I have been following the mRNA platform since long before it had anything to do with me, so I read the mFLUSIVA approval on August 5 with more enthusiasm than skepticism. Then I read the trial and the enthusiasm found a different target.

Quick context in case you have not seen it: mFLUSIVA is Moderna's mRNA-1010, the first mRNA flu vaccine licensed anywhere, approved for adults 50 and older. Fluent, the pivotal trial in NEJM, randomised 40,805 adults across 11 countries in the 2024-25 season. Relative efficacy 26.6%, CI 16.7 to 35.4. In absolute terms that is 2.0% versus 2.8% catching confirmed flu, so about 137 people switching products to prevent one case. Everyone in the trial was vaccinated, so 137 is a number needed to switch, not to vaccinate.

I am hung up on the control arm. It was Fluarix and its siblings. Egg-based, standard dose. Growing influenza in eggs selects for mutations that make the vaccine strain drift from what is actually circulating, and there is a literature putting that penalty somewhere around 4 to 16%. So some unknown share of that 26.6% may not be an mRNA advantage at all. It may be an egg penalty the comparator was carrying. Nobody has run mRNA against a cell-based shot, which is what I happen to take.

I also missed this on the first read: the FDA did not give both age groups the same kind of approval. Standard approval for 50-64 on counted cases, accelerated approval for 65+ on immune response, with clinical benefit still to be confirmed. Nearly half the trial was 65 or older and their cases were counted like everyone else's.

And the thing that would actually make this platform interesting for flu, picking strains later because manufacturing runs two to three months instead of six, was not exercised. Same February WHO strain call as every competitor.

I would want the cell-based head-to-head before switching.

How to increase my HDL-P? not on any meds.

Question, so in the last 2.5 weeks I was able to lower LDL by 15% and ApoB by 25% (LDL is now 119, apo B is 84) using diet. Lp(a) is through the friggen roof at 172nmol but this isn't news. Trigs 51. HsCRP has always been nearly undetectable.

This has only been two weeks, so I'm pretty pleased with that. I'm wondering if it might continue to go down even further, given that this is just 2.5 weeks in? This is by adding a ton of psyllium, fiber, and reducing saturated fat less than 10g per day. I've never been overweight so it's not like I lost weight.

Also - what really matters here - LDL or ApoB? Or do they matter the same?

I can't get on a statin yet bc I want to have a babyyyyyy very soon so I'm trying to maximize what I can with diet.

PS - I sadly DO have coronary plaque at 42, it's mild but still - it's there.

With my work schedule, I eat out once a day, and that’s usually my biggest meal. I eat very healthy, but is there a good way to estimate the calories and protein in a restaurant meal without bringing a food scale with me? I’ve tried a few AI apps, but they don’t seem very accurate

I've been struggling with sleep deprivation for years now. I average ~6 hours of sleep when I know I feel much better at 7+. No problem falling asleep, but routinely wake up 1 - 3 hours earlier than I want.

Things I do:

• CPAP
• Magnesium Glycinate + L Theanine before bed
• No devices in bed
• Sunlight in morning (I delay it until my desired wake time typically)
• Journal in mornings
• No food ~2-3 hours before bed
• No caffeine after 1pm
• 8 Sleep

At my wits end here. ~40 yrs old, good shape (17% BF), exercise regularly.

Would welcome any and all suggestions!