Podcasts about sglt2

New AHA/ACC guidelines overhaul pulmonary embolism management with a five-tier risk classification, endorsing ED discharge for low-risk patients and DOACs as first-line therapy. A JAMA trial confirms IV acetaminophen adds modest but real pain relief when combined with morphine. A large cohort study shows SGLT2 inhibitors dramatically reduce kidney, cardiovascular, and liver complications in diabetic cirrhosis patients.

Heart failure management has evolved dramatically, and nurses are central to optimizing outcomes and preventing hospital readmissions. In this episode, we break down the core medication classes used in heart failure, including ACE inhibitors, ARBs, beta blockers, mineralocorticoid receptor antagonists, diuretics, and newer agents like ARNIs and SGLT2 inhibitors. You'll learn how these medications improve symptoms and survival, key monitoring parameters such as blood pressure, potassium, and renal function, and common adverse effects to watch for. We'll also review practical bedside considerations and patient education pearls that improve adherence and safety. Your support helps me provide more free resources like this! Consider supporting and getting more amazing pharmacology content! Head on over to meded101.com/nurse

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode, Kara Umbarger discusses the latest updates in kidney care, including the exciting new GFR equation and the role of SGLT2 inhibitors in managing chronic kidney disease. Stay informed on how recent advances can improve outcomes for patients and the importance of timely referrals to nephrologists.  Learn more about Kara Umbarger, APRN

Bij communicatie over artrose spreken we vaak over ‘slijtage', maar dat beeld klopt niet. In deze aflevering spreekt Anne met hoogleraar Experimentele Reumatologie Peter van der Kraan, die pleit voor andere taal. Ook onderzoeker Sabine Voigt schuift aan: zij stelt dat we kritischer moeten kijken naar de cijfers achter zorgbeleid en de methodologie van de studies waarop dat beleid is gebaseerd. De warme douche gaat naar onderzoeksjournalist Joop Bouma.Gerelateerde artikelen:Artrose is geen ‘slijtage'De schijn van zekerheidErytrocytose door SGLT2-remmers bij hartfalenVoortzetting OAC na veneuze trombo-embolie is gunstig

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure.  We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients.  Disclaimer: All educational content in this podcast was developed as part of the Circulation Health collaborative working project between Boehringer Ingelheim Limited, Greater Manchester Primary Care Provider Board and Health Innovation Manchester. Content has been created by Circulation Health Clinical Leads for educational purposes, reflecting NHS Clinical Lead and guideline-based recommendations. Boehringer Ingelheim had no input into content development. They have provided financial resources to support Podcast recordings related to this project. Darren would like us to make you all aware that he has working relationships with pharmaceutical industry partners. Specifically, that he has received speak fees and consultancy fees from AstraZeneca, GSK, Novartis, Boehringer Ingelheim, Bayer, and Lilly, and has been part of collaborative working agreements with Novartis, Boehringer Ingelheim, and AstraZeneca. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Resources: Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/ Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/ International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/ Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899 CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/ Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896 UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

A JAMA Network Open consensus guide standardizes adult UTI triage for telehealth and in-person care. Nonpregnant women with classic cystitis symptoms and no resistance risks may receive empiric antibiotics without testing; men and higher-risk women require urinalysis with culture before treatment. Urine color or odor alone does not justify testing, and urgent evaluation is advised for suspected complicated infection or sepsis. A Danish registry study in JAMA Internal Medicine found SGLT2 inhibitors offer greater kidney protection than GLP-1 receptor agonists in type 2 diabetes. Long-term ASPREE follow-up in JAMA Oncology showed low-dose aspirin did not lower cancer incidence and increased cancer-related mortality in older adults.

In today's episode, Neil Iyengar, MD, moderated an OncLive Insights discussion about adverse effect management when using breast cancer therapies targeting the PI3K, AKT, and mTOR pathways. Dr Iyengar is an associate professor in the Department of Hematology and Medical Oncology and co-director of Breast Medical Oncology in the Department of Hematology and Medical Oncology at Emory University School of Medicine; as well as director of Survivorship Services at the Winship Cancer Institute of Emory University in Atlanta, Georgia. He was joined by Heather Moore, CPP, PharmD, a clinical pharmacist practitioner at the Duke Cancer Center Breast Clinic in Durham, North Carolina; and Sarah Donahue, MPH, NP, a nurse practitioner at the University of California San Francisco Health.  In our exclusive discussion, the experts highlighted the importance of early and comprehensive testing (using both tissue and liquid biopsies) for genetic alterations to guide treatment decisions. They also noted strategies for managing diarrhea, including patient education on diet, proactive use of loperamide, and regular monitoring. They also explained that hyperglycemia management should hinge on prophylactic use of metformin or SGLT2 inhibitors, dietary restrictions, and frequent glucose monitoring. Their conversation on rash management included insights about prophylactic antihistamines, patient education on skin care, and involving dermatology for severe cases. Overall, the experts spotlighted the importance of multidisciplinary collaboration and proactive patient education when treating patients with breast cancer.

Inflammation isn't just part of aging... it drives it! In this second conversation with Joel Greene, we explore what aging really is, why chronic low-grade inflammation is so common, and how it impacts metabolism, gut health, immune function, weight gain, and long-term health. We discuss inflammaging, endotoxins (LPS), the body fat–gut lining axis, telomeres, muscle, fasting myths, yo-yo dieting, and the realities of modern weight-loss drugs including GLP-1s and SGLT2 inhibitors. This episode is about restoring balance, protecting muscle, and reducing inflammation to support a healthier, more resilient body as we age.

Doug Reynolds welcomes listeners back to the LowCarbUSA® Podcast with a guest who works in one of the most specialized—and most misunderstood—corners of cardiovascular medicine: the heart's electrical system.  Dr. David Nabert is an electrophysiologist ("EP" doctor), focused on heart rhythm disorders, and he's one of the featured speakers at the Boca Symposium for Metabolic Health (January 23–25)—including the event's full day-plus dedicated to cardiovascular conditions. What gives this episode its pull is the combination of clinical depth and lived experience. David isn't just talking about rhythm problems from a textbook perspective—he's explaining how his own curiosity about metabolic health evolved, what shifted when he started questioning conventional assumptions, and why those questions matter for real patients in the real world. David describes how his entry point into metabolic health didn't begin in a clinic—it began with a random Google search. In 2021, while looking up a cardiology formula, he accidentally landed on a Nina Teicholz talk at the Cato Institute. "I started to watch it, and all of a sudden, an hour and a half passed," he says—one of those moments where interest turns into momentum. He listened to Teicholz's book, The Big Fat Surprise, then began searching for more voices in the low-carb space and quickly reconnected with familiar names, including Dr. Robert Cywes and Dr. Eric Westman (both will also be presenting in Boca), whom he calls mentors. That exploration ultimately led him to the Society of Metabolic Health Practitioners (The SMHP) and, importantly, a willingness to test ideas on himself. David is candid about his own weight journey. He describes a time when a body mass index under 25 felt "skinny" to him, and he's open about losing weight, regaining some after a series of hip surgeries, and continuing to work on it. What ultimately shifted, though, wasn't just the number on the scale—it was how he began to rethink what "doing everything right" actually means. For years, he approached weight loss the way many clinicians were trained to: low-fat, high willpower, endure the hunger. He describes his old strategy bluntly: "The only way I had lost weight… was by doing protein sparing modified fast… I was just eating almost no fat." Predictably, it wasn't sustainable. When he later shifted to a lower-carb, higher-fat approach—"bacon, eggs, hamburger"—he was "amazed at how quickly I started to lose weight," and he began seeing changes in markers that traditional cardiology often de-emphasizes. After stopping long-term statin therapy (which he had been on for 25 years), he saw his LDL return to roughly where it had been earlier in life, but other changes caught his attention: triglycerides dropped to the lowest he'd ever seen, HDL improved, and fasting insulin improved as well. Just as meaningful were the changes he felt: "Every 10 or 20 pounds I lost, my hips got better," he says, attributing it not only to less load, but "also part of it was less inflammation." From there, the episode moves into the heart of why David is speaking during the cardiovascular-focused programming in Boca: rhythm, electricity, and the surprising overlap between conditions that seem unrelated—like seizures and arrhythmias. David explains that early ketogenic diet research in the 1920s focused on refractory seizures, and he argues the connection matters because many antiarrhythmic drugs and antiseizure drugs overlap mechanistically. In his view, these aren't separate worlds. "Treating seizures or treating cardiac arrhythmias is basically two faces of the same coin," he says—and that opens a practical question: if ketosis can help reduce seizures, might it also influence certain rhythm symptoms? He shares a striking clinical example that stuck with him: a former submariner with PTSD and episodes of fast heart rates who said, "I know when I'm… ketogenic… when I fall off the wagon… then I start having palpitations and fast heart rates." David later learned the patient was experiencing atrial fibrillation, and while he's careful not to overpromise, he describes a pattern he's observed: in earlier stages of rhythm problems, being in a ketogenic state may reduce symptoms and potentially slow progression for some people. "It doesn't cure atrial fibrillation," he emphasizes, but he's seen ketosis "improves symptoms," not only in AFib, but in other rhythm issues like SVT and PVCs—especially early on. From there, David widens the frame to what he's seeing in younger patients—particularly young women—showing up with palpitations, rapid heart rate, anxiety, and signs of metabolic dysfunction even when they don't "look" unhealthy by BMI alone. "Only 90% of them are metabolically unhealthy," he says, describing a familiar cluster: A1C not quite normal, resting heart rates high, daytime heart rates that shouldn't be running 100–120, and a nervous system dialed up in what he calls a "hyper adrenergic state." The mainstream response is often medication—beta blockers, for example—but David argues metabolic context matters, and he's exploring how nutritional strategies (including ketosis, sometimes even supplemental ketones) may reduce symptom burden in certain cases. He also discusses POTS (Postural Orthostatic Tachycardia Syndrome), noting it can be associated with viral infections and has become more common since "the bad virus we had five years ago." Again, he's measured in his claims: ketosis isn't a cure, but he's seen it help reduce symptoms in select patients who have tried many other standard approaches first. The second half of the conversation touches on medications and the tension between "lower the number" cardiology and whole-person outcomes. David brings up PCSK9 inhibitors and recalls being troubled by early data patterns: "You were less likely to die from that, but you're more likely to die from cancer or infection… And… the overall mortality was the same." That line of thinking captures what pushed him toward metabolic health: a concern that focusing on a single marker can obscure the bigger picture of risk, resilience, and long-term outcomes. He also discusses SGLT2 inhibitors (like Jardiance and Farxiga) as potentially useful tools—especially in heart failure and diabetes—while stressing the importance of monitoring and hydration. In a moment that captures both his clinical caution and his enthusiasm for empowered patients, he tells people who go low carb on these meds to "get a Keto Mojo to check your ketone levels," because the goal is to use tools intelligently, not blindly. As the episode closes, Doug returns to the bigger mission behind the upcoming Boca program: helping attendees develop a confident, educated response to the most common fear tactic people face when they change their diet—LDL, heart attacks, and the assumption that low carb automatically means danger. Doug notes there are still "so few that really do get it and support it and talk about it," which is exactly why the cardiovascular-focused day-plus at the Boca Symposium for Metabolic Health (January 23–25) matters. David, for his part, is grateful to be part of it—and to be healthy enough to show up differently than last time. He reminds Doug that at previous events he was "either walking with one or two canes," but now, "I'm actually not going to run up on the stage, but I'll be moving pretty quickly." That moment captures the heart of the episode: metabolic health isn't theoretical. It's lived. And in Boca, that lived experience meets serious clinical discussion—especially for anyone trying to better understand cardiovascular risk, rhythm disorders, and the metabolic foundations that too often go unaddressed. If this conversation sparks your curiosity, the next step is obvious: join the community in Boca January 23–25 and immerse yourself in a day and a half of cardiovascular-focused talks designed to help you think more clearly, speak more confidently, and act more effectively—whether you're a clinician, a patient, or someone trying to help the people you love. Learn more about the Boca Symposium and register here.

Subscribe to our channel: https://www.youtube.com/@optispanGet Our Newsletter (It's Free): https://www.optispan.life/As we close out 2025, I'm sharing a comprehensive and honest review of my personal health optimization protocol. I break down the exact lifestyle habits, supplements, and medications I use daily, and just as importantly, which popular ones I avoid and why.I detail the massive impact of my "Four Pillars" and explain the thought process behind each item in my regimen, from Omega-3s and creatine to testosterone, SGLT2 inhibitors, and rapamycin.If you've ever wondered what a data-driven, no-BS approach to longevity looks like in practice, this is it.*Timestamps:*00:00 - Podcast Start / Topic Overview01:16 - Philosophy: Focus on Foundations, Not Hype02:10 - The Four Pillars of Healthspan (Eat, Move, Sleep, Connect)03:27 - My Personal Pillars Assessment04:33 - Avoiding Risky Behaviors (Alcohol, Drugs, Environment)06:44 - Pillar 1: EAT - My Rules, Keto Bread, Protein Sources09:51 - Pillar 2: MOVE - Weekly Exercise Routine (Zone 2, Weights, HIIT)12:19 - Pillar 3: SLEEP - Routine & The Alcohol Effect13:29 - Pillar 4: CONNECT - Relationships & Personal Growth14:52 - SUPPLEMENTS: My Skeptical Philosophy16:43 - Supplement Disclosures (Past/Present Company Ties)17:47 - My Daily Supplements List: Omega-3, Vitamin D, Rejuvent (CA-AKG), Lithium, Methylfolate, Creatine23:03 - Supplements I DON'T Take: Magnesium, Collagen, Fiber, Ashwagandha, NAD+ Boosters, Senolytics & Why28:42 - How to Choose a Supplement Brand (ConsumerLab Warning)30:19 - MEDICATIONS & PREVENTATIVE DRUGS30:48 - Testosterone Therapy: My Protocol, Impact, & Monitoring33:49 - Jardiance (Empagliflozin): SGLT2 Inhibitor for Biomarkers35:55 - Repatha (PCSK9 Inhibitor): For Heart Disease Prevention37:47 - Tirzepatide (Mounjaro/Zepbound): My Microdosing Experience40:01 - Rapamycin (Sirolimus): My Cyclical Protocol & Stance on Recent News41:41 - Tadalafil (Cialis) & Metformin: Why I'm Off/Against Them For Now46:08 - Final Summary & Take-Home Principles46:50 - The Importance of a Good Doctor & Rational Risk/Reward48:48 - Wrap-Up & Holiday WishesThis video was produced by One Billion Media, an agency that specializes in YouTube virality for health brands and experts. Learn more about their work here:https://onebillionmedia.com/DISCLAIMER: The information provided on the Optispan podcast is intended solely for general educational purposes and is not meant to be, nor should it be construed as, personalized medical advice. No doctor-patient relationship is established by your use of this channel. The information and materials presented are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. We strongly advise that you consult with a licensed healthcare professional for all matters concerning your health, especially before undertaking any changes based on content provided by this channel. The hosts and guests on this channel are not liable for any direct, indirect, or other damages or adverse effects that may arise from the application of the information discussed. Medical knowledge is constantly evolving; therefore, the information provided should be verified against current medical standards and practices.More places to find us:Twitter: https://x.com/Optispan_IncTwitter: https://twitter.com/mkaeberleinLinkedin: https://www.linkedin.com/company/optispanInstagram: https://www.instagram.com/optispan_/TikTok: https://www.tiktok.com/@optispan

Subscribe to our channel:    / @optispan  Get Our Newsletter (It's Free): https://www.optispan.life/Join Matt and Dr. Nicole (Nicki) Byrne, Clinic Director at Optispan, for a deep dive into preventative Healthspan Medicine. In this episode, they discuss why traditional reactive healthcare is failing us, what true preventative care looks like, and the comprehensive, data-driven approach used at Optispan to catch risks early and optimize long-term health. From advanced diagnostics to lifestyle pillars and evidence-based medications, learn how to shift from treating disease to building resilience.

SGLT2 inhibitors in CKD: are they really effective in all patients?

Chegou o episódio escolhido por vocês! Marcela Belleza e Joanne Alves convidam Carol Millon para conversar sobe 6 clinicagens de inibidores de SGLT2, as gliflozinas:Indicações além do DMRisco de CAD euglicêmicaQuando não usar?⁠Cuidados com doença aguda (sick day) e hipovolemia⁠Cuidados pré-operatórioRisco de fratura e amputaçãoReferências:1. Bailey CJ, et al. Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin: a randomized, double-blind, placebo-controlled 102-week trial. BMC Med. 2013;11:43. Published 2013 Feb 20. doi:10.1186/1741-7015-11-432. Bersoff-Matcha SJ, et al. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019;170(11):764-769. doi:10.7326/M19-00853. Chang HY, et al. Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes. JAMA Intern Med. 2018;178(9):1190-1198. doi:10.1001/jamainternmed.2018.3034 4. Clar C, et al. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open. 2012 Oct 18;2(5):e001007. doi: 10.1136/bmjopen-2012-001007. PMID: 23087012; PMCID: PMC3488745.5. Das SR, et al. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145. doi: 10.1016/j.jacc.2020.05.037. Epub 2020 Aug 5. PMID: 32771263; PMCID: PMC7545583. 6. Fralick M, et al. Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study. BMJ. 2020;370:m2812. Published 2020 Aug 25. doi:10.1136/bmj.m28127. Li D, et al. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017;19(3):348-355. doi:10.1111/dom.128258. Neal B, et al. Rationale, design, and baseline characteristics of the Canagliflozin Cardiovascular Assessment Study (CANVAS)--a randomized placebo-controlled trial. Am Heart J. 2013;166(2):217-223.e11. doi:10.1016/j.ahj.2013.05.0079. Nyirjesy P, et al. Evaluation of vulvovaginal symptoms and Candida colonization in women with type 2 diabetes mellitus treated with canagliflozin, a sodium glucose co-transporter 2 inhibitor. Curr Med Res Opin. 2012;28(7):1173-1178. doi:10.1185/03007995.2012.69705310. Perkovic V, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-2306. doi:10.1056/NEJMoa181174411. Rosenwasser RF, et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metab Syndr Obes. 2013 Nov 27;6:453-67. doi: 10.2147/DMSO.S34416. PMID: 24348059; PMCID: PMC3848644.12. Sridharan K, Sivaramakrishnan G. Risk of limb amputation and bone fractures with sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Opin Drug Saf. 2025;24(7):797-804. doi:10.1080/14740338.2024.237775513. Ueda P,  et al. Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study. BMJ. 2018;363:k4365. Published 2018 Nov 14. doi:10.1136/bmj.k436514. Watts NB, et al. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab. 2016 Jan;101(1):157-66. doi: 10.1210/jc.2015-3167. Epub 2015 Nov 18. PMID: 26580237; PMCID: PMC4701850.15. Zhuo M, et al. Association of Sodium-Glucose Cotransporter-2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open. 2021;4(10):e2130762. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.3076216. Emerson Cestari Marino, Leandra Anália Freitas Negretto, Rogério Silicani Ribeiro, Denise Momesso, Alina Coutinho Rodrigues Feitosa, Marcos Tadashi Kakitani Toyoshima, Joaquim Custódio da Silva Junior, Sérgio Vencio, Marcio Weissheimer Lauria, João Roberto de Sá, Domingos A. Malerbi, Fernando Valente, Silmara A. O. Leite, Danillo Ewerton Oliveira Amaral, Gabriel Magalhães Nunes Guimarães, Plínio da Cunha Leal, Maristela Bueno Lopes, Luiz Carlos Bastos Salles, Liana Maria Torres de Araújo Azi, Amanda Gomes Fonseca, Lorena Ibiapina M. Carvalho, Francília Faloni Coelho, Bruno Halpern, Cynthia M. Valerio, Fabio R. Trujilho,  Antonio Carlos Aguiar Brandão, Ruy Lyra e Marcello Bertoluci. Rastreamento e Controle da Hiperglicemia no Perioperatório – Posicionamento Conjunto da Sociedade Brasileira de Diabetes (SBD), Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira para o Estudo da Obesidade e Síndrome Metabólica (ABESO). Diretriz Oficial da Sociedade Brasileira de Diabetes (2025). DOI: 10.29327/5660187.2025-10 , ISBN: 978-65-5941-367-6.17. Singh LG, Ntelis S, Siddiqui T, Seliger SL, Sorkin JD, Spanakis EK. Association of Continued Use of SGLT2 Inhibitors From the Ambulatory to Inpatient Setting With Hospital Outcomes in Patients With Diabetes: A Nationwide Cohort Study. Diabetes Care. 2024;47(6):933-940. doi:10.2337/dc23-112918. Mehta PB, Robinson A, Burkhardt D, Rushakoff RJ. Inpatient Perioperative Euglycemic Diabetic Ketoacidosis Due to Sodium-Glucose Cotransporter-2 Inhibitors - Lessons From a Case Series and Strategies to Decrease Incidence. Endocr Pract. 2022;28(9):884-888. doi:10.1016/j.eprac.2022.06.00619. Umapathysivam MM, Morgan B, Inglis JM, et al. SGLT2 Inhibitor-Associated Ketoacidosis vs Type 1 Diabetes-Associated Ketoacidosis. JAMA Netw Open. 2024;7(3):e242744. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.274420. Fleming N, Hamblin PS, Story D, Ekinci EI. Evolving Evidence of Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Cotransporter 2 Inhibitors. J Clin Endocrinol Metab. 2020;105(8):dgaa200. doi:10.1210/clinem/dgaa20021. Neuen BL, Young T, Heerspink HJL, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(11):845-854. doi:10.1016/S2213-8587(19)30256-622. Braunwald E. Gliflozins in the Management of Cardiovascular Disease. N Engl J Med. 2022;386(21):2024-2034. doi:10.1056/NEJMra211501123. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa150472024. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa161192525. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa181238926. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. doi:10.1056/NEJMoa191130327. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424. doi:10.1056/NEJMoa202219028. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa210703829. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa202481630. The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, et al. Empagliflozin in...

Coming to you from the #NCPA2025 expo floor, host John Beckner and co-host Ed Cohen talk with Brian Connelly, president and CEO of TheracosBio, about Brenzavvy (bexagliflozin), an FDA-approved oral SGLT2 inhibitor for adults with Type 2 diabetes. They discuss how the company's model bypasses PBMs to offer pharmacists and patients a fair, transparent price.

In Deutschland leben etwa 9 Millionen Menschen mit einem diagnostizierten Typ-2-Diabetes. Jedes Jahr kommen ca. 450.000 Patientinnen und Patienten neu dazu: Die Belastung des Gesundheitssystems wird aller Voraussicht nach in den kommenden Jahren zunehmen. Bei vielen Betroffenen mit Diabetes mellitus treten zeitgleich Komorbiditäten auf, darunter oft kardiovaskuläre Erkrankungen bzw. chronische Nierenkrankheit. Man spricht auch vom kardiorenal-metabolischen Syndrom.

Join me for a fascinating deep dive into the science of immune aging with Dr. Natalia Mitin, founder and CEO of Sapere Bio. We explore why the aging of the immune system is the primary driver of aging for the entire body and unpack the concept of cellular senescence—often called "zombie cells"—where stressed cells persist and create chronic inflammation. Dr. Mitin explains why consumer tests that assign a specific "biological age" in years are often scientifically lacking compared to measuring where you stand within a population's trajectory. We also discuss cutting-edge longevity targets, including T-cell exhaustion (and how drugs like Rapamycin and SGLT2 inhibitors address it), the critical role of gut health (where 70% of the immune system resides), and how mitochondrial function in stem cells can correlate with an extra 15 years of healthspan.

N478 - EASD 2025 - Diabetes Tipo 2: GLP-1 e SGLT2 se destacam após Metformina - André Vianna, Fernando Valente e Melanie Rodacki by SBD

N411 - ADA 2025 - Alzheimer e Diabetes: GLP-1 reduz risco em 68% e SGLT2 em 25%! - Fernando Valente, João Salles e Ruy Lyra by SBD

N413 - ADA 2025 - GLP-1, GIP-GLP-1 ou SGLT2: qual usar? - Rodrigo Lamounier e Márcio Krakauer by SBD

N433 - ADA 2025 - SGLT2 para todos? Quem precisa não está usando! - Fernando Valente e Virgínia Fernandes by SBD

N448 - ADA 2025 - SGLT2 e GLP-1 no Tipo 1: Novos dados e cuidados! - Marcio Krakauer e Rodrigo Lamounier by SBD

N457 - ADA 2025 - GLP-1 e SGLT2 em transplantados renais! - Marcio Krakauer e Talita Trevisan by SBD

  Chronic kidney disease now affects nearly 850 million people worldwide, yet early detection and simple, evidence-based interventions can dramatically change the trajectory of both kidney and cardiovascular health.

SGLT2 inhibitors have a multitude of beneficial effects on horses with equine metabolic syndrome.Read the full article at https://equimanagement.com/research-medical/research/updates-on-sglt2-inhibitors-for-horses/. Mentioned in this episode:EquiManagement on Audio All the articles you have come to love in EquiManagement Magazine are now available in this podcast for free. Each article is released as its own separate episode to make them quick and easy to listen to. EquiManagement always has the latest insights on equine health, veterinary practice management, and veterinarian wellness.

Updates on SGLT2 inhibitors, fish oil and hemodialysis, GLP-1 drugs, and more: Katherine R. Tuttle, MD, education committee co-chair of Kidney Week 2025 and a professor of medicine at the University of Washington, shares clinical research highlights from the recent meeting. Related Content: SGLT2 Inhibitors, Fish Oil in Hemodialysis, GLP-1 Drugs, and More—Highlights From Kidney Week

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure.  We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients.  Disclaimer: This episode was supported by Greater Manchester NHS who received support from Boehringer.  You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Resources: Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/ Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/ International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/ Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899 CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/ Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896 UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

CME credits: 0.25 Valid until: 18-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/engaging-your-patient-shared-decision-making-in-hf-with-lvef40/29910/ Enhance your ability to apply shared decision-making in patients with HF and LVEF ≥40%. Through real-world clinical vignettes, Dr. Scott Solomon illustrates how to uncover patient goals, clearly communicate risks and benefits, and build collaborative treatment plans. The session emphasizes early use of SGLT2 inhibitors and finerenone to reduce hospitalizations, improve quality of life, and optimize long-term outcomes. =

In this in-depth conversation, Dr. Brad Stanfield sits down with Dr Matt Kaeberlein to discuss his journey from a primary care physician in New Zealand to a leading voice in the evidence-based longevity space. We cover the launch and philosophy behind his YouTube channel, the challenges and exciting results of his self-funded rapamycin clinical trial, and his critical perspective on supplements, medical guidelines, and the future of aging research.Dr. Stanfield provides a unique clinician's viewpoint on hot topics like GLP-1 agonists (Ozempic), SGLT2 inhibitors, vitamin D testing, and the pitfalls of biological age clocks. We also dive into a spirited debate on the role of medical societies, the balance between risk and benefit in prescribing medications, and why he believes the field of longevity is still in its early stages of discovery.Key Topics & Timestamps:00:00 - Introduction00:52 - Brad's Background02:47 - Starting the YouTube Channel & Philosophy on Science Communication07:39 - The Rigor of Clinical Data vs. Misinformation10:14 - Admitting Mistakes in Public (Resveratrol, Metformin)14:40 - Funding and Designing the Rapamycin Clinical Trial19:25 - Rapamycin Trial Results Submitted & Plans for a PhD23:28 - Preventative Care: New Zealand vs. US Healthcare Systems27:59 - The Vitamin D Debate: To Test or Not to Test?35:18 - Trust in Medical Guidelines & The Hormone Replacement Therapy Controversy43:42 - The Problem with Biological Age Clocks46:22 - Patient-Centered Care: Inform vs. Decide in Medicine49:49 - How to Judge the Quality of a Clinical Trial (CONSORT)53:44 - Risk vs. Benefit: When Should We Prescribe Preventative Drugs?58:05 - GLP-1 Agonists (Ozempic) and SGLT2 Inhibitors in Practice01:02:00 - Brad's Personal Use of an SGLT2 Inhibitor01:05:38 - The State of Longevity Research: How Much Do We Really Know?01:08:34 - Closing RemarksDISCLAIMER: The information provided on the Optispan podcast is intended solely for general educational purposes and is not meant to be, nor should it be construed as, personalized medical advice. No doctor-patient relationship is established by your use of this channel. The information and materials presented are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. We strongly advise that you consult with a licensed healthcare professional for all matters concerning your health, especially before undertaking any changes based on content provided by this channel. The hosts and guests on this channel are not liable for any direct, indirect, or other damages or adverse effects that may arise from the application of the information discussed. Medical knowledge is constantly evolving; therefore, the information provided should be verified against current medical standards and practices.Dr. Brad Stanfield's Socials:Website: https://drstanfield.com/YouTube: https://www.youtube.com/@DrBradStanfieldX: https://x.com/BradStanfieldMDMore places to find us:Twitter: https://x.com/Optispan_IncTwitter: https://x.com/mkaeberlein Linkedin: https://www.linkedin.com/company/optispan/Instagram: https://www.instagram.com/optispan_/  TikTok: https://www.tiktok.com/@optispanhttps://www.optispan.life/

Email List: ⁠https://huntershealthhacks.beehiiv.com/⁠Get My Book On Amazon: ⁠⁠https://a.co/d/avbaV48Download⁠⁠The Peptide Cheat Sheet: ⁠⁠https://peptidecheatsheet.carrd.co/⁠⁠Download The Bioregulator Cheat Sheet: ⁠⁠https://bioregulatorcheatsheet.carrd.co/⁠⁠1 On 1 Coaching Application: ⁠⁠https://hunterwilliamscoaching.carrd.co/⁠⁠Book A Call With Me: ⁠⁠https://hunterwilliamscall.carrd.co/⁠⁠Supplement Sources: ⁠⁠https://hunterwilliamssupplements.carrd.co/⁠⁠Amazon Storefront: ⁠⁠https://www.amazon.com/shop/hunterwilliams/list/WE16G2223BXA?ref_=cm_sw_r_cp_ud_aipsflist_R7QWQC0P1RACB2ETY3DY⁠⁠Socials:Instagram: ⁠⁠https://www.instagram.com/hunterwilliamscoaching/⁠⁠Video Topic Request: ⁠⁠https://hunterwilliamsvideotopic.carrd.co/In this episode, I dive deep into what I believe could be the most powerful synergy in the entire world of longevity and metabolic optimization — the combination of SGLT2 inhibitors (like Jardiance and Farxiga) with GLP-1 agonists (like Retatrutide, Tirzepatide, and Semaglutide).These medications were originally created for diabetics, but what we're learning now is that they may be rewriting the entire playbook on healthspan and lifespan extension. I break down the research showing how SGLT2 inhibitors not only lower blood glucose but also improve cardiovascular health, protect the kidneys, reduce inflammation, and even clear senescent cells — all while mimicking the effects of caloric restriction and fasting.Then, I explain how pairing them with a GLP-1 creates a metabolic symphony unlike anything else we've ever seen. Together, they reduce insulin resistance, improve energy metabolism, and activate the same longevity pathways linked to caloric restriction, AMPK activation, and mitochondrial renewal.If you care about living longer, staying leaner, and protecting every organ system in your body, this episode is a must-listen. I share what I've seen personally, what's happening in clinical data, and why I believe the GLP-1 + SGLT2 combo could end up being one of the greatest discoveries in modern medicine for both health and performance.

CME credits: 0.50 Valid until: 05-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/the-hidden-threat-transforming-ckd-care-across-the-diabetes-spectrum/36523/ Chronic kidney disease (CKD) is a common complication in type 2 diabetes that is closely linked to cardiovascular risk and often diagnosed late. Early detection with UACR and eGFR, plus treatment with therapies such as SGLT2 inhibitors, finerenone, and GLP-1 receptor agonists, has transformed treatment and guideline recommendations. Attention is now shifting to CKD in type 1 diabetes. Ongoing trials, such as FINE-ONE with finerenone, may soon expand therapeutic options and ensure no patient is left behind. =

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter revisits the “proven, promising, fuzzy, noise, nonsense” scale and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 receptor agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #76 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: A scale for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [1:30]; Strong convictions, loosely held: the mindset that separates great scientists from the rest [7:30]; GLP-1 receptor agonists: are there benefits beyond improving metabolic health and promoting weight loss? [12:45]; GLP-1 drugs and the brain: exploring the potential cognitive benefits [18:45]; GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [23:00]; Rapamycin and geroprotection: why it remains in the “promising” category [25:45]; SGLT2 inhibitors and their potential geroprotective effect [27:30]; Methylene blue: examining the evidence of an anti-aging effect [34:45]; Methylene blue's potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [41:15]; Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [43:45]; Does the idea of targeting telomere length to extend lifespan have scientific merit? [50:15]; Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [55:00]; Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [1:00:45]; Debunking the protein–cancer myth: why higher protein intake doesn't promote tumor growth [1:06:15]; The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [1:13:15]; Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [1:17:00]; Why injectable follistatin is theoretically possible but impractical for real-world use [1:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

In this education program through Vividh Bharati (All India Radio), Dr. Sunil Gupta explained in detail that diabetes is a multifactorial disease that can affect multiple organs including the eyes, nerves, liver, kidneys, heart, and even sexual health. He highlighted that non-alcoholic fatty liver disease (NAFLD), sleep disturbances, frozen shoulder, and sexual dysfunction are among the common complications associated with diabetes.  He elaborated that diabetes medications—such as Metformin, Glitazones, and SGLT2 inhibitors—work in different ways: some drugs like sulfonylureas increase insulin secretion, others improve insulin sensitivity, while some help eliminate excess sugar through urine. Dr. Gupta clarified that starting medication does not necessarily mean lifelong dependency; if blood sugar levels remain under good control, the dosage can be reduced under dose monitoring or, in some cases, the medication can be stopped under medical supervision.  Concluding his address, he emphasized that “the true treatment of diabetes is not just controlling blood sugar but taking care of the whole body through a disciplined and healthy lifestyle.”  Expert- Dr Sunil Gupta  Anchor- Mrs. Shraddha Bharadwaj  Podcast: 22/02/2019  Recorded at: Akashwani Nagpur  Episode: 87

A large real-world study of over 1.2 million adults with type 2 diabetes found that SGLT2 inhibitors and GLP-1 receptor agonists reduced major cardiovascular events compared with metformin, while sulfonylureas and insulin increased risk. A separate French population study showed no association between first-trimester mRNA COVID-19 vaccination and congenital malformations, supporting vaccine safety in pregnancy. Finally, researchers at Mass General Brigham reported that large language models can produce “sycophantic” but incorrect medical advice, emphasizing the need for clinician oversight when using AI in healthcare.

What if your patient's blood sugar looks “okay,” but their kidneys are already under attack?In this episode of ReInvent Healthcare, Dr. Ritamarie uncovers the common progression of kidney damage fueled by insulin resistance and elevated glucose. Most practitioners miss the early clues. And most patients never feel symptoms… until it's too late.Discover the early biochemical markers, the overlooked tests, and the clinical action steps you can take now to prevent progression to fibrosis, dialysis, and even renal failure.What's Inside This Episode?The silent mechanisms linking insulin resistance to kidney scarring and declineWhy normal creatinine and BUN may be misleading and what to test insteadWhich labs signal decline before patients show symptomsThe food patterns and protein levels that support vs. stress the kidneysTargeted botanicals, nutrients, and fasting strategies for protecting kidney functionHow to approach intermittent fasting, inflammation, and oxalates with nuanceWhen medications like SGLT2 inhibitors or ACE inhibitors may be protectiveThe practitioner's role in prevention, education, and root-cause reversalResources and Links:Download our FREE Health Detective Checklist.Download our FREE Guide to for Lab Test RecommendationsJoin the Next-Level Health Practitioner Facebook group here for free resources and community supportReserve your spot for our Reinvent Healthcare Online Event Nov 7-9! It's the event of the year for practitioners serious about root-cause healing. Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results. Check out other podcast episodes here

In this VETgirl veterinary continuing education podcast, we interview Dr. Christopher G. Byers, DACVIM, DACVECC about SGLT2 inhibitors for the treatment of diabetes mellitus to manage hyperglycemia in cats. Tune in to know how to select the ideal feline diabetic candidate for this diabetes mellitus treatment option!Sponsored By: Boehringer Ingelheim

In this VETgirl veterinary continuing education podcast, we interview Dr. Christopher G. Byers, DACVIM, DACVECC about SGLT2 inhibitors for the treatment of diabetes mellitus to manage hyperglycemia in cats. Tune in to know how to select the ideal feline diabetic candidate for this diabetes mellitus treatment option!Sponsored By: Boehringer Ingelheim

Heart failure remains a leading cause of hospitalization, prompting ongoing research into treatment strategies that improve outcomes for patients. A recent study explores the potential of combining an MRA agent and SGLT2 inhibitor, showing meaningful clinical benefit while also reinforcing the need for thoughtful patient selection and safety monitoring. Tune in to explore how this evidence may shape pharmacist-driven care and contribute to more confident, individualized treatment decisions.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTZachary Cox, PharmDProfessorLipscomb University College of PharmacyJoshua Davis Kinsey has no relevant financial relationships to disclose. Zachary Cox is a consultant for Roche, Reprieve Cardiovascular, Abiomed, Vectorious, Kestra Medical Technologies, and WhiteSwell. He was also a consultant for Lexicon Pharmaceuticals (ended 2025) and conducted research for AstraZeneca (ended 2024). All relevant financial relationships have been mitigated.  Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe the clinical evidence supporting the use of multiple drug classes in combination therapy for heart failure.2. Identify pharmacist considerations for evaluating patient-specific factors related to efficacy and safety of combination treatment approaches.0.05 CEU/0.5 HrUAN: 0107-0000-25-299-H01-PInitial release date: 10/20/2025Expiration date: 10/20/2026Additional CPE details can be found here.

Heart failure remains a leading cause of hospitalization, prompting ongoing research into treatment strategies that improve outcomes for patients. A recent study explores the potential of combining an MRA agent and SGLT2 inhibitor, showing meaningful clinical benefit while also reinforcing the need for thoughtful patient selection and safety monitoring. Tune in to explore how this evidence may shape pharmacist-driven care and contribute to more confident, individualized treatment decisions.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTZachary Cox, PharmDProfessorLipscomb University College of PharmacyJoshua Davis Kinsey has no relevant financial relationships to disclose. Zachary Cox is a consultant for Roche, Reprieve Cardiovascular, Abiomed, Vectorious, Kestra Medical Technologies, and WhiteSwell. He was also a consultant for Lexicon Pharmaceuticals (ended 2025) and conducted research for AstraZeneca (ended 2024). All relevant financial relationships have been mitigated.  Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe the clinical evidence supporting the use of multiple drug classes in combination therapy for heart failure.2. Identify pharmacist considerations for evaluating patient-specific factors related to efficacy and safety of combination treatment approaches.0.05 CEU/0.5 HrUAN: 0107-0000-25-299-H01-PInitial release date: 10/20/2025Expiration date: 10/20/2026Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

A new meta-analysis in HeartRhythm found that SGLT2 inhibitors reduced sudden cardiac death risk by about 18% across patients with type 2 diabetes, heart failure, or chronic kidney disease, with consistent effects and minimal trial variation. A Cochrane review of over 100,000 participants showed RSV vaccines are highly effective and safe: protein-based shots cut severe lower respiratory infections in older adults by ~75% and protected infants when given to pregnant mothers, halving RSV-related care and hospitalizations. Finally, WHO and EMA reaffirmed acetaminophen's safety in pregnancy, rejecting suggested links to autism or neurodevelopmental harm, noting decades of safe use and the risks of untreated pain or fever.

How do you take one complex medical concept and make it clear, accurate, and actionable for both clinicians and patients, without losing credibility?If you're a CME writer, you know the challenge of translating science into education that actually sticks. But as more CME projects tether clinician education with patient-facing components, the real test is flexing your craft to serve two very different audiences at once. Get this right, and you not only improve learning, you expand your professional scope and impact.In this episode, you'll discover:How to apply practical frameworks to dual-audience writing.Structural techniques that make content engaging, empathetic, and accessible.A simple 3-sentence exercise to sharpen clarity for patients and precision for clinicians—anytime, anywhere.

Type 2 diabetes is one of the most common chronic conditions in the U.S., but it doesn't have to define or limit your life. In this episode, Dr. Steve Edelman and Dr. Jeremy Pettus—two endocrinologists with decades of experience—break down practical strategies for living well with type 2. From the latest medications and tools to everyday lifestyle choices, they highlight what really makes a difference in the long run. Their goal? To show you that type 2 diabetes is not only manageable but that taking control can actually improve your health and quality of life.Get Educated About What's Happening in Your Body: Understanding insulin resistance, metabolic syndrome, and why type 2 diabetes is more than just “high blood sugar.”Know Your Numbers: The key benchmarks for A1c, blood sugar, cholesterol, and blood pressure—and why even small improvements matter.Build the Right Care Team: How to find and work with providers who can guide you through treatment options and keep you on track.Food and Drink That Work for You: Why portion control, balance, and smart substitutions matter more than strict diets or deprivation.Move Your Body (Without Overthinking Exercise): How realistic activity goals—walking, stretching, or even gardening—can improve insulin sensitivity and overall health.The Medications Changing the Game: Why GLP-1s, SGLT2 inhibitors, and CGMs are considered life-changing tools in type 2 diabetes care—and what you should know about them.And That's Just the Start…: From mental health to long-term complication prevention, there are even more strategies in this episode to help you thrive with type 2 diabetes. ★ Support this podcast ★

Disclaimer: The views expressed in this video should not be used for medical diagnosis or treatment or as a substitute for professional medical advice. Individual symptoms, situations and circumstances may vary. Sponsored by Abbott Summary In this episode, Dr. Eden Miller discusses the concept of Euglycemic DKA, a condition that can occur even when blood sugar levels are normal. The conversation covers the importance of understanding the symptoms, the role of medications like SGLT2 and GLP1 in increasing the risk of DKA, and the necessity of regular ketone checks. Dr. Miller emphasizes the need for education and empowerment in managing diabetes, especially in unique situations like pregnancy and prolonged fasting. The episode concludes with strategies for preventing Euglycemic DKA. Chapters 00:00 Introduction to Euglycemic DKA 02:00 Understanding Euglycemic DKA 04:08 Impact of Medications on DKA 07:10 Symptoms and Confirmation of DKA 09:20 The Importance of Regular Ketone Checks 11:07 Exploring GLP-1 Medications 12:30 Other Causes of DKA 16:22 Preventing Euglycemic DKA Resources: https://diabetesandobesity-care.com/ https://www.linkedin.com/in/eden-miller-b02a5a178

Here is the second part of my conversation with biochemist Jon Brudvig to delve into the fascinating world of longevity and contemporary health interventions. We tackle topics ranging from SGLT2 inhibitors and their unexpected benefits to the controversial nature of microplastics in our environment. This dialogue is a treasure trove for anyone interested in the intersections of health, science, and longevity. What You'll Learn: Exploring SGLT2 Inhibitors: Discover the multifaceted benefits of SGLT2 inhibitors, originally diabetes drugs, for heart, kidney, and possibly cognitive health. Metformin: A Mixed Bag: Get an overview of the metformin debate, examining its potential benefits and the contentious nature of the research. Fasting Fundamentals: Gain insights into intermittent fasting, its impact on metabolism, potential benefits, and the critical role of resistance training to mitigate muscle loss. Microplastics: An Underestimated Threat: Learn about the insidious presence of microplastics in human tissues and their potential health repercussions. Potential Interventions: Hear about experimental approaches to reducing microplastics in the body, including the potential role of sulforaphane. Key Takeaways: SGLT2 inhibitors: These drugs have shown promising longevity benefits beyond their initial purpose for diabetes management. Metformin's Controversy: While some data suggests potential longevity benefits, criticism exists regarding its exercise interference and study methodologies. The Role of Fasting: Intermittent fasting can be beneficial, particularly for metabolic health, but must be carefully balanced with nutritional needs and physical activity. Microplastics Concern: Ubiquitous in the environment, microplastics are potentially linked to inflammation and adverse health outcomes, necessitating further research and interventions. Self-Experimentation: Personal health experiments, like those done by Jon Brudvig, highlight the importance of understanding one’s own biology in response to health interventions. Resources: Connect with Dr. Jon Brudvig for more insights into longevity and health: LinkedIn: Jon Brudvig Substack: https://jonbrudvig.substack.com/ Support the Podcast: If you found this episode valuable, please consider subscribing to our podcast and leaving a review. Your feedback helps us continue bringing important conversations like these to a wider audience. Whether you're driven by personal health challenges or broader scientific curiosity, this conversation provides a unique peek into the current and future possibilities of living healthier, longer lives. Share this with individuals passionate about health and longevity, and join the ongoing dialogue to advance our understanding and well-being. 00:12 Understanding SGLT2 Inhibitors 02:51 Mendelian Randomization and SGLT2 Inhibitors 06:24 Benefits and Mechanisms of SGLT2 Inhibitors 09:47 Discussion on Metformin 14:36 Intermittent Fasting and Ketone Supplements 17:46 Fasting, Autophagy, and Muscle Health 22:38 Exploring Glycine and N-Acetyl Cysteine 24:48 Microplastics: A Growing Concern 26:25 The Impact of Microplastics on Health 31:54 Self-Experimentation with Sulforaphane 38:33 Final Thoughts and Future Work See omnystudio.com/listener for privacy information.

Join Kate, Mark, Gary and Henry as they discuss 4 great new POEMs (studies with the potential to change practice): a digital mental health intervention, the risk of DKA in patients using SGLT2 inhibitors, esketamine's effects on suicidal ideation and unresponsive depression, and whether “one-size-fits-all” thyroid reference ranges misleading.Links:Essential Evidence Plus: www.essentialevidenceplus.comDigital mental health app for depression: https://pubmed.ncbi.nlm.nih.gov/40227715/RIsk of DKA with SGLT2s: pubmed.ncbi.nlm.nih.gov/40070044/Esketamine and resistant depression or suicidality: pubmed.ncbi.nlm.nih.gov/39790081/ What is a normal TSH: https://pubmed.ncbi.nlm.nih.gov/40324200/ Joseph O'Connor and the Escape Line Trilogy (2 great novels): https://www.amazon.com/The-Rome-Escape-Line-Trilogy-2-book-series/dp/B0BSNX3C89 

In this essential episode of Parallax, Dr Ankur Kalra welcomes Dr Shelley Zieroth, Professor of Medicine, clinician-scientist, and advanced heart failure and transplant cardiologist in Winnipeg, Canada. As we mark the 10-year anniversary of the landmark EMPA-REG OUTCOME trial, Dr Zieroth provides a comprehensive update on how SGLT2 inhibitors have revolutionized cardiovascular care. Dr Zieroth takes us through the remarkable journey from the initial 2015 trial that transformed SGLT2 inhibitors from anti-diabetic agents into cardiovascular powerhouses, delivering highly significant reductions in cardiovascular death and heart failure hospitalization. She explores how these medications have become fundamental pillars of cardio-kidney-metabolic medicine, with evidence spanning the entire ejection fraction spectrum. Dr Zieroth discusses prescribing these agents in heart failure - including the straightforward 10-mg daily dosing, monitoring strategies, and crucial patient selection criteria. She shares insights from the recent EMPULSE trial on safe in-hospital initiation, addresses important considerations for diabetic patients, and highlights key contraindications like indwelling catheters that clinicians must recognize. Beyond the basics, Dr Kalra and Dr Zieroth examine the evolving role of SGLT2 inhibitors in valvular disease and diastolic dysfunction, tackle the ongoing reimbursement challenges across different healthcare systems, and discuss the critical importance of multidisciplinary collaboration in the cardio-kidney-metabolic space. They also look ahead to exciting combination therapies on the horizon that promise to further advance heart failure prevention and treatment. Questions and comments can be sent to "podcast@radcliffe-group.com" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Doctor Warick Bishop, a cardiologist, author, and keynote speaker, discusses heart failure with preserved ejection fraction (HF PEF) in this podcast episode featuring Dr. Fiona Foo, a cardiologist in the Sydney Cardiology Group. They delve into HF PEF diagnosis, treatment, and prevention strategies, focusing on managing blood pressure, weight, and other risk factors like diabetes and kidney disease. They elaborate on medications such as SGLT2 inhibitors and GLP1 receptor agonists, which have shown benefits in reducing HF PEF hospitalizations and cardiovascular risks. By emphasizing lifestyle changes and pharmaceutical support, their conversation underscores the importance of maintaining a healthy weight and managing related conditions to reduce the risk of heart failure. It's a comprehensive discussion aimed at empowering listeners to prioritize heart health and make informed choices.

This week, we explore the potential role of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with systemic lupus erythematosus (SLE) and comorbid type 2 diabetes (T2D)—a population historically excluded from landmark SGLT2i trials. Our guest, Dr. Karen Costenbader, discusses the rationale behind the study, the nuances of trial emulation design, and key findings regarding cardiovascular and renal outcomes, infection risk, and prescribing patterns in this complex cohort. We also unpack implications for clinical decision-making and the evolving landscape of metabolic and cardiovascular care in autoimmune disease. 

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Brian Kennedy is a renowned biologist, leader in aging research, and director of the Center for Healthy Longevity at the National University of Singapore. In this episode, Brian shares insights from ongoing human aging studies, including clinical trials of rapamycin and how dosing strategies, timing, and exercise may influence outcomes. He presents two key models of aging—one as a linear accumulation of biological decline and the other as an exponential rise in mortality risk—and explains why traditional models of aging fall short. He also explains why most current aging biomarkers lack clinical utility and describes how his team is working to develop a more actionable biological clock. Additional topics include the potential of compounds like alpha-ketoglutarate, urolithin A, and NAD boosters, along with how lifestyle interventions—such as VO2 max training, strength building, and the use of GLP-1 and SGLT2 drugs—may contribute to longer, healthier lives. We discuss: Brian's journey from the Buck Institute to Singapore, and the global evolution of aging research [2:45]; Rethinking the biology of aging: why models like the hallmarks of aging fall short [9:45]; How inflammation and mTOR signaling may play a central, causal role in aging [14:15]; The biological role of mTOR in aging, and the potential of rapamycin to slow aging and enhance immune resilience [17:30]; Aging as a linear decline in resilience overlaid with non-linear health fluctuations [22:30]; Speculating on the future of longevity: slowing biological aging through noise reduction and reprogramming [33:30]; Evaluating the role of the epigenome in aging, and the limits of methylation clocks [39:00]; Balancing the quest for immortality with the urgent need to improve late-life healthspan [43:00]; Comparing the big 4 chronic diseases: which are the most inevitable and modifiable? [47:15]; Exploring potential benefits of rapamycin: how Brian is testing this and other interventions in humans [51:45]; Testing alpha-ketoglutarate (AKG) for healthspan benefits in aging [1:01:45]; Exploring urolithin A's potential to enhance mitochondrial health, reduce frailty, and slow aging [1:05:30]; The potential of sublingual NAD for longevity, and the combination of NAD and AKG for metabolic and exercise enhancement [1:09:00]; Other interventions that may promote longevity: spermidine, 17