Podcasts about plavix

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma and Biotech world.The White House has announced a new drug pricing policy that includes the revival of the most favored nations rule and extends to the private markets, leveraging the patent system, drug importation, and more. Meanwhile, Lilly's Zepbound has been found to have a superior benefit-risk ratio compared to Novo's Wegovy, BMS and Sanofi settle a Plavix lawsuit with Hawaii for $700 million, and biopharma companies are focusing on developing a cure for HIV as federal funding for related research is being cut. Sino Biological offers comprehensive solutions for autoimmune diseases, and Roche promises a $300 million investment in China production after a multibillion-dollar investment in the US. On the other hand, Lexeo and IGM have both announced significant layoffs. Novartis CEO has expressed concerns about Trump's pricing controls.Funding for HIV-related research and infrastructure is being cut by the Trump administration, leading biopharma companies like Gilead and Immunocore to focus on finding a cure for HIV. In the field of neurology, there is a need for more precise diagnostic tools to effectively treat neurodegenerative conditions. The new HHS vaccine requirement has been criticized by leading vaccine physician Paul Offit as potentially being anti-vaccine activism disguised as policy. Companies like Novartis, Bayer, and AstraZeneca are exploring new indications and innovations in radiopharmaceuticals, hoping to capitalize on a market that could reach $16 billion by 2033. The FDA has faced delays in reviewing certain drugs, while biotech stocks have fallen after the appointment of Vinay Prasad to succeed Marks at CBER. Vertex has decided to abandon AAV in the gene therapy space.Upcoming events include a webinar on surviving and thriving in the biotech downturn. Job opportunities in the biopharma industry include positions at Takeda, Daiichi Sankyo, and AbbVie. Heather McKenzie, senior editor at BioSpace, is open to suggestions for future coverage topics in neuroscience, oncology, cell & gene therapy, metabolic, or other areas.

About Sig MullerBelow is part of the orgin story of "Be the World's Best". I talk about Day 0 - Not My Day to Die in a blog on my website. The below is about the Days after I died.Day 1 & 2 - "You Are the World's Best"The first two days in the Intensive Care Unit (ICU) I don't remember anything.I was intubated, out of it, amnesiac, and told sometimes combative (trying to take out the intubation tube on my own - I really didn't like it!). Everything I will recount here I was later told by friends, family and caregivers. By the morning of Day 1 (evening of Day 0), my sister Maria was there along with my sons Ashton, and Sig 3 (affectionately known by me as Sigareeno) and his wife Becca.Sigareeno put his second year medical school skills to work with his Dad as a real life case study in consulting with the Doctors about my condition and care. The biggest concern he had was that I might might be in a permanent vegatative state given the length of time my heart was stopped and I was without oxygen.Maria was supportive and there as the captain for the duration of my 6 days in the hospital - everyone needs a Maria in their life! She helped everyone row together, remain optimistic, and to make sure I got the World's Best Care.While in my amnesiac state I repeatedly said 2 things thousands of times to everyone who came into the room. Family, friends, doctors, nurses, lab technicians, janitors et. al. Everyone who came in was told repeatedly and continuously:1. "You are the World's Best"2. "Don't give me clopidogrel" (Plavix)https://www.betheworldsbest.com/https://www.linkedin.com/in/sigmuller/----------------------------------About Oreet KaufmanI left corporate. I finally did it and took the plunge to go out on my own. After spending 20+ years in training and development, I now solve critical communication challenges and build confidence through amazing presentation designs. What problems do I solve?1. Deadline panic - you need to create a fantastic deck in a short amount of time.2. Poor use of resources - you need your team to do other work besides creating presentations.3. Clear messaging - you're worried your story won't land with your audience.How do I solve these problems? I deliver confidence with:1. Presentations that inspire change2. 'Word dieting' - clear and concise messaging that sticks3. Designs that stands outFor example, when I get a client with just a mountain of words on a page my first thoughts are, oh boy, this is a lot and no one will read it. Then I dive right in. 1. What is the author trying to achieve - a sale? change a habit? raise money?2. Does the flow of the content make sense? Is there a beginning, middle and end to this story?3. With my 'red pen' I start cutting - what is redundant, what is extra, what can be speaker notes or an appendix? (this is the most gratifying part, honestly)4. What are the right images and visuals to bring this story to life?https://ocdesigns.info/https://www.linkedin.com/in/oreetkaufman---------------------------------About Brittany HansenWomen in tech are trending, but beyond the buzzwords, the reality is a rollercoaster of ambition, obstacles, and unexpected wins. I know this firsthand.As a mom of four—two with special needs—I've co-founded a SaaS company without venture capital, navigating the challenges of fundraising, scaling, and doing business in Idaho, a state just beginning to carve out its place in the tech world. The journey has been both rewarding and brutal, filled with lessons in resilience, adaptability, and the power of relationships.https://go.viiision.app/topic/663bd5880f24b611104fa7d5----------------------------------When It Worked Podcasthttps://getoffthedamnphone.com/podcast

The governor just announced the state's won more than $900 million in a lawsuit over the blood thinning drug Plavix. It's a victory over two of the country's largest pharmaceutical companies.See omnystudio.com/listener for privacy information.

Today's West Coast Cookbook & Speakeasy Podcast for our especially special Daily Special, Smothered Benedict Wednesdays, is now available on the Spreaker Player!​​​​​​​Starting off in the Bistro Cafe, the Trump criminal plan was revealed in a major unsealing in the Mar a Lago espionage case.Then, on the rest of the menu, a Hawaii court ordered drug companies to pay the state a combined $916 million in the Plavix blood thinner lawsuit; a Texas petrochemical company has pleaded guilty to a violation of the Clean Air Act and agreed to pay more than thirty million dollars in connection with two explosions near Houston; and, the Massachusetts Senate is weighing a tuition-free community college plan.After the break, we move to the Chef's Table where a man charged with helping the Hong Kong intelligence service in the UK has been found dead; and, politically motivated crimes in Germany reached their highest level in 2023, since tracking began more than twenty years ago.All that and more, on West Coast Cookbook & Speakeasy with Chef de Cuisine Justice Putnam.Bon Appétit!The Netroots Radio Live Player​Keep Your Resistance Radio Beaming 24/7/365!"To those of us who believe that all of life is sacred every crumb of bread and sip of wine is a Eucharist, a remembrance, a call to awareness of holiness right where we are. I want all of the holiness of the Eucharist to spill out beyond church walls, out of the hands of priests and into the regular streets and sidewalks, into the hands of regular, grubby people like you and me, onto our tables, in our kitchens and dining rooms and backyards.”-- Shauna Niequist"Bread and Wine: A Love Letter to Life Around the Table with Recipes"Become a supporter of this podcast: https://www.spreaker.com/podcast/west-coast-cookbook-speakeasy--2802999/support.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: Jan 18, 2018When it comes to stroke, treatment is dependent on the stroke mechanism. But most patients wind up on aspirin anyway. Or Plavix (clopidogrel). And sometimes both. The question this week is, Why? I hope you're hungry for some fruit because we're comparing a bunch of apples to oranges in this episode of the BrainWaves podcast.Produced by James E Siegler. Music by William Ross Chernoff's Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision-making. Even if this episode is all about choosing aspirin or clopidogrel when you're treating stroke patients. Always talk with your doctor, and if you are a doctor, you should rely on institutional policies and your own clinical judgment when treating patients.REFERENCESAntithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324(7329):71-86. Erratum in: BMJ 2002;324(7330):141. PMID 11786451Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006;354(16):1706-17. PMID 16531616CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet 1997;349(9066):1641-9. PMID 9186381Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994;308(6921):81-106. Erratum in: BMJ 1994;308(6943):1540. PMID 8298418CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348(9038):1329-39. PMID 8918275Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364(9431):331-7. PMID 15276392Hong KS, Lee SH, Kim EG, et al. Recurrent ischemic lesions after acute atherothrombotic stroke: clopidogrel plus aspirin versus aspirin alone. Stroke 2016;47(9):2323-30. PMID 27418597Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44(3):870-947. PMID 23370205Kennedy J, Hill MD, Ryckborst KJ, et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol 2007;6(11):961-9.

With the expertise of top cardiologists and medical researchers Dr. Michael Koren and Dr. Miciah Jones we follow up on the October 18, 2023 podcast Exploring Cardiac Health: Acute Coronary Syndrome, Gender Differences, and Cholesterol Management Ep 148. We uncover the truth about Plavix and its role in treating, not preventing, heart disease. We also shed light on the overlooked signs of heart disease in women and how the medical community is stepping up its game in diagnosis. Dive into hospital procedures for heart attack assessment and the potential lifelong use of cholesterol drugs.Ever wondered about the complexities of stress testing in heart disease diagnosis? We unravel these intricacies, discuss the pros and cons of various tests, and emphasize the importance of collaborating with the right healthcare professionals. Highlighting how a deep understanding of your body's anatomy and physiology can help detect potential health issues, we walk you through the labyrinth of diagnostic options. Don't miss out on this enlightening and potentially life-saving discussion as we delve into heart disease and its management.Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Clopidogrel Trade Name Plavix Indication Atherosclerotic events, MI, CVA, PVD, acute coronary syndrome Action Inhibits platelet aggregation Therapeutic Class Antiplatelet agent Pharmacologic Class Platelet aggregation inhibitors Nursing Considerations • May cause GI bleeding, neutropenia, hypercholesterolemia • May increase risk for bleeding in warfarin, aspirin, heparin • Can increase risk for bleeding with garlic, ginkgo, ginger • Monitor for signs of bleeding • Monitor bleeding times • Monitor CBC and platelet count • Discontinue use 5-7 days before surgery

Please join Circulation Senior Associate Editor Sana Al-Khatib and Associate Editor Mercedes Carnethon as they discuss the seventh Go Red for Women issue of the journal. Dr. Sana Al-Khatib: Hello and welcome to the Special Circulation on the Run podcast focused on the seventh Go Red for Women issue of the journal. I am Dr. Sana Al-Khatib. I'm an electrophysiologist at Duke University Medical Center and a senior associate editor for Circulation. I had the pleasure of co-leading this issue with a colleague and friend, Dr. Dr. Mercedes Carnethon: Well, I am so pleased to be with you today, Sana. My name is Mercedes Carnethon from the Northwestern University Feinberg School of Medicine. I'm an associate editor at the journal Circulation and extremely excited to join you this year on the seventh issue, as a guest editor for our Go Red for Women Issue. And we've got so many great pieces today, so let's get going. Dr. Sana Al-Khatib: Wonderful. So we're very excited to provide you with some highlights of the issue that covers a broad range of topics related to cardiovascular disease in women. In this particular issue, the content is presented as five original research articles, three research letters, five online articles, and one in-depth review article. And like prior podcasts, this year's podcast will only focus on the original research articles, so let's get to it. The first original research article is titled Exercise for the Prevention of Anthracycline Induced Functional Disability and Cardiac Dysfunction. This was the breast cancer randomized exercise intervention Brexit study. In this trial, the investigators enrolled 104 women who were between 40 and 75 years old and had stage one to three breast cancer. And these women were scheduled for anthracycline based chemotherapy and they randomized them to three to four days per week of aerobic and resistance exercise training for 12 months and they were randomized in one-to-one ratio to either do the exercise or really usual care. Very interesting study Merci, don't you think? Dr. Mercedes Carnethon: Absolutely. This is such an important issue, particularly for survivors of breast cancer. Dr. Sana Al-Khatib: Exactly. And in this trial, they focused on looking at the following measures, cardiopulmonary exercise testing to quantify the peak VO2 and functional disability, cardiac reserve, quantified using exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output stock volume, standard-of-care echocardiography-derived resting LVEF and global longitudinal strain. And exercise training was found to attenuate functional disability at four months, which was really interesting, but not at 12 months. But when they looked at it, Merci, in a per protocol analysis, functional disability was found to be entirely prevented at 12 months among participants who adhered to exercise training. Dr. Mercedes Carnethon: That is so exciting to hear, especially with the potential to intervene for better outcomes. Dr. Sana Al-Khatib: Exactly. And then listen to this, as compared with usual care at 12 months, exercise training was associated with a net plus 3.5 milliliter per kilogram per minute improvement in the peak VO2 that coincided with improvements in cardiac output, stroke volume, LVEF and RVEF reserve, all of them improved, Merci. Dr. Mercedes Carnethon: That is such great news. What did the authors have to say about these findings? Dr. Sana Al-Khatib: Well, of course they were really excited about these findings because hopefully this will help a lot of patients. Now, when they looked at the exercise training in relation to resting measures of LV function, there didn't seem to be an effect. So they concluded that in women with early stage breast cancer undergoing anthracycline based chemotherapy, 12 months of exercise training did not attenuate functional disability, but it certainly provided clinically meaningful benefits in relation to the peak VO2 and cardiac reserve. So really interesting findings. Obviously I personally would like to see these findings replicated by other studies, but I think these results are promising. Dr. Mercedes Carnethon: I'm so excited to be able to feature that important piece in here, especially as more women are living and being treated for breast cancer. Dr. Sana Al-Khatib: Indeed. So Merci, I'll turn it over to you to tell us about a couple of your articles. Dr. Mercedes Carnethon: Well, I'd love to do two of mine back to back if that's okay with you because they address similar issues. So in one of the first from Dr. Yuan, Liu, and colleagues, they studied the influence of maternal exposure to particulate matter, small, fine, particular matter, and how that influenced the risk of congenital heart defects. We certainly know that congenital heart disease is a significant problem. And what's even more interesting is that the author's site that more than 80% of congenital heart disease has no known cause. However, prior research does suggest that particulate matter is a plausible environmental exposure that could damage follicular development, disrupt hormone homeostasis, cause inflammation and glucose intolerance. All of those processes could lead to abnormal placentation and fetal development. And so I thought it was really exciting that they would pull together this very large study. And in fact, this isn't the first study to ask this question, but it is one of the largest. It was carried out in China, which is an area with relatively higher levels of pollution. And the authors did some really cool things. I can't wait to tell you Sana, because I feel as though I rarely get to say NASA was involved in a study that we're featuring here in Circulation. So let me tell you about it. Not just cardiologists, not just obstetricians and gynecologists, but environmental scientists were involved here and the mean monthly measures of PM 2.5, which is small fine particulate matter, were made via satellite, NASA satellites, and imputation procedures were used that combined a number of meteorologic variables, land use types, road network information, elevations and emissions to train models using machine learning to make estimates of the burden of PM 2.5. Isn't this cool? Dr. Sana Al-Khatib: Wow. How interesting. Absolutely. Dr. Mercedes Carnethon: Yes. It's probably not something you do every day in your cardiology practice, but it's particularly important for us to be able to get these precise measures of PM 2.5 exposure and what the authors were doing were matching up these units of exposure with the preconception period three months before pregnancy, the first trimester three months after pregnancy, and the entire window to determine how exposures to PM 2.5 during those critical periods for fetal development influenced congenital heart disease and they studied the major causes of congenital heart disease, the major classes using ICD 10 codes. Dr. Sana Al-Khatib: Wow. Well, I can't wait to hear the results. Dr. Mercedes Carnethon: So the results suggested that in general, the risk of delivering a baby with a congenital heart defect increased by 2% for each 10 nanogram per meter cubed in maternal exposure to PM 2.5 during the preconception period. And this relationship was even stronger preconception than it was during the first trimester. And when they studied different types of congenital heart diseases, the strongest associations were with septal defects. And this was regardless of the exposure window, this was preconception, the first trimester and the entire peri-conception window. I think another really compelling thing about a study of this size, and did I mention that it was 1.4 million births that were studied here during a period of time between 2014 and 2017? 1.4 million births. Dr. Sana Al-Khatib: That's a very large study. Dr. Mercedes Carnethon: Yes, and one of the benefits of having a study of that size is that you have the opportunity to look at subgroup effects to determine whether there are other characteristics that modify the relationship of the exposure and the outcome in this case PM 2.5 exposure. And what they found was that the relationship of PM 2.5 exposure with congenital heart disease was even stronger for births that took place in northern China or births that happened in areas with a low per capita disposable income. And even more surprising, and I'm not sure if this surprised you, but the relationships were even stronger in births to mothers who were younger than age 35. And that's particularly telling given that many births are obviously happening when women are below age 35. So I think these findings are just so compelling. I think they are important certainly for our cardiology community, but I think they're also important for policy makers as they consider the implications of air quality and how that affects our long-term health. Dr. Sana Al-Khatib: Yeah, no, absolutely. Very important implications here, Merci. I agree. Dr. Mercedes Carnethon: Yes. Well, so I was really pleased to feature that article and then in the same issue, if I can continue to hold the microphone here. Dr. Sana Al-Khatib: Yes, please. Dr. Mercedes Carnethon: In the same issue, we have another paper led by authors from China, Zhang and colleagues, who carried out a study of what happens when women grow up with congenital heart disease and they have their own pregnancies? And so the goal of this particular paper was to look at the influence of pulmonary hypertension, which is a common complication of women with congenital heart disease when they become pregnant, to see how the severity of pulmonary hypertension influences pregnancy outcomes in these women. Dr. Sana Al-Khatib: A very important topic. Yeah, I agree, Merci. Dr. Mercedes Carnethon: Yes. And so this was carried out in over 2000 pregnant women with congenital heart disease who had completed pregnancies. This was a retrospective analysis. And of those a significant portions, 729 women, had pulmonary hypertension. And these range from mild to moderate to severe. And unfortunately, maternal mortality was an outcome in this study along with birth outcomes among the babies. And what the authors found, I guess, consistent with what one might hypothesize, is that the severity of pulmonary hypertension was associated with adverse outcomes. Those women who had more severe pulmonary hypertension were more likely to experience maternal mortality. They were more likely to experience heart failure and other cardiac complications. And unfortunately, those risks were as well passed along to the babies where there were more obstetric complications and other adverse events. So it's an unfortunate finding, but I would say that there were a number of bright spots and a few bright spots to this particular study. And their findings were that those women who had follow-up care with a multidisciplinary team, strict antenatal supervision, tended to have a lower likelihood of these adverse events. Dr. Sana Al-Khatib: That is so good to know. Of course, I mean, we have thought of that to be the case, but now to have a study showing that is really impactful. Dr. Mercedes Carnethon: It certainly is. And especially such a well done study. These aren't common. And so this team managed to find a relatively large sample size so that they could produce robust estimates that we can use and consider when we consider helping women with congenital heart disease manage their developing families. So I really thank you for letting me talk about two of these studies back to back, but I can't hog the microphone. We have so much good work in this episode. Dr. Sana Al-Khatib: Yeah, no problem. But it's so good to see more work being done on the adult congenital heart disease, by the way, because this is a growing patient population, and it's great that we were able to feature it in two articles, Merci. So let me present the second paper that I had the pleasure of handling in many ways, this particular paper. First of all, it is a topic that's near and dear to my heart as I am an electrophysiologist and the paper provides data on the comparative effectiveness of left atrial appendage occlusion versus oral anticoagulation bisects in patients with atrial fibrillation. And not only am I interested in the topic, but I actually was the senior author on this paper, and so I really need to acknowledge that and would like to share some highlights of the paper with you. So in this particular paper, Merci, we analyzed Medicare claims data from 2015 through 2019, and we really focused on patients who were deemed to be eligible for left atrial appendage occlusion. And we divided them into sex subgroups. And of course, we had to apply robust statistical methodology first in terms of making sure that patients with left atrial appendage occlusion were well-matched in one-to-one ratio to those receiving anticoagulant therapy. Obviously, a lot of selection bias goes into those assignments in clinical practice, and so we needed to make sure to match those groups, and we did that for women and we did that for men. And we were really interested in looking at the risks of mortality stroke or systemic embolism as well as bleeding between these matched groups, so we wanted to compare those risks. And so among females, we had 4,085 left atrial appendage occlusion recipients, and those were again matched in one-to-one ratio to women who were receiving anticoagulant therapy. And if you look at the subgroup of males, 5,378 were left atrial appendage occlusion recipients. And again, those were similarly matched to men who received oral anticoagulation. And so of course, after doing the matching, we applied the further adjustment to take care of remaining differences between the groups. So what did we find? We found that left atrial appendage occlusion was indeed associated with a significant reduction in the risk of mortality as well as stroke or systemic embolism and this was true for females and males. And when we looked at the bleeding risk, we found that that risk was significantly greater in left atrial appendage occlusion recipients early after implantation, because as you know, Merci, those people for the first six weeks have to be treated either with anticoagulation or a combination of aspirin and Plavix, and so it's not surprising that bleeding was actually high early on, but really lower after the six week per procedural period for both females and males. And so what we concluded in this study, which was a real world study, and that's the significance of this because several trials had been conducted, but many of us always raised the questions of, well do the results of the clinical trials apply to the average patient that we see in clinical practice? So many of us would like to see comparative effectiveness analysis being conducted in real world populations, and here we were able to show that left atrial appendage occlusion was associated with a reduction in the risk of death, stroke, or systemic embolism as well as long-term bleeding both in females and males. So really very interesting results that I think should help inform shared decision making discussions with patients. Dr. Mercedes Carnethon: Oh, absolutely. I have to say I'm not biased. It's not because you are the senior author, it's because this is just truly excellent work, really a creative design. And I agree with your assessment that doing this sort of real world work is critically important because sometimes we don't have the representation in clinical trials of a distribution of people who would ordinarily be the targets of these types of therapies. And so I really applaud you and your team for really leading an excellent study that I hope people will find extremely useful. Dr. Sana Al-Khatib: Well, thank you very much, and I really want to give a lot of credit to the first author, Dr. Zeitler, who has been mentee of mine for many years and has done a great job and really a lot of credit to the rest of the co-authors. Dr. Mercedes Carnethon: Well, that's fantastic. I'm glad that I chose the ordering that I did because the final study that I'd like to talk about is in fact a randomized trial. And I think similar to the one that you just described, this is another study that's comparing sex differences. So this particular study led by Coughlan and colleagues describes sex differences in 10-year outcomes after percutaneous coronary intervention with drug-eluting stents. And given the positive impact that drug-eluting stents have had on improving coronary artery disease, I think it's critically important for us to find out whether or not there are any disparities by sex and the types of outcomes that occur following percutaneous coronary intervention. And so in order to address this question, what the authors did was to carry out a pooled analysis of five individual patient data from trials of drug-eluting stints that had at least 10 years of follow up. And the objective here was to really address the controversy in the field about whether the outcomes were worse for women, which was observed in some studies versus in other studies where there was no difference. And the benefit of using this pool design, again, this sample size, I'm an epidemiologist, I love big samples for what can be done. And in the 9,700 patients that were included in this trial, 24% of them were women. So really it required this type of a meta analytic design in order to have enough women to answer these questions. So the outcomes of interest here included death from all causes, death from cardiovascular disease, MI, stent thrombosis, and revascularization of the target lesion, the target vessel, and the non-target vessel. So one of the challenges in interpreting findings from prior studies of this question are the concerns that the clinical characteristics of men versus women who underwent PCI were different. And in fact, in this particular pooled analysis, men were more likely than women to have three vessel disease, and they had a lower, lower mean ejection fraction coming in the characteristics following angiogram and the procedure also showed some differences by sex groups, namely that women had smaller vessel reference diameters before PCI and a smaller minimal luminal diameter after PCI. But men had a longer total stinted length as compared with women. So I'm sure you want to know what ended up happening. Dr. Sana Al-Khatib: Please. Dr. Mercedes Carnethon: Yes. So when the authors tested their primary hypothesis of sex differences in tenure outcomes, they found that some of the very minor differences in the proportion of women versus men who experience the outcomes of interest were eliminated following adjustment for relevant characteristics, or in fact that women were slightly less likely to experience the outcomes of interest. Specifically women were less likely to experience death from any cause over 10 years, but there was no difference in cardiovascular death as compared with men. Women though were significantly less likely than men to require repeat revascularization of the target legion, the target vessel, and the non-target vessels over 10 years. But unfortunately, the findings weren't all good. A notable exception was that when the offers examined the one-year event rates, women had a significantly increased likelihood of MI in the first 30 days after PCI. And I'm not sure why this is, but the authors did advance numerous hypotheses to explain their findings. One was that baseline and procedural characteristics varied markedly between men and women, and that the age was a primary confounder of these findings. And this was because they carried out a series of sensitivity analyses where they didn't account for age and when they didn't account for age, women had an increased risk of cardiovascular death through the entire 10 years of follow up. And it's curious why this would happen. And the observation was thought to be attributable either to women developing CAD later than men in life, or because they're diagnosed later because of decreased physician awareness among women. And that's shocking to hear since we all know that cardiovascular disease is the leading cause of death among women. So I really think that the observations in this large pooled analysis do warrant further study and investigation. And a point that I think we discussed earlier is that the representation of women in clinical trials, we have to have more women in these trials and this was an argument that the authors advanced because then without more women in these trials, we don't have adequate power to investigate these sex differences and to explore reasons behind these sex differences. And so I hope that investigators will really heed these calls so that we can generate the best possible science to inform treatment options for women so that we can maximize our health outcomes. Dr. Sana Al-Khatib: No, absolutely. Those are excellent points, Merci, that you make. And we certainly need to make sure that we have more women participating in clinical trials and that to the extent that we can, that patients enrolled in clinical trials are representative of patients that we see in clinical practice. You bring up excellent points. Thank you for that great summary. Dr. Mercedes Carnethon: Thank you so much, and thank you really for letting me join you in this special issue. I'm so excited about all of our pieces, not just these original research pieces, but as well our research letters and the rest of our content. I think there's just a lot for our readers to dig into here. Dr. Sana Al-Khatib: Yeah, no, absolutely. Merci, it's been a pleasure for me to co-lead this issue with you and I agree while we focus this podcast on the original research articles, the other articles are equally interesting and impactful. So a lot for our readers to enjoy here. So in closing, we want to wholeheartedly thank Dr. Joe Hill, the editor-in-chief for Circulation, Dr. James De Lemos, the executive editor of the Journal and all authors who submitted the research for this issue. We also want to thank the Circulation associate editors and staff who worked so hard to deliver what you are about to experience. We're very excited about this issue and know you will find it very informative and interesting. This concludes our Go Red for Women issue Circulation on the Run podcast. Thank you so much for listening. Dr. Mercedes Carnethon: Thank you. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. 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, please visit ahajournals.org.

HOST: Dr. Jimmy Stewart, Professor of Internal Medicine and Pediatrics at the University of Mississippi Medical Center.TOPICS DISCUSSED: Prepping for the physician; Cervical dystonia; EKG tests; Angina symptoms; Geriatric doctor shortage; Primary care physician search; Plavix vs Xarelto; TIA diagnosis after stroke; Fatty Liver disease causes, symptoms & treatment; severe Coronary Artery disease; migraine diagnosis and TMJ correlation to breast size. EMAIL: remedy@mpbonline.orgIf you enjoyed listening to this podcast, please consider making a contribution to MPB: https://donate.mpbfoundation.org/mspb/podcast. Hosted on Acast. See acast.com/privacy for more information.

Join us for episode 27 of Quad Pro Quo where we discuss Grumpy Old Men and answer questions like:Are one-piece ski suits hot?Does anyone eat SPAM on purpose?andHave you ever heard of Fistletoe?

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/ClopidogrelPlavixNursingConsiderations    Generic Name Clopidogrel Trade Name Plavix Indication Atherosclerotic events, MI, CVA, PVD, acute coronary syndrome Action Inhibits platelet aggregation Therapeutic Class Antiplatelet agent Pharmacologic Class Platelet aggregation inhibitors Nursing Considerations • May cause GI bleeding, neutropenia, hypercholesterolemia • May increase risk for bleeding in warfarin, aspirin, heparin • Can increase risk for bleeding with garlic, ginkgo, ginger • Monitor for signs of bleeding • Monitor bleeding times • Monitor CBC and platelet count • Discontinue use 5-7 days before surgery

In this podcast, Dr. Ron Tarrel, a Stroke Neurologist with Allina Health, discusses everything stroke. Dr. Tarrel walks through recognition, evaluation, and management of stroke. He also discusses current guidelines, as well as the future of stroke medicine. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Identify and describe warning signs of stroke and its initial presentation. Assess when initial urgent/emergent evaluation, imaging, coordination of care and decision making needs to occur in regards to stroke. Discuss treatment options and indications in regards to stroke care. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. ADDENDUM TO SHOW NOTES:Please note the Dr. Tarrel refers to TPA as a blood thinner at one point throughout the podcast. He would like the listerner to know that this medication (TPA) is a clot dissolving medication and not a blood thinner. Dr. Tarrel does not wish to confuse the listner on the nomenclature of TPA vs blood thinners (i.e. anticoagulants). SHOW NOTES: FAST The American Heart Association (AHA) put forth an initative for the lay person to recognize signs and symptoms of stroke and that was the FAST assessment which is (Facial asymmetry or weakness, Arm weakness, Speech difficulties, and Time), but now it has moved to the BE-FAST screening test. the BE portion of the FAST exam is assessment of Balance and Eyes to determine if there are posterior circulation findings. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.116.015169 HINTS ExamThe HINTS exam is a bit more specific and sensitve, looking for posterior circulation strokes in the correct patient population. Briefly, HINTS is a Head Impulse test direction-changing Nystagmus in eccentric gaze, or skew deviation. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.551234 Common DeficitsThe majority of strokes are going to occur in the anterior circulation which would be the carotid distribution, then into MCA (M1, M2, M3, M4, M5). Most of the deficits are going to be unilateral weakness, sensory or cognitive symptoms - example: aphasia/ neglect (cortical symptoms). Whereas, posterior circulation (vertebrobasilar) may have more devastating qualities. Symptoms for posterior stroke can include dizziness, nausea and vomiting, nystagmus, coordination, ataxia. However, see the article linked below where posterior cirulation vs anterior crculation infarcts can sometimes be difficult to determine on a clinical exam alone. Therefore, neuroimaging is recommended to accurately determine stroke distribution. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.112.652420 This study indicates that the symptoms/signs considered typical of posterior circulation infarcts occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate posterior circulation infarcts from anterior circulation infarcts. Neuroimaging is vital to ensure acurate localization of cerebral infarction. Hemorrhagic vs Ischemic StrokeWhich one is it? According to Dr. Tarrel, intracranial hemorrhage appears to exhibit more headache symptoms, such as this is the "worst headache of my life" , whereas ischemic stroke appears to be more painless, usually. Blood pressure and loss of consciousness can closely mimic hemorrhagic vs ischemic. Telestroke GuidelinesTelestroke guidelines are generally insitution specific. Refer to the linked article below, on the current guidelines in telestroke medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802246/pdf/tmj.2017.0006.pdf BP / 1st Line AgentFor hemorrhagic strokes, the neurosurgeons and neurologist like the systolic blood pressure to be in the 140-160 range. BP is usually controlled with Nicardipine as a 1st line agent. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.020058 Last Known Well (LKW)Last Known Well (LKW) is extremely important especially since we know that we are working against the closk for the use of lytic therapy (currently 4.5 hour window).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630074/pdf/nihms699406.pdf https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.116.023336 Imaging Imaging modalities for stroke workup can often include an initial non-contrast CT of the head to rule out ICH, but hen what happens? Generally, it is recommended to work in concert with the stroke neurologist to then determine the next line of imaging studies. If it is determined the patient looks to have a high NIHSS and concerns for LVOT (Large Vessel Occulusion) a CTA of the head and neck can be considered. Perfusion studies and advanced MR imaging should be discussed with consulting neurologists. Clinicians should also remember to follow their specific institutional guidelines for imaging studies if the stroke neurologist is unavailable or there is a delay in consultation. LKW along with CTA and CT perfusion of the head in ischemic stroke patients can sometimes give us a picture of the infarct core with surrounding penumbra (ratio). If circumstances are faborable, it may allow the pursuit of a thrombectomy. The current guidelines are for thrombectomy within 6 hours, but consideration upwards of 24 and beyond in the right patient population. Please see the DAWN and DIFFUSE 3 trials. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.027974 ThrombectomyGenerally the neurointerventionalist does not pursue thrombectomy beyond the MCA (M2 region), sometimes depending on anatomy. ASPECT ScoreThe ASPECT Score (Alberta Stroke Program Early CT Score) determines the volume of subcortical and cortical infarct involvement via perfusion study. Generally the score provided is 1-10. Anything less than a 6 portends a poor outcome. More early changes seen on CT suggest poorer outcomes from stroke. Patients with scores >8 have a better chance for an independent outcome. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.016745 IV TPAIV TPA with thrombectomy is safe. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.568451 TNK appears to have the same efficacy as TPA. Single dose IV push over 5 minute infusion. Easier and faster delivery of TNK. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.025080 Institutions may have different absolute and relative contraindications to TPA. Practice should be guided by institutional protocol and consultation with neurology. https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000086 Secondary PreventionSecondary prevention of stroke with the aid of DAPT (Dual Antiplatelet Therapy) - usually Plavix and Aspirin. Patients with cerebra ischemia are at high risk for early recurrent stroke, and use of DAPT for secondary prevention is reflected in current guidelines. Good BP and lipid management is paramount for 2nd stroke prevention. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.028400 Scoring SystemsHAS-BLED score for major bleeding risk. CHA2DS2-VASc Score for artrial fibrillation stroke risk. Anti-thrombotic Therapy & Elderly PatientsChoosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls.https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/484991 Fall risk and anticoagulatoin for atrial fibrillation in the elderly: A delicate balance. https://www.ccjm.org/content/ccjom/84/1/35.full.pdf  

Episode 39: The Ins and Outs of Antiphospholipid Syndrome With Guest Dr. Jill Schofield In this episode, guest Dr. Schofield discusses Antiphospholipid Syndrome. APS is a complex multisystem autoimmune disease. It is often comorbid with Lupus. It can be primary or secondary. Females are more likely to have APS than males. It tends to occur more in younger females. Women are more likely to have memory loss and migraines than males. This is a lifelong disorder, although as one ages, the antibodies might go away.   Symptoms can include migraines, memory loss, stroke, POTS symptoms, seizures, blood clots in arteries or veins, and severe pregnancy complications. It is helpful to go to a doctor to investigate for APS if they have livido reticularis, refractory migraine, pregnancy issues, Raynaud's, memory loss in a young person, thickening of the heart valves, family history of autoimmune disease, personal history of autoimmune disease, nonspecific white matter changes in the brain ,low platelet count, recurrent stress fractures, and/or avascular necrosis. Beware because APS is an MS mimic. Usually, APS is kicked off by some sort of trigger. POTS and migraines often start around the same time. Plavix, aspirin, or blood thinners can help significantly with migraines. Potential pregnancy complications include miscarriage (often late), stillbirth, recurrent early miscarriage, preeclampsia, eclampsia, and/or intrauterine growth restriction. To minimize those effects during pregnancy, doctors often prescribe aspirin, Vitamin D, heparin, and plaquenil, and do close monitoring of the pregnancy and fetus. Other common nonpregnancy-related complications include stroke, blood clots, stress fractures, and heart attacks.     Dr. Schofield discusses the many problems with the current diagnostic system of APS. A person is diagnosed by having clinical symptoms of APS and positive antibodies for APS. If you have APS symptoms and you start having new symptoms of a clot or neurological symptoms, get checked out ASAP to ensure that you are not having a clot or a stroke. She also recommends thromboprophylaxis after a surgery or after giving birth.   Links: Center For Multisystems Disease Migraine Paper Dr. Graham Hughes   Website Facebook Instagram Email Twitter     Please subscribe to our podcast in the iTunes store, or wherever you find your podcasts, Leave us a 5-star review, to help us know what you like and what you don't like, and to make sure other like-minded people find support through this podcast. Hosted by: Jessica Temple  Music by Antarcticbreeze Music Disclaimer: Our show is not designed to provide listeners with specific or personal legal, medical, or professional services or advice. Listeners should always consult their health care provider for medical advice, medication, or treatment. Copyright 2021 Jessica Temple

#AI #FutureofMedicine #EricTopol Dr. Eric Topol M.D. is a Physician-Scientist, Author, Editor and is The Gary & Mary West Endowed Chair of Innovative Medicine, and the Executive VP, Scripps Research. We discussed the meaning of life, ways for Artificial Intelligence to improve patient outcomes…and concomitantly, benefit physicians too. We explored the ethical imperatives incumbent on doctors— is it ok to exaggerate medical benefits/risks to incentivize greater patient participation. We closed with his concerns about Elon Musk's long-term space travel from a medical perspective, including his thoughts on the Kelly twin astronaut study. Support our Sponsors LinkedIn Jobs! Use this link to post your first job ad for FREE LinkedIn.com/impossible biOptimizers for better sleep https://magbreakthrough.com/impossible 00:00 Introduction 00:05:14 Why is teaching resistant to change? 00:11:44 How do you handle authority bias? 00:15:26 What do you think of the possibility of artificial "life"? 00:19:44 What is deep empathy? 00:22:40 Why is there a global physician burnout crisis? @Ali Abdaal ‘s Survey of Disenchanted Doctors 00:25:28 The problem with the unsustainable healthcare workforce. 00:31:44 About virus genomic sequencing and the Delta variant. 00:41:10 What new, non-invasive sensors for acquiring patient data may become available? 00:49 54 Final thoughts on COVID Get Eric's answers to my Thrilling Three Existebttial questions Please join my mailing list; just click here

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN The body system we continue to cover is gastrointestinal and omeprazole, esomeprazole, lansoprazole, pantoprazole are all proton pump inhibitors PPIs.  TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd Suffixes Omeprazole (Prilosec) with the -prazole suffix, p-r-a-z-o-l-e suffix is a true proton pump inhibitor, abbreviated PPI. We want to watch out for aripiprazole (Abilify) and brexpiprazole (Rexulti) which are antipsychotics, not PPIs but have the -piprazole ending, p-i-p-r-a-z-o-l-e. Also, some drug cards say the ending is -azole, but that is not an actual suffix, that is a chemical group, using that ending might have you confuse antifungals like fluconazole (Diflucan) for PPIs, so again, the PPI suffix is -prazole. You will notice that omeprazole (Prilosec) and esomeprazole (Nexium) are very similar and it's that omeprazole contains two molecules, a left and right mirror image and esomeprazole only contains the left-handed image. In Latin, left is sinister, so the “es, e-s” represents that only left-handed side. Why does that matter? That left-handed molecule is the active molecule. Mechanism of Action (MOA) PPIs or “prazoles” work by blocking your stomach's parietal cells which normally release hydrogen ions contributing to the stomachs' acidity. This, without the proton pump inhibitor, could lead to heartburn or possible GI ulceration. The proton pump inhibitor blocks the hydrogen/potassium ATPase pump preventing protons from going in the stomach. This raises the pH, making it more basic, and removes the excessive acid. Indications We then use proton pump inhibitors to manage heartburn, gastroesophageal reflux disease (GERD), peptic ulcer disease, and Barrett's esophagus. Barrett's esophagus is a condition where the acid reflux damages the esophagus causes it to redden. Many times patients who are on chronic NSAIDs or anticoagulants have a higher GI bleed risk and a proton pump inhibitor is for prophylaxis rather than active treatment. Dosing Traditional dosing is to give the PPI 30 to 60 minutes before breakfast. A concern comes when the medication does not seem to work, but it is not the medication, rather, the patient is taking with or even after breakfast. Make sure you know which is which. Also, H2 blockers work a bit more quickly, so the patient might expect a similar timetable with a PPI, let them know that it will take a bit longer. Clinical Considerations Acute use for a few weeks, especially with over-the-counter lengths of time, usually 2 weeks, tends to cause few side effects. Long term, however, we have concerns of B-12 deficiency, increased fracture risk, C. Diff, an opportunistic infection. Again, B-12 deficiency comes because the now less acidic stomach does not do as good a job at absorbing B-12. Before we start this section, here's a reminder contrasting enzyme inhibition and enzyme induction. A drug that inhibits and enzyme blocks the enzyme somewhat increasing drug levels making the patient toxic. A drug that induces and enzyme, makes the enzyme work better reducing drug levels and making the patient subtherapeutic. CYP2C19 inhibition can happen with citalopram (Celexa) and escitalopram (Lexapro), so in this case the antidepressant drug levels can go up leading to QTc prolongation. That's why we have dosing maximums on citalopram of 20 milligrams daily with someone on omeprazole. CYP2C19 induction with omeprazole and clopidogrel (Plavix) is one class example as clopidogrel is a pro-drug and by inducing the enzyme to break down more clopidogrel, the enzyme lowers clopidogrel levels. A pro-drug is one that is not quite the drug yet, the liver may have to metabolize it into a drug. Clopidogrel itself is an antiplatelet drug, so reducing the effectiveness of an antiplatelet drug while trying to prevent myocardial infarction (heart attacks) and strokes.   Note, prescribers can use cilostazol (Pletal) for intermittent claudication, a problem with blood flow in the legs where they might be in pain for short distances and the drug allows them to walk further is also a concern. Using lansoprazole or a similar PPI might create a favorable effect. Some drugs need an acidic environment for absorption like iron supplements and lowering the acidity runs counter to the best situation for iron. Adding ascorbic acid, vitamin C can help. Cefuroxime (Ceftin) is a second-generation cephalosporin antibiotic with good gram-positive coverage, but one might change to another antibiotic if they see omeprazole in the chart. Mesalamine (Pentasa) for ulcerative colitis and itraconazole (Sporanox) and antifungal both both benefit from an acidic stomach.    

Eric Rieger  0:00  Gut Check project fans and KBMD Health family. How are you doing today? It's your host, Eric Rieger, soon to be joined by my co host, Dr. Kenneth Brown. This is episode number 56. And if you've heard 54 and 55, which we've gotten plenty of email about, thank you for all of that. You know that 56 is kind of the combination here. So we're talking about issues around erectile dysfunction, and more or less kind of the catalyst that causes it as it pertains to inflammation and systemic disease and certainly virus infections. So that being said, go ahead and dive in here to 56 I think that there's a lot of hope here. There's a lot of things that people can actively do to stave off some of these manifestations because that's what erectile dysfunction is it's it's a signal that something else is happening. So without further ado, let's get to our sponsors. Of course there is artron to get your daily poly females that are trying to go to love my tummy calm again. It's love my tummy, calm us, slash KB MD and get your daily poly phenol today developed by my co host, Dr. Kenneth Brown. Dr. Ron teal is chock full of polyphenols does not matter if you have gut issues if you suffer from IBS or related symptoms or you're just a a an active athlete and you want to optimize your daily health so that you can be your best you need polyphenols, there's no way around it. So are trying to go to love my tummy.com slash KB MD. You got great tasting food, unrefined bakery go to unrefined bakery.com because it does not matter. If you have a specialty diet or not. unrefined bakery can make things available to you that maybe you thought were now impossible because you are celiac, or because you're paleo, or because you're keto? No, they have cracked the code using all natural ingredients. Go to unrefined bakery.com Get yourself some bread, get some tasty, tasty bread, knowing that you're both celiac and paleo. You can do it there. And it's gonna taste great, so unrefined. bakery.com use code, gut check and save 20% off of your very first order. They delivered to all of the lower 48 states even though they're based here in the DFW Metroplex of North Texas, so unrefined bakery.com Last but not least, KB and D health.com. kb MD health calm is the home of the gut check project. That's where Dr. Kenneth brown makes available his own CBD as well as broccoli and artron. teal, so check out KB Md health.com. Use code GCP and save 20% off of any order at any time. Okay, without wasting any more of your time. Let's get to episode number 56.Hello, Gut project fans and KB MD Health family hope you having a great day. It's me Eric Rieger here with the awesome co host, Dr. Kenneth Brown. It's Episode 56, a continuation of 54 and 55. So, Dr. Brown, why don't you kind of set the stage for us?Ken Brown  3:32  Yeah, so this is part three of what we didn't really realize it would turn into a part three series, right? That part one of this particular series. So Episode 34, was that I was seeing so many patients that were coming in. And because of the job that I have being a physician against neurologists, they're willing to talk about certain things. They're young men that had never had issues were showing up with erectile dysfunction. months, like eight months after having COVID. They want to know if there was a correlation. Well, because of that, I started looking into things. And then we actually did find that there's some studies going on with this. And so it's going to be much bigger than what people think we're just a little ahead of the curve on this. So Episode 54 was about how it's doing it. Episode 55 is a natural ways to try and protect yourself and Episode 56. It's a continuation of that. As it turns out, there's tons of science on this. And if you just look and you know where to look and you have access to people that can get these articles. It's fascinating. fascinating, because what we're talking about is not just a reptile health, we're talking about overall health. Every one of these topics that affect Well, if something affects your penis, it's probably affecting other parts of your body.Eric Rieger  4:44  Yeah. If that were to happen, it would probably affect your mentation, your mood, your drive to do a lot of things. So yeah, it definitely it's everything is universal. Everything that seems local is really universal. Yeah, vice versa.Ken Brown  4:58  Yeah. So it's We're gonna go over some really cool stuff today.Eric Rieger  5:02  So just briefly personal Eric anything cool going on man we're still remodeling kids are fine. Marie's on a, she took a trip to Montana she's on her. They were hired her social media conglomerate that she built is the Montana filming awesome stuff that probably looks different than a GI sweet I kind of wish I was looking at it.Ken Brown  5:23  That's awesome. For me. Same stuff we're remodeling, no big deal only issue is is that with some countries in some states having different COVID stuff, my kids want to start traveling more, but I don't know if that particular country would is going to cancel the tournament. And I'm trying to rearrange my schedule to go and book flights. It's just so annoying. And what a privilege to say that the what not, I mean, honestly a privilege to say it's annoying that I'm trying to plan a trip, although I'll be extremely important for my kids. We're in a position here in Texas where most of the economy is opened up. Oh, yeah, yeah, there's still places where everything shut down. So if you're a restaurant owner in New York or California, it's still super difficult. And I'm kind of complaining about the fact that I can't book a trip because I don't know if that country is going to, you know, do some blocking haveEric Rieger  6:18  been talking about this today. But before you walked into the room with one we had a patient from Canada, originally from Canada, so as a sister who lives there, and she was sharing with us that they are still you it's almost like textile blue laws out there every day. So you can't go into a Walmart and shop on the side of their textileKen Brown  6:38  blue laws. Me. Ah,Eric Rieger  6:41  so then in the old days, and I think even a New Jersey, in this, it's changed, it may still be the same. On Sunday. You can't buy certain textiles. Really? Yeah, it's just a blue law. I mean, I don't I don't know. I don't I don't want to talk out of turn there. But back in when I was really, really young, you couldn't couldn't go into a mall and shop at like a dillards was closed on Sunday. So yeah, I we don't do that anymore. No,Ken Brown  7:07  we don't cuz that's like the only time I'd be willing to go to a mall, like, really early. But, but really, Mother's Day anniversaries come on? Yeah, I have the moles that are, youEric Rieger  7:20  know, no one in my household. But what was interesting is she said that in the Walmart, for instance, is kind of a universal way to break it down, that they have blocked off or quarantined off, anything that's not food related. So you go into the store, and you'll see everything rubbed off, you cannot go over there to make a purchase or anything like that. And that's it. That was in Ontario, Canada. So I don't know if that's universal for the entire country. She just knew what her sister was relaying. And so if you're watching this, this is recorded. May 19 2021. It's starkly different here in Texas, where our governor released here recently that we're at the at the low, and everything's pretty wide open,Ken Brown  8:06  it's pretty wide open mass are no longer require they're suggested. And I don't think we're seeing a big bump. I talked to the doctors at my house. And they're like, no, we're not seeing a big bump COVID. Now, of course, IEric Rieger  8:17  live in a more rural setting in you do. And as far as what people say, is wide open, quite frankly, 1010 miles west of me is, I think has been wide open since a year ago.Ken Brown  8:30  It's just it's fascinating. Because we're gonna look back at these things. We're gonna look back at our first COVID episodes. Oh, yeah, we were with everybody else. But I felt like we were looking at the data ahead of the data that was being discussed on national news in Fauci and all these other people, because, shockingly, we were pretty spot on the whole time. And I think I hope that people when they walk away from this podcast can realize that this is not a politically motivated, or really, I think that a lot of things that we come to we don't know what the answer is going to be, or are certainly open to the we're going to change our mind.Eric Rieger  9:05  I think in a moment, you're gonna ask me a little bit about cbds, kind of the heads of he gave me but I'm not really sure where we're going. But years ago, you and I both had doubts if it did anything. And now I would say that we were open enough to try and you've got to be able, I think, to be intellectually honest with yourself when you have something new or information to make sure that you're receiving it, and you're evaluating it and not just putting up a wall because it disagrees with where you are currently.Ken Brown  9:34  100% I mean, I think that that is when you talk about the cognitive dissonance, or Oh, yeah, how's your views are different than mine? I'm going to shut you off before you're we did a whole episode on anger or agreement and how much of your brain gets occupied when you disagree with somebody and you're trying to combat it? Because you one of the things I notice, in fact, I noticed this with this podcast, because I heard I heard Joe Rogan talking about it, you know joselyn To be a really good listener. I mean, one of the flaws of what we do here is that I have all this science, I want to make sure that we get through in a timely fashion. And sometimes when we're talking and we can have like, great conversation, I'm kind of looking at my notes going, Okay, well, we need to make sure that we cover this because this is this was on my agenda. Sure. I'm listening to you. And now just realize that I do that I'm going to work on that I'm gonna work on listening, as his most recent guest said, We teach in school. reading, writing, arithmetic, and speaking and listening, but not listening. Yeah.Eric Rieger  10:37  All right, I certainly younger version of me definitely could have been a much better listener. And I think it's active. I mean, I'm not even trying to be funny. It just, as I've grown older, I've learned that listening is a skill, listening to someone tell their story. And even though you feel like you have a story that relates to them, if they're really airing out something, don't try to match their story, just listen to them. And that's, that's I mean, quite honestly, it's been difficult for me growing up because you feel like you're building a common bond. Oh, that happened to you. This happened to me. But you can see where that goes. When you're really young. It turns into a one upsmanship. And then eventually, you're like, well, I don't want to tell them anything. They just tell me what they did was 10 times better than what I did.Ken Brown  11:21  Yeah, I'm really, really guilty of this, as pointed out when on my 50th birthday met Jr. and Brian, and it was the running joke was me storytelling. It's just like, oh, you went 10 minutes without talking to your boss. Like, oh, yeah, I'mEric Rieger  11:40  gonna work on that for now. Hey, man, but the greatest thing is, it's not that you did or didn't do it in the past, it's in everybody can do it. And it doesn't have to be about storytelling. It's, what is it? Who do I want to be? And how do I get there? And what things can I improve to make it easier?Ken Brown  11:54  And as we're always doing the show, all these things are mental improvements that people do. But there's so many times when people have health hindrances that have pain, or they're not sleeping well, or that is the least of their concerns. Definitely, you know, I mean, I try and control my diet, I try and meditate, I try and do some breathing exercises on a daily basis. But it's because I have the luxury of not having severe health issues. That is not the primary concern, right, because I went for about two months, as we discussed last time, where my primary health concern was my severe neck pain. And that just shut everything down. And the only thing that I could really wrap my brain around was okay, you need to figure out how to not panic, right. And by practicing those things leading up to this, when that happened, I felt like it kind of helped me get over the acute phase of it. And now I'm into this kind of new aspect of now we're rehabbing soEric Rieger  12:55  and I don't want to derail that. analogies are just something that I've always liked. And we You and I both build on these throughout every single episode, we find an analogy, but something that was realized that occurred, I can remember being young, and we were complaining in elementary school, it was it was something really silly had to do with participant participation, and how you could earn to be the first one out at PE or something like this. And there was someone in our class who I didn't feel like it, several of us didn't feel like it earned the right to do it. And then quietly, our teacher pulled us aside and said, this is the best thing that's happened to her because she doesn't have a home. Like what you have, and I started thinking a lot was wanting to get to PE first she just wanted a place to sleep. And when you're young, that kind of context is important because I mean, yeah, it was kind of shoved in our face, but it shows you that your I don't know I don't know how to put it the immediacy of what you think that you need or want. Sometimes somebody else may need or want that same thing but at the same time they don't even have you said your health so that you could do the exercises to feel good sometimes you don't have the base things that allow you to Oh, Peter, just do whatever. Oh, let'sKen Brown  14:17  talk about I mean generosity feeds right there. 100% I mean, generosity feeds Ron Kobani feeds kids that normally only eat at school, those are the only meals that they get when they go home on Friday. They don't eat until Monday. And recognizing that need and spending his life to correct that one. small niche is just amazing to me. 100%Eric Rieger  14:43  and shout out to Ron generosity feedsKen Brown  14:46  Yeah, and we're we're avid sponsors and have been for the last couple of years and I'm just so blessed to have met people like that, that inspire me to be a better person.Eric Rieger  14:54  Yeah. Now didn't want to derail But anyway, that just popped in my mind. Yeah. You know, you got That's what this that's what I think that we're talking about though how do you get to the point where you can make better decisions for who you want to be and how you want to be there and a lot of that comes from take care of your if your physical health and it will allow you to do that.Ken Brown  15:14  Yeah, that and you know, be open minded that the maybe your initial ideas as you grow and experience them What ifEric Rieger  15:24  when they can't be open minded because your physical health is bad. AndKen Brown  15:27  one of them that's today was today was open minded lesson I came across it You and I were we're scoping today and I came across an article, which I thought was entertaining. And then you became academic on me, which then now I'm like, Oh, I just want to gloss over right now. As as, as a fellow there's, you know, you go to residency and then you go to fellowship. So you do three as a residency three is a fellowship, depending on what you do. And it became a running joke between all these people that I basically did. I don't even want to compare it. But as we've discussed before, when you rush or go through basic training, or you do residency, you get very close to these people, because you're all have this common bond. Oh, yeah, you're kind of getting beat down a little bit. But you're doing it together, but you're doing it together. Yeah. So in residency, I had friends that became cardiologists nephrologist. I'm a gastroenterologist. And there would always be this running joke about who has the smartest organ, silly, nerdy arguments, the kidneys smarter than the GI tract, and so on. And I would always go will the anus is the smartest thing, it could actually determine, can your organ determine the consistency between a gas liquid or solid? No other organ can do that? No. So I've always said the innocent, smartest. And I was gonna joke around about how a new study just came out that basically makes my system the winner. And it starts with, I kid you not, it's a bunch of new sites that have come out citing a scientific study out of Japan, saying how mammals, mice and pigs at least have the capability of breathing. They said breathing through their butts was the title. I had to stop and looked at it. And it was an Associated Press article, or a BBC or a New York Times, they're all jumping on this, because it's a bit of clickbait. And you and I were talking about it today. And I said, Yeah, basically, the rectum, or the distal rectum absorbs is anything that's put in there so readily, that this, the scientists figured out that they could hyper oxygenate the rectum, while not allowing the animal to breathe. And the animal stayed alive and corrected, its hypoxia. And then you started asking all these scientific questions as an anesthesiologist should?Eric Rieger  17:51  I didn't know, I was just curious if oxygen going in is a very, very important part of the process. But at the same time, what's the vehicle or the means for the waste gas, co2 and other things to be blown off? Because as co2 builds up, you become more acidotic? And that's where organ systems can, you know, this is a gastroenterologist, they can fail. So they become too acidotic. And that becomes a problem. However, it turns into, I think that that question we were like, like, this isn't just a joke topic. This is something that Yeah, soKen Brown  18:25  I came in with a joke, I was gonna make fun of it. And they asked me questions. So then I had to do the thing that we do. And I tracked down the original article. And it's thick, and it's beautiful as the scientists should not be made a joke of which is what their bit what's being done. I guess any press is better than no press. But it's quite elegant. And I would like to discuss this in the future where you walk through this article as a, a expert in the acid base physiology due to your anesthesia training into how you can oxygenate, but it is kind of an interesting phenomenon where maybe we could use something like this instead of making fun of it and look at that and say, Look, in certain situations, maybe some form of rectal oxygenation hunter says, You and I talked about, because we're really into rectal delivery of other things. So which, which, honestly, decades or centuries ago would have been odd to think that you can actually give a medicine through the rectum. That doesn't make sense, right? Yeah. SoEric Rieger  19:31  someone did it. They demonstrated that it works. So obviously, they may be getting made fun of today. But who knows, if somebody has an injured lung? Maybe this is a way that you can help someone who's in distress. And I can't imagine one's going to do it voluntarily.Ken Brown  19:46  Why No, I mean, like, I mean, who knows? 50 years from maybe they will 50 years from now you may walk into a hospital code saying where the patient's crashing, and it's just like we need mouth to buy Right nowEric Rieger  20:00  I won't work. I will not work there. I've been called things where maybe people have thought that I must breathe through. NowKen Brown  20:10  that is, so that is an example of just being I came here to make fun of it. And then you started questioning the science. And I went, you're right. Whoa. So we'll talk about that some other time. I changed my mind, I'm I am accepting that. I should not hang on to certain ideas, because our knowledge changes our experience change. And if we as everyone should not just completely hang on to idea because the idea is not you. It's just an idea.Eric Rieger  20:42  Yeah, that's, that's a really good point. And I would also add that if in 10 years, I have all of the same beliefs and whatever that I do today, that I'm not grown. I'veKen Brown  20:55  learned nothing. That's a Mohammed Ali quote. I wasn't really Yeah, it really is. It was he? He's, he's a boxer. No, I think he was actually quoted as saying, Do you feel like you're the same man now than you were whatever, there were there. Were kind of implying that you're, you're 40. And it was 30. And his response was, if I'm the same man, I was then then I just wasted 10 years.Eric Rieger  21:17  Oh, yeah. Oh, I've heard that. Yeah. But I'm sure that's subconsciously in there somewhere. But no, I feel that way. Because I'm not the same person that I was 10 years ago, or 20 year old me, probably and I hate I wouldn't be free. Anyway, so what's up?Ken Brown  21:35  Alright, so let's get into some other cool stuff. We're gonna, we're, you know, this is the part three. It's there's a little bit of science here, but it all makes sense. And I want if you're listening to this, when I keep talking about the different aspects of either reptile dysfunction, or the CNS, or the endocannabinoid system, picture, how it works everywhere, it's not selective. That's the key to this. People are not putting this together, they're not realizing that you can take control of your health in a natural way. And it's not conjecture, it's based on science. So that's what this is. Okay, so to recap, in part one, erectile dysfunction, we showed that inflammatory damage from COVID actually causes erectile dysfunction by affecting the endothelial cells, which is the lining of the blood vessels. Part Two was how effective poly phenol zz are in working as a potent anti oxidant and blocking inflammatory pathways, which ultimately increases nitric oxide, and also activating the cert one pathway. So after we get done with that episode, okay, you and I went to the next room, and you started asking me all these questions about nitric oxide?Eric Rieger  22:55  Yeah, I did. Because you had, you had initiated, something I didn't. I didn't know. And I don't even know that I fully understand it. But that nitric oxide can exist in different forms just as the compound itself.Ken Brown  23:08  So as it is, it's like, shit I didn't have to answer. And so I'm like, Oh, my gosh, now I got to go down this, this, you have to lay the foundation to be able to understand everything else.Eric Rieger  23:17  Yeah. And just to add, you had labeled nitric oxide, and essentially, there was neuronal nitric oxide. I've already forgotten the other two thatKen Brown  23:27  I'll go through right now for you don't even worry about it. Because I think that's what that is the really cool thing. So when people talk about nitric oxide, one of the things that I have heard before and in our adaptive or in our innate immune lecture, we talked about how nitric oxide can actually be a pro inflammatory. And so meaning you can cause inflammation. So now I figured some stuff out. To make nitric oxide, there has to be an enzyme called nitric oxide synthase. These are a family of enzymes that catalyze what they do is they're the thing that makes the reaction happen to produce nitric oxide from an amino acid called l arginine. So nitric oxide is a cellular signaling molecule and it helps modulate tons of stuff like vascular tone, insulin secretion, airway tone, peristalsis, which is gut movement, and it's involved in angiogenesis, which is blood vessel growth, in addition to that neuronal development, meaning your neurons, and shockingly I did not notice it works as a neurotransmitter as well. So basically, we're talking the whole body. It does unique things in unique places. So as Eric was mentioning, there's three main types. There's inducible, nitric oxide, I nos. So I nos is a pro inflammatory nitric oxide synthase enzyme. So what it does, it helps acute insults so if you get infected by a virus infected by bacteria, your ionos will go up. And during an acute infection, it helps get rid of everything thereEric Rieger  25:09  does want to clarify, you're saying that's the enzyme not nitric oxide, I nos is the enzyme,Ken Brown  25:14  yes or no. So as it turns out, an imbalance of nitric oxide will result in oxidation. But we're going to get into this. And this is where it gets really neat. The AI nos has a specific role in making sure that there's an inflammatory process that happens. Okay, so I'm just saying that nitric oxide synthase. So if you're out there buying supplements, and you're like, oh, man, it's increases nitric oxide. You want to know, how is it? Yeah, arginine is at the substrate. Yeah, because if you're somebody with chronic inflammation, tons of inflammation that's going on, and you start beating yourself, Argentine, theoretically, you could be feeding your ionos. Because, like an acute infection with a bacteria or virus, you want this to happen, because you want to squash that. But if you have chronic inflammatory cytokines going on, it will actually induce more eyeness. So in other words, if you're chronically inflamed, yeah, taking Argentine could be fueling the fire that's doing it. So if you have chronic inflammation, I nos has been been associated with creating more of the inflammatory cascade, which results in more ionos, which results in a vicious circle. Ultimately, I nos is been implicated in being very high in autoimmune disease, Parkinson's, Alzheimer's, multiple sclerosis, and even strokes. So when we talk about nitric oxide, it is all about the balance and about where it's happening. And Angie sent me a really cool article explaining specifically about how certain cytokines will induce ionos. But that's irrelevant. Bottom line is, if you are chronically inflamed, and your eye nos is using this against you, so it's using your fuel against you, you have to stop the chronic inflammation first.Eric Rieger  27:05  That makes sense, though, because the probably the most notable activity of nitric oxide on its surface, regardless of where it comes from, is basal dilation and a key part or key component of an inflammatory process just like carrying away anything else is recruitment, recruitment of cytokines or whatever needs to be so it makes it makes sense.Ken Brown  27:26  Yeah, that that actually makes sense. And that was surprising to me, because I did not know about this until I started researching for this. The second type that we talked about on the second episode is endothelial nitric oxide, e nos. This is found in the lining of blood vessels. This aids in tissue repair, regeneration. And the key here is it enhances blood flow, and I did not know this. It dissolves plaques. Hmm. And it will dilate the blood vessel. Yeah, so we talked about this during the poly phenol episode. And it does this by several different ways, but it dramatically activates endothelial endothelial, nitric oxide synthase in us. And so that's one of the ways that does it. And another really simple way to do it is to have is to go exercise when you exercise, you release enas. And that's what allows for the blood vessel dilation and everything. Okay, I bring up the plaques because as we sit there and talk about if you have coronary artery disease, and you're put on Plavix and things like that, nobody's discussing this. Now. How do you turn on your emails, it gets rid of plaques increase the blood vessels. It's doing what these pharmacologic agents are hoping to do without the side effects of a cerebral bleed are these different issues? Interesting something to think about? If you can turn on the enzyme, which does this, then you can do it through exercise and or through various things. We're going to get into all of them.Eric Rieger  28:58  Something just popped in my head. Of course, we've talked previously, you've probably year and a half ago, about different diet intervals, fasting and intermittent fasting, and how those have been shown especially like water fasting for over 72 hours, I think it is, can demonstrate or they've shown that you can I think valter Longo talked about you could initiate the decrease in plaques and stuff like me. Is that related, do you think to enough? Actually,Ken Brown  29:30  I absolutely think that there is something about that. I think that there's some other components to it. Dr. William Davis discussed how as a cardiothoracic surgeon or cardiologist remember what he is. But he said that he's taking people that had 90% plaques and put them on a five day fast and then redid their AMG grant angiogram. Yeah. And it was clean. So there is something to this. So if you're going to do this, and if you have fast you turn on, I mean, I'm speculating. Now if you turn on your stem cells and you increase The nos, you're going to you need something to clear the plaques. Yeah, dilate the blood vessels. So you don't cause a clot. Think about that. It dilates. And if you've got plaques there, it shifts them off, and it's in a big pipe, so it doesn't stick. Yeah. If those plaques shear off into what we discussed in the last episode, where it creates the bumps, hung up is the thumb over the hose thing. It's the thumb over the hose. It'll just block it. So enough, very important. Interesting. Now, you and I are always about the brain. So now let's talk about neuronal nitric oxide and nos. This acts on the brain in the nervous system enhances the ability of the brain and nervous system to adapt to change, and enhance the communication between neurons and to recover from insult. So enmasse modulates neuronal function through release of neuro transmitters, when you said earlier, is that the nitric oxide, they have actually proven that and nos can do things directly. Okay, I nos can do things directly. He nos can do things directly independent of nitric oxide. Wow. Okay. And they get turned on for different reasons. So this has been shown to be involved in long term prevention of depression, and improved memory formation. So when you have en nos going on, and it's also part of the neural plasticity and regeneration. I'm a big fan of the Huberman podcast and he, his whole, his whole theme is neural plasticity. And this guy hasn't even talked about this yet. talks about everything else, but I'm like, calm and start talking some and so if you if you know him, or whatever it's yell, you know, you're not even talking in nice, man, you're just scratching the surface. But um, you could say it like that also. Alright, so here's the part that we were confused by. Okay. So your question to me was, I don't get how nitric oxide functions differently in different places. And I just stared at you blankly after our episode notEric Rieger  32:06  clarified not just as a molecule unless it's being contained, or specifically only releases certain time that that was that was our discussion.Ken Brown  32:13  Yes. So as it turns out, nitric oxide is nitric oxide. Okay. So it's not like there's different nitric oxides that we know of right now. But the different nitric oxide synthase is caused different responses. So first would be the amount of nitric oxide produced too much, and you can't clear it, it becomes a pro inflammatory,Eric Rieger  32:36  oxidized, right?Ken Brown  32:36  It'll oxidize, okay. That's the first thing and the second that each type of these enzymes can actually have a direct effect on the cells in the local area. So like, in the case of ionos, it can actually increase oxidative stress through superoxide production, or en nos can have direct neurotransmitter capabilities. So a lot of science just there. It's allEric Rieger  33:02  brand new, but that that brings some clarity thatKen Brown  33:05  it brings some clarity, which which will bring clarity to all these other studies I'm going to bring up and we're going to go through really quickly and by all I just made a few, but it it reiterates that what we're talking about and what you can do for your health is based on scienceEric Rieger  33:18  now that's fantastic.Ken Brown  33:20  Okay, so while I was figuring out all this nitric oxide stuff, this is actually where this went down a rabbit hole. I kept finding studies that they kept discussing the endocannabinoid system and nitric oxide. And I ended up going down some rabbit holes and discovered some studies on how cannabidiol CBD and the endocannabinoid system is involved in this whole process. And ultimately, how it relates to erectile dysfunction because if you're like this is part three of erectile dysfunction. I haven't heard anything about that yet.Eric Rieger  33:52  Yeah, well, it is where we talk to them as part of an inflammatory process check jack and is the ECS and have a problem with with too much inflammatory process? Yes, yes,Ken Brown  34:03  sir. It does. Alright, so ECS? endocannabinoid system. Eric, can you just recap what it is? Oh,Eric Rieger  34:10  no cannabinoid system we have it all throughout our entire body. It basically is the copyright strikes the balance between reacting to something but not overreacting. Let's see here. You got to get some some cannabis. Or I'm sorry, I'm gonna say the right the neurotransmitters that we have or the cannabinoids, endogenous Canada in the largestKen Brown  34:31  categoryEric Rieger  34:33  was tripping over my own words but so you've had an and amide into ag. There's the two main ones and then to augment that activity, you can take exogenous which means you consume it. cannabinoids, THC and CBD with CBD being the one that we legally use to attenuate or lessen issues of inflammatory process, absolutelyKen Brown  34:56  by increasing your own endocannabinoids and probably a little bit of direct stimulation as the science becomes more but yeah,Eric Rieger  35:03  see it so and like everything in the body, you know, neurotransmitters are consumed by enzymes. And so what CBD they think does it doesn't necessarily replace an end of mind, for instance, but I think what it does or it can do is it will stop some of the hyperactivity of the enzyme that gobbles up an animal.Ken Brown  35:24  Correct. So I think that's pretty much what you I think that's exactly what I want to hear. Yeah, that's, that's exactly. Alright. So knowing that the endocannabinoid system, if you've not read about that, or if you've heard some things about CBD, that it's shocking how much science there is on all of this, and how nobody really talks about this. And it changes and it changes. And it changes when scientists do stuff. But let's talk about this. Alright, so I found some really cool stuff going down this rabbit hole. At first, they were talking about three studies briefly out of the same university in Egypt, because I think that they knocked over the first domino and went, well, what happens when this happens? What happens when this happens? And it's actually really cool because it applies to humans directly. So the key to all these studies is how the nitric oxide synthase pathway was regulated, and it's regulated independent of the colon nergic pathway, which in the episode 54, we went into great detail about Yeah, so in other words, it's another way to stimulate nitric oxide synthase these guys figured this out. Okay, so the first paper that they published, looked at how the CB one receptor interacts with enough endothelial nitric oxide synthase, they were able to show that the how the effect by increasing a Nandha mind, the endocannabinoid that Eric just talked about caused relaxation in the corpus cavernosa. corpus cavernosum are the spongy, blood filled vessels in your penis that allows for interaction. It was not through us through acetylcholine, which is how every other urology book describes erection. Yeah, now one medical book that I've come across actually talks about CB one doing this. So this is fascinating about this. So and it is doing this by actually increasing inas, the endothelial nitric oxide synthase. So by stimulating CB one through an and amide, they could actually show an increase of the e nos. And this resulted in increased corpus cavernosum blood flow.Eric Rieger  37:33  That's impressive. For a lot of different reasons. Number one, that no one's really glommed on to it or captured it. It's understandable that while you were in training that it hadn't been discussed at all, because I don't think that the the idea that an ECS existed until the 90s, so that that's okay. And so now you've got to figure out where all these functions are. But what what I found already and what you said is a change in science and really changing the way that I'm approaching it is I thought that for the most part, cb ones were in the CNS, or just the, you know, the brain and spinal cord.Ken Brown  38:08  That's a really good point. Yeah, because we've always been taught that they say that CB one is or I'm sorry, we haven't been taught in the most recent books have been published that discuss how CB one is more related to the neurologic aspects. These guys are showing that now send your penis also.Eric Rieger  38:21  Yeah, I don't even just started. Sometimes what we get accused of thinking withKen Brown  38:27  anyway, I gotta study for that also. So then the same group said, Well, wait a minute, we've just discovered something really cool. So they said, Well, what happens in disease? So they took some rats and they gave them cirrhosis? I'm not really to really get into the details, whatever, get into the, you know, like the methods of the study. Okay, so I picture a bunch of really cool rats hanging out at a bar for hours on end. They're like, Hey, man, we're just talking about we got this great lab gig and they didn't know that there that they were causing cirrhosis. I think it was done in a very different way. But I don't think I imagined it that way. Yeah, that you can imagine that way. I'm gonna imagine it that way. So what they did is they cause cirrhosis in rats, and then they were able to demonstrate enhanced relaxation of the corpus cavernosum those spongy tissues. In other words, they showed increased blood flow, when the CB one system was activated once again using an and amide then they wanted to have the cause and effect. And what they did is they blocked the CB one receptor, and there was nothing happened. So it was definitely related to the endocannabinoid system, not some other weird thing that we haven't figured out. This is the cause and effect of this receptor stimulation. So the unique thing about this is even in a disease state like cirrhosis, it helped these little rats to have directions directions. Yeah. Which is interesting because they're talking about cirrhosis. And remember the episode that we actually debunked how the FDA came out and said that CBD causes cirrhosis? Oh,Eric Rieger  40:04  yeah, I recall that. And it was completely erroneous.Ken Brown  40:08  Yeah, it's completely erroneous. And it didn't make any sense at all. Where is that we got one of those apps. I don't even know what episode it was. But we actually talked about that. And this is an example of Look, this is a way to take a certain disease, which generally has severe erectile dysfunction and they're like, now if you stimulate this looks like you can overcome it in different way. So that's cirrhosis, but you're like, ah, only a small percentage of drunken rats gets a very small percentage.Eric Rieger  40:40  But unfortunately, that's not true either.Ken Brown  40:44  But there's a there's a much higher percentage of donut loving rats that have Yeah, so they got so excited after that first study that they did a third study where they looked at the endocannabinoid system in diabetic rats Okay, then they showed on this study that the first thing is once they made the the rats diabetic, their baseline endothelial nitric oxide synthase, Enos was lower than all the non diabetic rats Think about that for a moment, okay, by having diabetes, your e nos is lower. In other words, your ability to produce nitric oxide becomes lessEric Rieger  41:25  Yeah, and and all the ramifications that you talked about what he nos actually does vascular, you're losing that ability, you'reKen Brown  41:32  losing it, it's not just in your penis, you're losing it everywhere, and nobody's talking about that aspect, which is, why don't we focus on something to increase the e nos. Alright, so by adding a Nanda amide, directly, they showed increased vascular activity in the corpus callosum and increased nitric oxide consistent, proportionally to the increase in nitric oxide synthase or enas. Now this part is really cool. When they added Argentine l arginine, which is a substrate to make nitric oxide, it synergistically went up. Make sense? So if you have a proper diet, and you are have a balanced endocannabinoid system, even if you have diabetes, your ability to have an erection is should go up based on these animal studies. And you know, we're not making any claims here. I'm just saying, based on these studies, it's super interesting to talk about.Eric Rieger  42:26  Yeah, no, it's it's, it's fascinating. I mean, and let's, let's call it what it is the the meds that have been approved to treat erectile dysfunction, they essentially they got here, we talked about the five different ways or the five different things that have to happen for an erection to occur. Essentially, what viagara is doing is it's stopping the phosphate arrays from breaking down. So this is what that that was a valid mechanism to address. This is yet another, in my opinion, valid mechanism to addressKen Brown  42:57  Yeah, so viagara doesn't work until you've arched actually formed the nitric oxide, right. So once you form it, you can have a longer sustained direction due to not breaking down the nitric oxide. man you got to get it started someplace. Well, one great way to do it looks like is to make sure that you have a balanced endocannabinoid system.Eric Rieger  43:16  Yeah, no, that makes sense. And I've never heard that before. And right now,Ken Brown  43:20  all of this is, all of this is new to me. I've got to be totally honest. And it was all sparked off of you asking you a question. I don't really get the whole, why you can act differently. And then this led to these things. Thank goodness. And that's what I love about hanging out with you is that you ask questions. You got to I mean, there's times where you're not been there and you're just like, Why is the sky blue? And why is why do my feet feel so heavy and I just have to look up everything.Eric Rieger  43:48  I can't even come up with something ridiculous.Ken Brown  43:52  Alright, so then, here's another interesting study by a totally different group. They were looking at it in a more indirect way. So your response of which head is actually responsible for the sexual function. These guys took some of this information and I bring this up, because this is looking at the end neurone the end nos process or the neuronal nitric oxide synthase. They looked at how the endocannabinoid system helps improve neuronal and Nos. and in prior studies, it was shown that a NAND amide helps not only form and nos, but it also works to drive the nitric oxide into neuronal cells. So and amide goes, Hey, and nos we need some more nitric oxide. They produce it and then of my grabs, it shoves it in a neuron.Eric Rieger  44:47  Maybe I'm leaving too far ahead, but this sounds like neuroplasticity could be enhanced simply with a healthy ECSKen Brown  44:56  100%. So in this study, what they did is they took neuronal cells. And they showed how stimulation of the CB one leads to a massive increase in neuronal nitric oxide. Now, if you say massive, Well, isn't that inflammatory? If you have something that puts it in a cell and puts it to using us, it's been you. Yeah, it's not accumulating. Yeah. So the CB one receptor and the N nos protein have been shown to be in close proximity. So, and randomize here, cb one receptors here, I'm sorry, the nitric oxide synthase stimulation is here, a Nana Midas or the CB one receptors here. And when they're together, this is where nitric oxide will help not only the neuron that they live in, but since it can move over, and it is nitric oxide, which is a gas I guess. It moves over and it can work in what's called a parrot grind function. In other words, it can help its neighbors. So if a cell gets injured, yeah, and sends a signal and your Endocannabinoid is healthy, it'll stimulate en nos and say, let's get some nitric oxide over here Help Help my friend who's just been injured. Fascinating,Eric Rieger  46:13  very, and that's the first time that there's been any of this is very superficial, but it's the first time I've ever felt like there's context or who was it that was talking to us about CBD, and that they were studying it for Ms stuff. Because if you're thinking about how ms functions and the breakdown, a lot of that comes down to the schwann cells file and and she's breaking my own sheath. And so you're you're losing transmission, you're you're leaking it's there's no insulation on the long nerve. So what if that role of CBD in part is that not only is it staving off inflammation, but it's actually allowing other neurons in the area to donate help to one that is distressed? I mean, we're leaving here. We don't have that in front of us. But I'm curious.Ken Brown  47:05  That's pretty much what they're saying though. Yeah, that's pretty much what they're saying, at least in this animal model that interesting. So yeah, so this is where nitric oxide can help the neuron that it's in, in the neurons that it's nearby. So because the two receptors are nearby, that's how they actually do this. And then this is the leap for the indirect erectile dysfunction. This kind of surprised me also, they actually act on the so this is we're talking about the endocannabinoid system, cb one receptors and act on the gonadotropin releasing hormone. So the endocannabinoid system can help with both the neuro component of erectile dysfunction as well as the endothelial component. So by releasing gonadotropin releasing a by stimulating gonadotropin releasing hormone that results in an increased testosterone.Eric Rieger  47:57  That's fantasticKen Brown  47:58  or estrogen because it's again, a trouble releasing Yeah, everything's in balance. Everything is not black and white is the yin and yang of the body and you need enough of everything. That's the beauty of the endocannabinoid system. It's our great balancer. Like you said it was the it's the traffic cop that says more or lessEric Rieger  48:15  Yeah, as fans. Fascinating I've never heard this stuff.Ken Brown  48:20  It's I was pretty shot. This is this is what's fun about doing this podcast is that you pose a question and then I'm like, dang it. I'm definitely not staying up because sleep is super important. If you don't sleep, you screw it up. But I will wake up early and go, Well, I'm not gonna work out today, I'm going to go down these rabbit holes. All right. And so oh my gosh, there's so much more research out there that we can't even get into today. But like, like this title of this article that was published recently, cannabis dial induces on top of G to protect neuro neural cells from mitochondrial dysfunction by up regulating cert one to inhibit NF Kappa beta and notch pathways. That's the title. So we've talked about all these things, and it sounds super complex, and nobody would probably ever read this, but it's actually a really good read because what they showed is that CBD protects neurons by turning on the cert one pathway, which we talked about last episode, causing a toughie G, which is programmed cell death in old and sick cells, while down regulating inflammation through the NF Kappa beta pathway. Sounds freakley familiar to how polyphenols do it.Eric Rieger  49:34  Yeah, it really does. I mean, and you can throw in there the cuz I think that last week, we labeled NF Kappa beta as the black hat cowboy. Oh, yeah. And then we said that the white hat cowboy would be a nerf to NRF two. And so it, it seems to me like these are simply complements that we are uncovering that could Be a far more natural way for your body to determine. Look, just give me the tools for the tool chest. I'll figure out what things goKen Brown  50:08  100% another article I gotta read this title because these scientists need always in the titlesEric Rieger  50:17  thatKen Brown  50:18  they need a marketing agent. Let's get this know that that breathe through your bot is all over the news.Eric Rieger  50:27  Yeah, that's a click. That's a clickbait clickbaitKen Brown  50:29  and it's way more than that these guys put a title that says CBG CBD Delta nine THC CBN CB g a CB, d A and delta nine t. h ca as antioxidant agents, and they're in intervention abilities in antioxidant action.Eric Rieger  50:48  It's important stuff and no one's gonna read that. Bob, doKen Brown  50:51  you want all that in there? Yeah, I want it all. We're all out of seas. Yeah, we're all out of seeds. Alright, so the title is too much. But basically what they presented was that they reported the antioxidant activity of CBG, CBD and all those other ones. And they present a data to prove that all the examine cannabinoids named exhibit potent anti oxidant activity in their ability to scavenge to scavenge free radicals to prevent the oxidative process. So very last episode, we're talking about how polyphenols are potent antioxidants. nobody's really discussing how CBD and THC and CBG are potent antioxidants. But they the whole study is how they actually do it, how they scavenge free radicals.Eric Rieger  51:44  And it's brilliant, honestly. And it just, it just lends more credence to why it's important to have a healthy ECS. I mean, I know that those are all exogamous that you read off, I think for the most part, but they from what I understand that ECS to date, they really serve complement to your Endocannabinoid. So exactlyKen Brown  52:03  an exhaust meaning these are the ones that we take in through our diet, or through smoking or whatever if, if it's that, but these are the ones that we ingest that actually do that.Eric Rieger  52:13  Yeah. Fascinating.Ken Brown  52:14  It's totally fascinating. And then oh, my gosh, one last one, because this one blew my mind, as I'm sitting there looking at these different articles, and you're reading through them. And it's the sad part is, as we're preparing for this, there's only so much we can actually talk about right here. But like, I want to call people I'm reading I'm like, Are you kidding me? This is nuts. Like I want to call the guy that made that title and be like, here's the deal. Next time you do a paper, let me write the title for you. And it'll be clickbait all the way his scientific colleagues will just be like, what kind of title is that? And it's just like, CBD causes you know, decreased baldness and it's like, but that's not really what it's about. It's about the telomeres and it's about you know, the the flu avian cells and he's like, Yeah, but and this guy said baldness, and I just want to Pulitzer. Yeah.Eric Rieger  53:03  I mean, that's really what it comes down to. You've got to get it language that someone's gonna read 100Ken Brown  53:07  Exactly. Alright, so we did a whole episode on Brock elite. We did. So love broccoli. It's on the KVM the health store. And broccoli is the really world's only stable sulfur fame product. We did this with David Roberts and dr. john Gill de wickedly smart people, both of them. That's Episode 44. highly suggest that you go take a look at that. Because of that knowledge that we learned on that show. I was I came across an interview quite a while ago actually with a doctor Jed Fahy who, what's her name, Rhonda Patrick. And he was discussing how his research was showing that a there was some similarities between a isocyanate called more engine is similar to sulforaphane not quite but similar. And his reasoning for this is that it's actually it's a tree that's very abundant in subtropical regions. And they should be looking at this for adding it to diets of certain things. Then remembering that I came across this article, which led me to start looking at various things. And this thing popped up anti inflammatory and antioxidant effects of CBD and more engine and lipid polysaccharides stimulated macrophages. So lipid polysaccharide is a protein on the outer. It makes up the outer shell of a bacteria. It's what our bodies react to. And it's also what causes inflammation. So what they did is they looked at how do macrophages, part of our innate immune system respond to stimulation when they're exposed to these lipid polysaccharides? In other words, when you feed a macrophage a piece of bacteria, what does it do? And they wanted to see how it reacts to pro inflammatory markers like TNF alpha interleukin. Sex etc. And they wanted to know how exposing the macrophages to CBD in one arm Morrigan in one arm, and then what happens if you put both of them together and see what happens. So remember that CBD has already been shown to have anti inflammatory anxiolytic anti cancer capabilities. More ringan is under this class of glucosinolates, like sulforaphane, and these molecules, these molecules are potent anti inflammatory regulators as well, in this case, it's called an isotherm cyanate meridian from the poly phenol Moringa. Okay, you see how it's all coming together here. Alright, so bottom line is the results are pretty cool. The pretreatment with either CBD or meridian resulted in significant decrease in anti inflammatory and antioxidant effects from CBD and more ringan separately, with decreases in TNF alpha, interleukin six and all the other inflammatory cytokines that we talked about. But when combined, they showed exponential decrease in inflammatory markers, while increasing NRF to white hat and good cytokines like interleukin 10. So the combination also enhance the nuclear intracellular level of antioxidants. So it KVM D on our store, we had the biohack combo, which is atrantil, CBD and broccoli. They did a study on the biohack combo. Yeah, they did. This is crazy. And it doesn't mean that you're not gonna be able to mount an anti inflammatory response. It's that living in the Western world, you're exposed to chronic inflammation. Yeah, chronic inflammation leads to all these things. So lots of articles, lots of rabbit holes to wrap up. We started with COVID, causing a reptile dysfunction and affecting endothelial cells. Then we went to how do you protect that by increasing e nos and decreasing inflammation with polyphenols? And now we've wrapped up with how CBD can help with this. And ultimately, the combination of sulforaphane plus the polyphenols and atrantil plus CBD, according to these studies, likely protect both your brain and your endothelial cells, ultimately, protecting your penis.Eric Rieger  57:22  Yeah, ultimately,Ken Brown  57:23  that's a lot of science to say, don't let COVID take your penis. Yeah, it'sEric Rieger  57:29  a lot of science to say exactly that we probably didn't even need to have you science to say just that.Ken Brown  57:36  Probably that one statement alone. Be like a T shirt.Eric Rieger  57:40  Yeah, we could have just said that, and probably called it a day. But now that, honestly, all of that is fascinating. It's informative. But it makes it makes sense. And even though it feels like that we go to like a local focal point to john Miller gets address interest. It just, it forced us to find out, like you said about nitric oxide and the different uses. And really, it's it's still universal. It's still universal throughout the entire human body. These are things that we need to be concerned about. And yes, we're talking about a penis today. But that process is happening there. It's the same thing that can be used to protect your brain, protect your heart, protect the rest of your organ systems, so that you can do what we were talking about the very beginning of the show, which is what kind of life would you like to live? How do you get there?Ken Brown  58:28  So I guess if we were to talk about the mission of this podcast, I would say that, you know, we've always talked about healthspan. But now I've got this whole new process, you cannot truly develop as an individual if you're being hindered by day to day aspects that prevent you from leading a normal life. Right? So it's really hard to say you should meditate when you don't have food on the table. Yeah. It's really hard to say you should go exercise when you have heart disease, and you can't, you can't exercise. I mean, there's all these aspects. So I guess the goal of the gut check project is to improve the health span.Eric Rieger  59:13  Now how 100% I mean, yeah, it's You're right. I like those examples telling, telling a homeless person to take in more fruits and vegetables. That's exactly a weird thing toKen Brown  59:24  Yes, they need those but there are other pressing needs so that they'll need to address so that they can tell you a parent that was two jobs to the weekend that they can't be home and they don't have food to give their kids to make sure that their kids don't eat cheap food. That's whatever it it. Just it doesn't happen that way now, and if we can, if we can do something, something becauseEric Rieger  59:49  maybe maybe people who watch this show or share the show. It's not necessarily that we're talking only to you but if you share with someone else And you are on your pathway to becoming healthier so that you're more vibrant than maybe that's kind of where it starts. I'm talking about myself too. I mean, I need to be healthy so that I can help take care of people that I'll take care of same for you. And same for anybody who's watching or listening. So you can't help somebody if you can't help yourself.Ken Brown  1:00:18  Yeah. And this is a good example that if you follow the show, or if you have a question, the questions turn into. In my mind, all of this is new to me. If it's not new to you, then you're way ahead of the game. As a guest, right now,Eric Rieger  1:00:37  yeah, yesterday.Ken Brown  1:00:39  But if this is new to you, as well, then please like share, we will always do the disclaimer that everything I've talked about today I am a doctor Eric is a certified crna. But we are not giving medical advice, while all we're doing is trying to show that there is some science behind all of this. And we are passionate about trying to make people healthier, ultimately, not just physically healthy. We're not talking about looking good. We want you to feel good. And we want you to be mentally healthy as well, because all of it is tied in together. And that's what we keep doing almost every single time is we're like wow, every time we want to separate. We want to do a three part episode on the penis, it ends up being the bodyEric Rieger  1:01:23  100% brain, we want you to stay healthy, mostly so that you can stay around long enough to ventilate through your anus. So we'reKen Brown  1:01:31  gonna get to that one. I want to make fun of it. I'm just gonna Heckle you the whole time. You have to show me the real science about why it's valid.Eric Rieger  1:01:40  Okay, that sounds great. I hope it's in there. But no, I'm excited that they're gonna be a good episode.Ken Brown  1:01:45  SoEric Rieger  1:01:46  that's Episode 56. Thank you all so much for hanging with us from 54 to 56 on this particular topic, it's very interesting. Hopefully, it's helpful. We've gotten not surprisingly, lots of feedback on anything discussing erectile dysfunction. Now I know why Pfizer cares so much about war. So anyway, thank you all for writing in and we'll see you Episode 57. I don't think it'll be a continuationKen Brown  1:02:11  conspiracy theory. Pfizer also came out with the first vaccine knowing that COVID can cause erectile dysfunction is the vaccine only partially is not where we need to buy. Bye, everybody.

Eric Rieger  0:00  Hello gut check project fans and KBMD Health family, I hope that you are having a great day today to host Eric Rieger soon to be joined by my other host, Dr. Kenneth Brown, and Ken Brown KB MD, he's the reason that we get to gut check project. So let's talk a little bit about this episode that's going to follow these announcements. And it's episode number 55. It's continuation of Episode Number 54, where we talked about men's health, specifically how inflammation from various diseases and, and viruses, for instance, can cause erectile dysfunction, and what can be done about it, maybe to recognize it. But what 55 is going to talk about specifically, is the continuation of what we talked about in 5474, we, we kind of delved a little into, you know why inflammation can cause such a problem when two people are trying to be intimate. And now in 55, we're going to talk about what actionable items you can take to hopefully avoid these situations. And if you're experiencing them, maybe you can try this and get over it instead of just always having to turn to pharmaceutical. So anyhow, of course, this is an informative podcast, so we are not your direct healthcare providers, butjust definitely want to share the information. So without wasting any more time, let's get into our sponsors, of course are trying to talk to kids browns, baby, and artron deal is where you're going to get your daily polyphenols, we talk a lot about polyphenols and for good reason. It's what the bacteria in your microbiome in your gut, what they not only wants what they need, in order to provide the post biotic materials and compounds that your body uses every single day to stave off inflammation to stave off disease to give you more energy to protect your telomeres. Why because that can actually be an anti aging mechanism. So regardless, polyphenols are what your body needs. artron teal just happens to be chock full of some of the most stable polyphenols known to man instability matters, because that's how the bacteria is going to get them to break them down and give you what your body wants. So are trying to go to love my tummy.com that's love my tummy.com slash KB MD. Pick up your daily polyphenols today. And of course, unrefined bakery, we've talked about it. And for good reason because unrefined bakery has incredible food and it does not matter if you need to avoid bread because you are a gluten free eater or you're a keto eater or you happen to be paleo. They specialize in those types of diets. And they make the right kinds of breads, desserts, treats, packs, snack mix, all of the things that possibly you thought you couldn't have any more why you adhered to a specific diet, unrefined bakery has unlocked industry and they shipped to all the lower 48 you can go to unrefined bakery.com that's unrefined bakery.com and use code gut check at checkout, save 20% off of your entire first order. Like I said, it's just great food doesn't matter if it's keto, paleo etc. They've got all of the different diet specialties spelled out on there, but they will deliver or shipped to your house. And, you know, check them out unrefined bakery.com delicious food, use code gut check at checkout save 20% Last but not least KB MD health name for Ken brown MD. And this has not only the store that features the three products that Ken has absolutely no problem standing behind Brock elite as well as adriaan deal in KB and D CBD. But you can leave us a message you can inquire a little bit more we're trying to build up a little bit of the content that we have on there but a lot of that's going to come from what it is that you want. So shoot us some more messages I know the way we produce the podcast but we're looking to see if we can't expand on some of that. So go to KB MD health comm check out the store as well as the archived podcasts and if you have any questions or just a comment to say shoot us an email from the button on there and we will do all we can to get back to you as soon as we can. So without wasting any more time go let's go to what I mean go to I'm taking us there we're gonna go to Episode 55 right now on the go jek projectHello gut check project fans and KBMD health family. It is greatAnd I'm here with my awesome co host, Dr. Ken Brown, what's going on, man?Ken Brown  5:04  We got Episode 55, which is part two of the prior episode that we did regarding Men's Health and some erectile dysfunction stuff. And it was really good timing because we got some pretty cool research to go over today, and it's all appropriate. So sit back, learn a little bit about how to protect your penis naturally,Eric Rieger  5:27  naturally. And so that's what Episode 55 is going to be about a continuation of Episode Number 54. But before we get into that, I think that we, we need to touch on some things that I know that you've been doing with someone who was actually on show.Ken Brown  5:43  Alright, so we always do a little personal stuff. Yeah. So what's been going on in my life? I got my stem cells. So shout out to Dr. Wade McKenna and his team, which by the way, his staff is awesome. Yeah, they are. They are absolutely amazing. So it's the first time I've ever been sedated. And so I've had two colonoscopies three and das cuppies, two of which I did on myself, which was, which was a gag fest. And I've always been the owl that we put people you put people to sleep right all the time. First time I've ever received propofol. Wow, it was amazing. It was like the coolest thing ever. It's like I just like suddenly two hours labs and Dr. Jerry Lewis shout out to him, it's a way brought him in and they were able to actually float a catheter into my foraminal opening, and I got pictures of this. And injected stem cells after doing a bone marrow harvest on me. I don't remember any of it, no pain. And quite honestly, I'm feeling really good. And it's only the beginning because I'm doing IV infusions now.Eric Rieger  6:47  So the crazy thing is, is working with you and st talking everyday like we do at work, etc. I saw when you had true deficit, like you really could not extend your right arm, the the tricep really was not responsive. Literally, Brown is standing while we were scoping, you were kind of positioning yourself to work the scope differently than you just normally would, because you'd lost basically faculty in yourKen Brown  7:14  yard. So what happened is, is that with the disc bulge, it actually compressed the nerve. I've got foraminal which is where the nerve comes out. I've got foraminal stenosis, and I was the swelling that took place from the disc bulge was compressing the nerve, and I didn't have all my usual strength and one of them being these six, seven when I saw Wade the first time Yeah, he was like all here's like, Oh, yeah, yeah, you're not gonna have tricep strength, you're gonna lose your medial pec Rouse, which is exactly right. And he goes, that happened to me years ago, and this is what I did. And Dude, that guy is such a stud. He had a back thing where he did his own bone marrow harvest taught his colleague, because he's the only guy that has done it this much said, this is exactly how you're gonna do it. And did his own bone marrow harvest, made his own stem cells and then had him injected in him? And I didn't want to say that was like 10 years ago or 11 years ago that question, yeah, you know, and he's, he's done well, so if you're somebody that has knee injuries, shoulder, for sure. Knee, low back shoulder, they do this all the time. Neck for me looks like it's going to be a really good success. I'm no pain right now. And I'm gaining function back. It's really it's a it's a humbling experience to go to the gym. Yeah. And be proud that you like can you know, we're usually dumbbells would be? It's this. It's my ego getting in the way. But normally, it would be like, Yeah, I did you know, 110 and each each arm dumbbell incline dumbbells now, I'm just like, sweet. I got 20.Eric Rieger  8:48  Yeah. In your left hand. And five in your right. Yeah, exactly.Ken Brown  8:51  Yeah, exactly. So, yeah, so shout out to him. So if anybody has any issues, please. In fact, you You did a revisit of the episode. I did. Yeah. So you did a Facebook post and Instagram pose,Eric Rieger  9:04  we tried something new. So if we have, we have a different studio now. And honestly, the audience has grown significantly over the last two and a half years. So some of the episodes that we had the old studio there, we didn't really have the network. We didn't have Paul helping us push out things more on the internet. We were more kind of internet radio based back then which we had a great audience there. But now we've kind of got a new or a lot of new viewers. So what we're going to try to do is do some revisits when we can or when this last week, we're both super busy and just couldn't film an episode. So check out the revisit number one, which actually features Dr. Wade McKenna. And we were prompted to do that really, because of what you've been doing.Ken Brown  9:46  Yeah, absolutely. And if you want to learn a little bit more about stem cells, there's number one look at that episode, because, wow, I did not realize that this has been Wade's background his entire career. And you can look at some TED Talks. With some German doctors because the rules are a little bit more lacks over there. So they've been, they've been researching stem cells a lot longer than we have. It's incredible. I think it's going to be how we're going to treat disease in the future for sure.Eric Rieger  10:12  100% so I've known Wade for almost two decades. And when when I was covering for him in the O r, it was nothing for him to have a research project going on having someone in the room simply taking samples from the patient that would be spun down and he did all kinds of I mean, he's one of the first doctors to utilize PRP. I mean, it goes back a really, really long timeKen Brown  10:33  ago. Yeah. For anybody that's wondering, anybody that's worried about anesthesia, I will now get my first hand take on it. I gave my first hand take on what it feels like to get a colonoscopy. I'm so angry at myself, but I believe my crna his name was Corey, Troy. TroyEric Rieger  10:49  now try is Troy's. Wade's PA, it's probably Cory. Cory it'sKen Brown  10:55  probably Cory. Anyways, great guy. Great crna knew you because you guys trained together at some point he trained he trained under you. He told me, he goes, here's what's gonna happen, we're gonna they they got the IV in, because we're gonna go ahead and lay down the gurney here. We're going to harvest the bone where you're going to go to sleep and then we're going to wake you up. You're going to hop over on this floor, oh table go facedown. Then we're going to go ahead, the doctors will come in, they will then float the catheter get in there. Jerry Lewis is going to assist Dr. McKenna. Once they get in the right position, though, inject it, then we will stop the anesthetic and roll your over your wake up and you're going to you're going to do great. I said, awesome. So all of a sudden, I remember being Chuck a little bit now. I'm like, Okay, so we're gonna do that. We just did the bone marrow. Awesome. And I tried to go, where's the flow table? They're like, you're all done. Like, you're all done. I looked up. I'm like, it's been two hours. Holy cow. And I was like, euphoric and felt great. And sort of, whoa, I gotta do this more often. You're not more stem cells anymore.Eric Rieger  12:04  Just Just relax. Just relaxingKen Brown  12:06  anesthesia. Yeah, exactly. Personally, what's going on with you?Eric Rieger  12:13  We are still remodeling the house. It's interesting to not be in our normal home and having to go back and watch them kind of do demo, etc. But gates just came home from college yesterday. So it's very, very exciting Mac core, still swinging at basketball, and they just finished a big tournament down in San Antonio. They want three or four to get to the championship. So he did great and Murray's social media companiesKen Brown  12:38  really taken off. That's awesome. As far as my household, Karla won her tournament last weekend, so shout out to Carlos super proud of you did great. The Lucas his last tournament, Costa Rica hurt his heel. And just to be just because I'm a worrywart. I ended up taking them to direct orthopedic care, which actually was kind of impressive. They got us in right away, and they x rayed him and did all this he were in a boot for a week. And now his foots better. Fortunately, nothing was broken. And then same thing with you remodeling. So loida spending a lot of time with my wife loida, looking at white paint. And she keeps asking me, which white should we use? For what room where it's going to go? Yes, what shade of white and honestly, it's all the same to me. I honestly think I'm white colorblind. I clearly see just white. Well, isn't that what it is? Well, not loida. She sees nuances kind of like, kind of like a dragon fly would see like an ultraviolet light or something. I think she sees the nuance of weird whites that I don't get. So I'm just nodding. And I'll just be like that one. And she's like, Are you kidding? That has hints of gray and Oh, honey, thatEric Rieger  13:53  one is the one.Ken Brown  13:55  That is not what I want. Right? That we're gonna Yeah. So no,Eric Rieger  14:00  I understand. I just, I agreed with Marie, that she should pick out all things aesthetic. And she said, Well, you don't want to help. And I said, why would I want to do that? I don't know what we're looking at. And so that's pretty muchKen Brown  14:15  part of the thing I've been doing for my neck is I've been going to North Dallas Spine Center, where I've been getting traction on my neck. And so I lay down in one of those traction machines where they hold my neck table. Yeah. And they have a TV above me and they keep it on HGTV. And it dawned on me that if you've got nothing going on, HGTV will give you a home renovation. So pretty sure that my daughter Carla and loida can have their own HGTV Home renovation show because that's what they do. Can like you talked about Marie, it's like this tile, that tile looked at this look at this, and it's just like, Oh, this is gonna accent this and it is dizzying. Oh,Eric Rieger  14:55  it's a specialty and it's a specialty that I have no special skill andKen Brown  14:58  no at all. None of All so well that's awesome. So you get it? Yeah. All right. Oh my gosh, I totally forgot about this. I am so pumped. Oh, yeah, that is not so pumped. An article recently came out. You know, like when you're always posting Jeff's have like a guy falling off a skateboard, like a bunch of times, like screwing up. And you're like, isn't this guy awesome? And then I'll post under that. No, Eric, he's not awesome. He really needs lessons in a helmet. And then you'll respond with like, lol. And I just look at that and go. Is he saying lol? Because he now gets that the guy's bad? Or is he saying lol? No, it just adds to a lot of confusion. Well, what does lol mean? Well, it's it's laugh out loud. And it just but you know how you always do that all the time. And I'm always doing thatEric Rieger  16:00  I know how I always walk into these scenarios that I learned about myself.Ken Brown  16:06  Anyways, fortunately, shout out to university Central Florida, because we don't got to worry about these confusing social media exchanges that you and I have. Yeah, frequently, all of the time, all of them. So a study was just published may 8, in the Journal of entropy, where University of Central Florida has developed thank goodness, okay, to save our podcast relationship, a newly developed artificial intelligence algorithm that can accurately detect sarcasm in comments written on social media. Yeah,Eric Rieger  16:44  I want to challenge it now. TheKen Brown  16:47  dough Miami man or Florida man, I should I shouldn't just key in on Miami right there. Alright, so computer science, researchers at the University of Central Florida have developed a sarcasm detector.Eric Rieger  16:59  How can that even work?Ken Brown  17:01  So social media has become a very dominant form of communication for not only people but as it turns out, businesses, companies are always trying to sell products and services. And somebody is always assigned to respond to the comments that people do properly understanding and responding to the call to the customer feedback on social media platforms is critical for success. airgo somebody needs to invent something to help those people understand that your customer is being sarcastic. NotEric Rieger  17:31  I don't, I don't know. I mean, I hope that they make a lot of money moving this app out. But who cares? But it's wellKen Brown  17:37  anyway, so I got really into it because of our exchanges on social media, as I've said multiple times. That's where something called sentiment analysis comes in. This University of Central Florida team developed a technique that accurately detects sarcasm, and social media texts. Effectively, the team taught the computer model to find patterns that often indicate sarcasm, and combine that with teaching the program to correctly pick out cue words in a sentence, that were more likely to indicate sarcasm, they taught the model to do this by feeding it large data sets, then checked its accuracy. And I believe that our exchanges were probably fundamental to their research.Eric Rieger  18:21  Yeah. Actually, after hearing that, I think I think this is actually really, really important.Ken Brown  18:28  So I think it's super important also, and I was so interested in this, that I actually contacted the scientists themselves and wanted to speak with them. And I contacted another sarcasm expert. Oh, yeah, yeah, to get another take on the whole field. And so so your wife, Marie commented that sarcasm isn't always easy to identify in conversation.Eric Rieger  18:49  That's weird that she would say that, because I'm never sarcastic atKen Brown  18:52  home. And then the scientists are quoted as so you can imagine. It's pretty challenging for a computer program to do it and do it well. So my own research on this has determined that sarcasm is a difficult thing. And doing it on letting your computer decided is hard.Eric Rieger  19:12  Yeah, again, I just want to reiterate how important I think this is yes,Ken Brown  19:17  sarcasm has been a major hurdle since sarcasm relies heavily on vocal tones, facial expression, and gestures that cannot be represented in text. It's important science super important.Eric Rieger  19:31  This this makes sense to me.Ken Brown  19:34  In a quote, detecting sarcasm in textual communication is not a trivial task. Dr. akula is quoted or maybe it was Marie, I don't remember which expert was quoting. Now she's often given many lectures on sarcasm, I'm sure thatEric Rieger  19:52  it could go either way.Ken Brown  19:53  That's why I went to her and asked her I wanted to interview her. So kudos to University of Central Florida,Eric Rieger  19:58  and we're getting ready to Get on to this awesome.Unknown Speaker  20:03  Very important science super important.Eric Rieger  20:06  Incredibly. That is the weirdest thing that we've ever done. IKen Brown  20:12  saw that article and I was like, Oh my gosh, real scientists are spending a lot of time trying to pick out sarcasm and I'm like, wow,Eric Rieger  20:21  yeah, it sucks that they don't get it.Ken Brown  20:27  Alright, enough of that that was but it's it's real. You can look it up. It's to me, it's to me. It's just hilarious. That's why we have emojis, you know, the little gestures that people do. Alright, so let's just jump into this episode, Episode 55. To more important, more important topics, health. So remember that last episode was all about how I was seeing more patients, post COVID young patients otherwise healthy as I would start discussing things with them, they would ask me very honestly have Is there any relation to COVID and having erectile dysfunction, because after I've had COVID, I've been having issues. So we started looking into that. And that's what that episode was actually about where we covered how there is this plausible reason for this and how certain studies are showing that they're aggregating some data where people post COVID the long haulers are actually having issues with erectile dysfunction. That was last episode. Check this out. This was just published two days ago.Eric Rieger  21:32  Oh, wow. So definitely new information since our last episode.Ken Brown  21:35  Definitely new information. And this is why I said instead of you know, go Florida man go Miami man because out of the University of Miami to Florida studies, one episode out of the University of Miami researchers report COVID-19 found in penile tissue could contribute to erectile dysfunction, really.Eric Rieger  21:53  So we're like, corpus callosum? What are we talking?Ken Brown  21:58  Great question. So basically, it's a very small case series, but it is pretty interesting. a urologist out of the University of Miami published this, that COVID 19, or SARS cub to let's say it that way, it can present in the penis tissue long after men recover from the virus. So the widespread blood vessel dysfunction, or endothelial dysfunction, which is what our last episode was all about, right? And that results from COVID-19 infection can contribute to erectile dysfunction. According to this study that was just published in the world Journal of men's health. What this urologist did is he was implanting penile implants, okay, in patients with refractory erectile dysfunction. He had a few patients that were post COVID. And they develop this afterwards. So his idea was that the SARS cov to virus can affect the endothelial and create inflammation, which then can result in erectile dysfunction. What's crazy about this is that we know that you the endothelial lining is the lining of blood vessels, and outlines origins as well. So it can be anywhere in the body. What is really crazy about this is that he took these people that had this prior history COVID and then he took a subset of people that did not but we're coming into the same issues, right? So severe diabetic or somebody that that is having reptile dysfunction, that is, it's devastating enough that you're going to go have surgery for it and have an implant on. So it said this isn't like a big deal. This is. I mean, it's one of those things that I guess, you know, a lot of pharmaceutical money's made on it. A lot of you know, snickering is done with it. But the reality is if you get an infection, and then this affects that it affects your relationships, it affects your mood and all this. What was fascinating is that he did biopsies of the corpus cavernosum cavernosum sorry, yeah, the of the corpus cavernosum. And this is nuts that he sent it off to a research facility where they did electron microscopy on it, and they found a bite virus sitting in the corpus cavernosum consistent with it being SARS cov two hanging out in the corpus cavernosum in patients that had recovered eight months before from COVID-19 and had antibodies,Eric Rieger  24:27  so it hadn't really gone anywhere. It was basically sitting there dormant that's causing long term infection and problemsKen Brown  24:32  we don't know that part it this is possibly possibly I should say that Yeah, possibly. And I guess you know, like one of my questions I got a lot of questions for that guy is are you sure that SARS cov two shirts on another virus? Are you sure it's not whatever is your co infection with all these other things, but that is crazy, because that means you clear the virus and you got SARS cov two hanging out in your penis. Well, it'sEric Rieger  24:56  let's go the other way. He just at least identified that It's possible that there was a virus that happened to look like SARS. But inevitably, it's inflammation that is causing the reptile dysfunction. He thinks he believes that's the connection. So it in essence, it doesn't just have to be SARS, cov. Two, it really could be, how are you going to protect yourself from long term inflammation? Right?Ken Brown  25:23  You're exactly right. And that's what we're going to talk about today. Okay, this is exactly what we're going to talk about today. Because on so many episodes we discussed, almost, it seems like somehow we get into the fact that inflammation, right chronic inflammation, acute inflammation, it's good chronic inflammation band can create all different kinds of problems. So today, we're going to talk about how to protect your penis naturally. Okay. And I have not heard this anywhere. And so to me, it's a very, very fascinating article about how we're going to do this naturally and using Mother Nature's secret weapon. So let's just recap really quickly the physiology of from the last episode of erectile dysfunction. So if you remember, your brain somehow becomes aroused in any one of the centers, it becomes aroused. And then it releases acetylcholine, where acetylcholine leads to the conversion of arginine to nitric oxide via something that we're going to talk about nitric oxide synthase. The nitric oxide causes vezo dilation of the blood vessels in the corpus cavernosum, which are the spongy tissue in the penis, which then allows for an erection. Ultimately, when you don't need the erection anymore, another enzyme called PD five breaks down the nitric oxide and you go back to your normal state, the etiology of of erectile dysfunction can be psychogenic neurogenic, hormonal, or vasculogenic. And so when you look at all that, keep in mind that almost all of those have an underlying common theme. And that is chronic inflammation,Eric Rieger  27:09  right? And all of those have to be working for it to work to work.Ken Brown  27:12  Exactly, exactly. So that's that's what we're gonna look at. So if you have any, if I suggest everybody go look at the last episode, because we went into significant detail about this. And and and we were theorizing almost that getting COVID can do this. And now we just have an article that just came out two days ago, actually showing on biopsy that it's that it, it's not only plausible, but it's probably likely Wow, man, it is really, really wild. I know it's not. So this got me really thinking. After seeing this article, I started thinking about the whole aspect of how do we, after the last podcast if this is going to be a more common theme for so many people or you know, have been infected? Then what can we do from a natural perspective. And today I want to talk about the role of dietary polyphenols in the management of erectile dysfunction. In fact, a very brilliant article was published in 2017, out of a research group out of Africa, where they specifically looked at that, and what they were really looking at is the mechanism of action. And these guys go into great detail about erectile dysfunction, noting how many things can cause it, but also that one of the main underlying themes was inflammation at its root. Okay, so when I get articles, so Angie, and I exchange articles all the time, and when I get articles, I'll briefly read through the abstract. And when somebody says that in the abstract, I'm like, this, this group is speaking our language, right? So what that's what we're going to talk about today is specifically the inflammatory process, and how it leads to this Xay, we're specifically looking at reactive oxygen species, meaning the underlying cause of inflammation is free radicals that can be caused by so many different things. So it doesn't matter if it's arterial, it doesn't matter if it's the hormonal bottom line is if you have inflammation in tissue, how does that cause it? And how can how can it be prevented? Am I making sense?Eric Rieger  29:28  Yeah, you're making sense essentially, what you're saying his long term inflammation has this byproduct called reacted or I'm sorry, reactive oxygenation species? Is there something that we can do to help clean up that mess so that we can have a better chance of achieving things where inflammation is getting in the way?Ken Brown  29:43  Absolutely. So when you think about this when you because we always hear about antioxidants? And and people talking about, oh, take this antioxidant, it's a superfood, it's whatever. Yeah, what does that really mean? Well, specifically, inflammation from reactive oxygen species leads to increased production of free wrap. radicals, which ultimately leads to lipid peroxidation, meaning breaking down fat that kicks off more inflammation, protein oxidation, meaning breaking down protein, which kicks off more inflammation, DNA oxidation, which means you actually break down your DNA. And so that's the epi genetic component of some of this stuff. And then decreased synthesis of nitric oxide, and upregulation, of pro inflammatory cytokines.Eric Rieger  30:32  And that actually is a double whammy. So if you are stopping and just correct me if I'm wrong, but if if you are stopping the production of nitric oxide, you're now decreasing blood flow. And by decreasing blood flow, you're actually allowing whatever happens to be in that area to linger longer. And if you are increasing cytokine release in that area. Now, not only are there pro inflammatory markers now in the area that we don't want them, it's going to take longer for them to be flushed out because there's just simply not enough blood flow.Ken Brown  31:05  Did you speak with the researchers?Eric Rieger  31:07  I didn't, because that'sKen Brown  31:09  spot on. Okay, well, with a little more detail, but it's almost like you had a phone call with them.Eric Rieger  31:16  After we talked about the sarcasm meter.Ken Brown  31:23  All right. So you're exactly right. But what's really cool is the actual mechanism and how these polyphenols can help in this process at different stages. So reactive oxygen species cause oxidative stress, because you had an imbalance between the pro oxidants and the antioxidants in a cellular system. So once you tip that damage to the DNA, proteins and lipids and proteins, like I just talked about results in a massive increase in inflammatory cytokines, right? Yes, like you were saying. So in theory, anti oxidants could help protect the endothelium the lining of the corporate cap of the corpus cavernosum by shifting that inflammatory cascade someplace else, the most potent natural anti oxidants are in the form of poly phenol. So this study really reviews the dietary polyphenols and the role they play in the management of erectile dysfunction. From an inflammation perspective.Eric Rieger  32:33  It's it's fascinating. And then when our most of our viewers know that if you're addressing inflammation with polyphenols, you're not just addressing it for Ed, you're actually going to be addressing it systemically. This is what your body needs to balance everything out.Ken Brown  32:47  I'm blown away that the more that we do this podcast, the more that I keep uncovering research that has existed, this is 2017 never even heard about this and like holy cow. And it was so good. It's like when we had Charlene on with the celiac stuff correct? Holy cow. Really quick, can you just explain in case somebody is turning tuning in for the first time what a poly phenol isEric Rieger  33:07  poly phenol, so the easiest way to find them are knowing that they are the compounds that you find naturally in fruits and vegetables, which are responsible for the colorful fruit, or I'm sorry, the colorful visualization visualizations that you see in you know, green broccoli, or red apples, etc. But what they do when you consume them is they are really what your gut bacteria want for food. They've got specific functions by the time that they get there they arrived, your bacteria know exactly what to do with them. And then they can turn into beneficial products after they're consumed so that you can protect yourself from inflammation, you can give yourself a better chance of anti aging, the bio products of poly phenol, metabolism, I guess you could call it and your colon really pay long term dividends. It's the reason why we've always been coached to drink I'm sorry to drink to eat fruits and vegetables daily. And they're they're the workhorse inside fruit vegetables.Ken Brown  34:09  Exactly. So what you're going to see in the future, I'll say in the future of research, followed by the future of the market, is that there's a shift going from the probiotics that we're now learning are probably not as quite beneficial as initially touted, and there's lots of marketing behind it. And most research or a lot of researchers are moving away from probiotics to studying these poly phenolic molecules. And you summed it up perfectly, and that's awesome. It's like when I hear you, I'm just like, man, he's so smart. Why would he comment such a silly thing about that skateboarder?Eric Rieger  34:47  I don't know. I don't know why did that on that social media exchange that we never had.Ken Brown  34:53  Alright, so what these researchers looked at initially, they said, well, we're gonna we're gonna pull a bunch of studies and And what they looked at was something that that is very interesting to me as well is that they realize that all the studies really involved large, stable polyphenols like pro anthocyaninsUnknown Speaker  35:13  interesting. I think we know a little bit about prime we know a little bit about that,Ken Brown  35:17  as Eric mentioned, pro anthocyanins are the polyphenols, which are found in the fruits and vegetables with the most vibrant colors, the blueberries, berries and things like that. So that's what they were looking at with these studies, not so much that they were trying to select those. It's that what other people had published. So this study that I'm talking about is like a mini meta analysis. And what a meta analysis is, is when a research group will take data that exists small studies, they'll congregate it, and then they'll do a review and say, This is what the data shows when you put all the data together. Okay. So if you have a couple case series, then you put those together, and that's what so this is like a mini meta analysis, looking at several studies, not several, like many studies. For instance, prior studies have shown that poly females exert their action directly on the endothelial lining of blood vessels. One of the studies cited sums your whole message up where it goes all over the body. This is really true. One of the studies cited found that they radio labeled poly phenol metabolites. Okay, so and then just to break it down, that's what the that's the compound that would exist after the bacteria has taken up all the phenol and broken it down to what it knows is beneficial, right, exactly. So by radio labeling the large poly phenol once it gets broken down, then they can see wherever it goes. And the reason why I say that is because To their surprise, nothing was excreted in the urine. But they did find these polyphenol metabolites in the brain, heart, kidney, spleen, pancreas, prostate, uterus, ovary, Mary glands, testes, bladder, bone, skin, and highly concentrated in all endothelial linings.Eric Rieger  37:09  So essentially, every organ in all of our blood vessels are highly dependent upon these metabolites.Ken Brown  37:14  Yeah, and none are essentially none were being excreted through the urine. So as we sit there and talk about this, and we've talked about this, this is when these polyphenols, you take a large, stable poly phenol, right, like abbraccio proanthocyanidin. And if you have a diverse microbial base, your microbiome will break this down into beneficial metabolites that find their way everywhere.Eric Rieger  37:38  Why if it weren't important, and if your body didn't want it, it would be doing all it could with the reason why you brought up urine is it would be doing all that it could to eliminate them, but it's not doing that.Ken Brown  37:50  Well. It's not doing that because if it was, so I guess you could think about this, if it were absorbed correctly, you'd pee it out, right? Because all urine is is filtered blood, right? And if it's not absorbed at all, then what you would see is that radio label tracing in the totalEric Rieger  38:09  Yeah, and still Yeah, yeah.Ken Brown  38:11  So it's, it's pretty wild. So these authors want to know, well, okay, knowing that it's going to go everywhere. How would this correlate in erectile dysfunction? And more importantly, what are the mechanisms and how it actually does? Okay? So, knowing that these polyphenols can work directly on the endothelial lining, and that inflammation can cause erectile dysfunction. What studies exist to explain how these polyphenols can help directly with erectile dysfunction, so I admire these guys, it's a really thick articles. It was I had to read it like 700 times or something like that.Eric Rieger  38:51  I think the sarcasm meter has alarmed us that 700 is probably inaccurate. HoldKen Brown  38:57  on, let me check the computer. Oh, you're right. The AI says that I was being sarcastic. That's awesome stretch. All right. So first, they referenced many different studies showing how polyphenols have been found to have a direct anti oxidant effect. So when people think about polyphenols, they always refer to it as being potent antioxidants, preventing this oxidative stress. But a more important role that they have determined is that there may be very beneficial indirect effects. And we've talked about these indirect effects on multiple episodes. Absolutely. And so one of these that they went into tremendous detail is a pathway called the n f Kappa beta. Nf Kappa beta. We talked about this on the immune episode. We talked about it when we had the when we had david on broccoli on Yeah, the sulfur fans we've this NF Kappa beta is the is the first domino that gets turned on. So it's almost like a puri trophic phenomenon where it sets off This huge cascade. So if you want to know more about that, and about the cascade, go to our episode on the immune system, because that is where I just drew it all outward shows how complex it is. But basically, to sum it up, it causes this release of inflammatory cytokines just blood turns it all on, polyphenols control his process by controlling the NF Kappa beta. Okay, so it doesn't let NF Kappa beta come in and just say let's throw a party, it's as well hold on, just calm down. It's what down regulates that pathway. In addition, and this is something I did not know, poly phenol is regulated regulate local enzymes that are pro inflammatory, like something called ionos, which is inducible nitric oxide synthase. And I just shout out to Angie, because she said if you're going to do an episode follow up, she sent me a full article. She's like, I've always been confused about this, because sometimes people refer to nitric oxide as being part of the inflammatory cascade. And I'm like, but it's always there. And she's like, this is a great article that summarizes it. As it turns out, there's eyeness, Enos, and US and US is neuro nitric oxide synthase. Wow. Okay. In US is endothelial nitric oxide synthase. I nos is inducible. Okay, so inducible is very important when you have an acute inflammatory response.Eric Rieger  41:33  Yeah, it's, it's being induced to respondKen Brown  41:35  to being induced to respond, okay. But when you turn on certain chronic inflammatory issues, I nos, actually is an enzyme that converts nitric oxide into an inflammatory type molecule are really super cool. So anyways, polyphenols, block, the enzymes like that. And cyclo oxygenase two, or Cox two, right? Do you've ever seen any commercials, we just have commercial all the time about Cox two inhibitors, right. And so it blocks these two enzymes, which, to me is super, super fascinating, because I did not know that it did this on a local level as well. While it's doing this, it's increasing anti inflammation pathways like the and our F two pathway, which we've shown that that is the exact opposite. If you want to think about good guy, bad guy, yeah. And RF to, you know, the old cowboy movies wearing the white hat, the NF Kappa beta is the bad guy wearing the black hat. So you know who's good and who's bad. That's the old timey movies, I remember. That's how that I bring that that's really dating myself, but I'm bringing that up, because that's how I was taught during pathology, about how to read. You're looking at slides. If it's cancer, it basically has all this chromatin staining on top and I remember, my mentor, Dr. Brady would say, look, remember this, when you see a slide and if it's really dark on top, that's a black hat. That's a bad guy. Okay? And if it's darker in the middle, it's it's okay. You have a polyp. It's not cancer yet, but once it does that, so it's just always think about that. So basically, NF Kappa beta, bad NRF, two good pathways that do. One does a whole pathway a bad one does a whole pathway of good polyphenols decreased the bad pathway, and they increase the good pathway, nice and increases inflammatory cytokines or anti inflammatory cytokines like aisle 10. Okay, so that's part of what they get into, which is, which is really, really cool. And then instead of they go into tremendous detail about how this information or the rat of oxygen species creating this inflammatory process, actually, once the NF Kappa beta is turned on, it creates a pop ptosis in the endothelial lining. It's a big word. YouEric Rieger  43:57  know what that is? It's when cells automatically die, or they are, it's like programmed cell death. They are to they're told that they're, they need to terminate,Ken Brown  44:05  yeah. So when the NF Kappa beta gets turned on, it goes around, it tells healthy endothelial cells to kill themselves. Yeah, so to speak, which results in cell dying, which then leads to denudation, or sloughing of healthy blood vessel cells, which now needs to be replaced and repaired, which needs to be replaced and repaired, which sometimes that inflammatory process then leads to either scarring or plaque buildup or things like that. Yeah. So if you don't block the inflammatory cascade, it's just a vicious cycle. So this is going to lead to inflammation and fascinating what these guys showed in multiple studies is when you have this a pop, ptosis and denudation. The other thing that you're getting rid of His endothelial nitric oxide synthase,Eric Rieger  45:04  which is going was going to form nitric oxide, right?Ken Brown  45:08  Yeah. So its job is to form the good nitric oxide, which helps dilate blood vessels, you actually decrease the amount that's even available.Eric Rieger  45:17  Now, it's unfortunate, that's not what you want in this particular instance.Ken Brown  45:20  That's not what you want in this instance at all. And that is not sarcasm. That it No, that is true. That is the truth. Yeah. So anyways, that's enough. So basically, you have you decrease the nos or decrease the amount of nitric oxide that you have. If you stop and think about this, and you know that it goes all over your body. We need blood vessel dilation to keep our blood pressure down to increase the blood flow to our brain. You we have strokes because you blocked the blood flow, we have heart attacks, because you blocked the blood flow, you can have erectile dysfunction because the blood flow is decreased. Correct. So it's all making sense now. So without nitric oxide, you have increased adhesion. So now you have a lining of a blood vessel, which has lost its endothelial and smooth pathway. Yeah. And then now you've got these like ridges, yeah, so as platelets, and leukocytes is your white blood cells and your platelets come swimming through, they're like getting hit and they get, they get hung on, and they get stuck. And this actually causes a release of something called thromboxane. A to because they're like, oh man, we get we need to get out of here, we're stuck. thromboxane a two is a vasoconstrictor. Because if you think of plumbing, you have a big pipe like this, if you're getting decreased flow, if you constrict the pipe, you'll have higher pressure. And so the body's going oh my gosh, I got platelets that are stuck there. Let's release the strongbox saying, Yeah, that's exactly it. I read this, I was like, Oh, shit, yeah, all this stuff is going on with COVID. And people are having strokes, heart attacks, clotting. Now it makes total sense 100%, the inflammatory process is using up your nitric oxide synthase, so that you don't have as much nitric oxide, and then your body's producing a clotting mechanism to overcome that. Yeah. Nobody has discussed this that I've seen. I haven't seen Fauci or anybody talked about that I keep hitting my mic. Get all excited.Eric Rieger  47:29  Now, I've not seen anyone talk about it from that approach whatsoever. Granted some of this information, some is new as it pertains to COVID and the pandemic, but that the actual process of this though, is not new. There. What they're doing is they're applying some relatively recent knowledge and saying, guys is the same process. We have to get out in front of this.Ken Brown  47:50  Yeah, absolutely. And I just saw, we've talked about this, but I just saw that the guys that we work with it. And I'll try until they just filed for their they're finalizing their study where they're actually using polyphenols in hospitalized COVID-19 people. So it's public now nice. we've kind of been hiding it. I've been known. I've known about it for over a year now where that's is what they've been trying to do. But they they have their data done. And so now it's public knowledge that they have petitioned to be able to publish this. The data is out publicly yet, but they've at least shown that this is what they're doing. Right. And now it's making sense. Yeah, it doesn't make sense. So to recap, this oxidative stress leads to inflammation, which leads to decrease nitric oxide, and eventually vasoconstriction and clotting. So let's pause for a moment because I feel like I'm just throwing a ton of stuff out there. Well, there'sEric Rieger  48:49  a lot of stuff. But ultimately, the takeaway through all of this is make certain that you get rest, and that you have polyphenols on board, because that's what your body needs. Really breaking down is why, why do we need this? Why does it workKen Brown  49:03  exactly asEric Rieger  49:04  you referenced earlier, and it's to bring our attention back? We've been told that we needed probiotics 25 years ago, but they didn't really know why that is, knew that we wanted, or not. Even more importantly, how, yeah, how does it work? We knew that we needed bacteria in the colon, but we didn't really know of taking probiotics was going to really give us the diversity in the colon that we needed to give us the byproducts of the metabolites that our body was wanting. And what we're seeing here with polyphenols is that we know not only why we need them, how they work, and where specifically with erectile dysfunction, we can see that it could actually correct some some damage.Ken Brown  49:52  Absolutely. Absolutely. Well, well said. Alright, so we're gonna keep moving on because that's not it. It's done. Actually just stop there. Oh, no, there's more. There's more. Do you remember when we had that patient? Who was he is a cancer researcher, okay. And he was talking about how the research he's been doing was looking at blocking arginase enzyme to help as a cancer treatment vaguely. So, essentially, there's and then I had another patient who's a cancer. He's an MD, PhD, and I asked him, I was like, Hey, I had a patient that said, he was Oh, yeah, we've known about that. So he's MD, PhD. So in the research world, they've known about this for a long time. Okay. Basically blocking the enzyme that breaks ArgentineUnknown Speaker  50:42  down, okay.Ken Brown  50:44  helps your body heal itself.Unknown Speaker  50:47  Wow.Ken Brown  50:48  Okay. And I thought that was fascinating, because they're basically, they're basically developing a drug that which is more of like a dietary supplement to treat cancer. Fascinating.Eric Rieger  50:59  Yeah, it isKen Brown  50:59  super cool. So lots of research is going on in the cancer world regarding arginase inhibitors, and then doesn't take long for the pharmaceutical industry to realize there's money and other things. Sure. So there's lots of research going on in the world of erectile dysfunction, trying to use arginase inhibitors for erectile dysfunction. Big money, definitely big, big money. So as it turns out, there are studies out there that have shown that Polly females actually have a strong arginase and Ace to inhibition as well.Eric Rieger  51:37  And I think this is important, though, to point out because there's a big distinction, at least in our experience of the motivations behind pharmaceuticals, again, is to just find something to block that one enzyme arginase. polyphenols are really the far more natural way for your body to have the things at its arsenal and its disposal to use when needed, which is a much different approach, give your body the tools if I if if I needed a lug nut taken off of my of the wheel, so you change the tire, that'd be great to have that lug nut, you know, wrench. But then later on as a screw comes loose in the car, or I need to any I need to get my spark plugs or something else like that, I would much rather have the toolbox that had the lug nut wrench, the gap for the spark plug and the screwdriver. Versus well now I've got to try to fix my spark plugs with this wrench, and it's not gonna workKen Brown  52:36  100%. So think about this, if you develop a drug that is purely an arginase inhibitor. Yeah, but you don't have any nitric oxide synthase. To convert the arginase to nitric oxide, there's,Eric Rieger  52:47  there's no there's no balance in what you're what you're doing. There's no balance at all in that give your body the fuel to make use from the tool chest as it needs.Ken Brown  52:58  Absolutely. There have been studies that have shown this, they cite several different studies. But one in particular that I just want to bring up is a polyphenol called Moringa. I'm only bringing this up because we will be discussing Moringa on a future episode. Because it ties in I'm just I love doing this podcast because I learned a lot. I love it when anybody else listens to it, and they comment on it. We do get a lot of emails, and I'm loving that. But the reality is that it's fascinating how many things just come together? Yeah, when you're like, Oh my gosh, nobody's put this to this. Nobody's put this to this. So when I say that we're gonna talk about Marina in the future. Like in the very near future, I got some really cool stuff that I've come across. But there's, we can't, there's only so much we can discuss and on one episode at a time. So when we're looking at all this, and we said in the very beginning of this episode, that inflammation is the root cause. Well, you have to bring up will then address some of that, like, Are there any studies that show when somebody has chronic disease?Eric Rieger  54:08  for erectile dysfunction, there's tons of that, like diabetesKen Brown  54:12  for Oh, for instance. There was a study where it looked at how a poly phenol from a lactic acid, improved erections and diabetic rats. And they were able to demonstrate in these diabetic rats, they induced diabetes in them that this was done through an inhibition of the reactive oxygen species directly and locally in the corpus cavernosum. So diabetes is one disease, okay. There was another study that ingesting pomegranate polyphenols improved penile vasodilation in rats, that they caused severe arterial genic erectile dysfunction, so vascular disease, and this One, after administration of polyphenols they documented increased intra cavernosa blood flow. So increased blood flow to the penis, compared to the untreated rats with the same vascular disease, in other words, coronary artery disease. And the key point in this study was that the decrease in reactive oxygen species allowed an increase in nitric oxide to stick around long enough to override the lack of blood flow. I'll say it again. Wow, the that whole process that I just talked about, where you have inflammation, reactive oxygen species leading to the inflammation, causing the NF Kappa beta to turn on, which leads to vasoconstriction. As it turns out, by giving the poly phenol it allows the nitric oxide to stick around long enough and go like Braveheart hold. I was able to hold open the vessels and be like, we're gonna get an erection one way or the other. Just paint my face blue. Let's go. Let's do it. Yeah, no,Eric Rieger  56:01  I get it. Hey, I find that interesting, though, too, because it's once again, it's the antithesis is how we got to the problem in the first place. You mentioned COPD, or coronary artery disease, which also include probably similar diseases like peripheral vascular disease, having a problem but what inevitably do they think leads to those, those deposits or those blockages NCD And usually, it's long term inflammation processes, and it can be kicked off by anything can be kicked off by long term sleep apnea, etc. But you end up being deficient in molecules that your body wants to basically control that inflammation. It happens every single time. It's theKen Brown  56:45  tipping point, right? When you don't have enough antioxid antioxidants and the pro oxidants turn enough on the NF Kappa beta. Oh, you're on the wrong way.Eric Rieger  56:56  And then that's a long explanation in and of itself. I'm just highlighting that. That that is ca D is just another instance where what we needed to control systemic or even local inflammation is deficient in the molecules needed to prevent that accumulation that blockage.Ken Brown  57:13  Do you remember and stepbrothers when they, after they, when they met up at the Catalina wine mixer and he goes, are you still? Are you still? Whatever he said karate chop and watermelons. Whatever he said, he goes, No. And he was but I am taking a daily aspirin. He's like, that's the smart thing to do thing. Yeah. Somewhere in there was the whole enterprise rent a car, they teach you to be your own boss. But anyways, so the whole idea of taking an aspirin a day? Is it because it blocks the the cyclooxygenase pathway? Or is it the antiplatelet pathway? Or oh my gosh, really? aspirin is an anti inflammatories? Yeah,Eric Rieger  57:55  that's exactly what it is. And it does. It's an anti inflammatory because it was blocking CoxUnknown Speaker  58:00  Right. Yeah.Eric Rieger  58:01  So what is polyphenols doKen Brown  58:03  co x by the way? Yeah,Eric Rieger  58:05  yes. It's we're on that subject are we highlight the early in the show? Have you heard him say that's nuts twice? I heard that. So.Ken Brown  58:18  Yeah, so let's think about that. Like, like, my, everything was just going off in me. I was just like, wait a minute. That's why what we showed that taking an aspirin antiplatelet activity of Plavix. Why do we put people on Plavix to be antiplatelet without treating the underlying inflammatory process?Eric Rieger  58:37  Yeah, I mean, I think our society just become really accustomed to turning to the drug, which really is only targeting one small thing instead of giving your body the opportunity to correct the more universal problem. Because let's face it, if you're on a antiplatelet therapy like Plavix, of course, it can be saving your life if you had a standard etc. I'm not saying don't take Plavix. However, you do have side effects that come from that that you you can bruise easier. you bleed out you have a scrape. I mean, it's just it's fun.Ken Brown  59:10  Alright, so we know that you have to if you have a cardiac event, cardiologist goes in get a lot of Cardiology friends and they place a stent open up your artery increases the blood flow problem is the stent has little ridges on it. Yep. And that's where platelets can it he's exact same thing is happening when you do a nude. Oh, yeah,Eric Rieger  59:29  vessel. That's right.Ken Brown  59:30  Yeah. You create little ridges, that platelets will stay 100%. Yeah. And then that's all from inflammation. That's all from inflammation. And then finally, in another study using a poly phenol combo from grapes, apples and saffron, they demonstrated that an indirect mechanism in this case, by activating the sirtuin one pathway, we haven't mentioned that yet, but we've talked about it before the sirtuin one pathway which resulted in decreased apoptosis of the endothelium and resistance towards oxidative stress. If the cert diet rings a bell with anybody, that's because a Delta the cert diet lost a bunch of weight and everybody kept talking about the cert diet. It's a poly phenol that yeah, it turns on the serotonins, which basically function to block this stuff that we're talking about a pop ptosis denudation, reactive oxygen species, definitely. So super. Alright, so the bottom line is polyphenols are badass in the natural prevention of erectile dysfunction. And it was shown to do this by multiple mechanisms. Let's just go over the mechanisms super fast. Number one direct anti oxidant effect, right? So it is the antioxidant to protect the pro oxidants that are going on reactive oxygen species. It increases nitric oxide by decreasing the enzyme inducible nitric oxide. So that's the bad one. And it was actually shown to increase nitric oxide synthase because that goes down with inflammation. Correct? Number three, inhibiting arginase. SoEric Rieger  1:01:14  we didn't talk about this earlier, I think we're gonna get sidetracked. But why is arginine important for nitric oxide production. So if we break down arginine before it has an opportunity to be used by by nitric oxide synthase, then obviously it's just done a fuel or components to makeKen Brown  1:01:32  nitric oxide correct 100%. So in the prior episode, we talked about it in detail where acetylcholine turns on this ability for arginine to get moved through an enzymatic pathway using nitric oxide synthase. that converts Argentine into nitric oxide, right. So that's why it's so important. So if you don't have enough Argentine, then even if you're doing well, and your body wants to have an erection, it needs this substrate. Yeah. And if your body is breaking it down all the time, because arginase goes up during inflammation, then you don't even have the substrate to do it withEric Rieger  1:02:08  just not enough fuel.Ken Brown  1:02:10  There's not enough fuel, that's that's the best way to put it. Number four, it blocks pro inflammatory pathways like NF Kappa beta. And that, that just leads to blackhat. That's the black hat that just leads to decrease in TNF alpha and interleukin six and all these other inflammatory cytokines. Then it also turns on anti inflammatory pathways through the NRF two pathway, which is the white hat, which turns on the shuts down NF Kappa beta and turns on a whole host of other anti inflammatory processes. And then finally, number we're on six it activates the cert one pathway leading to less a pop ptosis. And it also helps with protecting the reactive oxygen species a pop ptosis creating the bumpy lining the denudation. So Mother Nature secret weapon new and improved for erectile dysfunction. We talked about it for other things, but we didn't really discuss it. Regarding this.Eric Rieger  1:03:11  I mean, at this point at this point. If you've been on the fence on Should I take polyphenols but you're not on the fence if if you like to have sex? And the answer is yes. If the answer's no, then I mean keep keep skipping. But if you want to protect an intimate love life, then polyphenols are critically important when they just aren't and they always have been it's this isn't new.Ken Brown  1:03:37  Well, this isn't new, and we just discussed the study out of Miami. We're now we're gonna start we're gonna see a lot more people younger people showing up saying I have erectile dysfunction. What's going on?Eric Rieger  1:03:47  Yeah, it's gonna be more devastating. The younger that you Oh, one is it's not normal.Ken Brown  1:03:53  That's not normal. The 100% and it's just one of those things. Nobody. Well, not well, no, I'll say nobody wants to talk about it. Yeah, nobody talks about it until Mike Ditka went on a Viagra commercial. It was like wolf ditches talk about it, then. I guess we can talk about it a little bit more. Oh, yeah. Remember that?Eric Rieger  1:04:08  Yeah. And then it thank thanks to them honestly, because it broke the barrier to where they became commonplace. I don't remember anybody talking aboutKen Brown  1:04:16  it publicly. No. And then if you're sitting there just going okay, you're done with these polyphenols. Which one that I talked about? You talked about grape. You talked about pomegranate, you talked about Moringa. The bottom line is the larger the more stable poly phenol you have. It will be broken down into the metabolites, the post biotics and we talked about on a prior episode with Silvia her research was she's PhD from Spain. Shout out to her for English being distant second language I think she speaks four languages also. But English being her last to learn and she came on the show and discuss it. Her research show that when you take a large table polyphenol like abbraccio and chestnut, your colonic bacteria, she fermented it, she digested it and fermented it, meaning that it was the metabolites, you kick off all these different smaller phenolic compounds that people try to study like allergic acid, like root and like reservatrol, like curcumin. It's incredible. You give your body what it wants you and we always talk about, you know, get it in your diet first. So eat a very colorful plate, you're going to get that. But to get the same amount of polyphenols, proanthocyanidins in five bowls of berries, it's equivalent to two doses of autoruns. Hill, it's correct. So from poly poly phenol content to poly phenol content of proanthocyanidin. That's, that's where it comes in. Yeah, and that's why I'm so passionate about it andEric Rieger  1:05:49  poly finos we made a reference or I made reference earlier to having having a toolbox. So certain polyphenols individually, they're great, they're great for you. But that may just be a small tool bag. And a larger molecule poly phenol like a pro anthocyanin is really like the entire tool chest. Regardless, you're giving your body all of the tools that it needs or several of the tools that it needs in order to make the right metabolites that you're in need of.Ken Brown  1:06:15  Yeah, so awesome. Do you want to recap this real quick? Because it's thatEric Rieger  1:06:22  man do I want to do it right now?Ken Brown  1:06:27  So I got one last question. Which which white? Do you like better?Unknown Speaker  1:06:37  hereKen Brown  1:06:37  Why would you choose that? works at all? Yeah, Episode 55. In the books we covered both sarcasm and directionsEric Rieger  1:06:46  we did we covered sarcastic directions. Thank y'all so much for joining us and we look forward to Episode 56 and that's actually a mystery we're gonna find out what that topic Yeah, thatKen Brown  1:06:58  one's gonna be a bit of a mystery. So as always, everything that we're talking about on this show, I am a physician Eric is a crna we do treat people on a regular basis but we are not your doctor and unless you are my patient and you're listening to this. So please do not take this as medical advice. This is a show it is for entertainment. And we are also trying to educate so in that light, we would love it if you would share this if you would subscribe. And if you would, you know like it post a comment whatever, so that we can run it through our AI software to find out if you're being sarcastic.Eric Rieger  1:07:31  Definitely do that we want to run it through our AI software. I thank y'all so much please like and share. Honestly this type of topic kind of gets shadow banned on certain platforms. So if you're ever going to share an episode, please share this one and episode number 55. And of course check out our first ever revisit with Dr. Wade McKinnon because this guy here went and visited him for some stem cell treatment.  Thanks everybody. Bye bye.

1- make sure pts follow up on positive FIT test 2. symptom severity — driven particularly by catching/locking and clicking/popping — correlated significantly with the burden of cartilage damage. CARTILAGE DAMAGE!! 3. U.S. Food and Drug Administration announced it is allowing the use of the Binx Health Assay for point-of-care testing for Chlamydia trachomatis and Neisseria gonorrhoeae 4. In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin 5. ADHD- “results favored using methylphenidate in children and adolescents, and amphetamines in adults as first-line, short-term (12 weeks or under) treatment.” 6. when it comes to PAD it is true what they say! no pain no gain- but maybe they should say no walking pain less loss and more walking pain much bigger gains in 6minute walking distance The Push for Timely Follow-up After Abnormal At-home Colon Cancer Screening Results | Cancer Screening, Prevention, Control | JAMA | JAMA Network The pandemic has brough on way more things done at home which Is good and bad More stay at home school- bad More stay at home colon cancer screening- good Article talked about a need to make sure pts if positive then get the colonoscopy. Poit out one study where only 44% completed a colonoscopy within 6 months of a positive FIT result even though 89% received a referral, Reasons for the low rates are complex. Patients who are reluctant to get a colonoscopy. and physicians don’t always convey the importance of follow-up. Other factors such as inadequate insurance, lack of transportation, or a facility backlog may be out of a patient’s control. I think in the end we just have to make sure we do our part and while I wouldn’t say scare them make sure they know the importance of this test and how likely it is that they have colon cancer based on it being positive And as a reminder Zorzi M, Hassan C, Capodaglio G, et al. Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test. Gut 2018;67(12):2124-2130. Over a 10-year period, the rates of detection of colorectal cancer (CRC) and advanced adenomas using fecal immunochemical testing (FIT) are similar to those seen in studies of screening colonoscopy. But how good is it you ask? Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. N Engl J Med 2014;370(14):1287-1297. FIT was 74% sensitive and 95% specific. Which in pt terms means for every 11 positive FIT there was 1 cancer detected on colonoscopy A positive fit has you down to a 1 in 10 chance of cancer—get the follow up! And speaking of follow up Patient-reported catching or locking of the knee and other “mechanical symptoms” (i.e., popping, clicking, or pain on pivoting) Usually gets a follow up with an ortho surgeon That patient usually goes to get an arthroscopic knee surgery for symptoms attributed to meniscal tears. BUT BUT BUT what if the text book and board question of pain or instabilitiy with (i.e., popping, clicking, or pain on pivoting) Isn’t a meniscus problem at all?? Meniscal and Mechanical Symptoms Are Associated with Cartila... : JBJS (lww.com) Farina EM et al. Meniscal and mechanical symptoms are associated with cartilage damage, not meniscal pathology. J Bone Joint Surg Am 2021 Mar 3; 103:381. (https://doi.org/10.2106/JBJS.20.01193) Researchers prospectively evaluated 565 patients (mean age, 48) who had arthroscopic knee surgery for symptoms connected to meniscus pathology. Pts were asked about the presence and severity of symptoms prior to surgery and then while in surgery, the surgeon recorded characteristics of meniscal tears and the severity of cartilage damage. In the end “We did not observe an association between meniscal pathology and preoperative patient-reported knee symptoms." Instead they found overall symptom severity — driven particularly by catching/locking and clicking/popping — correlated significantly with the burden of cartilage damage. CARTILAGE DAMAGE!! And if you had tricompartmental cartilage damage (i.e., medial, lateral, and patellofemoral). Then there was even greater symptoms severity…almost a dose response of cartilage damage to symptoms severity Perhaps the observations in this study help to explain why arthroscopic meniscal surgery has not consistently proven to be better than conservative management in randomized trials FDA Allows for First Point-of-Care Chlamydia and Gonorrhea Test to be Used in More Near-Patient Care Settings | FDA the U.S. Food and Drug Administration announced it is allowing the use of the Binx Health Assay for point-of-care testing for Chlamydia trachomatis and Neisseria gonorrhoeae, The test, which uses female vaginal swabs and male urine specimens, takes about 30 minutes and can be done right there in the office This is the first point of care test approved for Chlamydia trachomatis and Neisseria gonorrhoeae testing And I have no idea how much it will cost but my guess is a pretty penny Next article Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve | NEJM The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months. In this open-label design Randomized trial of 1005 patients who were randomized to either 20 mg once daily rivaroxaban vs dose-adjusted warfarin in patients with atrial fibrillation and a bioprosthetic mitral valve In the end In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin When it came to the composite primary outcome of death, major cardiovascular events, or major bleeding at 12 months. I have a couple problems Industry funded and open-label design – immediate bias into event rates. People doing the trial get paid ot do the trial and enroll people. They want this to work, they will try to show benefit as much as possible whenever possible. Nothing wrong with them, just human nature. This is for bioprosthetic mitral valves NOT mechanical valves HOWEVER This does seem to be consistent with observational and subgroup analysis from other studies and likely will change practice going forward. ADHD is real and what do you write for- well what if we could just get a large meta-analysis of almost 24K people Well we are in luck Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis - The Lancet Psychiatry Researchers examined efficacy and tolerability of data of the drugs used to treat attention-deficit/hyperactivity disorder from published and unpublished double-blind, randomized, controlled trials. In total they had 133 trials and included close to 14,000 children and 10,000 adults. They analysis was able to do indirect comparison which is when you take one study active arm and compare it to another study active arm and in the bit of statistical magic you get what appears to be results between the two active arms. So aspirin vs placebo and then Plavix vs placebo and then you can do an indirection comparison and BOOM stat magic and you have results for aspirin vs Plavix. Is it perfect? NO but is it better than nothing, usually. Some interesting results For children based on teachers' ratings only methylphenidate and modafinil were more effective compared to placebo BUT In adults modafinil didn’t beat placebo The best drug for adults was amphetamines I think one of the authors who commented on this said it best “results favored using methylphenidate in children and adolescents, and amphetamines in adults as first-line, short-term (12 weeks or under) treatment.” The authors did look for data at 26 and 52 weeks but found insufficient evidence. Which is to be expected as most mental health drugs only show improvement in the short instead of long duration but it also speaks to the importance of drug holidays when possible. These drugs have evidence for 12 weeks we have no idea what the good or bad long term effects are when taken for 12, 22, 32, or 42 years. Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease: The LITE Randomized Clinical Trial | Cardiology | JAMA | JAMA Network How long or fast do you need to walk if you have PAD Does a low-intensity work just as good at high intensity? 305 participants with PAD Randomized to either low-intensity exercise, high-intensity exercise, and a nonexercise control group Participants in the walk groups were asked to walk 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. There were weekly phone calls with their ‘coach’ to help with adherence. Adherence was pretty good at around 85%!!! THAT ALONE IS IMPRESSIVE All participants did a 6 minute walk test at the beginning of the study and then again at the end of the study The primary outcome was mean change in 6-minute walk distance at 12 months In the end if you did Nothing then you decreased in for walk test distance by −15m, high intensity group GAIN 35m on their 6 minute walk test, but what about the low intensity- that is what we all care about is just a little bit of exercise beneficial. Is it ok to walk at a pace that is slow and doesn’t produce any pain and THOSE randomized to the load intensity group showed a DECREASE in their 6minute walk distance! They went down by -6.4M! No pain no gain! If you have PAD you can just lolly gag your walk around the block you have to push it. Sure a lolly gag pace wont lose you as much as doing nothing but if you push it you will see gains! I guess when it comes to PAD it is true what they say! no pain no gain but maybe they should say no walking pain less loss and more walking pain much bigger gains in 6minute walking distance

Becky Winslow PharmD, of PGX for Pharmacists podcast, joins Eric Geyer PharmD in this mash-up 'Pharmacy Podcast' hybrid episode where we discuss not only the Plavix case but several other cases where pharmacogenomics could help make a huge difference in our healthcare system, including in how we treat opioid addiction. Hawaii recently fined Bristol Myers Squibb and Sanofi under consumer protection standards for their drug Plavix (clopidogrel). This could be a game changing case due to the fact that it could have been prevented with more studies using pharmacogenomics.  Special insert from KHON2 News with Hawaii Attorney General Clare Connors held a news conference on Tuesday to discuss the million-dollar lawsuit against Bristol-Myers Squibb Co. and Sanofi. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Becky Winslow PharmD, of PGX for Pharmacists podcast, joins Eric Geyer PharmD in this mash-up 'Pharmacy Podcast' hybrid episode where we discuss not only the Plavix case but several other cases where pharmacogenomics could help make a huge difference in our healthcare system, including in how we treat opioid addiction. Hawaii recently fined Bristol Myers Squibb and Sanofi under consumer protection standards for their drug Plavix (clopidogrel). This could be a game changing case due to the fact that it could have been prevented with more studies using pharmacogenomics.  Special insert from KHON2 News with Hawaii Attorney General Clare Connors held a news conference on Tuesday to discuss the million-dollar lawsuit against Bristol-Myers Squibb Co. and Sanofi. See omnystudio.com/listener for privacy information.

Becky Winslow PharmD, of PGX for Pharmacists podcast, joins Eric Geyer PharmD in this mash-up 'Pharmacy Podcast' hybrid episode where we discuss not only the Plavix case but several other cases where pharmacogenomics could help make a huge difference in our healthcare system, including in how we treat opioid addiction. Hawaii recently fined Bristol Myers Squibb and Sanofi under consumer protection standards for their drug Plavix (clopidogrel). This could be a game changing case due to the fact that it could have been prevented with more studies using pharmacogenomics.  Special insert from KHON2 News with Hawaii Attorney General Clare Connors held a news conference on Tuesday to discuss the million-dollar lawsuit against Bristol-Myers Squibb Co. and Sanofi. See omnystudio.com/listener for privacy information.

Hawaii recently fined Bristol Myers Squibb and Sanofi under consumer protection standards for their drug Plavix (clopidogrel). This could be a game changing case due to the fact that it could have been prevented with more studies using pharmacogenomics. Becky Winslow, of PGX for Pharmacists podcast, joins me in this hybrid episode where we discuss not only the Plavix case but several other cases where pharmacogenomics could help make a huge difference in our healthcare system, including in how we treat opioid addiction. https://podcasts.apple.com/us/podcast/pgx-for-pharmacists/id1496611877

New scooter company Go X discusses cautious launch; Danny and Allen Castro, ten years later; Reality Check: Makers of blood-thinning drug Plavix fined $834 million over undisclosed health risks; Frank De Lima shares his latest musical parodies on aging, COVID-19

Texas refineries and wells shutter due to storm; drugmakers face $834 million judgment over Plavix; Parler says the app will be back online this week

At its most basic, marketing often consists of simply explaining a product's qualities relative to its alternatives. Can this go too far and amount to a competition law infringement? Isabelle de Silva, President of the French Competition Authority (FCA), and Bill Batchelor join John Roberti and Matthew Hall to discuss product denigration by reference to the FCA's cases in the pharma sector. Listen to this episode to learn more about these cases and how to draw the line between illegal disparagement of rivals and factual communication of differences. Related Links: FCA's AMD (Avastin) decision September 2020 FCA's Subutex decision December 2013 FCA's Plavix decision May 2013 FCA's Durogesic decision December 2017 Hosted by: John Roberti and Matthew Hall

Clopidogrel is an antiplatelet drug. When I was in school it was the “classic” example of a prodrug. The brand name is Plavix. This drug works by irreversibly blocking the P2Y12 component of ADP receptors which prevents GPIIb/IIIa activation causing a reduction in platelet aggregation. Based on indications and diagnosis there may be a loading dose of 300 mg to 600 mg with the general treatment dosing of 75 mg po qd. The active form of this drug relies on the Cytochrome P450 CYP2C10 oxidation to active thiol. Common side effects include bleeding, bruising, rash. There is a black box warning for CYP2C19 metabolism and diminished efficacy in poor CYP2C19 metabolizer. Go to DrugCardsDaily.com for episode show notes which consist of the drug summary, quiz, and link to the drug card for FREE! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. The main goal is to go over the Top 200 Drugs with the occasional drug of interest. Also, if you'd like to say hello, suggest a drug, or leave some feedback I'd really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on twitter @drugcardsdaily --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

October 29 is World Stroke Day! Might as well know how it is best treated. This week, Jim Siegler revisits a 2017 episode on the differences between two of the most commonly prescribed post-stroke treatments, with some key updates, recent trial results, and practice-changing paradigms. Produced by James E. Siegler. Music courtesy of William Ross Chernoff’s Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9. Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9. Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86. Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. 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10/14/20 - Host Doug Stephan and Dr. Jack Stockwell, www.forbiddendoctor.com Phone: 866-867-5070 begin with more clarification on why you should drink coffee after breakfast, instead of before or with. Did you know this is Breast Cancer Week? A new study shows that just about any surface can carry COVID 19. We are literally walking through a jungle of microbes, that we cannot see. Doug offers details of a physical that he recently had. Next, Dr. Jack explains why vaccinations are always itchy. Plus, lots more great tips and ideas to help you maintain your Good Health.

Wouldn't it be great if your body came with a user manual?   Which foods should you eat, and which ones should you avoid?   When, and how often should you be eating?   What type of exercise does your body respond best to, and when is it best to exercise?   Discover the social interactions that will energize you and uncover your natural gifts and talents.   These are just some of the questions you'll uncover the answers to in the Epigenetics Testing Program along with many others.   There's a good reason why epigenetics is being hailed as the "future of personalised health", as it unlocks the user manual you'll wish you'd been born with! No more guesswork. The program, developed by an international team of independent doctors, researchers, and technology programmers for over 15 years, uses a powerful epigenetics analysis platform informed by 100% evidenced-based medical research. The platform uses over 500 algorithms and 10,000 data points per user, to analyze body measurement and lifestyle stress data, that can all be captured from the comfort of your own home.   In this episode Lisa and Neil discuss how they use the program to help people optimise their health, performance and well-being. For more information on the epigenetics health program visit https://www.lisatamati.com/page/epigenetics-and-health-coaching/ or to join Lisa and Neil on their next live epigenetics webinar register at https://epigenetics.lisatamati.com/   We would like to thank our sponsors for this show:   For more information on Lisa Tamati's programs, books and documentaries please visit www.lisatamati.com   For Lisa's online run training coaching go to https://www.lisatamati.com/pag... Join hundreds of athletes from all over the world and all levels smashing their running goals while staying healthy in mind and body.   Lisa's Epigenetics Testing Program https://www.lisatamati.com/pag... measurement and lifestyle stress data, that can all be captured from the comfort of your own home   For Lisa's Mental Toughness online course visit: https://www.lisatamati.com/pag...   Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds" Visit: https://relentlessbook.lisatam... for more Information   ABOUT THE BOOK: When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn. She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying. This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy. Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine. This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option.   We are happy to announce that Pushing The Limits rated as one of the top 200 podcast shows globally for Health and fitness.  **If you like this week's podcast, we would love you to give us a rating and review if you could. That really, really helps to show get more exposure on iTunes**   Transcript of the Podcast:   Speaker 1: (00:01) Welcome to pushing the limits. The show that helps you reach your full potential with your host. Lisa Thomas brought to you by Lisa Tamati.com. Well, hi everyone. And welcome back to pushing the limits. Fantastic to have you with me again and today I have my best buddy, Neil Wagstaff, new, how you doing? How are you? Very good now. And for those who don't know us, Neil is my business partner and running hot coaching. And, uh, he's also been my coach for God knows way too long, cause we're way too old now new way and have a huge history. And he's been on this podcast a number of times and we have shared, uh, many different, uh, aspects of what we do and some of their expertise. Um, certainly Neil has a huge background as an exercise physiologist and a coach, and pretty much you name it, he's done it in the fitness industry. Speaker 1: (00:54) Um, and today's topic is going to be all around all about something called epigenetics, very big word. And you probably go, what the hell is that? Well, you would have heard of DNA and how we all have different DNA that we've inherited from our mom and dad. And you might have heard of gene testing and how important this can be. And we've done a few episodes here on the podcast recently with dr. Mentor Muhammad, which was very fascinating looking at specific genes and what that means for you. But today's one is about epigenetics. So epi means above genes. So this is what influences your genes. So you're born with a code from mum and dad. You inherited genes from mom and dad. And from this, this is like your blueprint. So if you think of this about like an architect, who's done the blueprints for your house, your jeans, or your blueprints, and you build a build your house. And it's what the builder does that actually influences your genes. If you like. So this is your environment, what you eat, what you sleep. We knew how much exercise you do. Uh, what toxins you're exposed to. All of these things are actually going to affect your genes and what expresses and what doesn't. So we're going to talk you through a program that we use at running hot coaching, and we've had fantastic success with it. What it's all about and explain a little bit. So Neil, we do want to start with us Speaker 2: (02:22) As a, that's a good question. A big question. Well, a good place to start is when we were, we were personally as athlete in and, and coach, um, feeling confused as to some of the results that we were getting your training. And then as we applied the training to our, so our members that running vocation as well, wondering why we're getting different results. Um, so from a sport point of view, we started raising some pretty significant questions as why some people getting results, others weren't on exactly the same program. Um, was it down to effort or was it down to motivation or was it down to the environment they were training and how their genes were expressing? Um, so how we got to where we, where we got with it and also, which I'll get you to, to probably explain as well Lisa's we were asking more and more questions, especially when, um, around your mom's health as well. We started asking a lot of personal questions about around health questions, about, um, our family's health and then those we're working with and coaching and the same with the RJ moment have a lot more, which is why are people not getting the results that they could be and should be, and what's stopping that happening. Yeah. Speaker 1: (03:27) So it's, it's looking at, you know, um, before jeans came on the site and the science of epigenetics and DNA testing and so on, it was a one size fits all program. We were all taught. And when you studied, certainly you knew with your exercise science background, you studied stuff. If you do this, you create that adaptation. Then your body should get stronger or, or lose weight or do things, you know, calories in calories out, uh, strength training causes us response in the body and so on, but it was all a one size fits all approach. And that was all we had to go on. And then you'd have these people who got fantastic results just after the, you know, as the book says it should happen. And then you would get people who dieting for forever, uh, exercising for Africa. And this is something that I experienced as well and not getting the results that they deserved and getting very, very frustrated and wondering why the guy next door, who's eating fish and chips every night and drinking beer has got a six pack and I slugging my guts out and I'm, I'm not getting anywhere. Speaker 1: (04:32) And so this is what seemed to us into this direction. And then when my mum had her aneurysm, um, we really wanted to tailor rehabilitation plan to her genes. And we came across this program, which has really been a game changer for us in what we do as a business and in our personal lives. And it's certainly changed the trajectory of my health and Neil's as well. And we were, we were fit and strong and, and, and generally what you'd call healthy anyway, but this for us was a game changer. Wasn't it? Neil? Um, Speaker 2: (05:08) I think the aha moment for us as a, as, as I was thinking about it before we started chatting today was really understanding that 95% of how our genes express themselves is really controlled by our lifestyle and environment. So that for me, was like, ah, alright, now that really means that we, as in us individually and all the people we work with and our families are really in the driving seat, it's a bit being able to control their control, their health and how their genes, the genes express themselves. So once you realize that, and as you said in the introduction with epi, the epigenetics being outside or above, so it's the things outside and above that will affect how your genes express themselves. If we can take control of that, which we started to do, and then starting to see the results by taking control of that, all of a sudden it's like, wow, this is pretty cool. Speaker 2: (05:54) The other real significant thing was what I needed to do to get my genes expressing a certain way was very different from what you needed to do, and probably different from what your mum needed to do. And very different with the hundreds of people that were taken through the program with what they need to do. So it really did nail down for us that the, this, everything should be truly personalized. It's definitely the way health and fitness is going. It's definitely the way that medicine is going nutrition. If you are not getting a personalized approach to you or medical care to your health and fitness, do nutrition and dietary advice, then you're not getting good advice. It needs to be personalized and tailored to tailor to you. So they were definitely the aha moment so that we are now in control of what we're doing and how we're doing it. Speaker 1: (06:39) Yeah. So this has been an, it sort of give you an example from my life. So obviously being an ultra marathon runner doing absolutely stupid long distances. And I remember this sort of came home to me when I ran through New Zealand a few years back and I was running 500 kilometers away, like absolutely ridiculous amount of running, right. You know, not normal, not healthy, not recommended. Um, you know, I was putting on weight and I was like, what the hell is going on here? I was burning muscle and I was putting on fat. Um, so that was for me, like, you know, like for goodness sake, what do I have to do to get lean and, and have, um, a strong, healthy body. This obviously isn't doing it. And it was because I was sending my body into a state of panic and stress. The stress response in the body was holding on to everything. Speaker 1: (07:31) And when we looked at my jeans and I went through this program, it actually said that I would match better suited to the shorter shopper high intensity workouts. And combining that with a lot of things like yoga and Pilates to calm my, my nervous system down because I have a body that runs a lot on adrenaline. Uh, and therefore I need to calm it down. So I needed that sort of yin and yang type of training yoga on the one hand and Plavix. And on the other hand, high intensity and actually doing the super long distance slow stuff for hours on end was not optimal for my body. And when I changed that and started to do, uh, more CrossFit style workouts, more circuit training, more high intensity with medium weights for my body type, not heavy, heavy weights, then I got massive results. Uh, and this was on the quarter or at least an a quarter of what I had been doing previously. And that was like, you've got to be coming up to speak 20 years, throw it at the wrong way. And it doesn't mean that I cannot ever do an ultra marathon. It just means that if I am training for an ultra marathon, I need to approach it differently. And I also not a need to not do it back to back because that really isn't healthy. And that's what I was having a lot of, um, problems with as that, especially as I got older. Um, yeah, so let's Speaker 2: (08:48) Key thing as well as well. It's just, it's, it's allowed you and ask those, we're working with, to create a user manual for there. For that. It's not, it's not a case of, you know, you, we've what we established from the program, you to your point ultra with the money, wasn't the best thing. It just means that what we can do now is approach that from a programming point of view, a whole lot, a whole lot more wisely, Speaker 1: (09:13) It doesn't mean you cannot do your goals. It just means, okay, well, you're going to do it slightly different than, than the guy down the road. Speaker 2: (09:20) Exactly, exactly. It was probably good as well. Just following on from what you're saying there, if we, if we're just talking through and looking at the, how much impact environment does have on what you're doing, um, training wise as well. So there's some great research and studies where you've, we've looked into and discussed over the years as well, at least with studies, with identical twins, that same genes. So therefore should be identical. They look identical, but they'd been spent time in different environments. And then as a result, their phenotype, how they look and how they present when we're looking, looking at them is significantly different. Now, a lot of that is going to be driven and triggered by, um, from an environmental point of view could be stress load. It could be type of exercise, could be chronobiology or the time of day that they're doing the things, the social connection they're having either too much of, or lack of and the people around them. Speaker 2: (10:11) So those are your listen that high, and you may well been in an environment that you feel that you just thrive in and buzzing, and you can't quite put your finger on it, but you know, that it really energizes you and puts you in flow. That is your genes expressing themselves in a positive way. He will also been in environments where you're like, it just doesn't feel right here. And you feel actually leaves you feeling more unhealthy. You actually find that being in there for prolonged periods, you actually start to change body shape and put weight on because your body's been thrown into a stress response just because of the environment that you're, that you're in. So it's really, really quite fascinating. How, how important the environment is to the point that when we're programming people, now, we're not just thinking about numbers, numbers of squats, type of strength training, or how far they're running and what type of exercise they're doing. We actually think, you know, how much connection are they getting? Is there a place I, their home set up as it should be their workplace, all those things set up to positively influence their, um, their genetic expression. So, Speaker 1: (11:11) And that's like, I remember, you know, you telling someone to go home and set up their office space better with plants and so on too, because they spent a lot of time in this environment and it wasn't set up properly, and that was causing their body stress. And that made to the fact that their training wasn't getting the results. You'd go, wow, let's real. We were, you know, that's real sort of like weird, but they came back the four weeks later and going, Oh my God, well, it's different. Same age. Cause I was in an environment that I was happy in and therefore my stress levels throughout the day were lower and therefore I got better results and it has a knock on effect. And it's a cumulative thing. You know, if you are, if you're sleeping at the right times for your biology, for your genes, if you are eating at the right times. Speaker 1: (11:54) So one of the, so this is, um, this program that we are trained in and, and, uh, educated them is been something that's been developed by hundreds of scientists. So the science behind this as just absolutely phenomenal and both new and nice science nerds. So we'd like to pull everything apart and make sure that, uh, you know, all this learning that we're doing and all this sort of information makes sense. And actually as robust, as far as the clinical trials behind it, the information behind it. Uh, and it's, it's been mind blowing to, to see scientists across so many different science disciplines. And this is what is really fascinating with program that we do as it's, it's, uh, taking, not the old traditional siloed approach of, you know, one science might be embryology and another science anthropometry, and another one is neuroscience and they're all separate. Speaker 1: (12:48) This is where, uh, you know, hundreds of scientists have collaborated across 15 different science disciplines to give us and using AI artificial intelligence and these massive computing ability that we now have to be able to take, uh, information about you and your genes, which has done through a questionnaire, not done through actual DNA. Like you're not spitting into a viral in this case. Um, this is a different way. And it's collecting a teen thousand bits of data about you, your ancestry, your, uh, ratios, body, uh, parts, uh, measurements of all the body, uh, color, behave, the color of your eyes, looking at the, all the genetic markers. Do you have a widow's peak, um, his ring finger longer than your index finger, all these weird sort of, uh, measurements are taken. And what this does is it gives them information about what genes are actually in play in this person and how more importantly these are expressing right now. So that from that information, we can take the, the, the, the reports, if you like that this gives us to actually build a program that will help your entire health performance, your wellbeing, uh, and all of that into account. So it's been a, an, a, an amazing ride for us. Isn't it? Neil? Speaker 2: (14:16) Yeah, massively, massively. So all that information, it's a once, once you've got it and you throw that into, it's amazing what you can, what you can, what you can do. Some of the other examples. And once you've got that information, then one of the questions that we started the started the podcast with was just people not getting results. So imagine joining a 12 week program of some sort of the intention of losing, losing weight or changing shape, or putting on some lean tissue and totally not responding to it. So there's a lot of, lot of studies we've looked at where people are just nonresponsive and factory responders. So no response to the exercise nutrition they're using. And that could be simply speaking with information. Lisa was just talking about, there is rather than going to try, for example, bootcamp at six in the morning for 12 weeks, with a recommended nutrition and realize that throughout the process, you either don't respond or you actually changed shape by putting on adipose tissue and body fat. Speaker 2: (15:12) If you knew that that time in the morning, wasn't a good time for you to be training the type of food that you were eating. Wasn't the right type of food for you and the people you're hanging out with doing it just wasn't suiting your, your body and health site. And all of a sudden you can flip that and then join a program that actually works for your works, your body. This is where it becomes so valuable, so valuable. It takes away the trial and error. It takes away the guesswork, and really now starts to increase motivation and adherence because you're actually feeling like you're you, that's the other massive support as well is it's okay to be you. It's all right, to be unique. It's all right to be you. And there's so many messages out there in the health and wellness and fitness world that kind of points to the fact that we should be a certain way. And it's all right to be different. It's all right. To do it in a different way and follow a different path that gets you, gets you different. Speaker 1: (16:04) Yeah. I mean, I'll give you an example here of my, my husband, um, Heisley, uh, I used to make him get up at 5:00 AM and do a CrossFit workout. And, um, and this was actually a disaster for his body type. He put on weight and he didn't feel good and he didn't enjoy it. Um, and when we did the epigenetics program with him, we now understood why, because his hormones for example, are replacing themselves at that era of the morning. So I was smashing as testosterone production. So that's not a good thing ever because I was doing it at the wrong time of the day. So chronobiology is a very big piece of the puzzle. Uh, the, the type of exercise that he was doing, which was CrossFit style. So it was really hard, high intensity back to back, no breaks in between the sets type training. Speaker 1: (16:56) Now this caused and him, he's got a slow ATP, uh, replenishing in the cells is that there's a bit slower than say in my, my genetics. So he needs to be doing heavier weights, but slower, uh, set. So he needs a rest in between each set and to be doing slower, heavy weights, whereas I'm better to do sets back to back to back. So I'm getting a cardiovascular workout and muscle workout at the same time, and I can do that. Um, so when I was training him the wrong way for him, that was just causing chaos in his body, um, causing an inflammatory response, knocking down as hormones, uh, knocking his sleep patterns around because that's a time when he should be asleep at 5:00 AM in the morning, very important for his genotype. Um, and all this sort of thing was a really a bad pattern. Speaker 1: (17:48) And you would've that the discipline that he showed and the, and the hard work that he was putting in, he should be getting a results. Now he does more long distance ultra marathon type running, and that's perfectly suited to his body type and his genotype. He is very slow start to the day. So he doesn't get up early and go and smash himself. He waits to later on the day, if it's lifestyle will allow that, and we can get into working in the gray a little bit later. Um, but he's been here in the afternoon. If he does this training, he should not eat an early breakfast. He should not be eating into at least 10 o'clock if not longer. And he's more suited to doing a fasting. So overnight fasting, if he can and eating a little bit later, uh, then has his food style should be, um, two to three meals, a day, bigger meals, but two to three, uh, and he should be having a, sort of a low carb, low protein at nighttime. Speaker 1: (18:47) He doesn't, he shouldn't definitely not be eating carbs late into the night because that's really, really bad for his, uh, epigenetic type. If you like. So all of this information, now he can take that away and go, you doesn't do it all all the time. I mean, let's be honest, life gets in the way, and sometimes you want a glass of wine at night and that's fine, but he's making that choice then with the knowledge that that's not really ideal for him, but he has the ability to pick the training program that now suits his body type to work out at the right time of the day. And to do all these other things, like what time of the day is his brain going to be working best? Where does he best? So his intellectual work, when is it best to have a social interactions, all this information, um, that has really been a game changer, isn't it? Yeah. Speaker 2: (19:32) Yeah. Massively. And if I use my own personal examples on the, on the flip side, I want to be calling my system in the evening when Hayes is going to be coming into his own a little bit more. So he'll still be able to be quite low and productive personally, for me, I want to be calming my system the evening to calm my cortisol levels. Um, calm my hormones and let my, let my body body settle. I'm much better early in the morning. Um, early morning training works from my perspective. So you get quite a contrast and those of you understand or have heard about, um, somatotypes before or body shapes. So you've got your, um, ectomorph your mesomorph and you're in the morph body shapes. So the example there hazy sitting more on the endomorph side, and I'm sitting more on the X more side. Speaker 2: (20:17) So with that, you get quite different needs. So with how the body responds, my body doesn't respond well to, um, to high amounts of weight. My body would generally break my body's more rigid and more fragile haze. His body. You can put a lot more resistance through a lot more weight and hair respond very well to it. Are we better at faster or higher endurance, higher intensity? Hey, this is going to be better, a longer distance slow and steady. Now, again, once we got this information, we can know where we're no, we're at the, we've a lot about exercise and nutrition and just giving the example of how you use on three meals a day. He's, body's going to be better fasting, whereas my body will need more like five meals a day. Um, I'm less likely to, um, break my food down. So will a low amount of stomach acid. Speaker 2: (21:03) So I have to be careful that my food is well cooked and easy, easy to break down. So all these little nuggets of gold that you get, and you start to see just comparing me and Hayes, how people are very, very different. So if I were, let's look at a fasting program for long periods, um, it wouldn't be as beneficial for me, more carbs to me, cause it's going to fuel my brain more effectively for Hayes. If he was looking at fasting, he is going to be a better thing for him to be, to be doing. So all those diets and recommendations around food that are out there, people often ask me is fasting good? Yes, it is good. And it's good. It's great for most cases, a certain level for people, but it's a, what level is right. Um, and what each person, what time, um, certain people are going to be more vegetables. Speaker 2: (21:51) Certain people are gonna need more, um, more protein in their, in their diet. There's understanding all of these, all of these things. Once you got that information, you can, you can run with it, um, from a hormonal point of view as well. Um, it is going to be different hormones of relevance for each body type and health type as well. And this has a big impact on how people behave, so where we've got some massive wins and it was nice to be lost. As we talked about this lease with, with relationship wise, both with our, with me, with my wife, same with you with Hayes, with us as athlete and coach and his business partners and me with my children as well, and how we interact and communicate with those around us is a massive, massive eye-opener just to really understand more about behavior and personality as a result of the hormones were driven by. So do you want to, Speaker 1: (22:38) I went up a little bit, so we don't scrap as much as much as we used to. And you understand me better now? Yeah, because like, uh, just giving the example of me new working in the business as if like coach for many years, uh, I used to drive Neil nuts because I'm so I I'm more in the mesomorph ectomorph mesomorph area. So we have some similarities in the, in the way we like to pull things apart and ask a million questions and so on, but I'm very much an take action now, person all the time and jump in without any preparation, without any planning. And just go, go, go, go, go. Cause that's, I'm driven by driveline is my dominant hormone. Um, dopamine, we both have a problem with dopamine. We don't have enough, so we're always chasing that. So in that way, we're similar. Speaker 1: (23:25) But I used to drive Neil nuts with, I would be just tight, always after the new thing, chasing shiny objects all the time, new areas of science to go and chase or whatever. Or I was very much head through the wall as far as go hard or go home all the time and everything that I do. And with Neo, he would take a more planned approach and more strategic approach. You'd look at the bigger picture and so on. And so this caused a lot of tension in the business because I would be going ahead and doing things before he thought we were ready to be doing them. Now we understand that about each other and that he plans and does things more strategically. So what, what we've changed, the roles that each of us have, and we still have the odd time when he's like, Oh, for goodness sake, just slow down. Speaker 1: (24:17) But generally speaking, he can now let me take those roles where I'm ripping open opportunities on I'm diving into new areas for us in the future. I'm looking on the, you know, definitely got, um, good visionary skills and so on. And he is cleaning up the mess behind me and putting structure in place into the programs that we're doing and actually making things flow and work properly properly from a myth, a myth, what do you call it? Mythological and methodical approach to things. Um, and so we learned to work better and to just go, Oh, well, that's less going off the deep end again. And you know, he also can reign me in when he can see that I, because I'm so driven by dream land and chasing his own dopamine all the time when I'm starting to spin out of control and get going. Speaker 1: (25:08) Cause I had a tendency to go so hard and then crash go hard again, crash. And he can warn me now when he sees and I do listen now, I didn't always, uh, pull back, slow down. You're over-training, you're overworking. You just, just have a bit of time out. And so we can keep each other in check and I can go, come on, Neil, hurry up. We want to get this happening and, and, and can give them a bit of a bomb to get going at times when that's needed. So that's helped us work together. And the same with my husband Haisley, he's what they call a diplomat on these programs. They have different names for the different, uh, somatotypes, uh, phenotypes, and he's very slow to get everything going. Uh, so you have to give them plenty of warning. If I want to go on a, uh, I don't know, a trip or vacation or something, I better give him six months to plan for it. Speaker 1: (26:00) Or if I want a fence boat in the back garden, it's gonna take at least a year. And I, if it, if it was me, I would be like, Oh, that's a good idea. And I'd be boating it the next day. And there'll be no planning. And the feds have probably pulled up for library in a couple of years, whereas Haisley would take two years to vote, but it will be done properly if that makes sense. So now we understand that about each other. I give him more heads up more time to get ready for an event change. And he has to just put up with the fact that I'll just keep charging and doing too much, Speaker 3: (26:38) But it's really amazing how, Speaker 1: (26:40) How much a dominant hormones, uh, fit our personalities and our neuro-transmitters affect our personalities and the which part of the brain we use. And all of this information comes out of the program, which is eye opening in the corporate setting, because you can, um, understand your colleagues better. You can understand how to motivate your, your people that you're working with, your team mates, your, your underlings, you can help them achieve better because you know how to motivate them, you know, what they need and what they don't need. Uh, and what time of the day they'll probably be at their best. And when they won't be, uh, all of these sort of little variants. And so we work in the corporate space and that's been really, really, uh, game changing for a lot of, you know, corporate teams being able to work together and understand each other better and have more empathy with one another. Um, and of course that all affects the bottom line at the end of the day. Speaker 2: (27:36) Yeah, it was so, so true. Fun, little, um, fun at work sizer. So listeners can, can do it homeless if we ask them just to hold up one of their hands and look at the difference between their second digit and their fourth digit. So looking at the difference between second and fourth digit or second and second finger ring finger. Now, if you look at those, if you look at the difference in size, um, and if the, the fourth digit or the ring finger is, is quite a bit longer or longer than the second digit, that'll indicate that you're exposed to more, um, the stress hormones or drilling testosterone when you, uh, you were grinding mom's tummy. So that will indicate more from a it's one of the measurements we use as part of the program, but that starts to indicate you're more like the top of person Lisa was describing herself as, so I'm more, would like challenge a lot. Variety would like change would like to jump over the fence first without worrying about what's on the other side and deal with it when she gets over there. Those generally with shorter, um, or fingers, similar length, one shorter, a generally want more organization, or want more structure will want more answers before they jump over the fence. And interestingly, as you look at leases, you'll have, Speaker 1: (28:50) Yeah. Longer than mine Speaker 2: (28:53) Then on the flip side, mine's similar size. Um, so again, you can start to see the connection between the science, the measurements, the, the, the, the balance, and then the things that are important to that person taking, taking challenge away from Lisa, taking variety away from her, taking, not letting her express herself. So it's real important from Lisa's perspective that she can express herself and let those emotions and feelings out for some of us as not so much of a, not so much of an issue, but there's, there's some people, and you may know them in your family and in your own social circles where you will think they, haven't got a huge amount of filter between brain amounts. Speaker 2: (29:35) You know what I'm saying? But he's saying what they think and being able to express themselves. And I think you do that exceptionally well. So, but you also know that if there's ever situations where you've been not allowed to do it, that affects you, you get frustrated and get a stress response, because you're not allowed to, you're not allowed to, um, to, to share that in the same way for me, if I'm asked to make a decision or go in and present something without having the information in lined up, that creates a stress response to me, whereas for you, it excites you more cause it's challenged. So that's what we want to point out to Pete. Everyone that's listening is that it's, it's stress is so individualized as well and how we have a stress response. Once you learn what triggers that in people you're then in a much better position to help control it. And especially in the current environment with this year, there's been so much uncertainty it's really been able to take control of the environment as it is, and then control your, how your body's performing or responding from a stress stress point of view. Speaker 1: (30:33) Yeah. We could almost see a, you know, working in the corporate situations that we have been, um, the people that are going to do well in the home environment, you know, working from home environment, uh, and the people who are gonna find that really difficult. And we can sort of see that before they tell us whether that is or not, because we know from their type their, their genetic type, uh, what's what what's going to be a problem for them or not be a problem for them, for me, for example, that that was fantastic. As long as I could get out and do my exercise when they took that away, going out there, it wasn't great, but being able to control my own environment, being able to do things on my time, doing it in my own environment, not having structure and things is actually for me, was fantastic for, for other people. They felt isolated, uh, cut off from the colleagues and, you know, all of that sort of, uh, stress. So that caused them more feelings of loneliness and stress and worry. Um, you know, it's just, everybody reacts differently. And when you understand that person's a driving force, if you like the driving hormones, the driving neurotransmitters, you know, you understand the chemistry that's going on in their body, but better than you can have more empathy with other people too, with your fellow human beings that they aren't all just like you. Speaker 2: (31:49) And then the connection between biology and performance and productivity is just, as you can start to connect the dots, because if you maximize your biology performance wise and productivity wise, you'll, you'll see a sustained improvement and, uh, increase increase as well. It's the people, um, then some other, some other good wins just to share with everyone as well. At least it's just, when you understand you're different, you're gonna have different areas. You should focus on the health and fitness industry. Traditionally tells us to focus on nutrition and exercise. And it's one of the, the craziest messages that generally the, the fitness industry has been built by crusaders activators and the, in the earlier days. And therefore it was the message always been around, eat little, um, eat little and often train at high intensity, or, you know, anaerobic threshold stuff, which works. We discussed the today. Speaker 2: (32:40) You can see why it worked for a percentage of the population, but there's a lot. It wouldn't, it wouldn't shouldn't work for us. So with that in mind, there's different priority areas that people should look at for some people focusing on their minds and allowing their mind to switch off each day, turning the volume down should, um, should be a priority. And that longterm will help them change shape, lose weight, more than exercise will. Okay. Exercise is still important, but it's my understanding that they've had those particular people, the, the exome Wars have had more development through their nervous system from an embryology point of view. So when they were growing in mum's tummy, um, the, the exome was had more energy put into it. So it was developed more extensively. So therefore they're going to have a high developed nervous system and their brains going to raise a whole lot faster. Speaker 2: (33:28) So the brain is racing faster, switching it off is there's going to be key others. If I had development in different areas where food, for example is like kindling to their sort of fire, they put food in their burn through equipment. So they're going to need more, more food more regularly, and they're gonna need more movement more regularly than other types. Um, and then they're going to need to, as they move in regularly, they can need to rest hard as well. So the recipe for each person is going to be different. Others are going to need to know that their family, their friends around them, uh, safe and well, because that will allow them to start getting the results they're going to need good social interaction to boost hormones like oxytocin. That's going to be key. So point is that the guidebook rule, the rule book, you're talking about creating your own guide book for your own body. It's going to be a different, a different book for each person. Speaker 1: (34:19) Yeah, it does really well. Uh, so give me an example of that. So my mum is what they call a guardian, one of the bio-type names, um, and for her, her top priority area is social. So I want to, as you, as a trainer, as your coach, as a rehabilitation person, after her aneurysm, I want to focus on food and exercise because that's what would suit me. Um, and where I think she can get, you know, Geneva, a lot of it, obviously, because she needs to rehabilitate her ability to move and so on. But at the top of her priority is social. So if she is not feeling connected and loved and supported, and that her family is that a got place, she's not going to be interested in exercising right. Or eating, right. She won't, she'll be eating the wrong food. She won't want to exercise. Speaker 1: (35:08) She won't be motivated and so on and so forth. So I have to make sure that she's mentally and socially meaning her family and her friends circle that she's getting good, happy, social interactions that she's happy where family's at. And if that's all good, she will do the work. So for some, for me, sometimes as a coach, that means letting her go off to the movies with their sister instead of taking her to the gym. And that's a big jump for me, because for me it's all about, but you should be moving 10 times a day, you know? Um, but understanding that when she does, and she has that time and that connection with her sister or a friend, that's going to enable her to actually come back and then exercise better and be more able, because she's not stressed out to focus on her food and their exercise. If that makes sense, Speaker 2: (36:00) That side, at least that's a gold gold example. So I think the biggest thing for the lessons to be hopefully taken away is that it's all right to be you, it's all right, to be different. You should be different. And if you've been struggling in any way to get any results in any aspect of your life from a, from a work and corporate point of view with yourself personally, or those that you're managing or driving, um, from your health and fitness perspective and sport and performance from a parenting or relationship side, then start to realize that you need a unique plan. You need a personalized plan, and you need to look at yourself as an individual and challenge those around you that are giving you advice, ask them what's, what's going to be best for me because there's so much science evidence and research out there. And we are all, all our experience with the people we've taken through the program. Once you personalize it, the results start to come a whole lot quicker. Speaker 1: (36:59) Absolutely. In all areas of life, as we said, not just your food and exercise cause that's, uh, you know, that's only a piece of the pie, um, in, in this program, as we said, um, if anyone wants to check it out, we do hold a webinar every couple of weeks, a public webinar that you can just register, um, and rotate you through the whole science side of it so that you can understand what is in behind it to, to, to a certain degree, at least in a, what we can do in an hour. Um, and to understand the implications of what we've been talking about today and how it can actually benefit you. Um, if you are interested in doing that, I'll put the link in the show notes, but it's just epigenetics.lisatamati.com to register for that webinar. And you can come and hang out with us and find out a little bit more. Speaker 1: (37:46) Um, and if you, if you want more information around this, otherwise, um, you don't want to wait for the webinar, just hop on over to my website at lisatamati.com And go to the, working with us tab and you'll find the epigenetics program near. And it all explained, um, this is, you know, this is apart from this program, the whole of medicine, the whole of the genetic testing, uh, the epigenetic programs like this, it's all going towards personalizing everything to your set of genes and your environment and optimizing that. And this goes right through from your, the medications that you're taking right through to the food that you're eating, you know, right across the board. So it's, uh, I'm really, really excited for the stuff that's coming down, the, the lines now from a point of view, because that's what Neil and I do is we just spend every waking moment that we're not actually coaching and working study and finding the latest stuff and always upgrading it. Speaker 1: (38:47) And I'm just absolutely ecstatic at the stuff that's coming down the pipelines now, and the information that we can get. And it's like, why didn't we get taught all this stuff, you know, and this is why I'm passionate about this podcast, getting these experts on and sharing their insights into the latest science, if you like sometimes before it's ever got to the medical schools or the textbooks or the, uh, you know, it's stuff that you need to know about now. And, um, this program is really, really exciting. So check that out at epigenetics.lisatamati.com Register for the webinar in a couple of weeks, uh, every two weeks we hold one. So you can find out more about it, um, new or anything else that you wanted to add on onto there. Just go and be, go be you to be you, if it feels right, if it doesn't question it, question it, I think if you don't, even if you don't do the program and you don't want to do this. Speaker 1: (39:43) And so on question with the CrossFit that you are doing, or the ultra marathon running you were doing, or the keto diet that you're doing, or the paleo diet, is it working for me? If not try something else, if you want to cut out the trial in the Euro though, come and check out what were you doing? But if it just because it's getting results for your friend down the road does not mean it will get results for you. And that's probably the biggest takeaway, understand unique, love it, loose. Love it. Thank you. Awesome. Well, thanks guys for listening today. If you enjoy the show, please give us a rating and review. We hit the top 200 in the world now, and that health and fitness genres. So everybody who has given us a rating and review on iTunes or any of the other platforms, we really, really appreciate you. Speaker 1: (40:31) We love feedback on the show, uh, everything that we're doing, and if you do enjoy it, please share it with your friends and your context, because it's only through that, that we can keep this going. Um, it is a labor of love and, um, it takes up a heck of a lot of time and energy to produce these podcasts and get them out there. Uh, some really do appreciate your support in that area as well. And if you've got any questions for Neil arrive, um, come check us out at lisatamati.com, Where we're happy to help you. There is the contact details on there, and we'll hopefully see you again next week. Speaker 4: (41:06) That's it this week for pushing the limits, be sure to write review and share with your friends and take over and visit Lisa and her team at lisatamati.com

Extracts of amla (Indian gooseberry) were pitted head-to-head against cholesterol-lowering statin drugs and the blood thinners aspirin and Plavix.

Dr. Jennifer Daniels Author of The Lethal Dose: Murder By Medicine is No Accident Dr. Daniels is a former medical doctor who had her medical license suspended due to not prescribing enough drugs and truly healing her patients. Dr.Daniels is widely considered one of the foremost Alternative Healing Physicians alive today. She graduated from Harvard University with Honors receiving a BA degree. Her education continued at the University of Pennsylvania where she received her Medical Degree (MD) and also attended Wharton where she received her MBA in Health Care Administration. She practiced medicine for 10 years as a Board Certified Family Practice Physician where she saw first hand the power of Natural Methods. She has been coaching clients to successfully heal naturally since 1985. She is the author of the award winning book, Do You Have the Guts to Be Beautiful? Show highlights: Dr. Daniels is 63, but looks 16; what is her secret for fabulous skin? When did Dr. Daniels realize that what is taught in medical school is all wrong What Dr. Daniels was taught about vaccines in school Does Dr. Daniels think we will see a mandatory COVID vaccine? She shares what President Trump said about it and it’s GREAT news; you can’t mandate a vaccine for a disease that has a cure Dr. Daniels still insists that this virus does not exist We’re trained now to believe everything we are taught; we need to go back to questioning everything like we did in past generations The importance of upgrading our data set The Elite want the right to exterminate you at will Does ginger cause wrinkles? How flaxseeds can be used to retain moisture in the body Dr. Daniels on the air how she takes turpentine with sugar; do not do this until you study the protocol on Dr. Daniels website; she experiences more comfort and flexibility in her body than she did in her 20s How to learn how to deliver your baby at home The big problem with blood tests The healing benefits of eating cow brains What is causing the high Parkinson’s diagnosis’? Why Dr. Daniels doesn’t eat a lot of fish A listener has a little white ball inside their lower lip; what could be the cause? The problem with Plavix; is there a natural blood thinner? Taking a look at your strategy for living; it it possible to thrive under any political regime The idea of “autoimmune” issues is nonsense Why would an ear keep filling up with fluid? Healers Home Study Course http://vitalitycapsules.com/health_accelerator_sale1 Consultation with Dr. Daniels http://drjenniferdaniels.com Candida Cleaner Report: vitalitycapsules.com You can get Dr. Daniel’s free report on using turpentine safely and effectively. Get the “Candida Cleaner” here.

This is in reference to State v Jennifer J Shipon, Burlington County NJ Prosecutor Scott A. Cofina prosecuting, court date Aug 3, 2020. The truth is never libel or slander. I am asking the State of NJ and the FBI to charge both my brother Theodore L Shipon and my sister-in-law Jennifer J. Rogers Shipon with the attempted murder by medication of my mother Laura Shipon, who is irrevocably injured with a Plavix poisoning stroke; and my father Stanley H Shipon, who survived but has his Lasix taken out of his medication regimen for 4 days by Jennifer Rogers and Ted Shipon. This was a double assassination attempt and the investigating detective hasn’t convinced the Prosecutor yet in case 2020-9956. Time to speed up the work of our civil servants. We don’t need less law enforcement. We need it to be swift as the angels. I hereby certify that everything represented here is true to the best of my knowledge. I know my Miranda rights and submit it into evidence for Burlington County NJ Prosecutor’s file 2000-1893. My electronic signature is my sworn testimony in a court of law — The Truth. Signed, sincerely, so help me God. Dr Randolph Shipon, licensed psychologist and Freemason, raised in Columbia Lodge No. 91 F&AM. The Nazis are all around us. Let’s fight them. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app · Charity Promotion: Democracy Works: This advertisement is part of a charitable initiative in partnership with Democracy Works. howto.vote

In Re Plavix Marketing

Hematology blood thinner meds. Antiplatelets. Salicylic acid, bayer, aspirin, acetylsalicylate, Plavix, clopidogrel bisulfate. Free quiz & full course at https://Simplenursing.com/nursing-school  Pharmacology Master Class - 100 videos not on YouTube - Try it for Free!    Pharmacology Master Class - Try it for Free: https://Simplenursing.com/nursing-school  100 videos not on YouTube    FREE Access to new app + 1,000 videos not on youtube!  https://Simplenursing.com/nursing-school   NCLEX FREE TRIAL:  https://simplenursing.com/NCLEX   STAY IN TOUCH

Contributor: Don Stader, MD Educational Pearls: When do we give antiplatelet drugs or anti-coagulation drugs? Arterial issues get antiplatelet therapy Venous issues, or slow flow states, get anticoagulation therapy. High flow areas (arteries) are more prone to platelet clotting while the venous system is more prone to allowing blockages caused by coagulation factors. The main side effect with antiplatelet and anticoagulants is bleeding. Typically antiplatelet drugs cause more bleeding issues because platelets are made in the bone marrow, while coagulation factors are made in the liver, so it takes longer for the bone marrow to replete platelets versus the liver which is a fast synthesizer of clotting factors.    Reversal of antiplatelet drugs can take a while, so patients on these drugs (ex. Plavix) may need a week of withholding the drug to get surgery, while anti-coagulation drugs (ex. Xarelto) can be stopped a day or two prior to surgery. References 1. Altiok, E. Marx, N. Oral Anticoagulation: Update on Anticoagulation With Vitamin K Antagonists and Non–Vitamin K–Dependent Oral Anticoagulants. Dtsch Arztebl Int. 2018 Nov; 115(46): 776–783. Published online 2018 Nov 16. doi: 10.3238/arztebl.2018.0776 2. Kapil, N. Et al. Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke. Clin Appl Thromb Hemost. 2017 May;23(4):301-318. doi: 10.1177/1076029616660762. Epub 2016 Jul 26. 3. Ostergaard, L. Fosbol EL. Roe MT. The Role of Antiplatelet Therapy in Primary Prevention. A Review. Curr Pharm Des. 2017;23(9):1294-1306. doi: 10.2174/1381612822666161205115540.   Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

Episode 28 Pharmacogenomics with Dr. Natasha Petry, PharmD, BCACPNatasha has a bachelor’s degree in Microbiology and graduated with a Doctor of Pharmacy in 2012 from North Dakota State University in Fargo, ND. She completed a post graduate Pharmacy Practice Residency at Trinity Health in Minot, ND and joined the faculty at NDSU as an Assistant Professor with a clinical appointment at Sanford Health. She is a board-certified Ambulatory Care Pharmacist and began working in the area of Pharmacogenomics in 2014. She is an affiliate member of the NIH funded Implementing GeNomics In practice (IGNITE) network. She currently works as a Pharmacogenetics Clinical Pharmacist for Sanford Imagenetics. In addition, she is pursuing a Master of Public Health degree. Natasha is a wife, mother to 2 beautiful girls, and enjoys attending sporting events.Pharmacogenomics: The genetics of how people metabolize (break down) medications. Genetic information can help guide the use of medication dosing and medication choice. Genetics looks at the enzymes that break down medications. Can help determine efficacy or utility, safety and/or dosingStill limited but growing rapidly- another “tool in the toolbox”Genetics does not change in a lifetimeCost can be limitingCurrently useful in prescribing antidepressants, some pain medications, cholesterol medications (statins), clopidogrel (Plavix), warfarinLimitations:No standardization in lab testing regarding which allele variants are testedCostLimited actionable results that impact a finite number of medicationsGenetic testing collected through blood, saliva, cells from the cheeks depending on lab usedVariable insurance coverage: preemptive testing not likely covered, reactive is being covered more oftenDirect to consumer testing vs. laboratory (health system) derived testingNeed Medical Geneticists and Pharmacists to help interpret informationHealth Pearl: Try out meal delivery kits for improved healthResource list: https://imaginetics.sandordhealth.orghttps://www.genome.gov/FAQ/Pharmacogenomicshttps://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomicshttps://www.yourgenome.org/facts/what-is-pharmacogenomicshttps://nigms.nih.gov/education/pages/factsheet-pharmacogenomics.aspxhttps://www.cdc.gov/genomics/disease/pharma.htmhttps://pharmgkb.org/page/pharmacogenomicshttps://www.pharmkb/page/iAmACitizenFollow us on Facebook and Twitter

In this podcast, Dr. Mark Young, a stroke Neurologist with Abbott Northwestern Hospital, discusses current guidelines for ischemic stroke management and care. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Summarize the latest guidelines and management for acute ischemic stroke. Describe current interventional management for large vessel occlusion with thrombectomy. Identify modified Rankin scores and the impacts on stroke patients. Demonstrate an understanding of new timelines to guide therapy such as Diffuse-3 and DAWN trials. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Stroke Updates: Guidelines and Management for 2018-2019" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”    FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: One large impact on stroke care 2018 is the thrombectomy window expansion time for large vessel occlusion out to 24-hours. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023310 Current perfusion imaging available is able to identify core infarct- establish the quantity and mismatch ration of available brain that is salvageable. Futile reperfusion is something that should not be undertaken due to high risk of reperfusion hemorrhage which can ultimately worsen outcomes. Last known well time means exactly that. When was the patient last seen well. So if they go to bed and then come in with a wake up stroke then LKW is when they went to bed. Some studies on wake up strokes showed that the majority developed symptoms 2-3 hours prior to waking up. LKW and wake up stroke are different but can often help us guide therapy. For instances pt goes to bed is LKW time and then wakes up with stroke like symptoms. Perfusion imaging is instrumental in the decision process for these patients often guiding us with further management. The NINDS trials came out in '95-'96. However the bottom line showed - in patients, with ischemic stroke within 3 hours, tPA administration significantly improved HIHSS scores but did not confer survival benefit. https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 Stroke neurologist typically want a call early in clinical course. Don't wait for CT prior to calling. Then when was the last known well time. Blood glucose, blood pressure, PMH and deficits (ie NIHSS), 'what are you observing'. Don't wait on labs - consideration is warfarin. There are trials following the NINDS trial that show evidence that patient with low HIHSS with potentially disabling deficits and rapidly improving stroke improve with TPA treatment and that the hemorrhage rates are lower. Definitely consider treating rapidly improving stroke sxs. With stutter stroke sxs, the clock resets when the patient returns back to baseline. CHAPTER 2: Most stroke centers uses -0-4.5 hours time frame for IV thrombolytics. Absolute and relative contraindications for thrombolytics include: greater than 2/3 MCA territory don't treat as there is little benefit. Patient on warfarin with INR greater than 1.7. Recent stroke or ICH. Endocarditis. Coagulopathy. People on DOACs. Significant thrombocytopenia. There are many more but these are the highlights. American Stroke Association says patient must be off DOAC's for 48-hours before lytic treatment as relative contraindication. Dr. Young's standard conversation with pt who are experiencing a stroke when discussing TPA. First, it is the standard of care, next the chance of hemorrhage is around 6-7%, but Abbott has a much lower rate of around 2.5%. We know that even with that risk patients do much better overall. At 90 days, the chance that the patient will be living independently are much better. 90-day Modified Rankin Scores are standards that we use to measure stroke outcomes. Modified Rankin Scale score of 0 is no deficit, no residual. MR of 1 can do everything you use to do although may still have mild symptoms that patient may notice. MR of 2 - you have some limitations but can live independently and do all ADLs MR of 3 - is dependent with ADLs although can walk with or without a device. MR or 4. Can't walk. MR of 5 - bed bound. MR of 6. DEAD. Some criteria for TPA with lower HIHSS with compelling deficits are #1, what's disabling #2. Others include limb ataxia, aphasia, paresis, dominant hand problem, dysphagia, dysarthria. Controversy Hemianopsia. Greater than or equal to NIHSS of 6 is generally recommended to get a CTA to evaluate for LVO stroke. Imaging generally requires CT/CTA of the head and neck. Always include imaging of the neck. Rapid perfusion imaging for LVO used in Diffuse 3 - (6-16 hours) for the window vs DAWN out to 24-hours. CHAPTER 3: So the order of imaging includes noncom CT head, CTA, CT perfusion. When evaluating the imaging studies we want the core infarct to be less than 70ccs and the ratio of the core infarct to at risk brain penumbra to be greater than 1.8. The use of rapid sequencing MRI has utility for post circulate symptoms, ie vertigo with/out nystagmus, abrupt onset. Generally diffusion weighted gradient echo/T2 flair images looking for blood. Other indications maybe for subacute findings/duration. LVO's that can be intervened on include: anterior communicating, distal carotid or carotid terminus, MCA M1, M2, basilar, distal verts, maybe PCA/P1. Important point if a patient has a LVO lesion and is within the 4.5 hour window at a small rural setting with lytic capabilities and the patient is going to a large tertiary stroke center does the patient still need to receive IV lytic therapy - knowing that the patient will require thrombectomy and answer is YES. No increased risk when using lytic with thrombectomy. A little controversial but we maybe seeing the bypass of non-stroke hospitals specifically with LVO to tertiary stroke centers with a new scoring system that EMS can do called RACE (Rapid Arterial oCclusion Evaluation)  https://neuronewsinternational.com/racecat-trial-update/ CHAPTER 4: After care by the PMD what can we expect from these patients follow a LVO? 90-day Rankin  50% with modified Rankin 2 less to live independently following LVO. 50% of LVO have a 90 mortality. 70-80% will not live independently. Discharge meds for these patients will include DOACs or Warfarin, antiplatelet agents - such as Plavix. Occasionally patient will end up on dual antiplatelet therapy depending on disease state. Stoke mimics that have been given thrombolytics have less than 1/2% chance of hemorrhage.

Contributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing the release of Von Willebrand factor, helping to stabilize clots.  The use of DDAVP for intracranial hemorrhage in patients on antiplatelet agents (mainly Aspirin and Plavix) was recently reviewed In this retrospective review, they found an 88% decreased likelihood of hemorrhage expansion, in those who received DDAVP, compared to those who did not. Furthermore, they found no significant increase in adverse effects like hyponatremia or thrombosis  However, no difference in mortality or neurological status was found DDAVP for intracranial hemorrhage in the setting of antiplatelet agents may be safe and reduce the expansion of intracranial bleeds but not change important patient outcomes References Feldman EA et al. Retrospective assessment of desmopressin effectiveness and safety in patients with antiplatelet-associated intracranial hemorrhage. Crit Care Med 2019 Sep 24; [e-pub] Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

In this Live Friday CME Series recap, Dr. Todd Holcomb, an Internist and hospitalist with Lakeview Clinic and Ridgeview Medical Center, presents an interesting Internal Medicine case that is sure to scratch some heads, and remind us of the need to go back to the beginning, if it's not making sense after several attempts. Dr. Holcomb is accompanied by cardiologist Dr. Joshua Buckler, with Minneapolis Heart Institute, Dr. Jonathan Larson, family physician at Lakeview Clinic, Dr. Carl Dean, nephrologist with Kidney Specialists of Minnesota, and Dr. David Gross, radiologist with Consulting Radiologists.  So put on your thinking caps, listen closely and ask yourself what you would do as Dr. Holcomb guides us through this interesting case. Enjoy the podcast! OBJECTIVES:    Upon completion of this podcast, participants should be able to: Identify secondary causes of hypertension. Identify when further testing is warranted. Discuss newer treatments available for cholesterol related conditions. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org.   CLICK ON THE FOLLOWING LINK FOR YOUR CME CREDIT: CME Evaluation: "2019 Internal Medicine Case Conference" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: PART 1: Alright, let's break down the first portion of this case discussion. This is a 60 yo male with chest pain for over a year. Intermittent aching and burning in right anterior chest, worse with activity and lately has worsened overall with a stressful job and strong family hx of heart disease. General exam ins unremarkable. ECG normal. HDL is 60 and LDL slightly up at 137. PFTs and CXR are normal.  Stress echo is normal.  Cardiology referral results in a low Ca++ score but some plaque in the LAD. Dr. Buckler, the cardiologist, feels this is ischemic heart disease until proven otherwise. Therefore, a coronary angiogram is necessary. Imaging has its limitations, as do stress tests. When the history still doesn't point in another explicable direction, we must follow the logic and most likely etiology, which is till coronary artery disease and ACS. One of the problems with stress tests in general, is there are limitations inherent. It's hard to miss the big stuff, but the more minor findings can be missed. With a high pretest probability, he could have perhaps gone straight to angio. In this case, though, he was started on a statin and aspirin. Per Dr. Buckler, Imdur could also have been given. Two year later, he comes in with headaches in the same area of the head since his wife recently passed away. He takes Advil for this. BP has been elevated at home. Dr. Jonathan Larson, family physician, questions the type of headache, it's location and possible etiologies. Is the Advil causing rebound headaches or contributing to the headaches? The elevated home blood pressures also need further investigation. His kidney function is temporarily normal. NSAIDs are d/c'd and Lisinopril is started. A month later, the headaches have improved. BP improved, but not tremendously. In addition, his chest pain has gone away. A new antihypertensive, a combo HCTZ/Lisinopril regimen is started. Although Amlodipine would have been a reasonable choice. A year later, he returns with the same chest pain on exertion. Normal ECG. Normal renal function too. He now goes back to a CT angiogram showing multi-vessel disease. Per Dr. Buckler, one of the reasons he has worsened on a statin is that we may have limited understanding of his pathology, or potentially the CTA was not accurate the first time. Virtual FFT now can show the flow and how significant the lesion is, which is an advancement in this technology. Unfortunately, despite aggressive lipid therapy, sometimes people progress. A few days after the CTA, his Creatinine goes up a bit and GFR goes to 43. This is also after years of Lisinopril. Dr. Carl Dean comments on this alteration in renal function. He feels this is not entirely unexpected, but the data doesn't really reflect CIN (contrast induced nephropathy). Yet intuitively and experientially, we sometimes see this. The amount of contrast used is significantly more on a CTA than on an invasive angio. At this point, the ACE inhibitor is held and Amlodipine is started. Renal function now has improved. The angiogram demonstrates significant 3 vessel disease, with good downstream targets. The SYNTAX surgical risk score directs the cardiologist toward CABG instead of PCI. Post angio, he develops some lower extremity edema, and he is discontinues on Amlodipine, resumed on the HCTZ, Lisinopril. The creatinine is now 2.4. Did he receive enough fluids for the angiogram? Or was the few hundred cc's he obtained during the angio okay? Again, hindsight is 20/20, but the data doesn't support a causality for AKI due to CIN, nor is there a true preventable measure, including n-acetylcysteine or bicarbonate. Perhaps, in this case, CIN as a possibility in the past as discussed, that many would not argue with overhydrating. Ultimately it was felt the ACE and contrast contributed to his creatinine elevation. The ACE combo is now stopped and he is started on Hydralazine and Metoprolol. Creatinine improves, and he goes into CABG surgery. He is discharged and he continues on aspirin and Plavix for 3 months, and Carvedilol and Hydralazine. Atorvastatin is increased to 80 mg daily, a more aggressive dose. EF is normal on echo.  Do statins affect kidney function positively or negatively? According to Dr. Dean, there is no trial that supports either. His BP starts to increase, and Lisinopril is once again added, along with an increase of creatinine, and the ACE is again d/c'd. HCTZ was added. Then spironolactone for ongoing HTN. He's still running high though. Labetalol is replacing carvedilol now. And the pressure is still running high. What is happening here? What to do next? Do we try Lisinopril again? It is attempted, and he once again fails the creatinine test. It goes up again. PART 2: What we do now for this patient? It seems he can only improve on Lisinopril for blood pressure, but his creatinine continues to go up. According to Dr. Dean, in this patient, Lisinopril may not be a great option going forward, not only due to creatinine increase, but it will not help him in terms of mortality outcome. renal artery stenosis is a concern in this case. Dr. Tara McMichael interjects the question, could a loop diuretic have been tried? With a creatinine of 2.3, a loop diuretic could have been an option, since volume and sodium retention could be contributing to the hypertension. Isosorbide with hydralazine is also an option if more meds were to be added. Per Dr. Buckler, however, a four drug regimen that is poorly controlling blood pressure doesn't necessarily indicate adding a fifth drug. We need to know if there is a secondary cause of HTN. Sometimes, even in the setting of renal artery stenosis, patients still require significant anti-HTN drug regimens. Also, per Dr. Dean, the pretest probability in this type of patient for renal artery disease is high. And will an intervention be desirable if it is found? The ASTRAL trial demonstrated no improvement in outcomes. The CORAL trial was also done and considered to be a negative trial. One of the trial criticisms though was that it didn't include patients with severe enough disease. According to Dr. Dean, refractory hypertension should cause screening for this and an intervention should be done if it is seen.  Our patient has a renal u/s that shows bilateral RAS. Dr. David Gross, radiologist discussed the results of the MRA. The aorta, SMA and celiac trunk show atherosclerosis. The renal arteries are paired bilaterally. They have moderate to high grade narrowing of the arteries. Dr. Buckler asks the question of the safety of gadolinium in renal disease. In the setting of low GFR, in other words, less than 30, the risk for nephrogenic systemic fibrosis exists, although very rare. This is usually fatal, though. Basically, he has 4 out of 4 arteries occluded. Dr. Dean feels referral to a center of excellence for this unique issue is best for the patient. He undergoes transaortic endarterectomy, as his creatinine is rapidly going up. A significant plaque is resected from the aorta which was extending into the renal arteries. Post-procedure, he is placed on metoprolol, requiring nothing further. Rosuvastatin, Zetia and baby aspirin is started. Basically, unclogging the pipes resulted in a cure. And a while later, he's no longer on any antihypertensives. Blood pressures are great now. LDL now 57 on the new cholesterol meds. Zetia has limited data, but the PcsK9 inhibitor and his LDL is now 1. Dr. Buckler states there is a lot of unknowns about the LDL levels and whether there is a point of diminishing returns, but the science is not there yet. In this case, Dr. Buckler feels that stopping the Zetia and continuing the pcksk9 inhibitor makes sense. PART 3: Renovascular HTN is more commonly found in the setting of acute, severe, refractory, very high blood pressure. Work-up is needed when there is a strong possibility of secondary cause, and in the absence of another secondary cause, like pheochromocytoma or hyperaldosteronism. Also in an acute rise in BP, a young age, elevated Cr after starting an ace inhibitor, etc. Renal asymmetry on imaging and flash pulmonary edema are other clues. If Cr and BP are stable in the setting of stenosis, no intervention is indicated. Testing can potentially worsen function, as can the interventions performed to treat the disease. Who benefits most? People with short term hx of HTN, people who fail optimal medical therapy, not tolerating medical therapy and progressive renal failure. Ultrasound and CTA or MRA are the options for work-up. US is cheaper, but time consuming and operator dependent, with modest sensitivity/specificity. CTA is accurate for atherosclerosis. Highly sensitive and better if GFR below 30. MRA is highly sens/spec. Gadolinium complications can ensue in low GFR situations. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9) will lower LDL up to 60%. 50% decease in stroke and MI risk. The PCSK9 enzyme binds to liver LDL receptors and thereby increases plasma LDL levels. so inhibiting this enzyme leads to a lower LDL level. These inhibitors also can decrease triglycerides, increase HDL somewhat and decrease the volume of atheroma. Low adverse effects are noted with the med as well. Regarding renovascular HTN, Dr. Dean also reminds us that someone who is significantly older with chronic renal ischemia in the setting of this disease, may not have improvement in renal function even after intervention. Therefore, some of these patients who suddenly reperfuse a chronically ischemic kidney may actually worsen. Renal artery stenosis is also not an absolute contraindication for ACE. Such as in low EF heart failure. If the creatinine markedly rises, it can be discontinued again. Fibromuscular dysplasia patients, unlike atherosclerosis patients, should all receive an intervention. This is more commonly found in younger patients. Dr. Buckler addresses the ease of use and cost of the PCSK9 inhibitors. It turns out the cost is high at this point, up to $14k/year. But coverage has shown promise in FH and refractory high LDL. As it was alluded to by Dr. Holcomb, the patient really doesn't exercise and has a very stressful job, as it turns out. His dies wasn't discussed. Was he managing his risk factors very well? What does that mean nowadays? We have potent medications and skillful intervention options for reacting to this sort of pathology nowadays, but where are we at with prevention? Hopefully a conversation for another day.

All right. Welcome to the gut check project. I'm here with your host, Dr. Kenneth Brown. I'm Eric Rieger. This is gut check project, Episode Number 26. We're going to wind up 2019 with some awesome info. What's up, Ken?What's going on Eric? How are you doing, man? Episode 26. Unbelievable. I apologize if I'm a little too sexy today because I'm just coming off of a small cold. I think the hottest people are those that are sick.Well, I'm not sick. I'm post sick. Remember, the viral prodrome. The reason why we always like pass so many viruses is that you tend to pass the virus before you even know that you're sick by the time you're actually sick. You're probably okayYeah. At that point you can go back and say I heard you might be sick. I was too back then.Yeah, exactly. Good to see you?Well, today's episode is going to be pretty awesome. We're going to tackle number one, we've received tons of email in your clinic because you also sell the KBMD CBD at your clinic, you get these questions. These have been coming in Fast and Furious over the last little over 14 days. And it's questions about the safety of CBD oil and its application. So we're going to tackle that I do need to tell everyone. Thank you. We're on episode 26 because the first 25 shows were so well supported by all of you who've been keeping up with a gut check project. We grow every single day. Paul, the guy who's helping us put together the production now and helping us spread the word. We just hung up the phone with him. We've gotten more and more downloads each week. So thank thank you every single one of you for liking, sharing, emailing, telling your friends about it. We sincerely appreciate it.We learned so much about it like today we have a new a different guests we do Instead of gutsy our little mascot or green frog, but since we do film on a green screen, he gets blocked out did not know that didn't even realize that. So now we're going to go with a dung beetle, right here? Yeah, yeah, we did. So that's Dilbert, the dung beetle,Dilbert, the dung beetle. So one of my favorite things is whenever we're bringing any patients back and somebody sees you, and they're like, hey, you're Eric, I watch your show that just warms my heart. So if you happen to be a patient and show up and you watch the show, if you say that it just makes us both feel really, really well...needed wanted, appreciated.Yeah. At least outside of me putting you to sleep. Take five or six good deep breaths. Exactly. Today's episode is sponsored by Atrantil. Your bloating relief, it's what we do. So go to Atrantil.com or lovemytummy.com/KBMD. Today it's also sponsored by KBMD CBD oil. You can find your own KBMD CBD oil at kbmdhealth.com which of course, the initials KB, Kenneth Brown, it's endorsed by the guy who's sitting across the table from me. So Ken, why is...What does MD stand for? Well, I'm not really sure.I thought it was your buddy Mike Doyle, but I don't know.Yeah, it's probably. So tell us a little bit about KBMD CBD. Alright, so KBMD CBD oil. I got involved with the science of CBD because I saw the beneficial effect with my patients when we developed Atrantil I then learned that the science of Atrantil the polyphenols in it actually augment CBD. So I'm seeing this combination do incredible things for people. So this particular CBD is one that we have researched, I've seen it work clinically. And we know that it comes with a certificate of analysis. It is organically grown, it is naturally extracted with co2, so it meets all the criteria that you want in your CBD because this is important. The rest of this podcast is going to be all about the dangers of CBD.Definitely and It's really interesting since we do have so many people who have begun to purchase CBD find benefit. It's really kind of weird what's occurred over the last two weeks. And what I would say is a little bit of misinformation. But it's more or less probably just misunderstood information and or or misapplied information. But regardless, the benefits of CBD used correctly, have been undeniable with the people who've come back through the clinic with people that we've scoped, and how well that they are doing. And so, hopefully today, we're going to provide some context on why more or less the dangers that you may or may not have read about in the news recently are really a little concerned. But we'll, we'll see. We'll see how far along we get in at the last. The last thing. Our last sponsor is the KBMD health box. You can find KBMD health box by going to kbmdbox.com. Now last week we did a full unboxing which is something I think we're going to try to do at least once a month. But essentially, if you want almost $300 of physician vetted supplements that can help you benefit your life and get them for only $147 which you would spend, not you would spend more than $147 worth of time driving somewhere to pick them out for yourself and having someone handpick them for you. Go to KBMDbox.com. What was one of the things that we had a patient come through just earlier this week, who showed us his lab results that he took to his primary care physician? So we're starting to make a difference in the landscape of health here in the DFW Metroplex and different places. I've been getting emails and calls from people around the country that will actually hear the podcast and then they'll want to sign up for the box. And what we're seeing is that these vetted supplements actually are making a difference with both subjective how they feel and objective the labs. So the reason why I chose these things is they all have third party analysis. And they all have some scientific background that actually explains how they're going to help you. So much so that I'm thinking of ordering my household, another box. So although it is the KBMD Health box, I actually I love the fact that I can get these things that I'm going to purchase anyways, they come into my house, so my whole family's on it. Now we're running out of stuff. So I'm gonna end up having to double up on everything. So it's one of those things that I feel really good that we can look at different aspects. And when somebody says, Oh, I tried X, Y, and Z, I didn't notice anything. I'm like, oh, did you try one that had a third party analysis? No. And then they do and they're like, Oh my gosh, big difference. Same thing with CBD. I mean, a lot of CBD out there doesn't really have what's on the label. And we're going to get into that because we're going to talk about what the FDA thinks about it. We're going to talk about the different media and what they're doing, and hopefully get into all that but that's the whole point of that box is I want to deliver these vetted things to your house monthly so that you can continue to improve your health. Hundred percent. So without further adieu, be sure to like and share the gut check project. We certainly appreciate all of the support to date. We're going to hop right into it. So what we've received here recently is a lot of speculation and concern from people who have said, Hey, I'm interested in CBD. I know that you and Dr. Brown have heavily studied, been entrenched with CBD and its application over the last few years. I just learned that the FDA is associated or made public a study that says that it may be hepatic toxic or bad for my liver. It's, unfortunately, it's a weird jump off point. So I'm going to kick it to you. Because immediately I had lots of different thoughts and instead of getting emotional, what did we do? We went and tried to find the sources of where this information came from. We want to backtrack on how they got to that conclusion. And I think that we can put a lot of questions at ease and even help people learn how to be a little bit more critical with the data that they receive when they receive it. Because let's face it, lots of stuff that we see on the internet, or that we hear on the news or reading the paper, it's basically clickbait. It's basically things to keep you engaged, whether or not the actual substance is worth the headlines that are written so...So what you're referring to is recently the FDA put out a statement, a consensus statement in the news and it's making all kinds of traction in the news that they're saying that CBD is not as safe as people think not only that it can be harmful. Now this has bled onto TV and my patients have been asking me about this FDA statement. Then there's been other news articles like the one that Forbes published, read said that CBD causes liver failure. Failure. That was the title liver failure caused by CBD. I want to get into all that I wanted to take a really deep dive into the science of all of this as a gastroenterologist, I'm board certified gastroenterologist, which means not only am I a simple country, butt doctor from Texas, but we actually have to learn liver disease, hepatology, I'm not a hepatologist like some of my other friends where I send like really complex things, but we at least have to understand the liver, how it works and what it does. So a lot of these articles discuss this but they don't clarify so many little things. Because and they shouldn't it's a it's a journalist writing an article they want they want it to be shared. And anytime you mentioned CBD, anytime that that is thrown out there, you're going to get some clicks, you're going to get a whole lot more clicks. If you say you're going to die from taking CBD. It reminds me of the I remember Jerry Seinfeld was on Saturday Night Live one time and they were making fun of the nightly news where they always do the promo at like three o'clock. Like five household items that are guaranteed to kill you, tonight at six.You're like what? If it was so important, they probably wouldn't make you wait.No, I'm gonna die before you put this on the air. So what I'd like to do is talk about the briefly the science of the endocannabinoid system and CBD, then do a little bit deeper dive into the liver. So everyone's going to get a primer on the liver 101 here, because these studies don't make sense unless you know, some of this knowledge. It's just sensationalism. For some of it, some of it is a little bit unfair. I think some of it is for what the FDA got, and it's there. But I just want this podcast today to be something that can be useful for industry people that can be useful for patients or people that are thinking about taking CBD and it can be useful for a subset a small subset of people that may be should not consider taking it. Yeah. So all of this is kind of, you know, for the future of this podcast, It's almost going to be a bit of a rebuttal. Not necessarily a defense of hemp derived CBD. But let's just buckle up and kick some science. This might be a little bit I don't know how long we're going to go where we're going to go with this. We're just going to feel it out and see what happens. But I at least want to be able to explain why I still believe that a lot of people should be taking CBD even though Forbes is like you're gonna die from this.Yeah. It's not arsenic people. No it isn't and I think another cool application here is there are people out there who have been on the fence on whether or not I should try CBD or is this something that's good for a family member for me? And unfortunately, there you hit this intersection, where a news headline is written that CBD causes liver failure. Well, if they've been on the fence, that's a pretty big No, no, right? So now you've taken away maybe an avenue that they were considering to help them out. What I hope that we can do with this particular episode is basically let's temper and let's see things in context. I think context is a word that as you get into sensationalism is something that is kind of the rescue item. If I could put something into context, then at least I'm giving someone a fair chance to understand the information that's before them. I don't feel like sensationalized headlines do things like that. Then again, I also don't feel like someone who shakes, hand picked or cherry pick studies is doing that either. So what I think today that we can do is fairly evaluate and talk about the process of how the liver works, and why some of these studies are or are not applicable to the nature they were presented.Absolutely. So the first one we got to discuss is what what what the heck did the FDA say? Sure. So the FDA came out and they mentioned that they've got several issues with the safety of CBD. The two main ones that they're really concerned about are potential for liver injury, and interactions with other drugs. What they actually said is that they're concerned that people may mistakenly believe that trying CBD can't hurt the agency wants to be clear that they have seen only limited data about CBD safety. And these data point to two real risks that need to be considered as part of the drug review and approval process for the prescription drug containing CBD. Interesting. Now, what I say this is because the FDA is referring to the data that was presented to them by GW Pharmaceuticals, who has a epid... eipdi..x you know?E-p-i-d-i-o-l-e-xYes, which is the first FDA approved prescription CBD isolate,Right,for seizure disorders.It's important to point out that is not full spectrum. Correct. That is not full spectrum. And there's some that's important because here later in the podcast, and think we're going to draw some comparisons and just if you're listening, just remember, epidiolex is a CBD Only isolate it is not a full spectrum product.So let's talk about what the FBA what the FDA actually does. So the FDA has a really daunting task. The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy and security of products. So it is super daunting because there's a lot of products hitting the market, and the FDA has tried keep up with this to try and protect people. And let's be honest, let's look at the elephant in the room. The elephant in the room is that there are a lot of bad CBD products out there. Yep. In fact, in a jam article 2017 showed that 70% of the CBD products that they looked at did not have what was on the label and what was there could be higher levels of CBD could be lower levels of CBD. So it's a gamesmanship that's going on right now. So it is totally true that you need to make sure that you've done your homework on what type of CBD that you're actually taking. There currently is little to no regulation in the CBD industry. There is the President and CEO of Natural Products Association NPA. His name is Daniel Fabricant. He's a PhD. I love this quote. He's quoted as saying it is well past time to bring science into the equation, as federal rules require safety and Consumer Protection must come first. I agree. And we all agree with that. Sure. And I think that all companies that have reputable CBD companies, they all want that. Problem is when you have these different stories leaking out, which gain much more traction, it just starts creating a little bit of confusion misconception, and then people don't really know where to turn. So the feeling is, is that possibly statements by the FDA saying that it creates this narrative that questions the safety of CBD overall, strictly to address a few number of companies which are producing quite frankly, some crap products.What was the number that we learned the last time that we were in Utah at meeting I believe it was one out of every 23 to 24, I could be off it was definitely in the 20s. But every to every 23 or 24,25, CBD labels available for retail purchase. One is seen as a reputable well marketed or correctly labeled product, which means that even if it happens to be off a little bit, you've got 23 or 24 other labels which are just not truthful or probably not correct, don't have a certificate of analysis or are blatantly, just not even what's in the bottle.100%. There's a lot of people out there trying to take advantage of this wave that's coming. So I do not. I believe that the FDA is doing their job by looking at the data that was actually presented to them Agree. So let's take some time and break all this down for the consumers, health care providers, industry personnel. Starting with the question, does CBD cause liver damage? Unfortunately, or fortunately, because I like science we really need to talk about what the endocannabinoid system is. Because if somebody's listening to this, they're like, Well, I was thinking about taking this but I'm worried becasue it can cause liver failure. I don't know why I'm taking it. Why in the world should I be taking it? So let's do a quick one minute discussion of the endocannabinoid system. Let's do it!All right, the endocannabinoid system. The endocannabinoid system is a system which was discovered in the 90s that we now realize it's probably everywhere in the body. There's primarily two different types of receptors, but essentially, the way that I try to explain it to my patients, it's concentrated more so in the neural areas, nerves, brain and the immune areas. Although we now know it's in every single organ, that's where all the original research was. We now realize that its job, the endocannabinoid system is to produce these products called endocannabinoids. Which work as traffic cops. They just kind of get your body to get back to an area of balance. If you've got too much activity, they go Whoa, slow down a little bit. If it's not enough, they go, come on. Let's go ahead and get some more going here. So you have this fantastic system in your body that really just tries to keep balanced. Think of it that way. And you're going to hear a little bit later why I think most of America is out of balance. I think most of America needs some replenishment of their own endocannabinoid system. So that's the important thing is is that there's a dire need to try and get us all back to a certain balance, because the reality is we're getting sicker as a nation. And one of the causes could be that we took hemp derived foods out of our diet and out of our livestock diet. And there's a theory on that, that possibly that's one of the reasons why we're having more autoimmune diseases, why we're having more of the other problems that we're seeing, Well at least contributing factor.Certainly at least a contributing factor. So keep this in mind. So the the primer on the endocannabinoid system is if you're, if you have ears and you're hearing this, you also have an endocannabinoid system, and you have a higher than likely chance that you are out of balance with that. And if you are out of balance with that, then you probably could benefit from some of this. Sure. So right now you're going well, I'm out of balance, I'm going to probably benefit but I'm going to go into liver failure if I do this. So let's talk about what liver failure means. You have a genius living within you. You probably have multiple geniuses living within you.Thank you. That feels great. Sometimes the voices in your head don't say to do bad things.The evil genius. Yeah.Well, one of the geniuses living within you as this beautiful origin called your liver. So you have this and it's amazing. So to understand where they're going with this, let's talk about what the liver actually does. So we all have livers. And they work differently in every single person, and they can continue to adapt, evolve and change. One of the only organs that you can transplant a partial portion of it and it will grow into a full liver. So the nephrologist think that the kidneys, the smartest organ, the neurologists will think that the brain is the smartest organ The cardiologist says if you don't have blood, you can't think so It must be the heart. Yeah, yeah, exactly. I'm gonna say, well, for health span, smartest organ in the body is the endocannabinoid system. So eventually, we're going to have Endocannabinoidologists. Because what ends up turning out is that the endocannabinoid system is in all these different organs.Correct.They're not completely separated. So let's talk about the liver. The liver is responsible if you ever wonder what the liver does. So do you have any idea what the liver does? I've got a little bit of an idea... Little bit of an idea. So the liver is responsible for selective uptake, concentration, metabolism, and excretion of the majority of drugs and toxins, also known as xenobiotics. So let me just say that again. Basically, the liver takes the crap that you bring into the world. And it says, I'm going to convert it to something useful, or I'm gonna get rid of it for you. Yeah, it can detoxify it, or it can say, Oh, you need to be this and then you're useful. That's why I say it's a genius in your body. And it the liver figures this out, it figures out what you need, and it determines if it's a drug, or if it's a toxin, and it can turn into a better form. Now, one of the problems I have with these different articles that I've been reading, is that they discuss that then enzymatic process called the P 450 system, and they just write it like that they're like, CBD has been shown to affect the P 450 system. What doesn't affect the P450? So that's the issue. So let me break that down, I bring up the P 450 because in the lay literature without even describing what it is, it is a complex. It's called a phase one metabolism of the liver. Under p 450. It's an umbrella term that has over 60 different genes, that code for hundreds of enzymes to break down anything that comes your way. So the P 450 enzyme is like saying, Oh, I don't even know an analogy, but it's top of the funnel down. It's like you just so generic,  that you can't just say that. So but they write it in the lay literature almost as a sounds sciency so I'm sure that it's, I'm sure that it's right. That's kind of my feeling on I'm like, why would and all these people it's almost like these news articles parrot each other. And nobody's stopping going, wait a minute, because as it turns out, the P450 system, not the P450 enzyme, the system breaks down almost everything that we put in our bodies. Yeah, no joke. So a lot of going back to the pharmaceutical days, I remember that was one of the biggest challenges with with any of the drugs that we detailed a physician on was, how is it affecting the P 450. And that would be something that they would be all salespeople be coached on that before they would go on calling a physician. But the truth is, it doesn't have to be a compound. It doesn't have to be a medical pharmaceutical compound for that to be somewhat important. Something as simple as grapefruit juice. Also, detectibily inhibits the metabolic ability of the P 450. So there's all there's a handful of different drugs that people who are elderly, maybe caution, don't drink grapefruit juice, because it will inhibit your ability for your body to clear this particular drug. And I say that to say this. It's not nothing is inherently just special because it does or does not directly affect the P450, almost everything you take into your body is either cleared quickly or slowly by that same system.Yeah, so they kind of imply like CBD is the only thing that gets...Not even close....that gets processed in the in the P450 system. In fact, we know that there are multiple medications that can be altered by certain foods. Grapefruit is the most common one, and that really affects like immunosuppressants tremendously and that's where it really came up. When they realized, oh my gosh, you have these different drugs, let's say blood thinners and immunosuppressants, which have a very narrow therapeutic window, you have to have these things like right dialed in. Yeah. And then people talk about grapefruit but you know, other things that have actually been shown to do this cranberry juice, black tea, pepper, even chocolate Yep. has been shown to affect drug absorption and they have been shown to affect certain pharmaceuticals. We don't even know the tip of the iceberg on this because you have to do the study on it. You have to do the pharmaco kinetics, the PK is what it's called to actually determine that which is so funny because they say oh CBD is metabolized by the P450 system. That means nothing. And so if you take CBD and or chocolate and or drink tea, be careful. I mean...I think a good analogy a seriously a good analogy is it the P450 being metabolized by the P450. It may be good for base knowledge, but the truth is, is does it overwhelm that, as you put it system, if it is overwhelming that system, chocolate, for instance, for most intents and purposes would be like a single car driving down a six lane highway by itself. It's not really if the highway was a P450 and the car was the chocolate. It doesn't take anything to funnel that that car through.Correct.The problem is is whenever you happen to overwhelm that system. And that is important to know. But I would say in terms of context, kind of the way that we started this discussion in context. It's not my belief through what I've read and seen that CBD inherently overwhelms or becomes more than a single car down that six lane highway.So not only is it just one single car going down the highway, remember that not only foods but drugs, nobody's talking about drug drug interaction.Right.So there's a reason. So I see a lot of patients that one drug may be very effective one thing may be very effective, but there's so many variables like for instance, drugs, the sex of the person plays a role, you may have different levels, the age of the person and any diseases can all affect this whole system called the P 450 which produces enzymes. So not only that, but then genetics play a huge factor, alcohol intake.Alcohol intake, all of that. I mean, genetically, this may be why some drugs work on certain people and why they don't work and others fact there's a whole field of science right now where people are trying to determine the genetics ato go, Oh, you're going to need a higher level of whatever Plavix which is one that they've actually looked at. Or you can, you're going to take less. So we this is a whole field of this beautiful science where we can go Okay, genetically, you're going to be predisposed to need more medications. So when these enzymes get used up, basically if you've got this one chocolate, which is a car, one on six lane highway, and then you add fluconazole, which is an antifungal, that's an but that's not a car, that's a semi now and then you add alcohol, which is a minivan could be ccould be a couple minivansand then you do whatever something else, but you can see that the liver has to try and process this right. So what happens is it becomes this once it becomes a traffic jam. Then people start getting angry, they start honking their horn that is a rise in your what we call lfts liver function panels liver function test Yeah, so AST and ATL are the two ones that we always talk about, that's exactly what the FDA was referencing. So I want everybody hear this. When you overwhelm the liver with multiple cars using your analogy, then honking starts and the honking the warning sign is this rise in AST and ALT. So, for instance, your body can adapt to it. We've seen this all the time. If you drink alcohol on a regular basis. you build more lanes, you build more lanes, you get really good at metabolizing alcohol. Build tollways. I'll use myself as an example.Not with alcohol.With coffee, Okay.I always have to laugh. Whenever I go to the my own doctor. They say how much coffee do you take? I just write obscene amount because I've down regulated by receptors or I've had the ability to ramp up my my livers ability to convert that coffee into an inert thing and there it is. So you see it as an anesthesiologist or as a crna. I mean, describe what your experiences whenever you try and put somebody to sleep using propofols, different medications.Yeah, well, I mean, definitely, if someone says that they happen to be a large consumer of or a consumer of large amounts of alcohol, it generally takes anywhere between 20 and 30% more of an agent to put them to, to sleep safely, say, But back to your point of body habitus, for whatever reason, even just something as simple as someone being a redhead fair skinned, those people generally take more agent to make them go to sleep. Yeah, let's go ahead and clarify this. This is a well known thing in anesthesia. You're not being prejudiced? No, not at all. No, they literally just for whatever reason, the metabolism rate of someone who's fair skinned with red hair is typically higher than the average calculation and you can go through any types of weight based medications that we use to bring sedation to someone and generally fair skin redhead folks just take more. Is that interesting?Yeah, it is. So that is more than just anecdotal like they've actually done some studies on this and they've actually shown probably because whatever lineage, they come from Scotland, Ireland, they have a higher P450 to metabolize that particular or a higher subset of the P450 systems. So just keep that in mind. So when you take certain foods or drugs, everything's competing for your liver, to do to just say, hey, fix me, you know, figure out what's going on. Fortunately, it is a badass organ and the liver is tough and it can handle a lot, the largest solid organ that we have in the body. So usually it can handle everything. Now the most common example like we've talked about, if you take grapefruit juice with certain immunosuppressants and things then that particular combo because those drugs need exact or how they were manufactured need exact metabolism numbers. Not only that, did you know that like nutrition plays a big role. So, high protein diet will actually affect your P 450 and malnutrition will affect it. of course it will. So those are all of our paleo friends over at paleo FX and such those guys have revved up p 450s. Eating a lot of protein working out a whole lot, they're able to do this. Unfortunately, malnourished people probably can't tolerate as muchNo and they aren't they aren't they honestly they don't have the supply to rebuild the enzymes that are that are used within the P 450 I mean it's just malnutrition is going to deplete all different types of systems, not just the liver.So in the intro, I kind of mentioned that we're getting sicker. And so let's use nutrition as an example. federal policies tightened by the controlled substance act of 1970 essentially banned the production of industrial hemp during the war on drugs effectively we made hemp CBD illegal and put it under the umbrella of cannabis cultivation. Now what were we were talking with Will Clyden of O-hi energetics right, who actually discussed this and he said some cool stuff on this. He back before this when they were they were using hemp and hemp has been used for ever like since we landed in America, hemp has been using hemp has been used in China for thousands of years and all this other stuff that we were feeding because it's a fantastic crop. It's it detoxifies the soil. And it actually works. It grows quick. It's a great crop industrial. What were we thinking making it a banned substance, I don't know, separate discussion. But they've got data to show that when they were feeding chickens, so for everybody out there I had a patient today who said I said Oh, she was suffering from some things and I think CBD would help with and I mentioned Hey, have you ever considered CBD Oh, I would never ever, ever, ever do anything like that. I am not like that. I said, Okay, that's cool. said hey, let me tell you something. Do you know that before 1970 we were actually feeding animals like chickens and cattle. One of the primary things that we would feed them would be hemp, and it's been shown that you can take a chicken egg and it had over 250 milligrams of CBD, right so right now if you're somebody that just spent $200 on your CBD that has 300 milligrams in 1968 you could've just had an egg.A three cent egg.I know 3 cent egg. And I looked at the literature and I and I could not find anything that said death by egg otoxicity. It didn't so everybody that's sitting there thinking oh my gosh, no. I'm not going to do CBD. We were having CBD in our diet. A great Great example, to learn a lot more about this and do a deep dive. Our friend Chris kresser had Will Clyden and the CEO of O-hi, O-hi energetics on and he went into this tremendously. It was so cool. It was just like I just it's crazy that we stopped like, and I as a physician have seen that we are getting sicker as a country. So in 1970, we've got since 1970. We've got more chronic disease, we've got more dementia, we've got more autoimmune disease. coincidence, like we said in the intro, maybe it's at least a contributing factor. And now we have the FDA saying that CBD can be harmful yet it was in our food supply up until 1970.That's nuts, dude.It is nuts. And it doesn't make sense and if you look at mean hemp seed, birds eat seeds, birds consume seeds, they do all kinds of things where they can they take in product, What's the matter? No, I'm just looking at I'm trying to make sure we get through everything.Okay good, but I mean they eat everything and people have been consuming eggs from not just chickens they've been consuming eggs from all different birds on the planet for that long. The fact that we've restricted hemp growth etc has only taken away one of the natural things that birds were eating.If you're if you're really interested in this like I said go to Chris Cressors podcast where he's got Will Clyden on there is really cool wills smart dude Chris is super smart dude. So those guys those guys kick some crazy knowledge.Right?So that is it's weird that we're talking on this episode about CBD causing hepatotoxicity. And we've already shown that the liver's pretty badass, right? It can do a whole lot and we've already shown that the endocannabinoid system is necessary and since 1970, or up until 1970. We are taking in significant amounts of CBD in our dietRight.Weird.It is weird, but it's not so weird when we get down to why everyone's alarmed. So you want to get into a...Now let's go ahead and look at the studies. So that is sort of the phase one of this podcast because now we're going to start geeking out a lot. So I hope I didn't hope I didn't lose everybody with a but you kind of need that background to understand what we're going to talk about next.Sure, you definitely that background.Alright. So what they're talking about is the FDA published this revised consumer update. So this is the consumer update that they put out there for everybody detailing the safety concerns about CBD products. Now, this was based on the studies provided by GW Pharmaceuticals, GW Pharmaceuticals has done multiple different studies looking at different things to get their FDA approval. And I'm going to say right now, that kudos to GW for being the first company to step up and really try and make something for a group of people with intractable seizures have an alternative. Kudos to the FDA for doing their job and looking at the data that was presented to them. What I'm going to do is go next level and say, Well, you didn't look at everything. That's the bottom line here. So I'm not bashing anybody. Let's make let's make certain of this. Sure. So there have been several randomized, controlled and open label trials that studied the effects of epidolex, I'm going to call it epidolex from now on it's just easier, which is a 99% pure oral CBD extract on patients with refractory epilepsy. So this in turn led to the FDA approval for two diseases, dravet syndrome and Lennox-Gestaut syndrome. So if you recognize those names, bless you, because you're dealing with some serious stuff, It's a serious seizure issue. If you don't know those. Count your blessings. It's one of those times to go well, no matter where you're at in life. It's like well, thank goodness that I don't have to Deal with a child that has this because that's, that's a really big deal. These are intractable seizures. So they looked at the data on that. And in these studies, the kicker here is I'm going to say it again, getting back to the lane highway, the patients maintained on their stable drug regimen with a median of three anticonvulsant drugs. That's important. It's super important. Three anticonvulsant drugs. So when we use the analogy of the car on the road, imagine a six lane road. And three of those roads. Three of those lanes are double semis.Yeah, that are closed construction... Or closed, Yeah, that's more likely or closed. So let's talk about that. So when we're talking about three different agents used to control seizures, some of those agents would be and I'm assuming here, but probably Depakote, probably Dilantin, also known as phenytoin, or fosphenytoin, which is seravex. There's a handful of anti seizure medications and through my knowledge, all of them, all of them have been recorded as raising the enzyme levels used by the liver which of course would lead to ALT and AST elevation, showing that the liver is essentially working overtime to long term process these drugs right or wrong?Correct. Correct, which is exactly what the FDA is supposed to do. They're supposed to look at this data and go Okay, so let's just look at the study that they're talking about. So the FDA accumulated this data, and they looked at what GW presented GW presented in isolette of CBD, not a full spectrum. And the dose they ramped up to 20 mg's per kick 20 mg's per kick. What that means is a guy like me would take 1954 milligrams a day.That's a lot more...of CBD isolate. Now I see the effects, beneficial effects of taking KBMD health CBD 15 milligrams twice a day,that's 30 milligrams,that's 30 milligrams.The exact dose of what makes people feel better is very argued because all the data coming out of Israel shows that a lot higher doses, but I'm seeing effects at these doses So let's be real quick let's stop for context. So right now at this intersection what we're what you're saying is with a full spectrum and we said this at the beginning of the podcast that what GW Pharmaceuticals has with epidiolex is a CBD isolate and what they've done...You're saying epidiolex now that's funny. Yeah, whatever it is, Well, because I started with that. Then you told me no, that's not how you say it.I think we should switch it up the whole time. EPA max the way it was edimax. What they did is they were able to establish that almost 2000 milligrams for you would be the ideal dosage however, you...isn't that correct? That's the dosage that they went for or the dosage that they felt was safe, Safe. Okay, I'm sorry. So but but on the upper end of... That was what they were aiming for on everybody. In essence, though, from where you have had beneficial effects, you're talking 60 times that amount, two months worth, is what they are saying the safe level would be in one day where you're finding the beneficial spectrum. So just just in terms of context, full spectrum, CBD, one 60th of the dose that they're saying it's a it's a safe level is really all that you need from our experience.Yeah. Now in GW's defense, let's look at the data. So in dravet syndrome, seizures dropped 39% and in Lennox-Gestaut 42%. So... that's good. So they probably did their homework and said, well, we need to get up that high to actually help that so I don't know anything about that. I'm not a neurologist. That's where it's at. But I'm just saying that when we look at that dose, no average consumer is going to be able to consume that Much CBD in a single day, unless it comes through this 2 full grams a day is more than most take Yes,yeah. Now here's the problem 94% of the people had side effects. Okay 94% at the highest dose compared to 75% placebo, kind of weird. So there's just a huge placebo side effect profile that doesn't get discussed at all.Did they say what it just had a curiosity do they state with the placebo was for the control,They did not stay with the placebo was oh, I take that back. I don't know what they use, but basically they left people on the same medications. So, essentially, let's just look at this and say okay, but the good news is, most of it was not a big deal. Most of it was what the FDA also discussed beyond the liver tests and beyond the drug metabolism. They also said Oh, CBD can cause nausea. It can cause drowsiness. It can cause all these other kind of nuisance things. That's what they're referring to right here. It's interesting though, that have a side effect profile assigned to a placebo that's that exceeds around the 30% range, because that's generally the throwaway number. Yeah. So we've gone twice away from the throwaway number. And they've had they've had reported side effects, which I'm not trying to over draw conclusions here, but it could at least indicate that side effect profiles assigned to CBD in this study probably weren't solely to CBD, Well, you're dealing with one of the highest risk populations you can get your hands on, when I did clinical research and when we would do a moderate to severe Chron's study. The placebo arm would have tons of side effects because the disease is bad. That's what's going on here also. So most was not a big deal, upper respiratory tract infection, somnolence, decreased appetite, diarrhea, blah, blah, blah, blah, blah. But the one that they focused on is the increase in amino transferase concentrations. This once again was a revised consumer update, they put this out to the public and their statement is increase in liver amino transferase concentrations when I just got done explaining what the liver does. Did I ever say amino transferase concentrations? No. I said liver enzymes. right? frickin talk to the public if you're going to release a consumer paper. yeah, liver enzymes. AST ALT. This is hiding behind scientific garbaly goop. It's like you're doing half science half anyway. But but whatever. So a patient show up and they're like, I need you to check my amino transferase concentrations. I'm like, Whoa, why? They Hand me this, this, this news article. Right? This is what we're trying to address right here. So what they found is that in the higher dose, 20 mgs per kg, there was a rise in some patients in three times the level which is significant, so if your normal is 20. You can be 60 if your normal is 40 it can be 120. When patients come into me and it's three times the level it sounds alarming. Do you know what happens when somebody gets hepatitis A acute infection? It's way more than that thousands of times the level when somebody goes into foaming at failure there AST and ALT will go from 40 to 10,000.AST and ALT have risen for almost everyone who's listened here, way more than three times throughout their lifetime multiple times in acute or in very isolated settings. It happens with illness.So getting back to your highway analogy, which I think is really cool analogy. I'm glad you came up with that. Thank you .Getting back to the highway analogy. 80% of them were taking a drug called valproic it matters Depakote Yeah, that matters. That matters a lot.It's when you take these medications, which is why at the beginning of the show, I said you're more likely don't have to worry about it. But if you're on certain medications, keep it in mind. Now that being said at the lower dose didn't see this stuff. So there is a dose dependent usage of the P450 enzyme you can if I give you one drink, or if I give you a bottle of tequila 512 which in my opinion is really one of the tastiest, most fantastic tequilas you can ever get your hands on. It is delicious. It's delicious. I'm gonna I'm gonna digress right here. Oh my God, Tequila 512... Also sponsored by Tequila 512Tt was really good seriously, ummm in every single person with liver test rose.They went back to normal if they decreased the anticonvulsant or decreased the CBD. So either one it went back to normal. So it wasn't number one, it wasn't permanent liver damage. More than likely correct they were able to  return back to normal. And number two, it was simply A case of an overwhelmed P450 pathway more more than likely.So you want to get really confusing? Not really but we might as well try. I don't want to but here's what's really interesting, then they kind of get a little geeky. So GW presented their their stuff and then they showed that the P450 in this enzymes and they went into will, the CYP to, 2c19 CYP three a four can inhibit the CYP blah, blah, blah. Those are all just cytochromes people. Those are all just cytochromes It's under the umbrella of P 450. That's how complex this is. Yeah,It is nuts how complex. The highest plasma concentration to CBD occurs within two to three hours after exposure to the Epidolex. With medication, so timing of these medications going to play a role, which actually got me down a weird rabbit hole where i started thinking. We haven't done this much analysis on what happens if you take your Ace inhibiter and you take your cholesterol medicine, timing wise PK analysis on different people and everything. Because when they do these pharmacokinetics, they do it to get the FDA approval, they do it on people that are healthy, that they can understand it. Let's put this into context again, if you're listening to this you've ever taken tagamet. Have you ever thought about when you take your tagamet, you probably only take it whenever you're afraid that you're going to have acid problems, right? Cimetidine?Yeah, guess what? It's also known as a high level p 450 inhibitor if it's over consumed. So I guess what I'm saying here is, there's probably way more alarms being driven over something that yes, is handled by the P 450 system, but is far less invasive or it's much it's a much smaller vehicle on this highway than some of the other things that the alarms are not sounding over.And then surprise surprise after I just got done talking about the liver and the genetic variability and all these other things. When they looked at the pharmacokinetics there was tremendous variation. Hmm. Weird. Yeah. Odd, right? So and anybody that's listening to this that is a, a pharmacist or is a scientist or like Well, yeah, duh. Like I know, duh. But why put out such an alarming statement? Yeah. Without context.Yeah, yeah, you're right. So it for Okay, so it's a little bit of clickbait stuff, right. And so maybe even the journalist who wrote it doesn't understand specifically, the implication, they may have only seen P450, written somewhere turned to a health care provider and said, What is this? Well, that's indicating that things are rising up, they freak out. They write a headline that says CBD causes liver failure. I just learned that from this health care provider. So I'm going to write this piece.Well, that we're going to get into that. The liver failure. This is still just the FDA. Oh, yeah. To the consumer. So I hope that the FDA looks at this and says, You know what? That's right. All that stuff that was just being said it's right. But we didn't have the time to do it. We couldn't sit there put that on paper, we'd lose everybody. I get it. It's quite true. We all we all but we all have a responsibility, much like any doctor to try and explain. You and I have this ability to have this forum to reach hundreds of trillions of people.Yeah. It eflects in our subscriptions on YouTube. They so many trillions of people subscribed, they started his back over to about 200. Yeah, so every time we got trillions, they start back over. Yeah. So So anyways, so what what you're realizing here is exactly what we're talking about. When you put stress on the liver. The liver honks its horn and does a little rise and the lfts goes, Well, hey, guys, maybe not so much. Can we just back off the traffic a little bit and see what's happening here. So additional studies have shown that levels of the anticonvulsant drugs actually caused the daily effects. So now we start wondering that the that the CBD may actually rise some of the anticonvulsants and then you have more side effects from that comes down to the same thing we're talking about how many things do you want to tax your liver, that's the bottom line. To summarize high dose of a pure CBD isolate, not full spectrum, while using a mean of three other anticonvulsants can cause temporary rise in liver tests and affect the metabolism slightly of the anticonvulsant. Of note, it did not happen at lower doses. So one more time, if you are on an anticonvulsant discuss with your doctor and make sure that you stay well below the 2000 milligrams a day. Yep. So this whole thing of Oh We're going to block the P 450 the P450 is So frickin complex, it is nuts. So anything you want to add to that, because I'm going to move on to the thing that I really want to, like kind of make fun of No, not really, I just want to say that I think that the FDA, unfortunately, is a very important and serious organization within our government. And I think that for all of the flack that they take their, unfortunately, with any other entity, there are limitations on what it is that they can do. And I do believe that they try their best to fairly ascertain and address situations as they are presented to them. Regardless of how frustrated that one of this may get is we don't get a result from them. A lot of it is just simply because there's not enough manpower. Oh, absolutely. They get thrown everything think about, think if you're in an organization where you know that 70% of the crap that's out there needs to be pulled off the shelves and you're limited. It's a government organization. These people making these statements are MD's. I'm really limited fortunately, I have well, we have the show where I kind of enjoy looking up some of this stuff. Fortunately, we have some friends of ours that are that work in the nutrition industry that are fantastic at researching articles. And some of that gets gets brought to me I want to make sure that we all get better this is the whole purpose of this.Hundred percent.I want to help the FDA and help GW I want to help the CBD industry. I want to help all of it. But let's just talk about this because something super weird happened. And this is the one that got the most press A Forbes article came out that promoted a mouse study and made the sensational claim that CBD causes liver failure.Yeah, that's kind of what I was referencing earlier. I may steal the thunder but yeah, you're right.Yeah, so this is you're exactly right. In the intro, you said it was clickbait. I really after looking at this study after pulling the study, because how many people read that article are actually going to pull the study.Well is the is the person who wrote this study that well versed in reading studies like that. I mean, that's that's an important thing. I mean, they I think that probably even the author of the article feels like that they are doing a service to the reader, but probably doesn't understand. And if they do, then shame on them, but if they don't, I think that would be a better explanation doesn't fully understand how to read the study and the quality and the qualifications of that study to make a statement like that.Yeah. And you know, this, this could be an arguable point, I'm sure that the person that that wrote this feels very strongly that what they said was right, the bottom line is the goal of this study was to investigate CBD cannabidiol hepatic toxicity, meaning liver issues in an eight week old male mouse. So they they took a group of eight week old male mice, and then they gave them a CBD that they produced. The CBD that they produced and Will Clyden will just jump up and down when he hears this because he decided Is this on Chris Cresser's podcast. The CBD that they produced was used to extract using hexane, which is a molecule that is known to be hepatotoxic. Yeah, you're not supposed to have heaxane. Don't do that! Will Clyden talked about the fact that if you find a CBD with an outrageously high amount of of CB, if you find a full spectrum CBD with an outrageously high amount of CBD more so and the price ranges, okay? Because what they did is they extracted that with hexane in a cheap way and threw it in their bottle and said, there you go. Now you can check that's got 10,000 milligrams of CBD or whatever. And it's really interesting because there's so much going on in the industry like this. So this particular study out of the University of Arkansas, took the CBD, or they made their own CBD using hexane which is a hepatotoxic in itself and in their certificate of analysis. It was there and then they gave it to these mice. Second thing neatI don't even know there has to be a second but we can hear it. Because I mean seriously, that's, that's like saying, I know your stomach hurts. You should take this Pepto bismol. And then I don't tell you that I've broken up some glass shards and have you drink it and you're like i'm bleeding now! What's going on? I'm like, I don't know. Yeah, but you only paid half the price.I made it myself.Which, by the way, that last batch of propophol that you did in your bathtub is working phenomenally. I'm sure it is. Now we do not make propophol in our bathtubs.Alright, so the second issue. If we have any mice that are subscribers to our show, or listening, I would like you to have your children removed from the room at this moment. Because they took these poor mice, and they gavaged to them. Would you mind defining what gavaged is? I think it's when you kind of force feed somebody I don't think it's willing. That's your I think gavaged something you kind of threw one at me there I think to gavaged someone you basically introduce a funnel to the esophagus and well you kind of get after it, don't you? Yes, I'm currently gavaging my mic right now trying to figure it out. I just undid everything. You're gavaging our ears with your, your microphone adjustments?All right, so gavage is they forcibly give these mice?The CBD extract? Yeah, I don't think it's comfortable nor pleasant.No typically through a tube feeding or down the throat to the stomach is how they generally gavage things. A quick side note, now because I'm now all of a sudden I feel like I'm living in a glass house when I was an undergraduate student. I actually did my first surgery on a rat and we took out their adrenal glands. And I'm just saying that so I don't want to sit there and pretend like I'm not done mean things to an animal. But that was when I knew immediately I could not be a bench researcher. I did not like that. At all, now I was like, I need to, I want to heal. I want to heal. I don't want to hurt these animals, but it's it's a whole separate discussion. So anyways, so they gavage these animals with different doses, and it's really interesting. Now in what they call their defense, they call it allometric dosing, which means they're trying to get the body weight to human weight ratio appropriate. I've read some rebuttals of this article where it is a joke, you just can't do that. And when I read vitamin weed Michelle Ross? Michelle Ross, when I read vitamin weed she dis... she specifically discusses why research on CBD versus mice is very difficult to do because the weight basing the endocannabinoid system is different, all these other things. So allometric dosing being said, assuming that they're saying it's right, so the dose would be the equivalent of what they gave and What a human would give So I'm doing the allometric dosing, which I think is actually higher than what it actually is separate thing. They took mice and they gavaged them with zero milligrams of hexane derived CBD 246 milligrams per kilogram 738 milligrams per kilogram or 2460 milligrams per kilogram of dirty CBD. It doesn't make sense dirty CBD isolate. So for instance, in a horrible alternate universe where humans are now the test subjects and we have large mice which are running tests on us, and they decided to gavage me with the same thing. That would be the equivalent at the highest dose of 241,080 milligrams of hexane derived CBD isolate. I'm not even sure what the hexane would do it 240,000 milligrams 242,000 milligrams.No I mean that being the more or less than now at this point, it's just an additive. It's just I mean it's it's not an excipient It's a straight up additive. That would not make sense at all. Oh, it's crazy.It's poison.This article came out in Forbes and said CBD causes hepatotoxicity. Also hexane causes hepatotoxicity.It is nuts. Alright, spoiler alert. The mice suffered hepatic toxicity and death at the highest dose. Shocking... You know what? I also hear it's bad to have breakfast cereal with not milk but drain-o. Just something that I'm gonna go out on a whim. Don't think you're supposed to do that. It just doesn't make sense. It's It's It's not. That is not an apples to apples comparison if you're talking Okay, so we talked about it earlier. reputable CBD source there is no reputable CBD producer that's going to have and Will special shout out to you it's going to have hexane as a byproduct or an excipient in their full spectrum COA approved which is also why KBMD Health with powered by olyxenol hundred percent is does not have that. I mean they do co2 extraction, which is the important thing which is a reason why we partnered with them to make that product. So we are the one out of the 23 or 24 that is the safe and trusted COA back no hexane etc etc. Doing this study is not an apples to apples comparison on what would happen because who knows? Who Okay, I don't get it because GW we already did that study. They determined that 20 Meg's per kg which is still a shit ton. It's a lot. It's a lot. Yeahis the safe maximum dose. These guys went times it by 100.Yeah, they did.And see what happens? Yeah, it's it's a bad it's a bad comparison. I mean, yeah, honestly, if you wanted to find out if CBD plus hexane causes liver toxicity at a ridiculous amount, top to bottom, then that's a great study outside of that, since nobody does it, I would say it's a bad study. Speaking of road, that's a road to nowhere.Yeah. And so study like this, uh, like you had mentioned is essentially it's not science. It's clickbait. Yeah. And right now that that author, that journalist is just kind of laughing. He's like, I know, and now you're bringing it up, and I'm going to get another whatever, because that's what people are trying to do. They're trying to get attention at this point.So at that point, good for you, you got to click but I would be truly interested if possibly that particular journalists would say, you know what, I didn't fully understand it. I mean, that's okay. Let's look reading studies, right? There's there's a study to reading studies. I mean, we heard that we heard the breakdown that kresser did on Joe Rogan is he Twice had to address his approach to completely different topic about the the plant based diet and then how he had to re approach that with the rebuttal. All that just simply to say, there is a science to reading studies and being really good at understanding what is and is not applicable and then how to find studies that you can compare to each other for good meta analyses. So what we're doing right now is I'm telling you that maybe sometimes there aren't studies, but my anecdotal evidence, I have a busy practice, you hear the patients, we hear them talk I listen to them, when they say that doesn't work. I go, Okay, I'm not publishing it. I don't have time to do that. I wish I did. If I published everything that we're gathering data on, if we're looking at, you know, just so many different things, CBD is just one of them. We've got I love I'm a huge fan of brain.FM for the ability to use sound to change your mood. I Would love to they're unpublished, a lot of studies on stuff like that. There's, there's tons of stuff. So when people go, oh, the studies aren't out there, there is something to be said about the Socratic method, or I'm sorry, the paternalistic method, the way that medicine used to be where the guy in front of you that saw thousands of patients, this is the method that he has. You see me scope, I mean, there's a difference in scope techniques.So they, although some may even still say it qualifies as anecdotal, I will say that there's objective data in both in a scope, somebody can't just come, anybody can come to you say I feel better. Anybody can even if they don't mean it. But they can't make the disease disappear from the imaging that we see in their colonoscopy, or the the mucosal samples that you take. And that's something that's completely objective data. That we see. So those are the everyday results that we see from these types of applications where you just, look it's not made up whenever we okay full pleasure when we first started looking at CBD, I thought was bullshit. Who you looking at?Just anybody who's out there. But when we first started talking about it, I didn't believe it. I was like, man, let's see, because we've been down this road before but we tried new, new without throwing a bunch of things under the bus. We tried new or innovative different things and high hopes. And unfortunately, low expectations and the expectations get met and the hopes are never never realized. The opposite for me personally occurred with CBD over the last three and a half years. And that is it actually stinking works.Dude, I knew that we were onto something with Atrantil, because after we did the initial studies,  everybody came back and said, I want more. I knew that I was onto something or I was not on something. I knew that CBD had a viable place in my practice, because I bought and the story goes all the way back which is why we work with which is why it's powered by elyxenol right now, when we went to paleo FX, and I ordered a couple cases and I just gave them away to patients. That was not cheap. Not because I was sitting there trying to be altruistic, not because I was doing charity. I'm like, I don't know. I didn't. And I told everybody, I don't have a clue. I haven't even looked at this yet. All I know is try this. Tell me what happens. And when about 80% of them came back said I want more. And I went, Okay, we're onto something. And that's when I took my clothes off the deep dive into the science and went, holy cow. Yeah,this is crazyUp until that point, I just didn't know there was a whole lot to it. I mean, it really didn't. And then the fact is, oh, and to clarify, it's not like Brown just handed out CBD to just anybody who came to the clinic. You literally just like we did with Atrantil you found very diseased patients to say and who had gone through a gamut of different pharmaceuticals and weren't finding relief, and suddenly they're like, this is working for me. Tell me more about it. And I was, I was blown away.So let's talk a little bit. So we're I'm over here going well studies I haven't published and everything. Let's talk about a few studies. So I've got a Mendeley account, I know how to look at PubMed. I know how to get a Google Scholar, I just want to talk about a couple studies have come out recently. And let's kind of compare it and see if it still makes people concerned that they're going to die of liver failure.Sure. Alright. So in the Journal of Clinical Pharmacology published in 2019, the this was actually a study, also sponsored by GW Pharmaceuticals, as part of the process of getting the FDA approval that the FDA did not reference the best I can tell they did not reference this. This is way more complex and it gets super cool, because what they're looking at is the pharmacokinetics or how CBD is actually metabolized by that beautiful genius called a liver. In high doses in people with liver disease. Yeah, they went through the trouble to take high doses of CBD and give it to people People that did not have liver disease had mild liver disease moderate and severe. This was ballsy to say the least, because using a product like this in somebody with liver disease is is risky. This thing could backfire and it could shut down the whole process. Here's what's nuts, the pharmacologic and safety of a single oral dose of 200 milligrams of epidolex, which is the CBD isolate. They were assessed in subjects they had eight people with moderate or with mild disease, six people with moderate and eight people with severe and then they had this collection of normal people. Blood samples were collected to check for the pharmacokinetics This is how drugs are looked at. They give you a drug and then they check your levels. Basically, the blood concentration was higher in the hepatic impairment and they describe it in nanograms. So the nanogram comparison is that it's a little bit higher in those with severe hepatic impairment. But this is what's nuts there was no increase in adverse reactions. There was no change in blood levels. So basically, the only adverse reaction that they found was a little bit of diarrhea. And it all happened in the mild hepatic impairment. So the FDA had mentioned Oh, studies have shown that it causes diarrhea. What was really funny about

http://keywebco.strikingly.com/blog/kidney-stones-lithotripsy-and-what-to-expect Your body gives these signs when your kidneys are in danger. Changing of Your Urinary Function Difficulty or Pain While Urinating Blood in the Urine Foamy Urine Swelling or Oedema Extreme Fatigue Dizziness and Inability to Concentrate Feeling Constantly Cold Skin Rashes and Itching Ammonia Breath and Metallic Nausea and Vomiting Shortness of Breath For those who have suffered, are suffering or know someone suffering from liver disease know that it is a silent killer. What makes it even more dangerous is that it gets diagnosed at very late stages for most people. Not many individuals are educated enough to know that the symptoms of kidney disease are not silent, but are redundant enough to not care. Unfortunately, in some cases, the symptoms may not even become present until the condition is critical. So this makes knowing and recognizing the symptoms that much more crucial. Lithotripsy Treatment It may sound harsh- but many people are choosing to blast or obliterate their kidney stones rather than undergo surgery. Using a tried and true method of directing shock waves. "The shock wave treatment is called ESWL. A long name- extracorporeal shock wave lithotripsy - we usually just call it lithotripsy," says Dr. James Borden, urologist on Lee Memorial Health System's medical staff. It is shocking, but patients aren't exposed to electricity. It's a machine-generated energy wave that passes through the skin without hurting it. "We focus the energy to a very concentrated point. We know where that point is. We put the patient in position on an x-ray table over where that high energy is. And that energy travels from the outside, it doesn't hurt your skin, it travels to that point where the stone is and it breaks the stone into smaller crystals that can then pass," says Dr. Borden. Lithotripsy is an outpatient procedure, performed under anesthesia. Relatively painless, the recovery time is minimal. Making it a popular choice among people who have frequent, recurring kidney stones and those who are taking time off from work to get treatment. "If someone has a very large stone that will not be the treatment. In those situations, we'll actually make a small incision in the skin and go into the kidney and put a small tube into it about the diameter of my finger and through that tube, we'll work inside that kidney and remove very large stones," says Dr. Borden. Under the right conditions, lithotripsy is helping patients get quick relief from a painful condition. What to expect: Rest as much as you need to after you go home. You may do your regular activities. But avoid hard exercise or sports for about a week or until there is no blood in your urine. Diet You can eat your normal diet after lithotripsy. Continue to drink plenty of fluids, enough so that your urine is light yellow or clear like water. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the number of fluids you drink. Medicines Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines. If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do. If you take medicine to stop the burning when you urinate, take it exactly as recommended. Call your doctor if you think you are having a problem with your medicine. This medicine may color your urine orange or red. This is normal. You will get more details on the specific medicine your doctor recommends. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. Be saf --- Send in a voice message: https://anchor.fm/roger-keyserling/message Support this podcast: https://anchor.fm/roger-keyserling/support

In this episode I discussed three interesting articles the first article discusses the quality of life of patients with jaw and facial deformities before and after jaw surgery and the notable unremarkable quality of life improvements from both a psychological and functional component. I also discuss whether antiplatelet drugs need to be stopped and whether the increase the risk of bleeding after dental implant surgery and a very good crossover study supporting the conclusions of this and I talked about spiking your local anesthetic with dexmedetomidone in an attempt to increase the onset of action the total length of duration and improve the properties of lidocaine local anaesthetic

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore.                                                 Today's feature paper is about statins, and it's the first population-based study to show a dose-dependent benefit on amputation and survival in peripheral artery disease. Very important data and a very important discussion coming right up after these summaries.                                                 The first original paper this week indicates for the first time that the natural history of coronary stenosis is better predicted by physiologic information by FFR, or fractional flow reserve, than by anatomic information from angiography. First author, Dr. Ciccarelli, corresponding author, Dr. DeBruyne, from OLV Hospital in Belgium compared the values of angiographic diameter stenosis and of fractional flow reserve in predicting the natural history among 607 patients from the FAME 2 trial who had documented stable coronary disease and in whom no revascularization was performed. The primary end point was defined as vessel oriented clinical end point at two years, and this was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent and non-urgent revascularization.                                                 The overall results showed that FFR predicted the natural history better than diameter stenosis. In addition, among the stenosis with mismatch between diameter stenosis and FFR, more than half had a low FFR in the presence of an angiographically mild stenosis and the rate of primary outcome was higher in those with reduced FFR regardless of whether diameter stenosis was significant or not. The take-home message is, therefore, that measurements of FFR should be considered not only an angiographically intermediate stenosis but also perhaps a mild or severe stenosis by visual evaluation.                                                 The next study provides population-based data on cardiovascular outcomes and risks after initiation of a sodium glucose cotransporter-2 inhibitor, or SGLT2 inhibitor. First and corresponding author, Dr. Udell, from University of Toronto, and his colleagues, performed population-based cohort study among type 2 diabetes patient with established cardiovascular disease and newly initiated on antihyperglycemic agents within the US Department of Defense Military Health System between 2013 and 2016. After propensity matching, more than 25,250 patients were followed for a median of 1.6 years. Initiation of SGLT2 inhibitors was associated with a lower all-cause mortality, lower hospitalization for heart failure events, lower major adverse cardiovascular events, but higher below-knee amputation risk. Findings underscore the potential benefits and risks to be aware of when initiating SGLT2 inhibitors. Importantly, it remains unclear whether the risk of below-knee amputation extends across a class of medications as the study was not powered to make comparisons among individual treatments.                                                 The next paper reports results of the redefined trial, which is the first trial to study the effects of renin-angiotensin-aldosterone system inhibitors in adults with tetrology of Fallot and mild right ventricular dysfunction in the absence of severe valvular lesions. First author, Dr. Bokma, and corresponding author, Dr. Bouma from Academic Medical Center Amsterdam, and their colleagues, studied 95 patients in the redefined trial and found that 150 mg of losartan daily did not significantly improve the primary outcome of right ventricular ejection fraction change compared to placebo. There were no significant treatment effects on secondary outcomes of left ventricular ejection fraction, peak aerobic exercise capacity or NT-proBNP. However, in a post hoc analysis, losartan was associated with improved right ventricular ejection fraction in a subgroup of 30 patients with nonrestrictive right ventricles and incomplete remodeling. The conclusion is, therefore, that losartan had no significant effect on right ventricular dysfunction or secondary outcome parameters in repaired tetralogy of Fallot. Future larger studies may determine whether there might be a role for losartan in specific vulnerable subgroups.                                                 The final study reinforces that vesicle trafficking plays an essential role in the signal regulation of pathologic hypertrophy and identifies a novel potential target in this process. This novel target is the transmembrane BAX inhibitor motif containing 1, or TMBIM1. First author, Dr. Deng, corresponding author, Dr. Li, from Wuhan University in China, and their colleagues, found that TMBIM1 expression levels were substantially decreased in both clinical and experimental hypertrophic hearts. Mechanistically, TMBIM1 interacted directly with tumor susceptibility gene 101 and accelerated the formation of multivesicular bodies to degrade activated toll-like receptor 4. Toll-like receptor 4 degradation in turn was essentially for the progression of cardiac hypertrophy. Importantly, expressing TMBIM1 in monkeys via lentivirus protected their hearts from aortic banding induced cardiac hypertrophy. In summary, these findings shed light on the role of vesicle trafficking in signal regulation during cardiac hypertrophy and provide a novel therapeutic target for treating hypertrophy.                                                 That wraps it up for our summaries. Now for our feature discussion.                                                 Peripheral artery disease, a disease that affects more than 200 million individuals worldwide and associated with a high risk of cardiovascular events and death and, of course, the much feared amputations. Yes, statin guidelines for peripheral artery disease are largely based on coronary artery disease or stroke data. Well, today's feature paper really addresses an important knowledge gap between statins, doses, amputation survival in peripheral artery disease. I'm delighted to have the first and corresponding author, Dr. Shipra Arya from Stanford University School of Medicine and, of course, our favorite, Dr. Josh Beckman, Associated Editor from Vanderbilt University.                                                 Now, Josh. I understand there's a bit of a back story of how this paper came to circulation. Want to share? Dr Josh Beckman:            Oh, absolutely. First of all, I have to say that one of the jobs of an associated editor is someone who kind of goes antiquing in every single store. Every place I am where people are presenting really good science, I'm kind of scoping it out. I'm interested. I want to see what's going on. I like to talk to the people who are doing the work to see how they're thinking about it, and I was lucky enough to see Dr. Arya's presentation. I think it was at an ATVB meeting, wasn't it? Dr Shipra Arya:                  That's right. Dr Josh Beckman:            I thought that this is an incredibly cool piece of work, and I basically hoped, I prayed, I asked. I said, "You know, maybe you should send this to us because we would really like to see the full manuscript," because inside I hoped that it would be just as impressive when it was written out as a full manuscript as it was when she was discussing it at the meeting. And, lo and behold, we were lucky enough that she submitted it to us and you can see the results online right now. Dr Carolyn Lam:                Indeed! Well put. Shipra, with that kind of lineup, please, tell us about your study and what you found. Dr Shipra Arya:                  Thank you for that invitation to submit to Circulation because initially I wasn't sure if Circulation would be interested in my work, so it was really great to hear when Josh said that this is something that it would certainly consider. The basic premise was to try and find out whether high-intensity statins as defined by the 2013 lipid guidelines, they would also have limb protective effects for PAD along with reduction mortality. As you said in the introduction, most of the data comes from either coronary data or comes from small groups of PAD patients, but never from such a large population.                                                 We identified about 150,000 veterans in the National VA database from 2003 to 2014 and excluded people who didn't have a diagnosis of PAD before 2003, and why this was such a labor of love was also to figure out how to identify the certainty that people had PAD and then getting into their pharmacy files and trying to parse out whether they were on high-intensity, low, moderate, or no statin. Initially, I had done the analysis of no statin, but then after review and discussion, it became clear that we needed a control group, which was people who were also on some guideline-directed therapy and not just no statin because they could be patients who were the noncompliant patients and who don't show up to the doctor's visits, and that's why they do poorly.                                                 That's why we chose a control group which were on antiplatelet therapy, at least aspirin or Plavix, any other antiplatelet agent. Even in that comparison, we find that after risk adjustment, patients who are on high-intensity statin had a more than 30% risk reduction of amputation as well as about a 24, 25% risk reduction of mortality compared to people who did not take a statin but at least took an aspirin. Low to moderate intensity statins were also effective, about 20%. Risk reduction in both amputation and mortality, but high-intensity statins when directly compared to the low to moderate intensity statins outperformed them.                                                 Just to be sure of our findings, we did it so many different ways. We did the Cox modeling. Then we did propensity matching that which person is more likely to receive the statin versus the other. Then we did subgroup analyses where we put people in different subgroups that people who had coronary artery disease as an indication, maybe that's why they were on these statins. But, people without coronary artery disease also same association [stack 00:11:12]. We were pretty confident in our findings, and that's why we sent it to Circulation. Dr Carolyn Lam:                Wow. You know, Josh, you are the best at putting papers like this into context and really expounding on the significant. Tell us, why did this catch your attention so much? Dr Josh Beckman:            Every time I think that statins have become just a standard part of therapy for patients with atherosclerosis, the first thing I noticed in this paper was that there were so many people who were still not on any statins or people who were on homeopathic doses of statins, and I can't understand how that happens. I think the mortality data was nice and consistent, but the amputation data is what really made a big difference. I'll ask Dr. Arya, but in my impression, the literature has been sort of back and forth as to whether or not statins really reduced limb outcomes. Your paper, I think, was clearly the largest sample that had taken a look at that question. Can you sort of separate out your papers from some of the previous work in that area? Dr Shipra Arya:                  Sure. I would add that a lot of work about amputations has been coming out from vascular surgery data, and a lot of that work just focuses on short term outcome for limb loss. They look at 30 days. Maybe they'll go look up to six months to a year, but actually patency of bypasses, patency of vessels is a long-term phenomenon. Much like mortality that can happen years later, your amputation risk can happen years later, too. I think what separates us is the lifetime followup for these patients, and we are looking in a cohort of patients who are in this veterans' healthcare system so the data is automatically getting captured even if they get their care outside. Records do make it back and diagnoses do make it back. It's the VA [inaudible 00:13:03], and we did some sensitivity analysis to show that, yes, most of the veterans we have in [inaudible 00:13:09] actually get their care and have data being added continuously into the corporate data warehouse.                                                 That was something I think that lent to the power of making the [sure 00:13:20] conclusion and that's where previous studies have not been able to show a significant association with amputation. The studies, if they are single center or they are focused from electronic medical records or perspective followup, either the patients get lost to followup or go see other doctors or other healthcare systems, and that information doesn't get back to the researchers, while mortality data you can get from Social Security Death Index or other sources. I think that's what makes the study different than other studies in this similar field in terms of followup. Dr Josh Beckman:            I don't think you're giving yourself enough credit. There's a whole bunch of things that make the study unique. One of the things that I was most taken with right upfront was the way that you defined peripheral artery disease for this population. There has been, as far as I know, at least seven or eight different definitions that people have used with administrative data to try and ferret out who has PAD, and in contrast to coronary disease and stroke, it's a much more complicated endeavor to do that. So, when I saw the way that you did it ... I'm going to say this in a way that I know is going to sound funny, but you made the complicated look really simple. Your definition is not something that required 3,000 lines of ICD-9 codes within inclusion and exclusion criteria and speaks, in my opinion, to the power of the large sample because, basically, they needed one ICD-9 code and either two ABIs, a visit to a vascular surgeon or procedural code. Now, I know that this definition comes from some of your work, so can you tell us how you derive this and then let's talk about what that means. Dr Shipra Arya:                  Absolutely. We looked at practice patterns for patients with vascular disease across the VA, and most patients who undergo procedures for PAD, we can confidently say that they do have PAD. When we look at the specificity of just that occurrence, it's pretty high, like [90% 00:15:23]. Then what we did was we did some random sampling in the VA data, about 300 patients, and used different codes to see if patients came back to the vascular surgeon within ... We used 14 months because it's usually one year followup that most people prescribe, so whether they went two months before or after because the appointment hours. We found that that was again a high specificity of about 80%. Then, when you look at patients who come back with ABI followup. So, we looked at CPT codes for ABI. We found out it's like a 99% specificity. If you have ABI followup within a year, and we relaxed it to 14 months, you could be 99% confident that this patient does have PAD.                                                 We just combined all those three together, and this is ... If Circulation is interested, I can send you this, too. We are working on this manuscript where we are giving researchers different algorithms that they could use to identify PAD because I wanted a more specific sample because I was looking at PAD outcomes. I wanted the PAD definition to be tight. Our specificity is greater than 80% combining all these three together, about 84%. We are fairly confident in this that, yes, these patients truly have PAD, so when we follow them up for outcomes, we can be confident in our results. If researchers wanted a more relaxed definition of PAD, they could use other algorithms that we are putting in that paper where they could say, "We will only use one ABI measurement, or we would use a combination of these." Dr Josh Beckman:            That brings up two points. You talk about this brings up the power of large data and the ability to tone down on people who really, truly, absolutely have PAD without any question. So, number one, are you worried that you're missing people that probably do have PAD and would benefit from therapy, and number two, do you worry that you're basically concentrating on the sickest right end of the curve of the group of PAD patients? Dr Shipra Arya:                  Right. That's a great point, and I discussed that with my coauthors and mentors and we wanted to be sure about our outcomes and not want to include people who did not have PAD, and then we are kind of including the effect size of what we may find, but yes, these are truly what we are calling a symptomatic PAD, and I think I mentioned that in the manuscript somewhere, that we probably would be missing people who are asymptomatic and not really being followed up. If we extended this analysis to people who are not regularly being followed or being under surveillance for their PAD, the results could be different. So, yes, it does not generalize the whole of that population. If we had gone that route and relaxed our inclusion, my worry was that we would get ... Because of large data setting up, as you say, if we include a bunch of people who are truly not PAD, we would be a [threading 00:18:17] risk in non-PAD patients. Dr Carolyn Lam:                Josh and Shipra, I loved the paper, but after this discussion I'm even more in love with the paper and impressed, so I think I just have a question for both of you. Is there any excuse not to give statins now? Do we actually think a trial is going to come on this topic? Is this the best data that we have? Is it going to enter guidelines? What do you think? Dr Josh Beckman:            I can give you my opinion first, if you want, because you're the person who actually has control of all the data. I would say this. I think it's been well known that statins should be used in all the patients with PAD for their cardiac outcome. My guess is that there are two things that are going to happen that are going to make people consider statins for limb outcomes.                                                 One, data like this and there's never going to be a trial, a prospective randomized trial at this point, I mean unless you disagree, but there's no way people will randomize to not statin. I think the second reason is the recent data on the PCSK9 inhibitor, evolocumab, which showed that on top of statins in PAD patients, there was a further reduction in limb events. I think we're heading towards getting the LDL to zero. It may take a couple more steps, but that's basically what's going to happen. Dr Shipra Arya:                  I agree. I think there has been time and time again data that shows, especially those already data supporting the mortality benefit for larger cohorts of patients with cardiovascular disease including PAD. I think this study really nails down the limb protector effects of statins, and doing a trial of this magnitude would be very difficult to do because to get that would be effect size that you have. You would need a huge cohort of patients, and you probably won't find statin-naïve patients because you have already half the patients with PAD have coronary artery disease, as well. So, not every study needs a trial. Not every question needs a trial, in my opinion. I think that's the power of large data sets. I think the evidence is overwhelming, and I would agree with Josh. Dr Josh Beckman:            I have always had a hard time explaining to people who came to see me for legs problems that they have to take a drug for their heart. It's sort of a weird two-step that people have a hard time accommodating. Do you think by telling them that this drug will also save their leg that they're going to be more likely to take the medicine by the end of the year? Dr Shipra Arya:                  Yes, absolutely. That's what I tell my patients who come and see me, that this medication works on arterial plaques, and it stabilizes them. It's not just the same plaque that you have in your heart is the one you have in your leg. Maybe a little different, but to oversimplify, yes. This is not just a heart medication, and this is not just a cholesterol medication. This is a medication for your plaques, for your blockages. That's how I explain it to them, and I think the uptake would be more if we explain to them that, yes, this will help you keep your leg, stay ambulatory and stay at home and not end up in assisted living or nursing home. Dr Josh Beckman:            Carolyn, this is so much fun, especially when we get to talk to the people that do so much hard work to put stuff in circulation, so I just want to say thanks again to Shipra and her coauthors. Dr Shipra Arya:                  Thank you so much, and thank you for giving us the opportunity. I think the comments from Circulation really made our paper better, so thank you for doing that. Dr Carolyn Lam:                I wish that we could just keep going on and on because I just know that Josh has even more great questions up his sleeve. See, Shipra, I told you, he's amazing. But, there you go. You're amazing, too. Your paper is amazing. Thank you so much for joining us today.

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track!  Check out today's questions: Ruben: Hello Dr. Cabral, First of all THANK YOU for putting in the time to put out the podcast on a regular basis. I wasn't sure what address to reach out with my question, so I figured I would start with this one. The question is actually for my wife. She had a annual exam yesterday and the Cholesterol test came back high. The doctor prescribed her a low dose Statin. My wife has been really sad since then because she really watches what she eats and is active. here is a brief overview: Height: 5'8 Weight: 134 lbs Age: 38 - Does not eat beef/pork - Eats chicken ( once a week) - eats fish ( once a week) - drinks a green drink 98% of the time, daily ( spinach, banana, apple, ginger, tumeric, spirulina, water) - when she doesn't pull her back ( she has few back issues), she works out about 4 times a week. - workouts consist: 10 minutes cardio fast pace, 20-30 minutes strength and conditioning. - Prior to the blood test she hasn't really worked out for about 2 weeks here are the numbers ( fasted test) Chol: 280 Trigly: 173 HDL: 51 Chol/HDL rate: 5.49 LDL: 194 Non HDL Chol : 229 Rest of the numbers look good. She has a history of high cholesterol even though she doesn't eat bad at all 2012 : Chol 169 | Tri 62 | HDL 40 | Ratio: 4.23 | LDL 117 2015: Chol 246 | Tri 139 | HDL 46 | Ratio: 5.35 | LDL 172 2017: Chol 226 | Tri 186 | HDL 47 | Ratio: 4.81 | LDL 142 2018: Chol 280 | Tri 173 | HDL 51 | Ratio: 5.49 | LDL 194 She does not want to start taking a statin but she really feels defeated, so I am reaching out to see if there are any other tests that she could do to make sure there aren't other things that are actually causing the high cholesterol. Also, if she can do any of your protocols or any of the daily support products. Any info that could give us some hope or something to try in the near future would be really really appreciated! Kind Regards, Ruben Breanna: Hi Dr. Cabral. Thank you so much for providing us with such amazing content, and inspiring many to live happier, healthier and happier lifestyles. I listen to your podcast daily and have providing me with the knowledge I've always wanted to know growing up. I have a little story for you. For as long as I can remember I would be in excruciating pain 24/7, especially in the morning. I was diagnosed with lactose intolerance as a baby, but it wasn't until I was 11 years old that the doctors diagnosed me with Celiac Disease... then depression, then anxiety, then acid reflux, then anemia... my symptoms never went away, my intestines never fully recuperated and I was taking 5 different pills daily at 12 years old, despite eliminating gluten. I stopped taking all medication a year ago because I was fed up and I am now 18. Through your podcast I now realize why all these extra symptoms occurred and how they were going against me.. the health system failed me. My intestines still aren't fully recuperated but this isn't part of my question. I just believe my health background may play a part in my current situation. I was always super active growing up as I was a competitive dancer. A year ago I decided to start going to the gym and got approached by a coach who offered her services to help prepare me for a bodybuilding competition. I did my first competition in april and won 2nd place. That diet wasn't bad and didn't have to do too much cardio as I was only 17 and she didn't want anything bad to happen. 3 months later I started prepping for my second show, at 18 years old. My "diet" lasted 12 weeks. She started me off at 1800 calories, lowered weekly and by the end I struggled to loose weight. For the last 4 weeks I was doing 2 hours of cardio + 1 hour weight training, and my diet composed of 5 chicken breasts and 2 tbsp ground flaxseed (+ 1/4 cup oats ONCE a week on leg day, and cut out those carbs 2 weeks out). How did I survive? Barely. I realize that this is extremely unhealthy, but I was too far in to give up. I had 0 days off the gym in 4 months. Also, I was extremely constipated. There was a period where I went 4 weeks only pooping 3 times and had to use diuretics each time to force myself to go!!! I started taking probiotics as another coach had told me this helped her use the bathroom, and it did for a while. My body toxicity was so high. She also advised me to use "estro control" to help get rid of that toxicity and loose my last pounds on my legs. I won first place by the way :). But here is my question.. what exactly did I do to my body? And what could I do differently next time? From listening to your podcasts, (especially your low carb diet ones), I realize I lowered my metabolism dramatically, lowered my thyroid, increased cortisol, burned a lot of muscle and increases levels of disease from purely eating chicken. To put in perspective, I'm 18, 5ft, mesomorph body type, was 95 pounds before going to the gym, gained a lot of muscle and started my diet at 112 lbs but cut down to 98 lbs for my competition. To reverse diet, she advised me to eat 200g carbs, 100g protein and 45g fat, and 0 cardio.I had very minimal "cheats", meaning I only eat whole clean foods such as sweet potato, rice, berries, gluten free oats, veggies, protein powder, eggs, chicken, extra lean ground turkey, rarely red meat, nuts, peanut butter and coconut oil (literally all I eat). Following this diet I am 5 weeks post show and 120 lbs!!! I went from being 10% body fat to having the most fat on my body I've ever had. So what do I do now? Do I just follow this new diet and wait for my metabolism to reset? I know that lowering my calories and doing cardio is only going to hurt me more in the long run (metabolism, thyroid, cortisol)... so I'm just confused and extremely unhappy. On top of that, I haven't gotten my period in months (and no I'm not pregnant). I now go to the gym 5 times a week to weight train and I take multivitamins, omega 3, potassium, digestive enzymes and probiotic5, but no more estro control... should I still be taking these supplements? I have recently started implementing your morning routine (water, yoga, smoothie) and definitely feeling better, but not looking better. Can you help me? I'm sooooo lost. And I know you are the best of the best, and the only person I would trust answering this properly, as you always look at all perspectives. Amanda: Hi Dr. Cabral, I have been listening to your show for over a year and absolutely love it. I receive more knowledge from you to help my clients than most other sources. My question is about a current private client I am working with. She is about 65, has had 2 heart attacks in the last 8 years (the last one about 2 years ago) and she is on about 12 different medicines (metformin, wellbutrin, Spironolactone, Zetia, *Metoprolol ER, *Crestor, *Aspirin, Cymbalta, Levothyroxine, Plavix, Avapro) progesterona along with 2 topical hormones estrogen and testosterone. My question is, what would be your order of operations for this client. She is open and ready to change her diet and lifestyle and ideally, one day she would love to not be taking any medications or the least amount possible. I've got her on your daily support shake and doing berry smoothies daily. We are working on increasing her stomach acid and next I would like to help her get rid of heavy metals (is there something you recommend for this that won't interfere with her medications?) She is on so many medications and I can see that they are crossing to cause many of her symptoms, I also want to be sure to take things really slow and respect her doctor decisions (although she has tried to come off medications many times and they almost always resist her requests). Any advice would be great, thanks for all that you do   Judy: Hi Dr. Cabral! I just finished your podcast (713) on body types and Inhave a follow up question. I am currently on week 2 of your detox and I have suffered for over a decade with adrenal fatigue and hypothyroidism. Therefore, I have metabolism issues that I didn’t always have at a young age. When determining my body type, should I consider my current state or when I aas a kid with no health issues? Judy: Hi Dr. Cabral, In your podcasts, you mentioned the importance of a cheat meal once a week for grehlin and leptin levels. I have a hard time resisting cravings once I cheat. I am on week 2 of your detox and no linger crave all the bad foods. I worry I will go downhill again once I allow myself the bad foods. What do you recommend I do to prevent a relapse? Are the better cheat foods to stick with that still address grehlin and leptin and avoid a relapse? What about portion sizes for cheat meals?   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions! - - - Show Notes & Resources: http://StephenCabral.com/771 - - - Get Your Question Answered: http://StephenCabral.com/askcabral  

When it comes to stroke, treatment is dependent on the stroke mechanism. But most patients wind up on aspirin anyway. Or Plavix (clopidogrel). And sometimes both. The question this week is, Why? Hope you're hungry for some fruit. We're comparing a bunch of apples to oranges in this episode of the BrainWaves podcast. Produced by James E. Siegler. Music by William Ross Chernoff's Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. Even if this episode is all about choosing aspirin or clopidogrel when you're treating stroke patients. Always talk with your doctor, and if you are a doctor, you should rely on institutional policies and your own clinical judgment when treating patients. REFERENCES Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9. Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9. Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86. Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17. Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12.

Markus dela Cruz, RN Mark is an ED Nurse extraordinaire who turned into a Cath Lab RN. He is also found working in PACU units and still works some ED shifts. Mark also considers himself a foodie and likes exploring Queens, NY. Mark works at a Level 1 Trauma Center that is also a STEMI receiving center in Queens, NY. Fun fact: When I first started working, there were rumors that Mark can get an IV line with a full set of labs on sick patients with NO tourniquet! To this day, I believe this may be more truth than fiction. Disclaimer: This is how Mark and I manage our STEMI patients going to the Cardiac Cath lab for PCI. These are suggestions. Follow your institution's policies. Your Patient's Going to the Cath Lab! How can we ensure the fastest and smoothest transition from the moment your patient is identified as a STEMI and accepted to the Cardiac Cath lab? PCI (Percutaneous Coronary Intervention) is the treatment of choice for a repercussion of a patient having an active MI. It is a life-saving procedure. You may be a receiving facility getting transfers. If your facility does not have a Cath lab, you will transfer to a facility that does. 3 Sites of Entry: Right Radial Artery and Bilaterally Femoral This is a CMS reportable event and the door to balloon time is within 90 minutes. Preferably, you get your patient into the Cath lab WELL before the 90 minute mark because your Cath lab team have a lot to do. Prepping Your Patient Get your patient butt naked! Seriously, no underwear! (A running theme!) IV Medlocks Minimum 2 IV medlocks. 3 is super! Avoid Right Wrist and Right Hand. Left arm preferred Vitals also include: Weight All medications given in the Cath lab are weight-based. Height intra-aortic balloon pump is sized by height EKGs (just leave the leads on! You'll be repeating these!) Defibrillator Monitoring (use radiolucent pads) Telemonitoring & transport monitoring (esp. your cardiogenic shock pts) Not all facilities have fancy defibrillator monitors that also have BP and Pulse Ox. If you do, obviously use it! History Ask the patient and/or EMS what meds were given (esp. aspirin dose) Consent Can we trust the Cath fellow with the original? If we have time, I usually make copies and tape it to the top of the stretcher and get it scanned in the ED Chart. Secure all property and jewelry with family member or security - label and seal the property bags. Keep left chest wall and right wrist clear of all jewelry. Document in chart where property went. Medications All Patients with STEMI Aspirin 325mg PO If EMS gave 2 baby aspirins (81mg each), give another 2 for a full dose of 325mg Heparin Bolus IV Most facilities are weight-based, but some still give the standard 5000 units IV Heparin IV Myth-Buster! Always administer bolus dose heparin by IV. Never subcutaneous! IV Heparin helps prevent the existing clot to not get larger and prevents new clots aPTT in anticoagulated therapeutic range is the goal! Don't wait for an aPTT/INR result before administering Heparin IV. Pts need to be anticoagulated because PCI attracts clot formation. Cath labs have fancy machines that measure aPTT and INR in real time and can adjust heparin as needed. ACT (Activated Clotting Time) Machine Worse case, heparin's antidote (protamine sulfate) is readily available in the Cath lab. If PCI w/Stents Loading doses of clopidogrel (Plavix) and ticagrelor (Brilinta) Additional Medications Heparin Drip When did you start it? What's the current dosage/rate? If the pt received thrombolytics and you are a receiving hospital, pt should most likely be on a heparin drip to prevent further clots. Speak with Cath fellow/cardiology/EM MD. NSTEMI patients boarding in your ED may be on a heparin drip. Check aPTT every 6 hours and adjust drip as needed for anticoagulated therapeutic levels - goal...

Pharmacogenetic Testing This week I connected with Vanderbilt University s Dr. Dan Roden to learn about pharmacogenetic testing. This tool provides physicians and other prescribing health professionals with individual-specific data about how a patient s body will respond to particular medications or types of medication. For example, a popular drug, Plavix, which is prescribed to reduce risk […] The post Pharmacogenetic Testing appeared first on Business RadioX ®.

Click Here Or On Above Image To Reach Our ExpertsUS. Can Learn From China's Spot-The-Spy ProgramPeople can respond to drugs very differently. A medication that brings relief for some patients might show no benefit at all in others, or even cause harmful side effects.A growing array of genetic tests is designed to help predict how people are likely to respond to many common medications, from antidepressants and antihistamines to pain relievers and blood thinners. The tests, which are controversial, look for tiny variations in genes that determine how fast or slow we metabolize medications.Because of such gene variations, codeine, frequently prescribed to relieve pain, has little effect on as much as 20% of the population, while 2% of people have such a strong reaction that a normal dose can be life-threatening. About 25% of people can't effectively absorb Plavix, a clot-busting drug, putting them at increased risk for a heart attack or stroke. PRO-DTECH II FREQUENCY DETECTOR(Buy/Rent/Layaway)Even everyday drugs such as Advil and Motrin, for pain relief, and Zocor, to lower cholesterol, can have widely varying effects. Testing patients for gene variations could avoid some of the 700,000 serious drug reactions in the U.S. each year, some experts say. Proponents of the tests, which are done with a cheek swab, say they also could help doctors rely less on trial and error in choosing the right drug and the right dosage for individual patients.CELLPHONE DETECTOR (PROFESSIONAL)(Buy/Rent/Layaway)The Food and Drug Administration has included cautionary information for people with certain gene variations on the labels of more than 100 prescription medications. As yet, only about 20% of doctors order such tests, according to a survey by the American Medical Association, and many patients don't know they exist.PRO-DTECH III FREQUENCY DETECTOR(Buy/Rent/Layaway)Some major medical associations, including the American College of Cardiology and the American Psychiatric Association, have been slow to endorse the testing, mainly because there are no large, randomized controlled trials showing the technique significantly improves patient care. And the tests, which range from $500 to $2,000, are only covered by some insurers in some cases.PRO-DTECH III FREQUENCY DETECTOR(Buy/Rent/Layaway)NOT RIGHT FOR EVERYONEMany common medications can affect people differently depending on minor variations in the genes that regulate key enzymes. The variations can make people metabolize certain drugs either more slowly or rapidly than normal. Some examples:DRUGSPain relievers codeine or oxycodone, including Tylenol 3 and PercocetENZYME PATHWAY AT WORKCYP2D6IMPACTA standard dose can have little effect in up to 20% of people, while as many as 2% can have a life-threatening reaction.DRUGSBlood thinner Plavix (clopidogrel) and acid reducers Prilosec (omeprazole) and Prevacid (lansoprazole)ENZYME PATHWAY AT WORKCYP2C19IMPACTUp to 15% of people metabolize these drugs very slowly, resulting in a higher effective dose and greater risk of side effects.DRUGBlood thinner Coumadin (warfarin)ENZYME PATHWAY AT WORKCYP2C9IMPACTPeople with some gene variants have twice the risk of severe bleeding, but other factors are involved and population percentages are unclear.DRUGCholesterol reducer Zocor (simvastatin)ENZYME PATHWAY AT WORKSLCO181IMPACTUp to 40% of people have impaired ability to metabolize this drug, giving them increased risk of muscle pain and other side effects.Source: Clinical Pharmacogenetics Implementation ConsortiumAlan Pocinki, an internist in Rockville, Md., says he orders gene testing for patients who have a history of unexplained symptoms or who haven't gotten relief from drugs in the past. In many cases, he is able to find a better treatment based on their DNA, he says. “It makes a huge difference clinically among people I see every day.”PRO-DTECH III FREQUENCY DETECTOR(Buy/Rent/Layaway)How people's genes affect their response to medic

This week we review delayed ICH in patients with head trauma on blood thinners and discuss the role of repeat imaging and admission. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_43_0_Final_Cut.m4a Download 2 Comments Tags: Clopidogrel, Delayed Intracranial Hemorrhage, Head Trauma, Plavix, Warfarin Show Notes Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and perjury warfarin or clopidogrel use. Ann Emerge Med 2012; 59(6): 460-8. PMID: 22626015 Menditto VG et al. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med 2012; 59(6): 451-5. PMID: 22244878 Miller J et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg 2015; 79: 310-3. PMID: 26218702 Read More

This week we review delayed ICH in patients with head trauma on blood thinners and discuss the role of repeat imaging and admission. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_43_0_Final_Cut.m4a Download 2 Comments Tags: Clopidogrel, Delayed Intracranial Hemorrhage, Head Trauma, Plavix, Warfarin Show Notes Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and perjury warfarin or clopidogrel use. Ann Emerge Med 2012; 59(6): 460-8. PMID: 22626015 Menditto VG et al. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med 2012; 59(6): 451-5. PMID: 22244878 Miller J et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg 2015; 79: 310-3. PMID: 26218702 Read More

This week we review delayed ICH in patients with head trauma on blood thinners and discuss the role of repeat imaging and admission. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_43_0_Final_Cut.m4a Download 2 Comments Tags: Clopidogrel, Delayed Intracranial Hemorrhage, Head Trauma, Plavix, Warfarin Show Notes Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and perjury warfarin or clopidogrel use. Ann Emerge Med 2012; 59(6): 460-8. PMID: 22626015 Menditto VG et al. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med 2012; 59(6): 451-5. PMID: 22244878 Miller J et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg 2015; 79: 310-3. PMID: 26218702 Read More

The post Clopidogrel (Plavix ) appeared first on NURSING.com.

In this third episode reviewing the 2015 guidelines, Dr. Rosenblum summarizes and quotes ASRAs latest Guidelines for Patients who are on anticoagulants and are planning to undergo pain procedures.   PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.    References Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications: Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain Regional Anesthesia & Pain Medicine: May/June 2015 - Volume 40 - Issue 3 - p 182–212

In this second episode reviewing the 2015 guidelines, Dr. Rosenblum summarizes and quotes ASRAs latest Guidelines for Patients who are on anticoagulants and are planning to undergo pain procedures.   PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.    References Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications: Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain Regional Anesthesia & Pain Medicine: May/June 2015 - Volume 40 - Issue 3 - p 182–212

Dr. Rosenblum summarizes and quotes ASRAs latest Guidelines for Patients who are on anticoagulants and are planning to undergo pain procedures.   PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.    References Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications: Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain Regional Anesthesia & Pain Medicine: May/June 2015 - Volume 40 - Issue 3 - p 182–212

Pharmacogenomics This week on Health Connect South Radio we featured Bob Bean, CEO of Harmonyx, a technology company specializing in pharmacogenomics. Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop […] The post Pharmacogenomics appeared first on Business RadioX ®.

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A conversation between Robert Goldberg, MD, and Yoash Enzer, MD. All patients on aspirin or warfarin were once advised to stop taking these anticoagulants two weeks before surgery. But new evidence shows that many patients suffer serious thrombotic events as a result, underscoring the need for a more measured approach. In today

Plavix (generic: clopidogrel bisulfate) is an antiplatelet (anticoagulant, anti-clotting) agent that is marketed by Bristol-Myers Squibb and Sanofi-Aventis. Plavix is used in patients with atherosclerosis, acute ST-segment elevation myocardial infarction (STEMI), acute coronary syndrome without ST-segment elevation (NSTEMI), and after placement of coronary stents. For patients who have had heart attack, stroke or poor leg circulation, or have recently had angioplasty, an anti-clotting drug such as Plavix is often prescribed. Did you or a family member take Plavix / clopidogrel bisulfate and suffer from gastrointestinal side effects such as peptic ulcers or bleeding? If so, you have legal rights. Please contact Mark & Associates, P.C. today for a FREE legal consultation about your potential Plavix case. Our defective drug lawyers take Plavix cases on contingency, meaning that there will be NO legal fees unless we win compensation on your behalf. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with our defective drug team today, or fill out our online Plavix case form.

Plavix (generic: clopidogrel bisulfate) is an antiplatelet (anticoagulant, anti-clotting) agent that is marketed by Bristol-Myers Squibb and Sanofi-Aventis. Plavix is used in patients with atherosclerosis, acute ST-segment elevation myocardial infarction (STEMI), acute coronary syndrome without ST-segment elevation (NSTEMI), and after placement of coronary stents. For patients who have had heart attack, stroke or poor leg circulation, or have recently had angioplasty, an anti-clotting drug such as Plavix is often prescribed. Did you or a family member take Plavix / clopidogrel bisulfate and suffer from gastrointestinal side effects such as peptic ulcers or bleeding? If so, you have legal rights. Please contact Mark & Associates, P.C. today for a FREE legal consultation about your potential Plavix case. Our defective drug lawyers take Plavix cases on contingency, meaning that there will be NO legal fees unless we win compensation on your behalf. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with our defective drug team today, or fill out our online Plavix case form.

The rate of heart failure in older Americans is on the rise but deaths due to heart failure are declining, especially in men.  We discuss this phenomena, and how the supplement coenzyme Q10 (CoQ10) may be beneficial for those who suffer from heart failure. We discuss the power of prayer, and findings from a study directed by Harvard University psychologist Jeffrey A. Dusek. Lower the risk of heart attack and stroke.  Depending upon a couple of facotrs, you may or may not want to take both aspirin and Plavix, an antiplatelet medication. Should you take glucosamine and chondroitin if you have arthritic knees?  We'll discuss the results of a new study. Dr. Cooper takes calls.