Podcasts about rcts

This is my personal favorite topic, but probably your least favorite: strength training.  Before you run away, hear me out! Because whether you’re bed-bound, housebound, or just convinced your body can’t handle it right now, this episode is for you. I’m breaking down exactly WHY resistance and strength training isn’t just helpful for vestibular disorders—it’s essential.  You Have to Move Your Body to Manage Your Dizziness From the dizzy-anxious-dizzy cycle to blood sugar regulation to better sleep to reduced inflammation, strength training touches virtually every struggle vestibular warriors face. I’m not letting anyone off the hook, but I am meeting you exactly where you are. Starting with 3 minutes? That counts.  Walking to the mailbox and back? That counts too.  Because the goal here is progress, not perfection. And you know I have the science to back every single word of it! In this episode, we'll dig into: Why strength training is non-negotiable for vestibular disorder management How exercise helps break the dizzy-anxious-dizzy cycle “In the moment” vs. “hangover” dizziness and how to adjust your approach Why EDS, HSD, or MCAS makes building muscle even more critical The truth about the fear of getting “bulky” How to start exercising when you’re bedbound or couch-bound What physical activity guidelines actually say, and where most people fall short How functional movements like the deadlift directly support vestibular patients How Vestibular Group Fit makes strength and resistance training accessible Whether you start with 3 minutes or 30, the most important thing is that you start. Because your vestibular system, your mood, your balance, and your future self are all counting on it. Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Citations: Adriano Oliveira, Andressa Fidalgo, Paulo Farinatti, Walace Monteiro,Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis,Archives of Gerontology and Geriatrics,Volume 124,2024,105451,ISSN 0167-4943,https://doi.org/10.1016/j.archger.2024.105451.(https://www.sciencedirect.com/science/article/pii/S0167494324001274) Yu Y, Wang J, Xu J. Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs. Front Psychiatry. 2024 Sep 12;15:1436499. doi: 10.3389/fpsyt.2024.1436499. PMID: 39328348; PMCID: PMC11424528. Zhang Y, Zhou M, Yin Z, Zhuang W, Wang Y. Relationship between physical activities and mental health in older people: a bibliometric analysis. Front Psychiatry. 2024 Oct 21;15:1424745. doi: 10.3389/fpsyt.2024.1424745. PMID: 39497901; PMCID: PMC11532734. Garcia Meneguci, C. A., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PloS one, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275 Mennitti C, Farina G, Imperatore A, De Fonzo G, Gentile A, La Civita E, Carbone G, De Simone RR, Di Iorio MR, Tinto N, Frisso G, D’Argenio V, Lombardo B, Terracciano D, Crescioli C, Scudiero O. How Does Physical Activity Modulate Hormone Responses? Biomolecules. 2024 Nov 7;14(11):1418. doi: 10.3390/biom14111418. PMID: 39595594; PMCID: PMC11591795. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25. PMID: 20188719; PMCID: PMC3629815.  Chastin, S.F.M., Abaraogu, U., Bourgois, J.G. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med 51, 1673–1686 (2021). https://doi.org/10.1007/s40279-021-01466-1 Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022 Jan;70(1):49-59. doi: 10.1111/jgs.17477. Epub 2021 Sep 24. PMID: 34536288. Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25. PMID: 35876019; PMCID: PMC9378548. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(19):1262-7. doi: 10.1136/bjsports-2014-094306. Epub 2015 Aug 3. PMID: 26238869. Chandrasekaran B, Ganesan TB. Sedentarism and chronic disease risk in COVID 19 lockdown – a scoping review. Scott Med J. 2021 Feb;66(1):3-10. doi: 10.1177/0036933020946336. Epub 2020 Jul 27. PMID: 32718266; PMCID: PMC8685753. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi: 10.1007/s12603-021-1665-8. PMID: 34409961; PMCID: PMC12369211. Bunnell E, Stratton MT. The Impact of Functional Training on Balance and Vestibular Function: A Narrative Review. J Funct Morphol Kinesiol. 2024 Dec 3;9(4):251. doi: 10.3390/jfmk9040251. PMID: 39728235; PMCID: PMC11679947. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Warner A, Vanicek N, Benson A, Myers T, Abt G. Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression. PLoS One. 2022 Nov 3;17(11):e0277031. doi: 10.1371/journal.pone.0277031. PMID: 36327341; PMCID: PMC9632890. “Metabolic Equivalent (MET): Pick the Best Exercise for Longevity.” Whyiexercise.com, www.whyiexercise.com/metabolic-equivalent.html. Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— strength and resistance training, exercises for vestibular disorders, living with vestibular migraine, guidelines of physical activity, anxiety and depression, chronic dizziness, couch bound, bed bound, dizzy-anxious-dizzy cycle, physical therapist

The following question refers to Section 7.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by University of Michigan fellow and CardioNerds FIT Ambassador Dr. Kayla Secrest, and then by expert faculty Dr. Sunil Rao. Dr. Rao is an interventional cardiologist, Professor of Medicine at NYU Grossman School of Medicine, Deputy Director of the Leon H. Charney Division of Cardiology, and the Director of Interventional Cardiology for the NYU Langone Health System. He is the Editor-in-Chief for Circulation Cardiovascular Interventions and was the Chair of the Writing Committee for the 2025 ACS Guidelines. This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Question #1 A 68-year-old man with a history of hypertension, hyperlipidemia, stage III chronic kidney disease, and prior tobacco use presents to a local emergency department with reports of chest pain while raking leaves at home. Upon arrival, he is hemodynamically stable with a heart rate of 86 beats per minute and a blood pressure of 133/85 mmHg. His EKG reveals ST elevations in the septal and anterior leads (V1-V4). He is given 324mg of aspirin and is promptly evaluated by the interventional cardiology team, who elects to take him emergently to the catheterization lab. Upon arrival to the catheterization lab, the nurse asks the interventional fellow which access sites they should prep for this case? How should the interventional fellow respond? A Right radial artery only B Radial + bilateral femoral C Bilateral femoral only Answer #1 Explanation  The correct answer is B. Radial and bilateral femoral Radial artery access is the preferred vascular access site for coronary angiography and PCI in patients with ACS. Transradial access has been shown to reduce mortality, bleeding, and vascular complications compared with transfemoral access (Class I, LOE A). Radial access also allows earlier ambulation and is associated with greater patient comfort. Although the right radial artery is the most widely studied upper-extremity access site, alternative sites such as the ulnar and distal radial arteries have demonstrated similar outcomes. However, the radial artery may be required as a bypass conduit for CABG. In institutions where the radial artery is routinely used for surgical grafting, this potential future use should be considered when selecting vascular access. In addition, transfemoral access—preferably performed with ultrasound guidance—should be considered in patients in whom temporary mechanical circulatory support (MCS) is anticipated or in those for whom radial access is not feasible due to anatomical or technical constraints. Prepping bilateral groins in addition to the radial artery provides a backup strategy for urgent MCS placement or for transition to femoral access should radial access fail. For these reasons, prepping both the radial artery and bilateral groins is the most appropriate response. Radial-only preparation is incorrect because, although radial access is preferred, patients with STEMI may still require emergent MCS or alternative access if the radial artery is unsuitable. Preparing only the wrist without backup femoral access may delay care should hemodynamic instability occur. Femoral-only preparation is incorrect because transradial access provides superior outcomes in ACS, including significant reductions in all-cause mortality, major bleeding, and vascular complications. RCTs and meta-analyses, including MATRIX (which showed lower MACE and net adverse clinical events with radial access) and SAFARI-STEMI (which showed no difference in mortality but was underpowered)—support radial as first-line access when feasible. Main Takeaway For patients with ACS undergoing PCI, radial access is strongly preferred to reduce mortality, bleeding, and vascular complications. Guideline Loc. Section 7.1  

It's in the News! The top diabetes stories and headlines happening now. Top stories this week include: Afrezza inhaled Insulin is Approved for Kids, CGM + Ketone Monitor gets European approval, Food Coloring & Diabetes Study, Device Recalls include Omnipod and Dexcom, Beta Bionics shares more about their patch pump, ADA conference info and more! This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcripts: Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bring you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. ADA starts this week – safe travels to those of you heading to New Orleans. We'll be covering remotely so please follow on social – make sure to Like the FB page or join the group. We've got a wrap up episode planned for this podcast as well as some indepth interviews with the newsmakers from the conference. I will see some of you next week in Chicago. We have a couple of seats left for our Club 1921 dinner on June 10th in Northbrook – this is a FREE dinner for HCPs and patient leaders – all about screening for T1D. More info on the website under the events tab. Okay.. our top story this week: XX Afrezza inhaled insulin is now approved for kids and teens. The FDA okayed MannKind's afrezza for children 6 and older with type 1 and type 2 diabetes. MannKind says its proprietary Technosphere drug delivery platform enables the rapid absorption of insulin into systemic circulation. This follows FDA approval earlier this year for an update that revises recommendations for the starting mealtime dosage when patients switch from subcutaneous mealtime insulin regimens. MannKind also completed enrollment in February for a study evaluating the initiation of Afrezza therapy shortly after type 1 diabetes diagnosis in pediatric patients.   The company said it made Afrezza available for eligible patients for $35 or less per month. Desmond Schatz, professor of pediatrics at the University of Florida College of Medicine, said: "Mealtime insulin can be especially challenging for children because eating and snacking patterns, activity levels, and daily settings like school and sports often vary. With its rapid onset and dosing at the start of a meal, Afrezza may help clinicians better match insulin therapy to how children and families live day to day, while offering a needle-free mealtime option." Lots more to come on this – we're working on a bonus episode with one of the pediatric endos who worked on the clinical trials that led to this approval – hopefully have that out later this week. https://www.massdevice.com/mannkind-fda-approval-inhaled-insulin-children/ XX FDA has agreed to consider a new drug for the treatment of adults with type 1 and chronic kidney disease. Finerenone (fy-near-uh-known) is currently approved in the US for adults with CKD associated with type 2 diabetes and for adults with heart failure with left ventricular ejection fraction of 40% or greater. Chronic kidney disease (CKD) is present in over one-third of adults with diabetes, and because it's such a serious condition, interventions are needed to reduce its incidence and help people live a long and prosperous life. https://www.docwirenews.com/post/fda-grants-priority-review-to-finerenone-snda-for-type-1-diabetes-associated-ckd XX Abbot gets European approval for the world's first dual glucose‑ketone sensing technology for people with diabetes. They're calling this Libre Duo and Libre Duo 10 Day, and it's designed to continuously measure glucose and ketone levels every minute. Abbott plans to begin launching Libre Duo systems in select European countries later this year. Libre Duo delivers up to 15 days of wear and will be offered to adults ages 18 and older. Libre Duo 10 Day offers up to 10 days of wear and is intended for people ages 2 and older. Abbott is also working with leading pump companies to allow automated insulin delivery (AID) systems to connect with the sensors. https://abbott.mediaroom.com/2026-05-27-Abbott-secures-CE-Mark-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes   XX Huge recall for Omnipod. Insulin says a manufacturing issue through ongoing product monitoring that could result in insulin under-delivery  with specific lots of its Omnipod 5, Dash and Eros pods. Insulet said the scope of this action reaches approximately 7 million pods. This issue is separate from the March recall that affected certain Omnipod 5 lots. According to the Acton, Massachusetts-based company, some of its affected pods may have a small tear in the tubing (cannula) just above the skin. This tear lands between the pod and the point where the cannula enters the body. If this occurs, insulin may leak outside of the device instead of being fully delivered into the body as intended. This may lead to under-delivery of the therapeutic.   Individuals using an affected pod may notice wetness on the skin or pod adhesive or detect the smell of insulin. However, some cases may prove difficult to detect and go unnoticed. Of the approximately 7 million pods included in the action, approximately 60% have been consumed or are expired. The pods affected by the correction represent approximately 8.5% of the 2025 global Omnipod pod prodcution. Insulet says it has sufficient supply to replace affected pods. It expects no disruption to product availability. The company said it has notified the FDA and all other relevant regulatory authorities of its action.   The full list of affected pod lots can be found here. https://www.massdevice.com/insulet-another-omnipod-5-recall-dash-eros/ XX Dexcom is warning that certain scrapped glucose sensors have been stolen and resold. Dexcom said it has not received any reports of severe adverse events associated with the stolen product. One lot of scrapped devices carries a risk of infection for sensors that are not properly sterilized, and another lot had an elevated internal testing failure rate, meaning users would have an increased risk of having no sensor readings available. Dexcom said the affected sensors were stolen during the destruction process and then sold by third parties. The company routinely scraps sensors that do not meet its standards. The sensors are sent to a third-party vendor for destruction and recycling.   Dexcom said it traced sales of the stolen devices to Pharmsource, which is not an authorized Dexcom distributor but supplies some independent pharmacies and U.S. durable medical equipment distributors. Because of this, pharmacies that purchase products from Pharmsource should review their inventory, Dexcom said.   People with sensors from the affected lots should not use those sensors and can call customer support to request replacements. Dexcom has set up a website to help users check if their devices are affected. https://www.medtechdive.com/news/dexcom-warns-of-scrapped-glucose-sensors-being-resold/821139/ XX XX   Beta Bionics plans to debut its first insulin patch pump by the end of the second quarter of 2027, subject to Food and Drug Administration clearance. The device, called Mint, would be compatible with Beta Bionics' interoperable automated glycemic controller, a software that allows for the pump to automatically adjust insulin delivery based on readings from a glucose sensor. Beta Bionics first unveiled the prototype for Mint last year at the American Diabetes Association's Scientific Sessions. The device is expected to have a similar size and wear time, at three days, to Insulet's patch pumps on the market. It would have a 200-unit insulin reservoir.   Mint differs by containing a mix of reusable and disposable components. Beta Bionics plans to make the device exclusively available in the pharmacy channel, building on its existing agreements for its current iLet insulin pump. Beta Bionics is one of several diabetes tech companies developing patch pumps to compete with market leader Insulet. Tandem Diabetes Care and Medtronic spinoff MiniMed have also announced planned patch pumps. Tandem said it plans to file a 510(k) submission this quarter for a tubeless version of its small, durable pump, and Medtronic plans to submit its patch pump to the FDA this fall.   https://www.medtechdive.com/news/beta-bionics-to-launch-its-first-insulin-patch-pump-to-compete-with-insulet/821091/ XX CVS puts Zepbound back on it's coverage list – with it's Caremark PBM. They also added Foundayo, Lilly's obesity pill. CVS had dropped Lilly's Zepound last summer but kept competitor Wegovy. It'll be back at Caremark October first. All three of the nation's largest pharmacy ⁠benefit managers ​now cover Lilly's full obesity medicine portfolio. https://www.reuters.com/legal/litigation/cvs-brings-back-coverage-lillys-obesity-drug-zepbound-2026-05-28/   More to come, including a new benefit from metformin for women, something new from Tidepool, big news for T1D in Austalia and more.. XX A new study suggests that higher long-term exposure to food colouring additives — including both synthetic and natural colourings commonly found in processed foods and beverages — may be associated with an increased risk of developing type 2 diabetes. Researchers analyzed data from more than 108,000 adults in the French NutriNet-Santé cohort between 2009 and 2023, following participants for a median of just over eight years. During that time, 1,131 participants developed type 2 diabetes. The study found that people with the highest intake of total food colouring additives had a 38% higher risk of developing type 2 diabetes compared with non- or low-consumers.   Several specific additives were linked to increased risk, including caramel colouring additives such as total caramel (E150 family), plain caramel (E150a), sulphite ammonia caramel (E150d), and beta-carotene (E160a). Additional associations were observed for curcumin (E100), anthocyanins (E163), paprika extract (E160c), lutein (E161b), and cochineal-derived colourings (E120). "Our findings revealed positive associations between widely consumed food colouring additives and type 2 diabetes incidence," the authors wrote, adding that further research is needed to better understand the mechanisms behind the findings and whether food colouring regulations should be reevaluated. https://www.medscape.com/viewarticle/use-common-food-colours-tied-high-type-2-diabetes-risk-2026a1000hes XX Big news for Australia – their Therapeutic Goods Administration (TGA) approves Tzield. Tzield is now approved in Australia to delay the onset of stage 3 (or clinical) T1D in people aged eight years and older with stage 2 T1D – the early, pre-symptomatic stage of the condition, where changes in blood glucose levels have begun but insulin therapy is not yet required. Breakthrough T1D Australia Chief Executive Officer, Sydney Yovic, said the approval represented a transformational moment for Australians affected by T1D. https://newshub.medianet.com.au/2026/05/landmark-approval-of-tzield-in-australia-ushers-in-a-new-era-of-delay-for-type-1-diabetes/155036/ XX https://www.theatlantic.com/health/2026/05/diabetes-pregnancy/687324/ XX A common diabetes drug may hold great potential to help with aging, even if scientists aren't exactly sure why. According to a study, the drug metformin doesn't just help patients to effectively manage their type 2 diabetes. it may also give older women a better chance of living to 90. Scientists in the US and Germany used data from a long-term US study of postmenopausal women.   Records for a total of 438 people were selected – half of whom took metformin to treat diabetes, and half of whom took a different diabetes drug, sulfonylurea.   While there are some caveats and asterisks to the study, those in the metformin group were calculated to have a 30 percent lower risk of dying before the age of 90 than those in the sulfonylurea group. The study used age 90 as the marker for 'exceptional' longevity. However, scientists aren't yet sure that the drug extends lifespan, especially in humans – which is part of the reason for this study. RCTs could follow further down the line to dig deeper into these results, the researchers suggest. In the meantime, as the global population continues to skew older, studies continue to find ways to keep us healthier for longer and reduce damage to the body as we age. https://www.sciencealert.com/a-common-diabetes-drug-is-linked-with-exceptional-longevity-in-women XX The American Diabetes Association® (ADA) will host the 2026 Scientific Sessions from June 5-8 in New Orleans. The ADA's Scientific Sessions is the world's largest diabetes meeting, convening an expected audience of over 12,000 leading physicians, scientists, researchers, and healthcare professionals from around the globe. The premier diabetes meeting, which is also offered virtually, will feature the latest scientific findings in diabetes and obesity, where leading experts and peers will share findings in research for prevention, care, and cures at the Ernest N. Morial Convention Center. Key themes will include: Advancing obesity and metabolic health: Prevention, early detection, and disease modification: Improving cardiometabolic outcomes: Transforming care through innovation and access: New research will highlight how technology, artificial intelligence, and implementation strategies are reshaping diabetes care—reducing treatment burden, expanding access, and enabling more person-centered care. Advancing beta cell replacement and cure strategies: Fostering innovation: On Saturday, June 6, from 4:30-6:00 p.m., the Innovation Challenge, which debuted in 2023, invites emerging companies to pitch novel ideas to improve the lives of people living with diabetes. A panel of judges, with input from a live audience, determines which contestants will earn a private audience with potential funders. XX Tidepool, the nonprofit leader advancing innovation in diabetes technology, announced that Tidepool+ Direct Connect is now available through the Epic Showroom. Built on SMART on FHIR, Direct Connect brings interactive diabetes device data directly into Epic workflows, helping clinicians use patient data during routine care. "Tidepool has always focused on making diabetes data more accessible and actionable," said Brandon Arbiter, CEO. "We're excited to empower clinicians using Epic with insightful, intuitive patient data that fits directly into their encounter workflow so they can use it to improve care in the moment it matters."   Tidepool+ Direct Connect supports scalable deployment across Epic-enabled health systems. This architecture enables faster, more intuitive rollouts, enhancing Tidepool's existing EHR integration capabilities.   Direct Connect is part of Tidepool's ongoing work to improve how clinicians can use timely and relevant diabetes device data during patient visits to help drive better health outcomes.   The feature is now available in the Connection Hub of the Epic Showroom.   https://www.businesswire.com/news/home/20260527780274/en/Tidepool-Launches-in-Epic-Showroom-to-Bring-Diabetes-Device-Data-into-the-Point-of-Care XX

Jonathan Howard and Wendy Orent call this week their "Red Wedding": within days, FDA Commissioner Marty Makary resigned, Vinay Prasad was pushed out of CBER, Tracy Beth Hoeg was fired, and Senator Bill Cassidy lost his Louisiana primary. The hosts argue this is not a tragedy but a long-foretold collapse — a group of physicians who built careers as COVID-era contrarian podcasters discovering that running a regulatory agency is fundamentally different from posting about one. Howard works through the wreckage: Makary's reported approval of flavored nicotine products days before his ouster, the FDA's treatment of the rare disease community, the leaked memo claiming pediatric COVID vaccine deaths that career staff refused to sign off on, and the broader pattern of "regulatory whiplash" that drove the agency into dysfunction. The episode then turns to who is still standing — Jay Bhattacharya at NIH, Robert F. Kennedy Jr. at HHS — and what Kennedy is reportedly doing to vaccines from behind the scenes via Martin Kulldorff's review effort. Throughout, the hosts return to a single thesis: the skills that made Makary, Prasad, Hoeg, and Cassidy famous during COVID — opinion, tweeting, posturing — do not translate into running institutions, and the medical commentators who vouched for them (John Mandrola, Adam Cifu) have lost any remaining credibility. Key Topics Discussed Bill Cassidy's primary loss and the cost of the Kennedy confirmation vote Cassidy's earlier vote to convict Trump after January 6 followed by his decisive vote advancing RFK Jr. as HHS Secretary. Howard and Orent's view that Cassidy's promise to "keep Kennedy in line" was hollow from the start. What Cassidy's defeat signals about Trump's grip on the Republican base in Louisiana — and the hosts' read that his lame-duck status may give him cover to block the next round of HHS nominees. Marty Makary's resignation and the "worst FDA Commissioner in 25 years" framing The Stat News piece characterizing Makary's tenure, and the reporting that flavored nicotine was the precipitating issue with Trump's tobacco-industry donors. Howard's counterpoint: Makary reportedly approved a batch of electronic nicotine delivery systems (ENDS) on May 5, 2026 — the weekend before he resigned — undercutting the "principled stand" narrative. The pattern of selfie videos, public-facing performance, and what former FDA staff describe as hostile management of career scientists. Makary's pre-FDA record: the "medical error is the third leading cause of death" claim, Omicron as "nature's vaccine," "Omicold," herd immunity calls in May 2021, and the Nazi-bioweapon Lyme disease theory amplification. Vinay Prasad, regulatory whiplash, and the rare disease community How Prasad's stated preference for randomized controlled trials translated into rejection of rare disease therapies — and the disconnect between calling for RCTs on Twitter and the practical impossibility of running them for small patient populations. Right-to-try advocates, the libertarian wing of MAHA (Senator Ron Johnson), and why they turned on Prasad. Howard's point: Pfizer's halted COVID vaccine RCT in 50–65-year-olds is the case study — the trials Prasad demanded couldn't actually be enrolled. Tracy Beth Hoeg, the leaked pediatric deaths memo, and the Maryanne Demasi interview Hoeg's insistence she was fired, not resigned, and her interview with Brownstone Institute–adjacent journalist Maryanne Demasi. Her claim that the chaos at the FDA was "created by the media" rather than real. The memo alleging 10 pediatric deaths from the COVID vaccine that career FDA staff would not sign off on — and Howard's contrast with the J&J/thrombosis response, where nine deaths produced immediate, transparent action. Hoeg's role in the Denmark-style vaccine schedule rollback memo alongside Makary. The Makary–Prasad ZDoggMD clip on FDA "vindictiveness" — and the irony Audio pulled from a pre-appointment Prasad/Makary appearance describing the FDA as "erratic," "capricious," and politically pressured. Howard's read: every criticism they leveled at the Biden-era FDA describes their own tenure — political pressure from Trump, demoted career staff, inconsistent standards. The Peter Marks / Marion Gruber / Phil Krause booster episode reframed in light of what followed. John Mandrola, Adam Cifu, and the cost of vouching Mandrola's "Can We Give the New FDA's Leadership a Chance?" piece a year earlier — and the line about Prasad and Makary inducing companies to run proper RCTs, set against Pfizer's halted trial. Howard's account of an email exchange with Cifu following Cifu's visit to NYU — Howard's offer of a serious content-level conversation, and Cifu's decline. The broader "medical conservatives" project and what the hosts argue has happened to its credibility. Jay Bhattacharya, NIH, and the resignation letter from departing staff The letter from a senior NIH scientist on Bhattacharya's leadership — political termination of grants, deals institutions are making to recover funding, and Bhattacharya's silence. Howard and Orent's read on Bhattacharya's visible deterioration and his retreat into Great Barrington nostalgia. Kennedy's behind-the-scenes vaccine review and Martin Kulldorff The New York Times reporting (Christina Jewett and Sheryl Gay Stolberg) on Kennedy's vaccine inquiry being led by Kulldorff. Howard's pushback on the framing of Kulldorff as merely "a critic of restrictions and mandates" — and the 2020 record of his herd-immunity-through-infection advocacy, including his Stockholm "almost at herd immunity" claim in April 2020. The hosts' concern that the COVID amnesia project lets pandemic-era pro-infection figures re-enter regulatory power with their record sanitized. Casey Means, Surgeon General nomination withdrawal, and MAHA fracturing The withdrawn Surgeon General nomination and what it signals. The Robert Malone vs. Makary public falling-out over the unreleased pediatric deaths data. Why the MAHA coalition — held together by shared COVID grievance — is coming apart now that COVID has receded from headlines. Notable Moments On Cassidy: "He betrayed his oath as a physician, he betrayed the American people, and he's going down into the ignominious dust." — Wendy Orent On the Makary–Prasad–Hoeg trio: "The same skill sets that catapulted these guys to power — essentially being excellent podcasters — do not translate into leading a government agency of tens of thousands of employees that regulates 20 percent of the US economy." — Jonathan Howard On the legacy: "These guys are now cautionary tales for medical students. I would love to teach a course called 'Be the Opposite of Bill Cassidy, Marty Makary, Vinay Prasad, and Tracy Beth Hoeg.'" — Jonathan Howard On Bhattacharya: "His soul has been totally corrupted by the people who he teamed up with. You also see it in his face. He's not the same person that took the position." — Jonathan Howard References Mentioned in the Episode Stat News — "Why Marty Makary Was the Worst FDA Commissioner in 25 Years" Vinay Prasad's 2016 Stat News rebuttal of Makary's "medical error" claim David Gorski (Science-Based Medicine, 2016) — rebuttal of the medical-error-as-third-leading-cause-of-death claim Jonathan Howard, Science-Based Medicine — recent piece compiling Makary's COVID-era statements New York Times — Christina Jewett and Sheryl Gay Stolberg on Kennedy's vaccine inquiry Washington Post — "Ouster of RFK's Allies Tests MAHA-Trump Alliance" Ben Mazer, The Atlantic — on whether Makary and Prasad enacted lasting change Francis Lee — In COVID's Wake Alfred Crosby — America's Forgotten Pandemic Maryanne Demasi interview with Tracy Beth Hoeg MedPage Today — Makary and Prasad, "The Importance of Humility in Medicine" People Referenced Marty Makary — outgoing FDA Commissioner Vinay Prasad — former CBER Director Tracy Beth Hoeg — fired FDA official Senator Bill Cassidy (R-LA) — lost primary Robert F. Kennedy Jr. — HHS Secretary Jay Bhattacharya — NIH Director Martin Kulldorff — leading Kennedy's vaccine review Peter Marks — former CBER Director, Operation Warp Speed Bob Kadlec — Operation Warp Speed David Kessler — former FDA Commissioner (referenced) Marion Gruber and Phil Krause — former FDA vaccine reviewers John Mandrola and Adam Cifu — "medical conservative" commentators Robert Malone — anti-vaccine activist Casey Means — withdrawn Surgeon General nominee Senator Ron Johnson (R-WI) Representative Jake Auchincloss — opened FDA whistleblower line Art Caplan — bioethicist (retirement) Erica Schwartz — CDC Director nominee, unconfirmed  

 Dr. Matthew Nagra makes his fourth appearance on the podcast. And this time he's laser-focused on the social media-driven controversy around seed oils. Dr. Nagra and his team put in the hours and reviewed the science around seed oils, examining three main, viral claims we bust down in this episode, including:  1.     “Seed oils cause inflammation”, 2.     “The RCTs prove harm”, 3.     And “Heating or processing creates toxic compounds”. Dr. Nagra is a Naturopathic Doctor devoted to bringing the most up-to-date, evidence-based nutrition information to his patients in his Vancouver-based practice, and to the public via social media, presentations, and scientific publications. He aims to correct mis- and disinformation in a way that is easily digestible, helping people make fully informed dietary choices. He has also contributed to multiple nutrition textbooks, including Springer Nature's Handbook of Public Health Nutrition, and is a nutrition science advisor for the highly anticipated documentary, The Game Changers 2. You can also catch him in Episode 84, where we look at evidence around swapping out animal and plant-based meat; Episode 47, focused on misinformation around the Food Compass System; and Episode 2, where we talk about nutrition myths and misinformation more broadly. RESOURCES Concerns about the health effects of industrially produced seed oils are without scientific foundation: a scoping narrative review of the clinical and observational evidence Dr. Nagra's Website Instagram Facebook X Support the show

Gina, a perinatal fitness trainer, birth doula, and founder of MamasteFit in North Carolina, explains how exercising during pregnancy improves quality of life during pregnancy and postpartum—not just birth outcomes—while noting prenatal exercise research is still limited. She highlights a 2025/2026 American Journal of Obstetrics and Gynecology systematic review (11 RCTs) finding the strongest biomarker benefits from 12+ week programs done 2–3 times/week at moderate-to-vigorous intensity, including reduced pro-inflammatory markers, improved glucose/insulin regulation (supporting lower gestational diabetes risk), better lipid regulation, and favorable hormone/growth-factor changes linked to placental function and possibly baby brain development. Another 2025 review (9 RCTs, 1,500+ participants) suggests strength training may reduce excessive weight gain, low back/sciatic pain, and improve mood, sleep, fatigue, and well-being. She also cites studies indicating high-intensity lifting and even Valsalva can be well-tolerated with adequate rest and self-monitoring, then outlines MamasteFit's endurance-focused programming (compound lifts, accessory multi-plane work, myofascial slings, and posterior-chain emphasis) and promotes their app/video programs with a discount code.00:00 Why Prenatal Exercise Matters00:46 Meet Gina and MamasteFit01:38 What Research Can Tell Us02:23 Biomarkers and Training Dose05:11 Inflammation and Glucose Control08:05 Lipids Hormones and Baby Brain10:46 Strength Training Quality of Life13:17 Heavy Lifting and Valsalva Safety18:03 Listening to Your Body18:58 How to Program Prenatal Lifting20:54 Movement Variety and Posterior Chain23:04 Programs and Final Takeaways————

Welcome to Episode 1 of the SciTech Critical Evaluation of Literature and AI Series: “Evidence Unlocked: Separating Gold from Gravel"Not all evidence is created equal, so how do you separate gold from gravel? Join experts from the MAPS Scientific & Technical Knowledge Domain for a fast-paced session designed to simplify critical appraisal for busy professionals. In just a few minutes, you'll learn how to navigate the hierarchy of evidence and apply practical frameworks. We'll also share a step-by-step approach for rapid evaluation, helping you assess robustness, and clinical relevance without getting lost in complexity. If you want to make smarter, faster evidence-based decisions, this podcast is for you!Learning Objectives: Understand the hierarchy of evidenceExplain the differences between randomized controlled trials (RCTs), observational studies, real-world data, and preprints, and why they matter for evidence quality.Recognize key frameworks for critical appraisalIntroduce GRADE, PRISMA, and CONSORT as practical tools for evaluating robustness, reproducibility, and clinical relevance.Apply a rapid evaluation approachProvide a simple, step-by-step method for quickly assessing scientific literature without compromising rigor.Hear more from the Scientific & Technical Knowledge Domain through their position paper: "Safeguarding Scientific Rigor in the Critical Evaluation of Literature"

In episode 620, Mike K and James bring back Danielle Perry, this time to talk about the evidence around the use of colchicine for secondary cardiovascular prevention. There are some large RCTs so we talk about all the numbers and as always put them into the proper context. To claim your CPD credits, click the link below and then select "Claim Credits Now".  BS Medicine Episode #620: Back on the stand: Colchicine for secondary cardiovascular prevention update - CFPCLearn

Creatine Beyond Muscle: Cognitive Benefits, Supplement Basics, and Pragmatic Sports Nutrition with Dr. Jose Antonio Jason Wright interviews Dr. Jose Antonio about creatine's mainstream status, dosing (3–5 g/day vs. 10–20 g/day), and emerging cognition data, noting higher doses may be needed to raise brain creatine and benefits appear mainly under stress such as sleep deprivation, with vegans/vegetarians responding more. Antonio argues for a pragmatic approach that values RCTs but also real-world evidence, and debunks myths about “better” creatine forms (monohydrate is best studied), puffiness, and liver/kidney harm. He recommends focusing on exercise first, then basics like post-workout protein, creatine, a multivitamin, and omega-3s, with performance aids (sodium bicarbonate, beta-alanine, nitrates, carbs) depending on sport. They discuss EAAs, fasting, GLP-1 weight loss and lean mass loss, and Antonio's current research on energy drinks (mostly caffeine), beta-hydroxybutyrate, and a planned creatine/eye-tracking study relevant to sports. Antonio invites listeners to the ISSN conference in Fort Lauderdale (June 17–19). 00:00 Creatine Comes Full Circle 03:56 Creatine Mainstream and Brain Dosing 05:33 Science Pragmatism Over Purism 11:17 Mechanisms Sleep and Vegans 14:40 Creatine Myths and Forms 18:00 Safety Kidneys and Liver 20:02 Simple Supplement Stack Over 40 28:27 EAAs Protein and Fasting 31:43 GLP-1s and Lean Mass Concerns 33:25 GLP-1 Lean Mass Tradeoffs 34:28 Body Positivity Backlash 35:46 Staying On Drugs Long Term 37:06 Building Exercise Habits 42:21 Health Over Vanity 42:59 Sponsor Authentic Health 44:30 Supplements Compliance Reality 48:08 Energy Drinks And BHB 49:57 Creatine For Eye Tracking 54:38 Training For Longevity 58:01 Lateral Movement And Balance 01:00:12 Conference Invite And Wrap 01:01:21 Medical Disclaimer

Wherever Roshaneh Zafar went in Pakistan in the early 1990s, documenting World Bank social development projects, women told her the same thing: the water and sanitation are fine, but what about economic opportunity?Zafar tells Tim Phillips how that question led her to train with Muhammad Yunus and the Grameen Bank, and then back to Pakistan to found Kashf Foundation in 1996 — the country's first specialised microfinance institution for women. Thirty years on, Kashf serves more than one million clients, has covered six million lives through micro-health insurance, and has financed over 3,000 low-cost private schools. Zafar describes a model that long ago outgrew its Grameen origins: customised for Pakistan's diversity, run on a partnership rather than a hierarchical footing, and now embracing climate risk, ultra-poor programmes and AI-assisted credit decisions.The episode also confronts the question: Does microfinance actually empower women? Research has questioned whether it makes a difference. Zafar has ten years of longitudinal data that tells a different story, and a view on why the two bodies of evidence are not as contradictory as they appear.Research and references discussed in this episode:Banerjee, Abhijit, Esther Duflo, Rachel Glennerster, and Cynthia Kinnan. 2015. "The Miracle of Microfinance? Evidence from a Randomized Evaluation." American Economic Journal: Applied Economics 7(1): 22–53.Rana, Annum Ather. 2025. Evidence on the Impact of Microfinance Program on Poverty Reduction and Income Security. Kashf Foundation Focus Note Series, April To cite this episode:Phillips, Tim, and Roshaneh Zafar. 2026. "Roshaneh Zafar on 30 years of microfinance and mindset change in Pakistan." VoxDev Talk (podcast). Assign this as extra listening. The citation above is formatted and ready for a reading list or VLE.About Roshaneh ZafarRoshaneh Zafar is the founder and managing director of Kashf Foundation, Pakistan's first specialised microfinance institution. A development economist by training, she worked at the World Bank before leaving to found Kashf in 1996 after training under Muhammad Yunus at Grameen Bank in Bangladesh. Her work spans microfinance, micro-insurance, women's economic empowerment, low-cost private education and behaviour change communication. Research and context cited in this episodeGrameen Bank and the Grameen model. Founded by Muhammad Yunus in Bangladesh in 1983, Grameen Bank pioneered group-based lending to poor women without requiring collateral, on the premise that social accountability within borrower groups could substitute for asset security. Yunus received the Nobel Peace Prize in 2006. Kashf was established as a Grameen replicator but diverged significantly in its approach: hiring women loan officers from the outset, replacing the group hierarchy with a peer partnership model (using the Urdu term baji, meaning sister, for both client and staff), and adapting products for Pakistan's religious, linguistic and cultural diversity.The 2008 microfinance delinquency crisis in Pakistan. Over-indebtedness, predatory lending practices and the absence of a credit information bureau led to a sector-wide delinquency crisis in Pakistan in 2008. Following the crisis, regulators, lenders and the Pakistan Microfinance Network introduced enhanced consumer protection standards and a credit bureau to prevent multiple borrowing. Kashf now limits lending to clients with no more than two active loans from any provider.Banerjee et al. (2015) randomised controlled trial. The paper, a randomised evaluation of a microcredit expansion in Hyderabad, India by Spandana Sphoorty, found no statistically significant effect on women's empowerment, health, education or consumption over an 18-to-24-month follow-up period. It became the most-cited challenge to microfinance's development impact. Zafar's counter-argument turns on time horizon: empowerment, she argues, is a decade-scale process that short-panel RCTs cannot capture. A University of Minnesota longitudinal analysis of ten years of Kashf client data found a statistically significant positive correlation between the number of loans taken and business income, and between savings behaviour and subsequent business investment.Behaviour change communication: theater and television. Kashf has used street theater for thirty years to communicate on topics including child marriage, girls' education, reproductive health and insurance take-up. After Zafar attended a conference session on the impact of telenovelas on gender norms in Brazil and Mexico, the foundation moved into television drama production, covering topics including child sexual abuse, human trafficking and cybercrime. A child sexual abuse drama prompted a legal notice from PEMRA (the Pakistan Electronic Media Regulatory Authority), which was successfully contested. The dramas are produced with a media and creative team to ensure sensitive handling of difficult subjects.The gender bond and gender sukuk. In 2005, Zafar rang the opening bell at the New York Stock Exchange. The experience prompted a long-term ambition to connect micro women entrepreneurs to capital markets. Kashf subsequently issued a gender bond listed on the Pakistan Stock Exchange, followed by a gender sukuk (Sharia-compliant bond) listed on the Luxembourg Stock Exchange — the first such instrument linking Pakistani microfinance to international Islamic capital markets.Low-cost private schools. Research by Kashf found that clients, once they had access to income, were moving their children from public to low-cost private schools; teacher absenteeism in private schools was far lower. Further research showed 70% of these schools were run by women. Kashf began financing them; it now supports over 3,000 such schools, with a requirement that girls constitute at least 50% of enrolment.More VoxDev Talks on this topicBreaking down access constraints faced by women: Experimental evidence from Pakistan, a VoxDev Talk on how removing specific barriers to vocational training take-up shifts economic participation among women in Pakistan — the supply-side complement to Kashf's demand-side model.How safe transport could unlock women's labour force participation in Pakistan, a VoxDev Talk on how mobility constraints suppress women's economic activity in urban Pakistan, and how subsidised women-only transport services can shift that.Related reading on VoxDevWhat have we learned about microfinance?, a VoxDev article reviewing the evidence base on microfinance impact, including the conditions under which credit does and does not produce lasting change in household welfare.Women's microcredit groups empower women politically, a VoxDev article on evidence that participation in group lending schemes produces political voice and civic engagement even when economic empowerment effects are limited.Empowering women through digital financial services, a VoxDev article on how mobile money and digital accounts give women a private, named financial identity — and what that does to their control over household resources.

This episode considers how antibiotic use can be safely reduced in children in high-risk scenarios or with severe infections. To discuss this we are joined by Dr Nadja Vissing and Dr Ulrikka Nygaard, paediatric infectious disease specialists from Copenhagen University Hospital, who led a randomized controlled trial in Denmark evaluating the early discontinuation of empirical antibiotics versus extended treatment in children with cancer and high-risk febrile neutropenia. We hear about the importance of this trial for children with cancer and their families as well as for broader antimicrobial stewardship. We discuss other recent RCTs that are informing safely reducing antibiotic exposure in children with urinary tract infections, uncomplicated bone and joint infections and probable early onset neonatal sepsis. Nadja and Ulrikka share with listeners their take home messages related to antibiotic decision-making from these trials along with words of wisdom and motivation for other paediatric clinical trialists. Click here to read the full article: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(26)00039-8/fulltext

CoQ10 and Stroke Recovery: What the Science Actually Shows Your brain is the most energy-hungry organ in your body. It accounts for roughly 2% of your body weight but consumes about 20% of all the energy you produce. One of the key molecules driving that energy, CoQ10, quietly declines from your 30s onwards. For stroke survivors navigating fatigue, cognitive changes, and the long arc of recovery, that raises an obvious question: could supplementing with CoQ10 actually help? This mini-episode examines the peer-reviewed evidence — not marketing copy, not supplement industry claims, but what clinical research actually shows. What Is CoQ10 and Why Does It Matter After a Stroke? Coenzyme Q10, also known as CoQ10, or ubiquinol in its active form, is a molecule your body produces naturally. It lives primarily in the mitochondria, the energy-producing structures inside your cells, where it plays two roles: generating ATP (the cellular energy currency everything in your biology runs on) and acting as a powerful antioxidant that neutralises free radicals. When a stroke occurs, whether ischemic or hemorrhagic, the brain undergoes what is called ischemia-reperfusion injury. Blood flow is cut off, then restored. That restoration triggers inflammation and a surge of oxidative stress. Mitochondria in neurons start failing. Cells die not just from the original event but from the metabolic fallout that follows. CoQ10 goes directly to the site of that problem. If levels can be sustained or supplemented adequately, the theory is that it could reduce the secondary damage unfolding in the hours, days, and weeks after stroke. What Does the Clinical Research Actually Show? A landmark 2025 review published in the journal Nutrients analysed 12 animal studies and 8 human randomised controlled trials examining CoQ10’s effects on the brain. The findings are genuinely mixed, which is exactly what honest science looks like. In animal models, the evidence is consistent and compelling. Across Alzheimer’s, Parkinson’s, and epilepsy models, CoQ10 supplementation produced meaningful improvements in cognitive function via reduced oxidative stress, decreased neuroinflammation, increased ATP production in the hippocampus, and reductions in amyloid plaque burden. In humans, the picture is more complex. Of the 8 human RCTs reviewed, 4 showed evidence of benefit in specific conditions. In Progressive Supranuclear Palsy, frontal lobe cognitive function improved significantly. In Chronic Fatigue Syndrome, 150mg daily for 8 to 12 weeks improved working memory and reduced oxidative stress markers. In one Parkinson’s trial combining CoQ10 with creatine, cognitive improvements were measured at 12 and 18 months. However, trials in Alzheimer’s disease and Mild Cognitive Impairment showed no significant cognitive benefit, even at high doses. There is also an unresolved question: whether supplemental CoQ10 can cross the blood-brain barrier in meaningful quantities. Indirect pathways improved cerebral blood flow, reduced systemic inflammation, and may account for observed effects rather than direct brain-level action. What This Means for Stroke Survivors The honest assessment: the research supports a biologically plausible mechanism. CoQ10 is depleted by the conditions that cause and follow stroke. Supplementation shows real benefit in some neurological conditions. Animal evidence is consistently positive. But large-scale human RCTs specifically in stroke populations are still limited. Two practical points worth raising with your treating team before starting CoQ10: Form matters. Ubiquinol (the reduced form) has significantly higher bioavailability than standard ubiquinone, particularly important for older adults whose absorption is lower. Drug interactions. CoQ10 can reduce the anticoagulant effect of warfarin, a medication many stroke survivors take. It may also amplify blood-pressure-lowering effects of antihypertensive medications. Take the research, not the marketing, to your neurologist or GP. Ask whether it is appropriate, given your specific stroke type and current medications, what dose the evidence supports, and how long a reasonable trial period looks like. For more evidence-based tools and conversations with people who have walked this road, Bill’s book is a good place to start: https://recoveryafterstroke.com/book Support the community on Patreon: https://patreon.com/recoveryafterstroke This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. The post CoQ10 and Stroke Recovery: What the Science Actually Shows appeared first on Recovery After Stroke.

This month for the April 2026 episode of the RCEM Learning Podcast I speak with eight amazing speakers from the RCEM Annual Conference. This will be an absolutely bumper episode, and next month I will be speaking to seven speakers who are just as interesting. If you'd like to email us, please feel free to do so here. After listening, complete a short quiz to have your time accredited for CPD at the RCEMLearning website! (02:53) RCEM AC Interview Megamix - Part 1 of 2 (02:53) Andrew Lockey - Defibrillation strategies: To dual or not to dual? (15:01) Chelcie Jewitt - Not just a surgical problem: Sexual misconduct in EM (23:49) Michael Barrett - The MAGPIE Trial (42:30) Rebecca Whiticar - Top 5 common claims in EM (51:02) Ben McKenzie - AMAX4 (01:03:58) Annette Rickard and Ali Griffiths - Making dying better in the ED (01:17:36) Dan Horner - Diagnosis and management of pulmonary embolism in the ED (01:28:45) Dan Perry - Getting CRAFFTy about SCIENCE: Results from international RCTs in paediatric orthopaedic trauma Further Links and Reading Cheskes et al. - Defibrillation Strategies for Refractory Ventricular Fibrillation Surviving in Scrubs Hartshorn et al. - Treatment of acute trauma-related pain in children and adolescents with methoxyflurane (Penthrox®) compared to placebo (MAGPIE): A randomised clinical trial MPS & Rebecca Whiticar - Law at the front door AMAX4 Plymouth Hospital End of Life Pathway High Five for High PEITHO? Intermediate-high risk PE (St. Emlyn's) The CRAFFT Study

Event Objectives:Use the See/Believe/Create framework to identify at least one actionable, evidence-based change in their practice or community to reduce preventable morbidity and mortality among their patients.Apply the Burden × Amenability framework to rank preventable conditions by their potential for population-level impact—and explain why that ranking should drive clinical and advocacy priorities.Distinguish the strengths and limitations of RCTs from other forms of evidence—using examples such as back-to-sleep—to evaluate clinical and public health recommendations critically.Claim CME Credit Here!

Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? A viewer reached out recently with a question I have been getting more frequently: Does near infrared light therapy actually help the brain recover after stroke? It is a fair question — the claims circulating online range from cautiously promising to outright extraordinary. In this post, I am going to cut through the noise and look at what the peer-reviewed research actually shows. What is Near-Infrared Light Therapy? Near infrared (NIR) light therapy — also called photobiomodulation (PBM) or transcranial photobiomodulation (tPBM) when applied to the head — uses specific wavelengths of light (typically 630-1100 nm) to penetrate tissue and interact with cells at a biological level. This is not a tanning lamp or a heat lamp. The mechanism is specific: NIR light at the right wavelengths is absorbed by cytochrome c oxidase, a key enzyme in mitochondrial energy production. When stimulated, cytochrome c oxidase increases ATP synthesis — essentially giving cells more energy to carry out repair and function. For neurons recovering from ischaemic or haemorrhagic stroke, the theory is compelling: damaged brain cells that are energy-starved might benefit from an additional energy stimulus. The Mechanism: What the Biology Says The cytochrome c oxidase pathway is well-established in photobiology. What is less settled is whether light at therapeutic intensities can penetrate the skull deeply enough to reach relevant brain structures. Skull and scalp tissue absorb and scatter light substantially. Transcranial delivery requires sufficient power density (irradiance) at the source and long enough exposure to accumulate meaningful fluence (energy dose) at depth. Studies using ex vivo human skull specimens suggest that only 1-3% of surface irradiance reaches cortical tissue at clinically relevant depths — and deeper subcortical structures receive even less. This does not make tPBM ineffective — it means dosing is everything. And most consumer devices do not disclose their irradiance or fluence specifications, which makes comparing them to clinical trials nearly impossible. What the Research Shows Animal Studies: Encouraging Signals Several well-designed rodent studies have demonstrated that tPBM applied within hours to days of stroke onset reduces infarct volume, improves functional recovery, and modulates neuroinflammation. A 2019 study by Thunshelle et al. found tPBM reduced lesion size in ischaemic stroke models and improved neurobehavioural scores. Animal models are useful for mechanistic insights. However, rodent skulls are thinner and brain structures are more superficial than in humans — so translational accuracy is limited. Human Clinical Trials: More Complicated The human evidence is where the story becomes nuanced. The NeuroThera Effectiveness and Safety Trial (NEST-1 and NEST-2) were the most prominent early RCTs. NEST-1 (2007) reported positive outcomes for acute ischaemic stroke patients treated within 24 hours. However, NEST-2 (2009), a larger double-blind RCT with 660 patients, failed to replicate those results on its primary outcome measure. NEST-3 was halted early in 2013 after an interim analysis showed it was unlikely to meet its primary endpoint. What went wrong? Researchers identified several issues: heterogeneous stroke populations, inconsistent dosing protocols, and the fundamental challenge of transcranial light delivery in adults with varying skull thickness and tissue composition. More recent work has shifted focus. A 2023 review by Zomorrodi et al. examined pulsed tPBM and found preliminary evidence for cognitive and neurological benefits in traumatic brain injury and neurodegeneration — but noted the absence of large, well-powered RCTs in stroke specifically. The Consumer Device Problem Here is where I have to be direct with anyone considering purchasing a NIR device for home use. Clinical studies use medical-grade devices with precisely calibrated irradiance, typically 10-700 mW/cm2 at the source, with controlled exposure times to achieve specific fluence targets (often 0.9-36 J/cm2). Consumer devices vary enormously — and most do not publish their specifications at all. Buying a NIR cap or helmet marketed for brain wellness is not equivalent to receiving the protocol used in clinical research. This does not mean it is harmful. It means we do not know whether you are getting a therapeutic dose, a sub-therapeutic dose, or anything in between. The Stakes If you are in recovery from a stroke or brain injury and you are exploring every option — which I completely understand — the risk here is not primarily financial. The risk is investing hope, time, and energy into something that may or may not be delivering what clinical trials suggest is therapeutic. The opportunity, on the other hand, is real: the underlying biology is sound, and the research pipeline is active. This is an area worth watching closely. Three Actionable Steps Talk to your neurologist or rehab physician before purchasing any device. Ask specifically whether tPBM has been considered in your care plan and what the current clinical guidance is. If you want to explore the evidence yourself, search PubMed (pubmed.ncbi.nlm.nih.gov) for transcranial photobiomodulation stroke — filter for systematic reviews and RCTs published after 2018 for the most current picture. Check ClinicalTrials.gov (clinicaltrials.gov) for active trials recruiting stroke survivors for tPBM studies. Participation in a trial gives you access to a properly calibrated protocol and contributes to the evidence base. What Recovery Can Look Like When the brain is given the right conditions — adequate sleep, nutrition, rehabilitation, reduced inflammation, and potentially adjunct therapies that the evidence supports — healing happens in ways that can surprise both patients and clinicians. I have spoken with hundreds of stroke survivors on this channel who found approaches that contributed meaningfully to their recovery. Not a single one found a shortcut. But many found tools — used thoughtfully, in partnership with their medical team — that made a genuine difference. That is what this channel is about: doing the work so you can make informed decisions. References Lampl Y et al. Infrared laser therapy for ischemic stroke: a new treatment strategy. Stroke. 2007;38(6):1843-9. PMID: 17463313. pubmed.ncbi.nlm.nih.gov/17463313 Zivin JA et al. Effectiveness and Safety of Transcranial Laser Therapy for Acute Ischemic Stroke (NEST-2). Stroke. 2009;40(4):1359-64. PMID: 19233936. pubmed.ncbi.nlm.nih.gov/19233936 Thunshelle C, Hamblin MR. Transcranial Low-Level Laser (Light) Therapy for Brain Injury. Photomed Laser Surg. 2016;34(12):587-598. PMID: 27854434. pubmed.ncbi.nlm.nih.gov/27854434 Zomorrodi R et al. Pulsed Near Infrared Transcranial and Intranasal Photobiomodulation Significantly Modulates Neural Oscillations. Sci Rep. 2019;9(1):6309. PMID: 31004089. pubmed.ncbi.nlm.nih.gov/31004089 Bill Gasiamis is a stroke survivor and the host of the Recovery After Stroke podcast. He is not a medical professional. Nothing in this post constitutes medical advice. Always consult your treating physician before starting any new therapy. The post Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? appeared first on Recovery After Stroke.

Send us Fan MailDr. Brandon Tucker and Dr. Jenelle Ferry share two studies tackling some of the most pressing challenges in the care of extremely low birth weight infants. Dr. Tucker presents a quality improvement initiative examining whether switching from PRN glycerin suppositories to scheduled glycerin enemas every 12 hours reduces feeding intolerance and spontaneous intestinal perforation in babies under 1,000 grams — with early results trending in the right direction. Dr. Ferry then shares findings from a meta-analysis of 14 studies and nearly 4,700 babies showing that an exclusive human milk diet is associated with a roughly 20% reduction in the odds of death — a finding that reached statistical significance when RCTs and observational cohorts were pooled together, and one that carries real weight for units still weighing the evidence on human milk-based nutrition.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Jonathan and Wendy unpack the most surprising political move of Trump's second term: the nomination of Dr. Erica Schwartz — a physician, lawyer, former Coast Guard public health official, and unapologetic architect of military vaccine mandates — to run the CDC. Praised by figures like Jerome Adams, Vin Gupta, and Dorit Reiss, and openly loathed by RFK Jr.'s attack-dog attorney Aaron Siri, Schwartz's selection is read as a signal that the White House is quietly sidelining Kennedy ahead of the midterms and trying to win back the saner corners of the GOP. From there, the hosts dig into the widening fault lines inside MAHA: Marty Makary vs. Robert Malone — the "10 children killed by the COVID vaccine" report Makary promised has never materialized, and Malone is now publicly accusing him of the exact cover-up Makary accused his predecessors of. Vinay Prasad's exit from the FDA — his much-hyped randomized controlled trial of the Pfizer COVID vaccine in healthy 50–64-year-olds failed to recruit, proving (again) that tweeting about RCTs is easier than running them. Jonathan plays Prasad's own year-old promise back against him. The rumored FDA replacement — ophthalmologist and Twitter personality David Hooman, whose COVID-vaccine misinformation record would send exactly the wrong signal. Jay Bhattacharya on the rally circuit — CPAC, Turning Point USA, Kennedy rallies, DeSantis rallies — all while insisting "science shouldn't be political." Plus his role in suppressing a CDC vaccine-safety study and the UCSF faculty petition to block Prasad's return. The peptides free-for-all at the FDA, and why Kennedy still has enough juice to throw bones to his wellness-grifter base. Also: measles in Utah, a Moab travel detour, and a plea to every journalist, clinician, and listener still pushing back. MAHA is on its back foot — the job now is to keep the pressure on.

RCTs and intervention studies show plant-based diets improve survival and treatment response for prostate, breast, and colorectal cancer. #CancerSurvivorship #WholeFoodHealing #NutritionScience #OncologyCare

In episode 620, Mike K and James bring back Danielle Perry, this time to talk about the evidence around the use of colchicine for secondary cardiovascular prevention. There are some large RCTs so we talk about all the numbers and as always put them into the proper context. Show Notes Tools For Practice Back on […]

OxygenCare, a leading provider of life-saving medical equipment and solutions, has announced the launch of its new online shop and rental platform. In addition to other medical devices, the platform will provide exclusive access on the island of Ireland to Medela Symphony hospital-grade breast pumps, enabling parents and healthcare providers to rent or buy them. By improving access to the Medela Symphony breast pump, OxygenCare is well-positioned to better meet the high demand for breast pumps from parents across Ireland. The HSE reports that there has been an 18.6% increase in the percentage of babies breastfed at the 3 months developmental check-up since 2015. Breast feeding provides unparalleled health benefits for both baby and mother. From powerful immune system support and perfect nutrition aiding easy digestion for baby to fast post-partum recovery for mum. Breast pumps act as a supportive tool that empowers mothers to continue providing those benefits while navigating the demands of modern life, managing health challenges, and sharing the joy of feeding their baby with others. The Symphony breast pump supports mothers with: 2-Phase Expression Technology, which imitates a baby's natural sucking action Initiation Technology, which imitates a newborn's sucking pattern in the first few days after birth and can increase milk supply by 50% Pre-set programmes that are easy to use An anatomical oval breast shield with 105? angle, resulting in more milk while experiencing more comfort. Symphony stands as the most rigorously studied hospital-grade breast pump currently available. Its clinical efficacy is supported by a robust body of peer-reviewed research, including 8 randomised controlled trials (RCTs), 1 non-randomised controlled trial (NRCT), and 2 cohort studies. As the exclusive and sole distributor for the Medela Symphony breast pump, OxygenCare has developed a rental programme within its online shop which allows new parents to set up a rolling or once-off agreement. Individuals can then collect the breast pump from the OxygenCare office or a designated pharmacy*. Alternatively, it can be delivered to a location of their choice. Linda Ryan Head of Sales OxygenCare said: "When you have a baby, there is so much to think about and not everyone's birthing and feeding experience is the same. Whatever the circumstances, our aim is to make it more convenient for those who want to use breast pumps to access these vital devices." Maurice Moran Managing Director OxygenCare added: "As with everything we do at OxygenCare, the rollout of our online shop and these products is all about providing more choice, reliability and value for both healthcare providers and patients. In turn, we hope to improve support and enhance experiences." In addition to Medela Symphony® breast pumps, the OxygenCare online store also facilitates the purchase of AED defibrillators and accessories, as well as the TempoTherm Thermometer. The medical device webstore will continue to expand its offering over the coming months to include other product offerings. You can access the OxygenCare medical device web shop at www.shop.oxygen-care.com. See more stories here.

Feeling drained, foggy, and inflamed — and can't figure out why? In this episode of the supplement ingredient series, Nurse Doza breaks down glutathione, the body's master antioxidant. Produced in the liver and essential for fighting oxidative stress, glutathione levels are depleted in 1 in 4 people with fatty liver — making supplementation a game-changer for energy, brain clarity, digestion, and overall detox capacity.    Featured Partner: SHED   SHED delivers glutathione in a direct-to-bloodstream vial format — bypassing the gut degradation that makes most oral supplements ineffective. For anyone battling fatty liver, brain fog, low energy, or chronic inflammation (exactly the conditions discussed in this episode), SHED's bioavailable glutathione offers what diet alone can't replicate: fast, measurable antioxidant replenishment at the cellular level.

What does it really take to lift millions out of poverty and prevent needless deaths?In this special compilation episode, 17 past guests — including economists, nonprofit founders, and policy advisors — share their most powerful and actionable insights from the front lines of global health and development. You'll hear about the critical need to boost agricultural productivity in sub-Saharan Africa, the staggering impact of lead poisoning on children in low-income countries, and the social forces that contribute to high neonatal mortality rates in India.What's so striking is how some of the most effective interventions sound almost too simple to work: banning certain pesticides, replacing thatch roofs, or identifying village “influencers” to spread health information.Full transcript and links to learn more: https://80k.info/ghdChapters:Cold open (00:00:00)Luisa's intro (00:00:58)Development consultant Karen Levy on why pushing for “sustainable” programmes isn't as good as it sounds (00:02:15)Economist Dean Spears on the social forces and gender inequality that contribute to neonatal mortality in Uttar Pradesh (00:06:55)Charity founder Sarah Eustis-Guthrie on what we can learn from the massive failure of PlayPumps (00:14:33)Economist Rachel Glennerster on how randomised controlled trials are just one way to better understand tricky development problems (00:19:05)Data scientist Hannah Ritchie on why improving agricultural productivity in sub-Saharan Africa is critical to solving global poverty (00:24:36)Charity founder Lucia Coulter on the huge, neglected upsides of reducing lead exposure (00:47:48)Malaria expert James Tibenderana on using gene drives to wipe out the species of mosquitoes that cause malaria (00:53:11)Charity founder Varsha Venugopal on using village gossip to get kids their critical immunisations (01:04:14)Rachel Glennerster on solving tough global problems by creating the right incentives for innovation (01:11:31)Karen Levy on when governments should pay for programmes instead of NGOs (01:26:51)Open Philanthropy lead Alexander Berger on declining returns in global health, and finding and funding the most cost-effective interventions (01:29:40)GiveWell researcher James Snowden on making funding decisions with tricky moral weights (01:34:44)Lucia Coulter on “hits-based giving” approaches to funding global health and development projects (01:43:01)Rachel Glennerster on whether it's better to fix problems in education with small-scale interventions versus systemic reforms (01:48:12)GiveDirectly cofounder Paul Niehaus on why it's so important to give aid recipients a choice in how they spend their money (01:51:09)Sarah Eustis-Guthrie on whether more charities should scale back or shut down, and aligning incentives with beneficiaries (01:56:12)James Tibenderana on why we need loads better data to harness the power of AI to eradicate malaria (02:11:22)Lucia Coulter on rapidly scaling a light-touch intervention to more countries (02:20:14)Karen Levy on why pre-policy plans are so great at aligning perspectives (02:32:47)Rachel Glennerster on the value we get from doing the right RCTs well (02:40:04)Economist Mushtaq Khan on really drilling down into why “context matters” for development work (02:50:13)GiveWell cofounder Elie Hassenfeld on contrasting GiveWell's approach with the subjective wellbeing approach of Happier Lives Institute (02:57:24)James Tibenderana on whether people actually use antimalarial bed nets for fishing — and why that's the wrong thing to focus on (03:05:30)Karen Levy on working with governments to get big results (03:10:53)Leah Utyasheva on how a simple intervention reduced suicide in Sri Lanka by 70% (03:17:38)Karen Levy on working with academics to get the best results on the ground (03:29:03)James Tibenderana on the value of working with local researchers (03:32:15)Lucia Coulter on getting buy-in from both industry and government (03:35:05)Alexander Berger on reasons neartermist work makes sense even by longtermist standards (03:39:26)Economist Shruti Rajagopalan on the key skills to succeed in public policy careers, and seeing economics in everything (03:47:42)J-PAL lead Claire Walsh on her career advice for young people who want to get involved in global health and development (03:55:20)Audio engineering: Ben Cordell, Milo McGuire, Simon Monsour, and Dominic ArmstrongContent editing: Katy Moore and Milo McGuireMusic: CORBITCoordination, transcriptions, and web: Katy Moore

Walking Home from the ICU PodcastTranslating the ICU with Stephen Ramsey — Series 1, Episode 1Episode SummaryKali Dayton officially welcomes Stephen Ramsey — CVICU physical therapist, creator of the Ramsey Protocol, and lead author of the ELSO guidelines — as the newest member of the Dayton ICU Consulting team. In this kickoff episode of Translating the ICU, Kali and Stephen explore why physical therapists and occupational therapists are often rotating generalists in the ICU rather than dedicated specialists, and what needs to change to elevate rehab's impact on critically ill patients.Key Topics Covered​Introducing "Translating the ICU" — a new podcast series focused on physiology, pathophysiology, and critical thinking applied to real and theoretical ICU case studies​CSM 2024 recap — Stephen's talks on redefining PT's role in the ICU and point-of-care ultrasound; Kali's panel on what early mobility should actually look like​The case for dedicated ICU rehab staffing — why rotating therapists undermine momentum, relationships, and patient outcomes​PT/OT education gaps in critical care — invasive hemodynamics, pharmacology, diagnostic imaging, and ventilator management are largely absent from training​Competency vs. potential — why redefining practice standards matters more than questioning individual intelligence or capability​Mobility as a physiology test — Steven's framework for PT as "physiology tester," using mobilization to generate clinical data and drive medical decision-making​Johnson 2019 data — dedicated CVICU PT/OT staffing increased from 2 to 4 clinicians → ICU length of stay decreased by 3.6 days​The 2025 meta-analysis (60+ RCTs, ~8,500 patients) — timing matters more than intensity in early mobility​Ventilator management and SBTs — why PTs need to understand spontaneous breathing trials and provide physiologic feedback before extubation decisions​Building trust on the ICU team — demonstrating competency through relationships, not just credentials​Barriers facing revolutionists — fear of mistakes, leadership pressure, staffing rotations, and how to push forward anywayResources & People Mentioned- Steven Ramsey — @ThePOCUSPT | The Ramsey Protocol | ELSO Guidelines​Kali Dayton — DaytonICUConsulting.com​Christina Perme's ICU Rehab Course​Heidi Engel & Jenna Hightower​Johnson 2019 CVICU staffing study​2025 early mobility meta-analysis (60+ RCTs)Connect & Work With Us​Consult with Kali on transforming your ICU's sedation and mobility practices → DaytonICUConsulting.com​Coaching with Stephen Ramsey — one-on-one or team sessions for ICU rehab staff → www.DaytonICUConsulting.com and @ThepocusPT​Online courses — coming soon from both Kali and Stephen​Critical care ultrasound course for ICU clinicians — available now at ThePocusPT.comFollow Kali on Instagram for open discussion, anonymous Q&A, and cross-disciplinary ICU conversations.

Send us Fan MailIn this interview episode, Ben and Daphna sit down with Professor Brett Manley to discuss a paradigm shift in neonatal research: adaptive platform trials. Frustrated by the inefficiencies and underpowered results of traditional RCTs, Dr. Manley outlines the ambitious Platypus Adaptive Platform Trial launching in Australia and New Zealand. They dive into how shared primary outcomes, novel consent models, and massive cross-center collaboration can answer pressing clinical questions—like optimal PPROM antibiotics and caffeine dosing—simultaneously. Tune in for a fascinating conversation on moving beyond medical dogma, embracing humility, and keeping families at the center of NICU research!Learn more about the Platipus trial here: https://www.platipustrial.org/ Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

This episode examines whether unprocessed red meat has a causal role in (1) type 2 diabetes risk and intermediate measures of glucose intolerance (insulin resistance, beta cell dysfunction, glycemic markers) and (2) cardiovascular disease (CVD) risk. While there is commonly observed risk signal from observational cohorts, there exist short-term randomized controlled trials (RCTs) that show largely null effects on glucose homeostasis. This had led to differing opinions and interpretations of the evidence base. Some feel that in the context of an otherwise healthy diet, there isn't much to suggest concern about consuming unprocessed red meat. While others are of the view that there does exist a risk and that limiting or even avoiding consumption is prudent. The crucial concept of replacement effects is discussed. Increasing red meat intake always means decreasing something else or increasing total energy intake. Therefore, interpreting evidence requires specifying the comparator food(s), the background dietary pattern, the dose, the cut (lean vs fatty), and how the meat is prepared. To discuss their interpretations of this contentious evidence base, Dr. Mario Kratz and Dr. Gil Carvalho join the podcast to go through the studies most directly related to these questions. Timestamps [06:20] Red meat's impact is debated [10:54] Mechanisms linking meat to diabetes [15:31] Cohort evidence on diabetes risk [24:43] Differences between cohorts and threshold effects [33:13] RCT evidence and substitution trials [45:49] Why comparator foods matter [50:43] RCT examples and mixed results [01:00:30] Is there cardiovascular risk beyond saturated fat? [01:08:10] Epidemiology patterns and dose thresholds [01:11:36] Personal recommendations and risk tolerance [01:16:19] Key ideas Related Resources Go to episode page (study links, guest bios, additional resources) Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Mario's YouTube channel: Nourished By Science Gil's YouTube channel: Nutrition Made Simple!

Can a ketogenic diet improve mental health?This week marks a significant moment for metabolic psychiatry and ketogenic therapy for serious mental illness.A New York Times piece highlighted early research from Stanford University, The Ohio State University, and the University of Edinburgh—alongside stories from individuals who have shared their lived experience here on Metabolic Mind.This kind of visibility matters. It reflects years of work by researchers and clinicians like Drs. Chris Palmer, Shebani Sethi, and Iain Campbell, research funded by Baszucki Group, advocates like Jan Baszucki, as well as the many people who have been willing to share their personal stories.Lived experience alone isn't enough. Early data alone isn't enough. But together, they point to something that must be tested, confirmed — or challenged — through high-quality science. That's why we are excited about several RCTs currently completed or underway around the world.We need to continue efforts to advance education, public awareness and research on a scale that will require public funding. That's how medicine moves forward. And that's the exciting work ahead.

Guest Dr. John Gore and host Dr. Davide Soldato discuss JCO article, "12-Month Results from the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent Non-Muscle Invasive Bladder Cancer," which compares radical cystectomy and bladder sparing therapy for patients with recurrent high-grade non-muscle invasive bladder cancer. Dr. Gore and Dr. Soldato focus on the study's patient-centered approach, eligibility criteria, and quality of life after treatment. TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes. Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. John Gore, urologist at Fred Hutch Cancer Center and professor of urology at University of Washington School of Medicine. Today, we will be discussing the article titled, "Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non-Muscle-Invasive Bladder Cancer." Thank you for speaking with us, Dr. Gore. Dr. John Gore: Thank you so much for having me. Dr. Davide Soldato: So, I just want to jump right in. We know that patients who are diagnosed with recurrent high-grade non-muscle-invasive bladder cancer can be treated with two different approaches. So, one is radical cystectomy, and the other is bladder-sparing therapy. I just wanted to understand: what was the gap that you were trying to fill with this study? In particular, one point that is very important is that this study is very centered on the preference of the patients. Why did you choose this endpoint instead of going for more solid oncology-based endpoints? Dr. John Gore: Yeah, so CISTO was a study that was derived really organically from patient engagement. I think as a clinical gap in care, making a decision about when to pursue radical cystectomy for patients with non-muscle-invasive bladder cancer is a tough decision for us as clinicians. We did some engagement work partnered with the Bladder Cancer Advocacy Network and my partner Angela Smith, and found that it is also a huge gap for patients. You know, they are very anxious about recurrences, and the decision about when to take out the bladder is a very difficult one. We did an evidence synthesis and found that evidence guiding this decision is fairly limited. The reason we chose more of a patient-reported endpoint is several-fold. One is that we, as part of our engagement work, also worked with our patient survey network to identify outcomes that were important to patients. Some of those are the same outcomes that we care about as clinicians - recurrence-free survival and metastasis-free survival - but several outcomes came out that were more patient-centered. These were patient-reported outcomes such as the burden on my finances, the burden on my caregiver or loved one, and the ability to return to physical activities that are important to them. Part of what is unique about CISTO is that this was a contract with PCORI where we knew we would only have about 12-month outcomes for the majority of our patients. That is too early to really derive a lot of the clinical outcomes, but we are able to answer that patient-centered question of, "Am I going to be able to return to physical activities that are important to me?" And that was the genesis of that as the primary endpoint. Dr. Davide Soldato: So, who were the patients that were eligible to participate in the CISTO trial? What were the key eligibility criteria? This is very particular to this study because this was actually an observational study. Why did you think that such a pragmatic approach still can inform us on what is the best treatment approach for these patients? Dr. John Gore: The intent of CISTO was not necessarily to focus on the tightly defined BCG-unresponsive patient population. That is a clearly important patient population, but every day we are all faced in our real-world practice with patients with challenging, high-grade recurrences that don't fit neatly into that BCG-unresponsive box. The reason we chose a broader inclusion was to help doctors and patients answer these same questions they have when it doesn't fit nicely into this BCG-unresponsive category. You know, maybe their BCG exposure was two years ago, but now they are having a recurrence after intravesical chemotherapy. That is no less challenging a clinical conundrum, and we wanted to be able to enroll those patients. Other key inclusions were that all of the patients in CISTO had to have BCG at some point, and they had to have recent exposure to some adjuvant instillational or intravenous therapy like pembrolizumab. We also had some exclusions that were important. They couldn't be participating in a phase 2 clinical trial, and they couldn't have had a prior upper tract urothelial cancer. The other point about the observational trial design is I think a really important one. Part of our engagement work also asked patients about their willingness to randomize. There is a ton of literature in our history of trials that failed to accrue well when they were comparing a large-scale surgical intervention with a more conservative management strategy. What we found is only about 10% of patients would be willing to randomize when the clinical comparison is between radical cystectomy and bladder-sparing therapy. So it was very clear that an observational study design was the only way we were going to get evidence to inform clinical care when one of the key comparators was radical cystectomy. And so that is why we utilized the observational trial design. Dr. Davide Soldato: Starting to go deeper into the results, you mentioned before that the endpoint you chose for this trial was really centered on what patients thought was more important to them. In particular, the primary endpoint of the study was physical function as measured by the EORTC QLQ-C30 questionnaire. I just wanted to understand: first, did you have a solid hypothesis regarding how physical function could be impacted by either radical cystectomy or bladder-sparing treatments? And second, what were the key results of the study? Dr. John Gore: We figured that at 12 months after enrollment, given the burden and morbidity of a radical cystectomy, that patients in the radical cystectomy arm would have worse self-reported physical functioning than patients in the bladder-sparing therapy arm. We did hypothesize that some of our secondary outcomes might potentially be better after radical cystectomy, such as recurrence-free survival and potentially some other cancer-specific outcomes, because it is a more definitive management strategy. For our primary endpoint, however, we hypothesized that it would be worse. What we found, and the key finding of our study, is that at 12 months after enrollment, physical functioning was not different between patients undergoing radical cystectomy and patients undergoing bladder-sparing therapy, which is just important in terms of clinical counseling because it just means that you can tell your patients, "Gosh, if we could fast-forward your life six to nine months after this procedure, your physical functioning would be similar to as if you had been able to keep your bladder." Dr. Davide Soldato: And you mentioned that there were some key secondary endpoints of the study, which included both other dimensions of quality of life and also hard clinical outcomes. We mentioned metastasis-free survival, for example. Going a little bit into the key secondary quality of life outcomes, we know that radical cystectomy can impact physical functioning, but we also know that bowel, sexual symptoms, and also genitourinary symptoms might potentially be impacted by this type of treatment. We also know that, especially in a system like the US, financial toxicity can be a significant burden for patients. Considering the two different approaches, was radical cystectomy better also in other key secondary quality of life outcomes, and was financial toxicity different between the two arms? Dr. John Gore: Thank you for highlighting some of the really important secondary outcomes that I think are really important to trying to figure out what's best for your patients. Some of the main ones were some of the bladder cancer-specific quality of life outcomes you highlight. Urinary quality of life was worse at enrollment in patients in the radical cystectomy arm but was no different 12 months after. What is unique about how we measure that is we used an instrument called the Bladder Cancer Index because we're comparing a population of patients who have lost their bladder with a population of patients who have retained their bladder, and there are different considerations by gender. And so that instrument is agnostic to urinary diversion status and gender. We found that bowel function and sexual function were worse in the radical cystectomy arm. It appeared that bowel functioning was getting better to the point of near equivalence at 12 months in the radical cystectomy arm but was still inferior to bladder-sparing therapy, and that probably relates to the fact that we use the bowel as part of the urinary diversion, and that causes some transient disruption in bowel function. Financial toxicity is an outcome we weren't initially planning on having as part of the CISTO study, but based on that patient feedback, we made that one of our key secondary outcomes. That actually demonstrated superiority in the radical cystectomy arm. I think it's important that we remember that when we do bladder-sparing therapy, those patients are predisposed to a number of visits to our office, whether they're for instillational therapies or cystoscopy surveillance visits. Sometimes that involves the patient themselves, and sometimes that involves a caregiver. We live in an area with a very large geographic catchment, so sometimes that involves overnight hotel stays and airfare. It can be a particular burden, as you made mention, especially in our healthcare system. Dr. Davide Soldato: Going back to the quality of life dimensions and especially considering the different treatments, 50% of the patients received radical cystectomy with robotic surgery. Did you look a little bit into whether the type of surgery that they received might potentially impact on these dimensions of quality of life? Dr. John Gore: These are some questions that a lot of urologists have asked us in the surgical arm, related to surgical approach, so robotic versus open, and urinary diversion type. We sometimes reconstruct the urinary tract with an incontinent diversion called an ileal conduit where the urine drains tonically into a bag, and we sometimes do a continent diversion where someone typically will have a neobladder, where you reconstruct a sphere reservoir out of intestines and sew it to the urethra. About 20% of patients in the radical cystectomy arm in CISTO had a neobladder. We have not yet looked at specific surgical factors and some of those outcomes. That is one of the secondary analyses that we have planned, but we have not drilled into how different surgical approach factors can affect some of our outcomes. Fortunately, we have about 200 patients in the radical cystectomy arm, so it's enough patients that hopefully we can look at some of those factors in the future. Dr. Davide Soldato: Going back to the clinical endpoints, you mentioned that several of these were measured. There was metastasis-free survival, cancer-specific survival, and progression-free survival. We now have the data at 12 months. I am just wondering if you can comment on those when comparing the radical cystectomy with the bladder-sparing techniques. Dr. John Gore: I think importantly, bladder cancer-specific survival was very high in both arms, over 95% at one year. So both patient populations do very well in terms of cancer-specific and overall survival at one year. You know, when you take out the bladder, you're taking out a big source of recurrences. Not surprisingly, there was a marked reduction in recurrences in the radical cystectomy arm, so they had better recurrence-free survival. There actually was worse progression-free survival in the radical cystectomy arm, but there is a big asterisk to that. As you noted, it is an observational study, and one of the areas of imbalance in the study is that we had higher cancer severity in the radical cystectomy arm. So there was about a 20% rate of progression at the time of radical cystectomy to muscle-invasive and node-positive disease. Of those progressions, the overwhelming majority of them were progressions at the time of radical cystectomy, which I think speaks to a couple of important factors. Number one is the challenge in staging these patients. Our staging of non-muscle-invasive bladder cancer is very reliant on our resection. And so there is this risk of understaging our patients. Number two is just the challenge of decision making, that we fear losing our window of cure in this patient population, which is why we try to steer some patients toward radical cystectomy, and that progression figure kind of speaks to that. Dr. Davide Soldato: Also, one of the factors that was most common in the patients who received radical cystectomy was the presence of other high-risk features. For example, non-urothelial histology, which I think is something that in clinical practice we tend to fear a little bit in terms of recurrence, and so it might potentially bias a little bit towards proposing more strongly radical cystectomy to the patient. Another thing that I wanted to have a comment on, so this is not really in the paper, but I think it speaks a little bit to how the data will evolve over time. Do you imagine these clinical outcomes changing over time, and do you think that with higher maturity of these endpoints, this study might be even more informative when counseling patients regarding what they are obtaining with a radical cystectomy versus the other type of treatments? Dr. John Gore: You know, I think in this cancer universe, 12-month outcomes are great, but I think we all want to see two-year and five-year outcomes. We're very fortunate to supplement the work that we've done in the initial CISTO study, we're very fortunate that we've gotten supplementary funding from the National Cancer Institute to get long-term outcomes in this patient population. So we are continuing to follow all of our CISTO study patients to get two-year and five-year outcomes. What we expect to find is the accrual of new events in the bladder-sparing therapy arm. About 7% of patients in the bladder-sparing therapy arm underwent cystectomy in the first year, but that number will probably go up either as they have recurrences or progression events. We definitely expect the recurrence-free survival to continue to have superiority in the cystectomy arm, but we probably will see the progression events equilibrate as more progression events accrue in the bladder-sparing therapy arm. Maybe by five years, we hypothesize that we'll see clinical superiority in the radical cystectomy arm. By then, we might also see mortality events that separate bladder cancer-specific survival and overall survival between the two arms potentially. But we don't know. Hypothetically, cystectomy has its own downstream risks. It is a major reconstruction with some metabolic sequelae and renal functional sequelae, and so there may be some general medical events that accrue in the cystectomy arm that are also impactful. Dr. Davide Soldato: One other thing that I think should be complimented on this study is that you also looked at several other endpoints that might be important for patients. For example, anxiety symptoms and depression symptoms. Dr. John Gore: Yeah, I think one of the other key secondary outcomes we looked at were mental health outcomes. We utilized the PROMIS domains of anxiety and depression. Not unexpectedly, our radical cystectomy arm patients exhibited higher anxiety symptoms and higher depression symptoms at enrollment. What we found is at 12 months, they actually had significantly lower anxiety and depression than patients in the bladder-sparing therapy arm. We hypothesized in this paper that that actually relates probably mostly to cancer-specific anxiety. You know, when you experience this cavalcade of recurrences, it just breeds an anxiety about adverse cancer-specific outcomes, and by taking out the bladder, you kind of eliminate this prevalent source of anxiety. We followed up the study with a qualitative piece where we interviewed 50 patients and 20 caregivers. Based on those interviews, and that's just a sample of the patient population, it did seem to be cancer-specific anxiety that was driving a lot of those responses. Dr. Davide Soldato: I would like to end with a methodological consideration on your part because we said that this was an observational study. Frequently we tend to think that observational studies come with a lot of bias, and so we tend to downgrade a little bit the results. But I think that a lot of the merit that goes in the CISTO study that was published in the JCO, and I think it also speaks to the fact that this is very high-quality data, comes with the fact that the methodology behind this study was really robust in terms of informing us. Even with this observational study that, as you said, was the only one that we could perform considering the patient population. So just a comment on your part also to speak to the solidity of the data that was published. Dr. John Gore: Importantly, you know, if you look at ClinicalTrials.gov or other sources, CISTO is the only trial that has radical cystectomy as a major comparator. In many ways, this study is our only source of evidence for radical cystectomy. So we'd rather have flawed observational evidence than no evidence at all. We all experience flaws of our RCTs as well. They tend to be these narrowly defined patient populations that may not match the patient in front of you. So I think there are unrecognized flaws on the other side as well. The way that we try to counterbalance that, and none of these techniques are perfect, but we used a strategy called 'targeted maximum likelihood estimation'. Like many methods, such as propensity scores or instrumental variable analysis, what we're trying to do theoretically is coax randomization from non-randomized data. And TMLE, which is the technique we use, tends to be pretty robust to that. So it's the best available way that we can try to counterbalance the bias based on age and clinical severity between the two patient arms. I also think what's important about this is that even when there are biases, I think we are able to infer those out and still extract meaningful details from the data. So even with the biased data, I think we all glean some really important clinical learnings from it. Dr. Davide Soldato: Absolutely, but I would also say that in terms of observational data, the work that you have done is really something that makes us quite confident about what you found in the CISTO study. So with this, I would like to thank you again for joining us today. Dr. John Gore: Thank you so much, and thank you for highlighting the CISTO study. We are very excited about the data. Dr. Davide Soldato: So Dr. Gore, we appreciate you sharing more on your JCO article titled, "Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non-Muscle-Invasive Bladder Cancer." If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Guest Disclosure Dr. Gore:Consulting or Advisory Role: Astellas Pharma  

The conversation with formulator Matt Legge pulls back the curtain on the supplement industry, framing it as a metaphysical struggle between genuine intent and the corporate Machine. Matt's journey is a hero's exile from structures like Metagenics, which prioritize efficiency over the soul of the product. This machine churns out soulless, AI-generated formulas that chase "white space," utterly neglecting the deep clinical insight of Root Cause Analysis—a meditation of the pulse. The founder's sacrifice creates the Pearl of Reciprocity, the organizational soul. The primary struggle is protecting this soul from "middle management" by constantly acting as the Chief Reminding Officer (CRO). The ultimate takeaway is a profound choice: to ethically play the regulatory puzzle with a full-spectrum approach and prioritize being the most respected—the "early bird gets the worm"—over merely being the biggest.   CORE INSIGHTS: [1:00-1:50] The Formulator's "Exile" and the Call to Invent: Deemed "unemployable" by a major practitioner brand due to his excess of innovative ideas, Matt Legge was effectively pushed to start his own supplement brand. [2:30-3:30] Critique of Claim-Driven Formulation: The core problem in the supplement industry is formulating for claims using single, trademarked extracts, disregarding the natural synergy of multi-ingredient or whole-herb formulations. [5:30-6:30] The Threat of AI-Generated Formulas: New brands often use AI or agencies to formulate identical, "soulless" products (e.g., Ashwagandha, B6, Magnesium Glycinate) based on market "white space," which sidesteps genuine root cause analysis. [9:30-10:30] Root Cause as Clinical "Meditation": Identifying the true root cause is subjective, requiring deep clinical insight—like a "meditation" of the pulse—that goes beyond generic university diagnoses. [11:30-13:00] The Limitations of RCTs in Natural Medicine: The parachute analogy to argue that natural medicine, with thousands of years of traditional use, does not always require modern RCTs that often exclude the sick people the medicine is meant to help. [14:00-15:30] The "Pearl of Reciprocity" and Organizational Soul: Mason views a founder's genuine intent and sacrifice as creating the "Pearl of Reciprocity"—a metaphysical, organizational soul that guides the company toward its purpose of "health and harmony." [29:00-30:00] The Chief Reminding Officer (CRO): To combat high staff turnover ("The Wiggles Theory"), the founder must act as the "Chief Reminding Officer" (CRO), perpetually repeating the brand's foundational ethos and "campfire stories" to maintain its core cultural spirit. [35:30-36:30] Innovation Stifled by Middle Management: Middle management, lacking the company's ethos, stifled innovation by rejecting Matt's inventions because a market segment for the original ideas did not yet exist. [54:30-56:00] The Ethical Full-Spectrum Formulation Approach: Modern ethical formulation uses a nuanced approach: combining standardized extracts (for regulatory claims) with full-spectrum whole herbs to ensure nature's full synergy. RESOURCE: Instagram: leggylegge. LINKEDIN: Matt Legge

The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects.  Features Dr. Jack Cush, Editor at RheumNow.com.  SHOW NOTES FDA sent a complete response letter to AstraZeneca on their application (BLA) for anifrolumabs (Saphnelo) subcutaneous use in SLE. Despite a positive TULIP-SC trial & EU approval of SC-anifrolumab, FDA & sponsor still have to work things out. CRL reasons are unknown https://t.co/3dNwEyolrj Review of Calcinosis Cutis - Surgical intervent. most effective (excision, curettage, laser ablation, etc). Medical measures inconsistently, partially effective, best if used early & localized (CCB, TCN, probenecid, immunomodulation, biologics, colchicine, NA thiosulfate, & JAKi https://t.co/rv0hQBv6nX Systematic Review of Targeted Rx for Systemic Sclerosis: from 32 RCTs & 2036 pts Rx w/ 23 targeted agents. Guselkumab had greatest effect on mRSS, followed by tofacitinib, inebilizumab, & baricitinib. For FVC, B-cell Rx (belimumab, RTX) had highest efficacy https://buff.ly/vHOSRws Dermatomyositis outcomes w/ 2475 pts (claims) & 1196 pts (EHR). Half had myositis panels & 35% had + MSAbs. Steroid use common in 69% & 74%. HCQ, MTX, MMF. Outocmes (per 1000PYs) wereL all-cause hospitalisation 92, malignancy 15.3, ILD 6.4, and myocarditis 2.1 https://t.co/DJqKGNGX76 Danish DERMBIO registry of psoriasis pts Rx w/ biologics. Among 3790 bionaive pts ustekinumab had best 1-5 yr survival vs (ADA & SEC). In 3403 bioexperienced pts, bimekizumab, guselkumab, & risankizumab had highest 2-year drug survival rate. https://t.co/TInyLPMYkb Real-world study of 1202 #PsA pts shows that secukinumab retention rates were lower w/ smoking (79%/73%/72% in never/former/current smokers) but not w/ obesity (72%/77%/77% in normal/overweight/obese), Adh HR signif. higher w/ former (1.32) & current smokers (1.27)   https://t.co/1REWmod73W Together PSO Trial - Combination Ixekizumab and Tirzepatide Today Lilly announced top line results of the TOGETHER-PsO open-label, Phase 3b trial demonstrating the significant benefits of concomitant ixekizumab (IXE: an IL-17A inhibitor) and tirzepatide (TIR: GLP-1agonist) over https://t.co/YWCjN2NyGM

EVOLUT Low Risk data, a provocative meta-analysis, DNR orders, targeted hypothermia, good news in HFpEF evidence, and GLP-1s as AF drugs are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I EVOLUT Low Risk 6-year Results and a 5-year Meta-Analysis of TAVR vs SAVR 6-Year Outcomes of TAVR vs SAVR https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5063 EVOLUT Low Risk Trial at 2 years https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 EVOLUT Low Risk Trial at 3 years https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 EVOLUT Low Risk Trial at 4 years https://www.jacc.org/doi/10.1016/j.jacc.2023.09.813 Nonproportional Hazards for Time-to-Event Outcomes in Clinical Trials https://www.jacc.org/doi/10.1016/j.jacc.2019.08.1034 TAVR vs SAVR 5-Year Outcomes - Systematic Review https://heart.bmj.com/content/early/2026/02/11/heartjnl-2025-327092 TAVR vs SAVR Updated Meta-Analysis of RCTs https://www.jacc.org/doi/10.1016/j.jacc.2024.12.031 UK TAVI Trial https://jamanetwork.com/journals/jama/fullarticle/2792251 Dr David Cohen on X https://x.com/djc795/status/2023556582030852172?s=46&t=zXMCUoVjSsdyemzWlzeBjA II DNR in the Hospital Inadequate Documentation of Unilateral DNR Orders https://jamanetwork.com/journals/jama/fullarticle/2829203 GeriPal Blog Unilateral DNR Orders https://geripal.org/unilateral-dnr-gina-piscitello-erin-demartino-will-parker/ III Yet another failure of Targeted Hypothermia 2-Year Follow-Up of TTM2 Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2845193 TTM2 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2100591 IV Good news in HFpEF Evidence ALT-FLOW II Trial https://doi.org/10.1093/ejhf/xuaf016 V GLP-1 as AF drugs Semaglutide as Adjunctive Therapy in Obesity-Related PAF https://doi.org/10.1093/europace/euag018 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Are statins as risky as labels suggest?

In this episode of Chewing It Over, Jack speaks with researcher and osteopath David Evans about what has actually changed in low back pain care over the past 20 years — and what hasn't. Using data from a unique follow-up study comparing physiotherapists, osteopaths, and chiropractors, David reveals that the story is more nuanced than the usual “hands-on vs hands-off” narrative.Spinal manipulation use has fallen across all three professions — not just physios — while massage and acupuncture have increased, suggesting clinicians haven't abandoned hands-on care, but have shifted the type of intervention used. Specific exercises have declined while general exercise has risen, aligning more closely with guideline messaging around activity and self-management. Interestingly, these trends don't map neatly onto clinical guidelines, raising questions about what really drives practice change: pain science discourse, safety concerns, professional identity, training exposure, and system pressures all emerge as possible influences.The conversation moves beyond techniques to bigger issues in MSK care: the limits of pathway-based models, the “average effect” problem in RCTs, and why back pain research may be set up to underestimate treatment impact by measuring outcomes many months later. A major theme is the long-standing struggle to move beyond “non-specific low back pain.” David argues the future may lie in mechanism-based subgrouping (nociceptive, neuropathic, nociplastic, inflammatory) — if diagnostic precision can improve enough to meaningfully guide treatment.

Is everyone really low in vitamin D? Or have we been sold a narrative that doesn't hold up under scrutiny? In this mind-blowing episode, Tara sits down with Regina and Kristin, the investigative duo behind the Normal Curves podcast, to explore the truth behind the so-called "vitamin D deficiency epidemic." Spoiler: it may have been manufactured by outdated, flawed science—and driven by people with major conflicts of interest. This is a must-listen for anyone taking vitamin D or worried about their levels. If you've been told your D is "low," this episode might change everything. In this episode we cover: How the original vitamin D reference ranges were set (and how they were quietly reversed in 2024) Why testing vitamin D routinely may be doing more harm than good The role of conflicts of interest in shaping clinical guidelines What the latest randomized controlled trials (RCTs) actually show about supplementing vitamin D for disease prevention Why observational data can mislead us, and how low D might be the consequence—not the cause—of illness How much sun you actually need to make enough vitamin D (hint: it's a lot less than you think) Why the "low D" narrative stuck around even after the science was overturned If you're thinking about taking D, already taking D, or have been told your vitamin D is "low" (it likely isn't) then this one is for you.   WATCH THIS EPISODE ON YOUTUBE -https://www.youtube.com/@TaraThorne   Regina Nuzzo is a Gallaudet professor, award-winning science journalist, and co-host of the Normal Curves podcast. She brings statistics to life for students and audiences worldwide, often using sex-science examples to keep things lively. Her writing has appeared in Nature, The New York Times, Scientific American, and the Los Angeles Times, where she wrote a column on the science of sex and relationships. Alongside co-host Kristin Sainani, she penned a long-running statistics column for Physical Medicine & Rehabilitation and now teaches a Stanford summer course on statistics for clinical informatics. Regina's work earned the American Statistical Association's Excellence in Statistical Reporting Award.   Kristin Cobb Sainani is a Stanford professor, science journalist, and co-host of the Normal Curves podcast. She brings statistics and scientific writing to students and audiences around the world. She also works as a statistician on sports medicine projects. Kristin has written widely about health, science, and statistics for both academic and popular audiences. She was a health columnist for Allure magazine for ten years and, alongside co-host Regina Nuzzo, penned a long-running statistics column for the journal Physical Medicine & Rehabilitation. In 2018, she received Stanford's Biosciences Award for Excellence in Graduate Teaching. Known for her statistical sleuthing and ability to cut through academic jargon, Kristin champions clear language and rigorous methods in science.   Mentioned in this episode: Normal Curves Podcast https://www.normalcurves.com/vitamin-d-part-1-is-the-deficiency-epidemic-real/     https://www.normalcurves.com/vitamin-d-part-2-good-for-more-than-just-your-bones/     Normal Curves Website: https://www.normalcurves.com/     EQUIP PRIME PROTEIN – Click HERE to grab yours and use my code: TARA to get 15% off. When you sign up for a subscription via my link, you'll save 30% on the first month & 15% on any subsequent months! Purchase Herbatonin here to get 15% automatically applied to your cart: https://symphonynaturalhealth.com/Tara PIQUE TEA – These are some of Tara's favourite teas! They're crystal form, which makes them super unique and easy to transport in your purse, (they come in single use satchels!) and higher in polyphenols. They're made from high quality ingredients with triple toxin screening, (super important when it comes to your tea). Click HERE to visit the shop. HRT Made Simple™ - Learn how to confidently speak to your doctor about the benefits of hormone replacement therapy so you can set yourself up for symptom-free, unmedicated years to come without feeling confused, dismissed, or leaving the medical office minus your HRT script. Hair Loss Solutions Made Simple™ – This course will teach you the best natural, highly effective, and safe solutions for your hair loss so you can stop it, reverse it, and regrow healthy hair without turning to medications. The Perimenopause Solution™ – My signature 6-month comprehensive hormonal health program for women in midlife who want to get solid answers to their hormonal health issues once and for all so they can kick the weight gain, moodiness, gut problems, skin issues, period problems, fatigue, overwhelm, insomnia, hair/eyebrow loss, and other symptoms in order to get back to the woman they once were. [FREE] The Ultimate Midlife Perimenopause Handbook - Grab my free guide and RECLAIM your confidence, your mood, your waistline and energy without turning to medications or restrictive diets (or spending a fortune on testing you don't need!).   [BOOK A 30-MINUTE SESSION WITH TARA HERE]

In this episode of A Whole New Level, Christopher Gardner, PhD, joins Mike to discuss his decades in nutrition research, the challenges of conducting randomized controlled trials (RCTs) on diet, and how to communicate complex science to the public. Gardner has led some of the most rigorous research ever comparing dietary approaches in real-world conditions, so his insights about what works (cutting processed food and sugar) and what doesn't (obsessing about macronutrients) are worth a listen. Sign Up to Get Your Free Ultimate Guide to Glucose: https://levels.link/wnlIn this episode, we cover:What a nutritional interventionist is – someone who studies people who are asked to change their diet, tracking them and taking samples to see what might have changed.How to square widely-accepted lessons about nutrition (i.e., junk food=bad) with the high degree of individuality in diets that work.The concept of "equipoise" in study design, which means making sure both diets being compared are well-represented versions of that diet (e.g., a "kick butt diet A and a crappy diet B" is avoided).The dilemma of communicating single-study results to the public and the role of the Netflix documentary on Gardner's famous twin study in making science engaging.Dr. Gardner's experience on the Dietary Guidelines Advisory Committee and the methodology used to reach conclusions.The focus on ultra-processed foods and the need to message the consensus points of eating more whole foods and vegetables, and avoiding added sugar and refined grains.The learnings from the DIETFITS study, which compared low-carb and low-fat diets among 600 people for a year, and why there was more variation among people within a diet than between the two diets.

Send us a textMore of us are being seen by nurse practitioners (NPs) and physician associates/assistants (PAs); for routine care outcomes look similar to physician visits, but for complex, new, or worsening problems you should push to see the doctor and ask for clear oversight.Key topicsWhy this is happening: Longer waits and rising demand meet a physician shortfall, so systems lean on NPs/PAs to expand access. New-patient waits average ~31 days, varying widely by city and specialty (AMN). Fewer people have a usual source of care, pushing visits to urgent care/ER (Milbank Scorecard).The scope shift: NP involvement in Medicare outpatient visits rose from 14% in 2013 to ~26% in 2019 (Harvard/Tradeoffs summary). Projections show rapid growth in NP and PA roles through 2030 (ValuePenguin analysis).Training differences (at a glance): NPs typically complete a master's/DNP with ~500–700 supervised clinical hours and, in many states, can practice independently; PAs complete a master's with ~2,000 supervised hours and practice with physician collaboration; physicians complete medical school plus 3–5+ years of residency (~10,000+ hours) and broad rotations—critical for complex differential diagnosis (AJMC overview).Quality of care, by the evidence: For common, protocol-driven issues, outcomes are generally similar. A Cochrane-summarized evidence base finds comparable results for blood pressure control, mortality, and patient satisfaction, with longer counseling time in NP visits (AJMC summary of RCTs). Patients often feel PAs spend more time with them (JAAPA survey). Diabetes care quality appears similar across clinicians (PubMed); NPs tend to deliver more smoking-cessation counseling (AANP brief).Where this works well: Routine follow-ups (blood pressure, cholesterol, diabetes), protocol-based care, minor acute concerns (UTI, simple URI), post-op checks when all is going well—especially with clear physician involvement.When to push for the doctor: New, unclear, or non-resolving problems (e.g., complex headaches, persistent back pain, ongoing fatigue or depression), multiple chronic conditions, many medications, or when a serious alternative diagnosis must be ruled out (e.g., “heartburn” vs. cardiac disease).Advocate for transparency: Ask in advance who you'll see, whether your case will be reviewed with a physician, and how escalation works if you're not improving.TakeawaysAccess will keep driving NP/PA growth; use it to be seen sooner.For routine care, NPs/PAs are often a solid choice with similar outcomes and more counseling time.For complexity, insist on physician evaluation or documented oversight.You have the power to ask questions, confirm the plan, and request escalation when needed.Links mentioned in this episode AMN wait-time trends →

This DIR® Dialogues panel explores the research base behind DIRFloortime®, highlighting both its strong, transdisciplinary foundations and the challenges of measuring developmental, relational change within traditional research models like randomized controlled trials (RCTs). The discussion emphasizes the need to rethink what counts as “evidence,” prioritize outcomes that reflect lived experience and long-term development, and expand research approaches to better support access, funding, and practice across ages and contexts.Link to the show notes with links to key discussion points and other ways to view or hear the episode here: ⁠https://affectautism.com/2026/01/23/dir-research/Consider joining our DIR® Parent Network or becoming an Affect Autism member for bonus content and support from a like-minded community of Floortimers here: ⁠⁠https://affectautism.com/support/

Exploramos los hallazgos más recientes sobre compresiones manuales versus compresiones mecánicas en la reanimación cardiopulmonar. ¿Qué opción ofrece mejores resultados en pacientes con paro cardíaco? ¿Qué deben saber los proveedores de ACLS hoy?

I was shocked at the comments on this post. Many people, some of them I know to be smart, thought I was nuts for suggesting two middle-aged women who had isolated high LDL-C needn't take meds because their calculated 10-year risk was less than 3% What shocked me is that our guidelines suggest treatment with statins when 10-year risk is ≥ 7.5%. You may not know this but clinicians are supposed to consider cholesterol (and BP) based on overall risk, which include things like age, blood pressure, smoking status as well as HDL. Here is a link to the PCE. It drives me bananas that clinicians don't go over this with patients. They just look at LDL-c in isolation. Content like this comes free of industry support. Please consider becoming a free or paid subscriber.Experts chose this a 7.5% threshold because they felt it was the point where the absolute risk reduction from statins (about 20-25% relative risk reduction) for nonfatal cardiac events outweighed any potential downsides of statins. It is an arbitrary threshold. The thinking: We know from many RCTs that statins reduce future risk by about 20-25% over 5 years. So .25 x the estimated risk outputs the absolute risk reduction. Let's say a person has a calculated risk of 10%. They can expect a 2.5% risk reduction (.25 x 10% = 2.5%) over 10 years. But .25 x 3% = .75, so a person with an estimated risk of 3% who takes a daily pill for 10 years goes to 2.25%. That's not much. Here are some pics of the pushback I recieved:My colleagues rightly point out that atherosclerosis of the coronary arteries is a slow process and longer exposure to lower LDL-c is beneficial. They feel that the 10-year horizon is too short. They cite something called Mendelian randomization studies which find that people who were born with genetic profiles that cause low cholesterol also have low rates of heart attacks. I wrote a post about this. I actually think that statins and blood pressure drugs may have greater effects in younger people who are at lower risk. But come on. Both individuals who I helped calculate risk were below 3%. That's too low to worry about. Further, if you think we treat people with elevated LDL levels who have this low of a risk, why do we need risk calculators? Or…why don't we just treat everyone above a certain age, since age is the largest driver in the calculators? These are issues I spoke with Drs Foy and Murthy about. I learned a ton. I hope you will too. Topics include:* The value of risk calculators* The uncertainty of prediction* The best time window to consider (statin trials were for 5 years; can we assume effect sizes over 5 years are similar at 30 years?) * The causal role of LDL-c vs “metabolic health”* The value of coronary artery calcium testing * Lipoprotein (a) Academic people like to make fun of podcasts, but I can't imagine a more educational 40 minutes. Andrew and Venk are two of the most thoughtful people in cardiology today. Enjoy and consider supporting Sensible Medicine This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

In this episode of the Smarter Not Harder Podcast, Dr. Matthew Bernstein joins Jodi Duval for a pioneering conversation about the rise of metabolic psychiatry — the intersection of mitochondrial health, nutrition, and brain performance. From ketogenic therapy to personalized mental health biomarkers, this episode offers a radically hopeful perspective on treating conditions like depression, OCD, bipolar disorder, and schizophrenia. Join us as we explore: • What metabolic psychiatry is and why it matters now   • How insulin resistance, inflammation, and mitochondria affect mood and cognition   • Why ketones aren't just fuel — but also powerful brain signals   • Tools like CGMs, RCTs, and the ACCORD program   • Supplements and real-world protocols for psychiatric healing This episode is for you if: • You or someone you love has struggled with medication-resistant mental illness   • You're curious how nutrition and metabolism affect the brain   • You want a psychiatrist's view on keto, CGMs, and continuous feedback   • You believe mental health deserves smarter, not harder solutions You can also find this episode on…   YouTube: https://youtu.be/-B6A63IG9p4 Find more from Dr. Matthew Bernstein:   Accord Program: https://accordmh.com/ LinkedIn: https://www.linkedin.com/in/mattbernsteinmd/ Instagram: https://www.instagram.com/accordmh/ Find more from Smarter Not Harder:   Website: https://troscriptions.com/blogs/podcast?utm_source=youtube&utm_medium=video&utm_campaign=snh_podcast_guest_episode_2025_10&utm_content=podcast_asset Instagram: https://www.instagram.com/troscriptions Get 10% Off your purchase of the Clinical Metabolomics Module by using PODCAST10 at https://www.homehope.org  Get 10% Off your Troscriptions purchase with code POD10 at https://www.troscriptions.com  Get daily content from the hosts of Smarter Not Harder by following @troscriptions on Instagram.

Send us a textIn this episode of the Active Mom Podcast, I'm joined again by Dr. Rita Deering, PT, DPT, PhD — Associate Professor of Physical Therapy and Director of the Movement Sciences Laboratory at Carroll University. With 18+ years of clinical experience and 15 years specializing in pelvic health, Dr. Deering is a leading researcher in perinatal musculoskeletal health, pregnancy and postpartum exercise, pelvic floor function, and female athlete performance.This conversation is a must-listen for anyone navigating the overwhelm of women's health information — clinicians, coaches, athletes, and moms trying to get real answers outside the noise. We dig into how to actually interpret research (not just quote it), what different study types really mean, and how to confidently separate evidence-based guidance from trending misinformation on social media.Whether you're dealing with pelvic floor symptoms, postpartum return to running or lifting, perimenopause changes, or pregnancy athletic performance, this episode brings clarity to the research so you can make informed decisions with confidence.We break down:What “evidence-based” actually means in pelvic health & pregnancy fitnessDifferent types of research (RCTs, systematic reviews, case studies) and how to interpret themWhy outliers in research don't invalidate lived experienceMaking research relatable and useful for everyday moms & athletesHow AI, algorithms, and social media fuel misinformationTranslating research to clinical practice without fear-based messagingWhy respectful, nuanced conversation in women's health actually helps patientsTime Stamps1:00 Introduction3:15 making research accessible7:58 what is PubMed13:50 different types of research18:20 transferring research to the clinic22:44 looking at the studies33:19 different levels of evidence37:04 systematic reviews and meta analysis43:10 changing approach to implementing research48:55 where the funding goes51:20 rapid fire questionsCONNECT WITH CARRIEIG: https://www.instagram.com/carriepagliano/Website: https://carriepagliano.comCONNECT WITH RITA:IG: https://www.instagram.com/ritadeeringphd/Website: https://www.carrollu.edu/faculty/deering-rita-phdThe Active Mom Podcast is A Real Moms' Guide to pregnancy, postpartum, perimenopause & beyond for active moms & the professionals who help them in their journey. This show has been a long time in the making! You can expect conversation with moms and professionals from all aspects of the industry. If you're like me, you don't have a lot of free time (heck, you're probably listening at 1.5x speed), so theses interviews will be quick hits to get your the pertinent information FAST! If you love what you hear, share the podcast with a friend and leave us a 5 ⭐⭐⭐⭐⭐ rating and review. It helps us become more visible in the search algorithm! (Helps us get seen by more moms that need to hear these stories!!!!)

Colette is joined by Dr. Ishan Shivanand, mental health researcher, professor, bestselling author, and founder of Yoga of Immortals (YOI). Raised in Indian monasteries within a 21-generation yogic lineage, Dr. Shivanand brings a rare integration of ancient wisdom and modern science. His groundbreaking double-blind RCTs show up to 82% improvement in insomnia, anxiety, depression, and overall quality of life in as little as 4–8 weeks. Together, they explore how meditation, breathwork, Yoga and Ayurveda can transform mental health and how these ancient sciences understood the mind long before modern neuroscience. This conversation offers both profound insight and practical inspiration for anyone seeking holistic wellbeing and preventative health practices. In this episode, they discuss: How a 21-generation monastic lineage shaped Dr. Shivanand's understanding of the mind What ancient Yogic and Ayurvedic teachings reveal about consciousness and brain function Dr. Shivanand's perspective of today's scientific understanding of mental health The surprising results of the 12 month clinical studies on the impact of meditation on short and long term health How Yoga, meditation and breath unlock expanded states of consciousness and why they are essential for human evolution Links & Resources Practice of Immortality Book by Dr. Ishan Shivanand - https://ishanshivanand.com/about-the-book/ Group Digestive Reset Cleanse – Join the next Group Cleanse starting January 23rd, 2026 https://www.elementshealingandwellbeing.com/group-cleanse Private DIgestive Reset Cleanse - choose dates that work for your schedule. Learn more at https://www.elementshealingandwellbeing.com/digestive-reset-cleanse Exciting News: The New Elements of Ayurveda Podcast Community is Live! Over the years, this podcast has blossomed into a global community, a gathering of seekers, healers, and lifelong learners. And now, I'm delighted to share that our revitalized community space is officially open! This new online home was created for those who wish to go deeper into Ayurveda, together. Inside, you'll find: Early access to podcast episodes  Member forums for discussion and Q&A  Mindfulness and self-care practices  Monthly live Zoom meetups  Seasonal group challenges and reflections It's a conscious, supportive space to connect, learn, and grow with others walking the Ayurvedic path. Come say hello, introduce yourself, and be part of this living, breathing sangha. Join the new Elements of Ayurveda Podcast Community here:  https://www.elementshealingandwellbeing.com/community I look forward to connecting with you soon! Check out Colette's online services:  Online Consultations https://www.elementshealingandwellbeing.com/consultations At-home Digestive Reset Cleanse https://www.elementshealingandwellbeing.com/digestive-reset-cleanse Online Daily Habits for Holistic Health Program https://www.elementshealingandwellbeing.com/daily-habits Reset-Restore-Renew Program https://www.elementshealingandwellbeing.com/reset-restore-renew Have questions on Colette's online services? Book a FREE 15 min Services Enquiry Call here. https://www.elementshealingandwellbeing.com/consultations Do I have an accumulation of ama/toxins in my body? Take this quiz to find out https://www.elementshealingandwellbeing.com/resources Stay connected on the Elements Instagram https://www.instagram.com/elementsofayurvedapodcast/ and Facebook https://www.facebook.com/elementshealingandwellbeing Thank you for listening! If this episode supported you, please consider leaving a review and if you think this information would be helpful to family or friends, please share this episode so we can spread this wisdom of Ayurveda.  Stay tuned and stay aligned with the Elements of Ayurveda Podcast. Thanks for listening!

An elegant study in post-TAVI atrioventricular block, a PSA for my structural colleagues, revascularization in women, and a CTO PCI trial are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AV Block After TAVR Heart Blocks During vs After TAVR Show Distinct Patterns https://www.medscape.com/viewarticle/heart-blocks-during-vs-after-tavr-show-distinct-patterns-2025a1000ypp Mechanisms Underlying Alterations in Cardiac Conduction After TAVR https://jamanetwork.com/journals/jamacardiology/fullarticle/2842748 II Related PSA Announcement to My Structural Colleagues III Revascularization Strategies in Women with Severe Chronic CAD Women With Chronic Severe CAD Fare Better With CABG vs PCI https://www.medscape.com/viewarticle/women-chronic-severe-cad-fare-better-cabg-vs-pci-2025a1000ygd PCI vs CABG in Women With Chronic CAD https://doi.org/10.1093/eurheartj/ehaf806 PCI vs CABG - Meta-Analysis of 4 RCTs https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02334-5/abstract CABG vs Drug-Eluting Stent Implantation for CAD - Meta-Analysis https://www.jacc.org/doi/10.1016/j.jcin.2016.10.008 RECHARGE trial https://therechargetrial.com/ IV A CTO PCI RCT – But don't get your hopes up Early vs Late-Staged PCI After Subintimal Tracking and Re-entry for CTO https://doi.org/10.1016/j.jacc.2025.09.1598 DECISION CTO trial https://pubmed.ncbi.nlm.nih.gov/30813758/ National Inpatient Sample Database PCI CTO Associated With Higher Mortality https://pubmed.ncbi.nlm.nih.gov/37356643/ V Mandrola's Top 10 Stories You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In episode 613, Mike and James discuss with Jessica Kirkwood the evidence for post-exposure prophylaxis of sexually transmitted infections. We go over the 4 RCTs that have looked at the value of a single dose of doxycycline. It does reduce the risk for some specific infections – but as always you need to know the […]

I will be a member of a roundtable discussion on equine dentistry in December, along with a dozen or so other equine dentists. The goal, according to the manager of this discussion, is to table everyone's ideas and to hear everyone's opinion. We have all been asked not to denigrate contributors because equine dentists are siloed into their beliefs and are contentious in defending their beliefs as fact. Facts, however, are facts, and with them, theories can be proven. Sir Arthur Conan Doyle (Adventures of Sherlock Holmes - A Scandal in Bohemia) famously said this: "I never guess. It is a capital mistake to theorize before one has data. Insensibly, one begins to twist facts to suit theories, instead of theories to suit facts." Unfortunately, scientists, veterinarians, and equine dentists have twisted facts to fit theories. Therefore, theories are defended with passion because there are no facts to support them, and all that is left is the emotion of being important. Countering unproven theories are data collected over 84,000 horses that I have floated. With large numbers, patterns develop. This kind of accumulation of observations is called an observational study. They are not anecdotal, which means they are not based on fact. Rather, observational studies are conducted over time with large numbers to identify patterns. They may also be called wisdom or experience and can be supported by evidence from randomized controlled trials (RCTs). However, with limited funding, RCTs will never be conducted. ********** Community.TheHorsesAdvocate.com is a place to learn about horses, horse barns, and farms. Its information is free, and there is a membership side that allows horse owners to attend live meetings to ask questions and deepen their understanding of what they have learned on the site. Membership helps support this message and spread it to everyone worldwide who works with horses. The Equine Practice, Inc. website discusses how and why I perform equine dentistry without immobilization or the automatic use of drugs. I only accept new clients in Florida. Click here to make an appointment. The Horsemanship Dentistry School is a place for those interested in learning how to perform equine dentistry without drugs on 97% of horses. Please give a thumbs-up or a  5-star review and share these everywhere. I know horse owners worldwide listen, and the horses need every one of you in "Helping Horses Thrive In A Human World."

In this high-impact solo episode, Darin strips away the noise, hacks, and hype to deliver a clear, no-BS roadmap for transforming your body, brain, energy, and direction in life. This is a straight-talk breakdown of the 5 foundational habits that matter most — the habits backed by science, ancient wisdom, and Darin's decades-long experience living this work every day. Expect practical steps, micro-experiments, timing rules, and the mindset needed to reclaim sovereignty in a world full of distraction. If you're ready to build a stronger, clearer, more powerful version of yourself… this is the episode.     What You'll Learn 00:00 – Welcome to SuperLife How this podcast helps you build sovereignty through real habits, real truth, and real practices. 03:07 – Why this episode is different Darin lays out the mission: habits, hacks, hard truths — without dogma or fluff. 03:44 – The 5 foundational moves that change your biology A preview of the metabolic, physical, mental, and behavioral levers that create huge shifts.     1. METABOLIC EDGE — Eat Like You're Building a Future 04:03 – Terrain theory + why your food timing matters How altering the internal environment of your cells changes everything. 05:02 – The two levers that unlock metabolic health Time-restricted eating + plant-forward whole foods. 05:23 – Compressing your eating window Why 8–10 hours is ideal, how it improves glucose, insulin, weight, and inflammation. 06:18 – Practical weekly ramp-up Week 1: 12 hours. Week 2: 8–10 hours. Simple, sustainable, achievable. 07:10 – Darin's personal eating window 10 a.m. to 6 p.m. — and why eating earlier aligns with digestive fire.     2. MOVEMENT THAT MATTERS — Strength Is Survival 11:04 – Why strength training is non-negotiable Muscle protects metabolism, bone density, insulin sensitivity, and longevity. 11:51 – What the evidence says Huge cohort studies show strength training reduces all-cause mortality. 12:23 – The perfect weekly formula 3x/week compound lifts + daily movement + micro-bursts every hour. 13:06 – Real-life practicality Darin's routine of walking, sprinting dogs, mountain biking, and breaking up the day with movement.     3. SLEEP — The Ultimate Biological Reset 16:26 – The truth everyone ignores You cannot out-supplement or out-biohack poor sleep. 16:40 – The real impact of chronic sleep loss Cognition, memory, hormones, emotional regulation — all decline. 17:37 – The universal rule: consistent timing Same bedtime ± 30 minutes, every night. 17:52 – 60-minute wind-down protocol Screens off, light down, nervous system softening. 18:32 – Using sauna as a down-regulation tool Infrared benefits + why Darin does it twice a day in winter.     4. MINDSET & CONSCIOUSNESS — Your Attention Is Your Power 20:00 – Why optimization fails without attention training You can master food, workouts, and sleep — but scattered attention destroys progress. 20:48 – Darin's morning protocol Water → elixir → infrared pad → meditation → visualization → journaling. Every day. Everywhere. 21:01 – Meta-analysis proof Meditation reduces anxiety, depression, stress — and rewires your brain. 21:23 – The perfect 10-minute breathwork formula 5–5–5–5 or 4–4–4–4 cycles for nervous system reset. 21:56 – Journaling as medicine Stream-of-consciousness to activate clarity and emotional release.     5. WEALTH — Treat Your Time Like Capital 22:36 – Redefining wealth It's not money — it's your magnetism, output, relationships, and purpose. 23:16 – The compounding effect of tiny decisions Time batching, micro-actions, and protecting your attention from the social media attention economy. 24:02 – Mini productivity framework 90 seconds → 3 important calls. Every Friday → 1 paragraph on what scaled this week. 25:14 – Darin's post-meditation rule No scrolling — replace with proactive actions: reading, outreach, Patreon replies.     FINAL TAKEAWAYS 26:02 – The master checklist: • Time-restricted eating • Plant-focused meals • Resistance training • Daily meditation • Consistent sleep • Sauna recovery • Treating time like capital 26:11 – The real danger Chasing hacks before mastering fundamentals leads to burnout, confusion, and stress. 27:58 – Your power is in the basics These are simple, accessible, and life-changing. 28:04 – Closing message "Have your best Super Life Day ever."     Thank You to Our Sponsors Our Place: Toxic-free, durable cookware that supports healthy cooking. Go to their website at fromourplace.com/darin and get 35% off sitewide in their largest sale of the year. Manna Vitality: Go to mannavitality.com/ and use code DARIN12 for 12% off your order.     Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences     Key Takeaway "Your biology changes when your decisions change. Nail your sleep, nail your strength, honor your attention, and treat your time like capital — and you will build a Super Life from the ground up."     Bibliography Time-restricted eating (human RCTs / reviews) — Wilkinson et al., 10-hour TRE reduced weight and improved cardiometabolic markers (2019). PMC  Intermittent fasting / metabolic health review — comprehensive reviews showing metabolic switching benefits. PMC+1  Plant-forward/vegetarian diets & cardiometabolic outcomes — BMJ/Nutrition reviews and JAMA network evidence showing improved CVD risk markers and metabolic benefits. BMJ Nutrition+1  Sleep and cognition / brain health — Nature/Harvard coverage & meta-analyses: short sleep impairs cognition and links to amyloid processes. Nature+1  Resistance training & mortality / physical function — systematic and cohort evidence that muscle-strengthening activity lowers risk and preserves function. British Journal of Sports Medicine+1  Mindfulness & mental health meta-analysis — Goyal et al. 2014 and subsequent meta-analyses showing reductions in anxiety/stress. PubMed+1  Sauna bathing and cardiovascular outcomes — JAMA Internal Medicine / Mayo Clinic Proceedings reviews on sauna and lower CVD risk signals.

This year, the non-profit Educate Girls became the first Indian organization ever to receive the Ramon Magsaysay Award—often called Asia's Nobel Prize. The foundation recognized the group for its groundbreaking work enrolling out-of-school girls, improving learning outcomes, and shifting social norms in some of India's most underserved communities. It's a remarkable milestone for an NGO that began in rural Rajasthan and now reaches millions of households across the country.To discuss the challenges—and the opportunities—surrounding girls' education in India, Milan is joined on the show this week by Gayatri Nair Lobo, the CEO of Educate Girls. Gayatri has more than 25 years of experience across the consulting and development sectors. Before joining Educate Girls, she led the ATE Chandra Foundation and the India School Leadership Institute. She has also held senior roles at Dalberg Advisors and Teach For India.Milan and Gayatri discuss the origins of Educate Girls, the supply and demand-side barriers to girls' education, and the launch of the world's first Development Impact Bond. Plus, the two talk about the use of tools like randomized controlled trials (RCTs) and machine learning in delivering education and how to forge lasting partnerships with state governments.Episode notes:1. “A Blueprint for India's State Capacity Revolution (with Karthik Muralidharan),” Grand Tamasha, May 23, 2024.2. “Understanding the Delhi Education Experiment (with Yamini Aiyar),” Grand Tamasha, January 22, 2025.3. “How India's Women Are Redefining Politics (with Ruhi Tewari),” Grand Tamasha, November 5, 2025.4. “Rohini Nilekani on the Secret to Successful Governance,” Grand Tamasha, October 5, 2022.

Send us a textMethods & challenges of establishing causal relationships in health research, emphasizing epidemiology, randomized trials, and genetic approaches.Topics:Epidemiology: Studies disease influences using observational designs like case-control and prospective cohorts, plus trials, to identify patterns and test hypotheses.Hierarchy of evidence critique: Rejects rigid pyramids favoring RCTs, as all studies can be biased; advocates triangulation integrating varied data types for robust conclusions.RCT strengths & weaknesses: Randomization balances confounders, but issues like poor blinding, attrition, or subversion can undermine results; large samples may yield spurious precision if biased.Confounding & reverse causation: Examples include yellow fingers and lung cancer (both from smoking) or early atherosclerosis inflating CRP-disease links; hard to fully control statistically.Nutrition epidemiology: Observational studies often overstate benefits (e.g., vitamin E for heart disease), leading to failed trials; incentives favor new findings over revisiting errors.Mendelian randomization: Uses genetic variants as proxies for exposures (e.g., ALDH2 for alcohol metabolism) to mimic randomization; reveals no heart benefits from alcohol, unlike observational data.Negative controls: Tests implausible outcomes (e.g., smoking and murder) or exposures (e.g., paternal smoking in pregnancy) to check for confounding artifacts.Evidence triangulation: Combines diverse studies with different biases (e.g., cross-cultural comparisons) for causality; applied to dismiss HDL-raising drugs despite initial promise.Practical Takeaways:Scrutinize health claims by checking for negative controls or variety in evidence sources to avoid mistaking correlation for causation.For personal decisions like alcohol intake, consider genetic studies showing risks at all levels, and aim for moderation or abstinence based on overall evidence.When evaluating supplements or diets, prioritize trials over observational data, and question media hype that ignores confounding factors.About the guest: Dr. George Davey Smith, MD, DSc is a professor of clinical epidemiology at the University of Bristol and director of the MRC Integrative Epidemiology Unit.*Not medical advice.Support the showAffiliates: Lumen device to optimize your metabolism for weight loss or athletic performance. MINDMATTER gets you 15% off. AquaTru: Water filtration devices that remove microplastics, metals, bacteria, and more from your drinking water. Through link, $100 off AquaTru Carafe, Classic & Under Sink Units; $300 off Freestanding models. Seed Oil Scout: Find restaurants with seed oil-free options, scan food products to see what they're hiding, with this easy-to-use mobile app. KetoCitra—Ketone body BHB + electrolytes formulated for kidney health. Use code MIND20 for 20% off any subscription (cancel anytime) For all the ways you can support my efforts

In this solo episode, Darin reframes one of the most misunderstood forces in life — stress. Instead of seeing it as the enemy, he explores how stress is actually a messenger, guiding you back to alignment, safety, and awareness. Through science, spirituality, and lived experience, Darin breaks down how stress shows us where we're trying to control, where we're disconnected, and where our nervous system is calling for attention. He unpacks the layers of modern stress — from trauma and environment to community and purpose — and offers practical, embodied tools to restore calm, clarity, and resilience.     What You'll Learn 00:00:00 – Welcome to Super Life: Solutions for a Healthier Life and Better World 00:00:32 – Sponsor Spotlight: TheraSauna - Natural Healing Technologies (15% off with code Darrandai) 00:02:10 – The Super Life Podcast: Finding Contentment, Happiness, and Purpose 00:02:51 – Today's Topic: Stress - Reframing Stress as an Ally and Dashboard Light 00:04:54 – The "No Choice" Universe: Reconnecting to Infinite Possibilities 00:05:16 – The Reality of Stress: Statistics and the Impact of Chronic Stress 00:06:21 – Stress is Layered: Beyond a Single Cause, Addressing Chronic Stress 00:08:29 – Solutions for a Super Life: Safety over Calm and the Vagal Response 00:09:38 – The Inner Dialogue Layer: Trauma, Unconsciousness, and Spiritual Bypassing 00:11:47 – The Social Field Layer: Relationships, Community, and Finding Your Way Home 00:14:20 – Sponsor Spotlight: Bite Toothpaste - Sustainable, Non-Toxic Tabs (20% off with code Darin20) 00:16:35 – Creating Your Own Vision: Setting Boundaries with Media and Social Algorithms 00:17:29 – Finding Your Purpose: From Raising Children to Healing Injuries 00:18:35 – Environmental and Existential Stress Layers: Clutter, Noise, and Service 00:19:26 – Stress Load and Resiliency: Why Small Triggers Cause Blow-Ups 00:20:02 – Understanding the Dashboard Light: Acknowledging Unwillingness 00:20:35 – Safety as the Signal: Body Relaxation and Providing Inner Security 00:23:44 – Reframing Trauma: Was it the Protector You Needed at the Time? 00:25:00 – Releasing Trauma: Techniques, The Healing Code, and Waking the Tiger 00:26:06 – Finishing the Survival Response: Shaking, Crying, Screaming, and Stretching 00:26:38 – Stress as a Multiplier: Impact on Immune System, Heart, and Aging 00:28:10 – Stress Slows Repair: Inflammation, Cardiovascular Risk, and Cellular Aging 00:29:48 – The Integrative Approach: Changing Your Environments to Support Anti-Stress 00:30:07 – Actionable Stress Solutions: Circadian Rhythm, Nature, and Noise Reduction 00:30:44 – Actionable Stress Solutions: Gratitude, Conscious Breath, and Movement 00:31:32 – Energy Drains to Eliminate: Conflict, Clutter, Scrolling, and Late Caffeine 00:32:17 – Connecting to Greater Purpose: The Super Life Patreon Platform 00:32:54 – Morning/Night Questions: Letting Go, Creating, and Contributing 00:33:17 – Final Toolkit: Slow Breathing, Movement, Nature, Sauna, and Sleep 00:34:25 – The Invitation: Digging into all Layers of a Super Life on Patreon   Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences   Key Takeaway "Stress isn't your enemy — it's your compass. Every wave of tension points you back to what's asking for care, attention, and love. When you stop fighting stress and start listening to it, you don't just survive — you evolve."       Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

Right on the heels of the release of the 2025 AHA guidelines, including one on preferentially using IVs over IOs, comes two RCTs in the same edition of NEJM that compare intial attempts with IVs to IOs in out of hospital cardiac arrest. Dr Jarvis discusses these two papers while answer a listeners question, and tries to put this, and early epinephrine, into context. And he might throw in some commentary about the AHA's recommendations on mCPR and Heads Up CPR.Citations:1. Couper K, Ji C, Deakin CD, et al. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):336-348. doi:10.1056/NEJMoa24077802. Vallentin MF, Granfeldt A, Klitgaard TL, et al. Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):349-360. doi:10.1056/NEJMoa2407616

Stress isn't just something to “manage” — it's a signal, a teacher, and often, an invitation to look deeper at our health, our choices, and our lives. In this solo episode, Darin reframes stress not as an enemy, but as a dashboard light pointing toward misalignments in our nervous system, environment, relationships, and purpose. Drawing on science, practical tools, and personal insight, Darin reveals how layered stress silently drains our vitality — and how to transform it into an ally for growth, healing, and deeper contentment. Whether it's hidden trauma, toxic environments, unresolved conflict, or the modern distractions constantly pulling at our attention, Darin lays out a roadmap to stop the leaks and reclaim the energy already within you. This episode is a powerful reminder: stress isn't the end of the story — it's the beginning of awareness, safety, and a super life.     What You'll Learn in This Episode [00:00] Introduction to the Super Life podcast [03:27] Why stress might not be your enemy [04:17] Stress as an ally: the signals it gives us about misalignment [04:32] The dashboard light metaphor: how stress reveals hidden issues [05:28] The illusion of “no choice” and the infinite possibilities always available [06:12] Global stress statistics and why most people underestimate their stress load [07:23] Hidden stress revealed through heart rate variability and physiology [08:23] Layered stress: how sleep, exercise, and poor choices compound each other [09:25] Safety vs. calm — why your nervous system craves safety first [10:15] Trauma and the unconscious mind: how old wounds drive our stress response [11:54] Inner narratives and negative self-talk as hidden stress multipliers [12:22] The role of community and your social field in stress and resilience [13:53] Relationships, honesty, and how your circle shapes your energy [14:55] Why boundaries around media and politics are vital for mental clarity [17:42] Finding micro-purpose when life feels overwhelming [18:52] Environmental layers of stress — light, air, and clutter [19:15] The existential layer: stress from living without service or purpose [20:12] Stress as a risk amplifier — how it undermines healing and health [20:55] The deeper truth of safety, connection, and higher power [23:00] Practical tools: breathing, grounding, nature, and conscious choices [24:01] Trauma reframed: not a problem, but a protector at the time [25:25] Lessons from Peter Levine and wild animals: releasing trauma physically [26:04] Questions to ask trauma: “What are you protecting me from?” [26:56] Stress as a multiplier of aging, disease, and poor outcomes [29:20] Why stress isn't a single cause — it's layered and chronic [30:18] Anti-stress strategies: circadian rhythm, nature, and gratitude [31:49] Energy leaks to avoid: clutter, poor food, scrolling, bad boundaries [32:22] What matters most: service, contribution, and alignment [33:28] Final toolkit: breathwork, movement, nature, sleep, and gratitude [34:38] The deeper invitation: step into sovereignty and live your SuperLife     Thank You to Our Sponsors: Manna Vitality: Go to mannavitality.com/  or use code DARIN20 for 20% off your order. Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order.     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Check out my podcast with Dr. Amy Abbington     Key Takeaway “Stress is not the enemy. It's a dashboard light — a teacher showing you where you're out of alignment. When you reframe stress, you reclaim your energy and create space for healing, safety, and the joy of living a super life.”     Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756.