POPULARITY
5 episodes with multifactorial
2 episodes with multifactorial
2 episodes with multifactorial
2 episodes with multifactorial
2 episodes with multifactorial
2 episodes with multifactorial
2 episodes with multifactorial
Today, Dr. Robert Whitfield chats with Dr. Joshua Schacter, an orthopedic surgeon based in Wichita Falls. They dive into how functional medicine can be woven into orthopedic practices, especially when it comes to joint health and how our lifestyle choices affect our musculoskeletal system. Dr. Schacter is all about taking a holistic approach, looking at the bigger picture by tackling underlying health issues like inflammation and metabolic health to help avoid major surgeries. They talk about making changes to your diet, exploring cutting-edge treatments like PRP and stem cell therapy, and how mindfulness can play a role in managing pain. Tune in to hear about a shift in orthopedic care, including more comprehensive, patient-focused practices. Show Highlights: Focus on Joint Pain (00:06:38) Multifactorial nature of joint pain and its commonality in aging Pharmaceutical Companies' Interests (00:10:43) Skepticism about the altruism of pharmaceutical companies concerning health improvements Trends in Joint Replacements (00:13:04) Discussion on the increasing number of joint replacements in younger patients Weight Loss and Joint Health (00:22:20) Importance of weight loss in improving joint health and reducing pain Functional Medicine Approach (00:23:45) Introduction to a holistic assessment of patients to understand underlying causes of joint pain Measuring Inflammation (00:25:15) Methods for assessing inflammation, including historical data and biomarkers Biomarkers and Gut Health (00:25:36) Details the use of various biomarkers and the critical role of gut health Anti-Inflammatory Diet (00:27:01) Effectiveness of an anti-inflammatory diet in reducing joint pain Platelet-Rich Plasma (PRP) Therapy (00:30:51) Benefits of PRP therapy for joint inflammation and healing Optimizing Joint Care (00:38:34) The potential to prevent unnecessary surgeries through holistic joint care strategies Bio: Dr. Josh Schacter Dr. Joshua Schacter, DO FAAOS, is America's Holistic Orthopedic Surgeon, dedicated to providing alternatives to surgery, steroids, and prescription medications. With nearly 20 years of experience and over 15,000 surgeries performed, he has seen the limitations of traditional medicine firsthand. In 2023, he founded Pinnacle Integrative Orthopedics, combining functional medicine with advanced orthobiologics to treat patients holistically. Dr. Schacter focuses on empowering patients to manage joint pain, regain mobility, and avoid invasive treatments. A passionate athlete and fitness enthusiast, he is committed to offering innovative, minimally invasive solutions that promote longevity and a better quality of life. Connect with Dr. Schacter Call Pinnacle Integrative Sports Medicine (940) 285-5007 Website (https://pinnaclesportsmedicine.com/), Facebook (https://www.facebook.com/PinnacleOrthoWF), Instagram (https://www.instagram.com/pinnacleintegrativeorthopedics/), TikTok (https://www.tiktok.com/@drjoshuaschacter/video/7448051466331262254), YouTube (https://www.youtube.com/channel/UCGldwrLAG_tG_Fa4FygNVmQ/videos), Bluesky (http://@drjoshuaschacter.bsky.social) Let's Connect... Podcast: https://podcasts.apple.com/gb/podcast/breast-implant-illness/id1678143554 Spotify: https://open.spotify.com/show/1SPDripbluZKYsC0rwrBdb?si=23ea2cd9f6734667 TikTok: https://www.tiktok.com/@drrobertwhitfield?t=8oQyjO25X5i&r=1 IG: https://www.instagram.com/breastimplantillnessexpert/ FB: https://www.facebook.com/DrRobertWhitfield Linkedin: https://www.linkedin.com/in/dr-robert-whitfield-md-50775b10/ X: https://x.com/rob_whitfieldmd Read this article - https://www.breastcancer.org/treatment/surgery/breast-reconstruction/types/implant-reconstruction/illness/breast-implant-illness Shop: https://drrobssolutions.com SHARP: https://www.harp.health NVISN Labs - https://nvisnlabs.com/ Get access to Dr. Rob's Favorite Products below: Danger Coffee - Use our link for mold free coffee - https://dangercoffee.com/pages/mold-free-coffee?ref=ztvhyjg JASPR Air Purifier - Use code DRROB for the Jaspr Air Purifier - https://jaspr.co/ Echo Water - Get high quality water with our code DRROB10 - https://echowater.com/ BallancerPro - Use code DRROBVIP for the world's leader in lymphatic drainage technology - https://ballancerpro.com Ultrahuman - Use code WHITFIELD10 for the most accurate wearable - https://www.ultrahuman.com/ring/buy/us/?affiliateCode=drwhitfield
In the world of functional health, we frequently find ourselves standing on the uncomfortable edge of pioneering thought and “proven” mechanisms and therapeutic strategies. Oftentimes we're working with tools that are a long ways from being accepted by conventional healthcare and it can feel like we're working in the wild west. And yet, there is a substantial and growing body of research that supports the functional approach. That said, our relationship with research and the latest science isn't always an easy one. Just like with mainstream medicine, it can take some time for new findings to make their way into the functional clinical practice. In this episode of the RWS Clinician's Corner, we have a nuanced conversation on this extremely important topic with Dr. Jordan Robertson, a Canadian Naturopathic Doctor and founder of The Confident Clinician, a practice resource and database for Naturopathic Doctors to help elevate their professional practice by offering clinical practice guidelines, patient resources, and ongoing training for health professionals in the functional space. In this interview, we discuss: How to navigate new, innovative approaches that get exceptional results in practice but that don't yet have substantive evidence. When is it appropriate to lean on the research? And how do we continue to pioneer within that context? Bias - how do we detect our own, that of the researchers, and how do we navigate this in the context of making clinical decisions for our clients? How do we navigate the research itself - what is credible and what is not? How and when should we change clinical practice based on new evidence? How much new evidence is necessary before we change our ways? The Clinician's Corner is brought to you by Restorative Wellness Solutions. Follow us: https://www.instagram.com/restorativewellnesssolutions/ Connect with Dr. Jordan Robertson: Website: www.confidentclinicianclub.com Instagram: @drjordannd and @theconfidentclinicianclub The Confident Clinician is the first resource for clinicians of its kind. With a complete database and clinical decision-making tool built for integrative medicine clinicians, there's no more digging through studies on your own or wishing nutrition information was included in the major databases from the past. You can get a sneak peek of the full power of The Confident Clinician by unlocking access to the AI search tool for 24 hours. You can ask any clinical question, ask it for an opinion on how to support a specific type of patient, or ask it to give you the best research for a supplement you'd like to use in practice. Access the trial by creating a free account here: https://discover.theconfidentclinicianclub.com/lm-ai-search-tool Timestamps: 00:00 Undergraduate program fostered critical thinking skills. 10:05 Critical thinking bridges functional and conventional medicine. 12:22 Hold functional medicine to conventional care standards. 18:22 Functional medicine should collaborate with conventional medicine. 26:51 Nutrition research is complex and difficult compared to pharmaceuticals. 31:10 Multifactorial, subjective standards challenge effective care practices. 37:43 Probiotic research biases; clinical practice varies results. 41:57 Selective preference influences supplement purchasing decisions. 48:03 Integrative clinicians should collaborate with conventional medicine. 50:31 Embrace collaboration, avoid assumptions, understand diverse perspectives. 57:07 Dr. D'Agostino pioneers integrating diet and oncology. 01:00:23 Adapting recommendations based on evolving research evidence. 01:08:48 Join Clinician's Corner podcast, share, suggest topics. Speaker bio: I can't think of anyone more qualified to have this conversation with. Not only is Dr. Robertson is the founder of The Confident Clinician, she is also the founder of Clarity Health, a Naturopathic Clinic in Ontario, Canada that has served over 20,000 patients, a podcast host with ambitions of making accurate women's health information accessible to all, the off-site ND for the Endometriosis Clinic at McMaster hospital and instructor for the undergraduate Health Sciences program. And perhaps most importantly, Dr. Robertson is a fierce advocate for evidence-based approaches in functional health. Dr. Jordan is changing the way Naturopathic Doctors practice and integrate in medicine, with the Confident Clinician currently supporting over 600 NDs in North America and worldwide. She could see all of the problems in her industry that were holding practitioners back and built the program to solve them. Keywords: standards of care, clinical strategy, integrative care research, evidence-based practices, commercial interest bias, supplement companies, self-reported symptoms, lab tests, unbiased clinical decisions, robust evidence, nutrition database, supplement information, clinician training, integrative medicine journal, social media controversy, Confident Clinician Club, cognitive bias, functional medicine, gluten-free diet, multifactorial health outcomes, guru wars, naturopathic practices, critical thinking, vitamin D dosing, estrogen dominance, collaboration with conventional medicine, industry-funded research, product efficacy, brand bias, dietary strategies. Disclaimer: The views expressed in the RWS Clinician's Corner series are those of the individual speakers and interviewees, and do not necessarily reflect the views of Restorative Wellness Solutions, LLC. Restorative Wellness Solutions, LLC does not specifically endorse or approve of any of the information or opinions expressed in the RWS Clinician's Corner series. The information and opinions expressed in the RWS Clinician's Corner series are for educational purposes only and should not be construed as medical advice. If you have any medical concerns, please consult with a qualified healthcare professional. Restorative Wellness Solutions, LLC is not liable for any damages or injuries that may result from the use of the information or opinions expressed in the RWS Clinician's Corner series. By viewing or listening to this information, you agree to hold Restorative Wellness Solutions, LLC harmless from any and all claims, demands, and causes of action arising out of or in connection with your participation. Thank you for your understanding.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SQE865. EBAC/CME/MOC/AAPA/IPCE credit will be available until November 1, 2025.How to Make Multifactorial Clinical Decisions in HR+, HER2- EBC and MBC: Guiding Precision Amid Growing Complexity In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
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Hello and welcome to The Progress Theory, where we discuss scientific principles for optimising human performance. I am Dr. Phil Price. And on today's episode, we are joined by Powerlifter and S&C coach, Rob Palmer. Now, I've known Rob for many, many years and I know he knows a thing or two about getting as strong as possible. He's won many national titles and international titles in Powerlifting and was an S C coach in professional rugby for over 15 years. So I wanted to know a bit more around his processes on getting as strong as possible and see if we can use that to improve our bench press.In this episode, we discuss:0:47 - Introduction7:20 - The importance of a strength culture14:19 - Learning from programming for rugby and powerlifting19:00 - Multifactorial approach to programming22:46 - Common mistakes in strength training25:35 - Variability in strength training & Programming32:27 - Identifying limiters of bench press performance34:01 - Rob's bench press training37:00 - Reflecting on Rob's powerlifting career50:07 - Common mistakes in powerlifting skill55:35 - What is 969 strength?Key FindingsThe Challenges of Professional Sport: "The job in professional sport, you're challenged to make lots and lots and lots of decisions every single day that realistically could have a very negative outcome for the player.""The Value of Strength Training": I still think people don't value strength training as much as they should, because things come in and out of vogue, don't they? So when I first came to the sport, strength training was massive in terms of the thought process of what strength training can do for you. And I'm talking about basic strength training, getting good at deadlifting, getting good at squatting, getting good at being able to bench press, overhead press as much weight as possible, you had this kind of culture.Viral Topic: The Importance of Recovery in RugbyQuote: "In rugby, it's all about the recovery. It's got nothing to do with because the guys who are obviously aerobically really well developed, they're not particularly strong, but they can come in and hit 80% plus, 90% plus. It doesn't seem to affect them the same way that it does the guys who are less fit now, if you take them out of that context, say they get injured and they come out. The guys who are less aerobically developed as soon as they start the weight training. And obviously this is a bit of what you're born with, isn't it?"The Future of Sports Science: "My biggest learnings from rugby are more that kind of truly holistic kind of programming where you have to consider you have an appreciation and consider all the facets of what make an athlete good.""Improving Strength in Training": "Are you applying a stimulus? And is that stimulus great enough to elicit some sort of adaptation as you come back up?"Injury Prevention in Sports Training: "So you do lots of volume and you work on lots of different muscle groups in isolation down here, so you can deal with the amount of stress is greater, although it's not on the higher end of the intensity spectrum.""The Importance of Variation in Strength Training": With the squat you'd use lots of variations, so you get total leg development and it's the same kind of principle. You get total development of all the muscles required to enhance your, in this case, bench press performance. On that isolated muscle side, you get this kind of every single muscle gets developed to its maximal ability or its maximal potential there in isolation. Then you start to strip away, don't you?Periodized Training: "Yeah, it would be the longest phase of all the phases. But within that so one of the key things for me within all...
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/RRR865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 9, 2025.Custom Care Compass: Mastering Multifactorial Clinical Decision-Making in High-Risk HR+, HER2- MBC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoyce O'Shaughnessy, MD, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AbbVie Inc.; Agendia; Amgen Inc.; Aptitude Health; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; Bristol Myers Squibb; Celgene Corporation; Daiichi Sankyo, Inc.; Duality Biologics; Eisai Inc.; F. Hoffmann-La Roche Ltd.; G1 Therapeutics, Inc.; Genentech, Inc.; Gilead Sciences, Inc.; GRAIL, Inc.; Halozyme, Inc.; Heron Therapeutics, Inc.; Immunomedics, Inc.; Ipsen Biopharmaceuticals, Inc.; Lilly; Merck & Co., Inc.; Myriad Genetics, Inc.; Nektar; Novartis Pharmaceuticals Corporation; Ontada LLC; Pfizer; Pharmacyclics LLC; Pierre Fabre group; prIME Oncology; Puma Biotechnology, Inc.; Samsung Bioepis; Sanofi; Scorpion Therapeutics, Inc.; Seagen Inc.; Stemline Therapeutics, Inc./The Menarini Group; Syndax Pharmaceuticals Inc.; Synthon; Taiho Oncology, Inc.; and Takeda Pharmaceutical Company Limited.Faculty/PlannerSara M. Tolaney, MD, MPH, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for 4D pharma plc; Aadi Bioscience, Inc.; ARC Therapeutics; Artios Pharma; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; BeyondSpring Pharmaceuticals Inc.; Blueprint Medicines; Bristol Myers Squibb; CytomX Therapeutics, Inc.; Daiichi Sankyo Inc.; eFFECTOR Therapeutics; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Incyte; Jazz Pharmaceuticals; Lilly; Merck & Co., Inc.; Myovant Sciences Ltd.; Natera; Novartis Pharmaceuticals Corporation; Pfizer; Reveal Genomics; Sanofi; Seattle Genetics, Inc.; Stemline Therapeutics, Inc./The Menarini Group; Systimmune; Tango Therapeutics; Umoja Biopharma; Zentalis; Zetagen; and Zymeworks Inc.Grant/Research Support from AstraZeneca; Bristol Myers Squibb; Cyclacel Pharmaceuticals, Inc.; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Lilly; Merck & Co., Inc.; NanoString Technologies Inc.; Nektar; Novartis Pharmaceuticals Corporation; Pfizer; Sanofi; and Seattle Genetics, Inc.Other Financial or Material Support from Steering committee for CytomX Therapeutics, Inc. and OncXerna Therapeutics, Inc.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/RRR865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 9, 2025.Custom Care Compass: Mastering Multifactorial Clinical Decision-Making in High-Risk HR+, HER2- MBC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoyce O'Shaughnessy, MD, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AbbVie Inc.; Agendia; Amgen Inc.; Aptitude Health; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; Bristol Myers Squibb; Celgene Corporation; Daiichi Sankyo, Inc.; Duality Biologics; Eisai Inc.; F. Hoffmann-La Roche Ltd.; G1 Therapeutics, Inc.; Genentech, Inc.; Gilead Sciences, Inc.; GRAIL, Inc.; Halozyme, Inc.; Heron Therapeutics, Inc.; Immunomedics, Inc.; Ipsen Biopharmaceuticals, Inc.; Lilly; Merck & Co., Inc.; Myriad Genetics, Inc.; Nektar; Novartis Pharmaceuticals Corporation; Ontada LLC; Pfizer; Pharmacyclics LLC; Pierre Fabre group; prIME Oncology; Puma Biotechnology, Inc.; Samsung Bioepis; Sanofi; Scorpion Therapeutics, Inc.; Seagen Inc.; Stemline Therapeutics, Inc./The Menarini Group; Syndax Pharmaceuticals Inc.; Synthon; Taiho Oncology, Inc.; and Takeda Pharmaceutical Company Limited.Faculty/PlannerSara M. Tolaney, MD, MPH, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for 4D pharma plc; Aadi Bioscience, Inc.; ARC Therapeutics; Artios Pharma; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; BeyondSpring Pharmaceuticals Inc.; Blueprint Medicines; Bristol Myers Squibb; CytomX Therapeutics, Inc.; Daiichi Sankyo Inc.; eFFECTOR Therapeutics; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Incyte; Jazz Pharmaceuticals; Lilly; Merck & Co., Inc.; Myovant Sciences Ltd.; Natera; Novartis Pharmaceuticals Corporation; Pfizer; Reveal Genomics; Sanofi; Seattle Genetics, Inc.; Stemline Therapeutics, Inc./The Menarini Group; Systimmune; Tango Therapeutics; Umoja Biopharma; Zentalis; Zetagen; and Zymeworks Inc.Grant/Research Support from AstraZeneca; Bristol Myers Squibb; Cyclacel Pharmaceuticals, Inc.; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Lilly; Merck & Co., Inc.; NanoString Technologies Inc.; Nektar; Novartis Pharmaceuticals Corporation; Pfizer; Sanofi; and Seattle Genetics, Inc.Other Financial or Material Support from Steering committee for CytomX Therapeutics, Inc. and OncXerna Therapeutics, Inc.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/RRR865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 9, 2025.Custom Care Compass: Mastering Multifactorial Clinical Decision-Making in High-Risk HR+, HER2- MBC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoyce O'Shaughnessy, MD, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AbbVie Inc.; Agendia; Amgen Inc.; Aptitude Health; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; Bristol Myers Squibb; Celgene Corporation; Daiichi Sankyo, Inc.; Duality Biologics; Eisai Inc.; F. Hoffmann-La Roche Ltd.; G1 Therapeutics, Inc.; Genentech, Inc.; Gilead Sciences, Inc.; GRAIL, Inc.; Halozyme, Inc.; Heron Therapeutics, Inc.; Immunomedics, Inc.; Ipsen Biopharmaceuticals, Inc.; Lilly; Merck & Co., Inc.; Myriad Genetics, Inc.; Nektar; Novartis Pharmaceuticals Corporation; Ontada LLC; Pfizer; Pharmacyclics LLC; Pierre Fabre group; prIME Oncology; Puma Biotechnology, Inc.; Samsung Bioepis; Sanofi; Scorpion Therapeutics, Inc.; Seagen Inc.; Stemline Therapeutics, Inc./The Menarini Group; Syndax Pharmaceuticals Inc.; Synthon; Taiho Oncology, Inc.; and Takeda Pharmaceutical Company Limited.Faculty/PlannerSara M. Tolaney, MD, MPH, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for 4D pharma plc; Aadi Bioscience, Inc.; ARC Therapeutics; Artios Pharma; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; BeyondSpring Pharmaceuticals Inc.; Blueprint Medicines; Bristol Myers Squibb; CytomX Therapeutics, Inc.; Daiichi Sankyo Inc.; eFFECTOR Therapeutics; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Incyte; Jazz Pharmaceuticals; Lilly; Merck & Co., Inc.; Myovant Sciences Ltd.; Natera; Novartis Pharmaceuticals Corporation; Pfizer; Reveal Genomics; Sanofi; Seattle Genetics, Inc.; Stemline Therapeutics, Inc./The Menarini Group; Systimmune; Tango Therapeutics; Umoja Biopharma; Zentalis; Zetagen; and Zymeworks Inc.Grant/Research Support from AstraZeneca; Bristol Myers Squibb; Cyclacel Pharmaceuticals, Inc.; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Lilly; Merck & Co., Inc.; NanoString Technologies Inc.; Nektar; Novartis Pharmaceuticals Corporation; Pfizer; Sanofi; and Seattle Genetics, Inc.Other Financial or Material Support from Steering committee for CytomX Therapeutics, Inc. and OncXerna Therapeutics, Inc.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/RRR865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 9, 2025.Custom Care Compass: Mastering Multifactorial Clinical Decision-Making in High-Risk HR+, HER2- MBC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoyce O'Shaughnessy, MD, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AbbVie Inc.; Agendia; Amgen Inc.; Aptitude Health; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; Bristol Myers Squibb; Celgene Corporation; Daiichi Sankyo, Inc.; Duality Biologics; Eisai Inc.; F. Hoffmann-La Roche Ltd.; G1 Therapeutics, Inc.; Genentech, Inc.; Gilead Sciences, Inc.; GRAIL, Inc.; Halozyme, Inc.; Heron Therapeutics, Inc.; Immunomedics, Inc.; Ipsen Biopharmaceuticals, Inc.; Lilly; Merck & Co., Inc.; Myriad Genetics, Inc.; Nektar; Novartis Pharmaceuticals Corporation; Ontada LLC; Pfizer; Pharmacyclics LLC; Pierre Fabre group; prIME Oncology; Puma Biotechnology, Inc.; Samsung Bioepis; Sanofi; Scorpion Therapeutics, Inc.; Seagen Inc.; Stemline Therapeutics, Inc./The Menarini Group; Syndax Pharmaceuticals Inc.; Synthon; Taiho Oncology, Inc.; and Takeda Pharmaceutical Company Limited.Faculty/PlannerSara M. Tolaney, MD, MPH, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for 4D pharma plc; Aadi Bioscience, Inc.; ARC Therapeutics; Artios Pharma; AstraZeneca; Bayer HealthCare Pharmaceuticals, Inc.; BeyondSpring Pharmaceuticals Inc.; Blueprint Medicines; Bristol Myers Squibb; CytomX Therapeutics, Inc.; Daiichi Sankyo Inc.; eFFECTOR Therapeutics; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Incyte; Jazz Pharmaceuticals; Lilly; Merck & Co., Inc.; Myovant Sciences Ltd.; Natera; Novartis Pharmaceuticals Corporation; Pfizer; Reveal Genomics; Sanofi; Seattle Genetics, Inc.; Stemline Therapeutics, Inc./The Menarini Group; Systimmune; Tango Therapeutics; Umoja Biopharma; Zentalis; Zetagen; and Zymeworks Inc.Grant/Research Support from AstraZeneca; Bristol Myers Squibb; Cyclacel Pharmaceuticals, Inc.; Eisai Inc.; Exelixis, Inc.; Genentech, Inc./F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Lilly; Merck & Co., Inc.; NanoString Technologies Inc.; Nektar; Novartis Pharmaceuticals Corporation; Pfizer; Sanofi; and Seattle Genetics, Inc.Other Financial or Material Support from Steering committee for CytomX Therapeutics, Inc. and OncXerna Therapeutics, Inc.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.
Are you experiencing symptoms and wondering how to know if you've entered of perimenopause? In the latest episode of The Hormone Balance Solution podcast, we take a look at the signs and symptoms of perimenopause. From hormonal fluctuations to lifestyle adjustments, this stage of midlife can be managed with the right knowledge and support. Low Progesterone and Estrogen Symptoms of low progesterone and low estrogen are telltale signs of perimenopause. Recognizing changes such as mood swings, irregular cycles, hot flashes, and more can indicate that you've entered this transition. The Transition Period Perimenopause can last for 12-15 years, and it's crucial to support your body through this transition. Multifactorial approaches including hormone replacement therapy, inflammation reduction, and blood sugar balance are essential for managing symptoms and setting the stage for long-term health. Beyond Perimenopause It's not just about managing perimenopause, but also setting yourself up for a healthy future. By addressing diet, lifestyle, functional testing, and custom supplementation alongside hormone therapy, you can support your body through perimenopause and beyond. Explore the full podcast episode for a deeper understanding of perimenopause and discover how to navigate this stage with grace and empowerment. Share this with the women in your life who can benefit from this important information, and stay tuned for more insightful episodes. Don't miss out on valuable insights - subscribe to The Hormone Balance Solution podcast today! Mentioned in this episode: EQUIP PRIME PROTEIN – Click HERE to grab yours and use my code: TARA20 to get 20% off Register for my Live Training coming up in February - More details HERE! Hi, I'm Tara Thorne, FDN-P, RHN, FNC and women's health and hormone expert. After serving hundreds of women in my signature program, The Hormone Balance Solution, I bring to you, the HBS Podcast. This podcast is all about educating women, and giving them actionable strategies for supporting hormonal harmony. It's my passion to empower women to take back their health and their happiness. We'll cover gut health, mineral balancing, nutrient deficiencies, cellular health, nervous system health, functional testing, and so much more. No Fluff. No BS. Just everything you need to know and nothing you don't.
Hablamos con la doctora Cristina Ortega Casanueva de alergias alimentarias y sus consecuencias en las relaciones sociales en el ámbito escolar fundamentalmente. La obesidad es de nuevo protagonista en el programa con el doctor Felipe Casanueva que nos muestra que es una enfermedad crónica y multifactorial.Escuchar audio
In this episode, we're joined by Dr. Anshul Gupta, a leading expert in Hashimoto's thyroiditis. Together, we delve into the intricate world of Hashimoto's, exploring crucial topics such as the significant of identifying root causes, the top foods to avoid and include, the impact of gluten and caffeine, the debate around iodine supplementation, and the intriguing connection between heavy metals and Epstein Barr virus.Dr. Anshul Gupta is a best-selling author, speaker, researcher, and the world expert in Hashimoto's disease. He educates people worldwide on reversing Hashimoto's disease. He is a Board-Certified Family Medicine Physician, with advanced certification in Functional Medicine, Peptide therapy, and also Fellowship trained in Integrative Medicine. He has worked at the prestigious Cleveland Clinic Department of Functional Medicine alongside Dr. Mark Hyman. He has helped thousands of patients to reverse their health issues by using the concepts of functional medicine. SHOW NOTES:0:51 Welcome to the show!1:12 Pop Quiz of the Day6:33 Zooming in on Hashimoto's7:20 About Dr. Anshul Gupta8:06 Welcome him to the podcast9:42 His life's mission10:08 What is Hashimoto's Disease?10:46 What is the missing link in diagnosis?11:50 Underlying root causes14:02 Multifactorial causes of Hashimoto's15:13 Top foods to avoid15:50 Addressing caffeine intake19:20 Gluten & Dairy for Thyroid22:56 Top Superfoods for Thyroid24:35 Importance of high-quality fats26:26 Eggs: Yay or Nay?28:39 Goitrogens & Iodine30:38 * Troscriptions Calm *33:36 Testing for iodine levels36:55 Fasting & Hashimoto's41:05 * Magnesium Breakthrough *43:38 Environment Toxins & Heavy Metals46:01 Caution: Detox Protocols48:25 Testing for heavy metals & mold toxins50:20 Amalgam fillings & thyroid toxicity52:45 Exercise as a stressor55:15 Poor Sleep & Adrenals56:48 Managing stress58:52 Hormonal System as a symphony1:00:25 Epstein Barr & Thyroid1:05:30 Full Thyroid Panels1:07:37 Expected healing timeline1:09:43 His final piece of advice1:10:31 Where to find him1:11:55 Thanks for tuning in!RESOURCES:AnshulGuptaMD.comFacebookInstagramYouTubeLinkedInTroscriptions Calm - code: BIOHACKERBABES for 10% offBiOptimizers Magnesium Breakthrough - code: BIOHACKERBABES10 for 10% offSupport this podcast at — https://redcircle.com/biohacker-babes-podcast/donationsAdvertising Inquiries: https://redcircle.com/brands
They didn't teach this in medical school.Orthopedic surgeon Carlos Moreyra had to do his own research to learn that diet plays a crucial role in maintaining orthopedic health. A variety of factors can affect bone strength and density. Your choice of food can either help prevent orthopedic disease or increase the likelihood of orthopedic diseases including osteoarthritis, osteoporosis, and even fractures.In this episode, Dr. Moreyra discussed how advanced glycation end products affect bone health in several ways. He notes that chronic medication can affect bone health and highlights the necessity to cut back on carbohydrates, processed foods, and sugars to maintain strong bones. He advocates dietary and lifestyle changes to prevent orthopedic conditions and make you stay off his operating table.Quick Guide01:08 Introduction09:26 Why isn't diet being talked about in the orthopedic community17:52 Would diet changes affect the traumatic injuries of professional athletes?25:26 Oxidized LDL and how it affects day to day life29:25 Multifactorial reasons for orthopedic problems36:23 Diet that affects the bone formation of children37:22 Osteoporosis and advanced glycation end products42:06 Building a bone is like building a house49:06 Chronic medication57:21 The nutritional benefit of consuming organsGet to know our guestDr. Carlos Moreyra is an orthopedic surgeon whose treatment goals include dietary and lifestyle changes. “So I think what people need to focus is about, look at their diet. Make sure you kind of clean it out, cut the sugars, grains, refined carbohydrates... Focus on protein, because bone is going to be 40% protein.” - Dr. Carlos Moreyra Connect with himWebsite: https://carlosemoreyramd.com/Twitter: https://twitter.com/moreyraorthoEpisode snippets06:53 - 08:01 - An inflammatory component driven by diet20:20 - 21:06 - Diet and mechanisms of injury26:13 - 28:02 - How oxidized LDL becomes problematic to the body30:58 - 31:47 - Injury reasons are multifactorial34:33 - 35:26 - A precursor for diabetes42:56 - 44:36 - Building a bone is like building a house Continuous Glucose Monitors are the best way to monitor your own metabolic health and learn how to better care for yourself. Get a Continuous Glucose Monitor for yourself through the Stay Off My Operating Table* podcast.Go to iFixHearts.com/UltraHuman for details.*Offer good for residents of the United States only. Contact Stay Off My Operating TableTweet with us: Dr. Ovadia: @iFixHearts Jack Heald: @JackHeald5 Learn more: Get Dr. Ovadia's book Stay Off My Operating Table on Amazon. Take Dr. Ovadia's metabolic health quiz: iFixHearts visit Dr. Ovadia's website: Ovadia Heart Health visit Jack Heald's website: CultYourBrand.com Theme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey(c) 2016 Mercury Retro Recordings
CME credits: 0.25 Valid until: 28-02-2024 Claim your CME credit at https://reachmd.com/programs/cme/personalizing-the-treatment-of-recurrentmetastatic-hnscc-a-multifactorial-path/14953/ KEYNOTE-048 has opened new vistas to managing patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Nonetheless, uncertainties remain in matching the correct patient with the correct strategy. Join Drs. Barbara Burtness and Nabil Saba as they parse the key trials and offer insight into building treatment algorithms designed to optimize outcomes for your patients with R/M HNSCC.=
La dispepsia es una patología del tracto gastrointestinal superior, más conocido como un trastorno funcional digestivo, ya que en la mayoría de los casos no existe ninguna alteración anatómica ni funcional. Las personas que lo sufren refieren dolor centrado en la parte superior del tracto, opresivo y ardoroso, con llenura temprana, náuseas después de las comidas o vaciado lento, eructos, ruidos estomacales… Su diagnóstico implica una série de pruebas médicas invasivas, como una gastroscopia.Para que realmente se trate de un trastorno funcional cronificado tiene que haberse dado, por lo menos 3 veces/semana en los últimos 3 meses. Si solo sucede de forma puntual, se conoce como indigestión. Es un trastorno Multifactorial: emociones, tensión laboral y familiar, la cantidad de ácido de nuestro estómago, infección por HP.Tratamiento: se trata según las causas presentadas, o según manifestación clínica. En HP se trata la infección, con una gran mejora cuando se consigue erradicar. Si es por ingesta de fármacos irritantes, se puede tratar para mejorar los síntomas, como con fármacos inhibidores de la bomba de protones. Cuando se siente plenitud alimentaria: (problema de vaciamiento gástrico) se utilizarán los medicamentos procinéticos. Incluso el uso de fármacos tranquilizantes o técnicas de relax para el paciente pueden ayudar a mejorar el dolor y los síntomas asociados.
Thinking about where to start your homestead? In todays episode, we chat about all the shit you should consider before taking the plunge on deciding where to put down roots ;) Multifactorial for sure, we highlight some of the basic and some of the obscure questions to ask when deciding where to start a homestead :) Want DAILY pics, videos, and moments of our hilariously chaotic lives?? Of course you do!! Follow us on our social media platforms! Instagram ~ https://www.instagram.com/ourkindofhomesteading/ (https://www.instagram.com/ourkindofhomesteading/) AND FaceBook ~ https://www.facebook.com/ourkindofhomesteading (https://www.facebook.com/ourkindofhomesteading) Social media allows us to build relationships with our listeners (which we ABSOLUTELY LOVE!) and deepen connections! And connections, my friend, is what it's all about!! Hope to see you there! :) Want to be a part of our feedback and awesome community?? Leave a review!! Click this link to our podcast website, https://ourkindofhomesteading.captivate.fm and leave a raving review (hopefully all good things!!) about us, our podcast, what you like about it, and anything you want us to start adding!! We LOVE hearing your thoughts!! So start typing. ;) As always, reach out to us with any questions or just to chat! We LOVE hearing from you! Also, keep a look out for our brand new podcast coming soon! Yay!! Porch Talks, only on Patreon, is just more of us in all our glory, giving you tons of laughs without having to interrupt the comedy for any info-giving ;) We're super excited and can't wait!! :) We'll be sure to give all the links and info as soon as it's all up and going! :) Happy Homesteading! This podcast uses the following third-party services for analysis: Chartable - https://chartable.com/privacy Podcorn - https://podcorn.com/privacy
The use of the combination of stimulants and antipsychotic medications is increasing in pediatric patients who suffer from Attention Hyperactivity Disorder (ADHD). In this podcast, Dr. Mohamed Mohamoud discusses how this combination may result in acute hyperkinetic movement disorder in children. Using the FDA Adverse Event Reporting System database, Dr. Mohamoud and his colleagues conducted a case series analysis and identified 36 instances where a pharmacodynamic drug-drug interaction may have resulted in the disorder. Their report is published in the May/June 2022 issue of the Journal of Clinical Psychopharmacology. Prescribing information has recently been updated and this podcast discusses the data upon which that information was changed. Dr. Mohamoud is being interviewed by FDA press officer Charlie Kohler.
You know what it's like if you don't get enough sleep. You end up grouchy, stressed and struggling to concentrate. We all have times when our sleep is poor, but when it goes on for an extended period, it can have a massive impact on quality of life. Whilst good sleep hygiene can help, sometimes we need to get to the root of what's interrupting the sleep behaviours. What's our relationship with our bed like! How much is the anxiety around not sleeping causing us not to sleep? Well, I got these any many other questions answered when I had a virtual coffee with Tracy Hannigan, AKA The Sleep Coach recently. Tracy uses Cognitive Behavioural Therapy for Insomnia to help her clients to not only get a good night's sleep but to change their relationship with sleep for good. Tracy is ffering listeners of Generation Exceptional a 10% discount on her CBTi for Insomnia online Sleep Recovery course with the code GENX22. Check out Tracy's Instagram channel @Tracythesleepcoach https://www.instagram.com/tracythesle... or head over to her Facebook Community Sound Sleep Strategies https://www.facebook.com/groups/14935... You can also follow her on YouTube 'Tracy The Sleep Coach' https://www.youtube.com/channel/UCQle... Transcript: Tracy Hannigan Hi everyone. And welcome to another episode of generation exceptional with me, Bev Thorogood. My guest today is really going to appeal to any of the women out there who really struggle with midlife sleep disruption. My guest is Tracy Hannigan, Tracy, The Sleep Coach, welcome to the show. Thank you very much. Very excited to be here. You're very welcome. This is one that I'm really interested to talk about because I hear so many women tell me how poorly they sleep. Now I've been quite lucky. I have occasional disrupted sleep. I think that's probably quite normal. It's probably a little bit more frequent now than it was in my thirties, but it's not a major problem for me, but I know some women, it is absolutely ruining their lives, that they're not getting enough sleep. So I was fascinated to have you on the podcast. I saw you speak a couple of months ago at a Facebook event. And I just thought I have got to get Tracy onto the podcast because the way you talk about managing sleep and repairing sleep patterns, I suppose it's different to anything I'd ever heard before. Let me stop talking for a moment and introduce you, I'll let you introduce yourself. . Just tell us a little bit about who you are, your background and how you ended up as a sleep coach. Right. So my name is Tracy Hannigan. My background is actually as a registered healthcare professional and that has taken different guises over time. I worked in community mental health, courtesy of a degree in psychology, back in the States and obviously in that environment, dealing with a lot of situations and a lot of people who really struggle with their sleep, either as a cause or consequence of their mental health issues. Moving to the UK and training as an osteopath, obviously seeing a lot of pain issues with sleep issues. And so the more I looked around, the more I saw sleep as just a very fundamental problem. We all have disrupted sleep for short periods, but there is a certain percentage of the population who struggle in an ongoing way. Often unnecessarily with, with their sleep. And I'm very interested in sleep from a, from a personal point of view as well. I had my first bout of insomnia in my early twenties, after the death of my husband. Obviously you would expect that there'd be sleep disruption, but it went on for years. And then another bout a little bit later in life where I learned the tools and the skills that cognitive behavioral therapy for insomnia can give somebody and decided that I would train in this particular technique courtesy of being able to use the other bits of my background and began working in a clinic setting in person with people. And then when the pandemic hit I took that online. I'd thought about doing it and then the situation, the context, just gave me that little bit of an extra push. And so now I'm working completely online with people who are trying to sort out their insomnia. We'll talk about the methodology that you use in a second or two, but I'm just wanting to pick up, you said in terms of cause or consequence. That was interesting. So insomnia is the cause of problems or insomnia is the consequence of problems? I'm guessing from what you said it can be either. It can be either. What do you see normally? Is it, is it normally that the sleep is disrupted? You mentioned your first bout was after a bereavement, I imagine stress is a major factor when it comes to insomnia. Yeah. So insomnia can be a cause or a consequence. Very often in sleep coaching we talk about things that predispose people, make them more likely to be to have problems with sleep in the future. And those are much more common. So if someone is an anxious person or if they have generalized anxiety, some kind of clinical anxiety disorder or panic disorder, PTSD, your whole collection of mental health issues as well as physical health issues, that can predispose somebody to having difficulty sleeping. The most common thing is a predisposing factor to anxiety or a personality trait that some of us might unfortunately know all too well, which is an unhealthy level of perfectionism. Yeah, so all of these things make somebody more likely to develop longer-term sleeping problems after a short-term bout of sleeplessness, because it's really important to differentiate because stress can cause short-term sleeplessness. It happens to all of us, something exciting is going on. Something sad is going on, but what turns that short-term bout of sleeplessness into a longer term sleeping problem? And the answer for a lot of people is one of those traits. Okay. So is there a genetic predisposition to insomnia, is there a physical predisposition? So it depends on how you're defining insomnia. When I'm using the term I'm speaking about insomnia disorder, which is a discreet clinical condition. There are a lot of other sleep disorders that people will often describe as insomnia that aren't insomnia. And some of them can have a genetic predisposition, but I would say that the most likely genetic factor would be in those predisposing factors. The things that make people more likely to develop insomnia. So if there is a genetic predisposition to a certain kind of mental health condition in the family that will make it much more likely that you will be predisposed to developing sleeping difficulty. Why do we see such an upsurge in sleep disruption in women as they enter perimenopause and go through their menopause transition? Because anecdotally I definitely see that the majority of women that I talk to, and I talk to lots of menopausal women, as you can imagine. I would say probably 80 to 90% of them have sleep disruption as one of their key symptoms. Where's the connection. Why such a rise? Yeah, there are a few different explanations for why insomnia becomes more prevalent. And in the literature, when they are looking at broad population levels, the prevalence ranges from 23 to 65, 70%. So it depends on what kind of community you are in. Obviously in these communities, we're seeing people who are very self-directed about wanting to sort out their issues so the, the number of people seems very large and the number is too large. And the consequences are too high. So the question is then why they're still, (you would think that they would have this one down and there'd be tons of research about this.) picking it apart. I would say that there is. in women who are going through perimenopause menopause and post-menopause, there is a predisposition because of the hormonal change to anxiety and depression. So those conditions alone are predisposing factors to developing sleeping difficulties. The change in hormone levels can affect the production of melatonin, which can create further sleeping difficulties. And then you layer on repeated wake-ups because of vasomotor symptoms and hot flushes and all of these sorts of physical symptoms that affect women at night. And those obviously wake people up, but in the entire context of all the other symptoms that are being experienced, anxiety about being woken up repeatedly at night feeds the sleeping problems. Multifactorial. I was going to say, is that almost a self fulfilling prophecy here? That actually my sleep is disrupted now I'm anxious about the fact that my sleep is disrupted So as the anxiety worsens, the sleep worsens. Exactly. Exactly. Okay. So let's talk about the methodology that you use because we are all fed the idea (and I am probably I'm one of those people spouting off the idea) of sleep hygiene, you know, make sure you have a regular wake time, a regular bedtime, have a wind down towards bed time, magnesium in your bath. Then, you know, like magnesium sprays and warm baths before bed. How much of that is rubbish, how much of that being spouting isn't really helpful? Or does it help? Because those aren't your methods actually, are they? Yeah, they are a tiny part of what is considered the evidence-base for working with adult insomnia. So when we're talking about sleep hygiene, sleep hygiene is what we would consider helpful, necessary for some but not sufficient in and of itself. No amount of nice smelling sprays on the pillow or warm baths is going to counteract your anxiety about not sleeping at night. It might help you relax, might feel really nice, but the sleep hygiene tips and tricks don't get into the root of what's feeding the insomnia long term. And that's why we say they're necessary, helpful, but not sufficient in and of themselves. And in terms of the research, sleep hygiene interventions alone are not considered to have any evidence when compared to things that have a lot more evidence. It doesn't mean that your cup of tea in the evening is a negative thing. It doesn't mean that you shouldn't have a hot bath if you enjoy having a hot bath, but what happens is people go online or they get a handout from their GP with all the sleep hygiene tips and tricks in it. They feel like they have done it all because that's the most easy to access information. And they are frustrated because it didn't work, you know, in big air quotes “it didn't work” as they're still having difficulty sleeping. So it sets off this perpetual search and this perpetual anxiety about finding the answer. And I've had people come to me with literal spreadsheets full of things that they do. Their routines have become so rigid because they have attached a certain order of things and a certainty. Perhaps a certain spray and I got a good sleep that night when actually it may have nothing to do with it. And then when it quote unquote “stops working”, it fuels that anxiety even more. Interestingly in terms of sleep hygiene and CBTi there are more and more CBTi - I wouldn't want to call them tips or tricks - but basic principles that are creeping into those lists, which is nice to see. But without the context and without doing the cognitive work, the behavioral pieces alone are not always enough either. And I can talk a little bit more about that. Talk about how it all works. I'm just thinking as well, you know, certainly I found for me my sleep hygiene at that surface level isn't always great. I'm a bit of a night owl always have been. But actually what I do find is even when I, you know, when I put myself into that position where actually I'm going to really focus on getting to bed on time and doing the things like not having backlit lights, that sort of thing. It does help me get off to sleep, but it doesn't stop me waking up at three o'clock in the morning with my head full of stuff and not being able to get back off to sleep again. Yeah. It's a different category of experience. And I have to say that because a lot of people who come to me come after doing online sorts of methods, they have much better sleep hygiene than I do. And they still have sleeping difficulties, you know, they've got a dark room, that room is cool. Now these things, again are not necessarily negative things, unless you start obsessing about them. That's when they actually feed the problem rather than helping with the problem. I think as well, you know, I guess if you've put all of these sort of factors into place and you're having the warm bath you know, you've got your bamboo sheets or whatever else it might be, if it's not working, suddenly that becomes “there must be something fundamentally wrong with me. If I'm doing everything I'm being told to do, and I still can't sleep. What's wrong with me.” Now you've already mentioned CBTi which is the methodology, the system, (I don't know whether that's the right word) that you use to help people. Talk us through what CBTi is. I know what CBT is, cognitive behavioral therapy. But if you could do me a favour please and just go through in essence, what CBT is and why CBT for insomnia is your chosen methodology? Yeah, CBTi is my chosen foundation for the work that I do, because it is where there's over 30 years of evidence behind it. It works for over 85% of people for whom it's suited. It's very effective. Unfortunately it's just not that well known and it does get confused with CBT. Are they very different? They are different in the sense that CBTi the behavioral component focuses on both physical behaviors around sleep, as well as mental behavior. So in behavioral sleep medicine and in cognitive behavioral therapy world, we think of thought patterns as behaviors, the mental behaviors. CBTi works on the physical behaviors around sleep, as well as the mental behaviors around sleep. So somebody comes to me and they're having difficulty with sleeping. Some of the tools that we use for the mental behaviors for the cognitive side, they are very similar and are often drawn from the work that is done with CBT, but we focus exclusively on the thoughts and emotions and feelings behind the sleeping issue rather than more broadly, because that's, for me, that's outside of my scope of practice. But the behavioral pieces that apply to the physical sleep world are usually not things that are ever addressed in CBT for say anxiety or phobias, for example. So there is some overlap but the pieces that don't overlap are more around the behaviors around sleep. So things like not spending nine hours in bed, trying to catch a few minutes of extra sleep when you're able to only generate six hours, because it's a little bit like rolling out a pizza dough. If you only have a six inch blob of dough and you try to roll it out onto a nine inch pizza plate what's going to happen. It's going to get full of holes. It's going to get thin around the edges. It's not going to support what you need to put on top of it. It's a great analogy for sleep. And that sort of thing is not addressed in CBT for things like anxiety. Okay. Gotcha. Gotcha. What about this idea that all adults need between seven and nine hours sleep. I think I now realize that I work best on about seven hours and 15 minutes. Seven hours and 15 minutes I feel great. If I have less than that, I feel a bit groggy. And if I have more than that, everything aches. , I found that seven 15 is my sweet spot, but we're all so unique and so different is that one of those sort of throw away lines, like 10,000 steps, 7 to 9 hours sleep, what should we be getting? Because cause I think we get hung up on, oh gosh, I haven't had my full seven hours sleep. I'm not going to get through the day when I'm not sure, is that true? Such a good question. So somebody's individual sleep need is genetically determined and there's going to be an optimal amount of sleep for a given individual. Unfortunately, the soundbites are, you know, if you don't get eight hours, you're going to have strokes and all of this other stuff is going to happen to you. And it's just, that's like saying everybody needs to wear a size six shoe. It's just not the case. If you imagine a bell curve, the majority of people say that they feel pretty good in that seven to nine hour range. And really it's not the amount of hours that's the important piece. It's about is whatever sleep you're getting enough for you to feel refreshed and able to do what you need to do during the day. And for some people that might be six and a half hours for some people that might be nine hours and it actually creates problems for people who need less sleep to start searching for more sleep. Oh, tell me more about that. So it is like if somebody has, and I heard the wonderful podcast, can't remember the name of the podcast now, this gentlemen was definitely a perfectionist type personality who created projects out of everything and had been reading that he needs eight hours of sleep. We take this hypothetical person. And he is able to generate six and a half hours but really wants eight because eight is supposed to be the optimum. And this person's always interested in optimizing their life. Well, that's like taking that six hour blob of pizza dough and trying to stretch it out onto a plate that's too big. You actually give yourself insomnia. And in the research world, when they are testing, short-term sleeping medications, they actually induce insomnia in healthy people who don't have sleeping troubles. By having them do things like stay in bed for 12 hours when you can't generate 12 hours of sleep. Their sleep becomes broken and unhealthy. So how do you know if you're getting enough sleep? That is a very common question. You know, how do I know what my number is? In the process of CBTi that becomes clear, but if you are falling asleep within 15, 20 minutes but not less than five. If you wake up a couple of times in the night and you fall back to sleep within that same amount of time, 15, 20 minutes. And if you wake up in the morning, feeling refreshed, whatever that number is, is your number. You got to embrace your number and not search for a different one. It's really, important because actually I know there's, there's certainly been times where I felt like I've slept really well but felt exhausted when I've woken up and I'm guessing it's because we go through all these different stages of sleep, light sleep, REM sleep, deep restorative sleep, et cetera. I have a Fitbit that tells me, I have no idea how accurate it is, the levels of sleep that I've been in. How can we, how can we make sure that we're getting to those deeper kind of more restorative levels of sleep? Having good sleep that is satisfying for us, that has a good quality - we'll generate the amount of time that we need in each of these kinds of sleep areas. So people ask me about different kinds of tracking devices. And unfortunately, although they're getting better with are you asleep or are you awake, they're still not great. They're really not very good about what phase of sleep people are in. So people often show me their graph and, oh, I've got like three minutes in deep sleep. What's wrong with me? It doesn't necessarily mean you actually only got three minutes of deep sleep because the brain will generate the sleep that it needs. If you have had a period where you've been extremely sleep deprived, And then you have a really deep sleep and you spend the whole time dreaming and you wake up exhausted because the brain is saying, I need this kind of sleep. So as soon as we fall asleep, I'm going to get all of that sleep. So avoiding as best people can , having things like insomnia, treating sleep apnea etc, that's really important, particularly for women as we get older and our hormones change, those hormonal changes affect more than the skin just above our knees and our wrinkles and things. It affects all of our soft tissues and makes us more prone to sleep apnea, which really destroys sleep quality. And being mindful of things like not too much alcohol that also can destroy sleep quality. If we can get out of the way of our sleep system. it does a pretty good job of giving us what we need. Good. Good. Good. So how does does CBTi look then? What actually happens? Yeah. The first and most important thing when somebody comes to me or any other therapists doing CBTi is that they are screened for safety. So like I was saying, insomnia is just one of many, many different kinds of, of conditions. And some of the interventions that are suggested to some people, when doing CBTi in the beginning can make people more sleepy. If they have another sleep disorder already, that makes them sleepy, they could become unsafely sleepy. So you first get screened for these sorts of things, any untreated or out of control,mental health issues, things that would get in the way of CBTi then what happens typically, at least in the beginning to get a foundation is we do a prospective sleep diary. So we look at what does the sleep actually look like going forward because human beings are not good at necessarily knowing, what their sleep is like on average because we tend to focus on the worst nights. Sometimes looking at diary data over a couple of weeks, it's actually really easy to pick out, you know a statement such as when I have a bad night, it wrecks the rest of the week. Yeah, it doesn't always, and sometimes you can show that to people right. In their data. And in standard CBTi which isn't necessarily appropriate for everybody we want to use the principles and apply them to the person's situation. But we typically do behavioral interventions first because they help reinforce the idea in a person's lived experience that their sleep system is not broken. These interventions typically make people sleepy and the first one is geared around helping create the appropriate size pizza plate for the amount of sleep that someone can generate. This helps deepen someone's sleep quality so that the sleep they are getting, even if it's not enough is a better quality and is more refreshing and restorative. And then we look at behaviors around sleep in the bed that can interfere with people's association with the bed. Because before we develop sleeping difficulties, we don't think about our relationship with our bed. It's a completely unconscious thing. We get sleepy, we lay down, we fall asleep. So if you have a relationship like that for years and years, and then suddenly your relationship is that sometimes I sleep and sometimes I toss and turn and sometimes I lay here sweating and upset, and sometimes I lay here worrying about what's going to happen tomorrow, or I'm going to have an argument with my spouse, the relationship becomes confused. And so adjusting people's relationship to their bed vis their behavior, whether they're in bed or out of bed, is the second, most powerful thing that we do. And then when someone is feeling a little bit more confident in their ability to sleep, we don't stop there. Even if people are sleeping really well. It's a good idea to not stop there because what hasn't yet been addressed and we begin to address, is why are you terrified of not sleeping in the first place? Because it is the anxiety of not sleeping well after a short-term bout of sleeplessness. The worry about that short-term sleeplessness is what creates the longer-term problem, which is why you can have an incident or an excitement. And then after it passes people still aren't sleeping. So working on all of those cognitive pieces, which is the CBT and the mindfulness Acceptance and Commitment Therapy kind of element does that. It's fascinating because it's so individualized to the person and what their particular worries are. So we would kind of pick through which ones of these are rational and which ones aren't. And how can we reframe how we think about sleep? For example, being up all night can be terrifying for some people, because it's what they're trying “to not do”. And the trying is fed by the fear of being awake. But if we can reframe that being awake one night by looking at actually the consequences, aren't that bad, because look, you never crashed the car and you used to get in arguments with your spouse when you slept well. And you just put these things into perspective. And you're building sleep drive, which will build sleep quality in the long run. You just flip it on its head and look at it differently with the support of somebody who's working with you, it takes that arousal down because it doesn't matter how little sleep you've gotten, usually, or what time of night it is, what time your circadian rhythm is telling you, you know, it's time to not be awake, now you should be sleeping. It doesn't matter how strong those two components of the sleep control system are. If we think of bears coming into the cave and we're responding to sleeplessness, like a bear is coming into the cave, we're not going to be able to sleep. That's why it is so important to kind of see it through and do the mental work and the work with the anxiety. That is how I now can have bouts of sleeplessness that don't turn into yet another insomnia problem, because I'm very neutral now about when I don't get good sleep. When does a disturbed sleep pattern become insomnia? That's a really good question. So according to the big, big textbooks that define insomnia, you want to be waiting three months before it actually gets defined as insomnia. But if somebody has not been sleeping well for a few weeks and has this kind of pattern and this developing anxiety, I'm not going to tell them that they need to wait for three months before they can get some help. I really like the idea of doing this, actually writing a kid's book, teaching children or young adults that after their sleeping has settled back down from their teenage years this kind of sleep disruption is normal and to not panic about it, because we could prevent so much ongoing sleeping disturbance. You know, you go through your life and even if you have a medical condition or if you have pain or if you're having vasomotor symptoms, those things may wake you from your sleep. But if the sleeplessness is like on a 10 scale is like an eight out of 10 and five of it is due to that anxiety, we can reduce that a lot and really help improve people's quality of life. Yeah just for the listeners, I'm sure most people do know, but when you're talking about vasomotor symptoms, we're talking about that sort of internal temperature gauge in the body so leading into hot flashes night sweats, those sorts of things. Okay. So tell us a little bit more about you and your business? The business is Tracy, The Sleep Coach . So how can people get help from you if they are struggling? There are a variety of different ways that I work. I do run kind of a do it yourself. CBTi based sleep recovery course. I offer one-to-one calls. So I call it a sleep jumpstart call where you get the entire assessment diary and spend a 90 minute call with me and you leave with a really solid plan based on your needs to tackling things from a behavioral point of view and some things around the anxiety piece And then a package that includes some follow-up calls. And usually that's more appropriate if there is quite a lot of sleep anxiety or the issue has been really long-standing. And I do offer a quick start call, which is essentially you can book almost the same day, 30 minute chats. Obviously doesn't have that assessment piece in it. But I guess people find that helpful for, I would've thought just to reassure that actually this is quite normal. Yeah. Yes. I had somebody come to me with a perfectly normal sleep diary once very worried about it taking, you know, 10 minutes to fall asleep on waking up in the night for 10 or 15 minutes. And it was simply a matter of education. But that's actually normal. If somebody is taking less than five minutes to fall asleep, we actually consider that a problem. Okay. Gosh, that's my husband. As soon as his head touches the pillow, and he has been like that for as long as I've known him, I've been talking to him and I'll hear his breathing change. I think, goodness, me, it's only like two minutes since he got into bed. So I guess for him, it's probably his normal if that's the way he's always bee? Now you've got me worried that he's got a problem haha! Yeah, we can definitely talk about that. In any of the services that I offer one-to-one is that screening for safety. And there's a really simple assessment. And it tends to revolve on how easy is it for you to fall asleep in weird places, what it comes down to. Cause that's more associated with other sleeping disorders. Whereas insomnia is that tired and wired kind of can't nap. I can't fall asleep. I wake up. I had a question in my head and my menopausal brain has just done its normal thing and the question's completely escaped me. What, what was it? I will come back to that. Okay. So where can people get hold of you? People can find me through my website, www,tracythesleepcoach.co.uk. I'm also on Instagram @Tracythesleepcoach and brand new sparkly slowly growing YouTube channel again, tracythesleepcoach. If you put it in, you'll find me in all of my places. I do run a free Facebook group called Sound Sleep Strategies that is underpinned by the fundamentals of CBTi and there are a lot of video resources in there to help people get started. Brilliant. So you've got your Facebook, your Instagram. Tell me about the course, this DIY course. I guess most of us want a quick fix with everything. It's human nature, isn't it, to want to quick fix which is probably why things like sleeping tablets and all the rest of it are such a go to for a lot of people, I think that certainly for a lot of women in menopause, you know, that that sense of relief. Just, just give me a sleeping pill and now I can get a good night's sleep. How how long does it take to put things right. If that's not too open ended a question and the DIY course that you're talking about how much of this can we do ourselves? Because it sounds like something you would need to work with a therapist. Yeah. So how long is how long does it take to work through? This really is how long is a piece of string? However, People can learn the skills that they need to learn in terms of understanding their sleep patterns, understanding how to adjust their sleep patterns, depending on what their issue is and getting a really good head start on using the tools to help them identify where their anxiety lies and what to do about it within sort of like 6 sessions. Usually 4 to 6 sessions, depending on how long the sessions are. And that's why the course is geared toward being six weeks long. I'm actually thinking of, of extending it a little bit, but sometimes we have something that goes on too long it's difficult for people to kind of maintain the consistency with it. The Sleep Jumpstart that I offer. It is quite an intensive 90 minutes where we look at all of these things. I explain the fundamentals and give a person a plan, but in that kind of four to six session, four to six week mark people can learn those skills themselves and they can do it themselves. I know a lot of people who've done really, really well learning to apply those fundamentals to their own situation. And then I'm always around to help tailor it if it needs to be further tailored. Yeah. So tell me about the sleep recovery course. Yeah. It it's a 6 week course with a 6 week built in mindfulness component. Mindfulness is what I would put into any program because it helps with that sitting with the anxiety piece. So I think it's really, really important not to just use relaxation techniques, like a hammer on a nail, like, Ooh, I need to fall asleep I'm going to do a relaxation technique. But because of hyper arousal that feeds insomnia as a 24/7 problem, Mindfulness is a fantastic way for people to really easily practice in their daily life. So I run them in parallel. Each module of the course working through the mental pieces and the physical behavioral pieces has a mindfulness module attached to it. So it goes through a basic sleep education, understanding how the sleep system works and helping people identify where their sleep behaviors may have gone wrong and potentially contributed to the problem. And then we look at the physical environment. So there is a sleep hygiene component to it with a bit of a twist it's all focused on that hyper arousal piece rather than a prescriptive “if you take a bath at this time, that's the best”. There is kind of more expansive concept of sleep hygiene module. There's a set of modules on understanding what it is that you are thinking and what those fears are. And teaching people how to use the tools. They can dig into their own fears around what and why is it that not sleeping is scary because there's a difference between discomfort and something being scary, but we often pair those things together. So helping people unpair those mental and emotional responses and working with those and then really, how do you not do things like take a six hour blob of dough and try to stretch it out onto an eight hour piece of pizza. And then when you're getting really good sleep for whatever hours that is for you, how do you expand it out until you get the amount of sleep that you need? That's deep in quality, refreshing and allows you to live the life that you want to live and be prepared for future sleep blips. The last module in the course is all about acknowledging that in the future, things are going to affect our sleep. We cannot help that from happening. What we can do is we can be aware of what our patterns are, what we tend to want to do, whether that's going to be a helpful thing for sleep or not. And just reframe how we approach those short-term bouts of sleeplessness. It sounds absolutely brilliant. And I know you're very, very generously offering listeners, a 10% discount on the D I Y course with the code GENX22, which I'll put in the show notes anyway, which is very, very kind. And this has been fascinating. Some of it I can't really relate to because I wouldn't say I have any major sleep issues, I have occasional problems as most women do. But what would be three top tips for someone who maybe doesn't have severe insomnia, but just, you know, wants to have better sleep hygiene if we're allowed to kind of go down that route. Yeah, definitely. The number one tip that I give people I think is particularly pertinent to women who are waking up in the middle of the night is to stop watching the clock and letting the clock tell you how you should be responding the next day to how your day is going to be. We spend a lot of time cycling in and out of, of light sleep and deeper sleep. And that's totally normal. If you wake up one night at three o'clock. For whatever reason. And you look at your watch and you say, oh, M G it's 3:00 AM. nd tomorrow is going to be a disaster. You're accidentally training your safety system to say, oh my, if I'm, if I'm going through one of these lighter phases of sleep, I better wake up and really check that something really scared her and something really upset her. So it leaves you less places to hang any anxiety about waking up in the night. If we don't know what time it is - and to be honest, knowing that you're awake for 47 minutes in the middle of the nigh - it doesn't help your sleep at all. You cannot use that information. So my number one tip is always to stop watching the clocks, take your alarm clock, turn it around, face it away from you. Don't look at your phone for lots of reasons, but particularly for the stimulation of the, of the time piece. The second thing is that no matter how well or poorly you might've slept the night before, if you're having any difficulty at all with sleep, always get up at the same time of day. So pick a time that works for you throughout the week on average, and even in the beginning, even on the weekends in the beginning, get up at a consistent time. This will allow you on nights where you're not sleeping so well to have almost a training effect. Your brain will say, Ooh, I only get this amount of time to sleep I better sleep more deeply and get what I need because she's going to get up and start her day. Having lie ins also can mess with our circadian rhythms and as we get older, our circadian rhythm is going to shift anyway. So it just helps introduce a little less chaos into that, into that picture. Just, just on that so get up at the same time. Are you then therefore saying go to bed at the same time or just, just make sure you have the wake time nailed? So, if someone is sleeping reasonably well, I would say, don't worry about what time you go to bed. Getting up at the same time is a more important piece, but if somebody is not sleeping well, getting up at that, that consistent time, what happens is if somebody is not sleeping well, they may take quite a long time to fall asleep. It doesn't help them to get into bed and lay there and wait for it to happen because usually that creates stress and anxiety, which then becomes associated with the bed. So the correlate to that would be go to bed when you are sleepy enough to fall asleep. Brilliant. And your 3rd one? Don't be in bed if you're not happy to be there. So I've gotten to a place now where I'm very emotionally neutral about when I'm awake in the night. I'm not awake nearly as much as I used to, but life still happens. I still wake up thinking about things, as long as I'm kind of content and relaxed and feeling neutral about it I stay in bed. It's really advisable if you are laying there tossing and turning fretting worrying, sweating, being upset. that you take those feelings and you bring them someplace else, have them out in the living room. If you can sit in a chair you don't like, have that experience there. You'll be building sleep drive because you're awake and you're physically active and you will be helping to improve the association with your bed. You take those feelings. Do what you need to do with them. Go back to sleep when you're really sleepy. And it's not like, oh, I did that for two days and it didn't work. It is a retraining process. You're simply saying, look, brain sleepiness bed. Oops, didn't work this time. Let's do it again. Brain, sleepiness, bed, and doing that with consistency can help rebuild that positive association with your bed. And that is actually one of the most evidence-based standalone approaches for all of the tools we have in behavioral sleep medicine, so simple. But I think the idea of getting up when you're absolutely exhausted and you're not sleeping, you're wide awake and your head's spinning, the idea of getting up and going into a different room and doing something different, feels counter intuitive. It feels like, well, I'm never going to sleep if I'm sat up in a chair. Although I must admit, I know I've had times where I've got out of bed and gone down to the living room, sat on the sofa and fallen asleep like that. I've actually had some really good quality sleep on the sofa. Am I therefore building up other patterns whereby I associate good sleep with the sofa? Such and good point because the caveat to this particular technique, if it's appropriate for somebody is to not surf and fall asleep elsewhere. Because if you have a really angsty relationship with your bed and you've got lots of sleep drive, cause you're not sleeping well and you can't sleep in bed, but you got a lot of negativity there and you go to the sofa and you don't have that negative. And you're already up. So you're not like trying to force yourself to sleep. You're not doing something to try to sleep. Your arousal comes down. That bear leaves the cave and wow you fall asleep. You can actually develop a sleeping association with your bed, with your sofa or your recliner and if that works for people, that's fine. My mother still sleeps on the sofa after 20 years, it works for her relationship. But what happens then is if you decide you want to be sleeping back in your bed, you have two hurdles, you have to tear yourself away from the place you're getting sleep and recreate the sleepiness association with your bed. So what becomes a nice reassuring short-term fix can create longer term problems. Just being really aware of that is real important. . That's really good to know. Now in true menopausal fashion I've remembered what I was going to ask about 10 minutes ago. It always is there. If I just hang around long enough, it normally comes back. I heard a term a little while ago that I'd never come across before, but by God it's me - sleep procrastination. Have you come across that? I'm sure you probably have. I wrote a feature in The Independent on sleep procrastination! Well, I'd not heard of this. And then I heard a gentleman talk about it on a podcast and I thought I do that! I can be beyond tired sort of midnight with every ounce of my being screaming at me to go to bed. And I will find a dozen different jobs to do- a little bit more surfing or the end of another Netflix episode. And actually, my husband's the complete opposite. He will walk away midway through a program. Cause his body says it's time for bed. I'm tired. And he'll just say I'm off to bed now. And I'm like, how can you not watch the end of this episode? Talk to me about it? Because it's a real thing for me. And when we're talking about that cognitive behavioral piece, I know that I am sometimes in danger of getting anxious about the fact that I procrastinate about going to sleep. And that makes it worse. Hmm. Yeah. Sleep procrastination is really common and it's on both ends of the spectrum. So sometimes people will wake themselves up prematurely in the morning to have time for themselves or time for certain activity. Some people will stay up later than they should. They're denying themselves sleep opportunity, as we would say, because they are trying to get other things done. And I think people fall into two camps there. The procrastinator camp in general, for whom this is just the thing. Yeah. Lots of other areas as well, to be fair. And in the boundaries issue, because I think a lot of people, particularly women who tend to, for better or worse, take on kind of a caregiving role, we give, give, give, give to other people all day long. And we give to our business all day long and we give to all of these things except for us. And it's the only time where we feel we can go and we're still conscious. Right. And part of us wants that conscious time with ourselves. And I think one of the things that I learned, because this was an issue for me, and it's sometimes an issue for me still is really time-blocking and managing time and boundaries more appropriately so that I can have that time for myself during the day to do the things. It really did help the procrastination piece for me, especially for me as a fellow procrastinator, it weaves its way in to so many different arenas. I could spend six hours doing two hours of work, but if I'm time blocking, I'm now blocking time for myself at the beginning of the day, in the middle of the day and the end of the day, and stacking those times with myself as habits on the things that I'm already doing. It's like being given a smaller handbag, you have to decide what you're going to put in that handbag. And it helps you choose where you want to put your energy and how you want to direct your energy during that gap. So working on those boundaries and time management pieces will often leave people feeling like they don't need to do that at night, or they don't need to do it in the morning, or at least not so much, but it's a really fascinating phenomenon and it can lead to insomnia in some people because of the worry about not getting enough sleep. What you've just said that around sort of giving too much to the business. You know I work far more hours in the day now that I work for myself, than I did when I was working you know, in my paid job, my employed job. But it doesn't feel like work a lot of the time. I enjoy doing it. I'm working for myself. It's a blessing, isn't it? But it does bleed out. But actually it does mean, as you say, I don't give myself a huge amount of time for me during the day. And maybe that is why, you know, come the evening when Mark has gone to bed, cause he does generally go to bed before I do, I have this, this time, this block of probably two hours that is just for me. And I guess I'm probably hanging on to it. It's one of those things where, you know, logically I know I should be going to bed, but emotionally I'm clinging on to this time. I haven't really made the connection as I've always been a night owl but I don't think I've ever procrastinated around sleep in this way. Absolutely fascinating. It is a really, really interesting topic. Really interesting. I mean, I would think, well, I want time for myself. I'm going to go knit or something like that, but what do I end up doing? Like, well, let's scrub the stains off the back of the pots, you know, just like weird things like that. I just sit there watching Netflix or scrolling through Instagram. Anyway. Tracy, thank you so much. I think this is a fascinating conversation. I think sleep is one of those things where we really don't, even to this day still don't really know a huge amount about. I do think that we underestimate how important sleep is in our lives. Certainly for me. I know that when my step is disrupted , my stress is higher and when my stress is high my sleep is disrupted. It does seem to go hand in hand. And when we've got brain fog already with perimenopause, actually lack of sleep and stress,don't help with brain fog. So, I think for anybody listening, if you are struggling, genuinely struggling with poor sleep do look Tracy up, Do go and grab her sleep recovery course, even if that's just a foot in the door to get an idea of what all this is about before they come to you for some one-to-one help, . I love the way you explained it all, you make something complicated feel really simple. Well, not necessarily easy, but it's actually very straightforward once you understand how it works. Brilliant. Thank you so much. It's been an absolute pleasure. Thank you for giving me your time and we will talk to everybody again soon. Thanks for listening guys. Take care.
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Dr. Jordan is joined this week by Dr. Juliette Whitney, a pediatric resident sharing her insight and experience working with children during COVID and the ramifications of an increased sedentary lifestyle in childhood and adolescence.
Dental podcast: Welcome to DentalTalk. I'm Dr. Phil Klein. We hear a lot about ways to stay healthy in our society; eat well, exercise, try to minimize stress. But are there specific concerns for dental hygienists? Today we'll be highlighting musculoskeletal disorder, the importance of proper ergonomics in our workplace and things that we can do in the operatory to maintain health for long term career satisfaction. Our guest is Schelli Stedke, who has worked in many areas of dentistry including clinical care and dental hygiene education. And, we should note, she recently gained her certification as a registered yoga teacher. She has a passion for helping her fellow dental professionals stay healthy and well for the duration of their career.
Dental podcast: Welcome to DentalTalk. I'm Dr. Phil Klein. Today we'll be discussing how to incorporate yoga, breathing and meditation as a form of professional self care in conjunction with proper equipment and ergonomics to help build a routine that leads to better long term career satisfaction and personal wellness. Our guest is Schelli Stedke, who has worked in many areas of dentistry including clinical care and dental hygiene education. And, we should note, she recently gained her certification as a registered yoga teacher. She has a passion for helping her fellow dental professionals stay healthy and well for the duration of their career.
Feeling stuck with your GERD and Reflux? Is prescription the only to treat it?Join Amy and Nikki as they discuss some tips from a nutritionist, MOLLY, who had personal experience with GERD and Reflux. Molly Pelletier is a Nutritionist, BS Dietetics BU, MS Dietetics Candidate BU '22, 500-hour registered yoga instructor You Can reach Molly through:Instagram: @zucchini.whoYouTube: Molly PelletierTime Stamp: 0:00 Introduction10:00 Multifactorial approach of Molly15:30 Restrictions 21:21 FODMAPS vs GERD32:00 PPIs and GERD41:34 Recommendations for GERD41:51 HERBS44:18 Possible long term side effects of some Herbs for GERD53:00 Lifestyle Recommendations
Para Ale Gutiérrez, candidata del PAN a la alcaldía de León, el tema de inseguridad lo generan muchos factores, por lo que también la solución debe ser multifactorial, checa la #Entrevista con Ale Gutiérrez
Multifactorial management is essential in diabetes and can often require multidisciplinary care. In order to help patients reduce their risk of kidney disease, or to help manage the condition of someone with a confirmed diagnosis, effective collaboration with nephrology colleagues is key. So how can diabetes and nephrology specialists best work together? Providing the perspective of a nephrology specialist is Professor Ian de Boer, Professor of Medicine and Associate Director of the Kidney Research Institute at the University of Washington in Seattle, and co-chair of the 2020 Diabetes in CKD Guideline published by Kidney Disease: Improving Global Outcomes or KDIGO. For more free education, visit the DKIP website, follow us on Twitter (@dkipractice) or connect on LinkedIn. Disclosures: Professor Ian de Boer declares the following: Advisor: AstraZeneca, Bayer, Boehringer-Ingelheim Received equipment and supplies for research: DexCom Funding statement: This independent educational activity is supported by an educational grant from Eli Lilly, Merck Sharp and Dohme Corp., and Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; the financial supporters have had no influence on the content of this education.
Today on the podcast I have author and researcher Ralph Sanchez to speak into the importance of understanding glycation and why it serves as an important risk factor for Alzheimer’s disease. Our insulin response mechanisms are vital to our long term health and Ralph articulates the many shifts that can happen in the body with glycation. Click here to download the completed Matrix from this week’s episode To learn more about Ralph Sanchez click here To check our Ralph’s book ‘The Diabetic Brain in Alzheimer’s Disease’ click here Related Blogs: For more from Andrea on Dr. Dale Bredesen and his “36 Holes” approach click here Click here for Andrea’s blog on the term “Multifactorial”
Cancer is not caused by a single factor so do not blame yourself for not eating healthily in your childhood or having experienced negative emotions in your life --- Send in a voice message: https://anchor.fm/yogawcancer/message
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.11.16.384826v1?rss=1 Authors: Ari Yuka, S., Yilmaz, A. Abstract: Competing endogenous RNA (ceRNA) regulations and crosstalk between various types of non-coding RNA in human is an important and under-explored subject. Several studies have pointed out that an alteration in miRNA:target interaction can result in unexpected changes due to indirect and complex interactions. In this paper, we defined a new network-based model that incorporates miRNA:ceRNA interactions with expression values and then calculates network-wide effects after perturbation in expression level of element(s) while utilizing miRNA interaction factors such as seed type, binding energy. We have carried out analysis of large scale miRNA:target networks from breast cancer patients. Highly perturbing genes identified by our approach coincide with breast cancer associated genes and miRNAs. Our network-based approach helps unveiling the crosstalk between node elements in miRNA:target network where abundance of targets leading to sponge effect is taken into account. The model has potential to reveal unforeseen and unpredicted regulations which are only evident when considered in network context. Our tool is scalable and can be plugged in with emerging miRNA effectors such as circRNAs, lncRNAs and available as R package ceRNAnetsim https://www.bioconductor.org/packages/release/bioc/html/ceRNAnetsim.html . Copy rights belong to original authors. Visit the link for more info
The World Health Organization defines a fall as “an event which results in a person coming to rest inadvertently on the ground, floor or other lower level.” Fall-related injuries may be fatal or non-fatal, however, most are non-fatal, but may still result in significant injury or disability. Falls are the second leading cause of unintentional injury deaths worldwide, second only to road traffic incidents. November is Fall Prevention Month in Canada and the Public Health Insight Podcast seized the opportunity to discuss this historical month-long commitment to raising awareness about the incidence of falls, the underlying causes and associated risk factors, and negative health outcomes that occur as a result of falling. References for Our Discussion American Public Health Association (APHA) | Nation’s Health: Preventing senior falls requires community approach: CDC resources help health workers create programs that workShare Your Thoughts With Us!Follow us on Instagram, Twitter, LinkedIn, and Facebook. We would love it if you shared your thoughts by commenting on our posts, sending us a direct message through social media, or by emailing us at ThePublicHealthInsight@gmail.com. Until then, we’ll see you in the next one.Support Our ShowIf you like our show, feel free to lend us some support by making a contribution on our Patreon page (link below) so we can continue creating the content that you enjoy as we expand the Public Health Insight Community.Icon made by Freepik from www.flaticon.com Support the show (https://www.patreon.com/publichealthinsight)
Join us for a roundup of the 2020 ESC congress, discussing all the latest data related to diabetes and how it should impact practice. Featuring interviews with: - Professor Lars Ryden, discussing a subgroup analysis of REWIND - Dr Naveed Sattar, discussing pooled analysis of SUSTAIN 6 and PIONEER 6 This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.
Jatkettiin Johanin kanssa nopeudesta ja sen harjoittamisesta salilla. Puhuttiin Johanin French contrast harjoittelusta ja lisävarusteiden käytöstä valmennuksessa/omassa harjoittelussa. Aihetta sivuten, tässä linkki Johanin vastikään julkaistuun tieteelliseen julkaisuun: Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study https://bmjopensem.bmj.com/content/6/1/000758.full
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.06.01.127944v1?rss=1 Authors: Wattiez, A.-S., Castonguay, W. C., Gaul, O. J., Waite, J. S., Schmidt, C. M., Reis, A. S., Rea, B. J., Sowers, L. P., Cintron-Perez, C. J., Vazquez-Rosa, E., Pieper, A. A., Russo, A. F. Abstract: Chronic complications of traumatic brain injury (TBI) represent one of the greatest financial burdens and sources of suffering in society today. A substantial number of these patients suffer from post-traumatic headache (PTH), which is typically associated with tactile allodynia. Unfortunately, this phenomenon has been under-studied, in large part due to the lack of well-characterized laboratory animal models. We have addressed this gap in the field by characterizing the tactile sensory profile of two non-penetrating models of PTH. We show that multifactorial TBI, consisting of aspects of impact, acceleration/deceleration, and blast wave exposure, produces long term tactile hypersensitivity and central sensitization, phenotypes reminiscent of PTH in patients, in both cephalic and extracephalic regions. By contrast, closed head injury induces only transient cephalic tactile hypersensitivity, with no extracephalic consequences. Both models show more severe phenotype with repetitive daily injury for three days, compared to either one or three successive injuries in a single day, providing new insight into patterns of injury that may place patients at greater risk of developing PTH. Importantly, even after recovery from transient cephalic tactile hypersensitivity, mice subjected to closed head injury had persistent hypersensitivity to established migraine triggers, including calcitonin gene-related peptide (CGRP) and sodium nitroprusside, a nitric oxide donor. Our results offer new tools for studying PTH, as well as preclinical support for a pathophysiologic role of CGRP in this condition. Copy rights belong to original authors. Visit the link for more info
Thomas Olivier, CEO of Omnos.me joins me today after a bit of a wait to get him on the podcast. I met Thomas in 2017 when I joined him for my Nutrigenetics/Nutrigenomics training and knew that I had to get this story out to people about how they could get a handle on their health and mitigate some serious health conditions going forward based on their unique 'bio-individuality'' (N=1) Thomas has developed a stunning platform that allows for a person to take an in-depth dive into their health at the genetic level where the changes (SNP's) matter. This episode is one not to miss if you're treating to avoid the big 4 killer diseases! Thomas speaks about his journey to the launch of Omnos.me, and what this actually is! Timestamps: ... 05:48- We are dying of diseases 07:33 DNA, Epigenetics and what we are made of (hint its 37 trillion cells and more) 11:02 Whole genome sequencing, do we need this or specific tests? What's the cost? 14:37 Would veganism suit my genes? How would I know and why is Omega 6 and 3 important? 17:02 Scientifically validated genetic and functional testing. Why does this sound like NASA? 18:30 The four killers. Multifactorial? 21:38 Gamification of health systems, #levelup? 24: Toxic environments, car fumes what harm can they do? 30:50 Choices in health: will COVID make a difference? 33:00 Our vulnerability, body wisdom and connectedness 36:15 New Health architecture, the new future? 40:00 Health Optimisation events and sharing of knowledge 45:00 The future is faster, why Kotler and Diamandis make their mark in this conversation! (love this bit, but I am biased with tech) 50:00 Are health predictions like meteorology? 52:00 Balancing not boosting your immune system 55:00 Optimsiing: what is this? You can find Thomas at Omnos.me on Instagram... the platform is https://www.omnos.me/ as always to find out more, sign up for free courses around Epigenetic Psychotherapy & Functional health visit www.catherineknibbs.co.uk
A mountain of data exist for each antihyperglycaemic agent, from metformin through to the most recently approved agent. Considering all these data, what are the most significant observations to date? Join Professor Jens Juul Holst from the University of Copenhagen for a summary of data on DPP-4 inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists, including a particular focus on within-class differences and whether oral vs injectable formulations have different effects References - Pinto LC, et al. Diabetol Metab Syndr. 2015; 7(Suppl 1): A58 - Craddy P, et al. Diabetes Ther. 2014;5(1):1-41. - Uccellatore A, et al. Diabetes Ther. 2015;6(3):239-56 - Nauck MA, et al. Diabetologia. 2016; 59(2):266-74. - Aroda VR, et al. Diabetes Obes Metab. 2020; 22(3):303-314 - Ahrén B. Front Endocrinol (Lausanne). 2019;10:376 - Rosenstock J, et al. JAMA. 2019 Sep 19. [Epub ahead of print] - Kristensen SL. Lancet Diabetes Endocrinol. 2019; 7(10):776-785 - Romera I, et al. Diabetes Therapy 2019; 10:5-19 - McMurray JJV, et al. N Engl J Med 2019; 381:1995-2008 - Perkovic V, et al. N Engl J Med 2019; 380:2295-2306 - Fitchett D, et al. Diabetes Obes Metab. 2019;21 Suppl 2:34-42. This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.
[PART 2] Dr. Pastore continues on the topic of brain health, and what celiacs & non-celiacs can do now to lower the risk of future neurological & cognitive health issues. He covers what medical tests to have done, recommended foods and supplements, as well as ways to cognitively challenge your brain. Recap of part 1, upcoming in episode [0:40] Key action steps for celiac and non-celiac patients for brain health Decrease in gray & white matter in the brain for those with celiac disease, even if following a strict gluten-free diet [1:35] Can lead to cognitive decline or mental illnesses Celiac Disease & Mental Health (Part 1) podcast episode: https://podcasts.apple.com/us/podcast/on-mental-health-celiac-disease-part-1/id1455383694?i=1000468339779 Why celiacs feel brain fog, forgetful or fatigued [2:30] Multifactorial - many reasons for these symptoms based on structural gray/white matter changes in the brain celiacs have Malabsorption of nutrients due to damaged villi, causing nutrient deficiency [4:15] Recommended test #1 for brain health and cognition: BrainSpan [4:40] https://www.brainspan.com/home Can be ordered directly to your house & mailed back Finger-prick blood test Measuring Omega 3 fatty acid levels EPA/DHA Celiacs should use fish oil supplementation [6:30] Brain health & cardiovascular diseases are connected [8:50] Plaquing of the arteries negatively affects brain health High blood pressure presents with a higher risk of dementia Analyze palmitic acid levels to help normalize insulin, leptin signalling, appetite cues, never feeling full [10:05] Blood test is paired with brain games both developed by US military physician & used by physicians from Harvard. Sanjay Gupta, MD of CNN is an advisor [11:40] Measures memory, sustained attention, cognitive flexibility, and processing speed Celiacs - speak to your physician about the test [13:00] Covered by Medicare in USA Recommended test #2 for brain health and cognition: Bloodwork for nutritional deficiencies [15:30] Deficiencies for celiacs podcast episode https://podcasts.apple.com/us/podcast/on-nutritional-deficiencies-increased-infection-risk/id1455383694?i=1000454914981 Deficiencies for non-celiacs https://podcasts.apple.com/us/podcast/on-common-nutritional-deficiencies/id1455383694?i=1000445381290 High blood sugar & insulin [16:45] Previous podcast: Alzheimer's Type 3 diabetes https://podcasts.apple.com/us/podcast/on-alzheimers-disease-a-new-type-of-diabetes/id1455383694?i=1000448202120 Poor circulation can affect white & grey matter in the brain Previous podcast on Blood Sugar & Insulin here: https://podcasts.apple.com/us/podcast/on-blood-sugar-insulin/id1455383694?i=1000438688442 Previous podcast on Triglycerides & Glycemic Index here: https://podcasts.apple.com/us/podcast/on-the-glycemic-index-triglycerides-and-cholesterol/id1455383694?i=1000440223375 Celiac disease is connected to Type 1 diabetes Eat low-glycemic index carbohydrates Identify if there is a risk factor for insulin resistance [18:45] Take fasting glucose & fasting triglycerides level from last bloodwork to predict risk of insulin resistance [20:05] Triglyceride-Glucose Index - https://jscalc.io/calc/4VDpIssERFymapm5 (calculator) Fasting Glucose * Fasting Triglycerides / 2 Index of 4.9+ have greater risk of insulin resistance Foods & Nutrients to consume daily for brain health [22:55] Berries - blueberries, strawberries [23:20] Harvard study: 2 servings per week delayed memory decline by 2.5 years Caffeine [24:40] John Hopkins: Caffeine equivalent to 1 cup of coffee, better memory recall the next day than placebo Genetics affect reaction to caffeine [25:35] Previous podcast on caffeine genetics: https://podcasts.apple.com/us/podcast/on-functional-nutrigenomics/id1455383694?i=1000446534488 Omega 3 Fatty Acids [28:10] UCLA study: Walnut consumption improved cognitive test scores Rich is ALA, converted into EPA Fish Can reduce beta amyloid plaque production, improving brain signalling Choline [29:25] 92% people deficient in choline ~400-550mg/day Critical for white matter function & reducing inflammation Found in beef liver, egg yolk, chicken breast, ground beef, cod, broccoli Celiacs not absorbing food optimally Supplementation recommended Power ON to improve cognitive function and cell integrity - https://poweronpoweroff.com/products/power-on Brain games to improve cognition [36:05] AARP brain games, apps such as Lumosity Get adequate sleep [37:05] Journal of Sleep - short sleep duration showed worse white matter markers in mid-life Middle-aged celiacs with already lower white matter because of the disease especially need adequate sleep to lessen risk of cognitive decline, dementia, stroke Power OFF to help calm the mind & improve sleep quality https://poweronpoweroff.com/products/power-off Learn something new and complex [38:45] Leads to rapid structural changes in white and grey matter Must be complex - multiple steps to achieve success Must be something entirely new to you - language, computer code, tactile skill, musical instrument, a new exercise with proper form Probiotics [40:40] Journal of Nutrients April 2019 study showed You must care for your gut microbiome Eating healthy, whole foods Removing digestive irritants/intolerant foods Consuming fiber (prebiotic) Take a probiotic supplement *if* recommended by a physician Gut & Mood are connected for cell communication and neurotransmitter production Podcast: LINK Episode recap [41:45] We'll be back next week with a COVID19 episode
How do we retain control of our psychology when physiologically we are out of control? The Nervous, Endocrine and Multifactorial responses aimed at maintaining homeostasis, often work against us - then people describe maladaptive responses including: Panic Attacks Chronic Anxiety and Poor Mental Health This episode will help you to overcome. Then you can utilise it to level up and make your Personal Upgrade. This is a hard topic for sufferers, feel free to reach out as required... michaelpulser@gmail.com
Join Dr Kevin Fernando for a detailed discussion of how to implement recent guideline recommendations into daily clinical practice, including 2019 ESC recommendations and the 2020 EASD/ADA update. References Buse JB, et al. Diabetologia. 2020; 63(2):221-228. Davies MJ, et al. Diabetes Care. 2018; 41(12):2669-2701 Consentino F, et al. Eur Heart J. 2020; 41(2):255–323 This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.
Featuring an interview with Professor David Matthews, President of the EASD. How should we consider individual factors when setting multifactorial targets - and once these are set, how should we prioritise achieving them? Catch up on the latest guideline recommendations across glycaemic, lipid and blood pressure targets and how these should be met in clinical practice. References Consentino F, et al. Eur Heart J, 2020; 41(2): 255–323 Buse JB, et al. Diabetes Care 2019 Dec; dci190066. ADA. Diabetes Care 2020; 43(Suppl 1): S1-S2 This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.
Im zweiten Teil der Episode über Rückenschmerzen, besprechen Patrick und ich fünf weitere Fakten und Mythen rund um das Thema Rücken, Rückenschmerzen, Bewegung, Schmerzen und wie man damit umgeht. Als Kern dieser Episode haben wir das Paper von Peter O'Sullivan et al. (2019) die generell verbreitete Mythen über unspezifische Schmerzen im unteren Rücken genauer unter die Lupe genommen. Wir versuchen dem Zuhörer klar zu machen, wie ein solcher Schmerz entstehen kann, was so ein Schmerz nun konkret heisst und wie ihr damit umgehen könnt. Für mehr Informationen über den unteren Rücken und Schmerzen, könnt ihr euch noch die Episode #13 anhören. 10 Fakten über Rückenschmerzen, O'Sullivan et al. (2019): https://bjsm.bmj.com/content/early/2019/12/31/bjsports-2019-101611 Core Training: Evidence Translating to Better Performance and Injury Prevention, Stu McGill (2010): https://pdfs.semanticscholar.org/b3a0/220d60c1b01bef2ea67214bbbeeeea02a217.pdf A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment (2017): https://www.tampereenurheiluakatemia.fi/wp-content/uploads/2017/09/Mendiguchia-et-al..pdf Core Stability in Athletes: A Critical Analysis of Current Guidelines. (2017): https://www.ncbi.nlm.nih.gov/pubmed/27475953
Hoy el Dr. Carlos Daniel se encuentra con la Dra. Daniela Juárez hablando sobre herencia multifactorial. ¿Sabes qué es? Acompáñanos a descubrir más sobre el tema
CFMD gets back to his family practice roots with a dive into the treatment of migraines. Take a listen to CFMDs approach to catching, setting realistic goals and expectations, prophylactic and abortive regimens, as well as taking that knowledge into the ED. You will also get his approach to treating the ED patient and using that clinic based approach. Multimodal and multifactorial are key concepts. And a hint-narcotics are a rarity........
Decir que la obesidad es una enfermedad multifactorial, quiere decir que no hay una razón única por la que se produce la enfermedad. Aquí te expongo algunos factores que la provocan: Factores genéticos Hay ciertos tipos de obesidad que tienen un origen genético y que se asocian a problemas de desarrollo físico e intelectual. Sin embargo, en la mayor parte de pacientes que desarrollan obesidad no suele ser la única causa, ya que la obesidad se debe a la combinación entre genes, el ambiente y el estilo de vida. Metabolismo eficiente Se han encontrado numerosos genes implicados en la aparición de obesidad que hacen que el gasto energético basal disminuya. Algunos individuos obesos en realidad requieren menos kilocalorías para el funcionamiento normal del organismo que los individuos delgados, ya que utilizan de forma muy eficiente sus kilocalorías. Estas personas en realidad podríamos decir que son más eficientes energéticamente y que en un hipotético caso de necesidad tendrían más posibilidades de sobrevivir. Tejido adiposo marrón Existen mecanismos implicados en la pérdida de energía, en forma de calor procedente de la termogénesis. El tejido adiposo marrón contiene una gran cantidad de mitocondrias que permite ajustar la liberación de energía en caso de frío, ayuno, embarazo, etc…. que permite ajustar la liberación de calor. Los osos por ejemplo, tienen una elevada cantidad de tejido adiposo marrón, esencial para poder llevar a cabo la etapa de hibernación. En el ser humano, en cambio su funcionalidad es muy limitada. Es posible que algunas personas obesas tengan deficiencias en el tejido adiposo marrón, o una menor cantidad del mismo. Teoría del punto fijo Las dietas muy bajas en calorías pueden reducir el aporte de grasa a cada célula pero no destruirla. Las células grasas vacías envían una señal de hambre. La persona obesa que ha reducido peso, debe aprender a ignorar estas señales de hambre de forma constante. Por eso es difícil el mantenimiento del peso corporal una vez perdido el peso en pacientes obesos. Factores endocrinos Las alteraciones en la función de hipotálamo, tiroides y glándula suprarrenal puede provocar obesidad. Factores ambientales El tener hábitos alimentarios de alta densidad energética pueden conducir a un incremento de peso ya desde la infancia sobre todo debido al sedentarismo infantil. La ausencia de mercados con disponibilidad de frutas y hortalizas o su ubicación a grandes distancias, sobre todo de núcleos humanos con niveles económicos escasos, son factores condicionantes de un mayor aumento del índice de grasa. Comer fuera de casa, el consumo de comida rápida habitual (más de una vez a la semana) puede contribuir al incremento de calorías en la dieta y con ello la ganancia de peso y obesidad. Tamaño de raciones. El ofrecimiento de raciones de mayor tamaño por el mismo precio o por poco dinero más, condiciona un aumento en la ingesta energética de las personas con el consiguiente aumento de las calorías. Palatabilidad. Contra más sabroso es el alimento, más se consume. Comer rápido. Disminuye la saciedad porque no da tiempo a que las señales de saciedad lleguen al cerebro. La ingesta de bebidas azucaradas/Carbonatadas. El consumo frecuente de bebidas azucaradas está asociado con IMC mayores puesto que estamos aportando un mayor número de calorías diarias y casi sin darnos cuenta. Actividad sedentaria provoca aumento de peso. Hemos de aumentar nuestra actividad para que nuestro gasto energético sea mayor o igual que nuestra ingesta. Sobre todo cuando nos vamos haciendo mayores, ya que el gasto energético basal (a grandes rasgos es la energía que necesita nuestro cuerpo para sobrevivir en reposo) disminuye con la edad. Esto conlleva que por lo que la misma cantidad de comida nos engorda más, esto lo podemos compensar aumentando el gasto con ejercicio. Conclusión Hemos de procurar mejorar nuestra dieta ya no por estética, sino porque el cada vez más extendido síndrome metabólico (conjunto de alteraciones asociados a la presencia de obesidad abdominal) nos puede llevar a una multitud de problemas de salud como: Aumento de triglicéridos. Reducción del colesterol bueno (HDL). Aumento de la presión arterial. Aumento de la glucosa en sangre en ayunas. Artrosis. Lesiones articulares. Deformidades óseas. Cáncer. Enfermedades cardiovasculares. Alteraciones cardiorrespiratorias. Disfunción menstrual. Síndrome de ovarios poliquísticos. Incontinencia urinaria. Alteraciones digestivas. Alteraciones cutáneas. Alteraciones psicológicas. En resumen, una disminución de la calidad de vida en general. Si no quieres hacer una dieta estricta, por lo menos has de cambiar patrones alimentarios pobres, como realizar pocas ingestas al día, con una densidad calórica elevada y poco aporte de nutrientes: alimentos con calorías vacías, procedente normalmente de ultraprocesados y procesados de poca calidad. Más consejos como este y Dietas personalizadas en : https://www.misdietasparaadelgazar.com
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Luke discusses the different types of muscle fatigue an individual can experience during an event and how to best combat it. More free resources at https://go.metsperformance.com.au/free-mets-mastermind
Genetics Korf, B Multifactorial Inheritance Podcast 032316 by OPENPediatrics
When addiction centers fail to treat the metabolism of addicts, they get repeat business. How is the addiction treatment protocol changing with TRT? When will the medical industry begin to recognize the benefits of TRT? How will community supported healthcare and wellness make doctors insignificant? On this episode, Russ Scala is back to talk about addiction, weight loss and the current state of medicine. When we want to grow new brain tissue, we give someone testosterone. -Russ Scala Takeaways If you have low-circulating dopamine levels, you are more susceptible to addiction. One area addiction treatment isn’t paying attention to is the opiate bowel. 95% of men who present with a deficiency in testosterone won’t get the treatment they need from doctors. The community is doing a lot more to help people attain and maintain health than doctors. At the start of the show, Russ shared on the work he’s doing including biochemical individuality, and his interest in the aging workforce. Next, we talked about the current model of healthcare and how competition will shift it towards preventative healthcare and wellness. We also talked about an LA times article about the struggle many Americans are having with obesity. We went on to talk about the many benefits of TRT and testosterone as rehab in the HPA axis. Towards the end of the show, we shared on how testosterone protects the brain. Russ also shared insights on; Why we need addiction treatment protocols designed for metabolism The warrior gene and its connection to addiction Opiate induced neuroplasticity Why addicts have with muscle waste Why doctors will become insignificant As medicine remains bogged down in Pharma-controlled, backward practices that aren’t helping people, the community is going to step up and help people get better, not doctors. People are going to continue to crowdsource their health solutions to tribes that are already adhered to a practice, and people who have the foundational principles and real world quantifiable results. This can change the game for addicts, testosterone deficient men and other people who aren’t being served well by the doctors who are meant to help them. Guest Bio Russ Scala is a former paramedic and SWAT team member who went on to found Scala Precision Health and the Institute of Nutritional Medicine and Cardiovascular Research. He’s developed specific protocols for everything from brain health to athletic performance, from active longevity to rapid recovery. Go to http://scalaprecisionhealth.com/ for more information. To Download Your FREE PDF Copy of the Amazon Best Seller: The Definitive Testosterone Replacement Therapy MANual, Click Here For a FREE Paperback Copy. The TRT MANual has helped hundreds of thousands of men around the world reclaim their health and vitality. Don’t suffer in silence a moment longer! PS. As an added bonus, upon finishing the book-once you provide a Thoughtful, High Quality Review on Amazon (hopefully 5 STAR), we will send you our new unreleased eBook 7 Lies You’ve Been Told About Testosterone for FREE.* (To receive book, email jay@trtrevolution.com a screenshot of your posted review.)
Interview with Simona Soverini, from Italy. Simona Soverini discusses the topic 'Sickle cell disease A multifactorial disorder'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.
Interview with Simona Soverini, from Italy. Simona Soverini discusses the topic 'Sickle cell disease A multifactorial disorder'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.
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