#slow transit constipation

[nevermindtheb0ll0cks]

do people really have lives that arent focused around their bowels and digestive system?

[moeitsu]

The Tie Which Linked My Soul To Thee

Ch 17 - To Watch The Dying of the Day

Summary: Say, isn't it strange? I am still me, and you are still you. In this place. Isn't it strange how people can change? From strangers to friends, friends into lovers. To strangers again.

Ao3  Wattpad Masterlist - All Chapters  Previous Chapter / Next Chapter

A/N: Oh gosh, it's been so long! A mixture of burnout and chaos will do that to a girl. But it's here, coming in at a strong 7k words. It's on the shorter side, especially since my previous chapters have been anywhere between 10-13k words. But this chapter is transitioning us back into the main story. So do with that information as you will, its going to be a bumpy ride....

TW: None really, just hella angst.

Tag List: @photo1030 @ariacherie @thatweirdcatlady @ultraporcelainpig @marygillisapologist @eternalsams @lunawolfclaw 

**please let me know if you would like to be tagged in future chapters!

StoryTags: Widowed, Original Character(s), High-Honor!Arthur Morgan, Arthur Morgan Does Not Have Tuberculosis, Arthur Morgan Deserves Happiness, Chubby!Arthur Morgan, Canon Divergence, Mutual Pining, Slow Build, Eventual Smut, Eventual Sex, Eventual Romance, Emotional Sex, Fluff and Angst, Hurt/Comfort,Touch-Starved, Sexual Tension, Friends to Lovers, Child Loss, Infant Death, Trauma, Canon-Typical Violence, Emotional Hurt/Comfort, Slow Burn, Torture, Blood and Violence, Survivor Guilt, Aftermath of Torture, Caretaking, Injury Recovery, Period-Typical Racism, Anxiety, Self-Hatred, Night Terrors, Emotional Constipation, Self-Doubt, Men Crying, Bathing/Washing, Sweet/Hot, Romantic Angst, Romantic Fluff

“Are you out of your goddamn mind, John?” Abigail’s voice echoed through the camp as the tent flaps were shoved open harshly by the young man, who only ignored her comment. He was making a beeline for the one person he needed to complete his team—the one person he knew would stand by his side to enact revenge on the men who nearly took his brother's life.

Kate was chopping celery and carrots for an afternoon stew when she heard the heavy footsteps of John approaching. His gaze was determined, each step fueled with a fiery purpose. She glanced up to see Abigail standing not far behind him, arms crossed in frustration, throwing her hands in the air as John continued to ignore her protests. Kate already knew what he was going to ask of her.

John had found Colm O’Driscoll’s hideout, and he was ready to take action.

Kate placed the knife down with a sigh. Since their return from Emerald Ranch, things had been relatively calm. At least as calm as life could get when you were running with a bunch of outlaws, hanging onto the threads of some "plan" by a man she barely trusted. When they arrived back from their trip, Sean and the boys had planned a small party for Arthur—a ‘Celebration of Life,’ the ambitious Irishman had called it. Though it was more likely just another excuse to drink beer, dance, and be rowdy.

They used the get-together as an opportunity to tell the others about their relationship. Kate drank and sang with the girls, talking with them into the late hours of the night about her time with Arthur. Their small circle was filled with ‘aww’s’ and teasing glances. Kate felt a weight lifted off her shoulders after telling them, like somehow their relationship was finally real now that the rest of the gang knew—at least the ones most important to her.

Arthur was gradually reintegrated into jobs and missions, starting with small fishing trips and eventually moving on to more lucrative endeavors like robbing stagecoaches. Kate protested at first, trying to convince him there were safer ways to make money, but she knew she couldn't take the thrill of the heist out of the outlaw so easily. Arthur found work where he could, especially when Dutch wasn’t ordering him around. All of Arthur’s worries about being replaced seemed to dissipate in the days after his return. Dutch, ever the charmer, appeared overjoyed that Arthur was making a steady recovery and happy that his son found some happiness in a woman. He couldn't resist leaving Arthur with a gentle reminder that their priority was, and still is, to make enough money to escape. Arthur assured him with a promise: he would see it done.

This morning, Dutch sent Arthur, Sean, and Micah into Rhodes to meet up with Bill. Sheriff Gray wanted to speak with them about some work, and Arthur felt mighty proud to be involved, given his month-long absence. After breakfast, Kate pulled him aside for a few quick good-luck and be-safe kisses. It had become a new habit of theirs, since alone-time was rarely granted. They always made sure to say goodbye when one was leaving for a job, sealed with a kiss and a hug.

Kate looked up at John from under the brim of her hat, wishing in that moment Arthur was there to set him straight. But she knew nothing was going to change the young outlaw’s mind.

“Kate,” John greeted with a nod, his tone indicating he was ready to say more.

Wiping her hands on her raggedy apron, she leaned against the cutting table. “Fine afternoon, ain’t it, John?” she said with a smile, squinting up at the sun.

John wasted no time. “We’re ridin’ out today, to Hanging Dog Ranch. You coming?”

“Is that so?” She sighed. “What for?” Kate’s voice carried a hint of feigned ignorance. She knew why, but she was still trying to find it in herself to say no.

Since their ride back from Emerald Ranch, Kate had wrestled with Arthur’s words. She knew revenge was foolish, but seeing the way it had changed him cut her so deep she feared she would carry that rage with her for a long time. It was the same rage she felt years ago when she lost everything. Back then, her anger often consumed her, but over time she learned how to control it, to use it to protect herself and others. Right now, she wanted nothing more than to keep her word to Arthur, but also to protect him.

“You know why, Kate,” John’s voice grew stern, pulling her from her thoughts. “Colm’s men are up there. This is our chance.”

Kate’s heart clenched. She wanted to protect Arthur, to ensure that what happened to him never happened to anyone again. But she also knew that succumbing to vengeance could destroy her just as easily as it could destroy their enemies.

“John,” she began, her voice wavering slightly, “I promised Arthur I wouldn’t get swept up in this mess.”

John’s expression softened a moment, but his resolve remained firm. “I get it, Kate. But we need you. If we don’t take this chance, we might not get another.”

Kate huffed and lowered her voice so only he could hear, “Does Dutch know about this? Doesn’t he have a plan to get back at Colm?” She tried to make him see reason in her questions.

John only shook his head. “To hell with his plans. The way I see it, Colm doesn’t see us as a threat anymore. He tried to lay a trap and set the law on us. Well, he fucked around and it's about time he found out.”

Kate rolled her eyes at John’s ambitious statement. “John, no. I can’t go through with this and you shouldn't either.” She planned to leave him with that, pulling the apron over her head and starting to walk away.

John grunted and followed behind her, his frustration growing more evident. “C’mon, Kate, quit pussyfootin’ around. We need you, and we’re losing daylight.”

Kate turned and saw behind him as the others began saddling their horses and loading their weapons. Her eyes widened slightly when she saw Sadie packing her saddlebags, and her heart began to race as Lenny waited proudly on the back of his stallion, ready to take off at a moment's notice. Charles was there too, making his way over to see what the hold-up was. She was surprised to see this was the group that would be leading the charge. But, after all, these were Arthur’s closest and most trusted comrades.

Consequently, they were also the people Kate cared for deeply and saw as her own family. They were all putting themselves in harm's way for the sake of revenge.

“What would Arthur say about this?” Kate said finally.

Charles had finally caught up to them and heard the last bit of the conversation. “Arthur would say revenge is a fool’s game,” he stated.

“Exactly, thank you Char-”

“But those are his words, not mine,” Charles interrupted.

Kate pinched the bridge of her nose as John continued his persuasion. “Arthur’s the goddamn fool. We need to strike back, now. What if they come after us again? What if this time Colm takes one of the girls, or you?”

Kate felt the weight of John’s words settling heavily on her shoulders. The thought of Colm’s men taking her or any of the other women gnawed at her heart. She couldn’t deny the logic in John’s argument, even if it went against Arthur’s wishes.

Looking past the two men, she saw Lenny waving to her as if simply asking, "What are you waiting for?" John must have told them she would be joining, as Sadie looked over in anticipation, already holding Lorena’s reins, ready to leave as soon as Kate gave the word.

“Charles,” she began, her voice deep with conviction, “you’ve got a level head. This is a bad idea. How could you go through with this?”

Her words came out with a bite, unintended, but they stung nonetheless. Charles had always been a beacon of reason, often the one she or Arthur leaned on in times of need.

Charles' response betrayed no hurt, only his own sense of determination. “These bastards deserve it. Arthur suffered enough.” 

Kate found herself seething at his words, anger bubbling up like black coffee neglected over a fire for too long. The gang knew Arthur better than she did, Kate understood that much. But nobody had watched him suffer like she had. Night after endless night, holding his broken body and cradling him as she willed with all her strength that the pain and tortuous nightmares would cease. Her thoughts drifted to the night of their shared intimacy, seeing how Colm had broken him in unimaginable ways.

Nobody understood the extent of his suffering, except for Kate.

“Sadie suffered by them too,” Charles added after a moment. 

“We’ve all suffered from the O’Driscolls!” John exclaimed with a defeated sigh. “Choose your battles, Kate. But we’re going to send a message to Colm, whether you come or not.”

The two men turned to walk away, their boots kicking up dust as they marched back to their horses, saddled and ready for battle. Moments later, a third pair of footsteps fell in time behind them.

Kate had made her choice.

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The dry spell had lingered for well over a month, and the oppressive heat of Lemoyne had turned the air into a stifling, dusty haze. The town of Rhodes lay beneath a thick, barren cloud of yellow dust, each gust of wind sending particles stinging into Arthur’s throat and eyes, making them water. The winds whipped past him as he spurred Belle forward, urging her faster and faster. His grip on the reins was white-knuckled, his breath coming in sharp, shallow gasps as he tried to steady his racing heart.

The Sheriff had caught on to their schemes, and set them up in Rhodes. Sean had paid the ultimate price with a bullet between the eyes. The image of Sean’s lifeless body was seared into Arthur’s mind, a haunting image he knew would never leave him. He shook his head, trying to dislodge the relentless memory that played over and over like a broken motion picture. Sean had been on the cusp of becoming a man, his 24th birthday just a few months away. Though Arthur gave him grief since the day he joined their gang, deep inside he saw the ambitious Irishman as his younger brother. 

The irony of the situation gnawed at Arthur’s consciousness. Sean had warned them it was a setup. He had sensed something was off from the moment they entered the sleepy town, but both Arthur and Micah had dismissed his concerns as mere paranoia. Now, anger swelled in Arthur's belly, especially toward Micah. As much as he despised the shady outlaw, Arthur couldn’t deny that he wouldn’t have made it out alive without his help. Micah recognized that Arthur’s injuries had hindered his abilities, though his accuracy remained as deadly as ever. Together, they had picked off nearly every lawman and trigger-happy drunk who stood in their way, barely escaping with Bill in tow. Arthur knew his disability had slowed him down, and he blamed himself for Sean’s loss. 

The escape was a blur of gunfire and chaos. Arthur's mind raced with the events of the ambush, replaying each moment as a jarring blend of fear and fury. Belle's hooves thundered against the ground, each stride a desperate attempt to outrun the mix of anger, guilt and shame that threatened to overwhelm him. The acrid taste of dust and blood lingered in his mouth, a reminder of the violence they had scarcely escaped.

As they galloped through the barren landscape, Arthur's thoughts turned to Kate. He knew she would be waiting for him back at camp, a small comfort amidst the chaos. But the moment of peace would be short lived, they would have to leave again, and soon. The law would catch up to them in a matter of days. 

The thought of facing Dutch made Arthur cringe inwardly. Dutch would undoubtedly demand a report of what happened, and Arthur knew it could go one of two ways: Dutch might dismiss the incident, as he had when Arthur previously warned about their increasing sloppiness and the Pinkertons closing in. Or he might tuck-tail and opt for retreat to a new hideout, favoring the path with the fewest casualties. Either way, Arthur was in for an earful back at camp. He silently hoped that someone would go back for Sean, praying he wouldn't be discarded in a mass grave. Every man deserved a proper burial, but for people like him and his gang, it was a luxury rarely granted. 

As Clemens Point came into view, a deep sense of unease settled over Arthur. The camp seemed unusually quiet, devoid of the usual bustle and chatter. An eerie silence had taken its place. He panicked for a moment, what if the law had found them while he was away?

Arthur barely had time to dismount before Abigail came running towards him, tears streaming down her face. Dutch was close behind her, his expression grim. A chill ran down Arthur's spine.

Abigail grabbed Arthur's arm, her voice trembling with panic. “Arthur, they took Jack! Someone took Jack!” she cried, her eyes wild with fear.

Dutch placed a reassuring hand on her shoulder, though his eyes were hard with determination. “We’ll get him back, Abigail. I promise you that,” he said firmly.

Arthur opened his mouth to explain what had happened in Rhodes, but the urgency of the situation left no room for words. His mind was whirling with this new information, trying to piece together what happened while he was away. There was a moment of silence, and Arthur’s heart skipped a beat as he realized Kate was also nowhere to be seen.

“Who took him?” Arthur said finally, his voice betrayed no hint of the unease he was feeling.

Hosea stepped forward, his expression was dire. “We believe the Braithwaites have taken Jack. They’ve been gunning for us ever since we crossed them,” he explained.

“Where is my son?” Abigail shouted. “If anything–oh God,” she choked on the words. “Where is my son Dutch!” 

“We will find him,” Dutch affirmed, clenching his jaw, eyes blazing with resolve. “We’ll make that Braithwaite bitch pay for this.” He surveyed the three men as Bill and Micah stood awkwardly nearby, unsure what to say. “What the hell happened to you three? Where’s Sean?”

Arthur took in Hosea’s words and then let out a breath as he shook his head. “They set us up, Dutch. Sheriff Gray killed Sean, nearly got Bill too. We shot up half the town trying to escape. If we’re not careful about this, we’ll surely be caught by the law.” They were in deep shit now, both families were gunning for them. They couldn't afford another casualty, let alone young Jack. The situation tore at his heart. 

Dutch’s eyes darkened, his mouth set in a tight line. Arthur recognized that look—it was the look of a man out of options. “We’re getting that boy back, Arthur, or so help me God—”

At that moment, the thunderous sound of hooves echoed down the path to their hideout. Arthur's hand hovered over his revolver, his mind still in fight-or-flight mode. As the riders emerged from the trees, he saw John leading the group, with Kate at the rear. A wave of relief washed over him; at least the law hadn't caught up to them yet. But as they drew closer, Arthur noticed Kate's clothing was stained with blood. His relief quickly turned to a mix of worry and dread.

As John dismounted, Abigail flung herself into his arms, sobbing uncontrollably. “They took him, John! They took our boy!” she cried, her voice breaking with desperation. John shot a confused look at Arthur, his own emotions swirling with shock and concern. He held onto Abigail, trying to process the chaos around him.

Dutch's voice cut through the commotion like a knife, demanding answers. “How nice of you to finally show up. Where have you lot been?”

“Taking care of business,” John replied dryly, his grip on Abigail tightening as he tried to make sense of the unfolding crisis. The air was thick with urgency and panic, even the winds seemed to hold their breath, anticipating the next move.

“What business?” Dutch spat, his agitation palpable as he glared at his returning crew members. The tension crackled like electricity in the air, setting everyone on edge.

Arthur's heart pounded in his chest, the rapid beat echoing the chaos of his thoughts. Sean's death, the ambush, Jack's disappearance, and the blood on Kate’s clothes all swirled in his mind. He moved with heavy, purposeful steps toward Kate, his focus narrowing to her alone. He tuned out the escalating argument between Dutch and John, his attention solely on the woman he loved.

“Kate,” he called, his voice rough from the dry air and his mounting anxiety.

She turned at the sound of her name, immediately reading the worry etched into Arthur’s face. Noticing her bloodied clothing, she quickly reassured him, “It’s not my blood.”

Relief flooded Arthur, and he pulled her into a tight hug, inhaling her familiar scent. The rhythm of her heartbeat against his chest provided a momentary solace amidst the turmoil.

“What’s going on?” she whispered, her breath warm against his ear as she pulled away slightly.

“Rhodes was a trap. They set the law on us, Sean’s dead,” Arthur briefly explained, his voice heavy with grief. Kate gasped softly, her eyes widening. “We just got back, and Jack’s missing. Hosea thinks it was the Braithwaites.”

Kate stood speechless, feeling the weight of the world crashing down around her. "Oh, Arthur, we have to—"

Arthur gripped her arms fiercely, his eyes burning with a mix of confusion and betrayal. Desperation etched into every line of his face. “Where were you, Kate?” he demanded, his voice laced with hurt and anger.

He hadn’t meant for the words to come out with such force, but his mind was a whirlwind of doubts and anxiety. Jack could be dead for all he knew. The thought of an innocent child being involved in this nightmare gnawed at his soul. Despite everything, Arthur blamed himself for Jack's disappearance. He cursed himself for not ensuring someone was watching over the boy when he left. Normally, there were plenty of people he and Abigail trusted with Jack, but those people had been gone nearly as long as he had. He desperately needed an explanation for her absence.

Kate pulled away from his grip but held his hands tightly, her gaze filled with guilt. Arthur’s heart began to sink, a cold dread settling in his stomach. “We were up at Hanging Dog Ranch,” she breathed. “Where Colm’s men were hiding.”

Arthur’s gaze hardened, a cold look crossing over his features. “I don’t s’ppose you were there to play hooky?” he spat, sarcasm dripping from his words. He felt the world spinning around him, losing Sean, losing Jack, and now, feeling a profound sense of betrayal from the woman he loved.

Kate shook her head quietly, her cheeks flushing pink with shame. “Arthur, I—”

Arthur’s grip on her hands tightened momentarily before he let go. “You promised me, Kate,” he said, his voice breaking. “You promised you wouldn’t get involved with Colm.”

Kate’s heart shattered at the pain in his eyes. “I know, and I am so sorry. But I thought—”

“You thought what?” Arthur interrupted, his voice rising with a mix of anger and fear. “You thought this would help? That getting yourself killed would make things better?”

Kate’s eyes filled with tears, her voice trembling slightly. “I just wanted to protect you and the others from those terrible people.”

“That is not your job, Kate!” Arthur shouted, and Kate flinched, taking a step back from him.

Arthur let out a breath, shaking his head, the betrayal cutting deep. “You just don’t get it, do you? You don’t understand what it does to me, seeing you put yourself in danger like that.”

“I see you put yourself in danger every day,” she answered meekly, her voice wavering with a mix of fear and frustration.

“Don’t make this about me,” he said sharply. “I trusted you to keep that promise.” The life he lived, the life she had joined, was a dangerous one. And Kate wouldn’t be the first woman he lost to such violence. Born from a promise that he broke, costing the life of his family. If he had lost her and Jack in the same night, he feared what he would unleash upon himself.

“I’m sorry Arthur,” Kate breathed deeply, tears finally spilling over and streaming down her cheeks. There was an old selfish ache deep in her soul, a desperate need to make them suffer for taking someone from her. Her fear of loss drove her every thought, every action, every breath. It had consumed her, nearly losing herself during Arthur’s recovery. Kate had never known anything but grief and loss. Holding on so tightly to her sliver of happiness that she was smothering it. Her selfish need cost her Arthur’s trust. 

“Kate,” his voice was softer now, laced with deep sorrow. Arthur shook his head, “I can’t go through this again.” His eyes softened, though the hurt remained. 

Kate opened her mouth to respond, but the words wouldn’t come. She felt a dark sense of dread, knowing that despite her intentions she had broken his trust and his heart. 

The weight of the moment pressed heavily upon them, a suffocating silence settling in. Arthur’s eyes, filled with a mix of anger and hurt, searched hers. The pain of his words, the pain of her actions, it all mingled together in a storm of emotions that neither of them could escape. A deeper love that remained unspoken.

Before she could find the words to make things right, Dutch’s voice boomed across the camp. “We’re not waiting another damn minute! Mount up, we’re riding out to get Jack back now!”

Arthur turned away, his expression unreadable. “I’m glad that you’re home safe. I wish I could say the same for Jack,” he said, walking over to mount his mare once more. The other boys were saddling up, the tension in the air thick with anticipation.

Kate stood in stunned silence, tears streaming down her face. The fear of losing Arthur, the guilt of breaking her promise, and the terror of what lay ahead gnawed at her. She felt an overwhelming sense of helplessness as she watched Arthur ride off into the night, leaving her standing there with her heart in pieces.

As she watched the men race down the winding path out of Clemens Point, she noticed Abigail's trembling form. Abigail was using her apron to wipe the tears that stained her cheeks. Kate swallowed her sorrow, pushing down her own broken heart. This was about Jack and Abigail.

━━━━━༻❁༺━━━━━

“I bet this has something to do with why you got shot to hell in town.” John’s voice broke Arthur from his clouding thoughts. The trees raced past them in a blur, and Arthur hadn’t even realized his brother was riding right beside him.

Arthur’s mind was a whirlwind of anxiety and turmoil. The events of the day had left him feeling raw and exposed. The setup in Rhodes, Kate’s actions, and now Jack’s abduction—all of it weighed heavily on him. The feeling gnawing at his insides.

“I don’t want to think about that right now, John,” he answered, trying to push the memory of Sean's lifeless body out of his mind. “We have to focus on Jack.”

John’s voice rose with anger, a mirror of Arthur's own inner turmoil. “I swear, I’ll kill every single one of them.” The desperation in his voice was palpable, and Arthur could sense the fear behind his brother's bravado.

Dutch’s voice called from the front of the line, a forced calmness trying to steady the group. “Easy, John. Try to stay calm. We’ll make them pay for this.”

“What about the plan, Dutch? Isn’t this family sitting on gold?” Bill’s voice cut through the night, his ulterior concerns evident.

Hosea answered, his tone grim and weary. “I hate to break it to you, but there is no gold. I’ve turned every stone. If they ever had any, it's gone.”

“For Christ’s sake, Hosea, after everything? Another perfect plan fed to the dogs,” John retorted, his voice laced with bitter frustration. Arthur felt the same anger bubbling up inside him—another one of Dutch’s schemes that had led them into danger and kept them on the run from the law.

“We underestimated them,” said Hosea, his voice heavy with regret and concern.

“No, they underestimated us!” Dutch roared, his voice echoing through the trees. “Enough talk. There’s no point arguing how we got here. This is where we are. And we are going to kill every one of those inbred trash.”

Arthur’s grip tightened on the reins, his knuckles white with tension. The thought of what lay ahead mixed with a fierce determination to bring Jack back safely. His heart pounded in his chest, a relentless drumbeat of anxiety and resolve. As they rode on, the night closed in around them, a shroud of darkness and danger. The only sounds were the thunder of hooves and the heavy breathing of their mounts. Arthur’s mind was a storm of emotions, the weight of his responsibilities pressing down on him.

The ride to Braithwaite Manor was filled with a tense silence, each man lost in his own thoughts. Arthur’s mind kept drifting back to Kate. They were close now, and there was no turning back. Jack’s life was at risk. The stakes were higher than ever, and the weight of their mission rested heavily on his heart. There was no room for distraction or hesitation.

Dutch’s voice broke through the silence, a final order before the storm. “Nobody makes a move until I say so. Follow my lead.”

The tension in the air was electric as they approached the manor, each man ready for the fight of their lives. As they dismounted, Arthur’s thoughts turned briefly to Kate once more. 

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Kate couldn’t sleep. The lamp was down to the midnight oil in the small green canvas tent that the Marstons called home. She had stayed with Abigail while the men were out in search of Jack. She couldn’t tell how long they had been gone; her weary mind drifted in and out of consciousness. She tried to stay alert for their arrival, or for anyone else who might try to abduct another member of their gang.

Abigail slept beside her, her cheeks tinted pink from tears. She clutched Jack's nightgown tightly to her chest, inhaling the scent of her child, her whole world. Kate understood that feeling. She looked down at her hands, the dim light flickering across her fingers. Old blood was dried into the cracks of her nails. Images flashed before her eyes of the violence that had defined her day. She had unleashed herself on Colm’s men, disregarding her promise. And consequently, she had neglected the safety of those left behind at camp.

An acidic queasiness settled in her belly. It had felt good to kill those men. By some miracle, or perhaps coincidence, she had found Arthur’s captors amongst the men hiding at the ranch. The two men had recognized her, though she had no idea how. They had never met before. But like most cocky men, they boasted about Arthur’s torture and the pain they would inflict upon her. Little did they know who she was.

Keeping them alive as the last two men standing, Kate gave them the same courtesy they had given Arthur. She made sure they would never use their arms again, and strung them up by their ankles. Finally, she sliced open their bellies, their blood draining like pigs for the slaughter. Her friends watched in cautious silence. And when she was done, she mounted Lorena, and together they left the ranch without so much as another word.

It was justice, Kate tried to convince herself. But no, it was a deep selfishness. One that an old friend had stoked like flames to a fire. Perhaps it was in her nature, to lose lives and take them. All of the people Kate was, and tried to be, were always a part of her. The mother, the nurturer, the defender, and the killer.

She regretted her actions, but selfishly, she would do it all again. The thrill of revenge had brought her a temporary sense of control, a fleeting moment where she felt powerful in a world that constantly threatened to strip her of everything she held dear. But as she sat in the tent, the reality of her choices weighed heavily on her. She wasn’t sure if she could ever reconcile the different parts of herself—the woman who longed for peace and the one who couldn’t escape the violence that had shaped her life.

Exhaustion finally overcame her. The flickering light of the lamp faded as she drifted into a restless sleep, haunted by the faces of the men she had killed and the fear of what might come next.

When Kate awoke the next morning, the first light of dawn seeped through the tent’s seams. She reached out instinctively, but the space beside her was empty. Abigail was gone. Panic gripped her heart as she sat up quickly, straining to hear the muffled voices outside the tent.

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Arthur stood at the back of the crowd, his eyes scanning the faces around the small wooden table where Dutch sat, the tension palpable in the air. Dutch was deep in thought, the weight of leadership pressing heavily on his shoulders as the gang awaited his orders. Abigail stood silently next to John, her face a mask of fury and desperation. Her tears had dried, replaced by a seething anger at the men she had trusted to protect her family, now arguing over their next move.

The Braithwaites didn’t have Jack. They had passed him off to a man named Angelo Bronte. Arthur’s mind raced with strategies for their next step. Bronte was supposedly in Saint Denis, the heart of the new modern America, where law was heavily enforced, and policemen patrolled every corner. They needed to be cautious. Any misstep could end with them at the end of a rope, and that wouldn’t help Jack at all.

As Arthur idly rubbed his wounded arm, the pain a constant reminder of his recent ordeal, he replayed the events of the night over and over in his mind. They had stormed the Braithwaite manor, killing everyone who stood in their way. But they had been too late. Dutch had shot Catherine Braithwaite without hesitation and ordered the house to be burned to the ground. An entire empire, a long-standing family, wiped out in an instant. 

He was lost in his thoughts when a gentle touch on his arm brought him back to the present. Turning around, he found himself face to face with Kate. The memory of her actions, the betrayal he felt, and the look in her eyes were too much to bear. He quickly averted his gaze.

“Arthur,” she began quietly, her voice trembling with worry. “Where is Jack? Is he—”

Arthur shook his head, cutting her off. “They didn’t have him,” he said curtly.

“W-what did you find?” she stuttered, her voice edged with panic.

He knew he was being cruel by withholding details, but the turmoil inside him made it difficult to be gentle. With a sigh, he turned to face her again. “They handed him off to some Bronte fellow. Jack is somewhere in Saint Denis.”

“I don’t understand, why would they do this? What do we do now?” she asked, her voice rising in desperation.

Arthur gestured towards the group of men who were still arguing heatedly. “They’re working on it,” he said, trying to keep his voice steady.

Feeling incredibly defeated, Arthur’s thoughts were a blend of frustration and sorrow. He had thought things were getting better. After nearly dying from sepsis, he had started to find comfort and joy in Kate’s presence. But now, everything seemed to be falling apart. Sean’s death had barely been processed, overshadowed by Jack’s disappearance. His recent fight with Kate had left a gaping hole in his heart, the urge to mend things with her gnawing at him. But there was no time for feelings right now.

The gang was on the brink of a precipice, and Arthur knew they needed to act quickly and decisively. As much as he wanted to fix things with Kate, Jack’s safety had to come first. Pushing down his own emotions, he focused on the task at hand, knowing that every moment they delayed could bring them closer to disaster.

“It’s gonna work out, John,” Hosea’s voice joined the commotion, his tone reassuring. “Jack will be fine. Just listen to Dutch.”

Dutch’s voice cut through the din, authoritative and calm. “I don’t expect you to understand this, but I need your trust. Your word, now more than ever. No more running off behind my back. I know you were trying to do the right thing—”

“If I don’t get that boy back safe, I’m—” John shot a glance at Abigail, who stood trembling with a mix of anger and fear. “She’ll kill us all.”

“Looking at this logically, that boy is fine. They only took him to scare us. Nobody takes a child to harm him,” Dutch continued, his words meant to be comforting but failing to ease the tension.

“It’s true, John,” Hosea chimed in, placing a reaffirming hand on his shoulder. “Arthur, what do you think?”

Arthur sighed, shaking his head slightly. They were all trying to be strong for John, but deep down, they were just as scared. They’d seen what this world could do to children. The cruelties of their life were too real, too close. There was no guarantee Jack was safe.

“The boy will be fine,” Arthur lied, trying to steady his voice. “But of course, Marston’s scared rotten. We killed all those people, stirred up all that trouble…for nothing.”

Dutch scoffed from his seat. “No. No, not for nothing. For living. We get that boy back, and we go. It’s about time we leave this place. Trust me.”

Suddenly, Lenny’s voice boomed from the camp entrance. “Dutch! We’ve got a problem!” He shouted, rifles raised and pointing at two strangers who walked into camp with their hands held high.

Arthur’s mouth went dry. It was the Pinkertons. Agent Ross and Agent Milton.

“Not a problem, visitors. We come with a solution,” Milton said coldly, his demeanor relaxed and confident. His gaze found Arthur’s. “Ah, Mr. Morgan. Nice to see you again.”

Instinctively, Arthur stepped in front of Kate, shielding her from whatever was about to unfold. The other gang members began to surround the two agents, their suspicion evident. Dutch betrayed no hint of surprise, remaining seated comfortably.

“To what do we owe the pleasure, Agent Moron?” Dutch said, his tone dripping with sarcasm.

“I don’t know if you’re aware, but this is a civilized land now. We didn’t kill all them savages only to allow the likes of you to act like human dignity was not yet invented,” Milton explained, his disdain palpable. “This thing? It’s done,” he spat.

Dutch finally rose from his seat, confronting the agent. “This land was never civilized. It’s consumed with man’s love for greed.”

“And that lets you take what you please? Kill whom you please and hang the rest of us? Who made you the messiah to these lost souls you’ve led astray?” Milton retorted coldly.

“I’m nothing but a seeker, Mr. Milton,” Dutch replied.

“You’re nothing but a bunch of killers. But I came here to make a deal; you come with me and I’ll give the rest of you three days to run off and disappear. I’m giving you one last chance to live like decent human beings.” Milton’s voice rose, addressing everyone in the gang.

A bitter chuckle rose from Dutch’s throat. “Ain’t that a fine thing? You risked death by coming into a den of murderers and thieves to have me. And to give them the chance to live and love?”

Kate remained quiet behind Arthur, her hand ready to draw her pistol at a moment's notice. But she sensed that this man, this detective, was telling the truth. Why would he risk so much for one man unless he was out of options?

“I don’t want to kill all these people, Dutch. Just you,” Milton answered, his resolve unwavering.

Dutch raised his hands, a hint of mockery in his voice. “In that case, I’d be happy to join you, Agent Milton.” As he stepped closer to the detective, everyone simultaneously began to draw their pistols.

Kate watched the moment unfold with genuine concern and admiration. These people, Arthur’s gang, were willing to risk everything for one man. Their loyalty and dedication ran deeper than she could ever imagine.

It was Ms. Grimshaw who leveled her shotgun and gave the final orders. “I think it’s time our new friends leave.”

Agent Milton raised his hands once more as Lenny and Javier began to escort them out of camp. “You’re making a big mistake, all of you!”

“The only mistake is how you keep following us. Good day, sir,” Dutch said, turning away, suddenly unbothered.

“I’m afraid I can’t do that. And when I return, all of you will die. Run away from this place, you fools!” Milton’s tone carried a desperate warning. As he turned to leave, his gaze locked with Kate’s for a moment. He narrowed his eyes, trying to piece together her familiar face, but Javier’s gun pushed him along.

“How dreadful,” Dutch chuckled as he returned to his seat.

Arthur approached Dutch quickly, his steps heavy with the weight of the situation. “What now?”

“We get out of here. Have the women start packing. I’m sending you and the others to look for a new hideout. We’re running out of time,” Dutch said quietly, his urgency clear.

As Arthur turned to carry out Dutch’s orders, his eyes met Kate’s once more. The pain and fear were mirrored in their gazes. There was no time for reconciliation now. They had a mission to complete, and the stakes had never been higher.

“Arthur, maybe we should consider—” Kate began her voice quiet, searching for the right words to address their precarious situation.

Arthur spun on his heel so fast it made her dizzy. “Don’t. Don’t you even suggest it. You don’t have a say in this anymore, Kate.” His rage towards the Pinkertons and his anxiety about the lives at stake spilled out in hot bursts towards the woman he loved, and he couldn't stop the fire from spreading.

“Excuse me?” she responded, her voice a mix of offense and hurt. “I only want what's best for the gang.”

“The best thing to do now is leave. Go help the women pack,” he ordered, turning away from her.

“When does it end, Arthur? This cat-and-mouse game you have with seemingly every lawman in this country. How many more people have to be killed for it to stop?” Kate’s voice wavered with her fading strength. It was all too much to handle; everything was changing so fast. And now an innocent child was involved. She didn’t know what to do.

Arthur’s voice roared back, “I don’t know! Make up your goddamn mind, Kate. You go back on your word and put a target on your back. And now you want to lecture me on my poor choices? If you’re tired of running, you can leave. I won’t stop you.”

He left her with those words, his steps heavy and final. The men took off without a moment's hesitation, Ms. Grimshaw dishing out orders to begin loading the wagons. Kate felt a bitter moment of déjà vu, back to the day at the Downes ranch. She had scolded him for his actions, as if she were one to reprimand him. Kate had glimpsed the kind of man he truly was that day—the hardened outlaw, the merciless killer. She knew there was a kind heart inside him, and she had fallen in love with that part of him. Convinced herself that she could persuade him to leave it all behind, to give up that title for something softer. Arthur wanted it too, but only now was she beginning to understand the giant inside him. The man who had never known peace, who spent every moment fighting for his life and the lives of his family.

Arthur was consumed by his loyalty, as Kate was consumed by her grief. The realization hit her hard, and she felt a deep, gnawing sorrow. She watched him mount his horse, his back tense with determination and anger. The bitter truth settled over her like a shroud—no matter how much they loved each other, the world they lived in was tearing them apart.

A/N: I hope this chapter was alright! To be honest I went back and forth over this conflict for a while, and I think that’s where the birth of my writers block began. I wasn’t intending for their fight to become so heated, but then i was like “you know what? Their situation is a crock of shit, it can’t all be sunshine and rainbows.”

(Also trying to squeeze this in while simultaneously returning to a major plot point of the game was really hard haha)

So yeah, i may have gotten a bit carried away. But fear not, my summary for this chapter was incredibly dramatic. They’re not breaking up! They just got to figure themselves out, and come to understand one another. I want to make it clear that Kate has just as many flaws as Arthur, and that she suffers in silence too. God these two really need each other 😭

I think this was my first time writing some serious angst that didn’t involve one of them nearly dying (lol). So let me know how I did! It’s been awhile since I updated this story, and sometimes things can get lost to the tricks of time. If you notice any inconsistencies or plot holes please don’t be shy to point them out to me! 🙏❤️

[chronicallypainful]

My recent antidepressant adventures

Before I go any further, let me be really clear about one thing. This is my personal experience with anti-depressants. It is not a typical experience at all. Antidepressants can be life-changing (in a positive way) and even life-saving for some people. I'm going to express a lot of frustration with what these drugs did to me, how they were studied, and how I was informed about their possible risks. This is not intended to deter anyone else from taking these medications if it makes sense after a conversation with your doctor about the risks and benefits for you.

Some history. I actually started taking my first antidepressant before my pain disorder was even diagnosed. My GP hadn't been able to give me a proper diagnosis for my pain but suggested that Cymbalta might still help. It did help somewhat, and I stayed on it for several years. A couple years later, after I've gotten a proper diagnosis, the rheumatologist who diagnosed me suggested trying Savella instead of Cymbalta for my pain. I had significant headaches and dizziness while trying to transition from one drug to another, and my doctor and I made the decision to discontinue that transition and return to Cymbalta.

Fast forward about four years and I'm a graduate student. My anxiety has gotten really bad and started to seriously interfere with my studies, which is finally enough to motivate me to see a psychiatrist. After trying a few other things, this doctor concluded that I was having an unusual side effect of SNRI's where they can actually make anxiety worse. So he had me taper to zoloft, an SSRI. The side effects were again terrible. For about two weeks I laid on the floor of my apartment and tried not to move because any movement made me extremely dizzy. I picked the floor rather than my bed because the stability of the floor minimized my dizziness. Even shifting position in bed made me feel like I was spinning around or swinging in a hammock. Within a couple days of reducing my Zoloft, though, my anxiety improved considerably. That improvement and anxiety gave me the motivation to wait it out. It was a couple months before I was fully back to normal, but the worst of the dizziness and other symptoms improved within three weeks.

And now we are reaching close to the present. I've been struggling with anxiety quite a bit for the past several years, though I have been quite successful at blaming it on external (and hopefully temporary) factors: COVID-19, moving to a new city, starting a new job, having difficulty obtaining disability accommodations at that job. Well, this past January, I made the decision, together with my therapist, that I should see a specialist about medication management and hopefully see if a change in medication could help me. To say that that has backfired would be a massive understatement.

I found a physicians assistant in psychiatry who I genuinely do like. I had my first appointment with her in late January. I shared with her my prior experiences changing antidepressant medication and how many side effects I've had and how severe those side effects have been. She promised me that we would use a very slow taper, and also assured me that she would support me with FMLA paperwork if I needed to take time off of work due to side effects. She recommended that I try lexapro, wrote me a prescription and a tapering schedule, and sent me on my way.

Somehow, this time was worse. Within two days of starting the taper, I was dizzy, had frequent headaches, couldn't sleep through the night, had frequent mood swings, and was having alternating diarrhea and constipation. Based on my experience switching from Cymbalta to Zoloft, I assumed these symptoms should resolve within three or four weeks. They did not.

I spoke with my provider at the three week mark. She told me that she was surprised I was having such severe side effects but that she thought they would go away once I was stable on a constant dose of Lexapro.

So I stuck it out. I had to work from home because I couldn't safely drive. I couldn't take my dog on walks because I was scared he might pull me off balance leading to me falling. Instead of taking my dog on walks, I took my hiking sticks for extra balance. My exercise was limited to just walking because, again, I couldn't drive. I struggled with social isolation.

After a five week taper, I was on a constant dose of Lexapro. I was still having the same set of side effects. There were day to day variations in severity but no trend towards improvement. I spoke with my doctor again and she encouraged me to give Lexapro a full four weeks for everything to stabilize. I did. It didn't get better.

At this point, I've been dealing with substantial additional impairment for a full two months. I haven't driven in two months. My ability to exercise and manage my pain disorder has been significantly limited. I have been socially isolated, making my anxiety worse. I want to be done and this is what I tell my provider. She agrees to a rapid two week taper off of Lexapro. Unfortunately, eliminating the symptoms would not be so easy.

During the two week taper, my symptoms are very similar to what they have been. I'm still dizzy. I'm still having G.I. symptoms. I'm still having mood swings.

I took my last dose of Lexapro on April 8. A couple days later, the symptoms got much worse. My dizziness got substantially more severe. I no longer felt safe taking a walk, even with my walking sticks. I felt like I had a fever, complete with the chills and the alternating sensations of feeling hot and cold. My sleep is a total mess, and I'm waking up more than a dozen times each night, eventually lying in bed tossing and turning for hours. I'm crying uncontrollably about everything and nothing. I started experiencing a lot of muscle tightness especially in my shoulders and upper back, and this leads to severe pain.

Up to this point, I had been continuing to work full-time from home. After this new wave of even more intense withdrawal symptoms, even I had to admit that I couldn't do it anymore. I've reached out to HR and medical provider and coordinated medical leave. I ended up being fully off work for three weeks, and then I worked part time for another month after that.

Through the months of April and May, most of my symptoms did resolve. By the time I reached June, I was only left with the muscle tightness (And accompanying pain) and the dizziness. And it's honestly hard to tell where the line is between medication withdrawal causing tight muscles and fibromyalgia simply perpetuating tight muscles. But the dizziness has been extremely stubborn. It has slowly improved since mid April, but I am still dizzy as I sit here today writing this post in late July.

As I sit here today, it has been 3 1/2 months since my last dose of an antidepressant. And yet I am still dizzy. As I sit here today, I don't feel it is safe for me to drive after about 2 PM (the severity of my dizziness is related to time of day). As I sit here today, I am still socially isolated by my inability to drive in the evenings. As I sit here today, my pain management options are limited, again by my inability to drive. As I sit here today, I don't have a good explanation for why I am still dizzy 3 1/2 months after discontinuing my antidepressant.

At risk of stating the obvious, this is not what I signed up for. I knew I had had bad reactions to changing antidepressant medications in the past. I knew that I might have severe symptoms for several weeks. But I never dreamed that it would be several months. And I never guessed that those several months were turning into half a year.

I am angry, pissed off, livid. I'm also scared. While my dizziness does seem to still be very slowly improving, I'm scared that it won't resolve. I'm scared that it will become one more chronic issue that I have to manage. I'm scared this is another manifestation of central sensitization and that, now that I've had the sensitizing experience, I won't ever be able to fully recover due to my broken nervous system. A lot of that is probably my anxiety disorder talking. But my brain isn't pulling these things from thin air. The last time I had a medical issue which lasted multiple months and for which I could not get a clear explanation doing those many months, well, I ended up with my chronic pain disorder.

[gloryseized]

[HAIR KISS NIP] Affection, tenderness: a gesture of affection and care. ( from r. revali )

Meme Tag -- @flockrest

Link's cheeks are flushed, breath misting in the cold air as he finally allows himself to take a break, the raw ache in the place where his right arm used to be doing most of the work to bring him to the ground. Mechanized bits and bobs have rubbed the reminder of the stump on his right arm raw, and he hisses slightly as he reaches up to release the strap that holds the replacement mechanical arm in place.

The arm is the work of Robbie and Purah's--they're pride and joy as far as Link can tell. Their joint effort that Link can't help be suspicious that the pair took too much delight in creating for him. Most days, Link is grateful to be able to have functionally two arms again, especially after the hand granted to him by Rauru vanished once the spell on Zelda ended. But there are also days when he's reminded that this new arm did not transition quite so seamlessly as Rauru's had. He doesn't even have any sort of sensation in this new arm, except for the burning in his stump where it rubbed.

And he knows he should take it slow too, allow his body to grow more used to the prosthesis, but if he has to sit in one place for any longer, he might do something drastic, and Zelda already has enough on her plate, shifting back into the rebuilding process for the realm. Besides, Purah said he should remain active with his new arm, although she probably didn't mean attempting the strenuous Rito archery range, shifting from bow to paraglider and back again. He's completed several runs at that, although his aim is a bit off, and he lands heavily at the observation tower to take a break. Maybe call it for the day?

But no, Revali is there. Looking like himself more than ever, and still Link can't even begin to read his expression--a cross between concerned and vaguely constipated, as far as Link could tell. He's surely about to get some kind of reprimand, a mocking commentary about how even a 'nestling could hit the targets with more grace, flare, and style' than what the Champion has just witnessed. And Link wrenches the prosthetic arm off his body, the sweat beading the area and heat rising off his body from there too. Just a short break then. He can't be seen resting too long with Revali there.

Resisting the urge to throw the mechanical arm into the snow drifts below, Link sets it down on the wooden platform next to him, taking a swig from his canteen before searching through his pack for medicine or food, whichever comes first. With his eyes locked on what he's doing, he doesn't actually see Revali grow closer, although he does feel it, expecting the remarks to come at any time, but instead of his usual words, Link feels a brush at the crown of his head, brushing some hair out of his line of sight as he looks down, followed by several more lines drawn through his hair.

Gentle, oh so gentle. Not the pulling he's felt when brushing his own hair, and especially not the pain he's felt after he's forgotten to tie his hair back or it's gotten particularly dirty. No, this is a different sensation, and Link looks up sharply to see Revali's face suddenly very close to his own.

Goddess, is he blushing? Can Rito blush? A distracted part of Link wonders as the Rito fluffs the feather in his chest. 'You looked like a fledgling after their first flight,' Revali says, a scolding in his voice somehow, although Link isn't exactly sure what he's being scolded for.

Bemused blue eyes blink up at Revali before something almost like a smile tugs the corner of Link's mouth. Eyes drop down again just as quickly, hand tapping once to his mouth before swinging forward. << Thank you. >> he signs politely, confused thoughts still racing around his mind.

[cyanomys]

Recovering from almost having to go to the er for a blockage last night. I just wish I actually knew why I have these lifelong issues with constipation.

And every time I think l'm in remission sort of I have a horrible episode. Every time I make a lifestyle change that I think has solved it, it returns. I have missed out on so much of life from dealing with this.

I feel like there's not even any point in doing more tests about it because there's nothing to diagnose me with. I went through the misery of a barium swallow and all they did was say “huh….you don’t seem to maintain peristalsis normally….sorry about that” and didn’t even give me a real diagnosis of slow transit constipation or IBSc until I later begged a doctor to put something in my records.

They just don’t fucking care. They just tell me to eat more fiber when I try to tell them that too much makes it worse. I’ve been this way since I was A TODDLER. When I was a child they told me it was anxiety (as if I, a child, could fix that), or scolded me for not using the toilet enough (???) and said I would grow out of it. Now that I’m an adult it’s my fault because I must not eat enough fiber (I’m fucking vegan), or I must not exercise enough (I walk or do yoga every day), or I must need to meditate about it (I work constantly on my anxiety every day).

Some people with slow transit constipation have to get fucking colectomies and we STILL DONT KNOW ANYTHING ABOUT IT

It's the equivalent to being like "wow your arm hurts so bad and is so nonfunctional that we have to amputate it, but we can't be fucked to do research as to why this happens to people." Also “you know it's probably your fault anyway"

Constipation stigma is not only attached to unhealthy and obese people but also to drug addicts. I think that’s why the medical system leaves us behind. We’re constipated so we must be less than human like all the other people they ignore.

[ralith]

Back home from seeing ROTB. It was a solid summer flick. A fun watch. IMO it was more entertaining than the Bumblebee film, and incorporated some aspects of the bay films. Overall I'd give it a 6/10.

Now for HEAVY spoilers. I'll hide them under the cut so avoid if you haven't seen the film yet. My thoughts are a little disorganized, but whatever.

I will be making comparisons to bayverse, but I still love those dumpster fire films so...

It was very refreshing to see the bots take the majority of screentime. Their relationship though did not seem like one of friendship. We know in the bayverse that Optimus and his Autobots have known each other for a long time. They're friends.

This crew of bots feel more like coworkers? They fight together but it didn't feel like a cohesive relationship. Prime probably had the most connection to Bumblebee which we see come through when Bee dies. He's angry and throws things and blames himself. However, I think this is where bayverse Optimus actually excels emotionally. Bay Prime is angry and just fucking done with the Cons and later humans that killed Ratchet. So he lashes out. Caple Prime feels emotionally constipated at times, angry and sad and makes threats, but a chunk of his role after Bee's death feels like a pity party. And Primal is the one that has to snap him out of it.

The beginning of the movie felt slow. Probably the first 20 minutes I wanted it to speed up. Really missing that Transit fight.

I think the introduction to the bots was very weak compared to past films. No special scoring or cinematic entrance. They're just kinda there. Very boring.

Also, wow Mirage is fucking annoying. His dialogue was nothing but haha funny quips that were quite boring. He spoke waaay too much, more than any character and my god he needed to shut the fuck up. It was nice to see the bots have screen time and speak, but he spoke more than any bot.

Didn't think I would ever miss Bee, but he was enjoyable in this film, for the chunk he was alive. Mirage actually irritated me so much I missed Bee. Wtf?!

As for the humans, I really liked Elena and Noah. Of course it feels like they're gonna hook up in future films, but it wasn't all that forced which was nice.

As for the supporting bots, Arcee and Stratosphere were fine. Wheeljack was just, uh, there. He really did fuck all in the movie.

Scourge was...yeah he was the villain. Nothing special or spectacular. His dialogue was quite weak at times and trite. Typical evil villain dialogue. Nightbird was fine and played the aerial attacker.

But Battletrap my beloved! His fighting style was very unique, switching between gattling gun and creative ways of using his wrecking ball as a claw or grapple. I love him! But also Primal bashing his fucking skull in with the wrecking ball put a smile on my face.

But that brings up another point. The violence in the film. There were plenty of battles and blaster fire. But everytime a character died (with the exception of Bee) it was done off screen or shrouded in an explosion. We never saw graphic character deaths. I don't know if it was in an effort to limit how much they had to animate, or they were playing it safe with younger audiences. But in this way I dearly miss bayverse's in your face violence. The bay bots got fucked up and you know it.

Like Battletrap got his skull caved off screen and the moment Bee kills Nightbird they fucking cut to an explosion and her parts falling from the sky.

When Primal killed Airazor, I didn't know how he killed her. Did he rip out her spark, break her neck? I didn't see it because she just kinda...fell down.

Though Optimus pulling a bayverse and ripping Scourge's head straight off was beautiful. He also shoved his unprotected face straight into lava and I wanted him to make a give me your face joke so bad, but we never got it.

Now...the CGI. From the beginning I was nervous about how this film would look. When the CGI worked, it worked, but you could tell this was not up to the caliber of the bay films or even Bumblebee. When it was bad...hoo boy was it bad. Stratosphere felt like a late addition because he didn't feel finished. He did not blend in to any scene. Especially in plane mode.

And Noah wearing the Mirage power armor? Holy fucking shit it looked like piss. Absolutely the worst CGI in the film. I was taken out of the final battle immediately because it looked so horrible.

Music. It was mid. The hip-hop was fine. Not my taste of music, but it was fitting. The score however was just okay. Nothing spectacular imo. It was a movie score.

But when Arrival to Earth and No Sacrifice, No Victory started playing...my heart ached. I felt excited for the first time in that whole final battle. Ugggh it was so good to hear again.

The final battle was okay. It was a battle. Didn't feel like the stakes were very high.

I remember Primal saying the transwarp key contained this incredible amount of energy, like the blast of destroying it would be immense, but when Optimus broke it? He got thrown several feet. What? Anyone else get bayverse Matrix of Leadership vibes from the transwarp key design?

The ending didn't do anything for me. Optimus did his speech. Noah did a speech. And I think the movie should have ended there. The ending we got should have been a mid-credits scene because it feels like it changed the whole vibe of what we just saw. It was almost whiplash.

I know they're trying to make some Hasbro Cinamtic Universe by integrating GI Joe. But idc about GI Joe. Never have. So that ending had no effect on me aside from making for an awkward change of tone.

Also, I found it funny that they said Energon was natural on Earth and found in ample amounts. This was something we got very little evidence of in bayverse, mainly from the books. But it was nice to see, even if it was only used as plot convenience to revive Bee and nothing more.

[noramoya]

The comment I’m passing here is from a reader of the fanfic “https://archiveofourown.org/works/20473640

Comment by fanfic3112 : “

“I adored the chapter and they were sooooo perfect! I love the characters who played Wei and Lan Zhan in untamed and now through this story I couldn't help imaging them in perfect detail! Have you seen the harpers bizarre photo shoot they did or tegu figwort shot that Wei dud with his hair wet and tossed in leather and sun glasses? Or the really gritty shoot they dud in Thailand with red land gold lighting and all dark and shadowy and wang yibo (Lan Zhan) looking just hit as fuck. Wang yibo is so much like Lan Zhan in so many what's with the lack of being bake to match his facial gestures to the hot, quirky, grungy, street punk and sometimes even just cute dance moves but in those photo shoots he just came alive in them. He said he really didn't have very look facial muscles especially around his mouth and so really had to work hard to let his emotions well up in his chest send shine through his eyes but to do the subtle facial moves of Lan Zhan he actually used chop stuck to do exercises to develop more facial movement around hugs mouth sync jaw and I was like damn those chop sticks worked not only on his character in the film but in all of those photo shoots. He definitely got that sexy slow bedroom neck role and looking all sexy under his lashes thing going on. Both him and Wei were yummy you could almost lick then off the screens in the photo shoots. When wang yibo dances he is clearly so single minded and focused and likes all eyes on him because he knows he's so good and that when you get to see something in him behind his sometimes shy or quiet or move stoic look...you get to see what you hit across in one live in this story "I hope Wei appreciates that he is the only person I would ever kneel to. Lan Zhan knows he's capable and tough as shit and revered and try's to distance himself from being smug or prideful but you still see it on his face. Even when wang yibo smilies or laughs in videos he still Cary's this certain Lan zhan quality in his eyes (that constipated bitch face look I love!) but he scan defiantly smilie big when he us with Wei and they were goofing off but it's like over the course of filming he brought wang yibos smiles out more and more but even then after each one you usually see himself looking embassies or self conscious cause he's smirking or embarrassed yes smiling. They were so cute in this story and in untamed!

Yeah seeing untamed added a whole other dimension to the anime, manga, novel translation to me and the characters themselves. Then for the first time I found myself really engrossed in the kazillion bits of social media on them. What interests me so much is how Chinese anime, manga, novels and china itself in terms of history and landscape, Vern the music of Chiba that has that transitional feel used in untamed but also current the music of current bands like the characters who play Wei and Lan Zhan come from (uniq and xnine) but particularly the live wuxian, costume and historical drama. It's so interesting looking at why the whole founder of diabolism package basically opened up china to the world in ways I wonder if even they realize. Up until this last year I had never heard of, nor thought or or gone looking for Chinese anime, live drams, manga or Annie and I've held Annie clubs at middle and high schools abc libraries and taught anime drawing. Korean manga and some anime really only started becoming plentiful over the last two years and it had to do with a change in their laws. The whole china xlposiin of interest and more things showing up and getting dubbed has just blown up. There has to be more still the bottom of it than founder of diabolism had a better marketing plan and used social media better or that it all was just really good BL content although those things are definitely true. I can honestly say there's never been another star ir show from china I could name except the ones now from untamed. And it's not just here in the US, it's in Thailand, Dubai, Japan and multiple countries. It's like china is making itself more known but in a back door soft approach and they chose a BL wuxian drama with some hit young Chinese actors to do it with. Just watching the evolution of the two main characters I have found just as interesting. They have just flooded Twitter Facebook and utube bad from a foreign country that us hard yo get much content out there so it all appears to be licensed and apparently nothing happens in china in terms of film, TV or anime without the government abc the censorship board approving it. I love that untamed actually showed the beautiful scenery and landscape that is reflected in the art work. I always find it interesting how things like this can attract so many people and how the impact can ripple to other areas like tourism dollars, increased fame and money and more opportunities for the actors and writers. I love that but also just find it interesting. On a video Xiao Zhan (Wei) said "it kind of frightens me. I'm trying to stay just me and figure the storm will die down soon but I was really in the past kind of nobody and no one paid much attention to me. Now I've got friends everywhere and they all say they like me but I know that can just disappear anytime so I'm just trying to take the opportunities that come because of the popularity now. I'm prepared to fall back to being nobody again when the tine comes." Which sounded and looked so heartfelt. The interviewer had asked what he thought about all the fans in multiple countries he has now and that was his answer. In the past you just didn't see a zillion twitter comment, Facebook comments and tons if utube vid ribs with interviews and every aspect of their lives shown and tons of cool photo shoots and videos shot all subtitled in multiple languages. In the very recent past there wouldn't be most of that stuff and if you did come across it there wouldn't be subtitles and much of it would be blocked on utube. Of what I did see it just wasn't that good as untamed is. For me it's soldo that they deprecated the characters so well and both seem to be so interesting in their careers compared to America actors and stars. I have a friend that used to like watching the kardashians and I never really got how that was interesting but Xiao Zhan and wang yibo have become my kardashians and now I get why other people found them interesting!”

[bluepenguinstories]

Remoras Full Chapter LXXII: Hot and Cold

I was having a nice kale and olive salad (the olives came from my olive garden, the kale also from my garden) with vinegar as dressing (from my vineyard, no less) for lunch with my beautiful wife (wife came from the bedroom to have lunch with me).

“Nice salad, isn’t it?” I asked my beautiful wife with her radiant pigtails.

“No. It’s quite a mean salad, actually. It should be punished to the fullest extent of the law,” she joked while shoving a whole pile into her mouth. She got some vinegar all over her fingers, but that just added to her charm.

“But hun, this is our house. We are the law.”

We laughed together. These days, it was easier to laugh, and these light and soft moments helped put ease to my day to day life. It wasn’t a life without stress – there were chickens to feed, watering the garden and maintaining the farm, just to name a few. But those were stresses on my own terms, without worry over whether my life, or anyone else’s, were in danger.

There came a knock at our door. A series of heavy, intense thumps.

My heart raced. Made the same series of thumps that the door made.

Thoughts raced as well. Thoughts like, are we being raided? Are we under attack? From who? Cops? Mercenaries? Remnants of my pursuers from the past? Did I or my wife do something? Or is it because of our identity or how we live? Are they going to break the door down?

“I’ll get it,” my wife got up with a smile and seemingly not a care in the world.

“Wait!” I reached out to try to get her to stay put. Our safety was first and foremost. God damn it, we should have installed a backdoor. I wasn’t sure if either of us could fit in the window, but even if we could, what if we were too slow and whoever was out there got us?

Instead, she reached over and put her hand over my own.

“It will be okay,” she assured me.

Oh, how I wish I could believe that.

She went over to the door and opened it. I expected some shouting to occur next, or some forceful action that would put me in shock. Worse, I couldn’t even see who was outside due to the door itself blocking my view.

“Uh...a-are you Juniper?” Stuttered out the shaky words with a tone I could only describe as ‘constipated’.

Yet somehow, it’s familiar at the same time, I thought.

I leaped out of my seat and rushed toward the door.

“Yeah, I am! And you must be Rachel?” My wife, who indeed, was Juniper, answered.

“Something like that…”

When I stood behind Juniper, my eyes widened:

There stood a tall, well-built woman (though not as tall as me) in a worn out leather jacket opened up and a plain white shirt underneath. She had jeans with holes in them, but that wasn’t important. No, what was important? Uh, she fidgeted a lot, and shivered, too, perhaps out of nervousness. Her index fingers sometimes poked against each other, but she soon transitioned into folding her arms together, unfolding them and holding one off to the side, and then scratching at her arms.

Her hair was shaved near-bald with only remnants of small hairs intact, which, given their dark shade and thickness, I was left to assume she had black hair before. She had black circles around her otherwise radiant eyes, and I almost thought she had been given a black eye from someone not too long ago until I realized it was eyeshadow. Then there was her jawline, deep and wide. Her skin looked like a warm and rich brown hue. Really, if there was ever a beauty to rival Juniper’s…

Well, I’d be interested to know what her hair looked like before she shaved it, I considered before I made any more physical evaluations on this guest of ours.

“A-Are you checking me out?” Rachel looked past Juniper and asked. Now it was my turn to shiver, as goosebumps filled me.

“Ahaha, no!” I laughed, “I was just curious what you might look like. I imagined all sorts of things based on our talk on the phone! You know, you don’t sound like you do on the phone. Where’s all your suave and flirtiness?”

She looked shocked as she took a step back.

Why are you the one being shocked? What about me?

“I’m sorry...if I gave you such an impression. I have trouble talking to beautiful people, especially when they’re alive. Which you two tick both boxes…”

“Uh...as opposed to talking to dead people?” I asked in total confusion. So this wasn’t going how I thought it would be: I knew we would have a guest, someone who knew Demetria well, and someone who had fallen under hard times, but despite all that, I didn’t expect them to be so strange right out of the gate. Luckily for me, I had experience dealing with strange people.

“Heh,” she looked off to the side and smirked, as if she was recalling some fond memory. “Yeah. I feel like I’m in good company around those who have ceased to be.”

“Right…”

“Oh, sorry! Where are my manners? I always forget those exist...uh…” she shook as she held out her hand. “You must be Vesuvius, right?”

“That’s me,” I took her hand. It was rather warm. Not all that surprising, given spring was in its second half of its lifespan, but it still seemed worth commenting on, “but you can call me Ves. Your hand is warm, by the way.”

“Really? I’ve had people tell me I’m quite cold,” she remarked, without a stutter or pause, this time.

“Who tells you that?”

“Ah…” she chuckled, “well, actually, I haven’t talked to people in a while, you see.”

“Well, I’m sure we’ll have plenty of time to talk while you’re here!” I gave her a thumbs up and smiled.

“Yeah, we were wondering when you would show up since it had been a couple months since your call,” Juniper added.

“Sorry about that, J...J...Juniper,” her face seemed to grow red, “I had to walk from the place Demetria lives at with no forms of transportation to get me here faster.”

“Oh dear, I’m sorry.”

“Ah, it’s fine, I’m used to not having a home to go to...and I traveled with a strange homeless woman on the way here. She had some money, and it wasn’t so bad...I found some charcoal on the ground and rubbed it around my eyes because I lacked makeup. I wanted to make myself presentable.”

“About that: I think you should shower. I’m sure you’ll look fine, either way, but that can’t be good to keep on your face for who knows how long in such warm weather as this,” I advised.

“Warm? Is that so? My, the temperature is quite temperamental. I didn’t get the same treatment on the way here. I wish I layered up more…”

“Well, you had a long walk to get here. I’m sure sleeping outside didn’t help much.”

“Oh. I. Actually, I, sorta slept at a hotel a couple of times. There’s one on the highway near here. The receptionist even called me darling.”

“Really? Why didn’t she call you by name?” Juniper gave Rachel a suspicious look.

“It’s okay! Really! I’ve always wanted to be pampered.”

“Ah, I’m sorry. We don’t really do much of that here,” she shook her head.

What? Since when? Don’t you pamper me all the time, Juni? Why are you saying such things to our guest?

“I’m fine with that. I’ll be in your care as long as you allow me.”

“Sure. You’re welcome to stay as long as you like, ‘Rachel’,” she emphasized her name as if she were saying it in quotes. I side-eyed Juniper, but she didn’t give me any sort of indication what was going on.

“Yeah, we’re pretty easygoing people. Kind of boring, really,” I added.

“I can see that,” Rachel replied before walking inside.

I felt like a vein was about to pop. What the hell? Only I was allowed to say that we were boring. Who was this stranger to…

...Rachel walked over to the couch in the living room and laid down with the blanket drawn over her. Like she didn’t need an invitation and just went for it.

As Juniper closed the door behind her, she turned to me and whispered.

“She seems like the kind of person who gave me a hard time in a past life,” she said, quiet enough that Rachel couldn’t hear.

“What? What does that mean?” I whispered back.

“That’s just the vibe I get. You’re free to see her however you like.”

I must have had several question marks surrounding my face as Juniper walked into the kitchen and grabbed a mango.

What happened to the Juniper who smiled at everyone and was, perhaps to some, unbearably kind?

“You want a mango, Rachel?” Juniper asked. It was definitely closer to the Juniper I knew, even if her tone wasn’t quite the friendly one she usually had.

“Huh? Sure,” Rachel replied without looking over.

Juniper wound her arm back as if the mango was a baseball and she was about to toss it to the pitcher. Except Rachel didn’t have a bat.

Is she seriously thinking of hitting her in the face?! My jaw dropped.

Instead, she changed form and gave a light, underhanded toss in Rachel’s direction. To my surprise (and relief), Rachel caught it in one hand without even looking Juniper’s way.

Well, at least she’s a good catch.

I watched as Rachel took a bite into the mango, skin and all, as if it were an apple.

“So, how did you and Demetria meet?” I asked Rachel.

“If possible, I’d like to pretend I never met Demetria. Thank you for understanding,” Rachel said and waved her hand aside.

All that statement did was make me wish to ask more questions.

“I can tell you, however, how I fell under these hard times,” she said instead.

“Oh?” I dropped to the floor and sat with keen interest.

“Do you remember three years ago?”

One of the best and worst years of my life. So much chaos, in both the good, bad, and neutral sense of the word.

Of course, I didn’t tell her those superfluous things.

“You mean 2017?” I confirmed. It was taboo in some places to state what year it was, unless you had to write the date on a document. Often, in conversation, it was more wise to state ‘current year’. But all you had to do was say what year it was a certain amount of years ago, and it was clear what year it currently was.

“Oh yeah, remember the summer, hun?” Juniper chimed in. Soon, she sat down beside me. She even wrapped her arms around me from the side for good measure.

“I’d rather forget…” I groaned and looked off to the side.

“Why, what happened then?” Rachel asked. Oh, dear. I really didn’t want to get a stranger involved in one of my sob stories.

“Don’t you know already?” Juniper asked. That question struck me as a bit odd, but Rachel was the one who brought up three years ago first.

“Well, I know what happened to me then, but I’d like to hear about you first.”

There’s no getting out of this, is there? At least I won’t be expected to talk about the more out of this world stuff, right?

Luckily, Juniper was there to rescue me:

“Summer was when Ves here started working on her mental health! I’m very proud of the steps she’s taken. We weren’t always the picture perfect couple, y’know?”

“We weren’t?!” I balked.

Aw, who am I kidding? That cosmic possession thing did cause quite a strain.

“Well,” I huffed, “it was also the time when my mental health was at my lowest.”

“Sometimes you have to hit rock bottom to climb to the top, dear,” she stroked my back and made me feel like a horse that just won first prize at a race.

“Hmph. That’s right. I did do a lot of climbing, didn’t I?” A sudden surge of pride washed over me. Juniper sure had a way of making me feel triumphant.

“I’m glad to hear you overcame whatever obstacles you seem to have had. I even remember congratulating you over the phone,” Rachel pantomimed holding a phone up to her ear.

“Yes. What was that about?” I asked.

“It’s just the feeling I got from you. It sounded like you were in a better place than you once were, but still troubled by the past. Am I incorrect?”

I shook my head.

“You’re correct. I can never fully get over things, even when I say I have. I still struggle with certain things which haunt me, but I’ve been able to manage myself much better than I used to in the past.”

I looked over at Juniper for approval, as if I needed to prove that my words were sincere enough. She gave me a light peck on the cheek. That was all the approval I needed.

“So what about you?” I asked. “What was significant about three years ago?”

“Well, funny enough, you could say that was when my life ended,” she chuckled.

I don’t know why, but that struck a chord with me. Not so much a nerve, as I still had a few of those stockpiled.

“How so?” I asked.

“Well, you see, I used to be an underground boxer. It’s not so glamorous, as I didn’t have a full stadium out in the open, and there were less rules than a professional boxing tournament. It also meant it was more risky. That said, I made big bucks, I had my own manager, and I was quite famous in the underground circles. They called me Rachel ‘Frigid Fists’ Flores.”

“That’s a lame stage name,” Juniper sneered.

“What?! No way! It’s totally cool!” Rachel grew defensive. “You think so, right, Ves?”

“I don’t know anything about boxing, sorry,” I lied. I knew some things. Like gloves were involved. And people got knocked out sometimes.”

“Needless to say,” Rachel continued, “I fell into a coma.”

“I feel like we’re missing some steps here…” Juniper scratched her chin.

“Well, she probably got knocked out,” I suggested.

“You’d think so, huh? But nah, whenever someone got knocked out in battle, it usually didn’t last long. At worst, you’d lose a few brain cells, but if brain cells are so fragile that being knocked out will make you lose some, I’m inclined to blame the fragility of the human body and not the result of a boxing match.”

“So what happened, then?”

“Before I get to that, I have to explain that I never really got knocked out. I was locked into an abusive contract, pulled in many places, forced to train when time would have been better spent resting. But as long as I continued to win matches, I’d keep making money and have a roof over my head. My manager would remind me things like, ‘you don’t have a family or a home to go to. I picked you off the streets when no one else would take you in and I recognized your talent. I can always put you back on the streets.’ So yeah, despite knowing how bad my contract was and how lonely my existence was, there was incentive to keep winning matches.”

“Quite the pickle,” I sympathized.

“More like a situation, actually. I don’t know what cucumbers have to do with boxing. Anyway, I had a sense of purpose, I kept my manager happy, and I didn’t have any other skills that would make me appealing to society. Of course I’d want to keep winning matches, right? Well, as I said, I didn’t have other skills and I was quite limited on where I could go and what I could do. Eventually, I reached a breaking point. Something of an ultimatum: I can either keep at this until they forcibly retire me and kick me out to who knows where or I can upend my life right away.”

“So what did you do?”

“During one of my matches, I lost on purpose. I goaded my opponent into getting more and more aggressive by insulting her with the worst things I could think of while I stayed on the defensive and only made light jabs. She knew I was good. More than that, I knew she lacked form, but in matches like these, all you needed was a quick strike, which is exactly what I got out of her. When I fell to the floor, I stayed there, pretending like I was knocked out even though that was far from the truth. I let the countdown reach ten and…”

“You fell into a coma?” I finished for her.

“No. How does that make any sense? There’s a sequence of events, and there needs to be a cause and effect. We haven’t yet gotten to the cause, but the build up is essential.”

“Oh, all right,” I puffed my cheeks.

“So my manager could tell what stunt I pulled. I was promptly kicked. I was allowed to pocket some of the money I had earned through the years, but much of it went seized, leaving me with a considerate amount in terms of pocket change, but not enough to house myself. Luckily for me, the silver lining came in the form of a knife,” she made little stabbing gestures in the air.

“What I mean is that I got stabbed right after getting kicked out. I lost consciousness and I was rushed into the hospital. But despite surviving, I remained in a comatose state. When I awoke, which wasn’t even too long ago, I learned that my former manager had paid my hospital bills in an uncharacteristically kind gesture. That said, I had to undergo much treatment to get me back on my feet, and I had lost contact with anyone I once knew so long ago.”

“Wow, that’s so harsh,” I couldn’t believe the kind of life Rachel had. It must not have been easy. Seeing as once, I spent a considerable time on the run, and a considerable time after searching for answers, I could relate in some ways. Maybe my experiences were closer to the realms of fantasy, but that was neither here nor there.

Juniper shot her hand up.

“I just wanna know...why do you feel the need to lie?” Juniper asked.

When I say I almost gasped...well, thank goodness I didn’t, because that would be unladylike of me.

“Because sitting up is too much of a chore,” Rachel shrugged as if she wasn’t handed a huge accusation on a silver platter. I still wasn’t sure what the accusation was, because none of what Rachel said sounded like a lie. It all sounded like it came from the heart.

“If that’s the case, why the couch? There’s a guest room with a bed for you. And if you don’t mind sharing, you’re always free to lie in bed with Ves and I.”

“L-Lie in bed with Juniper? I can do that? I mean, I’ve thought about it. Maybe in my wildest fantasies. Maybe some not so wild. But here? Now? Is this true?” Rachel sat up and began fidgeting her hands together.

“Of course. All you have to do is be honest with us.”

“What are you doing, hun? She’s not the enemy,” I whispered to my love.

“I know she’s not. Maybe if we had met a few years ago, she might have been one. But here, she’s a potential dear friend. I just want her to be honest with herself, and with us,” she whispered back.

“About what?!”

“Hey Rachel. While you were up in the arctic with Demetria, did you meet Remora?” Juniper asked.

How is that relevant to anything?

Whatever I expected from Rachel next, what I wasn’t expecting was for a smile to spread across her lips and her voice to become much softer, in a sort of casual way.

“Yeah. Strange woman, isn’t she?” Her words flowed like they were blown from the wind. “I was, after all, sitting across from her when Demetria told you about me, and when you talked to Remora.”

I froze. Almost as if I was in the tundra, myself.

So when I said all those things about grief, Rachel was there. She heard all these things…

“So that’s how you knew to say all those things to comfort me,” I realized.

“Ahaha, you caught me. Sorry, eavesdropping, force of habit.”

“Did...did you ever lose someone close to you?” I asked.

Rachel shook her head, still smiling.

“I can’t lose what I never had to begin with. The closest I came to was when I met someone I wanted to get close to, but I lost that chance when I ‘fell asleep’, so to speak. I guess that’s a loss, but it’s really more my loss than anything.”

“Would you ever wish to see them again?”

Rachel leaned in close and her hands moved under her chin. Her eyes seemed to sparkle, and her smile lowered just a touch.

“I can barely remember a single thing about them. If I recall, I didn’t know them for very long, either. As far as I’m concerned, this is my second chance at life, and I’m just hoping I can make memories with this one.”

“I hope so too,” I smiled back at her.

We didn’t linger too long in the living room. Yes, introductions could be quite the chore at times, yet they were also necessary. Or at least, I thought so. Speaking of introductions, there was still the tour we had yet to get to.

First off, Juniper and I showed her to the guest room. Her response?

“No, thanks. The couch is enough for me.”

Oh well. I was sure she in her troubled mind must have thought something like, “I don’t deserve a bed right now” as that was once a thought I had. But I knew it would only be a matter of time before she was no longer able to resist the allure of a soft bed.

We went outside and I showed her the garden, the vineyard, and the farm. She yawned at each display. She didn’t even seem impressed when I showed off my greenhouse and my hydroponics.

Oh well. Everyone’s a critic.

Next, Juniper pointed way off in the distance to a small wood barn. That barn, of course, housed the chickens and had lots of hay and wheat for them to sit upon and roost.

“What a load of cocks,” Rachel remarked.

“Actually, they’re all hens,” Juniper corrected.

“What’s the difference?”

“Cocks are roosters.”

“Oh, it doesn’t matter,” I waved my hand and groaned, “they’re all chickens.”

“Yes,” Juniper nodded, “and if you want to win their affection, you must know all of their names. There’s Molly, Bruno, Bagel, Okapia, Okra, Okakoro, Onomatopoeia, Priscilla, and Doodle.”

She pointed to each one and some of the chickens looked over at Juniper. They were more hers than mine, as I mainly gathered the eggs every now and then. It was her compromise that if we were to live in a remote area, that we should at least have chickens. There was no way I could argue with her about that.

“Is this really necessary? And what’s with some of those names?” Rachel asked.

“Yes. It’s all necessary. Some won’t let you feed them or clean their plumage or take their eggs unless you address them by name.”

“Will they bite?”

“Some will. You’ll just have to endure it.”

“This world sure is harsh,” Rachel observed.

The last stop on the tour was Juniper’s workshop: a place where she invented all sorts of silly little gadgets and contraptions.

“Wow,” Rachel mouthed as she stared up in admiration at the garage where Juniper did her tinkering. She didn’t even look in and see any gadgets, but it was like she didn’t need to know what went on in there and just the simple fact that it existed was enough for her.

We soon finished our tour.

We had deviled eggs for supper, something which seemed to delight Rachel as she shoved several eggs in her mouth.

I’ll have to take note that she likes protein. Maybe I can grow some beans for her.

When she decided enough was enough, she patted her belly.

Both Juniper and I laughed, and when we did so, Rachel’s eyes shifted between us and began to shiver.

When it came time for Juniper and I to sleep, we took our leave to the bedroom while Rachel stayed out in the living room.

I preferred to sleep not long after dusk, as I was a simple woman. Of course, Juniper and I had sex nearly every night, which did keep us both awake a little longer, but also helped us to sleep at the same time.

Even when she was satisfied after a passionate bout of lovemaking and I was well past asleep, she had a tendency to still have plenty of energy and stay awake, absorbed in other tasks.

Sometimes I would wake up and see her with a book (she preferred non-fiction, and instruction manuals on how to build various things) and a dim light on the table next to her end of the bed. Other times, she would go out into the living room and watch TV, or play video games on the PC that rested in the corner of the room. That wasn’t even taking into account how sometimes she’d go out into her workshop and pull an all-nighter.

I wouldn’t have been surprised to wake up that night, either, and find she was awake and absorbed in some task.

Juniper the busybody. Juniper the handyman. Juniper the workaholic. Juniper the carefree.

Then there was me: one who would have been content to lay in a field of flowers and meditate. To wake at sunrise and sleep at sunset. To seek out the nearest source of calm and bask in it.

However, I couldn’t sleep that night.

Well, I did, but it didn’t last as my eyes shot open into the darkness.

I checked my phone: just a little past 1 AM.

Now why am I awake? I wondered. There were no signs from outside save for the noisy crickets. I turned over, as I expected the other end of the bed to be empty. However, there Juniper was, lying to her side, hugging a giant shark plush toy.

I poked her bare back and traced my fingers against her shoulder blade. She shivered, and I let out a silent laugh.

I should be careful not to wake her, I thought. I kissed the back of her neck, soft enough so as not to wake her.

Just outside the room, I saw a faint, orange glow coming from the living room.

Huh. I was sure the lights were off.

Despite the excitement earlier, I had a lapse in judgment where I forgot that we had a third person living with us now.

If Juniper is next to me, and the light is on…

I considered that maybe Juniper had been up earlier, decided to watch TV, and then went back to bed and forgot to turn the light off in the living room. I don’t know why I considered that, given Juniper wasn’t one to leave lights on, but here we were.

I pulled the covers off of me. I didn’t care that I was in nothing but my underwear (I can’t sleep wholly in the nude, or I’ll get cold), as I didn’t think anyone was out there. That said, I had enough sense to put up my fluffy nightgown with little pictures of sheep (I’m not sure if the nightgown was made of wool or not, but I wouldn’t be surprised if it was) printed on it.

When I entered the living room, I saw a large and imposing figure in a dark jacket with a blanket over them seated on the couch and shivering the whole while. I jumped in place, startled by the sight, before realizing just who it was.

“Rachel?” I asked.

The previous events of the day began to return to the forefront of my mind.

Rachel looked over and smiled, the warm glow from the lamp illuminating her face.

“Can’t sleep, princess?” She asked with a voice that was both soft and sneering.

I shook my head as if I had just sniffed a pile of ghost peppers and reeling back from the scent.

“I guess I just have a lot on my mind,” I said. I wasn’t sure if that was true or not. Since being awake, I haven’t explored my thoughts all that much. Some would say it’s important to explore such things, but in my experience, that’s a surefire way to keep one awake.

“Ah. The mind is a terrible thing, isn’t it?”

“Heh...hey, why do you call me ‘princess’, anyway?”

“Maybe it’s because you seem spoiled like one. Or rather, I don’t think anyone could look at you and not want to spoil you, if you catch my drift.”

“I don’t know if that’s a compliment or an insult.”

“Complinsult, perhaps? In any case, it’s just the fact of the matter: you’re like a cute kitten or puppy who needs lots of pampering and attention.”

“Uh, thanks?”

She continued to shiver and rub her hands together while pressing the blanket tighter over her.

“Cold?” I asked.

“Don’t mind me.”

I walked over beside the couch and sat down.

“Sorry, we don’t really have central heating or cooling. Typically, it’s warm in the daytime and cool in the evening up through dawn until midday. We just figured nature knew best.”

“That must be why you have all these wires and electronics,” Rachel gestured to the lamp and the TV.

“Ah. Well, we’re not completely cut off from modern conveniences, nor are we ‘off the grid’, so to speak. I just wanted to leave the city behind, and Juniper was happy enough to support me in that dream. In her own words, ‘it gives me a chance to try new things.’ We’re also not completely cut off from the woes of money. All you see here Juniper had to save up to build. Even now, I’ll sell any extra crops to farmer’s markets, and she’ll sell her little inventions. We’ve been able to take in a modest amount. We’re not looking to make ourselves rich, and most of the time the money goes toward upkeep on the house, or buying any food we don’t already grow at the nearest grocery store.”

Noticing I had talked a lot, I stopped myself and looked up: Rachel had on a serious expression.

“Sorry, I must have bored you!”

“No, not at all. I’m interested in your life.”

“Ha…” It made me a little warm hearing that.

“But what about you?” I asked, “I’d like to know more about you.”

“There’s nothing interesting about me,” she said with an utter indifference that it cut right through me.

“That can’t be true! There has to be something!” I protested. “I mean, everyone has something interesting about them! Everyone’s got a story to tell!”

Rachel put a finger to her lips.

“Careful, you’ll wake the missus.”

“Oh, sorry. I tend to get a little emotional.”

“I know. If it will sate your curiosity just a bit…” Rachel shimmied out of her jacket, then slipped off her t-shirt.

Although I too was topless (save for the nightgown), I was reminded of the time Demetria was over and she remarked at me being topless with, “it’s a tits out kind of morning.” Despite how things ended up with her, that was a rather fond memory in hindsight.

However, with Rachel not having a care in the world (I mean, I never even got around the explaining to her that Juniper and I both had a tendency to walk in the nude around the house when it’s just us), I saw scars all across her torso and her back.

Small scars, little cuts which have turned tender, to large ones, like slashes against her chest, and a long slash across her stomach. Under her right breast, there were burn marks which extended to part of her back. Along her back were several more scars and cut marks.

“Not a pretty sight, is it?” She asked rhetorically.

“That’s not it, I was just surprised. You actually have a nice figure,” I remarked, and it was true – she had hardened, chiseled abs, large arms, broad shoulders, and her breasts were petite and sagged a little. They were rather cute.

“Thanks, but we both know this isn’t a beauty pageant.”

“Does it hurt?” I asked.

“Would you like to touch them?” She offered with a chuckle.

It felt wrong, but I couldn’t resist the temptation as I reached out for the scar across her stomach and felt the pink, tender flesh. She shook as I felt along her scar. She let out a hoarse, but faint sigh as she shivered.

“Sorry I’m a little ticklish,” she said. I looked up and met her gaze. My face turned bright red as I hurried to back away.

“So how did you get those scars?” I asked, even though I figured the answer would be the same as how she got her muscles: she was a (somewhat) professional fighter.

“Fights, mostly. But not just inside of the ring. I’ve been in fights, and other dangerous situations, throughout my life. I can’t begin to tell you all the wounds I’ve had or how I’ve acquired them all. They say every scar tells a story, but most of mine are far too boring to tell. All except for the slash across my stomach.”

“What’s interesting with that one?”

“That was the scar which ended my old life and gave me the life I have now. It’s the scar I’m most fond of,” she explained with a smile.

I felt a chill down my spine. I couldn’t really explain why, yet it felt familiar. She felt familiar.

No, what am I doing? I thought.

“What’s wrong?” Rachel asked.

“Nothing,” I replied. And surely, if something was wrong, I couldn’t identify it.

“Does what I say bother you?”

“Not at all.”

“Good. I don’t wish to trouble you, princess. Most of my past life, I would rather forget. The cause of my scar, however, holds a special place in my memories. I hope you know that I wouldn’t show this scar to anyone but you and Juniper.”

“Why us?”

“Because I feel a connection to you two. Is that wrong?”

“No, it’s not. If anything, I’m glad you feel comfortable sharing that with me.”

I stood up and motioned back toward the bedroom. Rachel shimmied back into her shirt and jacket.

“I should go back to bed…” I gestured to the bedroom door. “Sleep well, Rachel.”

“Oh, I never get much sleep, but goodnight to you,” she replied.

That too was strange. Or maybe it wasn’t. Really, nothing strange has happened since she got here. It must have just been me feeling strange about the new addition to our household.

I didn’t get much sleep that night. I stayed in bed for a while, with my thoughts running through my mind:

I know what this is, but I told myself I would be over it. I’m not going to make that same mistake with Rachel, or anyone else, for that matter. No matter what similarities or coincidences arise, I can’t be comparing others to her. She’s gone. I know this.

There is no “second chance.” I need to do right by Rachel, not because of the past, but because Rachel is Rachel.

A couple of days have passed since Rachel entered our lives.

It seemed a fine enough adjustment; she helped out around the house, swept up when asked, and even watered the crops outside without being asked to. That last part worried me, because if she gave the crops too much water, that would have been overkill.

“You know what job you would be good at? Being a scarecrow!” Juniper joked. Rachel didn’t seem so amused.

“There’s only so long that my arms can hold a T-pose,” Rachel replied.

I had to agree: I preferred it when she moved around than when she stayed still. Which brings me to what she did when she didn’t do boring chore-like things: which is to say, nothing. Or rather, she sat in the living room. Either on the couch or on the floor next to the couch.

“Rachel, can you wipe off the crumbs you left on the table after you ate that peanut butter and zucchini sandwich?” I asked. “Oh, and when you get the chance, can you go feed the chickens?”

“Rachel this, Rachel that,” the suspect in question grumbled, “I swear, this woman will be the death of me.”

We were only three days in and already having problems? Did she think of me as nagging? But I just asked for her to do so. She doesn’t even have to.

“Please don’t say that,” Juniper scolded, “Ves actually went through a tough time and jokes like that don’t really help.”

“Oh really? I wonder what that tough time was,” Rachel remarked.

“I think it would be better if Ves told you herself, and only if she feels comfortable enough to do so. Please don’t force anything out of her.”

I smiled. Good on Juniper for sticking up for me. Not that I needed much defending, but it was nice to know that when push came to shove, she had my back.

Even if she groaned about it, she ended up cleaning the table, though she declined on feeding the chickens, as in her own words, “they’re too scary.”

There were other points of contention, however, like the fact that she took super long showers. And when confronted about it, she would say, “it’s not my fault the water was cold when I got in and wouldn’t heat up.” I’d end up turning on the faucet, with the dial set all the way to ‘H’ and cry out in pain when I was scalded by the scorching hot water.

Or how sometimes she’d knock on the bedroom door, waking both Juniper and I up, and asking, “you’re not using your blanket, are you? I’d like another.” When I got up and noticed that she had not only the blanket from the couch, but also the ones from the guest room, I was a little concerned.

But I wouldn’t budge.

“Sorry, but Juniper and I need our blanket to rest. If you’re bothered that much, maybe you can layer up more,” I suggested.

“Good idea. Can I wear your guys’ clothes since you’re not wearing any?”

“No. There’s plenty of clothes in the guest room.”

“I’m mad,” Juniper said in a sleepy voice. It was clear she was sleep talking. Both Rachel and I looked toward her.

“So cute,” Rachel said.

“I know,” I agreed, before I snapped out of the admiration to go right back to the matter at hand. “Anyway, figure something out. I need sleep.”

Needless to say, I was getting stressed and wondering if Rachel really wanted to be here. At any point, I expected her to up and disappear without a single word as to where she was going. I don’t know, it was just the vibe I got from her.

Also, needless to say, because I was getting stressed, I turned to my good friend, Ms. Bong.

It was the middle of the day, four days into Rachel living here. I was in the middle of the bedroom, sat down with my legs spread and the bong between my legs. Juniper was in the middle of her workshop, out in the middle of the fields. You know, I hadn’t even taken my first hit, but wasn’t it strange all these ‘middles’ we keep having?

In fact, I only managed a single hit by the time Rachel stopped in the middle of the doorway.

“Interesting. What is that?” She asked.

I stared up. I was far from high. Far from anything, really.

“It’s a bong. I’m gonna get stoned off my tits, because you’ve been stressing me the fuck out,” I retorted. It felt way too biting and passive-aggressive, but she didn’t look startled or offended at all.

“Oh, drugs. So this is how you cope with stress,” she noted. I felt like I was being studied under a microscope.

I got up to confront her.

“Now wait just a second! There is nothing wrong with getting high to relieve stress or anxiety!”

“I never said there was. There’s no need to get defensive. Or are you insecure about your coping mechanism?”

“No. I’m not insecure at all. About anything. I’m very mentally sound, I’ll have you know.”

“Good. I’m glad you’re taking care of your mental health.”

She walked away. I felt like she had just won an argument and I opened my mouth to fire back with my own venomous words, but nothing of substance would come out. I just stood in the doorway confused.

Just who are you, Rachel, and why do you feel so familiar yet fill me with dread?

[zaocare]

A Guide to the Health Benefits of a Plant Based Diet

Are you tired of feeling sluggish and unhealthy? Do you want to make a positive change in your life? Look no further than a plant-based diet! Yes, you heard that right.

By including more fruits, vegetables, whole grains, and legumes into your diet, you can experience a whole host of health benefits. In this article, we'll explore the power of plants and how they can transform your health.

What is a Plant-Based Diet?

A plant-based diet is exactly what it sounds like: a diet that revolves around plant foods. This means that the majority of your meals should be made up of fruits, vegetables, whole grains, and legumes. While some people may interpret a plant-based diet to mean a strict vegan or vegetarian lifestyle, it doesn't necessarily have to be that way. You can still incorporate small amounts of animal products, such as meat, dairy, and eggs, into your diet while maintaining a plant-based focus.

Health Benefits of a Plant-Based Diet

The health benefits of a plant-based diet are numerous and well-documented.

Here are just a few of the many reasons to consider making the switch:

Improved Heart Health: A plant-based diet has been shown to lower cholesterol levels and reduce the risk of heart disease, the leading cause of death worldwide.

Lower Risk of Cancer: Studies have found that a diet rich in fruits and vegetables can lower the risk of certain types of cancer, such as colon, breast, and prostate cancer.

Better Digestion: A plant-based diet is high in fiber, which can improve digestion and prevent constipation.

Weight Management: Because plant-based foods are typically lower in calories and fat than animal products, a plant-based diet can be an effective way to manage your weight.

Increased Energy: Plant-based foods are rich in nutrients and can provide your body with the energy it needs to thrive.

FAQs about a Plant-Based Diet

Here are some common questions and concerns people may have about switching to a plant-based diet:

Q: Will I get enough protein?

Yes! There are plenty of plant-based sources of protein, such as beans, lentils, tofu, and nuts.

Q: What about calcium and vitamin D?

Many plant-based foods are rich in calcium and vitamin D, such as leafy greens, soy milk, and fortified cereals.

Q: Won't I miss the taste of meat?

While it may take some time to adjust, there are many plant-based alternatives to meat that are just as tasty, such as tempeh, seitan, and veggie burgers.

Tips for Transitioning to a Plant-Based Diet

Making the switch to a plant-based diet can seem daunting at first, but it doesn't have to be.

Here are some tips to help you get started:

Start Slow: Begin by incorporating more plant-based meals into your diet gradually. You don't have to go cold turkey (no pun intended) on meat and dairy all at once.

Experiment with New Recipes: There are countless delicious plant-based recipes out there, so don't be afraid to try something new.

Focus on Nutrient-Dense Foods: Make sure you're getting enough vitamins and minerals by incorporating a variety of colorful fruits and vegetables into your meals.

Don't Be Too Hard on Yourself: It's okay to slip up occasionally and eat something that's not entirely plant-based. The important thing is to keep trying and make progress.

For more info about plant-based diet read the full article here:

Is a Plant Based Diet Good For Health?

[nevermindtheb0ll0cks]

Has anyone on here been diagnosed with slow transit constipation?

[sidewalkchemistry]

Why Cleaner Diets (Plant Based, Whole Foods, Raw Vegan, etc) Make People Sick & How to Easefully Adopt a Healthier Diet🦋 | Holistic Leveling Up!

Heard of people breaking out, unbalancing their hormones, getting fatigued, losing hair, developing gut issues, or becoming prone to colds having made a perfectly nutritious upgrade to their diet? (BTW I don't mean anything low-carb or high-fat. These don't meet the body's actual needs and lack fiber. They are not wise to practice unless you want fatigue and constipation).

Apart from the psychological and social difficulties of adhering to a healthier diet, there are also the physiological effects. Many people will claim that fully adequate diets made them sick and it must just not work from them because "everybody's body is different." The actual reason for this is that the body's natural detoxification pathways become less encumbered, and especially if drastic switches are made, the rates of cleansing can be too intense (simply eating more nourishing foods over junk foods is cleansing as it supports detoxification rather than inhibiting it). Most people are unaware that we have to take such permanent lifestyle transformations like this gradually, especially if we come from a history of illness or heavy junk food eating. I always recommend using the transitory principles of the Mucusless Diet Healing System (devised by Prof. Arnold Ehret), no matter how you are changing your diet. So, if you are looking to nourish your body as it deserves, seeking to remove processed foods, towards a primarily-fully whole foods, plant-based, home-cooked, mucusless, and/or frugivorous diet, all of the following applies.

Step 1: Understand that everything in nature makes permanent changes with transitory phases. For example, the life cycles of animals and growth of plants. Ehret says that "Nature's mills grind sure but slow." Overnight, cold turkey methods are not reliably effective because they work against nature. What we eat affects us chemically several times per day. To make a change in our foods is to change the chemical environment within us. (Making continual, progressive transformations to diet & lifestyle can look like this).

Step 2: Eliminate the worst mucus-forming foods first. Pus-forming foods (animal based products) are the most obstructing as they decompose in the digestive tract. They create the most powerful cravings and impediments to healing, since they have gummy residues and are fiber-less, which causes them to struggle to be fully eliminated from the digestive tract. If you are already off of animal ingredients, reduce/eliminate rice, gluten pasta, and other sticky grains from your diet. Opt for more coarse, sprouted, and gluten-free grains, like wild rice, millet, and buckwheat (until you transition away from them if that is your goal).

Step 3: Increase your intake of fruits and vegetables, especially the virtually fat-free and starch-free [or starch-free once cooked] ones because they are mucusless (for example, avocados, potatoes, and cassava are mucus-forming). These will help you to adjust to more nourishing meals because they are the best at developing a diverse & balanced gut microbiome. Base your meals around ripe fruits and well-grown vegetables. Have a predominantly or all-fruit breakfast (eg. baked peaches, spiced and stewed apples, smoothie, or fruit salad). Have a large delicious salad as (the bulk of) your dinner. Or follow the principles in the Transition Diet sections of the Mucusless Diet Healing System for most effective results. (For sensitive tummies or those unused to a fiber-rich lifestyle, introduce fiber gradually, focusing on fruit fibers, fresh cold-pressed juices, and smoothies). BTW eat enough! It can take a while to get used to feeling full up on plants. You may feel like you're eating tons, but it's all good :)

Step 4: Assist your body in its detoxification with holistically healthy habits. The most important of these is to undergo colon hydrotherapy. I know it seems strange from some, but since the gut is the foundation to our health and we have a long history in eating so many unsuitable foods don't eliminate completely (as we see with the prevalence of colon cancers and digestive problems), giving that additional cleaning to the intestines is as important as brushing your teeth. After having a natural bowel movement, it is suggested to do a lemon and distilled water enema (once a day to once a week, for best results). Enemas and colonics can also help relieve symptoms caused by lymphatic congestion, like headaches, colds, edema, bloating, toothaches, etc. Other holistic habits to assist cleansing: sweating, exercise & stretching, sauna, sunbathing (start with short periods in sun), salt/herb baths, fresh juice in the morning, breathwork, meditation & mindfulness (reduce stress), laugh more, get fresh air, aromatherapy, herbal teas, rational fasting protocols (begin first with mastering intermittent fasting and proper break-fast), naturally laxative food herbs (prunes, beets, chia seeds, psyllium husk, spinach, dates, etc), sound healing (relaxation), dry brushing, lymphatic massage, use of non-toxic products, etc. Try not to practice extreme things which can "shock" the body into intense detox phases. For example, cold plunging can be unhealthy for people with unregulated nervous systems.

Step 5: Kick out unhealthy cravings naturally. Replace them with whole food plant based, homemade alternatives. Or if you absolutely can not shake them, continue with your regular menus and eat it after your dinner salad. When your cravings are strong, be sure to continue with your colon hydrotherapy routine. Soon, your body will become cleaner and more sensitive to the foods (you will not want to experience their effects) and/or the craving will go away. Your cravings will tend to become healthier, for things like beans and your favorite fruit, rather than pizza and deep fried things.

Step 6: Keep things exciting. People often think eating healthier means more boring meals. Pfft. That's the exact opposite. There's so much intrigue in preparing high quality meals for yourself. And then...Your palate for all the rich plant flavors will expand too. I encourage you to try new fruits, vegetables, and herbs. Try some different beans, nuts, seeds, and grains too (if your goal isn't to be mucusless). Go to farmer's markets, wholesalers, ethnic markets & aisles, big box supermarkets, online specialty organic retailers (for bulk ingredients like dried fruit, herbs, or spices), and even clean convenience store items (eg. I've found unpasteurized tropical fruit pulps for smoothies, with no added ingredients). Research about the cuisines and herbal traditions from your own cultures and others. Often, the meals of the poor citizens were the most nourishing all along. You will discover more flavor combination ideas for salads, dips, sauces, spice blends, and teas. Rediscover that appreciation for simplicity and refreshing flavor in your meals.

Step 7: Enjoy the transition to doing bigger and better and more nourishing things for your body. You will easily become an expert in your own body and empowered to take your health into your own hands via these methods. Sometimes, it will feel arduous to get into the routine of meal prepping and grocery shopping -- but you're absolutely worth that effort. Understand the position you are in. You are making permanent epigenetic changes to the genetic codes you have been passed down. This is a gift that will impact the children you may have, the friends you make, the people you meet, and the generations to come. When we heal ourselves, we are not just healing our individual selves. It is about helping our world which has become so sidetracked with destructive habits & refortifying the influence of the nurturing instinct.

BEFORE YOU GO✨

Here's some extra guidance from 20+ year Mucusless Diet Healing Practitioner and Arnold Ehret expert, Prof. Spira in his article "Art of Transition":

"Although Ehret was a fruitarian thinker who asserted that a mono-fruit diet is the best for humans, he by no means suggested that people in our pathological condition can achieve such a level immediately without a considerable amount of dietary transition and PRACTICE of the Mucusless Diet. Many health seekers hear of fruitarianism and aspire to just jump right in without an extended period of transition...

Ehret’s healing system is not immediate raw-foodism, mono-fruit diet, or irrational extended water fasting, but a SYSTEM that coordinates the use of raw and cooked mucusless and mucuslean menus—in concert with short and long term periods of RATIONAL FASTING—to safety and effectively transition off of all mucus-forming foods. Yes, raw-fruit-mono diet is identified to be supreme, yet we must earn this level of excellence.

Not over night, but only after having paid reparations for the wrong that we, and our relatives, have done to our bodies all the days of our life. The key to sustaining the diet on a long term basis is the mastery of the Art of Transition. Whether it is through intuition, intellect, spiritual awakening, or scientific understanding, emancipating oneself from eating pus and mucus must be a top priority for those interested in physiological freedom.

And after generations of mucus-eating ancestors, it will simply not happen overnight. There is no shortcut around the transition. As Brother Air often says, 'you can be on the transition diet for more than 30 years if you need to be, but you will still be here.'”

May all beings be blissful💚😊🌼

[finest-23]

Ozempic for Weight Loss: Understanding Dosage and Administration

Ozempic has become a popular option for weight loss, offering a unique approach to managing weight through medical intervention. One key to its success is proper dosage and administration, which ensures that the medication works effectively while minimizing side effects. In this article, we’ll break down the correct dosing, how to administer Ozempic, and what to expect as you begin your weight loss journey with this medication.

What is Ozempic and How Does It Work?

Ozempic, also known by its generic name semaglutide, is an injectable medication used to control blood sugar levels in individuals with type 2 diabetes. However, its ability to suppress appetite and promote fat loss has led to its use as a weight loss medication. Ozempic works by mimicking the GLP-1 hormone, which influences insulin production and digestion, and slows down gastric emptying. This combination of effects helps reduce hunger, manage cravings, and lead to consistent weight loss.

For more details on how Ozempic functions in weight management, visit Ozempic for Weight Loss.

Ozempic Dosage for Weight Loss

The dosing schedule for Ozempic is carefully designed to allow your body to adjust to the medication and minimize side effects like nausea. Here’s a breakdown of the typical dosing pattern:

Starting Dose: Most people begin with a low dose of 0.25 mg once a week. This introductory dose allows your body to get used to the drug without overwhelming your system. Although 0.25 mg is not intended to result in weight loss, it helps reduce side effects.

Increase to 0.5 mg: After four weeks, your healthcare provider will typically increase the dose to 0.5 mg once a week. At this stage, weight loss effects may start to become noticeable as the medication more effectively suppresses hunger and regulates blood sugar levels.

Potential Increase to 1 mg: If needed, after another four weeks, the dose can be increased to 1 mg per week. This dose is more likely to lead to significant weight loss results, as it optimally regulates appetite and promotes fat burning.

Maintenance Dose: Some individuals may increase the dosage up to 2 mg if prescribed by their doctor. The goal is to find the minimum effective dose that helps you achieve your weight loss goals without causing intolerable side effects.

How to Administer Ozempic

Ozempic is administered through a once-weekly injection, which can be done at home. Here’s a simple step-by-step guide on how to administer the injection:

Prepare the Pen: Ozempic comes in a pre-filled pen. After washing your hands, remove the pen from its packaging and attach a new needle.

Select Injection Site: The best areas to inject Ozempic are the stomach (abdomen), thigh, or upper arm. You should rotate injection sites each week to avoid irritation or scarring.

Inject the Medication: After choosing your injection site, clean the area with an alcohol swab. Hold the pen at a 90-degree angle to your skin and press the button to release the medication. Hold the button for a few seconds to ensure the full dose is administered.

Dispose of the Needle: After the injection is complete, safely dispose of the needle in a sharps container. The Ozempic pen can be stored in the refrigerator until your next injection.

Make sure to inject Ozempic on the same day each week to maintain consistent levels in your bloodstream. Set reminders if necessary, and don’t hesitate to contact your healthcare provider if you have any concerns about self-administration.

What to Expect During Treatment

As with any medication, your body will need time to adjust to Ozempic. Many users report the following experiences during their first few weeks of treatment:

Week 1-4: During the initial phase (0.25 mg dose), you may experience mild side effects like nausea, bloating, or constipation as your body adjusts to the medication. However, you should not expect significant weight loss during this period.

Week 5-8: As you transition to the 0.5 mg dose, you may start to notice a reduction in hunger and fewer cravings for unhealthy foods. At this point, weight loss results may start to become apparent, especially when combined with a calorie-reduced diet and exercise.

After Week 8: By this time, you should be on a stable dose of Ozempic (either 0.5 mg or 1 mg). At this stage, weight loss becomes more consistent, and you may notice improvements in your energy levels and overall health.

It’s important to note that individual experiences with Ozempic may vary. Some individuals may lose weight faster than others, depending on factors like starting weight, lifestyle, and adherence to treatment.

Common Side Effects and How to Manage Them

Like any medication, Ozempic can cause side effects, though most are mild and temporary. Common side effects include:

Nausea: This is the most common side effect, especially in the first few weeks. Eating smaller meals and avoiding fatty or greasy foods can help reduce nausea.

Diarrhea or Constipation: Stay hydrated and maintain a balanced diet with fiber-rich foods to alleviate these digestive issues.

Fatigue: Some users may feel tired as their body adjusts to the medication. Ensure you’re getting enough rest and managing your energy levels with a healthy diet.

More serious side effects, such as pancreatitis or allergic reactions, are rare but should be reported to your healthcare provider immediately. Starting on a low dose and gradually increasing it can help reduce the likelihood of severe side effects.

Who Should Not Take Ozempic?

Ozempic may not be suitable for everyone. It’s essential to consult with your healthcare provider to determine if this medication is safe for you. People with the following conditions should be cautious or avoid Ozempic:

A history of thyroid cancer

A history of pancreatitis

Type 1 diabetes

Severe gastrointestinal issues

Your healthcare provider will evaluate your medical history and current health to decide if Ozempic is a suitable option for your weight loss journey.

For more information on eligibility and how Ozempic works for weight loss, visit Slimpharm Easy’s Ozempic page.

Maximizing Results with Ozempic

While Ozempic can significantly aid in weight loss, it works best when combined with healthy lifestyle changes. Here are some tips for maximizing your results:

Follow a Balanced Diet: Opt for nutrient-rich foods like fruits, vegetables, lean proteins, and whole grains. Avoid processed foods, sugary drinks, and high-fat meals that could trigger nausea.

Exercise Regularly: Engage in regular physical activity, such as walking, swimming, or resistance training, to help burn calories and maintain muscle mass during weight loss.

Stay Consistent: Take Ozempic on the same day each week and follow your prescribed dose. Consistency is key to seeing long-term results.

By adopting these habits, you can enhance the effectiveness of Ozempic and achieve sustainable weight loss.

Conclusion

Understanding the correct dosage and administration of Ozempic is critical to its success in promoting weight loss. Starting with a low dose and gradually increasing it allows your body to adjust to the medication, helping you achieve better results with minimal side effects. With the proper guidance and lifestyle adjustments, Ozempic can be an effective tool for individuals struggling with obesity or metabolic issues.

For more in-depth information on starting Ozempic for weight loss, visit Slimpharm Easy and consult with your healthcare provider to determine if it’s the right solution for you.

[socialvinod]

10 Must-Try High Fiber Foods for Babies to Prevent Constipation

Introduction

Are you tired of seeing your baby struggle with constipation? It's heart-wrenching to watch your little one in discomfort, and as a parent, you want to do everything you can to help. You're not alone. Many new parents face this challenge and are constantly looking for ways to keep their baby's digestive system running smoothly.

Constipation is a common issue among babies as they transition to semi-solid foods. Their developing digestive systems can sometimes find it hard to process new foods, leading to discomfort and distress. This makes finding the right high fiber foods for babies crucial in preventing and alleviating constipation.

High fiber foods play a vital role in promoting healthy digestion and preventing constipation. They help to keep things moving in your baby's digestive tract, ensuring regular bowel movements. But how do you choose the right high fiber foods for your baby, especially when there are so many options out there?

In this article, we'll uncover 10 must-try high fiber Indian foods for babies that can help prevent constipation. These foods are not only nutritious but also tailored to suit your baby's developing digestive system. By incorporating these foods into your baby's diet, you can ensure they get the fiber they need to stay happy and healthy.

Understanding Fiber and Its Importance

What is fiber?

You might have heard a lot about fiber, but what exactly is it? Dietary fiber is a type of carbohydrate found in plants. Your body doesn't digest fiber, in contrast to other carbohydrates. Instead, it passes through your digestive system, helping to keep everything running smoothly.

There are two types of fiber: soluble and insoluble. Both are important for your baby's health.

Soluble Fiber: This type of fiber dissolves in water and forms a gel-like substance in the stomach. It helps slow down digestion, which can be beneficial for nutrient absorption.

Insoluble Fiber: This type of fiber doesn't dissolve in water. Instead, it adds bulk to the stool and helps food pass more quickly through the stomach and intestines.

Benefits of Fiber for Babies

Adding high-fiber foods for babies to your little one's diet can have several benefits:

Prevents Constipation: Fiber helps to keep your baby's bowel movements regular and prevents constipation. This is especially important as they transition to semi-solid foods.

Supports Healthy Digestion: Fiber plays a crucial role in maintaining a healthy digestive system, ensuring that your baby’s gut works efficiently.

Provides Essential Nutrients: Many high-fiber foods are also packed with essential vitamins and minerals that support overall growth and development.

By understanding the importance of fiber and how it benefits your baby, you can make informed choices about their diet. Ensuring that your baby gets enough fiber will help them stay healthy and happy.

Myth Busting: Common Misconceptions About Fiber for Babies

Myth 1: "Fiber is not necessary for babies."

Reality Check: Fiber is Essential for Digestive Health

You might have heard that fiber isn’t necessary for babies, but that's a myth. Fiber is crucial for your baby's digestive health. Including high fiber foods for babies in their diet can prevent constipation and keep their digestive system working smoothly. Fiber helps move food through the digestive tract, ensuring regular bowel movements, which is especially important as your baby starts eating semi-solid foods.

Myth 2: "High-fiber foods are difficult for babies to digest."

Reality Check: Proper Preparation Makes Fiber-Rich Foods Baby-Friendly

Another common misconception is that high-fiber foods are tough for babies to digest. While it’s true that some fiber-rich foods can be hard for your little one to handle if not prepared properly, there are plenty of ways to make them baby-friendly. For example, you can:

Puree Fruits and Vegetables: Blend high fiber fruits and vegetables like apples, pears, and sweet potatoes into a smooth puree.

Cook Thoroughly: Ensure that vegetables and grains are cooked until they’re very soft. This makes them easier for your baby to digest.

Introduce Gradually: Start with small amounts and gradually increase the fiber content as your baby’s digestive system gets used to it.

By preparing high fiber foods for babies appropriately, you can make sure they get all the benefits without any digestive discomfort.

10 Must-Try High-Fiber Indian Foods for Babies

Oatmeal (Daliya)

If your little one is struggling with constipation, oatmeal (daliya) is a lifesaver. With 4 grams of fiber per cup, it's one of the best high fiber foods for babies. Here’s why oatmeal should be on your baby’s menu:

Easy Preparation: Cook it in milk or water until soft and creamy.

Gentle on the Stomach: Perfect for tiny tummies, preventing any discomfort.

Nutrient Boost: Add pureed fruits like bananas or apples for extra vitamins and flavor.

This tasty, nutritious option will help keep your baby's digestion on track and their tummy happy.

Serving Suggestions

Basic Oatmeal Porridge: Cook oatmeal in milk or water until it reaches a soft, porridge-like consistency. This is perfect for a gentle start to the day.

Fruity Oatmeal Delight: Mix in pureed fruits like bananas, apples, or pears. This not only adds flavor but also boosts the nutritional value.

Veggie Oatmeal Mix: For a savory twist, add pureed vegetables like carrots or sweet potatoes. It’s a great way to introduce veggies in a tasty form.

Whole Grain Cereal (Ragi)

If you’re looking for a nutritious and fiber-rich food for your baby, whole grain cereal like ragi is a fantastic choice. With 3.6 grams of fiber per 100 grams, it’s one of the best high fiber foods for babies. Here’s why ragi should be a part of your baby’s diet:

Nutrient-Rich: Packed with essential vitamins and minerals that support your baby's growth.

Digestive Health: The fiber content helps keep your baby’s digestive system healthy and regular.

Easy to Prepare: Serve it as a porridge or mix it with pureed fruits for added flavor and nutrition.

Serving Suggestions

Whole Grain Cereal (Ragi)

Ragi Porridge: Cook ragi flour in water or milk until it forms a smooth porridge. It’s a nutritious and filling option for your baby.

Ragi and Fruit Mix: Combine ragi porridge with pureed fruits like bananas, apples, or pears for added sweetness and nutrients.

Ragi and Veggie Blend: For a savory option, mix ragi porridge with pureed vegetables such as spinach or carrots.

Try ByGrandma's Ragi Poha

For a convenient and nutritious option, check out ByGrandma's Baby Food Ragi Poha. This product is designed to provide your baby with all the benefits of ragi, combined with the goodness of poha. It’s a perfect blend that’s easy to prepare and loved by babies.

Adding ragi to your baby’s meals is a wonderful way to ensure they get a balanced, nutritious diet. It’s versatile, easy to prepare, and packed with goodness – perfect for keeping your baby healthy and happy!

Apples

If you’re looking for a tasty, high fiber food for your baby, apples are a great choice. With 2.6 grams of fiber per medium apple, they’re perfect for little tummies. Here’s why apples are wonderful for your baby:

Digestive Health: High in soluble fiber, apples help keep your baby’s digestion smooth and prevent constipation.

Easy to Digest: Gentle on the stomach, making them ideal for your baby.

Simple Preparation: Serve them pureed or mashed for a delicious and nutritious treat.

Including apples in your baby’s diet will help keep their tummy happy and their digestion regular.

Serving Suggestions

Apple Puree: Cook apples until soft, then blend them into a smooth puree. This is perfect for younger babies starting on semi-solids.

Mashed Apples: Simply mash cooked apples with a fork for a slightly textured treat, ideal for babies who are a bit older.

Apple and Oatmeal Combo: Mix pureed apples with oatmeal for a delicious and fiber-packed breakfast.

Pears

Pears are an excellent high fiber food for babies, with 5.5 grams of fiber per medium pear. They’re not only nutritious but also delicious. Here’s why pears are perfect for your baby:

High Fiber Content: Helps prevent constipation and promotes healthy digestion.

Soft texture: Easy for babies to eat and digest, making them gentle on little tummies.

Hydrating: High water content helps keep your baby hydrated.

Serving Suggestions

Pureed Pears: Ideal for younger babies, providing a smooth and tasty treat.

Finger Food: For older babies, cut into small pieces to help them practice self-feeding.

Including pears in your baby’s diet is a great way to ensure they get the fiber and hydration they need for a happy tummy.

Avocado

Avocado is a fantastic high fiber food for babies, boasting 6.7 grams of fiber per half avocado. It's not only nutritious but also creamy and delicious. Here’s why avocados are a great choice for your baby:

High Fiber Content: Helps keep your baby's digestive system running smoothly and prevents constipation.

Rich in Healthy Fats: Essential for brain development and overall growth.

Creamy Texture: Easy for babies to eat and enjoy.

Serving Suggestions

Mashed avocado: perfect for younger babies, providing a smooth, creamy texture.

Spread on Toast: Great for older babies learning to eat finger foods.

Including avocado in your baby’s diet ensures they get the fiber and healthy fats they need for optimal growth and development.

Lentils (Masoor Dal)

Lentils, especially masoor dal, are a fantastic high fiber food for babies, offering 7.9 grams of fiber per 100 grams. They’re nutritious and easy to incorporate into your baby’s diet. Here’s why lentils are a great choice:

High Fiber Content: Promotes healthy digestion and prevents constipation.

Rich in Protein: Essential for your baby’s growth and development.

Gentle on the Stomach: Easy to digest, making them perfect for little tummies.

Serving Suggestions

Cooked and Pureed Lentils: Ideal for younger babies, providing a smooth and nutritious meal.

Lentil Soup: For older babies, you can prepare a simple lentil soup with a variety of vegetables for added nutrients.

Including lentils in your baby’s diet ensures they get the fiber and protein needed for healthy growth and digestion.

Sweet Potatoes (Shakarkand)

Sweet potatoes, also known as shakarkand, are a fantastic high fiber food for babies, providing 3 grams of fiber per medium sweet potato. They’re nutritious, delicious, and perfect for your little one. Here’s why sweet potatoes are a great choice:

High Fiber Content: Helps keep your baby’s digestion smooth and prevents constipation.

Rich in Vitamins: Packed with vitamins A and C, which are essential for growth and immune support.

Natural Sweetness: Babies love the naturally sweet flavor, making them a hit!

Serving Suggestions

Mashed Sweet Potatoes: Cook until soft, then mash for a smooth, easy-to-eat dish.

Pureed Sweet Potatoes: Blend cooked sweet potatoes for a creamy and nutritious puree.

Including sweet potatoes in your baby’s diet ensures they get the fiber and vitamins they need for healthy growth and a happy tummy.

Carrots (Gajar)

Hey there, super mom! Carrots, or gajar, are a fantastic high fiber food for babies. They’re not only nutritious but also delicious. Here’s why carrots are perfect for your little one:

Rich in Beta-Carotene: Carrots are high in beta-carotene, which the body converts to vitamin A. This is essential for healthy vision, immune function, and skin.

High Fiber Content: Helps keep your baby’s digestive system healthy and prevents constipation.

Gentle on the Stomach: Easy to digest, making them ideal for your baby.

Serving Suggestions

Steamed Carrots: Steam carrots until they’re soft, then puree them for a smooth texture that’s perfect for younger babies.

Mashed Carrots: For older babies, simply mash steamed carrots with a fork for a bit more texture.

Including carrots in your baby’s diet ensures they get the fiber and essential nutrients they need for healthy growth.

Papaya (Papita)

Papaya, also known as papita, is a fantastic high fiber food for babies. It’s not only nutritious but also delicious and easy to digest. Here’s why papaya is a great choice for your little one:

Contains Digestive Enzymes: Papaya contains enzymes like papain that aid in digestion, making it gentle on your baby’s stomach.

High Fiber Content: Helps keep your baby’s digestive system healthy and prevents constipation.

Rich in Vitamins: Packed with vitamins A and C, which are essential for your baby’s growth and immune support.

Serving Suggestions

Pureed Papaya: Simply peel and remove the seeds, then puree the papaya for a smooth and creamy texture that’s perfect for younger babies.

Mashed Papaya: For older babies, you can mash ripe papaya with a fork for a bit more texture.

Including papaya in your baby’s diet ensures they get the fiber and digestive enzymes they need for a happy and healthy tummy.

Spinach (Palak)

Hey there, wonderful mom! Spinach, or palak, is a fantastic high fiber food for babies. It’s packed with essential nutrients that are great for your little one’s growth and development. Here’s why spinach should be a part of your baby’s diet:

Rich in Iron: Spinach is an excellent source of iron, which is crucial for your baby’s growth and development.

High Fiber Content: Helps keep your baby’s digestive system healthy and prevents constipation.

Nutrient-Packed: Spinach is also loaded with vitamins A and C, calcium, and antioxidants.

Serving Suggestions

Cooked and Pureed Spinach: Steam or boil the spinach until it’s soft, then puree it to a smooth consistency. This is perfect for younger babies.

Mix with Other Vegetables: For older babies, you can mix pureed spinach with other vegetable purees like carrots or sweet potatoes for added flavor and nutrition.

Including spinach in your baby’s diet ensures they get the iron and fiber they need for healthy growth and a strong immune system.

Chickpeas (Chana)

Chickpeas, or chana, are a fantastic high fiber food for babies. They’re not only packed with nutrients but also versatile and delicious. Here’s why chickpeas are a great addition to your baby’s diet:

High in Protein: Essential for your baby’s growth and development.

High Fiber Content: Helps keep your baby’s digestive system healthy and prevents constipation.

Nutrient-Rich: Loaded with vitamins and minerals like iron, magnesium, and folate.

Serving Suggestions

Cooked and Pureed Chickpeas: Cook chickpeas until they’re soft, then puree them into a smooth consistency. This is perfect for younger babies.

Homemade Hummus: For older babies, you can make a simple hummus by blending cooked chickpeas with a bit of olive oil, lemon juice, and water. It’s a tasty and nutritious snack.

Including chickpeas in your baby’s diet ensures they get the protein and fiber needed for healthy growth and digestion.

Banana (Kela)

Hey there, super mom! Bananas, or kela, are a fantastic high fiber food for babies. They’re not only delicious but also packed with essential nutrients. Here’s why bananas are a great choice for your little one:

High in Soluble Fiber: Helps keep your baby’s digestive system healthy and prevents constipation.

Easy to Digest: Gentle on the stomach, making them perfect for babies.

Rich in Vitamins: Bananas are loaded with vitamins like vitamin C and B6, which support your baby’s growth and immune system.

Serving Suggestions

Mashed Bananas: Simply mash a ripe banana with a fork until smooth. This is ideal for younger babies who are just starting on semi-solid foods.

Sliced Bananas: For older babies, you can cut the banana into small, manageable pieces that they can pick up and eat on their own.

Including bananas in your baby’s diet ensures they get the fiber and nutrients they need for healthy growth and a happy tummy.

ByGrandma: High Fiber Foods for Babies, Meticulously Crafted for You

Hey there, super mom! At ByGrandma, we understand the importance of including high fiber foods in your baby’s diet to keep their digestive system healthy and prevent constipation. That’s why we’ve meticulously crafted a range of baby foods that are nutritious, delicious, and perfect for busy parents like you.

Why Choose ByGrandma?

We know that your baby’s health and happiness are your top priorities. Our products are designed to meet the essential dietary needs of your little one, ensuring they get the best start in life. With ByGrandma, you can trust that you’re providing high fiber foods that support healthy digestion and overall growth.

Our Nutritious On-the-Go Options

We’ve made it easy for you to provide high fiber foods for your baby, even on the go. Check out some of our specially crafted products:

Beetroot Baby Food: Packed with fiber and essential nutrients, our beetroot baby food is perfect for supporting your baby’s digestive health.

Apple Baby Food: Our apple baby food is rich in soluble fiber, helping to keep your baby’s digestion smooth and regular.

Oats & Makhana Baby Food: This blend provides a high fiber boost along with the goodness of oats and makhana, making it a wholesome choice for your little one.

Carrot Baby Food: Rich in beta-carotene and fiber, our carrot baby food is not only nutritious but also gentle on your baby’s tummy.

Convenient and Healthy

Our products are perfect for busy parents who want to ensure their baby gets the best nutrition without the hassle of preparation. Simply open and serve – it’s that easy!

At ByGrandma, we’re dedicated to making your life easier while providing the best for your baby. Explore our range of high fiber baby foods and give your little one the nutrition they need to thrive.

Tips for Introducing High-Fiber Foods to Your Baby

Gradual Introduction

Start with small amounts of high-fiber foods to see how your baby’s digestive system reacts.

Monitor for any potential digestive issues and allow your baby to get used to new textures and flavors.

Proper Preparation

Ensure high-fiber foods are cooked and pureed to a smooth consistency.

Soft, gentle foods like oatmeal, pureed fruits, and vegetables are easier for your baby to eat and digest.

Balanced Diet

Combine high-fiber foods with other essential nutrients.

Include proteins, healthy fats, and a variety of vitamins and minerals to support your baby’s growth and development.

By following these tips, you can help ensure your baby enjoys the benefits of high-fiber foods while maintaining a well-rounded and nutritious diet.

Conclusion

Introducing high fiber foods for babies are essential for their digestive health and overall well-being. By following these tips—gradual introduction, proper preparation, and maintaining a balanced diet—you can ensure your baby enjoys all the benefits of these nutritious foods.

For more convenient and healthy options, visit ByGrandma.in. We offer a range of meticulously crafted baby foods designed to support your baby's growth and development. Our products are also available on major online platforms like Amazon, Flipkart, FirstCry, and JioMart.

Give your baby the best start with ByGrandma's nutritious and delicious baby foods!

FAQs

What are high fiber foods for babies?

High fiber foods for babies include options like oatmeal, whole grain cereals, apples, pears, avocados, lentils, quinoa, sweet potatoes, carrots, and spinach. These foods help promote healthy digestion and prevent constipation.

How can I introduce high fiber foods to my baby?

Start with small amounts and gradually increase the quantity. Ensure the foods are cooked and pureed to a smooth consistency. Combine high fiber foods with other essential nutrients for a balanced diet.

Why is fiber important for my baby’s diet?

Fiber is essential for healthy digestion. It helps prevent constipation, promotes regular bowel movements, and supports overall digestive health. Fiber-rich foods also provide important vitamins and minerals.

Are there any risks associated with high fiber foods for babies?

Introducing high fiber foods too quickly can cause digestive discomfort. It's important to start with small amounts and monitor your baby's reaction. Always consult with a pediatrician before making significant changes to your baby’s diet.

Can I use packaged, high fiber foods for my baby?

Yes, you can use packaged, high fiber foods like those offered by ByGrandma. These products are designed to be nutritious and convenient, making it easy to provide your baby with the necessary fiber. Always check the ingredient list to ensure there are no added sugars or preservatives.

Read More: Click Here

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Signs Your French Bulldog Puppy’s Food Isn’t Right for Them

Choosing the right food for your French Bulldog puppy is crucial for their health and well-being. However, not all dog foods are created equal, and sometimes the food you select might not be the best fit for your pup. This guide will help you recognize the signs that your French Bulldog puppy’s food isn’t right for them and provide steps to take if you notice any issues.

Common Signs Your French Bulldog Puppy’s Food Isn’t Right

1. Gastrointestinal Issues

One of the most apparent signs that your puppy’s food isn’t right is gastrointestinal problems. These can include:

Diarrhea

Vomiting

Excessive gas

Constipation

Frequent digestive issues can indicate that your puppy’s food is not being properly absorbed or is causing irritation.

2. Skin and Coat Problems

Poor diet can manifest through your puppy’s skin and coat condition. Look out for:

Dry, flaky skin

Itching and scratching

Redness or rashes

Dull coat

These symptoms can be signs of food allergies or intolerances.

3. Low Energy Levels

Puppies are typically full of energy. If you notice a significant decrease in your puppy’s activity levels, their food might not be providing the necessary nutrients.

4. Weight Issues

Maintaining a healthy weight is vital for your puppy’s growth. Watch for:

Rapid weight gain

Weight loss

Difficulty gaining weight

Inadequate nutrition can lead to weight management problems.

5. Behavioral Changes

Sometimes, the wrong diet can affect your puppy’s behavior. This can include:

Increased aggression

Restlessness

Lethargy

Behavioral changes can be a response to discomfort or lack of proper nutrition.

Steps to Take if Your Puppy’s Food Isn’t Right

1. Consult Your Veterinarian

Before making any changes, it’s essential to consult with your veterinarian. They can provide professional advice and rule out any underlying health issues.

2. Review the Ingredients

Check the ingredients of your current puppy food. Look for common allergens such as:

Corn

Wheat

Soy

Artificial additives

Switch to a food with high-quality, natural ingredients.

3. Gradually Change the Diet

When switching foods, do it gradually to avoid further gastrointestinal upset. Follow these steps:

Start Slow: Mix 25% of the new food with 75% of the old food.

Increase Gradually: Over a week, gradually increase the new food while decreasing the old food.

Monitor Health: Keep an eye on your puppy’s digestion and overall health during the transition.

4. Choose High-Quality Food

Opt for high-quality dog food specifically designed for French Bulldog puppies. Look for brands that use real meat, vegetables, and minimal fillers.

5. Monitor and Adjust

After transitioning to a new food, continue to monitor your puppy’s health and behavior. If issues persist, consult your veterinarian for further advice.

Statistics on French Bulldog Puppy Food Sensitivities

According to a survey by the American Kennel Club, approximately 10% of dog owners reported their pets having food allergies or intolerances. Among these, the most common allergens are beef, dairy, and chicken. Choosing the best French bulldog food that avoids common allergens can significantly improve your puppy’s health.

Conclusion

Recognizing the signs that your French Bulldog puppy’s food isn’t right is essential for their overall health and happiness. By monitoring gastrointestinal issues, skin and coat problems, energy levels, weight, and behavior, you can determine if a dietary change is necessary. Always consult your veterinarian before making any changes and choose high-quality food to ensure your puppy thrives. For more information on selecting the best French bulldog food, visit French Bulldog Xpert.

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Constipation Treatment In Hyderabad

Constipation affects about 22% of the adult Indian population, specifically among aged grown-ups, women, and children, if you’re one of those and seeking constipation treatment in Hyderabad, look no further than Dr. N. S. Babu a Gastrointestinal specialist in Hyderabad who has treated more than 8500+ patients suffering from constipation and another complaint.

Dr. N. Subrahmaneswara Babu has been part of the world’s first randomized clinical trial on laparoscopic Vs open pancreatoduodenectomy, pioneering groundbreaking advancements in surgical techniques.

With 15+ experience he has treated many patients using both the laparoscopic approach (Key Hole Surgery) & open approach by effective treatments and ensuring patients receive a smooth recovery. Currently, Dr. Babu is a Consultant Surgical Gastroenterologist and Advanced Laparoscopic Surgeon at EVOKE Clinics, Secunderabad, and Apollo Hospitals Hospital, Hyderabad where he gives comprehensive care to patients with various gastrointestinal conditions.

What is Constipation?

Constipation is a condition where bowel movements are occasional or delicate to pass, frequently causing discomfort. It’s generally defined as having smaller than three bowel movements per week, with hard, dry droppings. Habitual constipation can significantly impact diurnal life and may need medical attention.

What are the symptoms of Constipation?

Fewer than three bowel movements per week

Hard, dry, or lumpy stools

Straining during bowel movements

Feeling of incomplete evacuation

Abdominal pain or bloating

Sensation of a blockage in the rectum

Needing to use manual maneuvers to pass stool

What are the Causes of Constipation?

Low Fiber Diet Lack of fiber in the diet can result in hard, dry droppings.

Dehydration Not drinking enough water can affect harder droppings that are delicate to pass.

Lack of Physical Activity Exercise helps stimulate bowel motions.

Ignoring the appetite and forgetting the appetite to have a bowel motion can result in constipation over time.

Conditions: Conditions like hypothyroidism, diabetes, and perverse bowel pattern can contribute to constipation.

Pregnancy Hormonal changes and pressure on the intestines can lead to constipation in pregnant women.

Complications of Chronic Constipation:

According to Dr. N. S. Babu colorectal specialist in Hyderabad states that chronic constipation can make it worse if left untreated, and can lead to several complications, including:

Hemorrhoids: Straining during bowel movements can affect blown modes in the rectum and anus.

Anal Fissures: Small gashes in the skin around the anus, which can be painful and lead to bleeding.

Fecal Impaction: Hardened excreta that can’t be expelled, leading to a blockage in the bowel.

Rectal Prolapse: Chronic straining can beget a part of the rectum to protrude from the anus.

Complications from Laxative: Overuse Dependence on laxatives can lead to electrolyte imbalances and other issues.

Types of Constipation:

There are two main types of constipation:

Primary( active) constipation:

This is the most common type of constipation and is not caused by a beginning medical condition. It’s supposed to be caused by problems with the muscles and nerves in the colon that control how coprolite moves through the body. There are three subtypes of primary constipation:

Normal Transit: Fewer than three bowel movements per week with normal stool transit.

Slow- Transit Coprolite moves too slow through the colon, causing bloating and occasional bowel motions.

Pelvic Floor DysfunctionDifficulty relaxing pelvic floor muscles, leads to straining and deficient evacuation.

Secondary constipation:

This type of constipation is caused by a medical condition, medicine, or lifestyle factor. Some of the most common reasons of secondary constipation include:

Medications, such as pain relievers, antidepressants, and iron supplements

Dehydration

A low-fiber diet

Lack of exercise

Hypothyroidism

Diabetes

Irritable bowel syndrome (IBS)

Colon cancer (in rare cases)

Still, it’s important to see a doctor to determine the underpinning cause and get treatment, If you’re suffering constipation.

How to diagnose Constipation?

Diagnosing constipation generally involves talking over your medical history and symptoms with a doctor, a physical test, and potentially fresh tests. Here’s a simplified breakdown:

Doctor Discussion Your doctor will interrogate you about your bowel patterns, diet, exercise, and specifics.

Physical test This may carry checking your stomach and anus for any abnormalities.

Additional experiments If demanded, imaging experiments like X-rays or bowel function experiments may be conducted to charge the inflexibility and rule out underpinning causes.

Treatment for Constipation in Hyderabad:

Biofeedback Therapy: Non-invasive biofeedback therapy is recommended by Dr. N. S. Babu to regain control of rectal muscles, particularly beneficial for conditions like Obstructed Defecation Syndrome. This therapy helps patients improve muscle coordination and enhance bowel movement efficiency.

STARR Surgery: In cases of severe constipation leading to rectal prolapse or Obstructed Defecation Syndrome, Dr. N. S. Babu may suggest STARR Surgery. This surgical procedure involves rectal resection to correct structural abnormalities and restore normal bowel function.

Lifestyle Changes: Dr. N. S. Babu emphasizes the importance of lifestyle modifications, including dietary adjustments, adequate hydration, and regular exercise, to promote bowel regularity and overall digestive health.

Laxatives: Prescribed laxatives are used under Dr. N. S. Babu’s guidance to ease stool passage and stimulate bowel movements when necessary. These medications are tailored to individual patient needs and preferences.

Electrical Stimulation: Non-surgical electrical stimulation is utilized by Dr. NS Babu to activate pelvic muscles and nerves, facilitating smoother stool passage and relieving constipation symptoms.

Surgical Options: In resistant cases where conservative treatments fail, Dr. N. S. Babu may consider surgical interventions similar to rectal prolapse repair or anal fissure treatment to give long-term relief from habitual constipation. He  offers personalized treatment plans tailored to each patient’s unique needs, ensuring comprehensive care and effective management of constipation and providing surgery for chronic constipation in Hyderabad if needed

Why Choose Dr. N.S. Babu for Constipation Treatment in Hyderabad:

Vast Experience: With an expansive background in Surgical Gastroenterology, General & Laparoscopic Surgery, as well as Piles and Fistula treatment, Constipation specialist Dr. N. S. Babu  has successfully performed over 10,000 surgeries, involving numerous related to constipation operations.

Specialized Skills: He specializes in a wide range of gastrointestinal surgeries, encompassing procedures similar to Esophagectomy, Appendectomy, Bariatric Surgery, Cholecystectomy, and Colorectal Surgery. His experience also extends to complicated interventions like Whipple surgery and Hepatobiliary surgery.

Educational Achievements: Dr. Babu holds a Master of Surgery degree, along with FMAS( Fellowship in Minimal Access Surgery) and DNB Surgical Gastroenterology. also, he has pursued fellowships in HPB Surgery, establishing a dedication to ongoing education and enhancement in the field.

Affiliation with Esteemed Institutions: Presently practicing at EVOKE Clinics in Secunderabad and Apollo Hospitals in Hyderabad, Dr. Babu is associated with prestigious medical institutions, guaranteeing high-quality healthcare services for constipation treatment.

Professional Memberships: He is a full-time member of professional associations similar to the Association of Surgeons of India( ASI) and the Association of Minimal Access Surgeons of India( AMASI). His active involvement in these communities contributes to the improvement of surgical practices, including those related to constipation operations.

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Complementary therapies for autism/Autism Spectrum Disorder (ASD) - Overview and recommendations for biological therapies

Autism spectrum disorder (ASD) is a genetically based neurodevelopmental disorder characterized by persistent impairments in social interaction and restricted, repetitive patterns of behavior, interests, and activities.

它是一种因大脑区域功能障碍而引起的精神障碍。

这也是一种精神表现异常的综合症。

It is a neurodevelopmental disorder of neural connections.

Excluding brain trauma, infection, tumors, etc., most causes of ASD are caused by inherited metabolic disorders (IEMs).

1. Signs and symptoms of ASD

Listed below are some common types of behaviors seen in people with autism/ASD . Not all people with autism will exhibit all of the behaviors, but most will exhibit some of the following.

1. Social communication/interaction behaviors may include:

Little or infrequent eye contact

Does not seem to be looking at or listening to others

Rarely shares interest, affection, or enjoyment of objects or activities (including rarely pointing to or showing things to others)

No response or slow response to others' name or other verbal requests for attention

Difficulty in back-and-forth conversation

Frequently talks at length about favorite topics without noticing that others are not interested or without giving others a chance to respond

Displaying facial expressions, movements, and gestures that are inconsistent with what is being said

Unusual intonation, which may sound sing-song or flat and robotic

Difficulty understanding other people’s perspectives, or being unable to predict or understand other people’s behavior

Difficulty adjusting behavior to social situations

Difficulty engaging in imaginative play or making friends

2. Restrictive/repetitive behaviors may include:

Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)

A persistent interest in a particular subject, such as numbers, details, or facts

Shows an exaggerated interest, such as in moving objects or parts of objects

Feeling uneasy about minor changes in daily life and having difficulty adjusting to transitions

Being more or less sensitive than other people to sensory input (such as light, sound, clothing, or temperature)

3. Complications

ASD is often associated with multiple physical and psychiatric disorders:

Feeding problems: eating disorders, anorexia nervosa, aversion to certain types of food, only eating foods with a certain taste/texture, which may cause abnormal weight, gastrointestinal symptoms such as diarrhea and constipation, or lack of nutrition due to unreasonable eating

Sleep disorders: sleep anxiety, tossing and turning, difficulty falling asleep, inability to lie flat to sleep, insomnia, repeated awakenings at night, sleepwalking and other abnormal sleep structures

Gastrointestinal (GI) problems: Gastroesophageal reflux, eosinophilic esophagitis, nausea and vomiting, constipation, diarrhea, flatulence, colitis, food intolerances

Allergic diseases: asthma, nasal allergies, allergic diseases (IgE-mediated), food allergies and intolerances

Toileting problems: difficulty learning to use the toilet during the day and night, not knowing when to use the toilet, communicating the need to use the toilet, being able to use the toilet independently or promptly, learning to use different and unfamiliar toilets, self-wiping, sensory differences (dislike of noises made by the toilet, the sensation of urine/faeces, cold toilet seats or excessive concern about water in the toilet), fecal smearing, a range of specific continence difficulties including bowel or bladder control difficulties

Abnormal responses to sensory stimuli: Over-, under-, or abnormal responses to environmental stimuli such as noise, touch, smells, tastes, or visual stimuli. Examples include looking out of the corner of the eye, excessive focus on edges, spinning objects, shiny surfaces, lights, or smells, refusing or only eating foods with certain tastes/textures, obsessive sniffing or licking of non-food objects, tactile defensiveness or resistance to being touched, or hypersensitivity to certain types of touch; light touch may be painful, while deep pressure may be soothing. There may be resistance to wearing certain textures or colors of clothing against the skin, apparent indifference to pain, a strong preference and/or persistence for certain textures and a strong aversion to other textures, and hypersensitivity to certain frequencies or types of sounds (e.g., a fire truck in the distance) but no response to nearby sounds or sounds that would scare other children.

For more information about this type of auditory and visual abnormalities, please refer to previous articles:

Symptoms of autism and CVI cranial neurological visual impairment

Mental health problems: epilepsy, intellectual disability, learning disabilities, attention deficit hyperactivity disorder (ADHD), tics, anxiety and depression, obsessive-compulsive disorder (OCD), personality and mood changes, visual and auditory hallucinations, phobias, schizophrenia and bipolar disorder.

4. Other clinical features:

Motor deficits: Children with ASD may have motor deficits, including abnormal gait, clumsiness, walking on tiptoes, or other signs of abnormal movement, such as low muscle tone. Motor deficits are common but are not a key feature of ASD.

Head deformity : About 15% of children with ASD have microcephaly, which is common in people with related diseases (such as Angelman syndrome and Smith-Lemli-Opitz syndrome). Among children with ASD, about 1/4 have head circumference greater than the 97th percentile. Up to 70% of children with ASD have accelerated head growth in the first year after birth, but these children do not necessarily become macrocephalic. People with ASD and macrocephaly may have PTEN gene mutations and are therefore at risk of developing hamartoma syndrome.

Special skills : Some people with ASD have special skills (i.e., "scholar" skills) in areas such as memory, mathematics, music, art, or puzzles, even though they have significant deficits in other areas. Other special skills include calendar calculation (calculating the day of the week on a given date) and precocious reading (spontaneous and premature mastery of single-word reading). This reading is usually formal, with little comprehension of meaning or understanding of the purpose of reading.

2. Causes of ASD: Impaired brain function

Excluding brain damage caused by brain trauma, tumors, and infectious diseases, most brain functional abnormalities in ASD patients are caused by IEM, an inherited metabolic disorder.

The introduction to Brodmann's brain partitioning shows the functions of various brain areas. When a patient has a problem in a certain area, the function of that area will be abnormal. Some areas are connected throughout the functional areas. Damage to these areas will cause the communication and expression of information in several areas.

The functional areas of the brain include the intelligence area, mental thinking and emotional area, muscle control, limb movement area, etc. These functional areas are interconnected with the eyes, ears, and body perception, and transmit the information seen by the eyes, heard by the ears, and felt by the body (cool, painful, hot and other limb sensory signals) to the various functional areas of the brain for analysis and response, and then respond to commands. This is accomplished by a whole set of brain functions. The neurons in some areas are interconnected and none of them can be missing.

This type of disease affects different areas of the brain in some patients, so the symptoms shown by each patient are different:

Some patients have normal or superior intelligence and logical thinking, but are not good at handling interpersonal relationships, that is, they lack emotional intelligence.

Some patients have normal intelligence but impaired logical thinking, and will show excellent stereotyped memory, but poor logical ability such as mathematical thinking.

Some patients have normal brain functions elsewhere, only poor sense of direction and prosopagnosia, which do not affect their daily life and work. However, they may have consumed large amounts of food and alcohol that their bodies cannot metabolize during adolescence or an infection, which triggered a metabolic crisis and caused brain damage. Therefore, if a metabolic disease exists, even if it is only a slight influence, it is still necessary to diagnose the disease and conduct disease management.

Articles that affect brain function:

Brodmann area

Brodmann area

Visual information travels through two communication streams: the dorsal stream and the ventral stream

3. Causes of ASD: Inherited Metabolic Disorders (IEM)

1. Common types of inherited metabolic disorders (IEM) :

Small molecule diseases: (1) Protein (amino acid) metabolism disorders and organic acidemias ; (2) Carbohydrate metabolism disorders ; (3) Fatty acid metabolism disorders ; (4) Porphyrin and heme metabolism disorders ; (5) Mineral absorption and transport disorders .

Organelle diseases : (1) Lysosome and lysosome-related organelle diseases; (2) Peroxisome diseases ; (3) Mitochondrial encephalomyopathy .

Others: (1) Purine, pyrimidine and neurotransmitter metabolism disorders ; (2) Vitamin and non-protein cofactor metabolism and transport disorders ; (3) Energy metabolism disorders ; (4) Cholesterol synthesis and metabolism disorders ; (5) Creatine metabolism disorders

For the types and diagnosis of IEM, please refer to previous articles:

Types and diagnostic methods of inherited metabolic disorders (IEMs)

Pathogenesis and clinical features of inherited metabolic disorders (IEMs)

Metabolic emergencies in SWAN syndrome (suspected inherited metabolic disorder): Presentation, evaluation, and treatment

Blood ammonia, blood sugar, blood lipids, lactic acid, blood gas analysis, cerebrospinal fluid analysis

2. Biochemical signs and symptoms of IEM

The signs and symptoms are grouped into organ systems and conditions (autonomic, cardiovascular, dental, dermatologic, digestive, malformation, ear, endocrine, eye, genitourinary, hair, blood, immune, metabolic, muscular, neurological, psychiatric, renal, respiratory , skeletal, neoplastic, etc.)

2.1 Eating disorders nervosa (anorexia and dietary avoidance):

Stereotyped and monotonous eating habits ;

Avoidant/Restrictive Food Intake Disorder (ARFID) ;

Mitochondrial neurogastrointestinal encephalomyopathy ( MNGE)

Migraine Complications: Irritable Bowel Syndrome (IBS)

2.2 Epileptic disorders: Epileptic disorders caused by IEM

2.3 Phenotypes of cerebral palsy: spastic type (including diplegia, hemiplegia and quadriplegia), involuntary movement type (including dystonia and choreoathetosis), ataxia type

2.4 Mental disorders: depression, autism, cognitive impairment, Alzheimer's disease

2.5 Movement disorders: dystonia, myoclonus, chorea, tremor, tics, Parkinsonism or ataxia, eye movement disorders, progressive myoclonic epilepsy, stroke and stroke-like seizures

2.6 Metabolic myopathy: muscle weakness, hypotonia, exercise intolerance, myoglobinuria (soy sauce urine), rhabdomyolysis

2.7 Metabolic kidney diseases: renal tubules, glomeruli, renal cysts, kidney stones, renal malformations

2.8 Metabolic liver disease MLD: Hepatomegaly; hepatocellular disease with elevated transaminases or frank acute liver failure; cholestasis; steatosis; fibrosis or cirrhosis; and liver tumors

2.9 Gastrointestinal disorders: loss of appetite, gastroesophageal sphincter dysfunction, constipation, dysphagia, vomiting, gastroparesis, intestinal pseudo-obstruction, diarrhea, rare manifestations of gastrointestinal cavities, pancreatitis, liver disease

2.10 Respiratory system diseases: interstitial lung disease, lower respiratory tract infection, chronic airway aspiration, pulmonary hypertension, alveolar hypoventilation, upper airway obstruction

2.11 Immunodeficiency: Innate and Adaptive Immunity

2.12 Metabolic ear disease: sensorineural hearing loss, mixed hearing loss, congenital external ear anomaly, congenital external ear anomaly, inner ear or retrocochlear involvement

2.13 Metabolic eye diseases: retinitis pigmentosa (RP), choroideremia, Stargardt's disease, cone-rod dystrophy (CRD), Leber congenital amaurosis (LCA)

2.14 CVI cortical visual impairment (cortical blindness): agnosia, visual field loss, visual stimulation

2.15 Tumors: Accumulation of toxic metabolites, tumor metabolites, mitochondrial dysfunction, metabolic reprogramming

2.16 Metabolic skin diseases and hair abnormalities: papules, skin nodules, xanthomas, melanin pigmentation, photosensitive dermatitis, pellagra, acrodermatitis enteropathica, angiokeratoma, short, sparse and/or brittle hair, alopecia nodularis

2.17 Metabolic cardiovascular diseases: cardiomyopathy, arrhythmia, vascular disease, cardiometabolic

2.18 Metabolic hypertension: H-type hypertension , endothelial-dependent hypertension

The following collection summarizes this type of genetic metabolic disease series represented by clinical symptoms such as ophthalmology, myopathy, and mental disorders in this collection and continues to update it, hoping to provide some clinical tips for undiagnosed patients. It is hoped that the patients' families will summarize these clues and submit them to professional metabolic doctors for analysis, so as to strive for early diagnosis and standardized treatment, thereby avoiding secondary organ damage caused by the disease, as well as preventing family-related diseases and early warning of reproduction.

Collection:

Inherited metabolic disorders affecting the eyes, liver, kidneys, heart, and muscles

Genetic metabolic diagnostic tests: blood and urine tandem mass spectrometry, blood gas, lactate, blood ammonia, liver and kidney function, etc.

IV. Introduction and evaluation of complementary and alternative therapies (CAM) for ASD

Complementary and alternative medicine (CAM) is defined as: "a diverse group of medical and health care systems, practices, and products that are not generally considered part of conventional medicine"

Traditional treatments for ASD include behavioral therapies, such as intensive behavioral therapies such as applied behavior analysis. Complementary and alternative therapies (biological therapies) are an integrative approach.

Some parents choose CAM (hereafter referred to as biological therapy) because they believe that traditional treatments are ineffective for ASD and they hope to find a cure, while others use CAM as a supplement to traditional treatments to help their children as much as possible. Parents' reasons for choosing CAM may include: treating a variety of symptoms, including the core symptoms of ASD (such as deficits in social communication and social interaction, as well as restricted, repetitive behaviors, interests and activity patterns), inattention, gastrointestinal symptoms and sleep disorders; promoting a healthy lifestyle; and concerns about the safety or side effects of traditional allopathic treatments (such as prescription drugs). Some treatments are used to address the biological conditions that parents believe contribute to ASD, regardless of whether there is scientific evidence to support the hypothesis. Parents who use such treatments have their own circle, which is commonly .

Biological therapies are classified according to their benefits and risks as follows:

1. No benefit

Secretin: Secretin is not recommended for children with ASD. Secretin does not improve the core features of ASD.

Secretin is a gastrointestinal hormone that inhibits intestinal motility and gastric acid release and stimulates the secretion of pancreatic juice and bicarbonate. Secretin may be used to treat children with ASD based on the hypothesis that autism is associated with abnormalities of the gastrointestinal system. However, there is little evidence to support this hypothesis. A 2012 systematic review of 16 randomized controlled trials involving more than 900 children failed to confirm that secretin improves the core features of autism. No serious side effects have been reported.

Facilitated communication: Facilitated communication is not recommended for communicating with children with ASD.

In assistive communication technology, a helper physically guides a nonverbal child to communicate using an output device (such as a keyboard or mouse) with their hands. An analysis of published research on assistive communication found no evidence to support its use for people with communication disabilities. Controlled studies show that it is the helper, not the child, who provides the information.

Augmentative communication must be distinguished from augmentative communication, which is an established nonverbal method of communication that uses gestures, picture exchanges, transducers, or sound output devices to communicate without the help of a facilitator. Augmentative communication is appropriate for some children with ASD.

2. Potentially beneficial but with potential risks

Gluten-free and casein-free diet: A gluten-free and casein-free (GFCF) diet is not recommended for children with ASD unless celiac disease or gluten sensitivity is confirmed. Evidence for the efficacy of a GFCF diet is weak and limited; strict adherence to a GFCF diet is difficult and may result in nutritional deficiencies (eg, calcium, vitamin D, amino acid deficiencies) unless monitored by a registered dietitian.

Despite the lack of evidence, many caregivers put children with ASD on a GFCF diet. Children with ASD need to get enough vitamin D, calcium, and protein. Rice milk, almond milk, and potato milk do not provide adequate protein. (See: Nutrient Protein )

The rationale for the use of a GFCF diet in children with ASD is that increased intestinal permeability allows gluten and casein peptides to leak from the intestine, resulting in excessive opioid activity and thus contributing to the behaviors seen in ASD. However, most children with ASD do not have an increased incidence of celiac disease or excess opioid compounds in their urine.

Multiple systematic reviews evaluating GFCF diets in children with ASD using randomized trials have found limited and weak evidence supporting the benefits of GFCF diets. Limitations include lack of blinding, small sample sizes, and differences in patient populations, interventions, and outcome measures.

A meta-analysis of six randomized trials with a total of 143 participants found that children following a GFCF diet had similar physician-reported core ASD symptoms, caregiver-reported levels of functioning, and behavioral disturbances compared with children following a conventional diet. The quality of this evidence was limited due to inconsistency, imprecision, and risk of bias. A subsequent randomized trial of 66 children aged 36 to 69 months found no differences in autism symptoms, maladaptive behaviors, and intelligence after following a study diet for 6 weeks.

Therefore, the GFCF diet may be effective for ASD patients with celiac disease and gluten allergy. Therefore, it is recommended that such patients can use a gluten-free diet. Of course, before using a gluten-free diet, it is necessary to test whether there is celiac disease or gluten allergy.

Symptoms of Celiac Disease Diagnosis and Gluten-Free Diet Introduction:

Diagnosis of Celiac Disease

Gluten-free diet

3. Unclear benefits and possible risks

The treatments described in this section have little evidence of effectiveness and may be harmful. Using these treatments may divert time, energy, and money from proven treatments. Given their potential harm, their use in treating ASD is discouraged.

Intravenous immune globulin: Intravenous immune globulin (IVIG) is not recommended for the treatment of ASD unless there is another indication for IVIG, such as a proven immunodeficiency or if the patient has immunodeficiency caused by an inherited metabolic disorder (IEM).

Immune deficiency caused by inherited metabolic diseases: innate immunity and adaptive immunity

The use of IVIG and other immunotherapies in children with ASD is based on the hypothesis that ASD is associated with a dysregulated immune system. Data to support this hypothesis are limited. Although small, open-label trials have shown that IVIG improves some areas in children with ASD, the available evidence is mixed, and adverse effects are common. The only randomized, placebo-controlled, blinded trial of 12 males with ASD found similar physician-rated outcomes in the IVIG and placebo groups, but greater improvements from baseline in scores on the Aberrant Behavior Checklist (ABC) or some subscales of the symptom inventory were observed in the IVIG group; the researchers noted that IVIG may only be beneficial in certain patients and cautioned against its misuse.

IVIG is expensive. Potential adverse effects of IVIG and other immunotherapies include transmission of blood-borne pathogens.

Chelation therapy: Chelation therapy is not recommended for ASD patients without a confirmed metal metabolism disorder. Chelation therapy has no evidence of efficacy and may cause serious harm.

Chelation therapy is used in metal metabolism disorders. Patients with such disorders will show abnormal manifestations of autism. Therefore, chelation therapy has flowed into the biosphere. Some parents do not diagnose ASD children with metal metabolism disorders and use chelation therapy, which is highly unrecommended. Moreover, the diagnosis of metal metabolism disorders is rigorous. It is necessary to test the excretion and metabolism of metal trace elements in patients (hair, blood, urine) in regular and specialized hospitals, and also to conduct genetic diagnosis, rather than diagnosing by measuring trace elements in fingertip blood in some institutions.

Metal metabolism disorders: Copper metabolism disorders: Wilson's disease, Menkes' disease, Iron metabolism disorders: familial hyperferremia, neurodegeneration with brain iron deposition, Magnesium metabolism disorders: magnesium-dependent epilepsy, magnesium transporter mutation disease, magnesium malabsorption syndrome, Manganese metabolism disorders: hypermanganeseemia.

Introduction to the diagnosis of metal metabolism disorders: Metal metabolism disorders and chelation therapy

Chelation is the process of removing heavy metals from the body by administering a substance such as ethylenediaminetetraacetic acid (EDTA), 2,3-dimercaptosuccinic acid (DMSA), or 2,3-dimercapto-1-propanesulfonate (DMPS).

The rationale for using chelation to treat ASD is based on the hypothesis that the behaviors of children with ASD are secondary to mercury or other heavy metal poisoning that these children are unable to effectively excrete. However, there is little evidence to support this hypothesis. The clinical manifestations of mercury poisoning do not resemble those of ASD, and there is no evidence to support a causal relationship between thimerosal and autism.

The safety and efficacy of chelation therapy (including over-the-counter oral or rectal products) for ASD have not been adequately studied in controlled trials. The only randomized trials have methodological limitations. Chelating agents bind ions nonspecifically and, in addition to reducing toxic heavy metals, can also reduce calcium, iron, and magnesium levels. Close monitoring is required when chelating agents are used to treat proven heavy metal poisoning. Fatal hypocalcemia has been reported with chelation therapy using sodium EDTA (but not calcium EDTA).

Hyperbaric oxygen: Hyperbaric oxygen therapy (HBOT) is not recommended for the treatment of ASD. HBOT is expensive and the evidence of its effectiveness is not sufficient.

The rationale for using HBOT to treat autism is that increasing atmospheric pressure increases the amount of oxygen delivered to the brain, thereby reducing swelling and promoting brain recovery.

A 2016 systematic review included the only randomized trial with 60 children and found that HBOT did not improve social interaction, behavioral problems, communication, and cognitive function in children with ASD. A subsequent review included literature from 2015-2021 and concluded that the effect of HBOT on children with ASD has not been proven. Adverse effects of HBOT include: barotrauma of the middle ear, sinuses, or lungs, reversible myopia, pulmonary oxygen toxicity, and seizures.

Antimicrobial agents: We do not recommend the use of antimicrobial agents, including antifungals (eg, nystatin, fluconazole), antibiotics, or antivirals, for the treatment of ASD. These agents have unproven efficacy and may cause adverse effects.

The use of antimicrobial agents is based on the hypothesis that individuals with ASD have an imbalance in the gut microbiota, such as overgrowth of yeast or bacteria.

Few controlled trials have evaluated antimicrobial therapy in children with ASD. Adverse effects include hypersensitivity reactions, hepatotoxicity, anemia, diarrhea, exfoliative dermatitis, and promotion of antimicrobial resistance.

Vitamin B6 and Magnesium: Vitamin B6 (pyridoxine) and magnesium supplements are not recommended for the treatment of ASD.

Although vitamin B6 and magnesium (magnesium is added to reduce the side effects of vitamin B6) have long been used to treat psychiatric disorders, few high-quality studies have specifically evaluated vitamin B6-magnesium supplementation for ASD. A 2010 systematic review included three small randomized trials (n = 33) with methodological flaws and found that the current evidence was inconclusive.

High doses of vitamin B6 (>100 mg/d) may cause neuropathy.

Vitamin B6 and magnesium are clinically used to treat some inherited metabolic disorders IEM. For example, magnesium is used to treat magnesium-dependent epilepsy and migraine, and vitamin B6 is used to treat vitamin B6-dependent epilepsy and hydroxykynureninuria, among which patients with hydroxykynureninuria have autistic symptoms.

Familial hypomagnesemic epilepsy is a hereditary disease of epilepsy and hypomagnesemia caused by mutations in magnesium transporters. The cause is due to mutations in magnesium transporters (MgT1) or magnesium transporters 2 (MgT2), which are responsible for the absorption and excretion of magnesium in the intestines and kidneys. Clinical manifestations include epilepsy, hypomagnesemia, hypocalcemia, and increased .

Neurotrophic drugs: mouse nerve growth factor, brain protein hydrolysate injection, etc. are promoted as neuroprotectants for treating brain nerves, but they cannot improve the symptoms of ASD because these neuroprotectants cannot penetrate the blood-brain barrier, and most ASDs are caused by genetic metabolic disorders. Repairing brain nerves directly without diagnosing the specific cause and resolving these metabolic disorders is like the broken barrel effect of patching while leaking.

Fecal microbiota transplantation (FMT): There is a hypothesis that the gut-brain axis causes autistic symptoms. Such diseases can be treated by improving the intestinal flora of autistic patients. However, some autistic patients do not see improvement in their symptoms after such treatment. There is currently insufficient evidence to prove this hypothesis. For example, some studies have shown that intestinal flora disorders are caused by the stereotyped diet of ASD patients. Some IEM diseases can cause the production of intestinal ammonia and propionic acid, which in turn cause a series of gastrointestinal symptoms such as abdominal pain, vomiting and refusal to eat. Therefore, some ASD patients have such intestinal flora imbalance and eating disorders caused by IEM diseases. Therefore, the disease should be diagnosed and treated instead of treating such abnormal gastrointestinal symptoms. A radical treatment method is needed.

4. Other interventions

Other interventions that have not been shown to be beneficial for ASD and their potential adverse effects include:

Vitamin A: Taking large amounts of vitamin A can cause toxicity

Vitamin D: A small randomized trial showed that vitamin D supplementation did not improve the core symptoms of ASD. Excessive use of vitamin D can also have adverse effects

Homeopathy: May contain undeclared toxic ingredients

Vagus nerve stimulation: It is a recognized intervention for epilepsy, but its effectiveness in ASD has not been proven.

Stem cell transplantation is currently being studied to treat certain central nervous system diseases that require nerve regeneration, such as spinal cord injury. However, since most ASDs are caused by genetic metabolic disorders, it is physiologically meaningless to use stem cells directly for regenerative treatment without confirming the specific cause. In addition, stem cell transplantation to repair nerve damage is still in the research stage and has not yet entered clinical treatment.

picture

Given the lack of demonstrated benefit and potential for harm, these therapies are not recommended for individuals with ASD.

5. Possibly beneficial and low risk

With the exception of melatonin for sleep disturbances, these therapies are not strongly encouraged for ASD given the lack of clear benefit. If used, these therapies should be monitored for side effects, interactions, and impact on the prescribed/recommended treatment.

Music therapy: Music therapy may be beneficial for children with ASD and is unlikely to be harmful. Until further research is done, we do not strongly encourage the use of music therapy to treat core features of ASD unless it is included in a broader comprehensive behavioral treatment program.

The use of music therapy for children with ASD is based on the hypothesis that engaging in musical interaction (sometimes interpreted as a form of nonverbal or preverbal language) can help individuals with autism develop communication skills and social interaction abilities.

A systematic review of 26 clinical trials with 1165 participants comparing music therapy with standard care or 'placebo' treatment (similar treatment that does not include music) found that music therapy was likely to improve participants' overall condition soon after the end of the intervention, with improvements in overall autism severity and quality of life, and did not appear to increase adverse events, with moderate confidence. It is uncertain whether music therapy improves social interaction, non-verbal communication, and verbal communication. Although no differences were found between the groups, the quality of the evidence was low due to risk of bias and lack of precision.

Melatonin: Open observational studies and randomized placebo-controlled trials have found that melatonin is beneficial for falling asleep and maintaining sleep in children with ASD. A meta-analysis included 5 randomized crossover trials with a total of 57 children with ASD. Compared with placebo, melatonin prolonged sleep time by 73 minutes and shortened sleep latency by 66 minutes, but did not affect nighttime awakenings. It has very few side effects. In a single study, the melatonin dose was 0.75-10 mg/d, and the duration of treatment was 14 days to 6 months.

These results suggest that melatonin 1-10 mg given 30 minutes before bedtime to children with ASD may help with sleep onset and sleep duration in the short term (i.e., up to 6 months). However, there are no guidelines for its use, nor is there information on long-term use and side effects. Side effects of melatonin may include difficulty awakening, daytime sleepiness, and enuresis.

If children with ASD have difficulty falling asleep and staying asleep despite appropriate sleep hygiene and behavioral or environmental interventions, melatonin is recommended. The starting dose of melatonin is usually 0.5 to 1 mg (depending on age), which can be increased by 1 mg each time as needed, to a maximum dose of 10 mg (although higher doses may be used clinically).

Melatonin is an over-the-counter drug that is not regulated by the FDA. When parents or caregivers purchase melatonin, they should choose preparations that contain melatonin as the only active ingredient.

Oxytocin: Small or open studies have shown that oxytocin may improve social interaction or function in children with ASD, but a blinded randomized trial did not find any benefit. Further randomized trials are needed to determine whether oxytocin can be recommended for improving social interaction in children with ASD.

Therapeutic Horseback Riding: Therapeutic horseback riding (hippotherapy) is not actively encouraged as a core treatment for children with ASD, but may be useful if used within a broader comprehensive behavioral/educational treatment program and monitored appropriately. Although some evidence suggests that hippotherapy is beneficial, further research is needed before this therapy can be actively recommended.

It has been hypothesized that therapeutic horseback riding may stimulate multiple domains of functioning in children with ASD, such as cognition, socialization, and gross motor skills. A randomized trial of 116 children and adolescents with ASD compared 10 weeks of therapeutic horseback riding with 10 weeks of barn-based activities without horseback riding and showed that therapeutic horseback riding improved measures of hyperactivity and irritability after approximately 5 weeks. Parent-report assessments showed that therapeutic horseback riding also improved social cognition and social communication. In a smaller nonrandomized study, 19 children with autism who participated in 12 weeks of therapeutic horseback riding had improvements in attention, distractibility, and social motivation compared with 15 wait-list controls.

The risk of injury from therapeutic horseback riding is similar to that of other "limited contact" recreational activities (eg, baseball, ice skating). If caregivers choose this type of therapy, they must emphasize the use of helmets and appropriate supervision.

Other types of animal/pet therapy: Observational studies suggest that the presence of animals can reduce social stress and increase social behavior in individuals with ASD, but further research is needed before animal therapy can be recommended.

A preliminary randomized trial comparing canine-assisted occupational therapy with standard occupational therapy (wait-list control) in 22 children with ASD found a trend toward improved on-task behavior and goal achievement in the canine-assisted occupational therapy group, but more research is needed.

Sulforaphane: Sulforaphane supplementation is not recommended for children with ASD. Further research is needed to confirm the benefits of sulforaphane.

Sulforaphane is an antioxidant derived from broccoli sprout extract that increases the activity of specific genes to protect aerobic cells from oxidative stress, inflammation, and DNA damage. It has been hypothesized that sulforaphane may reverse abnormalities associated with ASD, including neuroinflammation, oxidative stress, and decreased glutathione synthesis, mitochondrial function, and oxidative phosphorylation.

One trial evaluated the effect of sulforaphane in ASD, in which young men aged 13 to 27 years were randomized to receive daily sulforaphane (n=29) or placebo (n=15) for 18 weeks. During the treatment period, the ABC, Social Responsiveness Scale, and Clinical Effectiveness Summary-Improvement Scale rated by parents and doctors showed that the behavior of the sulforaphane group improved compared with baseline. After discontinuation of sulforaphane, the subject's behavior returned to baseline. A subsequent placebo-controlled randomized trial included 57 children with ASD aged 3 to 12 years, with 45 followed after 15 weeks (22 in the sulforaphane group and 23 in the placebo group). Clinical effects varied by outcome measure (no benefit on the Ohio Autism Clinical Global Rating Scale and Social Responsiveness Scale 2nd Edition, improvement on the ABC Scale) and were less significant than in the trial in young men. Sulforaphane was well tolerated in both trials, but the sample sizes were too small to adequately assess adverse effects. While these results are encouraging, more research is needed.

Until further research is done, broccoli sprouts or other foods rich in sulforaphane (such as Brussels sprouts and cauliflower) would not be specifically recommended for children with ASD, but given their other health benefits, there is no objection to their consumption. The subjects consumed 50-150 μmol of sulforaphane, which is much higher than the amount that can be obtained from food.

Transcranial magnetic stimulation: Transcranial magnetic stimulation (TMS) is not recommended for children with ASD unless used as a clinical trial protocol. Although TMS appears to be safe in clinical trials, further research is needed before TMS can be recommended for the treatment of children with ASD.

TMS is an energy-based therapy that may work through electromagnetic induction, which can alter neural excitability. Controlled and uncontrolled studies have shown that TMS may improve depression, bipolar disorder, schizophrenia, epilepsy, and Tourette syndrome.

The use of TMS in children with ASD is based on the hypothesis that autism is associated with disturbances in cortical modularity. A 2016 literature review found some evidence that TMS may reduce symptoms of ASD (core and associated symptoms), but more rigorous research is needed. TMS is generally considered safe for use in children and adults. Seizures are the most serious adverse event of TMS, but they are very rare.

Other interventions:

Other interventions that lack clear scientific evidence to support benefits for children with ASD but are unlikely to be harmful include:

●Yoga.

●Body manipulation and energy therapies such as Chi massage, therapeutic touch, healing touch, Reiki.

●Biofeedback/neurofeedback – In biofeedback/neurofeedback, behavioral therapy focuses on achieving self-regulation of cortical electrical activity measured by electroencephalography (EEG), often with the use of visual feedback. Reported side effects are minimal but may include headaches. Although safe, neurofeedback can be expensive and has not been proven to improve core symptoms of ASD.

●Hypnosis therapy.

Vitamin C (up to 2 g/day).

●Vitamin B12.

●Folinic acid and folic acid.

Given the lack of clear evidence of benefit, we discourage the use of these interventions in individuals with ASD unless the individual has a documented inherited metabolic disorder.

6. Benefits are unclear but risks are low

Given the unclear benefits of these therapies, their use in the treatment of ASD is discouraged. If caregivers insist on using these therapies, it is recommended that they monitor for side effects, interactions, and effects on the prescribed/recommended treatment.

Auditory Integration Training: Auditory Integration Training (AIT) is discouraged for children with ASD. Although AIT has a low risk of adverse effects, its efficacy is unproven and it is expensive.

The use of AIT in children with ASD is based on the hypothesis that repeated exposure to changing sounds through headphones can functionally alter central auditory processing, affecting language and behavior.

A systematic review of randomized trials showed that AIT did not improve language outcomes in children with ASD. The evidence is limited by inconsistent results and small sample sizes.

Omega-3 fatty acids: Although they may have some benefits, omega-3 fatty acids are not recommended for treating the core symptoms of ASD. Omega-3 fatty acids are essential fatty acids that may have cardiovascular benefits and include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Some studies have shown reduced plasma omega-3 fatty acid concentrations in children with ASD, but no clear clinical association has been found.

Introduction to fats: Energy-supplying nutrients for the human body: fatty acids and MCT oil

Several systematic reviews have evaluated the use of omega-3 fatty acids for ASD through randomized trials, with inconsistent results. Most trials found that omega-3 fatty acid supplementation did not improve core symptoms or associated symptoms of ASD, but was unlikely to be harmful. A meta-analysis showed that omega-3 fatty acid supplementation could slightly improve language and social deficits and related symptoms (such as inattention, irritability, behavioral disorders, and cognitive impairment), but these results were limited by the low quality of the included studies.

Common side effects of omega-3 fatty acid supplementation include gastrointestinal upset, such as nausea and diarrhea. Studies evaluating omega-3 fatty acid supplementation in individuals with ASD have not reported major side effects. Omega-3 fatty acid supplementation should be used with caution in patients with bleeding disorders or those with fish allergies.

There are no specific dosing guidelines for omega-3 fatty acids. Studies in children with ASD have used doses of 1.3 g/d and 1.5 g/d.

Probiotics: It is hypothesized that probiotics can correct the imbalance of intestinal flora in individuals with ASD. FDA regulation of probiotics depends on the type of product, such as biologics, drugs, dietary supplements, medical foods, and food ingredients. Probiotic products that are not strictly regulated may contain undeclared ingredients or strains.

Although the relationship between intestinal flora and ASD remains a hot topic and related research is underway, there is insufficient evidence to determine whether there is a causal relationship between the two and which is the cause and which is the effect. For example, studies have suggested that restricted diet and eating disorders in ASD patients affect the intestinal flora of many ASD people, rather than the intestinal flora causing ASD symptoms.

Eating disorders nervosa (anorexia and food avoidance):

Stereotyped and monotonous eating habits ;

Avoidant/Restrictive Food Intake Disorder (ARFID) ;

Mitochondrial neurogastrointestinal encephalomyopathy ( MNGE)

Migraine Complications: Irritable Bowel Syndrome (IBS)

The use of probiotics for ASD is discouraged. Although probiotics are unlikely to be harmful, their use in children with ASD has not been rigorously studied. A systematic review of six clinical trials concluded that probiotics have limited efficacy for gastrointestinal or behavioral symptoms in children with ASD. The trials used different strains, concentrations, and durations of treatment. Some evidence suggests that probiotics may be beneficial for other conditions, such as acute gastroenteritis and functional abdominal pain.

Cannabinoids: The use of medical marijuana or cannabinoids for the treatment of ASD or related symptoms is discouraged. Cannabinoids include cannabidiol (CBD; the non-psychoactive component of marijuana), tetrahydrocannabinol (THC; the psychoactive component of marijuana), dronabinol (synthetic THC), etc. Although CBD can be used to treat certain types of childhood epilepsy and appears to be safe, its benefits for children with ASD are not clear.

Although animal models suggest that endocannabinoid signaling may influence genetic disorders associated with ASD (e.g., Fragile X syndrome), few studies have evaluated the direct effects of medical marijuana in individuals with ASD. A randomized trial enrolled 150 individuals aged 5–21 years with ASD and found inconsistent efficacy. The study was limited by the lack of pharmacokinetic data and the wide range of age and functional levels of the participants. Other randomized and open-label trials are currently underway to evaluate the effects of cannabinoids on behavior in children with ASD. Observational studies have found that cannabinoids can lead to subjective improvements in behavioral problems (self-injury, hyperactivity), anxiety, and sleep, and reduce the need for other psychoactive medications. Limitations of these studies include the lack of objective assessment tools, poor follow-up, participant attrition, and inconsistent cannabinoid dosing regimens.

In randomized trials and observational studies of cannabinoid use in individuals with ASD, adverse effects have included somnolence, decreased appetite, irritability, and restlessness. Randomized trials of CBD in children with Lennox-Gastaut syndrome and Dravet syndrome have shown adverse effects including somnolence, fever, decreased appetite, diarrhea, and vomiting. However, some children discontinued CBD because of elevated liver transaminase concentrations.

Other interventions: Other interventions with unclear benefits but unlikely to cause harm include:

●Methylcobalamin and N-acetylcysteine.

●Zinc.

●Herbal products.

●Amino acids, including dimethylglycine (DMG; a derivative of glycine), and other amino acids such as taurine, lysine, and gamma-aminobutyric acid (GABA).

●Digestive enzymes.

Mindfulness-based approaches have been studied for children with ASD and their parents, but the quality of the evidence is low due to methodological limitations (eg, small sample size, use of self-reported outcome measures); mindfulness-based approaches are unlikely to be harmful.

●Acupuncture: Acupuncture is generally safe, but it can cause injury in uncooperative patients, and acupuncture of the brain carries the risk of inducing epilepsy.

●Craniosacral therapy: Although systematic reviews have shown that the risks of craniosacral therapy are low, its adverse effects may be underreported.

●Chiropractic (usually safe for children without spinal abnormalities).

7. Other risks of biological therapies for ASD

Biological therapy is not recommended without analyzing the patient's metabolic disorder range and without the guidance of a doctor and nutritionist, because sometimes the operation is reversed, which can lead to many risks:

Dietary risks: If an autistic patient has ASLD argininosuccinic aciduria (a type of urea cycle disorder), some patients with this disease will show mild intellectual disability and mental abnormalities. Undiagnosed patients will be clinically diagnosed with autism. If this patient follows a gluten-free diet without being diagnosed, the diet will be high in protein. ASLD itself is a protein metabolism problem. This kind of diet will aggravate the patient's metabolic disorder, thereby inducing a metabolic crisis and causing a series of disease risk problems.

Supplement risks: For example, some ASD patients will supplement arginine (an amino acid), but if the patient has hyperargininemia, supplementing arginine is the opposite operation. Some supplement therapies for inherited metabolic disorders (IEM) are used in excess of the instructions. Without a confirmed diagnosis of a specific metabolic disorder, large doses of supplements beyond the instructions, without a doctor's monitoring and management, can cause many health risks. For example, some parents take ASD patients to informal private institutions to test for methyl metabolism disorders, and take large doses of folic acid on the advice of these private institutions. These are not recommended behaviors because the diagnosis of the disease is rigorous. Even if a patient has a certain type of gene mutation during genetic testing, a doctor is needed to check the clinical symptoms with metabolite or enzyme results for diagnosis, and post-diagnosis drug treatment management also requires a doctor's guidance and monitoring.

5. Treatment of IEM diseases and biological treatment of ASD

Most of the alternative/complementary therapies (biological therapies) for ASD are based on IEM therapies. Many of these complementary therapies are not managed by a professional medical system and are basically a kind of therapy that parents in the biological therapy circle communicate privately. Therefore, the treatment is very similar to a hodgepodge therapy. Therefore, it is not recommended that parents carry out this kind of complementary therapy without the guidance of a professional nutritionist or doctor. ASD patients should not try to explore this kind of complementary therapies like Shennong tasting a hundred herbs, because without the supervision of a doctor, many therapies may bring risks. It is recommended that parents use this kind of therapy and carry out corresponding treatment after the disease is confirmed. For undiagnosed patients, the scope of metabolic disorders of ASD patients can be analyzed under the guidance of professional doctors, as well as corresponding nutritional management.

1. Current treatments for inherited metabolic disorders (IEMs)

1.1 Diet therapy

Low-protein, high-carb diet: For example, maple syrup urine disease restricts leucine, isoleucine, and valine + low-protein, high-carb diet, because maple syrup urine disease is a metabolic disorder of the three amino acids: leucine, isoleucine, and valine. Therefore, by restricting these three amino acids and a low-protein diet, early treatment of patients can achieve normal growth and development.

Dietary management of genetic metabolic disorders: low protein + high carbohydrate + moderate high fat

Ketogenic diet: A diet for GLUT-1 deficiency glucose metabolism disorder and partial mitochondrial metabolism disorder ( PDH ). GLUT-1 deficiency syndrome is a genetic disease (caused by SLC2A1 mutations) characterized by impaired glucose transport across the blood-brain barrier, leading to generalized epilepsy, developmental delay, and related movement disorders. It may also manifest as early-onset absence epilepsy. The ketogenic diet is an effective first-line treatment for this disease, providing ketones to the brain as an alternative source of energy. The ketogenic diet can also provide an alternative energy source for the brain in patients with pyruvate dehydrogenase (PDH) deficiency; PDH deficiency is a mitochondrial disease characterized by lactic acidosis, severe neurological impairment, and occasionally intractable epilepsy. In non-controlled reports, patients who received a ketogenic diet seemed to have improved neurological outcomes.

Dietary therapy for drug-resistant epilepsy and mitochondrial and sugar metabolism disorders: ketogenic diet therapy

Gluten-Free Diet: A gluten-free diet is currently the only way to treat people with celiac disease. Since there are no available medications or therapies, the only way to manage celiac disease is with a strict 100% gluten-free diet. People with non-celiac gluten allergies can also benefit from a gluten-free diet. Celiac disease is an autoimmune disease that is triggered by consuming gluten and causes damage to the small intestine. When someone with celiac disease eats gluten, the immune system sees gluten as a threat and attacks. However, it ends up damaging the villi in the intestines that help digest food. The damaged villi make it nearly impossible for the body to absorb nutrients, leading to malnutrition and many other problems. Mental problems caused by celiac disease: Schizophrenia, autism, brain fog, headaches.

Gluten-free diet

Celiac disease (non-tropical sprue and gluten-sensitive enteropathy)

1.2 Coenzyme factor supplementation

Vitamin B12: Methylcobalamin (a form of B12) is a cofactor for methionine synthase, an essential enzyme that forms methionine from homocysteine. B12 is used to treat methylmalonic acidemia and combined methylmalonic acidemia and homocystinemia.

Coenzymes, enzyme cofactors, and antioxidants that activate metabolic pathways or provide energy for the treatment of inherited metabolic diseases

Mitochondrial cocktail therapy: The term “mitochondrial cocktail” refers to a large number of vitamins, minerals, and other nutrients (L-carnitine) that play an important role in energy metabolism. This type of pharmaceutical supplement is designed to promote key enzymatic reactions, reduce the putative sequelae of excess free radicals, and clear out the toxic acyl-coenzyme A (acyl-CoA) molecules that accumulate in mitochondrial diseases .

Primary mitochondrial disease (PMD) Cocktail therapy of coenzymes, enzyme cofactors, and antioxidants used to activate metabolic pathways or supply energy

Creatine: Creatine is a nitrogenous organic acid that is mainly produced in the kidneys and liver and stored in high-energy demand tissues such as skeletal muscle and brain tissue. Creatine supplementation is often used to treat: creatine deficiency syndrome CDS and some mitochondrial metabolic disorders. CDS is a group of inborn errors of creatine metabolism and transport that cause intellectual disability, behavioral problems, autism, speech delay, epilepsy and movement disorders .

Creatine deficiency syndrome (CDS) causes autism, intellectual disability, intractable epilepsy, and myopathy and movement disorders

Folic acid (vitamin B9): It is necessary for one-carbon transfer reactions; the active form folinic acid (5-formyltetrahydrofolate) can cross the blood-brain barrier and is often used to treat some mitochondrial diseases and cerebral folate deficiency CFD and methylmalonic acid combined with homocystinemia. Folic acid is especially important for mitochondrial diseases associated with cerebral folate deficiency (such as polymerase gamma (POLG) deficiency, mtDNA) deletion, Kearns Sayre syndrome), which may cause white matter changes. This change may be reversible after supplementation with folinic acid (folinic acid), which is suitable for mitochondrial DNA depletion (including POLG) and Kearns Sayre syndrome.

Cerebral folate deficiency (CFD) causes autism, epilepsy, schizophrenia, and depression

1.3 Substrate supplementation and nitrogen removal agents

This type of therapy is common in the treatment of urea cycle disorders (UCD), which is a group of metabolic disorders that cause hyperammonemia. If patients are not treated in time, they will suffer from brain nerve damage such as intellectual and mental abnormalities.

Urea cycle substrates: arginine, citrulline

Nitrogen-removing agents: sodium benzoate, sodium phenylbutyrate, glyceryl phenylbutyrate oral solution

Guidelines for the diagnosis and management of urea cycle disorders and hyperammonemia

1.4 Liver transplantation

Inherited metabolic disorders (IEMs) are a significant cause of morbidity and mortality in children. Their clinical presentation is diverse and can include end-stage liver disease, hepatocellular carcinoma, renal tubular acidosis, epilepsy, encephalopathy, myopathy, and others. Liver transplantation (LT) is the treatment of choice for many metabolic diseases. LT is contraindicated for mitochondrial disease with significant extrahepatic involvement. Combined liver-kidney transplantation is indicated for disease in which the underlying defect severely impairs both organs. LT has excellent results in metabolic diseases. Adjuvant partial orthotopic LT is an attractive option as it delivers the defective enzyme, leaves the native liver intact, and has the option to remove immunosuppression in case gene therapy can be offered in the future.

Liver diseases caused by inherited metabolic disorders: the evolution of liver transplantation and the future prospects of hepatocyte transplantation

1.5 Future treatments for inherited metabolic disorders (IEMs)

The above therapies are the current treatments for IEM, none of which can cure this type of disease. In addition, some patients suffer from sequelae of brain damage due to failure to receive timely treatment. Because brain damage is irreversible, current therapies cannot cure brain damage. Future therapies will mainly focus on curative therapies: gene editing, enzyme replacement therapy, stem cell therapy, etc. Among them, gene editing and enzyme replacement therapy can cure this type of metabolic disorder in patients, and stem cell therapy can repair human nerves (brain nerves and muscle nerves, etc.). The combined treatment of these future therapies can change the current medical predicament of patients. Most of these therapies are currently in the research and development stage, and it is believed that they will be clinically used for patient treatment in the near future. At this stage, patients need to manage their diseases and nutrition and wait for the day of medical progress.

Future curative therapies for inherited metabolic disorders

2. Treatment of IEM disease and biological treatment of ASD

Combining the above introduction, we can find that there are many similarities between biological therapy for ASD and therapy for IEM diseases, because most genetic metabolic disorders will have manifestations of autism. After some autistic patients are diagnosed with IEM diseases in clinic, these patients can get timely treatment, and some patients' autism symptoms can be alleviated. Therefore, there are some hypotheses that IEM therapy can treat autism. However, there are thousands of IEMs, and there are many kinds of treatment methods involved. Some treatments are used in large doses beyond the instructions. Therefore, it is not recommended for ASD patients to try Shennong's tasting of herbs without being diagnosed with IEM disease.

Some ASD parents report that their children have made a lot of progress after receiving a certain type of biological therapy. In such cases, it is necessary to analyze whether the child is in a progressive stage of development. If the child does indeed benefit from progress and emotional stability through the use of a certain biological therapy, then it is necessary to analyze whether the benefits of these biological therapies mean that the patient has a metabolic disorder. For example, if the patient benefits from a low-protein diet, it is necessary to analyze whether the patient has amino acid or urea cycle disorders.

A patient had methylmalonic acid combined with homocysteine ​​(an inherited metabolic disorder IEM) and showed symptoms of intellectual regression, autism, and mental disorders. He was treated with B12 injections and his abnormal neurological symptoms were alleviated. This does not mean that B12 can treat autism, but because this patient had methylmalonic acid combined with homocysteine ​​and showed symptoms of autism, but B12 can treat methylmalonic acid combined with homocysteine, and the patient's clinical mental abnormalities were alleviated through correct treatment.

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The treatment of IEM, an inherited metabolic disorder, has many similarities with the biological treatment of ASD. The treatment of IEM is to carry out treatment and monitoring under the guidance of a doctor after the disease is diagnosed. Through correct treatment, the disease of IEM patients is controlled and some abnormal mental symptoms are alleviated. ASD biological treatment is an experimental treatment for patients with autism/autism spectrum disorder ASD without a confirmed diagnosis. Because there is no monitoring by the medical management system, most treatments are private actions of ASD parents. This article systematically introduces the risks and benefits of biological treatments for ASD. For biological treatments that may be beneficial and have lower risks, it is recommended to be carried out under the guidance of doctors and nutritionists.

The current recommendations for people with autism/autism spectrum disorder (ASD) are:

The cause of ASD symptoms should be investigated based on the family situation, because at this stage a small number of ASD patients have been diagnosed with IEM genetic metabolic disorders. Through diagnosis and management of the disease, the abnormal manifestations of autism in these patients are alleviated, especially the core symptoms. Of course, the prognosis is related to whether the disease is treated early and in time. The earlier the diagnosis and treatment, the lighter the neurological sequelae, or even no neurological sequelae.

If the cause of ASD patients cannot be found, we can wait until IEM metabolomics research is more advanced in the future to find out the cause. For ASD patients who have undergone genetic testing, the genetic data can be saved and provided to other doctors for re-analysis in the future, or genetic companies can be asked to re-analyze them regularly.

At this stage, it is necessary to manage the nutritional management of ASD patients, as well as appropriate individual intervention training and suitable outdoor sports activities.

Nutritional management of inherited metabolic disorders

The important role of genetic testing in disease diagnosis, family inheritance pattern analysis and reproductive planning

Genetic testing and sequencing: whole genome (WGS), whole exome (WES), next-generation sequencing (NGS), mRNA sequencing (RNA-Seq)

Reference for this article: UPTODATE