Adriana Elena M.D.

inverno per me — le gemme si gonfiano siamo in orario winter for me — buds swelling we’re on time #haiku

@KomadoriK 👏👏 The moment you experienced was truly wonderful in its simplicity. Many profound experiences do not come from great events, but from tiny moments of absolute presence: a hailstone in your mouth, a flash of red among the branches, a shadow on the asphalt

Walking among the tombs nestled in stone pansies of silent gardens watch me curiously — serene eyes between the one passing by and those who remain. #haiku #micropoetry

On the hedge, clouds of white flowers and pearly buds — I drift into a London May with its great meringues.

Vitamin B12 is absorbed through two pathways. The first is intrinsic factor, a protein produced by parietal cells in the stomach. IF binds B12 in the small intestine and carries it across the gut wall via a receptor called cubilin in the distal ileum. This pathway is efficient but has a hard ceiling: it saturates at roughly 1.5 µg per dose. No matter how much B12 you swallow beyond that, IF cannot carry any more. The second pathway is passive diffusion. About 1 to 2% of any oral dose diffuses across the intestinal lining without IF, and this occurs along the entire length of the gut. At dietary doses, this pathway is negligible. At supplement doses, it becomes the primary route of absorption. Adams et al. (1971, Scand J Gastroenterol) measured whole body retention of radiolabeled cyanocobalamin at different doses. At 1 µg, roughly 50% was retained. At 5 µg, about 20%. At 25 µg, just over 5%. The NIH Office of Dietary Supplements reports approximately 2% absorption at 500 µg and 1.3% at 1,000 µg. The fraction drops dramatically. But the total amount absorbed keeps rising. At 1 µg you absorb about 0.5 µg. At 1,000 µg you absorb roughly 13 µg total, of which approximately 10 µg comes from passive diffusion alone. The RDA is 2.4 µg. Even the backup pathway, working at 1% efficiency, delivers more than four times your daily requirement from a single pill. This is the basis for high-dose oral B12 as an alternative to injections in patients who lack intrinsic factor. The NIH notes that high-dose oral supplementation "may be another treatment option" for pernicious anemia, though injections remain standard first-line therapy and the available randomized controlled trials comparing the two approaches are considered limited in quality. One important nuance: absorbing B12 into your bloodstream is only the first step. After absorption, B12 must bind to a transport protein called transcobalamin to reach your cells. This complex, holotranscobalamin, is the biologically active fraction. It represents only about 20 to 30% of the total B12 circulating in your blood. The remaining 70 to 80% rides on a separate protein called haptocorrin, which does not deliver B12 to most tissues. This is why serum B12 can be misleading as a status marker. A person can have a "normal" total serum B12 level while their holotranscobalamin, the fraction that actually delivers B12 to cells, is low. Methylmalonic acid is a more sensitive functional marker because it rises when cellular B12 is genuinely insufficient, regardless of what total serum B12 shows. Absorption determines how much B12 enters your blood. Transport determines how much reaches your cells. Testing only total serum B12 measures neither of these processes accurately. Adams et al., Scand J Gastroenterol, 1971 NIH Office of Dietary Supplements, 2024 Allen et al., J Nutr, 2018

@WilliamWallace Personally,I choose fibers based on the metabolic or intestinal goal. For example: •If I want to nourish the microbiome,I usually recommend: legumes,oats,kiwi,berries,seeds,resistant starch,different vegetables and polyphenol-rich foods.

"Soluble vs insoluble" is one of the most enduring oversimplifications in nutrition. Two fibers in the same label bucket can do completely opposite things in your body. Fiber has at least four properties that vary independently: • Solubility (does it dissolve in water?) • Viscosity (does it form a gel?) • Fermentability (do colon bacteria eat it?) • Physical structure (intact or particulate?) Each property drives a different outcome. The label binary collapses all four into one. Examples: Cellulose (wheat bran, vegetables). Insoluble, non-viscous, barely fermented. Bulks stool, speeds transit. No metabolic effects. β-Glucan (oats, barley). Soluble, highly viscous, moderately fermented. Lowers LDL via bile acid sequestration. The FDA-approved oat health claim is built on this property. Psyllium. Soluble, highly viscous, poorly fermented. Survives intact through the colon. Lowers LDL. Normalizes stool (works for both constipation and diarrhea). Inulin / FOS (chicory, onions, garlic). Soluble but non-viscous. Highly fermentable. Bifidobacteria use it as substrate to produce SCFAs. Minimal LDL effect. Can bloat. Resistant starch (cooked-cooled potato, green banana). Insoluble but highly fermentable. Produces butyrate, the primary fuel for colonocytes (~70% of their ATP). Why the binary fails: Inulin and psyllium are both labeled "soluble fiber." Inulin ferments completely, produces SCFAs, has only minimal LDL effects. Psyllium passes through largely intact and lowers LDL via bile acid sequestration. They share one property and differ on every other one that matters. Practical translation. Match the fiber to the outcome: • LDL drop → viscous fibers (psyllium, β-glucan, raw guar gum) • Microbiome support → fermentable fibers (inulin, FOS, resistant starch) • Regular stools → either viscous gel-formers or coarse insoluble particles The label binary doesn't tell you which is which. The properties do. McRorie & McKeown, J Acad Nutr Diet, 2017 Donohoe et al., Cell Metab, 2011

Gut microbiota responses to bariatric surgery are associated with metabolic outcomes and type 2 diabetes remission dlvr.it/TSR0ST

Visceral adipose tissue (VAT) strongly links to obesity-related cancers beyond BMI. 🔐The biology of fat distribution matters! 🔎Read more: ow.ly/izoY50YWiMf #CancerResearch #ObesityResearch #CancerPrevention #WomensHealthResearch #BodyComposition @wiley

What are the three sources of the liver fat in fatty liver disease and how do you get rid of it? see.nf/3Q8USZP

A blue star fell among us. No one saw it — it is happy anyway.

@KomadoriK Beautiful! Very poetry

Between the bricks, a quiet delicacy persists. Through a thousand pains — life.

Blue petals in soft blur Wildflowers whisper in spring grass Small skies near the ground

Candy Sunset Little lake on fire — after a boring grey day I catch it on the fly and take it home warm little candy #Haiga #haiku #micropoetry

Moonrise at Tongariki (Easter Island) Rising silver Moon, swaddled in the pink blankets of sunset. You open a night of peace… Infinite peace #micropoetry #easterisland

Intermittent Fasting and Healthy Aging in Older Adults: A Systematic Review of Cardiometabolic, Mental Health & Cognitive Outcomes w/a Network Meta-Analysis of Anthropometric Measures ✅️ The systematic review suggests these intermittent fasting protocols are associated w/improvements in metabolic markers (HbA1c & blood pressure) & preservation of lean muscle mass. ▶️ The cardiovascular mortality risk associated w/very restrictive eating windows may emphasize the importance of moderate fasting approaches in in adults ≥60 years. mdpi.com/2072-6643/18/9…

Little Violet Sun Little violet sun you appear so suddenly in the forest dark Wild Hepatica of Bosco di Bardo. #Hepatica #WildFlowers #SpringHaiku

Laburnum

@KomadoriK Beautiful!

Forsythia at Bouzov A golden sphere on a green hill — May drizzle cools my skin. Forsizia a Bouzov Una sfera d’oro su un colle verde — pioggerella di maggio Rinfresca la mia pelle #Forsythia #BouzovCastle Nota : Bouzov, the park of the magnificent Bouzov castle, Cechia

the lean mass vs actual muscle protein distinction matters here. DXA picks up glycogen, water, and organ volume alongside muscle. some of what registers as lean mass loss is glycogen depletion, particularly early in treatment. what's interesting is the functional data. the Semalean study showed DXA lean mass declining while handgrip strength actually improved at 12 months. the scale number and the functional capacity aren't moving in the same direction.

Omega-3 supplementation may be associated with accelerated cognitive decline in older adults

@WilliamWallace SCFAs are also metabolic and immune signaling molecules. They influence: •GLP-1 •satiety •insulin sensitivity •intestinal permeability •inflammation •the gut-brain axis That is why we speak about “feeding the microbiome” and not simply “eating more fiber”.