Podcasts about prevacid

Acid Reflux Medicine May Cause Osteoporosis Stomach acid–blocking proton pump inhibitor drugs—PPIs with brand names like Prilosec, Prevacid, Nexium, Protonix, and AcipHex—appear to significantly increase the risk of bone fractures. Listen to today's episode to learn about the written by Dr. Michael Greger at @NutritionFacts.org #vegan #plantbased #plantbasedbriefing #acidreflux #GERD #osteoporosis #ppi #protonpumpinhibitors #Prilosec #prevacid #Nexium #protonix #acipHex ============================ Original post: https://nutritionfacts.org/video/acid-reflux-medicine-may-cause-osteoporosis/  Related Episodes: Acid Reflux 943: How to Prevent and Treat Heartburn Without Medication https://plantbasedbriefing.libsyn.com/943-how-to-prevent-and-treat-heartburn-without-medication-according-to-gastro-docs-by-dana-hudepohl-at-forksoverknivescom 174: [Part 1] Dining by Traffic Light: Green is for Go, Red is for Stop https://plantbasedbriefing.libsyn.com/174-part-1-dining-by-traffic-light-green-is-for-go-red-is-for-stop-by-dr-michael-greger-at-nutritionfactsorg 133: Treating Reflux in Babies with Diet https://plantbasedbriefing.libsyn.com/133-treating-reflux-in-babies-with-diet-by-dr-michael-greger-at-nutritionfactsorg 90: 'Plant Based Diet Healed My Gut and Made Me a Better Doctor' and '5 Ways to Reduce Food Waste at Home' https://plantbasedbriefing.libsyn.com/90-plant-based-diet-healed-my-gut-and-made-me-a-better-doctor-and-5-ways-to-reduce-food-waste-at-home   Osteoporosis 822: Calcium and Strong Bones https://plantbasedbriefing.libsyn.com/822-calcium-and-strong-bones-by-physicians-committee-for-responsible-medicine-at-pcrmorg  760: Fall Prevention Is the Most Important Thing for Preventing Osteoporosis Bone Fractures https://plantbasedbriefing.libsyn.com/760-fall-prevention-is-the-most-important-thing-for-preventing-osteoporosis-bone-fractures-by-dr-michael-greger-at-nutritionfactsorg  695: Is a Plant-Based Diet the Best for Senior Health? https://plantbasedbriefing.libsyn.com/695-is-a-plant-based-diet-the-best-for-senior-health-by-charlotte-pointing-at-vegnewscom 612: 5 Tips To Maintain Strong Bones And Prevent Osteoporosis https://plantbasedbriefing.libsyn.com/612-5-tips-to-maintain-strong-bones-and-prevent-osteoporosis-from-switch4goodorg  489: [Part 2] Calcium for Vegans https://plantbasedbriefing.libsyn.com/489-part-2-calcium-for-vegans-by-brigitte-gemme-at-veganfamilykitchencom 488: [Part 1] Calcium for Vegans https://plantbasedbriefing.libsyn.com/488-part-1-calcium-for-vegans-by-brigitte-gemme-at-veganfamilykitchencom 340: Milk and Osteoporosis: The Calcium Myth https://plantbasedbriefing.libsyn.com/340-milk-and-osteoporosis-the-calcium-myth-by-rick-scott-at-switch4goodorg   ============================ Dr. Michael Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. He founded NUTRITIONFACTS.ORG is a non-profit, non-commercial, science-based public service provided by Dr. Michael Greger, providing free updates on the latest in nutrition research via bite-sized videos. There are more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day.   His latest books —How Not to Die, the How Not to Die Cookbook, and How Not to Diet — became instant New York Times Best Sellers. His two latest books, How to Survive a Pandemic and the How Not to Diet Cookbook were released in 2020.  100% of all proceeds he has ever received from his books, DVDs, and speaking engagements have always and will always be donated to charity. ============================== FOLLOW THE SHOW ON: YouTube: https://www.youtube.com/@plantbasedbriefing     Spotify: https://open.spotify.com/show/2GONW0q2EDJMzqhuwuxdCF?si=2a20c247461d4ad7 Apple Podcasts: https://podcasts.apple.com/us/podcast/plant-based-briefing/id1562925866 Your podcast app of choice: https://pod.link/1562925866 Facebook: https://www.facebook.com/PlantBasedBriefing   LinkedIn: https://www.linkedin.com/company/plant-based-briefing/   Instagram: https://www.instagram.com/plantbasedbriefing/   

While modern medicine is definitely a wonder, it isn't always working to help your body. Chronic use of medicines like ibuprofen (Advil), acetaminophen (Tylenol), and proton pump inhibitors (Prilosec, Nexium, Prevacid, etc.) come with some nasty side effects that you might not know about. Inside this episode, you'll discover the potentially negative consequences of popping these pills daily, as well as what you can do to maximize your body's function and health without them -- pain-free! --- Show Notes: Your Daily Ibuprofen is Wrecking Your Gut! Tylenol SUCKS For Your Liver Pharmacology of Proton Pump Inhibitors Review of the Long-Term Effects of Proton Pump Inhibitors Proton pump inhibitors and dementia: A nationwide population-based study Join my pH Balance DIY Program - and get off the PPIs for good! --- Join the Compass Method DIY Program Jump inside my Rock the Bloat Minicourse Get my Core-Gi Workout Program with the exclusive listener discount! Join my Brain Rewiring Masterclass You can learn more about me by following on IG @imperfectlypaigewellness or by checking out my blog, freebies, and offers on my website: https://imperfectlypaigewellness.com Please share with #PaigeTalksWellness to help get the word out about the show - and join the Imperfect Health Fam over on Facebook.

Stomach acid–blocking proton pump inhibitor drugs—PPIs with brand names like Prilosec, Prevacid, Nexium, Protonix, and AcipHex—appear to significantly increase the risk of bone fractures.

For our 51st podcast episode, I discussed a contensious topic in the neonatal world, Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). Although it is a common occurrence amongst all infants, the lack of updated, clear, and consistent diagnostic and management recommendations remains, especially for the NICU population. Due to my personal and professional experiences, it is difficult for me to have one solid stance on the topic. As a former NICU nurse, I saw so many infants experience reflux. As a NICU parent, my son William, struggled with reflux once we brought him home and yes, at that time, it was managed with medication. And finally, now as a Neonatal Nurse Practitioner, I am more knowledgeable about what the evidence does and does not show regarding reflux and I understand its complexity. So I can fully appreciate how nurses advocate for their patients. I also completely acknowledge the internal battle parents endure as they helplessly watch their baby grapple with reflux and its associated symptoms, and I also embrace what the research has shown and why providers do not hastily start infants on reflux medications. Tune in now to learn the difference between Gastroesophageal Reflux and Gastroesophageal Reflux Disease, some common symptoms, and how it is typically diagnosed. Be amazed as I debunk some of the common myths and conditions that are thought to be associated with GERD. Additionally, listeners will also walk away with a better understanding of the most up-to-date recommendations for the management of GER and GERD including non-pharmacological and pharmacological treatments. So sit back and get ready to be empowered as we discuss Gastroesophageal Reflux. Free Resource: https://empoweringnicuparents.com/ger/Dr. Brown's Medical: https://www.drbrownsmedical.comOur NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Newborn Holiday Cards: https://empoweringnicuparents.com/shop/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/Episode 51 Show Notes: https://empoweringnicuparents.com/episode51Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Dr. Steven Sandberg-Lewis discusses Healing Reflux with Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]    Podcast Highlights 2:50  Heartburn.  Heartburn is a subjective sensation of burning, usually over the sternum, and it can be intense and sharp. People can even feel like they are having a heart attack.  Not all patients who have heartburn have reflux, though the majority do have reflux.  Regurgitation is when fluid or food comes up into the throat or mouth and this can be related to reflux. 4:57  Reflux.  Reflux can have to do with any fluid going through a tube in the wrong direction.  When the contents of the large intestine move from the large intestine to the small intestine instead from the small intestine down to the large intestine, this is called cecoileal reflux or ileocecal reflux.  If things move from the small intestine up into the stomach, that's called bile reflux. If things move from the stomach into the esophagus, that's called gastroesophageal reflux disease, GERD.  There is also GER, which is a normal reflux that occurs say three times after every average meal when some food or fluid from the stomach will move up into the lower esophagus and it doesn't cause symptoms.  This is not a disease and considered normal.  Reflux doesn't have to cause reflux disease, but it can if it's prolonged or if the esophagus is not able to protect itself with various protective factors. Normally our saliva, which is slightly alkaline and which is being swallowed every minute and helps to neutralize any acid that comes up. There are secondary contractions that contract the lower esophagus to move things down. There's also mucus production that coats the mucosal membrane of the esophagus.  If these mechanisms fail, then you can get Gastroesophageal Reflux Disease.  Therefore it is important to naturally bolster the protective factors in the esophagus. 7:32  What causes reflux?  For one thing, while it is often called acid reflux most patients do not start out having too much acid production.  In fact, many of them have too little stomach acid production. But after being on proton pump inhibitors like Prilosec, AcipHex, Prevacid, Protonix, and Nexium for a while, if they stop them even for short period of time to get the Heidelberg test that Dr. SS-L often performs, they will often get a rebound hypersecretion of acid, which makes it difficult to accurately test their acid levels in their stomach.  While the proton pump inhibitor is preventing the parietal cells in the stomach from making acid, the body keeps secreting more and more gastrin to stimulate those parietal cells to make acid. 10:25  The major causes of GERD include a sliding hiatal hernia.  This is when the upper 2-3 cm of the stomach slides up through the diaphragm that engages the lower esophageal sphincter that normally protects from reflux.  When the stomach moves up, you lose a lot of that anti-reflux muscle function.  Another reason is people who overeat or who eat rapidly will more likely have reflux.  When you eat too quickly, you don't get the signal to your brain that you're full.  Overeating or anything that causes distension of the stomach, such as gas, will lead the lower esophageal sphincter to relax and stay open for up to 20 seconds.  This is why SIBO can be a trigger for reflux.  Food sensitivities can also lead to reflux. Atrophic gastritis, those who don't make enough stomach acid, can lead to heartburn symptoms.  18:25  H. Pylori is generally protective against reflux.  H. pylori is a bacteria in the stomach that is a major cause of ulcers and many feel that it is a cause of reflux. While H. pylori can cause a type of lymphoma in the stomach called MALToma and it can cause gastritis and it can increase the risk of stomach cancer. H.

Episode 23:12 Why You Should Stop Taking Drugs For Reflux And Heartburn… And What To Do Instead Every day millions of Americans take a PPI drug - such as Prilosec, Prevacid, Protonix, Nexium - to help them deal with acid reflux (GERD), heartburn, chest pain and/or difficulty swallowing. Unfortunately many of these individuals ignore the warnings associated with these drugs... the warning informing them that they are not intended to be taken for more than two weeks at a time. As a result, they are putting themselves at risk for some serious side-effects such as kidney disease, broken bones and dementia. This has to stop… but how? That is, what can a person do to avoid taking these drugs? More importantly, what can a person do NATURALLY to help their digestive system improve to the point that they don't need a PPI drug? On this episode we lay out an exact plan. Specifically, we share four tactics anyone can employ to improve their digestion. In addition, we do something very few doctors will do: We discuss HOW a person develops acid reflux (GERD) and heartburn so they can better understand how to correct it. We also provide three very important questions a person should ask their doctor BEFORE ever taking a PPI drug. Please give this episode a good listen as you won't hear this information anywhere else. Then share this episode with a friend. Thanks! ———————- Want to learn more? Continue the conversation regarding this episode, and all future episodes, by signing up for our daily emails. Simply visit: GetHealthyAlabama.com  Once there, download the “Symptom Survey” and you will automatically added to our email list. ———————- Also, if you haven't already, we'd appreciate it if you'd subscribe to the podcast, leave a comment and give us a rating. (Thanks!!!) 

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         * This podcast is for informational and educational purposes only. It is not intended to diagnose or treat any disease. Please consult with your health care provider before making any health-related changes.

Do you have acid reflux, or the more severe form known as gastroesophagealreflux disease? (GERD) This is one of the most common digestive conditionstreated by gastroenterologists and primary care doctors.The most commonly prescribed drugs for GERD are proton pump inhibitors(PPIs).  PPIs currently available on prescription in the USA are: dexlansoprazole(Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole(Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).These drugs suppress stomach acid secretion. They can be effective inreducing GERD but they are not recommended for long term use. The most common side effects are headache, diarrhea, nausea, and vomiting.

Around 20% of people in the Western world are afflicted by GERD or acid reflux. The go-to prescription in most of these cases are PPIs or proton pump inhibitors, one of the most prescribed medications in all of health care. The drawbacks of long-term PPI use are many and their use fails to address the root cause of GERD and other GI issues for which they're prescribed. Learn more about the causes and root cause treatment of GERD, ulcers, H pylori and gastritis and the drawbacks of long-term PPI use. Lindsey Parsons, your host, helps clients solve gut issues and reverse autoimmune disease naturally. Take her quiz to see which stool or functional medicine test will help you find out what's wrong. She's a Certified Health Coach at High Desert Health in Tucson, Arizona. She coaches clients locally and nationwide. You can also follow Lindsey on Facebook, Twitter, Instagram or Pinterest or reach her via email at lindsey@highdeserthealthcoaching.com to set up a free 30-minute Gut Healing Breakthrough Session. Show Notes

In March, the Senate approved the Sunshine Protection Act - which, if passed, will make daylight savings time permanent. The bill has been praised by many, but Mariana Szklo-Coxe says not so fast. She studies how permanent daylight savings time will affect our sleep. Plus: Postpartum depression is one of the leading complications of childbirth, but most mothers are never screened for it. Jennifer Payne conducted a worldwide study and found that first time moms, young moms, and moms with twins have the highest rates of postpartum depression. Later in the show: Chemotherapy is the best weapon we have at fighting cancer. But it's notoriously hard on the body and causes a number of side-effects. Maxwell Hennings studies chemo brain, a mysterious ailment linked to cognitive decline in some patients who have undergone chemotherapy. And: Many people are prescribed drugs like Prilosec and Prevacid to treat their heartburn symptoms. But what if those same drugs could fight cancer? Randall Reif says these heartburn drugs could have the potential to revolutionize the way we treat certain cancers.

Monologue Dr. Wallach begins the show discussing the latest COVID 19 numbers of infections and deaths. As there continues to be spikes due the Delta and Omicron variants. Asserting that people are getting too relaxed about following the protocols such as social distancing, hand washing and wearing masks. Stating everyone should be supplementing with all 90 essential nutrients to support immune function. Pearls of Wisdom Doug Winfrey and Dr. Wallach discuss a news article regarding reasons not to take PPIs (proton pump inhibitors). Commonly known has acid blockers that reduce the amount of gastric acid secreted in the stomach wall. These PPIs are the most widely prescribed drug in the would nearly 270 million hospital trips made by adults via ambulance from 2006 to 2010. Cumulative sales of more than $10 billion dollars annually. Drugs like Nexium, Prilosec, Prevacid and others. Short term side effects include;nausea, vomiting, diarrhea, constipation, abdominal pain, gas, headaches, fever, cold symptoms, skin rashes, cognitive impairment and infection. With long term side effects including increased risk of kidney disease, increased risk of heart disease, digestive disorders, diminished brain function and increased risk of death. Callers Tanesha's father has been diagnosed with Alzheimer's disease. Sheryl has questions regarding chronic herpes outbreaks. Mark is experiencing liver problems including jaundice. Call Dr. Wallach's live radio program weekdays from noon until 1pm pacific time at 831-685-1080 or toll free at 888-379-2552.

The 11 Worst Medications Causing Atrial Fibrillation Could one of your medications actually be causing your AFib? Over the years I've seen a number of patients either significantly decrease their AFib episodes or even put their AFib into remission for a few years just by getting off an AFib causing medication. For those who needed a particular medication, catheter ablation was very helpful in eliminating the AFib so that they could continue to take their necessary medication. Below are my 11 worst medications causing atrial fibrillation. 1. Diuretics With the exception of spironolactone (Aldactone) and triamterene, diuretics can be problematic for atrial fibrillation patients. The reason is that most diuretics are well-known to cause mineral depletion in the body. Depletion of those key minerals, especially potassium and magnesium, is often enough to trigger atrial fibrillation. 2. NSAIDs Non-steroid anti-inflammatory drugs, or NSAIDs, can also induce AFib. NSAIDs are relatively common drugs like ibuprofen and naproxen that are often used to fight pain. NSAIDs are particularly troublesome for AFib patients because they also increase the risk of heart and kidney failure. For those who are also on a blood thinner, NSAIDs increase the risk of an emergency room visit for a life-threatening gastrointestinal bleed. 3. Proton Pump Inhibitors Proton pump inhibitors, which suppress stomach acid, can also atrial fibrillation by blocking magnesium absorption or possibly by changing a person's gut microbiome. These drugs include omeprazole, lansoprazole and pantoprazole, which are often sold under the brand names Prilosec, Prevacid, and Nexium, respectively. 4. Steroids Steroids, like prednisone and Solu-medrol, can cause atrial fibrillation, too, by raising blood glucose levels to very high levels and increasing blood pressure through fluid retention and weight gain. Over my career, I've even seen many cases of steroid injections triggering AFib. 5. Any Stimulant Cardiac stimulant medications, like albuterol inhalers or theophylline for asthma, have long been associated with AFib. Even over-the-counter decongestants such as pseudoephedrine, which is sold as Sudafed, or medications for attention deficit hyperactivity disorder can trigger an AFib attack. The bottom line is that anything that revs up the cardiovascular system has a risk of causing AFib. 6. Digoxin, Diltiazem, Verapamil, and Beta-Blockers Perhaps a bit counterintuitively, some if the classic drugs used to treat abnormal heart rhythms such as digoxin, calcium-channel blockers such as verapamil and diltiazem, and beta-blockers have all been associated with an increased risk of AFib. While the exact mechanisms whereby these drugs may increase the AFib risk aren't entirely clear, plenty of cases have been documented in the medical literature. We've even seen beta-blockers, which are often used to treat AFib, linked to AFib episodes due to associated weight gain, particularly with women. 7. Fish Oil As many readers know, there is prescription-strength fish oil, like Lovaza, as well as the over-the-counter fish oil. Prescription-strength fish oil is used to treat high triglycerides whereas the over-the-counter version is used to treat a myriad of complaints. Regardless of which form it is, fish oil has now been implicated as a potential cause of AFib. If fish oil has been particularly helpful for you, try keeping the dose under 1 gram per day to minimize the risk of AFib. Or, alternatively, you can do what I've done and go back to eating wild-caught fish high in omega 3s instead of taking a supplement. Interestingly, since stopping fish oil for myself, I've noticed a lot fewer palpitations. 8. Antiarrhythmics like Amiodarone, Flecainide, and Propafenone Another surprise to many readers is that the antiarrhythmic drugs, the ones that are supposed to prevent AFib, have been linked to AFib. For example, amiodarone is well-known to cause hyperthyroidism which ca...

Today we bring you the second half of Harry's conversation with Dave deBronkart, better known as E-Patient Dave for all the work he's done to help empower patients to be more involved in their own healthcare. If you missed Part 1 of our interview with Dave, we recommend that you check that out before listening to this one. In that part, we talked about how Dave's own brush with cancer in 2007 turned him from a regular patient into a kind of super-patient, doing the kind of research to find the medication that ultimately saved his life. And we heard from Dave how the healthcare system in the late 2000s was completely unprepared to help consumers like him who want to access and understand their own data.Today in Part 2, we'll talk about how all of that is gradually changing, and why new technologies and standards have the potential to open up a new era of participatory medicine – if, that is, patients are willing to do a little more work to understand their health data, if innovators can get better access to that data, and if doctors are willing to create a partnership with the patients over the process of diagnosis and treatment.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.Full TranscriptHarry Glorikian: Hello. I'm Harry Glorikian.Welcome to The Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare.Artificial intelligence.Big data.Predictive analytics.In fields like these, breakthroughs are happening much faster than most people realize. If you want to be proactive about your own healthcare and the healthcare of your loved ones, you'll need to some of these new tips and techniques of how medicine is changing and how you can take advantage of all the new options.Explaining this approaching world is the mission of the new book I have coming out soon, The Future You. And it's also our theme here on the show, where we'll bring you conversations with the innovators, caregivers, and patient advocates who are transforming the healthcare system and working to push it in positive directions.In the previous episode we met Dave deBronkart, better known as E-Patient Dave for all the work he's done to help empower patients to be more involved in their own healthcare. If you missed it, I'm gonna recommend that you listen to the first discussion, and then come back here.We talked about how Dave's own brush with cancer in 2007 turned him from a regular patient into a kind of super-patient, doing the kind of research to find the medication that ultimately saved his life. And we heard from Dave how the healthcare system in the late 2000s was completely unprepared to help consumers like him who want to access and understand their own data.Today in Part 2, we'll talk about how all of that is gradually changing, and why new technologies and standards have the potential to open up a new era of participatory medicine – if, that is, patients are willing to do a little more work to understand their health data, if innovators can get better access to that data, and if doctors are willing to create a partnership with the patients over the process of diagnosis and treatment.We'll pick up the conversation at a spot where we were talking about that control and the different forms it's taken over the years.Harry Glorikian: You've observed like that there's some that there's this kind of inversion going on right now where for centuries doctors had sole control over patient data and sole claims to knowledge and authority about how patients should be treated. But now patients may have more detailed, more relevant and more up to date data than your doctors does. Right. You've talked about this as a Kuhnian paradigm shift, if I remember correctly, where patients are the anomalies, helping to tear down an old paradigm, you know. Walk us through the history here. What was the old paradigm and what's the new paradigm and what are you some of your favorite examples of this paradigm shift?Dave deBronkart: Well, so I want to be clear here. I have the deepest admiration for doctors, for physicians and for licensed practitioners at all levels for the training that they went through. I don't blame any of this on any of them. I did a fair amount of study about what paradigms are Thomas Kuhn's epic book The Structure of Scientific Revolutions, like discovering that the Earth isn't the center of the solar system and things like that. The paradigm is an agreement in a scientific field about how things work. And it is the platform, the theoretical model on which all research and further study is done. And these anomalies arise when scientists operating in the field keep finding outcomes that disagree with what the paradigm says. So in the case of the planets circling the earth and the how the solar system works. They discovered that Mars and other planets all of a sudden would stop orbiting and when they would do a little loop de loop. I mean, that's what they observed. And they came up with more and more tortured explanations until finally, finally, somebody said, hey, guess what? We're all orbiting the sun. Now, the paradigm inn health care has been that the physician has important knowledge. Lord knows that's true. The physician has important knowledge and the patient doesn't and can't. Therefore, patient should do as they're told, so called compliance, and should not interfere with the doctors doing their work. Well, now along comes things like all of those things that I mentioned that the patient community told me at the beginning of my cancer. None of that is in the scientific literature. Even here, 15 years later, none of it's in the literature. What's going on here? Here's that first clunk in the paradigm. Right. And we have numerous cases of patients who assisted with the diagnosis. Patients who invented their own treatment. And the shift, the improvement in the paradigm that we have to, where just any scientific thinker -- and if you want to be a doctor and you don't want to be a scientific thinker, then please go away -- any scientific thinker has to accept is that it's now real and legitimate that the patient can be an active person in healthcare.Dave deBronkart: Yeah, I mean, you've said you don't have to be a scientist or a doctor anymore to create a better way to manage a condition. So, I mean, it's interesting, right? Because I always think that my doctor and I are partners in this together.Dave deBronkart: Good participatory medicine. Perfect.Harry Glorikian: You know, he has knowledge in certain places I definitely don't. But there are things where him and I, you know, do talk about things that were like, you know, we need to look into that further. Now, I'm lucky I've got a curious doctor. I found somebody that I can partner with and that I can think about my own health care in a sort of different way. But I mean, sometimes he doesn't have all the answers and we have to go search out something. You know, I was asking him some questions about HRV the other day that, you know, he's like, huh, let me let me ask a few cardiologists, you know, to get some input on this. So do you see that, I mean, I see that as the most desired outcome, where a patient can have their record. They're not expected to go and become a physician at that level of depth, but that the physicians who also have the record can work in a participatory way with the patient and get to a better outcome.Dave deBronkart: Exactly. And the other thing that's happened is and I've only recently in the last year come to realize we are at the end of a century that is unique in the history of humanity until science got to a certain point in the late 1800s, most doctors, as caring as they were, had no knowledge of what was going wrong in the body with different diseases. And then and that began a period of many decades where doctors really did know important things that patients had no access to. But that era has ended. All right, we now have more information coming out every day than anyone can be expected to keep up with. And we now are at a point also where we've seen stories for decades of patients who were kept alive. But at what cost? Right. Well, and we now we are now entering the point where the definition of best care cannot be made without involving the patient and their priorities. So this is the new world we're evolving into, like and Dr. Sands wears a button in clinic that says what matters to you?Harry Glorikian: So I mean, one of the other, based on where you're going with this, I think is you know, there are some movements that have been arising over the years. I don't know, maybe you could talk about one of them, which is OpenAPS. It's an unregulated, open source project to build an artificial pancreas to help people with type 1 diabetes. And I think it was Erich von Hippel's work on patient driven innovation. I talk in my book about, and I ask whether we should be training people to be better patients in the era of, say, A.I. and other technologies. What do you think could be done better to equip the average patient with to demand access to patient data, ask their doctors more important questions, get answers in plain English. You know, be more collaborative. What do you think is going to move us in that direction faster or more efficiently, let's say?Dave deBronkart: Well, I want to be careful about the word better, because I'm very clear that my preferences are not everyone's preferences. Really, you know, autonomy means every person gets to define their own priorities. And another thing is one of the big pushbacks from the hospital industry over the last 10 years as medical records, computers were shoved down their throats along with the mandate that they have to let patients see their data in the patient portal was a complaint that most patients aren't interested. Well, indeed, you know, I've got sorry news for you. You know, when I worked in the graphic arts industry, I worked in marketing, people don't change behavior or start doing something new until they've got a problem. If it's fun or sexy, you know, then they'll change, they'll start doing something new. What we need to do is make it available to people. And then when needs arise, that gets somebody's attention and they're like, holy crap, what's happening to my kid? Right. If they know that they can be involved, then they can start to take action. They can learn how to take action. It's having the infrastructure available, having the app ecosystem start to grow, and then just having plain old awareness. Who knows? Maybe someday there will be a big Hollywood movie where people where people learn about stories like that and. You know, from that I mean that I think nature will take its course.Harry Glorikian: Well, it's interesting because I recently interviewed a gentleman by the name of Matthew Might. He's a computer scientist who became a surrogate patient advocate for his son, Bertrand, who had a rare and undiagnosed genetic disorder that left him without an enzyme that breaks down junk protein in the cells. But he, you know, jumped in there. He did his own research found in over-the-counter drug, Prevacid of all drugs., that could help with Bertrand's deficiency. But, I mean, Dave, you know, Matt is a, he was a high-powered computer scientist who wasn't afraid to jump in and bathe in that, you know. Is that the type of person we need? Is that a cautionary tale, or an inspiring tale? How do you think about that?Dave deBronkart: Desperate people will bring whatever they have to the situation. And this is no different from, you know, there have been very ordinary people who had saved lives at a car crash because they got training about how to on how to stop bleeding as a Boy Scout. You know, it is a mental trap to say, "But you're different." Ok. Some people said, "Well, Dave, you're an MIT graduate, my patients aren't like you." And people say, well, yeah, but Matt Might is a brilliant PhD type guy. What you mentioned few minutes before gives the lie to all of that, the OpenAPS community. All right, now, these are people you need to know appreciate the open apps world. You need to realize that a person with type 1 diabetes can die in their sleep any particular night. You know, they can even have an alarm, even if they have a digital device connected with an alarm, their blood sugar can crash so bad that they can't even hear the alarm. And so and they got tired of waiting the industry. Year after year after year, another five years will have an artificial pancreas, another five years, and a hashtag started: #WeAreNotWaiting. Now, I am I don't know any of the individuals involved, but I'll bet that every single diabetes related executive involved in this thought something along the lines of, "What are they going to do, invent their own artificial pancreas?" Well, ha, ha, ha, folks. Because as I as I imagine, you know, the first thing that happened was this great woman, Dana Lewis, had a digital insulin pump and a CGM, continuous glucose meter, and her boyfriend, who's now her husband, watched her doing the calculation she had to do before eating a hamburger or whatever and said, "I bet I could write a program that would do that."Dave deBronkart: And so they did. And one thing led to another. His program, and she had some great slides about this, over the course of a year, got really good at predicting what her blood sugar was going to be an hour later. Right. And then they said, "Hmm, well, that's interesting. So why don't I put that in a little pocket computer, a little $35 pocket computer?" The point is, they eventually got to where they said, let's try connecting these devices. All right. And to make a long story short, they now have a system, as you said, not a product, they talked to the FDA, but it's not regulated because it's not a product. Right. But they're not saying the hell with the FDA. They're keeping them informed. What are the scientific credentials of Dana Lewis and her boyfriend, Scott? Dana is a PR professional, zero medical computer or scientific skills? Zero. The whole thing was her idea. Various other people got involved and contributed to the code. It is a trap to think that because the pioneering people had special traits, it's all bogus. Those people are lacking the vision to see what the future you is going to be. See, and the beautiful thing from a disruptive standpoint is that when the person who has the problem gains access to power to create tools, they can take it in whatever direction they want. That's one of the things that happened when typesetting was killed by desktop publishing.Harry Glorikian: Right.Dave deBronkart: In typesetting, they said "You people don't know what you're doing!" And the people said, whatever, dude, they invented Comic Sans, and they went off and did whatever they wanted and the world became more customer centered for them.Harry Glorikian: So. You know, this show is generally about, you know, data, Machine learning and trying to see where that's going to move the needle. I mean, do you see the artificial intelligence umbrella and everything that's under that playing a role to help patients do their own research and design their own treatments?Dave deBronkart: Maybe someday, maybe someday. But I've read enough -- I'm no expert on AI, but I've read enough to know that it's a field that is full of perils of just bad training data sets and also full of immense amounts of risk of the data being misused or misinterpreted. If you haven't yet encountered Cathy O'Neil, she's the author of this phenomenal book, Weapons of Math Destruction. And she said it's not just sloppy brain work. There is sloppy brain work in the mishandling of data in A.I., but there is malicious or ignorant, dangerously ignorant business conduct. For instance, when companies look at somebody who has a bad credit rating and therefore don't give them a chance to do this or this or this or this, and so and they actually cause harm, which is the opposite of what you would think intelligence would be used for.Harry Glorikian: So but then, on the opposite side, because I talk about some of these different applications and tools in in the book where, you know, something like Cardiogram is able to utilize analytics to identify, like it alerted me and said "You know, you might have sleep apnea." Right. And it can also detect an arrhythmia, just like the Apple Watch does, or what's the other one? Oh, it can also sort of alert you to potentially being prediabetic. Right. And so you are seeing, I am seeing discrete use cases where you're seeing a movement forward in the field based on the analytics that can be done on that set of data. So I think I don't want to paint the whole industry as bad, but I think it's in an evolutionary state.Dave deBronkart: Absolutely. Yes. We are at the dawn of this era, there's no question. We don't yet have much. We're just going to have to discover what pans out. Really, I. Were you referring to the Cardia, the Acor, the iPhone EKG device a moment ago?Harry Glorikian: No, there's there's actually an, I've got one here, which is the you know...Dave deBronkart: That's it. That's the mobile version. Exactly. Yeah. Now, I have a friend, a physician friend at Beth Israel Deaconess, who was I just rigidly absolutely firmly trust this guy's brain intelligence and not being pigheaded, he was at first very skeptical that anything attached to an iPhone could be clinically useful. But he's an E.R. doc and he now himself will use that in the E.R. Put the patient's fingers on those electrodes and and send it upstairs because the information, when they're admitting somebody in a crisis, the information gets up there quicker than if he puts it in the EMR.Harry Glorikian: Well, you know, I always try to tell people like these devices, you know, they always say it's not good enough, it's not good enough. And I'm like, it's not good enough today. But it's getting better tomorrow and the next day. And then they're going to improve the sensor. And, yep, you know, the speed of these changes is happening. It's not a 10 year shift. It's it's happening in days, weeks, months, maybe years. But, you know, this is a medical device on my arm as far as I'm concerned.Harry Glorikian: It's a device that does medical-related things. It certainly doesn't meet the FDA's definition of a medical device that requires certification and so on. Now, for all I know, maybe two thirds of the FDA's criteria are bogus. And we know that companies and lobbyists have gamed the system. It's an important book that I read maybe five years ago when it was new, was An American Sickness about the horrifying impacts of the money aspect of health care. And she talked about, when she was talking specifically about device certification, she talked about how some company superbly, and I don't know if they laughed over their three martini lunch or what, some company superbly got something approved by the FDA as saying, we don't need to test this because it's the same as something else.Harry Glorikian: Ok, equivalence.Dave deBronkart: And also got a patent on the same thing for being completely new. Right. Which is not possible. And yet they managed to win the argument in both cases. So but the this is not a medical device, but it is, gives me useful information. Maybe we should call it a health device.Harry Glorikian: Right. Yeah, I mean, there are certain applications that are, you know, cleared by the FDA right now, but, you know, I believe what it's done is it's allowing these companies to gather data and understand where how good the systems are and then apply for specific clearances based on when the system gets good enough, if that makes sense.Dave deBronkart: Yes. Now, one thing I do want to say, there's an important thing going on in the business world, those platforms. You know, companies like Airbnb, Uber, whatever, where they are, a big part of their business, the way they create value is to understand you better by looking at your behavior and not throwing so much irrelevant crap at you. Now, we all know this as it shows up. As you know, you buy something on Amazon and you immediately get flooded by ads on Facebook for the thing that you already bought, for heaven's sake. I mean, how stupid is that? But anyway, I think it's toxic and should be prohibited by law for people to collect health data from your apps and then monetize it. I think that should be completely unacceptable. My current day job is for this company called Pocket Health, where they collect a patient's radiology images for the patient so the patient can have 24/7 access in the cloud. And when I joined there, a friend said, oh, I gather they must make their money by selling the data. Right? And I asked one of the two founding brothers, and he was appalled. That's just not what they do. They have another part of the company. And anybody who gets any medical device, any device to track their health should make certain that the company agrees not to sell it.[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's to make it easier for other listeners discover the show by leaving a rating and a review on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing us a huge favor.And one more thing. If you like the interviews we do here on the show I know you'll   like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book is now available for pre-order. Just go to Amazon and search for The Future You, Harry Glorikian.Thanks. And now back to our show.[musical interlude]Harry Glorikian: You mentioned FHIR or, you know, if I had to spell it out for people, it's Fast Healthcare Interoperability Resource standard from, I think, it's the Health Level 7 organization. What is FHIR? Where did it come from and what does it really enable?Dave deBronkart: So I'll give you my impression, which I think is pretty good, but it may not be the textbook definition. So FHIR is a software standard, very analogous to HTTP and HTML for moving data around the same way those things move data around on the Web. And this is immensely, profoundly different from the clunky, even if possible, old way of moving data between, say, an Epic system, a Cerner system, a Meditech system nd so on. And the it's a standard that was designed and started five or six years ago by an Australian guy named Graham Grieve. A wonderful man. And as he developed it, he offered it to HL7, which is a very big international standards organization, as long as they would make it free forever to everyone. And the important thing about it is that, as required now by the final rule that we were discussing, every medical record system installed at a hospital that wants to get government money for doing health care for Medicare or Medicaid, has to have what's called a FHIR endpoint. And a FHIR endpoint is basically just a plug on it where you can, or an Internet address, the same way you can go to Adobe.com and get whatever Adobe sends you, you can go to the FHIR endpoint with your login credentials and say, give me this patient's health data. That's it. It works. It already works. That's what I use in that My Patient Link app that I mentioned earlier.Harry Glorikian: So just to make it clear to someone that say that's listening, what does the average health care consumer need to know about it, if anything, other than it's accessible? And what's the part that makes you most excited about it?Harry Glorikian: Well, well, well. What people need to know about it is it's a new way. Just like when your hospital got a website, it's a new way for apps to get your data out of the hospital. So when you want it, you know that it has to be available that way. Ironically, my hospital doesn't have a FHIR endpoint yet. Beth Israel Deaconess. But they're required to by the end of the year. What makes me excited about it is that... So really, the universal principle for everything we've discussed is that knowledge is power. More precisely, knowledge enables power. You can give me a ton of knowledge and I might not know what to do with it, but without the knowledge, I'm disempowered. There's no dispute about that. So it will become possible now for software developers to create useful tools for you and your family that would not have been possible 15 years ago or five years ago without FHIR. In fact, it's ironic because one of the earliest speeches I gave in Washington, I said to innovators, data is fuel. Right. We talked about Quicken and Mint. Quicken would have no value to anybody if they couldn't get at your bank information. Right. And that's that would have prevented. So we're going to see new tools get developed that will be possible because of FHIR and the fact that the federal regulations require it.Harry Glorikian: Yeah, my first one of my first bosses actually, like the most brilliant boss, I remember him telling me one at one time, he goes, "Remember something: Knowledge is power." I must have been 19 when he told me that. And I was, you know, it took me a little while to get up to speed on what he meant by that. But so do you believe FHIR is a better foundation for accessing health records than previous attempts like Google Health or Microsoft Health Vault?Dave deBronkart: Well, those are apples and oranges. FHIR is a way of moving the data around. Several years into my "Give me my damn data" campaign, I did a blog post that was titled I Want a Health Data Spigot. I want to be able to connect the garden hose to one place and get all my data flowing. Well, that's what FHIR is now. What's at the other end of the hose? You know, different buckets, drinking glasses, whatever. That's more analogous to Google Health and Health Vault. Google Health and Health Vault might have grown into something useful if they could get all the important information out there, which it turns out was not feasible back then anyway. But that's what's going to happen.Harry Glorikian: What is the evolution you'd like to see in the relationship between the patient and the U.S. health care systems? You know, you once said the key to be would get the money managers out of the room. You know, if you had to sort of think about what you'd want it to evolve to, what would it be?Dave deBronkart: Well, so. There are at least two different issues involved in this. First of all, in terms of the practice of medicine, the paradigm of patient that I mentioned, collaboration, you know, collaboration, including training doctors and nurses on the feasibility and methods of collaboration. How do you do this differently? That won't happen fast because the you know, the I mean, the curriculum in medical schools doesn't change fast. But we do have mid career education and we have people learning practical things. So there's a whole separate issue of the financial structure of the U.S. health system, which is the only one I know in the world that is composed of thousands of individual financially separate organizations, each of which has managers who are required by law to protect their own finances. And the missing ingredient is that as all these organizations manage their own finances, nobody anywhere is accountable for whether care is achieved. Nobody can be fired or fined or put out of business for failing to get the patient taken care of as somebody should have. And so those are those are two separate problems. My ideal world is, remember a third of the US health care spending is excess and somebody a couple of years ago...Guess what? A third of the US health care spending is the insurance companies. Now, maybe the insurance companies are all of the waste. I don't know. I'm not that well-informed. But my point is there is plenty of money there already being spent that would support doctors and nurses spending more time with you and me beyond the 12 or 15 minutes that they get paid for.Harry Glorikian: So it's interesting, right? I mean, the thing that I've sort of my bully pulpit for, for a long time has been, once you digitize everything, it doesn't mean you have to do everything the same way. Which opens up, care may not have to be given in the same place. The business model may now be completely open to shift, as we've seen with the digitization of just about every other business. And so I you know, I worry that the EMRs are holding back innovation and we're seeing a lot of innovation happen outside of the existing rubric, right, the existing ivory towers, when you're seeing drug development using A.I. and machine learning, where we're seeing imaging or pathology scans. I mean, all of those are happening by companies that are accessing this digitized data and then providing it in a different format. But it's not necessarily happening inside those big buildings that are almost held captive by the EMR. Because if you can't access the data, it's really hard to take it to that next level of analytics that you'd like to take it to.Dave deBronkart: Yes, absolutely.Harry Glorikian: I mean, just throwing that out there, I know we've been talking about the system in particular, but I feel that there's the edges of the system aren't as rigid as they used to be. And I think we have a whole ecosystem that's being created outside of it.Harry Glorikian: Absolutely. And the when information can flow you get an increasing number of parties who can potentially do something useful with it, create value with it. And I'm not just talking about financial value, but achieve a cure or something like that. You know, interestingly, when the industry noticed what the open apps people were doing, all of a sudden you could no longer buy a CGM that had the ability to export the data.Harry Glorikian: Right.Dave deBronkart: Hmm. So somebody is not so happy about that. When an increasing number of people can get out data and combine it with their other ideas and skills and try things, then the net number of new innovations will come along. Dana Lewis has a really important slide that she uses in some presentations, and it ties in exactly with Erich von Hippel's user driven innovation, which of course, shows up in health care as patient driven innovation. The traditional industrial model that von Hippel talks about is if you're going to make a car, if you're going to be a company going into the car business, you start by designing the chassis and doing the wheels and designing the engine and so on and so on. And you do all that investment and you eventually get to where you've got a car. All right. Meanwhile, Dana shows a kid on a skateboard who can get somewhere on the skateboard and then somebody comes up with the idea of putting a handle on it. And now you've scooter. Right. And so on. The user driven innovations at every moment are producing value for the person who has the need.Harry Glorikian: Right. And that's why I believe that, you know, now that we've gotten to sort of that next level of of datafication of health care, that these centers have gotten cheaper, easier, more accessible. You know, like I said, I've got a CGM on my arm. Data becomes much more accessible. FHIR has made it easier to gain access to my health record. And I can share it with an app that might make that data more interpretable to me. This is what I believe is really sort of moving the needle in health care, are people like Matthew Might doing his own work where it's it's changing that. And that's truly what I try to cover in the book, is how these data [that] are now being made accessible to patients gives them the opportunity to manage their own health in a better way or more accurately and get ahead of the warning light going on before the car breaks down. But one of the things I will say is, you know, I love my doctor, but, you know, having my doctor as a partner in this is makes it even even better than rather than just me trying to do anything on my own. Dave deBronkart: Of course, of course. Dr. Sands is fond of saying "I have the medical training or diagnosis and treatment and everything, but Dave's the one who's the expert on what's happening in his life." Right. And and I'm the expert on my own priorities.Harry Glorikian: Right. Which I can't expect. I mean, my doctor has enough people to worry about, let alone like, me being his sole, the only thing he needs to think about. So, Dave, this was great. It was great having you on the show. I hope this is one of many conversations that we can have going forward, because I'm sure there's going to be different topics that we could cover. So I appreciate you taking the time and being on the show.Dave deBronkart: Well, and same to you. The this has been a very stimulating I mean, and the you've got the vision of the arriving future that is informed by where we're coming from, but not constrained by the old way of thinking. And that really matters. The reality, the emerging reality, whether anybody knows it or not, is that people with a big problem are able to act now in ways that they weren't before. I mean, another amazing example is a guy in England named Tal Golesworthy has Marfan syndrome. And one problem that people with Marfan syndrome face is aortic dissection. The walls of the aorta split open and it can be pretty quickly fatal. And he describes himself in his TED talk as a boiler engineer. And he says when we have a weak pipe, we wrap it. So he came up with the idea of exporting his CAT scan data or the MRI data of his beating heart and custom printing a fabric mesh to wrap around his aorta. And it's become and medically accepted treatment now. Harry Glorikian: That's awesome, right.Dave deBronkart: This is the data in the hands of somebody with no medical training, just. But see, that's the point. That's the point. He enabled by the data, is able to create real value, and it's now an accepted treatment that's called PEARS and it's been done hundreds of times. And, you know, here's a beautiful, it's sort of like the Dana Lewis skateboard scooter progression, years later, a subsequent scan discovered something unexpected. The mesh fabric has migrated into the wall of his aorta. So he hadn't he now has a know what doctor, what hospital, what medical device company would have ever dreamed of trying to create that? That's the beauty of liberation when data gets into the hands of the innovators.Harry Glorikian: Well, that's something that everybody can take away from today is at least thinking about their data, how it can help them manage their health better or their life better. Obviously, I always say, in cahoots with your doctor, because they have very specific knowledge, but having the data and managing yourself is better than not having the data and not understanding how to manage yourself. So on that note, Dave, thank you so much for the time today. It was great.Dave deBronkart: Thank you very much. See you next time.Harry Glorikian:That's it for this week's episode. You can find past episodes of The Harry Glorikian Show and MoneyBall Medicine at my website, glorikian.com, under the tab Podcasts.Don't forget to go to Apple Podcasts to leave a rating and review for the show.You can find me on Twitter at hglorikian. And we always love it when listeners post about the show there, or on other social media. Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.

Procarenow.com for free samples. Use Code: Susan10 to save 10% Has someone told you to take vitamin B-12 for brain fog after bariatric surgery? B-12 helps to keep your brain healthy and even helps to prevent Alzheimer's disease as you age. Hi, I'm registered dietitian nutritionist Dr. Susan Mitchell. You're listening to the Bariatric Surgery Success podcast episode number 66. Most of my career I've worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That's what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you've connected with me. You're in the right place and I'm glad you're listening.I want to give a shout out to Brittany who posted in the FB group: I love your podcasts! Brittany I love you right back for taking time to say so and share with the group. If you want to join us in the facebook group, please do. It's an active group where you can find answers and support day-to-day or just vent if you need to. There's a lot to deal with after surgery, right? On facebook, search groups for bariatric surgery success with dietitian dr susan mitchell and ask to join. Click for the direct link.Has someone told you to take vitamin B-12 for brain fog after bariatric surgery? First let's take a broad look at the brain, then vitamin B-12 and it's tie to your brain and finally bring it home to bariatric surgery. Your brain has a lot of demands. It needs both calories and nutrients or vitamins and minerals. Don't miss this fact. The brain uses 20% of your calories. Did you have any idea it was that high? B-vitamins, folate, zinc and other vitamins and minerals all join in to keep the brain healthy. A deficiency of these can cause depression type symptoms, poor memory, problems with attention, learning, fatigue, mood and appetite or what just feels like brain fog or brain impairment. This is one of the big reasons that follow up lab work after your surgery is so very important. If you listen to some of my other podcasts, you know I talk about many vitamins and minerals working together as a team. B-vitamins, folate, zinc and other vitamins and minerals such as thiamin all work like an effective basketball team in your brain. Deficiencies in these or even too few carbs can all cause brain fog but today the focus is on your brain and B-12 also known as cobalamin.A B-12 deficiency after weight loss surgery is very common but did you know that B-12 deficiency increases with age too? This happens for a couple of reasons. Often as you get older, you tend to eat less, which decreases the amount of B12 in your diet. Also up to 1/3 of people who are 50+ don't absorb B-12 from their food because they don't produce enough stomach acid. This is the same thing happening after bariatric surgery but for a different reason. You have surgical changes which affect absorption. Less B12 is released in the stomach as much of the stomach is bypassed or removed. Add age to the picture and a low vitamin B-12 blood level is tied to what feels like brain fog or brain impairment and could also be tied to dementia including Alzheimer's disease. Maybe you've heard the word homocysteine. A high homocysteine level is not something you want. It's an amino acid in the blood and elevated levels have been linked to dementia, heart disease, stroke. The good news is that homocysteine can be lowered with the B vitamins B6, B12, and folic acid which seem to slow down the loss of brainpower.Let's review the science in today's Science 101 on Vitamin B-12 specific to bariatric surgery. The absorption of B-12 can be affected due to changes in acid production and reduced availability of what's called the intrinsic factor. This intrinsic factor helps the B-12 to be absorbed and used by the body. When it's not there or insufficient, B-12 doesn't get absorbed and used as it should. You could experience brain fog symptoms and feel like your coordination is off plus numbness and tingling of your arms, legs. This is a prime reason why routine screenings are so important and typically done every six months or so. These screenings help your health care provider pick up on a possible deficiency hopefully before it becomes a problem. Two other tips to keep in mind. First, are you taking proton-pump inhibitors (PPIs) like Prilosec, Nexium or Prevacid? These meds reduce stomach acid and stomach acid is necessary to absorb B-12. Even meds such as Zantac or Pepcid can increase the risk for B-12 deficiency. Number two. Alcohol. It inhibits the absorption of B vitamins such as B12 and thiamine. Even without alcohol, you may already be struggling to get enough of these vitamins due to surgery so be aware. Go back and listen to podcast #30 on Bariatric Surgery and Alcohol Buzz for more in depth info. As a reminder. Do you recall what foods contain B12?B12 is found in protein foods like meat, eggs, cheese, fish, chicken, milk, and fortified breakfast cereals meaning it was added to the cereal. You want these in your diet but the amount needed is higher than typically what food can provide. How much vitamin B-12 do you need after surgery? The dose is 250-500 micrograms (ug) a day with most suggestions in the 350-500 microgram range daily or 1000 mcg every other day. The dose depends on your surgery, your lab results and the route of administration meaning under the tongue, injection, etc. Sometimes an intramuscular injection of B12 or a nasal spray will be ordered by health care team. You can take B12 at any time or with any other supplements. It's likely that your multi will have enough B-12 in it so check the label before you buy additional. Be sure and discuss your lab screenings with your health care team before you decide to take any extra.PS Check out the Supplement Facts on a number of products to see what you like best. As I've shared before I'm a fan of and partner with ProCare Health.

Harry's guest this week is Matthew Might, director of the Hugh Kaul Precision Medicine Institute at the University of Alabama at Birmingham. Might trained as a computer scientist, but a personal odyssey inspired him to make the switch into precision medicine. Now he uses computational tools such as knowledge graphs and natural language processing to find existing drug compounds that might help cure people with rare genetic disorders.Might's odyssey began with the birth of his first child, Bertrand, in 2007. Bertrand seemed healthy at first, but soon developed a cluster of symptoms including developmental delay, lack of motor control, inability to produce tears, and epilepsy-like seizures.  For more than four years, doctors were unable to diagnose Bertrand's condition. But eventually a technique called whole exome sequencing revealed that he had no functioning gene for NGLY1, an enzyme that normally removes sugars from misfolded proteins. Bertrand, it turned out, was the first person in the world to be diagnosed with NGLY1 deficiency—and as with so many other "N of 1" diseases, there was no known treatment.After the diagnosis, Matthew and and his wife Cristina decided to used social media and the Internet to locate other patients with NGLY1 disorders around the world. Eventually the couple discovered 70 patients with the condition. Reasoning from first principles about the role of NGLY1, Might discovered that giving Bertrand a sugar called N-acetylglucosamine, a metabolite of NGLY1, helped restore his ability to form tears. (Around the same time Might, co-founded a startup that screened existing drugs to see whether they could treat ion-channel-driven epilepsy similar to what Bertrand experienced; the company was quickly sold to Q State Biosciences.)Working with collaborators at the University of Utah, Might studied planarian worms that had been engineered to lack NGLY1, and found that those that also lacked a second gene had a higher survival rate. That meant one way to treat Bertrand might be to inhibit the analogous gene in humans, in this case a gene for an enzyme called ENGase. Might used computational screening to look for existing drugs that would be inverse in shape and charge to the catalytic domain on ENGase, and might therefore inhibit it. He found more than a dozen drugs that were already FDA-approved. One was Prevacid, a proton-pump inhibitor sold as common over-the-counter medication for acid reflux. It turned out that as a previously unsuspected side effect, Prevacid is an ENGase inhibitor. Bertrand started taking the drug, and Might says it was one of the treatments that helped to extend and enrich his life.Sadly, Bertrand died in 2020 at the age of 12. But by that point, his father's work to apply computation to basic biology, and thereby speed up the treatment of rare disorders, had sparked a movement that will long outlive him. Years before, Bertrand's story had caught the attention of the Obama administration, which invited Matthew to the White House to work on a range of precision-medicine projects. One was an NIH program called the All of Us initiative, which is collecting the genomes and medical records of a million Americans to search for correlations between mutations and health impacts. Might also launched a smaller pilot program called the Patient Empowered Precision Medicine Alliance (PEPMA) with the goal of repeating what he and Cristina had done for NGLY1 deficiency—that is, quickly diagnose the problem and identify possible treatments. Might resigned from his White House role about one year into the Trump administration, then got an offer from University of Alabama to come to Birmingham to set up an institute to scale up the PEPMA idea. One project there called mediKanren involves using logic programming to highlight what Might calls the "unknown knowns" in the medical literature and identify existing, approved drugs that might treat rare disorders.Please rate and review MoneyBall Medicine on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to the page of the MoneyBall Medicine podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3.Scroll down to find the subhead titled "Ratings & Reviews."4.Under one of the highlighted reviews, select "Write a Review."5.Next, select a star rating at the top — you have the option of choosing between one and five stars. 6.Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7.Once you've finished, select "Send" or "Save" in the top-right corner. 8.If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9.After selecting a nickname, tap OK. Your review may not be immediately visible.Full TranscriptHarry Glorikian: I'm Harry Glorikian, and this is MoneyBall Medicine, the interview podcast where we meet researchers, entrepreneurs, and physicians who are using the power of data to improve patient health and make healthcare delivery more efficient. You can think of each episode as a new chapter in the never-ending audio version of my 2017 book, “MoneyBall Medicine: Thriving in the New Data-Driven Healthcare Market.” If you like the show, please do us a favor and leave a rating and review at Apple Podcasts.Harry Glorikian: My guest today is Matthew Might. He's a computer scientist who transitioned into precision medicine and now builds computational tools to find new treatments for rare diseases. Since 2017 he's been the director of the Hugh Kaul Precision Medicine Institute at the University of Alabama at Birmingham. Might's journey from pure computer science into medicine is a deeply personal story that began with the birth of his first child Bertrand in 2007. Bertrand seemed healthy at first. But soon he showed a mysterious cluster of symptoms including seizures, lack of motor control, and inability to produce tears. For more than four years, doctors were unable to diagnose Bertrand's condition. But eventually, using a then-new technology called whole exome sequencing, they determined that he had no functioning gene for NGLY1, an enzyme that normally helps to clear junk proteins out of cells. It turned out that Bertrand was the first person ever to be diagnosed with NGLY1 deficiency. There was no obvious treatment available. Matthew says that's when he began his transformation into an amateur biologist. He shared Bertrand's story on social media and in the press, and was able to locate and organize the families of dozens of other patients around the world who had the same mutation. He worked with colleagues at the University of Utah to make genetically engineered planarian worms that had a similar mutation. Experiments on the worms led showed that knocking out a second gene, for another enzyme called ENGase, seemed to help the worms live longer.So on a hunch, Might set off on a computational search for compounds that might bind to ENGase in humans and inhibit its activity. He discovered that there was a drug on the market called Prevacid that was approved to treat acid reflux but also, as an unexpected side effect, inhibits ENGase. So Bertrand started taking Prevacid, and it helped. Matthew says it was one of the treatments that helped to extend and enrich his life.Sadly, Bertrand passed away last year at the age of 12. But by that point, his father's work to apply computation to basic biology, and thereby speed up the treatment of rare disorders, had sparked a movement that will long outlive him.The story caught the attention of the Obama White House, which asked Matthew to lead several new initiatives in genomics and precision medicine. One of those was a pilot called the Patient-Empowered Precision Medicine Alliance, which had the goal of quickly diagnosing rare conditions and identifying treatments for more patients. Now Might is continuing that work at the University of Alabama, Birmingham, where the Precision Medicine Institute uses computer science techniques like knowledge graphs and natural language processing to find more drugs that can be repurposed to fight rare diseases.We covered all of that ground and more when we talked in late August. And once you hear our interview, I think you'll agree with Might that computation is accelerating the genomics revolution in a way that's going to change healthcare not just for people with rare diseases, but for everyone.Harry Glorikian: Matthew, welcome to the show. Matthew Might: Oh, thanks. Good to be here. Harry Glorikian: [I] spent a lot of time reading about what you're doing your past and sort of the history here, but I want to start off with, which sort of which fits right into the show, is you've said that data is the greatest drug of the 21st century and that precision medicine delivers data as a drug. Can you expand on what you mean by thatMatthew Might: Yeah. And I've said this a few times in a few ways, but the principle here is that I think we need to look at data itself as a kind of intervention,that exposure to one's own data could have ramifications for your health. And you can imagine this in a very general sense.Like if you get detailed data about your health and you might do something about it,  but if you give extremely detailed data to your physician, they might be able to do something with.  and, and oftentimes I'm thinking in terms of the very molecular in that case. And that's really where I spend a lot of my time, but giving clinicians molecular resolution on the nature of your specific health problems is really what I think is so revolutionary about medicine, right now. And the ways in which we can gather that data and the computational tools that will be available someday to physicians, and even to a certain extent right now will enable them to do things that no drug can do on its own. Harry Glorikian: Well, it's, it's interesting that you say data and, in that sense is I was just playing with something that pulled in all my medical data and put out all the longitudinal charts for me and highlighted all the ones where I was out of whack. And I texted my doctor. I'm like, we need to get on a Zoom call. I need to show you a couple of things that are out of whack, and I want to figure out why they're out of whack. So I agree with you that molecular will be that, that really high resolution level to get to. But even I think the simple data to give patients I think is powerful. It can move the needle,  if we can communicate it to them effectively. Matthew Might: Yeah. I mean, I think even the simplest incarnation of this could do some good, like imagine if your scale not only told you your current weight, but just drew a line between your last three readings and said, this is where you're going to be in 10 weeks. Something that simple might help.Harry Glorikian: My scale does do that and it tells me that you are getting fat, so you gotta, need to do something. So I try to intervene when I can. But, so, you have an interesting history and past, I mean, you went from pure computer scientist from the university of Utah into precision medicine at the University of Alabama. I mean, that's, I almost want to say based on what I was reading like that revolves around your personal experience from finding a diagnosis and treatment for your son. Can you give the listeners may be a condensed version of that story and how did it turn out that your experience studying things like functional programming turned out to be so useful for studying rare diseases?Matthew Might: Yeah, well, that's a wonderfully broad question. And yeah, I've had an unusual path to this point. So I'm currently the director of the Precision Medicine Institute at UAB. And so it's, it's a, very focused medical research institute. We want to help patients find tailored therapies for them.My background in computation and computer science certainly influences that. We have a host of computational tools to help do that. Some are based on  artificial intelligence. Some are very systems biology focused, that start to invoke aspects of functional programming. And you're right. And the reason I started all this is my oldest son, who unfortunately passed away in October,  had an undiagnosed [disease]. And for four years I had no idea what he had. Eventually through a novel application of exome sequencing was able to determine that he had the first case ever known of this ultra rare disease called NGLY1 deficiency.And I think that's safely the point where I really flipped in my head from a computer scientist to an amateur biologist. I knew enough to try to get him diagnosed, but that's one where I said, I've got to find some way to help him. And even though he passed away, it's hard to look back on his life and see it as anything but a major success in many ways, because he was born with a very short life expectancy and yet he made it to almost 13 years old and that would not have happened without sort of a sequence of emerging technologies that came just barely in time to extend and enrich his life and bring him a lot of joy.I miss him every day, but I'm lucky that I have the opportunity to work every day, literally every day towards his legacy of helping patients with science. A lot of which is computational, but much of which is sometimes just good old fashioned wet biology where we go to the bench and try something out. Harry Glorikian: Yeah. I mean, you've sort of described the Precision Medicine Institute as a form of research consultative service, where the goal is to find the next step for any patient that reaches out on their diagnostic or therapeutic odyssey. I mean, that sounds amazing. I mean, maybe you could describe more of what happens on a day-to-day basis. Matthew Might: Yeah. So, it all comes down to Monday. So Monday is case review day. So if someone has reached out to the institute or if we are sort of currently working on something for them, Monday is where we all synchronize and put our heads together and try to figure out that next step.So for patients that have reached out for the first time, it's, “Okay. What's the direction of a therapy.” And for those that are in flight, if there's been a change, if some experiment has completed, if some lab has come back, if new information has been introduced, we check to see, is there a new next step? Is there some, is there some new insight? And sometimes on those Mondays information will come back that enables a query to be run on one of our computational tools where, the best example would be, targets emerged. Like, if we modulate the behavior of this gene, we think it will be therapeutic for this patient now. And so we can run queries to see, can we modulate the behavior of that gene using some kind of small molecule or some other approach. Harry Glorikian: So, but when you're doing all this, I mean, are you, do you have a mission to sort of either scale up or automate? And if you do, how's that going? Matthew Might: Yeah, so it's, it's both. And in fact, it's, it's scaling through automating. We realized pretty early on that humans are an essential part of this process, right now, in the sense that humans really do need to—in this case, when I say humans, I mean, undergraduate students, because they're the ones within the institute that act effectively as the case managers and reach out and sort of pull in the information, digest it to some kind of structured format that the tools can process.They might engage with the physician. They might reach out to some basic scientists that have insight on the relevant biological processes and figure out how do we drive it to a query or a recommendation for an experiment. And so, in some sense, when I think about scale, what I'm really thinking about is the efficiency of these undergraduates. How many cases per week can we get them to process and how much tooling and automation can we build to make them better and better at what they do? So that's how I think about scale. And then I think about replicating this as a process and every academic medicine, medical center across the country. There's no reason you couldn't have a team of extremely bright students in every center of the country that run this kind of process for their patients locally.Harry Glorikian: Yeah. I mean, I would think that that would be one hell of an experience for the students to sort of see something actually being practically applied,as opposed to reading it in a book and it being a little bit more theoretical. Matthew Might: It is actually, in fact, I've noticed that literally 100% of the students that have participated in this program, I mean, all of them have gone on to graduate school, either for an MD, a PhD or both. So it's a 100% success rate to getting students in the grad school or med school.And now we have a course version of it. And so in fact, several course versions of this, where you can take this class and you'll get to practice on some existing solved cases, but we even throw some unsolved ones in the mix to see how they do. And when they take these courses, and then for the honors students now at UAB, they can take a special course sequence as freshmen, where they'll get into the lab and build model organisms that represent some of the patients, which could ultimately enable the discovery of therapies for them. So I have to say it's, I can't think of a lot of other places where you get that kind of experience as an undergraduate. Harry Glorikian: Well, no, that's what I was thinking. I was thinking, “Hmm. How do we get this more broadly out there so that more people are doing this and, and get their head in that, in that zone and understand these issues.”But I think one of the projects that I was looking at was mediKanren, if I'm pronouncing it correctly. What is it meant to do?Matthew Might: So mediKanren is really our flagship artificial intelligence tool that we use primarily for drug repurposing. We kind of built it with the end application in mind. So I'll tell you what it's really good at doing. If you tell it a gene and you tell it a direction to go, like, I want to make this gene more active or make this gene less active, it does very well on those kinds of questions and it can scour a number of data sets to do this. So we're part of a, actually a larger effort through the NIH called the Translator Consortium. This is a huge research effort. We have lots of teams working together to both mine out all biomedical knowledge and make it structured. And another set of teams are trying to do automated reasoning on top of all of that knowledge. So we're on the automated reasoning side. We can do some of the mining too, but,  the other teams do such a fantastic job that we mostly just consume what they produce in terms the mining. And then we try to stitch it together,  so that we can find interesting ways to go after targets of interest. Harry Glorikian: So it's reasoning over medical knowledge graphs, I think, that you're trying to do. And so it sounds like a promising way to find unexpected connections between diseases and existing drugs. But if you had to explain that to a layman, how would you explain sort of a knowledge graph and what you guys are doing with it? Or do you have a favorite example? Matthew Might: I have pictures, but I can also do it with words. Knowledge graph. So let's talk about what it represents. Ultimately, there's a structure, but that's not actually all that important. A knowledge graph is a collection of facts,  and in facts are sentences. And they're sentences of the form “A somehow relates to B in some sense.” and knowledge graph is just a huge collection of these sentences, “A is related to B,” where there's a specific relationship.So a biomedical knowledge graph is going to have some constraints on it. So the A's and the B's that you're connecting are going to be nouns from medicine and biology. So there'll be drugs and diseases and genes and metabolites and all the other stuff that you typically read about in and medical papers. And the relationships are going to be biomedical in nature too. So it's going to be things like A inhibits B, A activates B, A causes B, A treats B. And so if you collect all of these sentences together, you have what we call a knowledge graph. And the cool thing about a knowledge graph is that you can do logic on top of it and try to look for relationships that are there, but not explicitly stated.The simplest example of this is let's suppose there's two sentences in this knowledge graph, there's Aa increases B and B increases C. We can infer logically that if you increase A, you should also increase C, because B went up and so C should go up. So that's an example of logical inference on top of one of these knowledge graphs.Harry Glorikian: And so that's typically—there's a human intervention at some point to sort of look at this and then say, yes, this makes sense? Matthew Might: Yes, absolutely. So one of the major roles of these undergraduate analysts is to actually double check what comes back from a tool like this, because it's going to admit a logic argument. It's going to say, “I believe that this is going to influence the right target because,” and then the analyst can look at the because, and it's going to have references into biomedical data sets. It's going to have references to papers in PubMed, and they can go read those. They can look at the data sets and they can double-check the reasoner and say, you know what, I think you got this right. Or no, you made a mistake. And it does make mistakes sometimes. So a lot of the knowledge from the literature has been done by natural language processing and that makes mistakes. It's critical to have a human in the loop to double-check that.And towards your earlier question about how we do scale, one of the things that we've added to the tool is ways to make that check go faster. So, for example, on the latest interface, when it tells you that it believes, for example, A increases B and you click on that, it's going to jump straight to the sentence that it pulled that from in the paper. And so you can just look directly at that sentence and say, do I believe this? Do I believe it got A right? Do I think it got B right? Do I think it got the relationship right? It's sitting right in front of the analyst. Whereas previously that was a few clicks away. They had to click on that. They had to click on the paper it found they had to go to the paper on their web browser. They had to look at the abstract, they had to find the sentence that it got it from,  and then figure it out. That's a long process actually now, and going from, a few minutes to verify and inference to a few seconds, that's a huge increase in efficiency for these analysts. Harry Glorikian: one of the things I would say is I always try to find out, is it shortens the overall process of even finding this relationship. I mean, if you had to put sort of time scales on this, how much faster you think that we're speeding up this whole process of being able to even identify something that might have this effect?Matthew Might: Yeah. Yeah. I mean, we we've had some natural experiments in this regard where in some cases there were answers sort of buried in the literature that seemed to have been therapeutically relevant and yet, very motivated disease communities hadn't stumbled across them, and motivated physician-scientists researching these diseases had not run across them, or didn't sort of connect the dots to realize that this could actually be relevant to a patient. Probably the most recent example of this is ADNP-driven autism, where there were results in the literature that could imply the key finding, which is that low-dose ketamine will increase ADNP. That's the key thing that the researchers trying to treat this disease were after. And in some sense that was out publicly known, if you will, in the literature. And yet it took running this query to find it,to sort of make the realization that this was true.It's kind of interesting actually to think about the fact that there's stuff out there that as a species we know, but we don't know that we know. So we call that sometimes the “unknown known.” It actually happens a lot in different contexts. And I even remember this happening in computer science, where there were communities out there so disparate that one had solved a problem the other had been trying to solve for three decades, and they just didn't know that I had effectively been solved. I mean, it can happen, actually.Harry Glorikian: Yes. And I talked to different groups that are working on systems that will make those unknowns more easily findable,  or at least highlight them so that people know they're there. But you guys search scientific literature, drug databases, for existing and approved [drugs]. And basically you're looking to find something that's going to perturb an ultra-rare disease. Why is it better to look for an existing drug rather than a new one? I'm just, curious of the practical arguments around that. Matthew Might: I'm not against developing a novel drug for a single patient. It's just that most patients don't have $2.6 billion. So it's a little out of their price range. That said, of course there's technologies that are changing this equation substantially. So I would say oligonucleotide therapies in general, it's not down to a thousand dollars a patient, but it's dramatically less than $2.6 billion. We're probably closer to the range of a couple million dollars, and that's falling fast, to do these sort of custom-programmed therapeutics for individual patients. So,  yeah, I'm not against finding novel matter. It's just that it's still outside the budget of what most ultra-rare patients can handle.Harry Glorikian: Right. Right. Well, I was talking to, it hasn't even come out yet, but I was talking to Kevin Davies in one of my last podcasts about CRISPR and just exactly that same discussion. So I don't know if you guys have sort of done a ballpark or sort of a thumbnail of what do you think, what fraction of rare conditions do you think, are treatable the way that you're you guys are approaching it? Is it fair to say that eventually you'll exhaust that approach in that we'll have to develop a new drug for the next disease?Matthew Might: Yeah and I guess we've got to sort of clarify what we mean by approach. So there's the AI-based approach or sort of strictly computational approach. And then there is what we can do if we're allowed to go to the wet lab for a little bit of stuff.If you play the game where you can only use a computer, there's the answer for today and the answer in the limit. Once we've sort of saturated biomedical knowledge graphs, if you will, with everything wherever we're going to know—and already, right off the bat, I think we jumped to a reasonable suggestion somewhere between 5 and 10% of the time, for the case of ultra-rare genetic diseases, and there are factors that can influence that. So for example, if it's a dominant disorder where the genetic insult has really just sort of tweaked the thermostat on a gene, so it's a little overactive or a little underactive, we tend to have a better success rate jumping straight to an answer with a computational tool than if the gene has been wiped out and now we have to find a way to replace that activity. Now the good news is if you look at sort of the census of rare disease, 70 or 75% of all patients fall into that bucket of the genes have become a little overactive or a little underactive. And so it's very amenable to an approach like this. And for the patients that where the gene is missing, there are still things we can do computationally. The call I had right before this one was exactly that case for you. What can we do computationally? And by playing with the tool, we found some alternate targets to go after. But it takes some play to do it at that point. It's not quite as automated, but you're still using the tool as targets emerge to ask the right questions. [musical transition]Harry Glorikian: I want to pause the conversation for a minute to make a quick request. If you're a fan of MoneyBall Medicine, you know that we've published dozens of interviews with leading scientists and entrepreneurs exploring the boundaries of data-driven healthcare and research. And you can listen to all of those episodes for free at Apple Podcasts, or at my website glorikian.com, or wherever you get your podcasts.There's one small thing you can do in return, and that's to leave a rating and a review of the show on Apple Podcasts. It's one of the best ways to help other listeners find and follow the show.If you've never posted a review or a rating, it's easy. All you have to do is open the Apple Podcasts app on your smartphone, search for MoneyBall Medicine, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but it'll help us out immensely. Thank you! And now back to the show.[musical transition]Harry Glorikian: Before you moved to UAB, you were working on precision medicine initiatives for the Obama White House, I believe, and then briefly for the Trump White House. Can you update the status of the, was it, the All for Us initiative and then the Patient Empowered Precision Medicine Alliance? Matthew Might: Sure. So, yeah, I did spend, I think, in total, about three years either working with or working for the White House,  under both Obama and Trumpm on the precision medicine initiative and related initiatives, like the Million Veterans program, as well as micro-initiatives, like the Patient Empowerment Precision Medicine Alliance, where we were just kind of trying to test it out, to see if these ultra-tailored approaches would work. So as far as where things stand today, All of Us is a very successful, large scale clinical genomics research program, which is, I think on the way to hitting its target of enrolling a million Americans. And the way I described that program even at the time was like you're trying to build the Rosetta stone of the human genome. It turns out we reached a point where it's really easy to sequence a genome. Not so easy to interpret a genome. So if I sequence you or me and we find mutations, we go, “huh. Well, that's interesting. What does that mean?” And we go, I don't know. But let's suppose you got a million people that donate their health records and their genomes. Well, now you can start to draw statistical connections between what this mutation or this collection of mutations means in terms of actual human health. So it's finally a way to start decoding it. And so that's really what All of Us is about in my view. It's about building that Rosetta stone for the human genome.For the Million Veterans program, it's actually sort of inside of it, yet also outside of it and really trying to do the same thing, but leveraging the extensive clinical records and histories that the VA happens to have access to,  and taking a slightly different method to get there in terms of genomic data, starting with SNP chips and genotyping, as opposed to full-on sequencing.And then for PEPMA, that was really a pilot project where we just said, okay, can we take a small number of patients and can we actually sort of run this process all the way forward, where we get a genotype and try to find a medication that might help them. And it turns out for a handful of cases, we were actually able to do it. It was all thanks to getting a group of private entities, like, companies and universities to come together so that we actually had enough infrastructure in one place to run the process. And so we were actually able to do that. Harry Glorikian: Yeah, it's funny because I always think to myself, like all these silos, if we could just have them integrate in some way, you'd have a lot more data to work with. I always find that in the beginning, you always find those low hanging fruit that sort of fall out and then it gets harder. If you have enough to start with, something interesting falls out of it. You've said that in precision medicine, for a lot of cases that we deal with, we don't have sort of the right drug right away, but we can always prescribe an experiment. What do you mean by that?Matthew Might: Yeah, by that, I mean, and so this gets into sort of like the philosophy of medicine itself. So you'll hear clinicians use terms like “This is not actionable.” And then you hear that an awful lot in rare disease. You hear it a lot at the end of cancer, where they'll say, oh, there's nothing we can do, or there's no clinical utility in this. And, and I think precision medicine subverts that whole approach and says that, well, if you've run out of clinical options, you can still do some science.And increasingly I think we can systematize that science, so that it's not okay. We need to do something. It's, here's a set of things that you could reasonably do at this point, a set of experiments that if run, might point to what to do or might point to another next step. And a great example of that is,  for, for, particularly for a rare genetic disorder, in many cases you can build a model organism, you can build a fly and you can build a worm pretty inexpensively,  to model that genetic disease, using things like CRISPR. People don't appreciate, I think, the full importance of gene editing. People think about editing human genomes, but the fact that it made it so much easier to edit animal genomes was actually in many ways an even bigger impact and a more immediate one as well.So yeah, you could for virtually any genetic disease, if there's an animal equivalent to that gene, you can build the animal. And if it's a small animal, you can test a lot of drugs on it, pretty inexpensively. So, I've got a friend and collaborator, Ethan Perlstein, who built a company around this approach and was very successful actually in treating, some patients this way. I have a collaborator, Clement Chow, who is an academic doing this on the academic side, focused on Drosophila, doing this very successfully.So, that's not a drug, it's not a procedure, not a medical procedure anyway, but it's a very well-defined process. And it's a process whose outcomes could be measured statistically. So you might even know what your odds of success are before you try it, whether or not you're going to find something. So I think it takes an evolution in our thinking to realize that this is a perfectly reasonable thing to do for a lot of patients: build that fly, build that worm and test a bunch of drugs. Harry Glorikian: And, there's a lot of times where things seem perfectly normal for me to suggest, and I've had people look at me, like I just grew like two more heads off, off my shoulders.So, but this sounds like if this is your fundamental belief that there is nothing that is not actionable, medicine or otherwise. Matthew Might: Right, right. And I think it also requires a degree of stoicism because just because there's something to do, it doesn't mean it's going to work in time. And this was something I was always mindful of during my son's life, was that while there was always something to do, I was mindful that it was probably not going to always happen in time. It was always a race against the clock. But there was always something to do. And even today there's still, as I say, I'm still working on his condition. I'm still very actively engaged in drug development for his disorder. So even now there's something to do. As a parent it's still brings me benefit to know that it, it will benefit others. So it does require a shift in perspective about the meaning of actionable. Harry Glorikian: It feels like finding [computational] ways to use existing drugs, to help people with rare problems, was waiting to be solved with someone with your exact skillset in computer science and your exact set of motivations as a father of a child with a genetic disorder. And so many other key players that I've talked to in this sort of that have this N of 1 stories have very similar biographies. I mean, there's been a few movies made about it, right? It makes somebody wonder that if you know your son hadn't been born to you with your expertise, who could apply knowledge and bring that experience to it, that you wouldn't be moving the ball forward. How does that make you feel about the state of science or medicine? Matthew Might: Yeah. And, you're not the first to make an observation that I sort of ended up in the right place at the right time with the right set of motivations. And there's a lot of truth to that. I think about if he'd been born even a few years earlier, or a few years later, how things would have played out differently.I realized early on that there's a desperate need for computer science within medicine, that there is so much opportunity just left on the table for lack of expertise. But I made a deeper observation, which is that as much as medicine needs computer science, what it needs even more is computer scientists.The problem is that the average computer scientist doesn't have sufficient motivation to go learn. Medicine's big, it's messy. And I got to say, biology is so messy that to the mind of a computer scientist at times, you're just like, God, what a disaster biology is. It's like every time you have a rule or a law, most of the time at the end of it, there's nothing ever that's always true. And when you come from a field like computer science, where you can put clean little theorems around everything and layers of abstraction that never break, it's like, oh gosh, who designed all this? Who was the engineer that thought that was a good idea?That that's how I feel half the time when I dive into biology. And yet there are abstractions that you can borrow from computer science and you can use these things to start to describe the way biology does what it does. And so I do think of the cell as a computer or a machine—maybe a Rube Goldberg machine, but a machine nonetheless. And one that you can sort of intellectually approach, from the direction of computer science. Within computer science, I happen to have a background in functional programming. And there are times when, describing the mechanics of how biological processes operate, where this kind of feels like, I'm playing with a little functional programming language. Like I'm doing graphic writing instead of term rewriting. There's been these moments where I'm like, yeah, this is just a programming language. It's weird, but it is one. And then I think, gosh, I mean, it is strange that I arrived with that particular skill set at this point in biology's history,  to make these observations and use that profitably towards helping patients.So in terms of how they makes me feel? Lucky, I guess, that I've, I've just sort of been there on the right place at the right time. And the same thing is true for almost everything else that's occurred since,  since Bertrand was born, from the timing of the precision medicine initiative itself, to getting his story in front of President Obama at just that moment, to getting the invitation to go, to getting the invitation to participate, and then join the team. I mean, the timing on all of it was just so ridiculous to me that I look back and think, I can't believe that happened. Harry Glorikian: Wow. I mean, timing. Being in the right place at the right time, a little luck, I'll take that every day, right, where everything starts ti come together.I think back to, because I was involved at Applied Biosystems when we did the genome and wow, that was such a big deal. And then every once in a while I still see an article saying. Yeah, the genome hasn't really done much. And I'm like, these people, how do they write these things with a straight face? And it gets published in a reasonable journal. And I'm like, these people are out of their minds, considering everything in biotech, everything in, functional genomics, all this stuff is, is grounded in that information.Matthew Might: I see the same stuff and I think, what do you mean nothing has come out of it. What are you talking about? Everything has come from that. And then, when I point to success stories with individual patients, which are growing and growing, they're like, yeah, but that's the exception. It's turning into the rule more and more, and I think what you're seeing now is that as with any new technology, the barrier to entry starts very high. But that barrier has been falling fast to the point where, people who start off, the parent side, like me, are increasingly finding that they can get into the game and that they can do something.And I think it's at a level now where almost any, patient or parent that has a technical background can jump over and do something. But even patients without that background are making the jump now, too. So barrier to entry is falling so fast that it really has changed everything when it comes to patients moving the needle for themselves using the fruits of the genomic era. Harry Glorikian: Yeah. And I think computational, power and costs and ease of use are starting to come down dramatically, which then brings the two together, which is of course the idea of behind the whole show and everybody that I talk to, and I see the, some of the companies I talked to they're like, yep, we sort of eliminated three years of work. We could get it done in, a week to two weeks because of what we're looking at, how we've applied our computer science. How many new pathways we can sort of identify of course, for new drugs. Matthew Might: And I, I can give you examples of where the barriers fell overnight as I needed them to, just by luck. Or when it came to creating model organisms, right? Before CRISPR, gosh, that was an expensive, daunting. process, it took a lot of time. And then CRISPR shows up and they're like, oh yeah, no, it'll be a few months and $10,000. And it was just, I mean, just like that it happened. And there's equivalent revolutions happening on the computational side too. If you look at your protein folding technology, it was a joke, that like, yeah, it'll never happen in silico. And then all of a sudden, like now some say maybe the only way we'll ever get some structures is in silico.  And then that was kind of an overnight thing too. Obviously it wasn't overnight for the engineers on the project at Google. But once it appears like, oh my gosh, what a game changer. Harry Glorikian: Well, and then as soon as somebody does it, it motivates more people to sort of grow and it sort of moves the space forward that much faster. That's the part I find interesting is most people have trouble understanding the speed of change, and it's moving faster now than—and I'm used to, trying to keep track of how fast everything's going, and I'm finding myself having trouble keep up with how quickly things are shifting. Matthew Might: It really is changing faster than I think any one person can predict. And the disruptions are coming almost out of nowhere. Like no one saw CRISPR coming. You might reasonably foresee that at some point, some efficient gene editing technology would have emerged. But I think it emerged much faster than was expected.I remember when I would work with patients, five or six years ago, I'd say, yeah, there's this thing, these antisense oligonucleotides, and maybe someday, but we're probably, I would say at the time, like maybe 20 years away. Then you see oligonucleotide therapies really take off and, then I think it was two years later there's an FDA approval. Then a couple of years after that, there's the first big N of 1 introduction. And then like a year and a half later, we were all injecting mRNA into ourselves. Well, that happened pretty fast. It wasn't a couple years. Harry Glorikian: Yeah. And, and for people like you and me that are in this, like, my, my mind is like, wow, this is awesome. And then I try to explain to someone and they don't understand the impact that some of this is happening in the implications of what we're talking about. Matthew Might: Yeah. And, I think that, going forward, it's going to be a much steeper acceleration than anybody can really predict because we've suddenly just burst into the era of programmable therapeutics. I mean, COVID really suddenly just threw it on the table. There it is. And an example as well, people said, okay, well, if you can just give mRNA directly, instead of trying to deliver these complicated proteins to do the gene editing, why don't you deliver the mRNA for the CRISPR protein or, for, for CAS9 and deliver this along with the guide RNAs, well that's much easier. And my, my gosh, it looks like it might actually work. So these things, they couple in unexpected ways, and very quickly too. And so I I'm excited cause I have no way to know what's coming now. Harry Glorikian: I've always felt, I don't know what's coming. That's why I try to read such a broad array of, sources, everything that's going on in, you know, chip development to what's going on in our world. But I think the next big wave of shifts is going to be how a lot of this gets implemented, the business models behind it. And that's the next big shift because you don't have to do it exactly the same way you had been doing it up til now.Matthew Might: Oh, I agree. And, and oddly enough, yeah, I spent a fair amount of time thinking about stuff as mundane as how do we get payers to actually pay for some of these things? How do we show them that there is value to be captured already? And, because there is, I think we're not far away from a future where payers realize that it's going to be cheaper to take this very expensive patient with a complex disease and look for sort of a root cause treatment than to continue paying for symptomatic treatment. I think we're at the threshold of that era. Harry Glorikian: Well, I think, the CEO of Illumina said we want to get whole genome down to $60. Right. I mean, at some point you're like, okay, when are you going to stop being worried about the cost of this? Because it's going to be a rounding error at some point. Matthew Might: Yeah. Over the course of someone's life, it's already a rounding error you know it's already there.Harry Glorikian: But $60, yeah. I mean, I was, I was,  talking to a company where they could do, if you could do the initial analytics for $60 and then do the computational on top of it for another $60, at some point you're like, look, we should just be doing this for everybody. The problem is the implementation. And can physicians keep up with, what does it all mean and what am I supposed to do? Matthew Might: Yeah. And that's why I think, when I talk about precision medicine and data as a drug, I always have to highlight the importance of computational aid for the physician. Because if you were to give a physician [raw DNA data[, they would go, “What, I don't know what to do with that.”  Even if you distill it down to the individual mutations, the average physician goes, “I still don't know what to do with that.” It's gotta be broken down into something far more actionable for them.And I think we're going to look back at now as sort of like the dark ages of IT in medicine, because we're in a situation where I don't know any physician that loves the EHR they use. In fact, they all hate it. It is a disastrous user experience across the board. And this is a classic problem in software where the people who pay for the things are not the people who use the things, and say, so what are EHRs optimized for? Billing. There's only one EHR as far as I can tell it's optimized for patient care, and that's at the VA, where they're not really concerned about billing. And so people like that one,  which is, not, not a big surprise. Harry Glorikian: Well, and they were talking about, they wanted to put in Epic. I was like, who got paid like behind some closed door to make that decision? That was the dumbest decision I've ever heard anybody make. Matthew Might: I thought the same thing as you, having worked in the Million Veterans program. Like, no, that's the crown jewel. That thing actually works and it works well, and it gets great data,  do not replace that. Keep it as is. Harry Glorikian: Yeah. Well you need to, unfortunately whoever's making that decision has no skin in that game as far as I can tell, but I agree with you. I mean, I've said over and over, if anything's gonna break medicine, it's going to be the existing EMR systems because you can't innovate if you can't get the data out. And Google and Microsoft and Apple and everybody's innovating because they get to change their system at will, right. Everybody gets to jump on AWS and innovate. The system is sort of stuck in stasis and can't move out of it, which is what I find worrisome. Matthew Might: I agree. You've either got to get the data out or the computation in. Preferably both. I've dealt with physicians where I can say, “Hey, we could give you this really cool genomic test for your patients. And then if they try to take a drug, you'll know if it's not going to work for them.” And they go, “Well, will there be automated decision support in the EHR to tell me if that happens? Or do I have to sort of look at the note and see that they have this variant?” I go, “Well, you can have to look at the note.” And they say, “No, I do not want that, because if that note is in there and I don't figure that out, and I prescribe a drug that causes an adverse event. I'll get sued. But if the information's not there at all, I can't be sued.” That's the world we live in.Harry Glorikian: Well, listen, it was great to speak to you. The stuff you're doing is awesome. I wish more people knew about it. I wish more students were involved in it so they could get firsthand experience. Like you said, I think that's when we can start to teach people the crossover between medicine and computational work in general, because I'm always trying to find people that know both, and there's not a lot of fruit on that tree at the moment. More is growing, but not as much as you'd like.Matthew Might: I agree. We need to get people going more often in both directions. And that's one of my missions at the Institute as well as to cross-train folks in into both sides, biology and computer science.Harry Glorikian: Excellent. Well, it was great to talk to you. I appreciate the time. Matthew Might: Likewise. It has been a pleasure.Harry Glorikian: That's it for this week's show. You can find past episodes of MoneyBall Medicine at my website, glorikian.com, under the tab “Podcast.” And you can follow me on Twitter at hglorikian. Thanks for listening, and we'll be back soon with our next interview.

Alternative Titles for this episode include:Speaking of MeatTeam Elope andPants, Prevacid, Puppies Join Kristi and Jordan after a long, hard day to talk about cooking, baking, and Big Boy the train. Full disclosure - Jordan was totally in the bath during the recording of this episode, so if you don't like echoey voices or gurgling noises, then this episode might not be for you. Sometimes, you just need to call your mom!

What is really happening when a child has colic or reflux? There is a mis-interpretation of the experience. The baby has taken in food but then it mis-interprets the meaning of that food! The problem isn't a lack of Pepcid or Prevacid. It is a confusion of the situation. Of course there might be a physical or physiological issue (sensitive/allergic to something in the breastmilk/formula), but the underlying question is: why? It all points to the brain!

In this weeks episode, I discuss the prevalence, problem and a proposed solution to over usage of PPI medications. I dig in and questions the why and why nots as well as explaining details of how PPI's affect us.Key Takeaways:It's estimated 15 million Americans use PPIs or proton-pump inhibitors. "Proton-pump inhibitors (PPIs) are members of a class of medications whose main action is a profound and prolonged reduction of stomach acid production." Some names you might be familiar with are Nexium, Prilosec, and Prevacid.  PPI's are used to heal ulcers but also, often prescribed generally for complaints of heartburn, bloating, and indigestion. Sometimes they're even used prophylactically with other medications. Problem with over usage of PPI's: Good digestion begins with good stomach acid. HCl (stomach acid) is responsible for breaking down your food along with ensuring an acidic environment in the stomach to protect your body against "bad" microbes and/or microbial overgrowth.  Chronically low stomach acid opens you up to a world of gut imbalances and pathogens that cause food digestion issues that may later create food sensitivities and maybe a feeling of “heaviness” or “bloating” when eating certain foods because they aren't being properly digested.Often when prescribed, PPI's are serving as a band-aide and not addressing the root causes of the problem. You must address the root cause in order to heal.Mentioned in this episode: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-clostridium-difficile-associated-diarrhea-can-be-associated-stomachhttps://pubmed.ncbi.nlm.nih.gov/23927671/https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-low-magnesium-levels-can-be-associated-long-term-use-proton-pumphttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124653In my private practice, I help people with gut, skin, and energy issues, by taking them through a root cause approach process that addresses all of these potential causes of heartburn, GERD, or indigestion and reviews the need for PPIs in order to help them get off medication and on to reducing symptoms to uplevel their life, health and happiness.Check out our resources, including a new guide on “how to heal your gut” or book a call atchristabiegler.com/linkPersonalized functional medicine with Christa Biegler:http://www.lessstressednutrition.comLess Stressed Life Podcast: http://www.lessstressedlife.comLess Stressed Life Facebook Page:https://www.fb.me/christabieglerrd/Loving the podcast? Leave us a review!reviewthispodcast.com/lessstressed

The Case:  Candace is 39 and has been dealing with acid reflux for years. She was diagnosed with GERD and prescribed acid lowering medication but when it stopped working she switched to probiotics and digestive enzymes.  These helped a little but she was still suffering and needed to find the root cause. Gastroesophageal reflux disease (GERD) and acid reflux diagnoses have been increasing dramatically for the past 20 years. So much so that it is now considered a very common disorder with an estimated 20-30% of the Western population experiencing it. However, many people who suffer from it are prescribed acid-blocking medications like Prevacid, Omiprezole and Nexium however, these options come with their own concerns and cautions. Few patients are encouraged to look for the cause of their issue, but when Candace came to see me, I knew that was exactly what we needed to do.  The Investigation Candace experienced some relief by following a strict course of probiotics and digestive enzymes however it didn’t completely relieve her symptoms. I knew that there had to be something that was continuing to cause inflammation and an imbalance in the gut.  Lisa Pomeroy is a naturopathic doctor and functional medicine consultant. She coaches and offers online training through the Pomeroy Institute for Functional Nutrition. She is also a clinical consultant for two of the top functional laboratories where she guides the experts in interpreting functional lab test reports and developing effective nutritional protocols.  Causes of GERD and Acid Reflux The increase in occurrences of GERD and acid reflux may be attributed to the increase in gastrointestinal infections. Many of these go undetected and over time cause acid reflux. Lisa also thinks that our shifting diet (including refined processed foods and non-organic foods) is also a culprit in the increased rate of GERD diagnosis. And, our eating habits can also contribute to the development of GERD. Common GI Tract Infections There are many potential infections that can affect the stomach but the most common is Helicobacter pylori (aka H pylori). This infection of the upper digestive tract can cause symptoms of stomach pain (especially within an hour or so of eating), feelings of hunger when there shouldn’t be, and acid reflux. Food is usually digested within 90 minutes of eating so feeling like food is ‘sitting like a rock’ in the stomach 90-minutes or more after eating can also be a clue that H Pylori might be the present. An aversion to protein may also be an indicator.  Symptoms of H Pylori In addition to the above mentioned gut issues, H Pylori can also manifest as sleep issues, fatigue, malnutrition (not absorbing nutrients), or skin issues such as rosacea, acne, psoriasis or eczema. Hashimoto’s and other autoimmune issues can be triggered by H Pylori. Mental health issues like anxiety or depression may also be a result, or exacerbated by H Pylori.  Too Little or Too Much Stomach Acid A lot of people think that acid reflux is because there is too much acid in the stomach, however, it can also be caused by not enough acid in the stomach. Acid is required to break food down so when there is too little, it can cause an imbalance of digestive enzymes and other digestive issues. Acid is also what helps keep food in the stomach by triggering the lower esophageal sphincter or L.E.S. When there is not enough acid, this can open up and allow food and stomach bile to travel back up into the throat. Testing for H Pylori The conventional test for H Pylori is a serum antibody test however Lisa does not like to use this test because there are a lot of false negatives and there is no way to know if the infection is new or old. A breath test is also common in conventional medicine but this can also deliver a false negative. Additionally, traditional doctors will do an endoscopy and biopsy which may or may not find the infection. Lisa’s preferred method of testing for H Pylori is a stool test (and there are few versions of this type test to consider). Detecting H Pylori with PCR There is one stool test that Lisa prefers over others (and I agree with her) and it’s a DNA stool test using PCR technology. We like it because this technology not only allows us to test for the H Pylori at a DNA level but it also can identify the virulence of the infection. When we know how active the infection is, we are in a better position to effectively attack it.  Treating H Pylori Conventionally Once H Pylori is diagnosed, treatment will often include antibiotics (the strength of which may be adjusted according to the virulence of the infection) as well as proton-pump inhibitor medication. This is the more conventional approach and Lisa says that it’s only effective half the time and can do a lot of damage to the body.  Treating H Pylori Naturally Lisa uses a clinically-proven botanical protocol to treat her patients with H Pylori. This includes a higher-dose mastic gum in combination with DGL (deglycerized licorice root). This approach does take a couple of months but it’s effective and a lot more gentle on the digestive system.  Other Contributing Infections H Pylori often attracts other infections and parasites to the gut. There are two that are commonly attracted and: dientamoeba fragilis and blastocystis hominis which are both protozoa parasites. It is not uncommon for the epstein Barr virus to join in the party. Often these infections aren’t discoverable until after the H Pylori has been dealt with. These parasites may be treatable with herbs but an anti-protozoa medication like ‘Alinia’ might be the better bet depending on how the individual responds.  Avoiding H Pylori H Pylori is a communicable infection so you can catch it from saliva (even a little bit of it). This means that if you or someone you know is diagnosed with it, then anyone who you may have kissed, shared a straw or a fork with should be tested (even if they don’t have symptoms because they could be a carrier). This is especially important because even if one person gets rid of the H Pylori, they can catch again from their spouse or anyone close to them from whom they might ingest saliva.  Happy Ending for Candace We did a full GI Map using the PCR technology from Diagnostic Solutions Labs which revealed that Candace did indeed have H Pylori along with a few other dysbiotic bacteria. Some of the supplements she was taking were contributing to the issue not helping. We adjusted her supplements and treated her H Pylori with Pyloricil and Mastica . We followed this with an antimicrobial protocol and introduced a strong probiotic. It took some time but soon she was symptom free and her stool tests proved that she was also H Pylori free.   Eliminating Health Mysteries For Candace we were able to get to the real root of the problem so she could get off the medication and feel well again. Could H Pylori be the missing clue for you or someone in your life?    Links: Resources mentioned Thanks to my guest Lisa Pomeroy.  You can connect with her through her website: www.Pomeroyinstitute.com or Facebook.    Suggested Products: Pyloricil GI Microb-X FC Cidal Orthobiotic 100 Orthobiotic L Glutamine Powder   Thanks for Listening If you like what you heard, please rate and review this podcast. Every piece of feedback not only helps me create better shows, it helps more people find this important information. Never miss an episode –  Subscribe NOW to Health Mysteries Solved with host, Inna Topiler on Apple Podcasts, Spotify, Stitcher or Google Podcasts. Find out more at http://healthmysteriessolved.com   PLEASE NOTE All information, content, and material on this podcast is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Some of the links provided are affiliate links. This means we may make a very small amount of money should you choose to buy after clicking on them. This will in no way affect the price the product but it helps us a tiny bit in covering our expenses.

Heartburn drugs can be deadly. Proton pump inhibitors, like Prevacid and Prilosec, are known to have serious side effects. Now researchers have documented the ways in which they may be deadly. President Trump is sparring with Congress again. The Department of Justice announced the president has asserted executive privilege over Congressionally subpoenaed documents on the addition of a citizenship question to the 2020 Census. House Democrats want those documents to figure out why the question was added. How will they get them now? Hollywood Burbank is selected as the country's best airport while LAX is tabbed as the world's worst according Fodor's. It says Burbank is an airport free of most of the hassles that take the fun out of travel plans while LAX is called a "behemoth time suck." You see them pitched all the time on TV infomercials. Reverse mortgages are billed as a way for senior citizens to secure much-needed cash to last through their retirement. But a report from USA Today has found these seemingly benign money plans have turned into nightmares. Nearly 100,000 loans that allowed senior citizens to tap into their home equity have failed, leading to foreclosure notices for many. How can people protect themselves? The idea of a single payer healthcare system, sometimes billed as "Medicare for All," is a popular idea in progressive left circles. Presidential candidate Bernie Sanders is pushing for the system. The plan is getting unlikely allies now in the business world. Some owners and CEOs are now expressing their support. We talk to a CEO leading this charge. Britain's Atlantis is finally found--8,000 years after it was swallowed by the sea. A big alligator chomps off a piece of a cop car. See omnystudio.com/policies/listener for privacy information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

PROTON PUMP INHIBITORS (ppi'S) WHICH INCLUDE THE WELL KNOWN BRANDS LIKE PRILOSEC, OMEPRAZOLE, PREVACID, PROTONIX AND NEXIUM..ARE AMONG THE MOST COMMONLY PRESCRIBED MEDS IN THE WORLD. THOUGHT THAT 10% OF THE WORLD ARE TAKING THEM. NOW WE ARE LOOKING AT A MUCH INCREASED RISK FOR KIDNEY DAMAGE WITH LENGTH OF TIME YOU ARE TAKING THEM. TUNE IN FOR DETAILS. Tune in every day to hear Dr. Len Brancewicz of The Nutrition Shoppe discuss today's hottest health topics and news from a complimentary perspective.  From colds to cancer and everything in between, Dr. Len can offer honest advice that makes sense. As a Registered Pharmacist (RPh), Certified Clinical Nutritionist (CCN), Doctor of Naturopathic Medicine (NMD), and a homeopath, Dr. Len has over 35 years experience in helping to keep you and your family healthy and happy. Call the show today to ask about your most pressing health concerns! Visit us on the web at www.TheNutritionShoppe.net or call  678-228-8900    to set up a personalized consultation, shop products, or ask questions! ---- Tags: health, natural health, supplements, vitamins, prescriptions, medications, pharmacist, naturopath,

Millions of people take medicines like Prevacid, Prilosec or Nexium every day. But while such proton pump inhibitors may ease symptoms of heartburn, they can also lead to serious side effects. Dr. Philip Gorelick, spokesperson for the American Heart Association, describes the research linking these heartburn drugs to an increased risk of stroke. Alternatives to PPIs? What […]

October 28, 2015 “The most critical factor in all of the issues facing women with PCOS is systematic inflammation and its origin which is probably in the gut,” explains Dr. Felice Gersh in our most recent interview. Dr. Gersh is a doctor of integrated medicine and a renowned expert on PCOS. Our conversation was wide ranging as she clearly explained the origin of many of our toughest symptoms. The gut-brain-hormone link can be a delicate balancing act, but once we get it worked out, Dr. Gersh assures, our physical and emotional health will radically improve. Listen in and learn: Why the gut is called the 2nd brain What steps to take in order to calm and treat GI inflammation The impact of stress, emotions and anxiety on your gut and overall health The link between nutrient deficiencies, leaky gut, insulin resistance, acne, hair loss, Hashimotos and other auto immune disorders How mouthwash is ruining your arteries Foods and supplements that can help repair your gut and reduce inflammation The extreme dangers of pharmaceuticals like Prilosec, Prevacid and Nexium.

The 3 Most Dangerous Over-the-Counter Medications Just because you can buy medicine without a prescription doesn't mean it is safe.  In this article, I share the three most dangerous over-the-counter medications and offer simple solutions to avoid these drugs. As a disclaimer, please don't stop any medications without speaking to your doctor first.  As with everything in life, your doctor can help you weigh the risks versus benefits of any treatment.  It is possible that your doctor has you on one of these drugs to prevent a life-threatening health condition. 1. Proton Pump Inhibitors (Prilosec, Prevacid, and Nexium) Proton pump inhibitors, or PPIs, are a multi-billion dollar industry.  No other stomach acid blocking medication comes anywhere close to PPI drugs with regards to efficacy.  As 60% of all Americans experience acid reflux in any given year, it is no wonder why PPI drugs are so popular. While PPI drugs may help to prevent cancer in people with a diagnosis of Barrett's esophagus, a new study this week showed that taking PPI drugs increases your risk of stomach cancer. If the risk of stomach cancer wasn't frightening enough, my former Stanford professor, Dr. John Cooke, recently published a study showing that PPI drugs can wear out your heart, brain, and kidneys. Studies also show that PPI drugs block the absorption of crucial vitamins and minerals for health like magnesium, iron, vitamin B12, calcium, and vitamin C.  Perhaps this explains why PPI use is associated with an increased dementia risk.  Lastly, PPI drugs have been shown in studies to wreak havoc on the gut flora. With all of these risks, why do people still take PPI drugs?  Speaking as someone who used to gobble down PPI drugs for eosinophilic esophagitis, PPI drugs allowed me freedom from acid reflux chest discomfort without having to change my lifestyle. In my case, eliminating dairy and junk food, in addition to losing 35 pounds, cured me of acid reflux.  For most of my patients, cleaning up their diet and losing weight has also got them safely off PPI drugs.  As one of the main causes of acid reflux is increased pressure within your abdomen, just losing weight may be your acid reflux cure. I should point out here that just because you have acid reflux doesn't mean you should avoid dairy.  Dairy and junk food, in addition to being overweight, were my acid reflux triggers.  What it does mean is that you should look for your own specific acid reflux triggers or food allergies. Other natural treatment strategies for acid reflux include eating smaller meals, avoiding fatty foods, staying away from anything with caffeine, sitting up for a few hours after eating, eating an early dinner, increasing physical activity, and finding ways to embrace stress.  If you must take a PPI drug, make sure your doctor is aware and that you take the lowest dose possible to control your symptoms. 2. Non-Steroidal Anti-Inflammatory Drugs (Advil, Motrin, Aleve, etc.) Non-steroidal anti-inflammatory drugs (NSAIDs) can seem like a lifesaver to people with arthritis or musculoskeletal pain.  As someone who used to suffer from an autoimmune disease, ankylosing spondylitis which attacks the spine, my neck and back were always in a state of discomfort.  NSAIDs, or in my case Aleve, is what helped me to get through the day. The two main problems with NSAIDs are that they increase your risk of a heart attack and internal bleeding. Indeed, studies show that all NSAIDs increase your risk of a heart attack by about 50%.  In addition to the heart attack risk, studies also show that NSAID users have up to a 4-fold increased risk of gastrointestinal bleeding and are at significant risk of kidney failure. In my case, the two most important things I did to dramatically reduce my NSAID use was cleaning up my diet and losing 35 pounds.  As most people take NSAIDs for arthritis or musculoskeletal pain, getting back to a normal weight allows your joints to heal na...

Camden, TN physician and author Dr. Ken Berry Is our guest in episode 1324 of "The Livin' La Vida Low-Carb Show". Ken D Berry, M.D., has been practicing Family Medicine in rural Tennessee for over a decade.  He is board certified in Family Medicine, and was recently awarded the degree of Fellow by the American Academy of Family Physicians.  Having seen over 20,000 patients over his career of all ages, he is uniquely qualified to advise on both acute and chronic diseases.  More and more, Dr. Berry has focused of chronic disease caused by the Standard American Diet and Lifestyle, and has made it his mission to turn the tide on the epidemic of Type 2 Diabetes, chronic inflammation and dementia.   Listen in today as Jimmy talks with Dr. Berry about his book, Lies My Doctor Told Me, where he exposes lies told by doctors to patients, often in a well-meaning way, which sabotage the patient's health, Curing Type 2 Diabetes, how the Keto/Paleo Diet Lifestyle changed his life, the eat less/exercise more dogma, whole grains, why there are fat doctors, the Lipid Theory controversy, chronic overuse of PPI's (Nexium,Prevacid), Vitamin D, and much more. ORGANIC BRANDS YOU LOVE FOR LESS THRIVEMARKET.COM/KETO FOR 25% OFF NOTICE OF DISCLOSURE: Paid sponsorship GET A $39 BOTTLE OF OLIVE OIL FOR JUST A BUCK GET YOUR $39 BOTTLE FOR JUST $1 NOTICE OF DISCLOSURE: Paid sponsorship DELIVERED TO YOUR DOOR – WITH FREE SHIPPING Use coupon code LLVLC for $200 OFF NOTICE OF DISCLOSURE: Paid sponsorship Join The Keto Clarity Club For $1 Blood Ketone Test Strips!   NATURAL BLOATING RELIEF GO TO LOVEMYTUMMY.COM USE COUPON CODE “JIMMY” FOR 15% OFF Links discussed in episode 1324: – SUPPORT OUR SPONSOR: Organic brands you love for less at thrivemarket.com/keto – SUPPORT OUR SPONSOR: The world’s freshest and most flavorful artisanal olive oils. Get your $39 bottle for just $1 – SUPPORT OUR SPONSOR: Love your tummy with Atrantil. (Get 15% off with the coupon code “JIMMY”) – SUPPORT OUR SPONSOR: Join The Keto Clarity Club For $1 Blood Ketone Test Strips! BestKetoneTest.com Dr. Berry on Youtube Dr. Berry on Facebook Sign up to receive a free chapter of Lies My Doctor Told Me

Our guest this week is leading digestive health expert, Dr. Michael Murray. Dr. Murray has authored more than 30 books on natural approaches to health and optimization. On today's episode we explore digestive health and dispel common misconceptions regarding heartburn medications, enzymes, probiotics and the public's perception of the term "natural". A few of the common digestive health questions we address: Digestive Enzymes vs. Probiotics (When and Why to use each) Why you should avoid the class of heartburn medications known as Proton Pump Inhibitors (like Nexium, Prilosec, Prevacid, etc) Discover the natural alternatives to these drugs  Why the public links "natural" with "not scientific" Learn why Ginger and Licorice should be staples in your pantry Why the "therapeutic dose" matters in the food vs. supplement debate How certain drugs get on the market before researchers fully understand their impact and what it takes to eventually pull them once we know they're harmful If you enjoy this episode, you can get more gut health information in Dr. Murray's FREE online Digestive Health Summit 9/9-9/17

What is Leaky Gut Syndrome? Well... Leaky Gut Syndrome, or intestinal hyperpermeability, is where the small gaps in your intestinal wall -- or “tight junctions” -- become loose due to pro-inflammatory foods and stressors. These loose intestinal walls can then lead to inflammation that can affect the whole body by allowing harmful bacteria and toxins to directly enter your bloodstream. Many health experts are now saying that inflammation may be the root cause to many of today’s chronic health diseases. Some of these diseases include--but are not limited to--diabetes, cardiovascular and autoimmune disease, Alzheimer's, Parkinson’s, and even cancer. I’m not trying to scare you guys, but I am trying to get the point across that taking care of your health is much more than eating whole foods. That’s why I’m honored to have Dr. David Perlmutter on episode #20 of Ancestral Health Radio. Not only do David and I talk shop about inflammation and gut permeability, we go deep into the science of how to heal this inflammation from the inside out. In today’s episode, you’ll learn… The direct correlation between diabetes and dementia, What coconut oil, ghee, and turmeric all have in common, How to heal your gut using fats and prebiotic fiber, and… Much, much more. Subscribe on  iTunes | Stitcher Radio | Google Play | SoundCloud Episode Breakdown Why people are being affected by carbohydrates and grain sensitivities How Leaky Gut Syndrome occurs and increases inflammation in the body The ONE thing that causes chronic diseases (e.g.- cancer, coronary disease, and Alzheimer’s) What ingredient makes up 40% of the foods we eat in America The #1 Cause of Death in the World The Glamorization of Gluten-Free Foods How carbohydrates affect degenerative brain diseases The Correlation between Diabetes and Dementia The BEST cure for Dementia and maladaptive gene expressions A 1960s scare tactic used to distract you from the dangers of sugar What soft drink manufacturers hope you never find out about artificial sweeteners What you do to screw up your gut and how to fix it The Surprising Truth about your Sweet Tooth Why you should embrace cooties Which foods have the highest levels of prebiotic fiber Why Fat is important in your diet How genetically modified fats are affecting your genome The Problem with blanket statements about “high fat” diets Grass-fed beef vs. Most beef sold in stores Which vitamin is vital to heart health and brain health The Debate between Dr. David Perlmutter and Dr. John Douillard How the Mediterranean Diet is often misunderstood Why people who take acid-blocking drugs (e.g. – Prevacid, Nexium, etc.) should beware The myth sold to teens with acne How Autism and gut-bacteria are related What coconut oil, ghee, and turmeric have in common And many, many more...

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

Gastro-Esophageal Reflux Disorder GERD, or just Reflux. Reflux is a word that is used to describe something in your body that flows backwards.  The fluids in your body have a certain direction they naturally flow for your body to work properly.  If they start flowing backwards, it's called reflux, and can lead to problems. Is that like heartburn? Yes, heartburn is a type of mild reflux.  Something (like a certain type of food or overeating) causes the stomach acid to bubble back up into the esophagus. Overeating or other physiological disorder can cause the lower sphincter to not close tightly or completely. Ulcer They lining of your stomach produces the acid, thus it's intended to be resistant against the acid.  The lining of the esophagus is not intended to handle that acid.  And stomach acid is way more acidic that our saliva or acidic foods that we may eat. Now, if the acid-producing (and acid-resistant) lining of the stomach wall gets injured, and the layers underneath come in contact with the acid, it causes pain. Would that cause someone to throw up blood? Yes, it possibly would.  Any tissue that is living and working in your body, requires a blood supply to bring in nutrients and carry out waste.  So, the walls of your stomach is full of blood vessels.  If the acid, eats through the layers and gets to the blood vessels, that blood will spill into the stomach.  Unfortunately, your digestive system isn't intended to digest large amounts of blood.  The pain from the acid plus the large amounts of blood can lead to nausea and vomiting. How I assess ulcer or reflux Where does it hurt? - Reflux: in the esophagus or throat (even to the point of hoarseness) - Ulcer: Stomach Does it hurt worse when you're hungry or after you eat? - Reflux: hurts after food has gone into stomach or you lay down at night because you don't have gravity holding the acid down into the stomach. - Ulcer: hurts when the stomach is empty because the acid only comes in contact with the stomach lining, rather than having food to work on. Treatment The treatment for both is the same.  The goal for both is to reduce the acid production.  People will try to self-treat by taking tons and tons of OTC antacids (liquid or tablets).  Antacids are bases, so they goal is to neutralize the acids, but once that amount has moved into the intestines, the base is gone and the acid is till there.  Other acid reduces are OTC as well.  Histamine 2 Receptor Blockers (Pepcid, Zantac) can start to work within 30 minutes.  Proton Pump Inhibitors (Prilosec, Prevacid, Nexium) can take up to 2 weeks to reduce the acid, so not intended for instant treatment. Bottom Line Whether it's ulcers or reflux, your doctor needs to know what's going on so they can monitor your progress.  Anything that manipulates cells in your body (whether stomach cells damaged in an ulcer or esophageal cells being corroded by acid) can cause cellular changes that may become cancer. Connect with me Support us on Patreon *NEW* Join the Pharmacist Answers Podcast Community on Facebook Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio Like the Facebook page Music Credits:  "Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

America’s most popular heartburn drugs might be harming our kidneys. Research published in the February issue of JAMA Internal Medicine suggests that regular use of drugs like Nexium, Prevacid or Prilosec is associated with a higher risk of chronic kidney disease. While the research shows an association and doesn’t establish that the drugs are causing kidney […]

Have you noticed that when a person starts taking medications, more medications are prescribed to treat the side effects caused by the original medications. Many of these side effects are caused by Medications That Cause Nutritional Deficiencies that these drugs create. In the end, these medications can really add up.   Many prescription drugs on the market cause nutrient deficiencies. For example, a common medication like the statins (Pravachol, Lipitor and Crestor), which are used to treat high cholesterol, reduces CoQ10 in the body. CoQ10 is the most abundant antioxidant in the body. It is very important for muscle function. A symptom of CoQ10 deficiency is muscle aches, like thigh or trunk pain. Patients cannot feel the depletion of CoQ10 in the heart muscle, however. Absolute CoQ10 depletion can cause heart failure and death.   Another example would be diuretics that patients are prescribed for hypertension. These medications get rid of water as well as the minerals Magnesium and Zinc. When men are deficient in Magnesium and Zinc, they are unable to make Testosterone.   So, when you look at the complex biochemical cascade, many cofactors are necessary for these pathways to run properly in the body. When one or many or lacking, the results can cause a decrease in the hormones produced. See how a simple deficiency in Magnesium or Zinc caused by diuretics can cause another problem such as low Testosterone. The male then experiences the side effects of low Testosterone, which are plentiful.   If a medication causes low Magnesium, this mineral has 300-400 functions in the body. Low Magnesium can lead to an enormous amount of problems in the body. Physicians who specialize in Functional and Regenerative Medicine or Anti-Aging can test for Magnesium and there are high-quality Magnesium supplements available if you are deficient. You can look at Triton Nutrition and read the article on Magnesium to find the best form of chelated Magnesium supplement for maximum absorption and look at their online store to view their product Mag Powersorb. Low Magnesium leads to poor blood sugar control, poor bowel function (constipation), poor blood pressure control, muscle cramps and spasms, and insomnia or poor sleep. One deficiency leads to a multitude of problems.   Proton Pump Inhibitors such as Prilosec, Nexium, and Prevacid are prescribed to reduce the amount of acid in the stomach. Without a certain amount of acid in the stomach, we don't absorb certain minerals like Calcium. So, it is common to see a person who started taking Proton Pump Inhibitors (PPI) end up with Calcium depletion and weak bones. Actually, Functional Medicine Physicians believe that the treatment with acid is what is needed instead so that the lower esophagael sphincter will tighten and close off after it is signaled by a proper amount of acid in the stomach.   Your micronutrient levels can be tested. It is necessary before you start bio-identical hormone replacement therapy to supplement any deficiencies before you start on your therapy for you to receive optimal results. Also, hormone replacement therapy can cause nutrient deficiencies so you must monitor your micronutrients so they can be replaced sufficiently. The most common deficiencies that require repletion are Folic Acid, Magnesium, and Vitamin B12 after you start your therapy. These are all necessary cofactors.   For more information, Dr. Pamela Wartian Smith, a physician with American Academy of Anti-Aging, wrote an excellent book called Vitamins, Minerals, Herbs and More. There you will find specific protocols on how to overcome specific nutrient depletions. Natural database has a chart on common medications that cause nutrient depletions.   A prescription drug depletion chart complements of Maryland Medical Center can be downloaded as well.   by Robert Seik, PharmD