@Shawna Van Gilder Good morning Shawna, and thank you for the kind words — I really appreciate that. You’ve given me a few useful clues there, especially the low overall fluid intake, long stretches without drinking, occasional leg cramps, OMAD, and variable meal timing. I would not assume your nighttime waking is automatically a problem with carnivore itself, especially since it has been present for much of your adult life. I also agree that 8 uninterrupted hours is not a universal requirement. What matters more is your total sleep, how restorative it feels, your daytime energy, recovery, and whether the awakenings are brief or disruptive. The first thing I would clean up is the hydration pattern. I would rather see you spread fluids more evenly earlier in the day instead of trying to catch up on the drive home. The cramps make me want to look at hydration and electrolyte balance a little more closely too, but I would not start randomly adding supplements without a reason. Your OMAD timing is another variable worth testing, especially on the days your meal is closer to 7 PM. If sleep is more disrupted on those nights, that is useful information. For now, I would keep it simple and track for a week: meal time, fluid timing, nighttime waking, cramps, and how you feel the next morning. That alone may show you a pattern without changing your whole routine. And yes, I would interpret your bloodwork in the context of your actual diet and lifestyle, not simply compare one number in isolation to the average population. The pattern matters.

@Travis Miller this is a really good example of actually learning your own pattern instead of chasing random fixes. The beer piece is especially interesting because what you’re describing makes physiological sense: alcohol can make you feel like you “slept well” because it can shorten sleep onset and sedate you, but the architecture and recovery quality can still be disrupted. The fact that you notice a **3–5 night hangover effect on sleep quality** is valuable personal data. At that point, the experiment has already answered the question for you — beer simply has too high a recovery cost. Your meal-size observation is also important. There’s a big difference between eating until you’re comfortably satisfied earlier in the day versus having a very large last meal close to bed. A heavy evening meal can increase digestion, thermogenesis, reflux risk, and general nighttime arousal. So your strategy of making the final meal lighter makes sense. The only part I’d keep an eye on is the **bedtime snack**. If it genuinely helps you settle and does not worsen reflux, glucose swings, or nighttime waking, then it may be fine for you. But I’d still test it rather than assume you need it every night. You could compare a week with the small snack versus a week without it while keeping everything else the same. And yes: the nighttime routine matters more than people realize. Stretching, qigong, slow breathing, meditation, dimmer light, and simply doing the same sequence every night can all help reinforce the transition into parasympathetic dominance and sleep readiness. The apnea piece is still the one I would not ignore. Even if your behavioral routine is excellent, untreated sleep apnea can keep fragmenting sleep in the background. So I’d separate the two ideas: **1. Improve the signals you control** alcohol, meal size, meal timing, nervous-system downshifting. **2. Don’t let those improvements distract from the airway issue.** What I like most about what you’re doing is that you’re not changing ten things at once. You’ve identified a few very clear personal signals:

@Travis Miller @Barbara Friedman 😊 Travis is right — I’m saving that mineral for the next video (sunday). I left it as a cliffhanger on purpose because it deserves its own explanation: what it does, why it matters for energy, muscle function, sleep, protein use, and why some people may still be missing it even when the diet looks “perfect.” So keep an eye out for the next release — I’ll break it all down there.

@Leilani Tedeski The most important point is this: if she has an active Klebsiella urinary infection and kidney stones, the urologist needs to know the current infection status before stone treatment. Current urology guidelines specifically recommend checking urine for infection before stone removal, treating a UTI first, and delaying definitive stone treatment if there is an infected obstructed kidney until the infection is controlled. Uncontrolled UTI is also listed as a contraindication to shock-wave lithotripsy. So I would not rely on the Google/AI answer that says, essentially, “the procedure will force Klebsiella into the bloodstream and she may die.” That is too absolute and frightening. But the underlying concern is real: stone manipulation in the setting of an active infection can increase the risk of bacteremia and sepsis, which is why urine culture, antibiotic sensitivity, obstruction status, and appropriate antibiotic coverage matter so much. Because her procedure is tomorrow, what I would want her to do today is call the urologist’s office and ask very directly: - Was a recent urine culture done? - Is Klebsiella still present? - What is the antibiotic sensitivity pattern? - Is she currently on an antibiotic that the organism is actually sensitive to? - Is there any obstruction or hydronephrosis? - What type, size, and location are the stones? - Does the urologist suspect an infection stone such as struvite? - Given the infection history, do they still feel shock-wave lithotripsy is the safest procedure tomorrow? That is a much better use of the next 24 hours than trying to rapidly change her diet. On the question of whether she can simply change her diet now and pass or dissolve the stones naturally, the answer is: we cannot assume that at all. It depends completely on the stone composition, size, location, and whether there is obstruction. Most calcium stones do not dissolve with dietary changes. Small stones may pass on their own, but larger stones or stones causing obstruction often require intervention.

@Mariam Als. Hi Mariam 🧡 Yes — if **DHEA-S has been persistently elevated for a long time**, including before carnivore, and it did not really change after a year low carb, I would not automatically blame the diet. Your thought process is reasonable in one sense: **DHEA-S is produced predominantly by the adrenal glands**, so an isolated elevation does make me think about the adrenal source more than the ovaries. But I would be careful with the phrase “nervous system issue,” because elevated DHEA-S by itself does **not** prove that stress or the nervous system is the cause. What matters is **how elevated it is, whether it is stable or rising, your age, your symptoms, and what the rest of the androgen picture looks like**. If testosterone and SHBG are normal and you do not have progressive signs like worsening facial hair, severe acne, scalp hair loss, voice deepening, increased muscle mass, menstrual disruption, or other signs of virilization, that is generally less concerning than a rapidly rising DHEA-S accompanied by obvious androgenic symptoms. Rapid progression or severe biochemical androgen excess is where endocrinology becomes more urgent. I would also want to know the **actual DHEA-S value, units, your lab's reference range, and your age**, because DHEA-S naturally declines with age and should be interpreted against an age-appropriate range. Different laboratories and assays can also give somewhat different results, so one isolated number is less useful than the trend. A few things I would want to rule through systematically: **1. PCOS or an adrenal-predominant androgen pattern** PCOS can involve elevated DHEA-S even when testosterone is not dramatically elevated, although the diagnosis is based on the whole clinical picture, not DHEA-S alone. Menstrual regularity, ovulation, acne, body-hair changes, ovarian findings and other hormones all matter. Since you mentioned insulin is now low and looking good, that is excellent metabolically, but it does not completely rule PCOS in or out.

@Mariam Als. That additional context actually makes the picture a lot clearer. A DHEA-S around 500–510 µg/dL that has stayed in roughly the same range for five years is very different from a value that suddenly jumped or keeps climbing. At 24, it is definitely above the usual age-adjusted range you quoted, so I still think it deserves a proper endocrine work-up, but the stability is reassuring. The fact that your periods are regular, painless, testosterone-related symptoms are minimal, and you have no virilization also lowers my concern for something aggressive. The history of severe cystic acne does tell me that your androgen signaling may have been clinically relevant, but the fact that it improved substantially on carnivore is interesting and may reflect improvements in insulin signaling, inflammation, skin oil production, or other downstream factors rather than DHEA-S itself falling. On the caffeine question: yes, I would take it seriously, but I would not assume caffeine is the reason your DHEA-S is high. Caffeine can increase sympathetic activity and can acutely raise cortisol and catecholamines, especially in people who are sensitive to it, sleep-deprived, under-recovered, or using larger doses. But there is not good evidence that ordinary caffeine intake by itself explains a stable DHEA-S elevation for five years. So I would think of caffeine more as a possible recovery amplifier than the root cause. If you notice that coffee gives you: - higher resting heart rate - lower HRV - anxiety or wired feeling - worse sleep - poorer training recovery then I would absolutely experiment with it. You do not need to quit forever. I would do something simple like: reduce the dose by 50% or remove it for 10–14 days, keep everything else as stable as possible, and watch your sleep, HRV, resting heart rate, recovery and how you feel. That gives you actual information. The same thing applies to training. Your comment about your “crazy gym routine” may be more important than you realize.

@Ioanna Polymenea This was Module 5 (Lesson 1 -> Supplements) it is listed under -> Classroom -> Weekly Live Classes. https://www.skool.com/mauricedaher/classroom/850ad8ae?md=44e4bccd17d84acf829e42a11d70c122