Harm reduction

This page indexes harm-reduction measures for drugs, medications, training, and environmental exposures from a Peat metabolic perspective. Each entry links to its full article; see there for mechanisms, citations, and what the sources do and do not support. Sections without a link have not yet been moved to their own article and are not fully sourced. This is not medical advice, and no measure here makes an exposure safe. See also Disease & mental disorder.

Recreational drugs and alcohol

Prescription drugs

Behavior and circumstances

PED/Hormone abuse

Sports

Toxin exposure

Radiation

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Alcohol

• Alcohol: increases endotoxin absorption and loads the liver with acetaldehyde and NADH; avoid PUFA, add vitamin E and copper-rich foods, and do not stop abruptly if dependent.
• Sugar with drinking: in 109 men given alcohol, fructose or glucose prevented the low blood sugar, high lactate, high free fatty acids, and metabolic acidosis of the hangover period, with fructose the stronger of the two, though neither sugar eased the felt symptoms.

Cigarettes

• Cigarettes and nicotine: burning tobacco adds carbon monoxide and polycyclic aromatic hydrocarbons, and smoke releases and oxidizes PUFA; Peat preferred transdermal nicotine to smoking.

Cannabis/Weed/Marijuana

• Cannabis: estrogenic and antiandrogenic effects plus smoke exposure; protein, thyroid, sugars, and saturated fat are protective; psychosis risk in vulnerable users.

Psilocybin/Magic Mushrooms

• Psilocybin: a psychosis-like syndrome through serotonin-2A agonism, more likely at high or repeated doses; avoid both.

Amphetamines/Uppers (Adderall, Ritalin, Meth, Cocaine)

• Cocaine: fentanyl-contamination risk and test strips, route-specific risk, cardiovascular strain, cocaethylene with alcohol, oral/dental damage, and lasting dopamine changes.
• Amphetamine and other stimulants: the crash and withdrawal, norepinephrine depletion, and TSH readings that mask hypothyroidism; prescribed-stimulant cardiovascular data is on Methylphenidate.
• Brain toxicity: In rodents and monkeys, high or repeated doses of amphetamine, methamphetamine and MDMA damaged dopamine nerve endings, with oxidative stress, mitochondrial dysfunction, overheating and brain inflammation among the mechanisms studied. Brain scans of stimulant users show changes in brain structure and connectivity, though nerve damage from stimulants has not been firmly shown in people. In experimental models, caffeine protected nerve cells.

Overdose

If severe, call emergency services and say what was taken and how much. Emergency care is described on each substance page.

LSD

• LSD: a quiet room, monitoring, and benzodiazepines for severe agitation; the peak is 2 to 4 hours and effects last up to 12.

Heroin

• Opioid overdose: naloxone reverses respiratory depression; call emergency services first.

Ecstasy

• MDMA: hyponatraemia and overheating are the life-threatening risks.

Weed

• Cannabis: acute intoxication is managed with a calm environment, reassurance, and observation.

Cocaine

• Cocaine: benzodiazepines, oxygen, and rapid cooling in hospital; never with alcohol.

Alcohol poisoning

• Alcohol: recovery position, no caffeine or cold showers, and call emergency services.

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Finasteride

• Finasteride: harms can persist after stopping and involve broad neuroactive steroid disruption and gut inflammation; the recovery approach centers on thyroid, vitamin D, and pregnenolone.

SSRIs

• SSRIs: withdrawal is the main hazard; taper slowly and keep metabolism, progesterone, and pregnenolone support in place.

Birth control

• Birth control: synthetic progestins are not progesterone; the pill blunts stress recovery, raises copper, and is classified as carcinogenic by IARC.

Naloxone

• Naloxone: short courses of low-dose naloxone or naltrexone, for a few days at a time, target excess endorphins; not for continuous use.

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Unemployed

In a 2007-2012 NHANES analysis, free T3 among older adults was associated with unemployment and hours worked.

Pornography addiction

See Pornography.

Short-form video (TikTok/Reels/Shorts)

fMRI in 56 young adults found that watching a preferred, liked short-form video to completion deactivated the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, the regions responsible for cognitive control and impulse-stopping; disliked or skipped clips did not produce this effect. Resting glutamate levels in the dorsal anterior cingulate predicted how strongly a person's cognitive control shut down, with higher glutamate linked to less suppression. Over three months in 234 young adults, short-video addiction predicted rising loneliness, which raised anxiety and in turn lowered life satisfaction. Treat compulsive short-form scrolling as a real self-control drain, not just a time-waster; limiting exposure (app timers, removing apps, batching viewing) reduces the number of times this shutdown gets triggered.

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Gear/Steroids/PEDs - supraphysiological amounts

• Anabolic steroids: suppression of natural testosterone after use, estrogen and aromatase-inhibitor risks, cardiovascular and liver effects, and mood and brain effects; the page covers what the sources support.

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Weight Cutting / Dehydration / Making Weight

• Weight cutting: performance often recovers after regain, but the cut raises cortisol and aldosterone and lowers thyroid output; sodium and carbohydrate are the controllable variables.

Endurance training and testosterone

• Testosterone and exercise: six months of building to about 56 km of running per week lowered total testosterone and the free androgen index in previously sedentary men.

Overtraining & gut permeability

• Overtraining and gut permeability: intense or prolonged training diverts blood from the gut and raises permeability and endotoxin exposure; heat compounds it, and 1 g of vitamin C blunted the endotoxin rise.

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Heavy metals

• Heavy metals: reduce exposure and support clearance.

Tattoo

• Tattoos: ink drains to the lymph nodes and causes inflammation that persists for months; the sources describe no mitigation.

Carbon monoxide

• Carbon monoxide: after poisoning, carbon dioxide helps restore damaged cells, and thyroid hormone with good vitamin nutrition supports producing it.

Fluoride

• Fluoride: see the page for mechanism and adverse effects.

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X-ray

• Medical x-rays and scans: cumulative dose is rarely tracked, CT scans deliver hundreds of times the dose of a chest x-ray, and progesterone, vitamin A, aspirin, and vitamin E are the protective agents named. Caffeine is anti-inflammatory and antioxidant and speeds the kidney clearance of mobile isotopes in the blood.

Polypharmacy

Polypharmacy is the routine use of five or more medications by a single patient, most often an older adult managing several diagnoses at once. It is common rather than an edge case, and it carries real costs: more adverse drug interactions, a higher rate of cognitive impairment and delirium, worse treatment adherence as regimens become harder to follow, lower quality of life, and higher mortality.

A 2026 Iranian population-based study of 558 elderly patients (age 60+) with dyslipidemia found 20.8% met the threshold for polypharmacy (5 or more medications), and the odds rose sharply with each additional diagnosis stacked on top: a sharply higher likelihood with hypertension, diabetes, or existing cardiovascular disease, each comorbidity adding its own prescriptions rather than being folded into a shared underlying treatment.

The prescribing cascade

Much of polypharmacy builds itself: a drug's side effect gets mistaken for a new condition and treated with a second drug, which produces its own side effect, treated with a third. Each addition compounds the odds of an interaction no one modeled, since drug trials are run on single agents in relatively healthy volunteers, not on patients already taking four or five other medications for unrelated diagnoses.

Ray Peat on drug-based medicine

Peat's writing treats most named diseases as different surface expressions of a small number of underlying problems, mainly low metabolic rate, chronic stress, and unopposed estrogen; a medical system built around a separate drug for each symptom multiplies prescriptions instead of addressing what the symptoms have in common.

In fact, the old research going back 40 or 50 years shows that it is simply a temporary suppression of inflammatory symptoms while, in the long run, increasing the inflammatory degenerative processes.

— Ray Peat

Drug-industry economics is a reason older, cheap, and effective substances lose out to patentable synthetics. Natural progesterone cannot be patented; the industry's synthetic substitutes can:

In the 1940s, while Alexander Lipschutz was showing that progesterone could prevent cancer, and Katharina Dalton was starting to use it to treat PMS, the pharmaceutical industry was claiming that they had produced synthetic drugs more useful than progesterone during pregnancy, which they called progestogens.

— Ray Peat

Because aspirin has been abused by pharmaceutical companies that have competing products to sell, as well as by the original efforts to promote aspirin itself, people can easily find reasons why they shouldn't take it.

— Ray Peat

Thousands of well-meaning teachers and physicians helped to spread and perpetuate the fraudulent ideas originating with the corrupt pharmaceutical industry. (The U.S. Dept. of Justice and FBI found fraud in connection with research on diuretics, but it didn't affect the FDA's approval.)

— Ray Peat

Bioenergetic alternative

Addressing the shared mechanisms behind several diagnoses at once, such as low thyroid function, unopposed estrogen, or chronic stress, reduces the number of separate drugs a symptom-by-symptom approach would otherwise call for. This does not mean stopping prescribed medication unilaterally; abrupt discontinuation of some drug classes carries its own withdrawal risks that need medical supervision.

Practice

Medical diagnosis and management of existing prescriptions remain necessary; this is not a substitute for that. A periodic medication review with a treating physician or pharmacist, aimed at identifying drugs added to treat another drug's side effect, is a standard first step recommended in the polypharmacy literature.