Saturday, March 07, 2020

Cell surface oxygen consumption (4) Influenza

This press release, from 2013, surfaced on twitter (embarrassingly I have again lost the tweeter due a hat tip for this. Mea culpa. Found him, it was resurfaced/retweeted by Gu├░mundur J├│hannsson).

Glucose: Potential new target for combating annual seasonal flu

which summarises this paper:

Glycolytic control of vacuolar-type ATPase activity: a mechanism to regulate influenza viral infection.

Over the last few weeks I happen to have been immersed in vacuoles/lysosomes, cysteine toxicity, longevity and yeasts. Oh, and mTORC1, which is deeply associated with lysosomes. So I'm in a mindset of how lysosomes/mTOR control longevity/anabolism.

Anyhoo. Influenza A virus uses lysosomes to maximise its survival. My prediction is that it activates mTOR to induce a marked anabolic state and hijacks that anabolic state to generate lots and lots of influenza A virus particles. It will do that, much as a cancer cell might, by aerobic glycolysis working on the basis that glycolysis, while inefficient, is very, very fast at generating ATP compared to OxPhos. This would suggest that the free availability of glucose secondary to hyperglycaemia (or increased access of glucose to the cytoplasm secondary to hyperinsulinaemia) will increase the success of the influenza virus, as found in Kohio's paper.

Which brings us to anabolism and glycolysis. Not only does aerobic glycolysis supply ATP for anabolism faster than OxPhos can but it also supplies phosphoenolpyruvate for amino acid synthesis, plus other anabolic substrates come from glucose via assorted pathways.

However for every glucose molecule which generates a pair of 1-3 bisphosphoglycerate molecules two NAD+ are consumed. If these glycerate molecules are used for anabolism via phosphoenolpyruvate they will not restore the NAD+ balance by converting to lactate. The basic story is in

Cell surface oxygen consumption (2)


Cell surface oxygen consumption (3)

with an introduction to the concept in

Cell surface oxygen consumption (1)

The glycerophosphate shuttle won't do the job because this too is limited to the speed of OxPhos. Cell surface oxygen consumption does fit the bill for rapid restoration of NAD+.

So. Does influenza virus drive cell surface oxygen consumption to facilitate anabolism at a speed fast enough to keep it one step ahead of the innate immune system?

I don't know.

But another standard (primarily rodent) model RNA virus certainly does.

Oxygen uptake associated with Sendai-virus-stimulated chemiluminescence in rat thymocytes contains a significant non-mitochondrial component

I think this will be a basic feature of rapid anabolism, be that viral or neoplasia related.

Will hyperglycaemia and/or hyperinsulinaemia facilitate viral directed anabolism under infection by another, more topical novel human RNA virus?

Personally, I'm not planning on finding out the hard way when I get around to catching the current bug.



  1. Wow. The intersection of coronavirus and cancer.

  2. Anabolism cave, tissue repair does it too, I believe. Not that hyperglycaemia would be my preferred approach to healing injury!!!


  3. What can we do best to avoid getting sick with corona virus or flu virus ? Do you have any recommendations without hand washing etc? I eat PKD diet take cold shower 3-4 times a week a little infra red sauna 2-3 times a week trying to get enough sleep. What about fasting if people should be attacked of virus ? Many people recommend large doses of vitamin c, which I find strange when you see evolution and human access to it here in the north (Norway)

  4. This was an interesting read but a bit rough in translation. Bit rough in general. I wondered if ARBs would block those receptors in mucosal linings?

    There is some connection between vit D status and ace2 --- enzyme or receptor? --- I don't know. People use the term ace2 ambiguously. However there don't seem to be anywhere near as many cases of CV in the southern hemisphere yet. OTOH there aren't anywhere near as many people down here either.

  5. Here's the advice from the program I contribute to:

    Peter's readership here is probably already on top of low-net-carb aspect of it, but may not have optimal 25-OH D3 levels, nor have completely eliminated various grain hazards, and may be completely unaware of what we might do to optimize microbiome (and thereby, contribute to immune status). Extended keto, by the way, makes getting ample prebiotic/insoluble/resistant fiber carb more challenging. The Undoctored/What Belly diet is in my view just on the glycemic/keto borderline.

    Anecdotally, when I switched to the original Wheat Belly diet in 2011, I stopped* getting sick, although it took several years to notice, because humans are inept at noticing when the unexpected doesn't happen. The dysbiosis topic didn't even enter the program until 2014, so there appears to be a lot of benefit in just being grain-free, very low net carb, and attending to the top modern micronutrient deficiencies.

    Vitamin C, by the way, is not program core. Many people swear by it for viral defense, and it's relatively harmless to consume, up to grams per day.

    * I did finally manage to catch something in the Fall of 2019, but had to get exposed to two separate huge crowds of people, numbering in the tens of thousands. It passed quickly.

  6. My best advice would be to try not to be elderly and try not to be diabetic.

    Re Vit C I would avoid it so as to maximise the effectiveness of my immune cell generated ROS unless I was making enough ROS deep in my lungs so as to develop ARDS, at which point a big dose IV might help but would be hard to organise if sedated and ventilated in an ITU at the time!


  7. Great general advice; the problem (for someone 70) is the lack of specificity on how not to be elderly :-(

  8. re: …try not to be elderly…

    Sure, but just what is it that puts the elderly at higher mortality risk? The years per se, the extra decades of demented dietary dogma, overlooked matters to exploit, or some combo?

    On age per se, the risk:age distribution for COVID-19 appears to be similar, although somewhat more exponential for '19, vs. typical annual flus. A speculation on that is the older someone is, the more annual flus they've been exposed to, and thus there may be some immunity. The present agent may be too novel for anyone to have immunity.

    re: …lack of specificity on how not to be elderly…

    The Undoctored program seems to be finding itself heading in that direction (in terms of not just preventing age-related declines, but perhaps unwinding such things as can be unwound).

    It started out as TrackYourPlaque, devoted specifically to atherosclerosis, but as effective strategies for that provided unmistakable wider benefits, it became more focused on healthspan — which might turn out to be something like: live in great health until 95, then die suddenly of stroke. Aging topics arise frequently on that blog.

  9. Hello Peter!

    I have been going through your blog for the past couple of days and I must say that it is really a goldmine! I have learned so much! Though I have not read all of it yet!
    I was wondering do you know any research that links high levels of omega-6 in the standard American diet to thyroid antibodies? Do seed oils influence autoimmunity? I am trying to research if there is a connection.

    Thank you very much.

  10. the elderly, and all of us, can raise the temp and humidity in our houses:

    "maintaining indoor relative humidity at levels greater than 40% can significantly reduce the infectious capacity of aerosolized flu virus."

    "For infected guinea pigs housed at 5 degrees C, the duration of peak shedding was approximately 40 h longer than that of animals housed at 20 degrees C; this increased shedding likely accounts for the enhanced transmission seen at 5 degrees C."

  11. Probably this tweet, from a discussion with Maratos-Flier two years ago.

    I first explored this topic back in 2014:

    Glucose and the Stomach Flu—Starving a Fever

  12. Hi Bob N—I recognize you from Dr. Davis' site.

    Just like you and others, ever since I went grain-free and low-carb, I don't really get sick (respiratorially, anyway—Lyme doesn't count). Over 10 years, I got a very mild case of the flu-or-something only once, after going to a Star Wars opening with a theater full of people during a local whooping cough outbreak. Another time there was a norovirus going around and everybody else in the household got violently sick for several days. I felt a little bit oogy overnight and then it went away. Not a single cold in all that time, knock on wood.

    It's interesting that Bob should respond to Peter's cheeky comment about not being old with a serious query: what is it about being old that makes one more susceptible to severe consequences?

    Being 66, I'm counting on my general lifestyle resistance to respiratory illnesses to cover me on that front. Plus I live out in the middle of nowhere where it's easy to avoid large crowds, especially in light of the fact that the huge international tourist crowds to my area (specifically grocery store) are certain to be very curtailed this summer.

  13. HI Peter,

    well I caved and bought Virkon S for home in Sydney! ( Logically knowing good old soap and water just fine) Advantage over bleach, it does not ruin surfaces!

    Still using it in HK as well!
    The kitty with Feline Coronavirus in Macau doing just fine too, fingers crossed it does not turn nasty!

    Thank you as always for such great content on your site. This article was v timely as Australia comes in to flu season and we have community outbreaks of SARS-2 Cov blah blah!

  14. Peter, do you know this study where glucose significantly increased survival chances?

    I'm not sure what to make of it. It seems to contradict several other studies of course. A diet of 100% protein or 100% olive oil is unnecessarily extreme, and it's a mice study with only one strain. But still, the results seem to merit some further experiments...
    Maybe we need a bit of anabolic metabolism to combat virus infections (or some virus infections)?

  15. Sorry for unrelated post:

    Seems they have finally nixed Omega 3 supplements. Surprised they didn't see more harm.

  16. cavenewt: I recognize you from Dr. Davis' site.

    And if anyone is interested in whether Dr.D's suggestions might provide (possibly substantial) extra benefit in COVID-19 prevention, they'll need to nav there deliberately, because it appears that self-appointed search net nannies are censoring it in results.

    cavenewt: I felt a little bit oogy overnight and then it went away.

    That's been my experience, many times. I'll go to bed thinking: I'm going to have a cold on the morrow, but in the morning, it's gone. My presumption is that this the experience of a properly functioning immune system.

    Eric, on those new Omega 3 reports:
    0. one is Cochrane
    1. they are metas
    2. they are pay-walled
    So although we might be able to infer PI agendas, a key thing would be which inconvenient fish oil trials they omitted. And then we have to look at the trials left in, for things like sub-clinical dosing, using ALA instead of DHA+EPA, what the "placebo" was (if any), what else was inflicted on the hapless arms (e.g. statins).

  17. Bob: Both are available without paywall. One here, the other here Haven't read them though, I share Richard Feinmans opionions on meta studies. :)

  18. There's lots of evidence that ApoA1 is protective against ARDS sepsis.
    The comorbidity risk factors for COVID-19 mortality are CVD> T2D > hypertension.
    This implies that either, CVD is the worst form of T2D, as per Kraft, or artificially lowered lipoproteins are an even bigger risk factor than glucose.
    Not mutually exclusive, of course.
    Selenium is important; pre-2019 coronavirus encoded for 60 selenocysteine residues per core protein, Se depletion weakens immunity and target tissues, and can cause RNA viruses to mutate and become more virulent.

  19. passthecream mentioned ACE2. Ran across this today:


    "The virus enters the body through the nose, mouth or eyes, then attaches to cells in the airways that produce a protein called ACE2. The virus is believed to have originated in bats, where it may have attached to a similar protein."

  20. There is that ambiguity again. I think it attaches to the ace2 RECEPTOR from what I've read, Sars etc also. The ace2 receptor is expressed on certain cell types including some mucosal ones. Ace2 itself ie Angiotensin-Converting-Enzyme-2 also attaches to the ace2 receptor. That's how it does its job. Several articles just say 'ace2' like that but it is an important difference.

    I have read ( somewhere in the bazillions of paragraphs on the topic!) that many of the elderly Chinese male hypertensives who have succumbed were smokers so that would load the dice hugely but per my speculation above I wonder if it is hypertensives who are being treated eg via ace2 receptor blockers and/or statins etc. who are more susceptible? Or less? We will probably never find out.

    Stay safe.

  21. Btw from my time a few years back on ace inhibitors and then ace2i, particularly the former, I remember the swallowing difficulties. They are receptor blockers btw. Blood pressure pills.

  22. Thanks for the links, Frunobulax

    The Cochrane appears to be trying to win just based on thud factor (sheer mass of pages), and would take months to untangle.

    The BMJ is just silly on its face. Whether Omegas are helpful in T2D is moot, as it's an utterly optional ailment, not really a disease, unless allowed to degenerate to the point of irreversible complications.

    I suspect we agree on metas. Somehow they always manage to exclude this one:
    I'm sure they have their reasons. Perhaps, to paraphrase a line from Amadeus "Too many variables".

    On Dr. Davis subscription forum, the membership, always on alert for black swans, has been tracking fish oil papers basically since the site started (as TrackYourPlaque). I've duly noted these two.

  23. Kevin and Bob, I think Figure 4, bottom section in describes nicely how to avoid being elderly.

    Hi Helsman, I’ve never looked at thyroid and seed oils in detail. To me auto immunity is secondary to increased intestinal permeability and while plant toxins are the core driver then I would not argue with seed oils doing the same. There are suggestions of this but I have no studies.

    Hi Tucker, I think the press release may well have come up in that thread but someone “resurfaced” the thread in the last few weeks…

    Hi Shaza, we’re mostly encouraging elderly relatives to limit exposure risk. We’re lucky to be a fairly rural family and this is reasonably possible.

    Hi Frunobulax, great study, they’re really trying and the years of research that went in to the paper are impressive. Ultimately there are enough people around eating ketogenic diets that a simple reality check is to ask whether eating keto gets you in to the ITU during routine flu seasons. There is enough anecdote out there to suggest that the research group has advanced our knowledge of immunity vs glucose levels in C57Bl/6 mice with their known wide range of metabolic dysfunctions. Much though I love Bl/6 mice I feel this paper doesn't pass a simple reality check, not that the authors would have that check available as they are unlikely to be aware of the keto community experience of routine influenza seasons.

    Hi Eric, I note the omega 3 folks have issues with the paper…

    George, that’s interesting. I’ve long regarded ApoA1 as a surrogate for saturated fat intake, whatever it does in its own right. Possibly omega 6s are the core driver of ARDS? A brief look at the literature on ITU enteral feeding reveals depressingly poor quality papers. I recall Tucker has cited links that suggest that acute radiation sickness is essentially omega 6 mediated. I would have no problem with ARDS being similarly mediated.


  24. Interesting stuff as usual..

    There is a further bit - eating carbs is linked to flare ups of osteoarthritis. I think we know that the "wear and tear narrative" is false - they are seeing cytokines and more. What I think is likely is we have hidden infections that they don't detect in the blood stream - low level - chronic - could flare up with increases in BG. As we age the ones we can't get rid of accumulate.

    (The idea that your doctor can detect every infection is just wrong - they miss about 50% of urinary track infections - just a few years ago, if you went in with Lyme's disease they sent you to a shrink. Even with PCR they have to know what they are looking for in order to detect it ).

    One of the things I learned when digging through lipoprotein papers is they are part of the innate immune system - best not to mess with it. The idea that we understand the immune system fully is just nuts - the immunesystem is everywhere - involved in everything going on in our bodies - we are walking ecosystems of bacteria.

    The other bit I am puzzled with is why the mass hysteria? They really don't know the death rate - they are only testing the people that are sick. Influenza has a rate of about 0.1% - they are claiming Corona has a rate of 1-3%(just wild guesstimates) - but if you remember SARS had a rate of 10%(or do we really know?).. How many of the deaths would be in next years influenza statistics? It appears that these people are mostly set to die - and some infection is the precipitating event. I think the fear of the virus is going to do more harm than the virus.. (For the record - I wash my hands after I'm out in public - always have - to prevent colds and influenza - but what is happening now is nuts.)

    So I'm wonder - we have a world where never before were so many people fed and safe and housed - yet addicted to cell phones-TVs-computers - and not happy. So many want to blame someone/thing else for this unhappiness - the opposing political leaders - some other group - and now a virus? Or is it the electronic device addictions that have turned us into a world of neurotically addicted pansies? This smells of mass hysteria - anyone want to buy tulips?

  25. karl,

    I've always viewed osteoarthritis as metabolic syndrome of the chondrocytes but I'm open to related ideas.

    The panic is fascinating. I have no problem with our elderly relatives opting for some level of social isolation, at least this gives time for the virus to attenuate a bit and the for the queue for ITU beds to shorten a little. For myself I don't much worry about getting infected, apart from not wanting to be the one to pass the bug on to our potentially at-risk relatives.

    I quite like tulips, excepting the squirrels seem to get most of those planted in random flower beds. Happily I have not spent my life's savings on a single bulb. Nor on a single roll of toilet paper!



    So fresh air and sun cant be wrong.But north in Europe its not d-vit before may from the sun.


  27. karl: "(The idea that your doctor can detect every infection is just wrong - they miss about 50% of urinary track infections - just a few years ago, if you went in with Lyme's disease they sent you to a shrink. Even with PCR they have to know what they are looking for in order to detect it )."

    People place a depressing amount of confidence in modern medicine. Don't even get me started about testing for Lyme disease, especially in the US. I had an acute infection a couple years ago and consequently learned way too much about it. There *is* a PCR test, but you don't qualify for that until you test positive on an ELISA screening test, which has something like a 50% false negative rate in the early stages of infection. Whose bright idea was that?

  28. Well the panic keeps increasing - they have cleared the shelves of toilet paper, closed the schools - not a single case in the county. Government idiots fanning the flames of irrational fear.

    I've seen this on small scale during coastal floods - this is different - is it organic or a pych-opp? The positive feed back loops of social media/mass media reinforces the 'Maddness of Crowds' If this continues to grow, I suppose we get violence next? Marshal law?

    @Peter - you can search osteoarthritis inflammation markers on Google scholar - number of papers come up - I don't think we know anything yet - The chondrocyte narrative could account for it. I really don't think it is just a disease of old age - some people just don't get it. There is a possible link with NO production. The other parroted narrative is it is "autoimmune" - but that assumes we KNOW that there are no hidden infections. I am not satisfied with any of the narratives yet. Lots of quiescent infections that we don't understand well.

    Several NO disrupters are linked with CAD - Lead exposure/high BG/PPIs/stress. There is some evidence that some old malaria and TB drugs might work(poorly)(some inflammation reduction without a good explanation). I've wondered if CAD/osteoarthritis/SFPN/etc have a common cause.

    I think part of the problem is most research has the goal of producing a paper for an advanced diploma - we really need more research where there are a series of experiments that tie together.. and are real science. Much of this is potentially knowable - yet so little that we know.

  29. Thank you Peter! Yes I agree, perhaps seed oils effect gut permeability. It's really fascinating!

    BTW I found this paper "Dietary lipids and risk of autoimmune disease."

    It argues that Omega-6 contributes to autoimmunity. Also there is a fascinating paper, where someone got rid of their Graves antibodies by consuming flaxseeds(ALA).

    Your thoughts?

  30. Also Peter, it appears that flaxseed influences "Intestinal Tight Junction Protein and TNF-alpha Gene Expression", perhaps that explains the resolution of Grave's disease in that paper.

  31. Deuterium depleting , its interesting result against cancer and maybe flu virus .


  32. karl,

    The panic here in the West San Gabriel Valley just east of Los Angeles is getting underway. What a difference a week makes.

    Costco is rationing bottled water. They were out of toilet paper, paper towels, facial tissue.

    Walmart is rationing toilet paper and other paper goods, eggs, common cheeses. The processed meat and cheese "deli" wall was cleaned out. Almost all canned goods were cleaned out. At least they had Green & Blacks 85% and Lindt 95%. That made me happy.

    Trader Joe's was hit hard. All frozen vegetables were cleaned out. Dairy was cleaned out. I got the last package of cluster tomatoes before closing. An employee told me that when the store opened Saturday morning the line to get in was halfway down the parking lot.

    I don't think government is fanning the flames as much as the politicians are just trying to keep their jobs. If there are many deaths, something of which I'm skeptical, there will be political hell to pay. I think the panic is more news-media-driven.

  33. Bob, that's hysterical, in a non funny way.

    People are really expecting the mains water supply to fail? I believe there is still mains water in Wuhan!


  34. Peter,

    Here in the USA, or at least large parts of it, there seems to be a prejudice against tap water (which I think is what you mean by "mains water"). People tend to buy gobs of bottled water. My elderly uncle, when he was still alive, was struck by how "fashionable" it was for people to carry and drink from plastic bottles all day long.

    I drink tap water because I've read there are few quality standards attached to bottled water, so it might easily be tap water after all. I do let it sit out in open glass containers for a day or so, because I've read the chlorination converts to salt, and this slightly improves the taste.

  35. Peter said: "Possibly omega 6s are the core driver of ARDS? A brief look at the literature on ITU enteral feeding reveals depressingly poor quality papers. I recall Tucker has cited links that suggest that acute radiation sickness is essentially omega 6 mediated. I would have no problem with ARDS being similarly mediated"

    Well, tweeted this a while ago:

    "As plasma linoleic acid concentrations decreased, there was usually an increase in plasma 4-hydroxy-2-nonenal values, one of its specific peroxidation products, suggestive of severe oxidative stress leading to molecular damage to lipids."

    "Plasma FA changes and incr. lipid peroxidation in patients with ARDS"
    Showing LA converting to HNE.

  36. Nice one Tucker, did you pick up this one too Got it from the related links.

    Plasma PUFA on admission predict who will go on to develop ARDS in the ITU. Dying of ARDS? Thank your cardiologist. Should you happen be there through fulminating pancreatitis you can thank them for that too. Mmmmm, corn oil...


  37. That's remarkable. Have you found full-text?

    That led me to this:

    "Oleic acid is the most common and abundant fatty acid in the body of healthy individuals."

    Nevertheless, it's trying to kill you.

    "Acute Respiratory Distress Syndrome: Role of Oleic Acid-Triggered Lung Injury and Inflammation"

    I think they need a better model...

  38. This comment has been removed by the author.

  39. Bob said "Here in the USA, or at least large parts of it, there seems to be a prejudice against tap water."

    This is absolutely true and I believe it's a result of marketing propaganda by bottled water manufacturers.

  40. Tucker said "'Oleic acid is the most common and abundant fatty acid in the body of healthy individuals'...I think they need a better model." By "better model", do you mean a better example of a healthy individual, as opposed to an average person eating the SAD? I always wonder about this. What they now consider the average healthy (non-sick anyway) person is not necessarily the same as an evolutionarily healthy person.

    Anyway, you guys might find this of interest. "Metabolism as a Novel Facet of Virus-Host Interaction" July 2019.

  41. RE vitamin C, the only time I take this is if I feel as if I have a cold/flu coming on. Even then, I can't handle anywhere near the grams most people recommend. After 6+ years low carb/keto, this vitamin makes me feel...strange. I don't like it. I tend toward black elderberry, zinc, etc., instead. And those usually only if a pandemic approaches or there is sickness in the house. Both my kids got the flu this year, but oddly, neither my wife nor I got it.

    I've been "carnivore-ish" for a while now, though lately I've been testing a minor amount of carbs after exercise (lifting to failure + HIIT), particularly with high-stearic acid butter oil in them.

    As for Wheat Belly, I use to go to his site all the time. When I made 6+ batches of his l-reuteri yogurt and got no benefit at all (other than I got to eat yogurt), and I reviewed a lot of the studies he said supported it and found only marginal support, I stopped going. I do think his approach is beneficial for most, though.

  42. "Hypokalemia and Clinical Implications in Patients with Coronavirus Disease 2019 (COVID-19)"

    "CONCLUSIONS: Hypokalemia is prevailing in patients with COVID-19. The correction of hypokalemia is challenging because of continuous renal K+ loss resulting from the degradation of ACE2. The end of urine K+ loss indicates a good prognosis and may be a reliable, in-time, and sensitive biomarker directly reflecting the end of adverse effect on RAS system."

  43. cave, maybe that's why all the tinned tomatoes have been hoarded!


  44. Peter, it's not just the tinned ones!

    cavenewt, nice find. Malcolm Kendrick mentions this in his March 18th blogpost, partially to address questions about ACE inhibitors for infected people.

    The US may be facing imminent lockdown. I need to go out tomorrow and stock up on more eggs and tomatoes if I can find them!

  45. Here in southern Utah, we are already locked down. Two days ago to the state health department closed hotels and restaurants. Locals are breathing a sigh of relief because we live in a tourist town and are swamped with foreign visitors six months of the year. Of course the economic impact will be severe, and maybe not even hindsight will tell us if this was wise or not.

    Personally, as a mostly retired person who lives in a tiny isolated community 20 miles from the tourist town, I'm in pretty good shape. Because of our isolation we tend to keep pretty good food stocks already. As long as the power stays on we're OK — everybody has their own well and very few have solar backups for the well pumps.


  47. Haven't looked into it yet, but my wife's grandma was on it for years for rheumatisim and tollerated well. Interesting that something that might be immunosuppressive would help. Then again, maybe it isn't so surprising in a population that has overreative immune responses.

  48. @Justin The study is observational twaddle, unfortunately.
    Christian Drosten, the leading COVID-19 expert in Germany, says they measured virus concentration in the throat and not in the lungs. Apparently the virus concentration in the throat goes down after a week independent of the severity of the symptoms. Bottom line, it's wasted effort because they measured the wrong thing.

    He also says that the patient groups were different ages and hospital (the control group was younger and brought in from another hospital), and the results would look as if the one group was simply brought in and diagnosed a bit later, which could explain the difference in viral load. According to Drosten, a placebo might have achieved exactly the same results.

    This doesn't mean that hydroxychloroquine is useless. But it does mean that we simply don't gain any knowledge from this study.

    1. That's the risk you run when things are done in haste. I appreciate you taking the time to look into it! Hopefully there are other, better designed studies in the works.