How I lowered my resting heart rate from the 70s to the 40s (and why it matters)
Read this important thread, repost it for wider reach and bookmark for future reference. Post your comments and queries below.

1/n
🔸My resting heart rate (RHR) used to be in the 70s. Today, it is consistently in the low-to-mid 40s.
🔸I did not take any special supplements, and there are no hacks either. The ‘secret” is just 5.5 years of consistent lifestyle changes. 2/n
The biggest factor was running.
🔸For the first 2 years, I averaged 10–15 km/day. Over the last few years, I have averaged 6-8 km/day.
🔸Regular aerobic exercise trains the heart to pump more blood with each beat, so it doesn't need to beat as often at rest.

"My cholesterol is normal. How did I get a heart attack?"
This is one of the commonest questions I hear from patients.
The answer may explain why Indians develop heart disease 5-10 years earlier than many Western populations.
A thread. Repost for wider reach and bookmark for future reference.
1/n 🔸Many people believe: Normal cholesterol = No risk of heart attack.
🔸Unfortunately, this is not always true.
🔸A significant proportion of heart attacks occur in people whose routine lipid profile appears "normal."
2/n

Lipid Profile vs ApoB & ApoA1: Which Better Predicts Future Heart Disease Risk?
Most people are familiar with cholesterol testing. But increasingly, we are paying attention to two proteins:
🔸Apolipoprotein B (ApoB)
🔸Apolipoprotein A1 (ApoA1)
What are they and should you get them tested?
A thread.
1/n Traditionally, cardiovascular risk assessment relies on:
🔸LDL-C ("bad cholesterol")
🔸HDL-C ("good cholesterol")
🔸Triglycerides
🔸Non-HDL cholesterol
These tests remain extremely useful and form the foundation of risk assessment.
2/n

How Much Exercise Do We Need for Cardiovascular Protection?
Most people have heard the recommendation:
✅ 150 minutes/week of moderate-to-vigorous physical activity (MVPA)
▶️But an important question remains:
Does 150 minutes provide maximum cardiovascular protection, or is it simply the minimum effective dose?
1/n
A recent study in the British Journal of Sports Medicine helps answer this question.
✅Key Finding #1: 150 min/week works but the benefit is modest
🔸Meeting the current guideline of 150 min/week of MVPA was associated with approximately 8–9% lower cardiovascular disease risk compared with very low activity levels.
🔸However, it is not the level associated with the largest risk reductions.

✅Key Finding #2: Larger risk reductions require much more activity
🔸To achieve a >30% reduction in cardiovascular disease risk, participants generally needed around 560–610 minutes of MVPA per week
🔸This is roughly 80–90 minutes/day (4 times the minimum guideline recommendation).
2/n

Understanding Your Lipid Profile: What Really Matters?
Many people get a lipid profile done every year but are unsure how to interpret the results. This thread explains LDL, triglycerides, HDL and ApoB in simple language.
This is mainly meant for people who have NOT suffered a heart attack or stroke and are NOT already taking statins.
Share and re-post for wider reach and bookmark for future reference. Post your queries and comments below.
1/n How often should you check your lipid profile?
Most healthy adults should get a lipid profile at least once every 2-3 years.
More frequent testing may be needed if you have:
• Diabetes
• High blood pressure
• Obesity
• Smoking history
• Family history of premature heart disease
• Previously abnormal lipid levels
2/n

Sharing my experiences of running
I started regularly running in November 2020 (in the 50th year of my life). This is my 6th year as a runner. During this period, I have run more than 1000 10k runs and more than 150 half marathons.
Running has resulted in several health-related benefits. Notable ones among them include about 30 Kg weight loss (I weighed about 100 Kg before I started running) and reduction in resting heart rate to 40-45 bpm (from 70-75 bpm).
In this post, I will share my experiences (as well as my learning from published research studies) about running. Like, share, re-post, bookmark this post. Post your comments and queries below.
1/n One can start running at any age.
If you are medically fit and love running, you can start running at any age.
2/n

Clinical Quiz
"Doctor, my uric acid is 9.2. Should I start allopurinol or febuxostat?”

A 35-year-old healthy man underwent a routine health check-up. His serum uric acid was 9.2 mg/dL.
He had:
✅ No joint pains
✅ No history of gout
✅ No kidney stones
✅ Normal day-to-day functioning

Should he be started on medicines?

#MedTwitter #NeuroTwitter The answer, in most cases, is NO.

1. High uric acid is not the same as gout
🔸Many people have elevated uric acid levels but never develop gout.
🔸The diagnosis of gout requires symptoms and signs of urate crystal deposition, not just an abnormal blood test.

In this post, I will share a few practical points that can guide people suffering from migraine.
(Disclaimer: This is meant for general information and is not medical advice)

After reading, bookmark, share and re-post for wider reach. If you have any comments or queries, post them below.
1/n Typical features of migraine
✅Headache lasts for 4-72 hours (if medicines are not taken)
✅Associated with nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sounds)
✅Pain is severe enough to negatively impact personal and professional lives.
2/n

If you are planning a trip to Sikkim, this post could be helpful. Bookmark this for future reference.
We visited Sikkim in the first week of May 2026, covering Gangtok, Nathu la and Lachung (North Sikkim). Our group had six people, including my parents in their 70s.
(1/n) Itinerary
Day 1: Flight from Hyderabad to Bagdogra. Road trip to Gangtok.
Day 2: Road trip from Gangtok to Lachung
Day 3: Day trip to Yumthang valley and Zero point. Return to Lachung for night stay.
Day 4: Road trip from Lachung to Gangtok
Day 5: Trip to Nathu la and Tsongo lake (from Gangtok)
Day 6: Drive from Gangtok to Bagdogra.
(2/n)

Parkinson’s Disease: A Simple Thread for the Public
This post would be useful for anyone suffering from PD, or if they are giving care to a person with PD.
1)
Parkinson’s disease is a brain disorder that mainly affects movement. It usually develops slowly over years and is more common after age 60, though younger people can also develop it.
It is NOT simply “normal aging.” 2)
Common symptoms of Parkinson’s disease:
🔸Slowness in daily activities
🔸Tremor (shaking), often starting in one hand
🔸Stiffness of body
🔸Difficulty walking
🔸Reduced arm swing while walking
🔸Soft voice
🔸Small handwriting
🔸Mask-like facial expression

(Note: Not every patient has all symptoms.)

Clinical Quiz
35 year old IT professional; was detected to have a BP of 160/110 mmHg during a routine health check up. Subsequent two measurements at hospital were similar. Further BP readings taken at home was also in the range 160-170/100-110 mmHg.
🔸He sleeps about 6 hours, walks (covering 6-8 k steps daily), eats healthy, has normal body weight, does not smoke, drinks occasionally and has a good job (salary 60 lac per annum).
🔸His physician advised him to start anti-hypertensive medications, however, he refused, saying he would reduce his BP through lifestyle modification.

❓Who is correct here- the patient or the doctor? ✅In this scenario, the doctor is more likely to be correct.

A BP persistently around 160–170/100–110 mmHg in a 35-year-old is not “mild” hypertension. It falls into stage 2 hypertension, which substantially increases long-term risk of stroke, heart attack, kidney disease and heart failure.

The BP readings are consistently high at the clinic as well as home, so this is unlikely to be just stress or “white coat hypertension.”

Most people with diabetes or weight issues don’t fail due to “lack of discipline.”
They fail because of a few common dietary habits that quietly sabotage blood sugar control & fat loss.

Here are the big ones:
1. Liquid calories, such as fruit juice, smoothies and sweetened tea/coffee result in rapid glucose spikes, poor satiety and easy calorie excess.
✅Whole fruit is always healthier than juice.

2. Ultra-processed foods, such as packaged snacks, fast food and sugary cereals are hyper-palatable, resulting in overeating and worsening of insulin resistance. (1/7) 3. Low protein intake (especially early in the day)
This leads to more hunger later, higher overall calorie intake and worse post-meal glucose. Protein at breakfast changes the entire day.

4. Low fiber diet
Results in faster glucose spikes, less satiety and poor gut hormone response.
Fibre-rich diet is healthier. (2/7)

How you spend your first 60–90 minutes sets the neurobiological "tone" for the rest of your day.
To optimize health, mood, and energy, you must align your morning habits with your body’s natural circadian rhythms and chemical processes.

1. Prioritize Natural Light Exposure
🔸Within 30–60 minutes of waking, get outdoors. Sunlight triggers a timed release of cortisol (the "alertness" hormone) and sets a countdown timer for melatonin production in the evening.
🔸View 10–20 minutes of direct sunlight (not through a window). This anchors your circadian rhythm and improves mood via dopamine pathways. (1/7) 2. Delay Caffeine Intake (60–90 Minutes)
🔸Avoid reaching for coffee immediately. Upon waking, your body is naturally clearing adenosine (the chemical that makes you feel sleepy). Introducing caffeine too early blocks these receptors temporarily, leading to the inevitable "afternoon crash" when the caffeine wears off and the accumulated adenosine floods back in.
🔸Waiting 90 minutes allows for a natural adenosine clearance, ensuring sustained energy levels throughout the afternoon. (2/7)

The Diagnosis That Was Missed, Until History Spoke
1/
A 55-year-old man had back pain for 4 months.
He did everything right. He consulted local doctors
Blood tests, Nerve conduction studies and MRI (neck & lower back) were normal

Yet, his pain did not go away. 2/
He was treated with painkillers, muscle relaxants and advised rest. Still, he had no relief.
This is where many cases get labeled as "Chronic back pain” But this one wasn’t.

The "Cholesterol Myth" just got a reality check
We have been obsessed with "clogged pipes" (LDL-C) for decades.
But a massive new study of 40k+ patients just confirmed: The "Fire" (Inflammation) is more dangerous than the "Gunk." 🧵

New research data shows why your "normal" cholesterol might be lying to you. 39,697 adults with established heart disease (ASCVD) in a real-world setting were followed up.
Researchers compared two groups:
1️⃣ High Inflammation (hsCRP ≥ 2 mg/L)
2️⃣ High Cholesterol (LDL-C ≥ 1.8 mmol/L)

The results were a wake-up call for cardiology.

1/
Can a daily multivitamin slow aging?
A new randomized trial published in Nature Medicine studied adults ~70 years old and found that those taking a daily multivitamin showed slower biological aging based on DNA markers.

Here’s what it means for you. 🧵
2/
Researchers followed ~1,000 older adults for 2 years and used epigenetic clocks (DNA methylation markers) to measure biological age.

✅Result:
People taking a daily multivitamin showed about 4 months less biological aging compared with placebo.

A modest but measurable effect.

“A brain-dead woman came back to life after an ambulance hit a pothole.”
This news story from Uttar Pradesh has gone viral.

But from a neurological standpoint, this raises several important questions.

Let’s examine what likely happened. 🧵
1️⃣ Can a brain-dead person suddenly start breathing again?

No.
True brain death is irreversible.

🔸It means complete and permanent loss of all brain and brainstem functions, including the breathing center.
🔸If a patient later starts breathing, they were not brain-dead.
🔸They may have been in deep coma or a toxin-induced neurological suppression.

🧵 The "Acidity Pill" Trap: A Silent Health Crisis?
That daily antacid you pop for "gas" or heartburn might be doing more than just stopping the burn. As a neurologist, I see the long-term fallout of over-the-counter (OTC) drug misuse every day.

Let's talk about the hidden risks of PPIs (Omeprazole, Pantoprazole, etc.). 👇 1/5
Proton Pump Inhibitors (PPIs) are among the most over-prescribed and over-consumed drugs globally. They are intended for short-term (4–8 weeks) use for ulcers or severe GERD.

Yet, millions take them for years to manage minor indigestion.
The cost? Your long-term health.

Abdominal obesity is not cosmetic.
It indicates poor metabolic health. It is linked to inflammation, and it increases risk of stroke & heart attack.
If you have a “belly,” this thread may reduce your risk of diabetes, stroke & heart attack. 🧵👇 1️⃣ First truth:
You cannot spot-reduce belly fat.
No exercise melts abdominal fat selectively.
Fat loss is systemic.

But yes; visceral fat can be reduced.

Tailbone pain from prolonged sitting?
Read this before buying a “donut cushion.”

A 50-year-old woman.
Desk job 8–9 hrs.
Commute 1–2 hrs.
Now severe tailbone (coccyx) pain.
Most people immediately buy this 👇 (donut cushion).
1/n But here is what evidence & biomechanics tell us:
1️⃣ Donut cushions are NOT ideal for coccyx pain

They:
🔸Shift pressure to the rim
🔸Increase pressure on ischial tuberosities
🔸Can paradoxically increase coccygeal strain
🔸Are better for perianal pain and hemorrhoids; not true coccydynia

▶️Several rehabilitation guidelines advise caution with donut cushions for coccyx pain.
2/n

One phone call. One staircase. One misstep.

This video of Mr. Shashi Tharoor tripping while talking on the phone and walking downstairs is not about clumsiness. It’s about the brain.
(Glad to note that Mr Tharoor is doing well🙏)

Your brain is terrible at “walking + phone” multitasking.
Especially while going downstairs.

Why stairs are risky?
When you go downstairs, your brain is busy with:
▪️Balance
▪️Depth perception
▪️Foot placement
▪️Split-second corrections

Add a phone call → attention shifts → reaction time drops.
That’s all it takes.

As a neurologist, I can tell you:
Some of the worst head injuries I see come from simple falls, not big accidents.

Please don’t use your phone when:
🚫 Going up or down stairs
🚫 Crossing roads
🚫 Walking on uneven surfaces
🚫 Driving / riding

Your brain can focus on movement OR on your phone
Not both safely.

✅The simplest safety hack
▪️Pause the call.
▪️Look at the steps.
▪️Hold the railing.
▪️Your brain is too valuable to risk for a notification.

(Video credits @ShashiTharoor)

https://x.com/ShashiTharoor/status/2019102516416479508?s=20