Podcasts about BMI

CardioNerds (Dr. Jenna Skowronski [Heart Failure Council Chair], Dr. Shazli Khan, and Dr. Josh Longinow) are joined by renowned leaders in the field of AHFTC (Advanced Heart Failure and Transplant Cardiology) and mechanical circulatory support, Dr. Jeff Teuteberg and Dr. Mani Daneshmand to continue the discussion of advanced heart failure therapies by taking a deep dive into the world of durable LVADs (Left Ventricular Assist Devices). In this episode, we will review the history of ventricular assist devices, the basics of LVAD function, selection criteria for LVAD therapy, and surgical nuances of LVAD implantation. Audio Editing by CardioNerds intern, Joshua Khorsandi. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls There have been significant advances in the field of MCS/LVAD therapy since the first implanted LVAD in the 1960s, to the first FDA approved device in the early 2000's, to now the HM3 LVAD, with the most important change being a centrifugal flow/magnetically levitated design that led to minimized hemocompatibility-related adverse events (HRAE's) (MOMENTUM 3 trial comparing HM2 and HM3).  The REMATCH trial in 2001 was a pivotal trial for LVAD therapy, demonstrating that in a population of patients with advanced HF (70% IV inotrope dependent), LVAD therapy significantly improved survival at both 1 and 2 years as compared to medical therapy alone.    MOMENTUM 3 trial was a landmark trial for the HM3 device, showing that in a population of end stage HF patients (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.  There are both patient-specific factors and surgical considerations when it comes to candidacy for LVAD therapy.  RV function prior to LVAD is a key determinant for success post-LVAD  Many patients being considered for LVAD may not have robust RV function, however, predicting RV failure after LVAD is exceedingly difficult.   In general, it doesn’t matter how bad the RV may look on imaging; we care more about the pre-LVAD hemodynamics (look at the PAPi and RA/wedge ratio).   What happens in the OR may be the most important determinant of how the RV will do with the LVAD!  Notes Notes drafted by Dr. Josh Longinow.  1. Historical background of heart pumps and LVADs  LVAD Evolution   FDA approval year  2001  2008  2012  2017  Pump  HeartMate XVE   HeartMate II  Heartware HVAD  HeartMate III  Flow/Design Features  Pulsatile Technology   Continuous flow Axial design  Continuous flow  Centrifugal design  Continuous flow   Full MagLev + Centrifugal design  The 1960's ushered in the first ‘LVADs', when the first air-powered ‘LVAD' was implanted. It kept the patient alive for four days before the patient expired.   The first generation of LVADs were pulsatile pumps   The first nationally recognized, FDA approved LVAD was the HeartMate XVE (late 1990s to early 2000s, REMATCH trial). The XVE pump used compressed air (pneumatically driven) to power the pump.   Prior to the XVE, OHT was the standard of care for patients with advanced, end-stage heart failure.   The second and third generations of LVADs were non-pulsatile, continuous flow devices and included the HVAD, HM2, and HM3 devices.   MOMENTUM 3 was a landmark trial for the HM3 device, showing that in a population of sick patients with end stage HF (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.   The only pump that is currently FDA approved for implant is the HM3, although other pumps are in clinical trials (BrioVAD system, INNOVATE Trial).  2. What are LVADs, and how do they work?   In simplest terms, the LVAD is a heart pump comprised of several key mechanistic components:   Inflow cannula  Mechanical pump   Outflow cannula  Driveline  Controller/Power source  The HM3 differs from its predecessors (HM2 and HVAD) in several key ways;   HM3 is placed intrapericardial whereas the HM2 was placed pre-peritoneal.   Perhaps most importantly, the HM3 is a fully magnetically levitated, centrifugal flow pump, whereas the HM2 is an axial flow device.  Axial flow pumps are not magnetically levitated, leading to more friction produced between the ruby bearing's contact with the pump rotors, and higher rates of hemocompatibility related adverse events (HRAEs, i.e. pump thrombosis) and the HM2 was ultimately discontinued in favor of the HM3 (MOMENTUM 3 trial).  3. What do the terms ‘Destination Therapy' (DT) or ‘Bridge to Transplant' (BTT) mean when it comes to LVADs?   When LVADs first came on the stage, EVERYONE was a BTT; these early pumps weren't designed for long term use (I.e. REMATCH Trial, Heartmate XVE)  Destination therapy means the LVAD was placed in leu of transplant because there are contraindications to transplant   REMATCH trial brought about the concept of “Destination therapy”, comparing outcomes in patients (with contraindications for transplant) who received an LVAD vs optimal medical therapy  Bridge to transplant means we are placing the LVAD in a patient who may not be a transplant candidate at this moment in time (is too sick, or conversely, not sick enough), but may be down the line   Bridge to recovery is another term used when the LVAD is being placed for a patient we think may have a recoverable cardiomyopathy  4. What are some factors we should consider when assessing a patient’s candidacy for LVAD, in general, and from a surgical perspective?   Patient factors   Older age might push us towards thinking LVAD rather than transplant  In general, age > 70 is the cutoff for transplant, but this is not a hard cut off and varies institution to institution    In general, think about things that help predict recovery after a major surgery; Frailty and Nutritional status are important, we try to optimize these prior to LVAD implant   Right ventricular function remains the Achilles heel of LV support  We know that needing temporary RV support post LVAD puts you on a different survival curve than patients who don’t need RVAD support  Studies have not been able to successfully predict who will develop RV failure after LVAD implantation  What happens in the time between when the patient goes to the OR and when they get back to the ICU is an important determinant who might develop RV failure post LVAD   Surgical techniques such as implanting the HM3 in the intra-thoracic cavity, rather than intra-pericardial may help maintain LV/RV geometry to help optimize the RV post LVAD   Surgical considerations for LVAD candidacy  Small, hypertrophied LV: HM3 inflow cannula is small, but small hypertrophied ventricles tend towards chamber collapse during systole causing suction, needing to run slower with lower flow rates  Chest size/diameter: pumps have gotten so small now, that for adults, these have become less of a consideration  BMI: low BMI used to be more of a concern with the older pumps due to where they were placed, and the relative size of the pump itself, not so much now with the smaller HM 3 pumps  Calcified LV apex: would increase risk of stroke, bleeding   Driveline tunneling becomes a concern in the super obese population, higher risk for driveline infections (might tunnel these driveline's shorter, and to a less fatty region of the abdomen, could even tunnel out the thoracic cavity in the super obese to limit skin motion)    5. Is there a role for MCS (i.e. temporary LVAD such as Impella) in pre-habilitation of patients prior to LVAD surgery?   The theory of being able to improve systemic perfusion, decongest the organs, and make the patient feel better prior to surgery makes sense, but becomes problematic due to the lack of a hard end point/time for prehabilitation which might risk delays in surgery   More likely that it can lead to delay in the surgery, with less-than-optimal benefit; you don't want to prolong the wait for surgery and increase the risk for complications prior to surgery    An Impella 5.5 is currently FDA approved for 2 weeks of support, not 2 months so timing is important to keep in mind  It’s unlikely that you will take a patient and convert them from a malnourished, cachectic person in 2 weeks’ time   6. Is there a role for LVAD therapy in the younger patient population? Should we be thinking of LVAD up front for these patients, with the goal of transplanting down the line?   Recovery may be more likely in certain populations, particularly younger females with smaller LV's; in those populations, perhaps bridge to recovery should be the focus, optimizing them on GDMT etc.   The replacement of transplant, with MCS (LVAD) in young patients has become a topic of discussion, because these pumps have become better and better, with the thinking that an LVAD could bridge a patient for 10 years or so, and they could get a transplant later   It is still a big unknown, but several concerns exist  Patients who get LVADs might end up with complications that become contraindication to transplant down the line (stroke, sensitization etc)   Patients and providers are more hesitant because of the more recent iteration for the UNOS criteria for OHT listing which no longer gives patients with an uncomplicated LVAD higher priority, and therefore they could end up waiting a longer time for a heart after undergoing LVAD  References Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443. doi:10.1056/NEJMoa012175  Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019;380(17):1618-1627. doi:10.1056/NEJMoa1900486  Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol. 2015;65(23):2542-2555. doi:10.1016/j.jacc.2015.04.039  Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233-1242. doi:10.1001/jama.2022.16197  Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67(3):723-730. doi:10.1016/s0003-4975(99)00042-9  Kittleson MM, Shah P, Lala A, et al. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: A report from the REVIVAL Registry. J Heart Lung Transplant. 2020;39(1):16-26. doi:10.1016/j.healun.2019.08.017  Mehra MR, Netuka I, Uriel N, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023;330(22):2171-2181. doi:10.1001/jama.2023.23204  Mehra MR, Nayak A, Morris AA, et al. Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device. JACC Heart Fail. 2022;10(12):948-959. doi:10.1016/j.jchf.2022.08.002  Bhardwaj A, Salas de Armas IA, Bergeron A, et al. Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella. ASAIO J. 2024;70(8):661-666. doi:10.1097/MAT.0000000000002170 

Nutrition Nugget! Bite-sized bonus episodes offer tips, tricks and approachable science. This week, Jenn is talking about zero-calorie drinks and whether they are really the guilt-free option we have been led to believe. A well-known Copenhagen study compared four groups of people who drank a liter a day of regular soda, diet soda, milk, or water for six months, and the results were surprising enough to stop anyone mid-sip. Could a beverage with absolutely no calories still be working against your blood sugar, waistline and your metabolism? What do your gut, your pancreas, and even your taste buds have to do with it? Jenn digs into the science, questions the study's details, and shares what she has seen play out in real life with herself and her clients for years. But before you toss your diet soda or defend it to the end, you should hear what Jenn has to say about who this affects, why, and whether the calorie count on the label is telling you anywhere near the whole story. Like what you're hearing? Be sure to check out the full-length episodes of new releases every Wednesday. Have an idea for a nutrition nugget? Submit it here: https://asaladwithasideoffries.com/index.php/contact/ RESOURCES:Become a Happy Healthy Hub MemberJenn's Free Menu PlanA Salad With a Side of FriesA Salad With A Side Of Fries MerchA Salad With a Side of Fries InstagramNutrition Nugget: IQ MixCopenhagen StudyKEYWORDS: Jenn Trepeck, Nutrition Nugget, Salad With A Side Of Fries, Health Tips, Wellness Tips, Zero Calorie Drinks, Diet Soda, Artificial Sweeteners, Aspartame, Insulin Response, Blood Sugar, Weight Gain, Gut Microbiome, Metabolic Health, Calorie Counting, Sugar Cravings, Glucagon, Pancreas, Glucose, Fat Burning, Gut Bacteria, Sweet Taste Addiction, Copenhagen Study, American Journal of Clinical Nutrition, Diet Cola, Regular Soda, Sugar Soda, Milk, Water Intake, BMI, Non-Diabetic Subjects, Weight Loss, Caloric Beverages, Nutrition Research, Food Cravings, Hormones, Insulin Levels, Blood Pressure, Overweight, Obese, Beverage Choices, Wellness, Weight Management, Health Coaching, Microbiome, Nutrition Science, Zero Calorie Drinks And Weight Gain, Do Diet Sodas Cause Insulin Response

Robin Beach is an HIV specialist who began to turn a critical eye to the usefulness of body mass index (BMI) when it came to understanding the overall health of a patient. On the latest episode of NP Pulse: The Voice of the Nurse Practitioner®, she speaks with Sophia Thomas about using waist circumference as a way to measure the health of specific patient populations instead of BMI, and offers practical strategies for bringing this new tool into routine practice. 

In this episode of The Fertility Podcast, I'm joined by Ian Stones, co founder of Testhim, to talk about something that should be simple but still too often isn't. Testing men.We talk a lot in fertility about women's bodies, women's hormones, women's investigations. But male fertility accounts for around a third of infertility cases, and yet men are still frequently an afterthought.Ian and I explore when men should be tested, what those tests actually look like, why semen analysis is not always enough, and how men can advocate for themselves earlier in the process.If you are dealing with male factor infertility, recurrent loss, unexplained infertility, or you simply want to understand more about sperm health, this episode is for you.And if you are the partner trying to get a reluctant man to engage with this conversation, please share it.What we discuss in this episode:Why male fertility testing is often delayedWhen to start investigating male fertilityWhy semen analysis is only the starting pointThe role of sperm DNA fragmentation in recurrent miscarriageWhat a varicocele is and how it affects sperm qualityWhy testicular scans matterHow infections and oxidative stress impact sperm healthThe importance of seeing a male fertility specialist, not just a general urologistWhy lifestyle changes should happen at least three months before trying to conceiveThe impact of heat, cycling, tight underwear and hot tubsAlcohol, diet and BMI in sperm healthWhy men need to know their anatomy and check for lumps and changesThe emotional experience of male infertility and feeling like the spare partHow proactive testing could reduce repeated failed IVF cyclesWhat Testhim actually doesTesthim offers:Advanced male fertility testingA detailed male fertility questionnaire to build a personalised risk profileSperm DNA fragmentation testingOxidative stress testingTesticular ultrasound scansFollow up calls to explain results clearlyAccess to male fertility urology specialists across the UKMonthly male fertility support groupsA dedicated male fertility podcastTheir questionnaire...

Welcome to the first of hopefully many shorter episodes of Roots Music Rambler, we're calling our Backstage with episodes. These are short interviews Frank and Falls are able to grab backstage (or just somewhere in person rather than on our virtual, longer-form interview episodes) and catch up briefly. Our first such episode is with Josh Mitcham. The Breckenridge County, Kentucky native and farmer has a new solo album coming out in June called Gonna Be Alright. He's dropped a couple of singles from the album already and the sound is a level up from previous work as he brought the Alabama Sound Company to the table to produce the album. Josh is the former frontman for Jericho Woods and a 2026 Kentucky Music Hall of Fame Ambassador.  Falls caught him backstage at the Mercury Ballroom in early February, getting ready to open for Sundy Best. The two talked about the new songs and album, Josh's approach to promoting the music and a lot more.  Find Josh Mitcham online at joshmitcham.com, on Spotify, Instagram and Facebook.  Watch the Episode on YouTube Download the episode and subscribe at rootsmusicrambler.com, watch the full episode on YouTube, or download wherever you get your podcasts.  Also be sure to help spread the love of the show with Roots Music Rambler's new merch, now available at rootsmusicrambler.com/store. Authentic t-shirts, hats and stickers are now available.  Buckle up for The Hoe-Down and the Throw-Down! It's a new episode of Roots Music Rambler. Notes and links:  Josh Mitcham online Josh Mitcham on Spotify Josh Mitcham on Instagram Josh Mitcham on Facebook The Roots Music Rambler Store Roots Music Rambler on YouTube Roots Music Rambler on Instagram Roots Music Rambler on TikTok Roots Music Rambler on Facebook Subscribe to Roots Music Rambler on YouTube, Spotify, Apple Podcasts, GoodPods or wherever you get your podcasts. Theme Music: Sheepskin & Beeswax by Genticorum; Copyright 2026 - Falls+Partners. All music on the program is licensed by ASCAP, BMI and SESAC. Roots Music Rambler is a member of the Americana Music Association. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hidden fat stored deep inside organs, especially the pancreas and abdomen, links to brain shrinkage, cognitive decline, and a higher risk of neurologic disease even when your weight looks normal An MRI-based study of 25,997 adults found that fat distribution patterns inside the body predict brain aging and cognitive outcomes more strongly than body mass index (BMI) alone People with high pancreatic fat showed around 30% fat concentration in the pancreas, which was up to six times higher than lean individuals and tied to extensive gray matter loss The "skinny fat" profile involved high internal abdominal fat despite only moderate BMI, with men showing the steepest decline in brain volume and slower thinking speed Simple metabolic assessments like fasting insulin, HOMA-IR, CRP, lipid profiles, and waist-based ratios offer practical ways to detect hidden risks early, before obvious symptoms appear

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: big updates for stem cell and islet transplants, new pen option for Zepbound, an implantable insulin pump moves forward and more! Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  T1D Screening info All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcription with links: Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bringing you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. Quick reminder: I'm just back from MNO DC and I'm exhausted. But it's the best kind of tired. We had an incredible time – hope you can join us in Nashville. With a reminder that we have our first Club 1921 in Nashville – that's our educational dinner series for HCPs and patient leaders. All the info is over at diabetes-connections.com events/     Okay.. our top story this week: XX An "immune system reset" eliminated Type 1, diabetes in mice in a study conducted at Stanford Medicine without immune suppressant medications. This was a combined transplant of blood stem cells and insulin-producing pancreatic islet cells from a donor whose immune profile did not match the recipient. The dual transplant approach both restored insulin production and retrained the immune system. For the full six months of the experiment, the animals did not need insulin injections or immune suppressive medications. Challenges remain using this approach to treat Type 1 diabetes. Pancreatic islets can be obtained only after death of the donor, and the blood stem cells must come from the same person as the islets. It is also unclear whether the number of islet cells typically isolated from one donor would be enough to reverse established Type 1 diabetes. But the researchers are working on solutions, which could include generating large numbers of islet cells in the laboratory from pluripotent human stem cells, or finding ways to increase the function and survival of transplanted donor islet cells. https://scitechdaily.com/stanford-scientists-cure-type-1-diabetes-in-mice-without-insulin-or-immune-suppression/ XX An electronic implant interlaced with islet cells is being looked at to treat type 1. Researchers at the University of Pennsylvania School of Medicine worked with engineers at Harvard University to combine stem-cell biology with soft electronics. They inserted an ultrathin, flexible mesh of conductive wires — thinner than a human hair — into developing pancreatic tissue. As the cells assembled into clusters, the mesh became woven through them. The electronics can record the faint electrical signals produced by the cells that control insulin release. They can also deliver small pulses of electricity back to the cells.   After several days, the cells began to behave more like mature islets. Their internal signalling shifted, neighbouring cells started working in concert and insulin release became stronger and better timed.  Very early on here – and the transplanted cells still need to be protected from being attacked by the immune system. https://www.thetimes.com/uk/science/article/first-cyborg-pancreas-implants-type-1-diabetes-nxkv8r0fp?gaa_at=eafs&gaa_n=AWEtsqeJYYUF9TMR-GgGUG92hPyog-ISeiqGIgdyaaIKKcpvhtoftGiUaaOtQeG0NWI%3D&gaa_ts=699c50d4&gaa_sig=w-PQ0ArosZSznYDSWEzt8aQg4WC0FF5ZFRt9NedO5sSTL2FyWzupH8eSG7RCy2S8TQnlHOeKCudANWm1MNI59w%3D%3D XX Katie Beth (hand) Eledon trial – aaron kowalski post linkedin. Last fall we told you about promising results from Eledon's drug to prevent islet transplantation rejection in type 1 diabetes. The first six patients no longer had to inject or infuse insulin.. the trials continue and this month one of the patients – Katie Beth Hand – began posting about her experiences one month in, on social media, she says she's off basal insulin already and in range 99 percent of the time. She is also encouraging people to learn more about support the islet act https://lnkd.in/e8pQ7_Y7 XX This is a bill introduced last November which would change the wording on pancreatic cell transplants. The problem is that islets are classified as drugs rather than organs, making transplantations difficult for medical teams and centers to preform due to accessibility. Insurance companies are also less likely to provide reimbursements for treatment, which can cost hundreds of thousands of dollars. The official Journal of The Transplantation Society estimates the cost at about $140,000. The bill went to the senate committee of Health, Education, Labor, and Pensions in early November. No other action has been taken since then. https://www.wtoc.com/2026/02/19/bluffton-family-advocates-islet-act-help-diabetic-son/ XX Big change for the obesity drug Zepbound – now available in the multi dose KwikPen. This is a month's worth of doses in a single pen.. and it's multi dose – you can adjust it. Cash-paying patients can get the multi-dose device, called KwikPen, on the company's direct-to-consumer website, LillyDirect. Prices start at $299 per month for the lowest dose level. Until now, you could only get zepbound in a single dose auto injector or a sing dose vial. In a release, Lilly said the Food and Drug Administration approved a label expansion for Zepbound to include the multi-dose device. The KwikPen is already used for other drugs, such as Lilly's popular diabetes medication, Mounjaro – which is the same medication as zepbound, they're both tirzepitide. https://www.cnbc.com/2026/02/23/eli-lilly-launches-zepbound-obesity-drug-pen-one-month-doses.html   XX For years, researchers have observed that people who live at high elevations,  tend to develop diabetes less often than those at sea level. Although the trend was well documented, the biological explanation behind it was unclear. Scientists now say they have identified the reason. Their research shows that in low oxygen environments, red blood cells begin absorbing large amounts of glucose from the bloodstream. Their work showed that when oxygen is limited, red blood cells use glucose to generate a molecule that helps release oxygen to tissues. This process becomes especially important when oxygen is in short supply. The researchers also found that the metabolic benefits of prolonged hypoxia lasted for weeks to months after mice were returned to normal oxygen levels. They then evaluated HypoxyStat, a drug recently developed in Jain's lab that mimics low oxygen exposure. HypoxyStat is taken as a pill and works by causing hemoglobin in red blood cells to bind oxygen more tightly, limiting the amount delivered to tissues. In mouse models of diabetes, the medication completely reversed high blood sugar and outperformed existing treatments. https://www.sciencedaily.com/releases/2026/02/260221060952.htm XX Watching this one closely – Portal Diabetes gets FDA breakthrough device designation for its implantable insulin pump system. This is a system that includes not just a device that's implanted into the abdomen, but also a new, temperature stable insulin. It will work with – quote – "modern" CGM technology with a fully closed loop - and aims to deliver a functional cure for type 1. While reports say Portal's system is the first in the US – there was an implantable pump developed and used by about 500 people worldwide, including about 100 in the US – by MiniMed. Medtronic bought the company and in 2007 they stopped that program. Portal Diabetes expects to begin clinical trials on its combination system around the fourth quarter of 2027. https://www.drugdeliverybusiness.com/portal-diabetes-fda-breakthrough-implantable-insulin-pump/ XX Sequel Med Tech and Senseonics (NYSE:SENS) today announced the full U.S. launch of their CGM and insulin pump integration. That's the eversense cgm and twist pump. Sequel said its full launch with Eversense 365 makes twiist available with two compatible CGMs. twiist also pairs with the Abbott FreeStyle Libre 3 Plus sensor. Eversense 365, an implantable system, rests under the skin for the duration of a year. Users can change its external, silicone-based adhesive daily with almost no skin reactions. https://www.drugdeliverybusiness.com/sequel-senseonics-full-launch-twiist-eversense/ XX Right back with a Dexcom update, and a look at which type of diet reduces insulin use overall.. right after this: -- Back to the news.. Dexcom is watching for expanded Medicare coverage of its continuous glucose monitors to people with Type 2 diabetes who don't take insulin. CEO Jake Leach told investors on Thursday that the company has been "sitting here waiting for a coverage decision" from the Centers for Medicare and Medicaid Services Dexcom started to see commercial coverage unlock for Type 2, non-insulin users toward the end of last year, Leach said. He expects broader Medicare coverage for that group would allow nearly 12 million people to access CGMs.     In the meantime, the American Diabetes Association updated its guidelines last year to recommend clinicians consider using CGMs for Type 2 diabetes when patients are taking glucose-lowering medications other than insulin. Leach said that real world data the company has been generating supports that decision, and that Dexcom has launched a registry for non-insulin users. https://www.medtechdive.com/news/dexcom-seeks-expanded-medicare-coverage-of-cgms-for-type-2-diabetes/812223/ XX Medtronic's separation of MiniMed is not yet complete.. but continues to move forward. The company has submitted their next pump – MiniMed Flex – to the FDA. This is a pump smaller than the 780G but uses the same reservoirs and infusion sets. It will also work with both the Simplera Sync and Instinct sensors. Medtronic also began a U.S. pivotal study for Vivera, its third-generation algorithm for automated insulin delivery. It also remains set to submit its MiniMed Fit patch pump system to the FDA by the coming fall. https://www.drugdeliverybusiness.com/medtronic-submits-minimed-flex-fda-q3/ XX A study modelling how genes may influence a child's body mass index over time has found that BMI at age 10 and overall growth rate between ages one and 18 might be important factors, as the two are more likely linked to diabetes, high cholesterol, and heart disease in later life. Nearly 66,000 BMI measurements from around 6,300 children and adolescents aged one to 18 were analysed to understand the role of genes.     "Future research is needed to help identify the most effective ages to prevent obesity or poor growth for long-term benefit." https://www.ndtv.com/health/bmi-at-age-10-growth-rate-up-to-age-18-are-important-factors-for-diabetes-heart-disease-study-11125146 XX A low-fat vegan diet—without cutting calories or carbs—may help people with type 1 diabetes significantly reduce how much insulin they need. In a new analysis published in BMC Nutrition, participants following the plant-based plan lowered their daily insulin use by 28%, while those on a portion-controlled diet saw no meaningful change. Researchers say the reduced insulin requirement likely reflects improved insulin sensitivity. The original 2024 study reported additional benefits from the vegan diet. Participants lost an average of 11 pounds and showed improvements in insulin sensitivity and glycemic control. Cholesterol levels and kidney function also improved among those following the plant-based plan. https://www.sciencedaily.com/releases/2026/02/260212234212.htm XX Interesting little tidbit from the Winter Olympic Games.. the World Anti-Doping Agency (WADA) was monitoring GLP drug use. An advisory group that makes recommendations about WADA's list of prohibited substances discussed the status of GLP-1 medications, and added semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro, Zepbound) to its monitoring program That means patterns of use of these drugs will be tracked both in and out of competition.  The finding will be used to make recommendations about whether GLP-1 agonists should be added to the prohibited list, the spokesperson explained. While GLP-1 drug use is not currently prohibited, that could change before the next Summer Olympic Games in Los Angeles in 2028, he noted. https://www.medpagetoday.com/popmedicine/cultureclinic/119770 XX That's it for in the news!

I det här irrelevanta avsnittet av Frågeklådan, som tidigare bara funnits på Podme, diskuterar Niclas & Jonatan om tjockisar oftare överlever pistolskott, idioter på gymmet, favoritplatserna i Sverige, sambandet mellan BMI och styrkan på ens dialekt, när de blivit oväntat blödiga, om man skulle halsa en slumpmässigt vald vätska för 10 miljoner kr – och mycket annat! Hjärndött och tramsigt – haka på!Vi finns numera även på Podme! Det betyder att du hittar alla våra avsnitt, helt reklamfritt, i Podme-appen. Signa upp dig på podme.com – de första 14 dagarna är gratis. Ladda sedan ner appen i Appstore eller Google Play.

Komiker Ane Høgsberg havde aldrig drømt om at blive mor og troede ikke, hun overhovedet skulle have børn. Lige indtil hun møder Lasse og bliver gravid. På grund af sit høje BMI-tal bliver Ane fulgt tæt, men ender med at gå 10 dage over tid. Hør Ane fortælle om en lang fødsel, og om hvordan de første minutter efter Ebbe er blevet født sætter sig i hende som en selvbebrejdelse, der præger de første måneder af hendes moderskab. 

"No work takes deep root, or has real stability, or will perpetuate itself, unless the apostle has begotten the interior life in other souls. Naturally, he cannot do this unless he himself is strong in the inner life." This episode concludes Part Four of the classic work by the French Trappist monk, Dom Jean-Baptiste Chautard (1858-1935). Among other things, there is featured an illuminating description of the progressive stages of conversion, which Dom Chautard includes as an aid for spiritual directors. Episode 4: Part Four (sections e - g) 00:00 - Intro 00:39 - e. Because the Interior Life Begets Interior Life, Its Results Upon Souls Are Deep and Lasting 20:09 - f. Importance of the Formation of “Shock Troops” and of Spiritual Direction 46:12 - (Stages of Conversion - Categories for Spiritual Directors) 57:48 - g. The Entire Success of the Apostolate Depends on One Thing: An Interior Life Centered on the Blessed Eucharist This work will be released in its entirety in episodic format. Links The Soul of the Apostolate full text: https://www.cmri.org/0-olmc-mission/catholic-books/soul_of_the_apostolate.pdf SUBSCRIBE to Catholic Culture Audiobooks https://podcasts.apple.com/us/podcast/catholic-culture-audiobooks/id1482214268 SIGN UP for Catholic Culture's newsletter http://www.catholicculture.org/newsletter DONATE at http://www.catholicculture.org/donate/audio Theme music: "2 Part Invention", composed by Mark Christopher Brandt, performed by Thomas Mirus. ©️2019 Heart of the Lion Publishing Co./BMI. All rights reserved.

Have you ever felt like food is always on your mind like a constant background tab running no matter what you're doing? In this episode, Leslie opens up about her own decades-long experience with "food noise" and what it really felt like inside. From packing excessive snacks out of fear of being hungry, to scale panic spirals, to social anxiety around restaurants and events, she shares the raw truth about how exhausting and all-consuming food obsession can become. Leslie explains why dieting temporarily quiets the noise but never actually solves it. She reveals how food noise isn't about lack of willpower or discipline, but about nervous system dysregulation, perfectionism, identity, and a deep search for internal peace. The constant monitoring, restriction, and "all-or-nothing" control are not health they're survival patterns disguised as responsibility. Most importantly, she shares what exists on the other side of food noise: mental freedom, calm, presence, and the ability to fully live your life without waiting to lose weight first. This episode is both a wake-up call and an invitation to stop pushing the problem down and finally resolve what's underneath it so you can evolve into the life you're meant to live. "You're trying to fix a feeling by fixing your body. But losing weight does not stop the food noise." — Leslie Thornton What you will learn from this episode: 00:23 – What food noise actually feels like in everyday life 01:52 – How the scale can trigger panic and self-sabotage 03:02 – The social impact of food obsession and restaurant anxiety 05:01 – What "food noise" really means (and why dieting doesn't solve it) 07:40 – Why perfection temporarily quiets the noise but creates a bigger crash 09:11 – Why dieting is a temporary solution, not a root fix 14:17 – How identifying as a "food addict" reinforces the pattern 18:04 – The true definition of food noise: mental preoccupation and hypervigilance 20:11 – How restriction, stress, and survival wiring increase food thoughts 21:47 – Why both overeating and over-controlling come from the same dysregulated system 24:22 – The real driver underneath food obsession: trying to fix a feeling 25:58 – Why losing weight does not eliminate food noise 28:10 – The truth about BMI and health (Health at Every Size study) 31:17 – Why waiting to lose weight before living your life keeps you stuck 32:11 – What life actually looks like without food noise 36:15 – The "page turning" identity shift that ends the struggle Connect With Leslie Thornton: Book A Clarity Call Website Facebook LinkedIn Email: Leslie@hpwl.co If you enjoy the podcast, Would you please consider leaving a quick review on Apple Podcasts/iTunes in under 60 seconds? It brightens our day and helps us bring you incredible guests for top-notch content. Plus, I cherish reading every review! Click here to make a difference!

We swap small talk for a deep dive on body composition and why muscle and visceral fat tell a truer health story than the scale. Practical tools like DEXA, bioelectrical impedance, and a simple tape measure help you track what matters and take action.• why body composition beats weight and BMI for risk• what visceral fat is and why it drives inflammation• how muscle improves insulin sensitivity and metabolism• aging, sarcopenia, and protecting independence• methods to measure composition from DEXA to smart scales• using waist circumference as a powerful proxy• healthy body fat ranges for men and women• daily habits to build muscle and lower visceral fatSend us a message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN Artwork Rebrand and Avatars: Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/ Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qr Original Artwork Concept: Olivia Pawlowski

Sunday, February 22 Message: "Blessed Are You" Scripture: Matthew 5:1–12 By: Rev. Marisa Gertz Scripture: https://www.biblegateway.com/passage/?search=Matthew%205%3A1%E2%80%9312&version=NRSVUE Bulletins https://trinitygnv.org/s/Sunday-Bulletin-02-22-26-8AM-ambc.pdf https://trinitygnv.org/s/Sunday-Bulletins-02-22-26-930AM-WEB.pdf https://trinitygnv.org/s/Sunday-Bulletins-02-22-26-11AM-xsxl.pdf Copyright: https://ccli.com/us/en/church-copyright-license Copyrighted content included in this webcast is used with license under one or more of the following: Christian Copyright Solutions WORSHIP cast Streaming License and PERFORM music License #7840 (to publicly perform and/or web stream any musical composition controlled by ASCAP, BMI, and SESAC), CVLI (Christian Video Licensing International) #503915511, CVLI ScreenVue License #502477880, CCLI Church Streaming & Podcast License #CSPL016331, CCLI Church Copyright License #1022361, and/or CCLI Church Rehearsal License #CRL011587.

Joshua 8 | February 22, 2026 | Pastor Todd SmithIn the book of Joshua, we witness a powerful truth about God's character as God tells Joshua, "Do not fear and do not be dismayed." This message offers profound insight into overcoming the human tendency to fear the future and be discouraged by past failures. God's nature reveals itself through second chances, perfect timing, and flawless plans, reminding us that His delays are not always denials.Discover how to embrace the discipline of waiting and trust God's superior strategies for your life. Will you allow an all-wise, all-knowing God to call the plays in your life, or will you continue to force your own way?To find out more about Crossroads Community Church or to connect with us, visit the following links:→ lifeatcrossroads.org→ facebook.com/lifeatcrossroadsTo give online: lifeatcrossroads.org/giveonline.CCLI License: 2915685CCS WorshipCast License: 9466GRANT OF LICENSE. Crossroads Community Church is granted a non-exclusive, non-transferable license during the term of the agreement to publicly play, perform, and transmit via the website noted above, any musical composition controlled by one or more of the domestic Performing Rights Organizations (ASCAP, BMI and SESAC), as stated in the CCS WORSHIPcast License Terms and Conditions.

If you are worried about childhood obesity, BMI percentiles, or your child's eating habits, this episode is for you.As a pediatrician, I see how often parents are told to focus on weight, growth charts, and body mass index, or BMI. But when we focus only on the number, we miss the deeper factors influencing your child's health, emotional eating patterns, and relationship with food.In this episode of Family in Focus, I explain why weight is often just the tip of the iceberg and what parents need to understand beneath the surface to support healthy and sustainable change.So much of what we are taught to focus on is what we can see. The number on the scale. The BMI percentile. The growth chart. The food choices. When those numbers rise, it can feel urgent and scary.But what if weight is not the root issue?This episode explores the factors that influence child weight gain, eating habits, and overall health, including genetics, environment, hormones, social influences, and emotions.I also share a story from my pediatric practice that changed the way I approach conversations about child weight and growth. It is a reminder that behind every number is a child navigating weight stigma, body image pressure, and emotional experiences we cannot see.This episode is not about ignoring health. It is about understanding it more fully.In this episode, we discuss:Why focusing only on weight, BMI, and growth charts can cause harmThe iceberg metaphor and what influences child weight beyond foodHow genetics, environment, and hormones impact eating habitsEmotional eating in kids and how feelings shape behaviorThe impact of weight stigma and body image pressure on children and teensWhy connection based parenting creates healthier long term outcomesAt Family in Focus, I help parents improve their child's eating habits and health without shame, food battles, or pressure. This episode is an invitation to slow down, get curious, and support your child's health in a way that builds trust instead of fear.New episodes air every Wednesday.Join The Exhale, my newsletter for parents who want less stress around food, body image, and child weight concerns and more confidence in how they are supporting their kids.https://www.wendyschofermd.com/the-exhaleIf you would like support putting this into practice in your home, learn more about how I work with families at:https://www.wendyschofermd.comTo schedule a consult:https://wendyschofermdscheduling.as.me/consultFollow along and continue the conversation:Instagram: https://www.instagram.com/wendyschofermd/TikTok: https://www.tiktok.com/@wendyschofermdFacebook: https://www.facebook.com/wendyschofermd/LinkedIn: https://www.linkedin.com/in/wendy-schofer-md/While I am a doctor, I am not your doctor. This podcast is for education, not medical advice.

How AI Weight Loss Coaches Complement Clinical Care Ro Huntriss, Chief Nutrition Officer for Simple Life, shares how their AI weight loss coach complements clinical care, what they've learned about driving personal health behaviors, and why they continue to see success across every age group, gender, and BMI class.  All that, plus the Flava of the Week about CVS' intention to launch a new consumer engagement app. How do they describe the platform they're building and its benefits, and does this signal a renewed interest in consumer engagement as a top priority?  Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

The day this episode of Roots Music Rambler drops, so does a new album from virtual newcomer to the music scene, Trey Hedrick. But don't let the debut album and baby-faced Hedrick fool you: This guy can write songs and play like you wouldn't believe.  In fact, Hedrick is a rare guest on Roots Music Rambler: Generally unproven with just a few social media followers more than the average bar band. But he's got two things going for him that convinced us he's well on his way to becoming the next big thing: He's spent a few years touring and playing with other musicians many people couldn't keep up with; And, his team sent us the album raw masters early to hear the whole thing. It's good, y'all. Very good. We sat down with Trey back in the fall, well ahead of the album being finished. In fact, you'll be able to tell from the conversation that we didn't even know the name of the record (Sing, Appalachia) or the release date (today, Feb. 20, 2026) when we interviewed him. But we found, and you will discover, Trey has the mindset and maturity few first-album artists ever do. Hedrick grew up on a cattle farm in Southeast Ohio in a family peppered with seasoned musical talent. He's played guitar and mandolin since he can remember and told us his grandmother would call the grandkids in on a hot day and ask them to play songs for her. (Sneaky way of getting them to cool off.) Hedtrick cut his professional teeth in the Athens, Ohio, music scene and sent some acoustic demos of a few songs to Nashville producer Sean Sullivan, who has worked with Tyler Childers, Sturgill Simpson, John Prine and others. Sullivan liked the demos and the two went into the studio and cut the record at the Tractor Shed last summer. Hedrick's storytelling stems from his upbringing in a proud, working-class family. Almost all the men in his family have ties to the coal mines, too, so he's as Appalachian as they come. Our first impression of his songs was that he reminded us of a young Ricky Skaggs. We think you'll agree.  Also in this episode, Frank and Falls chat about a previous guest's plans for new music this year and share our Pickin' the Grinnin' picks for the week. Frank called out Swedish rockers Sabaton. Falls recommended Damn Tall Buildings, whom we interviewed in Episode 66. Trey Hedrick's interview fell before the Damn Tall Buildings one, but we saved it for debut day!  Watch the Episode on YouTube Download the episode and subscribe at rootsmusicrambler.com, watch the full episode on YouTube, or download wherever you get your podcasts.  Also be sure to help spread the love of the show with Roots Music Rambler's new merch, now available at rootsmusicrambler.com/store. Authentic t-shirts, hats and stickers are now available.  Buckle up for The Hoe-Down and the Throw-Down! It's a new episode of Roots Music Rambler. Notes and links:  Si Kahn online Si Kahn episode of Roots Music Rambler Trey Hedrick online Trey Hedrick on Spotify Trey Hedrick on Instagram The Roots Music Rambler Store Roots Music Rambler on YouTube Roots Music Rambler on Instagram Roots Music Rambler on TikTok Roots Music Rambler on Facebook Jason Falls on Instagram Jason Falls on TikTok Francesca Folinazzo on Instagram Pickin' the Grinnin' Choices Sabaton on Spotify Damn Tall Buildings on Spotify Subscribe to Roots Music Rambler on YouTube, Spotify, Apple Podcasts, GoodPods or wherever you get your podcasts. Theme Music: Sheepskin & Beeswax by Genticorum; Copyright 2026 - Falls+Partners. All music on the program is licensed by ASCAP, BMI and SESAC. Roots Music Rambler is a member of the Americana Music Association. Learn more about your ad choices. Visit megaphone.fm/adchoices

If you are worried about childhood obesity, BMI percentiles, or your child's eating habits, this episode is for you.As a pediatrician, I see how often parents are told to focus on weight, growth charts, and body mass index, or BMI. But when we focus only on the number, we miss the deeper factors influencing your child's health, emotional eating patterns, and relationship with food.In this episode of Family in Focus, I explain why weight is often just the tip of the iceberg and what parents need to understand beneath the surface to support healthy and sustainable change.So much of what we are taught to focus on is what we can see. The number on the scale. The BMI percentile. The growth chart. The food choices. When those numbers rise, it can feel urgent and scary.But what if weight is not the root issue?This episode explores the factors that influence child weight gain, eating habits, and overall health, including genetics, environment, hormones, social influences, and emotions.I also share a story from my pediatric practice that changed the way I approach conversations about child weight and growth. It is a reminder that behind every number is a child navigating weight stigma, body image pressure, and emotional experiences we cannot see.This episode is not about ignoring health. It is about understanding it more fully.In this episode, we discuss:Why focusing only on weight, BMI, and growth charts can cause harmThe iceberg metaphor and what influences child weight beyond foodHow genetics, environment, and hormones impact eating habitsEmotional eating in kids and how feelings shape behaviorThe impact of weight stigma and body image pressure on children and teensWhy connection based parenting creates healthier long term outcomesAt Family in Focus, I help parents improve their child's eating habits and health without shame, food battles, or pressure. This episode is an invitation to slow down, get curious, and support your child's health in a way that builds trust instead of fear.New episodes air every Wednesday.Join The Exhale, my newsletter for parents who want less stress around food, body image, and child weight concerns and more confidence in how they are supporting their kids.https://www.wendyschofermd.com/the-exhaleIf you would like support putting this into practice in your home, learn more about how I work with families at:https://www.wendyschofermd.comTo schedule a consult:https://wendyschofermdscheduling.as.me/consultFollow along and continue the conversation:Instagram: https://www.instagram.com/wendyschofermd/TikTok: https://www.tiktok.com/@wendyschofermdFacebook: https://www.facebook.com/wendyschofermd/LinkedIn: https://www.linkedin.com/in/wendy-schofer-md/While I am a doctor, I am not your doctor. This podcast is for education, not medical advice.

They also discuss safe, realistic strategies that support joint health, including tailored exercise and strength training, plus the emerging evidence on GLP-1 medications (like semaglutide/Ozempic/Wegovy) for people with obesity and arthritis. The key message: obesity is a treatable chronic condition, and care should be compassionate, individualized, and evidence-based.*Content note/ trigger warning: This episode includes discussion of body weight, obesity, BMI, and weight-loss medications (including GLP-1 drugs).  We approach this topic from a stigma-free, evidence-based perspective, as well as lived experience, but we know conversations about weight can be sensitive or activating, especially for those with a history of weight stigma, eating disorders, or body image challenges. Listener discretion encouraged.Episode at a glance:Weight and arthritis: inflammation + joint load (OA and inflammatory arthritis)Why adipose tissue can worsen pain and disease activityBMI limits: muscle loss, fat distribution, and rheumatoid cachexiaExercise myth-busting: movement helps when it's tailored and gradualStrength training for knee support and better joint mechanicsGLP-1 medications (semaglutide, tirzepatide): what research shows so farStigma-free framing: obesity is chronic, not a personal failurePractical next steps and trusted resources (Arthritis Research Canada webinar)Medical disclaimer: All content found on Arthritis Life public channels (including Rheumer Has It) was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.Episode SponsorsRheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now!  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The Silent Threat Women Face Heart disease remains the number one killer of women in America, yet nearly half of all women fail to recognize it as their greatest health threat. During a recent Community Health episode of The Valley Today, host Janet Michael talks with Dr. April Shewmake, a board-certified interventional cardiologist at Winchester Cardiology and Vascular Medicine I Valley Health, to uncover the truth about cardiovascular health. What emerged was a compelling conversation that challenges common misconceptions and empowers listeners to take control of their heart health. Understanding the Specialist's Perspective Dr. Shewmake brings a unique dual expertise to her practice. As an interventional cardiologist, she treats heart attack emergencies in the catheterization lab using minimally invasive procedures to open blocked arteries. However, she emphasizes that general cardiology—the preventive side of her work—plays an equally vital role. "Before things become an emergency or a heart attack," she explains, "that's the general cardiology piece." This preventive approach focuses on long-term care, diagnostic imaging, and medication management to stop heart disease before it starts. The Prevention Paradox Perhaps the most striking revelation from the conversation centers on prevention. According to Dr. Shewmake, between 70 and 90 percent of heart disease is entirely preventable. This statistic transforms heart health from a matter of fate into one of choice. The key lies in daily habits that many people overlook: maintaining a healthy diet, exercising regularly, controlling blood pressure, managing stress, getting adequate sleep, and remaining tobacco-free. Nevertheless, Dr. Shewmake acknowledges that genetics do play a role. Some patients develop heart disease despite doing everything right. This reality underscores why awareness and early detection remain crucial, even for those who maintain healthy lifestyles. Recognizing the Warning Signs When it comes to identifying potential heart problems, Dr. Shewmake urges people to pay attention to specific symptoms. The major warning signs include chest pressure, shortness of breath, fatigue, dizziness, nausea, and pain radiating to the jaw, arms, or back. Critically, symptoms that appear during physical exertion and improve with rest signal early-stage heart disease. Furthermore, Dr. Shewmake dispels the Hollywood myth that distinguishes heart attacks from indigestion. In reality, many people—particularly young adults and women—delay seeking treatment because they assume their symptoms indicate simple indigestion. Women especially tend to experience atypical presentations, manifesting nausea and shortness of breath rather than classic chest pain. "Don't delay," she insists. "If you think something's wrong, come to the hospital." The 911 Rule Dr. Shewmake reinforces a critical safety message: never drive yourself to the hospital if you suspect a heart attack. Instead, call 911 immediately. Emergency medical services can begin life-saving treatment en route, significantly improving outcomes. This advice echoes the guidance of other cardiologists and represents a consensus among heart specialists. Women's Unique Risk Profile The conversation takes a deeper dive into the specific challenges women face regarding heart disease. Dr. Shewmake reveals that nearly 45 percent of women over age 20 have cardiovascular disease, yet less than half recognize this reality. Heart disease kills more women than all cancers—including breast cancer—combined, claiming one in three female lives. Moreover, women face distinct risk factors that men do not encounter. Hormonal changes during menopause, pregnancy-related complications, and autoimmune conditions all contribute to cardiovascular risk. Additionally, women often present with symptoms later in life but develop more complex disease. The medical community sometimes dismisses women's symptoms, compounding the problem. The Caregiver's Dilemma Janet raises an important point about women's tendency to prioritize others' health over their own. Women rush their husbands and children to the doctor at the first sign of trouble, yet they dismiss their own symptoms as minor inconveniences. Dr. Shewmake validates this observation and emphasizes the need to close the gap in how heart disease gets recognized and treated in women. She advocates for reframing primary care visits as self-care—an hour dedicated to one's own wellbeing. Using the airplane oxygen mask analogy, she reminds women that they must take care of themselves first to remain available for their families.  The Rising Threat to Young Adults Alarmingly, cardiovascular disease increasingly affects younger populations. Dr. Shewmake shares that her youngest female heart attack patient was 38, while her youngest male patient was just 30. Janet recounts the tragic story of her son's two high school friends—both in their early thirties—who died from heart attacks within three months. This trend stems from rising cardiovascular risk factors among young people, including diabetes, high blood pressure, and high cholesterol appearing at earlier ages. Additionally, genetics likely play a stronger role in these younger cases. Young adults often assume they're invincible, delaying treatment when symptoms appear. This dangerous mindset can prove fatal. Know Your Numbers Throughout the conversation, Dr. Shewmake repeatedly emphasizes the importance of knowing four critical numbers: cholesterol, blood pressure, BMI, and blood sugar. These metrics serve as early warning indicators for heart disease risk. She encourages everyone to discuss these numbers with their primary care physician and take action when they fall outside healthy ranges. Importantly, all these risk factors respond to treatment. Modern medicine offers excellent options for managing weight, cholesterol, and blood sugar. Some newer weight-loss medications not only help patients shed pounds and lower A1C levels but also provide cardiovascular benefits. These treatments represent powerful tools in the fight against heart disease. The Technology Trap When Janet mentions the false sense of security that fitness trackers provide, Dr. Shewmake agrees wholeheartedly. While devices like the Apple Watch offer some benefits, they cannot replace a comprehensive medical evaluation. No wearable technology can measure cholesterol levels, assess blood glucose, or provide the nuanced analysis that comes from a conversation with a healthcare provider. The Path Forward Dr. Shewmake welcomes referrals from primary care physicians when patients need specialized cardiovascular assessment. She sees many patients who request consultations even when their primary care doctors deem it unnecessary, and she views these visits as valuable opportunities for in-depth risk evaluation. Cardiologists can order specialized tests and provide individualized guidance that goes beyond population-level statistics. Breaking the Biggest Myth As the conversation concludes, Dr. Shewmake tackles the most dangerous misconception about heart disease: that it primarily affects men. While society recognizes heart attacks as the leading killer of men, this awareness doesn't extend to women. This gap in understanding costs lives. Her final message centers on empowerment. She urges everyone—especially women—to listen to their bodies, take symptoms seriously, and advocate for themselves when they know something feels wrong. Heart disease may be common, but it remains both preventable and treatable. Early action saves lives, and awareness changes everything. The Simple Truth Ultimately, Dr. Shewmake's message boils down to simple, actionable steps: eat well, move more, manage stress, get enough sleep, know your numbers, and remain tobacco-free. These everyday habits make a profound difference in cardiovascular health. Combined with regular medical care and self-advocacy, they form a powerful defense against America's leading cause of death. The conversation serves as both a wake-up call and a roadmap. Heart disease doesn't discriminate, but knowledge and action provide protection. By recognizing symptoms early, understanding personal risk factors, and prioritizing preventive care, individuals can take control of their heart health and potentially add years to their lives.

Adele is joined by Dr Salas-Whalen to explore the evolving role of GLP-1 medications in perimenopause and menopause care. Moving far beyond outdated BMI measures and “skinny jab” stereotypes, they unpack body recomposition, metabolic health, strength training and protein intake, and ask whether GLP-1 therapy and HRT could one day work hand in hand to support women's long-term health, cognition and cardiovascular wellbeing. This is a nuanced, empowering discussion designed to help you make informed, evidence-based decisions about your midlife health. Follow Dr Salas-Whalen's Insta: https://www.instagram.com/drsalaswhalen/ Official site for Weightless the Book: https://weightlessthebook.com/ Dr Salas-Whalen's StrengthMD brand:  https://strengthmd.co/   ____________ Check out Adele's FREE symptom assessment here: https://adelejohnstoncoaching.com/free-copy-of-our-symptom-assessment/ 12 Minute Breathwork Method: https://adelejohnstoncoaching.com/breathwork/ The Menopause Cheat Sheet: https://docs.google.com/document/d/1ka-fN6J5DJW2J3IE0Qa80zFCKFXmTs4srlnlXYBf-gA/edit?usp=sharing If you want a chat for your future success, fuel yourself here: https://calendly.com/adelejohnston/successchat Download Adele's Journey Journal here : https://adelejohnstoncoaching.com/my-journey-journal/ Enquire about 121 coaching here : https://docs.google.com/forms/d/e/1FAIpQLSfw6vrmKPE7A1eYDKQJiR9No7ZDdpfq-grBdKYjZSR-vl0Qag/viewform For extra support: Support@adelejohnstoncoaching.com ____________ From your host : Adele Johnston I'm Adele Johnston, a certified nutritionist and positive psychology coach, passionate about helping women improve their menopause health and reclaim who you are without menopause taking over. This is a time in your life where you get to feel vibrant, sexy and reclaim you again! I'm proud to work with women like you and have created a very successful proven Reclaiming You 3 STEP PROCESS to help you take back control of your body during your menopause. For more details : https://adelejohnstoncoaching.com/ To get Adele's FREE 3-step Menopause Weight Loss Guide: https://adelejohnstoncoaching.com/menopause-weight-loss-guide/

Discuss Pediatric Weight Gain Without Triggering ShameWhat would you say if a parent asked, “Can you tell my son he needs to lose weight?”That question sits at the center of one of the hardest conversations in pediatrics.In this episode, I'm joined by Dr. Amy Beck, clinical psychologist and expert in teen mental health and weight stigma, to unpack how we address pediatric obesity without causing unintended harm.Because this isn't just about weight. It's about protecting kids in a culture obsessed with body size, while still doing our job as clinicians.In this episode, we discuss:Common clinician missteps that unintentionally trigger shameWhy focusing on numbers (weight, BMI, carbs) can backfireHow to talk to a 5-year-old vs. a teenagerWhat to say when teens give one-word answersHow to navigate wo very different clinical scenarios:A teen in a larger body with normal labs but poor body imageRapid weight gain with elevated sugars, where intervention feels urgentWorking with teens is tough. Getting them to engage can feel even tougher.Dr. Beck shares practical language, strategies, and mindset shifts to help you intervene medically without triggering restriction, shutdown, or long-term harm.This episode is about striking the balance: preventing long-term medical complications while protecting a child's mental health in the process.Connect with Dr BeckHealth Psychology Partners Any Questions? Send Me a MessageSupport the showConnect with Colleen:InstagramLinkedInSign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Send us a text if you want to be on the Podcast & explain why!Feeling buried under 800 pages of NASM CPT 2026? We turn the noise into a clear, fast track that gets you to a passing score and into confident coaching. We walk through the OPT model in plain language, show you exactly which acute variables to memorize, and explain how to move from stabilization to strength and power without turning your sessions into rigid templates. If you've ever passed a test and still felt lost on day one, this guide closes that gap.We dig into the essentials you'll see on the exam and in real intake sessions: BMI ranges, blood pressure norms, and the practical differences between type one and type two diabetes. You'll hear why positive, client-first coaching beats fear-based assessments, and how to use simple screens without overwhelming new clients. We also unpack behavior change with the stages of change model and SMART goals so you can help people stay consistent long after the first workout high fades.Beyond the test, we talk career fundamentals that make you a pro others trust: track contracts and receipts for at least four years, understand CEU requirements, and use a quick SWOT analysis to map your growth. We share how focused study guides, mentorship, and hands-on seminars can compress your study time while sharpening real-world skills. The result is a study plan you can finish fast and a coaching approach that delivers results clients can feel.Ready to study smarter and coach with confidence? Hit follow, share this with a trainer friend who's cramming for NASM, and leave a quick review so we can send you our free NASM cheat sheet. Your next strong session starts here.Want to become a SUCCESSFUL personal trainer? SUF-CPT is the FASTEST growing personal training certification in the world! Want to ask us a question? Email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show! Website: https://www.showupfitness.com/Become a Successful Personal Trainer Book Vol. 2 (Amazon): https://a.co/d/1aoRnqANASM / ACE / ISSA study guide: https://www.showupfitness.com

Host Doug Stephan welcomes back Elizabeth Miller with Calotren. Unlike trendy quick fixes or stimulant-heavy diet pills, Calotren focuses on sustainable results by working with your body while you sleep. Taken at bedtime, it supports your natural overnight repair cycle to help improve sleep quality, reduce joint pain, support lean muscle retention, boost metabolism and daytime energy, and gently tone and tighten the skin. As we head into the season of sweets and comfort foods—Halloween candy, Thanksgiving feasts, and December's parade of cookies and pies—Calotren can help you stay on track, with users reporting fewer cravings, more energy, and steady inch and weight loss that lasts.Calotren naturally rebuilds lean muscle tissue, supports joint repair, and promotes better, more restorative sleep. With an 86% success rate in the first 90 days, most people notice improved sleep by the end of the first month, followed by consistent fat and inch loss in months two and three—without the rebound weight gain common with other methods. Doug and Elizabeth also explore the rising popularity of prescription weight-loss injections and explain why Calotren pairs safely with them, as maintaining lean muscle, stable energy, and healthy skin elasticity may make it an essential complement to those medications. To learn more, visit TopLoss.com and explore their interactive product page, or call 1-800-325-4366 with any questions. When you're ready to order, select “Shop Radio Sale” and use promo code DOUG at checkout for free shipping, and start your Calotren journey today.Website: GoodDayHealthShow.com Social Media: @GoodDayNetworks

Joshua 7 | February 15, 2026 | Pastor Josh GoertzenThe story of Achan in Joshua chapter 7 serves as a stark warning about the devastating impact of hidden sin. Achan's secret disobedience brought pain and death not only to himself but also to his family and the entire nation of Israel. This ancient narrative reveals that sin, no matter how concealed, is never truly hidden from God's sight.The speaker challenges us to confront the deceit of the evil one, who whispers that nobody will know. Discover why exposing your sin is not about condemnation, but about finding profound forgiveness and freedom in Christ.To find out more about Crossroads Community Church or to connect with us, visit the following links:→ lifeatcrossroads.org→ facebook.com/lifeatcrossroadsTo give online: lifeatcrossroads.org/giveonline.CCLI License: 2915685CCS WorshipCast License: 9466GRANT OF LICENSE. Crossroads Community Church is granted a non-exclusive, non-transferable license during the term of the agreement to publicly play, perform, and transmit via the website noted above, any musical composition controlled by one or more of the domestic Performing Rights Organizations (ASCAP, BMI and SESAC), as stated in the CCS WORSHIPcast License Terms and Conditions.

Joshua 7 | February 15, 2026 | Pastor Josh GoertzenThe story of Achan in Joshua chapter 7 serves as a stark warning about the devastating impact of hidden sin. Achan's secret disobedience brought pain and death not only to himself but also to his family and the entire nation of Israel. This ancient narrative reveals that sin, no matter how concealed, is never truly hidden from God's sight.The speaker challenges us to confront the deceit of the evil one, who whispers that nobody will know. Discover why exposing your sin is not about condemnation, but about finding profound forgiveness and freedom in Christ.To find out more about Crossroads Community Church or to connect with us, visit the following links:→ lifeatcrossroads.org→ facebook.com/lifeatcrossroadsTo give online: lifeatcrossroads.org/giveonline.CCLI License: 2915685CCS WorshipCast License: 9466GRANT OF LICENSE. Crossroads Community Church is granted a non-exclusive, non-transferable license during the term of the agreement to publicly play, perform, and transmit via the website noted above, any musical composition controlled by one or more of the domestic Performing Rights Organizations (ASCAP, BMI and SESAC), as stated in the CCS WORSHIPcast License Terms and Conditions.

Happy Valentine's Day! Of course my dad had plenty of romantic music. So that's why we are able to do this special episode. There was a popular radio format known as Easy Listening. We listened to one of those stations from Cleveland when we were young. And there was one extremely popular orchestra that was the backbone of those radio station playlists. 101 Strings. So, get ready to hear the lush sound that immediately gets you into a romantic mood in Volume 253: Valentines is for Lovers.  For more information about this album, see the Discogs webpage for it.  Credits and copyrights 101 Strings – 101 Strings In A Symphony For Lovers Label: Somerset – P-4500 Format: Vinyl, LP, Album Released: 1957 Genre: Classical Style: Romantic We will hear all 7 songs on the album. Evening Star - From Tannhauser Written-By – Richard Wagner Barcarolle - From Tales Of Hoffmann Written-By – Jacques Offenbach Poem Written-By – Zdeněk Fibich Serenade Written-By – Franz Schubert 2nd Piano Concerto - 3rd Movement Written-By – Sergei Rachmaninoff Reverie Written-By – Claude Debussy Cradle Song Written-By – Johannes Brahms I do not own the rights to this music. ASCAP, BMI licenses provided by third-party platforms for music that is not under Public Domain. #valentinesday #valentines #romanticmusic #vinylcollecting #vinylrecords #musicalmemories #fyp

As BMIs and weights increase across the US population, there have been increased calls for universal screening for existing DM at entrance to prenatal care, if under 20 weeks. Others, including the ACOG, prefer to screen early those with additional risk factors (like prior GDM HX, prior macrosomia, BMI >30, PCOS, first degree relative with diabetes, or age >40). In July 2024, the ACOG released its publication, “Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum”. In this guidance, it states, “At this time, there are insufficient data to support the best screening modality for pregestational diabetes in pregnancy, but consideration can be made to use the same diagnostic criteria as for the nonpregnant population (A1c value 6.5 or higher, or fasting plasma glucose value 126 mg/dL or higher, or 2-hour plasma glucose value 200 mg/dL or higher during a 75-g OGTT, or random plasma glucose value 200 mg/dL or higher in patients with classic hyperglycemia symptoms)”. However, a new proposed protocol has been published in AJOG for early screening for DM in pregnancy. This also describes the differences in diagnosis and care for Standard GDM diagnosed at 24-28 weeks, vs a diagnosis of pregestational DM diagnosis made prior to 20-weeks vs “early” GDM also diagnosed under 20 weeks of gestation. Listen in for details. 1. McLaren, Rodney et al.nA Proposed Classification of Diabetes Mellitus in PregnancyAmerican Journal of Obstetrics & Gynecology, Volume 0, Issue 0. Epub Feb 2, 2026; https://www.ajog.org/article/S0002-9378(26)00061-X/fulltext2. ACOG Clinical Practice Update: Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum; July 2024; https://journals.lww.com/greenjournal/abstract/2024/07000/acog_clinical_practice_update__screening_for.34.aspx3. Simmons, David et al. “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.” The New England journal of medicine vol. 388,23 (2023): 2132-2144. doi:10.1056/NEJMoa2214956

Brent & Johnny welcome Scott Inman, whose music career has taken him around the world, allowing him to share the message of Christ on stages that many only dream of. With messages of faith, family, and life woven deep within his lyrics, this four-time BMI award-winning singer-songwriter and 2024 Singing News Artist and New Artist of the Year is breaking the mold. He's on Daywind Records and also Daywind Publishing. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Mark Boulos, Dr. Khullar, and Dr. Mak for an in‑depth discussion on a topic that has challenged clinicians for decades: Are hypnotics safe for patients with untreated obstructive sleep apnea (OSA)? As new therapeutic options emerge and our understanding of comorbid insomnia and sleep apnea (COMISA) evolves, clinicians are increasingly confronted with nuanced decisions about when—and whether—to use hypnotic medications. The guests unpack the latest evidence and share insights from recent studies, including research evaluating dual orexin receptor antagonists (DORAs) such as lemborexant in individuals with sleep apnea. The conversation begins with a review of hypnotic medication classes and explores which agents may be safer in untreated OSA, and which still raise concerns. The panel discusses a recent lemborexant study, its design, population characteristics (including BMI and OSA severity considerations), and whether industry sponsorship played a role. They clarify that while the study did not focus specifically on COMISA, it sheds light on how DORAs perform in people with sleep apnea—particularly in terms of respiratory metrics. Returning from the break, the experts tackle the practical clinical dilemma of treatment sequencing in COMISA: Should clinicians begin with cognitive behavioral therapy for insomnia (CBT‑I), initiate PAP therapy, or consider medications first? They walk through what is known about how different hypnotic classes—including z‑drugs, GABAergic agents, trazodone, and DORAs—affect respiratory drive and sleep architecture. The discussion extends to special circumstances such as REM‑related OSA, where increased REM sleep induced by certain medications may have unique implications. The episode also considers broader emerging questions: Do DORAs improve apnea–hypopnea index (AHI) even without PAP? Can hypnotics be used strategically to improve sleep continuity without worsening respiratory parameters? And will future insomnia care rely on identifying phenotypes that respond differently to GABA‑based medications or wakefulness‑impairment targets? Throughout the conversation, the guests emphasize evidence-based takeaways, including the central finding that DORAs do not appear to worsen OSA‑related metrics, offering reassurance for clinicians navigating complex COMISA treatment plans. Whether you regularly see patients with comorbid insomnia and untreated sleep apnea or simply want clarity on the evolving role of hypnotics in this population, this episode offers practical, research-grounded guidance for clinical decisionmaking. Join us for this important discussion on how hypnotics can be used safely and thoughtfully in patients with untreated OSA.

If most of us grew up the way Dakota Ray Parker did, we'd have given up a long time ago. But the resilient, friendly Parker navigated his way through a rough and tumble childhood to funnel those traumatic experiences into outstanding songs and singing in his music. Parker joined us on Roots Music Rambler this week to talk about his turbulent upbringing, finding music was a natural escape to distract himself, then to writing and recording music that is now finding its way to a nice audience for the Kentucky native. His music is inspired by everything from Southern Gospel to 90s Country and even hip-hop. He told us his first musical dream was to be a rapper. Parker released two albums in 2025 and continues to knock out singles every so often. His latest single “Clown” has already amassed 150,000 streams on Spotify thanks to his traditional sounding vocals and catchy lyricism. His new single “Freeborn Man” drops the day this episode does (Feb. 13).  We not only got to hear his story and how he approaches songwriting, but we'll listen to snippets of four of his songs on the episode as well.  Frank and Falls also chat about Falls's recent trip to the Grand Ole Opry and rant a little about people who talk at certain types of concerts. The two also have new Pickin' The Grinnin' choices for music recommendations this week. Frank points to multi-instrumentalist and frequent session and guest musician John Calvin Abney. Falls shouts out The Wildmans.  Watch the Episode on YouTube Download the episode and subscribe at rootsmusicrambler.com, watch the full episode on YouTube, or download wherever you get your podcasts.  Also be sure to help spread the love of the show with Roots Music Rambler's new merch, now available at rootsmusicrambler.com/store. Authentic t-shirts, hats and stickers are now available.  Buckle up for The Hoe-Down and the Throw-Down! It's a new episode of Roots Music Rambler. Notes and links:  Dakota Ray Parker Online Dakota Ray Parker on Spotify Dakota Ray Parker on Instagram The Grand Ole Opry online The Roots Music Rambler Store Roots Music Rambler on YouTube Roots Music Rambler on Instagram Roots Music Rambler on TikTok Roots Music Rambler on Facebook Jason Falls on Instagram Jason Falls on TikTok Francesca Folinazzo on Instagram Pickin' the Grinnin' Choices John Calvin Abney on Spotify The Wildmans on Spotify Subscribe to Roots Music Rambler on YouTube, Spotify, Apple Podcasts, GoodPods or wherever you get your podcasts. Theme Music: Sheepskin & Beeswax by Genticorum; Copyright 2026 - Falls+Partners. All music on the program is licensed by ASCAP, BMI and SESAC. Roots Music Rambler is a member of the Americana Music Association. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Sunil Gupta spoke in detail about the growing link between obesity, diabetes, pregnancy-related risks, and modern lifestyle habits. He explained that obesity—particularly abdominal or visceral fat—is a major driver of Type 2 diabetes, heart disease, hypertension, and other metabolic complications. Dr. Gupta expressed that Indians are especially vulnerable due to a tendency toward central obesity even at lower body weight, making early screening through BMI and waist circumference measurements essential. Dr. Gupta highlighted that unhealthy dietary patterns, physical inactivity, excessive screen time, and high consumption of fast food and sugary beverages are key contributors to the rising burden of diabetes among children, adolescents, and young adults. He stressed that gestational diabetes and poor glucose control during pregnancy significantly increase the lifetime risk of diabetes for both the mother and the child. Breastfeeding, regular physical activity, post-delivery weight management, and long-term follow-up were emphasized as important protective measures. Addressing common myths, Dr. Gupta clarified that diabetes is not caused by sugar alone but by sustained excess calorie intake, insulin resistance, and genetic predisposition. He also strongly warned against tobacco use in any form, stating that it accelerates diabetes-related complications such as heart disease, kidney failure, stroke, and limb-threatening gangrene. The session concluded with a clear preventive message—eat less, walk more, sleep well, and smile (to reduce stress) Expert- Dr Sunil Gupta Anchor- Bhavana Lokhande Podcast: 23/01/2026 Recorded at: Akashwani Nagpur Episode: 103

In this episode of Nacho Fitness Coach, Caleigh and Sara unpack a real-life situation that sparked a bigger conversation about fit shaming, body positivity, and where personal responsibility fits into health. We talk about bloating, food discomfort, “reading the room,” and why expressing how your body feels shouldn't be treated as a moral failure. Along the way, we dig into BMI, body composition, carbs, protein, and the difference between loving your body and ignoring your health. This episode is an honest, nuanced conversation about boundaries, accountability, and choosing your hard—without apologizing for it.Connect with us on social media!Instagram | TikTok | Threads | Youtube | Facebook | X (Twitter) | WebsiteThis podcast offers health, fitness, and nutritional information and is designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you may have heard on this podcast. The use of any information provided by Nacho Fitness Coach podcast is solely at your own risk.

Want ad-free episodes? Subscribe to Forever Strong Insider: https://foreverstrong.supercast.comThis episode brings together standout moments from The Forever Strong Experience, packed into one powerful episode.Featuring highlights from:Dr. Mark Hyman – Founder of the Cleveland Clinic Center for Functional Medicine, co-founder and CMO of Function Health, director of The UltraWellness Center, host of The Dr. Hyman Show (300M+ downloads), and 15x New York Times bestselling author, including Young Forever and Food Fix Uncensored.Layne Norton, PhD – Nutritional scientist, 4x USA Powerlifting National Champion and 2024 IPF M1 World Champion (93kg), record-setting deadlifter, coach to 1,700+ clients, and founder of Outwork Nutrition.Michelle Shapiro, RD – Integrative/functional dietitian who helps clients reverse anxiety, heal complex gut and immune issues, and approach weight with compassion. Host of the Quiet the Diet podcast.Alan Aragon, MS – Veteran nutrition researcher, co-author of 30+ peer-reviewed papers (including JISSN's most-viewed article), ISSN Position Stand lead author, and founder of Alan Aragon's Research Review and the Fit Advancement Mentorship (FAM).In this mashup, they break down:How to eat for long-term metabolic and muscle healthWhy protein and resistance training are non-negotiables as you ageThe role of stress, mindset, and past experiences in how you eat and feelWhat it really means to be “forever strong” in body and mindPerfect if you're tired of conflicting nutrition advice and want clear, evidence-based guidance you can actually use.Thank you to our sponsors: Our Place - Visit https://www.fromourplace.com/DRLYON and use code DRLYON for 10% off sitewide.Four Sigmatic - Go to http://foursigmatic.com/gabrielle for a free bag of their dark roast ground coffee (just pay for shipping & handling).Cozy Earth - Go to https://www.cozyearth.com/DRLYON for up to 20% off!Chapters: 00:00:00 The truth about nutrition00:01:06 Why is it so hard to follow health advice?00:03:07 What actually holds people back from progress?00:05:26 When “clean eating” backfires00:05:57 The nutrition “rule” that does more harm than good00:06:37 Why medicine got obsessed with BMI and fat00:08:47 Body composition fundamentals: what to do first00:10:53 “Rules” for better body composition (practical guidelines)00:13:20 Do you have to lift heavy to build muscle?00:16:24 Strength vs hypertrophy: what matters most as you age00:17:46 Sponsor: Our Place + What if muscle were taught as an organ system?00:20:14...

In this episode of Full of Beans, Han is joined by Jo Read, a mum to two daughters, ARFID advocate and 1/3 of 3 Mums 1 Mission ARFID. Jo's youngest daughter, Ethel, is diagnosed with ARFID and is awaiting an autism assessment. Since supporting Ethel through her sensory-based eating difficulties, Jo has poured her energy into raising awareness, because when you're living it, ARFID can feel unbelievably isolating.If you're a parent or carer navigating food fears, sensory sensitivities, “helpful” comments that aren't helpful, and the constant planning that comes with ARFID, this one is for you. You're not doing it wrong. You're responding to a very real, very complex need.Key Takeaways:The reality of ARFID as a genuine fear that can override hungerSensory sensitivities (texture, smell, predictability) are at the core of ARFIDWhy consistency and familiarity make certain foods feel saferThe limits of BMI as a marker of health in children with arfidHow sensory overload at mealtimes can increase food avoidanceThe impact of ARFID on family life, routines, siblings and social plansWhy “just stop feeding them” advice doesn't work for ARFIDThe value of community, advocacy and finding people who understandHow progress in ARID can look small but still be meaningfulTimestamps:00:00 Jo's story and Ethel's ARFID diagnosis02:20 Early Signs of ARFID 05:30 BMI and Nutrition10:50 Safe foods, Predictability and Super Senses 14:10 The Sensory Overload of Eating 17:00 Family Impact: Days Out, Siblilngs, Friends20:20 Social Judgement and Support29:00 Looking Ahead and Slow ProgressResources & LinksFollow @eff_and_arfid on InstagramListen to the 3Mums1Mission ARFID PodcastConnect with Us:Subscribe to the Full of Beans PodcastFollow Full of Beans on InstagramCheck out our websiteListen on YouTube⚠️ Trigger Warning: Mentions of eating disorders, ARFID. Please take care when listening.If you enjoyed this episode, don't forget to subscribe, rate, and share the podcast to help us spread awareness.Sending positive beans your way, Han

In this episode, Dr. Geo is joined by Dr. Steven Freeland to discuss the powerful intersection of urologic oncology and metabolic health. Dr. Freeland shares groundbreaking research on how dietary interventions—specifically low-carbohydrate protocols—can slow prostate cancer progression and counteract the metabolic damage caused by standard treatments like Androgen Deprivation Therapy (ADT).In This Episode, You'll Learn:The Metabolic Growth Signal: Why insulin and Insulin-like Growth Factor 1 (IGF-1) are considered "fuel" for prostate cancer cells and how reducing sugar can starve that signal.The 20-Gram Protocol: Insights from Dr. Freeland's study on ultra-low-carb diets, where participants saw a 20-pound weight loss and a significant slowing of PSA doubling time.Combatting ADT Side Effects: How a metabolic approach can improve insulin resistance by 30% and surprisingly help preserve bone density during hormone therapy.The "Slim-Fat" Reality: Why your BMI might be normal, but your visceral fat (adiposity) could still be driving inflammation and cancer growth.Clinical Markers to Watch: Why patients should ask about HOMA-IR (Insulin Resistance) and Hemoglobin A1C rather than just focusing on PSA alone.Key Quotes from the Episode:"Lifestyle intervention isn't alternative medicine; it is metabolic medicine." — Dr. Steven Freeland"Cancers need the same nutrients the body needs to grow. If we're reducing pro-growth stimuli to the whole body through weight loss and low carbs, it makes sense we're reducing it to the cancer." — Dr. Steven FreelandResources & Links Mentioned:Dr. Steven Freeland: Cedars-Sinai Faculty ProfileResearch Paper: Ultra-low carbohydrate diet and prostate cancer progression (referenced as the "20-gram study").Recommended Diet Protocol: Induction Phase Atkins (as used in the clinical trials).Clinical Markers: * HOMA-IR: (Fasting Insulin $times$ Fasting Glucose) / 405 (or 22.5 in SI units).Hemoglobin A1C: A 90-day average of blood sugar levels.Wearables: Fitbit, Oura Ring, and Whoop (discussed in the context of tracking "active steps" and sleep quality).Episode Breakdown by Timestamp:[07:35] Breaking down the 20-gram carbohydrate trial and patient adherence.[13:45] The impact of...

Matthew 16:18 | February 8, 2026 | Pastor Todd SmithPastor Todd explores the profound nature of the church as revealed in Matthew 16, where Jesus introduces the concept of "my church." He emphasizes that the church is not merely an organization but a divine rescue plan, built by Christ himself upon the confession of faith. This "Ecclesia" is a group called out for a specific purpose: to bring true worshipers into God's kingdom. The church is on offense, actively pushing against the gates of hell, not passively defending. It is a blood-bought body, owned and led by Christ, assuring its ultimate victory. Discover why the church is more than just a gathering and how you can be part of God's grand, victorious mission.To find out more about Crossroads Community Church or to connect with us, visit the following links:→ lifeatcrossroads.org→ facebook.com/lifeatcrossroadsTo give online: lifeatcrossroads.org/giveonline.CCLI License: 2915685CCS WorshipCast License: 9466GRANT OF LICENSE. Crossroads Community Church is granted a non-exclusive, non-transferable license during the term of the agreement to publicly play, perform, and transmit via the website noted above, any musical composition controlled by one or more of the domestic Performing Rights Organizations (ASCAP, BMI and SESAC), as stated in the CCS WORSHIPcast License Terms and Conditions.

Matthew 16:18 | February 8, 2026 | Pastor Todd SmithPastor Todd explores the profound nature of the church as revealed in Matthew 16, where Jesus introduces the concept of "my church." He emphasizes that the church is not merely an organization but a divine rescue plan, built by Christ himself upon the confession of faith. This "Ecclesia" is a group called out for a specific purpose: to bring true worshipers into God's kingdom. The church is on offense, actively pushing against the gates of hell, not passively defending. It is a blood-bought body, owned and led by Christ, assuring its ultimate victory. Discover why the church is more than just a gathering and how you can be part of God's grand, victorious mission.To find out more about Crossroads Community Church or to connect with us, visit the following links:→ lifeatcrossroads.org→ facebook.com/lifeatcrossroadsTo give online: lifeatcrossroads.org/giveonline.CCLI License: 2915685CCS WorshipCast License: 9466GRANT OF LICENSE. Crossroads Community Church is granted a non-exclusive, non-transferable license during the term of the agreement to publicly play, perform, and transmit via the website noted above, any musical composition controlled by one or more of the domestic Performing Rights Organizations (ASCAP, BMI and SESAC), as stated in the CCS WORSHIPcast License Terms and Conditions.

We are in the final week of our 4-part series on Cancer, the #2 killer in America.   And this week, we share the steps you can take to prevent Cancer.  In this episode, we talk about:—How Smoking is the main habit that can be changed to prevent Cancer.  And why Dr. Prather says second-hand smoke is “even worse" than primary smoke. —The n immediate change Dr. Prather recommends to smokers regarding the type of cigarette they are smoking. —Why Homeopathy, Acupuncture, and Auriculotherapy are "very successful" treatments at Holistic Integration to help smokers break their addiction. —The role of Obesity as a contributor to Cancer, including hormonal changes that can lead to certain types of Cancer.—How the Body Composition Analysis test at Holistic Integration is more accurate than BMI in determining a patient's body fat percentage. —Why alcohol consumption contributes to Cancer.  And why Dr Prather says that alcoholics need their nutritional deficiencies corrected before they will be able to stop drinking. —The importance of keeping a patient's Liver enzymes in the right range to "dramatically" increase their chances of surviving Cancer.  And why Dr. Prather is against patients trying to do Liver Detox programs they find online and without proper guidance. —How Dr. Prather estimates only 5% of Cancers are genetically-determined, but 65% of cases are determined by diet and nutrition.—Why getting an annual stool kit to screen for infections and parasites that contribute to Cancer is so important. —Plus, you'll hear the inspiring story of Joe, who "feels great" after being diagnosed with Stage 4 Colon Cancer 2 years ago and was originally being told by his oncologist that he only had 6 months to 2 years left.http://www.TheVoiceOfHealthRadio.com*Receive exclusive bonus content as a member of our Voice Of Health Patreon Community:https://www.patreon.com/cw/VoiceofHealthPodcast

The Hume Health Body Pod is the smart health scale Nurse Doza uses daily — at home, in the clinic, and everywhere in between. With 8 multi-frequency sensors and accuracy within 2% of a DEXA scan, it measures 45+ health metrics including muscle mass, visceral fat, bone density, heart rate, and metabolic age in just 3-5 seconds. As discussed in this episode, putting real body composition data in your hands is the key to becoming your own health advocate.

In your later decades, how can strength training reverse muscle loss? In this episode, I spoke with Dr. William Evans, the scientist who first described sarcopenia, to unpack why muscle loss—not aging itself—is the biggest threat to metabolism, independence, and long-term health. We explored why muscle is far more adaptable than most women realize, even into advanced age, and why traditional measurements like scale weight and lean mass miss the real picture. Dr. William Evans is a muscle researcher, former pharma scientist, and a professor at the University of California, Berkeley, whose work has been cited over 80,000 times. If you've ever heard that muscle loss drives aging, chances are it traces back to his research. What you'll learn: (04:33) How losing muscle directly lowers metabolic rate and increases disease risk. (06:49) Why common body composition tests fail to measure true muscle mass. (07:31) How a new non-invasive muscle test predicts strength, disability, and longevity. (13:32) Why muscle percentage is more predictive than body weight or BMI. (20:55) How neurological changes and inactivity contribute to muscle loss after 30. (23:37) Why strength and power training are essential for preserving fast-twitch fibers. (30:49) How protein intake and resistance training protect muscle during weight loss. Love the podcast? Here's what to do: Subscribe to the podcast. Leave a review. Text a screenshot to me at 813-565-2627 and wait for a personal reply because your voice is so important to me. Want to listen to the show completely ad-free? Go to http://subscribetojj.com Click “TRY FREE” and start your ad-free journey today! When you're ready, enjoy the VIP experience for just $4.99 per month or $49.99 per year (save 17%!) Full show notes (including all links mentioned): https://jjvirgin.com/drevans Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, I sit down with one of my former mentors and professors, Dr. Alan Penzias, Medical Director at Boston IVF and Associate Professor at Harvard Medical School, to discuss his recent editorial in the Annals of Internal Medicine titled "The Weighty Issue of Obesity and Reproductive Success."  Read the full show notes on Dr. Aimee's website.  We dive deep into how age and weight factor into the fertility equation and why these conversations are so critical for anyone trying to conceive. Dr. Penzias shares his decades of experience helping patients navigate the complex intersection of body mass index, maternal age, and reproductive success, offering practical guidance on when to seek treatment and how to optimize your health before trying to get pregnant. In this episode, we cover: How age remains the strongest predictor of fertility success and why both partners should consider timing The U-shaped curve of BMI and fertility: why both low and high body mass index can impact conception Practical strategies for doctors for discussing weight and fertility with patients in a shame-free, empowering way When to prioritize immediate fertility treatment versus taking time for weight optimization based on age The role of GLP-1 medications (like Tirzepatide) in fertility treatment and safe protocols for use Why unexplained infertility may have hidden explanations related to weight and metabolic health The "do the as if" philosophy: building sustainable health habits one step at a time Resources: Dr. Alan Penzias and Boston IVF: BostonIVF.com Dr. Penzias's editorial: "The Weighty Issue of Obesity and Reproductive Success" - Annals of Internal Medicine https://www.acpjournals.org/doi/10.7326/ANNALS-25-02742  Dr. Penzias's YouTube video: "Evidence-Based Approach to Unexplained Infertility" https://youtu.be/9j4lNvmaXts?si=zmMFZFOno0sWnhcn  American Society for Reproductive Medicine (ASRM) Practice Committee resources on overweight and fertility https://www.asrm.org/ Dr. Stephanie Fein  - Fertility Weight Loss Specialist: https://www.stephaniefeinmd.com/  Hillary Wright, Nutritionist at Boston IVF: https://www.bostonivf.com/physicians/hillary-wright Do you have questions about IVF?Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, February 9, 2026 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom.   Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org. Other ways to connect with Dr. Aimee and The Egg Whisperer Show: Subscribe to my YouTube channel for more fertility tips!Subscribe to the newsletter to get updates  

Show NotesAt NAMM 2026, Sean Martin sits down with Chuck Tennin, the President and CEO of Big Fish Music and Big Fish Music Publishing Group, for a candid conversation about the role of AI in the music industry and why the human element remains irreplaceable. Known as "The Big Fish" and "The Alligator," Chuck has spent more than five decades working as an engineer, record producer, music publisher, and consultant, and he pulls no punches when it comes to the limits of technology in creative work.Chuck draws a sharp line between AI as a tool and AI as a replacement for human creativity. He points to organizations like ASCAP, BMI, and the Recording Academy as allies in the fight to protect the creative process, arguing that AI cannot replicate the feel, the instinct, and the emotional investment that go into producing a record. For Chuck, the difference between producing music and producing a record is everything: a record has to connect with an audience on a level that no algorithm can manufacture.The conversation takes listeners through Chuck's journey from two-track analog recording to the digital era of Pro Tools, exploring how each technological leap brought efficiency but never fully captured the warmth and authenticity of tape. He reflects on the critical distinction between an MP3 and a WAV file, between convenience and quality, and between what sounds good enough and what sounds like a record.Chuck also shares hard-earned wisdom about the business side of music: the perseverance required, the reality that 90% of aspiring artists fail, and the belief in oneself that separates survivors from those who walk away. Drawing on stories from legendary artists he has worked with over the decades, he reminds listeners that every big name started in the same place and climbed out of the same struggle.This is a conversation about what technology can assist with and what it can never touch: the soul of music and the humans who create it.HostSean Martin, Co-Founder at ITSPmagazine, Studio C60, and Host of Redefining CyberSecurity Podcast & Music Evolves Podcast | Website: https://www.seanmartin.com/GuestChuck Tennin, President and CEO of Big Fish Music and Big Fish Music Publishing Group | On LinkedIn: https://www.linkedin.com/in/chuck-tennin-3468b6105/ResourcesThe NAMM Show 2026 is taking place from January 20-24, 2026 | Anaheim Convention Center, Southern California — Follow our coverage: https://www.itspmagazine.com/the-namm-show-2026-namm-music-conference-music-technology-event-coverage-anaheim-californiaMusic Evolves: Sonic Frontiers Newsletter | https://www.linkedin.com/newsletters/7290890771828719616/Keywordschuck tennin, big fish music, sean martin, AI in music, analog vs digital recording, record producer, music publishing, Pro Tools, ASCAP, BMI, Recording Academy, NAMM 2026, music industry, human creativity, songwriting, music, creativity, art, artist, musician, music evolves, music podcast, music and technology podcastMore From Sean MartinMore from Music Evolves: https://www.seanmartin.com/music-evolves-podcastMusic Evolves on YouTube: https://www.youtube.com/playlist?list=PLnYu0psdcllTRJ5du7hFDXjiugu-uNPtWMusic Evolves: Sonic Frontiers Newsletter | https://www.linkedin.com/newsletters/7290890771828719616/On Location with Sean and Marco: https://www.itspmagazine.com/on-locationITSPmagazine YouTube Channel: https://www.youtube.com/@itspmagazineBe sure to share and subscribe! Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Born in Bar Harbor, Maine, Jude Johnstone began writing songs at about age 8.  At 18, she was "discovered" by Bruce Springsteen's saxophonist, Clarence Clemons.  After spending some time in New York and New Jersey under his wing, in 1979, she moved to Los Angeles, where her songs quickly became sought after by other artists. She has been covered by Bonnie Raitt, Emmylou Harris, Bette Midler, Johnny Cash, Stevie Nicks, Mary Black, Jennifer Warnes, Trisha Yearwood and more, including a #1 song for Yearwood's debut album called "The Woman Before Me" which earned her a BMI award. Her songs then appeared on 8 other Yearwood cds. She also penned the title track to Johnny Cash's 1997 Grammy winning album "Unchained." Jude has released 9 cds of her own that run the gamut from Celtic, Gospel, Americana, to Jazz, Blues, and even Big Band. She has been featured on the CBS Early Show, and NPR Radio's "Morning Edition." Her songs have also been on several television shows including "Nurse Jackie",  "Army Wives" and "Lie To Me."Jude has opened shows for Jackson Browne, Emmylou Harris, Bonnie Raitt, Richard Thompson, Shawn Colvin, Chris Hillman, 10,000 Maniacs, David Crosby and many others and toured Europe under her own name numerous times. "If Jude Johnstone is not yet a musical household name, she sure as hell should be." Henry Carrigan, No Depression"Turning emotional pain into art is a tricky business.Sometimes I wonder if the end result is worth it.Jude Johnstone makes a good case that it is."Rodney Crowell"Jude's fertility, in regards to songwriting, is truly awe inspiring." Bonnie Raitt..."She's patently a master at capturing the heart's dark and desperate moments, just as she's capable of  encouraging belief in its resurrection." Mike Davies, Roots and Branches/The BeatTheme song: “Hollywood Faded' by Luna Halo@treymitchellphotography @feeding_the_senses_unsensoredfacebook.com/profile.php?id=100074368084848www.threads.net/@treymitchellphotographyftsunashville@gmail.com

BMI is one number, not the full story. Dr. Melody Rodarte breaks down what doctors miss and what actually matters.   In this episode, Josh sits down with Dr. Melody Rodarte, board-certified in Internal Medicine and Obesity Medicine, to unpack why BMI can be misleading, why "eat less, exercise more" is incomplete, and why calories are not metabolically equal. They cover GLP-1 medications and the right way to think about them, fasting vs timed restricted eating, autophagy, and why perimenopause can start earlier and last longer than most people realize. General discussion only, not medical advice.   __ Thank you to OneAccord for partnering with us on this episode. OneAccord's OASYS Strategic Planning & Execution system helps business owners increase company value, reduce owner dependency, and get truly ready for a successful transition or exit. Josh Zolin listeners receive a complimentary Value Readiness Snapshot using the link below.   Start here:  https://oneaccord.co/oasys/joshzolin __ ► Download Your 90 Day ROI Playbook — A value packed free guide created by Josh Zolin that teaches you how to Multiply Your Profits with the Skills No One Trains  https://bitnw.academy/roiplaybook      

As one form of cultural capital is democratized, “the elite” promptly establish a new (less accessible) social asset. Therefore, what could it mean across the CPG landscape after GLP-1s made thinness no longer a pursuit of rarity? And while I recently shared a short-form content piece on this topic, it was not nearly enough time to properly assess massive opportunities emerging from this social phenomenon. Either way, my hope is to expand (while also simplifying) a messy sociology and economics intersection that blends elements of the “leisure class theory” and the concept of social distinction (along with) my own first principles thinking. The result? Optimistically, you'll clearly see the beginning of an enormous (potentially multi-decade long) structural realignment of consumer demand, as this new “Age of Ozempic” era is facilitating a "measuring stick" shift (with thinness commoditized) and strength (defined by lean muscle and metabolic health) elevating into the ultimate social status. But consumer surveys still show most Americans are interested in losing weight. So, why are “the elite” changing the social distinction game…even as the previous one still feels mostly inaccessible to a broader population? Whether analyzing over a 100 million annual BMI classifications, taking notice of recent CDC data involving adult obesity rates, or noticing that calories consumed per capita is declining…it appears obesity has peaked in the United States. However, that societal trend alone isn't the culprit. Instead, its centers around how GLP-1 medications have become this sort of "social technology," rapidly moving thinness from a result of extreme discipline (and/or maybe rare genetics) to a broadly accessible pharmaceutical outcome. So, because GLP-1s often cause significant muscle loss, maintaining a "strong" physique now requires a level of investment that the drugs alone cannot provide. Accordingly, muscle mass serves as a signal of disposable income, time, and agency over one's schedule, as it requires resistance training and specific nutritional regimens that are harder to sustain than medication alone. Hence, the new social distinction isn't just about weight, but the biological quality of the body…with strength now framed as a “critical measure of health.” And the CPG industry has also been strategically repositioning itself to sell this new social distinction. And that's obviously the sector lens I primarily utilized when making the comment about “then you probably need to learn more about what I've dubbed the foundational triad of muscle health” within my beforementioned short-form content. Although (in all honesty) just recognizing protein, creatine, and HMB could (very) likely grow their relevance (and inclusion) even further within the various categorical intersections across packaged foods, beverages, and dietary supplements…probably isn't a compelling enough insight, right? Nonetheless, what happens when a sizable share of the CPG industry strategically repositions themselves to (more obviously) sell this new social distinction? It appears this new “Age of Ozempic” era is facilitating a "measuring stick" shift (with thinness commoditized) and strength (defined by lean muscle and metabolic health) elevating into the ultimate social status, which should trigger a multi-decade “muscle health revolution” (effectively putting consumers in a trillion-dollar productized chokehold)!

Adolescent obesity is rapidly turning into a worldwide health emergency. The World Health Organization (WHO) reports that over 160 million children and teenagers ages 5 to 19 are now overweight or obese A new study from the University of Gothenburg collected data from nearly one million Swedish men and found that obese teenagers are more likely to experience severe infections later in life Obesity is a chronic medical condition characterized by excess body fat that impairs health and leads to symptoms such as fatigue, shortness of breath, joint pain, and metabolic issues that tend to worsen over time Body mass index (BMI) has traditionally been the standard for assessing weight and health, but it has come under scrutiny because it frequently misclassifies risk You can tackle obesity at its root by eliminating metabolic health hazards like seed oils and ultraprocessed foods and instead, choosing healthy carbs and walking more

🧭 REBEL Rundown 🗝️ Key Points 💉 Hydrocortisone Saves Lives:The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.📊 Guidelines Are Catching Up:The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.🔥 Redefining “Severe”:Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.🍬 Main Risk = Hyperglycemia:Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.🧭 Early, Targeted Use Matters:Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response. Click here for Direct Download of the Podcast. 📝 Introduction Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). 📖 Historical Context & Long-Standing Skepticism For decades, the use of steroids in pneumonia was controversial.Early Use: Steroids entered practice in the 1940s and 50s for autoimmune inflammation, but there was immediate hesitation regarding secondary superinfections.Mixed Data: From the 1980s to the 2000s, small studies emerged on severe pneumonia and ARDS, but the data was inconsistent. Different trials used varying definitions of “severe” pneumonia and different C-reactive protein (CRP) cutoffs, making the data “spread” and easy to “cherry pick” to support or deny a benefit.Past Guidelines: This uncertainty was reflected in official guidelines:2007 (ATS/IDSA): The American Thoracic Society and the Infectious Diseases Society of America did not address the topic due to insufficient data.2019 (ATS/IDSA): Pre-COVID, the guidelines recommended against using corticosteroids in severe CAP. They acknowledged no benefit for non-severe pneumonia, but the data for severe pneumonia was considered too weak to endorse.Pre-Trial Consensus: Prior to 2023, the consensus was to avoid steroids in non-severe pneumonia, while severe pneumonia remained a “gray area” with no treatment showing a clear mortality difference. 📜 The Landmark Cape Cod Trial (NEJM 2023) The Cape Cod trial, published in the New England Journal of Medicine in 2023, reignited the discussion by providing robust, positive data.Trial Design: Phase 3, multi-center, double-blind, randomized, controlled trial.Intervention: 800 patients randomized to two groups, Hydrocortisone as a continuous infusion (200mg/day) versus a placebo infusion.Taper: On day 4, clinicians would decide whether to continue the infusion or begin a taper based on clinical response.Population: Patients with severe CAP, defined by meeting at least one of the following criteria:Pneumonia Severity Index (PSI) > 130.O2 by FiO2 ratio < 300.Need for mechanical or non-invasive ventilation (with PEEP ≥ 5).Need for high FiO2 (>50%) via non-rebreather or heated high flow.Primary Outcomes: Death for any cause 6.2% (hydrocortisone) vs 11.9% (placebo)Secondary outcomes:Death from any cause at 90 days 9.3% (hydrocortisone) vs 14.7% (placebo)Endotracheal intubation 18% (hydrocortisone) vs 29% (placebo)Hospital-acquired infections 9.8% (hydrocortisone) vs 11.1% (placebo)Gastrointestinal bleeding 2.3% (hydrocortisone) vs 3.3% (placebo)Vasopressor initiation by day 28 15.3% (hydrocortisone) vs 25.0% (placebo)Key Findings: The trial demonstrated superiority for hydrocortisone 📋 Updated Guidelines & Current Practice The Cape Cod trial, along with subsequent meta-analyses, has begun to change official recommendations.Society of Critical Care Medicine (SCCM): In 2024, an SCCM expert panel, reviewing the Cape Cod trial and 18 others, strongly recommended corticosteroids for severe CAP. They concluded that steroids reduce mortality and the need for mechanical ventilation.Meta-Analysis (Smit et al.): A 2024 meta-analysis in Lancet Respiratory confirmed the 30-day mortality benefit.European Respiratory Society (ERS): The ERS has issued a recommendation to use steroids for severe pneumonia but still urges caution regarding side effects.ATS/IDSA: As of the podcast recording, the ATS/IDSA had not yet updated their 2019 guidelines. 🛠️ Practical Application for Clinicians Defining “Severe” CAP: The key is to identify patients who qualify as “severe”. This can be done using:Scoring Tools: The PSI is the best validated tool for mortality but is cumbersome. Simpler tools like CURB-65 or SMART-COP are practical and acceptable for defining severity. 2023 meta-analysis from by Zaki et al showed both work well, but CURB-65 has better mortality prediction early on.Cape Cod Criteria: Any patient meeting the trial’s inclusion criteria (e.g., high-flow O2, non-invasive ventilation) qualifies, regardless of location (ED, floor, or ICU).Biomarkers: While not required, a CRP level was used in many studies. A CRP > 150 (Cape Cod) or > 204 (Smit meta-analysis) strongly indicates severe inflammation that would benefit from steroids.Clinical Judgment: A patient who looks “sick,” has “soft” blood pressure, or has dense infiltrates and high oxygen needs (e.g., >50% FiO2 on high flow) is a candidate.Adverse Effects:Hyperglycemia: This was the most significant risk identified, with rates between 6-12%. This is a primary concern, especially in patient populations with high BMI.GI Bleed & Secondary Infection: Fears of these side effects, which contributed to historical skepticism, were not borne out in the Cape Cod trial. The data does not support being overly concerned.Other Side Effects: Mood changes, delirium, insomnia, and agitation in the elderly are known side effects of steroids that were not specifically addressed in the trial but remain clinical concerns. 🔄 Clinical Pathway for Steroids in Severe CAP Unanswered Questions & Future Research Possible remaining questions:Biomarkers: Can we find a more precise CRP level to distinguish moderate from severe disease? Could other markers like ferritin or IL-6 be used? Dosing & Tapering: How much immunomodulation is needed, and when is it truly safe to taper?Gender Differences: Early data suggests females may respond better to steroids and experience fewer side effects. The question of female patients with severe CAP require less corticosteroids needs further exploration. 👉 Clinical Bottom Line The current literature, spearheaded by the Cape Cod trial, now supports the use of corticosteroids in severe community-acquired pneumonia. The best evidence currently points to hydrocortisone, started early (within 24 hours) after severity is identified using a validated tool. While hyperglycemia is a risk, the previous fears of GI bleeding and secondary infections were not substantiated in recent, rigorous trials. 📚 References Chapa-Rodriguez A, Abou-Elmagd T, O’Rear C, Narechania S. Do patients with severe community-acquired bacterial pneumonia benefit from systemic corticosteroids?. Cleve Clin J Med. 2025;92(10):600-604. PMID: 41033846Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023;388(21):1931-1941. PMID: 36942789Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024;52(5):e219-e233. PMID: 38240492 Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Alex Chapa, MD PGY 5 Pulmonary Critical Care Fellow Cape Fear Valley Medical Center Fayetteville NC 🔎 Your Deep-Dive Starts Here REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia Corticosteroids have long sparked debate in the treatment of bacterial ... Thoracic and Respiratory Read More The post REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia appeared first on REBEL EM - Emergency Medicine Blog.

Belly fat changes how your heart is built and works, even when your weight and body mass index (BMI) appear normal Men face earlier and more severe heart damage because they store more fat deep in the abdomen, which increases pressure on the lungs and forces the heart to work harder with every breath Standard scales miss this risk, but simple waist measurements reveal hidden stress on your heart long before symptoms appear Beer bellies form when cellular energy fails, pushing fuel into fat storage instead of burning it for daily function Restoring metabolism through food choices, gut repair, and daily movement reduces belly fat and protects heart structure over time