decades.

Instead of injecting insulin every single day, people with type 2 diabetes using Awiqli will only need one shot per week, on the same day, every week.

That means reducing from 365 injections a year down to just 52.

For anyone who has ever felt the weight of that daily ritual — the anxiety of forgetting, the physical discomfort, the constant reminder that their body needs help — this approval represents something much bigger than a dosing schedule.

It represents relief.

How the Drug Actually Works

Understanding why this injection lasts a full week requires a quick look inside the body.

Most traditional basal insulins are absorbed into the bloodstream and begin breaking down within 24 hours, which is why patients need a fresh dose every day to maintain stable blood sugar levels.

Awiqli works differently.

Its active ingredient, insulin icodec-abae, is engineered to loosely attach to a blood protein called albumin, which is found naturally and abundantly in the bloodstream.

This attachment creates a slow-release reservoir.

Instead of flooding the system and fading fast, the insulin releases gradually and consistently over an entire seven-day period, keeping blood sugar in a healthy range around the clock...

The FDA reviewed and ultimately declined to approve it for people with type 1 diabetes, citing concerns about a modestly increased risk of hypoglycemia in that population specifically.

Some regulatory agencies in other countries, including the European Union, Canada, Australia, and Japan, have approved Awiqli for both type 1 and type 2 diabetes, but for now the U.S. approval is limited to type 2...

What Comes Next

Awiqli is not standing alone in this space for long.

Eli Lilly is developing its own once-weekly basal insulin, called efsitora alfa, which is currently in late-stage clinical trials.

If that drug also earns FDA approval, it would give patients and doctors two once-weekly options to choose from, allowing for personalized decisions based on a patient’s health profile, insurance coverage, and individual response.

The broader direction of travel in diabetes care is unmistakable.

Fewer injections, smarter formulations, and better integration with digital tools like continuous glucose monitors and insulin-tracking apps are all converging toward a future where managing diabetes requires less daily mental effort without becoming any less medically precise...

A Small Shot With Large Implications

It is easy to look at a once-weekly injection and see only a scheduling change.

But the science behind Awiqli, the scale of the ONWARDS trials, and the consistent satisfaction reported by patients all point toward something that matters far more than convenience.

Diabetes management has always asked a lot of people.

It asks for daily vigilance, daily discipline, and a daily willingness to confront one’s own condition, sometimes in uncomfortable or inconvenient circumstances.

Anything that reduces that load, without reducing the quality of care, is worth taking seriously.

For the more than 37 million Americans living with diabetes, and the hundreds of millions more around the world, a simpler weekly routine could mean the difference between a treatment plan that works on paper and one that actually works in a person’s life.

That is the real significance of what the FDA approved on March 26, 2026.

Not just a new drug.

A new way of keeping people healthy, one week at a time.

Navigating gender dysphoria? Be heard and be counted in the science.

[pt: DO NOT TAKE THIS SURVEY]

Because it's not like you had to pay them, so once your family owned someone, they owned them and their descendants indefinitely. Could you pay and eventually free em- sure! You could also send them anywhere you want for any labor you want, could have an enslaved woman bred for more children, or maybe save up and buy new slaves and sell the old. Like cattle (thus, chattel slavery).

So it's interesting that many people go "oh well it's not like my family owned slaves!" Because like, one, how do you know that? Have you ever actually asked your grandmas about their grandmas? How many of your family members grew up with mammies? Have you ever asked? I wonder how many people have actually done the digging for the truth (or was it easier to just benefit). Because I've talked to my grandma, who picked cotton in the sea islands. She had to have been doing that for someone in the 1930s and 40s!

WARNING: This story contains details of experiences at residential schools (and SA if you click read more).

Roberta Hill remembers being sent to the Mohawk Institute Indian Residential School in Brantford, Ont., when she was six years old. Although she attended with five of her siblings, including her youngest sister, they were separated upon arrival. "I never saw her again for years after," Hill said. "She was my favourite little sister. So that was the start of the separation and the trauma." Hill, who is from Six Nations of the Grand River near Hamilton, was part of a group of residential school survivors who gave witness testimony to the Permanent Peoples Tribunal in Montreal on Tuesday.

Read more.

Tagging: @newsfromstolenland

A national 24-hour Indian Residential School Crisis Line is available at 1-866-925-4419 for emotional and crisis referral services for survivors and those affected. 

The European Union already forced Apple to abandon its proprietary charging port and adopt USB-C across its entire iPhone lineup. It just did something bigger. A new EU mandate requires every smartphone sold in Europe including Apple devices to feature a battery that can be replaced by the user without specialist tools, without voiding a warranty, and without sending the device to a manufacturer approved service center. Batteries must maintain a minimum capacity threshold after a set number of charge cycles and replacement parts must remain available for up to ten years after a model goes on sale.

The consumer electronics industry built its current business model around batteries that degrade, cannot be replaced at home, and create a natural upgrade cycle every two to three years. The EU just legislated that model out of existence in the world's largest regulatory market.

Apple, Samsung, and every other manufacturer now faces a choice between redesigning their devices for the European market or accepting that their current hardware architecture is no longer legally sellable there.

The FBI cut the phone lines during the 1977 disability rights sit-in. Then they turned off the hot water.

They locked the doors from the outside. One hundred and fifty people were trapped on the fourth floor. Half of them used wheelchairs. The government assumed they would leave.

Kitty Cone was thirty-three. She had muscular dystrophy. Her muscles were failing, but her logistics were flawless. She knew how to organize people.

The federal government had promised to sign regulations protecting disabled Americans from discrimination. The policy was known as Section 504. They printed the promise on paper. Then they stalled. Without a signature, it was just typography.

The protesters entered the regional Health, Education, and Welfare building in San Francisco on a Tuesday morning. They took the elevators to the director's office. They brought sleeping bags and catheters. They informed the staff they were not leaving until the law was signed.

By sunset, the police surrounded the exits. Kitty sat near the windows. She organized the floor plan. She assigned committees for security and sanitation. She kept her medication in a small cooler.

According to federal memorandums released decades later, the strategy to end the occupation relied on medical attrition. The building was not equipped for long-term habitation. The FBI calculated that a population requiring ventilators, specialized diets, and daily medical aides would voluntarily evacuate if the environment became sufficiently hostile. They instituted a blockade.

The blockade went into effect immediately. No food deliveries allowed. No medical supplies permitted through the lobby. Guards stood at the main doors checking identification.

Kitty's muscles deteriorated faster under the physical strain. She couldn't walk. When the phone lines went dead, the fourth floor lost contact with the press. The government waited for the quiet.

Kitty dropped to the floor. She realized the barricades were designed for standing adults. The police had blocked the hallways at waist height. They hadn't blocked the linoleum.

The floors were covered in cigarette ash and spilled coffee. She dragged her body through it. She crawled under the barricades to reach the restricted elevator shafts and unguarded offices.

She carried notes in her pockets. She found a single working payphone the FBI missed. She called the local news desks. She called the mayor's office.

She crawled back. When her arms failed, someone pulled her by her ankles. The Black Panthers heard the news reports. They crossed the police lines with hot meals. The FBI could not stop them without a riot.

They shut off the elevators, so she crawled.

The occupation lasted twenty-five days. It remains the longest non-violent occupation of a federal building in American history. On April 28, the Secretary of HEW signed the regulations without a single alteration.

The protesters left the building the next morning. They went back to their apartments. The Rehabilitation Act regulations laid the groundwork for every accessibility law that followed. The HEW building still stands on United Nations Plaza. The elevators run on a schedule. The doors are heavy glass.

Kitty Cone: the woman who crawled under the barricades.

Source: Kitty Cone's oral history, Bancroft Library.

Verified via: National Museum of American History.

And the people commenting similarly, in a lot of cases, are witnessing that suffering and saying, quite fairly, "that's great and all but I'm not forgiving you." And that's fine, and honestly in some ways they shouldn't because this is not the sort of thing you can get absolution or meaningful forgiveness for from randos on the internet.

But forgiveness and absolution are not something you earn. There is nothing you can do that will guarantee you forgiveness. The people you hurt may or may not ever choose to forgive you, and you need to be okay with that. That shouldn't have any bearing on whether you try to be a better person.

part of autism is just being incredibly stressed. overstimulation? stress. holding a conversation? stress. something happening to our schedule? stress. people talk about how often autism is recognized and diagnosed via our stress responses (like meltdowns) because it is just so common to see autistic people stressed because of lack of accommodations to how our brains work.

like. loud noises physically hurt. it’s like a static shock from my ears to my spine that doesn’t stop until the volume goes back down. i thought we all agreed that ‘that’s too loud!’ and covering our ears meant ‘ouch!’. turns out i’ve been dealing with a stressor almost no one else has, my whole life, alone.

ASU study finds data centers warming nearby neighborhoods

By Steven Sarabia

Published: May 19, 2026 at 10:16 PM MST

PHOENIX (AZFamily) — A new study from an ASU professor finds data centers aren’t just powering the internet; they may be turning up the heat in nearby neighborhoods.

Researchers tracked temperatures around four large data centers in the East Valley and found communities downwind are a couple of degrees warmer than other neighbors.

David Sailor, the lead researcher and director of ASU’s School of Geographical Sciences and Urban Planning, said in some neighborhoods downwind of these facilities, temperatures ran about one to two degrees Fahrenheit hotter than areas upwind. In the most extreme cases, temperatures were as much as four degrees hotter.

carbon emissions put out by lawn mowers (and other devices like leaf blowers). Lawn mowers produce significantly more greenhouse gases per hour of use than cars, and majorly contribute to smog.

Fertilizers get into bodies of water and cause algae blooms, converting all the diverse water plants to homogenous green slime.

Pesticides kill fireflies, bees, and all sorts of other beneficial insects, and many can kill or harm fish, birds and even humans.

Herbicides can have negative effects on the wrong targets too, but they are also causing common agricultural weeds to evolve resistance faster, increasing our dependence on pesticides.

Watering lawns does waste a lot of fresh water.

Lawns replace areas that once could have contained 100+ plant species with monocultures of frequently invasive species. Butterflies can't find host plants this way. Bees can't find food. Thousands of insect species rely on specific plants for food, and no other plant will do. A huge amount of the land is taken up by these wastelands.

Lawns also create dead, compacted, lifeless soil that is hard to grow other things in or near. The root systems of turf grasses are not robust enough to allow water to penetrate in. No matter how much nitrogen and phosphorous you dump on a lawn, it will still be lacking in the organic matter needed to create lush, absorbent dirt.

Dirt is supposed to be full of fungal mycelium. Scientists have discovered recently that the vast majority of all plant species are dependent on a network of symbiotic fungi attached to their roots for 80% of their phosphorous needs and 90% of their nitrogen needs.

Yes, this means that when you put a fungicide on your lawn, you've just nerfed that plant's ability to absorb nutrients by up to 90%. And you've also devastated its ability to absorb water, because plants are partly dependent on their fungi to get water out of dirt.

But fungicide isn't the only problem. Every plant in a natural environment is attached to multiple species of fungus, and most fungi are attached to multiple species of plant (though some are specialists). Trees literally use this system to send nutrients to other trees. We discovered recently that trees in deserts in California can survive extreme drought because they're attached to fungi that can break down rocks and extract water from the rocks.

If you don't have a good variety of plant species and rotting leaves and sticks and stuff, it doesn't matter how much fertilizer you put on it, your soil isn't "healthy" because it's not alive.

Vegetation that has been cropped extremely short doesn't hold in water, so a heavily maintained lawn is likely unnaturally dry for your climate, and a flower or bush in the middle of a lawn without tall grasses, shrubs and weeds nearby is getting pounded by the sun much harder than it's meant to handle.

Yeah, gardening isn't hard, most native plants are falling all over themselves to grow, it's just that the standard suburban backyard is ridiculously hostile to life.

Of course at this point you may be wondering

"What do I do instead?"

Well, here you go:

Stop weeding, spraying and fertilizing. Seriously. Stop it!! Stop it!! Chemical intervention in your lawn traps you in a vicious cycle of creating problems that need to be solved with more chemicals.

"Weeds" are a perfect example. Plants commonly considered "weeds" are adapted to take over areas that have been cleared out of other plants. Many "weeds" are actively harmed by the fungi that other plants depend on, meaning they can ONLY thrive in disturbed or devastated areas. The harder you work to eliminate biodiversity in your yard, the harder nature is going to bomb your yard with weeds.

By the way, google the "soil seed bank." Seeds can stay dormant in soil for years or even decades. If you want a "weed-free" lawn, get ready to apply herbicides for the rest of your life.

Mow less often. You really can't go wrong with this one.

Don't try to grow grass where grass doesn't want to grow. Lots of shade? Try moss. Extremely dry? Try drought-adapted plants. See what wants to grow there and let it do its thing.

It's fine to have a lawn area that you actually use. But if no one walks or plays on a stretch of your lawn, it should be something else. A wildflower patch, a stand of prairie grasses, some large shrubs, a grove of trees.

By the way, the idea that shrubs or flower beds are higher maintenance than lawns is wrong. The neat thing about native species is that once they've gotten settled, you literally just do nothing.

People think flower beds are high maintenance because people almost always underpopulate them. They think that there should be big spaces of mulch in between each plant. In a full sun flower bed that's actually filled to capacity, you shouldn't be able to see the ground. If your plants aren't babies anymore and there's still space, more plants.

if you live in an area that was once forest, PLEASE, plant some trees, and not just one tree. Trees are somewhat like guinea pigs, actually, they don't want to be alone. They send each other nutrients through their roots and screen each other from wind damage.

By the way, the "mature spread" of a tree as told on websites means when you plant it by itself. Trees can generally be planted 6-10 feet apart and be perfectly happy, they'll just grow taller and straighter instead of spreading out. (Look at pictures of forests.) HOWEVER large trees like large oaks should really be 25+ feet from structures and septic tanks

(Trees pop up by themselves in lawns. Constantly. Search for them in a woodland biome and you will likely find baby oaks and maples and other cool guys.)

Trees introduce competition for light into the areas you plant them, helping eliminate the "weeds." You know how fast your lawn grows up and gets weedy when you don't mow it? Yeah, that's partly because it's getting a CRAP TON of sunlight dumped on it with reckless abandon.

Because lawns are such hard packed earth with a very thin layer of greenery and roots on, they are TERRIBLE at rain absorption and cumulatively a suburb full of lawns WILL flood more often and/or quickly than one with more 'natural' gardens like those derin has described

Lawns are also more prone to erosion because the root systems of turf grasses, as mentioned, are terrible at infiltrating deep into the soil, so don't hold it together the way a more robust and complex root system would

Okay. Here's the deal.

Don't do anything.

If you have enough spoons, great! Go outside and check to see if you find invasive plants. If you do, try to get rid of them by pulling them out. But honestly, if you just...don't do things, things will get better. You might want to pull up grass and plant other things instead, but it's honestly okay if you don't have the spoons for that.

My current house (I'll be moving soon) has a raised area surrounded by bricks. Now, the interesting thing is that the bricks are able to be raised somewhat, giving a sort of cross-section of soil. Now, I'm aware it's far from typical -- it's a lot damper than I think soil typically would be, for instance. But it's still a good example.

I went outside today. Here are some of the things I spotted:

moss or lichen growing on the bricks

some plants growing beside the bricks

white threadlike things, presumably fungi

several worms

woodchips

pebbles

leaves

general soil-y stuff

roly-polies/pillbugs

a centipede

a spider (a Wetland Giant Wolf Spider, I think)

some eggs

lots of other things

And that was without looking very closely and only at probably a square foot of area, if that, combined. And all that has been done is just...letting it be. That's it.

Biodiversity wants to happen. It is actually easier to just...not.

Fair warnings, however:

you may be required to mow your lawn. citation: i once got a letter saying so :(

invasive species might pop up. again, if you have the energy, weeding them (AND ONLY THEM) is great

trees might grow uncomfortably close to your house :(

The substance I was addicted to was heroin. While I was actively addicted, it absolutely came before everything else. My life shrank around it. I kept using despite very real, very obvious negative consequences. If you’re looking for something that fits the “compulsion + harm + loss of control” model, that was it.

But what’s always sat strangely with me is what happened when that context changed.

Once my abusive relationship ended and I was no longer in an environment where it was readily available, it was shockingly easy to stop. I’m not saying it was physically comfortable. My body was pretty pissed off for a while. But psychologically, it just didn’t have the same hold anymore. I wasn’t spending my days white-knuckling cravings or constantly thinking about it. It dropped out of my life in a way that, according to the 12-step model, is not really supposed to happen.

And that’s where my issue with that framework starts.

Because 12-step ideology tends to assume that if you have ever had that kind of relationship with one substance, it reveals something fundamental and permanent about you. That you now have a generalized “addictive nature” that will attach itself to other substances or behaviors if you’re not constantly managing it. That you are, in some essential way, always on the verge of transferring that pattern onto something else.

And that just hasn’t been true for me.

I was a near-daily cannabis user for years. When it started consistently making me feel physically uncomfortable instead of good, I stopped. No drawn-out battle, no existential crisis, just “this isn’t giving me what I liked about it anymore” and I moved on.

I drink occasionally, in social or celebratory contexts, and I genuinely find alcohol kind of boring outside of that. It doesn’t have much pull for me.

I tried gambling once, got annoyed at how tedious and overstimulating it felt, and left the casino in under an hour. I have not felt remotely compelled to revisit that experience.

I use the internet a lot, and I play a handful of video games, but I can also go on a camping trip with no signal and be completely fine, unless you want to try and find something pathological about nature photography, in which case you can blow it out your ass. If anything, I generally enjoy the change of pace. There’s no sense of panic or withdrawal or “I need to get back to my computer/consoles immediately.”

So when I hear the idea that addiction is this broad, transferable trait that will latch onto anything with quick reward or low friction, I just don’t see it reflected in my own life.

What does make sense, looking back, is context.

When I was using heroin, I was in an abusive relationship. My environment was unstable, stressful, and honestly pretty bleak. The substance didn’t just exist in a vacuum. It fit into a specific set of conditions where it functioned as relief, escape, and regulation.

When those conditions changed, the behavior changed with them.

That doesn’t mean there was no dependency. There obviously was. It doesn’t mean there were no consequences. There very much were. My grades suffered. I dropped out of college. I lost my apartment because staying out of withdrawal and numbing out from the abuse felt more important than paying rent.

But it does suggest that what we call “addiction” might not always be this permanent, identity-level trait that needs to be managed forever. Sometimes it looks a lot more like a relationship between a person, a substance, and a specific environment.

When that’s the case, then a framework that assumes universality - “if this happened once, it will always be waiting to happen again, with anything” - is going to miss a lot of variation.

I’m not saying 12-step programs can’t help people. Clearly they can, or they likely wouldn’t exist in the way they do. But I do think they’re often treated as the model of addiction rather than a model that fits some people and not others, and when your experience doesn’t match that model, many people who swear by them will assume that you are misunderstanding yourself, in denial, or “not taking it seriously enough.” This paternalistic attitude only serves to make me even more skeptical of the framework.

For me, what mattered wasn’t declaring myself permanently “addictive” or treating every pleasurable behavior as a potential threat.

What mattered was getting out of the environment where that pattern made sense in the first place.

I was medicated outside of my ability to consent as a child, so my brain began to associate "drug" [set containing pill, Adderall, stimulant] with "coping" [set containing managing behaviors and emotions, feeling less bad]

As an adult, weed and alcohol became readily available, and mitigated the stress of being horribly maladapted to adulthood very easily. Drug equals coping.

I graduated to much more dangerous drugs (psychedelics, ecstasy, cocaine, meth), and the base framework didn't change. Drug equaled coping, and because more drugs brought more problems, coping became paradoxically noncomputational.

Post prison, I've developed (wholly by necessity) a better sense of how to cope with life. Is it perfect? Fuck no. During the week, I drink after work, because work is exhausting and super stressful. However, because I'm better at managing the things that cause me to drink, better at coping, the drinking is enough. I understand how much it costs me, and I mitigate it based on how good it feels against how good not being in prison and having control of my life feels.

If I stopped, I'd miss it. My brain would Do The Thing where everything sucks for a while. I'd need to find a new shortcut for coping. But for me at least, it's not one of those addictions that's tearing my life apart.

these are all really good and important things to be aware of and I recommend gathering that info for any new meds. i don't say this to like, blame people who were not given this info by their doctors and who took meds without being given this information, but rather to give people resources for being more in control of their own medical treatment going forward 💜

CYP450 is a family of enzymes in humans. enzymes are chemicals that speed up chemical reactions; in this case, in our bodies, CYP450 enzymes process the vast majority of currently available medications. because of that, they're responsible for most drug interactions.

different substances - including medications, supplements, and even foods - can affect the CYP enzymes in different ways.

a CYP inhibitor blocks the CYP enzymes from working to process the medication. that means you can end up with more of the medication in your body than you expect. that can cause mild, moderate, or severe side effects. good examples of CYP inhibitors are St. John's wort, grapefruit, and isoniazid (a tuberculosis medication).

a CYP inducer encourages the CYP enzymes to work faster. that means you can end up with less of the medication in your body than you expect. that medication may not work as well. this can be especially dangerous in cases where, for example, you're suppressing a dangerous effect (like autoimmunity or transplant rejection). some examples of CYP inducers are insulin, tobacco, prednisone, and in some cases, St. John's wort again.

a CYP substrate is just a substance/medication that is affected by an inhibitor or inducer. birth control is a very common substrate, and its effectiveness is affected by many medications.

each substrate is related to a different family of CYP enzymes, like CYP3A4 or CYP2D6. each one responds to different inhibitors and inducers.

you can see why they often don't tell patients this stuff: It is complicated. this is pharmacokinetics! it's difficult stuff. but i really, really believe it's important. knowing how your medications affect each other can save your life. doctors and pharmacists often do not check medication interactions. sometimes it really is up to us to understand what we're putting in our bodies.

at the very least, i urge you to check drug interactions with the drugs.com interaction checker. this checker automates some of the work of cross-referencing CYP relationships. if you have an account, you can save your drug list and cross-check all of your meds at the same time. keep in mind that not all "severe" interactions will necessarily apply to you; i recommend reading the "for professionals" version of the warning to make informed decisions about whether or not you want to be concerned. (this is also something you can discuss with a good doctor if you have the good fortune to have one.)

but, if you have the capacity, at a certain number of medications (i am taking 20+) it really is worth getting to know how they interact with CYP enzymes, what effects you might need to be watching out for (more intense effects from a higher concentration of medication? less intense effects as the medication can't attain high enough concentrations to work as it normally does?), and what meds might be the culprits of new problems as you add more medications.

to cross-check CYP relationships directly, i recommend the flockhart table. search for a medication (ctrl+f helps) and you can see all its documented CYP relationships. (they also have a mobile friendly version, but i find it slightly harder to interpret.)

here's how i do it.

start with a medication or substance. let's say i'm about to start celecoxib (Celebrex), a non-steroidal anti-inflammatory drug (NSAID). on the flockhart table, it's listed as an inhibitor of CYP2D6. (ctrl+f is helpful here.)

think through what the words mean. it's an inhibitor, so it makes the enzymes not work as well. it might increase blood levels of medications that are processed by CYP2D6.

what medications are processed with that enzyme? the flockhart table lists them if you click on the name of the medication you're curious about. CYP2D6 substrates include amitriptyline (Elavil), aripiprazole (Abilify), atomoxetine (Strattera), duloxetine (Cymbalta), oxycodone (Oxycontin), and propranolol, among others.

what effects do i need to be watching for based on the affected medications? for an inhibitor, we're looking for stronger effects; for an inducer, we're looking for weaker effects. let's say i take oxycodone daily. i want to keep an eye on the way i feel when i take oxycodone. am i feeling "higher" than usual? am i feeling dazed or dizzy or numb? or let's say i take propranolol. am i feeling dizzier or more lightheaded? am i having nightmares that i wasn't before?

here's another example. what if i want to check for a substance that might not be listed on the flockhart table? grapefruit is a good example.

wikipedia is actually a great source for this (though in some cases i recommend just searching "[substance] CYP" and seeing what pops up).

head to the list of CYP450 modulators on wikipedia. ctrl+f finds three instances of grapefruit: naringenin (a CYP1A1 inhibitor), generic 'flavonoids' (inhibiting CYP2A6), and bergamottin (a powerful CYP3A4 inhibitor).

think through what the words mean. any substrate medications processed by 1A1, 2A6, or 3A4 enzymes might be dangerously increased in my bloodstream if i consume grapefruit (or anything containing those substances; earl grey tea actually contains bergamottin, too!)

what medications are processed with those enzymes? this i can check on the flockhart table, or i can stay on wikipedia. atorvastatin - a cholesterol medication - is a substrate of 3A4. so is diazepam (Valium). valproic acid, an anti-seizure medication, is a substrate of 2A6. i'm having more trouble finding substrates of 1A1. it's not listed on the flockhart table. there is a paper published that mentions theophylline (an asthma medication) and difloxacine (a fluoroquinolone antibiotic).

what effects do i need to be watching for based on the affected medications? at a glance here, i'd be worried about having too much valium or valproic acid in my system (if i took those meds) - those could have pretty serious effects on my central nervous system. likewise, having too much of that fluoroquinolone antibiotic (if i took it - and i wouldn't, because if you have hEDS you should not take fluoroquinolones unless it's a matter of life or death!) could increase my risk for serious musculoskeletal side effects like tendon rupture. it could also disrupt my bacterial microbiome.

the physician who created the flockhart table, the late dr. david flockhart, was an exemplary physician who truly, truly cared about patients - a rare treasure. everyone's CYP-related genes are different, and it affects the way we respond to medication. we know that, just as we know that CYP relationships can cause serious and harmful drug interactions. but we don't put it into clinical practice. dr. flockhart wanted to change that, and he did pave the way towards that future. we're not there yet. but i do recommend his table.

i hate that this is not something that is widely taught and widely understood. i hate that we have this knowledge about how people metabolize drugs and how drugs work with each other and we often just do not talk about it at all. i hate that i was not instructed on the risks of taking clonazepam (a benzodiazepine, in the same class as Valium) and hydrocodone (Vicodin, an opioid) simultaneously. i experienced central nervous system depression - difficulty breathing, dizziness, confusion, fatigue - multiple times as a teenager before i figured out that i shouldn't take them close together. needless to say, mixing those two drug classes can be extremely dangerous. i got lucky and just felt awful. but at certain doses or under certain circumstances, taking those two simultaneously could kill someone. Does kill people, in fact!

a responsible doctor - one of my favorite doctors! - prescribed me those medications. he just wasn't thinking. it happens all the time.

we should not have to be doing all this work. but often doctors and pharmacists simply do not think about it. and the literature they hand out with medications, while helpful, is not going to cover all possible interactions, especially for polypharmacy patients or people on unusual medications.

likewise, you should know what medications interact with your conditions - like i mentioned fluoroquinolones and hEDS earlier. or how morphine tends to activate mast cells. that's something i can't cover here, though.

March 2026 was the first month that renewables generated more power than natural gas in the US. In fact, fossil fuels generated less energy this past March than they had in any March for the previous 25 years.