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🧭 REBEL Rundown 🗝️ Key Points 💉 Hydrocortisone Saves Lives:The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.📊 Guidelines Are Catching Up:The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.🔥 Redefining “Severe”:Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.🍬 Main Risk = Hyperglycemia:Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.🧭 Early, Targeted Use Matters:Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response. Click here for Direct Download of the Podcast. 📝 Introduction Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). 📖 Historical Context & Long-Standing Skepticism For decades, the use of steroids in pneumonia was controversial.Early Use: Steroids entered practice in the 1940s and 50s for autoimmune inflammation, but there was immediate hesitation regarding secondary superinfections.Mixed Data: From the 1980s to the 2000s, small studies emerged on severe pneumonia and ARDS, but the data was inconsistent. Different trials used varying definitions of “severe” pneumonia and different C-reactive protein (CRP) cutoffs, making the data “spread” and easy to “cherry pick” to support or deny a benefit.Past Guidelines: This uncertainty was reflected in official guidelines:2007 (ATS/IDSA): The American Thoracic Society and the Infectious Diseases Society of America did not address the topic due to insufficient data.2019 (ATS/IDSA): Pre-COVID, the guidelines recommended against using corticosteroids in severe CAP. They acknowledged no benefit for non-severe pneumonia, but the data for severe pneumonia was considered too weak to endorse.Pre-Trial Consensus: Prior to 2023, the consensus was to avoid steroids in non-severe pneumonia, while severe pneumonia remained a “gray area” with no treatment showing a clear mortality difference. 📜 The Landmark Cape Cod Trial (NEJM 2023) The Cape Cod trial, published in the New England Journal of Medicine in 2023, reignited the discussion by providing robust, positive data.Trial Design: Phase 3, multi-center, double-blind, randomized, controlled trial.Intervention: 800 patients randomized to two groups, Hydrocortisone as a continuous infusion (200mg/day) versus a placebo infusion.Taper: On day 4, clinicians would decide whether to continue the infusion or begin a taper based on clinical response.Population: Patients with severe CAP, defined by meeting at least one of the following criteria:Pneumonia Severity Index (PSI) > 130.O2 by FiO2 ratio < 300.Need for mechanical or non-invasive ventilation (with PEEP ≥ 5).Need for high FiO2 (>50%) via non-rebreather or heated high flow.Primary Outcomes: Death for any cause 6.2% (hydrocortisone) vs 11.9% (placebo)Secondary outcomes:Death from any cause at 90 days 9.3% (hydrocortisone) vs 14.7% (placebo)Endotracheal intubation 18% (hydrocortisone) vs 29% (placebo)Hospital-acquired infections 9.8% (hydrocortisone) vs 11.1% (placebo)Gastrointestinal bleeding 2.3% (hydrocortisone) vs 3.3% (placebo)Vasopressor initiation by day 28 15.3% (hydrocortisone) vs 25.0% (placebo)Key Findings: The trial demonstrated superiority for hydrocortisone 📋 Updated Guidelines & Current Practice The Cape Cod trial, along with subsequent meta-analyses, has begun to change official recommendations.Society of Critical Care Medicine (SCCM): In 2024, an SCCM expert panel, reviewing the Cape Cod trial and 18 others, strongly recommended corticosteroids for severe CAP. They concluded that steroids reduce mortality and the need for mechanical ventilation.Meta-Analysis (Smit et al.): A 2024 meta-analysis in Lancet Respiratory confirmed the 30-day mortality benefit.European Respiratory Society (ERS): The ERS has issued a recommendation to use steroids for severe pneumonia but still urges caution regarding side effects.ATS/IDSA: As of the podcast recording, the ATS/IDSA had not yet updated their 2019 guidelines. 🛠️ Practical Application for Clinicians Defining “Severe” CAP: The key is to identify patients who qualify as “severe”. This can be done using:Scoring Tools: The PSI is the best validated tool for mortality but is cumbersome. Simpler tools like CURB-65 or SMART-COP are practical and acceptable for defining severity. 2023 meta-analysis from by Zaki et al showed both work well, but CURB-65 has better mortality prediction early on.Cape Cod Criteria: Any patient meeting the trial’s inclusion criteria (e.g., high-flow O2, non-invasive ventilation) qualifies, regardless of location (ED, floor, or ICU).Biomarkers: While not required, a CRP level was used in many studies. A CRP > 150 (Cape Cod) or > 204 (Smit meta-analysis) strongly indicates severe inflammation that would benefit from steroids.Clinical Judgment: A patient who looks “sick,” has “soft” blood pressure, or has dense infiltrates and high oxygen needs (e.g., >50% FiO2 on high flow) is a candidate.Adverse Effects:Hyperglycemia: This was the most significant risk identified, with rates between 6-12%. This is a primary concern, especially in patient populations with high BMI.GI Bleed & Secondary Infection: Fears of these side effects, which contributed to historical skepticism, were not borne out in the Cape Cod trial. The data does not support being overly concerned.Other Side Effects: Mood changes, delirium, insomnia, and agitation in the elderly are known side effects of steroids that were not specifically addressed in the trial but remain clinical concerns. 🔄 Clinical Pathway for Steroids in Severe CAP Unanswered Questions & Future Research Possible remaining questions:Biomarkers: Can we find a more precise CRP level to distinguish moderate from severe disease? Could other markers like ferritin or IL-6 be used? Dosing & Tapering: How much immunomodulation is needed, and when is it truly safe to taper?Gender Differences: Early data suggests females may respond better to steroids and experience fewer side effects. The question of female patients with severe CAP require less corticosteroids needs further exploration. 👉 Clinical Bottom Line The current literature, spearheaded by the Cape Cod trial, now supports the use of corticosteroids in severe community-acquired pneumonia. The best evidence currently points to hydrocortisone, started early (within 24 hours) after severity is identified using a validated tool. While hyperglycemia is a risk, the previous fears of GI bleeding and secondary infections were not substantiated in recent, rigorous trials. 📚 References Chapa-Rodriguez A, Abou-Elmagd T, O’Rear C, Narechania S. Do patients with severe community-acquired bacterial pneumonia benefit from systemic corticosteroids?. Cleve Clin J Med. 2025;92(10):600-604. PMID: 41033846Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023;388(21):1931-1941. PMID: 36942789Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024;52(5):e219-e233. PMID: 38240492 Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Alex Chapa, MD PGY 5 Pulmonary Critical Care Fellow Cape Fear Valley Medical Center Fayetteville NC 🔎 Your Deep-Dive Starts Here REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia Corticosteroids have long sparked debate in the treatment of bacterial ... Thoracic and Respiratory Read More The post REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia appeared first on REBEL EM - Emergency Medicine Blog.
In this encore episode, we highlight vitamin D₃ in gastrointestinal health, with a focus on intestinal barrier function and the gut-immune axis. We discuss how vitamin D is metabolized into its active form, 1,25-dihydroxyvitamin D, and how 1,25-dihydroxyvitamin D can support intestinal health, while highlighting intestinal mucosal anatomy.Topics:1. Introduction - Highlighting intestinal barrier function and the gut-immune axis with a focus on vitamin D₃ 2. Vitamin D Synthesis and Metabolism - Skin and 7-dehydrocholesterol; dietary intake.- Transported through the bloodstream bound to vitamin D binding protein.- First hydroxylation in the liver to form 25-hydroxyvitamin D₃ (25(OH)D₃).- Testing.- Second hydroxylation in the kidney to form the active 1,25 dihydroxyvitamin D₃ (1,25(OH)₂D₃).- Local activation also occurs. 3. Intestinal Barrier Anatomy - The intestinal epithelium forms a selectively permeable monolayer that interfaces with the gut lumen.- Covered by a mucus layer.- Tight junction proteins and paracellular permeability.- The lamina propria and Gut-Associated Lymphoid Tissue (GALT). - Maintaining tolerance. 4. Vitamin D - 1,25-dihydroxyvitamin D₃, tight junction integrity, immune regulation, and more. 5. Vitamin D₂ and D₃ 6. Conclusion - Neither too high nor too low: optimal levels.- Multifactorial: Numerous factors regulate vitamin D levels.- Gastrointestinal health root cause approach.Thank you to our episode sponsor: 1. "Longevity" with Protein, Probiotics, Bovine Colostrum, Collagen, and More. Use code CHLOE for 25% off.*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.Thanks for tuning in!Follow Chloe on Instagram @synthesisofwellnessVisit synthesisofwellness.com
In this episode of "PICU Doc On Call," Drs. Pradip Kamat and Rahul Damania discuss the acute management of a 14-year-old boy with severe rectal bleeding and hypertension, ultimately diagnosed with inflammatory bowel disease (IBD). They review the approach to pediatric lower GI bleeding, diagnostic workup, and imaging, emphasizing early recognition and resuscitation. They outline IBD management, including steroids, biologics such as infliximab, and nutritional support, while highlighting the importance of screening for infections before immunosuppression. The episode provides practical insights for PICU physicians on handling acute GI emergencies in children.Show Nighlights: Clinical case of a 14-year-old male with hypertension and rectal bleeding.Diagnosis of inflammatory bowel disease (IBD) following significant blood loss.Approach to pediatric rectal bleeding and its implications.Diagnostic workup including laboratory tests and imaging modalities.Management strategies for IBD in acute pediatric care.Importance of early recognition and resuscitation in cases of shock.Physiological principles related to blood loss and shock in children.Differential diagnoses for lower gastrointestinal bleeding in pediatrics.Initial evaluation and stabilization protocols for pediatric patients.Nutritional support and multidisciplinary care in managing IBD. References:Romano C, Oliva S, Martellossi S, et al. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. World J Gastroenterol. 2017;23(8):1326-1337.Pai AK, Fox VL. Gastrointestinal bleeding and management. Pediatr Clin North Am. 2017;64(3):543-561.Padilla BE, Moses W. Lower gastrointestinal bleeding and intussusception. Surg Clin North Am. 2017;97(1):63-80.Kaur M, Dalal RL, Shaffer S, Schwartz DA, Rubin DT. Inpatient management of inflammatory bowel disease-related complications. Clin Gastroenterol Hepatol. 2020;18(11):2417-2428.Ashton JJ, Ennis S, Beattie RM. Early-onset paediatric inflammatory bowel disease. Lancet Child Adolesc Health. 2017;1(2):147-158.Bouhuys M, Lexmond WS, van Rheenen PF. Pediatric inflammatory bowel disease. Pediatrics. 2022;150(6):e2022059341.Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015;169(11):1053-1060.Conrad MA, Rosh JR. Pediatric Inflammatory Bowel Disease. Pediatr Clin North Am. 2017 Jun;64(3):577-591.
Heart disease, dementia, depression, diabetes: what do these conditions have in common? Dr Will Bulsiewicz, a gastroenterologist and New York Times bestselling author, says the answer is inflammation. In today's episode, Will explains the four nutrition workhorses that can reduce inflammation, heal your gut and supercharge your immune system - in as little as 24 hours. We explore discoveries in Will's new book, Plant Powered Plus, that explain the central role inflammation plays in health. You'll learn which symptoms that seem unrelated, such as fatigue, skin breakouts, bloating, headaches, and joint pain, all share a common driver. You'll also hear why he believes the gut and the immune system rise and fall together, and how a weakened gut barrier may keep the immune system on constant alert. By the end of the episode, you will have a clear understanding of what inflammation is, how it can cause damage, and practical, food-first ideas to wrestle yourself from its clutches. What's one small change you could try this week? In your meals or your routine to help your body switch off “fight mode”? Unwrap the truth about your food
Dr. Centor discusses the comparative risk for severe gastrointestinal adverse events associated with dulaglutide, semaglutide, and tirzepatide with Dr. Wajd Alkabbani.
In this episode, we review the high-yield topic of Choledocholithiasis from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Paralytic / Adynamic Ileus from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Zollinger-Ellison Syndrome from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Splenic Laceration / Rupture from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Gastritis from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Pancreatic Pseudocyst from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Esophageal/Gastric Varices from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Nutritionist Leyla Muedin details key aspects of supplement use and addresses frequently asked questions. Topics include the importance of targeted supplementation, the rationale behind personalized dosages, best practices for starting new supplements, and managing common issues like nausea and bright yellow urine. Leyla also explains why some supplements may cause gastrointestinal discomfort and provides guidance on how to adjust dosages for optimal results. Emphasis is placed on the benefits of pharmaceutical-grade supplements available on Fullscript and the necessity of regular blood tests to fine-tune supplementation.
Intestinal ischemia refers to a group of conditions seen with inadequate blood flow to the intestines. This includes acute mesenteric ischemia and chronic mesenteric ischemia, affecting the small intestine, and ischemic colitis affecting the large intestine. We cover the anatomy, pathology and signs of symptoms of each form of intestinal ischemia, and also look at the diagnosis and treatment. PDFs available here: https://rhesusmedicine.com/pages/gastroenterologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Intestinal Ischemia (Ischemic Bowel Disease)0:18 Blood Supply of Intestines 1:36 Ischemic Bowel Disease Pathology2:36 Ischemic Bowel Disease Symptoms (Mesenteric Ischemia Symptoms / Ischemic Colitis Symptoms) 3:45 Intestinal Ischemia Risk Factors (Ischemic Bowel Disease Risk Factors)4:03 Ischemic Bowel Disease Diagnosis4:53 Ischemic Bowel Disease Treatment (Mesenteric Ischemia Treatment / Ischemic Colitis Treatment)LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesInnerBody, 2025. Blood supply of the intestines – Lower torso cardiovascular anatomy. [online] Available at: https://www.innerbody.com/anatomy/cardiovascular/lower-torso/blood-supply-intestines.National Center for Biotechnology Information (NCBI), 2020. Anatomy, Abdomen and Pelvis, Blood Supply of Small Intestine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK554527/.MSD Manuals Professional, 2025. Acute mesenteric ischemia – Gastrointestinal disorders / Acute abdomen and surgical gastroenterology. [online] Available at: https://www.msdmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia.Disclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.
An adult male patient reports chronic back pain that has been episodic in nature and has worsened in the last two weeks. The patient reports that the pain is exacerbated by food and radiates to the right shoulder. The patient also reports dark tarry stools. Which of the following conditions is MOST likely present? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects. #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy
Expert insights on athlete nutrition timing: GI issues, RED-S, PCOS, and fueling strategies. Learn about tailored snack recommendations. Q: What recommendations do you have for athletes experiencing amenorrhea or relative energy deficiency in sport (RED-S)? A (Dr. Curtis): While not a typical GI condition, amenorrhea and RED-S require a multidisciplinary approach. Often, medication is prescribed to induce a period, but this does not resolve underlying hormone imbalances or decreased bone density. These conditions frequently arise from an athlete's energy deficiency, such as a marathon runner not increasing fuel intake to match activity, leading the body to prioritize survival over non-essential functions like menstruation. Q: How can athletes add more fuel to help resolve amenorrhea? A (Poole): It's a myth that athletes should not get their period; it is not normal. Addressing overall energy intake is crucial. In severe cases, decreasing activity while increasing fuel might be necessary. We often work with athletes who are injured or returning to sport, which provides an opportune time to address their fueling needs. Q: How do you address athletes dealing with PCOS and stress fractures? A (Dr. Curtis): The culture of sports often pressures athletes toward specific body images or weight classes, which is unhealthy. We must educate athletes that a balanced diet is acceptable and that restrictive diets are not always necessary. Coaches also play a role in fostering a healthier environment. Q: How do you approach discussing sensitive topics like nutrition and body image with athletes? A (Dr. Curtis): As a former pediatric sports medicine doctor, I learned the importance of creating a trusting and safe environment. While it's harder to have parents leave the room now in full sports medicine, fostering trust is key. A (Poole): We focus on the athlete's performance goals, as health often isn't the primary motivator for adolescents. We seek out what truly motivates them to achieve their best performance through proper nutrition. Q: What are the best snack recommendations for athletes? A (Bri Poole): Snack recommendations are highly individualized based on what works and what an athlete enjoys. Simple, easily digestible options like GoGo Squeez are generally safe choices. Q: Are there specific snacks you recommend for gastrointestinal (GI) comfort during exercise? A (Dr. Curtis): I don't have specific go-to snacks; the focus is on what an individual athlete likes and what doesn't cause GI distress. Suggesting foods they are unwilling to eat can lead to non-compliance. A (Poole): Simple carbohydrates are typically easy on the GI system around exercise. It's best to stick with foods the athlete has consumed before. Liquid carbohydrates can be a good option as they may sit better for some. While many believe "sugar is bad," simple sugars are the body's preferred fuel source during exercise. Q: Should athletes track their food intake? A (Poole): Some athletes have higher or different energy needs, even if they aren't playing intensely. Athletes generally have elevated caloric demands. It's perfectly fine for them to eat snacks, especially when readily available, such as on the sidelines. Q: How do you approach nutrition planning for athletes from diverse cultural backgrounds or those who observe religious practices like Ramadan? A (Poole): Always approach with an open and curious mindset. Ask questions to understand cultural practices better, especially regarding fuel timing within non-fasting windows. Work closely with the athlete to create a tailored plan. A (Dr. Curtis): Meet athletes where they are; you cannot simply forbid them from fasting. I am willing to write letters to coaches if training times need to be adjusted to accommodate an athlete's practices, ensuring they can continue to play safely. Q: How does pre-exercise nutrition differ for a morning lift versus a morning run? A (Poole): Many runners prefer not to eat before a run. For shorter runs (e.g., 5 miles or 3k), it can be acceptable if the athlete had sufficient fuel the day prior and will refuel adequately post-run. However, for exercise lasting 50-90 minutes or longer, pre-exercise fuel is essential, particularly for running due to its impact on bone resorption. The specific goals of the runner (e.g., marathon training) also influence recommendations.
This week's episode will be focusing on gastrointestinal stromal tumors, known as GIST with a 2025 update. We will go over important details on the diagnosis, mutations, and treatment of local and metastatic GISTs.
In this encore episode, we highlight key roles that zinc plays in supporting various aspects of mucosal barrier integrity, while detailing the structure of the intestinal mucosal barrier. We detail key anatomical features, including the mucus layer, epithelial cells, and tight junctions, before discussing zinc's physiological roles, its relationship with copper, and factors that can affect zinc levels. The discussion further details mechanistic features of zinc absorption as well as specialized forms such as zinc carnosine.Topics:1. Introduction - Overview of intestinal hyperpermeability and intestinal barrier function- Highlighting the role of zinc 2. Intestinal Barrier Anatomy - Four major layers: mucosa, submucosa, muscularis externa, serosa- Mucosa subdivisions; focus on epithelium 3. The Mucus Layer - Location over the epithelial surface- Composition: mucin-rich, secreted by goblet cells- Goblet cell mucin storage and expansion upon hydration- Functions: trapping pathogens, lubricating epithelium, housing molecules including secretory IgA- Small intestine mucus - Large intestine mucus 4. The Intestinal Epithelium - Monolayer of epithelial cells: enterocytes, goblet cells, and more- Tight junctions, paracellular transport - Continuous epithelial renewal 5. Introduction to Zinc - Zinc as a trace mineral required in minute quantities for numerous physiological processes - Second most abundant trace mineral after iron; majority stored in muscle and bone- Maintaining plasma and intracellular zinc concentrations within narrow range- Both deficiency and excess can disrupt biochemical processes 6. Zinc and Copper - Zinc and copper as closely interconnected minerals- Zinc, copper, and metallothionein binding in enterocytes- Both high and low zinc can disrupt zinc-copper balance- Metallothionein as a cysteine-rich metal-binding protein 7. Factors Affecting Zinc Levels - Multifactorial- Possible signs of low zinc status 8. Zinc Absorption - Dietary sources- Primary absorption in small intestine - In the stomach: HCl and pepsin denature proteins and cleave peptide bonds, releasing zinc from protein complexes- Dietary zinc often bound within tertiary protein structure- Specialized transporters 9. Zinc's Role in the Intestinal Barrier - Zinc and tight junction proteins- Zinc and Intestinal Epithelial Cells - Zinc and the mucus layer 10. Broader Context of Zinc in Physiology 11. Zinc Carnosine - Molecular complex of zinc and carnosine- L-carnosine composed of beta-alanine and L-histidine- Gastrointestinal context 12. Conclusion - Multifactorial and multi-system.Thank you to our episode sponsor: 1. Shop O-Liv High Phenolic Extra Virgin Olive Oil and O-Liv's Olive Oil Supplement. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.Thanks for tuning in!"75 Gut-Healing Strategies & Biohacks" Follow Chloe on Instagram @synthesisofwellnessVisit synthesisofwellness.com
Recorded on November 27, 2025 Book talk begins at 20:40 After 14 years and over 300 episodes, we have made the decision to wind down the podcast over the next year and finish in September 2026, our fifteenth anniversary. We have loved making the podcast and all of the people it has brought into our lives! We want to assure you that this decision wasn't made because of any kind of health reasons - we are simply both feeling that it's time to bring the project to a close. What we don't want to see end is our wonderful community - we will continue to see you on our Ravelry boards, at fiber events throughout the year, and on our weekly Zoom call on Saturdays at noon PST! Our 2025-2026 Fall Sweater KAL has begun and will go until January 15, 2026. You must be a member of this group to enter You must make an adult size sweater. If you have a sweater that is 50% finished or less, you can finish that sweater during our KAL Need some inspiration? We have bundles! Beginner Sweaters Bundle Adventurous Beginners to Advanced Sweater Bundle Crochet Sweaters Bundle Coming Events: New Year Fiber Retreat - January 1-4 in San Juan Bautista, CA TKGA retreat - November 6-9 in San Francisco, CA NoCKRs retreat April 10-13 in San Juan Bautista, CA KNITTING Barb has finished: 1. One Row Scarf (adopted from Stephanie Pearl McFee) using a Caron Cake 2. Bankhead Hat #35 Tracie Has Finished: 1. Carnegie Vest by James Magee (from Stitching in the Stacks) using Neighborhood Fiber Co. Studio Sport in the Sheridan Circle colorway 2. Swaddle Pal (cat) by Susan B. Anderson using assorted acrylic DK yarns 3. Leni Hat #1 by Isabelle Kraemer in Malabrigo Rios in Rheinhessen Caramel colorway 4. Leni Hat #2 by Isabelle Kraemer in Malabrigo Rios in the Aquamarine colorway 5. 2 Tubey Hats by Wooly Wurmhead in Hayfield Spirit in Sundown 6. I was a Teenage Mutant by Alex Tinsley from Doomsday Knits in Lisa SouzaBlue Faced Leicester Worsted in Styx Barb has cast on: 1. One-Row Scarf #2 Stephanie Purl McPhee using a Caron Cake 2. Pivot Cowl by Purl Soho using Duren Dyeworks in Contenment DK Tracie has cast on: 1. Nice to Gnome You by Sarah Schira using assorted scrap yarn Barb is still working on: 1. Colorwork Dip pullover by Suvi Knits, using 2 colors of Berocco Light in the Mist and the Peony colorway 3. Flax Sock pullover by Tin Can Knits, using Wonderland Dyeworks Smitten in the Deep Lilac colorway Tracie continues to work on: 1. Vanilla socks with FLK heel in Dreaming of Hue 75%SW Merino/25% Nylon in Unicorn Tales 2. Brooklyn Raglan Light* by Tori You in Mod Yarn Fingering 101 in Angeline 3. Ruby's Ruby Sweater, using the Darling Darby pattern by Jean Clement in Plymouth Encore Starz 4. #991 Neck Down Pullover for Men by Diane Soucy in Berroco Remix Chunky in the Fern colorway BOOKS Barb has finished: 1. The Frozen River by Ariel Lawhon - 4.5 stars 2. The Burgess Boys by Elizabeth Strout - 4 stars Tracie has finished: 1. The Various Haunts of Men by Susan Hill - 2 stars 2. All That is Mine I Carry with Me 3. The Mother Next Door: Medicine, Deception and Munchausen by Proxy by Andrea Dunlop - 5 stars 4. Skeleton Road (Inspector Karin Pirie #3) by Van McDermid 5. We Are All the Same in the Dark by Julia Heaberlin Tracie recommendeds content creators therapyjeff, willhitchins, professor_neil, and thespeechprof who all post reels calling out misogyny and poor male treatment of women.
The weight loss medication debate has taken a fascinating turn as public figures continue to grapple with the decision to use drugs like Ozempic and Wegovy. Oprah Winfrey, one of America's most influential personalities, has found herself at the center of this conversation, and her stance reveals the complex relationship many people have with these powerful pharmaceutical tools. For years, Oprah publicly resisted using Ozempic, stating that she felt taking the medication would be taking the easy way out. However, she later revealed that she had lost forty pounds using a weight loss medication, creating a significant shift in her public messaging that sparked considerable backlash from critics who pointed out this apparent contradiction to her earlier statements about the easy way out.The emergence of GLP-1 drugs like semaglutide, marketed as Ozempic, has fundamentally changed how we think about weight management. These medications work by suppressing appetite while you are taking them and stabilizing blood sugar levels. The science behind these drugs is compelling. A landmark clinical trial from 2021 published in the New England Journal of Medicine tested once weekly semaglutide at two point four milligrams in adults with overweight or obesity. Participants lost far more weight than those on placebo, achieving the kind of weight loss previously seen only after bariatric surgery. Beyond weight reduction, research from 2023 and 2024 found that semaglutide reduced major cardiovascular events including heart attack and stroke in people with overweight or obesity and existing heart disease, effectively moving the drug out of cosmetic territory and into life saving potential for specific patients.However, the medication comes with significant downsides that listeners should understand. Gastrointestinal side effects are not rare but rather expected. Nausea, vomiting, constipation and diarrhea affect most users, with higher doses associated with increased risks of these symptoms. These side effects represent the number one reason people discontinue the medication. Additionally, once patients stop taking the drug, hunger signals return to normal, metabolism shifts back, and many people regain some or most of the weight they lost. This is why doctors emphasize the importance of long term lifestyle changes alongside medication use.Other public figures have shared their experiences with these drugs. Elon Musk revealed using Wegovy specifically for weight loss and fitness benefits, while Tracy Morgan joked openly about being on Ozempic and losing weight like crazy. Amy Schumer admitted to trying Ozempic but quit because side effects made daily life unbearable. Sharon Osbourne publicly discussed losing too much weight on Ozempic and struggling to regain it. These varied experiences highlight that individual responses to GLP-1 medications differ significantly.The broader cultural moment surrounding Ozempic reflects how normalized GLP-1 culture has become in recent years. Social media has accelerated speculation about whether various celebrities use these drugs, with some attributing every photograph showing weight loss to semaglutide use. This tendency reveals an important problem with how we discuss body changes and medical treatments in the public sphere. Weight fluctuations at any age can result from exercise, hormones, stress, camera angles, health events, fashion and styling choices, none of which require a prescription.Ozempic remains neither a miracle nor a menace but rather a powerful medical tool that can change lives for better or worse depending on how and why it is used. The medication should only be prescribed after proper screening for heart, kidney and endocrine issues. Doctors warn against taking it before major events like weddings or holidays, obtaining it through questionable online pharmacies, or using it purely for cosmetic transformation. These drugs require genuine medical supervision and serious consideration.Thank you for tuning in to this episode. Please come back next week for more in depth coverage of health and wellness topics. Thanks for listening, please subscribe, and remember, this episode was brought to you by Quiet Please podcast networks. For more content like this, please go to Quiet Please dot Ai.Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI
On this episode, Dr. Chandler Wilfong and Dr. Edward Cho of the Gastrointestinal Cancer Program at OSF Healthcare join the podcast to discuss their work in expanding access to GI cancer care. They share how their nursing navigation program supports patients throughout the care journey, efforts to streamline services for greater convenience, and their plans to scale and broaden reach across the health system.
Featuring perspectives from Dr Tanios Bekaii-Saab and Dr Kristen K Ciombor, including the following topics: Introduction: Assessment of HER2 Status (0:00) Case: An otherwise healthy woman in her early 50s with HER2-positive metastatic gallbladder cancer and multiple intrahepatic metastases — Jeremy Lorber, MD (7:33) Case: A man in his late 60s with HER2-low metastatic gallbladder cancer — Brian P Mulherin, MD (11:58) Data Review: Biliary Tract Cancers (18:19) Case: A man in his mid 50s with HER2-positive metastatic rectal cancer — Sunil Gandhi, MD (26:25) Case: A woman in her early 60s with recurrent HER2-positive rectal cancer — Ranju Gupta, MD (31:31) Data Review: Colorectal Cancer (34:16) Case: An otherwise healthy man in his mid 50s with HER2-positive metastatic gastroesophageal junction cancer and several metastatic liver lesions — Shachar Peles, MD (38:06) Case: A man in his early 60s with recurrent HER2-positive, claudin 18.2-positive metastatic esophageal cancer — Susmitha Apuri, MD (43:21) Data Review: Gastroesophageal Cancer (46:55) Case: A man in his early 60s with HER2-positive esophageal cancer and isolated brain metastases — Priya Rudolph, MD, PhD (50:07) CME information and select publications
Dr Tanios Bekaii-Saab and Dr Kristen K Ciombor summarize the treatment landscape and review key datasets in consideration of HER2-directed therapies for patients with HER2-positive gastrointestinal cancers. CME information and select publications here.
Dr Tanios Bekaii-Saab and Dr Kristen K Ciombor summarize the treatment landscape and review key datasets in consideration of HER2-directed therapies for patients with HER2-positive gastrointestinal cancers. CME information and select publications here.
Dr Tanios Bekaii-Saab and Dr Kristen K Ciombor summarize the treatment landscape and review key datasets in consideration of HER2-directed therapies for patients with HER2-positive gastrointestinal cancers. CME information and select publications here.
You don't want to solve for this Y, Junior. Not on a full stomach, anyway.We have a lovely set of internet reviews this week, including (but not limited to) Fruit Pebble flavored Sparking Water from Liquid Death, fake mustaches' ability to absorb pacific northwestern goo, being a true human being in 'Wreck It Ralph', and a banana-based health supplement. We also do a deep dive into the late Ace Frehley's concert vibes on Momento Moreview. Do the math!Want more party? Check it out at https://www.reviewpartydotcom.com/ !
In this episode, we review the high-yield topic of Alcoholic Liver Disease from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Hepatitis from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Gastrointestinal bleeding is a frequent and potentially life-threatening presentation in the ED. With CT angiography increasingly being used as a first-line diagnostic tool, are we improving detection or simply overusing imaging? Join Dr. Guillaume as she discusses this recent JAMA Network Open study examining trends in CTA utilization for GI bleeding and whether rising scan rates are truly leading to better diagnostic yield.
In this episode, we review the high-yield topic of Hepatic Encephalopathy from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Outcomes of Left Atrial Appendage Occlusion in Patients With and Without Gastrointestinal Bleeds.
In this episode, we review the high-yield topic of Diarrhea from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Having to “Go” has long been the enemy of runners everywhere, but might it hold the key to unlocking higher performance? While any runner can attest to how critical a well placed porta potty can be to performance, few realize the powerful science backing it up. Today on The Shakeout Podcast we're joined by Dr. Chia Hua Kuo, professor in the department of health and physical education at the Education University of Hong Kong, to explore how defecation could play a powerful role in endurance sport. From fatigue delay to enhanced cognition, you'll never look at your pre-race ritual the same way again.This episode of The Shakeout Podcast is part one in a special two part series on Taming the Tummy: How runners of all ability levels can take control of the Gastrointestinal health to feel better in training and maximize performance on race day. Stay tuned for part two, where we'll connect with Registered Dietitian Jessalyn O'Donnell to learn how we can apply the science behind GI distress to training, racing, and everyday life.Subscribe to The Shakeout Podcast feed on Apple, Spotify, YouTube or wherever you find your podcasts.Huge thank you to this week's sponsor Smartwool. Join the Smartwool mailing list to receive updates and 15% off your first purchase. https://bit.ly/4hCway5 Conditions apply: Valid on regular-priced items. Can., 16+. Initial registration only. See terms for details.
In this episode, we review the high-yield topic of Proton Pump Inhibitors from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Zollinger-Ellison (ZE) Syndrome from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Crohn's Disease from the Gastrointestinal section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Following a fruitful European Society of Medical Oncology (ESMO) Congress 2025 for gastrointestinal malignancies, CancerNetwork® organized an X Spaces discussion hosted by 3 experts. They were Nicholas J. Hornstein, MD, an assistant professor at the Donald and Barbara Zucker School of Medicine of Hofstra University and Northwell Health; Timothy Brown, MD, an assistant professor in the Department of Internal Medicine and the associate program director of the Hematology & Oncology Fellowship at UT Southwestern Medical Center; and Udhayvir S. Grewal, MD, an assistant professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Each doctor focused on a specific disease type, highlighting the most important abstracts in colorectal cancer, pancreatic neuroendocrine tumors (NETs), and upper gastrointestinal cancers. The Phase 3 MATTERHORN Trial (NCT04592913) Results from MATTERHORN demonstrated that adding durvalumab (Imfinzi) to 5-fluorouracil, leucovorin (folinic acid), oxaliplatin, and docetaxel (FLOT) improved overall survival (OS) compared with FLOT plus placebo in patients with resectable gastric/gastroesophageal junction (GEJ) adenocarcinoma, regardless of pathological status.1 In the intention-to-treat population, the median OS was not reached in either arm, and the hazard ratio (HR) was 0.78 (95% CI, 0.63-0.96; P = .021). Notably, the improvement was observed regardless of PD-L1 status; in patients with PD-L1–positive disease, the HR was 0.79 (95% CI, 0.63-0.99), and in patients with PD-L1–negative disease, the HR was 0.79 (95% CI, 0.41-1.50). “This, I believe, will seal durvalumab plus FLOT as the standard of care for resectable [gastric/GEJ] cancers,” said Brown. The Observational ASPEN Study (NCT03084770) The ASPEN study showed that active surveillance was a safe approach for patients with low-grade, asymptomatic, nonfunctioning pancreatic neuroendocrine tumors (NETs) fewer than 2 centimeters in size.2 Of the 1000 patients enrolled in the trial, 20 patients died, of whom 18 underwent active surveillance and 2 underwent surgery. Nineteen of the deaths were unrelated to pancreatic NETs; 1 death in the surgery arm was related to a pancreatic NET. After surgery, 5 patients had disease relapse or progression. With a median follow-up of 42 months (IQR, 25-60), the OS analysis showed a P value of 0.530. “This really settles the debate on whether or not to surgically operate on patients with a [pancreatic NET] size of [fewer] than 2 centimeters and shows that active surveillance is a safe option for these patients with pancreatic NETs [fewer] than 2 centimeters in size and non-functional NETs,” said Grewal. Data From the Phase 2/3 FOxTROT (NCT00647530) and Phase 2 NICHE-2 (NCT03026140) Trials Neoadjuvant nivolumab (Opdivo) plus ipilimumab (Yervoy) achieved a clinically meaningful and statistically significant improvement in long-term outcomes, including responses and survival, compared with chemotherapy strategies in patients with mismatch repair deficient (dMMR) or microsatellite instability–high (MSI-H) locally advanced colon cancer.3 In NICHE-2, neoadjuvant nivolumab plus ipilimumab achieved a 3-year disease-free survival (DFS) rate of 100% compared with 80% (95% CI, 73%-85%) with all chemotherapy strategies in FOxTROT (P
Gastrointestinal complications are common—but often underrecognized—after lung transplantation. From diarrhea and nausea to malabsorption and poor appetite, these challenges can seriously impact recovery and long-term health outcomes.In this episode of the DNS Podcast, host Christina Rollins speaks with Bridget Doyle, MS, RD, LDN, CNSC, a transplant dietitian specializing in lung transplant nutrition. Bridget shares her expertise on identifying, managing, and supporting patients through complex GI issues post-transplant.Listeners will gain insights on:✅ The most frequent GI complications following lung transplant✅ How medications like immunosuppressants and antibiotics affect digestion✅ Practical nutrition strategies for diarrhea, nausea, and poor intake✅ Food safety guidance for immunocompromised patients✅ When to consider enteral or parenteral nutrition support✅ Key labs and nutrients to monitor for optimal recoveryTune in to hear evidence-based strategies for improving GI health and supporting successful long-term outcomes for transplant recipients. Visit us at dnsdpg.org to learn more.
Turns out when federal workers stay home, America keeps right on trucking. But while Washington idles without consequence, David stumbles into actual operational chaos at Rhode Island's mysterious "Preserve," where he survives a surreal evening featuring purple-coated moguls, hostage-taking hospitality staff, disappearing celebrity chefs, militant scheduling protocols, and Hobbit houses under armed guard. Think Goodfellas meets boutique hotel meets witness protection program, with a side of free-range rams.Then the conversation turns to Colorado's Taco Bell Ultra Marathon—a 31-mile gastrointestinal minefield where runners must consume nine Taco Bells worth of food while maintaining forward momentum. Mandatory chalupa supremes, crunchwrap supremes, burrito supremes, and nachos Bellgrande—all while your body screams for mercy and every exit strategy becomes a potential biohazard. Optional "challenges" include bathing everything in Diablo sauce and doing a Diablo shooter at the finish line, plus chugging two liters of Baja Blast without vomiting.
In this episode, we review the high-yield topic of Angiodysplasia from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic Alcoholic Liver Disease from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic Mallory-Weiss Tear from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
A 52-year-old patient reports persistent midthoracic back pain that worsens at night and improves with antacid use. Which of the following actions is MOST appropriate? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects. #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy
Inflammatory bowel diseases remain challenging for medicine, subjecting many to lifelong healthcare expenses and debilitating complications DMSO is an "umbrella remedy" treating diverse ailments through reducing inflammation, improving circulation, and reviving dying cells, making it uniquely suited for treating gastrointestinal disorders Extensive data shows DMSO produces incredible results for inflammatory bowel disorders (Crohn's disease, ulcerative colitis, IBS, diverticulitis, leaky gut syndrome, SIBO) and effectively protects gastrointestinal tissues from a wide range of otherwise lethal stressors Data also supports using DMSO for severe GI tract issues (gastritis, peptic ulcers, liver cirrhosis, cholecystitis, pancreatitis, peritonitis, amyloidosis) and problems like hemorrhoids and prostate enlargement This article will review how DMSO can be used to treat those conditions
In this encore episode, we detail hydrogen sulfide (H₂S)-dominant small intestinal bacterial overgrowth (SIBO), focusing on intestinal motility. We briefly review anatomy, focusing on and detailing the interplay between structures supporting motility. Lastly, we detail possible symptoms of hydrogen sulfide-dominant SIBO as well as possible overlap between or among subtypes.Topics:1. Introduction to Hydrogen Sulfide-Dominant SIBO - Overview of hydrogen sulfide (H₂S) SIBO - H₂S production - Sulfur-containing amino acids - Physiological roles of H₂S vs. in excess 2. Hydrogen Sulfide and Gastrointestinal Motility - Possible impact on transit - Possible association with IBS-like symptoms in excess 3. Anatomy: Intestinal Motility - ENS as the "second brain" - Myenteric and submucosal plexuses: regulation of peristalsis, secretion, blood flow - Gut-brain axis involvement - ICCs as pacemaker cells - MMC's role in clearing debris and bacteria 4. Dysregulated Motility and SIBO5. Overlap Across SIBO Subtypes - Possible symptoms - Hydrogen and H₂S-dominant SIBO vs. IMO 6. Gastric Acid and Its Role - HCl secretion by parietal cells and its role in digestion and microbial defense - Hypochlorhydria 7. Conclusion - Root cause approach.Thank you to our episode sponsor: 1. OmneDiem®'s Histamine Digest® and Histamine Digest® PureMAX : Use code STXAL9VI for 15% off.2. Histamine Digest® Histamine Complete with DAO, Vitamin C, Quercetin, Bromelain, and Stinging Nettle Root Extract: Use code STXAL9VI for 15% off.Get Chloe's Book Today! "75 Gut-Healing Strategies & Biohacks" Follow Chloe on Instagram @synthesisofwellnessVisit synthesisofwellness.com
Get the AD-FREE version of my sessions - PLUS playlists, repeat options, offline access, and THOUSANDS more sessions for day, sleep, and deep 4-hour sleep at https://www.freehypnosis.app Unlock your body's natural ability to heal gastritis, IBS, inflammation, and food sensitivities with this powerful daytime hypnosis session.
Get the AD-FREE version of my sessions - PLUS playlists, repeat options, offline access, and THOUSANDS more sessions for day, sleep, and deep 4-hour sleep at https://www.freehypnosis.app Experience deep, natural healing with this guided meditation designed to soothe and restore your gut. Whether you're struggling with IBS, gastritis, food sensitivities, or chronic inflammation
Durante seis días, se reunirán reconocidos talentos nacionales e internacionales en un festival que rinde homenaje a la riqueza culinaria global, fusionando sabores e ingredientes de todo el mundo con la esencia de la cocina mexicana. Hosted on Acast. See acast.com/privacy for more information.
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