Dr Kevin Lee
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dr-kevinlee.com
Dr Kevin Lee
@dr-kevinlee.com
1.7K followers 1.5K following 210 posts
Physician-Imager: endocrinology & nuclear medicine
#AusMedSky
https://www.linkedin.com/in/kevinleefracp/
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dr-kevinlee.com
With so much attention on NIH lately, can’t help but bring up lack of research focus of #myalgicencephalomyelitis #MECFS by NIH over the years. It’s so low make you wonder if intentional content.iospress.com/articles/wor...
February 15, 2025 at 5:27 AM
dr-kevinlee.com
www.frontiersin.org/journals/pha... #Quercetin Enhancement of Macroautophagy for Cellular Regulation. Its dynamic role in bolstering macroautophagy is a critical cellular process for maintaining homeostasis
Figure 3. Quercetin’s Enhancement of Macroautophagy for Cellular Regulation. The quercetin’s dynamic role in bolstering macroautophagy is a critical cellular process for maintaining homeostasis through the degradation and recycling of proteins and organelles. Quercetin modulates the mechanistic target of rapamycin (mTOR) pathway and activates AMP-activated protein kinase (AMPK), leading to decreased mTOR activity and the initiation of autophagy.
February 14, 2025 at 11:21 PM
dr-kevinlee.com
A small study but #mecfs pts with or without “psychogenic pseudosyncope “ diagnosis, greater orthostatic 🧠 blood flow drop pmc.ncbi.nlm.nih.gov/articles/PMC...
February 11, 2025 at 5:53 AM
dr-kevinlee.com
MMI vs autoimmune induced hypothyroidism, then potentially even more compelling mechanisms of quercetin - pmc.ncbi.nlm.nih.gov/articles/PMC...
Any human study on significant impact on thyroid function? Papers on in vitro studies, or in vivo rodent studies, tend to be quite speculative
Schematic representation of different signaling pathways and targets by quercetin as a potential therapeutic strategy in autoimmune diseases.
January 29, 2025 at 12:46 PM
dr-kevinlee.com
Wow is #quercetin benefits in #T2DM too good to be true? In a RCT vs control , multitude of benefits pmc.ncbi.nlm.nih.gov/articles/PMC...
Graph showing Percentage change (Δ%) in the 8 components/subscales of the SF-36 Quality of Life Scale from the beginning to eight months of this study among 88 patients with T2DM randomized to intervention (n = 42) and control (n = 46) groups.
January 29, 2025 at 10:38 AM
dr-kevinlee.com
Trying to find more published data on this: in #POTS trying to find how many pts respond to pharm & non-pharm management . These are some data I could find from myheart.net/pots-syndrome/
Pie chart- 70.8% answered yes to better manage and improve quality of life since official diagnosis of POTS Pie chart : most effective treatment experienced by individuals with POTS: • Medications: 52.7% found them most effective. • Other treatments: 25.6%. • Diet: 10.9%. • Exercise: 10.8%.
January 10, 2025 at 12:06 AM
dr-kevinlee.com
“compression tights reduced heart rate and symptoms both acutely and after several hours of use.” In #POTS

www.sciencedirect.com/science/arti...
Graphic abstract. Results Protocol #1: Standing heart rate was reduced (105 [99-116] beats/min vs 119 [105-130] beats/min; P < 0.001) and symptoms improved (P < 0.001), during AM-ON vs AM-OFF. Standing heart rate (P = 0.04) and symptoms (P = 0.004) increased when compression was removed after several hours. Protocol #2: Standing heart rate was reduced (84 [77-90] beats/min vs 89 [84-100] beats/min; P < 0.001), and symptoms improved (P = 0.03), during AM-ON vs AM-OFF. Standing heart rate (P = 0.02) and symptoms (P < 0.001) increased when compression was removed after several hours. Conclusions Commercially available compression tights reduced heart rate and symptoms both acutely and after several hours of use. This additional benefit persisted whether concomitant medications were used. (Compression Garments in the Community With POTS [COM-COM-POTS]; NCT04881318)
January 9, 2025 at 11:09 PM
dr-kevinlee.com
#luteolin vs #quercetin, the difference in estrogen effect- much more with luteolin pmc.ncbi.nlm.nih.gov/articles/PMC...
Estrogen agonist activity of luteolin and quercetin. T47D KBluc cells were treated with luteolin (circles), quercetin (squares), or vehicle for 20 h. Induction of luciferase activity by 1 nM 17β-estradiol is defined as 100 %
December 30, 2024 at 7:54 AM
dr-kevinlee.com
Note: naltrexone dose increase from 25mg to 100mg vary only little Mu-opioid receptor blockade but more significant increase in KOR blockade www.researchgate.net/figure/Simul...
Simulated receptor occupancy of naltrexone at the mu (red) and kappa (blue) opioid receptor as a function the log10 of the oral dose (D) The sixfold difference in naltrexone’s affinity for MOR over KOR results in a right shift of the dose-occupancy curve. As a result, the difference in receptor occupancy between 25 and 100 mg naltrexone is only 5.5% for MOR (red arrow), but 19.6% for KOR (blue arrow). Vertical reference lines represent 25 and 100 mg doses.
December 30, 2024 at 2:11 AM
dr-kevinlee.com
www.sciencedirect.com/science/arti... what to call it, Post-COVIDVac syndrome ? PCVS? #Longvax? As a group are they some of the most stigmatised/gaslit cohort of pots/ #mecfs / #longcovid pts we see?
December 30, 2024 at 12:18 AM
dr-kevinlee.com
interesting drug memantine " #NMDA receptor antagonist that improves memory by restoration of homeostasis in the glutamatergic system - too little activation is bad, too much is even worse" - i.e. allows right amount of glutamatergic signal to go through www.sciencedirect.com/science/arti...
This image explains the mechanism of action (MOA) of memantine in Alzheimer's disease (AD) based on the signal-to-noise hypothesis. Key Points from the Image and Caption: NMDA Receptor Dysfunction in AD: Alzheimer's pathology (e.g., Aβ, Tau, energy deficits) causes dysregulated NMDA receptor activity, leading to excessive "synaptic noise." Memantine's Role: Memantine acts as a filter blocking 'synaptic noise' by selectively blocking NMDA receptors. It helps differentiate between pathological noise and relevant synaptic signals. Restoration of Synaptic Plasticity: By filtering excessive noise, memantine allows synaptic plasticity to be restored and improves neuronal communication. Voltage-Dependent Action: Memantine preferentially blocks NMDA receptors under pathological conditions (e.g., excessive glutamate) without disrupting normal synaptic activity.
December 23, 2024 at 1:07 PM
dr-kevinlee.com
Certainly meta analysis of RCTs #LDN in #fibromyalgia , side-effects are no different to placebo, & there is efficacy www.epain.org/journal/view...
Methods: A comprehensive search was conducted on the Scopus, Medline, ClinicalTrials.gov, and Cochrane Library databases up until May 20th, 2024. This review incorporates RCTs that examine the comparison between LDN and placebo in fibromyalgia patients. We employed random-effect models to analyze the odds ratio and mean difference (MD) for presentation of the outcomes. Results: A total of 4 RCTs with 222 fibromyalgia patients were incorporated. The results of our meta-analysis showed a significant reduction in pain scores (MD: –0.86, 95% confidence interval [CI]: –1.20, –0.51, P < 0.001, I2 = 33%) and higher increment in pressure pain threshold (MD: 0.17, 95% CI: 0.08, 0.25, P < 0.001, I2 = 0%) among fibromyalgia patients who received LDN than those who only received a placebo. The fibromyalgia impact questionnaire revised and pain catastrophizing scale did not differ significantly between the two groups. LDN was also associated with higher incidence of vivid dreams and nausea, but showed no significant difference with the placebo in terms of serious adverse events, headache, diarrhea, and dizziness. Conclusions: This study suggests the efficacy of LDN in mitigating pain symptoms for fibromyalgia patients with a relatively good safety profile.
December 20, 2024 at 12:36 PM
dr-kevinlee.com
Disease trajectory of post-infection #mecfs (2004 giardia outbreak in 🇳🇴 ). I think gives us some insight #longcovid #PwLC that are 3-4 years down the track from turning phase to chronic phase now. 2025 is going to be a tough year
pmc.ncbi.nlm.nih.gov/articles/PMC...
December 20, 2024 at 4:26 AM
dr-kevinlee.com
Indeed evolutionary biology theory proposes #PCOS being a survival advantage phenotype- brain, autonomic, neuroendocrine, metabolic, immune/inflammation system changes in the ancestral environment www.mdpi.com/1660-4601/19...
This diagram illustrates the interplay between ancestral genes, environmental factors (past and modern), and how survival responses have evolved to adapt to challenges but can also become maladaptive in contemporary settings. Here’s a breakdown: Ancestral Environment • Challenges: Starvation, fear, and desperation prompted the adaptive survival response to conserve energy and enhance survival. • Adaptive Survival Response: • Physiological Outcomes: • Insulin Resistance: Maintains blood glucose during starvation. • Hyperandrogenism: Increases strength and fitness. • Enhanced Energy Storage: Boosts survival in harsh conditions. • Decreased Fertility: Increases survival of individuals under stress. Modern Environment • Challenges: Western diet, dysbiosis, sedentary lifestyle, stress, and chemical exposures activate a maladaptive survival response. • Maladaptive Survival Response: • Pathological Outcomes: • Insulin Resistance: Leads to PCOS and metabolic diseases. • Hyperandrogenism: Results in acne, hirsutism, and infertility. • Enhanced Energy Storage: Causes obesity and metabolic disorders. • Decreased Fertility: Necessitates infertility treatments. Developmental Programming and Transgenerational Transmission This concept highlights that survival responses (adaptive or maladaptive) can be passed down through generations via epigenetic mechanisms. The once advantageous adaptations to ancient environments now contribute to modern diseases when mismatched with current lifestyles. In summary, this diagram links evolutionary survival mechanisms to contemporary chronic health issues like obesity, PCOS, and infertility, emphasising the role of environmental mismatch.
December 16, 2024 at 9:27 PM
dr-kevinlee.com
#PCOS can be explained in terms of the extended autonomic system?
“1/3 women with PCOS developed hypoglycemic symptoms during the 5h OGTT. The symptomatic patients had lower nadir glucose levels & secreted cortisol and adrenal androgens while experiencing symptoms”
www.mdpi.com/2077-0383/12...
This flowchart illustrates the physiological cycle triggered by simple carbohydrate intake, leading to downstream metabolic effects. Here’s a breakdown: 1. Simple Carbohydrate Intake: Initiates the cycle. 2. Hyperglycaemia: Results in elevated blood glucose levels. 3. Sustained Hyperinsulinaemia: Chronic elevation of insulin in response to hyperglycaemia. 4. Reactive Hypoglycaemia: A drop in blood glucose following the insulin spike. 5. Snacking: Increased hunger leads to frequent snacking, perpetuating the cycle. 6. Obesity & Insulin Resistance: Repeated hyperinsulinaemia contributes to obesity and insulin resistance. 7. Cortisol Secretion: Hypoglycaemia stimulates cortisol production. 8. Adrenal Androgen Secretion: Cortisol indirectly stimulates androgen production. 9. Conversion to Testosterone: Androgens convert to testosterone. 10. Hirsutism: Excess testosterone leads to male-pattern hair growth, particularly in females. Feedback Loops: • Obesity & Insulin Resistance** exacerbate sustained hyperinsulinaemia. • Adrenal androgens further reinforce the metabolic dysfunction, worsening the cycle. This diagram reflects the complex interplay of hormones and metabolism often observed in conditions such as polycystic ovarian syndrome (PCOS) or metabolic syndrome.
December 16, 2024 at 7:03 AM
dr-kevinlee.com
www.mdpi.com/2075-4426/14...
The concept of Extended Autonomic System—beyond Langley's ANS➡️ brain, neuroendocrine, immune/inflammatory. Could neurodiversity, heightened senses, gut "feeling", rapid stress responses gave past survival advantage? #MCAS #hEDS
Figure 1. The extended autonomic system. The EAS consists of the central autonomic network (CAN)/stress system, Langley’s autonomic nervous system (ANS), neuroendocrine systems, and inflammatory/immune systems. The four components are bi-directionally inter-related, meaning 6 combinations of relationships. In the central autonomic network, the “stress system” in the Chrousos/Gold schema includes the paraventricular nucleus of the hypothalamus (PVN), which is the source of arginine vasopressin (AVP) and corticotrophin-releasing hormone that drive the hypothalamic-pituitary-adrenocortical axis (HPA), and the pontine locus ceruleus (LC), the main source of norepinephrine in the brain. Abbreviations: Abbreviations: A5 = A5 noradrenergic cell group; AMY = amygdala; ANP = atrial natriuretic peptide; ANS = autonomic nervous system; AP = area posterma; BNP = brain-derived neurotrophic factor; CING = cingulate cortex; CVLM = caudal ventrolateral medulla; DDA = DOPA-dopamine autocrine-paracrine system; DMNX = dorsal motor nucleus of the vagus nerve; ENS = enteric nervous system; GHE = ghrelin; HACER = hypothalamic area controlling emotional responses; Hippo = hippocampus; INS = insulin; LEP = leptin; NA = nucleua ambiguus; NO = nitric oxide; NTS = nuclear of the solitary tract; PACAP = pituitary adenyl cyclase-activating polypeptide; PAG = periaqueductal grey region; PNS = parasympathetic nervous system; Pre-Bötz = pre-Bötzinger complex; RAS = renin-angiotensin-aldosterone system; RPG = respiratory pattern generator; RTN = retrotrapezoid nucleus; RVLM = rostral ventrolateral medulla; SAS = sympathetic adrenergic system; SNS = sympathetic noradrenergic system; THY = thyroid; VTA = ventral tegmental area.
December 15, 2024 at 11:41 AM
dr-kevinlee.com
gov funding of complex care- which mostly not commensurate to the time it takes , eg illustrative of bookings for GPs , Dr Bob vs Dr Carol, latter does longer medicine- eg complex, women’s care. Fundamentally good #mecfs #longcovid care requires commensurate funding of complex care in general
This image compares two doctors, Dr Bob and Dr Carol, appointment slots using coloured bars, along with total amounts of $1005 for Dr Bob and $616.20 for Dr Carol, former with shorter consultations, latter filled with longer appointments
December 14, 2024 at 10:50 PM
dr-kevinlee.com
Plant kingdom’s gift - #quercetin therapeutic effects, in addition to antioxidant, mast cell stabilising, also glycemic effects by inhibiting amylase and glucosidase iadns.onlinelibrary.wiley.com/doi/full/10....
The image illustrates the inhibitory role of quercetin on enzymes involved in carbohydrate digestion, particularly α-amylase and α-glucosidase. Here’s a breakdown of the information: Key Points from the Diagram: 1. Carbohydrate Digestion Process: • Starch: Broken down by α-amylase into maltose, which is further hydrolysed into glucose. • Sucrose: Cleaved into glucose and fructose by α-glucosidase. 2. Effect of Quercetin: • Quercetin inhibits both α-amylase and α-glucosidase, reducing the breakdown of starch and sucrose. • This slows the release of glucose into the bloodstream, effectively lowering the glycaemic index of foods.
December 10, 2024 at 12:15 PM
dr-kevinlee.com
Thanks chatgpt. Grinch Care Co sounds mean indeed.
Imagine it’s Christmas time in a little town, and everyone is excited about a big family party. In this town, when you get sick, you need to give special presents to the doctor to help you feel better. You don’t keep these presents yourself—you give them to a big, green, grumpy business called Grinch Care Co. because they promise, “If you get sick, we will use these presents to pay the doctor!” But guess what? Grinch Care Co. doesn’t like to share these presents. When someone gets sick, Grinch Care Co. might take a very long time before giving any presents to the doctor. Sometimes, they say, “No! We won’t give any presents!” And if people say, “That’s not fair!” Grinch Care Co. tries to make excuses and pretend they did nothing wrong. By doing this, Grinch Care Co. keeps more presents for themselves, instead of using them to help sick people feel better.
December 8, 2024 at 1:10 PM
dr-kevinlee.com
My most fav cranial nerve is CN I - olfactory. The olfactory system is such a primitive part of the brain but also most interesting, its role in neuroinflammation, emotions, stress response etc www.researchgate.net/publication/...
Neuroinflammation and dysbiosis. During local nasal inflammation (chronic rhinosinusitis and allergic rhinitis), the count and type of microbial communities change significantly (there is a loss of key symbiotic species, while pathobionts often overgrow). Dysbiotic conditions result in alterations in immune responses, cerebral metabolism, endocrine signaling, and neuronal physiology due to epithelial barrier disruption. Thus, an increase in the production of proinflammatory mediators by the host (cytokines, oxidative stress, exosomes, etc.) and bacteria (exosomes, LPS, peptidoglycans), which can penetrate directly into the CNS through the olfactory pathway or the vessel-rich nasal mucosa, causing neuroinflammation. The anatomical relationship of the nasal cavity with olfactory pathways and the CNS (particularly the limbic system) and, therefore, with monoaminergic brainstem neurons may underlie several pathophysiological changes in emotions (depression), memory, hormonal, and autonomic dysfunctions, and may lead to neurodegeneration
December 8, 2024 at 10:47 AM
dr-kevinlee.com
Tell me about it, eg TSH reference intervals are for the population, not for the individual patient- TSH setpoint is much tighter and can be abnormal for pt even tho in range on blood test report
https://thyroidpatients.ca/2022/07/17/can-normal-tsh-rule-out-thyroid-disease/amp/ The image compares the distribution of TSH (thyroid-stimulating hormone) levels in a healthy population to the distribution of TSH levels for a healthy individual over time. It highlights that population-level TSH has a wider range, while an individual’s TSH tends to fluctuate within a much narrower range. Key points from the reference (Hoermann & Midgley, 2012): • Population TSH levels: These represent the variability across many individuals and follow a broader distribution. • Individual TSH levels: For a single healthy individual, TSH levels are more stable and confined to a tighter range.
December 8, 2024 at 7:08 AM
dr-kevinlee.com

#melatonin is arguably my most favourite hormone, in humans secreted by the pineal gland, but its origin dates back 3 billion years—as powerful antioxidants first produced by cyanobacteria, the ancestor of mitochondria, now inside all animals and plants
Figure 1. Melatonin originated 2.5 billion years ago, and it is present in all organisms from bacteria to humans; its structure has never been changed. https://www.mdpi.com/2076-3921/11/1/140
December 7, 2024 at 1:14 PM
dr-kevinlee.com
Reading about Delay, Deny, Defend posts on social media. Indeed Americans really need to ask themselves why they spend way more on health but have lower life expectancy.
The image visually highlights the relationship between life expectancy and health expenditure per capita across various countries. In the chart, the United States is an outlier, spending significantly more on healthcare per capita compared to other countries, yet achieving a lower life expectancy. Here's a breakdown of what this graph suggests: Key Observations: High Spending, Low Return (US): The US spends substantially more on healthcare (over $10,000 per capita annually), far exceeding other countries. Despite this, life expectancy in the US is considerably lower than in nations with much lower health expenditures. Other Countries' Performance: Countries like Japan, Australia, Switzerland, and Norway achieve higher life expectancy with lower spending. Most OECD countries cluster along a curve where incremental increases in healthcare spending correspond to modest life expectancy gains.
December 7, 2024 at 1:04 PM
dr-kevinlee.com
#autobesity, one obesity epidemic that is damaging in so many ways #transitsky
The image compares vehicle size evolution over the years: 1840, 1980, and 2022, showcasing the increase in width and space vehicles occupy on roads. It highlights the trend towards larger and heavier cars, like SUVs, over time. This is referred to as "autobesity," where cars increasingly encroach on public spaces, reducing room for pedestrians and cyclists, while impacting safety and the environment.
December 5, 2024 at 12:28 PM
dr-kevinlee.com
A comprehensive review of #clomiphene as safe, efficacious alternative to TRT in male hypogonadism , #endosky thoughts? www.mdpi.com/1424-8247/17...
Figure 1 Illustration of the targets of clomiphene citrate in the HPG axis in males. The hypothalamus secretes GnRH, which is delivered to the pituitary gland to stimulate the biosynthesis of the gonadotropins LH and FSH. LH functions within Leydig cells and results in the secretion of testosterone. Testosterone can be modified via aromatase for estradiol and acts as a negative feedback signal in the HPG axis. Clomiphene citrate can reduce this signal and weaken the negative feedback loop to improve testosterone synthesis
December 5, 2024 at 11:22 AM