Podcasts about pde5

In this refreshingly honest episode, Melissa chats with the inspiring and trailblazing Dr. Amy Pearlman—a US-based female urologist, twin, and co-founder of the Prime Institute in Florida. Known for her progressive and patient-first approach, Amy opens up about her journey into men's health, the procedures she performs (including penile girth enhancement), and the power of confidence in sexual wellbeing.  This episode dives deep into:  Why Amy chose a career in urology  How penile enhancement treatments like hyaluronic acid fillers are helping men regain confidence  The rise of penile retraction as a commonly ignored concern—and what can be done about it  Using tools like Restorex and vacuum erection devices for rehabilitation and enhancement  Why Botox for the penis (Bocox) might be the next frontier in treating ED and penile retraction  The role of filler sleeves in preserving shape post-injection  Her concierge model of care and how it allows for more personalised, holistic men's health treatment.  Dr. Pearlman also busts myths and shares real-world insight from her clinical experience. Melissa shares a fascinating case of six men from Papua New Guinea searching for penis enlargement in Perth!  Key Topics Covered:  Penile girth enhancement with hyaluronic acid filler  Filler safety, reversibility, and realistic expectations  Why sexual confidence matters in treating premature ejaculation  Treating penile retraction and post-surgical shrinkage  Erectile dysfunction therapies: PDE5 inhibitors, daily tadalafil vs. on-demand Spontan spray  How Dr. Pearlman learned procedures after formal training—and why that matters  The difference between snake oil and real innovation in men's health  Cosmetic urology vs. functional outcomes: bridging the gap    About Dr. Amy Pearlman:  Amy is a board-certified urologist, medical educator, and co-founder of the Prime Institute. Her career spans academic medicine, transgender surgery, male sexual health, hormone therapy, and now cosmetic urology with a focus on confidence, body image, and function. Known for her progressive mindset, Amy trains other professionals and speaks globally on men's health and innovation in urological care.  Prime Institute: www.theprimeinstitute.com  Follow Amy on Instagram: @amypearlmanmd  Resources & Links:  Book a telehealth consult with our sexual health nurse practitioners at Restorative Health Clinic  For more information check out our websites www.rshealth.com.au , www.makehardeasy.com.au and www.melissahadleybarrett.com.au   Listen & Subscribe  If you found this episode helpful, don't forget to subscribe, rate, and review the podcast! Your feedback helps us continue bringing important conversations to light. Search for The Penis Project Podcast on Spotify, Apple Podcasts, or your favourite podcast app.  Connect With Us  We love hearing from real people navigating penile health—just like Amy If you'd like to share your journey or ask a question, get in touch.  Email: admin@melissahadleybarrett.com  Website: www.rshealth.com.au  Websites:  https://rshealth.com.au/    https://makehardeasy.com.au   https://melissahadleybarrett.com   http://prost.com.au/  Facebook:  https://m.facebook.com/p/Melissa-Hadley-Barrett-100085237672685/  https://www.facebook.com/profile.php?id=100085146627814  Instagram:  https://www.instagram.com/melissahadleybarrett/  https://www.instagram.com/restorativehealth.clinic/  TikTok: @melissahadleybarrett  YouTube: Melissa Hadley Barrett  Linkedin:  https://www.linkedin.com/in/melissa-hadley-barrett/   TEDX  https://www.youtube.com/watch?v=IjHj1YTmLoA 

Today on the Penis Project Melissa chats to Professor Eric Chung who is recognised as one of Australia's leading urologists and has been invited as a speaker at many international and national meetings as well as received numerous national and international awards and research grants. In this candid and science-backed conversation, they discuss Spontan—a revolutionary nasal spray delivering the PDE5 inhibitor Vardenafil to treat erectile dysfunction (ED).  Unlike traditional oral ED medications like Viagra (Sildenafil) or Cialis (Tadalafil), Spontan uses an intranasal delivery system to provide rapid onset—within just five -fifteen minutes—making it ideal for spontaneous sexual activity. This episode dives into how Spontan works, its benefits over oral medications, who it's most suitable for, and the research behind its success.  This episode is a must-listen for anyone dealing with ED, exploring options beyond tablets, or simply curious about advances in sexual health treatments for men.  In This Episode:   Why Spontan offers faster onset compared to oral PDE5s   Differences in side effects between nasal and oral ED medications   Ideal patient profiles and common prescribing scenarios  Clinical insights from over 300 patient prescriptions   The role of Spontan in prostate cancer rehabilitation   Tips for effective usage and what to expect with first-time use   Why proper technique reduces nasal discomfort and sneezing   The quirky catchphrase: “Up your nose and up it goes!”  Key Topics Covered:  What are PDE5 inhibitors and how do they work?  Why nasal delivery bypasses gut metabolism for improved effectiveness  Comparing Spontan with oral Viagra, Cialis and injectables  Common side effects (and how to minimise them)  Using Spontan for post-prostate cancer sexual rehabilitation  Can Spontan be used more than once a day?  Compatibility with nasal decongestants (e.g., pseudoephedrine)  Patient success stories and selection criteria for best results  Spontan Nasal Spray: Currently available in Australia via the Special Access Scheme. Book an appointment today at www.rshealth.com.au    Resources & Links:  Book a telehealth consult with our sexual health nurse practitioners at Restorative Health Clinic  For more information check out our websites www.rshealth.com.au , www.makehardeasy.com.au and www.melissahadleybarrett.com.au   Listen & Subscribe  If you found this episode helpful, don't forget to subscribe, rate, and review the podcast! Your feedback helps us continue bringing important conversations to light. Search for The Penis Project Podcast on Spotify, Apple Podcasts, or your favourite podcast app.    Want to Share Your Story or Suggest a Topic?    We love hearing from listeners and professionals. Reach out via email at admin@melissahadleybarrett.com if you'd like to be featured or have suggestions for future episodes.    Connect With Us    Email: admin@melissahadleybarrett.com  Website: www.rshealth.com.au  Websites:  https://rshealth.com.au/  All genders  https://makehardeasy.com.au   https://melissahadleybarrett.com   http://prost.com.au/     Facebook:  https://m.facebook.com/p/Melissa-Hadley-Barrett-100085237672685/  https://www.facebook.com/profile.php?id=100085146627814    Instagram:  https://www.instagram.com/melissahadleybarrett/  https://www.instagram.com/restorativehealth.clinic/  TikTok: @melissahadleybarrett  YouTube: Melissa Hadley Barrett  Linkedin:  https://www.linkedin.com/in/melissa-hadley-barrett/   TEDX  https://www.youtube.com/watch?v=IjHj1YTmLoA 

In this episode, we dive into the early therapies and how our understanding of vascular physiology drastically changed the management of pulmonary hypertension. Intro 0:12 In this episode 0:18 Recap of part 1 & 2 0:31 What part 3 is about 2:31 WHO conference in 1975: Treating pulmonary hypertension 3:48 The Discovery of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Part 1 5:20 Epoprostenol 6:18 Prostacyclin 10:37 Endothelin antagonists 11:41 Phosphodiesterase type 5 (PDE5) inhibitors 14:08 Interaction of nerves and blood vessels 15:06 The Soups VS the Sparks 17:36 A dreamed experiment 19:06 Acetylcholine 23:23  Enter “the calabar bean” 24:45 Acetylcholine and vasodilation: 1976 26:01 Rabbit aorta 27:45 Nitric oxide 29:38 Why are we using nitric oxide to treat pulmonary hypertension? 31:31 Tachyphylaxis 33:48 TNT factories 35:09 Nitrous oxide and tachyphylaxis 36:52 Pfizer in the 1980s 38:06 Understanding the trigger of pulmonary hypertension 40:53 PDE5 and nitric oxide and pulmonary hypertension 43:07 The end of the ripping yarns 44:20 Coming up in part 4 46:17 Thanks for listening 47:29 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bernard C. C R Soc Biol. 1851;3:163-164. Furchgott RF, et al. Nature. 1980;doi:10.1038/288373a0. Galiè N, et al. N Engl J Med. 2005;doi:10.1056/NEJMoa050010. Ghofrani HA, et al. Nat Rev Drug Discov. 2006;doi:10.1038/nrd2030. Giordano D, et al. Biochim Biophys Acta. 2001;doi:10.1016/s0167-4889(01)00086-6. Guthrie F. Q J Chem Soc. 1859;doi:10.1039/QJ8591100245. Higenbottam T, et al. Lancet. 1984;doi:10.1016/s0140-6736(84)91452-1. Marsh N, et al. Clin Exp Pharmacol Physiol. 2000;doi:10.1046/j.1440-1681.2000.03240.x. Montastruc JL, et al. Clin Auton Res. 1996;doi:10.1007/BF02281906. Nejad SH, et al. Future Cardiol. 2024;doi:10.1080/14796678.2024.2367390. Tansey EM. C R Biol. 2006;doi:10.10116/j.crvi.2006.03.012. Warren JV. Trans Am Clin Climatol Assoc. 1988;99:10-6. Disclosures: Brown reports no relevant financial disclosures.

PDE5 inhibitörü olan ve uzun süre boyunca ereksiyonu koruyan bu ilacın sağlığa yönelik diğer faydaları nelerdir?

Dr. Gillett and Dr. Houman discuss male sexual health Optimization. 00:00 Intro02:53 ED in young men05:41 PDE5 inhibitors10:09 Unhealthy lifestyles and pornography exposure17:01 Vasectomies impact on testosterone22:03 Testosterone and cortisol25:14 Oral testosterone35:03 TRT benefits40:03 Botox46:19 Exosomes49:03 Sexual health optimization52:02 IVF before considering male fertility issues?54:35 Lifestyle changes benefit fertility, including diet, exercise, sleep, and stress reduction.Follow Dr. Houman:► https://www.instagram.com/justin.houman.md/?hl=en► https://houmanmd.com/For High-quality labs:► https://gilletthealth.com/order-lab-panels/For information on the Gillett Health clinic, lab panels, and health coaching:► https://GillettHealth.comFollow Gillett Health for more content from James and Kyle► https://instagram.com/gilletthealth► https://www.tiktok.com/@gilletthealth► https://twitter.com/gilletthealth► https://www.facebook.com/gilletthealthFollow Kyle Gillett, MD► https://instagram.com/kylegillettmdFollow James O'Hara, NP► https://Instagram.com/jamesoharanpFor 10% off Gorilla Mind products including SIGMA: Use code “GH10”► https://gorillamind.com/For discounts on high-quality supplements►https://www.thorne.com/u/GillettHealth#podcast #botox #menshealth #trt #erectiledysfunctionAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Un nouvel épisode du Pharmascope est disponible… Et on aborde encore l'andropause et son traitement! Dans cette deuxième partie, Nicolas, Isabelle et Olivier discutent des données d'efficacité et d'innocuité de la testostérone en contexte d'andropause. Les objectifs pour cet épisode sont les suivants: Discuter de la prise en charge pharmacologique de l'andropause Discuter des données d'efficacité de la testostérone en contexte d'andropause Discuter des données d'innocuité de la testostérone en contexte d'andropause Ressources pertinentes en lien avec l'épisode  Série documentaire « L'andropause sans tabou ». Disponible sur l'EXTRA d'ICI TOU.TV TTrialsSnyder PJ, et coll.; Testosterone Trials Investigators. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016 Feb 18;374(7):611-24. Resnick SM, et coll. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA. 2017 Feb 21;317(7):717-727. Roy CN, et coll. Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial. JAMA Intern Med. 2017 Apr 1;177(4):480-490. TRAVERSELincoff AM, et coll; TRAVERSE Study Investigators. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023 Jul 13;389(2):107-117. Pencina KM, et coll. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab. 2024 Jan 18;109(2):569-580. Bhasin S, et coll. Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1814-1826. Pencina KM, et coll. Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open. 2023 Oct 2;6(10):e2340030. Snyder PJ, Bauer DC, Ellenberg SS, Cauley JA, Buhr KA, Bhasin S, Miller MG, Khan NS, Li X, Nissen SE. Testosterone Treatment and Fractures in Men with Hypogonadism. N Engl J Med. 2024 Jan 18;390(3):203-211. Autres référencesLee H, et coll. Testosterone replacement in men with sexual dysfunction. Cochrane Database Syst Rev. 2024 Jan 15;1(1):CD013071. Domes T, et coll. Canadian Urological Association guideline: Erectile dysfunction. Can Urol Assoc J. 2021 Oct;15(10):310-322. Buvat J, et coll. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med. 2011 Jan;8(1):284-93. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Jan 1;76(1):31-40. Wittert G, et coll. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol. 2021 Jan;9(1):32-45. Bhasin S, et coll. Effect of Testosterone on Progression From Prediabetes to Diabetes in Men With Hypogonadism: A Substudy of the TRAVERSE Randomized Clinical Trial. JAMA Intern Med. 2024 Apr 1;184(4):353-362.

Mental health is deeply connected to s*xual health. Challenges like anxiety and depression can directly impact s*xual function, while unresolved s*xual health issues often exacerbate mental health struggles. The quicker individuals seek help, the better their prognosis. Prioritizing mental well-being is not just about avoiding catastrophic outcomes but enhancing overall quality of life. Globally, healthcare systems face challenges in providing affordable, accessible, and comprehensive s*xual health support. For example, treatments for erectile dysfunction (ED) like PDE5 inhibitors (e.g., Viagra) are rarely covered by insurance, despite being widely recognized as essential for many. This lack of coverage creates barriers for individuals seeking treatment and highlights systemic inequities.   For more free erectile dysfunction education and resources, please visit: https://erectioniq.com/    Mark Goldberg helps men resolve erectile dysfunction. He offers individual, one-on-one services to men throughout the world through a secure, telehealth platform. It's 100% confidential. You can visit the Center for Intimacy, Connection and Change website to schedule a free consultation: https://centericc.com/

In this episode, Dr. Rena Malik, MD, explores the potential benefits of Panax ginseng and Tongkat Ali for improving erectile function. She delves into the scientific evidence, including randomized controlled trials and meta-analyses, to assess their effectiveness in treating erectile dysfunction (ED). Dr. Malik discusses the various mechanisms through which these supplements may work, such as increasing nitric oxide production and inhibiting oxidative stress for Panax ginseng, and muscle relaxation and PDE5 inhibition for Tongkat Ali. She also highlights the potential side effects and precautions for individuals with specific health conditions. This episode provides a comprehensive overview for listeners interested in alternative treatments for ED and the importance of understanding the scientific evidence behind these supplements. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments ▶️Chapters: 00:00 Panax Ginseng 01:47 Side Effects 02:47 Tongkat Ali 04:03 Side Effects WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Dr. Rena Malik, MD invites Dr. John Mulhall, to explore the complexities of erectile dysfunction (ED) and penile health. Together, they examine the use of PDE5 inhibitors like Sildenafil for young, healthy men, highlighting potential pitfalls such as psychological dependence. Dr. Mulhall also sheds light on the efficacy and challenges of intracavernosal injections for ED, emphasizing the importance of proper technique and integratability into lovemaking. Additionally, they discuss the impact of prostate cancer treatments on erectile function and orgasmic health, providing nuanced insights into the intersection of cancer therapy and sexual well-being. Listeners will benefit from an in-depth understanding of ED management, the nuances of penile health, and the broader implications of prostate cancer treatments on sexual function. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments ▶️Chapters: 00:00 Starting PDE5 inhibitors 01:20 Psychological dependence on medication 02:45 Intracavernosal injections & Technique errors 07:13 Medication refrigeration challenges 08:20 Erectile dysfunction post-prostate cancer 11:03 Surgery vs. radiation for ED 12:26 Modern alternate therapies 15:05 Ejaculation vs. orgasm differences Don't forget to check out Dr. John Mulhall: Instagram: https://www.instagram.com/jsmeditorinchief/ Twitter: https://twitter.com/SaveYourSexLife Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode , Dr. Geo is joined by two distinguished urologists, Dr. Raphael Carrion and Dr. Raul Fernandez Crespo, from the University of South Florida. Together, they provide a comprehensive overview of medical approaches to treating erectile dysfunction (ED). The discussion covers the effectiveness of PDE5 inhibitors like Cialis and Viagra, as well as the intricacies of penile implant surgeries, exploring both malleable and inflatable options.Dr. Carrion and Dr. Fernandez-Crespo share their expertise on the step-by-step treatment process for ED, emphasizing the importance of personalized patient care and shared decision-making in selecting the right treatment. They also address the challenges posed by generic drugs, the significance of proper dosing, and considerations for surgical interventions. Dont miss this episode is a must-listen for anyone seeking a deeper understanding of the evolving landscape of male sexual health and the available treatment options for overcoming ED.----------------Thank you to our August SponsorsThis month on The Dr. Geo podcast, we're diving into a special four-part series on Male Sexual Health, and we are excited to introduce our sponsorBoston Scientific- [EDCure]- As a leader in innovative medical solutions, Boston Scientific is dedicated to improving patient health globally. Erectile Dysfunction (ED) affects one in five American men, even as young as 20 years old, but it's important to know that ED is treatable. From lifestyle changes and natural solutions to medical treatments like medications, vacuum devices, injections, and penile implants, there are various options available. Boston Scientific's AMS 700 Inflatable Penile Prosthesis is a long-term solution designed to mimic a natural erection, offering both functionality and a natural appearance. For more information on ED treatment options, click HERE for more information. Mr. Happy -This episode is also brought to you by Mr. Happy products-formulated by Dr. Geo Espinosa, these products address age-related health concerns like BPH and declining sexual health. By boosting nitric oxide levels and providing antioxidant support, Mr. Happy products help improve cardiovascular health, energy levels, cellular health, sexual health, mood, and stress levels. Experience the benefits of Mr. Happy products and visit > IamMrHappy.com ----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:

In this episode, Dr. Rena Malik and Dr. John Mulhall explore both the physical and psychological aspects of men's sexual health, focusing on the efficacy of PD-5 inhibitors for diabetic patients, erectile dysfunction post-prostatectomy, and the role of psychogenic ED. They delve into innovative treatments like intracavernosal injections, discuss the interplay between sexual habits and overall well-being, and offer evidence-based advice for optimizing intimacy and managing sexual dysfunction. Listeners will gain a comprehensive understanding of current practices in sexual medicine and actionable tips for improving sexual health and confidence. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments ▶️Chapters: 00:00:00 Introduction 00:02:25 No Nut November 00:00:08:27 Pornography 00:14:43 Semen Volume and Color 00:24:42 Clomipramine 00:25:47 Delayed Orgasm 00:33:51 Erectile Dysfunction 00:38:14 PDE5 inhibitors 00:39:50 Tadalafil and Sildenafil 00:42:27 Intracavernosal injections 00:45:28 Errors During Therapy 00:48:03 Erectile Dysfunction after Radical Prostatectomy 00:52:23 Focused Therapies 00:54:51 What Happens to Orgasmic Function with Treatment? 01:08:38 What's something you know now in life that you wish you knew earlier? Don't forget to check out Dr. John Mulhall: Instagram: https://www.instagram.com/jsmeditorinchief/ X: https://twitter.com/SaveYourSexLife Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

BLACK GINGER | Bigger, Harder, HappierA new podcast episode from In Search of Insight is here! This podcast episode is about our new Black Ginger extract. Black Ginger is a game-changing supplement for burning fat, achieving your fitness goals, boosting libido and sexual performance, increasing motivation and lifting mood.In this podcast, Product Specialist Emiel and podcast host Erika discuss the science behind Black Ginger's fat-burning and libido-boosting qualities. We explain key mechanisms for Black Ginger's benefits including thermogenesis, body recomposition, and the role of brown fat cells. We also explore the sexual function benefits of Black Ginger, namely its PDE5 inhibition which increases blood flow, which allows for better erections and arousal. Adding to these benefits, Black Ginger has a unique method of lifting our mood and motivation through it's modulation of neurotransmitter release and processing.Buy Black Ginger from Nootropics Depothttps://nootropicsdepot.com/black-ginger-extract-capsules/Podcast Chapters0:00 Introduction + Double Dose of Black Ginger4:34 Black Ginger Benefits5:00 Fitness + Endurance Benefits of Black Ginger10:47 Fat Burning + Body Recomposition Benefits19:21 Muscle Protein Synthesis Pathways23:11 Sitruin 1 Activation 28:45 Summary of Fitness Benefits + Pathways30:30 Sexual Function + Libido Benefits31:59 PDE5 Inhibition39:25 Neurotransmitter Release Process43:42 Summary of Libido Benefits49:12 Perceptible Benefits of Black Ginger53:15 Stacking Black Ginger

Solutions For Erectile Dysfunction In this episode, Cassidy Graham, NP discusses the evaluation and treatment of erectile dysfunction (ED). Cassidy explains how she uses a SHIM score to evaluate ED. The SHIM score (Sexual Health Inventory for Men), is a questionnaire used to assess ED. SHIM is a validated tool developed by researchers to help clinicians evaluate the severity of ED in men. It consists of five questions related to the frequency and quality of erections, with scores ranging from 1 to 25. A higher score indicates better erectile function, while lower scores suggest more severe ED. The SHIM score helps the Victory Men’s Health providers gauge the extent of the problem and guide appropriate treatment options for patients experiencing ED. Cassidy also examples the most common lifestyle factors that contribute to ED, the important role of nitric oxide in ED and the use of nitric oxide supplements, treatment options for mild, moderate, and severe ED, the use of penis pumps, and the importance of post-op care for prostatectomy patients. Takeaways The SHIM score and questionnaire are useful tools for evaluating ED. Lifestyle factors such as smoking, diabetes, and obesity can contribute to ED. Nitric oxide supplements can help improve blood flow and treat ED. Treatment options for ED include hormones, PDE5 inhibitors, wave therapy, penis pumps, and Trimix injections. Post-op care is important for prostatectomy patients to regain sexual function. Communication and support between partners are crucial in the treatment of ED. Chapters 00:00 Introduction and Overview 01:32 Evaluating for ED: SHIM Score and Questionnaire 09:12 Effects of Smoking, Diabetes, and Obesity on Vascular System 10:41 Role of Nitric Oxide in ED and the Use of Nitric Oxide Supplements 12:40 Benefits of Daily Cialis 19:36 Treatment Options for Mild ED 22:57 Treatment Options for Moderate ED 25:49 Treatment Options for Severe ED 28:23 Using Penis Pumps for ED 31:22 Treating ED Post Radical Prostatectomy 38:28 Importance of Post-Op Care for Prostatectomy Patients 42:24 Difference Between Oral and Sublingual PDE-5s 44:28 Importance of Communication and Support in ED Treatment 44:46 Conclusion SHIM Score Questions Click HERE To Purchase a Penis Pump Click HERE To visit Victory Men's Health Click HERE To purchase PDE-5's visit Victory RX Click HERE For questions email podcast@amystuttle.com Disclaimer: The Women Want Strong Men Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Nocturnal erections are the sixth vital sign no one talks about, which is a leading indicator of your vascular health. Join me and Dr. Elliot Justin in a conversation about how to improve sexual health using wearable technology. Dr. Justin is the CEO and Founder of FirmTech, focusing uniquely on the intersection of sexual and cardiac health. There are wearables of numerous health categories, but one that focuses on our intimacy has been non-existent until now. FirmTech's award-winning Tech ring—the first smart intimacy wearable of its kind enhances pleasure while improving cardiac health. We also touch on the broader implications for both men's and women's health, emphasizing the critical need for better tools and more research in an industry that often favors reactive treatments over preventive health. Other topics include how sexual health is inextricably linked to relationship satisfaction and overall well-being. Dr. Justin also discusses an increase in erectile dysfunction among younger men, the potential role of wearable technology in sleep and health assessment, and the benefits of PDE5 inhibitors such as tadalafil (aka Cialis). Throughout the conversation, it's a guarantee that you'll not only learn a few things but also get plenty of laughs along the way. Lastly, you'll be left with a potent reminder that communication is vital regarding health, just like in a good relationship. — Episode Chapter Big Ideas (timing may not be exact) — (00:00) Nocturnal Erections in Men's Health (04:07) Erectile Function Monitoring and Health Assessment (12:55) Cock Rings and Medication Benefits (23:28) Measuring Firmness and Nocturnal Erections (27:41) Sleep Quality, Erections, and Relationship Satisfaction (44:13) Increase Medical Device Adoption Strategies (56:45) Conclusion — Impactful Words From Dr. Elliot Justin — "Everyone knows about morning wood, and we poke our partners with it and laugh about it. But I didn't realize that the number of nocturnal erections is a leading indicator of a man's cardiovascular health, meaning it's predictive. Before the majority of men have a heart attack or a stroke, their number of erections go down." "Women have the same complaints that men do in terms of erectile dysfunction. It's called FSD, female sexual dysfunction. Younger women have more problems than men do because they want to blame it on men, but there are women taking antidepressants more than men do, and those have an impact on their sexual performance." — Connect with Dr. Elliot Justin and FirmTech — Website — https://myfirmtech.com/ Contact Dr. Justin — elliot@myfirmtech.com — Connect with Julian and Executive Health — Curious about becoming a concierge client? Sign up for a complimentary Executive Health Meeting — ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.executivehealth.io/contact⁠⁠⁠⁠⁠⁠⁠⁠ LinkedIn — ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/julianhayesii/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Join our weekly 'Executive Athlete Journal' + get our free executive health report: 'The Optimal Executive: 17 Impactful Actions to Look, Feel, and Stay at The Top of Your Game.' Visit— https://www.executivehealth.io/report ***DISCLAIMER: The information shared is not meant to treat or diagnose any condition. This is for educational, informational, and entertainment purposes. The content here is not intended to replace your relationship with your doctor and/or medical practitioner. Any decision to begin the use of the following supplements or use any of the information on this website or podcast should be discussed with your doctor and/or medical practitioner. --- Send in a voice message: https://podcasters.spotify.com/pod/show/executive-health/message

It's so tempting. His little blue pills are sitting there and seem to solve his problem. Why not take one and see what happens? It did wonders for Samantha on Sex in the City who had earth-shattering orgasms after she took her guy's Viagra™. Viagra™ is the trade name for sildenafil and is one of a class of drugs known as phosphodiesterase type 5 inhibitors, also known as PDE5 inhibitors. PDE5 inhibitors are currently only FDA-approved for men, but there are circumstances in which sildenafil and other PDE5 inhibitors can also be beneficial to women.  I discuss:  If a PDE5 Inhibitor is effective in treating sexual dysfunction in women What specifically a PDE5 Inhibitors will treat If a PDE5 Inhibitor is safe for women  If a PDE5 Inhibitor will ever be FDA-approved for women                               Compounding Pharmacy for Topical Sildenafil Midi Healthcare prescribes high-quality, scientifically backed prescriptions that improve skin, hair, and sexual wellness, including Midi Arousal Cream.  joinmidi.com This episode is an excerpt for Put the O Back in Mojo: A Guide to Post Menopause Libido and Orgasm, now available for pre-order on amazon.com For more information on this topic:  Episode 15: Post Menopause Orgasm- Everybody Come! Episode 21:  Say Yes! to Testosterone for Women Episode 46 Finding a Menopause Clinician Who Will Listen  Episode 47 Orgasm Equality with Dr. Laurie Mintz Episode 70- Is the O Shot a Good Idea?  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society.  Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.  Subscribe and Follow Dr. Streicher on  DrStreicher.com Instagram @DrStreich Twitter             @DrStreicher Facebook  @DrStreicher YouTube  DrStreicherTV Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy Put the O Back in Mojo: A Guide to Post Menopause Libido and Orgasm (available for pre-order) 

LTR Pharma Executive Chairman Lee Rodne joined Steve Darling from Proactive to share the exciting news that the company has initiated trading on the Australian Securities Exchange under the ticker symbol LTP. LTR Pharma is dedicated to improving men's health through the clinical development and commercialization of an innovative intranasal spray treatment for Erectile Dysfunction (ED). Rodne explained that their product, SPONTAN, distinguishes itself from existing ED therapies through its unique mechanism of action. It delivers an already proven, effective, and regulatory-cleared PDE5 inhibitor through intranasal delivery. This approach is designed to bypass the first-pass metabolism associated with many oral PDE5 medications, offering potential benefits to patients. In addition to this milestone, Rodne highlighted that LTR Pharma has received approval from the Bellberry Human Research Ethics Committee for a bioequivalence clinical trial. This trial will compare SPONTAN with the FDA-approved ED drug Levitra, further advancing the company's efforts in the field of men's health. LTR Pharma's presence on the Australian Securities Exchange signifies an important step forward in its mission to provide innovative solutions for men facing erectile dysfunction, addressing a significant medical need and potentially offering improved treatment options.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Bilal Chughtai discuss their workup for benign prostate hyperplasia (BPH) and how they use Greenlight Laser therapy and pharmacologic interventions to treat this common condition. --- CHECK OUT OUR SPONSOR Boston Scientific GreenLight Laser Therapy https://www.bostonscientific.com/greenlight --- SHOW NOTES First, the doctors discuss workup of BPH. Questionnaires, like the International Prostate Symptom Score (IPSS) are helpful when in the first clinic evaluation. They also discuss differential diagnoses of urinary obstructive symptoms. Then, they discuss who is and isn't a candidate for a GreenLight laser therapy. They also touch on the topic of pre-operative antibiotics. Dr. Chughtai then describes in detail the steps of the procedure to ensure an open channel and removal of the correct prostate lobes. Next, he discusses the possible risks and benefits of doing an ejaculatory hood sparing procedure. Additionally, they explore the hood technique and how it's used to preserve mucosa at the apex of the prostate. They also consider the importance of having a discussion about ejaculation with patients before the GreenLight procedure. Additional technology or adjunctive medications, such as alpha blockers and PDE5 inhibitors may be necessary as well. Finally, Dr. Chughtai explains his post-operative medications and the decision to discharge or admit for overnight observation. --- RESOURCES GreenLight Laser Therapy: https://www.bostonscientific.com/en-EU/health-conditions/enlarged-prostate/our-treatments/greenLight-laser-therapy.html

On this episode we discuss the management of benign prostatic hyperplasia (BPH) as well as overactive bladder (OAB). We review alpha blockers, 5-alpha-reductase inhihibitors, PDE5-inhibitors, anticholinergics, and beta 3 agonists. We close by discussing the best treatment options for patients with controlled BPH symptoms who are still experiencing urinary frequency and urgency.  Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! We want to give a big thanks to our sponsor, High-Powered Medicine. HPM is a book/website database of summaries for over 150 landmark clinical trials. You can get a copy of HPM, written by Dr. Alex Poppen, PharmD, at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to give a big thanks to our main sponsor Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx  This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

Erectile dysfunction (ED) is a common and distressing condition that affects millions of men worldwide. It is characterized by the inability to achieve or maintain a firm erection sufficient for sexual intercourse. ED can be caused by various factors, including psychological issues, lifestyle choices, and underlying medical conditions.  You might have heard of ED, but you may not realize how common it is. Its prevalence tends to increase with age (if you're in your 40's, you have a 40% chance of experiencing ED, and this risk increases by about 10% with every decade of life).  Fortunately, there are several treatment options available to address ED, including pharmaceutical medications, lifestyle changes, and emerging therapies like peptide treatments.  In this podcast, we will explore the causes and traditional treatments of ED before delving into the exciting potential of peptide therapies in managing ED. What causes erectile dysfunction (ED)? Erectile dysfunction is a complex condition influenced by a variety of physical and psychological factors. To understand the potential benefits of peptide therapies, it's important to understand the underlying causes of ED. Psychological Factors: Psychological factors can significantly contribute to ED. Stress, anxiety, depression, and relationship problems can all lead to a temporary inability to achieve or maintain an erection. Counseling, therapy, and stress-reduction techniques are often effective in these cases. Lifestyle Choices: Unhealthy lifestyle choices, such as smoking, excessive alcohol consumption, a sedentary lifestyle, and a poor diet, can increase the risk of ED. Making healthier choices can lead to significant improvements in erectile function Underlying Medical Conditions: Numerous medical conditions are associated with ED, including: Cardiovascular disease: Conditions like atherosclerosis can restrict blood flow to the penis. While high blood pressure and high cholesterol can also cause ED. In fact, people with ED are often diagnosed with a heart condition less than 5 years later. Diabetes: High blood sugar levels can damage blood vessels and nerves, leading to ED. The longer you have diabetes, the more likely you are to experience ED. Neurological disorders: Conditions like multiple sclerosis and Parkinson's disease can affect nerve signals.  Mental health conditions: Depression, anxiety, high-stress levels can also play a role in your ability to maintain an erection.  Hormonal imbalances: Low testosterone levels can contribute to ED. About 40% of men older than 45 have low testosterone (low T). Obesity: Excess body fat can lead to hormonal imbalances (your body starts to turn testosterone into estrogen) and cardiovascular issues, both of which increase ED risk.  Medications: Certain medications, such as those used to treat pain, enlarged prostate, hypertension, depression, and acid reflux, may have ED as a side effect.  Aging: ED becomes more common as men age due to a natural decline in testosterone levels and changes in blood vessel function. What are traditional erectile dysfunction treatments? The treatment of ED typically begins with lifestyle modifications and, if necessary, progresses to medical interventions. Traditional treatment options include: Lifestyle Changes: Quitting smoking Reducing alcohol consumption Exercising regularly Adopting a healthy diet Managing stress through relaxation techniques or therapy Medications: Oral medications such as sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil (Stendra) are phosphodiesterase type 5 (PDE5) inhibitors. They work by increasing blood flow to the penis, helping men achieve and maintain erections. Intracavernosal injections: Medications like alprostadil can be injected directly into the penis to induce an erection. Urethral suppositories: Alprostadil can also be administered as a suppository inserted into the urethra. Vacuum Erection Devices: These are mechanical devices that create a vacuum around the penis, drawing blood into the area and causing an erection. A constriction band is used to maintain the erection. Penile Implants: In cases where other treatments are ineffective, surgically implanted devices can help men achieve and maintain an erection. There are inflatable and semi-rigid penile implants available. While these traditional treatments are effective for many men, they may not be suitable for everyone due to side effects, contraindications, or personal preferences. This has led to the exploration of novel therapies, including the use of peptides. Peptide therapies for erectile dysfunction In recent years, researchers have investigated the potential of peptides in addressing ED. These peptides work by targeting specific pathways and mechanisms involved in erectile function. Here are some promising peptide therapies for ED: Melanotan II (MT-II): Melanotan II is a synthetic peptide initially developed as a tanning agent. However, it has gained attention for its potential to improve sexual function. MT-II stimulates melanocortin receptors in the brain, which can lead to increased sexual desire and improved erectile function. PT-141 (Bremelanotide): PT-141 is another peptide that targets melanocortin receptors, specifically MC3R and MC4R. It has been shown to increase sexual arousal and improve erectile function in both men and women.  Kisspeptin: Kisspeptin is a peptide that plays a role in regulating reproductive hormones. Studies have shown that kisspeptin administration can increase testosterone levels and improve erectile function, making it a potential treatment option for ED. Thymosin Beta-4 (TB4): TB4 is a peptide that has shown promise in promoting tissue repair and regeneration. While not directly targeting erectile function, it may help improve erectile function by enhancing tissue health and blood flow to the penis. Vasoactive Intestinal Peptide (VIP): VIP is a peptide with vasodilatory properties, meaning it can relax blood vessels and increase blood flow. It has been investigated as a potential treatment for ED, particularly in cases where vascular issues contribute to the condition. While peptide therapies for ED show promise, there are several challenges and considerations: Limited Clinical Data: Many peptide therapies are still in the experimental stage, with limited clinical data available on their long-term safety and effectiveness. Individual Variability: The response to peptide therapies can vary among individuals, and not all men may experience the same level of improvement in erectile function. Cost: Peptide therapies may be more expensive than traditional medications, and insurance coverage may be limited. Regulatory Status: The regulatory status of peptide therapies for ED can vary by country, and some may not be approved for clinical use. It's important to recognize that peptide therapies for ED are still in the early stages of research and may not be suitable for everyone. Consulting with a healthcare provider is necessary to determine the most appropriate treatment approach, taking into consideration individual needs and circumstances. As research in this field continues to advance, we can look forward to more effective and tailored treatments for ED, ultimately improving the lives of those affected by this condition. Thanks again for listening to The Peptide Podcast, we love having you as part of our community. If you love this podcast, please share it with your friends and family on social media, and have a happy, healthy week! Pro Tips We're huge advocates of using daily greens in your routine to help with gut, skin, nail, bone, and joint health. We take AG1 (athletic greens) every day. Not only does it have vitamins, minerals, and a diverse range of whole-food sourced ingredients, but it also has probiotics to promote a healthy gut microbiome and adaptogens to help with focus and mood balance. It's vegan, paleo, and keto-friendly.

In this two part episode Buck discusses male sexual health with Justin Houman, MD from Tower Urology in Los Angeles. Over half of American men over the age of 40 suffer from erectile dysfunction and other sexual disorders. Buck asks the questions many men are uncomfortable asking. 00:01:44 - The concept of Erectile Dysfunction 00:06:22 - Diagnosing Erectile Dysfunction 00:09:33 - What is sex therapy? 00:10:56 - Main causes of Erectile Dysfunction 00:12:02 - Testosterone Levels 00:15:48 - Venous Leak 00:17:32 - Erectile Dysfunction Treatment 00:20:54 - PDE5 inhibitors 00:26:14 - Erectile Dysfunction and Cardiovascular Disease? 00:31:38 - Intracavernosal injections 00:37:13 - GAINSWave Procedure 00:42:53 - Platelet-Rich Plasma (PRP) Injection

Erectile dysfunction is often a canary in the coalmine for metabolic health problems, and it might be just the motivation some men need to make some changes. Like all things related to health, restoring sexual vitality often requires a holistic approach, but the good news is that these changes have nothing but positive upsides. Listen and learn: The risk vs reward of PDE5 inhibitors Why diabetes and heart disease are often correlated with ED Soundwaves, lasers, and platelet-rich plasma (PRP) injections Why 90 percent of sexual dysfunction problems are physiological Links Dr. Truong's Site ABOUT OUR GUEST Dr. Anne Truong is a medical doctor specializing in anti-aging and biological cellular medicine, with a career spanning over 25 years. She is the author of the book, Erectile Dysfunction Fix, and runs an educational group called, The Modern Man Club. Like the Show? Leave us a review Check out our YouTube channel Visit www.yogabody.com

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Kidney stones are common and majority of the stones are made up of calcium oxalate, followed by calcium phosphate, uric acid, cystine, and struvite stones. The recurrence rate of kidney stones is quite high, but there are a lot of modifiable risk factors that are crucial we educate our patients about. Some of the modifiable risk factors include decreased fluid intake, low calcium diets, increased oxalate and Vitamin C ingestion, diets low in potassium, high dietary sodium, high dietary non-diary animal protein. When managing a case of kidney stones, it is important to assess patient's discomfort level and escalate pain management as needed starting with NSAIDs. Indications for inpatient admission are poor pain control, inability to tolerate PO, or fever. Stones that are 5-10mm may need an alpha blocker, CCB, or a PDE5 inhibitor to facilitate passage. If stone does not pass after 4 weeks or if stone is more than 10mm, urology consult is indicated. CT abdomen remains the modality of choice for initial image, unless your patient is pregnant. Follow up imaging to confirm stone passage can be done with digital tomosynthesis coupled with an US. We hope you enjoy this episode! Thank you for listening.  

Summary   Hello and welcome to episode #19!   This is Ralph Sanchez and today I'll be talking the outcomes of two recent studies that investigated the potential use of Viagra and Cialis in the risk reduction for late-onset Alzheimer's disease (LOAD).   I was in part inspired to provide an overview on these two recent studies as they are cautionary tales on how many studies do not include the interrelated factors that are essential in arriving to an integrated assessment and analysis that serves their very premise— which is, does this or that work in a potential solution to something else?   Does Viagra or Cialis offer any proposed solution to the risk for LOAD and dementia?   Well today, I'll be adding a great deal of information—the missing pieces to the puzzle as it were—with regard the pathways by which Viagra and Cialis may or may not work, and many other complimentary or natural alternatives that play a similar role in maintaining and optimizing a healthy cardiovascular and cerebrovascular system.   First, let me provide a little insight as to the molecular pathways in which drugs like Viagra and Cialis function, and why they may be considered as repurposed drug candidates for the treatment or in the risk reduction for LOAD.   Viagra (sildenafil) and Cialis (tadalafil) are Phosphodiesterase-5 inhibitors (PDE5is) which fall into a class of drugs that are normally prescribed to men to treat erectile dysfunction (ED), benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).   PDE5is can have a profound effect on cardiovascular health and PDE5is mediate their benefits by inhibiting the breakdown of a molecule, cyclic GMP (cyclic 3′,5′ guanosine monophosphate).   Cyclic GMP (cGMP) is an intracellular and second messenger molecule that modulates many downstream pathways, including significant effects in vasorelaxation—the ability of your blood vessels to dilate and expand as needed.   The vascular effect that is enabled by PDE5i-induced vasodilation is a pivotal pathway in vascular homeostasis and a healthy heart-brain axis.   And that vasodilation effect is how PDE5is improve and treat ED.   There is a lot more to that vasodilation benefit mediated by PDE5i therapy  which I'll get to here soon.   So on to a brief description of the two recent studies on Viagra and Cialis, and so much more that was not included in those studies that will provide a crucial insight into how you can improve your vascular health and reduce your risk for LOAD.   NIH Studies First, a recent (2021)National Institutes of Health (NIH) funded study reported a risk reduction benefit of 69% for Alzheimer's disease (AD) in users of Viagra (Sildenafil).   The analysis simply compared Viagra users to those who did not take it, and the study was focused on a screen of drugs that could potentially be repurposed in the risk reduction for AD in aging individuals.   In a similar and second NIH funded study published this year (2022) titled— Drug Repurposing for Effective Alzheimer's Medicines—(DREAM), the NIH analyzed data from Medicare beneficiaries that were treated with Viagra and Cialis.   The NIH team compared people with pulmonary arterial hypertension (PAH) treated with Viagra and Cialis over those with PAH on another class of drugs (endothelin receptor antagonists) used to treat pulmonary hypertension.   And note that PAH is a term that refers to high blood pressure in the blood vessels leading from the heart to the lungs   Yes, PDE5is are also prescribed to patients to reduce blood pressure in PAH, and off-label use of PDE5 inhibitors (PDE5is) is used to treat cardiovascular diseases, Raynaud's disease and women with female sexual arousal disorder.   The average age of patients included in the DREAM study “was 74 years (range 65–96 years), and 69% were women.”   Notably, studies have shown that in women, "PDE5 inhibitor efficacy is estrogen dependent in female heart disease."   The DREAM PDE5i study rationale for focusing on patients with PAH and treated with PDE5is, Viagra or Cialis, for the new study analysis over those individuals on another class of antihypertensive drugs was attributed to the odds that the two groups were  "more likely to have people with similar characteristics".   In comparing those two pulmonary hypertension groups in the DREAM study the research team concluded that they "observed no evidence for a reduced risk of Alzheimer's disease and related dementia with phosphodiesterase-5 inhibitors"—Viagra or Cialis.   Bottom line, two differences in the design and outcomes as the Viagra study was favorable while the DREAM study was not. Fair enough.   However, there is much more to this story that was not included in the two studies, which includes an important benefit for heart and brain health that is only in part mediated by PDE5i therapy.   And we begin with nitric oxide— a vital molecule produced in your body and brain that not only impacts many potential benefits to your health, it can also be a component in deleterious oxidative stress reactions that are very damaging to your body and brain.   Nitric Oxide Nitric oxide (NO) was first discovered in 1772 but it was not until 1987 that it was identified as an important signaling molecule that played a vital role in endothelium-dependent vasodilation in mammals.   A few years later, in 1992, the journal Science nominated nitric oxide as the “Molecule of the Year” due to its role as a fundamental signaling agent in cardiovascular health and function.   In the body and brain, NO can be synthesized by two distinct pathways.   First, endogenous nitric oxide (NO) can be synthesized from the amino acid L. arginine (L-arginine-NO-synthase pathway) which is the initial upstream driver of cGMP activation in vasodilation.   Remember that we started this overview by emphasizing the role of PDEis in blocking the degradation of cGMP.   However, NO signaling is where cGMP activation begins.   Additionally, another amino acid—L. citrulline—is metabolized from arginine and can be utilized in regeneration of arginine.   Both amino acids are at the center of many studies which showcases their metabolism in vasodilation pathways.   Nitric oxide may be also be derived from the intake and metabolism of foods rich in nitrate (nitrate–nitrite–nitric oxide pathway).   Vegetables such as beets, celery, arugula and spinach, and fruits (e.g., strawberries) supply approximately 80%—85% of dietary nitrates in individuals that consume such foods regularly.   Indeed, those foods are not only a terrific source of nitrate, they also are rich in many types of polyphenols which are key nutrients in protecting against oxidative stress pathways associated with nitric oxide metabolism.   Many of you listening in or reading the transcript have likely become familiar with supplements using beets, or arginine and citrulline and other synergistic ingredients that have been heavily marketed to athletes as performance enhancers.   In a clinical setting, these NO enhancing products are often used for ED and cardiovascular health support.   Drugs (organic nitrates) are also well-known NO donors (e.g., nitroglycerin, amyl nitrite).   Thus, NO can be produced from the precursors L. arginine and L. citrulline, or nitrates and nitrites that are either derived from foods, supplements and drugs.   Another important understanding in all of this is that oral and gut bacteria convert dietary nitrate (NO3) to nitrite (NO2), and in the acidic stomach nitrite is further reduced to nitric oxide.   NB, antiseptic mouthwashes inhibit nitrate to nitrite metabolism by eradicating oral bacteria, and proton pump inhibitors (PPIs) and antacids suppress stomach acid and nitrite to NO metabolism.   To recap NO is an essential signaling and vasodilatory molecule secreted by vascular endothelial cells, which stimulates the production of cGMP (NO/cGMP Pathway) via activation of the receptor for cGMP— soluble guanylate (guanylyl) cyclase (sGC).   Another important point about NO in women is that estrogen (E2) increases NO synthesis.   Thus, the estrogen-NO dynamic is vital in vascular relaxation and endothelial-dependent vasodilation in women and should be included in any risk assessment for cardiometabolic and dementia risk in perimenopause or the earliest stage of menopause.   In contrast, cardiovascular disease (CVD) risk factors such as excess belly fat, high blood pressure, insulin resistance and type 2 diabetes, glycation and chronic inflammation (inflammageing) disrupts endothelial function, promotes arterial stiffness, and blunts the synthesis of NO.   Studies have shown that ED occurs in approximatelym35% to 75% of men with type 2 diabetes, and related studies have concluded that ED predicts future cardiovascular events.   Additionally, CVD risk factors upregulate the formation of an arginine metabolite—ADMA (asymmetric dimethylarginine)—that inhibits vascular NO production (eNOS uncoupling).   ADMA impairs vascular endothelial function and increases vascular oxidative stress (NO-ONOO cycle), and elevated ADMA has been linked to CVD in many studies. See image below.   A useful assessment in analyzing the underlying factors associated with cardiometabolic disease such as atherosclerosis is the serum arginine/ADMA ratio which provides information on arginine bioavailability for production of NO.   So, to summarize, the integrity of NO-sGC-cGMP Pathway is critical to signaling and vasodilation mechanisms that are essential to blood flow and vascular/endothelial homeostasis.   Healthy endothelial function and NO levels is critical in the normal function of many vital organ systems including the cardiovascular and cerebrovascular system (neurovascular system), and the respiratory and renal systems.   Indeed, a healthy endothelium is a fundamental cornerstone to living younger, longer.   For a more thorough overview of the neurovascular system, please listen in to episode #16 titled: “Brain Detoxification-Part 1-The Role of the Blood Brain Barrier and The Glymphatic System” here on this channel.   NO-PDE5i Brain Benefits But what about the role of PDE5is in all of this?   Is there a role for PDE5i therapy in preventing cognitive decline?   Would the PDE5i—sildenafil, or other PDE5 inhibitors, impart the same benefits on brain and cognitive health as healthy levels of NO does?   Previous studies have shown that low dose sildenafil activates signaling pathways which suppresses the processing and generation of beta-amyloid and tau protein aggregates.   Additionally, PDE5 inhibition mediated benefits include: induces cellular antioxidant levels, blunts neuroinflammation, and stimulates the production of new mitochondria (mitochondrial biogenesis) Now, is there a world where the combined therapy of NO and PDE5i therapy exists?   Only a handful of recent studies have shown that supplemental citrulline or arginine therapy in combination with a PDE5 inhibitors could be a synergistic and therapeutic alternative to PDE5i monotherapy for severe ED and pulmonary hypertension.   Overall, combination therapy was superior to monotherapies.   No such combination studies that investigated PDE5 inhibitors with citrulline or arginine therapy in the risk for late-onset Alzheimer's disease (LOAD) have been undertaken.   Bottom line, given the lack of research that includes the multiple pathways of NO metabolism and its role in endothelial function, the investigation into Viagra or any other PDE5i in the risk reduction for LOAD is grossly incomplete.   And that answers the unfinished Viagra and Cialis story as a viable treatment for cognitive impairment or Alzheimer's as the NIH studies on Viagra and Cialis just did not go deep enough into interrelated mechanisms that intersect with the PDE5 enzyme.   However, key nutrients, nutraceuticals and herbs are well-known NO precursors and PDE5 inhibitors, and they also protect against the upregulation of NO and the pro-inflammatory pathways and oxidative stress cascades associated with excess NO production.   Without a doubt, dietary, nutrient and botanical/herbal extracts are vital interventions in an optimal heart-brain health protocol.   More on that below after this brief overview on the glycocalyx.   The Glycocalyx (preview) I must add that any overview on NO in vascular and endothelial health is incomplete without an overview on the glycocalyx—a gel-like thin protective layer covering present on endothelial cells which maintains the endothelial barrier.   In fact, almost every cell in the human body, including bacteria, are covered by a glycocalyx layer.   And yes, the role of a glycocalyx layer in bacteria is another story.   The degradation of the endothelial glycocalyx layer in aging and cardiovascular disease significantly reduces endothelial cell production of NO, and collectively these interactions are a major and underlying factor in cardiovascular AND neurovascular disease.   I have been closely following the emerging research with regard to the glycocalyx over the past 5 years, and the evidence that you cannot have a healthy-heart-brain axis without a vibrant endothelial glycocalyx is compelling.   Case in point, the recent studies that have demonstrated the importance of the glycocalyx in vascular/endothelial health have established a new and critical insight into the treatment and potential reversal of atherosclerosis.   Nutrition-Diet (preview) A host of nutrients, nutraceuticals and herbs are well-known NO precursors and PDE5 inhibitors.   First, apart from arginine and citrulline, vitamin C, E and D are core nutrients in NO-mediated endothelium-dependent relaxation.   Recently, vitamin K2-MK-7 studies have also been linked to enhanced NO-dependent endothelial function.   Glutathione has been shown to be an essential and protective antioxidant in modulating NO reactivity and protecting against the damaging NO-ONOO cycle.   Glutathione and glutathione-based enzymes detoxifies peroxynitrite (ONOO)—a reactive nitrogen species, and improves nitric oxide bioavailability and endothelial function.   And, tetrahydrobiopterin (BH4) is a key enzymatic cofactor required for the synthesis of several neurochemicals—serotonin, dopamine and NO.   Additionally, polyphenols and in particular flavonoids, are the most the most frequently reviewed and studied phenolic NO precursors and PDE5 inhibitors, and they support the integrity of the glycocalyx structure and function.   So many nutrients  to make a case for including the phytoestrogenic benefits of many flavanoids, but here is an abbreviated list of the most cited plant/herbal derivatives and nutrients: Resveratrol Quercetin Catechins, epicatechin (e.g.,green tea) Pine bark (Pycnogenol®) and grape seed extracts (GPSE) Isoflavones (e.g. genistein) Hawthorne (Crataegus species) Icariin (Epimedium brevicornum) Aged garlic extracts Pomegranate extracts Gingko biloba Black ginger (kaempferia parviflora) Xanthones (Anaxagorea luzonensis) And, all the nitrate/flavanoid-rich foods including beets, spinach/leafy greens, and celery, pomegranate, berries, cherries, citrus, garlic, dark chocolate and many others.   Of course, a low-carbohydrate Mediterranean diet or Mind Diet lifestyle is rich in polyphenols and other heart and brain health nutrients.   In addition, exercise training and caloric restriction promotes NO activity and endothelium-dependent vasodilation through activation of eNOS.   Additional points covered in this episode's audio file…   NO Synthesis (preview) Now, I'll briefly describe how NO is synthesized as there are principal pathways that illustrate key and elemental features of NO metabolism—good and bad.   The NO-cGMP pathway is in part regulated by the activity of a family of enzymes—nitric oxide synthases that regulate nitric oxide (NO) synthesis.   There are three NOS enzyme synthases—neuronal (nNOS), endothelial (eNOS), and inducible (iNOS).   iNOS driven NO production is associated with immune system responses to various stimuli such as infections, and NO can either function as a regulator of such responses, or excessive production of NO by iNOS can upregulate those pathways in a destructive manner.   Nitric Oxide-S-nitrosylation (preview) I want to add another important feature of NO metabolism with regard to the risk for LOAD.   And that is the physiological and pathophysiological role of another NO reaction that takes place in the body and brain which is termed S-nitrosation, or S-nitrosylation.   I was not planning on adding this to this episode, but a recent research study just published reported that a S-nitrosylation pathway was a risk factor in Alzheimer's disease in women.   S- nitrosylation is the bonding of NO to sulfur compounds on amino acids such as cysteine.   In a recent study finding reported on just a few days ago—December 14, 2022, the elevated S-nitrosylation modification of an immune system protein known as complement component C3 (SNO C3) was present at much higher (six-fold) levels in the brains of women who had died of Alzheimer's, compared to men who had died with the disease.   The postmortem brain research that was conducted at Scripps Research and Massachusetts Institute of Technology (MIT) also reported that declines in estrogen, which normally serves as a neuroprotective hormone, was likely a strong factor in the generation of the SNO-C3 form of complement C3.   Cured Meats (preview) Another key factor to weigh into this overview with regard to diet, nitrates, nitrites and NO, are cured meats.   In fact, some of you may be anticipating this section of the  overview by now as there is considerable concern and media dissemination of the potentially deleterious role of nitrates and nitrites used in various types of processed meat products such as bacon, sausages and other “deli meats”.   In fact, many studies have explored the risk of nitrate and nitrite added to various foods as their metabolism under certain conditions can potentially convert into a toxic nitrosamines (N-nitroso compounds)   That's it for this summary and as always, thank you for listening in or taking the time to read the summary . Please do listen in to hear the rest of the story. God bless and goodbye.   BrainDefend® Ralph Sanchez, MTCM, CNS, D.Hom. https://www.TheAlzheimersSolution.com   https://www.facebook.com/TheAlzheimersSolution/ https://www.linkedin.com/in/ralph-sanchez/ https://www.instagram.com/alzheimers_solution/ https://twitter.com/RalphSanchez        

Dr. Cameron Sepah of Maximus is back with yet another must-listen episode on the PricePlow Podcast! In Episode #062, we introduced Dr. Cam and spoke with him about the Maximus King Protocol, a better and safer way to boost testosterone with clinically significant results. This time, we talk about libido, sexual health, and optimizing male performance and mindset. Maximus is a consumer telemedicine company for male health and hormone optimization. It comes with a highly-active community known as the Maximus Tribe, featuring men who are working to better themselves in all aspects of life. With the Maximus Lover Protocol, they're focusing on boosting libido, male performance, and confidence using two prescription drugs described below – 5mg tadalafil (Cialis) and 2mg PT-141 (Bremelanotide). Beyond the drugs, Dr. Cam also covers many strategies to improve libido, which is a great indicator for overall health. The detailed show notes (with references) below, and you can watch it on YouTube or listen to it on your favorite podcast app: https://www.youtube.com/watch?v=-Imyeo3kGP4 Discussion #2 with Dr. Cameron Sepah of Maximus: Libido, Men's Health, Sex, and More (0:00) – Quick re-introduction (1:30) – Recap of Episode 062 (2:30) – Morning erections and libido – a very simple marker of overall health (3:40) – Anecdote of libido issues and ED drug sales (6:00) – Cosmetic pharmacology (8:00) – ED (erectile dysfunction) drugs and nitrate supplements (8:45) – Morning wood as a good status check? (13:00) – Libido is bio-psycho-social (15:00) – Warming up to The Maximus Lover Protocol (16:15) – Medications are not for any one particular purpose (16:45) – PDE5 Inhibitors (18:45) – Cialis vs Viagra (tadalafil vs sildenafil) (20:30) – Using tadalafil in the real world (22:00) – Side effects of PDE5 inhibitors (23:00) – Tadalafil dosage (25:15) – Interaction effects and pre-workouts (29:00) – Spiking NO supplements with PDE5 inhibitors?! (30:30) – Can you get a tadalafil prescription for gym pumps? (34:30) – Tadalafil post-surgery for blood flow (36:30) – Tadalafil and PDE5 Inhibitors as nootropics (39:30) – Caffeine vs. PDE5 inhibitors for focus and creativity (41:30) – Muscle protein synthesis and PDE5 inhibitors (42:30) – Is tadalafil the most important anti-aging drug? (43:30) – The Maximus Lover Protocol (44:30) – The background of sexual drugs for women and melanocortin agonists (46:45) – Introducing PT-141 (Bremelanotide) (48:00) – Combining PT-141 with PDE5 Inhibitors (48:45) – PT-141 / Bremelanotide / Vyleesi for women (50:00) – The Maximus Lover Protocol: Performance and enjoyment (51:00) – Melanotan-1 and Melanotan-2 vs. Bremelanotide (53:45) – Bremelanotide side effects? (57:00) – Bremelanotide taken sublingually with Maximus (58:45) – Healthy libido is important for successful men (1:01:00) – Channel libido instead of masturbate (1:02:30) – How do you get the Lover Protocol? (1:04:45) – Bremelanotide half-life? (1:07:... Read more on the PricePlow Blog

Dr. Cameron Sepah of Maximus is back with yet another must-listen episode on the PricePlow Podcast! Dr. Cameron Sepah is back on the PricePlow Podcast to introduce The Maximus Lover Protocol In Episode #062, we introduced Dr. Cam and spoke with him about the Maximus King Protocol, a better and safer way to boost testosterone with clinically significant results. This time, we talk about libido, sexual health, and optimizing male performance and mindset. Maximus is a consumer telemedicine company for male health and hormone optimization. It comes with a highly-active community known as the Maximus Tribe, featuring men who are working to better themselves in all aspects of life. With the Maximus Lover Protocol, they're focusing on boosting libido, male performance, and confidence using two prescription drugs described below - 5mg tadalafil (Cialis) and 2mg PT-141 (Bremelanotide). Beyond the drugs, Dr. Cam also covers many strategies to improve libido, which is a great indicator for overall health. The detailed show notes (with references) below, and you can watch it on YouTube or listen to it on your favorite podcast app: https://www.youtube.com/watch?v=-Imyeo3kGP4 Audio Version: Subscribe to the PricePlow Podcast on Your Favorite Service iTunesSpotify Google PodcastsSoundCloud Discussion #2 with Dr. Cameron Sepah of Maximus: Libido, Men's Health, Sex, and More Table of Contents Audio Version:Subscribe to the PricePlow Podcast on Your Favorite ServiceDiscussion #2 with Dr. Cameron Sepah of Maximus: Libido, Men's Health, Sex, and More0:00 – Quick re-introduction1:30 – Recap of Episode 0622:30 – Morning erections and libido – a very simple marker of overall health3:40 – Anecdote of libido issues and ED drug sales6:00 – Cosmetic pharmacology8:00 – ED (erectile dysfunction) drugs and nitrate supplements8:45 – Morning wood as a good status check?13:00 – Libido is bio-psycho-social15:00 – Warming up to The Maximus Lover Protocol16:15 – Medications are not for any one particular purpose16:45 – PDE5 Inhibitors18:45 – Cialis vs Viagra (tadalafil vs sildenafil)20:30 – Using tadalafil in the real world22:00 – Side effects of PDE5 inhibitors23:00 – Tadalafil dosage25:15 – Interaction effects and pre-workouts29:00 – Spiking NO supplements with PDE5 inhibitors?!30:30 – Can you get a tadalafil prescription for gym pumps?34:30 – Tadalafil post-surgery for blood flow36:30 – Tadalafil and PDE5 Inhibitors as nootropics39:30 – Caffeine vs. PDE5 inhibitors for focus and creativity41:30 – Muscle protein synthesis and PDE5 inhibitors42:30 – Is tadalafil the most important anti-aging drug?43:30 – The Maximus Lover Protocol44:30 – The background of sexual drugs for women and melanocortin agonists46:45 – Introducing PT-141 (Bremelanotide)48:00 – Combining PT-141 with PDE5 Inhibitors48:45 – PT-141 / Bremelanotide / Vyleesi for women50:00 – The Maximus Lover Protocol: Performance and enjoyment51:00 – Melanotan-1 and Melanotan-2 vs. Bremelanotide53:45 – Bremelanotide side effects?57:00 – Bremelanotide taken sublingually with Maximus58:45 – Healthy libido is important for successful men1:01:00 – Channel libido instead of masturbate1:02:30 – How do you get the Lover Protocol?1:04:45 – Bremelanotide half-life?1:07:30 – Enclomiphene vs. PT-141 for Virility Purposes?1:09:15 – The Maximus Supplements1:11:15 – Metabolic health is still key1:11:45 – Semen retention?!1:15:00 – Maximus is not a pill mill1:19:45 – Check your underwear! Is there polyester? Get rid of it!1:23:00 – “Give your balls a break”1:24:45 – What states is Maximus and its partner pharmacy now working in? 0:00 - Quick re-introduction If you don't know who Dr. Cam is, then you must listen to Episode #062 where he introduces Maximus and the King Protocol, which includes the drug enclomiphene! 1:30 - Recap of Episode 062 In the last episode, Dr. Sepah noted that testosterone is one of the most useful single biomarkers of overall health.

Evolutionary radio presents another exciting podcast. Host Stevesmi is joined by co-host Rick . Original content geared, no pun intended, to help you get the most of your workouts. 1. metforming a good bodybuilder drug? 2. coming off cycle training change 3. CNS, what is it and what it means 4. best 5 supps for steroids 5. soreness and workouts 6. offseason changes in my AI use https://www.evolutionary.org/forums/anabolic-steroids-peds/do-you-need-ai-just-dbol-83220.html

  https://www.globalresearch.ca/video-dr-sucharit-bhakdi-these-vaccines-are-killing-the-young-and-the-old-they-are-killing-our-children/5765866 Natural Herbal HPV "Cure" Discovered Chittaranjan National Cancer Institute (India), January 5, 2022 Despite the widespread belief that HPV infection is a singularly lethal force against which we only have vaccination defend ourselves, both ancient herbal medicine and our body's inherent immune defenses have newly been confirmed to have significant power against it. A groundbreaking study published in the Asian Pacific Journal of Cancer Prevention reveals that vaccination and watchful waiting are not the only recourse against HPV infection. The study is believed to be the first of its kind to find an effective and safe therapeutic intervention for the clearance of established cervical human papillomavirus (HPV) infection. Moreover, the study confirmed that HPV infection is self-limiting and clears on its own in 73.3% of the untreated placebo group within 37 days. (NEXT) Proper exercise can reverse damage from heart aging University of Texas Southwestern Medical Center, January 8, 2022 Exercise can reverse damage to sedentary, aging hearts and help prevent risk of future heart failure - if it's enough exercise, and if it's begun in time, according to a new study by cardiologists at UT Southwestern and Texas Health Resources. To reap the most benefit, the exercise regimen should begin by late middle age (before age 65), when the heart apparently retains some plasticity and ability to remodel itself. And the exercise needs to be performed four to five times a week. Two to three times a week was not enough, the researchers found in an earlier study. (NEXT) Aspartame Is Linked To Leukemia And Lymphoma In New Landmark Study On Humans Natural Health Federation, December 28, 2021 As few as one diet soda daily may increase the risk for leukemia in men and women, and for multiple myeloma and non-Hodgkin lymphoma in men, according to new results from the longest-ever running study on aspartame as a carcinogen in humans. Importantly, this is the most comprehensive, long-term study ever completed on this topic, so it holds more weight than other past studies which appeared to show no risk. And disturbingly, it may also open the door for further similar findings on other cancers in future studies. (NEXT) Rhodiola defeats chronic fatigue in just one week Uppsala University (Sweden),  January 5, 2022 The ancient Vikings reportedly utilized it for its refreshing powers. The Sherpa mountain people relied on it to help them scale the heights of Mount Everest. Rhodiola rosea, an herb grown in Arctic areas of Asia and Eastern Europe, is relatively little known in modern times – but, it probably should be. Recent scientific studies have consistently shown that rhodiola causes significant improvement in fatigue symptoms – and starts working in less than a week. (NEXT) Trial affirms arginine benefit in erectile dysfunction Università Federico II di Napoli (Italy), January 3 2022. A trial reported  in the Journal of Endocrinological Investigation added evidence to a benefit for supplementation with the amino acid L-arginine among men with erectile dysfunction (ED). The findings suggest that L-arginine could serve as an alternative to PDE5 inhibitor drugs used to treat ED which are not always effective or can be associated with side effects. Fifty-one men received two grams L-arginine three times per day and 47 received a placebo for three months. (NEXT) Using smells to boost learning during sleep The authors confirm that the strategic use of aromas while learning and during sleep might improve exam performance — even outside of the laboratory University of Freiburg (Germany), December 24, 2021 In a nutshell, the recent study concludes that if we smell an aroma while we take on new knowledge and then sleep next to a source of that same odor, we will find it easier to recall the information at a later date. To investigate, the scientists recruited 54 students from sixth grade classes in Germany. They asked these participants to keep rose scented sticks next to them while they learned English vocabulary at home. A week after the students first encountered the vocabulary during a school class, they sat an exam. The scientists split half of the students into four experimental groups: Group 1: No exposure to any odor cues. Group 2: Exposure to rose scent while learning at home and during the vocabulary test. Group 3: Exposure to rose scent while learning at home and during each night before the test but not during the test. Group 4: Exposure to rose scent while learning at home, every night before the test, and during the test. (NEXT) (ARTICLE) Woke Culture's Reality Deficit Disorder Richard Gale & Gary Null PhD Progressive Radio Network, January 7, 2022 If anti-racial wokeness is true, then the more deeply we probe and investigate it, the truer it should appear. This was one of William James' fundamental principles when he made efforts to turn the psychology of his day into a valid science. If James' methodology had not been obliterated by the rise of behaviorism in 1910, psychology would be completely different today. We might actually be treating and curing people of mental disorders without prescribing life-long medications. On the other hand, if DiAngelo's hypothesis is false, the more deeply one investigates, which includes introspection, the more false it will appear. That is where robust inquiry comes in: to determine what is simply true regardless of whatever your personal unsubstantiated and biased beliefs about it might be. What you believe has absolutely no impact upon whether something is true or not. This is also basic Buddhist epistemology that has been repeatedly replicated by contemplatives for several millennia. Neuroscience, including its gross failures and tendencies towards metaphysical realism, has more to tell us about the inherent dangers in White Fragility's doctrine. First, modern brain science has not produced an iota of evidence to confirm that the mind and consciousness are solely a product or output originating in neuron and synaptic activity. None. Contrary to the evidence, most neuroscientists and evolutionary biologists nevertheless embrace this opinion as a settled matter. But it is ridiculous to believe that evolution somehow dragged along our ancient single-celled ancestors until some point was reached when a conscious mind -- a “nothing” that is not observable, not measurable, not quantifiable, without atoms or photons, mass, electric charge or spin – mysteriously arose out of something, such as genes and biomolecular phenomena. Therefore cognitive scientists pretend to know something about the mind and consciousness when in fact they haven't a clue. Although DiAngelo is not stating that socialized racism among Whites is genetically determined, the trajectory of her argument has the potential to lead towards that conclusion. She does consider systemic White racism as being unconscious. Therefore she has moved her social theory into psychology. Since modern psychology today is becoming increasingly informed by the neurosciences, which in turn is being informed by evolutionary biology, it is only a small leap away to find her theory complementing genetic determinism as a means to explain Whiteness' conditioned racism. If her socialized determinism, and that of the neuroscience and evolutionary biology fields, are correct, then it would break the fundamental physical laws of energy conservation and causal efficacy. In effect, DiAngelo is saying White people have no choice. It's socialized chemistry or its socialized chemistry; either way its socialized chemistry.  In effect, DiAngelo is admitting that her own perceptions about reality are fundamentally flawed. Why is that? Dr. Donald Hoffman has been a professor of neuroscience at the University of California at Irvine for over three decades. He has an impeccable background having studied artificial intelligence at MIT. But unlike the vast majority of his colleagues, Hoffman broke ranks and passed beyond neuroscience's 19th century mechanistic base and dared to study modern quantum physics and relativity theory. Theoretical physics is almost anathema in human biological research and medicine, which is why these soft sciences have made so little progress to improve human health and well-being. Hoffman has performed hundreds of thousands of simulations comparing different species and their chances for survival based upon their ability to perceive and comprehend reality more accurately or not. His discoveries are startling and utterly revolutionary. Hoffman discovered, across the board, species that best perceive reality go extinct more rapidly than competing species that only perceive what is necessary for them to remain fit and survive. During an interview following a TED Talk, Hoffman stated, “according to evolution by natural selection,” – and here he is limiting himself solely to evolutionary biological theory and not the various competing theories about the nature of consciousness – “an organism that sees reality as it is will never be more fit than an organism of equal complexity that sees none of reality but is just tuned to fitness. Never.” In other words, evolution has nothing to do with perceiving reality more clearly, but only to be more fit in order to adapt, survive and procreate. And now physicists are even telling us that the primal cause behind all physical objects may be consciousness itself, which has no association whatsoever with natural selection. For example, Professor Edward Witten, regarded as “the world's smartest” physicist at the Institute for Advanced Studies at Princeton, has been compared to Newton and Einstein. Witten doesn't believe science will ever understand consciousness. “I think consciousness will remain a mystery,” Witten stated during a lecture, ”I have a much easier time imagining how we understand the Big Bang than I have imagining how we can understand consciousness.” Or we can listen to Stanford University theoretical physicist Andre Linde: “The current scientific model of the material world obeying laws of physics has been so successful that we forget our starting point as conscious observers, and conclude that matter is the only reality and that perceptions are only helpful for describing it. But in fact, we are substituting the reality of our experience of the universe with a conceptually contrived belief…” One may feel our critique is too abstract with little or no practical application; however to at least conceptually understand race in terms of our sensory perceptions can have enormous benefits to cut through and lessen the false semblances that arise from reality deficit disorder that winds up producing books such as White Fragility. Moreover, contrary to DiAngelo's arguments, British journalist Melanie Phillips offers a clearer understanding for why we should not rely upon the pundits of anti-racial wokeness to save us from ourselves. Despite disagreeing with Phillips on many of her other socio-political positions, she correctly identifies the fundamental flaws being voiced by arrested development wokeness across our campuses and within the corporate wing of the Democrat party. First, it is unable to establish a hierarchy of values and morals. For example, if one refuses to say that any lifestyle or culture is better than another, then it cannot be said that liberalism is better than conservatism or any other ideology.  Consequently, faux liberalism cannot legitimately defend the very principles upon which it defines itself: racial and gender equality, freedom of speech and religion, justice and tolerance, and class struggle.  It contradicts its own principles and follows DiAngelo's footsteps to remove the dignity of the individual, which in the past was at the heart of authentic liberalism and once served as its moral backbone. What we are witnessing therefore in Woke liberalism – and in DiAngelo's reinvention of racism -- is “the strong dominating the weak,” and this is an ill-liberal ideology that is already showing signs of having catastrophic consequences in classrooms and the workplace. Finally, if DiAngelo's theory is correct, then all Whites, without exception, in American history, were unconsciously transmuted into racists starting at the time of their birth. What is her proof? Is there any scientific evidence to support this outrageous claim? Did she consider the lack of sensitivity towards other peoples and races who were victims of racial identity and violence, such as the Jews who experienced genocide at hands of their Nazi overlords? And what would she say against those Whites who have fought against racism throughout the American experience, such as the Abolitionists in the US and UK who put their bodies at great risk?  In principle she is labeling them too as racist despite their fighting, protesting and even dying as committed anti-racists. Many Whites have embraced other races and cultures with open arms; however, DiAngelo wants us to believe this legacy was a sham, because in some strange voodoo way they were unconsciously racist. Is this not the height of hubris and arrogance?

Mohit Khera, MD, MBA, MPH, joins the Erectile Dysfunction Radio Podcast to discuss the use of PDE5 inhibitors for treating erectile dysfunction this week. PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are often prescribed to treat erectile dysfunction. Dr. Khera is a board-certified urologist. He serves as Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine in Houston. He specializes in the treatment of male infertility, sexual dysfunction, and declining testosterone levels in men as they age. The Erectile Dysfunction Radio Podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST. Learn to think differently about erections to resolve your ED struggles with our "Beyond the Little Blue Pill" eCourse: https://erectioniq.com/course     For more free erectile dysfunction education and resources, visit: https://erectioniq.com/    

In this episode, Dr. Cam interviews Dr. Wayne Hellstrom who is a Medical Advisor at Maximus. Dr. Hellstrom is also a Professor of Urology and the Chief of Andrology at Tulane School of Medicine. He is the leader in men's sexual health, performance and science. His practice is specialized in the diagnosis and treatment of sexual dysfunction including Peyronie's disease, surgical and vascular reconstruction, prosthetic surgery, male infertility (both surgical and medical therapies), BPH, and urethral stricture disease. Chapters 00:00 Intro 02:00 How Dr. Hellstrom got involved in Urology and Andrology 03:25 How Andrology and men's health has evolved over the last 40 years 07:00 Why Dr. Hellstrom decided to become a medical advisor for Maximus 10:00 Dr. Hellstrom's medical practice in men's sexual health & performance 12:10 The evolution of ED pills and treatment 14:25 Why younger men might be using ED pills 16:20 Breakdown of all ED pills available 21:50 Other uses for PDE5 inhibitors 24:10 New medications to improve sexual health and performance 26:10 Dopamine agonists and can they enhance sexual performance 28:00 Why are more men having problems with premature ejaculation 29:10 Options men have today for premature ejaculation 31:30 Average length of sexual performance for men 35:25 Physical causes of ED 38:10 The risks of numbing creams for sexual performance 40:10 New drug research for premature ejaculation and ED 41:40 Johnson & Johnson's "squeeze technique" to increase performance 42:40 SSRI's and their sexual side effects 44:40 Causes and Treatments for men with problems orgasming 47:00 Pornography and it's psychological effects on sexual performance 49:10 Hormones, Libido and why Testosterone is so important 55:10 Why Testosterone was incorrectly correlated with heart problems 01:01:40 Why Enclomiphene is used at Maximus and not TRT 01:08:50 What is DHT and why Finasteride has sexual side effects 01:14:10 Why DHT might affect younger men's drive and virility 01:16:10 What is in the future for Hormone Optimization 01:18:10 Outro

Sex therapist Cate Campbell and her son Diggory Waite invite Angus Barge onto the podcast to talk about his struggles with erectile difficulties. Angus tells the story about how it was opening up to his cousin on a long car journey that was the first step to dealing with his issue, what remedies were suggested online (from thrashing your penis with nettles to using PDE5 inhibitors like Viagra) and why he set up Mojo, an online resource to help men tackle ED.Later in the episode, Cate answers listener's questions like 'are more men are struggling to orgasm recently?' and how to stop crying after sex as well as finding time to have a dig at Coldplay.Make sure you send in your sex or relationship questions to our accredited therapist Cate who will answer them on the pod! You can email them to podcasts@hattrick.com or by DMing us on Instagram - @realsexedpodYou can find out more about Angus Barge and Mojo on https://mojo.so/You can find Cate's blog, going into more detail on what was discussed in today's episode, here: https://catecampbell.wordpress.com/The Real Sex Education is a Hat Trick PodcastReading List: The New Male Sexuality By Bernie Zilbergeld5 natural ways to overcome erectile dysfunction - Harvard Health - https://www.health.harvard.edu/mens-health/5-natural-ways-to-overcome-erectile-dysfunction Watching List:Do YOU have Erectile Dysfunction ? | Why it Happens and How to Fix it - https://www.youtube.com/watch?v=kZRYER3xyr8&ab_channel=JHPMedicalUK Support & Resources:https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/The New Male Sexuality By Bernie Zilbergeld See acast.com/privacy for privacy and opt-out information.

This week's episode features special Guest Host Mercedes Carnethon, as she interviews author Sung-Min Cho and Associate Editor Marc Ruel as they discuss the article "Cerebrovascular Events in Patients with Centrifugal-Flow Left Ventricular Assist Devices: A Propensity Score Matched Analysis from the Intermacs Registry." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature, we're going to look at centrifugal flow, left ventricular assist devices and cerebrovascular events. But before we get to the feature, how about we grab a cup of coffee and jump into some of the other articles in the issue? And maybe how about I go first? Dr. Carolyn Lam: All right. I got my coffee. Dr. Greg Hundley: So my first paper comes from Professor Dali Luo from Capital Medical University. And it's pertaining to calsequestrin-1. So calsequestrin-1, and calsequestrin-2 isoforms buffer calcium and regulate its release from the sarcoplasmic reticulum of skeletal and cardiac muscle. Human inherited diseases associated with mutations of calsequestrin-1 or 2 include malignant hyperthermia and environmental heat stroke and catecholamingergic polymorphic ventricular tachycardia. However, patients with hypothermia, environmental heat stroke events often suffer from an arrhythmia for which the underlying mechanism remains unknown. Dr. Carolyn Lam: Wow. Okay. And what did the current paper do and find? Dr. Greg Hundley: Great, Carolyn. So what the authors found, calsequestrin-1, the skeletal isoform of it is indeed expressed in cardiomyocyte sarcoplasmic reticulum for mirroring in human hearts, mostly presenting as a polymeric form and interacting with the ryanodine 2 receptor in ventricles. Second, calsequestrin-1 deficiency cause sinus tachycardia in basal conditions. And this is a novel finding which may be associated with sinus beat regulation and ventricular arrhythmia as an independent arrhythmogenesis if a high concentration of volatile anesthetics are used. Next, these volatile anesthetics and heating to 41 degrees C can directly induce calsequestrin-1 oligomerization, thereby causing enhancement of diastolic calcium leak and premature calcium transience through a reduced regulatory effect of calsequestrin-1 on ryanodine 2 activity. And so Carolyn, this novel mechanism underlying the arrhythmia occurring in patients with malignant hypothermia or environmental heatstroke episodes may provide different strategies for heart disorders as an independent profile in these syndromes. And finally, the finding of calsequestrin-1 confirmational change induced by triggers in those with malignant hyperthermia and environmental heatstroke could lead to novel therapeutic approaches to prevent these types of episodes. And that may also very, very useful in treatment of heatstroke.   Dr. Carolyn Lam: Wow. Thanks Greg. Well, moving from this preclinical world to a very common clinical question of the diagnosis of acute myocardial infarction. Now we know that in patients presenting to the emergency department with symptoms suggestive of an MI, the European Society of Cardiology zero and one hour algorithm is recommended by current ESC NSTEMI guidelines with a class one recommendation. Now, what this does is it combines a very high safety for early rule-out and high accuracy for rule-in allowing a definite triage of about 70 to 75% of patients using the zero in one hour sample. Dr. Carolyn Lam: However, what is the most appropriate management of the 25 to 30% of patients who remain in the gray observed zone? So this is the question that the current paper addresses. Now to answer this, we also need some more background that a single center pilot study previously of patients in the observed zone had derived a cutoff of seven nanograms per liter for a zero and three hour high sensitivity cardiac troponin T change to identify patients also eligible for early rule-out or rule-in of NSTEMI. So the current study that we're talking about in today's issue from Dr. Christian Mueller from Cardiovascular Research Institute in Basil, Switzerland, and colleagues, really aimed to externally validate that previously proposed seven nanogram per liter change cutoff, and if necessary derive and internally as well as externally validate some new criteria for these patients in the observed zone of the ESC zero in one hour algorithm. Dr. Greg Hundley: Wow, Carolyn, so we're learning a lot about cutoff values and also algorithms here with high sensitivity cardiac troponin T. So what did they find here? Very interested to hear. Dr. Carolyn Lam: So in two large prospective multicenter diagnostic studies, they found that the proposed zero and three hour high sensitivity cardiac troponin T change of seven nanogram criteria, unfortunately provided suboptimal safety for ruling out NSTEMI in patients remaining in the observed zone of the ESC zero and one hour algorithm. So this had a sensitivity of only 33% and missed 80 patients with NSTEMI. So they derived their own novel criteria based on zero and three hour samples. And these novel criteria combined a three hour high sensitivity cardiac troponin T concentration of less than 15 nanograms per liter and a zero and three hour absolute change cutoff of four nanograms per liter. Dr. Carolyn Lam: And that combination provided a high safety for ruling out NSTEMI in these patients in the observed zone and with a sensitivity of 99% missing only one patient with NSTEMI. Another further thing they found was at a zero and three hour cardiac troponin T absolute change of greater or equal to six nanograms per liter triage, 63 patients, or 11% towards rule-in thus resulting in a specificity of 98%. So in summary, this novel criteria based on zero and three hour sample seemed to balance safety and efficacy well for the further decision making in patients who are remaining in the observed zone after the zero and one hour cardiac troponin T algorithm. Internal validation of these novel criteria and external validation in an independent international cohort showed robustness of performance metrics and further strengthen its possible clinical use.   Dr. Greg Hundley: Very nice, Carolyn. Lots of data there, and hopefully very important clarification on both the zones as well as the cutoff values for using cardiac troponin T. Well, Carolyn, my next paper again comes from the preclinical science world and it's from Dr. Anne Eichmann at Yale University School of Medicine, and it pertains to activin receptor-like kinase 1. And we're going to call that ALK1.   Dr. Greg Hundley: Kinase 1 and we're going to call that ALK1. And it's an endothelial transmenbrane serine threonine kinase receptor for BMP family ligands that plays a critical role in cardiovascular development and pathology. And loss of function mutations of the ALK1 gene cause type 2 hereditary hemorrhagic telangiectasias, a devastating disorder that leads to arteriovenous malformations. Dr. Carolyn Lam: Oh, okay. And what did the authors find? Dr. Greg Hundley: Dr. Carolyn Lam, ALK1 mutants displayed defective polarization against the direction of blood flow in capillary and venous endothelium as well as increased integran VEGF receptor 2 mediated P13K activation of YAP/TAZ signaling. Dr Carolyn Lam: Okay, Greg, that was super summarized but what are the clinical implications? Dr. Greg Hundley: Carolyn, pharmacological integrin inhibition using cilengitide or ATN-161, or YAP/TAZ inhibition using verteporfin, prevented AVM malformation in ALK1 mutant mice. And therefore for this study, the authors revealed that integrin and YAP/TAZ were novel affectors of ALK1 signaling in AVM pathogenesis that might be targeted for AVM treatment in patients with hemorrhagic telangiectasias. Dr. Carolyn Lam: Thank you, Greg. Well, let's review what else is in today's issue. There's an exchange of letters between Doctors Amadio and Valentine on cell-free DNA to detect heart allograph acute rejection. There's an AHA Update paper by Dr. Churchwell on preemption, a threat to building healthy, equitable communities. There's a Research Letter by Dr. Merkler on the association between cervical artery dissection and aortic dissection. Dr. Greg Hundley: And Carolyn, I've got a paper from Professor Daniels regarding the Clinical Implications of Basic Research getting inside the engine, the myosin modulation of hypertrophic cardiomyopathy and systolic heart failure. And then finally, there's an In Depth piece from Dr. Viskin entitled, “Polymorphic Ventricular Tachycardia: The Terminology, mechanism, diagnosis and Emergency Therapy.”   Dr. Carolyn Lam: Nice. Well, let's go on to our feature discussion. Can't wait. Dr. Greg Hundley: You bet.   Dr. Mercedes Carnethon: Welcome to this episode of Circulation on the Run, our podcast where we have an opportunity to talk with the authors of some of the top articles within our journal for a given week. And we've chosen today to focus on a set of articles, one of which is led by Dr. Sung-Min Cho from the Johns Hopkins University. And I'm really excited to have you with us today, Dr. Cho and joining us as well as the associate editor, Dr. Marc Ruel who handled the paper. And my name is Mercedes Carnethon from the Northwestern University's Feinberg School of Medicine. I guess without further ado, welcome to you both and we'll just jump right into it. Dr. Mercedes Carnethon: Dr. Cho, I'd love to hear a little bit more about your paper today. What made you choose to pursue this particular topic and what really inspired you? Dr. Sung-Min Cho: Thank you so much for the invitation and opportunity to talk today. During my training as a neuro person, I'm a neurointensivist by training and neurologist. I noticed that we are getting a lot of consults for LVAD associated strokes. When I took a closer look at the ENDURANCE trial, very showed really 29.7% stroke rate at two years and a few years later, we had this MOMENTUM 3 trial, which showed HeartMate 3 device had 10% stroke rate at two years. And we realized that a stroke is a major issue in this population and I wanted to study the incidence respecters and outcome of this strokes in LVAD population. However, despite the many observational studies in the past, we were really interested in looking at device specific stroke risk for current continuous flow LVADs and we wanted to look at the device specific risk and prevalence of these patients balancing co-morbidities each cohort. And that's why we conducted this study. Dr. Mercedes Carnethon: Great, well Sung-Min, it's not often that as an epidemiologist and cardiovascular epidemiologist that I actually get to talk with neurointensivists and get their insights on the importance of their work. Can you tell me a little bit about what you found and whether it surprised you? Dr. Sung-Min Cho: Population, we used the Intermacs registry database. This is well established database as all cardiologists and cardiothoracic surgeons know, and we defined a neurologic adverse event as stroke plus TIA, transient ischemic attack. We used a propensity score matching analysis to assess the association of HVAD with stroke risk, to balance for pre-implant risk factors. And basically after performing propensity score matching, we found that hazard of stroke was higher for patients with HVAD device compared to HeartMate 3. We kind of expected this based on the randomized control trials in the past but there was no head to head comparison between these two cohorts. This study really confirmed our suspicion that HeartMate 3 actually had lower hazard of a stroke compared to HeartMate 3. Dr. Mercedes Carnethon: Well, thank you so much. It's a really great explanation. And for those who haven't had a chance to dig into the issue yet, I really encourage you to read the piece. I found it to be very instructive. And I'm interested as well, Mark in your take about what excited you about this piece. Dr. Marc Ruel: Well, thank you very much Mercedes and Sung-Min it's really a pleasure to have you with us today. As you know, this has been a very impactful paper and you were very kind to share with us the study around your idea as to why you wanted to evaluate this question but even more than your idea and what led to the completion of the paper are the implications of your paper. And I think it would be great if you shared with us a little bit, what has been the path that your paper has led to and including amongst others, very likely a decision by the Medtronic to pull the HVAD out of market. It's interesting that your data, to my knowledge, correct me if I'm wrong, were presented first at the annual meeting of the Society of Thoracic Surgeons in January, 2021. And again, I want to reiterate that Circulation's very thankful that you chose to send your paper to our journal and we feel that it will give it full justice, like many other journals of would have had but we're really excited to have received your paper and give it the fullest consideration. Dr. Marc Ruel: Can you tell us a little bit about the implications and for lack of a better word, the storm that your paper has created in the field and your take on it? Dr. Sung-Min Cho: Right. That's a great question. Thank you for that. Like I said, as a neurologist, we see these patients after complication, patients having stroke and then we see these patients and we always wanted, cardiologists and cardiothoracic surgeons and neurologists, we always wondered which device carried more risk for stroke and TIA. And really our group actually worked on many papers in the past looking at single institutional data and also systematic review meta-analysis looking at this topic, but really HeartMate 3 came along a couple years ago, more recent device so we didn't have a lot of data. Dr. Sung-Min Cho: So intermex registry really helped since we didn't have a lot of data. So, INTERMACS Registry really provided opportunity for us to look at this specific question, really balancing those two chords to look at the risk of stroke in this HeartMate 3 and HVAD. And when we did that two years ago, we submitted a proposal to INTERMACS, and Dr. Kirklin from UAB, he really helped us to look at this data closely with his statistical team. And we had really a thorough statistical method to perform a propensity matching analysis. And we finally finished the analysis and presented in annual STS meeting in January, and it did really trigger a lot of attention to a lot of academic institutions and people who are practicing LVAD, and after that, when we finally submitted this paper to Circulation, we had to have a lot of discussion in between FDA and the Medtronic and discussing this implication of this paper. When it was finally published in Circulation, we are happy that there's a lot of attention and we made it through. Dr. Marc Ruel: Well, thank you, Dr. Cho, and maybe for the listener of this podcast, I would like to reiterate some of the salient points of your paper essentially, and correct me if I'm wrong, over 6,200 patients were included, about roughly 3,000 patients per group comparing the HeartMate 3 versus the HVAD. Dr. Marc Ruel: Now, as you alluded to the HVAD is the more ancient device, if you will. So there's a slightly longer follow-up, around 12 months on median, versus nine months with the HeartMate 3. And there's adjustment that has been made for this. And I think to me, really the key finding is that in the early acute phase around implantation, there is no real difference with regards to the risk adjusted incidents of neuro adverse events. However, once you pass the early implantation acute phase, in the chronic stable phase, there starts being really a signal that is detrimental to the performance of the HVAD versus the HeartMate 3. And I think your hazard ratio, correct me if I'm wrong, it's around 5.7 for neuro adverse events. Dr. Marc Ruel: So this is a very compelling hazard ratio, even coming out of an observational study with all the careful attention that you provided to adjust for residual confounding, et cetera. Dr. Marc Ruel: So obviously this is a very strong finding, but I would like you to perhaps comment on this, the patients are not the same. There's some indication that the HVAD patients may have been a little sicker, more RV dysfunction, more tricuspid regurgitation, higher INTERMACS-1 incidents more often on ECMO prior to an implant. What are your thoughts about this? Dr. Marc Ruel: Obviously, you've been very careful and the reader will note in the paper that many attempts have been made to account for those. But please give us your take around that 5.7 hazard ratio for neuro adverse event that you found. Dr. Sung-Min Cho: Right? In fact, we were really being careful adjusting those compounders. So we did a propensity matching has a primary analysis, but as you pointed out, as a secondary analysis, we wanted to look at multi-variable logistic regression analysis, looking at multi-hazard analytics. And when we did the secondary analysis, as you said, in the beginning early hazard period, the risk was similar, as time went on in the constant hazard period, the hazard ratio was 5.7 for HVAD compared to HeartMate 3, which gives a much higher risk of stroke and TIA for those patients with HVAD compared to HeartMate 3. Dr. Sung-Min Cho: So, that was really convincing to us. Confirming the findings from propensity matching analysis, showing that same findings were consistent throughout the different analysis. As we pointed out, HVAD patients actually were sicker, they had more ECMO, and they had more ventilation requirement or sicker patients INTERMACS level. Those are all carefully balanced in both propensity matching analysis and also multi-hazard analytics. And both of these analysis consistently showed that HVAD carried more risk of TIA and stroke compared to patients with HeartMate 3. Dr. Mercedes Carnethon: Thank you so much Sung-Min. You know what excites me as I think about choosing articles for journal clubs, when we're working with our trainees, the propensity matched approach and comparing it directly with what you're getting from multi-variable regression really provides an excellent methodological strategy to be able to generate results from these real world studies where it's not a randomized trial of who received which device, but we're able to yield practical conclusions that are actionable based on these findings when we have these well done analyses. And Marc alluded earlier to the actions that were taken in response to the findings from your study. Can you expand on those just a little bit more? Sung-Min Cho: Of course. So I guess, I don't know the real backstory, what was going on behind the scene, but I know for sure that STS leadership and INTERMACS leadership, they had a lot of discussion with the company who made HVAD device and also FDA, and I know that this study, the results of this study contributed to the decision they made back in June, pulling up HVAD device from the market. Sung-Min Cho: So I'm glad that this study could contribute to the science and hopefully this will help the patients in the future for device selection. So yeah. Dr. Marc Ruel: Sung-Min, I think it's fair to say that your study is probably, if not the most impactful in the field of ventricular assist devices, and I probably would personally think that it is, if not the single most impactful, certainly one of the two or three that are the most impactful. So congratulations to you and your team. Dr. Marc Ruel: If you still have a minute or two, I had a couple of more secondary questions? Dr. Marc Ruel In your analysis I noted that in the early acute phase, there are some protective predictors, such as performing the LVAD implant by sternotomy, which essentially results in about half of the neuro adverse events that you would otherwise observe. So I was a little intrigued by that. And high volume centers had about 1.8 hazard ratio. I suspect that's probably reflective of baseline risk and more acute illness in those patients coming. But if you have a chance, I'd love to hear your thoughts around this? Dr. Sung-Min Cho: Yeah, that's exactly what we thought actually is, initially we thought, hypothesized that surgical volume, the center volume will be associated with lower risk of stroke, but it was the other way around. But as you said, probably higher volume centers were getting sicker patients, so that's the association probably we were getting in the analysis. And we wanted to adjust for surgical techniques, sternotomy versus thoracotomy, and even after adjusting for that, HVAD remained a significant hazard per stroke, which showed in the table two and three, I think in the manuscript. Dr. Sung-Min Cho: And if I may, I want to say these couple of things. In the raw number, in the 6.4% of patients actually had TIA and strokes, neurological adverse events in HeartMate 3, at one year based on our study. And the risk goes up with a longer follow-up time of course. Moment3 trials had two-year follow-up, about 10% had stroke. And this is still, after HVAD is taken off the market, still there's a significant risk for stroke in these patients and based on autopsy and MRI studies although there is a very small studies--MRI studies, although they're a very small series, studies looking at MRI'd brains after explantation of LVAD. And it shows actually more than 95% of patients have cerebral micro bleeds, which is a marker for small vessel disease in the brain. I think this is an important issue, and although we show that one device had a lower risk of stroke, still question remains, are these patients have a high risk of stroke? And there is a need for improving biomedical engineering aspect, and I'm sure cardiologists and cardiothoracic surgeons know much better than I do regarding hemo-compatibility, especially for stroke. Dr. Sung-Min Cho: There is also a dire need for early detection and intervention for these events to improve the outcome for these patients, because once you have a stroke, the outcome is devastating, right? So I think there needs to be better medical management, neuroprotective agent, as well as neuro- monitoring methods, maybe biomarkers to predict stroke or TIA to come so we can intervene and prevent these really devastating complications. Dr. Marc Ruel: Mercedes, if I'm so allowed, I do have one final comment and question. Dr. Mercedes Carnethon: Most definitely. This has been delightful, so yes. Dr. Marc Ruel: Wonderful. So, first, Sung-Min, I want to thank you for working with us. We at Circulation were interested in your paper. You may recall you and I spoke on the phone offline when the decision to revise was made, and we went carefully over what the editors were anticipating would make your paper even better. And you were very responsive. You and your co-author's team were tremendous. And I think the paper that we have before us is absolutely very, very insightful and very important. And obviously tremendously impactful. So I want to thank you again for that. Dr. Marc Ruel: And my question is probably the very difficult question which is in everybody's mind at this point and I would like your take as a neurointensivist. You have someone who you have to care for who has a well-functioning HVAD, two years post implant. What would you recommend in terms of optimization for the prevention of neural adverse events? I realize we don't have all the information, but you are one of the few experts in the world who can probably provide us with a very valid take on this very difficult question. Dr. Sung-Min Cho: Yeah, it is indeed a difficult question. And that's what I am, including me a lot of neurointensivists, they are very interested in this topic. I think really, as I alluded before, only detection is really important, but it's really tough because either patients, they cannot get MRI. There's no way to know who's going to have stroke or not.   Dr. Sung-Min Cho: We know that a bacteremia is a huge risk factor for these patients. Whenever they have device infection, dry valve infection, bacteremia, their stroke risk goes up quite a bit. We have a lot of data on that. So we can carefully monitor these patients, follow these patients. There is some data that, within six days from infection, their stroke risk goes quite high up for these patients. Dr. Sung-Min Cho: But really, neuro-monitoring and biomarker study, there's so little data on this, but patients who are sick like this, not just LVAD patients but ECMO patients or ICU patients, are close neurologic monitoring and some markers to predict occurrence of a stroke or vascular event. I think that's something we really need to study and look into. Dr. Sung-Min Cho: Of course, we have a lot of biomarkers we can pick up from the brain, brain injury markers that we can study, and that has not been done in this space. And there are a lot of opportunities, I think, to look at that. And there's some signal based on Cleveland Clinic data that Randall Starling actually looked into, use of PDE5 inhibitor in this patient population, some protection against the ischemic stroke, and I think that's something also we should look into for neuroprotective agent. Dr. Mercedes Carnethon: Thank you so much! This has been such a delightful discussion this morning with Sung-Min Cho, the lead author of the study and the Associate Editor, Marc Ruel who handled it. Dr. Mercedes Carnethon: I really appreciate your attention. I hope the listeners enjoyed this episode of Circulation on the Run. Please join us again next time. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit ahajournals.org.  

A number of specific therapies are now available for pulmonary arterial hypertension (PAH), and the outlook for patients with PAH has never been better. But first PAH must be differentiated from the other forms of pulmonary hypertension. In this podcast, Corinne Young, FNP-C, president of the Association of Pulmonary Advanced Practice Providers, talks with pulmonary hypertension expert Martha Kingman, FNP-C, DNP, about establishing the diagnosis of PAH, determining the subcategory of PAH, today’s approach to management, and the important role of primary care NPs and PAs in long-term follow-up. This activity is available for CE/CME credit.

Cialis works by inhibiting the enzyme PDE5. This enzyme keeps the cGMP down which contrasts the blood vessels and slowdown blood flow towards the sexual organ of the male. Cialis works by inhibiting the enzyme PDE5. This enzyme keeps the cGMP down which contrasts the blood vessels and slowdown blood flow towards the sexual organ of the male. When Cialis drug is swallowed by water by male, Tadalafil 20mg, the chemical in it prevents PDE5 from working. This allows nitrate oxide to stimulate cGMP for relaxing blood vessels. Relaxed blood vessels facilitate blood flow in the body. The blood flow in the blood vessels of the penis makes it easy to get an erection. Any dose of the Cialis has the same function.

On this episode of Turbo Charged MD, we discuss the upward trend in Erectile Dysfunction treatments, more specifically, non medication related treatment and therapies. Topics include: The FDA approved Viagra in 1998. Pfizers marketing investment blew open the conversation about ED. Men and Women are more open to discussing the issues and challenges. PDE5 inhibitors do not address the root cause of ED (poor blood flow) and have many side affects. Same with Tri-Mix and Quad-Mix. Men are asking questions like: Why do I have ED, could my ED have been prevented, or is it just an inevitable consequence of aging? Is my ED a condition in its own right, to be treated with PDE5 inhibitors and left at that, or is it a sign that I may have other problems that need attention, extending to therapies other than or in addition to Viagra? If ED is just another discomfiting aspect of normal aging, is it impossible for my ED to regress? Or will I need to take PDE5 Inhibitors for the rest of my life? Over 30 million men in the US have ED.' ED issues are relationship driven. What alternative therapies are there? Low Intensity Acoustic Wave Therapy, Priapus Shot, Stem Cells and Exosomes. The ED market revenues are almost $5 billion headed to $7 billion by 2024. How to monetize the market into your practice. Contact us for more information on how to incorporate ED solutions into your practice: 888-292-1147 --- Send in a voice message: https://anchor.fm/rich-force/message Support this podcast: https://anchor.fm/rich-force/support

cialis is a generic drug containing tadalafil which is an active ingredient in these Tablets, Cialis Pills is used to treat erectile dysfunction during intercourse . Tadalafil was approved by the United States Food and Drug Administration or FDA in 2003 for the treatment of erectile dysfunction and became the third phosphodiesterase-5 or PDE5 inhibitor to come onto the market, after Viagra and Levitra. --- Send in a voice message: https://anchor.fm/garrettbrown/message

Dr Carolyn Lam:                                Welcome to Circulation on the run, your weekly podcast summary and back stage pass to the journal and its editors, and welcome to a whole new podcast format in 2019. Ha-ha, I bet that surprised you. Well guess what? This new format promises more interaction, more discussion and a whole lot more fun, and that's because to begin with, you don't have to listen to me talk to myself half the time anymore. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore, and I am simply delighted that Santa gave me a partner on this podcast, and co-hosted with me, and my gift is none other than Dr Greg Hundley, associate editor from the Pauley Heart Center, at Virginia Commonwealth University Health Sciences. Welcome Greg. Dr Gregory Hundley:                       Thank you so much Carolyn. How exciting is it to start this new year with this exciting format, where we'll take several of the key manuscripts from Circulation and discuss them? Picking five each time, and as you've alluded to, we're not going to get rid of that favorite format, where we take a select paper and interview and work with the authors. Dr Carolyn Lam:                                Exactly. In fact, maybe I could liken it to welcoming everyone to join us over a cup of coffee, each week, with the journal in the hand and we're just going to discuss it, and never forgetting that feature paper with the authors, and this week's paper is huge. I love it. We're actually going to be talking about blood pressure control in the barber shop. But before then, here's the articles that we've chosen to discuss. So Greg, you got your coffee ready? Shall we start? Dr Gregory Hundley:                       Absolutely Carolyn, and let's get going first with Gorav Ailwadi, from University of Virginia, his paper evaluating the utility of MitraClips in those with secondary mitral regurgitation. This is really a follow-up from the EVEREST study. It's not a randomized trial, but it's a longitudinal look over time, at 616 patients. Interestingly, those individuals that had class three or four heart failure, that had the MitraClip, the left ventricular volumes got smaller in a year, the hazard ratio for events became less. The magnitude of mitral regurgitation went from 4+ down to 2+. Exciting findings. Dr Carolyn Lam:                                Interesting, but you know Greg, these all sound so positive. Why is it so different in the Mitra FR study?   Dr Gregory Hundley:                       Absolutely Carolyn. So, as you know, Mitra FR, that was a randomized trial. So, this study doesn't compare, the EVEREST study in this issue, doesn't compare with conventional medical therapy, that's number one, and Mitra FR did. Also, the Mitra FR patients were a little bit sicker. The ejection fraction really was 15 to 40 percent, and in the EVEREST study, much higher, average 45 percent. In fact, many had a normal EF. So it really raises a lot of questions as to whether or not this finding will hold up in future randomized trials, which we'll be looking to see the results. Dr Carolyn Lam:                                Indeed, and it was really nicely discussing the accompanying editorial wasn't it, which I really enjoyed. Well, the paper I picked out Greg is from Dr Gatzoulis from The Royal Brompton Hospital, and it's actually the MAESTRO trial. Now, MAESTRO is a randomized control trial of the endothelin receptor antagonist macitentan in patients with Eisenmenger syndrome. Short and long of it, macitentan did not show superiority over placebo on the primary endpoint of change in baseline to week 16 in exercise capacity. And there was also no relevant trends observed for the secondary endpoints.                                                                 However, among the exploratory endpoints, macitentan did reduce Nt-proBNP in the main cohort, and improved pulmonary vascular resistant index, and exercise capacity, in a hemodynamic sub-study. Importantly also, there were no specific safety concerns with macitentan. Dr Gregory Hundley:                       Sounds really interesting, Carolyn. But how did this compare with prior studies that have really focused on endothelin? Dr Carolyn Lam:                                Great question. So, MAESTRO's only the second randomized control trial of an endothelin receptor antagonist in Eisenmenger Syndrome. BREATHE-5 was the first, and this used a different endothelin receptor antagonist that was bosentan, also in Eisenmenger Syndrome, and actually found that bosentan reduced pulmonary vascular resistance as its primary efficacy endpoint, without worsening systemic pulse of symmetry.                                                                 So, very different trials in terms of endpoints, as you can hear, but also importantly, different populations that were enrolled. MAESTRO enrolled a more heterogeneous population with more complex forms of Eisenmenger, including patients with Down syndrome, had a broader WHO functional class inclusion, and allowed the use of pre-existing therapies such as PDE5 inhibitors.   Dr Gregory Hundley:                       That's really spectacular, Carolyn. Very interesting findings for something that these vasoconstrictors, vasodilators, often very harmful. Switching over, I've got sort of another paper that is also working on vasodilation, but comes really from the world of basic science. And it's from Ingrid Fleming from Goethe University in Frankfurt, Germany, examining how does hydrogen sulfide, a common gas that we have in the environment, it smells terrible, we worry about sulfuric acid and acid rain, but how does this promote vasodilation in the system?                                                                 And so, in this basic science study, they unlocked sort of a key that this hydrogen sulfide is produced by cystathionine gamma-lyase, CSE. And why is that important, and what does it do? Well, production of H2S by CSE goes and inhibits human antigen R, or HuR, that regulates cellular proliferation and growth. And so, basically these authors have unlocked a mechanism by which hydrogen sulfide can be protective.                                                                 So, what's interesting Carolyn is that patients can have elevated levels of L-cysteine, increased expression of CSE, so you've got the components and the manufacturer of H2S, but they still have low arterial levels. Dr Carolyn Lam:                                 Hm. So, how can this be addressed then? How can we raise that H2S? Dr Gregory Hundley:                       That's what's so clever that the investigators found out, Carolyn. They found a slow-release oral active drug, a sulfide donor called sodium polysulthionate, H2R, or sulfhydration, and can inhibit atherosclerosis development or progression when these levels are low. Dr Carolyn Lam:                                Indeed. sodium polysulthionate. Awesome, Greg! That is so cool. Honestly I just loved your explanation of that. Okay. Well, I've got another paper to share. And this is from Dr Bress and colleagues from University of Utah School of Medicine. And this one is really interesting because these authors estimated the number of cardiovascular disease events that could be prevented, and the treatment-related serious adverse events that could occur over ten years, if U.S. adults with hypertension were achieving the 2017 ACC/AHA guideline recommended BP goals, compared to their current blood pressure levels, as well as compared to achieving the older 2003 JNC7 goals, or the older 2014 JNC8 goals.                                                                 Now, basically they found that achieving and maintaining the 2017 guideline blood pressure goals over ten years could prevent three million cardiovascular disease events, a greater number of events prevented compared to prior guidelines, but this could also lead to 3.3 million more treatment-related serious adverse events. Dr Gregory Hundley:                       So, Carolyn, hasn't a main concern of this type of work been that these new guidelines over-extend the reach of our treatment? Dr Carolyn Lam:                                That's a real concern that I've also heard. The lower blood pressure thresholds used to define hypertension in the 2017 guidelines could indeed lead to more diagnoses. However, this paper helped because remember that the recommendation for anti-hypertensive drug treatment in patients with the pre-treatment blood pressure of 130-139 systolic, or 80-89 diastolic, was limited to those at high cardiovascular disease risk. So not everyone, but only those at high cardiovascular disease risk.                                                                 And so, treatment under the 2017 guidelines, by these data, would lead to more health gains, while only extending treatment to 5.4% more adults with hypertension compared to JNC7. So, this paper really modeled these things out with important contemporary U.S. adult populations using a national representative, a sample of U.S. adults, and NHANES, as well as REGARDS, and they also used estimates of benefit from the recent large meta-analysis of 42 blood pressure-lowering trials.                                                                 So, important data that I think are going to be reassuring to a lot of people managing these patients. Well Greg, that really brings us to the end of our little chat. Now, let's move to our future discussion, shall we?                                                                 Could cutting blood pressure in a barber shop be the long-term solution to hypertension in African-American men? Well, the future paper of this first issue in 2019 really talks about it. Greg and I are so delighted to have with us the authors of the paper, Dr Ciantel Blyler, and Dr Florian Rader from Cedars-Sinai Medical Center, as well as our associate editor, Dr Wanpen Vongpatanasin.                                                                 So, Ciantel, can you just perhaps start by telling us what you found. Dr Ciantel Blyler:                               So, what we're talking about today are the 12-month results as a follow-up to our 6-month results that we published earlier this year. So, we took 319 African-American men in Los Angeles County, and randomized them to two groups. One group saw a clinical pharmacist who worked with them to reduce their blood pressure, and the other group just worked with their barber to talk about blood pressure, and encourage usual follow-up.                                                                 And, as we saw at the 6-month mark, blood pressure really improved in the group that was able to work with the clinical pharmacist. So, we saw an almost 29 mm Hg drop in the intervention group, as compared to only 7 mm Hg in the control group. Dr Gregory Hundley:                       Ciantel, Florian, that is really exciting results. What is a collaborative practice arrangement, and how did you affect that in Los Angeles? Dr Ciantel Blyler:                               So, collaborative practice is actually widespread in the United States. California is one particular state that is kind of ahead of the curve with respect to collaborative practice between pharmacists and physicians. But what it essentially allows a pharmacist to do is to prescribe, monitor, and adjust medications underneath a physician's supervision. So, a document is drawn up, medications are selected, and an algorithm so to speak is put together so that a pharmacist can treat a patient independently of a physician needing to be there. Dr Greg Hundley:                             Very nice. And did you find in the pharmacist-led group that these patients were taking a different anti-hypertensive regimen, or were they more compliant? What do you think was the reason for the discrepancy in this magnificent blood pressure drop in this group of hypertensive men? Dr Florian Rader:                              So clearly, there were a lot of differences between the two groups. First of all, we had a protocol with our favorite blood pressure medications that we use clinically here in the hypertension center at Cedars-Sinai. Essentially it is long-acting calcium channel blocker, specifically Amlodipine, longer-acting angiotensin receptor blockers, or ACE inhibitors, and a third line, usually a thiazide diuretic, and also a longer-acting one, not the usual Hydrochlorothiazide, but specifically Indapamide that we used for this research study. Dr Greg Hundley:                             And do you think that there was more compliance in this pharmacist-led group? Dr Florian Rader:                              One would expect that. First of all, I think that seeing the clinical pharmacist, more frequently being reminded of taking the medications, having feedback by actually seeing the blood pressure numbers in the barber shop, I think would help. But then, in addition, we choose these medications not only because they affect it, but also because they're easy to take. They're once-a-day medications with very high continuation rates in larger studies, so they're just easier to take than other medications that are oftentimes prescribed. Dr Greg Hundley:                             It sounds like also, there might have been a trust factor. Because you're seeing the same person over and over in a very nice environment. Was that a factor?   Dr Ciantel Blyler:                               Absolutely. I think there's a different level of trust that's established when you meet somebody on their own turf. So I think the fact that we met men in barber shops where they felt comfortable, where many of them had been going to the same barber for over a decade, it made all the difference in terms of establishing a rapport, and gaining their trust with respect to having them take medications. So, I think that was a huge part of why we saw increased adherence, and really sort of a commitment to the program. Dr Greg Hundley:                             And we certainly recognize how harmful hypertension is in individuals of Black race. How does this group in Los Angeles translate to perhaps other Black men in the United States? Particularly, for example, in the South. Dr Ciantel Blyler:                               I think the program could translate really anywhere. I think what makes it so tailored to African-American men is this notion of going into a barber shop, which is a very important place in the Black community. So, again, sort of going back to what I said earlier, most of these men had been seeing the same barber as frequently as almost every two weeks for over a decade. So, it really helps increase the frequency with which we could interact with the men, and it helped with continued follow-up and adherence to the program.                                                                 With respect to the area of the country again, I think it translates. Dr Carolyn Lam:                                I've got a follow-up question to that, if you don't mind. So, I'm here listening all the way from Singapore, and I'm just so impressed, and frankly just enamored by this study. And wondering what is the barber shop to my local Chinese guy? I'm actually wondering if it's the kafei dian and that stands for coffee shop, and I'm also wondering what about the women? Wanpen, do you have any insights that you want to share? Dr Wanpen Vongpatanasin:         I believe that even Dr Victor had thought about the beauty shops, that is a barber shop study in parallel, and this could very well work very well. Who knows, we could be going to massage parlor, anywhere, that when we feel relaxed and be ourselves, we go out our way, out of our regular activity, and it could really be a neat idea. And for a study, I'm not sure I could do something out of the box. I would say it must have been successful as this approach, and partly it could be because of the additional pharmacists engage likely. So, I think this is a perfect combination. Dr Greg Hundley:                             Wanpen, you had mentioned Ron Victor. Maybe Ciantel, Florian, and Wanpen, you used to work with him. What did Ron mean to this study? Ron Victor unfortunately passed away this past Fall. Dr Florian Rader:                              Ron hired me almost seven years ago now straight out of fellowship. He was personally my mentor. He taught me all the tricks when it comes to the work of the management of hypertension, so personally I owe him a lot. Regarding the study, he's been thinking about this for a long time, this approach to hypertension management. He's tried it in Dallas. It worked partially, but not very well because he didn't have a pharmacist, and he didn't have somebody that made it their goal to lower blood pressure no matter what.                                                                 And in this study, we had somebody like that, the clinical pharmacist. So, Ron Victor has thought about this for a long time, has done a lot of analysis of the Dallas hypertension study, and figured out why it didn't work out in Dallas, and really cooked up a recipe for this trial, and the results speak for themselves. Dr Greg Hundley:                             Wanpen, do you have anything to add about Ron? I think he was your mentor as well. Dr Wanpen Vongpatanasin:         Absolutely. I trained with him actually from the internship until fellowship, and I owe my career to him. And actually, I see this idea stemming from the Dallas heart study when he did the survey, and realized that if you just wait for patients to show up in the clinic, that you're not going to get anywhere, because African Americans have higher blood pressure at a younger age, and are more susceptible for target organ damage. And as we all know, by the time many presented with, they already have end-stage kidney disease or cardiovascular disease by the time first presentation. So, to avoid it, we have to go into much earlier, not wait until they come to the healthcare facility, and I'm glad to see that this idea is really becoming widely successful more than anyone can imagine. Dr Carolyn Lam:                                What a beautiful tribute. What a poignant note. Thank you, all of you, for your great input, and for publishing this amazing paper with us at Circulation!                                                                 Thank you, listeners, for joining us today on Circulation on the Run with Greg Huntley and me. Thank you, and don't forget to tune in again next week.                                                                 This program is copyright American Heart Association 2019.  

I'm bringing another scientist on board today, Dr. Diego Golombek. Dr. Golombek won the Ig Nobel Prize in 2007, a parody of the Nobel Prize honoring achievements that "make people laugh, and make people think," for discovering that viagra aids jet lag in hamsters. The research can be found in this study. About Dr. Diego Golombek: Dr. Diego Golombek is an argentine biologist, communicator, popularizer of science and an experienced researcher in chronobiology. He is currently a professor at the National University of Quilmes and researcher at CONICET, and is an author of several books about biology and related topics. What We Cover in This Interview -% of circadian rhythm genes -Why you should sleep in a cool environment -PDE5 inhibitors and the best way to correct your circadian rhythm during travel -How nitric oxide can help with circadian entrainment -How much light exposure is needed during the day -Eating at night and why this interferes with our circadian rhythms -The effects of drugs on the circadian rhythm -The connection between jet lag, metabolic disorders, weight gain, and cancer

**Summary:** In Episode #180 Ari – joined by special guest hosts Nick Sonnenberg, founder of [Calvin App](http://www.calvinapp.com/) and co-founder of [Less Doing Virtual Assistants](http://www.lessdoing.com/VA) – interviews Abelard Lindsay, the creator of CilTep, a powerful, over-the-counter nootropic. Listen as Ari and Abelard talk brain chemistry, memory development, and cognitive function. **Special Announcements:** ## [Rockefeller Roundtable](http://helmsociety.com/ari-meisel-ceo-roundtable-nc/) Come watch Ari regale a roundtable of avid [Helm Society](http://helmsociety.com/) listeners with the lessons of Less Doing on September 9th from 10AM to 2PM in New York City. ## [Freeing Finland](http://www.biohackersummit.com) Come watch Ari and a collection of other well-renowned biohackers free the people of Finland from their bodily limitations at the 2015 Biohacker Summit being held in Helsinki, Finland from September 23rd through September 24th. Those interested in attending can [buy tickets here](http://biohackersummit.com/#pl_areauf9k2sm). ## [Leave Us a Review!](https://geo.itunes.apple.com/us/podcast/ari-meisel-less-doing/id605938952?mt=2&uo=6) Hey Less Doing Podcast Listeners, we want to hear from YOU! Visit us on iTunes and leave a review or subscribe to the podcast if you're not already a dedicated follower. **Time Stamped Show Notes:** - 18:34 – Introduction of Abelard Lindsay—Director of Research Development for Natural Stacks - 20:40 – Talking about CilTep - 21:20 – Coming up with the foundational ingredients - 21:53 – PDE4 inhibitors - 22:26 – There's a long cascade from short-term memory to long-term memory - 24:50 – Abelard basically conducted self-study with supplements to find the basis of CilTep - 26:20 – CilTep prolongs a state of wonder—it makes studying pleasurably addictive - 27:28 – When dopamine receptors are activated, they release CAMP into the neuron which causes memory encoding to increase - 29:08 – PDE5 is closely related to PDE4 but it drives sexual rather than mental arousal - 30:30 – Developing the pathway to improvement and problem solving - 33:10 – What Abelard takes regularly - 34:25 – Can you overdo it on nootropics? - 35:58 – Hard to clearly say because everyone is different - 36:45 – Nexus, CilTep, and Mitogen all work on different systems - 38:35 – None of Abelard's stacks feature caffeine - 39:10 – Abelard's _Top 3 Tips to be More Effective_ - 39:18 – Get to know your brain - 39:54 – Try to argue without using logical fallacies - 40:28 – Write down ideas - 41:38 – [www.AbelardResearch.com](http://www.AbelardResearch.com) and [www.NaturalStacks.com](http://www.NaturalStacks.com) and [www.axonlabs.io](http://www.axonlabs.io) and @CilTep **5 Key Points:** 1. Memory isn't a singular concept—there are different kinds of memory 2. Keep a written log of your ideas 3. Don't necessarily be opposed to self-experimentation. 4. Become close friends with your brain—get to know it. 5. Nootropic can help you create and prolong a natural state of wonder. **Resources Mentioned:** - [The MiFold](https://www.indiegogo.com/projects/mifold-the-grab-and-go-booster-seat#/story?utm_source=mifold.com&utm_medium=mifold.com&utm_term=hero_cta&utm_content=pre-order_now&utm_campaign=click-thru%20from%20mifold%20website) – A grab and go Car booster seat - [Drones for Blood Testing](http://www.vocativ.com/news/216434/bloody-good-drones-actually/) – Exploring the use of drones for blood transfer, testing, etc. - [The Slack Post](https://theslackpost.com/?ref=producthunt) – A simple online newspaper for the posting of all Slack integrations - [Chronic Inflammation and Behavior](http://www.medicaldaily.com/chronic-inflammatory-diseases-sometimes-cause-behavioral-problems-probiotics-might-345092) – From Medical Daily, an article highlighting how probiotics can help with mental illness - [Make a Game Out of Eating](http://www.yumit.io/?ref=producth --- Send in a voice message: https://anchor.fm/lessdoing/message

Editor's Audio Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the June 23/30, 2015 issue