On aphids

Awmack & Leather, Host Plant Quality and Fecundity in Herbivorous Insects, 2002.
* sap-suckers prefer high amino acid levels in phloem
* herbivores in general don't like high carbohydrate and lipid levels, because it dilutes their target nutrients. Although aphids were *more* successful under high CO2 conditions, so it might not be that simple.
* Plants produce defense compounds which can put off some insects (including aphids). This is more true of generalist feeders, whereas species-specific feeders don't seem to mind so much.

So at a guess, your plants might have *too much* nitrogen, which is why they look great but are suffering from aphids. And/or they are lacking some micronutrients which means they can't produce sufficient defense compounds. If your greenhouse is well-sealed, then elevated CO2 might favour aphids as well.

(I have seen this in brassicas. Once I started soil testing and balanced my soil, my aphid problems disappeared. Then I ran out of organic fertiliser pellets so substituted in blood and bone, and got an aphid infestation. I figure the highly soluble nitrogen from the B&B over-dosed by plants on N, making them more attractive to aphids.)
 
Powell et al, HOST PLANT SELECTION BY APHIDS: Behavioral, Evolutionary, and Applied Perspectives, 2006
* aphids use a whole range of methods to choose which plants to feed on
* during flight they are attracted to yellow wavelengths, rather than green, so are more likely to be drawn to leaves which are young, sick or senescing
* they are also attracted/repelled based on odours, but that seems to have more to do with finding the right species, rather than the health of the plant (though there are so many compounds they can sense it might be much more complex than that).
* once they get on the plant they "taste it" to get a feel for what the nutrient levels are like and the presence of defense compounds.

These reviews are getting old, though, so perhaps there is more up-to-date knowledge out there.

Books 2018

It's time for the annual book review round-up!

This year I read 71 books (second highest after 2017), with an average rating of 3.35 (same as 2017), continuing the trend towards lower scores as time goes on.

My gender split wasn't as good this year, at 37% female vs 63% male (last year was 48% female).  So I dropped the ball a bit on that one, though it is still an improvement over time.

However, my focus this year was on reading authors from a greater diversity of backgrounds.  This year 70% of authors were white/anglo/western, compared to 80-90% in previous years.

5 stars
None again this year. 

4.5 stars (6)
Black Swan Green,David Mitchell,"Life as a 12 year old boy in '82 England. So messy & agonising, glor… ",https://t.co/1DTp7dqzdW
The Good People,Hannah Kent,Captures the pervasive superstition & grinding desperation of a poor & i… ,https://t.co/1cK1fo77LR
The Patterning Instinct,Jeremy Lent,Reveals the cultural & cognitive biases we've built up over '000s… ,https://t.co/DaTQE8KdhZ
The Paper Menagerie and Other Stories,Ken Liu,"A splendid collection exploring historical wrongs, futu… ",https://t.co/2zujWRb7rh
How To Change Your Mind,Michael Pollan,"Upends decades of bias against psychedelics, which may actuall… ",https://t.co/CIrMGD3fNX
No Is Not Enough,Naomi Klein,Trump is the end-product of a disastrous economic & political system. Pa… ,https://t.co/SqvPN5EEIX

4 stars (14)
The Lacuna,Barbara Kingsolver,"Very slow to start, but builds a great head of steam encompassing Frida K… ",https://t.co/ODPMRT4lNh
Winter's Bone,Daniel Woodrell,"A cold and stark, yet hopeful, portayal of hillbilly life in the drug-hol… ",https://t.co/NMnlw2IqeZ
Girt,David Hunt,"Australian history made ... funny? And it works. Packed full of character, puns, and f… ",https://t.co/PbO02GEBBC
The Bush,Don Watson,"A sprawling tour of the settlement of Australia, and the dire consequences for natu… ",https://t.co/vpgDQKK4ka
How Did We Get Into This Mess?,George Monbiot,"A selection of his finest articles, exploring the madness… ",https://t.co/SVMronWbis
Lincoln in the Bardo,George Saunders,"Letting go through death. Quirky, original and quite a lot of fun. Completely unexpected.",
The People of the Book,Geraldine Brooks,"A fascinating journey through the history of European Jews, usi… ",https://t.co/yAkfZjP6aP
H is for Hawk,Helen Macdonald,Gets inside the wonderful and predatory mind of the goshawk. Hawking: not… ,https://t.co/RLsO5rMslZ
Assassin's Fate,Robin Hobb,"Fitz, the Fool, Wolf Father, Bee! A fitting finale (?) for some of fantasy's… ",https://t.co/SUrozKg1Kw
Utopia for Realists,Rutger Bregman,A convincing & enthusiastic call to dream big and be idealistic. A basic… ,https://t.co/R6NPbfR24A
In Other Lands,Sarah Rees Brennan,Makes up for poor writing with great characters and relationships. Tu… ,https://t.co/QETC1VRYNN
Planet of Exile,Ursula Le Guin,An intriguing world where each season last 15 years and a long-establis… ,https://t.co/S1XXBZizan
Rocannon's World,Ursula Le Guin,"A masterful melding of fantasy & sci-fi, highlighting the forces coloni… ",https://t.co/LY4iwQhmW9
Homo Deus,Yuval Noah Harari,Fascinating and confronting on the illusion of individuality and the spect… ,https://t.co/YIeG0TZKm5

3.5 stars (18)
The Morality Of Gentlemen,Amanda Lohrey,"Engaging insight into the inner working of unions, back when… ",https://t.co/tMDvwBuY6F
Oathbringer,Brandon Sanderson,Phew. Not so much epic as long. Some good twists to the good vs evil trope.,
The Call of the Reed Warbler,Charles Massey,"Not much new in the stories of regenerative agriculture,… ",https://t.co/Qvpa6ak61j
Looking for Jake & Other Stories,China Mieville,"His usual surreal, unsettling creations. Sentient st… ",https://t.co/OR1iyUyqNU
The Grace Of Kings,Ken Liu,Silkpunk fantasy with fun pre-steam tech. Some decent characters despite t… ,https://t.co/dgjr1UV7j3
The Wall of Storms,Ken Liu,"A world where strategy, learning & clever engineering win out over brute s… ",https://t.co/cVOAC4Uc9A
On The Banks Of Plum Creek,Laura Ingalls Wilder,Locusts! Fire! Blizzards! Mother Nature throws every… ,https://t.co/BEnwgAzsPu
Steam Pigs,Melissa Lucashenko,Coming of age through the muck and violence of being Indigenous in Quee… ,https://t.co/3nW8HEVObh
We Need New Names,NoViolet Bulawayo,"From the colour & chaos of a Zimbabwean slum, to the self-indulge… ",https://t.co/gHoYNCUyke
Other Minds,Peter Godfrey-Smith,"A pedestrian look at the evolution of intelligence, but with wonderfu… ",https://t.co/JI2bF9szro
All The King's Men,Robert Penn Warren,A lot more to this than I grasped. Wanders off in extravagent description.,
Don't Take Your Love To Town,Ruby Langford Ginibi,"An illuminating Indigenous biography, from grinding… ",https://t.co/GAjNc9OxUO
Down Among The Sticks And Bones,Seanan McGuire,"A wonderfully imaginative, contemporary fairytale. Ends abruptly.",
The Map That Changed The World,Simon Winchester,Evocative and enthusiastic portrayal of the trials a… ,https://t.co/qhxdmHdZBi
Whole Earth Discipline,Stewart Brand,A challenge to anti-science environmentalists. Mostly convincing… ,https://t.co/mTNjWXjGB6
The Complete Orsinia,Ursula Le Guin,"A tale of family, friends and revolution in a fictional but fam… ",https://t.co/i5eptztM81
City of Illusions,Ursula Le Guin,A journey to discover the truth in an era of paranoia. Less convincing than the others.,
The High Mountains of Portugal,Yann Martel,"Comically odd, mysterious and touching. Three entwined spiritual journeys (maybe?).",

3 stars (24)
And Then There Were None,Agatha Christie,"My first! A bit over the top, but a decent bite-sized piece of light entertainment.",
Love Over Scotland,Alexander McCall Smith,Same old. A bit like a well-worn TV series.,
Espresso Tales,Alexander McCall Smith,Light and humourous. A good switched-off holiday read.,
The World According to Bertie,Alexander McCall Smith,"Perceptive, charming & amusing.",
Transactions,Ali Alizadeh,Cynical and unnecessarily explicit.,
Terra Nullius,Claire Coleman,The tragedy of colonialism. Heavy-handed.,
The Underground Railway,Colson Whitehead,"Opened my eyes to disturbing extraordinariness of slavery, bey… ",https://t.co/SXpOPIOeHP
The Rapture of the Nerds,Cory Doctorow & Charles Stross,A quasi-dystopian comedy where humans have most… ,https://t.co/uIvZzjh6ry
True Girt,David Hunt,Lacks the hilarity and colourfulness of the prequel. Uses sarcasm to good effect r… ,https://t.co/zecEl3G6QX
Number9Dream,David Mitchell,"Momentarily horrifying, occassionally confusing, mostly harmless.",
A Million Wild Acres,Eric Rolls,"A labour of love. Traces, in excessive detail, the history of the Pilli… ",https://t.co/OfsK9CtiWR
IQ,Joe Ide,Sherlock goes LA gangsta style. Pulls it off but feels a little cheap.,
The Pedant In The Kitchen,Julian Barnes,Insufficiently pedantic (is that a heaped or rounded teaspoon??… ,https://t.co/XacR6ubm4T
Wild Cat Falling,Mudrooroo,The first novel by an Indigenous author. Dripping with cynicism and self-destructiveness.,
Skin In The Game,Nassim Nicholas Taleb,Scattered and incohesive. Dripping in arrogance. A useful persp… ,https://t.co/VKei9mXLeE
The Hundred Thousand Kingdoms,NK Jemisin,Caught up in an intrigue of the gods. Creative and satisfying.,
Lyra's Oxford,Philip Pullman,Pleasant enough. Rather short.,
The Land Before Avocado,Richard Glover,"Mildly amusing, but nothing too surprising - we've come a long way in 50 years.",
The Willful Princess & the Piebald Prince,Robin Hobb,"A nice little tale of love, power and treachery.",
Enlightenment Now,Stephen Pinker,Charts humanity's extraordinary progress thanks to the application of… ,https://t.co/G4ujdkySEw
Europe: A Natural History,Tim Flannery,"A bit repetitive, but has its moments. More engaging once humans come on the scene.",
The Bluest Eye,Toni Morrison,"The poverty, violence and self-hatred of African-American life. Couldn't q… ",https://t.co/j4mdi442SB
Tales from Earthsea,Ursula Le Guin,A pleasing fleshing out of her classic magical world.,
In Xanadu,William Dalrymple,A jaunt following Marco Polo. A bit heavy on architecture. Attitude shows it's age.,

2.5 stars (4)
The Three Body Problem,Cixin Liu,"Some cool physics and an interesting context (revolutionary China),… ",https://t.co/wZdb9nYWCQ
Monkey Grip,Helen Garner,"The delusion of free love, the disappointing clash of ideals and reality. Ov… ",https://t.co/xCS4wTEcp7
That Deadman Dance,Kim Scott,The (not so) friendly frontier. Jumbled and aimless.,
The Barefoot Investor,Scott Pape,"Rather simplistic, but usefully so for the financially clueless. Aw… ",https://t.co/8bq3OvQdGQ

2 stars (5)
The Crow Trap,Ann Cleeves,"Hardly 'thrilling'. A bit boring, to be honest...",
The Ministry of Utmost Happiness,Arundhati Roy,"Chaotic, confusing, directionless. A depressingly cynical picture of India.",
Solar,Ian McEwan,"Some decent prose, but a slothful, misogynistic, self-absorbed physicist does not make… ",https://t.co/fEfpyjmQu0
The Gold Coast,Kim Stanley Robinson,"Shows its age, set in a (now near) future full of Soviets and nuke… ",https://t.co/OA0MWxklqK
Whipbird,Robert Drewe,"Aussie family reunion goes bad. A decent snapshot of Australian life, but nothing of substance.",

Heart rate monitoring, pacing & ME/CFS

A good basic overview of heart rate monitoring is here:
http://www.cfidsselfhelp.org/library/pacing-numbers-using-your-heart-rate-to-stay-inside-energy-envelope

Case study from the originators of the technique:
https://www.healthrising.org/blog/2013/08/13/heart-rate-monitor-program-improves-heart-functioning-in-chronic-fatigue-syndrome-mecfs/

Research paper describing the approach (relatively technical & dense, but might be useful for sceptics!):
https://academic.oup.com/ptj/article/90/4/602/2888236

There is also a very supportive Facebook Group:
https://www.facebook.com/groups/ME.CFS.HRM/
Not quite as active as a year ago when I got involved, but still good.  There is a wealth of knowledge in the posts and the files, but it can be hard to sort through ...  If you post a specific question you are likely to get a helpful answer.

As for heart rate monitors (HRMs), you have a few options. You need something that will set off an alarm when you go over a certain heart rate (50-60% of max HR, usually about 100bpm).  It's also useful if it is waterproof so it can be worn in the shower, which can be the highest exertion a CFSer regularly does (I sit down in the shower now to keep my HR down).

* most accurate and cheapest: chest-strap sensor (e.g. Polar H10), sync'ed via Bluetooth to your phone.  Chest straps are very accurate, but some find them annoying to wear all day.  I haven't used this method so am not sure what apps are available that will sound an alarm when you go over a specified threshold.  You can also use a chest strap for advanced heart rate variability (HRV) monitoring.  HRV is used by athletes for identifying if they are over-training or not, and CFSers use it in a similar way.

* optical wrist sensors are incorporated into FitBit-type devices.  These are comfortable to wear 24/7, and also count steps and monitor sleep.  Optical sensors are not as accurate as chest straps, and can have quite a lag, which means they aren't very accurate when the HR is variable.  They also give bad readings when moving your fingers.  For this reason I wear mine on the ankle!  (Looks like a gaol bracelet, but then it kinda is ...  Also, you need slim ankles to do this.)  Having said that, I think they are accurate enough for our purposes. Can't be used for HRV though.  Polar now has a product designed to be worn on the upper arm, the OH1, but I'm not sure if it has a display or alarm (have to sync to phone).  I use a Polar a370 and am quite happy with it, though I have had to send it back twice for replacement (I think I've been unlucky).  Only the FitBit Ionic and Versa have an alarm, and FitBits have better sleep monitoring than other brands.  Also, someone has written a HR Pacing app which is available for FitBits!  Not sure if they are waterproof though.  Garmins are another option - some people use the Vivosmart 3.

Mould, CIRS, & ME/CFS

Now this is a can of worms.  There are two schools of though around mould: the Shoemaker Brigade, and the Mould Paranoids.

The Shoemaker Brigade follows the teachings/research of Ritchie Shoemaker, a doctor who has, over the past few decades, gradually developed the idea of Chronic Inflammatory Response Syndrome (CIRS).  Basically, he reckons that a subsection of the community is genetically susceptible to biotoxins (e.g. mould toxins, but also Lyme and algae), which they can't detoxify, and they develop a chronic inflammatory response which makes them Really Fucking Sick.  He reckons CFS actually is a sub-type of CIRS.  He has a set of criteria for diagnosis, including some blood tests, and a clear treatment protocol. However, there's not point treating it until you're not being exposed anymore, which requires testing your house for mould (which is another can of worms).  There are only a few Shoemaker-trained doctors in Australia (the main one is on the Sunshine Coast), and some of the most diagnostic blood tests aren't available in Australia (but they can't be sent there for $$$s).  The evidence base for all of this is not terrible (they have a few decent peer-reviewed papers), but it's mostly from the one group of researchers, and some of the assertions aren't well documented (though others are).  I've been thinking of writing up something to summarise everything I've learnt on my mould journey, as it's hard to find solid information.

I've attached a couple of documents that give a detailed overview of CIRS [1, 2].  Let me know if they are too much and I can find something simpler.  Also worth a look is the http://www.toxic-mould-support-australia.org/ website, which is pretty good and has a strong community behind it, which you can find on Facebook.  Though the CIRS crowd seems to have more nutcases in it than the CFS crowd!

Which brings me to the Mould Paranoids, who think that things are much worse than even Shoemaker thinks.  They practice extreme mould avoidance, and experience significant symptoms whenever they go into a mouldy building.  They find that they react to items that have been in a building, and the effect can takes years to wear off - many items cannot be remediated at all. Some people go to the extent of throwing out all their things and starting from scratch in a new house.  This all started with Erik Johnson, who was got CFS in the Incline Village epidemic in the 80s.  He found that he felt better in certain places, and using some toxin-avoidance protocols he learnt in the army, he worked out that the problem was mould exposure.  You can read about his story and how to practice mould avoidance here: http://paradigmchange.me/erik/

This all sounds pretty wild at first, but there is a strong community of people who go to great lengths to stay mould free, and that is probably only because it actually works for them.  One way to work out if this is your issue to to go on a Mould Sabattical: go to the desert for a few weeks, with *none* of your current belongings.  If you feel better, or crash big-time when you return, then mould might be a problem for you.  There is a guide on this here: http://paradigmchange.me/avoidance/  This is all pretty challenging for sciencey types like us, and the article below does a brilliant job of exploring the issue. It's written by a science writer, and she even does a double-blind experiment to prove that she actually is responding to items from her house.
http://www.slate.com/articles/health_and_science/medical_examiner/2017/06/be_skeptical_and_don_t_take_anything_at_face_value.html

I'm open to the mould hypothesis because I first got sick shortly after spending a few nights in a very mouldy caravan, and I later spent more time in another caravan and tent which could have been mouldy.  On the flip side, most of the time I've been in Hobart I was gradually improving, and was living in a dodgy rental that had obvious roof leaks and mould damage (though was very well ventilated).  But then I started going downhill and relapsed after moving into our own place, and I have identified a couple of mould problems here (one of which we've fixed, the other I just found (mouldy roof beams!)).  It's a slow jounrey working my way through all of this, but I'm gradually getting less panicked about it and just doing the best I can.

CFS tips

From a conversation I had with an acquaintance who has recently been diagnosed with CFS,. He asked for some tips, and I gave him a brain dump ...

I'm not able to work at the moment. I was gradually going downhill while I was at TIA in 2016. When my contract ended I kind of collapsed over the line and didn't bounce back like I expected. So I've been largely stuck at home doing my best to manage it. I've seem to have successfully stopped the backsliding, turned the ship around (it;s a bloody big one!) and seem to be headed in the right direction now. But I don't do much productive, and certainly can't be relied on. I'd say I'm 30% on the CFIDS scale:
http://www.cfidsselfhelp.org/cfs-fibromyalgia-rating-scale

 

I first got sick 10 years ago, and this is my first major relapse in that time. Until then, I was gradually getting better and could maintain a 50% workload. By the end of 2015 I was even doing some bushwalking and living a fairly full ife. But then we bought a house and I started working 3 days a week and I gradually dug the hole deeper. I always thought relapsing would be the worst thing that could happen, but it's much easier the second time around - my wife and I have learnt a lot!

 

Sounds like you've done a fair bit of research and learning yourself, so im not sure how much detail to go into. Maybe I'll just outline the things that I have found most useful and we can delve into things more deeply if you're interested.

DIAGNOSIS: You've probably been through this already, but it's worth making sure you've excluded all other possibilities. Depending on your doctor this may not have been done very thoroughly. I quite like the IACFS/ME Primer which includes the Canadian Consensus Criteria and a good guide to treatment options: http://iacfsme.org/portals/0/pdf/Primer_Post_2014_conference.pdf

 

PACING is by far the most important mainstay of managing CFS. The principle is simple enough but it's bloody hard to do well. The biggest challenge is working out what your energy envelope is, and whether or not you've gone past it - you can't rely on your body to tell you when that is - once you're tired, it's WAY too late.

Using a heart rate monitor has made my pacing massively more effective. I can now put an objective number on my envelope (in terms of the number of minutes I spend above 100bpm in a day). I have also been able to model how my HR effects my fatigue. So if I overdo it today, then I will start feeling it in 3 days' time, with the worst on days 4 and 5. This is nothing short of a revelation! For years I knew I had at least a day's lag between exertion and payback, but it wasn't until I started collecting detailed HR and symptom data that I could tease out the full picture.

So now I wear my HR monitor religiously, and it vibrates whenever I hit 100bpm (which doesn't take much), so I know I need to ease back and take a break. I rarely crash hard anymore, which I think is key to gradually getting out of the CFS hole.

 

When I'm managing my pacing well, my symptoms are minimal - I actually feel fairly normal. The trick is to no then overdo it! The HRM is a constant (unremitting, infuriating) reminder of my actual limits. Which means I probably do less than I would without it, but I am much more stable and I think ultimately happier and healthier.

 

A side note to the heart rate stuff is to explore if you have some form of orthostatic intolerance. This is a common co-morbidity with CFS and basically means you have trouble standing for periods. I have borderline POTS, which means my HR is much higher while standing than is normal. This makes it harder to stay within my HR limits. Orthostatic intolerance isn't very well understood but is probably to do with low blood volume and a screwy autonomic nervous system. There are ways you can treat it (at least partially). You can self test for POTS doing the standing lean test: https://www.healthrising.org/forums/resources/a-simple-test-for-orthostatic-intolerance-in-chronic-fatigue-syndrome-and-fibromyalgia-the-nasa-way.388/

 

SLEEP is super important, and often screwed up in CFS. Being 'tired but wired' can make it hard to get to sleep, and it's common to wake up raring to go at 4am. Valarian and melatonin are good sleep aids, but they don't help with the 4am problem. I saw a sleep specialist and he put me on a low dose of mirtazapine which has helped my sleep heaps. It also is an anti-anxiety drug and has reduced my POTS a bit. CFS doctors seem to use sleep meds fairly liberally.

 

Thankfully I haven't had much in the way of PAIN, so can't advise. I get achy legs and sometimes a killer tight neck but nothing nasty like fibromyalgia.

I also haven't had major issues with BRAIN FOG, so I can mostly read, write & think without too much trouble. But I think I am lucky here. I do get mood swings though, and was quite depressed/anxious for the first few years. Effective pacing and a low carb diet keep this under control.

 

DIET has a big effect for many with CFS, though there is a lot of variety as to what works for different people. I'm super-sensitive to sugars and carbohydrates - they make me anxious and irritable and give me burning abdominal pain. My current diet is sugar, fruit, potato, grain and legume-free. So I eat a lot of vegies, protein and fat. Dark chocolate is my treat. Low-ish carb seems to work for a lot of CFSers, so it's worth a try. Other diets to consider are: 

* low FODMAP (if you have IBS) 

* low allergy diet (from RPAH)

* ketogenic diet

* Autoimmune Protocol (AIP) - I plan to try this one day as there is mounting evidence for autoimmune (I have psoriasis too) and gut conditions, but it is pretty extreme.

 

NEUROLOGICAL: It could be worth getting some counselling to help deal with the trauma of chronic illness. I meditate daily to try and keep my sympathetic nervous system under control. When I first got sick I did the Gupta Amygdala Retraining Programme, which is semi-woo woo, but it was the first time I encountered a practitioner who totally understood the condition, and it definitely helped me break out of my obsessive sickness mindset, which took a layer off the top of the illness (but didn't get to the underlying problem.)

 

SUPPLEMENTS: I take a lot of supplements, though their value is questionable. I did a lit review a while back and identified all the ones that had some evidence. From memory they were: CoQ10, NADH, magnesium, acetyl-l-carnitine, n-acetyl cysteine. Other supps worth trying are zinc (really helped me with getting viruses all the time), D-Ribose, vitamin D and the B vitamins. I recommended trying things one at a time and keeping good record of your symptoms so you can identify which you tolerate and if they help or not. I can't take CoQ10, NADH or B vitamins - they all make me wired.

 

After this, you're getting into less certain territory. But that's the reality of this illness - not a lot of research or good evidence to work with. So treat yourself as a n=1 experiment and see what works for you. Things worth looking into are: 

* gut health/dysbiosis

* anti-virals (Valcyte etc) 

* low-dose naltrexone 

* Chronic Inflammatory Response Syndrome (aka toxic mould. Possibly dubious, but there may be something to it) 

* Lyme disease (if it fits) 

 

But in my view all of these things are hopes, something to pursue but not count on. Don't waste your life trying to find a cure - allocate some time to it but don't obsess over it. Focus on what you know works, manage yourself well and try to live the best life you can within those constraints. It's a shit of an illness but you can learn to control it.

EXERCISE: sounds contradictory, especially with all the rage about the PACE trial and CBT/GET, but there's place for it. The key is to go very very slowly, and to stay within your heart rate boundaries. I've been seeing an exercise physiologist who has a lot of experience with CFS. I am now doing free weights for upper and lower body - I do exercises that isolate one muscle at a time (to minimise stress) and which are prone or sitting (to minimise OI), lots of rest in between. I particularly enjoy the upper body weights and get a good feeling from it, as well as a little muscle tone My next step is to start doing more structured walking - short intervals with decent rests, but that is much more challenging HR-wise.

STRESS minimisation is key. Stress of all sorts: physical, mental, emotional. Sometimes just going to the doctor can get my heart racing all day, which can lead to a crash.  Having a solid routine is really helpful, and the less responsibilities the better (e.g. I occasionally cook dinner, but my wife never depends on me to cook, so there's no drama if I'm not up to it and I'm not tempted to push myself). When I've overdone it I can find it really hard to make decisions and it really stresses me out. We've developed a simple flowchart to help: Can I do X? If confidently Yes, then do it. If confidently No, then don't. If unsure, then don't. If I'm not sharp enough to make a decision easily then I need to back off. This takes the uncertainty out of life and is much less stressful.

Finally ... REST. Then rest some more. If in doubt, rest again. With this illness you will struggle to over-rest. Did I mention Rest?

 

BOR-ING!

Books 2017

This year I tried to read more female books.  I was also sicker than I have been in a long time so I may have done more reading.  Let's see how the stats look.

74 books in total (compared to 56 in 2016, 43 in 2015).
Gender: Male 43%, female 51% (37% in 2016), joint 4%, other 1%.
Origin: Anglo 84%, non-Anglo 16% (9% in 2016)
Type: Fiction 81%, non-fiction 19%

So I did well at upping my female authors, and improved slightly on diversity of origin (although that would have been skewed by Elena Ferrante's 4 books).  

No 5 star books!

4.5 stars: 6 books (8%)
"No Is Not Enough" Naomi Klein. 4.5 stars. Trump is the end-product of a disastrous economic & political system. Pa… https://t.co/SqvPN5EEIX Thu Jan 04 02:00:50 +0000 2018
"Butcher's Crossing" John Williams. 4.5 stars. A gut-wrenching account of how man destroys that which nourishes him… https://t.co/gjNBWNbw4r Tue Dec 05 06:25:45 +0000 2017
"Doughnut Economics" Kate Raworth. 4.5 stars. A comprehensive and satisfying demolition of neoliberal economics. Pr… https://t.co/8mf4v2cDio Fri Nov 10 06:50:34 +0000 2017
"The Narrow Road to the Deep North" Richard Flanagan. 4.5 stars. The agony and pointlessness of it all. Tue Nov 07 04:48:26 +0000 2017
"All The Birds In The Sky" @charliejane Anders. 4.5 stars. Unpredictable, clever & funny. A wonderful creation. Sat Sep 16 08:52:12 +0000 2017
"The Spare Room" Helen Garner. 4.5 stars. The agony of illness and the grasping for health. So well portrayed it feels like it must be true. Mon May 22 02:25:52 +0000 2017

4 stars: 17 books (23%)
"How Did We Get Into This Mess?" George Monbiot. 4 stars. A selection of his finest articles, exploring the madness… https://t.co/SVMronWbis Thu Jan 04 02:15:28 +0000 2018
"The People of the Book" Geraldine Brooks. 4 stars. A fascinating journey through the history of European Jews, usi… https://t.co/yAkfZjP6aP Thu Jan 04 02:14:56 +0000 2018
"In Other Lands" Sarah Rees Brennan. 4 stars. Makes up for poor writing with great characters and relationships. Tu… https://t.co/QETC1VRYNN Thu Jan 04 02:00:15 +0000 2018
"The Bond" Simon McCartney. 4 stars. Two young bold climbers push the envelope in Alaska, and barely get away with it. Climbers are NUTS! Sun Dec 24 03:33:08 +0000 2017
"The Water Knife" Paolo N Bacigalupi. 4 stars. The water wars of the near future. A hint of Mad Max. Frighteningly possible. Fri Nov 10 06:42:12 +0000 2017
"Bring up the Bodies" Hilary Mantel. 4 stars. A well executed clusterfuck. Poor Anne Boleyn: well and truly screwed (one way or another). Tue Nov 07 04:50:32 +0000 2017
"Those Who Leave and Those Who Stay" Elena Ferrante. 4 stars. Realistic characters are so frustrating! Tue Nov 07 04:48:58 +0000 2017
"The Nature Fix" Florence Williams. 4 stars. We are wild beasts - get out there and soak it up. Sat Sep 16 08:50:39 +0000 2017
"My Life On The Road" Gloria Steinam. 4 stars. The power of community organising -inspiring! In the thick of so much transformative change. Sat Sep 16 08:42:11 +0000 2017
"Here Come The Dogs" Omar Musa. 4 stars. Fantastic use of language. Life on the other side of the tracks ... in Queanbo! Tue Aug 08 10:26:50 +0000 2017
"Still Lucky" Rebecca Huntley. 4 stars. If you need your faith restored in everyday Australians, read this. A good and visionary people. Tue Aug 08 10:10:21 +0000 2017
"Wolf Hall" Hilary Mantel. 4 stars. English history has never been so fascinating. Cromwell and an era brought to life with clarity. Wed Jun 21 11:38:01 +0000 2017
"The Bride Stripped Bare" Anon. 4 stars. A few major issues to deal with here. Pha-ew! Wed Jun 21 11:33:27 +0000 2017
"Tiny Beautiful Things" Cheryl Strayed. 4 stars. The best sort of agony aunt. So much wisdom and compassion on the trials of being human. Mon May 22 02:28:06 +0000 2017
"Postcapitalism" Paul Mason. 4 stars. An unexpectedly Marxist revelation. A valuable perspective on history. Capitalism in its death throes? Sat Mar 04 06:02:06 +0000 2017
"The Trowenna Sea" Witi Ihimaera. 4 stars. Brings a fascinating piece of history gloriously to life. A touch academic at times. Sat Mar 04 04:24:57 +0000 2017
"Burial Rites" Hannah Kent. 4 stars. The cold drift towards death ... Sat Mar 04 04:21:37 +0000 2017

3.5 stars: 19 books (26%)
"Updraft" Fran Wilde. 3.5 stars. A wonderfully fantastical creation - never mind the physics, just fly with it. Sun Dec 24 03:45:39 +0000 2017
"Sweet Thursday" John Steinbeck. 3.5 stars. A light-hearted comedy starring a tight-knit community of down-and-oute… https://t.co/jbe3IHiHjr Sun Dec 24 03:39:23 +0000 2017
"The Long Way to a Small, Angry Planet" Becky Chambers. 3.5 stars. A likeable bunch on a Red Dwarf-esque journey through the galaxy. Sun Dec 24 03:30:41 +0000 2017
"The New Republic" Lionel Shriver. 3.5 stars. Takes fake news to a new level. WAY before its time. Tue Dec 05 06:25:21 +0000 2017
"The Stone Sky" NK Jemisin. 3.5 stars. Gets pretty out there. I like the idea of a furious Father Earth bent on revenge. Tue Dec 05 06:24:21 +0000 2017
"Gut Reactions" Justin & Erica Sonnenburg. 3.5 stars. A good overview of the microbiome and its critical role in ou… https://t.co/jpvHi9Sszu Tue Dec 05 06:21:53 +0000 2017
"Luna: Wolf Moon" Ian McDonald. 3.5 stars. Sequel brings plot together making for a decent book. Fri Nov 10 06:43:21 +0000 2017
"The Power" Naomi Alderman. 3.5 stars. An old trope, power corrupts, but with a gendered twist. Brutally pessimistic. Lacks subtlety. Sat Sep 16 08:45:31 +0000 2017
"The Story of a New Name" Elena Ferrente. 3.5 stars. A finely woven tapestry of brutal men, trapped women and social immobility. Tue Aug 08 10:34:22 +0000 2017
"The Fifth Season" NK Jemisin. 3.5 stars. An intriguing world, but slow reveal of bigger picture left me dangling. Tue Aug 08 10:08:55 +0000 2017
"Daughter of the Empire" Raymond Feist & Jenny Wurts. 3.5 stars. Such a linear plot, but excellent comfort reading. Wed Jun 21 11:40:18 +0000 2017
"High Tide in Tucson" Barbara Kingsolver. 3.5 stars. A pleasurable ramble to dip into. Wed Jun 21 11:26:31 +0000 2017
"Salt Creek" Lucy Treloar. 3.5 stars. The brutal and beautiful reality of the Australian frontier. Wed Jun 21 11:19:29 +0000 2017
"The Lies of Locke Lamora" Scott Lynch. 3.5 stars. Rollicking tale of cunning and dastardly thieves. Wed Jun 21 11:08:51 +0000 2017
"Wild" Cheryl Strayed. 3.5 stars. One hell of a traumatic life. Nothing that a good long walk can't sort. Wed Jun 21 11:05:14 +0000 2017
"My Brilliant Friend" Elena Ferrante. 3.5 stars. Full immersion in the colour and messiness of of working-class Naples. Captivating. Mon May 22 02:32:36 +0000 2017
"The Heroes" Joe Abercrombie. 3.5 stars. War. Bloody realistic war. Sat Mar 04 06:00:29 +0000 2017
"The Mists of Avalon" Marion Bradley. 3.5 stars. The myth! The legend! The melodrama! Such tragedy! Very slow to get going, and overly long. Sat Mar 04 05:57:55 +0000 2017
"March" Geraldine Brooks. 3.5 stars. Brings a harsh dose of reality to the family of Little Women. Sat Mar 04 04:17:54 +0000 2017

3 stars: 23 books (31%)
"The Rapture of the Nerds" Cory Doctorow & Charles Stross. 3 stars. A quasi-dystopian comedy where humans have most… https://t.co/uIvZzjh6ry Thu Jan 04 02:11:25 +0000 2018
"Wired to Eat" Robb Wolf. 3 stars. Interesting ideas on ketosis and individual response to carbs. But written for dummies. Sun Dec 24 03:33:37 +0000 2017
"For Whom The Bell Tolls" Ernest Hemingway. 3 stars. Excessive detail and agonising pace in the buildup. Some horri… https://t.co/pkaMPLChuR Tue Dec 05 06:24:58 +0000 2017
"Best Served Cold" Joe Abercrombie. 3 stars. Blood begets blood, again & again. Decent characters though, if over the top. Fri Nov 10 06:44:28 +0000 2017
"The Story of the Lost Child" Elena Ferrante. 3 stars. Somewhat unsatisfying, but perhaps that's life. Fri Nov 10 06:43:57 +0000 2017
"The Japanese Lover" Isabelle Allende. 3 stars. A little charming but somewhat pedestrian. Lacks sparkle. Tue Nov 07 04:51:26 +0000 2017
"Luna: New Moon" Ian McDonald. 3 stars. Loved the moon world, but too many characters, too little resolved. Dynasties, really? Half a book. Tue Nov 07 04:51:00 +0000 2017
"The Obelisk Gate" NK Jemisin. 3 stars. Finally, some useful context. Losing its edge, though. Tue Nov 07 04:47:41 +0000 2017
"Lagoon" Nnedi Okorafor. 3 stars. Enjoyed the vibrancy of Lagos life, but a bit random. Sat Sep 16 08:49:52 +0000 2017
"Conservation Worrier" Jamie Kirkpatrick. 3 stars. Self deprecatory & funny. Surprisingly informative view of the conservation process. Tue Aug 08 10:31:23 +0000 2017
"Servant of the Empire" Raymond Feist & Jenny Wurts. 3 stars. More of the same, but more sex and less shine. Wed Jun 21 11:41:53 +0000 2017
"Seveneves" Neal Stephenson. 3 stars. Audacious premise and world-building. Undermined by some serious conceptual failings. Wed Jun 21 11:34:59 +0000 2017
"New York 2140" Kim Stanley Robinson. 3 stars. Cool concept, but translating the political challenges of 2010 to 2140 isn't credible. Wed Jun 21 11:24:48 +0000 2017
"The Wild Things" Dave Eggars. 3 stars. A fun flight of fancy, but what's it getting at? Probably nothing! Wed Jun 21 11:21:21 +0000 2017
"Middlemarch" George Eliot. 3 stars. Allegedly 'literature', but really just a big ol' soapie. For the period drama tragic. Wed Jun 21 11:16:24 +0000 2017
"Payback" Margaret Atwood. 3 stars. The many devious ways debt inviegles its way into our lives and cultures. Wed Jun 21 11:14:31 +0000 2017
"The Death Of An Owl" Paul Torday. 3 stars. Tried to be amusing, but ended randomly weird. Wed Jun 21 11:00:13 +0000 2017
"The Gift" Alison Croggin. 3 stars. Passable though largely derivative fantasy. Mon May 22 02:26:30 +0000 2017
"The Secret Chord" Geraldine Brooks. 3 stars. Great way to live some history. Sat Mar 04 05:59:32 +0000 2017
"Fight Like A Girl" Clementine Ford. 3 stars. Disturbing view from the trenches. Never thought of myself as an agent of the patriarchy! Sat Mar 04 05:58:52 +0000 2017
"The Daylight Wars" Peter Brett. 3 stars. Unremarkable fantasy. Sat Mar 04 05:56:49 +0000 2017
"44 Scotland Street" Alexander McCall Smith. 3 stars. Harmless but amusing. Sat Mar 04 04:22:22 +0000 2017
"Strandloper" Alan Garner. 3 stars. The story of William Buckley. A confusion of language, perhaps overly creative, but the vibe feels true. Sat Mar 04 04:15:49 +0000 2017

2.5 stars: 7 books (9%)
"Anything is Possible" Elizabeth Strout. 2.5 stars. Vaguely engaging vignettes about boring small town people. Perh… https://t.co/UeluCGq9pL Sun Dec 24 03:46:15 +0000 2017
"Red Country" Joe Abercrombie. 2.5 stars. Another fantasy-western. Doesn't particularly benefit. Fri Nov 10 06:47:11 +0000 2017
"Territory" Judy Nunn. 2.5 stars. Fluff, but readable. A bit lame really - awfully contrived. Sat Sep 16 08:46:17 +0000 2017
"Three Moments of an Explosion" China Mieville. 2.5 stars. Some impressive feats of imagination, but often left me wondering, 'Why?' Sat Sep 16 08:43:23 +0000 2017
"God Help The Child" Toni Morrison. 2.5 stars. Not sure of it's point, and unnecessarily odd. Mon May 22 02:29:11 +0000 2017
"The Skull Throne" Peter Brett. 2.5 stars. Fine, but could get on with it a bit! Sat Mar 04 04:19:18 +0000 2017
"Heroes of the Frontier" Dave Eggars. 2.5 stars. Not sure of its point? And such poor outdoors decision making! Sat Mar 04 04:13:35 +0000 2017

2 stars: 1 book (1%)
"The Terranauts" TC Boyle. 2 stars. Strange lame sci-fi soapy mongrel. Some basis in reality though! Sat Mar 04 04:16:28 +0000 2017

1.5 stars: 1 books (1%)
"The Low-Carb Fraud" T Colin Campbell. 1.5 stars. Comes across more as a frothin' vegan than as an objective scientist. Sat Mar 04 04:23:12 +0000 2017

CFS Treatment Primer - first attempt

Criteria
The first step is to be sure of what you are treating.  There have been a number of definitions for ME/CFS over the years.  ME is Myalgic Encephalomyelitis, and CFS is Chronic Fatigue Syndrome.  Some patient advocates reckon there is a difference between the two, but I've never been clear on the exact details on that.  In the literature, the two are considered the same and the term ME/CFS is used.

There are two recent criteria for diagnosing ME/CFS:
1. International Consensus Criteria http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full
2. Institute of Medicine (IOM):
    https://www.ncbi.nlm.nih.gov/books/NBK284910/
    www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/MECFS/MECFScliniciansguide.pdf

These are well worth a read.  The main stand-out symptom is Post-Exertional Malaise (PEM), which seems to be unique to ME/CFS.  But there are a bunch of other common ones such as brain fog, stimuli sensitivity, muscle pain, POTS/OI, swollen glands, digestive issues, disrupted sleep etc etc etc.


Research
There have been a bunch of research breakthroughs in recent months.  Some highlights which are worth familiarising yourself with are:
* Hypometabolic state:
    https://www.healthrising.org/blog/2016/09/01/metabolomics-naviaux-chronic-fatigue-syndrome-core-problem/
* Pyruvate dehydrogenase
    https://www.healthrising.org/blog/2016/12/27/chronic-fatigue-syndrome-energy-problems-fluge-mella-study/
* Calcium ion channels:
    https://www.healthrising.org/blog/2017/02/28/biomarker-aussies-chronic-fatigue-syndrome/
* Pyruvate kinase:
    https://www.healthrising.org/blog/2017/03/08/davis-strategic-approach-chronic-fatigue-syndrome/

My rough explanation for what seems to be going on: the body undergoes some combination of stresses (infection, mental, gut, toxicity) and enters a hypometabolic state to protect itself.  Due to a number of genetic/epigenetic predispositions (mitochondrial, methylation, autoimmune), the body gets stuck in this state, with a dysfunctional aerobic energy metabolism.  Limited energy production has fall-out all over the place, particularly the gut and the nervous system which are major energy consumers. These dysfunctions may serve to maintain the disease condition.


Clinicians
There are a few CFS doctors that share their knowledge.
1. Ros Vallings has published probably the best and most comprehensive mainstream book on treating CFS, "Diagnosis and treatment of ME/CFS".
    http://calicopublishing.co.nz/book/chronic-fatigue-syndrome-me/
2. Jacob Teitalbaum, author of Fatigued to Fantastic.
    https://www.healthrising.org/blog/2014/04/21/dr-teitelbaum-talks-chronic-fatigue-syndrome-fibromyalgia/
3. Sarah Myhill has a very detailed website with lots of detail on her treatment approach. She seems fairly alternative and has rubbed the authorities up the wrong way ...
    http://www.drmyhill.co.uk/wiki/Summary_of_my_approach_for_CFS_/_ME_sufferers.
4. Chris Kresser doesn't specialise in CFS, but I really like his approach to medicine (holistic but evidence-based).  He has a great blog and podcasts.
    https://chriskresser.com/5-causes-of-fatigue-your-doctor-may-not-be-looking-for/


Treatments

Pacing
This is the most effective treatment there is for CFS, though it is more of a management strategy.  The premise is to work out your "energy envelope" and then not to exceed that.  Sounds simple, but it's actually feckin' hard to do.  The first reason is the your energy envelope on any given day way vary.  The second is that you have no timely feedback to indicate when you've gone outside your envelope.  Post-exertional malaise doesn't kick in until 24-48 hours after the exertion, so you don't know until it's (way) too late.

A recent development is to use heart rate monitoring to aid pacing.  The idea is that you need to avoid using your aerobic energy metabolism (coz it's broke, see above).  So you work out you threshold (roughly 60% of max heart rate) and do your best to stay below that.  This seems to work well for a subset of patients, particularly the more seriously ill ones. An extension of this is to measure heart rate variability (HRV), which is an indicator "vagal tone", or of how well your autonomic nervous system is working.  If you have overdone it then your HRV will be low, and you should take it easy.  Athletes use this to manage over-training.  Seems good in principle but in practice it doesn't seem to be so clear cut.


Meditation
Second on the list of effectiveness is meditation.  This probably works because it calms the autonomic nervous system, which tends to be overwrought in ME/CFS.  I have started doing a thing called "coherent breathing" which is a way of breathing which increases your HRV - 5 seconds in, 5 seconds out.  It leaves me feeling much calmer than meditating usually does, and I find it easier to do.


Lymph
Apparently CFSers have "sluggish lymph" and can benefit from treatments that help get the lymph moving.  I have had both manual lymph drainage and craniosacral therapy and am totally knocked out for a few days by both (in a good way).  So something is going on, and I like to think it is a good thing (clearing out toxins etc).  Craniosacral therapy is a pseudoscietific though ...

Third on the list of effective treatments in something called the Perrin technique, which is a form manual lymphatic drainage specifically for treating CFS.  My mate Phil is going to learn how to do it in May, so I'll let you know what I discover.


Sleep
CFSers have very poor sleep which is a major barrier to recovery. Good sleep hygiene is critical.  I snore and intend to get a sleep study done to exclude sleep apnea and see if there's anything else that can be done.


Gut
CFSers spend a lot of time messing with their diets.  There is no one answer, but many benefit from a low-carb diet.  Others find avoiding certain food chemicals to be helpful.
* GAPS
* Paleo Autoimmune Protocol
* SCD
* FODMAP avoidance - particularly for IBS
* RPAH Elimination diet - salicyclates, amines, glutamates
* low-oxalate diet

It's hard to say if dysbiosis and/or intestinal permability is a cause of CFS or a result of another mechanism (e.g. hypometabolism).  But it seems reasonable that treating it would improve nutrient absorption and reduce inflammation, which may help the body heal itself.


POTS/OI
POTS (Postural orthostatic tachycardia syndrome) and OI (orthostatic intolerance) are common problems for a subset of CFSers.  This seems to be tied to autonomic dysfunction.  Treatments are drinking lots of electrolyte, eating lots of salt, compression stockings and blood pressure medication.

My resting heart rate is about 55bpm.  When I stand up it shoots up to 105bpm but comes down to about 80 within a few minutes.  I don't think I would qualify for POTS because the high heart rate isn't sustained, but would be close (I intend to get this checked out by a GP).  I don't think my blood pressure is too much of a problem (rarely get dizzy). In any case I have been making my own electrolyte drinks and adding lots of salt.  Once it cools down I will try some compression stockings or Skins.


Methylation
This is a treatment approach many CFSers have pursued, though it may just have been flavour of the month. Having said that, I think recent research is showing that CFSers have a greater number of SNP mutations than normal in these areas.  I've had the 23andMe test done and have a couple of important homozygous mutations (MTHFR 1298 and CBS), but I think I need to get further tests done to work out if these are actually causing a problem.  Useful tests are homocysteine and organic acids - anything else you recommend?  This is quite the rabbit hole to go down ...  I have tried B12, 5-MTHF and a few other things but found they just made me wired.  I think I have been approaching this blind and need more hard numbers to work with, and an expert wouldn't go astray!


Anti-virals
Some research has shown benefit from treating patients with anti-virals, with the theory being that we have viruses that aren't active in the blood, but elsewhere (e.g. spinal cord, vagus nerve, gut).  One study treated EBC, CMV and HHV-6:
    http://phoenixrising.me/interviews-3/learning-cfs-dr-lerner-on-his-longterm-antiviral-treatment-study-0510-by-cort-johnson
Another doctor has been using oxymatrine as an anti-viral with some success:
    https://www.healthrising.org/chronic-fatigue-syndrome-mecfs-doctor-resource-center/dr-john-chia/


Immunotherapy
Cancer researchers in Norway found that Rituximab has been effective at treating CFS.  THey are doing clinic trials at the moment.  It kills B-cells, of which there can be too many in CFS.
    https://emerge.org.au/rituximab-mecfs-new-trial-begins/#.WMolPkT9lWc


Lyme
Lyme disease is a bit controversial in Aus, but there are doctors treating for it.  People with CFS sometimes turn out to have Lyme, or something Lyme-like.  Treatment is a shitload of antibiotics for a long time, which is expensive and seems risky!  I've had a test for Lyme, but not the one from the US which is supposedly more sensitive. 

There are other chronic bacteria infections that might be an issue for CFSers (e.g. Mycroplasma).

Amygdala retraining
There are neurolinguistic techniques that attempt to retrain the brain out of it's chronically wired mode.  I did the Gupta AMygdala Retraining programme about a year into my illness and found it helpful for breaking out of the sickness mentality (obsessing about symptoms etc).  Beyond that I doubt that it gets to the cause of the illness.  There have been a few small studies that show some benefit.


Toxicity
Exposure to toxins may be a trigger in some CFS cases, and detoxification can be impaired in those with CFS.  Heavy metals and mould are two prime candidates, though there are plenty more nasty chemicals out there.  Some people with CFS develop Multiple Chemical Sensitivity (MCS) which means they have to avoid *everything*.  One approach in CFS is to move to the desert and replace all your clothes to avoid mould!

I haven't been tested for heavy metals (except for lead).  What would be the best test for this?  Also, do you know anything about testing for mould?  I was exposed to mould just before I got sick, and our rental at Wellesley St had a leaky roof with mould problems.


Mitochondria
Lots of supplements used by CFSers aim to provide mitochondria support, and have some research bonafides  Ones that come up often are CoQ10, D-Ribose, NADH, Acetyl-carnitine.  I've tried some of these but not sure if all at once.


Thyroid and adrenals
These often have problems, though again I suspect they are the result of an underlying problem rather than the cause.  Hypothyroidism is common, and "adrenal fatigue" gets a lot of attention (though I'm not sure is that is a proper disease or not).  My thyroid isn't perfect: good TSH, free T4 and free T3 (even according to tighter "alternative" ranges) but my reverse T3 is high and I have TPO antibodies.  My reading suggests that the reverse T3 could be due to high stress (which is a given with CFS).  The TPO antibodies could be because my Mum has Hashimoto's, and apparently that can show up in my antibodies.  I take iodine and selenium to provide support for my thyroid, and have tried tyrosine before.  I've also has DHEA-S tested, which was fine, but haven't done cortisol.  I think it is best to do a 24 hour cortisol/DHEA test to pick up adrenal dysfunction.


Copper and pyrroles
I don't know much about this, but see it mentioned from time to time on the forums.  Not sure how much evidence there is for pyroluria?
    https://www.drbillsukala.com.au/nutrition/pyroluria-disease-myth/