Afshine Emrani MD FACC ✓
@afshineemrani · Los Angeles, CA · joined 13 Sep 2009
Cardiologist. Author. Jew. I write about Medicine. Longevity. The human condition. Live longer. Live wiser. Come walk with me. doctoremani@gmail.com
118 705Followers
208Following
112 064Posts total
2.4MViews on collected posts
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⚠️ FAUDA SEASON 5 SPOILER WARNING ⚠️
For European viewers, Doron, Eli, and Gabi are distant relics—soldiers shaped by a furnace most Westerners have never felt and will never understand.
Anne is different. Anne is immediate. Anne is familiar.
She is the classic middle-class
2.1K views · 67 likes
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⚠️ FAUDA SEASON 5 SPOILER WARNING ⚠️
There is a chilling moment when Gabi looks at Ann and admits:
“I don’t know how to talk to her. I don’t understand those people.”
Think about who is saying that. A veteran operative who has spent decades in the darkest rooms of the Middle h
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When we got married, my wife and I went out to dinner every Saturday night. We called them Romantic Date Nights.
Then came the kids. Dinner became playdates and birthday parties so loud you could feel your fillings vibrate. We called them Romantic Mommy-and-Me Parties. (I miss
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@afshineemrani My sister is taking the wegovy pill and it has barely worked. She lost only 12 lbs in about 6 months. She really struggles with weight so I don’t blame her for giving in and taking the drug. The problem is she hates the emotional side effects: the flatness, lack of
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12/12
Save this.The drug is a key.
The GLP-1 receptor is the lock.
Your phenotype is which door is jammed.
Dose, protein, muscle, sleep, and other medications decide whether the key even reaches the door.40 lb on two pens and 4 lb on the highest dose can both be honest biology.If
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11/12
What “working” actually looks like, so you stop measuring yourself against the 40-lb outlier.• Food noise drops before the scale does. That is the receptor in the brain.
• Portions shrink without a speech about discipline. That is satiation.
• The gap between meals gets
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10/12
Screenshot this protocol.
Confirm the product, the day, the site rotation, and 12 full weeks at the dose that is supposed to work.
Protein first. Target 1.2–1.6 g per kg of body weight per day. For a lot of adults that is 80–120 g or more. Eat it at the start of the meal.
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9/12
Before you call yourself a non-responder, most “failures” are still one of these:• Still on a starter dose. 0.25 mg and 2.5 mg exist so your stomach survives week one. They are not the working dose.
• Not 12 weeks at a therapeutic dose. For semaglutide that usually means
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8/12
Layer phenotype on top of the receptor. This is the map that explains the 40-lb patient and the 4-lb patient on the same pen.Hungry gut — normal plate, starving again in 90 minutes. Stomach empties fast. The gut often under-makes its own GLP-1 and PYY. These people are
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7/12
There is a second genetic story that is not the receptor itself.~10% of people carry PAM variants that create a kind of GLP-1 resistance: they run higher circulating GLP-1, but the hormone does less work. More key in the blood, weaker effect at the lock. That is not “you ate
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6/12
Genetics change the lock.A missense variant in GLP1R (rs10305420, Pro7Leu, in the signal peptide) was linked in a ~15–28k person analysis to extra weight loss — roughly 0.8 kg more per copy of the effect allele. Likely by helping more receptor get trafficked to the cell
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5/12
Semaglutide is a potent GLP-1R agonist. Strong key for one lock.Tirzepatide is a dual GIP/GLP-1 agonist. At GLP-1R it is actually a biased agonist: good cAMP signaling, relatively weak β-arrestin pull, less internalization. Plus it hits GIP receptors in fat tissue and brain
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4/12
Agonists that favor cAMP and keep more receptor on the membrane tend to keep working longer. Agonists that yank the receptor inside faster can desensitize the cell.This is why two GLP-1 drugs are not interchangeable even if both say “GLP-1.”4/12
Now the part almost nobody
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3/12
Your own GLP-1 is a short-lived meal hormone from gut L-cells. It lasts minutes. The drugs last a week because they were engineered not to be chewed up by DPP-4.Weight loss is mostly brain-driven reduced intake, not a faster metabolism. The drug reaches receptors around
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2/12
GLP-1 drugs do not melt fat.They are keys.
The lock is the GLP-1 receptor (GLP-1R) — a G-protein-coupled receptor on cells in:• brainstem and hypothalamus (appetite, “food noise,” reward)
• vagus nerve (gut-to-brain fullness signal)
• stomach and intestine (slow emptying)
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I'm a cardiologist. Here's a big challenge:
The same GLP-1 pen.
One patient loses 40 lb after a few doses.
Another barely moves on the highest dose.
That is not willpower.
It is often the receptor the drug has to bind.
If the shot “isn’t working,” read this before you quit or
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The Last Time, and Nobody Noticed
One day your parents picked you up for the last time, and neither of you realized it. There was no ceremony. You were heavy, or restless, or simply old enough to walk, and the arms that had lifted you a thousand times set you down and never
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@afshineemrani OH STFU...She committed a fireable offense...
They literally called her CRAZY!!! https://t.co/Cqzam6EvGo
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Dear @POTUS @realDonaldTrump Here’s your chance to slap FOX in the face by making the great @MariaBartiromo the White House Press Secretary.
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Fox just fired Maria Bartiromo.
She wanted to report China’s role in the 2020 election. Fox execs texted producers: kill it. She sent the order to the White House. They fired her.
12 years. Three number-one shows. Gone overnight. No goodbye.
They never went through Hannity, ht
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@afshineemrani Seems there was another brave flight attendant on Flt 11 that day.
Her name was Betty Ann Ong.
She got on a call to the American Airlines Reservations Center & calmly gave pertinent information to ground control.
She indicated 2 of the terrorists were sittig in 1
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@afshineemrani …and New Yorkers & others now vote for candidates who harbor the same mindset that drove 9/11.
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@afshineemrani Selfless and heroic in what she knew were her final moments.
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She knew she wasn’t coming home. And she chose to be a witness anyway.
On the morning of September 11, 2001, 35-year-old Madeline "Amy" Sweeney was working aboard American Airlines Flight 11. Minutes after takeoff, terror took the cabin. The cockpit went dark. Crew members were
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@afshineemrani Stunning that you say "the exact same toolkit that let us produce Covid vaccines" as though that's something to brag about. Are you even aware of the evidence now beginning to gush out that Covid vaccines are dangerous and in many cases lethal? Utterly destroys you
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9/ Let me close the way I always do — as the honest doctor, not the hype man, because you deserve both the awe and the truth in the same breath.
Most of what I just described is early. The personalized cancer vaccine is the furthest along, with a real Phase 3 win — but even it
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8/ Now step all the way back and see the shape of the whole thing, because this is the part that gave me chills.
Every one of these breakthroughs runs on the same underlying toolkit — and it's the exact same toolkit that let us produce COVID vaccines in a matter of months
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Against accounts of the same size
37 posts from the last 90 days, next to the 100K–1M follower range. ordinary reach for its size, stronger reaction than most.
Median views2 073this account5 983median for 100K–1M
Reach, %1.75%this account1.49%median for 100K–1M
Engagement, %1.17%this account0.93%median for 100K–1M
| Metric | This account | Median for 100K–1M | Ratio |
|---|---|---|---|
| Median views per post | 2 073 | 5 983 | 0.35× |
| Reach (views ÷ followers) | 1.75% | 1.49% | 1.17× |
| Engagement rate | 1.17% | 0.93% | 1.25× |
Others in this range → Compare with another account → How these benchmarks are built →
Growth & engagement
How the posts we collected actually performed: views and reaction rate post by post, what the audience did with them, and where the follower count goes.
Views per post
6814 Sep
620
515
492
490
609
539
457
146
2.2K
1.8K
34.8K16 Sep
2.1K
1.1K
Last 14 collected posts, oldest on the left. The scale is logarithmic: one post can outrun the rest a hundred times over.
Engagement rate per post
0.73%4 Sep
0.81%
1.17%
1.22%
1.43%
1.15%
1.30%
0.22%
0.00%
7.16%
1.31%
3.13%16 Sep
3.63%
3.70%
Reactions — likes, reposts, replies and quotes — divided by views. Median for 100K–1M accounts is 0.93%.
What the audience does
Likes80.2%14 347 in total
Reposts12.2%2 181 in total
Replies1.6%294 in total
Quotes0.7%124 in total
Bookmarks5.3%954 in total
Share of every reaction we collected for this account. Replies mean argument, reposts mean endorsement, bookmarks mean the post was worth keeping.
The follower curve appears once this account has two daily snapshots — we take one a day, and this one is on its first.
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