Podcasts about Hypertension

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Long term high blood pressure in the arteries

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  • Jan 12, 2022LATEST
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Best podcasts about Hypertension

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Latest podcast episodes about Hypertension

Perfectly Healthy And Toned Radio
Episode #174 Food Speaks...Be Quiet And Listen With Andrea Sapienza, RN

Perfectly Healthy And Toned Radio

Play Episode Listen Later Jan 12, 2022 71:00


Andrea Sapienza,RN is a registered nurse functional medicine geek. Ten years ago, she transformed her health by ditching the (SAD) or Standard American Diet. As a result, she was able to get rid of high blood pressure, digestive issues, and depression. In addition to chaging her diet, she also changed her mindset to make her changes permanent.

» Divine Intervention Podcasts
Divine Intervention Episode 360 – The Clutch Secondary Hypertension Podcast (Step 1-3)

» Divine Intervention Podcasts

Play Episode Listen Later Jan 3, 2022 40:27


Secondary hypertension is tested on essentially every USMLE exam in some way, shape, or form. The NBMEs love to integrate the topic with many other disciplines. If you struggle with this specific topic, this podcast is exactly what you need. I present numerous vignettes, integrations, and physiology/pathology tie-ins to help you make sense and simplicity … Continue reading Divine Intervention Episode 360 – The Clutch Secondary Hypertension Podcast (Step 1-3)

Kids Health Cast
Pediatric Hypertension

Kids Health Cast

Play Episode Listen Later Jan 3, 2022


Radha Gajjar, M.D., MSCE and Diane Liu, M.D. discuss what parents should know about pediatric hypertension. The panelists talk about the optimal blood pressure for children and adolescents and possible causes of hypertension in younger patients. They also share how pediatricians screen for hypertension in children. Finally, they discuss what lifestyle factors can be modified or started to help manage this condition.To schedule with Dr. Diane Liu To schedule with Dr. Anuradha Gajjar

Feeding Fatty
Change Your Habits, Change Your Future. Create Your Best Life Now!

Feeding Fatty

Play Episode Listen Later Dec 28, 2021 56:33


Change Your Habits, Change Your Future. Create Your Best Life Now! Featuring Dr. Lauren Keir Simmons We need to listen to our bodies. For whatever reason, even when we have a feeling that is abnormal, most will tend to kick it down the road until it develops into something more serious or worse yet, beyond help. It doesn't hurt to do some research to verify what we are told and don't hesitate to get a 2nd opinion. About Dr. Lauren  Dr. Lauren is a Certified Health Coach who went on a 2 year wellness journey in 2015. During this health journey, I experienced the hormonal ups and downs of an autoimmune disease which took me from 219lbs to 118lbs. After taking my autoimmune disease (Hashimoto Thyroiditis) into remission (in 8 months), I knew I had the skills to assist YOU at solving problems, changing bad habits and living a healthier lifestyle. Lauren Keir Wellness was born.  www.laurenkeirwellness.com www.feedingfatty.com Full Transcript Below Change Your Habits, Change Your Future. Create Your Best Life Now! Featuring Dr. Lauren Weir Simmons Sun, 8/1 4:12PM • 56:14 SUMMARY KEYWORDS eat, people, migraine, day, happening, body, autoimmune disease, medication, individuals, doctors, remission, pinched nerve, sugar, laughing, olive oil, symptoms, reiki, hypertension, food, Dr. Lauren, Change Your Habits, Change Your Future, Create Your best life SPEAKERS Terry, Dr. Lauren, Roy Barker Roy Barker  00:06 Hello, and welcome to another episode of feeding fatty. This is Roy,   Terry  00:09 this is Terry.   Roy Barker  00:09 So we're the podcast chronicling our journey to wellness. And of course, you know, when we started this, it was mostly about our diet, not a diet, but mostly you know what we were eating, trying to get that under control. And then we've talked a little bit about exercise, you know, and we've also pushed a lot into mindset, because even though a lot of us know what to do, it's actually getting it done, and then getting it done, where it's sustainable into the future. You know, I have to admit, I'm very good at getting something started. But you know, things change a month or so and then, you know, we're off track. So anyway, we're just looking for that path to where we can, you know, find the healthy wellness way and be able to stay on it. So a lot of times we talk about, you know what we're going through on our journey, but we also have professionals in the industry and today, we have Dr. Lauren with us, Terry, I'm gonna let you introduce her.   Terry  01:06 Dr. Lauren Keir Simmons is a certified health coach who went on a two year wellness journey in 2015. During this journey, she experienced the hormonal ups and downs of an autoimmune disease, which took her from 219 pounds to 118 pounds. After taking her autoimmune disease, harsh hashimotos thyroid thyroiditis, that's a mouthful into remission. She did that in eight months. She knew that she had the skills to assist you at solving problems, changing bad habits and living a healthier lifestyle. Lauren Keir wellness was born. Dr. Lauren, thank you so much for joining us today. I am so excited to hear about your journey. I have heard about it, but everybody else needs to hear about it because it is something else. tell tell us how how did you know i know i just read that. But tell us in your own words, what happened to get you onto this journey here?   Dr. Lauren  02:08 Yes, I was actually driving down the highway. And I experienced what I know now is an intractable migraine. And the the migraine, it was like a bolt of lightning that hit the top of my head and it zigzag through my body. And then it stopped at the bottom of my feet. Wow. And that was essentially the beginning of my wellness journey. I had no idea what it was at the time when it was happening. And I was driving down the highway, I thought that I was having a stroke. That's how bad it was. I you know, immediately, you know, turned around and went back to the nearest emergency room to find out you know, discover what was going on. And so that's what I learned after a little bit the initial restart, that it was what was diagnosed as an intractable migraine. So that's essentially what it is and what it was in a nutshell. And it has continued. It is essentially continue.   Terry  03:16 Well I'm What's the difference? I mean, what's the difference between a and I've had migraines off and on for years. What's the diff? What's an intractable mind? What does that mean?   Dr. Lauren  03:24 So so it laid the it was labeled and neurologists labeled it as an intractable migraine because it never stops? Oh, wow. Yeah, it just never said never stopped. They kept going on and on and on. And what happened was that neurologist at that time, she attempted to, you know, prescribe medications. And what she discovered was, was that medications would not, were not able to stop the migraine that it was. It was innnate. So it was biological, and it was not anything that they could do to No, there was no medication, you know, there there are general medications that they give you for them. The hypertension medications, they try seizure medications, and so forth. And none of that will work for me. So she said to me, at the end of 90 days, you're going to have to go natural. She said none of this will work for you. You're going to have to go natural.   Roy Barker  04:27 Yeah, no, just the question. I think you answered a little was, you know, was it you said it was biological, not like life circumstance. So what what is the trigger? Is it just something that was born genetically or was there something else that triggers that?   Dr. Lauren  04:45 Essentially, she did not know. And so what would what she meant by where I had was I had to go natural was I had to figure out like a natural solution. Whether it was How can I put it, whether it was a lack of nutrients in my body, whether it was food allergies that was causing it, you know, whether it was something environmental, possibly that was causing it. And you know, and I would have had to do the research, which I essentially did to learn, you know, what was happening. So there was several things that was that were going on at that time with my body. At that time, I had not yet been diagnosed with hashimotos thyroiditis. And so that was one thing that I learned. And then I had to get to, it went on to I had to get to the root cause of what was happening. You know, what, what brought on the hashimotos thyroiditis, because there is a root cause there's several root causes to Hashimoto thyroiditis, and most people never get to the bottom of their autoimmune disease, they just go ahead and take the prescription medication and the autoimmune disease never goes into remission. It just stays there. You're basically medicating it is what you're doing.   Terry  06:07 So putting a bandaid on,   Dr. Lauren  06:09 you're putting a bandaid on it. And so it was there was several things that were going on. At that time, I was perimenopausal, I had an autoimmune disease. And then I had the migraine. And so it was like what are we going to address first with the lesser of the evils? Yeah.   Terry  06:26 So what did you Where did you start? I mean, you have to get a hold of those migraines as much as you can. So yeah, the least function.   Dr. Lauren  06:36 So it's interesting, because I'm actually able to function with them, which is a bad, it's not a good thing at all. I learned to function with them. And I've had people to tell me, I don't know how you do it, because they bring me to my knees. Well, it's only a few of them that I've had that have actually like brought me to my knees where they makes me sort of kind of make me go blind, because you know that migraines will get behind one eye that I can I can literally function with them until it gets to that point. And then that's when I kind of you know, I kind of slow down. But I have, you know, since then began addressing the migraines, because you know, everything else is in check.   Terry  07:25 Right?   Roy Barker  07:27 So how have you found anything that has helped or anything that maybe you've cut out that has lessened either the intensity or the frequency of them.   Dr. Lauren  07:37 So the one thing, the one thing that I had to do was, I had to get through menopause, that was one. The second, the first thing was was that I brought the the autoimmune disease and that into remission, had to get through menopause, because that's what you know, they have hormonal triggers. And then the last thing was, you know, to try to figure out if it was something that was physical that was going on. And what I discovered, as it progressed, was that every time I would have, I would always get MRIs of my right on my right side of my brain, I would always get the right side of my brain scan, and they will find nothing, they like you're perfectly fine, you have nothing going on. I said, there's a problem, because every time I would get a migraine, they would see me doing this. My doctors would always see me doing this. And I was like what is wrong with your neck? And I'm like, I don't know, it just makes my you know, psychologically, it makes my head feel bad. And then one day I said, I said, Let me get my neck scan. And that's when we found out what was happening. So it was cervical radiculopathy a pinched nerve. Oh, wow. It was it was a pinched nerve. And so I began getting treated for that for a pinched nerve bestes that, you know, essentially what it is. So of course, you know, with a pinched nerve, you have to begin manipulating and this is me talking, manipulating the spine so that you can correct it and it can stop   Roy Barker  09:15 pressure on it, oh,   Dr. Lauren  09:17 pressure on it because it can cause it so it's it's behaving the same way that the sciatic nerve does. You know, when you have that pain in your lower back. It behaves the same way. And so, you know, for me if I sleep wrong or something like that, Oh, there goes a migraine and still feel natural, still have to go natural. So they had tricks and so on and so forth. You know, that you want to do to you know, to kind of manage them. Well, lots and lots of supplements. Yeah. Yeah, and a lot of people don't know that because You know, when you became begin medicating yourself, and and the medical profession, they're just throwing stuff at you like, okay, Here, take this, take this, take this, I'm not taking any of that stuff, because what happens is, you go back to, you begin medicating yourself with the prescription medications, and it will throw your autoimmune disease off. Okay? Yeah, and people don't pay attention to that stuff. And I'm like, I'm going to protect this first, because it's gonna take me out, if I let if I let it go out of remission is going to take me completely out. Yeah. So you know, certain things is, and there are many things that you can do, you can meditate. You can do Reiki, you know, you can do your Epsom salt. So, you know, the magnesium, magnesium relaxes your body more than anything, that you know that magnesium is very good, you know, for your body. And so it is extremely, you know, is extremely helpful. And it's extremely relaxing, you can get massages, massages can help to manage that. So, hat you have to I can't get my right now because, you know, I'm, you know, I'm being treated for, you know, being treated with a physical therapist, but you have to get them I get, I get the, you know, massages, just to control the, you know, for the environment and so forth. Because of, you know, all of the pollen and so forth, it clogs up my lungs, and I can't breathe. In the palate around here. It's very heavy. It's very heavy. So I get that so they can push, you know, my lungs out. And I can breathe. Right? Well, yeah,   Terry  11:52 well, and we also a couple of months ago, I guess it's been about two, maybe three months ago, we went to our first Reiki sessions. Like not just stayed away from it, because you know, the whole energy thing is just kind of, it's kind of those one of those strange things that you don't know too much about. So it's one you know, you have to research it so you can understand it, but it's so true. Everything is energy, I get it. It made made me feel great after my first one. And the second one, I was just like I was, I think I was trying to feel too much. So I didn't respond like I needed to, but Roy Roy had a really good experience, I think,   Roy Barker  12:32 yeah, it was interesting. And not that I'm a non believer, I just didn't know anything about it. And you really have to go into it. Just, you know, personally, I would say go into it, open minded and relaxed and you just have to see where it takes you. And it was very interesting. We actually taped an interview with the young lady I don't think it's aired yet that that we did it with but the heat that she pulled out of my body was incredible. I mean, just like she was over my forehead. And it felt like a hot coal was just on my head, forehead But anyway, and then it was also the other thing that was strange was kind of like got between that sleep and consciousness place. And I just had some you know, some things that came to me. I had three words patience, strength and wisdom which is like you know, I don't know where that came from   Terry  13:28 but must be met you   Roy Barker  13:33 you know it just it made my chest well up. Anyway, it was very interesting how that how that all went took place, but   Terry  13:41 it was very cool. Yeah,   Roy Barker  13:43 I was gonna ask about the the autoimmune. So how, how are you treating or how are you dealing with that? autoimmune. autoimmune disease? Yes.   Dr. Lauren  13:54 Is there a remission? Is I just go about it? Yeah, I just go about it. Normally, I actually pulled mine into remission with food. And you know with supplements and so forth. Yeah, it worked for me. Let me just say this, it worked for me. So that was what that was what I required.   Terry  14:12 So what kinds of things did you what kinds of things affect you like do you can you have dairy? Can you have eggs, can you have gluten? Can you have any of that or did you like start just stripped down and then you took everything out and then added it in as you went?   Dr. Lauren  14:29 So I am gluten intolerant? But I do not eat gluten non gluten thing. I don't eat things that are labeled as non gluten. Ah, that don't have gluten. I don't eat things that don't have gluten in them. I eat things that are natural that are totally natural. Dairy. Most people that have autoimmune diseases cannot cannot ingest dairy at all. It's just not it's just not it doesn't work for you. Um, So for me, I can't do I cannot do dairy at all. It doesn't work for me.   Roy Barker  15:06 What were some of the symptoms of the autoimmune because I've never, I've never dealt with it with humans. I actually had an animal that had it in the best way the doctor put it on me was that his body was actually turning against itself. Is that kind of thing? Okay.   Dr. Lauren  15:25 Yeah, so yeah, but your body? Yes. Yep. Yeah, your body actually does. It attacks its own self is what it does. And it does not. So you are like a foreign body to your body. So is is how can I put it? It's like it's invading it like Space Invaders or something like that.   Terry  15:45 Exactly what I was thinking,   Dr. Lauren  15:47 yeah, like Space Invaders. And so you kind of attacking yourself. So you have to retrain your body to say, okay, no, this is what I belong here. And this is what I should be eating. So what happens is another way that I can put it is, is that the foods that you are eating like like my, my, I call it my native foods in New Orleans, my body is tapped out. It will not allow me to ingest anything that I used to eat as a child. So if I want to eat crawfish, I cannot eat crawfish. If I want to eat gumbo, jambalaya, shrimp creole, any of those things at all, because my body is tapped out, it's exhausted.   Roy Barker  16:32 Now, what were the symptoms that you had to, you know, get you to seek out medical help with that.   Dr. Lauren  16:39 I was I had adrenal fatigue. I, I was I had brain fog. I had, um, I had I was hoarse. So um, you know, my thyroid was was a little inflamed, it was a little inflamed. I couldn't I had a lot of it was the headache. I had, that my, a lot of the symptoms that I were having was crossing over along with the along with a pinched nerve. So I'm trying to isolate those. It was I had the initial inflammation. It was initial inflammation. And then I started losing weight like crazy afterwards. But it was initial Yeah, the amp, the inflammation that went to 219 pounds. I had never been that that heavy before. So I was always hovering like around, like maybe I'll say 150 pounds, maybe, which is like a size eight, then I I've expanded to like a balloon to 219 pounds, which was the size 16. And then when I went down to what should have been my normal weight all along. I was 118.   Terry  18:09 Wow, how long did how long of a time period did it take for you to inflate, inflate, deflate the original expansion and then the deflation was? Was it eight year? No, not eight.   Dr. Lauren  18:30 It came on. So my way came on over a period of maybe about five years, mate, maybe about five minutes. Alex outstretching and say 10 years, it was maybe like about maybe about five years, five to seven years. And I'm going Something is wrong, something that you know, something is wrong, something is wrong. Like I've never been this large. And you know, you know how people will not be honest with you. Oh, you're fine. Yeah, yeah, something's wrong. Something is wrong. So I kept investigating and investigating. And then when the migraine hit, I said, up, yes, something's really wrong. So that's when I started, you know, going to all of the specialists and so forth. So I started gathering my documentation. And you know, each person would give me their diagnosis of what they felt was going on. And so they felt this was going on, and I would get a pill for this. And then this was going on, and I would get a pill with this. And then by the time I was done, I think I had like 20 or 21 different medications that the doctors had given me that I did not take. I said this is insanity, but they didn't you know, they only know traditional medicine only knows what they know they treat stuff by symptom, right. And so they were going by what I was telling them I would never know You know, I would never bad mouth any of the doctors for what, you know, for what I went through, because that's what they're trying to do. They're trying to give you medication for, you know, your symptoms and so forth. And they don't know the, you know, holistic side of medicine.   Terry  20:19 Well, and how did you start looking into the holistic side of it?   Dr. Lauren  20:23 So I, I reached back at to some information that I had gotten 10 years prior to my, my incident. And so I started doing a little research because I'm a little, I'm a little flu. You know, I'm a little, I'm a little researcher, by nature, because I have a background in psychology. So I started doing a little research. And I said, something is not right with this. So I started going, you know what, let me lay off of the sugar. So that's the first thing that I did when I extracted all of the sugar out of my diet. And it was it was a lot of it, which you think is it actually does not have sugar in it actually has sugar in it. I said, Why in the world? are we adding sugar to potato chip?   Terry  21:20 addiction? Everything's cocaine.   Dr. Lauren  21:24 Oh, yeah. So everything, you know, not that I was a potato chip eater. But as I was doing my research, I was like, This is pure insanity. I began getting, you know, extracting the sugar out of my system. So I mean, I went cold turkey. The first 72 hours of me going cold turkey. I have withdrawal like a crackhead. And it was it was insane. I was I was like this, I was like, and I said, I'm having a panic attack. And my mother says, I know you all go lay down.   Terry  22:02 Lay down.   Dr. Lauren  22:03 Yeah. She says, I know you wash. She said go lay down. And this is literally how I was talking. And she says no, go lay down. She was like, I can't, I can't because there was really nothing that she could do. I went cold turkey withdraw. And then after that, I was fine. extracted the sugar. And then I began to do a little more research. I went to probably about seven or eight. It may have been more specialists than that. Anything would have ologists. On the back of it. I was on the back of their title. I went to it at everything. I had gone to a I had gotten a colonoscopy and end up endoscopy. I went to an allergist, I went to a cardiologist. I went to a it was insane. I had I probably I fired two cardiologists. I actually fired no one went to another one. Because the first cardiologist I went to she was on hypertension medication. I said, If she's on hypertension medication, she can't help me. She cannot help me because I'm not trying to go on on hypertension medication. Because I said I had hypertension. I said No, I don't. Well, yes,   Terry  23:20 I mean, your body knows best.   Roy Barker  23:23 And that's why I think we have to be sure we listen to ourselves. Because we and I'm not speaking for you, I'll speak for me, but you know, we tend to I had the feeling today and then we'll be okay tomorrow and we kind of kick this can down the road until it can, you know, even turn into a lot worse things.   Dr. Lauren  23:41 Right? I was fortunate I always tell people, listen to your body, you know, go to the doctors, you know, hear what they have to say, listen to them. But I knew for myself, I knew I did not have hypertension, what I did have was because they were following it was my heart would start racing. That is a characteristic of hashimotos. When your heart just starts racing, I would be I would be in the bed and I would be getting waking up at five o'clock in the morning. just waking up and my heart would start racing.   Roy Barker  24:21 Wow. So So you've taken all this information that you've kind of gathered upon yourself and then now you're starting to help others.   Terry  24:30 Yeah.   Dr. Lauren  24:32 Yes, as best I can. Um, I know, I know what I know. And a lot of I've been able to help a lot of people, you know, as it relates to a few lifestyle diseases because generally what I focus on, you know, I can, you know, generally help individuals with, you know, hypertension, you know, kind of extracting those inflammatory foods that they have in their system, you know, working with the doctors, I do not take any Want off of medication, I do not put it put anyone on medication, the medical doctors do that. But I can't work alongside of, you know, the medical doctors to help them to tweak their patient's diet, to, you know, kind of reduce that inflammation, and, you know, kind of work with them to help to make them you know, as well, you know, as you know, as I can't, but I have definitely helped individuals, you know, with diabetes, pre diabetes, and so forth, to get their numbers back in check. Because you don't want that inflammation in your body, the longer you have that inflammation in your body, the more damage that it can do. And so, you know, the longer you want a lot of that medication, the more damage that it does to your body. And so that's why I was fighting so much that I did not want to take the medication they were giving me, you know, I do have, I was diagnosed with asthma as a child, and I've never taken an ounce of medication, they gave me inhalers and all this, I said, I'm not taking that stuff, that stuff will raise your blood pressure. And, and then then when your blood pressure's high, they're going to give you what hypertension medication. Now, so for myself, and I always say this is for myself, always make sure that you, you know, check with your physicians and so forth, because they know your medical history far better than I do. And so you definitely want to check in with them to, you know, to see, you know, what your numbers are, get your blood work, get your annual checkup, and so forth. And then, you know, make sure that you're living a healthy life.   Roy Barker  26:47 Yeah, I think that's another good point is that there's, you know, and we're not medical doctors, and we always specify, they'll see a doctor take their advice. But you know, one thing I think we've learned is that, well, it first off inflammation, you know, as we as more research has come out, it's like, it's kind of the root of most of the evil in our bodies. But a lot of this can be influenced by our diet. And like you said, we don't know what, well, we know, there are a lot of things you would think doesn't have sugar, but, you know, we don't eat a lot of sugar. And not long ago, we ordered from a little Italian restaurant. Oh my gosh, I'm telling you that red sauce, it was sugar Laden. I mean, it was almost like eating a candy bar. So anyway, you know, people do that stuff, because it makes it taste better makes the kids eat it. But sometimes it can be that addictive factor. And going back to your withdrawals, I found the same thing coming off of carbohydrates. When my doctor first diagnosed me with type two diabetes, he said, You know, I want you to cut your carbs back. And so that was on a Thursday, Wednesday, Thursday, Friday night, I started like, right above my eyes, it felt like my head was gonna blow off. And I carried that with me through Sunday. And to be honest, I thought I was dying or have, like you said, having some kind of a stroke. And so I went to, you know, the CVS a little drugstore and had an auto machine, my blood pressure was escalated. So it scared me I call my doctor the next day. And he's like, we'll come in, he took my blood pressure and it was normal. He said, Well, first off, those machines aren't that great. But he said secondly, he said you're just having withdrawals from carbohydrate. Pisa is like a drug and you will have to come off of that.   Terry  28:41 Yeah, surely there are like rehab places where you can go and get, you know, have, you know, get withdrawn from sugar and carbs and things that if there aren't, there needs to be because it's a hard, you know, three days for sure, if not a little bit longer, but then you have to learn what you need to be putting into your body. So you don't have those cravings in the future and make sure that you're addressing whichever issue it is that you have, whether it's the hashimotos or or type two diabetes or whatever, right.   Dr. Lauren  29:19 And that's what I teach people. That's what I teach people how to do when they the first 72 hours of the worst when you withdrawing off of sugar. They it's the worst and so you just have to kind of take it for me. I wanted to get rid of the migraines and so I knew that I had to tolerate it. I'm like it's gonna stop eventually. And it did. But what people do is when they relapse so when people are on their own a diet as they like to call it instead of a lifestyle, lifestyle change the first 72 hours when they stop eating sugar. All they think you know, okay, so So what can I eat? Drink water? No, no, what can I eat, drink water. Because you're dehydrated is what's happening. And so they don't even think about that. Know what can I eat? Like, I can't eat this or fill in the blank with this and no drink water just drink water. Yeah, people were so much negative. So we're born with addictions. Because when you think about think about this, when you're born with it, what is the first thing that people that that moms are giving their babies? No.   Terry  30:26 Milk.   Dr. Lauren  30:28 What is milk having it? Sugar, sugar, sugar, breastfed even if the babies are breastfed, whatever it is that you've ingested. Guess what they're ingesting? Oh, yeah. So they're getting it straight from so we come in, we come into the world with that sugar addiction, and so we're predisposed to it. So unless, unless the mom's body is clean. And the mom has detox before she had the baby. Guess what's happening? The cycle is happening. So if mom has asthma guess what the baby's gonna have will have asthma as well. Oh, yeah. So people are wondering why these little ones are born or coming out with this asmin. So for Guess what?   Terry  31:20 That makes so much sense. Oh, my gosh. It's so true. Okay, so what would you tell? So like we're dealing with? So I have, at one point they, I was told that I had hashimotos. But then they came came back and said no, no, you have hypothyroidism. But hashimotos. And hypothyroidism? They're two separate issues, right? I mean, the hashimotos is auto immune, and then the thyroid. The hyperthyroidism? Is the gland itself. The disease? Yes. So I did differently.   Dr. Lauren  32:02 So what Yeah, so what probably happened was, is that it's hot hashimotos can actually turn into hypothyroidism if you don't catch it in time. So it's the it's the progression of it. Ah,   Terry  32:16 okay.   Dr. Lauren  32:16 It's the progression in this the way that the numbers look, that's the way that's the way that it was explained to me. And so you can have normal, if you have normal TSH levels like I do. They don't, they don't really test you for the hashimotos or the high hypothyroidism, if you have normal TSH level, what has to happen is you have to continue to you have to do the second layer of tests, which the doctors don't like to do. So you're looking at the, you know, the T three, t four, you're looking at all of those numbers. And that is how you determine what the what the what the hashimotos is. So, yeah, you can always, you know, get a second opinion, you know, from another doctor and so forth. But what they do even with the Hashimoto, they want to put you on the, you know, on the on the medication. Yeah, I was I, that wasn't my case. I was fortunate, I always tell people that that wasn't my case. And so I always guard, I always guard my food with my life and pay attention to what it is that I'm eating, so I don't eat out.   Terry  33:32 You don't eat out? I don't eat out at all. We might withdraw with that, too. We're gonna withdraw from doing that. Yeah. But   Roy Barker  33:44 yeah, but really, you know, in order to know what's in this stuff, you really just have to because it's not that people do it maliciously. They do it to make the taste better, where people come in, and things like that. But we just never know what those ingredients are.   Dr. Lauren  34:00 I do know what's in it. And that's why I don't eat out. Yeah, yeah. And I don't eat out and I tell people this, you don't eat anything? No, I know. restaurants, the food industry is not in it to they're not in it for health. They're in it to make money. I get that. I get that. And so and so I have to eat at home because most oftentimes if you ask the chef's what's in the food, and they don't even know. They don't even know I'll give you a perfect example. I used to enjoy eating Ed said restaurant, I won't give the name. I used to enjoy eating at a certain restaurant. And I said what type of oil Do you use on your lamb chops? And they said, Oh, we use olive oil. That's what the chef said. And I said, No, it's something else that is in that I said because I can taste it. I can taste it. It tastes like grease. So I asked the manager Because what I do know is, is that olive oil burn at that high on that high heat, there are only two oils that you can use at high heat. And almond oil is one of them. Almond Oil is too expensive for them to cook with. Olive oil is too It does not it burns too fast, right? So I asked the manager, I said, What is it? What type of oil is that? He said, Oh, that's olive oil. And it's mixed with canola oil. I said I knew it. I know I was very inflammatory for your system. So that is generally if they say they cook with olive oil is olive oil mixed with vegetable oil, or whatever it is that they're using so that they can cook at high heat on those grills.   Roy Barker  35:47 And I'm sure the cost factor to they can put a little drip of olive oil in there and tell you that we're cooking with olive oil. But the ratios, the ratios probably more skewed to the canola oil.   Dr. Lauren  36:01 Oh, yeah, of course. Of course it is. And I didn't ask that. I get it. I said I get it. I said thank you for sharing that with me. I never ate at the restaurant again.   Roy Barker  36:11 The other thing they kind of trained us up on too is eating. So such large volumes of weight for days have become crazy. And that's something that you know we have trouble with is, you know, Terry's a great cook. And so even even as we eat at home, I like you know, I want that second helping, where if I would just give myself a few minutes round will eventually be full. And you know, the other day, I don't know, I was kind of snacking we and we hadn't eaten too much. And I just said, Oh, I'm I'm hungry for some popcorn or something like that. And I said I want some popcorn. And she's like, aren't you not full? I said, and I thought for a minute. I say yeah, I really am full. But I felt that like ran through my chest. I just kind of had this sinking feeling you know? And it was it was probably dehydration, it could it was probably being a little bit tired. Because it was the end of the day. Yeah, there's all these other feelings that I've begun to realize that you know, that hunger or the desire to eat. I'm not gonna say hunger because it's usually not hunger, it's a desire to eat comes from a lot of other places than being hungry.   Terry  37:20 Yeah, and I'm always trying to you know, I'm always I am not a good cook. He's very sweet to say that, but he's just so happy that a bay is taking care of him. Anybody and I am really not that great of a good. But I my goal is to make sure that he doesn't get snacky and, you know, that's a hard because, you know, like he said, it was just really right, you know, within an hour after we ate and I was like, Are you full? Are you still cool? No. And the the fact that he realized, you know, that's just his pole in his chest. And that's kind of what his deal his schpeel is, before he goes to bed. He's got to go through this. Maybe if he can just grab some water or you know something, do something else and then go to bed. Just go to bed.   Dr. Lauren  38:14 That's hard. Cuz you cuz you'd like to snack? Oh my gosh, hard.   Roy Barker  38:21 Popcorn, you know, saucy stuff. And then I don't know, somewhere along the way, I develop a sweet tooth. And so now it's even doubly because like, I need a little bit of sweet and then a little salt. After that,   Terry  38:33 probably that's probably me. But I am the grocery shopper. So I don't have to bring that stuff home. But I'm feeling you know, usually when I go I'm hungry. So I want to go and you know, Oh, those look great. Well, I'm going to get them nuts. But I'm not going to get the wrong nuts. But then I'm going to Oh, there's some cookies, I'm going to grill just a little bit.   Dr. Lauren  38:55 hard. I tell you, it doesn't end when you when you're eating a healthy lifestyle like I do. It doesn't And trust me, the cravings don't in, you just have to you know, you just have to take it baby steps. Yeah, I tell people baby steps with that. Because it's traumatic for you to have to just stop it like all at once. It really is traumatic. So you just have to take baby steps. You have to be kind to yourself, as well. You know, if you fall off the wagon, or you kind of partially on a wagon, you know, just get back on it.   Roy Barker  39:32 That's all I usually fall off and then get ran over by the wagon. But yeah, I mean, it's a lot. It's a it's an adult thing. I don't remember it as a child so much but you know, it's an adult habit that I've done for years. And you know what, the other thing I've learned is it's usually because of getting sleepy. So at night if I got something I want to do in the And I was like, well have something quick to eat instead of just listening to my body and just go into bed, drinking that glass of water and just go into bed. It's it's difficult. But like you said, we have to be kind and not be like, Oh, well, I fell off. So I'm just going to continue on this bad path, because we never get it fixed when we do that.   Dr. Lauren  40:20 Yeah, yeah, don't beat yourself. Yeah, tell people don't beat yourself up. It won't happen overnight, everyone has to do it. You know, you have your own path. Right? You know, is your body you have your own path, and you have to do it in your own way. You just have the knowledge if you have the knowledge, then you know what it is that you can do. Right, you know? And so that's essentially what it is. You just have a few things that you want to work out at a time just a few things that net Arielle take everything all at once like I did I tell people do not follow my lead. Trust me when I'm telling you.   Terry  40:59 Yeah, the big picture is just so hard. If you it's easier. I say that it's easier if you chip away. That's what helps me better. But do I do it all the time? And everything? I do? No, but I should.   Roy Barker  41:13 Yeah, yeah. Yeah. I think that sets us up for failure. Because you know, and I'm this guy, I'm always telling off for myself. But, you know, you wake up one day fed up, and it's like, okay, no more sugar, no more cars, I'm going to the gym. You know, I'm going to go crazy. And like, you got so much commotion in your life that you've just developed, that, it's no wonder that we, you know, have these temporary setbacks. And so, you know, trying to take one thing, and then also, you know, maybe doing things gradual, if you if you have the luxury of the time, you know, sometimes people get to a position that they have to make drastic changes immediately. But if you can, you know, just yeah, just start cutting back a little here a little there until you get to the point where you really want to be Yeah,   Terry  42:03 exactly. Well, you're right. I was I'm sorry, go ahead.   Dr. Lauren  42:08 You're right. That's what that's why a lot of people do fall off the wagon. And they're like, Oh, well, you know, and then you have the other individuals that are go, okay, I've eaten Well, all week. What cheat meal Am I gonna have this weekend? Why   Terry  42:24 the weekend, we're celebrating,   Roy Barker  42:26 saying, I can't do that. Because if I have one taste of this, whatever the cheat is, I want it more and more. So you know, some people can handle that. But I just have to say I'm not one I have to go to the extreme of just not having it. You know, cuz like those little I always say the cat, I don't know, the company. Somebody came out with these little 100 calorie little ice cream sandwiches a few years ago. Oh, yeah. I love those things. But you know, I eat four or five of them at, you know, at a setting down. So it really wasn't doing me any good. You know?   Terry  43:06 You had more so you were full. I   Roy Barker  43:08 didn't need anymore. I'd have been better eating the old original big ones. I probably only had 250 calories. Like, I just get a little taste for it. And then you know, it's just uncontrollable. I love it. Yeah.   Terry  43:22 Okay. Dr. Lauren, I wanted to let's, let's kind of Reel back I know, we're talking about all over the place. But so you're a certified Health Coach, what kind of programs do you offer on your website? And you have a new one that I want you to talk about as well?   Dr. Lauren  43:37 Yes, I have it. So it's called the metamorphosis health coaching program. And my signature program is the bee fly the top. So eventually, initially, I did a 21 day just to get people started. But what I discovered was, because I'm so adamant about it, I could do it. But other people like this is over whelming so what I did was I reeled it back in, and I wrote I'm rolling it back out on September the sixth. And it is going to be a self paced program is six modules. And it's going to be a self paced program. So you go at your own pace, and you can, you know, move it along, or you know, kind of stopping, you know, as you need to and then you know, you can kind of help yourself as you go along. And then you get me to answer your questions in our own little group on Facebook. So I get to you can come in there and ask as many questions as you can, as much as your heart desires. To talk about that you also get a you also get a health consultation, so that you can learn about out what it is that you know, you can eat, you know, we look at all of your habits your eating, past present, and what you're going to be eating in the future, because you're going to do a lifestyle change. And you know, we just kind of go from there.   Roy Barker  45:19 And I think I'll put this more as a question. But you know, for me, I find that sleep, I have come to realize sleep is pretty much my trigger for all my downfalls. Because here's how the pattern goes, stay up late, don't get enough sleep, and then get up in the morning need extra fuel food to get moving, but then you're too tired to get out and move in. I know that when we talk about weight loss, you know, it's more 80% diet. But for me, you know, I feel like I need to move every day and I don't I walk from you know, the bedroom to the office and sit down and stay here pretty much where I need that movement. But the other thing is, when I'm out moving, I'm not eating. So you know, it kind of works twice, double for me as it gets me moving. It's good for the rest of my body. But also, it's an opportunity not to be in front of food.   Dr. Lauren  46:19 Yeah, I give. So I have a couple of people who I coach who they work from home. And when they're not working from home, they travel. And I said, so this is what I need you to do. I need you to set an alarm at lunchtime, get up at lunchtime and go walk for half an hour. And then then you know, of course it was the excuses that came. Okay. So this is what I need you to do. If you need to take a phone call, if you are on a conference call, do it on your cell phone and go walk while you are on that conference call. Because a half an hour a day will be so much more helpful for you to do that walk in even if you if you need to be in the house and you have stamps in your house, do the steps. Yeah, the steps up and down. Even if it's just for 10 minutes, do those steps so you can get those get the walking in to get your body moving. Yeah. You know, so you have to kind of set that time aside in order to do that.   Roy Barker  47:21 Yeah. And it's easy, because I can't do all of mine that way. But the ones I can make the announcement. I'm gonna be breathing hard. I'm not being chased. I'm not dying. So don't worry, it's just me walking,   Terry  47:34 because I hurry up with your meeting so I can get on with it.   Roy Barker  47:37 But you know, the other thing we've talked a little bit about is I, my my big name, fitness watch. Kind of pooped out on me. And so I started using a different one the Fitbit again. And I really like it because it the other one may have had it, I just didn't use it. But this one has a every hour it wants me to get 250 steps in. So I get a little prompt like, Hey, you got this many. And I do what you said, if I can't get out, I will just get up and walk around the house. I can still get it in. But the awesome thing is that at the end of the day, I've got about 2500 steps, you know, to kind of get started, I'd like to get more than that. But it's a great start with just a little bit of effort throughout the entire day. Right now, you know, I'm telling you, I had to I was back out in the field this week for one day. And we were doing some field visits. And I was with two colleagues that just wore me out we had like, you know, 5500 steps through this day and I came home and was just   Terry  48:41 it was zero doubt. Yeah,   Roy Barker  48:42 after you know, sitting at home in a chair for so long.   Dr. Lauren  48:46 Yeah. I tell you something else that you can try. If that wears you out, you know yoga will give you cardio as well. Yeah. If you get up in the morning and do that. Do that breathing and so forth. Yoga, I love yoga. If you if you tell me something about running or walking or something like that. Yeah, I'm not doing it. Yeah. Yeah, I'm not doing it. But yoga, I will do 90 minutes of yoga. A day. I will start out with it in the morning and I will do it in the evening. And that is that is equivalent to the walking that you need to do. And it will wear you completely out.   Roy Barker  49:32 Yeah. Yeah, you know, that's a great thing about our day and time is you know, there's the negatives of the food and the drive throughs and all of that but the positive we have so many tools at our disposal, that if we will use them that they will help because you know like the watches it also it makes me input my water so I can keep up because again, that's another bad habit is I can go through to three days and not ever drink any water. Drink Coffee. Yeah, so I can put my water in. But we can also do the yoga on the computer, we've got a DVD where we could do it at home, you don't even have to get out of your pajamas to do it. So, you know, we got so many great things to take advantage of, I think we just have to make up our mind and just try to have that discipline to do it.   Terry  50:21 I think we even had a guest who said that she does. She does it in bed. Like when she first wakes up. I mean, there's just really not any excuse. If you want to lay down and do it in bed, then do yoga in bed. There's there's an app for that there's that you can watch a YouTube, whatever. And it's been in bed, yo. And we also, we also just talked to somebody about laughter yoga. Oh my gosh, if you have never experienced it, you have got to do it. Because you just laugh from deep, your diaphragm belly loud. You know, you go into it thinking, huh? What is that everybody's just going head. It's just kind of like a canned thing. That's what you think, Well, no, bye, bye. You know, 1015 minutes, everybody's laughing at everybody else's laughs you're there, to screen fulls of people and they were just dying. laughing. It was hilarious. But it's also good   Roy Barker  51:13 for the stress. Because, you know, when, when one of us gets stressed, the other one will start that, you know, laughter and the other one can't help but start laughing and then, you know, for myself, it takes me out of that. Not so great place and it'll put me in a better place to carry forward with the rest of the day where, you know, instead of just getting all stuck in the mud with wherever I was. I love it. Yeah, it's, uh, it was it's, it's kind of a blessing for fine. I'm, I can be a little intense at times. And so she can be like,   Terry  51:51 I'll just start laughing. I'll just look at him. Like, really? Just start laughing. He's like, what's funny? I'm like, nothing. Just laugh.   Roy Barker  52:02 With Dr. Lauren, we appreciate your time. We've gone way long. I know that but such a good conversation. So many great things to think about. You know, one of our questions we always ask is, so what is a habit or tool? What is something that you use in your daily life professional or personal that you feel adds a lot of value?   Dr. Lauren  52:22 For me, when I we just started talking about the yoga I do Reiki? Okay. Every morning, when I get up, I do Reiki It is so relaxing, before I start my day, and so I find that that relaxes my complete Body before I get going and so that's very helpful for me if I don't do anything else, you know, before I you know, before I leave out and in the morning, that is one thing that I do is my Reiki.   Roy Barker  52:52 Awesome, Alreight. Well tell everybody, who do you like to work with? How can you help them? And then of course, how can they reach out and get a hold of you.   Dr. Lauren  53:02 So I like working with individuals who are either trying to change their lifestyle, who want to learn how to eat healthier, those individuals who are who are plagued with lifestyle diseases such as hypertension, diabetes, obesity, and they want to change their lifestyle. I like working with those individuals. And, you know, genuinely, you know, when you're working with me, you're going to lose weight. For those individuals who want to bikini bodies, I can do that as well. I don't, you know, I don't specifically market to that population. But the individuals that I do work with those that do have, you know, the lifestyle diseases, and I do that through The B-Fly Detox Program. I also have, you know, work with individuals who have special events going on, you know, such as, you know, lifestyle, life events, you know, like weddings and so forth. I work with those individuals, red carpet events, I work with those individuals to get them prepared for that. And so, all of this is under my umbrella of The Metamorphosis Health Coaching Program, and they can find me at my website, which is www dot Laurenkeirwellness.com.   Roy Barker  54:31 Okay, it would be sure to put all that in the show notes. Speaking of weddings, just I'm a dude, so I don't get this I guess, but they we have a toll road authority here in town that's been advertising the last two days. Somebody lost their wedding dress. They found this really nice wedding dress on the side of the road. And they feel like it belongs to somebody they're trying to figure out well, how do you bet there's some bride that is absolutely beside herself thinking about her dresses laying on the side of the highway   Terry  55:00 So that's that's kind of an extreme way to say I really don't want to get married or maybe they were mad. Maybe they were getting divorced. Throw it out. I was out and yeah,   Dr. Lauren  55:12 I don't think that bride lost it. I think she you know, there was all times I think brides to get bridges on throw that guy's away time away. Well, okay,   Roy Barker  55:22 well hopefully she went on her way to the chapel when she threw it out the car window. Alright guys, well, thanks again. that's gonna do it for another episode of Feeding Fatty. Of course, I   Terry  55:33 am Roy. I'm Carrie.   Roy Barker  55:35 And you can find us at www.feedingfatty.com we're on all the major podcast platforms, iTunes, Stitcher, Google Spotify. If we're not a one that you listen to, if you'll reach out, I'll be glad to get it added so you can make your Lee's listening easier. Also, we're on all the major social media platforms hang out on Instagram a little bit more than any other place. So reach out we'd love to engage with you there. And a video of this interview will go up on our YouTube channel when the episode goes live. So be sure and check that out as well. Again, thanks for listening. Take care of yourself and take care of your health. www.laurenkeirwellness.com www.feedingfatty.com

Diabetes Knowledge in Practice Podcast
IDF 2021 | With Prof. Naveed Sattar

Diabetes Knowledge in Practice Podcast

Play Episode Listen Later Dec 28, 2021 16:48


Today we're joined by Professor Naveed Sattar for a summary of some of the key takeaways from the International Diabetes Federation Virtual Congress 2021. Professor Sattar is Professor of Metabolic Medicine at the University of Glasgow, and was Committee Lead for the Cardiovascular Disease & Hypertension stream at the congress. For more free education, go to diabetes.knowledgeintopractice.com, where you can see all past episodes of the podcast as well as other free CME resources. Follow us on Twitter (@dkipractice) or connect on LinkedIn. Disclosures: Professor Naveed Sattar declares the following: Advisory board: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Sanofi Speaker honoraria: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi Institutional research grant: Boehringer Ingelheim All conflicts have been mitigated prior to this activity. This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.

Diabetes Core Update
Diabetes Core Update January 2022

Diabetes Core Update

Play Episode Listen Later Dec 28, 2021 35:46


Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 20 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. This issue will review: Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine, Sitagliptin, and Metformin Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease Changes in the Prevalence of Symptoms of Depression, Loneliness, and Insomnia in U.S. Older Adults With Type 2 Diabetes During the COVID-19 Pandemic Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes Risk of Incident Dementia According to Glycemic Status and Comorbidities of Hyperglycemia     For more information about each of ADA's science and medical journals, please visit www.diabetesjournals.org. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

Obiettivo Salute
Il cammino amico del nostro cuore

Obiettivo Salute

Play Episode Listen Later Dec 27, 2021


Uno studio condotto all’Università di Kyoto in Giappone e pubblicato sulla rivista Hypertension sottolinea i benefici del cammino per il nostro cuore. A Obiettivo salute il commento del prof. Claudio Borghi, direttore dell'unità operativa di medicina interna al Policlinico Sant'Orsola-Malpighi di Bologna.

Frankly Speaking About Family Medicine
Favorite Podcast of 2021 - Frankly Speaking EP 256

Frankly Speaking About Family Medicine

Play Episode Listen Later Dec 27, 2021 19:40


Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-256   Overview: Live at Pri-Med East! In this episode, each podcaster will discuss the most impactful paper and podcast of the year.   Episode resource links: Ngan, H.Y, et al (2021), Diabet Med, 38: e14525. https://doi.org/10.1111/dme.14525 J Clin Gastroenterol 2021: DOI: 10.1097/MCG.0000000000001561 Mehta RS, etal. JAMA Intern Med. doi:10.1001/jamainternmed.2020.7238 https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   Guest: Susan Feeney, DNP, FNP-BC, NP-C, Alan M. Ehrlich, MD, FAAFP, Jill M. Terrien, PhD, ANP-BC, Jillian Joseph, MSPAS, PA-C   Music Credit: Richard Onorato

Pri-Med Podcasts
Favorite Podcast of 2021 - Frankly Speaking EP 256

Pri-Med Podcasts

Play Episode Listen Later Dec 27, 2021 19:40


Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-256   Overview: Live at Pri-Med East! In this episode, each podcaster will discuss the most impactful paper and podcast of the year.   Episode resource links: Ngan, H.Y, et al (2021), Diabet Med, 38: e14525. https://doi.org/10.1111/dme.14525 J Clin Gastroenterol 2021:  DOI: 10.1097/MCG.0000000000001561 Mehta RS, etal.  JAMA Intern Med. doi:10.1001/jamainternmed.2020.7238 https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667 Guest: Susan Feeney, DNP, FNP-BC, NP-C, Alan M. Ehrlich, MD, FAAFP, Jill M. Terrien, PhD, ANP-BC, Jillian Joseph, MSPAS, PA-C   Music Credit: Richard Onorato

On the Mend
Weight Management: Payne

On the Mend

Play Episode Listen Later Dec 21, 2021 19:06


You might be considering adding losing weight to your list of resolutions for next year. Dr. Drew Payne, an internal medicine practitioner for Texas Tech Physicians and an associate professor for the Texas Tech University Health Sciences Center (TTUHSC) School of Medicine, has advice on how to start your weight loss journey so that it's effective and healthy. For those not looking to lose weight, Dr. Payne has suggestions on how to maintain a healthy weight. 

One Black Man's Opinion Podcast
ONE BLACKMANS OPINION EPISODE 12 Choose a Lifestyle over Deathstyle

One Black Man's Opinion Podcast

Play Episode Listen Later Dec 20, 2021 11:01


KHOU-11 Houston reported Fifty percent of persons who died from COVID 19 in Houston, Texas were diagnosed with diabetes. It is reported by the Houston Health Department that 13.5 % or 311,118 of 2,304,580 Houstonians have diabetes. If the risk factors related to diabetes are Obesity and Overweight; Hypertension; High Cholesterol; and Cigarette Smoking according to the U.S. Department of Health and Human Services (Office of Minority Health), why is there not more emphasis on lifestyle changes rather than vaccine mandates? https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3...

ACC CardiaCast
Hypertension Management Series - The Underestimated Impact of Lifestyle on Hypertension

ACC CardiaCast

Play Episode Listen Later Dec 17, 2021 13:21


In this episode, Dr. Deepak Bhatt and Dr. George Bakris discuss the diagnosis of resistant hypertension, strategies to manage patient lifestyle, and the use of combination therapy.   Educational grant support provided by Medtronic. To visit the hub for the Overcoming Challenges in Hypertension Management grant, click here.   Subscribe on iTunes | Subscribe on Google Play |

Le Conseil Santé
Hypertension artérielle: quelles complications en l'absence de traitement?

Le Conseil Santé

Play Episode Listen Later Dec 16, 2021 2:09


L'hypertension artérielle correspond à une élévation anormale de la pression du sang sur la paroi des artères. Elle touche, selon l'OMS, plus d'un adulte sur trois, et peut entraîner un infarctus ou un AVC (Accident Vasculaire Cérébral). En effet, une tension trop élevée provoque un vieillissement accéléré des organes comme le cœur, le cerveau et les reins. Pourquoi est-il fondamental de surveiller sa tension ? Quelles sont les complications qui peuvent survenir si l'on n'est pas mis sous traitement ? Pr Michel Azizi, cardiologue, professeur de Médecine vasculaire à la Faculté de Médecine de l'Université de Paris. Chef de Service du Centre d'Excellence en Hypertension Artérielle de l'Hôpital Européen Georges Pompidou, Paris. Il dirige également le Centre d'Investigations Clinique 1418 APHP-INSERM et une équipe de recherche au sein de l'hôpital ► Retrouvez l'émission en intégralité ici

The Curbsiders Internal Medicine Podcast
#310 No Tension About Inpatient Hypertension

The Curbsiders Internal Medicine Podcast

Play Episode Listen Later Dec 13, 2021 62:06


Don't sweat inpatient hypertension any longer. Who needs guidelines when Dr. Noble Maleque (@nobility75, Emory University, Division of Hospital Medicine) explains the spectrum of hypertensive disorders in the inpatient setting, and an approach for thinking about treatment. Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Production, Script, Infographic, and Cover Art: Monee Amin, MD, Meredith Trubitt, MD MPH  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Monee Amin, MD, Meredith Trubitt, MD MPH  Reviewer: Adam Barelski MD Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Noble Maleque MD Sponsor: Panacea Financial Join the growing number of doctors nationwide that expect more from their bank and have switched to Panacea Financial. Visit panaceafinancial.com today for information on their student loan refinance loans and to learn about their “refer a friend” program. Panacea Financial is a division of Primis, Member FDIC Sponsor: Ten Thousand Ten Thousand is offering our listeners 15% off your purchase! Go to tenthousand.cc and enter code CURB  to receive 15% off your purchase!. Sponsor: Locumstory Locum tenens may sound like a funky Latin word, but you'd be surprised what it can mean for your career in medicine.  Locumstory is your source for all things locum tenens! Check out their website,  locumstory.com,  for resources, FAQs, and more! CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Definitions Case from Kashlak Elevated blood pressure / hypertensive urgency Contributing factors to elevated blood pressure in the hospital Hypertensive urgency—to treat or not to treat Transitions of care and case against intensification of treatment Case from Kashlak Hypertensive emergency diagnosis and treatment Secondary Hypertension Outro

Primary Care Update
Episode 92: urinary incontinence, forearm fractures in kids, COVID testing in schools, and a novel hypertension strategy

Primary Care Update

Play Episode Listen Later Dec 9, 2021 30:01


This week on Primary Care Update we talk about group PT visits for urinary incontinence in women older than 60, managing uncomplicated forearm fractures in children, a COVID testing strategy for keeping kids in school, and a quadpill for treating hypertension

Pri-Med Podcasts
The End of ACE Inhibitors? - Frankly Speaking Ep 253

Pri-Med Podcasts

Play Episode Listen Later Dec 6, 2021 8:01


Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253   Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension.   Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Frankly Speaking About Family Medicine
The End of ACE Inhibitors? - Frankly Speaking Ep 253

Frankly Speaking About Family Medicine

Play Episode Listen Later Dec 6, 2021 8:01


Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253   Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension.   Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

The Medical Journal of Australia
Episode 451: MJA Podcasts 2021 Episode 50: Hypertension: a call to action, with Prof Alta Schutte and Prof Markus Schlaich

The Medical Journal of Australia

Play Episode Listen Later Dec 5, 2021 22:43


Vol 215, Issue 11: 6 December 2021. Professor Alta Schutte is Professor of Cardiovascular Medicine at UNSW Sydney, and a Professorial Fellow at The George Institute for Global Health. Professor Markus Schlaich is the Dobney Chair of Clinical Research at the University of Western Australia. They discuss hypertension control rates in Australia and why they need urgent improvement, and how we can do that. This podcast accompanies their MJA Perspective, published here. With MJA news and online editor, Cate Swannell. 

Resoundingly Human
Resoundingly Human: Improving guidelines for hypertension treatment to save lives

Resoundingly Human

Play Episode Listen Later Dec 3, 2021 11:57


According to the CDC, nearly half of all adults in the U.S. have hypertension or are taking medication to control it. Of these individuals, only about 1 in 4 actually have their condition under control, whether through improved diet and exercise, making different lifestyle choices such as not smoking, or with prescription medications. Knowing when to start treating someone for hypertension is extremely important, as elevated blood pressure can lead to heart disease, stroke, and even death. However, there can be some uncertainty in the medical community on when it is appropriate to begin medication, as guidelines are frequently revised, and that decision can also vary from patient-to-patient based on additional factors. Anthony Bonifonte with Denison University joins me for this episode to discuss brand new research that can help guide a physician's decision of when to begin medicating for hypertension, as well as when to increase dosages. This study, “An Analytics Approach to Guide Randomized Controlled Trials in Hypertension Management” will be published in the INFORMS journal Management Science.

ACC CardiaCast
Hypertension Management Series - Regaining Control of HTN With Intensification of Therapy

ACC CardiaCast

Play Episode Listen Later Dec 3, 2021 15:34


In this episode, Dr. Suzanne Oparil and Dr. Sandra Taler discuss strategies to address deteriorating control rates of hypertension, including leveraging combinations of antihypertensive drugs, improving patient adherence, and increasing clinician inertia.   Educational grant support provided by Medtronic. To visit the hub for the Overcoming Challenges in Hypertension Management grant, click here.   Subscribe on iTunes | Subscribe on Google Play |

BGP Radio
Weidman talks us through the long road to get Symplicity ready to help patients with hypertension

BGP Radio

Play Episode Listen Later Dec 1, 2021 30:46


In this episode, Jason Weidman, SVP and President of Coronary & Renal Denervation at Medtronic, says he's doing exactly what he set out to do when he became an engineer over 20 years ago, creating lifesaving medical devices. Weidman is leading Medtronic's push to secure FDA approval for Medtronic Symplicity Spyral™ RDN system, which uses renal denervation to reduce hypertension. Medtronic's clinical trials of Symplicity have been among the most closely watched - and most difficult to execute - in the industry. Weidman will discuss the challenges while also sharing his reasons for optimism.

Questioning Medicine
Episode 186: 186. ACE vs ARB, Blood Clots, and Mifepristone

Questioning Medicine

Play Episode Listen Later Nov 30, 2021 17:38


Contraception 2021 Sep 20;[EPub Ahead of Print], D Grossman, S Raifman, N Morris, A Arena, L Bachrach, J Beaman, MA Biggs, C Hannum, S Ho, EB Schwarz, M GoldSTUDY DESIGNThis is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤63 days' gestation, electronically sent prescriptions for mifepristone 200 mg orally and misoprostol 800 mcg buccally to a mail-order pharmacy, which shipped medications for next-day delivery. Participants completed surveys three and 14 days after enrollment, and we abstracted medical chart data for this interim analysis.  In this prospective cohort study, researchers estimated the effectiveness, feasibility, and acceptability of medication abortion with mifepristone dispensed by a mail-order pharmacy with next-day delivery after in-person clinical assessment. The researchers found that complete medication abortion occurred for 96.9% of participants; 88.4% reported being very satisfied receiving medications by mail, and 89.6% said they would use the mail-order service again if needed. Of the 4.9% who experienced adverse events, none were related to mail-order dispensing. This research suggests that mail-order pharmacy dispensing of mifepristone is effective and acceptable to patients, providing further evidence that the in-person dispensing requirement for this medication should be removed.  IMPLICATIONSThe in-person dispensing requirement for mifepristone, codified in the drug's Risk Evaluation and Mitigation Strategy, should be removed.      Stevens SM et al. Antithrombotic therapy for VTE disease: Second update of the CHEST Guideline and Expert Panel Report. Chest 2021 Aug 2; [e-pub]. (https://doi.org/10.1016/j.chest.2021.07.055)  The ninth edition of the CHEST Clinical Practice Guidelines for managing venous thromboembolism (VTE) — published in 2012 and updated in 2016 — now has a second update, which addresses 14 clinical questions and offers 32 guidance statements for clinicians who manage patients with VTE. The 2012 guideline (Chest 2012; 141:Suppl:e419S and the 2016 update (NEJM JW Emerg Med Feb 2016 and Chest 2016; 149:315) both are publicly available.Key Recommendations Patients with isolated subsegmental pulmonary embolism (PE): Rule out proximal deep venous thrombosis (e.g., with ultrasonography). If risk for recurrent VTE is low, surveillance is recommended over anticoagulation. If risk for recurrent VTE is high, anticoagulation is recommended. (Weak recommendation, low-certainty evidence) Patients with incidentally discovered asymptomatic PE (other than isolated subsegmental PE): Same initial and long-term anticoagulation that patients with symptomatic PE receive should be used. (Weak recommendation, moderate-certainty evidence) Patients with cancer-associated VTE: Direct-acting oral anticoagulants (DOACs; i.e., apixaban, edoxaban, or rivaroxaban) should be used for the treatment phase of therapy (strong recommendation, moderate-certainty evidence). Caveat: for patients with luminal gastrointestinal malignancies, apixaban or low-molecular-weight heparin is preferred to reduce bleeding risk. Patients with antiphospholipid syndrome: Warfarin (target international normalized ratio, 2.5) is recommended over DOAC therapy during the treatment phase for VTE. (Weak recommendation, low-certainty evidence) Catheter-assisted mechanical thrombectomy: Recommended for patients with PE and hypotension who also have high bleeding risk, failed systemic thrombolysis, or shock that is likely to lead to death before systemic thrombolysis can take effect. (Weak recommendation, low-certainty evidence) Initial anticoagulation setting: Outpatient treatment is recommended over hospitalization in patients with low-risk PE, if access to medications and outpatient care is available. (Strong recommendation, low-certainty evidence) Treatment-phase anticoagulants: DOACs are recommended over warfarin. (Strong recommendation, moderate-certainty evidence) Extended-phase therapy (beyond 3 months) for VTE: Extended anticoagulation should be offered to patients with unprovoked VTE — i.e., with no major or minor transient risk factors. Risk for recurrent VTE, risk for bleeding, and patients' values and preferences should be considered in decisions about extended anticoagulation therapy. (Strong recommendation, moderate-certainty evidence) Low-dose apixaban or rivaroxaban is recommended over full doses of these agents. (Weak recommendation, very low-certainty evidence) Aspirin is recommended for patients who are stopping anticoagulation. (Weak recommendation, low-certainty evidence) Ingason AB et al. Rivaroxaban is associated with higher rates of gastrointestinal bleeding than other direct oral anticoagulants: A nationwide propensity score–weighted study. Ann Intern Med 2021 Oct 12; [e-pub]. (https://doi.org/10.7326/M21-1474) The study used icelands National databank to compare GI bleeding among almost 6000 patients receiving  apixaban, dabigatran, and rivaroxaban for the first time.  Patients were followed for 1-1/2 years and GI bleeding was verified by review of the medical records.  Once there was a propensity score analysis it was deemed that rivaroxaban had significantly high rates of minor and major gastrointestinal bleeding compared to apixaban with a number needed to treat of around 40 or 50.  However there was no difference between rivaroxaban and dabigatran.  I think this goes to what we have all seen and that the bleeding risk among most anticoagulate medications is not equal but unfortunately which medication the insurance companies will pay for it is also not equal.  However if your patient is at large risk for GI bleed likely should consider not using rivaroxaban                     Chen R et al. Comparative first-line effectiveness and safety of ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers: A multinational cohort study. Hypertension 2021 Sep; 78:591. (https://doi.org/10.1161/HYPERTENSIONAHA.120.16667) In this retrospective study of patients who initiated monotherapy for hypertension, researchers used eight large observational databases to compare outcomes for 2.3 million new users of ACE inhibitors and nearly 700,000 new users of ARBs.  Myocardial infarction, stroke, and heart failure occurred with similar frequency in the two groups, after extensive adjustment for demographic and clinical variables. However, cough, angioedema, pancreatitis, and gastrointestinal bleeding occurred significantly more often in ACE-inhibitor users than in ARB users.            Long-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis: Annals of Internal Medicine: Vol 174, No 10 (acpjournals.org) What happens if you extend anticoagulation past the 3 to 6 months for an individual who has a first unprovoked venous thromboembolism.  Often this is a debate in the clinical practice of while you seem low risk so maybe we should discontinue this anticoagulation or well you had his lab value is off to me we should continue anticoagulation.  The scary thing is you do not want to discontinue the anticoagulation and the may have a massive saddle embolism and die!  It is easy to start a medication but it is always so hard to stop the medication.  this study looked at that exact question --it looked at 14 randomized control trials and 13 cohort studies with just over 17,000 patients taking either vitamin K antagonist or DOACs.  The patient had to have received a minimum of at least 9 months of anticoagulation in order to be enrolled in the final analysis and they looked at patients who had had extended anticoagulation up to 5 years.In the end the incidence of major bleeding with warfarin was 1.7 events per year per 100 patients and much lower with the DOACs at 1.12 events per year per 100 people.  While that does not sound like a lot with the newer agents he has remember that is only after 1 year if he looked at the 5-year cumulative incidence of major bleeding for those individuals on either warfarin or a DOAC it was 6.3% which is certainly at significant risk of bleeding especially when you consider that the case fatality rate was 8.3% expirationThat was a whole bunch of numbers but basically I guess with this meta-analysis is really saying is that the current recommendations for anticoagulation after a unprovoked venous thromboembolism are 3 to 6 months and if you are going to extend that out to 9 months or a year or even up to 5 years he better have a darn good reason given that the eventual rates of bleeding are so high and the mortality rate from those bleeds are also so high.  

BJA Education Podcasts

In the November 2021 podcast, Pooja Shah speaks to Dr Simon Howell about this month's BJAEducation Editor's choice article: Preoperative hypertension: perioperative implications and management. We discuss the latest guidelines and evidence and how to tackle the perennial question of whether or not to cancel surgery for a patient whose preoperative blood pressure is > 180/110 mmHg.

The Peter Attia Drive
#185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk

The Peter Attia Drive

Play Episode Listen Later Nov 29, 2021 122:13


Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease. We discuss: Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30]; A primer on cholesterol, apoB, and plasma lipoproteins [16:30]; Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45]; Limitations of standard blood panels [29:00]; Remnant type III hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride [32:15]; Using apoB to estimate risk of CVD [37:30]; How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45]; Hypertension and CVD risk [49:15]; Factors influencing the decision to begin preventative intervention for CVD [58:30]; Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15]; The challenge of motivating individuals to take early interventions [1:12:30]; How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached [1:15:15]; PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45]; Defining risk and uncertainty in the guidelines [1:26:00]; Making clinical decisions in the face of uncertainty [1:31:00]; How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45]; Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45]; Advantages of a 30-year risk assessment and early intervention [1:50:30]; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AllanSniderman  Subscribe to receive exclusive subscriber-only content:  https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Real World NP
Chronic Care Conversations

Real World NP

Play Episode Listen Later Nov 23, 2021 25:28


I love caring for patients with chronic conditions now, but it wasn't always the case. Like so many new grads, I struggled with caring for patients managing chronic conditions -- where to start, how to proceed, feeling like we weren't making any progress towards “control” of those conditions (diabetes, chronic kidney disease, hypertension, etc).When I was a new nurse practitioner, I was incredibly focused on the diagnostic algorithms and medication management. Which, of course, is crucial to know, but isn't truly what moves the needle in chronic conditions.In this episode, I cover:What moves the needle in chronic conditionsNormalize what and why this is so hardWhat my dog has taught me about caring for patients (and can help you too)A practical framework for navigating the management of these conditions**PS our brand new course Managing DIabetes, Hypertension and CKD in Primary Care opens for enrollment next week. The only way to join is by email, so join the waitlist at realworldnp.com/courses.** See acast.com/privacy for privacy and opt-out information.

Circulation on the Run
Circulation November 23, 2021 Issue

Circulation on the Run

Play Episode Listen Later Nov 22, 2021 24:40


Please join first author Yuan Lu and Guest Editor Jan Staessen as they discuss the article "National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019)." Dr. Carolyn Lam: Welcome to Circulation on the Run: your weekly podcast, summary and backstage pass to the journal and it's editors. We're your co-hosts. 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, and director of Pauley Heart Center at VCU health in Richmond, Virginia. Dr. Carolyn Lam: Greg, today's feature discussion is about the national trends and disparities and hospitalizations for hypertensive emergencies among Medicare beneficiaries. Isn't that interesting? We're going to just dig deep into this issue, but not before we discuss the other papers in today's issue. I'm going to let you go first today while I get a coffee and listen. Dr. Greg Hundley: Oh, thanks so much, Carolyn. My first paper comes to us from the world of preclinical science and it's from professor Christoff Maack from University Clinic Wursburg. Carolyn, I don't have a quiz for you, so I'm going to give a little break this week, but this particular paper is about Barth syndrome. Barth syndrome is caused by mutations of the gene encoding taffazin, which catalyzes maturation of mitochondrial cardiolipin and often manifests with systolic dysfunction during early infancy. Now beyond the first months of life, Barth syndrome cardiomyopathy typically transitions to a phenotype of diastolic dysfunction with preserved ejection fraction, one of your favorites, blunted contractile reserve during exercise and arrhythmic vulnerability. Previous studies traced Barth syndrome cardiomyopathy to mitochondrial formation of reactive oxygen species. Since mitochondrial function and reactive oxygen species formation are regulated by excitation contraction coupling, these authors wanted to use integrated analysis of mechano-energetic coupling to delineate the pathomechanisms of Barth syndrome cardiomyopathy. Dr. Carolyn Lam: Oh, I love the way you explained that so clearly, Greg. Thanks. So what did they find? Dr. Greg Hundley: Right, Carolyn. Well, first defective mitochondrial calcium uptake prevented Krebs cycle activation during beta adrenergic stimulation, abolishing NADH regeneration for ATP production and lowering antioxidative NADPH. Second, Carolyn, mitochondrial calcium deficiency provided the substrate for ventricular arrhythmias and contributed to blunted inotropic reserve during beta adrenergic stimulation. And finally, these changes occurred without any increase of reactive oxygen species formation in or omission from mitochondria. So Carolyn what's the take home here? Well, first beyond the first months of life, when systolic dysfunction dominates, Barth syndrome cardiomyopathy is reminiscent of heart failure with preserved rather than reduced ejection fraction presenting with progressive diastolic and moderate systolic dysfunction without relevant left ventricular dilation. Next, defective mitochondrial calcium uptake contributes to inability of Barth syndrome patients to increase stroke volume during exertion and their vulnerability to ventricular arrhythmias. Lastly, treatment with cardiac glycosides, which could favor mechano-energetic uncoupling should be discouraged in patients with Barth syndrome and left ventricular ejection fractions greater than 40%. Dr. Carolyn Lam: Oh, how interesting. I need to chew over that one a bit more. Wow, thanks. But you know, I've got a paper too. It's also talking about energetic basis in the presence of heart failure with preserved ejection fraction, but this time looking at transient pulmonary congestion during exercise, which is recognized as an emerging and important determinant of reduced exercise capacity in HFpEF. These authors, led by Dr. Lewis from University of Oxford center for clinical magnetic resonance research sought to determine if an abnormal cardiac energetic state underpins this process of transient problem congestion in HFpEF. Dr. Carolyn Lam: To investigate this, they designed and conducted a basket trial covering the physiological spectrum of HFpEF severity. They non-invasively assess cardiac energetics in this cohort using phosphorous magnetic resonance spectroscopy and combined real time free breathing volumetric assessment of whole heart mechanics, as well as a novel pulmonary proton density, magnetic resonance imaging sequence to detect lung congestion, both at rest and during submaximal exercise. Now, Greg, I know you had a look at this paper and magnetic resonance imaging, and spectroscopy is your expertise. So no quiz here, but could you maybe just share a little bit about how novel this approach is that they took? Dr. Greg Hundley: You bet. Carolyn, thanks so much for the intro on that and so beautifully described. What's novel here is they were able to combine imaging in real time, so the heart contracting and relaxing, and then simultaneously obtain the metabolic information by bringing in the spectroscopy component. So really just splashing, as they might say in Oxford, just wonderful presentation, and I cannot wait to hear what they found. Dr. Carolyn Lam: Well, they recruited patients across the spectrum of diastolic dysfunction and HFpEF, meaning they had controls. They had nine patients with type two diabetes, 14 patients with HFpEF and nine patients with severe diastolic dysfunction due to cardiac amyloidosis. What they found was that a gradient of myocardial energetic deficit existed across the spectrum of HFpEF. Even at low workload, the energetic deficit was related to a markedly abnormal exercise response in all four cardiac chambers, which was associated with detectable pulmonary congestion. The findings really support an energetic basis for transient pulmonary congestion in HFpEF with the implication that manipulating myocardial energy metabolism may be a promising strategy to improve cardiac function and reduce pulmonary congestion in HFpEF. This is discussed in a beautiful editorial by Drs. Jennifer Hole, Christopher Nguyen and Greg Lewis. Dr. Greg Hundley: Great presentation, Carolyn, and obviously love that MRI/MRS combo. Carolyn, these investigators in this next paper led by Dr. Sara Ranjbarvaziri from Stanford University School of Medicine performed a comprehensive multi-omics profile of the molecular. So transcripts metabolites, complex lipids and ultra structural and functional components of hypertrophic cardiomyopathy energetics using myocardial samples from 27 hypertrophic cardiomyopathy patients and 13 controls really is the donor heart. Dr. Carolyn Lam: Wow, it's really all about energetics today, isn't it? So what did they see, Greg? Dr. Greg Hundley: Right, Carolyn. So hypertrophic cardiomyopathy hearts showed evidence of global energetic decompensation manifested by a decrease in high energy phosphate metabolites (ATP, ADP, phosphocreatine) and a reduction in mitochondrial genes involved in the creatine kinase and ATP synthesis. Accompanying these metabolic arrangements, quantitative electron microscopy showed an increased fraction of severely damaged mitochondria with reduced crystal density coinciding with reduced citrate synthase activity and mitochondrial oxidative respiration. These mitochondrial abnormalities were associated with elevated reactive oxygen species and reduced antioxidant defenses. However, despite significant mitochondrial injury, the hypertrophic cardiomyopathy hearts failed to up-regulate mitophagic clearance. Dr. Greg Hundley: So Carolyn, in summary, the findings of this study suggest that perturbed metabolic signaling and mitochondrial dysfunction are common pathogenic mechanisms in patients with hypertrophic cardiomyopathy, and these results highlight potential new drug targets for attenuation of the clinical disease through improving metabolic function and reducing myocardial injury. Dr. Carolyn Lam: Wow, what an interesting issue of our journal. There's even more. There's an exchange of letters between Drs. Naeije and Claessen about determinants of exercise capacity in chronic thromboembolic pulmonary hypertension. There's a "Pathways to Discovery" paper: a beautiful interview with Dr. Heinrich Taegtmeyer entitled,"A foot soldier in cardiac metabolism." Dr. Greg Hundley: Right, Carolyn, and I've got a research letter from Professor Marston entitled "The cardiovascular benefit of lowering LDL cholesterol to below 40 milligrams per deciliter." Well, what a great issue, very metabolic, and how about we get onto that feature discussion? Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Welcome listeners to our feature discussion today. We have a paper that is going to address some issues pertaining to high blood pressure, or hypertension. With us, we have Dr. Yuan Lu from Yale University in New Haven, Connecticut. We also have a guest editor to help us review this paper, Dr. Jan Staessen from University Louvain in Belgium. Welcome to you both and Yuan, will start with you. Could you describe for us some of the background that went into formulating your hypothesis and then state for us the hypothesis that you wanted to address with this research? Dr. Yuan Lu: Sure. Thank you, Greg. We conducted this study because we see that recent data show hypertension control in the US population has not improved in the last decades, and there are widening disparities. Also last year, the surgeon general issued a call to action to make hypertension control a national priority. So, we wanted to better understand whether the country has made any progress in preventing hospitalization for acute hypertension. That is including hypertension emergency, hypertension urgency, and hypertension crisis, which also refers to acute blood pressure elevation that is often associated with target organ damage and requires urgent intervention. We have the data from the Center for Medicare/Medicaid, which allow us to look at the trends of hospitalization for acute hypertension over the last 20 years and we hypothesize we may also see some reverse progress in hospitalization rate for acute hypertension, and there may differences by population subgroups like age, sex, race, and dual eligible status. Dr. Greg Hundley: Very nice. So you've described for us a little bit about perhaps the study population, but maybe clarify a little further: What was the study population and then what was your study design? Dr. Yuan Lu: Yeah, sure. The study population includes all Medicare fee-for-service beneficiaries 65 years and older enrolled in the fee-for-service plan for at least one month from January 1999 to December 2019 using the Medicare denominator files. We also study population subgroups by age, sex, race and ethnicity and dual eligible status. Specifically the racial and ethnic subgroups include Asian, blacks, Hispanics, North American native, white, and others. Dual eligible refers to beneficiary eligible for both Medicare and Medicaid. This study design is a serial cross sectional analysis of these Medicare beneficiaries between 1999 and 2019 over the last 20 years. Dr. Greg Hundley: Excellent. Yuan, what did you find? Dr. Yuan Lu: We actually have three major findings. First, we found that in Medicare beneficiaries 65 years and older, hospitalization rate for acute hypertension increased more than double in the last 20 years. Second, we found that there are widening disparities. When we look at all the population subgroups, we found black adults having the highest hospitalization rate in 2019 across age, sex, race, and dual eligible subgroup. And finally, when we look at the outcome among people hospitalized, we found that during the same period, the rate of 30 day and 90 day mortality and readmission among hospitalized beneficiaries improved and decreased significantly. So this is the main findings, and we can also talk about implications of that later. Dr. Greg Hundley: Very nice. And did you find any differences between men and women? Dr. Yuan Lu: Yes. We also looked at the difference between men and women, and we found that actually the hospitalization rate is higher among females compared to men. So more hospitalizations for acute hypertension among women than men. Dr. Greg Hundley: Given this relatively large Medicare/Medicaid database and cross-sectional design, were you able to investigate any relationships between these hospitalizations and perhaps social determinants of health? Dr. Yuan Lu: For this one, we haven't looked into that detail. This is just showing the overall picture, like how the hospitalization rate changed over time in the overall population and by different population subgroups. What you mentioned is an important issue and should definitely be a future study to look at whether social determine have moderated the relationship between the hospitalization. Speaker 3: Excellent. Well, listeners, now we're going to turn to our guest editor and you'll hear us talk a little bit sometimes about associate editors. We have a team that will review many papers, but when we receive a paper that might contain an associate editor or an associate editors institution, we actually at Circulation turn to someone completely outside of the realm of the associate editors and the editor in chief. These are called guest editors. With us today, we have Dr. Jan Staessen from Belgium who served as the guest editor. He's been working in this task for several years. Jan, often you are referred papers from the American Heart Association. What attracted you to this particular paper and how do you put Yuan's results in the context with other studies that have focused on high blood pressure research? Dr. Jan Staessen: Well, I've almost 40 years of research in clinical medicine and in population science, and some of my work has been done in Sub-Saharan Africa. So when I read the summary of the paper, I was immediately struck by the bad results, so to speak, for black people. This triggered my attention and I really thought this message must be made public on a much larger scale because there is a lot of possibility for prevention. Hypertension is a chronic disease, and if you wait until you have an emergency or until you have target organ damage, you have gone in too late. So really this paper cries for better prevention in the US. And I was really also amazed when I compared this US data with what happens in our country. We don't see any, almost no hospitalizations for acute hypertension or for hypertensive emergencies. So there is quite a difference. Dr. Jan Staessen: Going further on that, I was wondering whether there should not be more research on access to primary care in the US because people go to the emergency room, but that's not a place where you treat or manage hypertension. It should be managed in primary care with making people aware of the problem. It's still the silent killer, the main cause of cardiovascular disease, 8 million deaths each year. So this really triggered my attention and I really wanted this paper to be published. Dr. Greg Hundley: Very nice. Jan, I heard you mention the word awareness. How have you observed perhaps differences in healthcare delivery in Belgium that might heighten awareness? You mentioned primary care, but are there any other mechanisms in place that heighten awareness or the importance? Dr. Jan Staessen: I think people in Belgium, the general public, knows that hypertension is a dangerous condition. That it should be well treated. We have a very well built primary care network, so every person can go to a primary care physician. Part of the normal examination in the office of a primary care physician is a blood pressure measurement. That's almost routine in Belgium. And then of course not all patients are treated to go. Certainly keeping in mind the new US guidelines that aim for lower targets, now recently confirmed in the Chinese study, you have to sprint three cells. And then the recent Chinese study that have been published to the New England. So these are issues to be considered. I also have colleagues working in Texas close to the Mexican border at the university place there, and she's telling me how primary care is default in that area. Dr. Jan Staessen: I think this is perhaps part of the social divide in the US. This might have to be addressed. It's not only a problem in the US, it's also a problem in other countries. There is always a social divide and those who have less money, less income. These are the people who fell out in the beginning and then they don't see primary care physicians. Dr. Jan Staessen: Belgium, for instance, all medicines are almost free. Because hypertension is a chronic condition prevention should not only start at age 65. Hypertension prevention should really start at a young age, middle age, whenever this diagnosis of high blood pressure diagnosis is confirmed. Use blood pressure monitoring, which is not so popular in the US, but you can also use home blood pressure monitoring. Then you have to start first telling your patients how to improve their lifestyle. When that is not sufficient, you have to start anti hypertensive drug treatment. We have a wide array of anti hypertensive drugs that can be easily combined. If you find the right combination, then you go to combination tablets because fewer tablets means better patient adherence. Dr. Greg Hundley: Yuan we will turn back to you. In the last minutes here, could you describe some of your thoughts regarding what you think is the next research study that needs to be performed in this sphere of hypertension investigation? Dr. Yuan Lu: Sure. Greg, in order to answer your question, let me step back a little bit, just to talk about the implication of the main message from this paper, and then we can tie it to the next following study. We found that the marked increase in hospitalization rate for acute hypertension actually represented many more people suffering a potential catastrophic event that should be preventable. I truly agree with what Dr. Staessen said, hypertension should be mostly treated in outpatient setting rather than in the hospital. We also find the lack of progress in reducing racial disparity in hospitalization. These findings highlight needs for new approaches to address both the medical and non-medical factors, including the social determinants in health, system racism that can contribute to this disparity. When we look at the outcome, we found the outcome for mortality and remission improved over time. Dr. Yuan Lu: This means progress has been made in improving outcomes once people are hospitalized for an acute illness. The issue is more about prevention of hospitalization. Based on this implication, I think in a future study we need better evidence to understand how we can do a better job in the prevention of acute hypertension admissions. For example, we need the study to understand who is at risk for acute hypertensive admissions, and how can this event be preempted. If we could better understand who these people are, phenotype this patient better and predict their risk of hospitalization for acute hypertension, we may do a better job in preventing this event from happening. Dr. Greg Hundley: Very nice. And Jan, do you have anything to add? Dr. Jan Staessen: Yes. I think every effort should go to prevention in most countries. I looked at the statistics, and more than 90% of the healthcare budget is spent in treating established disease, often irreversible disease like MI or chronic kidney dysfunction. I think then you come in too late. So of the healthcare budget in my mind, much more should go to the preventive issues and probably rolling out an effective primary care because that's the place where hypertension has to be diagnosed and hypertension treatment has to be started. Dr. Greg Hundley: Excellent. Well, listeners, we've heard a wonderful discussion today regarding some of the issues pertaining to hypertension and abrupt admission to emergency rooms for conditions pertaining to hypertension, really getting almost out of control. We want to thank Dr. Yuan Lu from Yale New Haven and also our guest editor, Dr. Jan Staessen from Louvain in Belgium. On behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2021. The opinions express by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association for more visit aha journals.org.

Discover CircRes
November 2021 Discover CircRes

Discover CircRes

Play Episode Listen Later Nov 18, 2021 27:17


This month on Episode 30 of Discover CircRes, host Cynthia St. Hilaire highlights four original research articles featured in the October 29 and November 12 issues of Circulation Research. This episode also features a conversation with Dr Elisa Klein from the University of Maryland about her study, Laminar Flow on Endothelial Cells Suppresses eNOS O-GlcNAcylation to Promote eNOS Activity.   Article highlights:   Subramani, et al. CMA of eNOS in Ischemia-Reperfusion Liu, et al. Macrophage MST1 Regulates Cardiac Repair Van Beusecum, et al. GAS6/Axl Signaling in Hypertension Pati, et al. Exosomes Promote Efferocytosis and Cardiac Repair   Cindy St. Hilaire:        Hi and welcome to Discover CircRes, the podcast of the American Heart Association's Journal Circulation Research. I'm your host, Dr Cindy St. Hilaire from the Vascular Medicine Institute at the University of Pittsburgh and today I'll be highlighting articles presented in our October 29th and November 12th issues of Circulation Research. I also will speak with Dr Elisa Klein from the University of Maryland about her study, Laminar Flow on Endothelial Cells Suppresses eNOS O-GlcNAcylation to Promote eNOS Activity.   Cindy St. Hilaire:        The first article I want to share is titled, Chaperone-Mediated Autophagy of eNOS in Myocardial Ischemia Reperfusion Injury. The first author is Jaganathan Subramani and the corresponding author is Kumuda Das from Texas Tech University Health Sciences Center. Reestablishing blood flow to ischemic heart muscle after myocardial infarction is critical for restoring muscle function but the return of flow itself can cause damage, a so-called reperfusion injury. The generation of reactive oxygen species or ROS and loss of nitric oxide or NO both contribute to reperfusion injury.                                       Reperfusion injury is exacerbated when the NO producing enzyme, endothelial nitric oxide synthase or eNOS, produces damaging super oxide anions instead of NO. This switch in eNOS function is caused by glutathionylation of the enzyme, termed SG-eNOS. But how long this modification lasts and how it is fixed is unclear. This group used an in vitro model of ischemia reperfusion where human endothelial cells are exposed to several hours of hypoxia followed by reoxygenation. In this model, they found the level of SG-eNOS steadily increases for 16 hours and then sharply decreases. By blocking several different cellular degradation pathways, they discovered that this decrease in S-G eNOS was due to chaperone mediated autophagy with the chaperone protein, HSC70, being responsible for SG-eNOS destruction. Importantly, this team went on to show that pharmacological D-glutathionylation of eNOS in mice promoted NO production and reduced reperfusion injury, suggesting this approach may be of clinical benefit after myocardial infarction.   Cindy St. Hilaire:        The second article I want to share is titled Macrophage MST1/2 Disruption Impairs Post-Infarction Cardiac Repair via LTB4. The first author is Mingming Liu and the corresponding author is Ding Ai and they're from Tianjin Medical University. Myocardial infarction injures the heart muscle. These cells are unable to regenerate and instead a non-contractile scar forms and that fibrotic scar can lead to heart failure.                                     Cardiomyocytes specific inhibition of the kinase MST1 can prevent infarction induced death of the cells and preserve the heart function, suggesting that it may have clinical utility. However, MST1 also has anti-inflammatory properties in macrophages. So inhibition of MST1 in macrophages may delay inflammation resolution after MI and impair proper healing. Thus, targeting this enzyme for therapy is not a straightforward process. This study examined mice lacking MST1 in macrophages and found that after myocardial infarction, the inflammatory mediator leukotriene B4 was upregulated in macrophages and the animal's heart function was reduced compared to that of wild type controls. Blocking the action of leukotriene B4 in mice reduced infarction injuries in the hearts of MST1-lacking animals and enhanced repair in the injured hearts of wild type animals given an MST1 inhibitor. The results suggest that if MST1 inhibition is used as a future post infarction regenerative therapy, then leukotriene B4 blockade may prevent its inflammatory side effects.   Cindy St. Hilaire:        The next article I want to share is titled Growth Arrest Specific-6 and Axl Coordinate Inflammation and Hypertension. The first author is Justin Beusecum and the corresponding author is David Harrison and they're from Vanderbilt University. Inflammation contributes to hypertension pathology but the links of this relationship are unclear. It's thought one trigger of inflammation may be the hypertension-induced mechanical stretch of vascular endothelial cells. Mechanical stretch causes endothelial cells to release factors that convert circulating monocytes into inflammatory cells. And one such factor is the recently identified Axl and Siglec-6 positive dendritic cells, also called AS DCs.                                       AS DCs produce a large amount of inflammatory cytokines but little is known about the role of AS DCs or their cytokines in hypertension. This group found elevated levels of AS DCs in hypertensive people compared to normal tensive individuals. Mechanical stretch of human endothelial cells promoted the release of GAS6, which is an activator of the AS DC cell surface kinase, Axl. This stretch induced GAS6 release also promoted conversion of co-cultured monocytes to AS DCs. Inhibition of GAS6 or Axl in the co-cultured system prevented conversion of monocytes to AS DCs. This team went on to show that hypertensive humans and mice have elevated levels of plasma GAS6 and that blocking Axl activity in mice attenuated experimentally induced hypertension and the associated inflammation. This work highlights a new signaling pathway, driving hypertension associated inflammation and identifies possible targets to treat it.   Cindy St. Hilaire:        The last article I want to share is titled Novel Mechanisms of Exosome- Mediated Phagocytosis of Dead Cells in Injured Heart. The first author is Mallikarjun Patil and Sherin Saheera and the corresponding author is Prasanna Krishnamurthy from the University of Alabama, Birmingham. After myocardial infarction inflammation must quickly be attenuated to avoid excessive scarring and loss of muscle function. Macrophage mediated efferocytosis of dead cells is a critical part of this so-called inflammation resolution process. And resolution depends in part on the protein. MFGE8. MFGE8 helps macrophages engage with eat me signals on the dead cells and loss of macrophage MFGE8 delays inflammation resolution in mice. Because stem cell-derived exosomes promote cardiac repair after infarction and are anti-inflammatory and express MFGE8, this group hypothesized that perhaps part of a stem-cell derived exosomes proresolven activity may be due to boosting macrophage efferocytosis.                                     They showed that stem cell derived exosomes did indeed boost efferocytosis of apoptotic cardiomyocytes in vitro and in vivo. An in vitro experiments showed that if exosomes lacked MFGE8 then efferocytosis by macrophages was reduced. Furthermore, after myocardial infarction in mice, treatment with MFGE8 deficient exosomes did not reduce infarct size and did not improve heart function compared to control exosomes. These results suggest MFGE8 is important for the cardioprotective effects of stem cell-derived exosomes. And that this protein may be of interest for boosting efferocytosis after myocardial infarction and in other pathologies where inflammation is not readily resolved.   Cindy St. Hilaire         So today, Dr Elisa Klein from the Department of Biomedical Engineering at the University of Maryland is with me to discuss her study Laminar Flow on Endothelial Cells Suppresses eNOS O-GlcNAcylation to Promote eNOS Activity and this article is in our November 12th issue of Circulation Research. So Dr Klein, thank you so much for joining me today.   Elisa Klein:                 Thank you for having me.   Cindy St. Hilaire:        Yeah. So broadly your study is investigating how blood flow patterns specifically, kind of, laminar and oscillatory flow, how those blood flow patterns impact protein modifications and activity. So before we, kind of, get to the details of the paper, I was wondering if you could just introduce for us the concept of blood flow patterns, how they change in the body naturally but then how they might influence or contribute to disease pathogenesis in the vessels?   Elisa Klein:                 Sure. So obviously we have blood flow through all of our vessels and since we are complex human beings, we have complex vascular beds that turn and that split or bifurcate. And so every place we get one of these bifurcations or a turn in a vessel, the blood flow can't quite make that turn or split perfectly. So you get a little area where the flow is a oscillatory or what we call disturbed. There's lots of different kinds of disturbed flow. And the reason why that's important is because you tend to develop atherosclerotic plaques at locations where the blood flow is disturbed. So in my lab, we look a lot at what it is about that disturbed flow that makes the endothelial cells there dysfunctional and that leads to the atherosclerotic plaque development.   Cindy St. Hilaire:        That is so interesting. So I can picture how this is happening in a mouse at the bifurcation of different arteries but how are you able to model this in vitro? Can you describe the setup and then also how that setup can mirror the physiological parameters?   Elisa Klein:                 Sure. So we have a couple of different systems we can use to model this and they all have their advantages and disadvantages, right? So a few years ago we made a system that's a parallel plate flow chamber. So you basically have your cells that you see that on a microscope slide and you use a gasket that's a given shape and that either drives the flow… Usually it drives the flow straight across the cells. So that's a nice laminar steady flow. And we see that the cells align and they produce nitric oxide in that type of flow which are measures that they are responding to the flow in vitro. So, a few years ago we made a device that actually makes the flow zigzag as it goes across the endothelial cells. And that creates these little pockets of disturbed flow and we did that in our parallel plate flow chamber.                                       And that parallel plate flow chamber is really good for visualizing the cells. So you can stick it on a microscope. You can see what's happening, we can label for specific markers but it's not good for doing the things that we did in this Circ Research paper, where we want it to measure metabolism, because you need a lot more cells to measure metabolism and we needed a better media to cell ratio, so less media and more cells. So for this one, we designed and built a cone-and-plate device. So what it is, it's a cone and you spin that cone on top of a dish of endothelial cells and that cone produces flow. So it's going around in a circle. And if we just make it go around in a circle, it'll produce a steady laminar flow but if we oscillated it, so basically we kind of turn it back and forth, it'll make this oscillating disturbed flow. And then we have our dish of cells.                                     We do this in a 60-millimeter dish and then we have a small amount of media in there and a lot of cells. And we can culture the cells in there for a while.                                     Cindy St. Hilaire:        That is so neat. And so I'm assuming that then your cone system is very tuneable. You could either speed it up, slow it down or change that oscillatory rate with different, I guess, shifts of it? Elisa Klein:                 Yeah, that's exactly right. So we can do all those things. It's programmable with a motor and so we can run whatever type of flow we want. Cindy St. Hilaire:        That's great. So before your study, what was known regarding this link between hemodynamics and endothelial cell dysfunction and also endothelial cell metabolism? Because I feel like that's a really interesting space that a lot of people look at, kind of, metabolism and EC dysfunction or they just look at shear stress and EC dysfunction and you're, kind of, combining the three. So what was kind of the knowledge gap that you were hoping to investigate? Elisa Klein:                 Yeah, so we're really interested in macrovascular endothelial cell dysfunction. So this pro atherosclerotic phenotype that you can get in endothelial cells. And most of the work on endothelial cell metabolism had actually been done in the context of angiogenesis. So how much energy and how do cells get their energy to make new blood vessels? And that's more of a microvascular thing. So there was a study that came out before ours, actually, before we started this study, that was looking at how steady laminar flow could decrease endothelial cell glycolysis. And so that was after 72 hours of flow and they showed some gene expression changes at that time. Our study is shorter than that and we were still able to see a decrease in glycolysis in our cells in laminar flow. Before we started this study, no one had really looked at disturbed flow. So in the meantime, there are a few other papers that came out showing that the cells don't decrease glycolysis when they're in disturbed flow but not so much connecting them back to this function of making nitric oxide. Cindy St. Hilaire:        So we were kind of dancing to the topic of O linked N acetylglucosamine or how do you say it? Elisa Klein:                 GlcNAC. Cindy St. Hilaire:        GlcNAC? O- GlcNAC. So, O- GlcNAC is a sugar drive modification and I think it's added to Syrian and three Indian residues and proteins. Elisa Klein:                 Yup, that's right. Cindy St. Hilaire:        Okay, good. And that modification, it does help dictate a protein's function. And you were investigating the role of this moiety on endothelial nitric oxide synthase or eNOS and so what exactly does this GlcNAC do for eNOS' function and under what conditions or disease states is this modification operative? Elisa Klein:                 Yeah. So there's some really important studies from a little bit ago that showed that eNOS gets GlcNAcylated in animals with diabetes, right? So if you have constantly high sugar levels, you get this modification of eNOS. The thought was that eNOS gets GlcNAcylated at the same site where it gets phosphorylated. But a more recent study came out and said, well, maybe that's not the case but it definitely gets GlcNAcylated somewhere where it affects this phosphorylation site. So it may be near it and prevent the folding or prevent the phosphorylation site availability. So if the eNOS gets GlcNAcylated, the thought is that it can't get phosphorylated and therefore it can't make nitric oxide. Cindy St. Hilaire:        And so an interesting thing about this GlcNAcylation, which is probably the hardest thing I've ever said on this podcast, is that it's integrated with lots of different things. Obviously you need glycolysis and the substrates from the breakdown of sugars to make that substrate but also the enzymes that make that substrate are required. And so what's known about that balance in endothelial cells? Is there much known regarding the metabolic rate of the cells and this N-Glcynation? Elisa Klein:                 Yeah. So endothelial cells are thought to be highly glycolytic in terms of how they use glucose but they definitely take up glutamine to fuel the tricarboxylic acid or TCA cycle. And another paper came out a few years ago showing that quiescent and endothelial cells metabolize a lot of fatty acids. So they're fueling their energy needs that way. So there wasn't a lot known about GlcNAcylation in endothelial cells.                                     A lot of this work has been done in cancer cells, which are also highly glycolytic but their metabolism actually seems like it's maybe more diverse than people have thought for a long time. So the weird thing about GlcNAcylation, which if you're used to working with phosphorylation there's a thousand different enzymes that can phosphorolate right. But with GlcNAcylation there's one enzyme that's known to put the GlcNAC on and one enzyme that's known to take it off. And so they're global, right? So in our studies, if we say, okay, we're going to knock down that enzyme, you're effecting every single protein in the cell that's GlcNAcylated. And obviously ourselves in particular, we're not a big fan of that. Especially once you put them in flow, they were, like, nope, we're not going to make it. Cindy St. Hilaire:        Well, and that's a perfect segue to my next question because your results show that this flow really did not alter the expression of these enzymes that either add or subtract to the moiety. And rather it was the Hexosamine Biosynthetic Pathway that was decreased itself. So can you maybe give us a quick primer on what that is exactly and how that pathway feeds into the glycosylation... I think you wrote in the paper of over 4,000 proteins? So how would that fit in and why eNOS then? Elisa Klein:                 Yeah, so the Hexosamine Biosynthetic Pathway is one of these branch pathways that comes off glycolysis and there are these numbers sometimes there are these pathways out there and people say for the HBP in particular, 2% to 5% of the glucose that's going down through glycolysis gets shunted off into the HBP. We've done a lot of looking to try and figure out exactly where that 2% to 5%- Cindy St. Hilaire:        Yeah, what exact percentage? Elisa Klein:                 Yeah, but some percentage of it comes down and we really thought there were going to be changes in these enzymes that do the GlcNacylation, we thought there might be changes in the localization of the proteins and it's possible that those things do occur. We just couldn't detect them in our cells. And in the end, what we showed was the main thing was that when you have cells and steady laminar flow, you just decreased glycolysis. And therefore, that 2% to 5% goes down. So you seem to make less of this UDP- GlcNAC, which is the substrate that gets put on to eNOS in this case. The really strange thing that we could not explain despite a lot of work and obviously we don't get to put all of our experiments that didn't work in the paper- Cindy St. Hilaire:        The blood, sweat and tears gets left out. So- Elisa Klein:                 Exactly. So we tried really hard to figure out why it was eNOS specifically, right? Because in steady laminar flow, you see a lot of these like GlcNAcylated  proteins and a lot of them didn't change but eNOS changed hugely, essentially this GlcNAcylation just went away for the cells and steady laminar flow. So we couldn't quite answer that. We're still working on that part of the question and looking at some of the other proteins that maybe get GlcNAcylated more in this case and trying to figure out what they are. Cindy St. Hilaire:        I thought one of the cool results in your paper was one of the last ones. It was the one in healthy mice. In that you looked at healthy mice, just normal C57 black 6 mice that were 10 weeks old. So they just, kind of, reached maturity but you looked at their kind of these bifurcations and you looked at the inner aortic arch where there is more disturbed flow and you saw, similar to your in vitro studies, that there was this higher level of O-GlcNAcylation compared to the outer arch in the descending order. So my question is, these are healthy mice that are relatively young, they're not even full adults yet. That takes a couple more months. And so what are your thoughts about the role of this O-GlcNAcylation specifically on eNOS in driving atherogenesis. Where do you think this is happening in the disease process? It appears if it's in these wild type mice, it's already happening early. So where do you think this is most operative in the disease pathogenesis? Elisa Klein:                 I mean, I think it's very early, the effects of disturbed flow on endothelial cells. I can't imagine that there's a time when it's not having an effect on the cells. So I teach college students and I tell them all the time you think you're invincible now but these choices you're making today are going to affect your cardiovascular future in 50 years, which is very hard to accept. So I think it's very early in the process and I think it's only made worse by the things that we eat, in particular, that changed our blood sugar and our blood fatty acids and things like that. And our lab is looking into this more to try and see how when you change your blood metabolites then how does that then also affect this GlcNAcylation and the endothelial cell metabolism and then how does that affect endothelial cell function? Cindy St. Hilaire:        Yeah. And it's funny, it's really making me think of those, kinds of, extreme diets like keto diets and things like that where you're just like depleting sugar. And obviously there's lots of controversy in that field, but if you just think about the sugar aspect what is that doing to those EC cells? Why do you think endothelial cells have this response? Meaning why do you think it is that they've adapted to induce a metabolic shift in response to disturbed flow? Because, obviously it's not going to be perfect laminar flow everywhere. So what do you think it is that provides some sort of advantage in the shift? Elisa Klein:                 That's a really good question. I haven't thought about the advantage that it might provide. There are a lot of things that are going on in this area of disturbed flow. So there is the shear stress, the differential shear stress that the cells are experiencing. There's also transport issues, right? So if you have this area of disturbed flow, you have blood and the contents of the blood, including the white blood cells and the red blood cells, everything else that's, kind of, sitting around in that area and not getting washed downstream as quickly. So it is possible that maintaining glycolysis provides energy for repair or for protecting the endothelial cell from some sort of inflammatory insult or something like that, that's happening in the area of disturbed flow. And I feel like I just read something recently, it was in a different genre but... if they stopped the increased glycolysis or stop the metabolic shifts, it actually was worse.                                     Right? So I also believe that we treat humans for a single metabolic change, right? So if you have diabetes, I'm going to give you this drug and if you have high triglycerides, I'm going to give you this drug. But it's possible that if you have this metabolic abnormality, your body shifts the rest of your metabolism to protect the cells because of that metabolic abnormality. And so part of what we do as engineers is try and build computational models or we can take into account some of this complexity. So that's a really interesting question and my guess is that there are some protective aspects of this maintenance of high glycolysis and disturbed flow. Cindy St. Hilaire:        Yeah, maybe it would be perfectly fine until we get athero and then it all goes awry. So in terms of... obviously it's early days and I know you're a bioengineer but in terms of translational potential, what do you think your findings suggest about future potential therapies or future targets for which we can use to develop therapies? Is modulating this O-GlcNAcylation itself, a viable option? Elisa Klein:                 I don't think that modulating it is a super viable option, right? Because as I said, when we tried to change those enzymes ourselves did not enjoy going through flow or anything else. So it's very hard to change it overall. What I think is these things that are coming out about how metabolism may shift for endothelial cells when they're activated versus when they're quiescent, right? So when laminar flow or cells are quiescent, they decrease glycolysis, they increase fatty acid oxidation. Those things are important to take into consideration when you are treating a person who has a metabolic disorder. So that's the biggest translational piece that I think is, how do we give therapies that modify the metabolism of a cell holistically instead of trying to hit one pathway in particular.                                     We have done some studies where we tried to give endothelial cells something to inhibit a specific metabolic pathway and you see the cell shifts its entire metabolism to account for that. So we're starting to look at some of these other drugs like statins or metformin that do change endothelial cell metabolism, possibly even the SGLT2 inhibitors and trying to see not just how they change glycolysis but how they change metabolism as a whole and how that then affects endothelial cell function. Cindy St. Hilaire:        So what are you going to do next on this project? Elisa Klein:                 So on this project, so we have some stuff in the works like I said on statins and how statins work together. And one of our big goals is to sort of build a comprehensive metabolic model of the endothelial cell. So this study really focused on glucose but there are other things that endothelial cells metabolize, glutamine, and fatty acids, and trying to look at some of those and then seeing how changes in the glycolytic pathway may affect some of those other pathways. We also have some really nice mass spec data part of which is in this paper but part of which is going to go into our next work, which is looking at how laminar flow impacts some of the other side branch pathways that are in metabolism and coming off of glycolysis as well as the TCA cycle, right? So we don't think of endothelial cells as being big mitochondrial energy producers but they do use their mitochondria. And so we think it's really interesting and part of our goal of building an endothelial cell model and then hopefully a model of the complexity of the whole vascular wall. Cindy St. Hilaire:        Wow. That would be amazing. Well, Dr Elisa Klein from the University of Maryland, thank you so much for joining me today. This is an amazing study and I'm looking forward to seeing hopefully more of your future work. Elisa Klein:                 Thank you so much. It was a pleasure. Cindy St. Hilaire:        That's it for the highlights the from October 29th and November 12th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @CircRes or #DiscoverCircRes. Thank you to our guest, Dr Elisa Klein. This podcast is produced by Asahara Ratnayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy texts for highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire, and this is Discover CircRes, your on-the-go source for the most exciting discoveries and basic cardiovascular research. This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers on this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, visit AHAjournals.org.

The Whole Health Cure
"Shared Medical Appointments" with Jacob Mirsky, MD

The Whole Health Cure

Play Episode Listen Later Nov 15, 2021 34:41


Jacob Mirsky, MD, MA is a primary care physician at the Massachusetts General Hospital Revere HealthCare Center and a consultation physician at the Benson-Henry Institute for Mind Body Medicine. Dr. Mirsky attended medical school at the University of California San Francisco and completed residency in internal medicine at the Brigham and Women's Hospital in Boston as part of the Harvard Vanguard Medical Associates primary care track. In addition to his primary care practice, he leads virtual group visits (also called shared medical appointments) in primary care focused on healthy lifestyle change for symptom management and disease prevention. He helped open the MGH Revere Food Pantry in 2019, which provides free plant-based foods to patients with food insecurity, and he currently serves as its Medical Director. Dr. Mirsky also founded and is the Medical Director of the Division of General Internal Medicine Healthy Lifestyle Program (HLP). The HLP has a mission to establish healthy lifestyle change as the standard of care for preventing and treating chronic disease.In this conversation Dr. Mirsky talks about the idea, background and concept of shared medical appointments, also called group visits. Dr. Mirsky discusses the benefits of group visits for both - the patient and the provider - especially for managing and reversing conditions like hypertension, type II diabetes, and helping with weightloss through lifestyle medicine. He touches on how it enhances patient experience, allowing them more time with provider and building a support group; and contributes to physician satisfaction potentially counteracting burnout. Tune in to learn more about the evolution of the program and the success stories of patients who participate!To learn more, please visit:Website: https://www.massgeneral.org/medicine/internal-medicine/healthy-lifestyle-programTwitter: @DrJacobMirsky Emory Lifestyle Medicine invites you to join our upcoming virtual holiday cooking class on Friday, November 19 ar 12pm EST! Learn more of register HERE.Leave a review for our show on your favorite podcast platform, and get a chance to win a free admission to the class! Please send email to krystyna.rastorguieva@emoryhealthcare.org after you leave the review, to enter the raffle! We thank you for your support and value your feedback! This podcast is brought to you by Emory Lifestyle Medicine & Wellness. To learn more about our work, please visithttps://bit.ly/EmoryLM

The Doctor Is In Podcast
718. Sleep Apnea, Hypertension & Leaky Gut

The Doctor Is In Podcast

Play Episode Listen Later Nov 11, 2021 27:13


Dr. Martin pontificates on sleep apnea, hypertension and their connection to leaky gut in today's episode. He reviews a recent study by the Journal of Clinical Sleep Medicine.  

She Found Motherhood podcast
Hypertensive Disorders of Pregnancy

She Found Motherhood podcast

Play Episode Listen Later Nov 10, 2021 18:56


Hypertension is the fancy word for high blood pressure, a common condition where the long-term force of the blood against your artery walls is strong enough that it may cause health problems. Hypertensive disorders of pregnancy are health issues associated with high blood pressure in pregnancy, and they are the leading cause of maternal death due to long-term health complications, such as cardiovascular disease. They can also impact the health & safety of the developing fetus. Listen to today's podcast to learn more about the main types of hypertensive disorders of pregnancy, how they are diagnosed, treated, and how they might be prevented! Are you ready to optimize your preconception health?  Click here to grab our FREE Preparing for Pregnancy Guide!

CCO Infectious Disease Podcast
Should We Screen Patients With HIV for NAFLD/NASH?

CCO Infectious Disease Podcast

Play Episode Listen Later Nov 10, 2021 7:24


In this episode, hepatologist Giada Sebastiani, MD, discusses why the presence of obesity, metabolic syndrome, persistent elevation of ALT, or exposure to dideoxynucleoside analogues can trigger an evaluation for NAFLD and NASH, particularly in our aging population of patients with HIV with topics including:Metabolic factors  HIV-related factorsWhich patients with HIV are at riskPresenter:Giada Sebastiani, MDAssociate Professor of MedicineMcGill University Health CentreDivision of Gastroenterology and Hepatology and Division of Infectious DiseasesClinician ScientistResearch Institute of McGill University Health CentreMontreal, Quebec, CanadaContent based on an online CME program supported by an educational grant from Theratechnologies Inc.Link to full program: https://bit.ly/3BYoXBP

Cardionerds
159. ACHD: Coarctation of the Aorta with Dr. Ari Cedars

Cardionerds

Play Episode Listen Later Nov 10, 2021 43:45


CardioNerds (Amit Goyal and Daniel Ambinder),  ACHD series co-chair Dr. Agnes Koczo (UPMC), and episode FIT lead, Dr. Natasha Wolfe (Washington University) join Dr. Ari Cedars   (Director of the Adult Congenital Heart Disease Program at Johns Hopkins) for a discussion about coarctation of the aorta.   In this episode we discuss the presentation and management of unrepaired and repaired coarctation of the aorta in adults. We discuss the unique underlying congenital anatomy of coarctation and how that impacts physiology, clinical presentation, and diagnostic findings. We discuss the importance of long-term routine follow-up and screening of patients (including those who have been “repaired”) for common complications such as hypertension, re-coarctation, and aneurysm development. We end with a discussion of treatment options for coarctation and its complications. Audio editing by CardioNerds Academy Intern, Dr. Maryam Barkhordarian. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Claim free CME for enjoying this episode! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Coarctation of the aorta can occur as a discrete stenosis or as a long and hypoplastic hypoplastic aortic arch segment. Most commonly it is a discrete stenosis located at the insertion site of the ductus arteriosus just distal to the left subclavian artery.Three quarters of patients with coarctation of the aorta also have a bicuspid aortic valve.Hypertension is the most common long-term complication of coarctation of the aorta, whether repaired or unrepaired. Unrepaired coarctation is a rare cause of secondary hypertension in young adults with a difference in upper extremity and lower extremity BP by ≥ 20 mmHg. Systemic hypertension may not be consistently identifiable at rest in those with repaired coarctation, thus guidelines recommend ambulatory blood pressure monitoring or stress testing to identify hypertension with exertion.Chest and brain imaging via CT or MRI should be done every 5-10 years to screen for other long-term complications including re-coarctation (rate ~11%), aortic aneurysm development (higher risk in those with concurrent bicuspid aortic valve), pseudoaneurysm, aortic dissection, and cerebral aneurysms.Repair of coarctation or re-coarctation is indicated for patients who are hypertensive with a BP gradient ≥ 20 mmHg (Class I recommendation). Catheter-based stenting is the preferred approach when technically feasible. Show notes 1. What is the proposed embryologic origin of coarctation of the aorta? The aortic arch and its branches develop at 6-8 weeks fetal gestation. We all start with six aortic arches that go on to become the great arteries of the head and neck. The 4th arch forms the thoracic aortic arch and isthmus. The 6th arch persists as the proximal pulmonary arteries and ductus arteriosus. Thoracic aortic coarctation is therefore a manifestation of abnormal embryologic development of the 4th and 6th arches.There are two main theories regarding how aortic coarctation occurs.

UF Health Podcasts
Feline hypertension may be hiding in plain sight

UF Health Podcasts

Play Episode Listen Later Nov 9, 2021


Hypertension — or consistently high blood pressure — is a common problem in older…

Rheumnow Podcast
ACR2021 - Day2b

Rheumnow Podcast

Play Episode Listen Later Nov 8, 2021 29:12


Hypertension in AS: Drs. Swetha Ann Alexander and Jean Liew Depression in Axial Spondyloarthritis: Dr. Mrinalini Dey Predictors of mortality in RA lung disease? Dr. Meral El Ramahi An Exclusive Interview with Dr. Al Kim (#Wowkim): Dr. Kaythryn Dao Dr. Eric Dein: Can we Use Frax Score in RA Patients?

The 5 Minute Discipleship Podcast
#447: Is Your Soul Weary?

The 5 Minute Discipleship Podcast

Play Episode Listen Later Nov 6, 2021 5:47


Episode 447 - Show NotesWhen you open your Bible from the beginning, the very first thing we see God do is work. He is doing the work of creation, but the second thing God does is rest. He rests from his labor. I truly believe that from the earliest pages of scripture God is setting for us an example.While rest for our physical bodies is essential, the Bible talks about another kind of rest, one that God offers us. It is rest for our soul.What a powerful call this is! Jesus calls all of us who are carrying heavy burdens to come to him. Today if you are weary you can come to Jesus. If you feels as if you can't take it anymore, you can come to Jesus.What does Jesus offer us? He says he will give us rest for our souls. Doesn't that sound good to you? Would you like to experience rest for your weary soul? Are you tired of being overwhelmed by the cares of this life? Are you weary with the stress, anxiety, worry, and fear? In the presence of Jesus there is a deep rest for your soul.I'm convinced we carry burdens we have no business carrying. I suppose it's our human tendency to take on more than we can carry. We fight battles we shouldn't fight. We live with high levels of stress, pressure, and anxiety.  Hypertension, high blood pressure, panic attacks, and burnout are all too common in today's culture.When Jesus says he will give us rest for our soul, he is saying there is a divine rest for our inner life, the emotional part of us.  There is a God-given rest for the part of you that is afraid, anxious, worried, and stressed out. There is a peace for your soul that calms the storm within.This rest is received when we make a decision to trust him. Will you trust Jesus with the things that cause you to be anxious? I once hears someone say, “the truest sign of faith is rest.” Our faith is demonstrated when we can trust God with our needs and simply rest in belief that he will take care of everything.Matthew 11:28-29 - “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.”Psalm 62:1 - “Truly my soul finds rest in God; my salvation comes from him.”1 Peter 5:7 says, “Cast your anxieties on me, for I care for you.”5MinuteDiscipleship.comThe 5 Minute Discipleship Journal

Priorité santé
Priorité santé - Prendre soin de son cœur

Priorité santé

Play Episode Listen Later Nov 4, 2021 48:30


Hypertension artérielle, insuffisance cardiaque, infarctus, AVC… Les maladies cardiovasculaires sont la première cause de mortalité dans le monde : elles provoquent plus de décès que toute autre affection. Alors, comment préserver son cœur et ses artères ? Quelle est l'importance de l'alimentation et de la lutte contre la sédentarité pour prévenir ces maladies ? Comment reconnaître les signes qui doivent alerter ? Avec : Dr Jacques Fricker, médecin nutritionniste. Co-auteur de l'ouvrage « Prenez votre cœur à cœur », aux éditions Odile Jacob Dr Patrick Assyag, cardiologue en libéral, praticien attaché à l'Hôpital Saint-Antoine à Paris. Président du Syndicat des cardiologues de la Région Parisienne. Ancien président de la Fédération française de cardiologie. Co-auteur de l'ouvrage « Prenez votre cœur à cœur », aux éditions Odile Jacob Pr Roland N'Guetta, cardiologue interventionnel. Chef du service des Urgences et de Cardiologie interventionnelle à l'Institut de Cardiologie d'Abidjan. Président du Groupe de Recherche et d'Actions contre les Maladies cardiovasculaires en Côte d'Ivoire (GRAM). En fin d'émission, nous retrouvons la chronique sexualité du Dr Catherine Solano, sexologue. Rediffusion   

One Small Bite
End the War on Sodium and Still Lower Your Blood Pressure

One Small Bite

Play Episode Listen Later Nov 3, 2021 52:12


Hola amigos! Welcome back!The recommendations to lower sodium or salt in food is promoted as a personal responsibility. Is that fair? What does the research really say?Highlights of this episode:Sodium Controversy Jeff's StoryAlexithymia Sleep and High Blood PressureNovember is Men's Health Awareness Month  David's personal connection to this observance is from his father, who suffered from hypertension, high cholesterol, heart attack, stroke, and severe digestive bleed. His father passed away in 2016 due to prostate cancer. References: 2009 Review: A comprehensive review on salt and health and current experience of worldwide salt reduction programmes2013 Review: Effect of lower sodium intake on health: systematic review and meta-analysesThe DASH Diet, 20 Years LaterSleep and Cardiovascular DiseaseWhere do I go from here?Listener Feedback Survey is still open!  Click here to give your feedback.  Four lucky participants will be randomly selected to receive a $25 gift card to Amazon.com!David's book releases next year. It focuses on real clients, heroes and sheroes, that took one small bite towards their health that improved energy, mood, or sleep. The website has a sign-up sheet to launch a feedback group prior to publishing!Podcast StuffIf you like this episode, then download the show wherever you listen to your podcasts at Apple, Spotify, Stitcher, Google, iHeartRadio, Castbox, etc!Hit that subscribe button so you won't miss another episode. Big Ask: Leave a Review! Please, take a few minutes and leave me a review on your podcast app. Each review helps other listeners find the podcast, which provides me with the ability to continue bring you unique content. So spread the love. Loss for words? Just write what you like about the show.Share the show with friends.Nutrition Consulting If you want to work with us, schedule an appointment or a free 15-minute discovery call. Explore our website and click Schedule an Appointment. Or, reach us by email info@orozconutrition.com or phone 678-568-4717. Once again, I greatly appreciate you for listening and supporting my show. Remember, it really only takes One Small Bite to start transforming your life. Chop the diet mentality; Fuel Your Body; and Nourish Your Soul!

Wellness Evidence-Based Medicine
Hypertension...what does it mean and why is it important?

Wellness Evidence-Based Medicine

Play Episode Listen Later Nov 1, 2021 11:08


Dr. Safdi and Dr. Renner discuss hypertenison and why it is an important health issue.

CEimpact Podcast
Blood Pressure Goals in the Elderly

CEimpact Podcast

Play Episode Listen Later Nov 1, 2021 27:02


Hypertension is often managed by treating to a target blood pressure goal. But what if this is wrong? A recent meta-analysis found benefits of blood pressure lowering regardless of age. Host Geoff Wall is joined by Lindsay Davis, a cardiovascular pharmacist and educator, to make heads or tails of this article.Redeem your CPE or CME credit here! Claim CPE CreditClaim CME CreditNeed a membership?Join here for CPE CreditJoin here for CME CreditReferences and resources: Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021 Sep 18;398(10305):1053-1064. doi: 10.1016/S0140-6736(21)01921-8. Epub 2021 Aug 27. PMID: 34461040.Continuing Education Information:Learning Objectives: 1. Describe the methodology of a recent meta-analysis on blood pressure2. Identify appropriate blood pressure targets for patients regardless of age0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-21-359-H01-PInitial release date: 11/01/21Expiration date: 11/01/22Complete CPE & CME details can be found here!

One Small Bite
7 Warning Signs Diets Don't Work - Friday Food Cast

One Small Bite

Play Episode Listen Later Oct 29, 2021 21:55


Hola amigos! Welcome back!It's a trap! Tune-in for a rundown of why diets do not work. There is a better way to get what you want. Highlights of this episode:Diets are…unsustainable behaviors unscientific, no evidenceunrealistic promisescrazy extremes supplements can be harmfulendorsements, not evidencefeelings of increased desiresAnnouncements:In-person, individualized nutrition consultations and telehealth is available at Orozco Nutrition. Listener Feedback Survey is still open!  Click here to give your feedback.  Four lucky participants will be randomly selected to receive a $25 gift card to Amazon.com!David's book releases next year. It focuses on real clients, heroes and sheroes, that took one small bite towards their health that improved energy, mood, or sleep. The website has a sign-up sheet to launch a feedback group prior to publishing!David just joined Clubhouse, a new social media connection tool.Coming soon: newsletter, swag, and events!November is Men's Health Month! Hero Nathanial is introduced. Hypertension, high cholesterol, and men's eating patterns. Where do I go from here?Check out the website for show notes and to sign up for our weekly newsletter.If you like this episode, then download the show wherever you listen to your podcasts at Apple, Spotify, Stitcher, Google, iHeartRadio, Castbox, etc!Hit that subscribe button so you won't miss another episode. Big Ask: Leave a Review! Please, take a few minutes and leave me a review on your podcast app. Each review helps other listeners find the podcast, which provides me with the ability to continue bring you unique content. So spread the love. Loss for words? Just write what you like about the show.Share the show with friends.If you want to work with us, schedule an appointment or a free 15 minute discovery call. Explore our website and click Schedule an Appointment. Or, reach us by email info@orozconutrition.com or phone 678-568-4717.Once again, I greatly appreciate you for listening and supporting my show. Remember, it really only takes One Small Bite to start transforming your life. Chop the diet mentality; Fuel Your Body; and Nourish Your Soul!

The Curbsiders Internal Medicine Podcast
#301 LIVE! Top Pearls 2021: A Rapid Fire Review of Systems

The Curbsiders Internal Medicine Podcast

Play Episode Listen Later Oct 25, 2021 75:10


Join us for this rapid fire review of systems featuring our top pearls and articles LIVE! from the TriService ACP conference. Matt and Paul serve up their favorite practice changing knowledge food on antibiotics, MRSA, hair loss, dementia, seizures, diabetes, medications for hypertension, foods for constipation, diverticulitis, colon cancer screening, colon polyps, chronic sinusitis, chronic cough, treatment of uterine bleeding, and more!  No CME for this episode, but check out curbsiders.vcuhealth.org for past CME offerings! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Matthew Watto MD, FACP; Paul Williams MD, FACP    Cover Art: Sawyer Watto Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: BetterHelp Get 10% off your first month at betterhelp.com/curb.         Sponsor: ACP's National Internal Medicine Day Help the American College of Physicians celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD2021 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtag #NationalInternalMedicineDay. CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Show Segments Intro, disclaimer ID: Shorter is better; MRSA swabs; Antibiotics for diverticulitis Endo: Prediabetes in older adults,  MSK: Knee OA, orthopedic surgery Derm: Alopecia Neuro: Seizures, dementia quick typing Cardio: Coffee and arrhythmias; Hypertension management, ACEi vs ARBs Respiratory: Chronic cough and sinusitis GI: CRC screening, foods for constipation GU: treatment of uterine bleeding Addiction Medicine: smoking cessation, buprenorphine Outro

The Cribsiders
36. Off the Cuff - Managing Pediatric Hypertension in Your Primary Care Clinic

The Cribsiders

Play Episode Listen Later Oct 13, 2021 62:14


This episode on Pediatric Hypertension features a heart racing conversation with our guest, Dr. Carissa Baker Smith - a preventive and transplant pediatric cardiologist who serves as the director of the Nemours Preventive Cardiology Program. She also serves as the chair of the Atherosclerosis Hypertension and Obesity of the Young Subcommittee of the American Heart Association Cardiovascular Disease. You'll want to take off your white coat and sit with your feet firmly planted for this conversation about pediatric hypertension. We will review screening guidelines for blood pressure, initial work up and eventual treatment of hypertension in kids.