Podcasts about hscrp

Send us a textDr. Michael Koren joins Kevin Geddings to discuss how Knowledge is Power - especially when it comes to medicine. The doctor explains how diagnostic tests like high sensitivity C-reactive protein (HSCRP) empower physicians and patients by giving insight into heart attack and stroke risk. Dr. Koren also tells us that even simple things like knowing you are in a research study can improve patient outcomes, and that knowledge is the guiding principle in medicine.Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on Apple PodcastsWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramX (Formerly Twitter)LinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

In this episode of the RWS Clinician's Corner, Margaret talks with Chris Burres—a scientist, inventor, podcast host, and trained improv comedian—who brings a fresh, accessible perspective to complex chemistry. Chris is the founder of MyVitalC and the driving force behind ESS60, a molecule born from Nobel Prize-winning research, known for delivering the longest lifespan extension ever recorded in lab settings—an astonishing 90%. Margaret and Chris dive deep into the origins and science behind ESS60, exploring its clinical applications, real-world potential, and the crucial red flags to watch out for when sourcing it.   In this interview, we discuss:       -Unique properties and scientific relevance of ESS60      -Scientific studies and research - with reported improvements in sleep, energy, and focus      -ESS60's role in mitochondria and antioxidant capacity      -Differences between ESS60 and C60 — quality, sourcing, and background      -Manufacturing and natural occurrence of ESS60      -Safety, dosing, and usage guidelines The Clinician's Corner is brought to you by Restorative Wellness Solutions.  Follow us: https://www.instagram.com/restorativewellnesssolutions/   Connect with Chris Burres: Website: https://www.myvitalc.com/ Instagram: https://www.instagram.com/myvitalc/ YouTube: https://www.youtube.com/@MyVitalC/featured TikTok: https://www.tiktok.com/@myvitalc   MyVitalC Product Offer for RWS community: $15 off coupon with this link: https://www.myvitalc.com/rws/    Get 18 Tips by 50+ Experts Biohacking Tips here: https://www.myvitalc.com/biohacking-tips/   Timestamps:  00:00 From Scientist to Health Advocate 07:28 ESS60: From Toxicity to Longevity 13:41 "Addressing Exercise-Induced Inflammation" 19:14 "ESS60: Shielding Against Cellular Damage" 25:40 Supplement Industry Quality Concerns 27:06 Ensuring Safe C60 Market Entry 33:48 Addressing Anti-Inflammatory Protocols 41:39 Knee Pain Relief Success 43:08 Mitochondrial Health and Complementary Supports 51:41 Distributor's Discovery: Pet-Inspired Product Use 56:38 Impactful C60 Product Testimonial 01:01:19 Training Nutrition Strategy: MCT and ESS 60 01:08:56 "Impact Lives, Share Insights" Speaker bio: Published author, host of the Uncovering the Secrets to Longevity Health Summit, podcast host and patent holder with a surprising twist – he's not just a visionary scientist but also a master of comedy improv. Chris Burres is the founder and chief scientist at MyVitalC, where he manufactures a Nobel Prize winning molecule responsible for the single longest longevity experimental result in history, a full 90% extension of life. He is the intersection where science meets laughter and his life's mission is to help people live longer, healthier, happier, pain-free lives with science. Keywords: ESS60, C60, MyVitalC, mitochondrial health, longevity science, oxidative stress, antioxidants, inflammation, HSCRP, functional health professionals, bioavailability, clinical applications, rat studies, Nobel Prize molecule, supplement safety, research studies, human trials, animal studies, red flags supplements, practitioner protocols, cancer research, mitochondrial buffering, oxidative stress system, glutathione, melatonin, reactive oxygen species, sleep improvement, exercise recovery, supplement industry standards, fullscript integration, practitioner wholesale accounts Disclaimer: The views expressed in the RWS Clinician's Corner series are those of the individual speakers and interviewees, and do not necessarily reflect the views of Restorative Wellness Solutions, LLC. Restorative Wellness Solutions, LLC does not specifically endorse or approve of any of the information or opinions expressed in the RWS Clinician's Corner series. The information and opinions expressed in the RWS Clinician's Corner series are for educational purposes only and should not be construed as medical advice. If you have any medical concerns, please consult with a qualified healthcare professional. Restorative Wellness Solutions, LLC is not liable for any damages or injuries that may result from the use of the information or opinions expressed in the RWS Clinician's Corner series. By viewing or listening to this information, you agree to hold Restorative Wellness Solutions, LLC harmless from any and all claims, demands, and causes of action arising out of or in connection with your participation. Thank you for your understanding.  

Send us a textDr. Trevor Greene joins Dr. Michael Koren to discuss the effects of inflammation on the cardiovascular system. The two cardiologists talk about biomarkers that have increasing importance: including liporprotein(a) and hsCRP. The doctors finish up with actionable lifestyle changes everyone can implement. Koren's Key Takeaways:Inflammation plays a big role in the bodyChronic inflammation influences cardiovascular diseaseThe predictive value of hsCRP is being investigated nowBe a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on Apple PodcastsWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramX (Formerly Twitter)LinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

The Integrative Cancer Solutions podcast, hosted by Dr. Karlfeldt, introduces Chris Burres, the chief scientist at My Vital C. They discuss a groundbreaking molecule called ESS 60, discovered in 1985 by scientists at Rice University. This molecule, shaped like a soccer ball with 60 carbon atoms, initially found use in industrial applications before its potential health benefits were uncovered. A toxicity study on Wistar rats revealed that ESS 60 extended their lifespan by 90%, shifting focus towards its health applications. Users of the My Vital C product containing ESS 60 report improved mental focus, increased energy, and better sleep. The molecule has shown promise in preventing tumor growth in rats and potentially enhancing the efficacy of anticancer agents. However, it's important to note that while ESS 60 is not claimed to cure cancer, it's suggested as a possible cancer preventative. The manufacturing process for ESS 60 is complex and expensive, involving the vaporization of graphite rods in a vacuum chamber, which emphasizes the importance of high-quality production. The recommended dosage is one teaspoon daily, preferably in the morning, with olive oil serving as a carrier to improve bioavailability. Recent studies have shown that the product can reduce high-sensitivity C-reactive protein (hsCRP) levels in four to six weeks, which is an important indicator of overall health and cancer risk. The company behind My Vital C is committed to ongoing research and transparency, offering different oil options (olive, avocado, and MCT) for consumers and providing additional information through their book, "Live Longer and Better."ESS 60, a molecule discovered in 1985 and shaped like a soccer ball with 60 carbon atoms, has shown potential health benefits including extending the lifespan of rats by 90% in toxicity studies.Users of My Vital C, which contains ESS 60, report improved mental focus, increased energy, and better sleep quality.While not claimed to cure cancer, ESS 60 has demonstrated tumor growth prevention in rats and may enhance the efficacy of anticancer agents.The recommended dosage is one teaspoon daily, preferably in the morning, with olive oil as a carrier to improve bioavailability.Recent studies indicate that the product can reduce high-sensitivity C-reactive protein (hsCRP) levels in 4-6 weeks, which is an important indicator of overall health and cancer risk.----The Cancer Revolution: https://www.amazon.com/s?k=the+cancer+revolution+by+dr.+leigh+connealy+book&crid=2GS09LV93ONK5&sprefix=The+Cancer+Revolution%2Caps%2C199&ref=nb_sb_ss_ts-doa-p_2_21Be Perfectly Healthy: https://www.amazon.com/s?k=be+perfectly+healthy+dr+connealy&crid=30H1M792AF1Q6&sprefix=be+perfectly+healthy%2Caps%2C142&ref=nb_sb_ss_ts-doa-p_1_20----Website: https://www.drrobertwhitfield.com/Youtube: https://www.youtube.com/@breastimplantillnessexpertApple Podcast: https://podcasts.apple.com/us/podcast/explant-breast-surgery-recovery/id1678143554Grab my book A Better Way to Treat Cancer: A Comprehensive Guide to Understanding, Preventing and Most Effectively Treating Our Biggest Health Threat - https://www.amazon.com/dp/B0CM1KKD9X?ref_=pe_3052080_397514860 Unleashing 10X Power: A Revolutionary Approach to Conquering Cancerhttps://store.thekarlfeldtcenter.com/products/unleashing-10x-power-Price: $24.99-100% Off Discount Code: CANCERPODCAST1Healing Within: Unraveling the Emotional Roots of Cancerhttps://store.thekarlfeldtcenter.com/products/healing-within-Price: $24.99-100% Off Discount Code: CANCERPODCAST2----Integrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com

Send us a textCardiologist and research scientist with ENCORE Research Group, Dr. Michael Koren highlights the importance of monitoring your key health numbers with Kevin Geddings. The two talk about the importance of checking weight, cholesterol, and blood pressure, emphasizing consistency in measurement practices for accurate tracking. They discuss newer numbers to check for cardiovascular health, including lipoprotein(a) and hsCRP, a marker for vascular inflammation. Both of these metrics are gaining recognition for their role in long-term heart health.Koren's 3 Key Takeaways:Prevention and early detection are critical to long-term healthConsistency is the key to making sure numbers are accurateClinical research is developing new methods of tracking healthBe a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on AppleWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

Send us a textJoin Dr. Koren and Dr. Ridker for part 2, as they examine the effects of silent inflammation on heart health, emphasizing the importance of understanding specific body signals and the biomarker hsCRP. They also discuss the utility of hsCRP testing as a vital marker for predicting cardiovascular risk due to silent inflammation. The doctors explain how inflammation may play a bigger part in heart disease than many patients - and even some doctors - guess.Koren's Key Takeaways:Inflammation plays a critical part in chronic disease, including heart diseaseMedicine is constantly evolving, bridging the gap between research and practicePatients and physicians have to work together to push science forwardBe a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on AppleWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

In this episode Dr. Paul Ridker discusses the pivotal role of high-sensitivity C-reactive protein (hsCRP), a biomarker for inflammation, in cardiovascular prevention and treatment. He explains how inflammation and cholesterol together drive atherosclerosis, the significance of hsCRP testing, and the latest clinical trial findings. Dr. Ridker also highlights the importance of primary prevention strategies and the potential of targeted anti-inflammatory therapies to revolutionize cardiovascular care.

In this episode, Dr. Brittany Weber discusses the role of inflammation and high-sensitivity CRP (hs-CRP) in cardiovascular disease. She explores the connection between inflammation and atherosclerosis and how immune system activation contributes to atherosclerosis development, the importance of endothelial damage and pro-inflammatory cytokines, and the impact of systemic inflammatory diseases on cardiovascular risk. Tune in to learn about the mechanisms behind inflammation in cardiovascular disease and the significance of hsCRP as a biomarker.

In this episode, Dr. Amir Rezvan hosts a panel discussion with distinguished colleagues Dr. Paul Ridker, Dr. Brendan Everett, Dr. Michael Garshick, and Dr. Kaitlin Voigts Key. The panel explores what high-sensitivity CRP (hs-CRP) is and its normal levels, the role of hsCRP in diagnosing and treating atherosclerotic disease, and how inflammation and hyperlipidemia contribute to cardiovascular events. The panel provides practical advice on measuring hsCRP and interpreting high values. Tune in for this insightful discussion on the importance of hsCRP in preventive cardiology and how to effectively use this biomarker in clinical practice.

In this episode, Dr. Paul Ridker explores the crucial role of inflammation and high-sensitivity CRP (hs-CRP) in cardiovascular health. He discusses the importance of measuring hsCRP and addresses common misconceptions about the variability of this biomarker. Tune in to gain a deeper understanding of how hsCRP can be a powerful tool in predicting and managing cardiovascular health.

After receiving my recent blood test results, I was shocked to see how high my inflammation levels had climbed postpartum.  It made me realize just how much our bodies go through during pregnancy, birth, and recovery—and how important it is to take steps toward healing and wellness in those crucial months after delivery. Tune in to learn about my inflammation-reducing strategies, postpartum recovery tips, and more!   I TALK ABOUT:  07:00 - Blood testing with SiPhox Health (code: BIOHACKINGBRITTANY) and the importance of biomarkers 10:00 - HSCRP and its importance as a cardiovascular and inflammation marker 18:00 - Symptoms of high inflammation 22:00 - Common root causes of elevated HCRP and inflammation 29:00 - Tips for postpartum physical activity to manage inflammationn 36:00 - Strategies to reduce inflammation: diet, exercise, and sleep 38:00 - Physical exercise benefits and my postpartum workout routine 42:00 - Tips on managing sleep with a new baby 44:00 - Biohacking strategies for inflammation - curcumin, Pendulum Akkermansia, fermented cod liver oil, Tiny Health microbiome testing 49:00 - Sauna therapy and stress management   SPONSORS:  Save big on BiOptimizers supplements, including my favorites—digestive enzymes, probiotics, and magnesium. Get free gifts for every purchase at the BiOptimizers Black Friday sale this November! Use code BIOHACKINGBRITTANY for the best discount offer!  Your smile deserves a glycerin-free and fluoride-free toothpaste from Wellnesse. Use BIOHACKINGBRITTANY for 12% off.   RESOURCES: Optimize your preconception health by joining my Baby Steps Course today!   Optimize your preconception health and fertility through my free hormone balancing, fertility boosting chocolate recipe! Download it now! My Amazon storefront LET'S CONNECT: Instagram, TikTok, Facebook Shop my favorite health products Listen on Spotify, Apple Podcasts, YouTube Music

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/tackling-residual-risk-in-ascvd-and-ckd-9653SummaryInflammation plays a pivotal role in both cardiovascular and chronic kidney disease, making it a crucial target for reducing patient risk. In this focused 15-minute podcast, our experts break down the latest insights into how inflammation drives these conditions and explore innovative approaches to managing it.Listen to Dr. Ridker as he will delve into the critical role of inflammation in cardiovascular and chronic kidney disease, with a focus on the predictive value of hsCRP as a biomarker for ASCVD and CKD risk. Dr. Ridker explores emerging strategies to address inflammation, and how these advancements could potentially reduce cardiovascular risk and improve patient outcomes.Learning ObjectiveAt the conclusion of this activity, participants should be better able to:Recognize the role of hsCRP as a biomarker in evaluating the risk of ASCVD and CKDIdentify the role of current and emerging agents, based on their mechanism of action, to target inflammation and potentially reduce cardiovascular riskThis activity is accredited for CME/CE CreditAssociation of Black Cardiologists, Inc. (ABC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Association of Black Cardiologists, Inc. designates this enduring material for a maximum of 0.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners® (AANP) through the joint providership of the National Association for Continuing Education (NACE) and ABC. NACE is accredited by the AANP as an approved provider of nurse practitioner continuing education. Provider number 121222. This activity is approved for 0.50 contact hours (which includes 0.25 hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis educational activity is supported by an independent medical educational grant from Novo Nordisk.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

In this CCO Nephrology podcast episode, hear from cardiologist Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, and nephrologist Mark J. Sarnak, MD, MS, as they explore the pathophysiology and novel therapeutic strategies to target residual inflammatory risk associated with ASCVD and CKD.    Episode outline:   Moving beyond lipid lowering to address residual inflammatory riskNovel anti-inflammatory targets for ASCVD To learn more about targeting residual risk associated with systemic inflammation, find more educational activities and resources with the links below:   CME-certified text module with animated pathophysiology video and faculty voice audio clipsClinicalThought commentariesPodcast episode 1, discussing residual risk associated with systemic inflammation and the role of cardiologists and nephrologists in mitigating risk in ASCVD and CKD Podcast episode 3, featuring faculty discussion of new and emerging therapies to target inflammatory risk in patients with ASCVD and CKD 

In this episode, I'm joined by Dr. Jack Wolfson, DO, FACC, a board-certified cardiologist, who shares his expertise on heart disease prevention and treatment, focusing on lifestyle changes, diet, and natural interventions. We dive deep into the impact of cholesterol, the effectiveness of statin drugs, and alternative ways to assess cardiac risk. It's a comprehensive look at modern cardiology from a holistic perspective. Dr. Wolfson challenges the traditional reliance on cholesterol levels as the main marker for heart health, emphasizing the importance of focusing on inflammation and oxidative stress instead. Throughout our conversation, Dr. Wolfson highlights how crucial lifestyle choices—like regular exercise and getting enough sleep—are for maintaining cardiovascular wellness.   Key Takeaways: Cholesterol Myths: Understanding that cholesterol is essential for various body functions and is not the primary culprit in heart disease. Alternative Testing: Utilizing advanced markers like HSCRP, oxidized LDL, apob, and lipoprotein (a) to better assess cardiac risk. Lifestyle Matters: Emphasizing the importance of sleep, sunshine, diet, and physical activity in promoting heart health. Questioning Statins: Highlighting the minimal benefits and significant drawbacks of long-term statin use. Functional Nutrition: Advocating for a diet rich in whole, ancestral foods and the cautious use of supplements like berberine for cardiovascular benefits.   More of Dr. Jack Wolfson: Dr. Jack Wolfson is a board-certified cardiologist, Amazon best-selling author, husband, father, and the nation's #1 Natural Heart Doctor. In over twenty years, more than one million people have enjoyed the warmth, compassion, and transformational power of his natural heart health methods. Dr. Wolfson is the founder of Natural Heart Doctor, the worldwide leader in cardiovascular health. People from all over the world reach out to Dr. Wolfson for holistic heart health consultations. He has been named one of America's Top Functional Medicine Doctors and is a five-time winner of the Natural Choice Awards as the Top Holistic M.D. Dr. Wolfson's work has been covered by more than 100 media outlets, including NBC, CNN, and the Washington Post. His book “The Paleo Cardiologist: The Natural Way to Heart Health” was an Amazon #1 best-seller. He is also a contributing author to the Textbook of Integrative Cardiology. Dr. Wolfson and his wife Heather have four children and are committed to making the world a better place to live. They provide for those in need (including animals) and support natural health causes through their philanthropic efforts. Website Instagram   Connect with me!: Website Instagram Facebook YouTube

This week on the podcast, I'm thrilled to welcome Jean-Felix Turcotte, an integrated health practitioner with expertise in blood chemistry, genetics, and lab testing. We delve into the essential blood markers everyone should know about and the importance of personalized health assessments for proactive care.In this episode, you can expect to hear about:- Essential Blood Markers: The top blood tests, including CBC, CMP, GGT, and thyroid panels, that can provide a comprehensive view of your health.- Challenges with Lab Work: The difficulties and challenges in accessing comprehensive blood tests.- Genetic Testing Insights: How genetic mutations like MTHFR impact health and the significance of epigenetics in individualized health plans.- Proactive Health Strategies: The benefits of understanding blood chemistry and genetics in crafting personalized health foundations and lifestyle changes.If you're on the path to proactive and preventative health care, this episode is a must-listen. Together, Jean-Felix and I explore the critical role blood work plays in maintaining optimal health and the steps you can take to tailor your health journey. Tune in to learn how to better approach your health with the right knowledge and tools!Episode Highlight:"It's not just about getting the blood work done; it's about understanding what those markers mean for your proactive and preventative health measures."- Jean-Felix Turcotte Resources:- Find Jean-Felix on Instagram: https://www.instagram.com/jeanfelixturcotte_jft/- Top 10 blood markers to get tested annually: CBC, CMP, GGT, LDH, Lipid panel, Homocysteine, HSCRP, Ha1c, C-peptide, thyroid panel (TSH, T3, T4, rT3, TPO) , uric acid, Iron (ferritin, TIBC, saturation %, Serum Iron)- Book: Dirty genes by Dr Ben Lynch Other helpful resources here for you: - Join The Soul & Wealth Club, my monthly membership: https://vanessagrutman.coach/the-soul-and-wealth-club - Join Femme Biohacker: https://vanessagrutman.coach/femme-biohacker - Join my private Facebook group for free events, challenges and content: https://www.facebook.com/groups/biohackerfemme - 7-day liver detox: https://vanessagrutman.myshopify.com/products/functional-medicine-detox-7-day-protocol 
- My website: https://www.vanessagrutman.com/
- Find me on Instagram: https://www.instagram.com/vgrutman/- Join me on Youtube: https://www.youtube.com/@vanessagrutman
 
Disclaimer: Vanessa Grutman, IHP does not treat, cure or diagnose disease. This show doesn't offer medical advice. Always verify with your physician before undertaking a new protocol or trying a new product.

Join Joe as he delves into his journey with MSM (Methyl Sulfonyl Methane) supplementation, a key to detoxing the body and enhancing recovery.  In this episode, Joe discusses: The Impact of Heavy Metals on Health: Understanding the dangers of heavy metals and the importance of detoxing them from our bodies. MSM as a Detox & Methylation Aid: How MSM supplementation helps clear heavy metals and play a vital role in methylation. Recovery and Resilience Through MSM: How MSM aids in the recovery of tendon and joint injuries, contributing to better exercise outcomes. Combining Sulfur Sources for Optimal Detox: Strategies in integrating MSM with other sulfur sources. Enhanced Health Markers: Insights into how MSM positively influences key health markers like homocysteine, DHEA sulfate, ALT, and HSCRP. Discover the powerful role of MSM in detoxing heavy metals and enhancing physical recovery.  Tune in to learn how this supplement could revolutionize your approach to health and detoxification. If you're interested in learning more about how your DNA and genetics affect your health: - Check out SelfDecode: https://selfdecode.com/ - Join Joe's online community: https://thejoecohenshow.com/ 

If there are 6 root causes to all disease, what can we do to stop them?    With 50-60% of Americans on the road to Diabetes, it's clear that our population is sicker than ever. And the harsh truth? We're doing it to ourselves.    In the latest episode of The Darin Olien Show, I sit down with Dr. Darshan Shah to explore the common mistakes people make when seeking shortcuts to health, such as opting for advanced medical interventions while neglecting basic dietary and lifestyle habits. We also discuss the six root causes of disease and how to prevent them.    Dr. Shah shares insights into the impact of inflammation and high levels of biomarkers like HSCRP and homocysteine, which are often linked to poor gut health and a diet high in glucose and fructose. And practical advice on avoiding sedentary behavior, and prioritizing the right supplementation, nutrition and exercise.   Dr. Darshan Shah is the CEO and founder of Next Health, a trailblazer in health optimization. Starting his medical journey at 16, Dr. Shah has seamlessly combined his surgical expertise with an innovative approach to wellness. Under his leadership, Next Health offers advanced, personalized health services, focusing on longevity, vitality, and preventing disease. His vision embodies the fusion of technology and holistic health practices, positioning him as a leading figure in the health revolution.   What we discuss…   (00:00) - The evolution of medicine towards holistic and individualized health (15:34) - Bio-Optimizing through common sense for longevity and disease prevention (31:17) - The power of small daily habits for longevity  (42:51) - Understanding inflammation, and common misconceptions about health eating  (51:03) - The 6 root causes of disease and how to prevent them  (01:04:32) - Advice on nutritional supplements and incorporating functional medicine    …and more!   Don't forget:   You can order now by heading to darinolien.com/fatal-conveniences-book or order now on Amazon.   Thank you to our sponsors: Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Vivobarefoot: Get 15% off your first order with code DARINV15 at vivobarefoot.com Bite Toothpaste: Go to www.trybite.com and use code DARIN at checkout for 20% off   Find more from Darin: Website: https://darinolien.com/ Instagram: https://www.instagram.com/Darinolien/ Book: https://darinolien.com/fatal-conveniences-book/ Down to Earth: https://darinolien.com/down-to-earth/   Find more from Dr. Shah: Website: https://www.drshah.com/next-health Instagram: @darshanshahmd

Buck Joffrey, M.D. discusses metabolic syndrome which affects 1/4 of the global adult population and how it underlies the development of virtually every other major cause of death. Show Notes: 00:13 Understanding Metabolic Syndrome 05:29 Criterias of Metabolic Syndrome 23:40: Insulin Resistance and Hyperinsulinemia 24:49: Metabolic Syndrome and Diabetes 37:49: Recommended Lab Tests 42:05: The Health Implications of Liposuction 50:42: The Importance of HSCRP  

Wellness + Wisdom | Episode 591 Do you know how to biohack your heart, body, and mind? Dr. John Lieurance, Naturopath and Chiropractic Neurologist, joins Josh Trent on the Wellness + Wisdom podcast, episode 591, to share how he treats celebrities to help them breathe well, which biohacking products you should be using every day, how endotoxins cause inflammation in the body, and why suppositories are more effective than IV. "Everything stops working properly when you have too much inflammation in the body. You have areas that microbes can live and exist and secrete their excrement, right. Their toxic waste. This is called an endotoxin. And these endotoxins are literally at the root of all diseases. The 3 primary doorways are the nasal passage, the oral, the mouth, and the colon." - Dr. John Lieurance 10% Off MitoZen 10% OFF | CODE: “WELLNESSFORCE” MitoZen Scientific offers the most Advanced Natural Medicine and healing through detoxification. Relieve anxiety, calm your mind, reduce stress, or enhance your cognition. MitoZen has it all! Their carefully curated blends of ingredients are designed to support your mental and physical wellbeing. • MitoZen Nasal Spray ZEN Extra Strength + Oxytocin • MitoZen Lumetol Blue™ Bars+ • MitoZen Super SandMan Ultra™ (Melatonin Liposomal)+ • MitoZen Boca Zen™+- Vagus & Oral Health • MitoZen GlutaMax™ Bullet+- Glutathione In This Episode, Dr. John Lieurance Uncovers: [01:30] How to Activate Your Pineal Gland MitoZen - Get lifetime access to Mitozen Club for $10 + 10% off with code "WELLNESSFORCE" 436 Dr. John Lieurance | Melatonin Miracle: Supra-Physiologic Dosing, Sinus Health & Ending Inflammation 489 Dr. John Lieurance | It's All In Your Head: How To Relax The Default Mode Network, Endonasal Cranial Therapy + Why Psychosomatics: Transformation (LIVE at RUNGA) Dr. Joe Dispenza How breathwork impacts piezoelectricity in the pineal gland. Why fluoride causes calcification to the pineal gland. [07:00] MitoZen Blue Eyes + The Law of Attraction Blue eye drops with nano-gold for the pineal gland. The function of the pineal gland. Garrett McNamara How meditation brought Dr. John to what he does now. The Secret by Rhonda Byrne Trusting the universe and the law of attraction. [13:20] Pharmaceuticals VS Natural Supplements Dana White Why celebrities love using MitoZen products. MitoZen is not a supplement company but a vitality technology. How natural supplements and biohacking products directly compete with pharmaceuticals. Cured Nutrition - 20% off with the code "WELLNESS FORCE" Painkiller Most pharmaceutical companies care more about the money than about people's health. Remdesivir [20:30] Methylene Blue Increases ATP Production 361 Luke Storey: Relationships, Consciousness, & Coming Home To Yourself Why methylene blue is good for our bodies. Lumetol Blue Why ATP is the currency of energy. How methylene blue enhances mitochondria efficiency. The use of methylene blue in surgeries. [26:40] The Negative Effects of Antibiotics How methylene blue is produced. Why physicians choose new solutions over the old ones, even though they are less efficient. Unpacking how Josh found out about MARCoNS thanks to Dr. John. How antibiotic resistance is created. The benefits of butyrate. [32:30] Endotoxins + Inflammation Endotoxins are at the root of all diseases. How toxins trigger inflammation in the body. Ask your doctor to test your lipopolysaccharides (LPS), high-sensitivity C-reactive protein (HSCRP), MMP-9, and TGF-Beta-1. Why chronic inflammatory response syndrome is common amongst people. Dr. John's process of healing from Lyme disease. [37:10] Best Tools for Biohacking + Healing Disease 561 Codie Sanchez | Freedom From Financial Slavery: How To Use “Contrarian Thinking” To Rewire Your Mind For Wealth Why Dr. John was ashamed of being in a special needs class as a kid. Advanced Rejuvenation The free content members of the MitoZen club receive. Which MitoZen products are good for biohacking and which are good for health issues. [45:15] MitoZen Biohacking Products The MitoZen tool for breathwork and opening airways. 10% off Breath Honey, Blue Eyes, and Root Zen Using essential oils on different parts of the body. [51:35] The Benefits of Melatonin Taking melatonin doesn't shut down our own melatonin production. Research proves that melatonin is safe and also helps prevent some diseases. Melatonin: Miracle Molecule: Transform your life with 'high dose' Melatonin by Dr. John Lieurance How melatonin gives us stress resilience. [57:15] What Is The Right Melatonin Dose? Why you can take high melatonin doses regularly. The melatonin study performed on Siberian hamsters cannot be compared to the human body. How to dose melatonin according to your needs. Why methylene blue is good for learning and storing short-term memory. [01:06:40] Alter Your Stress Response The role of norepinephrine during a stress response. How traumatic experiences trigger stress hormones. Why people with chronic infection feel a lot of anxiety. One dose of methylene blue can improve memory consolidation which can treat phobias. How methylene blue improves the mood. Avoid serotonin syndrome reaction. Francisco Gonzalez-Lima [01:14:20] Functional Cranial Release How Dr. John helped Dana White heal sleep apnea. Why fighting is not only about violence but has a spiritual meaning. How functional cranial release works. Dura mater: the "tough mother" tissue in the brain. Why Aboriginal peoples had less breathing and teeth problems. Josh's experience getting his first function cranial release from Dr. John. [01:23:40] Maintain Your Youth with NAD The benefits of taking NAD and why our body needs it. How our NAD gets depleted from our body. Why we should fast regularly. The reason why NAD+Max contains senolytics. Why we want to activate or inhibit mTOR gene expression. [01:30:05] Suppositories Are Better Than IV Suppositories can have a greater absorption impact. Why NAD suppository is better than NAD IV. Sauna Space - 10% off with code "JOSH10" Why Dr. John likes to use near infrared sauna. Dr. John's perspective on what's going to happen in the future. Why everything is better with friends and community. Leave Wellness + Wisdom a Review on Apple Podcasts Power Quotes From The Show Locus Coeruleus: The Blue Spot "Locus coeruleus is the point of control master system to the entire system in the brain. We store the short-term memory. If we don't transfer the short-term memory to our upper cortex and integrate it, then we can't make sense of what's happening in the now as it relates to what's happened in the past to formulate in context our life, our mission, and our relationships." - Dr. John Lieurance Melatonin: The Safest Molecule "I would challenge anybody to bring me a molecule that has more testing showing safety than melatonin. There isn't. Every cell in your body makes it. We need melatonin to survive." - Dr. John Lieurance Dura Mater "The cranium is made up of separate bones which come together in unique ways to facilitate a motion called cranial rhythm. But there's a connective tissue layer just inside of the bones called the dura mater (tough mother). It's got 2000 pounds per square inch of tensile strength. It's very, very durable. And what happens when mothers are overly protective? The kid doesn't get to explore the environment and doesn't learn. The same thing happens with the neurological system when you have this bound connective tissue. It disrupts the flexibility, but it also causes the skull to be contracted and pulled into a collapsed position." - Dr. John Lieurance Live Life Well from Sunrise to Sunset Save 20% with code "WELLNESSFORCE" on everyone's favorite Superfoods brand, ORGANIFI, including their Sunrise to Sunset Bundle and their Women's Power Stack that includes HARMONY + GLOW for true hormonal balance and great health radiating through your beautiful skin. Click HERE to order your Organifi today. Are You Stressed Out Lately? Take a deep breath with the M21™ wellness guide: a simple yet powerful 21 minute morning system that melts stress and gives you more energy through 6 science-backed practices and breathwork. Click HERE to download for free. Biohack Your Mind & Body with Plunge Ice Baths!Save $150 on your PLUNGE order with code "WELLNESSFORCE" As seen on Shark Tank, Plunge's revolutionary Cold Plunge uses powerful cooling, filtration, and sanitation to give you cold, clean water whenever you want it, making it far superior to an ice bath or chest freezer. *Review The Wellness + Wisdom Podcast & WIN $150 in wellness prizes! *Join The Facebook Group  ***Check out all of our other fave Black Friday + Cyber Monday deals!*** Links From Today's Show  MitoZen - Get lifetime access to Mitozen Club for $10 + 10% off with code "WELLNESSFORCE" 436 Dr. John Lieurance | Melatonin Miracle: Supra-Physiologic Dosing, Sinus Health & Ending Inflammation 489 Dr. John Lieurance | It's All In Your Head: How To Relax The Default Mode Network, Endonasal Cranial Therapy + Why Psychosomatics: Transformation (LIVE at RUNGA) Dr. Joe Dispenza Garrett McNamara The Secret by Rhonda Byrne Dana White Cured Nutrition - 20% off with the code "WELLNESS FORCE" Painkiller Remdesivir 361 Luke Storey: Relationships, Consciousness, & Coming Home To Yourself Lumetol Blue 561 Codie Sanchez | Freedom From Financial Slavery: How To Use “Contrarian Thinking” To Rewire Your Mind For Wealth Advanced Rejuvenation 10% off Breath Honey, Blue Eyes, and Root Zen Melatonin: Miracle Molecule: Transform your life with 'high dose' Melatonin by Dr. John Lieurance Francisco Gonzalez-Lima Sauna Space - 10% off with code "JOSH10" Josh's Trusted Products | Up To 40% Off Shop All Products ***Check out all of our other fave Black Friday + Cyber Monday deals!*** BREATHE - 33% off with the code “PODCAST33” SiPhox - 10% off with code "JOSH" Holy Hydrogen - $100 off with code "JOSH" SinuSonic - 15% off with "JOSH15" Organifi - 20% off with the code ‘WELLNESSFORCE' QI-Shield EMF Device - 20% off with the code "JOSH" SEED Synbiotic - 30% off with the code "JOSHTRENT" BON CHARGE - 15% off with the code "JOSH15" MANNA Vitality - 20% off with the code "JOSH20" SimplyO3 - 10% off with code "JOSH10" Kineon - 10% off with code "JOSH10" Mendi.io - 20% off with the code "JOSH20" Adapt Naturals - 15% off with code "WELLNESSFORCE" SpectraSculpt - 15% off with the code "JOSH15" SaunaSpace - 10% off with the code "JOSH10" Cured Nutrition CBD - 20% off with the code "WELLNESS FORCE" PLUNGE - $150 off with the code “WELLNESSFORCE" LiftMode - 10% off with the code "JOSH10" MitoZen - 10% off with the code “WELLNESSFORCE” Paleovalley - 15% off with the link only NOOTOPIA - 10% off with the code "JOSH10" Activation Products - 20% off with the code “WELLNESSFORCE” SENSATE - $25 off with the code "JOSH25" BiOptimizers - 10% off with the code "JOSH10" ION - 15% off with the code ‘JOSH15' Feel Free from Botanic Tonics - $40 off with the code "WELLNESS40" Essential Oil Wizardry - 10% off with the code "WELLNESSFORCE" ALIVE WATERS - 33% off your first order with the code "JOSH33" Earth Runners Shoes - 10% off with code "JOSH10" DRY FARM WINES - Get an extra bottle of Pure Natural Wine with your order for just 1¢ Drink LMNT - Zero Sugar Hydration: Get your free LMNT Sample Pack, with any purchase Free Resources M21 Wellness Guide - Free 3-Week Breathwork Program with Josh Trent Join Wellness + Wisdom Community About Dr. John Lieurance Naturopath and Chiropractic Neurologist, Dr. John Lieurance, has been in private practice for over 27 Years. Currently, with Advanced Rejuvenation, a Multi-Disciplinary Clinic, with a focus on Alternative and Regenerative Medicine, Naturopathic Medicine, Chiropractic Functional Neurology, Functional Cranial Release (FCR), Lumomed, Lyme Disease, Mold Illness, and many other Neurological Conditions. His treatments have been proven very successful in treating many chronic neurological and chronic infection conditions. He believes that toxins and infections are at the root of many conditions including Autoimmune, Parkinson's, Alzheimer's, Inner Ear Conditions, and most Degenerative Neurologic Conditions. BOOKS BY DR. JOHN LIEURANCE He is the Author of Melatonin: Miracle Molecule and he's working on his second book on Endonasal Cranial Therapy. As the developer of Functional Cranial Release, he teaches as well as certifies these methods to doctors around the world. MITOZEN SCIENTIFIC He is also the Chief Scientific Officer of MitoZen Scientific, a cutting-edge healthcare technology company that has a focus on powerful delivery systems such Many of the products created are designed to be used for support for alternative practitioners to apply to chronic conditions such as mold toxicity (CIRS), heavy metal toxicity, autoimmune conditions, neurological diseases, and chronic inflammation. Also, many “BioHackers” find them helpful to enhance cognition and physical performance! Website Facebook Instagram Twitter YouTube Listen To The Latest Episodes... Don't Miss New Episodes: Follow Wellness + Wisdom on Spotify

Join us for a heart-healthy conversation on 'Resiliency Radio with Dr. Jill Carnahan' where we welcome the esteemed Dr. Howard Elkin, MD, a pioneer in the field of Integrative Cardiology. Key Points Learn the cardiovascular risk markers and lab testing that you can ask your doctor to order, including Lp(a), PLAC, MPO, hsCRP, insulin, glucose, A1C and c-peptide Women' risk of having a heart attack after menopause more than 3X that of breast cancer Optimal diet for cardiovascular prevention discussed How to be your own medical advocate

We are hearing more and more about how inflammation is implicated in many mental health issues including anxiety and OCD. But what does that mean? Are there ways we can see if our child is struggling with inflammation? Are there things we can change in their diet or lifestyle that will reduce inflammation?I don't know those answers, but I do know someone who does!That is why I invited Dr. Ann Kulze, a renowned physician and founder of the Healthy Living School to come and talk to us. Dr. Ann has been featured on the Dr. Oz show, Oprah and Friends Radio, Time, and WebMD sharing her expertise in this area.

Buck and Alan Viglione, MD discuss the Cardio IQ® report in detail and battle it out to see has the best numbers in this 2 part episode. Part 2 will drop as Episode 22. 0:01:31 - What exactly is a Cardio IQ? 0:03:15 - the cost of Cardio IQ 0:05:18 -Lipid panel, Total Cholesterol, HDL, Triglycerides, LDL Cholesterol 0:08:29 - HDL the so-called good cholesterol 0:13:55 - Lipoproteins 0:15:42 - LDL Particle Number 0:22:46 - Apolipoproteins 0:25:40 - Apolyte protein tag 0:27:48 - Apolipoprotein B or apoB 0:28:31 - Lipoprotein(a) or Lp(a) 0:31:41 - Statins: Crestor and Livalo 0:32:41 - How do Statins work? 0:33:11 - Repatha 0:36:58 - Inflammation and Atherogenesis 0:39:39 - High-sensitivity C-reactive protein (hsCRP) 0:40:43 - Lp-PLA2 activity  0:41:43 - Oxidative LDL 0:42:04 - Myeloperoxidase enzyme 0:45:07 - F2-isoprostanes as a marker of risk

Dr. Holly Lucille discusses Her Cancer Journey with Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]    Podcast Highlights 3:25  Dr. Lucille explained that she was in her infrared sauna and she had done a bentonite clay mask, when she did a breast self-exam and she found a lump in her left breast.  She saw her gynecologist, who recommended getting a full breast ultrasound.  She went for an ultrasound of her breast and the doctor told her that he did not think there was anything to worry about.  But he wrote in his report that the lump was most likely from trauma from an ill-fitting bra, which didn't make any sense for her.  She decided to go for a second opinion to a breast surgeon and he called her the next day and told her that she had both inner and outer breast cancer.  Then Dr. Lucille went for an MRI and there was also something in her other breast, so this doctor offered Holly different options.  She asked this doctor what she would do if it her were her sister, which is a good question to ask your cancer doctor?  Dr. Lucille she elected to have a double mastectomy surgery rather than lumpectomy with radiation and constant monitoring of her right breast. 8:57  Dr. Lucille looks at her current practice focus as caring for people with patterns of cancering.  When she went to see the standard of care oncologist at Cedars Sinai, all he said was here take this and if that doesn't work or has too many side effects, we have three others we can choose. He did not ask her anything about her diet or lifestyle, he didn't take any further blood work, and he didn't want to know anything else about what we call the terrain.  17:05  Most oncologists and radiologists will tell patients not to take any natural therapies, esp. antioxidant supplements because it might uncouple the treatment.  On the one hand, there is a lot of misinformation out there from people watching things on the internet.  On the other hand, there is a lot of scientific information out there when a patient is on a certain conventional regimen what is contraindicated and also what is beneficial when co-administered.  There are natural diet and lifestyle factors that can reduce side effects to allow patients to better tolerate the treatments as well as making the treatments more effective.  And this is needed, since we haven't moved the needle in improving standard of care therapy for cancer in 70 years as far as improving outcomes.  18:58  Test, assess, and address.  Dr. Lucille elected to have double mastectomy and it was recommended that she also take an aromatase inhibitor, which is a hormone blocking agent, but after taking it for two weeks, her pain was so bad that she decided to stop taking it.  She does work with an integrative oncologist and they do detailed lab work regularly, because she believes that rather than guessing, we should test, assess, and address. This lab work includes LDL isoenzymes to assess the mitochondria, SED rate and HsCRP to assess inflammation, a CBC with differential, a comprehensive metabolic panel, copper and ceruloplasmin, zinc, and a full iron panel.  While too much copper or iron can increase cancer risk, we have actually been seeing too little copper in some patients, since so many people were loading up on zinc for immune support due to COVID.  Labs also include glucose, Hemoglobin A1C, since insulin sensitivity is a driver of cancer, and also IGF-1 since this is also a driver of cancer risk.     Dr. Holly Lucille has over 20 years experience in clinical naturopathic practice.  After her own breast cancer diagnosis, Dr. Lucille devoted herself to learning everything about integrative approaches to oncology. Dr. Lucille is the author of several books, including Creating and Maintaining Balance: A Women's Guide to S...

KSQD 7-05-2023: American Society of Anesthesiologists now recommends drinking fluids with sugar until 2 hrs before a surgery; Masks are attributed to preventing COVID deaths in doctors during the pandemic; US Supreme Court rules against Amgen in a case of over-reaching patents of monoclonal antibodies that lower cholesterol; New pneumonia recommendations for vaccines are very confusing and dysfunctional; Is continuous monitoring for C-reactive protein, hsCRP, beneficial? What are the safe solutions for osteoporosis treatments? A FRAX score helps assess fracture risks; Advice on calcium, vitamin D and vitamin K supplementation for osteoporosis; Generic cancer drug supply problems; Giant African snail that carries infections is causing problems in Florida; Qantas Airlines helps passenger jet lag by adjusting meal timing and contents during very long flights; The EPA is finally going to ban the nasty pesticide chlorpyrifos; 10 pesticides that are toxic for Parkinson's disease have been identified; Speaking 2 languages when young reduces dementia symptoms when older; Memory prosthesis copies signals from the hippocampus to other parts of the brain to improve memory

Dr. Kabran Chapek discusses Concussion Recovery at the Functional Medicine Discussion Group meeting on June 22, 2023 with moderator Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]    Podcast Highlights 3:13  There are two main points to this talk: 1. Traumatic brain injuries are a significant cause of mental illness, incl. depression, anxiety, anger problems, and headaches.  2. There is a standard concussion protocol, but we need to take a more holistic approach and we need to look at treating the cause of the damage.  4:47  There are a lot of patients that have had a traumatic brain injury and don't know it.  You might have to ask your patient a series of patients till they recall an incident in which they fell out of a tree, had a car accident, played contact sports, etc..  It is important to figure this out because it is a different treatment approach if there's a brain injury.  Even a whiplash car accident without hitting your head can result in a traumatic brain injury.  We need to understand that the brain is composed of very fragile tissues and has the consistency of jello. In fact, if you take a fresh brain out and set it on the countertop, it'll be dew in a few hours because it will melt. 10:00  There's a standard concussion protocol with baseline testing preseason and referral to a medical provider when needed an MRI or CT scan and Tylenol and Advil and ice.  But we need to go further.  The primary injury of concussion is actually ripping of neurons and shredding of tissue.  What we tend to see in our offices are the secondary injuries from the cascade of inflammatory and oxidative stress on the brain that continues after the initial trauma.  There is a massive glutamate dump in the brain that stresses the mitochondria and there is a flooding of calcium. There's free radical production and oxidative stress. There are also glucose deficiencies in the brain.  Fortunately, studies with mice shows that glutathione, a simple nutritional intervention, applied to the mouse skull reduced brain cell death by 67% if applied immediately and by 51% if applied within three hours.  Between 29 and 60% of those who have a concussion, will go on to have a post-concussion syndrome, a chronic brain injury.  If you sprain your ankle on the filed of play we have a protocol that involves applying ice, compression and elevation that we apply immediately. But with head injury, we simply watch and wait to see if a post-concussion syndrome develops.  We should have a concussion rescue program to save brain cells that we apply immediately after a head injury. 16:04  A better approach to traumatic brain injury would be to address structural integrity, to look at sleep, nutrition, supplements, exercise, and brain retraining exercises.  We should also include some imaging--a SPECT brain scan and some questionaires to fill out to assess cognitive function.  T-B-I from Brainline.org is one good questionaire that assess for trauma, behavioral change, and impact on daily functioning. Other cognitive assessments include NSIBA, MoCA, and CNS Vital Signs. There is also an app, CRR (Cognition Recognition and Response), that athletes and coaches can use to track concussion recognition and response. 28:23  SPECT brain scan.  A meta-analysis shows that 99% of the reviewed articles show that SPECT brain scans pick up subtle differences in the brain, indicative of mild brain injury, whereas CT and MRI did not pick these up.  Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, Thornton J, et al. (2014) Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. PLoS ONE 9(3): e91088.    28:58  Labs recommended: 1. CBC, 2. CMP, 3. HsCRP, 4. Lipid panel, 5. Hormones, including morning Cortisol, IGF-1,

This week, Paul breaks down his latest set of bloodwork from March 2023. He not only reviews his own levels and ratios, but gives you an idea of what blood work you may want to order, and how to interpret it. 00:04:20 Why you may consider getting your own blood work done 00:11:00 What Paul eats in a day 00:13:40 Fasting insulin & prolactin 00:19:55 Cortisol to DHEA-S ratio 00:27:42 Sex hormones & phlebotomy 00:37:35 DHT 00:40:35 How to help (or hurt) your testosterone 00:48:45 Uric acid & GGT 00:50:30 Hemoglobin A1c & Comp. Metabolic Panel 00:53:20 Urinalysis  00:54:50 Amenorrhea profile, Prostate-Specific Ag, IGF-1, Reverse T3, Vitamin D, Lipoprotein (a), C-Reactive Protein 00:58:17 TMAO: is it harmful? 00:59:25 Homocysteine, Magnesium,  and TSH & Free T4 01:00:50 Lipids: do they matter? 01:05:20 CBC 01:06:20 Conclusions about blood work 01:07:45 NAFLD Paul's recommendations for what labs you should get: CBC Comprehensive Metabolic Panel Fasting Insulin PTH Full thyroid panel, TSH, antibodies, Free T3, Free T4, Testosterone, Free Testosterone, Sex hormone LH, FSH, Prolactin, DHT, Estrogens, Progesterone, Preglinulone, Cortisol, DHEA-S, HSCRP, Liver enzymes, Lipid panel, (Coronary Artery Calcium Scan), PTH. Sponsors: Heart & Soil: www.heartandsoil.co Carnivore MD Merch: www.kaleisbullshit.shop Make a donation to the Animal Based Nutritional Research Foundation: abnrf.org  Animal-based 30 Challenge: https://heartandsoil.co/animalbased30/ Earth Runners: www.earthrunners.com, use code PAUL for 10% off your order  Eight Sleep: $150 off the PodPro cover at www.eightsleep.com/carnivoremd Zero Acre: www.zeroacre.com/PAUL or use code PAUL for free shipping on your first order Bon Charge: boncharge.com, use code CARNIVOREMD for 15% off your order

This month's JHLT: The Podcast is hosted by Digital Media Editor David Schibilsky, MD, who leads a discussion of two studies from the March issue of The Journal of Heart and Lung Transplantation—and the first authors who presented them.   First, the editors explore a study entitled “Angiopoietin 2 and hsCRP are associated with pulmonary hemodynamics and long-term mortality respectively in CTEPH—Results from a prospective discovery and validation biomarker study,” which comes from Hadinnapola and colleagues at the Papworth group in Cambridge, UK.   The editors welcome Charaka Hadinnapola, MA, MB, BChir, first author on the CTEPH study, to share the rationale in performing the research, its main findings, the changing understanding of the pathobiology of pulmonary arterial hypertension, and how Ang2 and hsCRP fit into the bigger cytokine picture in CTEPD and CTEPH patients.   Next, the editors welcome author J.K. Peel, MD, MSc, from the University of Toronto to discuss the paper her first authored, “Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: a retrospective cohort study.”   This retrospective, before-after, propensity-score weighted cohort study explores how EVLP affects hospital costs and the associated transplant procedures, intending to evaluate whether the benefits of EVLP offset its additional cost. Dr. Peel shares what changes occurred at his center during the study period, how the results compare to other published evidence on EVLP costs, and whether the results are transferable to smaller centers.   Follow along at www.jhltonline.org/current, or, if you're an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.    

Kevés hús, kevés gabona, semmi alkohol, semmi túlsúly, jó alvás – ez a hosszú élet titka. Dr. Schwab Richárd gasztroenterológus a stúdióban. 02:45 A „french paradox”, tehát, hogy a vörösborfogyasztás jót tenne a szívnek – statisztikai tévedés vagy manipuláció. Kamu. 06:45 A magyar hasnyálmirigykutatás jelentősége az alkohol hatásának megértésében. 09:30 Az alkohol, mint erős fertőtlenítőszer tönkreteszi a bélnyálkahártya impregnáló rétegét, amitől áteresztővé válhat a bélfal. 10:30 A sima vérviszgálat HS CRP értéke jobban mutatja a szív- és érrendszeri betegségre való hajlamot, mint a koleszterinszint. 15:30 A magas vérnyomás leggyakoribb oka. 16:45 Az életmódorvoslás nagy hátrányban van a gyógyszerkutatással szemben. Nincs iparági érdek, nincs aki finanszírozza a kutatásokat. 18:45 A húsfogyasztás veszélye. A hamburgerkísérlet. 20:00 Ha valaki rendszeresen eszik húst, túlsúlyos, és még sem magas a vérnyomása, annak mázlija van. 22:10 Kockázati mátrix. Bioszenzorok és mesterséges intelligencia. 25:00 Józsa bácsi a hegyen, megissza a pálinkáját, kétszázzal megy az autópályán. 27:30 A gluténérzékenység is megszüntethető. 28:00 A gabonaalapú táplálkozás, a sok hús és a mozgásszegény életmód kódolja a civilizációs betegségeket. 29:30 A rákbetegségek jó része is bizonyíthatóan ilyen mechanizmusok miatt alakul ki. 30:30 Még egy kulcstényező: az alvás. 32:30 A rák gyógyításában is fantasztikus áttörés van. 37:30 Minden harmadik emberben 50 éves kortól polipok nőnek. 38:00 A vastagbélrák népbetegség. 45:00 Mit mondjunk a háziorvosnak? HSCRP-t 0,5 alá! Vérnyomást 120/80-ra! 21-es BMI-t! A száz év kitűzhető cél. 47:45 A propionát az új koleszterin. 49:30 Mérjük az alvásminőséget! Mindig óra nélkül ébredni, kipihenten. A Spotify-alapító új csodaszkennere. 55:00 Egyre több adatból egyre okosabb számítógépek diagnosztizálnak. A mesterséges intelligencia új korszakot nyit az orvoslásban.  60:00 Kis orvoscsapatok hatékonysága. 61:45 A százhúsz évet célzó techmilliárdosok és a koplalás. 63:00 A koplalás régi találmány, minden világvallásban megjelent, és működik. 65:00 A koplalás ki- és bekapcsolhat öregedéssel összefüggő géneket. 67:00 A generációk pörgetésében érdekeltek a génjeink, ezt kell meghekkelni. 68:30 A soványan tartott kutyák tovább élnek.See omnystudio.com/listener for privacy information.

Welcome to Day 5 of Dr. Mark Hyman's Commune course on Hacking Your Healthcare. In this program, Dr. Hyman explains how you can use your own doctor (no matter where you are in the world) to harness the power of Functional Medicine and tackle the root causes of chronic disease.In Day 5 -- Heart Disease -- Dr. Hyman reviews the difference between HDL and LDL cholesterol, triglycerides and insulin sensitivity, cardiac inflammation, known as hsCRP, homocysteine, associated with general inflammation, blood clot risk, and genetic cardiovascular risk.We are releasing Days 1 through 5 of Dr. Hyman's Commune program here on the podcast. You can watch the full 10-day video course with a free trial of Commune Membership. Visit onecommune.com/health to get started.This podcast is supported by:Thrive MarketJoin Thrive Market today and get a FREE $80 in free groceries when you go to thrivemarket.com/communeKyolicPrevention is the best way to protect your heart health. In addition to maintaining a healthy diet,exercise and good sleep patterns, you can include one of the best-researched natural herbal supplements to your routine, Kyolic Aged Garlic Extract. Request a sample at Kyolic.com/sample-request. Use promo code “Commune”.SEEDVisit seed.com and use code COMMUNE for a discount on your first month's subscription of probiotics.

Welcome to Day 5 of Dr. Mark Hyman's Commune course on Hacking Your Healthcare. In this program, Dr. Hyman explains how you can use your own doctor (no matter where you are in the world) to harness the power of Functional Medicine and tackle the root causes of chronic disease. In Day 5 -- Heart Disease -- Dr. Hyman reviews the difference between HDL and LDL cholesterol, triglycerides and insulin sensitivity, cardiac inflammation, known as hsCRP, homocysteine, associated with general inflammation, blood clot risk, and genetic cardiovascular risk. We are releasing Days 1 through 5 of Dr. Hyman's Commune program here on the podcast. You can watch the full 10-day video course with a free trial of Commune Membership. Visit onecommune.com/health to get started. This podcast is supported by: Thrive Market Join Thrive Market today and get a FREE $80 in free groceries when you go to thrivemarket.com/commune Kyolic Prevention is the best way to protect your heart health. In addition to maintaining a healthy diet,exercise and good sleep patterns, you can include one of the best-researched natural herbal supplements to your routine, Kyolic Aged Garlic Extract. Request a sample at Kyolic.com/sample-request. Use promo code “Commune”. SEED Visit seed.com and use code COMMUNE for a discount on your first month's subscription of probiotics.

In this episode you'll learn what a healthy blood insulin level is, and how to interpret your blood results.At Zivli, we advocate prevention before prescription and think it's wise to reverse risk factors before they become disease.To help you become aware of your risk factors for cardiometabolic diseases such as insulin resistance, diabetes, and heart disease, we've partnered with a lab to offer an at-home fasting insulin test, and a more comprehensive cardiometabolic panel.Our Cardiometabolic test kit measures fasting insulin, HDL-C, Triglycerides, Hemoglobin A1c, hsCRP, VLDL-C, LDL-C, and total cholesterol.To order one of these tests go to www.zivli.com/testing. You can also use blood work obtained from your doctor, but you may not have all the values discussed here.Highlights From This EpisodeWhy “normal” bloodwork numbers are not optimal. How to check your insulin levels at home. How to download a free health assessment tracker form. Optimal levels for fasting insulin, fasting glucose, glucose after a meal, hsCRP, Hemoglobin A1c, Triglycerides, VLDL, HDL, waist circumference, HOMA-IR, and Triglyceride/HDL ratio. How to calculate your HOMA-IR for insulin resistance.How to learn more about joining Zivli. Subscribe & ReviewSubscribing and leaving a rating and review are important factors in helping the Reshape Your Health Podcast and the YouTube Channel reach more people. If you haven't already subscribed, please do that today.We would also be grateful if you left a rating and review, too. In your listening app, scroll to the “Ratings and Reviews” section, then click “Write a Review” and let us know what you enjoy about our show. We appreciate you taking the time to show your support. Thank you!Resources From This Episode>> Join Zivli>> Book a Free Zivli Discovery Call>> Freebie: Weight Loss Mindset Audio Training>> Freebie: The Ultimate Food Guide>> Test Your Insulin At Home>> Health Assessment Tracker Form

This blood test helps reveal inflammation, a key driver of metabolic dysfunction and other conditions. Here's how to understand the marker and your results. Author: The Levels Team Reviewer: Dr. Ami Kapadia Link to article: https://www.levelshealth.com/blog/what-is-hscrp-and-why-does-it-matter Become a Levels Member – levelshealth.com Learn about Metabolic Health – levelshealth.com/blog Follow Levels on Social – @Levels on Instagram and Twitter

Videos:  How One Company Destroyed An Entire Country - Moon  Green tea EGCG backed to prevent life-threatening ‘artery explosion' Kyoto University, August 25, 2022   Drinking polyphenol-packed green tea could help to prevent a deadly condition in the body's main artery, according to new research in rats.   Writing in the Journal of Vascular Surgery, the Japanese research team reported that polyphenols from the nation's favourite drink, green tea, could offer benefits in preventing abdominal aneurysm expansion (AAA) – a serious condition characterised by destruction of the body's main artery.    The new study from the Kyoto University team found that rats fed a green tea extract containing epigallocatechin-3-gallate (EGCG) developed AAA less frequently than rats that were not given the polyphenol.   "The type of polyphenol found in green tea [EGCG] has recently been shown to regenerate elastin, an essential protein that gives the artery its stretchy, yet sturdy, texture," explains Setozaki. "Considering that abdominal arterial aneurysms are caused by inflammation and the degradation of elastin components in the arterial wall, we thought drinking green tea may show promise for treatment."    The results confirmed that EGCG blocked AAA progression in the rat model by preserving the aortic thickness and elastin content through regeneration of elastin.   “Regular green tea consumption might be advantageous for patients with a small AAA or as a prophylactic strategy for AAA,” the team suggested.         Lower potassium intake linked to premature mortality risk University of California at Irvine, September 2 2022.  A study reported on August 26, 2022, in the American Journal of Clinical Nutrition found a higher risk of dying during a median 5.8 to 7.8-year follow-up period in association with a lower intake of potassium. The risk was similar between individuals with normal or impaired kidney function.  “In healthy adults, higher dietary potassium intake is recommended given that potassium-rich foods are major sources of micronutrients, antioxidants, and fiber,” Yoko Narasaki of the University of California, Irvine and colleagues explained. “Yet among patients with advanced kidney dysfunction, guidelines recommend dietary potassium restriction given concerns about hyperkalemia [elevated blood potassium—ed.] leading to malignant arrhythmias and mortality.” The investigation included 37,893 continuous participants in the National Health and Nutrition Education Survey (NHANES, 1999–2014) whose potassium intake was calculated from 24-hour dietary recall interviews. Mortality data was collected through the end of 2014.  Among subjects with impaired kidney function, those whose potassium intake was among the lowest one-third had a risk of dying during a median 5.8-year follow-up period that was 18% greater than those among the top third. For participants with normal kidney function, mortality risk for those among the lowest third was 17% higher during a median 7.8 years of follow-up.  High intake of potassium primarily from plant sources was associated with lower mortality during follow-up in comparison with a low intake of the mineral from animal-dominant sources. In the group with impaired kidney function, a 24% greater risk of mortality during follow-up occurred among those who consumed a low amount of potassium paired with a high amount of protein compared to high potassium/high protein.  “Lower dietary potassium scaled to energy intake was associated with higher mortality, irrespective of kidney function,” the authors concluded. “Further studies are needed to elucidate pathways linking potassium intake and co-existing dietary factors with survival in populations with and without chronic kidney disease.”   People who lack compassion for the environment are also less emotional in general University of Michigan, September 2, 2022 People who respond less emotionally to images of damage to the environment are also less emotional and empathic in general, according to a new University of Michigan study. Differences in political ideology can limit policy adjustments that address climate change. Researchers and practitioners often raise concern by appealing to people's empathy. However, some people appear less emotionally impacted by environmental destruction—particularly those who are more ideologically conservative and less pro-environmental, the study showed. In a series of online experiments in the U.S., psychology professor Stephanie Preston examined the emotional responses of more than 600 people in a variety of contexts. People not concerned when viewing pictures of damage to the environment—such as oil spills on fire in a gulf—also did not feel bad about other images including crying babies, officers in distress, injured athletes, wounded soldiers and even moldy food. Consistent with this lack of contagious distress, more "impassive" people said that they felt less empathy for those in daily life and were less pro-environmental and less awed by nature. This group also responded less to positive images such as happy babies, ice cream and stacks of money, the research showed. The study's results suggest that some people's lack of concern for the environment may not be particularly political or reflect a specific disinterest in the environment. It is instead a characteristic of their broader emotional palette, Preston said. "Given that our sense of risk and decisions are strongly guided by emotions, more impassive people are less inclined to dedicate resources to this slowly building crisis," she said.   Amino acid supplements may boost vascular endothelial function in older adults: Study University of Alabama, August 28, 2022 A combination of HMB (a metabolite of leucine), glutamine and arginine may improve vascular function and blood flow in older people, says a new study. Scientists from the University of Alabama report that a supplement containing HMB (beta-hydroxy-beta-methylbutyrate), glutamine and arginine (Juven by Abbott Nutrition) increased flow-mediated dilation (FMD - a measure of blood flow and vascular health) by 27%, whereas no changes were observed in the placebo group. However, the researchers did not observe any changes to markers of inflammation, including high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-alpha) “Our results indicate that 6 months of dietary supplementation with HMB, glutamine and arginine had a positive impact on vascular endothelial function in older adults,” wrote the researchers, led by Dr Amy Ellis in the European Journal of Clinical Nutrition . “These results are clinically relevant because reduced endothelial-dependent vasodilation is a known risk factor for cardiovascular diseases   Break A Sweat For Your Brain: Exercise Protects Aging Synapses University of California at San Francisco, September 2, 2022 Scientists at UC San Francisco have found that the brains of physically active elderly adults contain more of a specific type of protein known to enhance the connections between neurons and help maintain healthy cognition. Importantly, autopsies show this held up even among people whose brains contained high levels of toxic proteins associated with Alzheimer's and other neurodegenerative diseases. “Our work is the first that uses human data to show that synaptic protein regulation is related to physical activity and may drive the beneficial cognitive outcomes we see,” says lead study author Kaitlin Casaletto, PhD, an assistant professor of neurology, in a university release. “Maintaining the integrity of these connections between neurons may be vital to fending off dementia, since the synapse is really the site where cognition happens,” Dr. Casaletto adds. “Physical activity—a readily available tool—may help boost this synaptic functioning.” The analysis revealed older adults who had remained active displayed higher levels of proteins that make the exchange of information between neurons possible. Moreover, researchers admit it was surprising to see the beneficial effects extend beyond just the hippocampus — the mind's memory center — to additional brain regions associated with cognitive function. “It may be that physical activity exerts a global sustaining effect, supporting and stimulating healthy function of proteins that facilitate synaptic transmission throughout the brain,” Dr. Honer explains.   Fermented soymilk isoflavones could cut UV damage Yakult Central Institute (Japan), August 30, 2022   Consuming fermented soymilk products may help protect against ultraviolet radiation damage by increasing the number of isoflavone compounds in the body, according to a study on mice.   Researchers from the Yakult Central Institute in Japan tested female hairless mice, feeding groups of six soymilk (SM) or fermented soymilk (FSM), with additional untreated and control groups. They found mice fed on FSM showed less skin reddening and skin thickening compared to those fed on regular soymilk.   The researchers found that isoflavone concentrations in the blood and UV-exposed skin were significantly higher in the FSM group compared to the SM mice. They had previously found isoflavone absorption is higher for subjects fed aglycone-enriched FSM compared to glucoside-enriched SM.   We believe that the higher delivery of genistein and daidzein to the serum and dorsal skin is due to differences in effectiveness between FSM and SM,” they added.   “Because of their similar structures, isoflavones exert oestrogen-like activity and can protect against hormone-dependent diseases. We believe that the oestrogen-like activity of isoflavones from FSM partly compensates for the oestrogen depletion in [ovariectomised] hairless mice, preventing the photodamage induced by UVB irradiation,” they added.

Moderna Clinical Trials Terribly Flawed — and FDA Knew It, Former Pharma Executive Tells RFK, Jr. South African FM: ‘Patronizing bullying' not acceptable Prescription Playground: Why so many children are now taking ADHD drugs | 60 Minutes Australia   HEALTH NEWS Chili peppers for a healthy gut: Spicy chemical may inhibit gut tumors How Tart Cherries Reduce Inflammation and Oxidative Stress Uncovering the links between diet, gut health and immunity Southern-style diet ‘increases death risk' in kidney disease patients Could Hibiscus Tea be Better than High Blood Pressure Drugs? Can breast milk feed a love of vegetables? Chili peppers for a healthy gut: Spicy chemical may inhibit gut tumors University of California, San Diego   August 1, 2022 Researchers at the University of California, San Diego School of Medicine report that dietary capsaicin — the active ingredient in chili peppers — produces chronic activation of a receptor on cells lining the intestines of mice, triggering a reaction that ultimately reduces the risk of colorectal tumors. The receptor or ion channel, called TRPV1, was originally discovered in sensory neurons, where it acts as a sentinel for heat, acidity and spicy chemicals in the environment. TRPV1 was quickly described as a molecular ‘pain receptor.'  But Raz and colleagues have found that TPRV1 is also expressed by epithelial cells of the intestines, where it is activated by epidermal growth factor receptor or EGFR. EGFR is an important driver of cell proliferation in the intestines, whose epithelial lining is replaced approximately every four to six days. “These results showed us that epithelial TRPV1 normally works as a tumor suppressor in the intestines,” said de Jong. In addition, molecular studies of human colorectal cancer samples recently uncovered multiple mutations in the TRPV1 gene, though Raz noted that currently there is no direct evidence that TRPV1 deficiency is a risk factor for colorectal cancer in humans. The current study suggests one potential remedy might be spicy capsaicin, which acts as an irritant in mammals, generating a burning sensation in contact with tissue.  The researchers fed capsaicin to mice genetically prone to developing multiple tumors in the gastrointestinal tract. The treatment resulted in a reduced tumor burden and extended the lifespans of the mice by more than 30 percent. The treatment was even more effective when combined with celecoxib, a COX-2 non-steroidal anti-inflammatory drug already approved for treating some forms of arthritis and pain. “Our data suggest that individuals at high risk of developing recurrent intestinal tumors may benefit from chronic TRPV1 activation,” said Raz. “We have provided proof-of-principle.” How Tart Cherries Reduce Inflammation and Oxidative StressNorthumbria University (UK),  August 4, 2022Michigan researchers had previously shown that a cherry-enriched diet not only reduced overall body inflammation, but also reduced inflammation at key sites (belly fat, heart) known to affect heart disease risk in the obese.This study offers further promise that foods rich in antioxidants, such as cherries, could potentially reduce inflammation and have the potential to lower disease risk.”

Two daily doses of the tart cherry concentrate was associated with significantly lower levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP), compared to placebo, according to findings published in Nutrients.

”This is the first study to investigate the impact of cherries on systemic inflammatory and oxidative stress induced by a series of metabolically challenging cycling bouts. Despite both groups demonstrating a similar drop off in performance and no differences in time trial performance, the results show that both oxidative stress and inflammatory responses were attenuated with Montmorency cherry concentrate supplementation versus placebo.” 

”With millions of Americans looking for ways to naturally manage pain, it's promising that tart cherries can help, without the possible side effects often associated with arthritis medications,” said Kerry Kuehl, M.D, Dr.PH., M.S., Oregon Health & Science University, principal study investigator. “I'm intrigued by the potential for a real food to offer such a powerful anti-inflammatory benefit — especially for active adults.”

Darren E. Huxley, MD says that a natural alternatives to pain medications are proving effective without unwanted side effects. “In this case we have cherries, another potent, natural antioxidant proving to be as, if not more effective than pain medications because of the ability for sustained long-term use without side effects in common anti-inflammatory drugs.Tart cherries have also been shown to contain naturally high levels of melatonin, a key compound in the human sleep-and-wake cycle, and new research in the European Journal of Nutrition confirms that melatonin from tart cherries is absorbed by humans.

In 2001, Burkhardt et al. even observed that the Montmorency variety, in particular, contains about six times more melatonin than the Balaton variety.  Uncovering the links between diet, gut health and immunity University of Sydney, August 5, 2022 A preclinical study from the University of Sydney has found a high-protein diet can change the microbiota of the gut, triggering an immune response. Researchers say the study takes us a step closer to understanding the way diet impacts gut health and immunity. “The focus of our work is on how the gut microbiota—the trillions of bacteria that inhabit the gut—affects the immune system,” said Associate Professor Laurence Macia from the University's Charles Perkins Center and Faculty of Medicine and Health. Traditionally, however, scientists have focused on the role of dietary fiber in maintaining a healthy gut. In this first-of-its-kind study, published in Nature Communications, the team from the Charles Perkins Center used sophisticated modeling to explore the impact of 10 diets with a different makeup of macronutrients—protein, fats and carbohydrate in mice. Mice fed a high protein diet increased their production of bacterial extracellular vesicles, complex cargo containing bacterial information such as DNA and protein. The body subsequently viewed this activity as a threat and triggered a sequence of events where immune cells traveled into the gut wall. “Here we found protein had a huge impact on the gut microbiota and it was not so much about the type of bacteria that were there, but the type of activity. In essence, we discovered a new way of communication between the gut bacteria and the host which was mediated by protein,” said Associate Professor Macia. While it is too early to say if this research might translate in humans, the researchers say activation of the immune system can prove either good or bad news. “By increasing antibodies in the gut you may see strong protection against potential pathogens, for example salmonella, but on the downside, an activated immune system could mean you are at increased risk of colitis, an inflammatory bowel disease, or autoimmune conditions like Crohn's,” said lead author and post-doctoral researcher Jian Tan. The results appear consistent with the population impacts of modern-day diets, with the Western world seeing lower rates of gastrointestinal infection but higher rates of chronic disease.  Southern-style diet ‘increases death risk' in kidney disease patients University of Alabama  1 August 2022 New research published in the National Kidney Foundation's American Journal of Kidney Diseases suggests that eating a “Southern-style diet” is linked with higher death rates in kidney disease patients. Investigating the influence of diet on kidney disease patients, the researchers studied  3,972 participants with stage 3-5 chronic kidney disease who had not started dialysis. Analyzing the dietary habits of the participants, the researchers found that those who regularly consumed foods familiar to Southern diets had a 50% increase in risk of death across the 6.5-year follow-up period. Foods that the authors identify as being part of a Southern diet include processed and fried foods, organ meats and sweetened beverages. Could Hibiscus Tea be Better than High Blood Pressure Drugs? Tufts University,  August 4th, 2022 Naturally healing foods, including hibiscus, don't carry the side effects of pharmaceuticals and can often offer similar (or better) benefits, without padding the pockets of Big Pharma companies. This is one example of a natural solution for high blood pressure. When it comes to high blood pressure, a completely preventable condition, there are many natural solutions. Things like cayenne pepper, apple cider vinegar, and celery are just a few alternatives, along with broad dietary and lifestyle changes. But many people aren't aware of the blood pressure lowering benefits of hibiscus. Dr. Diane McKay presented her own research on hibiscus Dr. McKay, of Tufts University, conducted a study on 65 people between the ages of 30 and 70 who had been diagnosed with prehypertension or mild hypertension. After receiving hibiscus tea daily for six weeks, participants experienced reduced diastolic, systolic, and mean arterial pressures when compared with those who received a placebo. The effects were most pronounced in those with the highest beginning baseline blood pressures. In another study, scientists received a surprise when looking at the effects of hibiscus tea on blood sugar. The study compared the effects of hibiscus and black teas and found that both impacted cholesterol levels. While the black tea positively influenced HDL levels, hibiscus tea helped keep LDL, HDL, and overall cholesterol at healthy levels. Can breast milk feed a love of vegetables?  Monell Chemical Senses Center, August 4, 2022  Want your preschooler to eat veggies without a fuss? Try eating veggies while you're breast-feeding. That's the message from a new study of lactating mothers and their breast-fed babies. The study found that those infants who took in veggie-flavored breast-milk were less likely to turn away from similar-tasting cereal when they graduated to more solid food. “Every baby's sensory experience is unique, but the flavor of their first food, beginning in utero, is dependent on what mom is eating,” said Julie Mennella. She is a biopsychologist at the Monell Chemical Senses Center in Philadelphia, and led the study. “The way I see it is: Mother's milk is the ultimate in precision medicine,” Mennella said. When an expectant mother eats vegetables, they flavor her amniotic fluid—and later, her breast-milk—and those flavors get passed along to her baby. As a result, the researchers said, if the baby learns early how veggies taste, he or she will be less apt to squawk when offered that first spoonful. For her study, Mennella randomly assigned 97 breast-feeding mothers to one of five groups. For a month, three groups drank a half-cup of carrot, celery, beet or vegetable juice before nursing. One group began when babies were two weeks old, another at 1-1/2 months of age and the third at 2-1/2 months. A fourth group of moms drank juice for three months, starting when their babies were two weeks old. A fifth group—the “control” group—did not use juice. The takeaway: Babies who'd been exposed to vegetable flavors in breast-milk preferred carrot-flavored cereal over plain cereal or cereal with the unfamiliar taste of broccoli. Only 8 percent rejected all of the foods, the findings showed.

One supplement every diabetic should be taken is Coenzyme Q10. This supplement is extremely beneficial for a diabetics health. Take advantage of an exclusive podcast offer today by visiting http://www.invitehealth.com/podcast. For more information on the products or studies mentioned in this episode, as well as a complete transcript of the audio, click here

Today's episode features Ms Annie Rubin, she is a Masters-level Registered Dietitian Nutritionist (RDN) and a Certified Leap Therapist (CLT). Annie works with adults struggling with a host of symptoms from underlying inflammatory and autoimmune conditions that include pain, fatigue, digestive challenges and reduced quality of life. This week Meg & Kylie pick her brain about autoimmunity- we talk what is it, what symptoms might someone who has it experience and most importantly- what can someone who thinks they might have autoimmune problems DO about it? In her work, Annie helps her clients implement a personalized nutrition roadmap designed to improve mobility, concentration and energy levels to ultimately live a vibrant and fulfilling life. She's also offering an amazing free workshop that goes live TOMORROW (June 21st, 2022) on how to discover the root cause & heal from your autoimmune disease triggers! Register for this free workshop here: https://annierubin.ck.page/f0b25cd096 (replay will be available if you sign up through that link until Saturday, June 25, 2022!) You can also connect with Annie by visiting her website at www.annierubin.com or connect with her on Facebook at annierubinnutrition or on IG @the.autoimmune.dietitian TLDL takeaways & action steps: 1) Autoimmune disease is when your body accidentally attacks itself. Many times there is a genetic predisposition that is "triggered" by something- like long term poor diet, stress, environmental toxins, etc. 2) It IS possible, in many cases, to manage your autoimmune disease to where it is basically in remission through diet & lifestyle changes 3) Autoimmune disease can effect ANY body system: skeletal/joints (Rheumatoid Arthritis), skin (eczema/psoriasis and to some extent even acne), gastrointestinal (Inflammatory Bowel Diseases- check out episode 009 on IBD with Ashley for more info on this!) and more! 4) Labs Annie recommends to explore if you might have an autoimmune disease: hsCRP and/or CRP, sedimentation rate, FULL thyroid panel (tune into the episode and episode 004 with Lacey Dunn to learn more about what that means!) 6) Who should be looking into whether autoimmune disease is a cause of their symptoms? Those who seem to have a ton of seemingly unrelated symptoms that there is no other answer for, like neurological conditions (brain fog, anxiety), skin issues, digestive issues, joint pain, chronic fatigue, etc! 7) Annie's action steps if you want to experiment on your own (aka see if these things help your symptoms) -----> Cut out processed foods (tune into the episode to learn what that actually means!) -----> Trial gluten & dairy free diet for at LEAST 1 month (at 100% effort!) 8) If it's an option, food sensitivity testing can be a really helpful option (but be careful! Not all food sensitivity testing is created equal!) --- Support this podcast: https://anchor.fm/curious-women/support

Chili peppers for a healthy gut: Spicy chemical may inhibit gut tumors University of California, San Diego   April 14, 2022 Researchers at the University of California, San Diego School of Medicine report that dietary capsaicin -- the active ingredient in chili peppers -- produces chronic activation of a receptor on cells lining the intestines of mice, triggering a reaction that ultimately reduces the risk of colorectal tumors. The receptor or ion channel, called TRPV1, was originally discovered in sensory neurons, where it acts as a sentinel for heat, acidity and spicy chemicals in the environment. "These are all potentially harmful stimuli to cells," said Eyal Raz, MD, senior author of the study. "Thus, TRPV1 was quickly described as a molecular 'pain receptor.' But Raz and colleagues have found that TPRV1 is also expressed by epithelial cells of the intestines, where it is activated by epidermal growth factor receptor or EGFR. EGFR is an important driver of cell proliferation in the intestines, whose epithelial lining is replaced approximately every four to six days. The scientists discovered that TRPV1, once activated by the EGFR, initiates a direct negative feedback on the EGFR, dampening the latter to reduce the risk of unwanted growth and intestinal tumor development. They found that mice genetically modified to be TRPV1-deficient suffered higher-than-normal rates of intestinal tumor growths. The researchers fed capsaicin to mice genetically prone to developing multiple tumors in the gastrointestinal tract. The treatment resulted in a reduced tumor burden and extended the lifespans of the mice by more than 30 percent.   (NEXT)   How Tart Cherries Reduce Inflammation and Oxidative Stress University of Michigan,  April 15, 2022 Michigan researchers had previously shown that a cherry-enriched diet not only reduced overall body inflammation, but also reduced inflammation at key sites (belly fat, heart) known to affect heart disease risk in the obese. This study offers further promise that foods rich in antioxidants, such as cherries, could potentially reduce inflammation and have the potential to lower disease risk. Two daily doses of the tart cherry concentrate was associated with significantly lower levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP), compared to placebo, according to findings published in Nutrients. "This is the first study to investigate the impact of Montmorency cherries on systemic inflammatory and oxidative stress induced by a series of metabolically challenging cycling bouts.   (NEXT)   Water outperforms sports drinks for young athletes Penn State University, April 14, 2022 Most youngsters don't exert themselves at an intensity or duration that requires the extra sugar and salt contained in sports drinks. Sports drinks can replenish some of what you lost during exercise, but you really need to be exercising for more than 45 minutes to an hour before you would consider that. Many of our kids are not doing enough to warrant it. Energy drinks that contain caffeine or other stimulants are also ill-advised for children, the physicians said. These beverages can boost blood pressure, cause heart palpitations and heart rhythm disorders, headaches and upset stomach. Coaches and parents should provide water to make sure children are properly hydrated during exercise, the doctors said.   (NEXT)   Ginger Found to Reduce Premenstrual Pain and Mood Symptoms Tehran University of Medical Sciences, April 17, 2022 New research has confirmed other findings that ginger root (Zingiber officinale) can relieve premenstrual pain and associated symptoms, without some of the side effects associated with NSAIDs. Medical doctors from the Tehran University of Medical Sciences in Iran studied 70 female students between 18 and 35 years old in a three-month long double-blind, placebo-controlled trial. The women had regular menstruation cycles and were not taking medications, but they each had at least five symptoms of PMS during their normal cycles. Both groups' PMS symptom severity scores were calculated before and after each of the three months. The researchers found that while both groups averaged between 106 and 110 points on the PMS severity testing at the beginning of the study, the ginger group scored significantly lower on all PMS symptoms at the end of each month. After one month, the ginger group's scores averaged 51, while the placebo group averaged 105.7. After three months, the ginger group's scores averaged 49 while the placebo group averaged 107. After the third month, the ginger group's scores average 47 while the placebo group averaged 106.   (SUPERFOODS)   Oranges: The orange is a vitamin and mineral-packed treasure chest of a fruit, rich in vitamins A, B and C, potassium, and calcium, as well as being an excellent source of fiber. One phytonutrient in oranges that boosts it into the super food category is the flavonoid hesperidin. This biochemical works to support healthy blood vessels and reduces cholesterol. What has been established so far overlooks what the public considers the orange's defining health trait, it being stocked with vitamin C, an important antioxidant that limits free radicals while also building the immune system. Vitamin C's healing properties are well known and have been repeatedly scientifically validated. These include the lessening of arterial plaque as well as protecting from Alzheimer's, Parkinson's, and Crohn's diseases, arthritis, and diabetes.

Are you concerned about cardiovascular health? Want an in depth look at your individual biomarkers and risk factors? Just curious about taking things beyond a standard cholesterol panel? Tune in to hear us navigate our CardioMetabolic Panel along with interventions for common concerns such as elevated triglycerides, low HDL, high LDL, elevated hsCRP and so much more!    If you joined us last week, we discussed heart health updates everything from how the heart works to myocarditis to improving endothelial function and more. This week we'll be covering how to assess cardiovascular health using our in depth CardioMetabolic Panel! We'll cover who should consider this panel, how it differs from a standard cholesterol panel you might get at your annual physical, and we'll be walking through a sample panel providing insights and interventions for common concerns.  Also in this episode: Beat the Bloat Program starts 4/6 - Sign Up Now Cardiometabolic Panel - $60 off with code CARDIO60 Episode 40 Heart Health and Cholesterol Episode 157 Cholesterol as Medicine Episode 128 Keto Cardiologist with Guest Episode 283: Heart Health Updates What is the CardioMetabolic Panel? View a Sample Panel Here How is this Different than a Standard Cholesterol Panel? Who Needs This Panel? What Markers are Included?Total Cholesterol HDL Cholesterol Triglycerides LDL Cholesterol LDL Particle Count & Distribution Lipoprotein (a) C-Reactive Protein LP PLA2 Activity Oxidized LDL Homocysteine CRP Fasting Insulin Fasting Glucose Leptin Adiponectin Intervention Strategies Elevated TriglyceridesLower Carbs, Eliminate High Fructose Corn Syrup  EPA DHA Extra 10 Day Detox  How to Increase HDLExercise, Fat Loss B Complex Red Wine - Dry Farms Bold Reds Multidefense Elevated LDLPhytoFiber Why NOT Red Yeast Rice Glucomannan 2-3g/day Foresterol Plant Sterol Stanols 2g/day Episode 237: Mediterranean Keto Elevated VLDL & Small Dense LDLIntermittent Fasting  Sauna/Cold Plunge High Oxidized LDL5 cups produce/day Cellular Antiox at 4 capsules/day Bio-C Plus at 2-4 capsules/day Super Turmeric at 3 capsules/day Lipoprotein aInflammazyme Bio-C Plus B Complex High PLACProbiotic Challenge Beat the Bloat Cleanse Rebuild Spectrum Probiotic Targeted Strength Probiotic High HomocysteineRelax and Regulate B Complex Elevated hsCRPInflammazyme Super Turmeric EPA DHA Extra MRT Food Sensitivity Panel (if experiencing inflammatory symptoms, food reactions or CRP is above 3.0) Fasting InsulinBerberine Boost 12 Week Food as Medicine Ketosis Program 12 Week Keto Meal Plan Consider a CGM from Nutrisense GycomarkEpisode: Why is my A1C Elevated? Leptin Adiponectin   Sponsors for this episode: This episode is sponsored by KetoCon! I am so excited to share that I will be speaking at/attending KetoCon Austin on July 8 - 10 this summer! KetoCon is an annual event held at the Palmer Event Center in Austin, TX. It is the largest event in the U.S. focused solely on the science and stories of living a ketogenic diet and lifestyle. It will feature over 50 speakers who are a combination of medical professionals, researchers, bloggers, technology developers, fitness experts and every day people who have used the ketogenic diet and lifestyle to improve their health. For discounted tickets, go to ketocon.org and click on the GET TICKETS button and use the discount code: nourished10 at checkout and receive a 10% discount code on 3-Day General Admission passes.   

Imagine rocketing head and face-first down a frozen track around 80 miles per hour with the rapidly moving ground just inches from your face. Well, that sport is called Skeleton and Duff Gibson won a gold medal in the 2006 Winter Olympics for being the best. Not only that, but he is the oldest gold medalist in history in the Winter Olympics, winning gold at age 39 after decades finding his niche in sport. Duff didn't start in Skeleton and spent a lot of time finding high degrees of success in winter sports, but it wasn't enough to help him realize his Olympic dream he had since childhood. Duff knew when to walk away and try new sports to help him achieve his ultimate goal- Olympic Gold. As an athlete, Duff was a provincial champion speed skater, a national champion and national team member in bobsleigh, and then a world and Olympic gold medallist in the sport of skeleton. As a coach, he led six different athletes to podium finishes at a world level. Competing against, working with, and learning from numerous world-leading athletes and coaches has provided Duff a breadth and depth of experience few others have had. Duff is passionate about the mental side of sport. He wrote the book the Tao of Sport chronicling his story along with many other high-achieving athletes and Olympians with the mental side of sport interweaved into the narrative. He regularly works with younger multi-sport athletes and is based in Calgary. "Number 1 is doing it forth the love of it. The mindset is give me the chance, give the chance and I'll show you my best as opposed to I hope I don't screw this up. So that's a mindset thing." -Duff Gibson   Key Takeaways How did he know when to switch sports Using positivity in sports What is skeleton? Managing fear in his sport How to deal with pressure How to use visualization in sport How to be confident if you don't know the path ___ Links Go to Tao of Sport My podcast episode mentioned: David Epstein and his book, Range My podcast episode mentioned: Youth Mental Training with Jennifer Etnier Check out my Substack about high-performance mindset Sign up for my weekly newsletter!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Muay Thai is a martial art and combat sport that uses stand-up striking along with various clinching techniques, and being plant-based has been a gamechanger for Cass Warbeck. Cass Warbeck started training martial arts at the age of 11 and is a black belt in Goju Ryu karate and black level in Kurama Yama kickboxing. After reading The China Study by T. Colin Campbell in 2013, she went plant-based and never looked back. A plant-based diet fueled her throughout her amateur Muay Thai fighting career and in March 2019 she fought for and won the World Kickboxing Association (WKA) North American Bantamweight Muay Thai Title. Cass has always loved inspiring and educating others to achieve better personal health through physical movement and nutrition. She completed a Bachelor of Science in Health and Fitness Physiology from the University of Calgary and worked as a Canadian Society for Exercise Physiology (CSEP) certified personal trainer before applying to medical school. Currently Cass is a 3rd year medical student at the University of Alberta wants to improve the nutrition education provided to medical students in Canada. She looks forward to utilizing the power of lifestyle medicine and plant-based nutrition in her future medical practice. Cass has been featured in the book, Legends of Change, and the magazine Canadian Vegan. She is a long term volunteer for the organization Nutritionfacts.org and is the host of The Plant Fueled Podcast. "I read this book and it opened my eyes to how food and diet can actually affect long term health, and not just your immediate body composition or how you look or how toned you are. It can actually affect long-term health and your longevity and all these different things. I just couldn't believe it.  I couldn't believe I hadn't learned this before. I was taking a nutrition course. I just had never made the connection. What I eat today could influence whether I would get breast cancer in the future.  It was just kinda downhill from there. I just started reading all I could about nutrition and plant-based diets."   - Cass Warbeck   Listen Now   Key Takeaways Muay Thai: what's it like to fight someone Confidence as a female fighter Her plant-based diet change Food affecting long term health and longevity Cutting weight for fights There's a lot more to health than exercise ___ Links Microsoft Word - Cass Warbeck Podcast Bio.docx Instagram: @plant_fueled Podcast: The Plant Fueled Podcast Listen to Cass interviewing me on her podcast Listen to my interview with T Colin Campbell, author of The China Study Listen to my interview with Dr. Michael Greger fo Nutritionfacts.org Sign up for my weekly newsletter!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

"It's too late for me. I'm too old to start." Have you ever used these excuses are barriers? Meet Ian Morgan, an ultrarunner who is crushing it in his 50s. And guess what? He didn't even start on this journey until he was in his mid-40s. Ian was primarily focused on his engineering career and property investment company in his 20s and 30s. Realizing that a primary focus on money, materialistic possessions, and career achievements wasn't making him happy, he took a 180 turn in his life. Ian said, " I was overweight, stressed, and unhappy with myself, so I started to run. This is where I discovered a passion for ultra running. Eventually, I sold everything I owned (Houses, cars, bikes, and all my furniture) and started living a more nomadic minimalist lifestyle, traveling the world and running 50 to 250 km plus ultra races in some of the world's wildest places." How did this happen? Starting as a proverbial couch potato to present day super-fit ultra runner (seriously, he ran a 2:50 marathon and as you just heard, he gets in some serious distance), Ian knows what it takes to claim responsibility for your life and make lasting changes. And to top it all off, he says you're never too old to get started. How many of us would think we could start our running career in our late 40s and early 50s? His current job is to run and he works with sponsors as a competitive lifestyle athlete and inspires thousands with his Instagram account. "Mental laziness is something that you can use as an excuse, but at the end of the day, I had to face myself and say "is that the person I really want to be?" I remember when I was a kid, I wasn't that way. I used to challenge myself, I used to push myself so I guess I went back to those childhood experiences, examined it and thought  “what can I do now as an adult to bring that to the forefront, to push myself again?" Once I realized I had this propensity for mental laziness, I then know when it comes up, I know when I start telling myself those excuses, I can check myself and use that discipline, use consistency and start putting in the work."   -Ian Morgan   Listen Now   Key Takeaways Who is Ian Morgan? Why we lose connection to ourselves as athletes Overcoming mental laziness The problem with taking on too much too quickly Ian Morgan's inspiring transformation You're never to old to start Defining Success ___ Links Follow Ian Morgan on Instagram My podcast episode I mentioned: Picking Yourself Check out my Substack about high-performance mindset Sign up for my weekly newsletter!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Sarah Sturm is a cyclist who can't be grouped into a specific category of cycling. Although you might know her bright smile and speedy results from gravel, she is a 2x Singlespeed Cyclocross National Champion, a podium finisher at the Leadville 100 Mountain Bike Race this year, has multiple high-profile gravel accolades (aka Belgian Waffle Ride, Steamboat Gravel (SBT GRVL), Oregon Trail Gravel Grinder, The Rift in Iceland, and more), and done a sizeable amount of racing road and cross-country mountain bike races... to bikepacking adventures for fun. Oh, and let's not forget to mention we met at the Trans BC Enduro stage race. When there are two wheels involved, Sarah's spirit for adventure, connection, and fun has taken her down many trails, roads, and paths. In addition to all the time Sarah Sturm spends cycling (in the saddle) and professional commitments, she also coaches young riders in the Devo Program in Durango, CO, and has a successful graphic design business called Oso Creative. Sarah isn't only inspiring a new generation of riders, but also the fellow racers lining up next to her. Sarah Sturm's trajectory as a cyclist hasn't always been easy. Early on, she found she wasn't having any fun racing her bike and after a hiatus, came back to it with a newfound sense of joy and perspective. In this episode, you'll immediately feel her ability to connect with just about anyone, her positivity, and vulnerability no matter who you are. "I know progress not perfection. We hear these things, but it's so hard to actually embody that sometimes because you just want to do well all the time and be the best. It's not even about crossing the finish line, but proving it to myself sometimes if that makes sense. I'm not very good at actually looking back and being proud at some of the stuff I've accomplished.”  - Sarah Sturm   Listen Now Key Takeaways the pressure of professional athletics progress not perfection challenges of being a female athlete how to have a good relationship on social media our own jealousy and insecurities how vulnerability can be powerful what's my worth how to deal with pressure ___ Links Follow Sarah Sturm on Instagram Grab the book Mindset by Carol Dweck Check out my Substack about high-performance mindset Sign up for my weekly newsletter!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Sonya has been committed to a plant-based diet for almost a decade. Her interest in and passion for the benefits of plant-based eating has led her to connect to those equally committed to the space.  Cue this week's episode with Stevan Mirkovich - owner of Planted Expo, a trade show, platform and network to connect Canadians to local vegan and plant-based businesses. Sonya will be speaking at Planted Expo this weekend and had a chance to speak with Stevan leading up to the event. Stevan is a recovering food addict, who experienced overeating, junk-food veganism, and eventually found his way to a plant-based style of living. He has guided hundreds of people in plant-based nutrition, cooking through sharing educational resources to help people transition to a better way of eating. Sonya and Stevan had a fantastic conversation spanning the topics of leadership, cooking, plant-based diets, human connection and more. "“That control piece is an interesting one because the truth is, you're the only one that can control what you eat, or should be the only one that controls what you eat, right? And it shouldn't be, well my spouse does this or my partner does this or my family does this, and therefore, I can't have the agency that I'm looking for in my dietary choices...just to really stay narrow here. But, that being said, it is tricky because the nuance there is what you raised, in that a lot of our responses to our emotional upheaval or our emotional dysregulation is a desire for control. That desire for control can express itself in a variety of settings, in a variety of ways. For me, it happened to express itself through controlling what I eat and I think probably for a lot of people that is the truth. So it's reframing your perception of control and not abnegating your agency in what you choose to eat, but also having a healthier relationship with the choices you make around food when you're aware of your emotional state.”"  - Stevan Mirkovich     Key Takeaways When something throws life out of balance For the love of food and coffee Planted Expo Cooking classes Getting comfortable in the kitchen with plant-based recipes Going plant-based in 2003 Emotions around food Searching for control Food as a social issue Importance of human connection ___ Links Learn more about Planted Expo Liked this episode? Listen to other podcasts on plant-based nutrition Check out all of my info on plant-based nutrition Check out my Substack about high-performance mindset Sign up for my weekly newsletter!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Pomegranate peel has protective effects against enteropathogenic bacteria US Department of Agriculture, August 31, 2021 A recent study by the U.S. Department of Agriculture revealed that pomegranate peel extract contains bioactive compounds that have potential antibacterial activity. The study's findings were published in the journal Nutrition Research. Pomegranate fruit peel is considered an agricultural waste product. However, it is a rich source of polyphenols like punicalins, punicalagins and ellagic acids. Earlier studies have shown that products derived from pomegranates have health benefits, including antibacterial activity, in vitro. There is limited evidence, however, of their antibacterial activity in vivo. For this study, researchers sought to determine the antibacterial properties of pomegranate peel extract in vivo. In particular, they focused on the punicalin, punicalagin and ellagic acid present in the peel extract. The researchers infected C3H/He mice with the bacterial pathogen Citrobacter rodentium, a bacterium that mimics the enteropathogenic bacterium, Escherichia coli. Prior to infection, the mice were orally treated with water or pomegranate peel extract. Twelve days after infection, the researchers examined C. rodentium colonization of the colon and spleen, as well as changes in tissue and gene expression. Fecal excretions were also analyzed for C. rodentium. The results revealed that the pomegranate peel extract reduced weight loss and mortality induced by C. rodentium infection. The extract also reduced C. rodentium colonization of the spleen. Additionally, pomegranate peel extract decreased the extent of damage in the colon caused by C. rodentium infection. In sum, pomegranate fruit peel extract contains bioactive compounds that can help reduce the severity of C. rodentium infection in vivo.   Vitamin D may protect against young-onset colorectal cancer Dana-Farber Cancer Institute and Harvard  School of Public Health, September 1, 2021 Consuming higher amounts of Vitamin D - mainly from dietary sources - may help protect against developing young-onset colorectal cancer or precancerous colon polyps, according to the first study to show such an association. The study, recently published online in the journal Gastroenterology, by scientists from Dana-Farber Cancer Institute, the Harvard T.H. Chan School of Public Health, and other institutions, could potentially lead to recommendations for higher vitamin D intake as an inexpensive complement to screening tests as a colorectal cancer prevention strategy for adults younger than age 50. While the overall incidence of colorectal cancer has been declining, cases have been increasing in younger adults - a worrisome trend that has yet to be explained. The authors of the study, including senior co-authors Kimmie Ng, MD, MPH, of Dana-Farber, and Edward Giovannucci, MD, DSc., of the T.H. Chan School, noted that vitamin D intake from food sources such as fish, mushrooms, eggs, and milk has decreased in the past several decades. There is growing evidence of an association between vitamin D and risk of colorectal cancer mortality. However, prior to the current study, no research has examined whether total vitamin D intake is associated with the risk of young-onset colorectal cancer. “Vitamin D has known activity against colorectal cancer in laboratory studies. Because vitamin D deficiency has been steadily increasing over the past few years, we wondered whether this could be contributing to the rising rates of colorectal cancer in young individuals,” said Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber. “We found that total vitamin D intake of 300 IU per day or more - roughly equivalent to three 8-oz. glasses of milk - was associated with an approximately 50% lower risk of developing young-onset colorectal cancer.” The results of the study were obtained by calculating the total vitamin D intake - both from dietary sources and supplements - of 94,205 women participating in the Nurses' Health Study II (NHS II). This study is a prospective cohort study of nurses aged 25 to 42 years that began in 1989. The women are followed every two years by questionnaires on demographics, diet and lifestyle factors, and medical and other health-related information. The researchers focused on a primary endpoint - young-onset colorectal cancer, diagnosed before 50 years of age. They also asked on a follow-up questionnaire whether they had had a colonoscopy or sigmoidoscopy where colorectal polyps (which may be precursors to colorectal cancer) were found. During the period from 1991 to 2015 the researchers documented 111 cases of young-onset colorectal cancer and 3,317 colorectal polyps. Analysis showed that higher total vitamin D intake was associated with a significantly reduced risk of early-onset colorectal cancer. The same link was found between higher vitamin D intake and risk of colon polyps detected before age 50. The association was stronger for dietary vitamin D - principally from dairy products - than from vitamin D supplements. The study authors said that finding could be due to chance or to unknown factors that are not yet understood. Interestingly, the researchers didn't find a significant association between total vitamin D intake and risk of colorectal cancer diagnosed after age 50. The findings were not able to explain this inconsistency, and the scientists said further research in a larger sample is necessary to determine if the protective effect of vitamin D is actually stronger in young-onset colorectal cancer. In any case, the investigators concluded that higher total vitamin D intake is associated with decreased risks of young-onset colorectal cancer and precursors (polyps). “Our results further support that vitamin D may be important in younger adults for health and possibly colorectal cancer prevention,” said Ng. “It is critical to understand the risk factors that are associated with young-onset colorectal cancer so that we can make informed recommendations about diet and lifestyle, as well as identify high risk individuals to target for earlier screening.”     Choosing personal exercise goals, then tackling them immediately is key to sustaining change University of Pennsylvania, September 1, 2021 When people set their own exercise goals – and then pursue them immediately – it's more likely to result in lasting positive changes, according to a new study at the Perelman School of Medicine at the University of Pennsylvania. The results of this research are especially important because they were found among an underserved population that is at particularly high risk of having or developing heart conditions. The study was published in JAMA Cardiology. “Most behavior change programs involve goal-setting, but the best way to design that process is unknown,” said lead author Mitesh Patel, MD, MBA, an associate professor of Medicine at Penn and vice president for Clinical Transformation at Ascension. “Our clinical trial demonstrated that physical activity increased the most when patients chose their goals rather than being assigned them, and when the goals started immediately rather than starting lower and gradually increasing over time. These findings are particularly important because the patients were from lower-income neighborhoods and may face a number of challenges in achieving health goals.” This study consisted of 500 patients from low-income neighborhoods, mainly in West Philadelphia but also elsewhere in and outside of the city. Participants either had a cardiovascular disease or were assessed to have a near-10 percent risk of developing one within a decade. These high-risk patients stood to greatly gain from increased physical activity. Patel's previous work at the Penn Medicine Nudge Unit often focused on the use of gamification, a concept used to create behavioral change by turning it into a game. The work usually tested whether playing a game attached to physical activity goals could make significant increases against not playing a game, or between different versions of a game. As with past studies, every participant was given a wearable step tracker that recorded their daily step counts through Penn's Way to Health platform. But what set this study apart from many of its predecessors was that the main outcomes of the research were less about participation in the games themselves and more about how goals were established, as well as when participants were encouraged to pursue them. Once every participant got their wearable step counter, they were given a week or two to get used to it. This time period also functioned as a baseline-setting period for everyone's pre-intervention daily step count. After that, participants were randomly assigned to the control group, which didn't have step goals or games attached, or one of the gaming groups with goals. Those in the gamified group also went through two other sets of random assignments. One determined whether they'd have input on their step goal, or whether they'd just be assigned a standard one. The second decided whether each participant would immediately start working toward their goals (for the entire 16-week intervention), or whether they'd ramp up to it, with minor increases in goals, until the full goals kicked in at week nine. After analyzing the results, the researchers saw that the only group of participants who achieved significant increases in activity were those who chose their own goals and started immediately. They had the highest average increase in their steps compared to the group with no goals, roughly 1,384 steps per day. And, in addition to raw step counts, the study also measured periods of sustained, high activity, amounting to an average increase of 4.1 minutes daily. Comparatively, those who were assigned their goals or had full goals delayed for half the intervention only increased their daily steps above the control group's average by between 500 and 600 steps. “Individuals who select their own goals are more likely to be intrinsically motivated to follow through on them,” said Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics. “They feel like the goal is theirs and this likely enables greater engagement.” The study didn't end when the researchers turned the games off. Participants kept their activity trackers, and in the eight weeks following the intervention, the group that chose their goals and started immediately kept up their progress. In fact, they achieved almost the exact same average in steps – just three less than during the active games. “It is exciting to see that the group that increased their activity levels by the most steps maintained those levels during follow-up,” Patel said. “This indicates that gamification with self-chosen and immediate goals helped these patients form a new habit.” Many programs, whether offered through work or by health insurance companies, offer incentives for boosts in physical activity. But these goals are often fairly static and assigned based on round numbers. Patel, Volpp, and colleagues believe this research suggests that adjusting goal setting in these programs can have a significant impact. And if these adjustments lead to gains among people with lower incomes, whom cardiovascular disease kill at 76 percent higher rates, that could be particularly important.           “Goal-setting is a fundamental element of almost every physical activity program, whether through a smartphone app or in a workplace wellness program,” Volpp said. “Our findings reveal a simple approach that could be used to improve the impact of these programs and the health of their patients.”   Comparing seniors who relocate long-distance shows that where you live affects your longevity Massachusetts Institute of Technology, September 1, 2021 Would you like to live longer? It turns out that where you live, not just how you live, can make a big difference. That's the finding of an innovative study co-authored by an MIT economist, which examines senior citizens across the U.S. and concludes that some locations enhance longevity more than others, potentially for multiple reasons. The results show that when a 65-year-old moves from a metro area in the 10th percentile, in terms of how much those areas enhance longevity, to a metro area the 90th percentile, it increases that person's life expectancy by 1.1 years. That is a notable boost, given that mean life expectancy for 65-year-olds in the U.S. is 83.3 years. "There's a substantively important causal effect of where you live as an elderly adult on mortality and life expectancy across the United States," says Amy Finkelstein, a professor in MIT's Department of Economics and co-author of a newly published paper detailing the findings. Researchers have long observed significant regional variation in life expectancy in the U.S., and often attributed it to "health capital"—tendencies toward obesity, smoking, and related behavioral factors in the regional populations. But by analyzing the impact of moving, the current study can isolate and quantify the effect that the location itself has on residents. As such, the research delivers important new information about large-scale drivers of U.S. health outcomes—and raises the question of what it is about different places that affects the elderly's life expectancy. One clear possibility is the nature of available medical care. Other possible drivers of longevity include climate, pollution, crime, traffic safety, and more. "We wanted to separate out the role of people's prior experiences and behaviors—or health capital—from the role of place or environment," Finkelstein says. The paper, "Place-Based Drivers of Mortality: Evidence of Migration," is published in the August issue of the American Economic Review. The co-authors are Finkelstein, the John and Jennie S. MacDonald Professor of Economics at MIT, and Matthew Gentzkow and Heidi Williams, who are both professors of economics at Stanford University. To conduct the study, Finkelstein, Gentzkow, and Williams analyzed Medicare records from 1999 to 2014, focusing on U.S. residents between the ages of 65 and 99. Ultimately the research team studied 6.3 million Medicare beneficiaries. About 2 million of those moved from one U.S. "commuting zone" to another, and the rest were a random 10 percent sample of people who had not moved over the 15-year study period. (The U.S. Census Bureau defines about 700 commuting zones nationally.) A central element of the study involves seeing how different people who were originally from the same locations fared when moving to different destinations. In effect, says Finkelstein, "The idea is to take two elderly people from a given origin, say, Boston. One moves to low-mortality Minneapolis, one moves to high-mortality Houston. We then compare thow long each lives after they move." Different people have different health profiles before they move, of course. But Medicare records include detailed claims data, so the researchers applied records of 27 different illnesses and conditions—ranging from lung cancer and diabetes to depression—to a standard mortality risk model, to categorize the overall health of seniors when they move. Using these "very, very rich pre-move measures of their health," Finkelstein notes, the researchers tried to account for pre-existing health levels of seniors from the same location who moved to different places. Still, even assessing people by 27 measures does not completely describe their health, so Finkelstein, Gentzkow, and Williams also estimated what fraction of people's health conditions they had not observed—essentially by calibrating the observed health of seniors against health capital levels in places they were moving from. They then consider how observed health varies across individuals from the same location moving to different destinations and, assuming that differences in unobserved health—such as physical mobility—vary in the same way as observed differences in health, they adjust their estimates accordingly. All told, the study found that many urban areas on the East and West Coasts—including New York City, San Francisco, and Miami—have positive effects on longevity for seniors moving there. Some Midwestern metro areas, including Chicago, also score well. By contrast, a large swath of the deep South has negative effects on longevity for seniors moving there, including much of Alabama, Arkansas, Louisiana, and northern Florida. Much of the Southwest, including parts of Texas, Oklahoma, New Mexico, and Arizona, fares similarly poorly. The scholars also estimate that health capital accounts for about 70 percent of the difference in longevity across areas of the U.S., and that location effects account for about 15 percent of the variation. "Yes, health capital is important, but yes, place effects also matter," Finkelstein says. Other leading experts in health economics say they are impressed by the study. Jonathan Skinner, the James O. Freeman Presidential Professor of Economics, Emeritus, at Dartmouth College, says the scholars "have provided a critical insight" into the question of place effects "by considering older people who move from one place to another, thus allowing the researchers to cleanly identify the pure effect of the new location on individual health—an effect that is often different from the health of long-term residents. This is an important study that will surely be cited and will influence health policy in coming years." The Charlotte Effect: What makes a difference? Indeed, the significance of place effects on life expectancy is also evident in another pattern the study found. Some locations—such as Charlotte, North Carolina—have a positive effect on longevity but still have low overall life expectancy, while other places—such as Santa Fe New Mexico—have high overall life expectancy, but a below-average effect on the longevity of seniors who move there. Again, the life expectancy of an area's population is not the same thing as that location's effect on longevity. In places where, say, smoking is highly prevalent, population-wide longevity might be subpar, but other factors might make it a place where people of average health will live longer. The question is why. "Our [hard] evidence is about the role of place," Finkelstein says, while noting that the next logical step in this vein of research is to look for the specific factors at work. "We know something about Charlotte, North Carolina, makes a difference, but we don't yet know what." With that in mind, Finkelstein, Gentzkow, and Williams, along with other colleagues, are working on a pair of new studies about health care practices to see what impact place-based differences may have; one study focuses on doctors, and the other looks at the prescription opioid epidemic. In the background of this research is a high-profile academic and policy discussion about the impact of health care utilization. One perspective, associated with the Dartmouth Atlas of Health Care project, suggests that the large regional differences in health care use it has documented have little impact on mortality. But the current study, by quantifying the variable impact of place, suggest there may be, in turn, a bigger differential impact in health care utilization yet to be identified. For her part, Finkelstein says she would welcome further studies digging into health care use or any other factor that might explain why different places have different effects on life expectancy; the key is uncovering more hard evidence, wherever it leads. "Differences in health care across places are large and potentially important," Finkelstein says. "But there are also differences in pollution, weather, [and] other aspects. … What we need to do now is get inside the black box of 'the place' and figure out what it is about them that matters for longevity."   Gut bacteria influence brain development Researchers discover biomarkers that indicate early brain injury in extreme premature infants University of Vienna (Austria), September 3, 2021 The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. "We investigated the role this axis plays in the brain development of extreme preterm infants," says the first author of the study, David Seki. "The microorganisms of the gut microbiome - which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes - are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain," explains the microbiologist and immunologist. Patterns in the microbiome provide clues to brain damage "In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury," adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. "Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided." Comprehensive study of the development of extremely premature infants Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. "Our data show that excessive growth of the bacterium Klebsiella and the associated elevated γδ-T-cell levels can apparently exacerbate brain damage," explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. "We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process," he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods - the team examined the microbiome using 16S rRNA gene sequencing, among other methods - the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants' brains. Research continues with two studies The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. "How the children's motoric and cognitive skills develop only becomes apparent over several years," explains Angelika Berger. "We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. " The most important cooperation partners for the project are already on board: "The children's parents have supported us in the study with great interest and openness," says David Seki. "Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that."     Amino acid supplements may boost vascular endothelial function in older adults: Study University of Alabama, August 28, 2021 A combination of HMB (a metabolite of leucine), glutamine and arginine may improve vascular function and blood flow in older people, says a new study. Scientists from the University of Alabama report that a supplement containing HMB (beta-hydroxy-beta-methylbutyrate), glutamine and arginine (Juven by Abbott Nutrition) increased flow-mediated dilation (FMD - a measure of blood flow and vascular health) by 27%, whereas no changes were observed in the placebo group. However, the researchers did not observe any changes to markers of inflammation, including high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-alpha) “Our results indicate that 6 months of dietary supplementation with HMB, glutamine and arginine had a positive impact on vascular endothelial function in older adults,” wrote the researchers, led by Dr Amy Ellis in the European Journal of Clinical Nutrition . “These results are clinically relevant because reduced endothelial-dependent vasodilation is a known risk factor for cardiovascular diseases. “Further investigation is warranted to elucidate mechanisms and confirm benefits of foods rich in these amino acids on cardiovascular outcomes.” The study supported financially by the National Center for Complementary and Alternative Medicine. Study details Dr Ellis and her co-workers recrtuited 31 community-dwelling men and women aged between 65 and 87 to participate in their randomized, placebo-controlled trial. The participants were randomly assigned to one of two groups: The first group received the active supplements providing 3 g HMB, 14 g glutamine and 14 g arginine per day; while the second group received a placebo. After six months of intervention, the researchers found that FMD increased in the HMB + glutamine + arginine group, but no such increases were observed in the placebo group. While no changes in CRP or TNF-alpha levels were observed in the active supplement group, a trend towards an increase in CRP levels was observed in the placebo group, but this did not reach statistical significance, they noted. “Although no previous studies have examined this combination of amino acids on vascular function, we hypothesized that the active ingredients of the supplement would act synergistically to improve endothelial function by reducing oxidative stress and inflammation,” wrote the researchers. “However, although we observed a trend for increasing hsCRP among the placebo group (P=0.059), no significant changes in hsCRP or TNF-alpha were observed for either group. “Possibly, the effects of the supplement on reducing oxidative stress and inflammation were subclinical, or the high variability in these biomarkers, particularly hsCRP, among our small sample could have precluded visible differences.” The researchers also noted that an alternate mechanism may also be responsible, adding that arginine is a precursor of the potent vasodilator nitric oxide “Although investigation of this mechanism was beyond the scope of this study, it is feasible that the arginine in the supplement improved endothelial-dependent vasodilation by providing additional substrate for nitric oxide synthesis,” they added.     Moderate coffee drinking associated with lower risk of mortality during 11-year median follow-up Semmelweis University (Bulgaria), September 1 2021.  Research presented at ESC (European Society of Cardiology) Congress 2021 revealed a lower risk of dying from any cause during an 11-year median period among light to moderate coffee drinkers in comparison with men and women who had no intake. The study included 468,629 UK Biobank participants of an average age of 56.2 years who had no indications of heart disease upon enrollment. Coffee intake was classified as none, light to moderate at 0.5 to 3 cups per day or high at over 3 cups per day. A subgroup of participants underwent magnetic resonance imaging (MRI) of the heart to assess cardiac structure and function.  Light to moderate coffee intake during the follow-up period was associated with a 12% decrease in the risk of dying from any cause, a 17% lower risk of cardiovascular mortality and a 21% reduction in the incidence of stroke in comparison with the risks associated with not drinking coffee.  “The imaging analysis indicated that, compared with participants who did not drink coffee regularly, daily consumers had healthier sized and better functioning hearts,” reported study author Judit Simon, of Semmelweis University in Budapest. “This was consistent with reversing the detrimental effects of aging on the heart.” “To our knowledge, this is the largest study to systematically assess the cardiovascular effects of regular coffee consumption in a population without diagnosed heart disease,” she announced. “Our results suggest that regular coffee consumption is safe, as even high daily intake was not associated with adverse cardiovascular outcomes and all-cause mortality after a follow-up of 10 to 15 years. Moreover, 0.5 to 3 cups of coffee per day was independently associated with lower risks of stroke, death from cardiovascular disease, and death from any cause.”

Can I Ignore This Study, Thoughts and Feedback on IF, LMHR, High Blood Pressure From Salt Consumption, Electrolytes and Long Haul Flights Make your health an act of rebellion. Join The Healthy Rebellion Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News topic du jour: leaky vaccines, super-spreads, and variant acceleration 1. Can I ignore this study? [19:10] Kat says: Hi Robb and Nicki, Your podcast is still one of my favourite podcasts :) I did post my question on the Healthy Rebellion and had some helpful thoughts from other members but I wondered if it might be an interesting one to discuss on the podcast: Context: I eat a reasonably high fat meat based diet due to Sjogrens Syndrome having majorly affected my gut. Before I figured out what I could tolerate I lost a lot of weight and was actually warned my heart was under strain and beating too slowly, and I could die if I caught the normal flu. Now I have the weight back on and my heart is back to normal. So when I read things like this I sort of worry, and then talk myself out of worrying after remembering that mouse models aren't always translatable and so many studies have limitations in other ways. Any way, here's a discussion of the study. I haven't been able to get access to the full journal article. https://medicalgroup.ucdavis.edu/health-news/newsroom/study-explains-why-food-high-in-saturated-fat-may-lead-to-plaque-build-up-in-arteries/2021/08 Thanks :) 2. Thoughts and Feedback on IF [21:58] John says: I'm a long time listener and just wanted to give some feed back and thoughts on my own experiences. Recently you mentioned the mistakes many are making with doing intermittent fasting or one meal a day with muscle loss etc. I can say from my own experiences as a 49 year old man I tried it and it was magical at first but then I did lose muscle and strength and have gone back to a lower carb paleo/ancestral diet and feel much better. Strength, muscle tone, energy, libido, etc.. I think maybe the intermittent fasting thing has become or taken over from the CR or calorie restriction group with many or all of the usual side effects. Obviously fasting and intermittent fasting are great tools especially if some one is over weight or diabetic but we can look at fasting in religions and see that there are probably reasons its only certain times of the year. I don't know just wanted to hear your thoughts and say you as usual were right on. A recent Harvard study show exercise and not fasting is probably the key to health and longevity. Who would have thought that eating real food and moving was healthy? https://highintensityhealth.com/exercise-better-than-fasting-calorie-restriction-for-aging-longevity/ https://highintensityhealth.libsyn.com/exercise-is-better-than-fasting-calorie-restriction-for-aging-longevity-harvard-scientists-say 3. LMHR [26:52] Patrick says: I'm a 42 year old male personal trainer in Texas. I'm 5'8", about 170 pounds and stay at around 5-8% body fat. I've been in pretty much the same shape for about a decade. About 3 years ago I learned about Dave Feldman's work after being denied life insurance for having high cholesterol. Initially I was worried since my total cholesterol had always been around 200, LDL 130 and HDL 80 with low triglycerides. But suddenly my total cholesterol had jumped to 380, LDL to 280 and HDL to 98 still with low triglycerides around 70. The only change to my diet had been to completely cut out all processed sugar and other processed carbs. Up to that point I'd been eating a pretty low carb diet but would still occasionally indulge in ice cream or something my wife baked. But after reading Nina Teicholz, Wired to Eat, Gary Taubes, etc, I wanted to see what a year with absolutely no cheating would feel like. About 4 months into this experiment I saw my cholesterol had skyrocketed and learned that I was an LMHR. This of course sent me on a journey down the cholesterol rabbit hole which as you know leads to dozens of other tunnels. Anyway its really interesting that literally the only change I made was cutting junk out completely and this was the result. Btw I've had 2 NMR tests, both had my particle number above 3000. My IR score was 25. They showed that have about 75% large type A LDL which are not associated with atherosclerosis. I've checked my insulin, homocysteine, hsCRP, LPa, and other markers all which have remained optimal. I lift, sprint, row and run. I eat lots of beef and lamb, low carb veggies and fruit. Conventional medicine says I'm at much higher risk for heart disease. Because I cut out sugar? Should we not paying more attention to LDL size or is it possible in an otherwise healthy individual, high LDL may not matter? 4. High Blood Pressure From Salt Consumption? [34:56] Rusty says: My diet, exercise, and the like all need work, but I'm wondering, generally, is there a scientific way of determining if high blood pressure is from salt consumption?  I know you're kind of on the supplemental end of the electrolytes, and it makes total sense for folks out there, in ketosis, and sweating... it's something I intend on doing more of. Is there a way of actually knowing how much salt you're holding onto, so you know you need to supplement or cut back? 5. Electrolytes & Long haul flights [39:04] Karyn says: Hello! I'm lucky enough to be traveling soon and have 2 x 15 hour flights with a 4 hour break between. I plan to stay low carb for the duration of the trip by bringing my own food, but I'm wondering how long haul flights might affect my electrolyte requirements? I currently feel best with an average of 3 LMNT packs per day - should I just maintain that or might I need more or less? Thanks so much, Karyn Share the episode! If something in this show helped you please share the episode with your friends! Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte packets to keep you at your peak! They give you all the electrolytes want, none of the stuff you don't. Click here to get your LMNT electrolytes Transcript: Download a copy of this transcript here (PDF)

Oncotarget published this trending research perspective on June 22, 2021, entitled, "Association of high-sensitivity C-reactive protein and odds of breast cancer by molecular subtype: analysis of the MEND study" by researchers from Duke University, Durham, NC; University of Lagos, Lagos State, Nigeria; Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria; University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria; Federal Medical Center, Abeokuta, Ogun State, Nigeria; UNC Gillings School of Global Public Health, Chapel Hill, NC; Our Lady of Apostle Catholic Hospital, Ibadan, Oyo State, Nigeria; University of Alabama at Birmingham, AL; University of Kentucky, Lexington, KY; University of Kansas Medical Center, Kansas City, KS. In this study, 555 Nigerian participants were assembled—of which 296 were confirmed breast cancer cases, and 259 were controls. The researchers collected clinical and reproductive characteristics of each participant, including the controls. In their first analysis, the researchers observed that newly diagnosed cases of Nigerian breast cancer were significantly more likely to have high levels of highly-sensitive CRP (hsCRP) compared to the controls. After adjusting for socio-demographic, clinical, and reproductive variables, the team still observed significant statistical significance for high levels of hsCRP associated with Nigerian BC. The findings from this cohort study also showed that high hsCRP was associated with a four-fold increased odds of BC. “We also provide novel evidence of associations between hsCRP and BC molecular subtypes, with significant associations observed for luminal A, TN, and HER-enriched subtypes.” Full blog - https://www.oncotarget.org/2021/08/12/trending-with-impact-analysis-of-breast-cancer-in-nigerian-women/ Press release - https://www.oncotarget.com/news/pr/oncotarget-odds-of-breast-cancer-by-molecular-subtype-analysis-of-the-mend-study/ Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.27991 DOI - https://doi.org/10.18632/oncotarget.27991 Full text - https://www.oncotarget.com/article/27991/text/ Correspondence to - Tomi Akinyemiju - tomi.akinyemiju@duke.edu Keywords - C-reactive protein, breast cancer, Nigeria, molecular subtype, menopausal status About Oncotarget Oncotarget is a bi-weekly, peer-reviewed, open access biomedical journal covering research on all aspects of oncology. To learn more about Oncotarget, please visit https://www.oncotarget.com or connect with: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget YouTube - https://www.youtube.com/c/OncotargetYouTube/ LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Oncotarget is published by Impact Journals, LLC please visit https://www.ImpactJournals.com or connect with @ImpactJrnls Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Robert Cheeke is 220 pounds of pure muscle.  As a vegan bodybuilder, author of x books, and motivational speaker, he has impacted many lives. He went vegan in 1995 when he was 120lbs and has built a physique naturally that shows his dedication to health, hard work, and consistency. And those themes not only show up in his athletic life, but in all aspects of his life. Robert is the author of 4 books, with his most recent book, The Plant-Based Athlete available for pre-sale now! It comes out in June and chronicles exactly how to succeed as a plant-based athlete. It also includes stories of plant-based Olympians, World Champions, and successful athletes. I was deeply honored to be featured in this amazing book and humbled to be on the list with some legends. Make sure you pre-order a copy of the book. It also has more than 60 scrumptious plant-based recipes (and a few of my own!)   "It all comes down to showing up. You gotta be at the starting line in order to achieve those things.  And what it means to even get to the starting line. You have to dig deeper, you have to figure out why you're doing it,  why it matters to you. Why you're there, what it's going to mean to you when you do it. What it can mean to you if you don't, if you don't even try. Those kinds of things really connected with me and made me want to work harder while I was writing the book" Robert Cheeke   You'll hear themes of showing up, work ethic, confidence, and not giving up. Topics Discussed in the Podcast  how bodybuilding changed his confidence and identity the problem with leading with ego Robert's ego checking moment tips for building muscle co-writing The Plant-Based Athlete with Matt Frazier (NoMeatAthlete) confidence and drive to do the unknown work ethic Links Get the book: The Plant-Based Athlete Check out VeganBodyBuilding.com (and Robert's Interview) Follow Robert Cheeke on Instagram Get my Plant-Powered Academy Cookbook! Join the Plant-Powered Academy on Facebook For more about calorie density (and also weight loss), listen to my episode with Chef AJ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Dean Karnazes, aka the UltraMarathonMan, is an extraordinary human. If you have ever followed ultrarunning, no doubt you've heard of some of his adventures. He's been named one of the "Top 100 Most Influential People in the World" by Time Magazine, He has taken on many unthinkable feats like running 50 marathons, in all 50 US states, in 50 consecutive days finishing with the NYC Marathon where...get this... he ran a sub 3-hour marathon for his 50th marathon in a row. He has run 350 continuous miles, foregoing sleep for three nights. He's run across the Sahara Desert in 120-degree temperatures, and he's run a marathon to the South Pole in negative 40 degrees. His long list of competitive achievements include winning the World's Toughest Footrace, the Badwater Ultramarathon, running 135 miles nonstop across Death Valley during the middle of summer. He has raced and competed on all seven continents of the planet, twice over. Despite his many accomplishments, awards and distinctions, he remains most proud of his ongoing contributions of time and funding to programs aimed at getting children and youth outdoors and active. He has raised millions of dollars for charity and was awarded the prestigious Community Leadership Award by the President's Council on Physical Fitness & Sports. Dean is a humble, down-to-earth guy with amazing stories (seriously, listen to him on the many podcasts he has done- you'll hear something different every time like eating with a fork and knife off a plate running down the road, fans pulling up next to him while he was running at 2 AM in the middle of nowhere on a backroad to autograph a book, and so many more). He is a NYT Bestselling Author and his 5th book, A Runner's High, just hit the stands. I read this book and it's beautifully written, entertaining, and a tale of how to manage expectations, goalsetting as you age (he is 58) and so much more.   "I think because we ultimately prove to ourselves that we are better than we thought we were and we can go farther than we thought we could. I think endurance sports are very quantifiable. You may think it's impossible to run a marathon. And I tell people that's why you need to go run a marathon. And when you finish the marathon you prove to yourself that nothing is impossible and that's the power in what we are doing." Dean Karnazes   You'll hear themes of discipline, commitment, being present, and vulnerability weaved into the thread of this podcast. Topics Discussed in the Podcast  Dean's writing process Putting yourself out there  masculinity and vulnerability aging and expectations as an athlete overthinking in a race vs. being present dealing with extremes the goal of winning vs. the goal of adventure dealing with self-doubt and inadequacy talking to kids about eating and exercise why endurance sports build our identity how not to quit his future dreams and goals ___ Listen Now: Dean Karnazes Links Get the book: A Runner's High Visit Dean's website Dean Karnazes Instagram ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

Mindset for athletes is one of the secret weapons that separate good from great performers.  Most people don't realize that you can actually train your mind like you can train your body.  Mindset for athletes is a growing field of relevance and importance, and my personal passion. In this podcast, I'm actually on the other side of the mic with Molly Hurford, host of The Consummate Athlete podcast asking me all the questions.  We talked about many of the topics in my Moxy & Grit Mindset Academy that is a 22-module course.  Please enjoy! Mindset For Athletes to Up Your Game! “Extrinisic motivation can help you get out of the bed some mornings and help you stay committed to your goal. Generally, you will stay motivated for longer if you can also focus on the person that you're trying to become with the goal of mastery, well-knowing you'll never actually master a task.  You're always going be climbing the mountain to all these different false summits, so learning to enjoy the hike itself is the key, not just getting to the summit.” -Sonya Looney   Topics Using intrinsic motivation to set goals Reverse engineering positivity and optimism framework of resilience what is mental toughness? how to stop beating yourself up does fake it till you make it work? Listen Now: Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results.

An often overlooked part of endurance training is strength training for cyclists. Many of us just want to ride our bike, but we don't realize that strength training helps us prevent injury and actually ride stronger!  Enter Derek Teel-  founder of Dialed Health and podcast host of strength training for cyclists. Derek Teel believes in leading from the front.  From racing as a Professional Mountain Biker in enduro races to building his online and in-person fitness company, Dialed Health- he is definitely leading from the front.  Consistency is the most important thing when it comes to success, and strength training is no exception.  Derek says you need to strength train a minimum of two times per week to see results.  He also said these sessions need to be full-body sessions. Dialed Health's mission is to take people to a higher level in their health and fitness through honestly assessing current health efforts and evaluating future goals. While strength training is a major focus, Derek also regularly helps people with nutrition tracking. "The seven effective movements are these movements right here.  You have a knee dominant movement, which is something like a step-up or a lunge. You have hip dominant like a squat or a deadlift. You have core, so anything like a plank or a Paloff press. You have horizontal push which is like a push-up. Horizontal pull which is a row. and then vertical push and pull which is like a shoulder press and a pull up for example. So you basically want to stop looking at specific moves and start looking at everything like movements, because you only have a couple days a week… so also that parameters of two days of strength training is the minimum based off of supercompensation." -Derek Teel Seven Effective Movements for Strength Training knee dominant movement: step up or lunge hip dominant movement: squat or deadlift core: Plank or Paloff press horizontal push: push-up horizontal pull: row vertical push: Shoulder Press vertical row: Pull Up Topics Discussed in the Podcast  Nutrition for cyclists & measuring your calories Portion control  Weight loss for performance The 7 Effective Movements Balancing strength and endurance training How to time strength training with cycling intervals Strength vs mobility Crash resilience What you need for your home gym Strength Training for Cycling Exercises [embed]https://youtu.be/chSTSgCYL9c[/embed] Posterior Pelvic Tilt: Great for low back pain! https://youtu.be/JPaiq9wd7ko Lay on the ground with your feet planted and knees bent at about 90°. Now, try to eliminate the space between the floor and your lower back by simultaneously contracting your lower abs and “tucking” your hips. Reinforcing the brain/muscle connection with your lower abdominals can help keep them more active while riding, reducing strain on your lower back. Do 10 slow reps before each workout or ride. What You Need For a Home Gym Adjustable Dumbells TRX Strap Online coaching like Dialed Health Pull Up Bar Resistance Bands Listen Now: Strength Training for Cycling Links Check out Dialed Health and Derek Teel's programming Follow DialedHealth on Instagram Listen to Derek's podcast: Strength Training for Cyclists Book mentioned: The Endurance Diet Improving your gut health ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results. _______________________________ 2 Ways to Give Back to the Show ________________________________________________   Don't Miss an Episode: Subscribe!        

A common topic of conversation is nutrition tips for endurance athletes.  There are many different approaches, but understanding the basics of sports nutrition will help you make personalized decisions to find the right fit for you.  Enter: Anne Guzman- sports nutritionist. Anne is a Registered Holistic Nutritionist with the Canadian School of Natural Nutrition, specializing in Sports Nutrition as a Sports Nutrition Consultant. She believes that athletes often undermine their training by not fueling their bodies with proper nutrition as well as not timing their nutrition optimally for performance gains. Anne has an interesting background as an athlete. She was a Varsity Freestyle Wrestler and also become a Professional Road Cyclist, racing both nationally and internationally. She has competed in World Cup Races, the 2007 Pan Am Games as well as in Europe. Anne's curiosity and love of learning enabled her to also use her own body as an experiment for recovery and race nutrition. "But when it comes time to get down and dirty and train hard, you have to be willing to... yeah you can do it with potatoes, but eat some easily digestible carbohydrates to fuel the work. I think it's a big picture, an athlete needs both sports nutrition and good daily nutrition but it's about knowing when you have to kind of step more into the performance nutrition based on how close you are to your training and what you're doing on the bike. And a lot of it has to do with digestion." -Anne Guzman Topics Discussed in the Podcast  Anne's love of learning Sports nutrition for activity level nutrition for competitive athletes versus exercising for health nutrition pitfalls of endurance athletes (carbs, caffeine strategy, hydration) the right kind of fatigue should you take supplements? restricting calories When to Eat Carbohydrates and How Much? Listen Now: Nutrition Tips for Endurance Athletes Links Check out all of Anne's articles on Prokit Follow Anne on twitter visit Anne Guzman's website Learn about RED-S Get the Plant Powered Academy Cookbook! Listen to this episode all about sports nutrition I recorded with Roxanne Vogel of GU Energy Labs Listen to Anne Guzman's podcast!  ___ Try Inside Tracker Blood Test for Athletes For 25% off, get the Inside Tracker Discount code!  The Inside Tracker Discount Code is good for all purchases store-wide. How does the InsideTracker blood test work? They measure over 30 biomarkers like cortisol, hsCRP (inflammation), magnesium, vitamin D, ferritin and so much more. Each biomarker shows an optimized range and how you can add in healthy foods to get your blood biomarkers to perform better. Offers InnerAge testing Over 2,000 partnering labs in the USA + home testing in Canada Gives you a big picture view of your health and wellness.  It's empowering to know what to do to enhance your performance and see tangible results. _______________________________ 2 Ways to Give Back to the Show ________________________________________________   Don't Miss an Episode: Subscribe!        

Even TIME magazine featured a cover in 2004, blaming inflammation for heart attack, stroke, Alzheimer's cancer, and other chronic diseases. Dale Bredesen in his book END OF ALZHEIMER'S, Brad Bale and Amy Doneen in their book BEAT THE HEART GENE, and others have their recommendations for biochemical tests for inflammation. Paul Ridker, MD at Brigham & Women's, is considered by many to be the father of chronic inflammation. He recently made headlines with the CANTOS trial. He looks simply at hsCRP. Bredesen adds albumin amounts and ratios. So do Bale and Doneen. Both added TNF alpha and IL6 previously. Both have also looked at Omega6:3. Bredesen looks at glutathione as well.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's article on inflammation testsPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

I tell the story of a friend that had a slightly positive Lp-PLA2 test. He was very worried about CV inflammation. I was able to put him at ease by describing the rest of his cardiovascular inflammation panel. This focus on CV inflammation started, and is still being researched, by Paul Ridker MD at Harvard. Here are the other tests we review: myeloperoxidase (MPO), high-sensitivity C-reactive protein (hsCRP), and microalbumin creatinine ratio (MACR). You can find a lot of this at the following link from Cleveland Heart Labs (CHL), which was recently purchased by Quest. For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's article on inflammation testsPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

This week’s episode features author Jaime Layland and Associate Editor Dharam Kumbhani as they discuss the ariticle "Colchicine in Patients with Acute Coronary Syndrome: The Australian COPS Randomized Clinical Trial." TRANSCRIPT BELOW: Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast, summary, and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center, VCU Health, in Richmond, Virginia. Dr. Carolyn Lam: Greg, for our feature discussion we're talking about a very hot topic these days, the role of colchicine, this time in patients with acute coronary syndrome, with Australian data. I cannot wait to get to that, but I'm going to make you wait because I want to tell you about a whole lot of other really cool papers in today's issue. Dr. Carolyn Lam: First, have you ever wondered what is the association between risk factor control and cardiovascular disease risk in type 2 diabetes? Well, today's paper answers that. It's from Dr. Wright from University of Manchester and her colleagues who looked at a retrospective cohort using data from the English practices from Clinical Practice Research Datalink, or CPRD, and the Scottish Care Information diabetes dataset. They also linked to hospital and mortality data and identified more than 101,000 patients with type 2 diabetes in CPRD matched with almost 379,000 controls without diabetes and almost 331,000 patients with type 2 diabetes in the Scottish Care Information diabetes database between 2006 and 2015. The main exposure was a number of optimized risk factors, and these are: (1) Nonsmoker; (2) total cholesterol less than 4 mmol/L; (3) triglycerides less than or equal to 1.7 mmol/L; (4) HB A1c less than 7%; and (4) systolic blood pressure less than 140 or less than 130 mmHg of high risk. Dr. Greg Hundley: Carolyn, I am very curious. Lots of data here. What did they find? Dr. Carolyn Lam: So the key findings were: Dr. Carolyn Lam: First, even with optimally managed risk factors, people with type 2 diabetes still had a 21% higher risk for all cardiovascular disease events and non-fatal coronary heart disease, and a 31% higher risk of heart failure hospitalization compared to patients without diabetes. Dr. Carolyn Lam: 2. Only 6% of people with type 2 diabetes had optimal risk factor controls, so a very low percent. Dr. Carolyn Lam: 3. The association between the number of elevated risk factors and cardiovascular disease events and mortality was much stronger in patients with type 2 diabetes but without cardiorenal disease compared to those with established cardiorenal disease. People without cardiorenal disease were also younger and more likely to have suboptimal risk factor control and fewer prescriptions for risk-factor-modifying medication. Dr. Carolyn Lam: So take-home message: Greater use of guideline-driven care, clinical decision support, drug intervention, and self-management support should be encouraged for risk factor control, and people with type 2 diabetes and without cardiorenal disease may especially benefit greatly from cardiovascular disease risk factor intervention. Dr. Greg Hundley: Very nice, Carolyn. Dr. Greg Hundley: Well, my first study comes from Dr. Gregory Lewis from Mass General Hospital in Boston, Massachusetts. Carolyn, another quiz: Have you wondered about differences in metabolism in those who exercise versus those that do not? Dr. Carolyn Lam: Greg, I wonder about that all the time when I'm running out there. Dr. Greg Hundley: In this study, cardiopulmonary exercise testing, or CPET, and metabolite profiling was performed on Framingham heart study participants aged about 54 years with 63% of them being women with blood drawn at rest in 471 subjects and then again at peak exercise in 411. Dr. Carolyn Lam: Nice, and kudos for the majority women. So what were the results? Dr. Greg Hundley: The authors observed changes including reductions in metabolites implicated in insulin resistance and increases in metabolites associated with lipolysis, nitric oxide bioavailability, and adipose browning. Exercise-induced metabolite changes were variably related to the amount of exercise performed, peak workload, sex, and body mass index. There was attenuation of favorable exercise excursions in some metabolites in individuals with higher BMI and greater excursions in select cardioprotective metabolites in women despite less exercise being performed. Four metabolite signatures of exercise response patterns were analyzed in a separate cohort. The Framingham offspring study of 2,045 were about age 55 years and 51% were women, two of which were associated with overall mortality over a median follow-up at 23 years. Dr. Greg Hundley: So Carolyn, in conclusion, the authors found acute exercise elicits widespread changes in the circulating metabolome. These findings provide a detailed map of the metabolic response to acute exercise in humans and identify potential mechanisms responsible for the beneficial cardiometabolic effects of exercise that could be useful in future studies. Dr. Carolyn Lam: Beautiful. I'm going to keep exercising and I bet you will, too, Greg. Dr. Carolyn Lam: So this next paper is a mechanistic study that revealed a special population of tissue regulatory T-cells in the heart with a unique phenotype and pro-repair function. So this comes from corresponding author Dr. Cheng from Tongji Medical College of Huazhong University of Science and Wuhan Hubei, China. He and his colleagues studied the dynamic accumulation of regulatory T-cells in the injured myocardium in mouse models of myocardial infarction, myocardial ischemia re-perfusion injury, or cardiac cryo injury, and using state-of-the-art methods such as bulk RNA sequencing, photo conversion, parabiosis, single-cell TCR sequencing, adoptive transfer, and functional assays. Dr. Greg Hundley: Carolyn, interesting. What did they find? Dr. Carolyn Lam: They showed that regulatory T-cells that accumulate in the injured myocardium after myocardial infarction or myocardial ischemia re-perfusion injuries had a distinct transcriptome which differs from lymphoid organ regulatory T-cells and other non-lymphoid tissue, and this represents a novel population of tissue regulatory T-cells in the heart. These heart regulatory T-cells were mainly thymus driven and recruited from the circulation showed active local proliferation with the IL-33/ST2 axis promoting their expansion. With the phenotype of promoting tissue repair, heart regulatory T-cells over-expressing spark contributed to elevated collagen content and enhanced maturation in infarct scars to prevent cardiac rupture and improve survival after myocardial infarction. Dr. Carolyn Lam: So in summary, this paper identified and characterized a phenotypically and functionally unique population of heart regulatory T-cells, which may lay the foundation to harness these cells for cardiac protection in myocardial infarction or other cardiac diseases. Dr. Greg Hundley: Wow, Carolyn. Very interesting. Dr. Greg Hundley: Well, my next paper comes from Dr. Michael Rubart from Indiana University School of Medicine, and as some background it's going to discuss calmodulin. So calmodulin mutations are associated with arrhythmia syndromes in humans. Exome sequencing previously identified a de novo mutation in CALM1 resulting in a P.N98S substitution in a patient with sinus bradycardia and stress-induced bidirectional ventricular ectopy. The objectives of the present study were to determine if mice carrying this N98S mutation knocked into CALM1 replicate the human arrhythmia phenotype and then to examine some of the arrhythmia mechanisms. Dr. Carolyn Lam: Okay. So what did they find? Dr. Greg Hundley: Carolyn, several techniques were used in this study. Mouse lines heterozygous for the CALM1 N98S allele generated using CRISPR and caspase 9 technology. Also, adult mutant mice and their wild-type litter mates underwent electrocardiographic monitoring. Ventricular D and re-polarization was assessed in isolated hearts using optical voltage mapping, and action potentials in wholesale currents as well as calcium influx were measured in single ventricular myocytes using patch-clamp techniques and fluorescence microscopy, respectively. Microelectrode techniques were employed for in situ membrane voltage monitoring of ventricular conduction fibers. Carolyn, it was really a comprehensive study. Dr. Greg Hundley: So what did the authors find? Heterozygosity for the CALM1 N9S mutation was causative of an arrhythmia syndrome characterized by sinus bradycardia, QRS widening, adrenergically mediated QTC interval prolongation, and bidirectional ventricular tachycardia. Second, beta adrenergically induced calcium influx L dysregulation contributed to the long QT phenotype. And finally third, they found that pause dependent early after depolarizations and tachycardia induced delayed after depolarizations originating in the His-Purkinje network and ventricular myocytes, respectively, constituted potential sources of arrhythmia in the CALM1 N98S positive hearts. Dr. Carolyn Lam: Wow. Sounds like a really comprehensive study. Thanks, Greg. Dr. Carolyn Lam: Let's talk about some other papers in this issue, shall we? There is a Perspective piece by Dr. Klassen on the COVID-19 pandemic, a massive threat for those living with cardiovascular disease among the poorest billion. There's an ECG challenge by Dr. Littman on a malignant electrocardiogram. Here's a hint: It's a pseudo-infarct pattern with important learnings. They're in an exchange of letters between Drs. Packard and Schwartz regarding the role of lipoprotein A and modification by alirocumab, a pre-specified analysis of ODYSSEY Outcomes randomized clinical trial. Dr. Greg Hundley: Oh thanks, Carolyn. I've got a couple other papers. Dr. Venkateswaran Subramanian has a Research Letter entitled Lysyl Oxidase Inhibition Ablates Sexual Dimorphism of Abdominal Aortic Aneurysm Formation in Mice. Professor Jan Cornell has another research letter entitled Colchicine Attenuates Inflammation Beyond the Inflammasome in Chronic Coronary Artery Disease. The LoDoCo2 proteomic substudy. And then finally, Dr. Sanjay Kaul from Cedars-Sinai Medical Center has a white paper reviewing the benefit/risk trade-offs in assessment of new drugs and devices. Dr. Greg Hundley: Well, Carolyn, how about we get on to that feature discussion and learn more about colchicine and acute coronary syndromes. Dr. Carolyn Lam: Yeah. Let's go, Greg. Today's feature discussion is all about colchicine, that commonly used treatment for gout that has recently emerged as a novel therapeutic option in cardiovascular medicine. I am so pleased to have with us the corresponding author of today's paper, Dr. Jamie Layland from Monash University, as well as our associate editor, Dharam Kumbhani, from UT Southwestern to discuss this very important trial data from Australia. Jamie, could you start us off by telling us all about this Australian COPS trial? Dr. Jamie Layland: We performed the Australian COPS trial back in 2015, and it finished recruiting in 2018. Essentially the trial was a trial to look at the safety and efficacy of colchicine being used in acute coronary syndromes, and this was prior to the release of important trial COLCOT. So essentially we randomized patients who presented to the hospital with an acute coronary syndrome to receive colchicine twice daily for one month followed by colchicine once a day for 11 months, and we followed these patients up for a minimum of 12 months. This was performed across 17 sites across Australia, and we looked at a composite endpoint of total death, acute coronary syndromes, unplanned urgent revascularization, and stroke. Dr. Carolyn Lam: Nice. So Jamie, could I first clarify that this was an investigator-led trial, I'll bet, and man, first of all, applause for doing this. I can only imagine how much work this took and maybe then tell us about the results. Dr. Jamie Layland: Yeah. So this was an investigator-initiated trial through a network of academic investigators across Australia on limited research funding, so through philanthropic and institutional support. So it was a huge effort over a number of years, and I'm very thankful to the support of Circulation and Dharam in supporting the paper, which I think was a great success. Dr. Jamie Layland: So the results of this trial were a surprise to us all, but essentially this was a negative trial in the sense that colchicine did not improve the primary outcome, so there was no improvement in the rate of the COLCOT outcome. And interestingly, there was an increase in total mortality, in particular non-cardiovascular deaths were higher at five compared to the placebo at one. That was over a 12-month follow-up period. Dr. Carolyn Lam: Interesting. So Jamie, I'm going to ask the question that's on everyone's mind then: What's the difference between your trial and COLCOT? Dr. Jamie Layland: That's a great question. Obviously, COLCOT was a much larger trial. COLCOT was an international trial of over 4,000 patients. Similar patient demographics, similar patient subgroup of acute coronary syndromes. However, importantly, COPS was a trial of inpatient initiation of colchicine. So patients when they had their STEMI, or non-STEMI most commonly, they were given colchicine usually within 72 hours of their index hospitalization and sometimes sooner, and this was given prior to discharge. With COLCOT, the median time of administration of colchicine was around 14 days, so slightly different groupings there. However, in COLCOT you were allowed to administer colchicine as an inpatient. You can see obviously from the European side of cardiology the impressive data when colchicine was given earlier in COLCOT how this translated to improved outcomes. So clearly, there is a potential benefit there for early administration of colchicine when you look at these two trials. Dr. Jamie Layland: But we administered colchicine acutely when patients presented in their index hospitalization. We also importantly used a different dosing schedule to COLCOT. So COLCOT was 0.5 mg daily and we used 0.5 twice daily. This was for the first 30 days, and this was based on early data from the group from western Australia who showed that when colchicine was given to patients at a BD dosing in those patients who were already on aspirin and high-potency statins, there was a significant reduction in hsCRP, obviously a commonly used marker of inflammation at four weeks, and also based on data showing that there was a heightened inflammatory response in the early days following an acute coronary syndrome. So we felt that using this twice-daily dose would be advantageous and potentially helpful for our patients. So they're the two main differences between the studies. Dr. Carolyn Lam: Thanks for explaining that so clearly. Dharam, could I have your thoughts? This was, of course, discussed heavily, right, by the editors. Could you give us a sneak peek of what else was discussed? Dr. Dharam Kumbhani: The trial is very important, although it is smaller perhaps in sample size and kind of done with less resources than COLCOT. I do think this adds to the body of literature on colchicine for secondary prevention of CAD. And one of the interesting things is that we see we also have the LoDoCo2 trial, which was a slightly different population, Jamie, which was the chronic coronary artery disease patients, but also still looking at secondary prevention. What is really striking to me is that a very similar signal in non-CV death was noted in that trial as well. Again, it was not seen in COLCOT and LoDoCo1, but it was very interesting that a similar finding was there. So I do think this is something that the field will need to investigate more and really try to understand is this just noise and by chance alone, or is this something that that's a real signal for. Dr. Carolyn Lam: Jamie, what are your thoughts about that and in LoDoCo differences with your trial? Dr. Jamie Layland: Good question, and a very important topic that obviously is currently under discussion amongst the colchicine community. As I said, it was a surprising result. We weren't anticipating this non-CV death signal, but as Dharam said when LoDoCo2 came out, a fantastic trial again, but this signal of non-CV death. I don't know whether it's merely just a noise as you say or whether it's a significant finding, but clearly we need to do more research in this field to understand the mechanism and whether this is a real signal or not. It seems a little bit discordant with previously published work. So if you look at the literature in patients with gout from across the world, there's no real signal of increased non-CV death in those patients. However, with patients with acute coronary syndrome as we are administering the colchicine on a daily basis and then commonly this isn't used for gout, so that is a slight difference. But certainly, there was no signal in the non-CV literature to support the findings that we had and the signal in LoDoCo2. Dr. Jamie Layland: The other thing to note is in a cohort of five non-CV deaths, three out of those five patients were actually not taking colchicine at the time of their death. They stopped the drug prematurely. So I think we just need to take a step back and really await the results. Obviously, we've got two-year and five-year data coming out from the COPS trial which will be interesting to look at, but also the Clear Synergy trial from the McMaster team, that would be a very important trial providing more data on this potential signal. But reassuringly, and I feel more reassured knowing the COLCOT data, which is a slightly similar cohort to ours, showing that there was no trend towards increased non-CV deaths. So I think it's something that we have to be aware of and there will be lots of metro-analysis I'm sure being published in the coming months looking at this specifically. But yeah, I think we shouldn't cast any aspersions on colchicine yet. I think that's too early, but I do think we need more data. Dr. Carolyn Lam: Thanks, Jamie. Speaking of looking deeper in your data and looking at those who died and were they taking the medication and so on, you did some other post-hoc analysis, right? And maybe you could just describe briefly, for example, the 400-day followup. Dr. Jamie Layland: Yes. So the interesting thing with our data, and I had mentioned this before, is that we had limited resources, so we really wanted to do this trial, and obviously competitive funding is tricky at the best of times, but we were really committed to doing this trial and we had a group of investigators who were all committed to doing this trial. But for this to work, we had a single research nurse and a fellow performing the follow-up. So at times, there was a little lag between the timing of the follow-up. So we ended up getting follow-up which was slightly prolonged over the 12-month window. On average, it was around 400 days. When we looked at the 400-day data, we saw that there was an increasing separation of the biomarkers after 365 days. Dr. Jamie Layland: The results, this was obviously not the primary outcome, this was a sensitivity analysis, but there was a suggestion or a significance out to 400 days with an improvement with colchicine. However, this is the primary composite outcome, so revascularization, acute coronary syndrome, stroke, and total death notwithstanding this positive outcome, there was still this trend to high rate of mortality, so that has to be taken into consideration. But there was a suggestion that the longer the duration of colchicine was given for, it culminated into these lights affect. And we see from CT data that colchicine actually has some plaque-modulating effects and reduces high-risk or low-attenuation plaque. So you could hypothesize that as the majority of the benefits seen in colchicine in LoDoCo2, in COLCOT, and in COPS was the reductions in urgent revascularization, stroke, and acute coronary syndromes. Dr. Jamie Layland: So perhaps there is this effect that colchicine is having on plaque stabilization so we're seeing less longer-term events, but this is just hypothesis generated and we need more data to support that. But it is a very interesting finding nonetheless. Dr. Carolyn Lam: Thank you. Dharam, could I hand you the last word on where you think this field is going or where you think it should go? Dr. Dharam Kumbhani: I think Jamie put it really nicely. I think he outlined the study nicely with its strengths and its limitations, and I think this is obviously a debate between perhaps the colchicine believers and the ones that are still perhaps trying to understand a little bit more about its true role, because as was mentioned I think there's really a benefit in ischemia-driven revasc. I think we've seen that in almost all the colchicine trials. There is no reduction in mortality, and as we saw in the COPS data maybe it goes the other way. So I think from a pathophysiological standpoint it makes sense. I think there's good translational data to suggest that it would be beneficial in this patient population, but I think that's the beauty of having clinical trials and the ones that are done by different investigators and perhaps in different settings, because they help us answer the truth. And whether colchicine becomes a stable part of our armamentarium for secondary prevention of CAD going forward, I think the jury is still out and as was mentioned I think Clear Synergy would probably be very helpful in hopefully tying all this together. Dr. Dharam Kumbhani: So again, I want to congratulate Jamie and his team for really providing us with a very interesting trial done in a very pragmatic setting, and I think the field is very thankful to them for providing us with this information. Dr. Carolyn Lam: Thank you, audience, for joining us today. You've been listening to Circulation on the Run. Don't forget to join me and Greg again next week. Dr. Greg Hundley: This program is copyright the American Heart Association 2020.  

FDA 批准血管紧张素II用于休克病人低血压的治疗NEJM 秋水仙碱在慢性冠心病患者中的疗效Circulation 心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展血管紧张素II（angiotensin II）2017年12月，FDA批准合成人血管紧张素II用于治疗分布性休克患者。《ATHOS-3研究：血管紧张素II治疗血管舒张性休克的3期临床研究》New England Journal of Medicine，2017年8月 (1)血管舒张性休克的患者对高剂量的血管收缩剂反应差，而且会增加死亡率。此研究的目的是评价这类患者使用血管紧张素II的疗效。研究纳入需要大剂量血管收缩药物维持血压的、血管舒张性休克的患者344人（去甲肾上腺素用量>0.2μg/kg/min或等剂量的血管收缩药），随机分入血管紧张素II治疗组和安慰剂组。用药3小时后，血压升高10mmHg或平均血压升高至75mmHg的患者，干预组达到69.9%，安慰剂组只有23.4%（P0.2）或高血压显著升高的情况（P>0.2）。结论：卡那单抗虽然可降低主要心血管事件发生率，但这些获益与血压变化无关。《COLCOT研究：小剂量秋水仙碱治疗心肌梗死的疗效和安全性》New England Journal of Medicine，2019年11月 (6)秋水仙碱是一种口服的，有效的抗炎药物，是用于治疗痛风和心包炎。研究的目的是评价秋水仙碱抗炎治疗近期心肌梗死患者对缺血性心血管事件的影响。研究招募了急性心肌梗死30天内的患者共4745人，随机分到秋水仙碱 0.5mg qd组或安慰剂。平均随访22.6个月后，秋水仙碱组和安慰剂组分别有5.5%和7.1%的患者出现主要终点事件（心血管原因死亡、心脏骤停复苏、心肌梗死、卒中或因心绞痛紧急住院导致冠状动脉血运重建）（P = 0.02）。与安慰剂相比，秋水仙碱心血管原因死亡的风险比0.84，心脏骤停风险比0.83，心肌梗死风险比为0.91；能显著降低卒中的风险达74%，同时能显著降低心绞痛住院再次血运重建的风险达50%。两组最常见的不良事件是腹泻，发生率没有差异，最严重的不良事件是肺炎，发生率分别为0.9%和0.4%（P = 0.03）。结论：在近期心肌梗死患者中，每天0.5 mg的秋水仙碱比安慰剂显著降低缺血性心血管事件的风险。《COLCOT研究：秋水仙碱治疗起始时间与心肌梗死后心血管预后的关系》European Heart Journal，2020年8月 (7)这项COLCOT研究的分析，纳入了4661例患者，按照启动秋水仙碱治疗距离急性心肌梗死的时间可分为三个亚组，8天组。平均随访22.7个月后，8天组没有统计学意义（风险比 0.96和0.82）。不仅如此，3天内启动秋水仙碱治疗的患者，心绞痛住院血运重建术的风险显著降低（风险比 0.35）、再次血运重建风险显著降低（风险比 0.63），而且所有的复合心血管死亡、心脏骤停、心肌梗死或卒中的风险均显著降低（风险比 0.55，P < 0.05)。结论：心肌梗死后，患者应尽早在医院内给予秋水仙碱治疗。《LoDoCo2研究：秋水仙碱在慢性冠心病患者中的疗效》New England Journal of Medicine，2020年8月(8)秋水仙碱的抗炎作用可降低近期心肌梗死患者发生心血管事件的风险，但对慢性冠心病患者的证据有限。这项随机、对照、双盲试验中，招募5522名慢性冠心病患者，随机分配至秋水仙碱0.5mg qd组或安慰剂组，平均随访时间为28.6个月。主要终点事件（心血管死亡、自发心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建）在秋水仙碱组和安慰剂组的发生率分别为6.8%和9.6%（P < 0.001)。次要终点事件（心血管死亡、自发心肌梗死、缺血性卒中）在秋水仙碱组和安慰剂组的发生率分别为4.2%和5.7%（P = 0.007）。秋水仙碱组的自发性心肌梗死或缺血驱动的冠脉血运重建的复合终点、心血管死亡或自发性心肌梗死的复合终点、缺血驱动的冠脉血运重建和自发性心肌梗死的发生率也显著降低。秋水仙碱组的非心血管疾病死亡发生率高于安慰剂组（风险比 1.51）。结论：秋水仙碱可以显著降低慢性冠心病患者发生心血管事件的风险。小羽点评：冠心病发病机制复杂，不仅限于胆固醇内膜浸润，也是免疫系统的全身和局部激活驱动的血管壁的慢性炎症的结果，最终导致斑块破裂或侵蚀、血栓形成、心肌梗死。在广泛使用他汀类药物后，仍有大量患者出现复发，反映了残留炎症并没有被充分控制。现在抗炎药物治疗成为热点，但是否能上升到一线治疗的地位，我们拭目以待。心脏干细胞修复技术《综述：心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展》Circulation，2020年7月 (9)在过去的十年里，许多类型的心脏干细胞（CSCs）从实验室到临床研究，但并有什么确切的治疗效果。有关干细胞示踪的基础研究开始质疑心脏干细胞的基础生物学和作用机制，挑战心脏干细胞的起源和存在。除了心脏干细胞在心脏再生中的潜在作用外，现有心肌细胞的增殖得到了更多的关注。中国科学院研究人员发表的这篇综述评估了过去和现在关于心脏干细胞和心肌细胞增殖的研究的方法和技术方面，也讨论了潜在局限性。作者认为未来的研究方向：（1）由于缺乏常驻CSC存在的证据，内源性心肌细胞增殖频率又非常低，如何促进心肌细胞增殖可能是未来一个重要的研究领域；（2）除了诱导心肌细胞增殖外，还可以考虑其他替代方法，比如通过过表达特定转录因子、或小分子诱导的方式，使成纤维细胞原位重新编程成为心肌细胞，如此使心肌细胞再生同时减少瘢痕形成；（3）人胚胎干细胞或诱导多潜能细胞来源的心脏祖细胞和心肌细胞已成功移植到大型动物模型中，并已证实了移植细胞在宿主心肌内的存活和心脏功能的改善；（4）即使没有直接的心肌细胞再生，促进新血管形成的方法，如通过移植能够分泌血管生长因子的间充质干细胞，或减轻心肌梗死后炎症损伤等方法，来改善心肌存活率、减少疤痕形成；（5）双重干细胞疗法协同改善心肌损伤后心脏功能和血管新生，如人类诱导性多潜能干细胞来源的心肌细胞和间充质干细胞，或人类胚胎干细胞来源的心外膜细胞和心肌细胞；（6）含有生长因子或多种心脏细胞类型的心外膜贴片，也被证明可以改善心肌梗死后的心脏功能和新生血管；（7）通过RNA修饰心外膜祖细胞后产生的血管内皮生长因子A可以使血管再生增强；最后，作者认为，由于内源性假定心脏干细胞的错误，因此，为达到心脏修复和再生的最终目标，应该将更多的精力和资源投入到更有前途的方向上是很重要的。《综述：对胚胎干细胞在心脏修复中的作用的评价》European Heart Journal，2020年7月 (10)尽管胚胎干细胞（ESCs）具有分化为心肌细胞的能力，胚胎干细胞或胚胎干细胞来源的细胞的移植仍面临着一些非常棘手的问题：（1）移植物排斥反应，通过药物诱导免疫抑制本身就是一种疾病；（2）心律失常，研究发现在灵长类动物中移植人类胚胎干细胞来源的细胞会导致危及生命的心律失常，而这种心律失常的发生与剂量无关；（3）恶性肿瘤，在当代临床研究中，对恶性肿瘤等灾难性影响的耐受限度为零。尽管胚胎干细胞分化成肿瘤的可能性非常低，但不是完全没有可能，特别是移植细胞的数量级在十亿的时候；（4）长期再生能力，虽然胚胎干细胞和胚胎干细胞来源的细胞被吹捧为具有长期再生能力，但干细胞示踪技术显示这些细胞在移植后迅速消失，没有长期移植或再生的证据；（5）越来越多的证据表明胚胎干细胞的作用是通过旁分泌机制来发挥的，尚没有开展或启动胚胎干细胞来源细胞在心血管疾病中的临床对照试验；作者最后对未来发展的方向做了预估：（1）成年细胞已用于数千名心脏病患者，没有显著的副作用，其结果令人鼓舞，值得进行II期和III期试验。（2）人诱导的多潜能干细胞提供类似胚胎干细胞的多能性，而不需要终身免疫抑制。《COVID-19患者中使用秋水仙碱治疗对心脏、炎症指标及临床预后的影响》JAMA Network Open，2020年6月 (11)研究旨在比较秋水仙碱和标准化治疗对心脏、炎症指标及临床预后的影响。在105例随机临床试验中，秋水仙碱干预组在常规治疗的基础上，首剂1.5mg，如果没有观察到胃肠道不良反应则60分钟后再给0.5mg，维持剂量为0.5mg qd（体重60kg）直至出院或满21天。对照组的主要临床终点、临床恶化率高于秋水仙碱组，而且对照组患者出现恶化比较快。两组高敏肌钙蛋白浓度无差异，但秋水仙碱组患者D-二聚体的增幅较小。结论：秋水仙碱对COVID-19由一定的治疗作用。参考文献1.Khanna A, Ostermann M, Bellomo R. 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Hypertension. 2020;75(2):477-82.6.Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019;381(26):2497-505.7.Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J. 2020.8.Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in Patients with Chronic Coronary Disease. New England Journal of Medicine. 2020.9.He L, Nguyen NB, Ardehali R, Zhou B. Heart Regeneration by Endogenous Stem Cells and Cardiomyocyte Proliferation. Circulation. 2020;142(3):275-91.10.Wysoczynski M, Bolli R. A realistic appraisal of the use of embryonic stem cell-based therapies for cardiac repair. Eur Heart J. 2020;41(25):2397-404.11.Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Network Open. 2020;3(6):e2013136-e.

FDA 批准血管紧张素II用于休克病人低血压的治疗NEJM 秋水仙碱在慢性冠心病患者中的疗效Circulation 心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展血管紧张素II（angiotensin II）2017年12月，FDA批准合成人血管紧张素II用于治疗分布性休克患者。《ATHOS-3研究：血管紧张素II治疗血管舒张性休克的3期临床研究》New England Journal of Medicine，2017年8月 (1)血管舒张性休克的患者对高剂量的血管收缩剂反应差，而且会增加死亡率。此研究的目的是评价这类患者使用血管紧张素II的疗效。研究纳入需要大剂量血管收缩药物维持血压的、血管舒张性休克的患者344人（去甲肾上腺素用量>0.2μg/kg/min或等剂量的血管收缩药），随机分入血管紧张素II治疗组和安慰剂组。用药3小时后，血压升高10mmHg或平均血压升高至75mmHg的患者，干预组达到69.9%，安慰剂组只有23.4%（P0.2）或高血压显著升高的情况（P>0.2）。结论：卡那单抗虽然可降低主要心血管事件发生率，但这些获益与血压变化无关。《COLCOT研究：小剂量秋水仙碱治疗心肌梗死的疗效和安全性》New England Journal of Medicine，2019年11月 (6)秋水仙碱是一种口服的，有效的抗炎药物，是用于治疗痛风和心包炎。研究的目的是评价秋水仙碱抗炎治疗近期心肌梗死患者对缺血性心血管事件的影响。研究招募了急性心肌梗死30天内的患者共4745人，随机分到秋水仙碱 0.5mg qd组或安慰剂。平均随访22.6个月后，秋水仙碱组和安慰剂组分别有5.5%和7.1%的患者出现主要终点事件（心血管原因死亡、心脏骤停复苏、心肌梗死、卒中或因心绞痛紧急住院导致冠状动脉血运重建）（P = 0.02）。与安慰剂相比，秋水仙碱心血管原因死亡的风险比0.84，心脏骤停风险比0.83，心肌梗死风险比为0.91；能显著降低卒中的风险达74%，同时能显著降低心绞痛住院再次血运重建的风险达50%。两组最常见的不良事件是腹泻，发生率没有差异，最严重的不良事件是肺炎，发生率分别为0.9%和0.4%（P = 0.03）。结论：在近期心肌梗死患者中，每天0.5 mg的秋水仙碱比安慰剂显著降低缺血性心血管事件的风险。《COLCOT研究：秋水仙碱治疗起始时间与心肌梗死后心血管预后的关系》European Heart Journal，2020年8月 (7)这项COLCOT研究的分析，纳入了4661例患者，按照启动秋水仙碱治疗距离急性心肌梗死的时间可分为三个亚组，8天组。平均随访22.7个月后，8天组没有统计学意义（风险比 0.96和0.82）。不仅如此，3天内启动秋水仙碱治疗的患者，心绞痛住院血运重建术的风险显著降低（风险比 0.35）、再次血运重建风险显著降低（风险比 0.63），而且所有的复合心血管死亡、心脏骤停、心肌梗死或卒中的风险均显著降低（风险比 0.55，P < 0.05)。结论：心肌梗死后，患者应尽早在医院内给予秋水仙碱治疗。《LoDoCo2研究：秋水仙碱在慢性冠心病患者中的疗效》New England Journal of Medicine，2020年8月(8)秋水仙碱的抗炎作用可降低近期心肌梗死患者发生心血管事件的风险，但对慢性冠心病患者的证据有限。这项随机、对照、双盲试验中，招募5522名慢性冠心病患者，随机分配至秋水仙碱0.5mg qd组或安慰剂组，平均随访时间为28.6个月。主要终点事件（心血管死亡、自发心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建）在秋水仙碱组和安慰剂组的发生率分别为6.8%和9.6%（P < 0.001)。次要终点事件（心血管死亡、自发心肌梗死、缺血性卒中）在秋水仙碱组和安慰剂组的发生率分别为4.2%和5.7%（P = 0.007）。秋水仙碱组的自发性心肌梗死或缺血驱动的冠脉血运重建的复合终点、心血管死亡或自发性心肌梗死的复合终点、缺血驱动的冠脉血运重建和自发性心肌梗死的发生率也显著降低。秋水仙碱组的非心血管疾病死亡发生率高于安慰剂组（风险比 1.51）。结论：秋水仙碱可以显著降低慢性冠心病患者发生心血管事件的风险。小羽点评：冠心病发病机制复杂，不仅限于胆固醇内膜浸润，也是免疫系统的全身和局部激活驱动的血管壁的慢性炎症的结果，最终导致斑块破裂或侵蚀、血栓形成、心肌梗死。在广泛使用他汀类药物后，仍有大量患者出现复发，反映了残留炎症并没有被充分控制。现在抗炎药物治疗成为热点，但是否能上升到一线治疗的地位，我们拭目以待。心脏干细胞修复技术《综述：心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展》Circulation，2020年7月 (9)在过去的十年里，许多类型的心脏干细胞（CSCs）从实验室到临床研究，但并有什么确切的治疗效果。有关干细胞示踪的基础研究开始质疑心脏干细胞的基础生物学和作用机制，挑战心脏干细胞的起源和存在。除了心脏干细胞在心脏再生中的潜在作用外，现有心肌细胞的增殖得到了更多的关注。中国科学院研究人员发表的这篇综述评估了过去和现在关于心脏干细胞和心肌细胞增殖的研究的方法和技术方面，也讨论了潜在局限性。作者认为未来的研究方向：（1）由于缺乏常驻CSC存在的证据，内源性心肌细胞增殖频率又非常低，如何促进心肌细胞增殖可能是未来一个重要的研究领域；（2）除了诱导心肌细胞增殖外，还可以考虑其他替代方法，比如通过过表达特定转录因子、或小分子诱导的方式，使成纤维细胞原位重新编程成为心肌细胞，如此使心肌细胞再生同时减少瘢痕形成；（3）人胚胎干细胞或诱导多潜能细胞来源的心脏祖细胞和心肌细胞已成功移植到大型动物模型中，并已证实了移植细胞在宿主心肌内的存活和心脏功能的改善；（4）即使没有直接的心肌细胞再生，促进新血管形成的方法，如通过移植能够分泌血管生长因子的间充质干细胞，或减轻心肌梗死后炎症损伤等方法，来改善心肌存活率、减少疤痕形成；（5）双重干细胞疗法协同改善心肌损伤后心脏功能和血管新生，如人类诱导性多潜能干细胞来源的心肌细胞和间充质干细胞，或人类胚胎干细胞来源的心外膜细胞和心肌细胞；（6）含有生长因子或多种心脏细胞类型的心外膜贴片，也被证明可以改善心肌梗死后的心脏功能和新生血管；（7）通过RNA修饰心外膜祖细胞后产生的血管内皮生长因子A可以使血管再生增强；最后，作者认为，由于内源性假定心脏干细胞的错误，因此，为达到心脏修复和再生的最终目标，应该将更多的精力和资源投入到更有前途的方向上是很重要的。《综述：对胚胎干细胞在心脏修复中的作用的评价》European Heart Journal，2020年7月 (10)尽管胚胎干细胞（ESCs）具有分化为心肌细胞的能力，胚胎干细胞或胚胎干细胞来源的细胞的移植仍面临着一些非常棘手的问题：（1）移植物排斥反应，通过药物诱导免疫抑制本身就是一种疾病；（2）心律失常，研究发现在灵长类动物中移植人类胚胎干细胞来源的细胞会导致危及生命的心律失常，而这种心律失常的发生与剂量无关；（3）恶性肿瘤，在当代临床研究中，对恶性肿瘤等灾难性影响的耐受限度为零。尽管胚胎干细胞分化成肿瘤的可能性非常低，但不是完全没有可能，特别是移植细胞的数量级在十亿的时候；（4）长期再生能力，虽然胚胎干细胞和胚胎干细胞来源的细胞被吹捧为具有长期再生能力，但干细胞示踪技术显示这些细胞在移植后迅速消失，没有长期移植或再生的证据；（5）越来越多的证据表明胚胎干细胞的作用是通过旁分泌机制来发挥的，尚没有开展或启动胚胎干细胞来源细胞在心血管疾病中的临床对照试验；作者最后对未来发展的方向做了预估：（1）成年细胞已用于数千名心脏病患者，没有显著的副作用，其结果令人鼓舞，值得进行II期和III期试验。（2）人诱导的多潜能干细胞提供类似胚胎干细胞的多能性，而不需要终身免疫抑制。《COVID-19患者中使用秋水仙碱治疗对心脏、炎症指标及临床预后的影响》JAMA Network Open，2020年6月 (11)研究旨在比较秋水仙碱和标准化治疗对心脏、炎症指标及临床预后的影响。在105例随机临床试验中，秋水仙碱干预组在常规治疗的基础上，首剂1.5mg，如果没有观察到胃肠道不良反应则60分钟后再给0.5mg，维持剂量为0.5mg qd（体重60kg）直至出院或满21天。对照组的主要临床终点、临床恶化率高于秋水仙碱组，而且对照组患者出现恶化比较快。两组高敏肌钙蛋白浓度无差异，但秋水仙碱组患者D-二聚体的增幅较小。结论：秋水仙碱对COVID-19由一定的治疗作用。参考文献1.Khanna A, Ostermann M, Bellomo R. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med. 2017;377(26):2604.2.Bellomo R, Forni LG, Busse LW, McCurdy MT, Ham KR, Boldt DW, et al. Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial. Am J Respir Crit Care Med. 2020;202(9):1253-61.3.Silvain J, Kerneis M, Zeitouni M, Lattuca B, Galier S, Brugier D, et al. Interleukin-1beta and Risk of Premature Death in Patients With Myocardial Infarction. J Am Coll Cardiol. 2020;76(15):1763-73.4.Everett BM, MacFadyen JG, Thuren T, Libby P, Glynn RJ, Ridker PM. Inhibition of Interleukin-1beta and Reduction in Atherothrombotic Cardiovascular Events in the CANTOS Trial. J Am Coll Cardiol. 2020;76(14):1660-70.5.Rothman AM, MacFadyen J, Thuren T, Webb A, Harrison DG, Guzik TJ, et al. Effects of Interleukin-1beta Inhibition on Blood Pressure, Incident Hypertension, and Residual Inflammatory Risk: A Secondary Analysis of CANTOS. Hypertension. 2020;75(2):477-82.6.Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019;381(26):2497-505.7.Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J. 2020.8.Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in Patients with Chronic Coronary Disease. New England Journal of Medicine. 2020.9.He L, Nguyen NB, Ardehali R, Zhou B. Heart Regeneration by Endogenous Stem Cells and Cardiomyocyte Proliferation. Circulation. 2020;142(3):275-91.10.Wysoczynski M, Bolli R. A realistic appraisal of the use of embryonic stem cell-based therapies for cardiac repair. Eur Heart J. 2020;41(25):2397-404.11.Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Network Open. 2020;3(6):e2013136-e.

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast, summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke-National University of Singapore. Dr Greg Hundley: And I'm Dr Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr Carolyn Lam: Greg, our feature paper today talks about the risks of sudden cardiac death, something that we still grapple with, and do you know what, really highlights the important emerging role of biomarkers of myocardial stress, myocardial injury, or even subclinical inflammation in predicting this risk. A really important discussion coming right up. But before we do that, let me tell you about a paper in today's issue that really provides novel mechanistic insights into atrial fibrillation pathogenesis. In fact, this is the first paper to demonstrate that decreased expression of a striated muscle preferentially expressed protein kinase, or SPEG in atria, is causally linked to altered diastolic calcium handling and human paroxysmal atrial fibrillation. This is from corresponding author, Dr Wehrens and colleagues from Baylor College of Medicine. And they used phosphoproteomic studies to identify S2367 on ryanodine receptor type-2 as a novel kinase substrate of SPEG. Through the study of novel ryanodine receptor type-2 phospho-mutant mouse models, they revealed that in contrast to previously characterized phosphorylation sites on this receptor, S2367 phosphorylation inhibited diastolic calcium release from the receptor, while loss of phosphorylation of the site increased atrial fibrillation susceptibility. Dr Greg Hundley: Wow, Carolyn. So the clinical implication is that normalizing S2367 phosphorylation in SPEG activity may provide novel therapeutic opportunities for the treatment of atrial fibrillation, right? Dr Carolyn Lam: You bet, Greg. Too smart. And this is discussed in an accompanying editorial by Drs Knollmann and Blackwell from Vanderbilt University Medical Center. Dr Greg Hundley: Very nice, Carolyn. Well, I've got a paper pertaining to COVID-19, and it comes to us from Dr Leo Nicolai from the Klinik der Universität München in Germany. Carolyn, I really enjoyed this article about COVID-19. I found it very intriguing, and the study addresses the mechanisms by which the SARS-CoV-2 infection, associated pneumonia or COVID-19, leads to subsequent respiratory failure, complicating renal and myocardial involvement, and the prothrombotic phenotype found in some patients with COVID-19. 62 subjects were included in the study, 38 patients with RT-PCR confirmed COVID-19 and 24 non-COVID-19 controls. The investigative team performed histopathological assessments of autopsy cases, surface marker-based phenotyping of neutrophils and platelets, and functional assays for platelet-neutrophil functions and coagulation tests. Dr Carolyn Lam: Wow, that sounds like really sort of in-depth testing. And what did they find? Dr Greg Hundley: Several things, Carolyn. First, the authors found evidence that organ involvement and prothrombotic features in COVID-19 are linked by immunothrombosis. They found that in COVID-19 patients, inflammatory microvascular thrombi are present in the lung, kidney and heart, containing neutrophil extracellular traps associated with platelets and fibrin. Second, they observed that COVID-19 patients also present with neutrophil-platelet aggregates and a distinct neutrophil and platelet activation pattern in blood which changes with disease severity, whereas cases of intermediate severity show an exhausted platelet and hyperreactive neutrophil phenotype. This finding differs for severely affected individuals. Among severely affected COVID-19 patients, there is excessive platelet and neutrophil activation compared to healthy controls and non-COVID-19 pneumonia. Finally, dysregulated immunothrombosis in SARS-CoV-2 pneumonia is linked to both ARDS and systemic hypercoagulability. So in conclusion, taken together, this team's data point to immunothrombotic dysregulation as a key marker of disease severity in COVID-19, and further work is suggested to identify methods to disrupt immunothrombosis in patients with COVID-19. Dr Carolyn Lam: Wow. That makes a lot of sense and is important information. Thanks, Greg. Well, this next study really aimed to assess the current trends in US mortality related to congenital heart disease from infancy to adulthood over the last 19 years, and to determine if there were differences by sex and ethnicity. This is from Dr Lopez from Texas Children's Hospital and Baylor College of Medicine and colleagues who conducted an analysis of death certificates from 1999 to 2017, and also used data from the National Center for Health Statistics' live birth data and US Census Bureau bridged-race estimates as denominators for these population estimates. Dr Greg Hundley: Wow, Carolyn. Really interesting article. So what did they find here? Dr Carolyn Lam: So overall, US mortality due to congenital heart disease throughout the lifespan has decreased over the last 19 years, with the greatest mortality rate in infants. Disparities in mortality due to congenital heart disease persists for males compared to females, with men having higher mortality than women, and for non-Hispanic blacks compared to non-Hispanic whites. For those less than 50 years old with congenital heart disease as a contributing cause of death, associated genetic abnormalities are the leading underlying cause of death, whereas myocardial infarction was the leading cause of death in those 50 years and older. And so, the authors also concluded that determining factors that contribute to these disparities, such as access to quality care, timely diagnosis and maintenance of insurance, will be very important moving into the next decade. Dr Greg Hundley: Boy, that is such a timely topic. Beautiful presentation. Dr Carolyn Lam: Thanks, Greg. And now for my last paper. We've heard a lot recently about angiotensin-converting enzyme 2, or ACE2, that’s that membrane protein that enables COVID-19 infectivity and which also converts angiotensin II, which is a potent vasoconstrictor, to angiotensin 1-7. Now, today we've got a paper that provides novel insights into the contribution of ACE2 to the development of pulmonary arterial hypertension. And this is from Dr Shyy and Yuan as co-corresponding authors from the University of California, San Diego, as well as Dr Yuan 00:08:06 from First Affiliated Hospital of Xi'an Jiaotong University in China. The authors used cultured endothelial cells, mouse models, and specimens from patients with idiopathic pulmonary arterial hypertension to investigate the post-translational modification of ACE2 in terms of, firstly, phosphorylation by AMP-activated protein kinase, which enhances ACE2's stability, and two, ubiquitination of oncoprotein murine double minute 2, or MDM2, which is involved in ACE2 degradation. Dr Greg Hundley: So what did they find here? Dr Carolyn Lam: MDM2 expression was increased in lung tissues from patients with idiopathic pulmonary arterial hypertension and animals with experimental pulmonary hypertension. On the other hand, N-kinase phosphorylates ACE2 at S680 and inhibits MDM2- mediated ubiquitination of ACE2 at K788. Functionally, ACE2 phosphorylation and deubiquitylation increases eNOS-mediated nitric oxide bioavailability in the endothelial cells. Dr Greg Hundley: Okay, Carolyn. What are the clinical implications here? Dr Carolyn Lam: So post-translational modification of ACE2 is a novel strategy to develop new therapies for pulmonary arterial hypertension. On the other hand, inhibition of MDM2 has great potential for pulmonary arterial hypertension by stabilizing ACE2. Dr Greg Hundley: Wow, beautiful summary there. Let me describe some of the other articles in the issue. First, Dr Jawad Butt has a research letter regarding the impact of COVID-19 on first-time acute stroke and transient ischemic attack admission rates and prognosis in Denmark. It's from a nationwide cohort study. Next, there's an exchange of letters regarding the article, preventive or deferred ablation of ventricular tachycardia in patients with ischemic cardiomyopathy and an implantable defibrillator, the Berlin VT multicenter randomized trial. And that comes to us from Drs Krisai and Kuck. Next, there's a very nice ECG challenge from Dr Arrey-Mbi wide complex QRS rhythm in a 52-year-old male with an altered mental status. And then finally, a nice case series from Dr Oscar Cingolani, entitled, ECMO therapy for cardiac lymphoma. Dr Carolyn Lam: Well, I've also got a research letter by Dr Verdonschot on distinct cardiac transcriptomic clustering in titin and lamin-associated dilated cardiomyopathy patients. There's also a white paper by Dr Butler on glucagon-like peptide-1 receptor agonists and heart failure, highlighting the need for further evidence generation and practice guidelines optimization. And finally, an On My Mind piece by myself and Dr Butler entitled, “Victims of Success and Failure,” where we really describe how, with so many effective therapies for HFrEF these days, have we become victims of our own success?   Dr Greg Hundley: Very nice, Carolyn. Well, how about we get on to that feature and hear a little bit more about myocardial stress injury and the association with sudden death? Dr Carolyn Lam: Yes. Let's go, Greg. Sudden cardiac death is the most common cause of death in the United States but identifying individuals at risk before they suffer a fatal event remains really challenging. In fact, it's the sad truth that the majority of sudden cardiac deaths occur in low-risk populations, often as the first manifestation of cardiovascular disease. Now, can biomarkers help us identify those at risk of sudden cardiac death? Well, you have to listen to our discussion of today's feature paper, a beautiful paper that I'm so pleased to be welcoming the first and corresponding author, who's also our associate editor, Dr Brendan Everett from Brigham and Women's Hospital, who will talk about it, as well as our guest editor, Professor Harvey White, who is director of research at the Green Lane Cardiovascular Service in Auckland, New Zealand. So welcome, gentlemen. And Brendan, could I get you to start by telling us what you did in this study and what you found? Dr Brendan Everett: We were interested in exploring this problem. Dr Albert, Christine Albert, who is the senior author on the paper, has years of experience looking at sudden cardiac death as an important outcome amongst patients who may not have yet been diagnosed with cardiovascular disease. And of course, as you mentioned in your introduction, it can be the first manifestation of cardiovascular disease. And because we, as physicians, don't get a chance to then help patients recover and treat them for their cardiovascular disease, we often feel like we've missed the opportunity to help people live longer and more productive lives. The problem, of course, with this is that there's a huge population of people who are at risk, but actually identifying tests that will work well enough and can be used in a broad population, who, in aggregate, are actually at low individual absolute risk, is very challenging. The markers that we selected to study for this paper included measures of lipids, in this case, total cholesterol, the HDL cholesterol, NT-proBNP, a marker of myocardial stress, which is, I'm sure, familiar to many people on the podcast, high-sensitivity cardiac troponin I, which again, is increasingly used throughout the world, including here in the United States, and hsCRP, a marker of subclinical inflammation. I think the advantage that we had is that, over the years, Dr Albert has compiled a number of cases of sudden cardiac deaths in cohorts that have been followed prospectively for a long period of time. These are NIH-funded cohorts and include studies that may be familiar to your listeners, like the Nurses' Health Study, the Physician's Health Study I and II, the Women's Health Study. These are cohorts that have been following patients for, in some cases, decades, and of course, when you have a lot of patients or participants and you follow them over many years, some of them die suddenly. Not very many, fortunately, but enough so that if you aggregate all six cohorts together, you can have a total of, in our case, 565 cases, which is more, I think, as far as I know, anyways, than other cohorts that are out there that have studied this question. We were able to match those two-to-one with 1090 controls, and then measure the biomarkers I mentioned earlier in all of those patients, and then look at the association between those common, relatively accessible biomarkers and the risk of sudden death. Dr Carolyn Lam: Congratulations. I do think this is the largest collection of sudden cardiac death cases, as well as with prospectively collected blood samples. And I do believe yours is the first to really have a multi-marker approach. So now, could you tell us what you found? Dr Brendan Everett: We first assessed each of these four markers individually and found that their risk of sudden cardiac death was relatively strong and was independent of other traditional cardiovascular risk factors, such as cigarette smoking or body mass index and those sorts of things. It appeared, at least in our analysis, that NT-proBNP and cardiac troponin might have been slightly more powerful correlates of the risk of sudden cardiac death in total to HDL cholesterol ratio in hsCRP. But nonetheless, when we put them all together in a comprehensive model, we found that the risk estimates for each individual marker were maintained. In other words, they were independent of one another and they all remained statistically significant. So this tells me, as a cardiologist and an epidemiologist, that we're getting a sense of somebody's risk from multiple different perspectives. We're integrating that information, and then potentially, when we combine those markers together, have the opportunity to have an improved ability to identify individuals at risk. And so, that's actually what we did, and I think this is what you're asking about. We decided to create a very simple biomarker score where we gave each participant one point if their concentration of a given biomarker was in the top core tile of that biomarker's range, so the top 25%. So just by way of example, if somebody had all normal biomarkers except for a high total cholesterol, the HDL ratio, they would get one point. The total number of points, of course, could range from zero to four, and then we looked at what the risk of sudden cardiac death was across that scale. And what we found is that it went up in a relatively linear fashion. The odds ratio increased by about 1.6 per individual point of score increase, such that, for example, compared to those individuals with a score of zero, who of course, had normal concentrations of these four biomarkers, if you had all four be elevated, your odds ratio of sudden cardiac death was actually seven. If you just had three out of the four being abnormal, it was approximately four. So those participants with at least three or four abnormal concentrations of these biomarkers seemed to be at a high relative risk or odds ratio for sudden cardiac deaths. Dr Carolyn Lam: Ah. Love it, Brendan. And for all of you who are listening, you have to pick up the paper and look at the figures. The story is all there, the individual biomarkers and that score. I love the simplicity and the clarity of the message. Harvey, could you summarize for us and perhaps give us a sneak peek of the discussions that occurred behind the scenes when this paper landed on your desk? Dr Harvey White: When I saw this paper, it was terrific. And I had to decide whether to get reviewers who are experts in sudden death, or are experts in cholesterol, or troponin, or each of the four biomarkers, and I chose to get people who are interested in sudden death. And I had three reviewers, and they all said it was absolutely terrific, elegant study, robust data. They focused on the cut points, for example, NT-proBNP. Initially, Brendan, you looked at the median for your study, and the reviewers said, "Well, can we look at clinically relevant?" So they requested that you consider that, and I must say, your responses were just terrific. And so, you went to a cut point of 125, which is clinically relevant. I think this is extraordinarily important. The reviewers stressed that you should be careful with your conclusions. And you carefully said, "This represents only the first step in testing whether these biomarkers may serve as valuable clinical tools." I would go further than that. I think these four tests are inexpensive, they're clinically available. I don't do them on all patients, but I do them on some. I always do lipids, and I do NT-BNP in somebody with heart failure or decreased ejection fraction. And I always do troponin, which I think is extremely important. Even in the normal range, it trebles its risk. So a question to Brendan. I think if I found a high troponin, I want to look at CRP, look at NT-proBNP, and I'd have the cholesterol HDL ratio. So what would you think about cascade screening and the implications of that on cost effectiveness? Dr Brendan Everett: I think that's a really excellent suggestion. We hadn't thought of that, as you know, and it doesn't come up as an idea in the discussion. I think, at least here in the United States, the standard test would be a total cholesterol to HDL ratio, and of course, with that, oftentimes in LDL cholesterol, because that's where we focus our preventative efforts with statins, as you mentioned. And we typically would not do a troponin in otherwise healthy and ambulatory patients. I think that's a creative suggestion, the idea that if you had an abnormal cholesterol, and then an abnormal NT-proBNP, and then would you move to a CRP and a troponin as well? I think in the type of patient that we're talking about, a primary prevention patient who may have occult cardiovascular disease, CRP is probably the best validated, epidemiologically, as a marker of risk and to guide therapy. But I think one thing that we struggled with, and I'd be interested in your view on this because you're such an expert on cardiac troponin, is, what are the therapeutic interventions that you would use for somebody with an elevated biomarkers for... And we addressed this a little bit in the discussion, and I think it's just common sense preventive therapy, but I don't know if that struck you as the right thing to do, or if you had other ideas about how to address somebody who might have, theoretically, an elevated risk of sudden cardiac death. Dr Harvey White: I think it's challenging common sense. Do people use them? So I think the stress should be that preventive therapy should be used in these patients. So blood pressure and history of hypertension is related to sudden death. In your study, sudden death was more common in individuals who didn't exercise. Obviously, they're higher cholesterol, so you got to promote weight loss, blood pressure, nonpharmacological means diabetes is associated with, and a higher HbA1c, so you really want to get the HbA1c down. Whenever you find an abnormal troponin, you need to go back to the patient and get an echocardiogram. Have they got left ventricular hypertrophy? Have they got underlying LV dysfunction, and so forth? And to get the patient on board, one of the things that you would challenge with doing is the drug use during follow up. And I was particularly interested in beta blockers, which of course, may reduce sudden death. But I'm also interested in, about 30% of patients with sudden death have taken cocaine or alcohol. And so, addressing drug use is important, addressing alcohol is important. And just as an add-on in this age of COVID, don't take hydroxychloroquine, because that might cause sudden death. Dr Carolyn Lam: Harvey and Brendan, those were just really excellent points. In fact, I was sort of thinking along the same lines of, what are the therapeutic implications of this? And I think one of the management implications addresses one of the limitations, perhaps though, because this study did not include electrocardiographic or imaging information, like left ventricular ejection fraction. I just wanted to double-check if that's the case, Brendan. And if you could, how has this impacted your own practice, or what's the next steps, you think? Dr Brendan Everett: You are absolutely correct, that as a routine, none of the studies that we included in this research work actually had baseline electrocardiograms or echocardiograms. I think when you take the perspective of wanting to screen or thinking about screening a broad population for the risk of sudden cardiac death, an echocardiogram is probably not a feasible study. Although, to Harvey's earlier point and to your own point, using that as a subsequent test, along the lines of the cascade screening approach, when you have an abnormal cardiac troponin or an abnormal NT-proBNP, perhaps an echocardiogram is a very good study to order at that point. The lack of electrocardiograms, I think, is another limitation of our work. Those are more commonly used, at least I think, as a screening tool, at least in the United States, when somebody has a history of hypertension, for example. I think, with respect to your last question, "How has it changed my own practice?", I think the key thing that I wanted to emphasize, which is an important limitation of the study, is that this is a case control study. So what we're able to do is, we're able to estimate relative risks. And relative risks of seven are high. They're impressive, right? The problem is that we can't actually estimate what the absolute population risk is of sudden death based on the patients or the participants in these studies. So it's hard to take the group of participants that we were able to look at and watch carefully prospectively, and then back-calculate what the absolute risk of sudden cardiac death would be in a broader population. So in order to take a research finding like this, where there's a high relative risk, and start to think about population-wide screening, you have to know how that will implicate or affect the absolute risk. If your absolute risk is tremendously low, seven times tremendously low is still tremendously low. However, if you can find a population where a relative increase of seven in your absolute risk actually becomes clinically important, then you begin to have an argument about population screening and whether or not it's worthwhile and effective, or potentially how it can reduce the occurrence of sudden death, which is our goal, after all, with a study like this. Dr Carolyn Lam: What a balanced discussion. So thank you, Brendan. That was a very important point. Finally, are you planning next studies, or what's the next step then, you think? Dr Brendan Everett: Well, I think the next step would be to try and figure out how to translate the data that we have here into a real sense of how this would affect absolute risk. This would then have implications for cascade screening, as Harvey mentioned earlier, potentially broader use of these biomarkers as screening tools in otherwise healthy populations, and of course, implications, both about the testing characteristics and false positives and those sorts of important issues, and then the cost and the cost effectiveness, how much it would cost to screen such and such a population to prevent one sudden cardiac death. Those would all be the next steps, I think, in terms of determining whether or not this approach could be implemented more broadly. Dr Carolyn Lam: Thanks, Brendan, and thank you so much for this paper. It's just so beautifully and elegantly put. It's something I'm going to remember and already taken my clinical practice to recognize persons at risk and whom I want to do further work of. Thank you so much for joining us today, Brendan. Thank you so much, Harvey. And thank you, audience, for listening today. Please tune in again next week. Dr Greg Hundley: This program is copyright the American Heart Association, 2020.  

Statistically, most of us have a problem with inflammation. Chronic inflammation can lead to a host of diseases and disorders, and it can even keep you from losing weight! I'm working on reducing the inflammation in my body, and I am monitoring it through bloodwork. I hope you learn a great deal from this episode, and I hope you get your hsCRP level checked! --- Send in a voice message: https://anchor.fm/lets-talk-dementia/message Support this podcast: https://anchor.fm/lets-talk-dementia/support

Using functional MRI as a microscope to study effects of drugs and hypnosis on the brain; Is the 3D mammogram more accurate for dense breasts? In a healthy 76 yr-old person with high cholesterol, taking a statin might be too risky; High diversity of bacterial species and a high fiber diet are the keys for a healthy microbiome; Primer on the immune system as it applies to Coronavirus vaccines being tested

Using functional MRI as a microscope to study effects of drugs and hypnosis on the brain; Is the 3D mammogram more accurate for dense breasts? In a healthy 76 yr-old person with high cholesterol, taking a statin might be too risky; High diversity of bacterial species and a high fiber diet are the keys for a healthy microbiome; Primer on the immune system as it applies to Coronavirus vaccines being tested

The hs-CRP test can help predict your future risk of a heart attack and heart disease. This is a test that should be added to your regular yearly check up. Hs-CRP is also called Cardiac-CRP and it is a proxy for inflammation. Here's what you need to know from Chief Scientific Officer and Pharmacist, Jerry Hickey, Ph. Exclusive Offer! Take advantage of an exclusive podcast offer today by visiting www.invitehealth.com/podcast or by clicking here. For more information on the products or studies mentioned in this episode, click here. 

Ivor Cummins BE(Chem) CEng MIEI PMP completed a Biochemical Engineering degree in 1990. He has since spent over 25 years in corporate technical leadership and management positions. His career specialty has been leading large worldwide teams in complex problem-solving activity.  Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has recently presented on heart disease primary root causes at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR). He has also debated Irish Professors of Medicine on stage, at the annual conference of the Irish National Institute of Preventative Cardiology (NIPC).   Ivor’s 2018 book “Eat Rich, Live Long” (co-authored with preventative medicine expert Jeffry Gerber MD, FAAFP), details the conclusions of their shared research: https://www.amazon.com/Eat-Rich-Live-Long-Mastering/dp/1628602732/   His public lectures and interviews are available on YouTube, where he has 60,000 subscribers and 5 million views have been recorded to date:  https://www.youtube.com/channel/UCPn4FsiQP15nudug9FDhluA.      Most of Ivor’s material is readily accessible via his rapidly growing website:  https://thefatemperor.com/   Ivor is currently the Chief Program Officer and for Irish Heart Disease Awareness: http://www.IHDA.ie   Ivor lives in Dublin, Ireland, with his wife and five children. Time Stamps: 13:19 Start of the Podcast  14:24 Ivor's background in cholesterol research. 18:14 Lab work/lipid panels. 21:04 Triglyceride/HDL ratio. 22:58 hsCRP and fasting insulin. 24:49 Ivor's ferritin levels. 25:12 Ivor's dietary changes. 29:34 Hypertension as criteria for metabolic syndrome.  32:23 How did Ivor's ferritin change ? 34:19 Iron overload on the carnivore diet. 39:19 LDL. 50:09 If LDL was enough to initiate atherosclerosis why do we not see atherosclerosis in veins? 51:59.Artery wall damage. 1:00::29 Glycocalyx. 1:03::48 Oxidized LDL. 1:05::29 Saturated fat and oxidized LDL. 1:08::19 APOE4 and insulin resistance. 1:11:49 Is fat in dairy inflammatory ? 1:17:09 The problem with combining carbohydrates and fat. 1:23:09 Refined fats. 1:27:34 Study on decreased saturated fat intake and increased polyunsaturated fat intake correlation with Lpa and oxidized LDL levels. 1:35:19 Should we be consuming a low linoleic acid diet? 1:38:44 Do humans need high amounts of Omega 3? 1:45:39 Omega 7 1:50:59 The negative effects of soybean oil. 1:51:49 Where to find Ivor's work. 1:56:49 The most radical thing Ivor has done recently. Belcampo: Use the code CARNIVOREMD for 10% off your order!    Ancestral Supplements https://ancestralsupplements.com/ Code SALADINOMD on the shopify site to receive 10% off.   White Oak Pastures: Use the code CARNIVOREMD at www.whiteoakpastures.com for 10% off your first order!   JOOVV: www.joovv.com/paul INSIDER: carnivoremd.com   My contact information:   Book: www.thecarnivorecodebook.com   PATREON: https://www.patreon.com/paulsaladinomd   SOCIAL MEDIA  Instagram: @carnivoremd Website: carnivoremd.com Twitter:@carnivoremd  Facebook: Paul Saladino MD email: drpaul@carnivoremd.com

Something fascinating starts to happen when you turn to a healthy nutrition plan like keto. You get so dialed into your diet and track various health markers like blood sugar, insulin, inflammatory markers, and more that when they don’t fall into the perfect ideal range we start to wonder what is going on. This was something that health podcaster and international bestselling author of KETO CLARITY Jimmy Moore saw this week in a message from one of his followers who heard him talk about the marker hsCRP on his Friday podcast called The KetoHacking MD Podcast (http://www.ketohackingmd.com). “It’s very tempting to see one lab result and respond by doing something drastic. Allow things time to see if they stabilize.” – Jimmy Moore Although her own personal hsCRP reading was in the healthy range at 1.4, she was so worried about what was wrong because it wasn’t as low as she thought it should be eating low-carb, high-fat, ketogenic. Listen to Jimmy share his insights on this and his warning to not let orthorexia creep into your pursuit of nutritional ketosis in this episode.

The Investigation Annual check-ups are supposed to confirm your health or raise flags on potential issues. But, could they be a false sense of security? I’ve had so many clients come in with a ‘clean bill of health’ from their doctor that doesn’t match how they feel. Today, we’re going to investigate why so many annual check-ups fall short.    Insufficient Blood Tests Are you getting the right blood tests with your annual check-up to truly determine if your healthy? It depends on your doctor. What tests are run is up to each individual doctor. I find that, unless you are seeing an integrative doctor, chances are good that your blood work is very basic. An integrative doctor will ensure that the blood work includes specific markers to get a complete picture of what’s going on in the body.    How Health Mysteries Start So often, clients dealing with a health mystery tell me that they’ve had an annual physical and that the blood work came back totally normal. Without more comprehensive blood testing, they presume that nothing is wrong and as a result, doctors may dismiss complaints or rule out issues prematurely. When we presume that things are ‘normal’ it can be very hard to dig deeper to find out what is really going on. And remember, imbalances often start months and years before symptoms appear and a disease is actually found. So, imagine if getting the right blood tests could mean that you catch things before they can turn into a health mystery!    Avoid Becoming a Health Mystery The number one way to avoid developing a health mystery is to use your annual check-up as an opportunity to do more comprehensive testing. What does this look like? Ask your doctor to do more than just the basics. You need to be specific, otherwise, you might still fall into a false sense of security about your health.    Normal is Too Broad Another way that issues can slip through the cracks is when our results come back inside the ‘normal’ range. The normal range is not the same as the optimal range and can vary depending on where you live. If you want optimal health, you have to compare your results to the ‘optimal’ range and not the normal range.    What Blood Tests Should be in an Annual Physical Most routine physicals will include a complete blood count (CBC), a metabolic panel (looks at your glucose, liver and kidney markers), and a lipid panel (cholesterol and triglycerides). This is typically not enough.   Here is what tests you should have done and the optimal ranges to look for: Vitamin D Check both 25 hydroxy and 125 hydroxy, ideally but if you just get one test, ask your doctor for the 25 OH.  The typical ‘normal’ lab range for vitamin D is 30-100. Optimally, we want to be somewhere between 50-60 and if you have an autoimmune disease some say even closer to 70.  Thyroid (listen to Episode 27 for more on this!) Most doctors won’t check this in a routine physical and if they do, it’s just a TSH test. You should test TSH, Total T4, Total T3, Free T4, Free T3, Reverse T3 and Thyroid antibodies. Check the PDF Download for optimal ranges of each of these Iron While the CBC includes a marker called hemoglobin but it is typically not enough to truly evaluate iron levels Ask for Total Iron, TIBC, Iron Saturation and Ferritin (which is the storage of iron). Inflammation Inflammation is what often leads to disease and very few doctors test for it in an annual physical. Ask for a test that looks a marker called HsCRP (high sensitivity c reactive protein). Ideally, this number should be below 1 even though the labs range may allow or up to 5. Also test ESR. Normal ranges is below 15 but optimal range is below 5.   High Homocysteine levels  can lead to inflammation and is a risk factor for cardiovascular disease. It is rarely checked. Most lab ranges show 0-15 as normal. Ideally, homocysteine should be between 7 and 8. B12 Normal ranges from 200 to 1100 but ideally, you want to be above 600. Hemoglobin a1c (if you’ve had elevated glucose or you have a family history of diabetes) Most tests are a one-time check of glucose but the a1c looks at average levels over 3 months.  Ideal levels are 5.6 or below. Between 5.7 and 6 indicates a higher risk for diabetes. 6-6.3 is considered pre-diabetes. Above 6.3 is diabetes ANA (anti nuclear antibodies) (if you suspect, have any history, or family history of autoimmunity) This general marker does not represent a specific autoimmune disease, having an elevated ANA can be indicative of some autoimmunity. If this is elevated, more investigation is warranted.  Histamine determination whole blood (done at Labcorp only, Test # 081315) Learn more about this, the MTHFR gene, and methylation by listening to episode 34 The optimal range for this marker is 40-70 Redefining the Basic Tests Most doctors will run the basics, including a CBC, Metabolic and Lipid Panels. Here are the key things to look for:  CBC Look at the white blood cells. The lab range is wide but an ideal white blood cell count is between about 5 and 9.   A low white blood cell count can mean there is some kind of underlying infection.  Look at thewhite blood cell differential, too. This shows the percentages of the different types of white blood cells. If your lymphocytes are elevated (and you’re not sick) it may be a sign that something is going on, perhaps a hidden virus the body has a hard time fighting off.   Hemoglobin Note that the bottom end of the range is at 11.7 but women should ideally be between 13.5 and 14.5 and men at 14.5-16.5.  Metabolic Panel Pay special attention to the glucose. It should ideally be between 79 and 90  Bilirubin should be between 0 and .8.  Numbers above .8 can indicate an issue with the glucuronidation cycle and tells me there can be an issue with hormone detox and potentially sulfur or oxalates.  Cholesterol Most doctors are pretty vigilant and may prematurely prescribe medication.  Remember, cholesterol is not the only predictor of heart disease so looking at how everything looks together including homocysteine and crp.  Acceptable LDL levels have been moving down over the last 10 years. Normal is now below 100. However the ratio is very important. If you have a good HDL, which is the good cholesterol, an LDL that is a bit over 100 is not typically a huge issue but of course we have to be mindful if its trending up. Prepare for your Annual Physical I’ve shared a lot of information in this podcast about what test you should be requesting from your doctor and why. It can be a bit overwhelming, I know. So, I created this cheat sheet PDF that you can take with you to your annual physical appointment. The OPTIMAL range are also listed so you can assess your test results accurately.  Click HERE to access this free PDF.    Eliminating Health Mysteries Many health mysteries are preventable. Getting a clear and complete picture of your health at every annual physical is the first step in avoiding becoming a health mystery. Make sure you share this information with everyone you care about so that we can eliminate health mysteries for good.    Links: DFH Complete Multi Seeking Health Prenatal/Multi   Thanks for Listening If you like what you heard, please rate and review this podcast. Every piece of feedback not only helps me create better shows, it helps more people find this important information. Never miss an episode -  Subscribe NOW to Health Mysteries Solved with host, Inna Topiler on Apple Podcasts, Spotify, Stitcher or Google Podcasts and remember to rate and review the show! Find out more at http://healthmysteriessolved.com   PLEASE NOTE All information, content, and material on this podcast is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Some of the links provided are affiliate links. This means we may make a very small amount of money should you choose to buy after clicking on them. This will in no way affect the price the product but it helps us a tiny bit in covering our expenses. 

If you haven’t noticed what’s been happening lately in the world of nutritional health, let me quickly bring you up to speed. There is a very deliberate move that is underway trying to push people into embracing more of a plant-based diet like vegetarian or vegan. This is happening on so many fronts (and we’re covering them all on JIMMY RANTS), but the latest one is in a new study claiming that the best possible health markers you can obtain are from eating vegan. Read about it below. Vegans have a ‘healthier biomarker profile’: https://www.medicalnewstoday.com/articles/324869.php While they look at some of the micronutrient makeup in the bodies of the people they tested (although there was no ketogenic or carnivore group amongst the five categories tested), this research is incomplete according to health podcaster and international bestselling author of KETO CLARITY Jimmy Moore. He asks why they didn’t take into consideration many other biomarkers that indicate optimal health like fasting insulin, blood sugar, inflammation markers like hsCRP, triglycerides, and so much more. “Don’t take what I tell you at face value, do you own research!” – Jimmy Moore Listen to hear him talk about the desperate need for everyone in the diet and health community to coalesce behind those commonly agreed upon markers that determine just how healthy you are in this episode. NOTE: Today we have a special JIMMY RANTS on The LLVLC Show for you. Jimmy is on his much deserved six-month sabbatical so we are bringing you some of the best content from Jimmy’s daily show JIMMY RANTS. Be sure to bookmark JimmyRants.com and dig through all of the content there during Jimmy’s time away.

My buddy Nathan Owens (@nathanequalsone) returns for a rousing discussion of all of our bloodwork. There’s a lot here, and this is technical episode. I hope that it provides value to the community and is helpful to those of you with questions about which bloodwork to order!    Time stamps:   12:25 Nathan's Podcast info. 15:04 Blood work Recommendations. 19:38 Where to order these tests online. 20:22 Extra-curricular labs. 21:42 Nathan's Blood Work-Cholesterol 24:01 What happened to  basic lipid panel when he went carnivore. 25:55 Familial hypercholesterolemia 27:15 Thoughts on why LDL goes up on a Carnivore Diet. 29:04 Sophisticated lipid panels  30:48 Atherogenic lipid numbers. 32:31 Nathan's LDL and HDL size. 33:50 What's the size of an HDL particle relative to the size of an LDL particle? 38:07 Ox LDL test. 41:20 Paul's bloodwork results. 43:14 LPPAL2 45:09Other lipid tests Nathan got. 47:05 Are plant sterols atherogenic? 48:35 Other inflammatory markers  49:38 Valuable Inflammatory Markers. 51:00 When to measure HSCRP? 51:39 Myloperoxidase and fibrinogen. 52:12 Homosistine. 54:50 Plant Folate  56:15 Hormones 57:53 Sex hormone binding globulin. 1:01:49 What Nathan did to quadruple his testosterone. 1:06:30 The takeaways in regards to testosterone  1:09:40 DHT  1:12:21 IGF1 1:13:25 Insulin 1:14:10 Importance of testing fasting insulin. 1:14:25 C peptide measurements  1:14:45 The Comprehensive Metabolic Panel. 1:16:37: B.U.N  1:18:27 Cystatin c  1:19:19 EGFR 1:19;54 Fasting glucose.  1:21:59 Continuous glucose monitoring.  1:23:13 Hemaglobin A1C. 123:53 Fructosamine levels. 1:24:44 Bilirubin  1:26:59 Biliary disease  1:28:58 ALT and AST 1:29:30 Alkaline Phosphatase. 1:30:16: GGT  1:31:53 CBC and DIFF. 1;33:58: White blood cell lineages. 1:36:24: Red blood cell count. 1:37:23 Hematocrit measures. 1:38:39 Mean Corpuscular volume. 1:40:35 Platelet count   1:40:50 Omega 3. 1:42:48 Relative ratios of ALA, DPA, DHA, EPA. 1:44:45 Other fatty acids. 1:47:47 Thyroid Hormones. 1:59:27: Vitamin E 1:59:38 CoQ10, minerals,and micronutrients. 2:07:09: Saunas and heavy metals. 2:07:39 Leptin. 2:08:04 Organic acid, G.I. tests. 2:09:10 Full Genome Sequencing. 2:13:17 The most radical thing Nathan has done recently.   Ancestral Supplements https://ancestralsupplements.com/   Code SALADINOMD on the shopify site to receive 10% off.   Use the code CARNIVOREMD at www.whiteoakpastures.com all month for 10% off your order!   JOOVV: www.joovv.com/paul   INSIDER: carnivoremd.com   My contact information: PATREON: https://www.patreon.com/paulsaladinomd   SOCIAL MEDIA  Instagram: @carnivoremd Website: carnivoremd.com Twitter:@carnivoremd  Facebook: Paul Saladino MD email: paulsaladinomd@gmail.com   Be sure to subscribe for more medicine and lifestyle content. Stay radical!  

If you are interested in lipids, you’ve probably heard of Dave Feldman and his work. If not,  you’ve got some homework to do, and I think you’ll be amazed at what you find. Dave’s work can found at cholesterolcode.com where he details his multiple, meticulous self-experimental projects. Prior to cholesterol adventures Dave was a senior software scientist and an engineer. He brings this “out of the box” thinking to the world of medicine and we are all better off for it.  He began a low-carb, high-fat diet in April 2015 and has since learned everything he could about it with special emphasis on cholesterol. He saw his own lipid numbers spike substantially after going on the diet and spotted a pattern in the lipid system that’s very similar to distributed objects in networks. He’s since learned quite a bit on the subject both through research and experimentation which has revealed some very powerful data. Where he induced a 73 point drop in my LDL-C and a 1115 point drop in my LDL-P.  Siobhan (she'-VAUN) Huggins is an independent researcher focused on lipidology, the immune system, and metabolic diseases. She spends most of her time at cholesterolcode.com where she works alongside Dave Feldman. She has been keto since August of 2016, and on a predominantly carnivorous diet as of October 2017. She has lost 80 lbs, reversed hypertension, and found a passion for research along the way. 5:47 Dave Feldman's blood testing at low carb San Diego 7:17 The Feldman Protocol 9:39 Does it matter whether subjects are a ketogenic vs. carbohydrate based metabolism 11:19 What labs were administered? 13:03 Shevawn(Siobhan??) on the inflammatory markers. 14:09 What's the sense of the half-life of HSCRP? 18:09 Ferritin 22:34 Other Markers being tested? 25:29 Glucagon 27:17 is it expected from these labs to find free fatty acids in the blood ? 29:23 What do you use as a cutoff for high fasting insulin? 30:00: C-Peptide 32:55 Hemaglobin A1C 34:37 Test frequency/pitfalls of looking at tests in isolation. 38:09 The Lipid Panel ,(triglycerides) 42:42 How are Triglycerides different from free fatty acids? 45:22 Measuring Triglycerides. What Happens to triglycerides after eating a high fat Carnivore meal? 50:13 Any utility to non-fasted lipid panels ? 50:52 Will triglycerides be higher on a Ketogenic diet (postprandially) 51:39 difference in postprandial triglycerides between Keto and carbohydrate based metabolisms.  54:14 Recommendations around Triglycerides. 58:32 What else elevates triglycerides? 1:01:39 Thoughts on Coffee 1:04:56 National Health and Nutritional Survey. 1:06:49 How many people are in this data set? 1:08:15 What is linear regression? 1:11:58 Why Dave wanted to look at all cause mortality. 1:13:52 Ldl and all cause mortality  1:14:57 Age parity  1:16:37 "The Dave Dance" 1:17:52 Critique:diseases that bring down LDL. 1:20:59 What epidemiology is useful for. 123:32 What happened when those who died within 10 years. 1:23:22 How many people ended up in the age parity subset? 1:25:20 How could LDL be good for you? 1:31:57 Evolutionary role of insulin resistance. 1:32:14 Insulin Resistance and infections. 1:36:37 Underlying Triggers 1:37:10 Virta program. 1:39:52 Carnivore Diet talk. 1:42:22 Studies on Antioxidants. 1:45:17 Lp(a) 1:50:07 Can you change Lp (a) 1:59:47 What characters would Dave and SIobhan be at Comic Con ? 2:00:42 The most radical thing they did recently  Dave’s contact information:   www.cholesterolcode.com  Twitter: @daveketo Instagram: @davefeldmanketo   Siobhan’s contact:   Twitter: @siobhan_huggins Website: cholesterolcode.com      Ancestral Supplements https://ancestralsupplements.com/   Code SALADINOMD on the shopify site to receive 10% off.   JOOVV: www.joovv.com/paul   INSIDER: carnivoremd.com   My contact information: PATREON: https://www.patreon.com/paulsaladinomd   SOCIAL MEDIA  Instagram: @carnivoremd Website: carnivoremd.com Twitter:@carnivoremd  Facebook: Paul Saladino MD email: paulsaladinomd@gmail.com   Be sure to subscribe for more medicine and lifestyle content. Stay radical!  

This podcast interview features integrative health expert Russell Jaffe, MD, PhD, CCN, who shares his philosophy about addressing men's health issues in clinical practice. Jaffe discusses hormonal balance, prostate health, gastrointestinal health, cardiovascular health, and inflammation. About the Expert Russell M. Jaffe, MD, PhD, is CEO and Chairman of PERQUE Integrative Health (PIH). He is considered one of the pioneers of integrative and regenerative medicine. Since inventing the world’s first single step amplified (ELISA) procedure in 1984, a process for measuring and monitoring all delayed allergies, Jaffe has continually sought new ways to help speed the transition from our current healthcare system’s symptom reactive model to a more functionally integrated, effective, and compassionate system. PIH is the outcome of years of Dr Jaffe’s scientific research. It brings to market 3 decades of rethinking safer, more effective, novel, and proprietary dietary supplements, supplement delivery systems, diagnostic testing, and validation studies. About the Sponsor PERQUE Integrative Health (PIH) is dedicated to speeding the transition from sickness care to healthful caring. Delivering novel, personalized health solutions, PIH gives physicians and their patients the tools needed to achieve sustained optimal wellness. Combining the best in functional, evidence-based testing with premium professional supplements and healthful lifestyle guides, PIH solutions deliver successful outcomes in even the toughest cases. If you are interested in delving more deeply into this and other integrative health topics, we invite you to join the PIH Academy. Transcript Karolyn Gazella: Hello, I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Thank you for joining me today. Our topic is men's health, and my guest is integrative health expert, Dr Russell Jaffe. Before we begin, I'd like to thank the sponsor of this topic, who is Perque Integrative Health. Dr Jaffe, thank you so much for joining me. Russell Jaffe, MD, PhD, CCN: Thanks for the invitation. Gazella: Well, before we dig into the specific health issues that men face, you believe in a philosophy first approach. I'm sorry, physiology first approach. What do you mean by- Jaffe: The philosophy is physiology. Gazella: Exactly. Jaffe: So, that was appropriate. Yeah- Gazella: So, what do you mean by that? Jaffe: Right. It's a high level, brief, 2 words, physiology first. What we mean is, physiology before pharmacology. We mean physiology first because it seeks an upstream assessment of the causes of risk or symptoms, in contrast to most conventional care today, even holistic or not, that remains rooted in downstream symptom management. Physiology first uses global evidence to reduce risks and prevent people from falling into the river of disease. Physiology first uses nature's nutrients in supplements, with enhanced uptake and chaperone delivery, for safer, more effective, essential replenishments, items we must take in since our body doesn't make them. Physiology first urges organic or biodynamic or locally grown sources of nutrient-dense whole foods, as minimally contaminated as possible. Physiology first focuses on underlying causes. For example, too little of essential needs being met, which are eating, drinking, thinking, doing—those are the 4 headline categories—rather than working back from symptom-reactive case management. And finally, physiology first uses predictive biomarkers interpreted to their best outcome goal values. Now, this is a paradigm shift for many colleagues but we now can impersonalize predicted, proactive, primary prevention practices, save individuals probably a million a year just by applying physiology first. Gazella: Yeah. Well, that's exciting so I'm glad that we went over that. Now in general, what should be on the radar of clinicians when it comes to addressing the special health needs of their male patients? Jaffe: Yes, and here again, now that we've kind of gotten the hundred thousand–foot level, we start and recommend colleagues start with self assessment. This includes transit time, urine pH after rest, hydration, and a sea-cleans as overall global self assessments, very inexpensive. The individual does much of it themselves, brings it to the expert who interprets it so that we get a snapshot of the metabolic or metabolon/microbiome, the digestion and metabolism. You interpret that to best outcome goal values. You use that to inform and inspire and motivate people to put it in effort for the 6 to 7 weeks that it takes to change a habit of daily living and you can add years to life, years of quality life and life to years. In people with chronic symptoms, well. Take a careful family history although family history is highly relevant if you have the same behavior and environmental factors. If you change your behavior, your habits, your environment, then your family history to a very large extent disappears into the midst of history. If there have been prior treatments and treatment failures, it's important to assess that. We use the predictive biomarkers to help people celebrate when they are at their best outcome goal value and take action when their risks increase. Now, men and women at all ages need activity, at least 45 minutes a day of walking or equivalent. Sitting is the new smoking. Weight-bearing exercise or cardio exercise 2 or 3 days a week and knowing about it or preaching about it is one thing. It's when you actually do it. I'm glad to tell you that I had just enough glimpse of the consequences of not doing that I do what I'm recommending. Now we want to teach men to prepare for sleep, achieve restorative sleep, using physiology before pharmacology, using salt and soda baths, Epsom salts and baking soda, plus or minus aroma oil, essential oil. The baking soda alkalinizes and relaxes muscles in the pores of the skin, and the Epsom salts, which is magnesium sulfate, allows the magnesium to come in and that's often very helpful. We recommend that teaching people, particularly men who have sleep issues, about abdominal breathing and active meditation and green dichromatic light, along with nature's sources of serotonin and melatonin, which is tryptophan. We ask about changes in urine stream flow and quality after urination. Is there any dribbling? How many times do they get up at night to urinate? And we make lifestyle suggestions tailored to the individual at their phase of life. We want to be proactive with prostate support nutrients, such as micellized soft gel that contains all of active saw palmetto, [inaudible 00:06:03], lycopene. Free lycopene, not just some ketchup. Hygeium, with 14 or 15% beta sitosterols. Urtica dioica, also known as stinging nettles. Zinc, in the picolinate form. And selenomethionine, selenium in the selenomethionine, healthier, safer form. And all of this micellized in pure pumpkin seed oil to enhance uptake in retention, to improve function. And we think people can be pleasantly surprised at how effective and synergistic the above prostate health support is, available in a single, easy-to-swallow soft gel. Ask about adult beverages. If they consume more than 5 a week, provide comprehensive liver support and recommend a glass of water above the four quarts or four liters a day that humans need to avoid marginal dehydration—1 or 2 or 3 percent dehydrated is a big stress on every organ in your body. So this is, again, at a headline level, how our comprehensive approach actually works. Gazella: Perfect. Now I'd like to kind of narrow our conversation and I want to stay on the prostate because you mentioned the prostate. So, what are the roles that testosterone plays when it comes to prostate health and men's health in general? Jaffe: Right. Both men and women need testosterone. They need a balance of free and bound testosterone. They need good and not bad testosterone. Now, what does that mean? Well, you can measure in saliva or in plasma. The free and the bound, free and total testosterone. You can measure the dihydrotestosterone. You don't want much of that, maybe zero. You can measure oxidized testosterone. You want zero of that. And you want to enhance the good T, the good testosterone and reduce the bad T based on testing results because testosterone is needed for brain and muscle and organ and joint and bowel renewal and many other functions beyond just being a male hormone. You want to enhance healthy testosterone production through healthy microbiome and metabolon functions, especially the family of the central antioxidants. Vitamins, minerals, and cofactors that along with good hydration optimize your healthy testosterone, which is one of the vitality factors in the body and minimize the bad testosterone that causes everything from hair loss to loss of erections. Gazella: Okay, perfect. So before we leave the prostate, remind us what the significance is of the PSA test. Jaffe: That's a very important question and I think we're finally, after half a century in laboratory medicine and I've been following the issue all of that time. The PSA test is a measure of prostate repair. So, the PSA goes up if you have prostatitis. For example, if you just sit in your car too long and hold your urine in too long. And the PSA goes up in some but not all prostate cancers, and you can fractionate the PSA, free and bound, and that usually but not always helps distinguish the prostatitis from the cancer risk. If you had concern about the prostate and about PSA levels and have a biopsy, after a single biopsy—often there are multiple biopsies—the future PSA has no interpretable value that I know of except for population, but we're talking about 1 man at a time. And so many review articles that I have seen in the last few years say do other tests of prostate health and don't even do the PSA because if you don't need the test, you wouldn't do the test. If it's a question, it's a gray zone, that's exactly what the test is not very sensitive or specific. Gazella: What about enlarged prostate? Jaffe: The first thing I would do and have recommended for many years for enlarged prostate is to take that combination of prostate vitality factors and we have had men whose prostate was double or triple than usual size come back to that of a 40-year-old by following for about 6 months a program that includes the supplements that I recommended just a few minutes ago, along with eating foods that the man can digest, assimilate, and eliminate without immune burden, and that means the lymphocyte response assay test that measures T and B cell function and that then says eat this and don't eat that, take the supplement and don't take that, follow this mental and physical plan because in the 80,000 cases that we put in our database, we've evolved a very personalized approach to, say, prostate size. Gazella: Okay, perfect. So, let's move on. What does it mean when a man wakes up with an erection or doesn't have an erection? Is that significant? Jaffe: Oh, absolutely. The headline is that every healthy man should wake up in the morning with an erection. In essence, it's the quality control check of the distinctive male. Too often and very commonly, when a man does not wake up with an erection, that's a sign that they have pregnenolone steal, that they have high stress cortisol levels and low DHEA, which is the antistress hormone, usually with low free healthy testosterone, often with a sluggish thyroid and an exhausted adrenal gland, due to lack of adequate intake of the essential antioxidants, minerals, cofactors that are necessary. In addition to prostate health nutrients, I would recommend checking the thyroid, TSH, 3T3, 3T4. That can be done on a blood spot or in many different ways. But you must, by my recommendation, get the 3T3, 3T4, TSH all at the same time, and the healthy range for TSH is .5 to 2.5, not above. The usual range has too many unwell people. (Usual lab range.) You want to check adrenal stress hormones, cortisol and DHEA at four times during one day. And at the same time, in the same saliva or plasma specimen, you can measure male and female hormones and their sources, their precursors to see if the body has learned a distress response that steals the healthy progesterone and pregnenolone and produces too much distress hormone cortisol and too little healthy male and female hormones. They come from the same source. You want to get both and in balance. Now in regard to male sexual performance, there are natural solutions to erectile dysfunction. The following vitamins, minerals, and amino acids work as a team to improve the quality and duration of erections B complex. One phrase is 'B complex is for boners'. Keep the urine sunshine yellow and feel the difference comprehensive B complex means. C, it is ascorbate vitamin C, always fully buffered, fully reduced and we recommend based on the C cleanse, taking that amount is associated with healthier and the more robust erections. Vitamin D is really a neuro hormone and it does a lot of things, including improving cell function and providing cell energy to sustain the generally sixfold increase in blood retention during an erection. Then magnesium choline citrate. Magnesium is essential for a lot of different things, including a healthy sexual function, and choline citrate at the same time, say 220 mg of magnesium solves and a teaspoon of choline citrate. That enhances the uptake dramatically. It enhances the retention because it is an alkalinizing, rather than an acidifying source. Most magnesium solves and magnesium products have very low bioavailability and are in the acid form, which makes the magnesium run out almost as soon as it comes in. And then last is L-citrulline and L-arginine, and these are 2 amino acids. They both enhance nitric oxide production inside cells, and when you take about a gram of L-citrulline and 500 mg of L-arginine 30 minutes before adult activities, most men notice the difference, especially men over 40. Foods that are rich in these amino acids include nuts, seeds, chickpeas, and other legumes, also known as garbanzos, and meats. Making an avocado and chickpea hummus with some mustard seeds or black and white sesame seeds added plus or minus some toasted pine nuts with fresh ground black peppers and your favored high-quality salt, that can blend into a nutritious, delicious, amorous and traditional food. Gazella: That's great and it sounds yummy as well. Jaffe: It is. It should be nutritious and delicious. Gazella: Exactly, exactly. Well, let's now move onto the gastrointestinal tract. What should practitioners focus here when it comes to their male patients? Jaffe: Well, in the 21st century it is a pretty fair assumption that the person sitting across a professional has mild digestion dysbiosis, some degree of atrophy known as enteropathy, a long transit time. Transit time should be 12 to 18 hours. We recommend doing that with charcoal. We have an online instruction if folks are interested because you want to assess what's called the microbiome, which is the digestive tract in its fullness, or the GNS, known as the gut nervous system, which is in constant conversation and communion with the reigning central nervous system. And so we recommend focusing on a full complement of personalized native antioxidant, minerals, and cofactors in their safer higher uptake forms based on the assessments and the predictive biomarker tests that we recommend. We want to pay attention to hydration because even a little bit 1, 2, 3% dehydrated puts a stress on every part of the body. We want to have prebiotics. That is unprocessed fiber from diet or supplements, 40 to 100 grams a day. That's what Dennis Burkitt taught me and the most knowledgeable nutritionists that I know recommend that much fiber a day. Probiotics, 40 to 100 billion healthy by a mixed bacteria, bugs. Then synbiotics, which is really recycled glutamine to energize and repair the lining of the digestive tract. Then you want to eat what you can digest, assimilate, and eliminate without immune burden. So, you've done some functional immunology testing like LRA, lymphocyte response assay. Take in no empty calories. You are sweet enough as you are. If you feed parasites and pathogens, fungi and yeast, they will grow. Improve the digestion, the microbiome and metabolon, the innate biological detoxification competencies and enhance your digestion by eating what you can digest, assimilate, and eliminate without activating your immune responses. We teach people to stop feeding the pathogens and they disappear as digestion improves, repairs improve, resilience is restored, and habits of daily living are improved. Then you want to look at the secretory IgA if you're concerned about the interface between digestion and the body. It's called SIgA, secretory IgA. You can measure that in saliva. There should be protected mucins so that if partially digestive materials get near the wall of the body, they don't become foreign invaders if you have healthy mucins and healthy secretory IgA. And there are other elected protected digestive functions that healthy people have that are lost when people lack the essential nutrients or the essential minerals when their cellular metabolism becomes acidic, when their body is reaching out, calling out, actually crying out for repair enhancement essentials, things you have to take in that you can't make in the body. So, we wanna taper or possibly discontinue medications that impair digestion. We want to use prebiotics, probiotics, and synbiotics, especially in people who have had antibiotics and other digestive-interfering medicines. We want to check transit time, should be 12 to 18 hours. When I have roast beets as a main part of my dinner, I expect to see red in the commode in the morning. But I can tell you after all these years when I see that red, my first thought is never, "Oh, I had beets last night" so that's why we use charcoal. Now, avoid fat-binding medications and supplements that reduce essential fat-soluble vitamin uptake. That's vitamins A, D, E and K. And you need bile from the liver to do that and for that you need phosphatidylcholine-rich foods and/or supplements, and we happen to micellize all of our soft gels with this PC, with this—not politically correct—phosphatidylcholine. Now, many men have atrophy of their intestinal lining because of stress and toxin exposure and it's the 21st century, and maybe less than perfect eating, breathing, and drinking. So, getting the essential needed nutrients restored may mean intensive supplementation for a few months, followed by maintenance supplementation for a long, healthy life, and I personally plan to be dancing at 120 and I would like you to join me. Gazella: That sounds perfect. So, you mentioned tests to assess the microbiome and you also mentioned secretory IgA. Are there other tests that you recommend in terms of assessing the microbiome? Jaffe: Right. So, the transit time we talked about, it's one of the self-assessments, 1 of the 4. Then this SIgA, the secretory IgA, in saliva or serum, with the comprehensive lymphocyte response assay, if there's any indication that the person has shifted from elected protected mode into survival mode, which means all the protective and repair functions are down regulated, that's called chronic illness to happen, or hormone tests that include cortisol and DHEA at 4 different time points, male and female hormones can be measured in their precursors on the same saliva specimen. You can use plasma if you wish. Adrenal and thyroid adaptogenic supplementation is recommended either based on clinical history or these test results. By all means include some way of determining how much ascorbate that person needs because ascorbate is the maternal antioxidant that sacrifices yourself that all others may be presode. And then the magnesium with enhanced uptake choline citrate. The choline helps build acetylcholine, an important neurotransmitter and neurochemical. It also helps build the choline-rich biosalts that are more soluble and help get the thicker bile out of the gallbladder and into the digestive tract, where that helps emulsify fat to be taken up into the body. And then based on the urine pH, we would adjust how many doses of the magnesium choline citrate you take. Do a regular hydration assessment and when in doubt, what I recommend is that you have a carafe of water in front of you and a glass. If the glass is full you drink it and if it's empty you fill it, and you just keep doing that. And personally my goal is to go to the bathroom at least every couple of hours and then I cut down the amount of liquid I take in after 7 or 8 PM so then I'm not overhydrated when I go to bed. But underhydration is a much more common and unappreciated problem. Monitor the breadth of our little chemicals, and this can give very interesting insights that are both diagnosis-specific of mild digestion dysbiosis enteropathies and so forth. But in addition that information often makes it very clear to the individual that this is true for them and not in general. And the last is a zinc taste test. Developed by Harry Henken, you drop a zinc solution on the tongue. The people who need zinc can't taste it. The people who say the zinc tastes strong have enough. And it's a pretty good one-dollar type assessment of a critical mineral and specifically for men, men need lots of minerals but especially zinc. You lose about 25 mg per every ejaculation. Gazella: Yeah, that's good. That makes a lot of sense. So, now it's time to discuss inflammation. Is inflammation really repair deficit and how does that change clinical practice? Remind us why that's such a big deal. Jaffe: Right. Well, we started with the physiology-first concept. Now I'm a doubly board-certified pathologist. I know the 5 aspects of inflammation. I know it's taught as a fire to be fought, something that has to be suppressed with anti-inflammatories. And now I pause and say: Anything that starts with 'anti' is using pharmacology before physiology. Inflammation is repair deficit. What my pathology colleagues see as inflammation is the cumulative lack of repair when your immune defense and repair system is doing too much defensive work because of foreign invaders from the breath or the skin or the gut, and if you enhance the innate immune system's ability to repair, your infrastructure is reborn, your bones get rebuilt, your joints are renewed, your mood is better. Your ability to get restorative sleep and meaningful relationships all are improved when you recognize that repair deficit is an opportunity. You use the hsCRP test as a predictive and validated biomarker. It's also an all-cause mortality, morbidity marker. The healthy goal value—and this is, again, where we have the reframing. I don't even look at the lab range because that includes too many unwell people. You know the goal value for this test, hsCRP, and it's less than 0.5. Ignore statistical lab ranges unless you're treating statistics, and knowing the best outcome goal value we add ascorbate based on the [inaudible 26:350, magnesium choline citrate based on the urine pH, and other similar kinds of monitoring so that the person gets more safely the forms that are more effective because of their enhanced uptake and retention and therefore the deficits get corrected more quickly. I mentioned hydration. I keep mentioning it only because every part of your body is healthier and more resilient and more able to repair when you take in healthy water, 4 liters a day or more of either mineral-rich, I happen to have well water but some mineral-rich water that's not contaminated and/or sparkling water. I happen to like Pellegrino but there's also Gerolsteiner and Apollinaris and actually every culture has a mineral-rich water known as a therapeutic or beneficial or health-promoting mineral water. So, you want to drink hard water, so water softeners are not recommended, at least not total home water softeners. If you want to soften the water in the pipes, I don't care, but your blood vessels are not pipes and now I care about the quality of the water that you take in. Gazella: Perfect. So, I love your perspective about looking at repair deficit as an opportunity. Are there other ways to kind of take advantage of that opportunity to reduce oxidative stress and reign in inflammation? Jaffe: Yes. And again, in a physiology-first point-of-view in regard to, say, blood fats. Cholesterol and triglycerides and blood fats and [inaudible 00:28:14]. If you keep the oxidation of those fats, if you keep oxidized cholesterol to zero, if you keep oxidized LDL to zero, because you're taking enough antioxidants and especially ascorbate. Now, the fat-related cardiovascular risks just went away. What remains is understanding your hemoglobin A1C, your hsCRP, your homocysteine, your LRA (lymphocyte response assay immune responses), your vitamin D, your first morning urine pH, your omega-3 index, and [inaudible 00:28:51]. Those are the eight predictive biomarker tests and we have online for folks to peruse and/or download or watch on YouTube discussions of why these eight predictive biomarkers cover all of that genetics, which is 92% of your lifetime quality of life and health. And yes, you can blame mom and dad for the other 8%, and yes transgenerational influences on RNA are a big scientific field but not yet ready to measure clinically. Live in the moment, do one thing at a time, practice gratitude and random acts of kindness, breathe abdominally for at least 5 minutes a day, and make enhance repair your practice and banish inflammation. Gazella: That's perfect. It's a very integrative approach that includes lifestyle as well. I'd like to end with heart disease because heart disease remains the leading cause of death for men in the United States. So, what do you recommend when it comes to protecting heart health for male patients? Jaffe: Yes, and as I think you know part of my primary research when I was in government service at the National Institutes of Health Clinical Center was collaborating with the Heart Institute on animal models of heart disease. Now, Paul Dudley White in the 1930s was a famous cardiologist. He helped invent the electrocardiogram. He taught when I was a young student that in the 1930s at Mass General Hospital in Boston, Massachusetts if they had 1 heart attack a year, they published the case. And yet 40 years after that, cardiovascular disease was the major killer of Western civilization. That's not a genetic change. It's too quick for genetics. A lot has to do with smoking and sitting, sedentary lifestyle, processing of foods, and all that goes with that. Jaffe: So, cardiovascular disease. If your heart attacks you, if you have a clog in a blood vessel, an artery, if you have a stroke, you didn't pay attention to the upstream warnings that you would know about if you did the self-assessment, if you did the predictive biomarker tests because these change. Your risk goes up dramatically decades before catastrophe. And if you change your consumption and attitude, if you change the environmental toxin exposures and by the way 80% of the toxins that people have in their body are of recent exposure, and you can dramatically reduce that by certain simple lifestyle changes. Include 1 to 300 mg a day of micellized CoQ10 in 100% rice-brand oil, and no glycose. No antifreeze in your CoQ10. Keep the 8 predictive biomarkers at their best outcome goal value and when they are, when those 8 tests are at their best outcome goal value, you have a 99% chance of living 10+ years, even if you're 100 at that point, and my main teacher Buntey was 110 when he passed and as I mentioned before I plan to be dancing at 120 by following this lifestyle, and I urge anyone who is willing and interested to join me. Gazella: That's perfect. Well, Dr Jaffe, we covered a lot today. Before I let you go, I'm just wondering if there's any final thoughts or anything else that you'd like to share with our listeners today. Jaffe: Yes. In essence, the physiology-first, the epigenetics is 92% of your life quality has to do with consumption, which you eat and drink and how you think and what you do. Now whatever season of your life is as a man, that may be different. When you're young and immortal, that's one thing. As soon as you're beyond young and immortal, be prudent. Cardiovascular disease starts in teenage years. Cancer risks goes up dramatically when your innate anti-cancer mechanism is turned down because you're eating foods that are causing too much defense burden in your immune defense and repair system. So, just follow through on this physiology-first approach looking at your individual needs for personalized health promotion and put pay to chronic ill health. Gazella: Perfect. Well, once again I'd like to thank today's sponsor, Perque Integrative Health, and Dr Jaffe I'd like to thank you for taking the time and sharing so much information with us today. Jaffe: Well, thanks for inviting me and for making it such an enjoyable time. I hope the listeners will take away much that will be of value, and it's my pleasure. Gazella: Well, thank you and I hope you have a great day. Jaffe: You the same, Karolyn. Always a pleasure. Gazella: Yes, it is. Bye-bye.

In Episode 146 of Keto Talk, Jimmy and Dr. Will Cole answer your questions about Healing Chronic Fatigue, Elevated Glucose Response To High-Carb Meal While Keto, APAO2 Gene, Keto & A-Fib, Daily Laxative For Opiate-Induced Constipation, and more! HOT TOPICS: Will's exciting new podcast The goop Fellas Podcast Why is being proactive about your health by doing things outside of conventional wisdom considered strange?  How do you mitigate the effects of cortisol and insulin resistance (even while eating keto) induced by taking prednisone for Crohn’s disease? What role could a ketogenic nutritional health plan play in the recovery from opioid addiction? What’s the difference between saturated, monounsaturated, and polyunsaturated fats and how much of each do you need in your keto diet? Should a Type 1 diabetic who eats keto and sees a major glucose rise from a powerlifting workout be concerned about the rise in glucose? How do I eat low FODMAP real food-based keto to control my IBS when my doctor tells me the fat-digesting bile is flowing back into my stomach? “At one point when I was on Lipitor before starting the Atkins diet I got my cholesterol down to 120, but you can ask my wife, I was NOT a happy man.” – Jimmy Moore “With the rise in awareness in wellness you also have a rise in skeptics and trolls. You can be objective without cynical and name calling.” – Dr. Will Cole HEALTH HEADLINES: Twitter CEO Jack Dorsey’s 'One-Meal A Day' Diet Is Absolutely Bonkers WHY LONG-TERM SUCCESS ON KETO CAN BE CHALLENGING FOR WOMEN, ACCORDING TO HORMONAL EXPERTS Diets high in red meat linked with greater health risks in two new studies There’s no such thing as a sugar rush Could Very Low 'Bad' Cholesterol Bring Stroke Danger? Limiting Carbohydrates Intake At Breakfast May Help Type 2 Diabetes Patients STUDY:  Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial – How do you heal fibromyalgia and chronic fatigue when you’re doing everything perfect in your ketogenic lifestyle? Hi guys, I’m a longtime listener listener and appreciate all of the information you give so generously! I’m trying to figure out how to heal from fibromyalgia and chronic fatigue syndrome which I was diagnosed with in 2014. I have eaten an LCHF diet for many years and lost around 30kg (~66 pounds). I'm 59 years old and have been a yo-yo dieter my entire life. On low-carb, I have been much more successful in stabilizing my weight and the trend has been moving slowly in the right direction with about 22 pounds left to go. It’s such a struggle. Even still, my fasting blood glucose is 5-6 mmol/L and blood ketones are 0.5-0.9 mmol/L. I’ve been very strict in my keto diet for a while, but the aches and pain in my arms and legs from my fibromyalgia and chronic fatigue persists. The good news is my brain is a lot clearer and I’m able work again. It’s so difficult to find any doctors here in Sweden willing to run the tests I need to dig a little deeper into this. What would you suggest I do to help with my health issues? Thanks for your input. Susan from Sweden – Why is the blood glucose response to a higher-carb meal greater since I’ve gone strict keto than it was when I was only eating low-carb? Hey Jimmy and Will, Can you explain more about the blood glucose rebound effect that happens after eating keto for a while and then having a higher carb meal? I’ve noticed much higher blood sugar readings when I eat carbohydrates while on a ketogenic diet than I did just eating low-carb. I suppose it’s sign that my insulin resistance has gotten worse, but I can’t imagine why since I’m on keto. Granted, it is not always perfect in my keto diet and I don't track macros anymore. But my normal readings two hours postprandial might have been 130 before but now it’s 160. Good luck with your six-month sabbatical, Jimmy. And thank you for answering my question. Donna – How can I optimize my keto lifestyle with the APAO2 gene mutation that makes it difficult to process saturated fat? Hi Jimmy and Dr. Cole, I have been keto for a year and a half and I’ve lost 60 without taking any medications. I recently learned that I have the APAO2 gene mutation that makes it difficult for my body to process saturated fat. My doctor insists that I cut my fat intake and eat a lot of vegetables. My LDL-P is 2418 and my heart calcium score came in very high at 268. I also have high oxidized LDL. I’ve been dairy-free for a year which has helped me boost my HDL cholesterol to an all-time high of 49. I took statin medications for almost 18 years before the side effects became too much for me to bear. I’m 68 years and just want to be as optimally healthy as I can possibly be. The one bright spot is my inflammation marker hsCRP is stellar at 0.3. Should I be eating more lean proteins and increasing my intake of avocado, olives, and nuts along with eating more leafy greens?  I am considering the Ketotarian way of eating since it seems to fit my genetic needs at this time. I just hate to give up so many of the animal-based foods I enjoy. Thanks for your help, Kenneth   – Will a ketogenic diet help patients dealing with atrial fibrillation? Hi Jimmy and Will, I just listened to your special episode with guest cohost Dr. Jay Wiles from a few weeks back where you discussed the bogus a-fib study. As someone who has this condition, I appreciated your input on that. But you guys didn’t say whether keto would help with this disease or not. My experience has been that my heart palpitations get worse eating keto and that if I backed off my thyroid medication I get relief from this. I’m not sure why, but I suspect it is the hormone regulatory effects that come from a ketogenic diet. Unfortunately, when I did this my TSH shot way up to (yes, that’s not a typo—338!), and my doctor was obviously VERY concerned. I went back on the medication for fear of not knowing what impact chronically high TSH would have on the body. (I live in Canada and doctors rarely test any of the other numbers on the thyroid panel). Can you talk more about what impact eating keto has on patients with a-fib? Thanks so much. Brenda KETO TALK MAILBOX: – Is using senna leaf as a daily laxative to deal with opiate-induced constipation causing damage to the microbiome and general gut health? Hey guys, I eat >keto, but have a really bad case of opiate-induced constipation which forces me to use senna leaf as a laxative on a daily basis.  I try to boost my gut health with fermented foods, probiotics, and digestive aids. But it seems I’m hopelessly addicted to taking laxatives since I can’t poop without help. This is probably a silly question, but is my microbiome suffering from this? I haven’t had a solid stool in months. So embarrassing! Thanks for helping me with this! Kristin

Dr. Jaffe is a wealth of knowledge and experience. While we could have talked for hours upon hours about this topic or any other, we flew through the deep conversation on environmental toxicants... (by the way, the word toxicant describes a chemical in the environment compared to toxin which describes a naturally occurring substance that has toxic effects in the body, i.e. aflatoxin from mold) We covered A LOT in this conversation, on the topic of environmental toxicants and beyond! Here are highlights from the conversation..  The 5 classes of environmental toxicants (+ the emerging 6th class) Persisting Organic Pollutants (POPs) Solvent Residues Heavy Metals Mold Radioisotopes (EMFs - check out www.bems.org for more) Indoor air quality is always worse than outdoor air - get outside/use an indoor air filter! Why it's important to take your shoes off indoors Reduce glyphosate by joining a CSA (Community Supported Agriculture) Why Gardening, Dancing, Walking, and Laughing are the best health-promoting practices Specific foods to enhance natural detoxification What it means to really alkalinize the body and how it is important to your health 8 predictive biomarkers to have your doctor order: hbA1C, hsCRP, homocysteine, LRA, urine pH, Vitamin D, Omega-3 index, 8-oxoguanine    Hopefully this is not too much INFORMATION and you can also feel a little INSPIRATION to move in the direction of health!   Links to learn more SHOW NOTES: https://alter.health/episode88/ SUPPORT US ON PATREON: https://www.patreon.com/alterhealth JOIN THE GROUP COACHING PROGRAM: https://www.alter.health/weekly-group-coaching GET OUR BOOK: https://amzn.to/2tmiOz3 APPLY TO WORK WITH US: https://alter.health/membership CONNECT ON FACEBOOK: https://fb.me/alterhealthinc CONNECT ON INSTAGRAM: https://www.instagram.com/alter.health

If you haven't noticed what's been happening lately in the world of nutritional health, let me quickly bring you up to speed. There is a very deliberate move that is underway trying to push people into embracing more of a plant-based diet like vegetarian or vegan. This is happening on so many fronts (and we're covering them all on JIMMY RANTS), but the latest one is in a new study claiming that the best possible health markers you can obtain are from eating vegan. Read about it below. Vegans have a 'healthier biomarker profile': https://www.medicalnewstoday.com/arti... While they look at some of the micronutrient makeup in the bodies of the people they tested (although there was no ketogenic or carnivore group amongst the five categories tested), this research is incomplete according to health podcaster and international bestselling author of KETO CLARITY Jimmy Moore. He asks why they didn't take into consideration many other biomarkers that indicate optimal health like fasting insulin, blood sugar, inflammation markers like hsCRP, triglycerides, and so much more. Watch Jimmy to hear him talk about the desperate need for everyone in the diet and health community to coalesce behind those commonly agreed upon markers that determine just how healthy you are in this video. Follow the live JIMMY RANTS episodes on his YouTube Live channel (http://www.youtube.com/livinlowcarbman), his Facebook Live channel (https://www.facebook.com/livinlowcarbman), and his Instagram Live channel (http://www.instagram.com/livinlowcarbman) airing daily (rotating around these various formats) and the rest of his work at http://www.LLVLC.com. And for more JIMMY RANTS, check out all of his past episodes at http://www.JimmyRants.com.

Dr. Stephen Lewis's website: www.Greenwisdomhealth.com Foot Soak Magnesium: https://livingthegoodlifenaturally.com Use coupon code LHT for 10% and discounted shipping! Food Analyzer: https://spectrum.ieee.org/view-from-the-valley/at-work/start-ups/israeli-startup-consumer-physics-says-its-scio-food-analyzer-is-finally-ready-for-prime-timeso-we-took-it-grocery-shopping Where to order a food nutrition analyzer: https://www.consumerphysics.com/order-scio   Thyroid Issues http://learntruehealth.com/thyroid-issues The rate of people suffering from thyroid issues is rapidly rising. Many factors contribute to thyroid issues. Some of the common causes of thyroid issues are autoimmune diseases, iodine deficiency, inflammation, nodules, tumors and genetic disorders.  But we don’t need to turn to drugs. My returning guest, Dr. Stephen Lewis will teach us ways on how to treat thyroid issues naturally. Dr. Stephen Lewis first guested on the show last year, and we talked about chronic fatigue syndrome. For those who haven’t heard Episode 117, which is my episode with Dr. Stephen Lewis, here’s some information about his background. Chiropractor Training Dr. Stephen Lewis first trained as a chiropractor. He got out of chiropractor college in 1981 and always believed in nutrition. Recalling his childhood years, Dr. Stephen Lewis remembers that his family’s chiropractor used to counsel his family on vitamins, mineral, and herbs. “Bottomline, it’s all about getting out the toxins and getting in the nutrients. Your body is smart enough to heal. Don’t lose hope,” said Dr. Stephen Lewis. “Have positive expectations because your spirit and your mind have a lot to do with what kind of outcome you have.” Current Situation Dr. Stephen Lewis says that some problems that contribute to the growing number of people with thyroid issues are the fact that the United States government subsidizes soy, wheat, and corn. So, it ends up being a cheap commodity. “And when it is fertilized, it creates more protein. And more protein in plants is called gluten. That’s where are a lot of the autoimmune diseases are coming from. In the end, you get the leaky gut syndrome.”  He adds, “Gut and inflammation are always in the equation. You can give the thyroid things it needs to work with but fix the gut first. When you fix your gut, your brain also gets well. You get better nerve signals to the thyroid.”  Recommended Foods Dr. Stephen Lewis admits that he was a fan of the Atkins diet years ago. But breaking down the foods to stay away from, Dr. Stephen Lewis suggest throwing the grains away. He also believes that MSG is too toxic. “Even some of the vitamins and drugs has cancer-causing dyes. The best way to heal things is to change the mental perception because we foresee things like food that’s not food,” said Dr. Stephen Lewis. “Forget the things that are in a box or bag that has all the ingredients that sound like chemicals.”  He adds, “We don’t love ourselves enough to accept the good things. The universe has incredible things for us. Healing the gut makes us live a more fulfilled life because of the neurotransmitters that make us happy. The probiotics do a lot to heal the gut and take the load off the thyroid.” Dr. Stephen Lewis says fermented foods can also be beneficial but more than that; he recommends eating more seafood. A significant factor in why Japan has a low rate of people suffering from thyroid issues and breast cancer is because the Japanese eat a lot of seaweed which is full of iodine. “I don’t think the iodized salt is enough. But I’m a big fan of Himalayan sea salt or Celtic sea salt. Because it has a better profile. Although I never give iodine to a Hashimoto’s patient. On the other hand, flour is devastating to a diabetic,” said Dr. Stephen Lewis.  Importance of Vegetables Like most experts who have guested on the show, Dr. Stephen Lewis recommends including a variety of vegetables, especially cruciferous vegetables in your diet. And corn, by the way, is not a vegetable. Cruciferous vegetables are known to protect us from disease, and it’s anti-cancer. Some examples of these vegetables are broccoli, cauliflower, cabbage, bok choy, Brussel sprouts and garden cress.  “My favorite is avocados, guava, apples, celery, cucumbers, tomatoes and different types of greens. Widen your scope of what you consume. I do a lot of walnuts and pecans. And I think the keto craze is the best thing ever,” Dr. Stephen Lewis said.  He adds, “I don’t judge. And although I’m not a vegan, having an all-meat diet is not good either. I don’t think vegan is the healthiest diet. Americans overeat meat. It all boils down to quality and moderation is the key.” Truth About Cholesterol Dr. Stephen Lewis reveals that there is enough inflammation to make the cholesterol stick. And there’s good and bad cholesterol that’s responsible for heart disease. One way to measure is via an hsCRP test. The test is a highly sensitive quantification of CRP, an acute-phase protein released into the blood by the liver during inflammation.  It is associated with the presence of heart disease.  “Thyroid has a lot to do with whether your cholesterol is good or bad, as does liver and GI function. Cholesterol is not about heart disease. It’s about what is your inflammation level or magnesium level,” said Dr. Stephen Lewis. Taking Supplements If you plan to take supplements, Dr. Stephen Lewis advises researching the ingredients of the product.  There is a big difference in the quality of supplements. “I suggest some products that happen to be animal-derived. Otherwise, there would be no results. You need a digestive enzyme that contains some animal products. And you need the glandulars, like the thyroid grandulars and the adrenal glandulars,” Dr. Stephen Lewis explains. Dr. Stephen Lewis sources most of his products from companies that get it out of Argentina and New Zealand where they have cleaner cows, sheep, and pigs compared to the United States.  He believes it’s a sad reality to have to source a lot of raw materials out of America to get it clean. Myths Around Thyroid Dr. Stephen Lewis says that most people jump to conclusions and self-diagnose themselves to have thyroid problems after exhibiting some symptoms. He believes you have to be careful with that because there are so many other conditions that present the same symptom. Some common symptoms are headaches upon waking up, depression, constipation, poor circulation and slowed immune system. Some other symptoms are itchy dry skin at the back of your arm, elbow, and shoulder, as well as hair fall. Iodine Treatment Dr. Stephen Lewis says that the first thing for people with thyroid issues is to go for iodine. But if you have Hashimoto’s, have yourself undergo a test first. “Many times when you get on the proper amount of iodine, you can override where those receptors are filled with bromine or fluoride or chlorine,” said Dr. Stephen Lewis. “Keloid scars will go away with a proper amount of iodine. Many cysts in the breast will go away.” Furthermore, Dr. Stephen Lewis says that people who have too much mucus production and hemorrhoids need iodine. The same applies to people with ovarian issues and prostate disorders. Ultimately, many people have benefitted many times from thyroid supplementation with iodine for the thyroid. Dr. Stephen Lewis usually sells iodine and iodide to patients and clients. He explains that your body needs co-factors. And if your body is depleted in those co-factors, that means your body isn’t optimally going to be able to benefit from the supplements you take.  “The thyroid has a lot to do with what your body produces and absorbs. I like to put on serotonin and dopamine. They are feel-good hormones. Dopamine deficiently is highly tied to the thyroid. And those who are deficient are the ones who become addicts,” said Dr. Stephen Lewis.  Green Wisdom Health If you’d like additional references from Dr. Stephen Lewis, do check out his website. It contains links to his blog, online store, podcast and his book called the Thyroid Sniper. The website also features a short quiz which will calculate your current health situation. You’ll be able to contact Dr. Stephen Lewis through the numbers published on his website. Words of Wisdom Lastly, Dr. Stephen Lewis advises being careful. And don’t go with just one list. It also helps if you can go to a good doctor. “Your body will take care of itself. And some of that paranoia is because the thyroid is not working correctly,” said Dr. Stephen Lewis. “I think that a good multi-vitamin is always good.” Personally, Dr. Stephen Lewis loves the excellent fish oils. Because of fish oil so anti-inflammatory. He says it’s a long process to get the inflammation down. It starts at about two weeks and then gets better after that. So, it’s best that you also find a good support system to guide you through.  “If a person is feeling sad, they need to do something to brighten someone else’s day. I think you need to give what you want the universe to give back to you. It can give you so much joy and energy to do that,” Dr. Stephen Lewis said.  Bio Dr. Lewis is the author of “The Thyroid Sniper”.  He is based in Texas with wife Janet who is a Certified Natural Health Consultant.  Together they run Doctor’s Nutrition, offering medical lab services at affordable rates.  Get Connected With Dr. Stephen Lewis! Official Website Facebook Twitter YouTube Book by Dr. Stephen Lewis Thyroid Sniper     Recommended Link: Episode 117 – Chronic Fatigue Syndrome ************************************ Need Help Ordering The Right Supplements For You? Visit TakeYourSupplements.com, and a FREE health coach will help you! http://takeyoursupplements.com ************************************ Learn How To Achieve Optimal Health From Naturopathic Doctors! Get Learn True Health's Seven-Day Course For FREE! 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Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor for the National Heart Center, and Duke National University of Singapore.                                                 How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest actually succeed? Well, to learn how, you have to keep listening to the podcast, because we will be discussing this right after these summaries.                                                 The first original paper this week tells us that recent developments in RNA amplification strategies may provide a unique opportunity to use small amounts of input RNA for genome wide-sequencing of single cells. Co-first authors, Dr Gladka and Molenaar, corresponding author, Dr van Rooij, and colleagues from Hubrecht Institute in Utrecht, the Netherlands, present a method to obtain high-quality RNA from digested cardiac tissue, from adult mice, for automated single-cell sequencing of both healthy and diseased hearts.                                                 Based on differential gene expression, the authors were also able to identify multiple subpopulations within a certain cell type. Furthermore, applying single-cell sequencing on both the healthy and injured heart indicated the presence of disease-specific cells subpopulations.                                                 For example, they identified cytoskeleton-associated protein 4 as a novel marker for activated fibroblasts that positively correlated with known myofibroblast markers, in both mouse and human cardiac tissue. This paper raises the exciting possibility for new biology discovery using single-cell sequencing that can ultimately lead to the development of novel therapeutic strategies.                                                 Myeloid-derived suppressor cells are a heterogeneous population of cells that expand in cancer, inflammation, and infection, and negatively regulate inflammation. However, their role in heart failure was unclear, at least until today's paper in this week's journal. Co-first authors Dr Zhou, Miao, and Yin, and co-corresponding authors, Dr Wang and Li, from Huazhong University of Science and Technology, measured the myeloid-derived suppressor cells by flow cytometry in heart failure patients and in mice with pressure overload–induced heart failure, using isoproterenol infusion or transverse aortic constriction.                                                 They found that the proportion of myeloid-derived suppressor cells was linked to heart failure severity. Cardiac hypertrophy, dysfunction, and inflammation were exacerbated by depletion of myeloid-derived suppressor cells but alleviated by cell transfer. Monocytic myeloid-derived suppressor cells exerted an antihypertrophic effect on cardiomyocyte nitric oxide, but monocytic and granulocytic myeloid-derived suppressor cells displayed antihypertrophic and anti-inflammatory properties through interleukin 10.                                                 Rapamycin increased accumulation of myeloid-derived suppressor cells by suppressing their differentiation, which in part mediated its cardioprotective mechanisms. Thus, these findings revealed a cardioprotective role from myeloid-derived suppressor cells in heart failure by their antihypertrophic effects on cardiomyocytes and anti-inflammatory effects through interleukin 10 and nitric oxide. Pharmacological targeting of myeloid-derived suppressor cells by rapamycin constitutes a promising therapeutic strategy for heart failure.                                                 In the FOURIER trial, the PCSK9 inhibitor evolocumab reduced LDL cholesterol and cardiovascular risk in patients with stable atherosclerotic disease. However, was the efficacy of evolocumab modified by baseline inflammatory risk?                                                 While Dr Bohula from the TIMI Study Group and colleagues explored this question by examining the efficacy of evolocumab stratified by baseline high sensitivity CRP. They also assessed the importance of inflammatory and residual cholesterol risk across the range of on-treatment LDL concentrations. They found that the relative benefit of evolocumab for the prevention of adverse cardiovascular events was consistent, irrespective of baseline high sensitivity CRP. However, because patients with higher high sensitivity CRP levels had higher rates of adverse cardiovascular events, they also tended to experience greater absolute benefit with evolocumab.                                                 In an analysis of baseline high sensitivity CRP in achieved LDL cholesterol, the authors found that at first cardiovascular event rates were independently associated with both LDL cholesterol and high sensitive CRP. Event rates were lowest in patients with the lowest hsCRP and LDL cholesterol, supporting the relevance of both inflammatory and residual cholesterol risk.                                                 The next paper provides further evidence that residual inflammatory risk, as measured by on-treatment high sensitivity CRP, remains an important clinical issue in patients on combination statin and PCSK9 inhibitor therapy. Dr Pradhan, from Brigham and Women's Hospital and colleagues, evaluated the residual inflammatory risk among patients participating in the SPIRE-1 and -2 cardiovascular outcome trials, who are receiving both statin therapy and the PCSK9 inhibitor bococizumab, according to on-treatment levels of high sensitivity CRP and LDL cholesterol measured 14 weeks after drug initiation.                                                 They found that among high-risk stable outpatients treated with moderate or high-intensity statins and PCSK9 inhibition, roughly one in two had residual inflammatory risk defined by an on-treatment high sensitivity CRP level of 2 or more mg per liters, and roughly one in three had values above 3 mg per liter.                                                 PCSK9 inhibition was associated with a 60% mean reduction in LDL cholesterol but little change in high sensitivity CRP. Levels of high sensitivity CRP above 3 mg per liter were associated with a 60% greater risk of future cardiovascular events, corresponding to a 3.6% annual event rate, even after accounting for on-treatment LDL cholesterol.                                                 Thus, PCSK9 inhibition, added to statin therapy in stable outpatients, does not lower high sensitivity CRP. Persistent elevations of CRP is associated with future cardiovascular risk in these patients, even after low levels of LDL cholesterol are achieved. If corroborated, these data suggests that inflammation modulation may yet have a role in the primary and secondary prevention of cardiovascular disease when LDL cholesterol is already controlled. Well, that wraps it up for our summaries. Now, for our future discussion.                                                 In-hospital cardiac arrests are common worldwide and they're so important because they represent opportunities for us to improve survival. Now, yet, overall rates of hospital survival after in-hospital cardiac arrests remain poor and there is substantial variation across facilities. This may be surprising because we all seem to follow or should follow the same ACLS algorithms across the world and yet, there are different outcomes.                                                 How do resuscitation teams, at top performing hospitals, for in-hospital cardiac arrest, how do they succeed? Pleased to be discussing this with a real star team in today's podcast. We have first and corresponding author of our feature paper, Dr Brahmajee Nallamothu. We also have Dr Steven Kronick, who is the chair of the CPR committee and both are from University of Michigan Medical School. We also have Dr Sana Al-Khatib, who is a senior associate editor of Circ, from Duke University. So, welcome everyone! Let’s go straight into it. Maybe starting with you Brahmajee, could you tell us what inspired you to perform this study? Dr Brahmajee Nallamothu            Thank you, Carolyn, for giving us the opportunity to talk about this study. I'm an interventional cardiologist here at the University of Michigan and typically, this isn't an area that interventional cardiologists are really greatly involved with. I became interested because I also, at times, I round in the cardiac intensive care unit, and that's a place where a lot of patients often times end up after they've had an in-hospital cardiac arrest at our institution and what I've noticed over the years, is the variability in care that would be occurring out there, and then also lots of gaps in the literature.                                                 Over a decade or so ago, I started partnering with a close friend and colleague, Paul Chan, from the Mid America Heart Institute and we started to do a series of studies on how in-hospital cardiac arrest care varies across institutions in the United States and we published a number of articles that have been in really high-profile journals over the last 10 years, but the problem has always been that even though we could describe really well what was happening, we had very little understanding of why it was happening or how certain hospitals were seeming to outperform others in this really challenging situation.                                                 We wanted to dive a bit deeper into the questions and reasons behind top performers doing so well and that's what brought us on to doing this study. Dr Carolyn Lam:                Great. You want to tell us a little bit about it? It's really very different from the other CPR studies I've seen. Could you tell us about it and what you've found? Dr Brahmajee Nallamothu:          Sure, so in the broader framework, it's a qualitative study and what I mean by qualitative is, we didn't really collect data either through surveys or through outcome assessments. What we did was, we actually went out and talked to people.                                                 The study though was really focused on what people call a mixed methods approach. We didn't just randomly talk to different hospitals, we actually focused on hospitals that were at the top-performing levels. We also focused on some hospitals that were non-top-performing as well, to get some contrast between the two and when I said we talked, we did this in a very systematic and pretty rigid way.                                                 We always had four interviewers go out to nine hospitals. We split them up, so we had two content experts and then two methodologic experts in qualitive studies, and we started to interview a bunch of people. In fact, we interviewed almost 160 people across these nine hospitals.                                                 We interviewed everyone from CEOs and hospital leadership, down to boots on the ground, including both clinical providers and even non-clinical providers, such as spiritual care, security. We tried to get this comprehensive view of what was actually happening during an in-hospital cardiac arrest across these nine hospitals, and really the results were quite fascinating to us.                                                 For someone, like myself, that's been in this space for ten years, I tell people I learn more talking to these nine hospitals than I have in the last ten years of looking at numbers on a spreadsheet. I really started to understand, for the first time, what was really going on, how these hospitals were dealing with these challenging situations because there's no bigger emergency in a hospital, and Steve, who we're going to hear from, we talk about this, but Steve has a great line about how when an in-hospital cardiac arrest occurs, that patient automatically becomes the sickest person in an institution and yet, we haven't set up systems that really build on how to handle that in the most consistent and positive way. Dr Carolyn Lam:                Oh, my goodness, I just love that line! Now, you have to tell us, so what's the secret? What's the secret of the succeeding hospitals? Dr Brahmajee Nallamothu:          What we found in general was, that resuscitation teams at top-performing hospitals really demonstrated the following features. They had dedicated or designated resuscitation teams. They really included the participation of diverse disciplines as team members during the in-hospital cardiac arrest. There were really clear roles and responsibilities of the team members that were set up right from the front.                                                 There was better communication and leadership, actually, during these events and finally, in the training aspect, one of the unique things we found was, the top-performing hospitals seem to have a high rate of in-depth mock codes, that they used as strategies for getting their clinicians ready for these events. Dr Carolyn Lam:                As you were speaking I was just thinking through the experiences of in-hospital cardiac arrests that I've encountered, and you're right. These elements, though we don't talk about them much, make a huge difference. Steve, I am so curious about your outlook. I mean you must have attended a kajillion CPRs as chair of the CPR committee. Tell us, what do you think is the take home message for clinicians and hospitals? Dr Steven Kronick:           My field is in emergency medicine and as chair of the CPR committee, I have responsibility of overseeing how we respond to cardiac arrests in our hospitals. I think that many institutions spend a lot of time and effort looking at in-hospital cardiac arrests are managed, and how to improve on it. We're able to use data to help compare ourselves to similar institutions, but beyond the bottom line of either ROSC or survival to discharge, we've most relied on process measures to figure out what we're doing.                                                 We're essentially flying blind, or at least not flying in any sort of formation when we do that. I think that this study validates some of the operational aspects of the arrest response, for those centers who use those and can help other decide where they want to direct their efforts. I think a good example that Brahmajee brought up, is this distinction we found between the use of dedicated teams, designated teams, or not having any organized team, and the impact that has on survival.                                                 The use of these teams can mean significant use of resources but showing that it's associated with better outcomes help provide support for that concept and for those centers who might already use one of those models, it helps them to steer their efforts to improving the delivery or the efficiency of that model. Dr Carolyn Lam:                Yeah, and indeed. Congratulations to both of you, Steve and Brahmajee. I do think that these are novel contemporary data, at least the first that I know of. Sana, you handle the paper and recognize this. Could you tell us a little about what you think are the novel and important aspects? Dr Sana Al-Khatib:            I really have been a fan of this paper from the get go and yes, it doesn't have the quantitative analysis that the statistical modeling, most of us are used to. It is a qualitative study, but I think that gives it strength. It makes it unique. This type of research, it can really only be effectively done through a qualitative study that really has all the important aspects of a good qualitative study, so I do want to congratulate them. Clearly, a lot of work went into this, and I appreciate all their efforts.                                                 In terms of the main findings, some of us might look at this data and say, well it's not surprising that those are the characteristics, or the features, of the top performing hospitals, but I felt like it was great, in terms of how the data were presented. Encouraging hospitals to adopt this. Giving them almost like a checklist of what they need to be doing to improve the outcomes of their in-hospital cardiac arrests, in terms of ensuring that they have designated resuscitation teams.                                                 The whole idea about diversity of participants in these arrests, and making sure everyone has a clear role and responsibility. The whole idea of making sure that somebody takes leadership and you have clear and very good communication among the different people who are doing this and great training. In fact, these people were doing in-depth mock codes. I think that spells it out very nicely and gives a lot of the hospitals, hopefully, action items that they can implement to improve the outcomes these patients. I love this paper. Dr Carolyn Lam:                Sana, I love the way you put that. Checklist, and you know what I was thinking as Brahmajee and Steve were talking earlier? I was thinking blueprint, almost, of the things that we should have. So Steve, could I ask your thoughts. I mean, are you going to put some of these things into practice in your own committee and how? Dr Steven Kronick:           There are a variety of things we can do. Some of these things are a pretty high-functioning place, but still looking at recommendations that have been laid out and how we help modify those things. Though the example is the roles that people play at an arrest. We can certainly improve on assigning those roles, how people work together as a team, and then also, getting to work more as a team, so that when they are called upon to perform those duties, they can do it in a more coordinated way. Dr Carolyn Lam:                How beautifully put. I'm going to steal a couple of minutes at the end of this podcast. I really have to because it's so rare to have Brahmajee on the line today and he's the Editor-in-Chief of Circ: Cardiovascular Quality and Outcomes. Brahmajee, could I ask you to say a few words to our worldwide audience about your journal? Dr Brahmajee Nallamothu:          We are a kind of daughter journal to Circulation. We are a bit more unique than the others, in the sense that we aren't disease or subspecialty focused. We deal with, broadly, the issues around outcomes research, health services research, quality of care research, and really health policy. We publish an issue once a month. We have a broad interest in things that are really relevant to the community around outcomes research and health services research.                                                 I will say that I really appreciate this because of the worldwide audience and reach, one of the big issues we've been very interested in is expanding our reach, from the United States to other parts of the world, and in fact, last fall, we had a global health issue, which was well received, and we received papers from across the world.                                                 In fact, every paper in that issue was a non-US-based paper, and it touched on a number of things from issues around healthcare utilization in Asia to demographics and disease registries in Africa, and it was a wonderful experience, so I think it's a journal that we're excited about.                                                 It was first launched by Harlan Krumholz, who has set a high bar and standard for us, and I think that my editorial team, which has been fantastic, has continued with that work. We would love to see papers from your readers and your listeners from across the world and excited about what that journal is going to be doing in the next five years. Dr Carolyn Lam:                Oh wow! That's so cool! Well listeners, you heard it right here, first time on Circulation on the Run. Thank you so much for joining us today. Don't forget to tune in again next week.  

In this podcast episode, we talk about cardiovascular labs with naturopathic cardiology expert, Daniel Chong, ND. Chong discusses the use of cholesterol panels and other tests he uses in practice. He dispels some common myths about how to interpret different lab results.   About the Expert Daniel Chong, ND, has been a licensed naturopathic physician, practicing in Portland, Oregon, since 2000 and focusing on risk assessment, prevention, and drug-free treatment strategies for cardiovascular disease and diabetes, as well as general healthy aging, and acute and chronic musculoskeletal injuries. Chong has also completed certificate training in cardio-metabolic medicine from the American Academy of Anti-Aging Medicine and is an active member of the Society for Heart Attack Prevention and Eradication (SHAPE). In addition to his clinical work, Chong serves as a clinical consultant for Boston Heart Diagnostics Lab. Tina Kaczor, ND, FABNO: Hello I'm Tina Kaczor editor-in-chief at the Natural Medicine Journal. I'm speaking today with my friend and colleague Dr. Daniel Chong a naturopathic physician and specialist in cardiology specifically. Dr. Chong is a founder and lead consultant at healthyheartacademy.com as well as a consultant for the cardiology industry. Dan, thanks for joining me today. Daniel Chong, ND: Hello Dr. Kaczor, it's nice to be here. Kaczor: We have talked informally, and I thought this would be a great opportunity to talk specifically for our audience, about the use of cholesterol panels, and we'll go into specifically some breakdown of the usefulness of common cholesterol panels, and then break that out into more particular cardiology panels. There's a lot out there right now about whether cholesterol is or isn't even linked to heart disease, so let's just start at the beginning. Can you give us a little bit about the roots of the cholesterol theory? We'll branch off from there. Chong: I can try. It definitely is a relatively long-standing theory now. As I understand it, the first thoughts as to whether or not cholesterol had anything to do with cardiovascular disease came in the early 1900s on animal research with rabbits, but at that point it was dismissed because people were still not clear whether or not you could make any correlations between findings in rabbits and extrapolate out to humans. The major real focus on the connection between cholesterol and heart disease started more in the mid-1900s almost simultaneously in a way with Ancel Keys and the Framingham study, so they started around the same time. Ancel Keys was one of the first people to really make a point of saying, "We should really research this because we repeatedly are seeing this potential connection," and so he was one of the first people to really start trying to splice it out. Then, the Framingham study started simultaneously. They don't come out with any of their more definitive conclusions until a little later than him with that. That's where it all began as far as I understand it. Kaczor: In the Framingham study specifically I know that there has been ... The broad interpretation in the professional world has been high cholesterol equals risk of heart disease, LDL being the "bad cholesterol," in general. Is there particular subpopulations that this is more true for? In other words, can we say if you are a 40 or 50 something-year-old male this is more true than if you're a 80-year-old male, or a female? Is there any way to delineate that with just looking at broad generic cholesterol levels, nothing too specific yet? Chong: Hopefully, it will be answering your question by saying this, but to me one of the most fascinating pieces of information I heard come out of the Framingham study in particular is that over the course of however many years ... this was a statistic we heard about maybe five or so years ago. The Framingham study had been active for well over 50 years and they had well over 50 years of data on how many thousands of people, and the statement was made by the former director of the Framingham study, so it was certainly legitimate. Essentially what they said was, one of the key pieces of information that they saw in terms of the relationship between at least total cholesterol and cardiovascular disease was that it appeared as though if a person's total cholesterol was at or below 150 naturally, so throughout their lives without necessarily an intervention with a drug or whatever, just the people in the study who had naturally low cholesterol did not get heart disease period. Of course, you can't then take that and make any truly definitive statements, but there is, in terms of a general viewpoint that was one of the things that came out. In other words, nobody with cholesterol under 150 naturally got a heart attack in their study. Again, there would still need to be more done to splice that out and figure out what exactly is going on there and why that is, but there's definitely something to be said. You can see the same exact type of finding if you look at epidemiological research on different cultures of people in history who did not get heart disease or got very little heart disease, all of those people regardless of where they were on the planet, what types of specific foods they were eating, even to some extent what their lifestyle was some of these people smoked, et cetera, the cultures of people who were known and found not to get cardiovascular disease all had cholesterol at or below 150. Kaczor: You're talking about total cholesterol? Chong: Correct. Kaczor: Let's move over to talking about the bad cholesterol. LDL- Chong: Can I pause you for one quick second? Kaczor: Yeah. Chong: Just to say one other thing about that. There's a lot of questions that would be immediately raised from those statements that I just made. One other way that I look at things is, and I know we'll get into it more, but cholesterol in of itself, I will say right from the beginning, has to be involved. It is not a worthless thing to measure, it is not something to just disregard and only focus on information. Time and again it has to be involved, technically it has to be involved. You can't make plaque without it, but it's just an important way to think about it. It's just whether or not it's the primary causative factor and we'll get into that. Kaczor: Yeah, that's an important point. I don't see many people with total cholesterol below 150, but we'll put that aside. It's pretty uncommon. I don't know about other people. Let's break it down- Chong: In modern times it absolutely it is. Kaczor: Let's talk about LDL specifically and just start out with there's a lot of more specific labs that are looking at LDL particle size rather than total LDL. Just a brief primer, if you would, on the difference between LDL- Chong: I like your emphasis on brief. Kaczor: Yeah. Chong: Sorry, go ahead. Kaczor: On LDL calculated as it is in a common cholesterol panel and the particle size as it is measured by several different labs now. Chong: I'll do two separate simple ways that I look at it. One is technically LDLC or "LDL cholesterol" measurements that are most commonly done in the average physicians' offices et cetera is technically measuring the mass or total amount of cholesterol being carried around on LDL molecules. Just as a reminder to people, these LDL molecules are protein-based particles that are essentially like cargo ships carrying around different substances, one of the main ones being cholesterol. When you are getting an LDLC you are getting an estimate of the mass of the total amount of cholesterol being a carried around by all of the LDL particles in the system whereas, an LDLP is specifically getting a count of the LDL particles floating around in any one measurement of blood. From an analogy perspective it's like you're counting either the cargo that's being ... The Pacific Ocean has a certain amount of cargo ships out in it carrying cargo and LDLC is like, "Okay, what's the estimate of total cargo being carried around by all of those ships?" Whereas an LDLP would be like, "Okay, we're going to go into the ocean, we're going to count each one of those ships and see how many there are." Depending on some different factors this is why you could theoretically ... Let's say a cargo ship could technically carry 100 pounds of cargo, you could technically have two ships carrying 200 total pounds of cargo or you could have 20 ships carrying 10 pounds of cargo each. In both cases the LDLC would be the same and yet one, there's 20 ships and the other there's two ships, if that makes sense. The reason why that's so important to make the distinction is that what we know now is that risk specifically goes up with ship count or particle count—not necessarily total mass or total cargo. If you have a way of identifying, "Aha, there is actually only two ships in this ocean versus 20," that can significantly impact risk level. Kaczor: Looking at the LDLC, which is the calculated one, it may or may not correlate with cardiovascular disease is what I'm hearing you say, and LDLP we can use as a more specific correlation with cardiovascular disease. Chong: Right, that is correct. In the grand scheme of things when we're also potentially considering other factors like inflammation, and oxidative stress, et cetera, it's still relative ... we're just talking about cholesterol-related markers and their impact on risk, so there are obviously ... I don't want to discount the fact there are other factors involved here, but when we're just talking about the cholesterol and its impact on future risk or not the particle count is what trumps everything. Again, just in the realm of the cholesterol markers. Just for an example, there's a research study I've seen where they looked at 16-year survival, from year 0 to 16 and measured LDLP and LDLC in each person. This is a very large study, and what they saw is a distinct difference between particle count and future event risk for cardiovascular disease. In other words, you had a distinct increase or higher rate of survival in people who have low particle counts regardless of what their LDLC or mass was. Whereas the people with worse outcomes all had high particles even though some of them technically had low LDLCs or low amount of total mass or cargo. Kaczor: It's been- Chong: It's been clearly seen that there's a distinct difference. It's also important to mention here, it is unfortunately true that there are some people out there who are still saying, "If I have large puffy LDL (i.e., my LDL particles are loaded with a lot of cargo per particle) and yet not necessarily ..." If you have a high LDLC, but all of your LDLs are large and puffy, and you also have a high LDL particle count you will still have an increased risk. There are some people out there who are under the misconception that if LDL particles are large and fluffy or large and puffy enough they can't cause problems, that's totally inaccurate. Bottom line, when we're talking about LDL, particle count trumps everything. Kaczor: Let's move on to HDL. That's really good points on the LDL because I do know that the size and the type, the fluffy or the dense, that idea is very much part of the verbiage that patients use when they come through the door- Chong: I'm sorry, I will say one other thing quickly about that. I don't mean to say that it's worthless to check LDL particle size because it's still true that LDL particle size, the smaller the particles the higher the potential is for future risk, but it's not just because of the mechanism itself. It's like just because there is a strong relation between what causes LDL particle sizes small and what causes cardiovascular disease. As an example, typically people with poor insulin sensitivity, or insulin resistance, diabetes, et cetera tend to have smaller particles, so it's still important to look at particle size because it does add to the predictive value of the test you're running. I don't mean to say that it's worthless or anything like that, you just can't say, "If my particles are large and puffy, I don't care how many there are." Kaczor: Got you. Okay. Let's go back and just come back to HDL, the high density lipoproteins. This we don't harp on as much, the drugs aren't targeted towards it as much. We tend to know that higher is better. How do you use HDL in your interpretations? Chong: One of the reasons why the drugs aren't targeted as much is because they keep trying and failing. Pretty much every study that's ever been done on a drug that it raises HDL shows that they clearly work and then oftentimes the people die sooner, so they have to stop. The bottom line is it's not a cut and dry direct simple relationship where the higher the HDL the better necessarily. Especially if you make a change in somebody, so like diet, lifestyle, et cetera, and their HDL goes up it is absolutely not a guarantee that they are getting better or that they are more cardio protected than they were beforehand. It might be the case, but it's not a certainty. From that perspective, at least personally, when I'm looking at HDL I'm always looking at the whole picture. If I see a relatively low HDL and yet this person might happen to be one of these lifelong naturally low in total cholesterol, naturally low in LDL people I'm not as concerned about that low HDL as I am in somebody who has really high LDL, really high total cholesterol, insulin resistance, et cetera, and they have low HDL. There's a definite difference. Those two people might both have the same HDL number, but one is way more concerning than the other one, and it just has to do with the role of these particles, these molecules, and what are they doing for us? If you really simplify it down HDL does a lot of complicated things, we still don't even know everything that it does, but definitely one of its main job is reverse cholesterol transport where it's helping to remove excessive cholesterol deposited in the periphery so to speak. I like to look at it as a garbage truck or a garbage collector. It is very true that if you do have a lot of "garbage" in the system, you have a high total cholesterol, a high LDL there's lots of cargo, or garbage, or whatever you want to call it being shipped outward you would hope to see the body responding to that by increasing garbage truck count to pick up the extras. You commonly see that on people who go onto low-carbohydrate, high-fat diets. Oftentimes you will see, hopefully, an elevation in HDL as the body is literally just adapting to the additional load on the system that you're putting on it. It does not, however ... Unfortunately, you can't take that response and then conclude that the low-carbohydrate diets are cardioprotective because they cause HDL to go up. It's not that cut and dry, it's more just that the body is responding and having to increase its HDL to adapt and make up for the extra amount of cholesterol in the system, if that makes sense. It's quite complicated. You do see HDL go up for that reason. The other thing is sometimes you'll see high HDL in somebody who's got disease, especially if they're inflamed or they have chronic inflammation. In those situations, in all likelihood, what's going on is that inflammation is known to hinder HDL function. The body always trying to adapt, always doing the best that it can to deal with the cards it's being dealt, if it has poorly functioning HDL it's going to spit out more of them in an effort to continue doing the job that needs to be done. If the HDL are dysfunctional as a result of oxidative stress, inflammation, et cetera in the system if the person has the capability you may sometimes see HDL production go up or HDL number go up on the person's lab because each one is not working as well as it should. Kaczor: That's an interesting idea, that it's a reaction. Chong: Absolutely. It's a fluid, functional system. Again, people just think, "Oh, HDL went up, that's good," or whatever. It's not like that. You have to think about why is the body doing that? What is the response going on? The body's always trying to maintain homeostasis, which would include not having cholesterol collect in the walls of the arteries. Kaczor: That's awesome. I appreciate that perspective. I think it's really helpful for us because we want the quickest most linear path to a conclusion, so it's good to remember to step back once in a while. Chong: For sure. Kaczor: We don't have time to go into labs, other labs in great detail, but what other laboratory parameters would you consider must haves? I'm going to give you a typical case, a patient comes to your office, they themselves have no history of cardiovascular disease. They have both sides lots of cardiovascular risk, so they believe that maybe there might be something going on there. What's your bare minimum of labs? What would you do? Chong: Especially in today's world where we're not necessarily billing insurance or whatever personally, for me, if I'm trying to get the most bang for my patient's buck in the realm of cholesterol I'm going to measure an apo A1, or apolipoprotein A1, I'm going to measure an apolipoprotein B, which for those people that aren't fully aware it's essentially like getting more precise HDL and LDL. Apo A1 is like getting a bit more precise HDL count and apo B is like getting a more precise particle count. Again, that's the name of the game, especially looking at the ratio between those two. I'm also going to measure a lipoprotein a, which has its own independent impact on things and is not necessarily going to be responsive to medications or dietary changes that do impact these other markers. It's a very important marker to assess and you can never really predict whether or not somebody's going to have high levels of that or not, but definitely the potential goes up with a strong family history. Then, beyond that in the realm of inflammation I'm at least going to want to see an HSCRP, I'm at least going to want to do some fundamental blood sugar metabolism related markers. I personally like to check a fasting insulin, and then potentially a hemoglobin A1c as well, although that sometimes has some questionable value depending on each patient. Beyond that, it starts getting a little bit more spliced out and potentially, depending on each patient, what you might go from there. I do check vitamin Ds pretty often, I check ferritin, and iron binding capacity pretty often at least screening that once to make sure there's no hemochromatosis going on. Those are probably the main ones I'm going to want to see. I will definitely do a CBC as well. Kaczor: The one I didn't hear you say, and I'm curious if you do, is homocysteine. Chong: Sorry, thank you Dr. Kaczor. Yes, absolutely homocysteine as well. Again, whenever I have the opportunity especially if there is a strong history and there's good reason to want to delve more deeply than average there are definitely some other markers I would typically run with people, but those would be a great starting point. I don't know if we're going to talk later about going outside of blood tests, but just long story short I don't consider an assessment truly complete without some type of imaging at least on the high risk population. Kaczor: By that, you mean? Chong: Sorry, carotid ultrasound, IMT, or a coronary calcium score. Kaczor: I can vouch for that. I've had several patients with cholesterols that didn't look too impressive, but their coronary calcium scores came back very, very good, and so they didn't have any [inaudible 00:24:42]. Chong: I will say one pearl type of information about that, the value of coronary calcium scores specifically goes up with age. The value of risk assessment using that test goes up with age. In other words, occasionally if a person is still relatively young, typically under about 55, you may have a situation where that person has a decent amount of soft plaque that has not been calcified yet and it will make their calcium score looks pretty good, but then if you check a carotid ultrasound it doesn't look so good. I have seen some mismatches in that regard with some of the slightly younger people, so my tendency is to measure carotid ultrasound, IMT tests with the understanding, obviously, that you're not checking the coronary arteries, but there's an over 90% correlation between the two. To me, a carotid ultrasound is a little pickier, a little more fine-tuned than the other one, but absolutely the high calcium score is a very powerful risk predictor. It's just whether or not you're going to catch everybody that way. Kaczor: Great. Dr. Chong, thank you so much for joining me today, I appreciate your expertise, taking the time. I think this is a to be continued type of thing because we didn't talk about what to do. Chong: I would love to keep talking, yes because I feel like we just started scratching the surface. Happy to delve more into some of these other details because there's a lot of other things to consider. Kaczor: We'll talk about treatments and we can talk a little bit more about imaging techniques next time. Thanks again. Chong: Super, yeah. Thank you.

"Just because you have genetic markers for things doesn't mean you necessarily have associated risks as long as you are eating real foods." – Dr. Will Cole If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing co-hosts are shooting them down one at a time. Keto Talk is co-hosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Pittsburgh, PA functional medicine practitioner Dr. Will Cole from DrWillCole.com who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. We’ve made it to 100 episodes, thanks to YOU! Listen in today as Jimmy and Will chew the keto fat in Episode 103. HERE’S WHAT JIMMY AND WILL TALKED ABOUT IN EPISODE 103: RESERVE YOUR TICKETS AT KETOFEST.COM NOTICE OF DISCLOSURE: Paid sponsorship "Just because you have genetic markers for things doesn't mean you necessarily have associated risks as long as you are eating real foods." – Dr. Will Cole YOUR NEW KETO DIET ALLY NOTICE OF DISCLOSURE: Paid sponsorship – HEALTH CRAZE HAS DANGEROUS IMPLICATIONS – Chestertown dietitian offers help with weight loss – Stop Blaming People for Being Fat! – The fight against 'fake meat' has officially begun  – Meat Madness: Americans Expected To Eat Record Amounts Of Protein In 2018 – Does giving blood temporarily reduce blood ketone levels? Why does this happen? MAKE KETO EASIER WITH FBOMB NOTICE OF DISCLOSURE: Paid sponsorship Hi Jimmy and Will, I’m a long time listener and really enjoy the wisdom and experiences you guys share. You both do such a great job! I started eating keto in January 2017. Unfortunately I wasn’t too strict last year with way too many “cheats” and I had a terrible time breaking my sugar addiction. Still I dropped 30 pounds in the first 2 months. I also do intermittent fasting and short extended fasts. I very gradually dropped another 10 pounds since then for a total of 40. I’m 58 years old and at 5’9” weigh 158 pounds. That’s probably where I was in high school and I feel great in so many ways! At the beginning of this year I gave a renewed effort to be strict with my keto and IF and have had pretty good success. I purchased a blood ketone meter from BestKetoneTest.com and I test daily to stay in nutritional ketosis. A few days ago, we had a blood drive in our community and I donated as I normally do. Before donating I had regularly been in the 3.0 blood ketone range. The morning after donating I dropped to 1.1, but then the following morning I was back to 3.1. My eating stayed the same and there were no other changes. While I’m not concerned, I am very curious about this—does donating blood affect ones ketone levels? Thanks again for all you guys do! Rich "They pretend that carbohydrate is the only source of glucose, but your body can make it from your dietary protein just fine." – Jimmy Moore – STUDY: Study Finds Food Quality Matters For Weight Loss, Not Calories THE PERFECT KETO SUPPLEMENT USE COUPON CODE LLVLC FOR 15% OFF NOTICE OF DISCLOSURE: Paid sponsorship 1. Why do I have a strong ammonia smell after exercising? Is it the acetone indicating deep ketosis? Dear Jimmy and Will, I am a 49-year old man who has been low-carb/keto for 2 years and I’ve lost 50 pounds and have kept it off. I don’t measure ketones because I don’t suffer from metabolic syndrome or diabetes so I can’t justify the expense of a breath meter or the pain of a finger prick. However, based on energy level, constant satiety, and mental clarity I’m pretty sure I am in ketosis more often than not. I recently started taking hour long walks at a brisk pace and transitioned to interval sprints with a goal of eventually running a 5K. At the end my last two sessions I smelled a strong ammonia scent. What does this mean? Online forums mentioned the following words and phrases: burning protein as fuel, amino acids, urea, nitrogen, uric acid, low glucose/glycogen levels in the muscles, and wait for it….kidneys! Am I doing more harm than good by exercising? Could the scent be an indication that I am in deep ketosis? Am I smelling acetone as a byproduct instead of ammonia? One forum mentioned the cure to the ammonia smell is to eat more carbs! Not going to happen! What gives? Love your show and your other platforms? Thanks, Ken 2. Why does my keto husband get tingling hands while sleeping? Why do I have an itchy scalp while eating ketogenic? Hi Jimmy and Dr. Cole, I listen to you guys often. Thanks for everything you do. I have a couple of questions for you guys: 1. When my husband eats strict keto, his hands tingle and go numb especially when sleeping. The strange thing is if he eats lots of carbs this doesn't happen. He supplements with potassium and magnesium, but it isn't helping. 2. I have eaten a strict keto diet for 18 months with no cheating with junk food. I have a bad itch towards the front of my scalp. It’s not dandruff, just a bad itch. Is this related to my ketogenic diet? Thank you for your help with my questions. Erin BECOME A NUTRITIONAL THERAPY PRACTITIONER Sign up by February 2018 for the 9-month program NOTICE OF DISCLOSURE: Paid sponsorship 3. Why has my fasting insulin and hsCRP levels increased since adopting a ketogenic diet? Hi Jimmy and Will, I just had some blood work done and my lipid panel looks worse, although I understand that this isn't uncommon when you’re losing weight following a ketogenic diet. Maria Emmerich stated in one of her books that all the excess fat from the fat cells gets released into the blood when you go keto. So, that part makes some sense to me. However, my fasting insulin has also increased (it was 10 in June 2016 and is now 13) and my C-Reactive Protein reading is also dramatically higher (1.6 in June, now 7.7). I'm mostly just shocked about the fasting insulin since I'm not eating hardly any carbs at all and no sugar. I'd be interested to hear any ideas you might have. I eat chicken or beef (homemade) bone broth regularly, Sauerkarut (no sugar) regularly, avocados almost daily, red leaf lettuce salad with black olives, some onion (white or green) with Primal Kitchen Ranch dressing almost daily, free range eggs, grass fed meats whenever possible, Wellshire sugar-free bacon, grass-fed ghee, coconut oil, avocado oil, Chai tea sweetened with Stevia with whipping cream (grass-fed), Lakanto monkfruit chocolate, cheeses from grass-fed cows, some beets, Miracle Noodles from time to time, and ketogenic wine usually only once per week. That's pretty much the extent. No fruit, no starchy vegetables. I usually don't eat until about noon every day and try not to eat after 6:30 pm. Thank you, Shelley KETO TALK MAILBOX – What is the criteria for a well-formulated ketogenic diet? We throw around “a well formulated keto diet” but I’m actually having trouble finding criteria for “well formulated.” Is there an agreed-upon definition? Dr. Jim Small, MD NOTICE OF DISCLOSURE: Paid sponsorship Apple Podcasts reviews:   LINKS MENTIONED IN EPISODE 103 – SUPPORT OUR SPONSOR: Register now for Ketofest at ketofest.com – SUPPORT OUR SPONSOR: Staying in ketosis just got easier – Your new keto-diet ally (Enter MOORE15 at checkout for fifteen percent off your first order.) – SUPPORT OUR SPONSOR: Drop an FBOMB for the freshest, high-quality fats from JimmyLovesFBomb.com (Get 10% off your first food order with coupon code “JIMMYLOVESFBOMB”) – SUPPORT OUR SPONSOR: Jump start your ketogenic diet with PerfectKeto.com/Jimmy (USE PROMO CODE LLVLC FOR 15% OFF) – SUPPORT OUR SPONSOR: Become A Nutritional Therapy Practitioner – SUPPORT OUR SPONSOR: The perfect keto-friendly snack with 85% FAT (Use coupon code JIMMY to get 15% off your order of Gra-POW!) – HEALTH CRAZE HAS DANGEROUS IMPLICATIONS – Chestertown dietitian offers help with weight loss – Stop Blaming People for Being Fat! – The fight against 'fake meat' has officially begun  – Meat Madness: Americans Expected To Eat Record Amounts Of Protein In 2018 – Does giving blood temporarily reduce blood ketone levels? Why does this happen? – STUDY: Study Finds Food Quality Matters For Weight Loss, Not Calories – Jimmy Moore from “Livin’ La Vida Low-Carb” – DR. Will Cole D.C. from DrWillCole.com    

Show Topic: Heart Disease Prevention Co-Hosts:  Judy Gaman, Walter Gaman, Mark Anderson   Segment 1 Intro – 30 sec. Today's topic is heart disease. It's the number one killer of both men and women and a topic that we all need to be educated on. Paint the picture of what a heart disease patient usually looks like What role do genetics play in heart disease What role does environment play in heart disease Warning signs – the symptoms you should never ignore Why women are often overlooked Research on bio-identical hormone replacement MUSIC FOR DOC SHOCK (JIM) THAT MUSIC MEANS ITS TIME FOR DOC SHOC. A TIME WHEN WE FIND SOMETHING SHOCKING IN THE NEWS OR WE'RE SHOCKED IT MADE THE NEWS. Heart disease is the leading cause of death in both male and females with more than 600,000 deaths each year just here in the US.  When someone suffers a heart attack, the good tissue is replaced with scar tissue. This stiff scar tissue affects the hearts ability to function properly. A new study may give a path to growing new heart tissue. Researchers at University of North Carolina and a group at Princeton University discovered a way to reprogram cells called fibroblasts into healthy heart muscle cells. There is still more work to do, but this is a significant step in saving lives. Read the study!   Follow us on Facebook! Tweet us on Twitter! Download the show on iTunes! Visit our website! Call us at 844-well 100 When we come back, the tests you need to assess your risk factors for heart disease.   Segment 2 Intro – 10 sec. About tease – 1 min. –Download the podcasts of the show and Daily Medical Minutes to stayyoungamerica.com or just searching StayingYoungShow 2.0.   ANDERSON - Immortal minute – 2 min.   Discussion of testing:   Explain the different types of heart disease: CAD, CHF, etc Lab tests: hsCRP, cholesterol (explain the advanced lipid panel), other lab results According to John Hopkins: Much research shows that vitamin D deficiency as a risk factor for heart attacks, congestive heart failure, peripheral arterial disease, and strokes. As well as high blood pressure and diabetes Purpose of a stress test. Why do VO2MAX instead? Calcium score   Tease 20 sec. – TAKE THE SURVEY!!!!    www.stayyoungamerica.com SHOUT OUT TO MILITARY, Facebook (stay young media group) , download podcasts – follow us on twitter @StayYoungMedia coming up  - Coming up –proactive steps you need to follow to keep your heart young and healthy   Segment 3 Intro – 15 sec. Judy – Tease the upcoming Dementia Defender 844-WELL100   Exercise and cardiovascular fitness levels Diet and cardiovascular disease Social aspects of staying heart healthy   Judy tease DD – grab a pen!  844-well100. Podcasts itunes, stayyoungamerica.com – 45 sec. Exit – 30 sec.   Segment 4 –   Intro – sec 15   Tease DD 844-Well100 – If you're just tuning in, catch this and every episode on iTunes under Staying Young Show 2.0 or follow us on TWITTTER @StayYoungMedia   Medical Mania Trivia – Josh How much mucus does the healthy human body produce per day? (One liter, a little over a quarter of a gallon) How many types of cancers are there? A.) ten B.) 56 C.) over 100 (Over 100 – any part of the body can be affected) True of false – Your heart beat will change with the music you listen to. (True) 20% of the oxygen in your body goes to what organ? (The brain) True or false, a significant part of your bones is water? (True – 31% of bones are made up of water)   Open discussion   DEMENTIA DEFENDER THIS DEMENTIA DEFENDER IS BROUGHT TO YOU BY SMART NEW YOU AND DR. CHARLES POWELL. IF YOU HAVE SLEEP APNEA AND YOU'RE READY TO DITCH YOUR C-PAP MACHINE CALL  214-524-6333. It's been around for millions of years, but is never more than a month old. What is it?   End Show   Thank you for listening to the Staying Young Show! With all the mixed messages on health, you need information that you can use and that you can trust. Listen in as the experts discuss all topics health related. It's time to STAY YOUNG and stay healthy! Each week we tackle a topic and often with leading scientists, best-selling authors, and even your favorite celebrities! As a listener of our show, your input is important to us. Please take a moment to fill out this quick survey so we can serve you better - Survey For more information on The Staying Young Show, please visit our website, and subscribe to the show in iTunes, Stitcher, or your favorite podcast app. You can also reach out to our host, Judy Gaman on www.judygaman.com for book purchasing, and speaking opportunities in your area!  

Metformin is one of the oldest and most studied drugs on earth, but a lot of people in the medical community are still hesitant to prescribe it. What are the benefits of this drug for people with different health problems and needs? What does it do for weight, insulin levels and high blood sugar? Does it make people hypoglycemic? On this episode, Dr Nelson Vergel gives a presentation on different studies of metformin and why it’s a great drug to use. Testosterone-metformin combination therapy decreased total and LDL cholesterol, uric acid, hsCRP, homocysteine and fibrinogen, and it increased plasma testosterone. -Dr. Nelson Vergel Three Takeaways Metformin shifts gut bacteria and gives patients the gut biome composition of a leaner person. Metformin doesn’t decrease blood sugar to hypoglycemic level. In HIV positive patients, studies have shown a reduction in T-cell exhaustion with the use of metformin At the start of the show, we talked about why metformin is such a hot topic right now, and Dr. Nelson began his lecture on metformin, starting with its history, benefits and some of the reasons why it causes patients to lose weight. We also discussed its benefit for people with cancer, and overweight people. Towards the end of the show we talked about what people get wrong about the ketogenic diet. We also discussed; How metformin affects the gut biome Metformin’s impact on HIV positive patients Why metformin is better than berberine Metformin and diabetic mortality rates Metformin is a hot topic right now, and with good reason. It has a lot of benefits, it is affordable and it has a great many studies backing it up. It dilates vessels, it decreases insulin and blood sugar, it improves metabolism of glucose, cardiovascular protection and it also decreases weight and lipids. Testosterone and metformin work very well together when it comes to body composition and inflammation. Metformin has also shown an ability to increase lifespan for people with cancer, and it helps people with HIV a great deal. There no risks with metformin unless you have some sort of renal issue, or take a drug with a contra-reaction.  If you’re going to start taking, it start low, and go slow. Guest Bio-   Nelson Vergel is a chemical engineer who, by his own necessity, has become a leading advocate for sports nutrition, supplementation, hormone and therapies, and the promotion of wellness. His search for cutting-edge health  knowledge started when he was diagnosed with HIV over 25 years ago during a hopeless era. This life-threatening diagnosis propelled him to explore therapies to save his life and that of his peers by reviewing available literature, attending numerous health conferences, becoming an advocate member of NIH research committees, moderating online groups, and networking with many progressive clinicians. With his survival knowledge he has been able  to help people to lead a healthy life regardless of their health status or background. He is the author of "Testosterone: A Man's Guide" and co-author of the book "Built to Survive"; the founder of the nonprofit organizations Body Positive Wellness Clinic and Program for Wellness Restoration; the Nutrition and Exercise forum expert at TheBody.com; and a bilingual speaker on body composition, exercise, nutrition, supplementation, testosterone replacement, metabolic disorders, and medication side effect management. Go to excelmale.com for more information. To Download Your FREE PDF Copy of the Amazon Best Seller: The Definitive Testosterone Replacement Therapy MANual, Click Here  For a FREE Paperback Copy. The TRT MANual has helped hundreds of thousands of men around the world reclaim their health and vitality. Don’t suffer in silence a moment longer! PS. As an added bonus, upon finishing the book-once you provide a Thoughtful, High Quality Review on Amazon (hopefully 5 STAR), we will send you our new unreleased eBook 7 Lies You’ve Been Told About Testosterone for FREE.* (To receive book, email jay@trtrevolution.com a screenshot of your posted review.)

Solving a problem requires understanding what caused it, and rarely is it good enough to move straight to remediation. The same applies to weight (fat) loss, and in this podcast, Dr Tommy Wood, MD, PhD and me discuss the underlying causes of over fatness and draw on three specific examples that represent common patterns we’ve seen in the 1,000 athletes we’ve worked with over the past three or four years. Here’s the outline of this interview with Dr Tommy Wood: [00:00:13] Podcast: Mind Pump Simulcast. [00:01:44] Problem solving. [00:03:22] Sustainability. [00:03:38] First Example: Elite female runner. [00:04:23] Relative energy deficit. [00:08:42] Description of NEAT or Non-Exercise Activity Thermogenesis. [00:09:03] Study: Pontzer, Herman, et al. "Constrained total energy expenditure and metabolic adaptation to physical activity in adult humans." Current Biology 26.3 (2016): 410-417. [00:11:33] Greasing the groove. [00:12:44] Counting and cycling calories. [00:14:27] 10% deficit. [00:15:42] Pharmacological interventions. [00:16:34] Second Example: Christopher Kelly. [00:16:48] Gravel grinder events. [00:17:07] Belgian Waffle Ride. [00:18:05] Reintroducing carbs. [00:19:45] Thyroid on keto. [00:20:26] Kiteboarding. [00:20:55] eBook: What We Eat (scroll to bottom of page). [00:22:24] Self regulating. [00:23:42] Visceral and subcutaneous fat. [00:25:25] Visceral fat has a higher fat turnover. [00:26:34] Killing fat cells with cold thermogenesis. [00:26:59] Lipodystrophy. [00:27:34] Gut health. [00:27:57] Blastocystis, Cyclospora. [00:30:47] Gut health and inflammation. [00:30:59] Podcast: Arrhythmias in Endurance Athletes with Peter Backx, PhD. [00:31:50] HsCRP. [00:32:14] Podcast: The Hungry Brain with Stephan Guyenet, PhD. [00:33:56] Study: Jönsson, Tommy, et al. "Digested wheat gluten inhibits binding between leptin and its receptor." BMC biochemistry 16.1 (2015): 3. [00:34:47] Paleo On The Go. [00:35:43] Visceral fat firewalls off the gut. [00:36:10] LPS (endotoxin) translocation across the gut wall. [00:40:22] Getting a dog. [00:41:28] MitoCalc developed by Alessandro Ferretti and Weikko Jaross as discussed in this NBT blog post by Dr. Tommy Wood. [00:43:21] Time restricted eating. [00:44:24] Walking. [00:45:13] Podcast: The Importance of Strength Training for Endurance Athletes with Mike T. Nelson. [00:46:27] Third example: 35 lb to lose. [00:47:44] The under eating thyroid pattern. [00:48:16] Understanding Local Control of Thyroid Hormones:(Deiodinases Function and Activity). [00:50:35] Resistance training. [00:51:13] Muscle is more metabolically active. [00:52:07] Podcast: Breaking Through Plateaus and Sustainable Fat-Loss with Jason Seib. [00:53:02] DXA or DEXA Scan. [00:53:14] Waist-hip ratio. [00:54:08] I'll happy when... [00:54:41] Icelandic Health Symposium 2017 featuring Dr. Satchidananda Panda, Dr. Tommy Wood and others. [00:55:58] Study: Longo, Valter D., and Satchidananda Panda. "Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan." Cell metabolism 23.6 (2016): 1048-1059. [00:56:16] There are over 600 genes regulated by circadian rhythm, reference 1, 2, 3 and 4. [00:56:56] Continuous feeding. [00:57:58] Eat when it's light outside. [00:58:47] Yearly cycles. [00:59:55] Frontloading calories. [01:00:40] The Nourish Balance Thrive 7-Minute Analysis.

If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing cohosts are shooting them down one at a time. Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Pittsburgh, PA functional medicine practitioner Dr. Will Cole from DrWillCole.com who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Will chew the fat and answer your low-carb, high-fat, ketogenic questions in Episode 81. MAKE KETO EASIER WITH FBOMB JIMMYLOVESFBOMB FOR 10% OFF YOUR FIRST FOOD ORDER NOTICE OF DISCLOSURE: Paid sponsorship Go to PayPal.me/KetoTalk to make a donation.  You can set up automatic monthly payments there. Join The Keto Clarity Club For $1 Blood Ketone Test Strips! KEY QUOTE: “If you're not losing weight you have to look at the nonfood factors as well. Stess, sleep, and toxins are just as important for some people.” — Dr. Will Cole Here’s what Jimmy and Will talked about in Episode 81: HOT TOPICS: Fasting counting net carbs vs. total carbs conventional foods vs. grass-fed/organic foods – Action on Sugar accuses food companies of avoiding clear food labelling – 'I have a way to beat this thing.' – Meat snacks clock faster growth than potato chips: Mintel – Wendy’s Japan replaces bun with meat in new sandwich, touts its low-carb nutritional merits   – How does someone eating a ketogenic diet with elevated LDL-C and total cholesterol get good life insurance? Is there a company that looks at the relevant numbers? Hey guys, I’ve enjoyed listening to you and your new co-host Dr. Cole on Keto Talk the past couple of weeks. I’m looking forward to hearing a lot more from you two! I have a quick question for you guys to address that I think impacts a lot of us Ketonians: Is there a life insurance company that understands the new way to look at lipid panels and related lab markers that give more credence to things like HDL, triglycerides, hsCRP, lower small LDL-P, lower ApoB, and more? It seems most of these companies prevent an otherwise healthy person from obtaining proper levels of life insurance unless their LDL-C and total cholesterol are in line with conventional thinking which we know is an incomplete picture. Thanks for addressing this important topic! Moe ONESTOPKETO.COM IS YOUR GO-TO PLACE FOR KETO FOODS Use coupon code KETOTALK for special discount NOTICE OF DISCLOSURE: Paid sponsorship STUDY: Ketogenic Diets And Cancer: Emerging Evidence 1. Can the fat you eat on a ketogenic diet make hot flashes and swelling worse just like carbs do? Hey Jimmy and Will, I’m a regular listener to Keto Talk and love what you are doing here. My question for you guys is about whether the fat I’m eating on my ketogenic diet is making my hot flashes worse and my fingers swell. I’m 57 years old, weigh 130 pounds, and am addicted to sugar. But when I replace sugar with fat, all of these things seem to happen in my health. Is this normal? Maybe I need to cut my fat and red meat consumption and eat more vegetables. Do you guys think this is a good idea? Thanks so much, Rainny KEY QUOTE: “ If you're going to fast, begin with a ketogenic diet because keto will cause you to be satiated and fasting will happen naturally”  – Jimmy Moore 2. Is eating more vegetables on my ketogenic diet the answer to my adrenal fatigue that seems to be halting my weight loss progress? Dear Jimmy and Dr. Cole, I have been on a ketogenic lifestyle since May and have not lost a single pound. I keep my carbs below 20g and went to see a ketogenic-friendly physician since I thought I was perhaps eating too much fat. In doing more research into what I might be dealing with, I suspected adrenal fatigue that has led to exhaustion and lab tests have confirmed this to be true. My keto doctor requires me to eat a lot more vegetables in my diet, but now I’m hungry again despite showing 1.0 mmol in my blood ketones. I’m a bit frustrated right now about what’s going on with me because I should be losing weight, right? Thanks for helping to point me in the right direction. Becky GET A $39 BOTTLE OF OLIVE OIL FOR JUST A BUCK GET YOUR $39 BOTTLE FOR JUST $1 NOTICE OF DISCLOSURE: Paid sponsorship 3. What natural pain remedies can be used by Ketonians who would rather not take medications? Hey Jimmy and Will, I’ve been experiencing an increase in pain in my shoulders, elbows, and knees since I went keto two months ago. I’m a 62-year old male who was diagnosed with hypothyroidism four years ago by an allopathic doctor and prescribed Synthroid. I never liked the side effects of that medication, so I switched over to iodine supplements to go more natural in my treatment of this. Keto has given me great energy, no more food cravings, and has zapped out my hunger allowing me to intermittent fast for 16 hours daily. I lost 45 pounds on a traditional diet before going ketogenic and have lost another 30 pounds in the two months I’ve been keto. My goal is another 100 pounds, but I need something natural to give me pain relief while I’m on this journey. Shalom, George JIMMY AND DR. ADAM NALLY’S KETO LIVING SUPPLEMENTS   KETO TALK MAILBOX – Is it normal to be sick of the dietary fat you consume on a ketogenic diet by day four of eating this way? Hey guys, I was wondering if it is normal to get sick of eating dietary fat after three days of eating keto. I absolutely love it for the first three days eating high-fat foods, but then something happens by day four when I can’t even think of eating another ketogenic meal. Is this normal and will I get over this? I really want to do this diet because of all of the health benefits and maybe lose a few pounds. But I need to know if I just need to push through the feeling I’m getting and get to the point where I will enjoy keto meals on a regular basis. Thank you for your help, Michele THE PERFECT KETO SUPPLEMENT USE COUPON CODE LLVLC FOR 15% OFF NOTICE OF DISCLOSURE: Paid sponsorship iTunes review:   LINKS MENTIONED IN EPISODE 81 – SUPPORT OUR SPONSOR: The Ketogenic Bible – SUPPORT OUR SPONSOR: Join Jimmy Moore’s Keto Support Group: KetoClarityAcademy.com – SUPPORT OUR SPONSOR: Join The Keto Clarity Club For $1 Blood Ketone Test Strips! BestKetoneTest.com – SUPPORT OUR SPONSOR: The world’s freshest and most flavorful artisanal olive oils. Get your $39 bottle for just $1. – JIMMY AND ADAM’S NEW SUPPLEMENT LINE: Try the KetoEssentials Multivitamin and Berberine Plus ketogenic-enhancing supplements – SUPPORT OUR SPONSOR: Jump start your ketogenic diet with PerfectKeto.com/Jimmy (USE PROMO CODE LLVLC FOR 15% OFF) – SUPPORT OUR SPONSOR: Drop an FBOMB for the freshest, high-quality fats from JimmyLovesFBomb.com (Get 10% off your first food order with coupon code “JIMMYLOVESFBOMB”) – SUPPORT OUR SPONSOR: Get a full selection of ketogenic-friendly foods at OneStopKeto.com (FREE SHIPPING on orders over $99 and use coupon code KETOTALK for a special discount) – Action on Sugar accuses food companies of avoiding clear food labelling – 'I have a way to beat this thing.' – Meat snacks clock faster growth than potato chips: Mintel – Wendy’s Japan replaces bun with meat in new sandwich, touts its low-carb nutritional merits – STUDY: Ketogenic Diets And Cancer: Emerging Evidence – Jimmy Moore from “Livin’ La Vida Low-Carb” – DR. Will Cole D.C. from DrWillCole.com – HELP KEEP KETO TALK ON THE AIR: MAKE A DONATION HERE

Commentary by Dr. Valentin Fuster

Michael Smith is a leading dietician / nutritionist who specialises functional medicine and in helping people get their health mojo working. This week we discuss what drives the ageing process and how we can turn back our biological clocks to give us more energy, vitality and longevity of life. It is a very informative and powerful discussion about the steps you can take to stop the ageing process and have you feeling younger than ever. Here's what we cover in this week's discussion: Can we slow the ageing process?Where do we start to slow the ageing process?Chronological age vs biological age, can we just feel younger than we really are?Intermittent fasting and its effect on ageThe steps to assist in turning back your biological clockWhat part does red wine play in the ageing process? The job of resveratrolWhat can we learn from there 7th Day Adventists?Is there an association between brain activity and ageing?Are we living longer but in worse health? What should we change?Exercise and living a longer, more fulfilling life - the role of resistance trainingHow long does it take to start to see a change in your ageing?What blood tests should we ask our GP for to test where we are at?The blood test list to identify potential inflammation and insulin resistance are HsCRP, HbA1C, homocysteine and FerritinCan we look ok on the outside, but be ageing on the inside?The science behind ageing and the roles of TelomeresThe effects of cold thermogenesis. How stress ages us and what we can do about it…. still the mindGenetic testing and interpreting the results