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Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Melanie Ruffner, an Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Dr. Ruffner describes her work in clinic and the paper she co-authored about pediatric and adult eosinophilic esophagitis (EoE). She covers the questions they considered in the paper and the conclusions they reached. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:17] Holly introduces today's topic, pediatric and adult eosinophilic esophagitis (EoE), and introduces today's guest, Dr. Melanie Ruffner.   [1:23] Dr. Melanie Ruffner is an attending physician with the Division of Allergy and Immunology in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Holly welcomes Dr. Ruffner to Real Talk.   [1:50] As an attending physician in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia, Dr. Ruffner sees patients who have eosinophilic esophagitis and other eosinophilic disorders, including eosinophilic GI tract disorders.   [2:09] Dr. Ruffner also leads a research group that studies how the immune system causes inflammation in response to certain foods, leading to EoE.   [2:20] Inflammation in the esophagus is tied to other diseases like epithelial barrier dysfunction and fibrosis.   [2:28] Our bodies use many different proteins that allow cells to communicate with one another. One type of signaling protein that causes inflammation is called cytokines.   [2:41] Dr. Ruffner's group is interested in how these signaling proteins called cytokines interact with epithelial cells and how that impacts the oral function of the esophagus in patients with EoE.   [3:02] In training, Dr. Ruffner became interested in eosinophilic esophagitis and other non-IgE-mediated food allergies because we don't have a lot of clear treatments or clear mechanisms that cause them.   [3:21] Dr. Ruffner felt there was a lot of work to be done in that area. It was rewarding to be in clinical encounters with those patients. Often, patients had spent a long time trying to find out what was happening and to find a treatment plan that worked for them.   [4:31] Dr. Ruffner's group sees some patients who have eosinophilic gastroenteritis and patients who are referred for hypereosinophilia with impacts of inflammation in other organ systems.   [5:06] Dr. Ruffner co-authored a paper about pediatric and adult EoE published in the Journal of Allergy and Clinical Immunology. It explored if EoE in pediatric patients and adult patients is a spectrum or distinct diseases.   [5:29] EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to foods and causes inflammation in the esophagus.   [5:47] Eosinophils are a type of white blood cell. Eosinophils infiltrate the tissue in the esophagus of people with EoE. Doctors look for eosinophils in the tissue of the esophagus as a sign that inflammation in the esophagus is EoE.   [6:04] The symptoms of EoE can vary in children and adults. That was one of the things the doctors were interested in when they were thinking about this paper. There are no blood or allergy tests that make it easy to diagnose EoE, which requires an endoscopy.   [6:31] An endoscopy is performed by a gastroenterologist. The gastroenterologists look at the appearance of the esophagus and take biopsies.   [6:49] A pathologist counts the eosinophils in the tissue to determine if there are eosinophils present. If there are more than 15 eosinophils in the high-powered field of the microscope and symptoms and clinical conditions are present, EoE is diagnosed.   [7:25] One of the variables Dr. Ruffner considers is that symptoms can be different in children versus adults. In older adolescents and adults, the classic symptom is difficulty swallowing or dysphagia. That is often caused by fibrosis in the esophagus.   [7:54] In younger children this is often not how EoE presents. They may vomit or refuse food. They may experience more weight loss. Symptoms vary over the lifespan. Pediatric EoE symptoms of nausea and abdominal pain can also show up in adults.   [9:54] Atopy refers to allergic conditions. In the paper, a history of atopy means a history of allergic conditions, like atopic dermatitis, IgE-mediated food allergy, allergic rhinitis, or asthma.   [10:37] These disorders tend to cluster together, over time, because they share many common genetic risks. They cluster in families because some of the genetic risks are the same. Not every family member will have the same atopic or allergic conditions.   [11:07] In families, perhaps one person will have atopic dermatitis and allergic rhinitis while another will have atopic dermatitis, allergic rhinitis, asthma, and EoE. They may have inherited different genetics or had different environmental exposures.   [11:50] Ryan says that describes his family. They each have different atopic conditions. Ryan got them all! Dr. Ruffner says it describes her family, as well.   [12:26] Dr. Ruffner says it's understandable for families to stress about atopic conditions. Unfortunately, right now, there's no way to predict who will develop which atopic conditions. It's on the minds of the medical and research communities.   [13:10] IgE is an antibody that binds to food allergens and mediates anaphylaxis, usually within 30 minutes, with hives, vomiting, and difficulty breathing. Not everyone with a diagnosed food allergy will be given an epinephrine auto-injector.   [13:44] IgE-mediated food allergies are influenced by type 2 cytokines. Cytokines are immune system signaling proteins that have been labeled as groups. The group that is involved in allergy most heavily is under the label type 2.   [14:15] These type 2 cytokines are responsible for influencing B cells to make IgE. In the tissue in EoE, we find that there is a large amount of these type 2 cytokines present.   [14:37] This is quite relevant because dupilumab, the monoclonal antibody that has been approved to treat EoE, targets type 2 inflammation by blocking type 2 cytokines.   [16:04] Dr. Ruffner says one of the biggest challenges in the field of EoE is we don't have a way to stratify who should get which treatment for EoE. Patients have to choose between diet and pharmacologic therapy.   [16:48] We don't know enough about the inflammatory profiles to give any patient the specific guided information that one therapy would be better than another.   [17:11] Pediatric and adult patients are given the same treatment options. Some dosing, such as proton pump inhibitors and dupilumab, is weight-based so different doses are needed.   [17:36] Over time, people's needs change. From early school age to when people leave home, they may have very different needs. They may do well on diet therapy when their diet is controlled by parents, but, on their own, that may not be the best option for them.   [18:20] Therapy may change over time to support each patient's individual goals. It can be challenging because therapies are imperfect. Each therapy has a percentage probability of success. Not every therapy is guaranteed to work for every individual.   [19:01] There is some flexibility and possibility of switching between therapies to support people. Ryan shares one of his experiences in changing treatments.   [20:03] Some patients are stable on a therapy for a time but then see symptoms creep back up. Dr. Ruffner strongly suggests they talk to their care team for an endoscopy and biopsy to see if they need to switch therapy and if their diet has changed.   [21:31] In young children, Dr. Ruffner sees a much higher incidence of feeding refusal. The child may have a preferred food or a preferred texture like puree, long past when that would be appropriate for the age.   [22:41] It can be very difficult to move past this learned behavior even if remission is achieved through therapy. The child may need feeding therapy to help with that. [22:59] Feeding behaviors in older individuals may be much more subtle. Talk about them with your care team. Needing water to eat, cutting food very small, and fearing to eat around people are common eating behaviors to discuss in older patients.   [23:53] These eating behaviors affect people's well-being deeply because they affect how social they feel when they are around people. Ideally, you want to be around people and share in social times.   [24:16] Holly has used these eating behaviors herself and notices them in other people. When adults come to her for therapy, she asks how many times they refill their water when they eat, and if food ever gets stuck. They are surprised that those are symptoms.   [26:01] Dr. Ruffner says it's important to recognize the difference in symptoms in diagnosing EoE. The main risk factor of EoE is fibrosis, over time. The thought is that early in EoE there is an inflammatory phenotype, but later, there is a fibrotic phenotype.   [26:51] The phenotype refers to the presentation or characteristic of disease. What is the appearance at endoscopy? What do we see in the biopsied tissue? Is there fibrosis or not?   [27:15] This is the crux of the paper: Is this on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to this fibrosis over time.   [27:40] One thing that is missing is following a group of patients from the start and having that evidence. There is mechanistic evidence from studies to show that inflammation can contribute to fibrosis. That was one of the discussions in the paper.   [28:29] In endoscopies, something that can be seen with fibrosis or fibrostenotic features is more of an appearance of rings and narrowing of the esophagus. A proportion of patients with strictures or narrowing need to have them dilated.   [29:11] For patients who have dilation, it can help with symptoms significantly. When pathologists look at the tissue with fibrosis, they can see changes in the protein structure. There is more collagen and other changes in the tissue, causing fibrosis.   [30:03] Some patients use adaptive eating behaviors to adapt to significant changes in their esophagus and go for many years without being diagnosed until they present with an impaction when food becomes stuck in their esophagus.   [30:46] This makes EoE a challenging disorder for many because it can be very difficult to diagnose. The journey to a diagnosis is very individual. As a group, adults are much more likely to have fibrosis, leading to dysphagia, strictures, or impaction.   [31:25] Statistically, across all patients, you see fibrosis more in adults than in children.   [32:42] In the paper, Th1 cells are mentioned. Th1 is an immune system term referring to a cell that produces interferon-gamma. Studies show there may be differences in interferon signaling in different age groups but it needs to be studied further.   [33:57] Dr. Ruffner's team had looked at a small group and saw that interferon signaling seemed to be relatively similar between children and adults. Both CD4 and CD8 T cells (types of immune system cells) are potentially producing interferon in the esophagus.   [34:32] More study needs to be done around those immune system cells and their potential significance in EoE, if any.   [35:33] The paper suggests that EoE in children and adults is essentially a spectrum of the same disorder rather than distinct diseases.   [35:42] Aspects of immunology, responses to different treatments across children and adults, the similar responses to diet and different medications, and over time in the same individuals, indicate these are changes and complications over time.   [36:41] Dr. Ruffner suggests that medical researchers need to understand which patients are at the highest risk of complications and work to identify the best treatments to prevent those.   [37:14] Dr. Ruffner is thinking about the response to proton pump inhibitor therapy. One of the things she is looking at is whether or not proton pump inhibitors affect how eosinophils migrate into the tissue.   [37:33] They are finding that it seems that PPIs can decrease the degree of migration of eosinophils into the tissue. They are very interested in looking at that. Ryan says when Dr. Ruffner gets that paper published, she'll have to come back on the show!   [38:06] Ryan thanks Dr. Ruffner. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:15] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:24] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:33] Ryan thanks Dr. Ruffner for participating in the podcast episode. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Dr. Melanie Ruffner, MD, PhD, Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia “Pediatric and adult EoE: A spectrum or distinct diseases?” by Stanislaw J. Gabryszewski, Melanie A. Ruffner, and Jonathan M. Spergel   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   “EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to food allergens and causes inflammation in the esophagus.” — Dr. Melanie Ruffner   “In EoE, there are no blood or allergy tests that make it easy to diagnose EoE without an endoscopy.” — Dr. Melanie Ruffner   “Is EoE on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to fibrosis over time.” — Dr. Melanie Ruffner   “When pathologists look at the tissue with fibrosis, they can see the changes in the protein structure.” — Dr. Melanie Ruffner   “There are some folks who have adapted their eating behavior quite significantly and may have quite a number of chronic changes in their esophagus that they have adapted around, and they go for many years without being diagnosed.” — Dr. Melanie Ruffner

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Is eating red meat actually raising your cholesterol — or are we blaming the wrong foods? In this episode, Claire Duchesneau, longevity coach at HealthspanMD, dives deep into one of the most misunderstood topics in nutrition: the connection between meat, saturated fat, and cholesterol. Red meat, in particular, has long been villainized for its saturated fat content, but the science is far more nuanced than most headlines suggest. Backed by insights from experts like Dr. Gabrielle Lyon and Dr. Don Layman, this episode explores what really impacts your cholesterol — and spoiler alert, it's not your weekly steak dinner.

Ever been diagnosed with stasis dermatitis? If you're dealing with swelling, redness, or relentless itchiness on your lower legs, it's not just dry skin or aging—it could be a sign of poor circulation.Stasis dermatitis is more than just a rash. If left unchecked, it can lead to painful ulcers, infections, and serious complications. It's often mistaken for cellulitis, which means unnecessary antibiotics—and in one case, a patient was hospitalized 11 times before getting the right diagnosis. And heads up—it doesn't just show up on legs. It can also affect areas like the belly and lower back where blood tends to pool.To help us unpack this overlooked condition, I'm joined by Dr. Peter Lio—a board-certified dermatologist and eczema expert. He's a Clinical Assistant Professor at Northwestern, Harvard-trained, and has published over 100 papers, including a textbook on integrative dermatology.Dr. Lio breaks down what stasis dermatitis is, why it's often missed, and how to spot it early. If you or someone you love has unexplained swelling, itchy legs, or chronic redness—don't miss this episode!⭐️Mentioned in This Episode:- Dr. Peter Lio - https://chicagoeczema.com/ - See all the references

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital and Mass General for Children, on the topic of immunology support for eosinophilic esophagitis (EoE). Dr. Accarino shares his experiences as a person living with food allergies, allergic asthma, peanut allergy, and eosinophilic esophagitis. He tells how his experiences help him in his work with patients. Dr. Accarino shares some education on a variety of allergy mechanisms and the treatments that mitigate them. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, immunology support for eosinophilic esophagitis (EoE), and introduces today's guest, Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital. Holly welcomes Dr. Accarino to Real Talk.   [1:49] Holly notes that Dr. Accarino is her allergist and immunologist.   [2:03] Dr. Accarino works at Massachusetts General Hospital and Mass General for Children. Allergy and Immunology is a field where he can see pediatrics and adults. Originally trained in pediatrics, now Dr. Accarino sees patients of all ages.   [2:23] Dr. Accarino grew up with allergies. He has experienced food allergies since he was young, along with allergic asthma, and some eczema, which he grew out of. Later in life, he was diagnosed with eosinophilic esophagitis. He talks with his patients about his experiences.   [2:47] Dr. Accarino also does research on drug allergies in the context of certain drug interactions that involve eosinophils.    [3:06] When Holly was referred to Dr. Accarino, it was for multiple sclerosis (MS). He told her, “It looks like you have EoE. I have EoE.” It was a huge relief to Holly not to have to explain EoE to her doctor.   [3:41] Some patients start to explain their EoE to Dr. Accarino, and he assures them he understands where they're coming from. Sometimes, he has to be careful not to think everyone has his symptoms, as there is a large spectrum of presentations.   [4:26] Dr. Accarino wasn't diagnosed with EoE until he was in his allergy fellowship, after he suspected it when he had a food impaction at a steakhouse at a graduation party from his pediatric residency. He tried to manage the EoE with lifestyle changes.   [5:39] Dr. Accarino didn't often go to see a doctor during residency, but he realized it was probably a good time to get an endoscopy.   [5:52] Holly shares how she was also diagnosed as a clinical fellow. She was subbing for someone on the GEDP team at Children's Hospital in Colorado. Listening to all the patients, she realized, “This sounds a little bit like me … What is going on?”   [6:23] Even with his medical background, it took Dr. Accarino some time to decide to get the endoscopy and biopsies. You or your doctor have to have a high level of suspicion to realize this isn't just reflux. Food doesn't get stuck in every person's throat.   [7:01] Thinking back, Dr. Accarino remembers an instance as a child when a dry muffin got stuck in his throat. He stayed calm and waited for it to pass. He thought it was normal.   [7:39] He drank a lot of water and chewed his food a lot. Those are markers of potential esophageal inflammation.   [8:20] Different groups have different management strategies for EoE. Dietary management, topical steroids, biologics. A subgroup of people with EoE are responsive to proton pump inhibitors (PPIs). Finding the best management strategy is a work in progress.   [8:53] With pediatric patients, the parents control the diet, and the children eat what is prepared. He notes that with adult patients, sometimes they let foods slip through.   [9:10] If you want to do a single-food elimination diet with dairy, there's a lot of dairy in the American diet. Dr. Accarino tried eliminating dairy and wheat, but he still had persistent eosinophils with dietary elimination.   [9:24] Dr. Accarino then tried PPIs. To know if you have PPI-responsive EoE, you might do twice-daily omeprazole at a significant dose. Have the endoscopy after a few weeks pass and see if the eosinophils are still present in the biopsy.   [9:59] Dr. Accarino did that recently and still has the eosinophils. He plans to talk to his gastroenterologist about considering dupilumab, but he feels that he can mitigate his subjective day-to-day experience of symptoms with dietary elimination and PPIs.    [10:24] If you still have the presence of eosinophils on biopsy, there's still inflammation happening. In the long term, you still have to worry about fibrosis and narrowing.    [10:34] The last treatment Dr. Accarino tried was as a research participant in a study for dissolvable fluticasone. He received either the medication or a placebo; he doesn't know which.   [11:01] To stay in the study, he had to journal and report his symptoms regularly. He didn't have enough symptoms to stay in the study. They were looking for a baseline to see how it changed with either the placebo or the medication.   [11:20] In research, you have to have a baseline to start, and then you want to see improvement, plus or minus. With EoE, it's difficult. You have the biopsy and eosinophils, but there's a large spectrum of symptoms that people may experience.   [12:40] Holly appreciates Dr. Accarino's unique perspective as a doctor with EoE who has experienced various treatments and diets. He understands the concerns of his patients.   [12:43] Dr. Accarino says even taking a twice-daily PPI or other medication is difficult for a lot of people, and that's the most simple of these therapies.   [13:06] Dr. Accarino wants to validate everyone's experience in terms of how difficult it is to treat this disorder, how it may present in different ways, and how there may be a delay in diagnosis.   [13:16] This isn't IgE-mediated immediate food allergy, where you eat a food and may have swelling within minutes; you may have flushing or hives. That's very clear. With EoE, it's a different mechanism; in many cases, there is a delay.   [14:37] Allergy, in general, is under the purview of clinical immunology. Dr. Accarino is allergic to peanuts and has an  IgE-mediated immediate reaction to them. If he eats a peanut, he has symptoms within minutes. He could have anaphylaxis. As a result, he carries an epinephrine auto-injector.   [15:01] If Dr. Accarino has a skin test, it will be positive for peanut. He has IgE antibodies to peanuts. He also has oral allergy syndrome where the body mistakes certain fruits, vegetables, or nuts with certain tree pollens or grass pollens.   [15:23] Oral allergy syndrome is usually a lower-risk condition where it's a less-stable protein that once cooked might not produce any symptoms. If it's raw when you consume it, you may have oral itching, a bit of throat discomfort, or tongue itching. [15:54] Your stomach acid breaks it down so it doesn't get into your bloodstream and you shouldn't have a systemic reaction.   [16:01] If Dr. Accarino eats a peanut, his stomach acid doesn't break down the high-risk, stable peanut protein, it gets into his bloodstream, and he can have a systemic anaphylactic reaction.   [16:20] Chronic EoE symptoms can present with something like a food impaction, or bad reflux or belly pain, and nausea. The reaction may not be immediate. It may be progressive over days or weeks.   [16:38] FIRE is an interesting condition that takes some time to narrow down. It's an immediate response of the esophagus, but we don't think it's histamine-mediated.   [16:56] We don't know, exactly, the mechanism but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers.   [17:11]  It took some time to figure out what was going on. Dr. Accarino felt like he had a lump in his throat, then a lump in his chest, nausea, and belly pain. It felt like a slow progression of EoE symptoms, and it was from specific food triggers, in his case.   [17:30] In some of the FIRE literature, they looked at banana and avocado. For Dr. Accarino, it took a couple of exposures to protein bars and milk protein whey isolate, specific to protein bars he had multiple times, until he figured out that was the trigger.   [17:50] Another protein whey isolate that Dr. Accarino scooped as a powder and made into a shake also led to FIRE.   [17:55] It took that event for Dr. Accarino to figure out it wasn't just a flareup of EoE or reflux but some trigger that caused this response that wasn't anaphylaxis but may be due to the recruitment of eosinophils or some immediate process not well understood.   [18:18] FIRE is going to be very hard to research. How would we figure this out? Would we bring someone in and do an endoscopy immediately and see what happens? There's a lot of descriptive data and case series.   [18:32] Dr. Accarino has had experiences when he knew it wasn't an immediate anaphylactic reaction, oral allergy, or reflux. He asked what else it could be in the context of EoE. When he looked at different case series, that's the presentation he had.   [19:17] Dr. Accarino acknowledges that having personal experience with FIRE, oral allergies, and IgE-mediated allergies, on top of EoE, has influenced his work as a medical professional. He can share anecdotes with patients as he explains the available testing.   [19:39] Dr. Accarino says a lot of immunology and allergy is explaining the diagnostic tools and management strategies we have and what we think is going on.   [19:50] The immune system is infinitely complex, and a lot of the practice is making a digestible analogy, not just in the context of allergic conditions but also everything with the immune system. There are so many cells doing so many different things.   [20:04] Dr. Accarino explains false positives in testing. He has positive scratch tests for peanuts, cashews, and almonds, which shows he has IgE for each of them. He is allergic to peanuts, but he can eat cashews and almonds. Those are false positives.    [20:56] When a scratch test is negative for immediate food allergy, it's a powerful predictive tool. But you may get false positives. How positive is it? There might be room for more discussion.   [21:10] There may be more hesitation for people who do large panels of food testing without any history of reacting to any foods.   [21:31] Some people have EoE triggered by milk or wheat but have negative skin tests. That doesn't mean they aren't triggered by these foods. The skin test is an IgE histamine mast cell mechanism, not for eosinophils, which are other immune cells.   [21:58] We go down these steps of thinking about diagnostic triggers and eventually treatment for those immediate symptoms mentioned for EoE.   [22:09] Dr. Accarino doesn't expect FIRE to be responsive to epinephrine. He doesn't have to stabilize the mast cells. It's a chronic disease that's flaring up. You treat it with a chronic type of treatment.   [24:10] Dr. Accarino says that for a doctor, immunology is rewarding, interesting, and complex, but it's intimidating until you get your foothold and see patients and clinical experiences.   [25:14] A lot of medical students and residents are a little fearful of immunology. They might not think about it too much. Dr. Accarino loves to talk about it and think about it. He can't think of anything more complex in terms of systems within our body.   [25:37] Ryan comments on his experiences with IgE-mediated food allergies, some environmental allergies that he has no idea how they work, and EoE, which he believes he has a good grasp on.   [25:55] Ryan imagines that having a physician with a good understanding of the immune system and also personal experience would be helpful for a patient with multiple allergic conditions.   [26:13] Dr. Accarino sees a large overlap of seasonal or year-round environmental allergies and EoE. There are some studies that show that endoscopies on patients with EoE may change at different times of the year if they have underlying seasonal allergies.   [26:33] Some people who have food allergies also have EoE or other eosinophilic disorders. Some discussions with them may be about blood tests that detect eosinophils in the bloodstream versus biopsies of the esophagus, stomach, or colon.   [27:15] It's thinking about what tests are available, what they tell us, and how to use them to predict the next steps, things like dietary changes or for immediate food allergy, considering challenges versus full avoidance. Each test has its pluses and minuses.   [27:35] People like a clear test, and they like an easy fix, but sometimes there's a lot of nuanced conversation of shared decision-making and trying things in a supervised setting.   [27:57] Holly speaks as a patient of the investigative testing Dr. Acarino is doing with her immune system trying to figure it out along with her MS and EoE.   [28:14] Dr. Accarino says the words immune system, immunity, and inflammation are used a lot in talking about foods. Dr. Accarino uses the framework of the immune system trying to help you.   [28:42] Sometimes, instead of making helpful antibodies to things like vaccines or viruses, that give you protection, the immune system makes antibodies that attack a certain organ or your joints.   [29:02] Dr. Accarino thinks of treatments that suppress the immune system in certain ways. Some treatments cool down the populations of many different immune cells. Oral steroids and prednisone are used for many conditions for autoimmune flares.    [29:29] Oral steroids, in the long term, may lead to weight gain, bone density changes, and diabetes. The big push for many diseases is toward non-steroidal biologics to target specific cells that cause disease.   [29:59] For Crohn's disease, a specific monoclonal antibody is used to target TNF-alpha molecules and blocks that inflammation pathway.   [30:14] For EoE, dupilumab, a specifically designed antibody, blocks a specific receptor in a specific pathway so the immune system doesn't have to be shut down and the patient doesn't have the side effects of steroids. It's a targeted therapy.   [30:32] What you see in commercials for injectable medications are large, designed antibodies that, if you took them in a pill form, your stomach acid would break down and digest. So they are injections and infusions that go directly into the bloodstream.   [31:22] Medications that end in -mab are monoclonal antibodies. They are very large molecules that would not be stable in stomach acid.   [32:09] Dr. Accarino talks of eosinophil normal function and aberrant function. IgE-mediated reactions are usually related to mast cells, a type of immune cell that shouldn't be in the bloodstream.   [32:54] Dr. Accarino can do a CBC with differential to see the number of white blood cells and the number of red blood cells. The differential of white blood cells will include neutrophils, lymphocytes, and eosinophils. It shouldn't show mast cells.   [33:19] If you have mast cells in your bloodstream, that's mastocytosis, a different problem. Mast cells live in your skin, in your gut, and around your blood vessels. They're full of granules like histamine and tryptase.   [33:38] Dr. Accarino explains how mast cells release their contents and how he would treat the resulting swelling or itch with an antihistamine or epinephrine. Epinephrine treats systemic reactions and stabilizes the mast cells.   [34:16] Mast cells have many receptors and may be triggered by many things other than IgE. This is a conversation Dr. Accarino has with patients who have chronic hives unrelated to any foods.   [34:29] Some people get hives from non-steroidal anti-inflammatory drugs NSAIDs. Some get hives from vancomycin. Some get hives when the temperature changes, from tight clothing, or from IV contrast. It's not an IgE-mediated mechanism, but it's still mast cells being degranulated.   [35:45] Dr. Accarino says people see hives and they think allergy. But, like EoE, it doesn't involve histamine. There can be hives that aren't related to allergies. This can be idiopathic urticaria or spontaneous urticaria.   [36:04] Sometimes, when switching from a day shift to a night shift, hormonal changes will trigger hives. Sometimes, the stress of having a family member in the hospital will cause hives. An accumulation of triggers can lead to mast cell degranulation.   [36:38] There are many ways that allergy can have different mechanisms and treatments, with different cells involved. There are different molecules that cause symptoms and manifestations.   [36:50] Navigating that and understanding what might be going on can give people a sense of reassurance. The biggest fear is a life-threatening allergic reaction. People will read about fatal anaphylaxis and wonder if it will happen to them with their condition.   [37:16] Sometimes, thinking of the cells involved and the pathways may give a level of reassurance that this may not be the same thing that they read about.   [37:28] Ryan thanks Dr. Accarino for joining us today.   [37:37] Dr. Accarino says it was nice to reflect on things and to go through different scenarios and experiences he has gone through. It was nice to have the opportunity to share them with Ryan, Holly, and all the listeners.   [37:57] For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:06] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:15] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:25] Ryan thanks Dr. Accarino for joining us today for this fun conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. John Accarino, MD, Allergist and Immunologist at Massachusetts General Hospital and Mass General for Children Episode 034: Food-Induced Response and Eosinophilic Esophagitis   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “Allergy and immunology is a field where I can see pediatrics and adults. I was originally trained in pediatrics, but now I see all ages, from infants up until older adults.” — Dr. John Accarino   “Part of the conversation sometimes is trying not to overly bias myself, where I say, ‘Oh, this is my experience.' … Like many diseases, there's a large spectrum of presentations, … different symptoms that people have.” — Dr. John Accarino   “We don't think [Food-Induced Response in Eosinophilic Esophagitis is] histamine-mediated. We don't know exactly the mechanism, but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers. It took some time to figure out that was going on.” — Dr. John Accarino   “When a scratch test is negative for immediate food allergy, it's a very powerful predictive tool. But there are times that you may get false positives. How positive is it? There might be room for more discussion.” — Dr. John Accarino   “There are a lot of ways that allergy can have different mechanisms and different treatments, with different cells involved.” — Dr. John Accarino

In this episode of Health Coach Conversations, Cathy Sykora speaks with Dr. Carrie Graham about how understanding adult learning can help health coaches and wellness professionals create lasting behavioral change in their clients. With a PhD in Adult Learning and Workplace Learning, Dr. Graham shares strategies for keeping clients engaged, tailoring learning experiences, and ensuring that knowledge leads to real-world application. In this episode, you'll discover: The difference between adult and child learning – Why adults require a different approach to learning and behavior change. How to keep clients engaged in programs – Strategies for preventing drop-off and maintaining motivation. Overcoming barriers to learning and change – Identifying personal and environmental factors that may prevent progress. How to avoid overwhelming clients with too much information – The power of small wins and incremental learning. Tailoring learning experiences for health and wellness professionals – How to customize programs for better client success. The importance of client-centered learning – Why one-size-fits-all programs don't work and how to guide clients toward self-discovery. Memorable Quotes “You don't give a toddler a steak or expect them to run a marathon. The same applies to learning—adults need small wins before they can build up to lasting change.” “It's not about what you know as a coach. It's about what your client needs to succeed.” “If you're working in a vacuum, you're only limited to what you know. Surround yourself with experts who can validate and expand your knowledge.” Bio Dr. Carrie Graham is an expert in adult learning and workplace development. With a background in sports medicine and a PhD in Adult Learning, she specializes in helping individuals and organizations create effective learning solutions. Dr. Graham is known for her ability to uncover unstated problems, ask critical questions, and provide clear, actionable strategies for personal and professional development. Mentioned in This Episode: Dr. Carrie Graham's Free Training Assessment – Take the Assessment Dr. Carrie Graham's Website – www.drcarriegraham.com Dr. Carrie Graham's Services – Explore Here Links to Resources: Health Coach Group Website – thehealthcoachgroup.com Special Offer – Use code HCC50 to save $50 on the Health Coach Group website. Leave a Review – If you enjoyed the podcast, please consider leaving a five-star rating or review on Apple Podcasts.

In this episode of the Food Junkies Podcast, Dr. Vera Tarman speaks with Dr. Donald Weaver, a world-renowned expert on Alzheimer's disease, its causes, and its treatment. Dr. Weaver, a Canadian neurologist, chemist, and researcher at the University of Toronto, has made significant contributions to our understanding of cognitive diseases, particularly Alzheimer's. His groundbreaking work suggests that Alzheimer's is not just an inherited brain disorder but also an autoimmune condition triggered by environmental toxins, including metals, plastics, pesticides, and—most relevant to our discussion—ultra-processed foods. Join us as we explore the science of Alzheimer's, the role of diet in brain health, and what we can do to prevent cognitive decline. Dr. Weaver will discuss the inflammatory effects of ultra-processed foods, the role of the immune system in Alzheimer's, and how diet is one of the most significant modifiable risk factors for this devastating disease. What You'll Learn in This Episode: ✔️ Dr. Weaver's journey into neurology and Alzheimer's research, including a personal story that shaped his career. ✔️ Why Alzheimer's is not just one disease but a collection of related disorders. ✔️ The role of inflammation and the immune system in developing Alzheimer's. ✔️ How ultra-processed foods contribute to brain inflammation and cognitive decline. ✔️ The similarities between Alzheimer's and autoimmune diseases. ✔️ Why head trauma, air pollution, and diet are major risk factors. ✔️ How diabetes and obesity increase the likelihood of Alzheimer's and why some researchers call it “Type 3 Diabetes.” ✔️ The potential of GLP-1 receptor agonists (like Ozempic) to reduce Alzheimer's risk. ✔️ Why it's never too late to make dietary changes to protect brain health. ✔️ The latest research on potential treatments and vaccines for Alzheimer's. Key Quotes:

Episode Summary: In this episode of the Health Science Podcast, brought to you by the National Health Association, Dr. Frank Sabatino sits down with Dr. Meagan L. Grega, a board-certified physician in Family and Lifestyle Medicine and the Co-Founder and Chief Medical Officer of the Kellyn Foundation. Together, they discuss the power of community-driven health initiatives, the importance of making the healthy choice the easy choice, and how the Kellyn Foundation is working to transform neighborhoods with lifestyle medicine programs. Dr. Grega shares insights on the evolution of her career, from her early passion for service to her realization that true healing comes from prevention and community support. She explains how the Kellyn Foundation integrates school-based education, gardening programs, mobile markets, and hands-on cooking classes to create sustainable change in the Lehigh Valley. If you're looking to learn how lifestyle medicine can be a powerful force for improving health outcomes, this episode is a must-listen! About Our Guest: Meagan L. Grega, MD, FACLM, DipABLM, DipABFM Dr. Meagan L. Grega is a leader in Lifestyle Medicine and the Co-Founder and Chief Medical Officer of the Kellyn Foundation (www.kellyn.org), a non-profit dedicated to making the healthy choice the easy choice through community-based health initiatives. The foundation's “Healthy Neighborhood Immersion Strategy” integrates school-based wellness education, hands-on cooking classes, and a mobile market providing access to fresh, nutrient-dense food. Dr. Grega graduated summa cum laude from Bucknell University with a B.S. in Biochemistry/Cell Biology and earned her MD from the University of Pennsylvania Medical School. She served as a medical officer in the United States Navy and currently manages the Llantrisant Retreat and Wellness Center (www.llantrisantretreat.com). She is actively involved in medical education, serving as faculty for St. Luke's University Health Network and Temple University's Lewis Katz School of Medicine, and is the current Conference Chair for the American College of Lifestyle Medicine Annual Meeting. She also serves on the governing boards of both the American Board of Lifestyle Medicine and the American College of Lifestyle Medicine. Key Topics Discussed in This Episode: Dr. Grega's journey from aspiring shaman to board-certified physician How lifestyle medicine addresses the root causes of disease The role of social nudges and choice architecture in shaping healthy behaviors The Kellyn Foundation's programs, including school-based education, gardening initiatives, and the Eat Real Food Mobile Market Challenges in implementing lifestyle medicine in schools and how to overcome them The importance of medically tailored meals and expanding access to nutrition-focused healthcare How future physicians are being trained in lifestyle medicine Resources & Links: Kellyn Foundation: www.kellyn.org Llantrisant Retreat and Wellness Center: www.llantrisantretreat.com Connect with Us: Subscribe and leave a review on your favorite podcast platform! Read more at: https://www.healthscience.org/podcast/episode-122-meagan-grega/

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital. Dr. Shreffler is also an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative. His research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy. This interview covers the results of a research paper on The Intersection of Food Allergy and Eosinophilic Esophagitis, co-authored by Dr. Shreffler. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host, Holly Knotowicz.   [1:15] Holly introduces today's topic, the intersection of food allergy and eosinophilic esophagitis.   [1:26] Holly introduces today's guest, Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital and an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative.   [1:43] Dr. Shreffler's research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy.   [1:54] Holly welcomes Dr. Shreffler to Real Talk. When Holly moved to Maine, she sent her patients to Dr. Shreffler at Mass General.   [2:25] Dr. Shreffler trained in New York on a Ph.D. track. He was interested in parasitic diseases and the Th2 immune response. Jane Curtis, a program director at Albert Einstein College of Medicine, encouraged him to consider MD/PhD programs. He did.   [3:31] Jane Curtis connected him to Hugh Sampson, who was working with others to help understand the clinical prevalence of food allergy and allergens.   [3:51] As a pediatric resident, Dr. Shreffler had seen the burden of allergic disease, caring for kids in the Bronx with asthma. His interest in Th2 immunity, the clear and compelling unmet clinical need, and the problem of food allergy guided his career.   [4:31] Dr. Shreffler's wife has food allergies and they were concerned for their children. Fortunately, neither of them developed food allergies.   [5:21] Dr. Shreffler thinks the food allergy field has a lot of people who gravitate toward it for personal reasons.   [5:53] Food allergy is an adverse response to food that is immune-mediated. There is still uncertainty about this but Dr. Shreffler believes that a large percentage of patients with EoE have some triggers that are food antigens.   [6:27] The broad definition of food allergy would include things like food protein-induced enterocolitis syndrome (FPIES).   [6:47] The way we use the term food allergy in the clinic, there are two forms: IgE-mediated allergies and non-IgE-mediated allergies, including EoE.   [7:40] Some patients have food-triggered eczema, some have FPIES.   [8:04] In 2024, Dr. Shreffler and Dr. Caitlin Burk released a paper that looked at the triggers of EoE, particularly the intersection of IgE-mediated food allergy and EoE.   [8:41] Dr. Caitlin Burk joined the group as they were publishing papers on IG food allergy and EoE. It was a moment where things unexpectedly came together.   [9:17] Adaptive immunity to food proteins comes from antibodies that cause milk allergy, egg allergy, peanut allergy, or multiple allergies. The IgE has specificity.   [9:40] T cells also are specific to proteins. They express a host of receptors that recognize almost anything the immune system might encounter. They have a long memory like B-cells.   [10:09] The overlap in these two threads of research was regarding a population of T cells that are important for mediating chronic inflammation at epithelial sites, including the gut.   [10:36] These T cells have been described in the airways in asthma, in the skin in eczema, and the GI tract. Researchers years ago had also described them as being associated with IgE food allergy. People with IgE food allergies avoid allergens.   [11:13] T cells, being associated with chronic allergic inflammation, now being associated with food allergies which are not having chronic exposures to the allergen, was interesting and surprising.   [11:30] Dr. Shreffler and his group found the T cell subset in patients who don't do well with Oral Immunotherapy (OIT) and patients who have EoE with immediate symptoms.   [12:01] Dr. Shreffler notes differences. There are immediate symptoms of IgE food allergy. There is a subset of patients with EoE who have immediate symptoms that are not fully understood. Maybe IgE plays a role there.   [12:28] There are different mechanisms for how symptoms are caused and so different ways of making a diagnosis. A food allergy with an IgE antibody can be measured through skin tests and blood tests. This can help identify which foods are the trigger.   [12:57] This common T cell subset that we see in EoE and food allergy, helps to explain why IgE alone is not always a very specific marker for identifying people who will have immediate reactions when they're exposed to the food.   [13:17] For patients who react at low levels, it's not just that they have more or better IgE but they also have an expansion of these T cells that are common between EoE and other chronic forms of allergy and IgE food allergy.   [13:41] There's a lot to learn that might be relevant for patients about this T cell subset.   [14:23] These T cells are a specific subset of the group of Th2 T cells, which are a subset of all CD4 T cells. Some CD4 T cells are important for responding to viruses and tumors. Others are important for responding to outside allergens.   [15:01] In an allergy or a parasite infection, Th2 T cells are important. There is a subset of T cells that is driven by repetitive and chronic exposure to the triggering protein, antigen, or allergen.   [15:47] Most antigens are proteins that trigger an immune response. An antigen that elicits an allergic response is an allergen. [16:30] A food trigger is a protein antigen that is an allergen. In IgE, food allergies, milk, and eggs are prevalent triggers early in life. For reasons not well understood, a lot of people outgrow them. In older patients, peanut and tree nut allergies are prevalent.   [17:01] In EoE, milk is one of the most common dietary triggers into adulthood. Some patients with IgE allergy to milk can tolerate it if it's well cooked. Patients with EoE are less likely to be able to get away with regular and ongoing exposure to milk protein.   [17:54] Milk, eggs, and nuts are common triggers in both conditions. There can also be rare food allergy triggers. That's part of the early evidence that the adaptive immune response was likely to be involved. It can be so specific for some people to rare things.   [18:20] Hallmarks of something being immune-mediated are that it is reproducibly demonstrable as a trigger. It's going to be long-lived. It's going to be generally relatively small amounts. The immune system is good at detecting small exposures.   [19:07] EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.   [20:14] A history of having blood in the stools can be milk-allergen-driven and was associated with a diagnosis of EoE in those kids when they're older.   [20:26] There are a lot of commonalities in the allergens but it's not always obvious clinically.   [22:40] A challenge in diagnosing EoE is that providers have to be on guard against their biases. They have to give a patient good advice. In EoE there is no test to identify triggers, except rigorous introduction, elimination, reintroduction, and endoscopies.   [24:18] For some of Dr, Shreffler's patients, it becomes less important to know their dietary triggers. They gravitate toward an approved form of treatment that may, if successful, allow them to have a more normal diet because of effective medication.   [24:50] Dr. Shreffler thinks there are other triggers, including pollens. There is evidence of seasonality of active EoE in patients shown to have allergic sensitization to pollens. That's indirect evidence. If the body is making IgE, it's likely making other responses.   [25:32] There are questions about how large the population of patients is who have EoE that may be more intrinsically than extrinsically driven because of genetic variations.   [25:54] Dr. Shreffler believes that EoE in some patients is allergen-driven and in some patients EoE is food-driven. Food is a trigger for the majority of pediatric patients and a large percentage of adult patients but not necessarily the exclusive trigger.   [27:04] If a patient is motivated to learn what dietary triggers may be at play, Dr. Shreffler often makes assessments outside of pollen season for allergens to which the patient has demonstrated positivity.   [28:09] Looking at the epidemiology, both EoE and food allergy are atopic disorders. You see an increased prevalence of asthma, hay fever, eczema, and even allergic proctocolitis in infancy. You see an enrichment of one disorder to another.   [28:29] The overlap of food allergy to EoE is stronger than you might expect. About 30 to 40% of patients with EoE will also have IgE food allergy. A higher rate will have IgE positivity, whether or not that food is a trigger of immediate symptoms.   [28:48] Patients with food allergies are about four times more likely to have EoE than the general population. That's a stronger association than the risk of eczema or other atopic conditions to EoE.   [30:09] There are differences between IgE food allergy and EoE. The presence of IgE gives a useful tool for identifying the food trigger in food allergy, but not in EoE. Identifying rare triggers in EoE patients is done by clinical observation.   [31:46] Epinephrine and antihistamines are not useful in treating EoE. Blocking IgE with Omalizumab has not been effective in trials in treating EoE. PPIs, topical steroids, and dupilumab are helpful for many EoE patients.   [32:38] Dupilumab has been evaluated a bit in food allergy in combination with OIT, and there was no statistically significant benefit from dupilumab in food allergy.   [33:25] A group in Pennsylvania has been evaluating epicutaneous immunotherapy as a modality to treat EoE. It's also being evaluated for IgE food allergy. Dr. Shreffler thinks it's something to keep an eye on.   [33:40] The oral route for immunotherapy can drive EoE for patients. As they become less sensitive from an immediate reactivity viewpoint, a significant percentage of patients develop GI symptoms. This has also been observed with sublingual therapy.   [34:14] Iatrogenic EoE, caused by the treatment, may resolve on the cessation of the immunotherapy treatment.   [36:25] Dr. Shreffler says in some cases, the shared decision is a decision where he has a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally supported by what we know right now.   [36:57] We've said that EoE is a contraindication for OIT. There is a shift happening. Dr. Shreffler sits with families and has a conversation about restricting diet or trying chronic therapy and keeping an ad-lib diet.   [37:38] What about doing the same thing by treating the immediate-type food allergy with chronic allergen exposure and then ameliorating the effects of EoE if it emerges, with another therapy? A hundred providers would have a diversity of responses.   [38:19] When there is a history of EoE in a family, Dr. Shreffler advocates for getting a baseline scope. It becomes an important “ground zero.”   [38:28] The goal is to have less invasive ways to monitor these conditions.   [39:32] Chronic inflammation, which is the hallmark of EoE, is well-targeted by therapies like PPIs and steroids. Steroids don't help with IgE-related food allergies. They're not effective at blocking the IgE-driven immediate response.   [41:13] Until recently, IgE food allergy has only been managed with avoidance. We have some other tools now. Xolair is not effective in EoE but is effective in two-thirds to three-quarters of patients with immediate-type food allergies for preventing anaphylaxis.   [41:45] Dr. Shreffler refers to an upcoming study on the effectiveness of Xolair in treating people with food allergies. Those who were able to tolerate a minimum amount were allowed to begin consuming allergen. We'll get insight into how those patients did.   [43:08] Food-induced immediate response of the esophagus (FIRE) is immediate discomfort with exposure to some allergens. Dr. Shreffler explains it. Data supports that these patients are experiencing an IgE-mediated but local response to those triggers.   [44:59] If FIRE is IgE-mediated, it may be that Xolair would help suppress it in these patients. It's worth looking at Xolair for this subset of EoE patients.   [45:20] Ryan invites any listeners who want to learn more about FIRE to check out episode #34 with Dr. Nirmala Gonsalvez.   [45:37] In the paper, Dr. Shreffler wrote about what he hopes will be the practical usefulness of the finding, the intersection between IgE food allergy and EoE.   [45:56] A subset of Th2 T cells express a protein called GPR15. It appears to be a marker for the subset of cells that are playing a role in the EoE.   [46:36] Caitlin Burk's work now is looking at their activation status in active disease and post-diet elimination and remission. She is developing a data set that is leading us toward the possibility of focusing on that cell subset and techniques to adopt in clinics.   [47:12] She is also working out more advanced techniques to look at the receptors. Dr. David Hill at CHOP is working on similar research. This research has the potential to lead to the development of better tests for EoE.   [47:44] Holly tells Dr. Shreffler this has been such an informative episode with so many tidbits of things to help patients advocate for themselves. Holly thanks him for sharing all of that.   [48:12] Dr. Shreffler is trying to see what can be utilized from their research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. He sees it as a huge unmet need.   [48:31] Ryan thanks Dr. Shreffler for joining us. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [48:41] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [48:50] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [49:00] Ryan thanks Dr. Shreffler for joining us today for this interesting conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Wayne Shreffler, MD, Ph.D., Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital “Triggers for eosinophilic esophagitis (EoE): The intersection of food allergy and EoE” Dr. Caitlin Burk Dr. David A. Hill   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “This fascinating problem of food allergy: why does the immune system do that for some people — recognize what should be nutritive and innocuous sources of energy as an immunological trigger? ” — Dr. Wayne Shreffler   “A food allergy; because there is this IgE antibody, we can do skin tests. We can measure that in the blood. It's a useful marker for helping to identify which foods are the trigger.” — Dr. Wayne Shreffler   “EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.” — Dr. Wayne Shreffler   “Everything is shared decision-making. In some cases, it's a shared decision where I have a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally justified.” — Dr. Wayne Shreffler   “Steroids don't help with IgE-related food allergy. They're not effective at blocking that IgE-driven immediate response.” — Dr. Wayne Shreffler   “I'm trying to see what we can utilize from our research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. I think that's a huge unmet need.” — Dr. Wayne Shreffler  

Ever heard of tapping (EFT) and wondered if it's actually backed by science? Or maybe you've been curious about how therapists can integrate it into their work for better client outcomes (and to prevent burnout for themselves)?By popular demand, we're re-releasing this fan-favourite episode with the brilliant Dr. Peta Stapleton, clinical psychologist, researcher, and a global leader in Emotional Freedom Techniques (EFT), aka tapping.EFT isn't just some woo-woo trend—it's a powerful, research-backed tool that's showing incredible results for issues like trauma, chronic pain, food cravings, burnout, and more. And in this episode, we dive into exactly why therapists need to be paying attention.What You'll Learn in This Episode:- The science behind EFT—how tapping works on a biological and neurological level- Why EFT is still considered “fringe” (and why that's finally changing!)- The research-backed benefits of EFT for trauma, stress, and even DNA changes- How therapists can use EFT to prevent burnout and compassion fatigue- The future of EFT—how it's being integrated into mainstream therapyIf you're even remotely curious about how tapping could transform the way you work with clients (and even support your own nervous system as a therapist), this is a must-listen episode!Rate, Review, & Follow on Apple PodcastsLove this episode? Let me know! Your reviews help more therapists find this podcast and confidently explore new, evidence-based tools like EFT.Here's how:Click here and scroll to the bottomTap to rate with five stars ⭐⭐⭐⭐⭐Select "Write a Review" and tell me what you loved most!Also, if you haven't already, hit follow so you never miss an episode—more game-changing insights are coming your way!Links & Resources Mentioned in This Episode:- Dr. Peta Stapleton's Website – Learn more about EFT and her research- Training for Health Professionals – Want to integrate EFT into your practice? Check out Peta's professional training - The Incubator Waitlist – Ready to scale your impact with an online program? Get on the waitlist for my signature program

Episode 430: Integrative Approaches to Recovery with Dr. Malasri Chaudhery-Malgeri In this episode of The Hardcore Self Help Podcast, I sit down with Dr. Malasri Chaudhery-Malgeri, also known as Dr. Mala, to discuss her integrative approach to addiction recovery, rehabilitation, and mental health treatment. Dr. Mala shares her personal journey that led her into the field, the importance of holistic and individualized treatment, and how she has worked to break down barriers in accessing quality care. What We Cover in This Episode: Dr. Mala's personal journey into psychology and addiction recovery work The challenges of pushing for integrative mental health care How trauma informed her approach to treatment The importance of cultural competence in mental health and recovery Understanding addiction recovery as a non-linear process The necessity of breaking isolation in the recovery journey The evolving role of virtual therapy and accessibility in mental health care How alternative and holistic approaches such as yoga, meditation, and adventure therapy are valuable in rehabilitation The role of family and loved ones in supporting recovery How to advocate for personalized treatment if current options aren't working Resources available through Recovery.com for both individuals and families Timestamps: 00:00 – Introduction to Dr. Mala and her background 02:00 – How Dr. Mala entered the field of psychology and recovery 06:00 – Why she emphasizes integrative approaches in treatment 10:00 – Challenges in advocating for a holistic recovery model 12:00 – Misconceptions about addiction and recovery 16:00 – The importance of connection and breaking isolation 21:00 – Alternative therapeutic approaches that work 27:00 – The role of family and community in recovery 33:00 – Steps to take if current treatment isn't effective 38:00 – Recovery.com and available resources 44:00 – Final words of wisdom for those struggling or supporting a loved one Resources: Recovery.com: https://www.recovery.com State of Recovery 2025: https://recovery.com/news/the-2025-state-of-recovery-5-trends-in-behavioral-health-you-need-to-know-about/ Giving Voice to Depression Podcast: https://www.givingvoicetodepression.com Connect with Dr. Mala: Recovery.com Podcast: https://www.recovery.com/podcast Instagram: https://www.instagram.com/recoverydotcom Connect with Me: Email: duffthepsych@gmail.com Website: https://www.duffthepsych.com YouTube: https://www.youtube.com/@duffthepsych Instagram: https://instagram.com/duffthepsych If you found this episode helpful, please consider sharing it with someone who might benefit. And as always, take care of yourself!

A Gluten Free PodcastEpisode 164Reading food labels can feel overwhelming when you have coeliac disease. With hidden ingredients, confusing “may contain” statements, and changing food labelling laws, it's hard to know what's truly safe. Plus, even when you're strictly gluten-free, you might still experience symptoms that feel like you've been glutened—but could something else be going on?In today's episode of A Gluten Free Podcast, I sit down with Dr. Kim Faulkner Hogg, an experienced dietitian specialising in coeliac disease and food intolerances, to break it all down. With years of research into gluten ingestion, nutrient deficiencies, and the science behind gluten-free food labeling, Dr. Kim brings clarity to the challenges many of us face on a daily basis.If you've ever struggled with label reading, wondered about nutrients at risk on a gluten-free diet, or experienced mysterious gut symptoms that don't seem to be gluten-related, this episode is packed with valuable insights!

In this episode of Message in the Middle, Marianne sits down with Dr. Moe Anderson, a TEDx speaker, award-winning podcast host, published author, cancer survivor, and Doctor of Dental Surgery. Dr. Moe's diverse background and dedication to wellness, communication, and building strong relationships make her an inspiring force for transformation.Dr Moe shares why she landed in a dentistry career but still became a celebrated author and motivational speaker. She shares her insights on balancing multiple passions, overcoming imposter syndrome, embracing change, and the powerful concept behind her tagline: “Change your words, change your world.”What You'll Learn in This Episode:Dr. Moe's personal career trajectory: The pivotal moments and mindset that led her to continue to expand her career.Balancing Passions and Responsibilities: Practical advice for managing multiple hats without feeling overwhelmed.Embracing Change: Tips for stepping out of your comfort zone and finding growth in discomfort.Imposter Syndrome & Self-Doubt: How to navigate feelings of inadequacy and find your confidence.The Power of Words: Dr. Moe breaks down her tagline and explains how changing your language can transform your life.The Intellectual Tourist Mindset: Discover how curiosity and exploration fuel personal and professional growth.Timeless Wisdom: The best piece of advice Dr. Moe has ever received.Links and Resources Mentioned:Connect with Dr. Moe Anderson:https://linktr.ee/drmoea Leave Us a Review: If you enjoyed today's episode, please leave a review and share your favorite takeaway. Your feedback helps us reach more listeners and bring you even more valuable content.Keep the conversation going - Join us for more insightful conversations in the Message in the Middle Private Facebook Community & subscribe to Message in the Middle podcast on your favorite listening platform. Connect with Marianne:Website: Message In The Middle with MarianneMessage In the Middle Facebook Group: https://www.facebook.com/groups/422430469323847/YouTube: https://www.youtube.com/@MessageInTheMiddle/playlistsEmail: Contact | Message In The Middle with MarianneSubscribe to Message In the Middle: Apple Podcasts Spotify YouTube

]Welcome to  Manlihood: a podcast for men, where we explore topics to help men improve their lives. In this episode, Dr. David Lipman, a chiropractic physician with nearly 40 years of experience, shares his insights on optimizing men's health through chiropractic care. We discuss the importance of treating the root causes of pain, innovative therapies, and how men can take control of their physical and mental well-being for a healthier life. What You'll Learn in This Episode: Dr. Lipman's journey from traditional medicine to holistic chiropractic care The importance of addressing the root causes of pain for lasting relief Innovative therapies like Deep Tissue Laser Therapy, Whole Body Cryotherapy, and more Practical tips for men to improve their health, fitness, and overall wellness How chiropractic care can optimize health and prevent long-term issues Why This Episode is a Must-Listen for Men:Manlihood  provides actionable insights for men looking to improve their health and wellness. Dr. Lipman's approach to chiropractic care and holistic health offers valuable guidance for men who want to feel better, live healthier, and enhance their quality of life. About Our Guest:Dr. David Lipman, DC is a pioneering chiropractor whose approach to pain management was shaped by his own journey as a patient. At his Physical Evidence Bio-Optimization Center, he combines cutting-edge therapies like Deep Tissue laser therapy, Whole Body Cryotherapy, and Photo Bio modulation with traditional chiropractic care. Rather than merely treating pain, Dr. Lipman focuses on correcting the underlying mechanical dysfunctions that cause discomfort, helping patients achieve lasting relief and optimal wellness through non-addictive, innovative solutions. Links:Website: https://physicalevidencechiropractic.com/ Subscribe & Share:If you found this episode helpful, please subscribe to Manlihood, leave a rating or review, and share this episode with others who can benefit from Dr. Lipman's expertise in men's health.

This week, Mike is joined by Kaley Z, who shares her inspiring journey of overcoming Multiple Sclerosis (MS) after being diagnosed at the young age of 12. Now symptom-free for over 10 years, Kaley opens up about her path to healing, which involves understanding the mind-body connection and integrating emotional freedom techniques (EFT) into her life. She recounts the early life challenges she faced while living with MS, including her experiences at school and seeking medical treatments.   Resources Mentioned in This Episode: Dr. Joe Dispenza The Tapping Solution App   Connect with Kaley: Website Courses  LinkedIn Instagram   Connect with Mike: Linktree   SPONSORS: Social Chameleon | Transform Your Podcast  Navigator Bookkeeping | Understand the full financial story of your practice Libsyn: First Month FREE with Promo Code BEGREAT Riverside | This interview was recorded on Riverside   Want to become a show sponsor? Email mike@socialchameleon.us   Copyright © 2025 Mike'D Up! with Mike DiCioccio | For permission to use this content in any way, please email mike@socialchameleon.us  

EP293: Chronic Pain with Dr. Howard Schubiner In this episode of Health Coach Conversations, Cathy Sykora speaks with Dr. Howard Schubiner, a clinical professor and pioneer in the treatment of chronic pain. Dr. Schubiner shares his groundbreaking insights on the science behind chronic pain and how addressing the brain's role can lead to lasting relief for patients. In this episode, you'll discover: The Brain's Role in Pain: How predictive processing influences pain and why understanding this can revolutionize treatment. Unlearning Pain: Why pain isn't always linked to structural damage and how neural circuits in the brain contribute to chronic pain. Effective Therapies for Chronic Pain: An introduction to Emotion Awareness and Expression Therapy (EAET) and other neuroscience-based treatments. Diagnosing Neuroplastic Pain: How to differentiate between structural and brain-generated pain using the FIT criteria. Hope for Chronic Pain Patients: Empowering approaches to offer relief and optimism to those struggling with chronic conditions. Memorable Quotes “Pain is a brain-generated phenomenon. That's what pain is, and that is mind-boggling.” “Stress and emotions activate the exact same parts of the brain as does a physical injury. So the pain is real—all pain is real—all pain is generated by the brain.” “Pain can be unlearned when there's no physical injury to account for the pain.” Bio Dr. Howard Schubiner is an internist and Clinical Professor at Michigan State University College of Human Medicine. With over 100 publications in scientific journals and books, he is a leading voice in chronic pain research and treatment. Dr. Schubiner co-developed Emotion Awareness and Expression Therapy (EAET), a novel and highly effective psychological treatment for chronic pain. He is the author of three books: Unlearn Your Pain, Unlearn Your Anxiety and Depression, and Hidden From View (co-authored with Dr. Allan Abbass). Dr. Schubiner sees patients virtually worldwide through Cormendi Health. Mentioned in This Episode: Dr. Howard Schubiner's Books: Visit UnlearnYourPain.com for resources and to purchase his books. Emotion Awareness and Expression Therapy (EAET): Learn more about this innovative approach to pain management. Links to Resources: Health Coach Group Website: thehealthcoachgroup.com Special Offer: Use code HCC50 to save $50 on the Health Coach Group website. Leave a Review: If you enjoyed the podcast, please consider leaving a five-star rating or review on Apple Podcasts.  

In this episode, Dr. Kenneth Lyons Jones, one of the pioneers who first identified Fetal Alcohol Spectrum Disorders (FASD) in the United States in 1973, and Dr. Christina Chambers, a renowned epidemiologist who has conducted groundbreaking research on the prevalence of FASD, join host Chris Stallman, CGC, to discuss the discovery of FASD, its common physical and cognitive traits, and its prevalence today. BONUS: Earn continuing education credits for listening to our entire FASD 3-part series. Scroll down to learn more. Resources Mentioned in This Episode: Dr. Kenneth Lyons Jones on the History of Fetal Alcohol Syndrome - FASD  Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities | Antenatal Exposures and Child Outcomes | JAMA | JAMA Network  Fetal Alcohol Spectrum Disorders – American Academy of Pediatrics Types of Treatment for FASDs | Fetal Alcohol Spectrum Disorders | CDC Choline supplements in young children with fetal alcohol spectrum disorder have lasting cognitive benefits | National Institute on Alcohol Abuse and Alcoholism (NIAAA)  _______________________________________________________________________________________________________ MotherToBaby: FASD Podcast SCPD4929     PROGRAM DESCRIPTION: This podcast series is intended to reach various audiences, including healthcare professionals, who can use the information presented to inform their practice and their interaction with clients/patients. The podcast episodes will educate participants on 1) the discovery, prevalence, and newest research on the topic of fetal alcohol spectrum disorders (FASDs), 2) CDC's work in addressing prenatal alcohol and other substance use and FASDs, and 3) the experiences of people living with FASDs. OBJECTIVES: After completing this course, the learner will be able to: 1.      Describe Fetal Alcohol Spectrum Disorders (FASDs). 2.      Describe the National Center of Birth Defects and Developmental Disabilities' (NCBDDD) approach to addressing FASDs. 3.      Describe the impact on people who are living with FASDs. 4.      Describe how interprofessional collaboration addresses FASDs. 5. Describe how interprofessional teams can help people living with FASDs transition from pediatric to adult healthcare.   FACULTY/                                                   CREDENTIALS: Laura Bousquet, Family Navigator/Self-Advocate, FASD United Christina Chambers, PhD, MPH, Distinguished Professor of Pediatrics, University of California, San Diego Elizabeth Dang, MPH, Behavioral Scientist, Centers for Disease Control and Prevention Nicholas Deputy, PhD, MPH, Health Scientist, Centers for Disease Control and Prevention Kenneth Jones, MD, Distinguished Professor of Pediatrics, University of California, San Diego  Chris Stallman, MLS, MS, CGC, Director,    MotherToBaby Arizona, University of Arizona  Jennifer Wisdahl, Chief Operating Officer, FASD   United   CE ORIGINATION DATE: CE EXPIRATION DATE:   January 9, 2025 January 9, 2027     URL   https://momtobaby.org/FASDep81youtube   INTENDED AUDIENCE:   Advanced Practice Nurses, Certified Health Educators, Medical Assistants, Licensed Practical/Vocational Nurses, Physicians, Physician Assistants, Registered Nurses, and Social Workers   PREREQUISITES:   Learners will have a basic understanding of what fetal alcohol spectrum disorders are.   FORMAT: This activity is Web on Demand   CONTACT INFORMATION: CDC's CE Accreditation Team has a policy for grievances that is available upon request.   Division of Birth Defects and Infant Disorders cdcinfo@cdc.gov    ACCREDITATION STATEMENTS:     In support of improving patient care, this activity has been planned and implemented by the Centers for Disease Control and Prevention and MotherToBaby. The Centers for Disease Control and Prevention is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team   CME: The Centers for Disease Control and Prevention designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. CNE: The Centers for Disease Control and Prevention designates this activity for 0.5 nursing contact hours. CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this program. CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 0.5 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. Continuing Competency credits available are 0.5. CDC provider number 98614. DISCLOSURE: In compliance with continuing education requirements, all planners and presenters must disclose all financial relationships, in any amount, with ineligible companies during the previous 24 months as well as any use of unlabeled product(s) or products under investigational use.    CDC, our planners, and content experts wish to disclose they have no financial relationship(s) with ineligible companies with the exception of Dr. Christina Chambers, PhD, MPH and she wishes to disclose she receives research funding from Amgen, AstraZeneca, GlaxoSmithKline, Janssen Pharmaceuticals, Pfizer, Inc., Regeneron, Hoffman La-Roche-Genentech, Genzyme Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Sanofi, UCB Pharma, USA, Leo Pharma, Sun Pharma Global FZE, Gilead, Novartis, and the Gerber Foundation.  All relevant financial relationships listed for this individual have been mitigated. Content will not include any discussion of the unlabeled use of a product or a product under investigational use. CDC did not accept financial or in-kind support from ineligible companies for this continuing education activity. The Centers for Disease Control and Prevention (CDC) complies with applicable Federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, and gender identity). To learn more visit: https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html. Instructions for Obtaining Continuing Education (CE) To receive continuing education (CE) for SCPD4929 – MotherToBaby: FASD Podcast, please visit CDC TRAIN and search for the course in the Course Catalog using SCPD4929 Follow the steps below by January 9, 2027. Register for and complete the course. Pass the post-assessment at 75 %. Complete the evaluation. Visit Your Learning to access your certificates and transcript.   FEES: No fees are charged for CDC's CE activities.   ______________________________________________________________________ Looking for even more education about FASD? Don't miss a special free Birth Defects Awareness Month webinar January 31, 2025 at 9a PT/12p ET. The webinar will be presented by Dr. Noemi Spinazzi of the American Academy of Pediatrics. It is a free webinar, but advanced registration is required at the following link: https://momtobaby.org/FASDwebinar2025

Podcast Show Notes Episode Title: From Pissed Off to Poised: Understanding Anger and Trauma with Dr. Arpita Gupta de Palma Episode Summary: Welcome back to the podcast! Today, we're thrilled to be joined by Dr. Arpita Gupta de Palma, a pediatrician, trauma-informed physician coach, and podcaster. Dr. Arpita first joined us in 2022 to discuss anger (Episode 37), and now she's back to dive even deeper into the topic. In this episode, we explore how trauma influences anger responses, why anger can act as an alert system, and how understanding these connections can lead to healthier emotional regulation. Dr. Arpita also shares insights into her new podcast, From Pissed Off to Poised, which combines practical tools for anger and time management. This conversation is packed with relatable examples, actionable strategies, and a generous dose of grace for anyone who struggles with frustration, anger, or the fast pace of life. What You'll Learn in This Episode: How trauma—past or generational—affects anger and emotional responses. Why anger is an alert system signaling core value violations or perceived threats. The biological and psychological mechanisms behind anger, including the role of the heart-brain connection. Strategies to pause and identify underlying emotions behind anger (e.g., disappointment, fear, or frustration). How anger develops in childhood and how early experiences shape adult reactions. The impact of trauma on leadership and how curiosity can enhance interpersonal dynamics. Key Highlights: Recognizing Trauma as Physicians: Training in medical school, residency, and beyond can carry trauma that shapes how we respond to stress and anger in professional and personal settings. Understanding Anger's Evolutionary Role: Our brain's survival mechanisms can confuse emotional threats with physical ones, leading to reactive anger. Generational Trauma: Trauma can be passed down through generations, influencing our responses in ways we might not consciously understand. Transforming Anger: Identifying and naming underlying emotions helps reduce the intensity of anger and shift to more productive reactions. Dr. Arpita Gupta de Palma's Podcast: From Pissed Off to Poised is a limited-series podcast that explores anger, trauma, and time management. Packed with actionable tips and insights, it's perfect for anyone looking to better understand their emotions and find practical solutions for managing life's pressures. Connect with Dr. Arpita: Website: www.thoughtworkmd.com Social Media: @thoughtworkmd Resources Mentioned in This Episode: Dr. Arpita's Anger and Time Management Courses (thoughtworkmd.com) HeartMath tools for heart-brain coherence Book recommendation: Transforming Anger by HeartMath Join Us for Free Training: Don't miss our free video training, How to Crush Physician Burnout for Good Without Cutting Back Hours, Quitting Medicine, or Sucking It Up in Silence. Scroll down in the show notes for the link and check it out today! Let's Keep the Conversation Going: If this episode resonated with you, let us know! Leave a review, give us five stars, and share your thoughts. Your feedback helps more doctors discover the podcast and keeps our ripple effect growing. Closing Thoughts: As Dr. Arpita reminds us, give yourself grace and props for recognizing the need to change how you show up. Anger is a universal experience, and addressing it with curiosity and compassion is the first step toward meaningful transformation. Remember: You are whole, you are a gift to medicine, and the work you do matters. Until next time! Resources: Book a free Physician Wellness Triage session with a physician coach Download our Free Video: How to Crush Physician Burnout (for Good) Arpita's Website From Pissed Off to Poised Podcast Transforming Your Anger Course HeartMath

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Jason Ingraham, an adult living with eosinophilic fasciitis (EF), and Dr. Catherine Sims, a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital. They discuss Jason's experiences living with EF and Dr. Sims's experience treating EF. They share Jason's journey to diagnosis and the importance of working with a group of specialists. They share tips on medication and physical therapy, how to communicate with your medical team, and manage your activity and mindset. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Holly Knotowicz.   [1:14] Holly introduces today's topic, eosinophilic fasciitis, with guests, Jason Ingraham and Dr. Catherine Sims.   [1:25] Jason is an adult living with eosinophilic fasciitis (EF). Dr. Sims is a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital.   [1:52] Dr. Sims explains what EF is. Patients may present with symptoms of large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.   [2:42] EF, as with most eosinophilic disorders, doesn't follow the textbook. Some people will present with one symptom and some with multiple symptoms. There is a disconnect between how we diagnose conditions like EF and how patients present.   [3:01] There are major and minor criteria for the diagnosis. As in Jason's case, it takes time for the symptoms to present. Things develop over time. It took multiple specialists to diagnose Jason.   [3:38] Eosinophilic conditions are incredibly different from each other. When Dr. Sims sees a patient with high eosinophils, she thinks of three major buckets: infection, autoimmune diseases, and cancer.   [4:12] Patients will often see many different specialists. In Jason's case, they had done a skin biopsy that wasn't as helpful as they hoped. That led him to get a deep muscle biopsy to collect the lining of the muscle.   [4:47] Fasciitis is the inflammation of the muscle lining or fascia. A sample of the fascia can demonstrate under the microscope if there is a thickening, swelling, or inflammation of the lining of the muscle.   [5:24] Dr. Sims as a rheumatologist treats a number of rare diseases. Eosinophilic fasciitis is an ultra-rare disease.    [5:43] Jason had a local primary care doctor and a rheumatologist who both did a really good job and referred him to Dr. Sims. She had the benefit of their hard work to guide her next steps. Because EF is so rare, she has pitched Jason's case twice in rheumatology grand rounds sessions.   [6:18] During one of these sessions, Dr. Sims was advised to get the fascial biopsy that ultimately led to the diagnosis. She benefited from the intelligence and input of dozens of doctors.   [6:59] In the Fall of 2022, while hiking on vacation with his wife, Jason was extremely fatigued, and his forearms and lower legs swelled. His socks left deep impressions. It was difficult to reach his feet to put socks on. He spent a lot of time uncharacteristically resting.   [8:09] Jason's primary care doctor ran lots of blood tests. He thought it might be a tick bite. Jason started seeing specialists, having tests and hospital visits.   [8:57] Jason worked with a rheumatologist in Wilmington, an infectious disease doctor, and a hematologist/oncologist who reached out to a Duke expert. He also saw a pulmonologist and a dermatologist. He got the referral to Dr. Sims for March of 2023.   [9:57] The first diagnosis Jason received was after his first hospital stay in January of 2023, when he had bone marrow biopsies, CT scans, ultrasound, and other tests. He was deemed to have idiopathic hypereosinophilic syndrome (IHES).   [10:30] It was only a few weeks before his local rheumatologist said his panels were back and one tipped it from an IHES diagnosis to eosinophilic granulomatosis with polyangiitis (EGPA). He joined the Vasculitis Foundation and researched EGPA.   [11:03] Dr. Sims told Jason that EGPA was a working diagnosis but he didn't check all the boxes. There was the underlying thought that maybe it was something else. He had a second flare when he came off of prednisone in June of 2023.   [11:48] Dr. Sims scheduled Jason for a muscle biopsy while he was off steroids. That's how he got the diagnosis of eosinophilic fasciitis (EF). Jason says the disorder is hard for him to pronounce and he can barely spell the words.   [12:52] Jason's wife Michelle encouraged Jason to track his symptoms and medications and keep track of data. Going from specialist to specialist, the first thing he did was give the history.   [13:31] Jason found it helpful to create a spreadsheet of data with blood test results, meds, how he was feeling each day, his weight, and even notes about when he had difficulty putting his socks on. Jason is an advocate of owning your continuity of care as you see different doctors.   [14:42] Jason says the doctors at Duke talk very well between themselves.   [14:49] Jason likes to look back at that spreadsheet and see how far he's come, looking at the dosage he was on during and after flares and the dosage he's on now, or zero, on some of the medications. That's a little bit of a victory.   [15:16] Holly works at a private hospital without Epic or CareEverywhere so she gives physical notes to her patients to give to their doctors. She comments that a great PCP, like the one Jason had, can make all the difference in the world.   [16:18] Jason's PCP, Dr. Cosgrove, referred Jason to Duke for a second opinion. That was where he met Dr. Sims. He's glad to have both Dr. Sims and his PCP accessible.   [17:35] Jason says the number of questions you have with this type of thing is immense. When you look up EF, you find very little and the literature isn't easily digestible by patients. Being able to reach out to your doctors for a quick question is super helpful. [17:56] Jason has been able to do telehealth follow-ups and not always have to travel or take off work, which has been extremely helpful. He has been at Duke a good handful of times for various things but remote follow-ups are helpful.   [18:52] Dr. Sims says people just don't know about EF as it is an ultra-rare diagnosis. Even physicians don't understand what causes it. It's lumped in with all other eosinophilic conditions but these disorders don't all present the same way.   [19:19] EoE doesn't look like EF, even though they're both driven by the same immune cells. Dr. Sims says the first need is educating providers and patients on what the diagnosis is; awareness in general when a patient is having this swelling of extremities.   [19:44] Dr. Sims says at his baseline, Jason is very active with multi-mile hikes. When Dr. Sims met him, he was off from the baseline of what he was able to do. Being aware of your baseline and changes from that is very informative for doctors.   [20:07] Dr. Sims talks about the patient being a liaison between multiple specialists. Bringing data to your subspecialist always helps facilitate care and come up with a bigger picture of what's happening.   [20:23] Jason first went to Dr. Sims with the diagnosis of EGPA. She said, let's treat the EGPA and see what happens but they kept an open mind. With ultra-rare diseases, sometimes it's difficult for patients not to have a label for their condition.   [20:45] Dr. Sims explains to her patients that sometimes we live in the discomfort of not having a label. She keeps an open mind and doesn't limit herself to just one diagnosis. She seeks feedback from providers who have seen this before and know what works.   [21:07] Just as Jason described, you will go through multiple diagnoses. Is this cancer? Is it a parasitic infection? Where did you travel? You will see many subspecialists. It's extremely anxiety-provoking.   [21:31] When Dr. Sims did her grand rounds, she gave a third of the presentation, and the other two thirds were presented by an infectious disease doctor and a hematologist. In these cases, you need more than one subspecialist to complete the workup.   [22:10] Dr. Sims says there are a lot of misconceptions that the patient will get the diagnosis right away and the right therapy and get better. There are multiple therapies, not just medications. There are lifestyle and work modifications; it's a gradual process.   [22:22] One of Dr. Sims's goals for Jason and Michelle is to get back to doing the things that they enjoy, tennis and hiking. That's a measurement of the quality of life that a patient has.   [22:34] Talking to your doctors about how you're feeling and how you're functioning is huge. It may be that this is your new normal, but it may also be that we can make adjustments to maximize your quality of life.   [23:00] There are misconceptions about the journey of diagnosis and treatment. Have a close relationship with your subspecialist. PCPs have a high burden of expectations. As a rheumatologist who treats rare diseases, it's helpful to take on a part of that burden.   [22:31] If you don't have good communication with your providers and they aren't listening to you, you can always go get another opinion. The provider relationship is life-long.   [23:43] It's important for your provider to take what's important to you into consideration when they make treatment decisions.   [25:00] As a rheumatologist, steroids are a first-line therapy for Dr. Sims. Their role is the quick control of inflammation. The goal is always to get you off of the steroids as soon as possible, in the safest way possible.   [25:17] When Jason came to Dr. Sims, he was on mepolizumab for the working diagnosis of EGPA. Mepolizumab is one of the primary therapies for EGPA. They talked about not making treatment changes as they were navigating what was happening.   [25:40] They didn't want to make a change of medication and then have that be mistaken for disease activity. They didn't want too many variables moving at once.   [25:47] Typically, the first-line therapy is steroids, meant to help with the swelling, pain, and tightness that patients will get lining their muscles and give them a bit more functionality and decreased pain.   [26:00] Long-term, Dr. Sims gives immunosuppressant medication. She prescribed methotrexate for Jason. In EF, the immune system is overly activated, attacking the lining of the muscles and causing the symptoms.   [26:51] If you suppress the immune system activity, that leads to decreased inflammation and symptoms in the patient. Steroid use, over a few months, is detrimental, with low bone density, weight gain, high blood pressure, and diabetes.   [27:14] Dr. Sims starts with prednisone and folds in medications like mycophenolate or methotrexate.   [27:19] Mepolizumab is an interleukin 5 blocker. Interleukin 5 is part of the immune system and is necessary for eosinophils to grow, function, and multiply. The goal of using mepolizumab is to lower the eosinophils that are contributing to the disease symptoms.   [27:48] Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer. We know how to manage those.   [28:08] If there is no response, we may add something like mepolizumab. As Jason was already on mepolizumab, Dr. Sims added methotrexate.   [28:20] IVIG, an infusion of immunoglobulin, has also been used as a quick way to control inflammation. It is used in other autoimmune diseases like myositis, which is inflammation of the muscle itself.   [29:08] With untreated eosinophilic fasciitis, the lining of the muscle may continue to be inflamed and can lead to fibrosis, damage that cannot be reversed. The patient can become very disabled. Contracture is one result of this.   [30:16] Jason says when he tried a new medication, he monitored if it was a good fit and if the side effects were less impactful than the underlying disease. Dr. Sims adjusted his dosages or tried to get off certain medicines as needed.   [30:59] After his muscle biopsy from his left calf, it took about a month to get back to walking easily. He was already in physical therapy, going many times for a variety of things. He had back pain, potentially related to his EF. His physical therapist was great.   [31:56] The stretches alternated between upper and lower body. Jason bought tools to do the stretches at home. When he's not feeling as well, he goes back to some of those same stretches. When he was on steroids, he took long walks to strengthen his bones.   [32:39] Jason started making phone calls to supportive family and friends on his walks and started listening to podcasts related to his condition or medications. Getting back to tennis and hiking is important to Jason. He's happy to be out there.   [33:20] Jason was open with his employer about his condition. Some of the weekly meds can make him not feel well. His employer gives him some flexibility. He has good days that far outnumber the bad days. He doesn't have to think about EF too much now.   [34:33] It's nothing like when he was in a flare, especially when he was in a flare before being diagnosed. What gets him through a bad day is giving himself some grace and understanding while he waits for his meds to catch up. He rests more than he wants to.   [35:33] Low-impact exercises like walking help Jason. He's trying to find a support network that gets EF. That led him to APFED, to find anyone experiencing something like what he was. He saw a conference that included a session on EF.   [36:09] Jason signed up for the conference and there he met Ryan's mother who has EF. They were each the first person the other had met with EF. They decided to connect after the conference. They talked on the phone for about an hour.   [36:39] She told Jason how she got into APFED and talked a lot about her son who had eosinophilic diseases. Soon after, Jason talked to Ryan as a primer for this podcast.    [38:15] Having a community to relate to, even if it's one person, is massive. It can make you feel less isolated.   [38:42] Holly says it's hard having a chronic illness. She thanks both Jason and Dr. Sims for sharing so much information and their journey and she asks for last words.   [38:58] Dr. Sims believes finding a community is critical. She interviews a lot of patients for research and isolation is a frequent theme. Even the doctor doesn't know what it's like to live with the condition you live with daily. As Jason said, give yourself grace.   [39:33] Dr. Sims tells her patients that they're different from the general population because they have to spend so much time and energy managing their condition that they can't do x, y, or z today, and that is OK. She says to stay motivated and positive.   [40:12] Find what works for you. Walking is good for your physical and mental health. Have the goal of getting back to what makes you happy. Take initiative and find non-medication ways to recuperate. You have control over ways you can feel better.   [40:43] Connect with others and share your story, like Jason did today. It may make someone's journey a little easier and make them feel less alone. Utilize your condition for good, for a bigger purpose.   [41:04] Jason had wished he could meet someone who could tell him what EF would be like over the years. He says to stay positive and find out what you have control over. Jason believes the future is bright for being able to do many things for a long time.   [42:26] For our listeners who would like to learn more about eosinophilic fasciitis, please visit APFED.org and check out the links in the shownotes.   [42:33] If you're looking to find a specialist who treats eosinophilic disorders, like Dr. Sims, you can use APFED's Specialist Finder at APFED.org/specialist.   [42:43] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections/.   [42:55] Ryan thanks Jason and Dr. Sims for joining us for this excellent conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Catherine Sims, rheumatologist Duke University Hospital Durham VA Medical Center   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “EF patients may present with large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.” — Dr. Catherine Sims   “Steroids are … first-line therapy. Their role is the quick control of inflammation. The goal is always to get you off steroids as soon as possible, in the safest way possible.” — Dr. Catherine Sims   “Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer.” — Dr. Catherine Sims   “Stay positive and find out what you have control over. The future is bright for being able to do many things for a long time.” — Jason Ingraham

Get 20% off the New 2nd Generation Tone Device HERE with the code VANESSA Hi friends! This episode is about Keto & Carb-Appropriate Diets for Fat Loss & Lifting Weights with Dr. Cliff Harvey.  Today, I'm joined by Dr. Cliff Harvey, a registered clinical nutritionist, researcher, and expert in the field of keto and carb-appropriate diets. Dr. Harvey is known for his unique approach to tailoring macronutrient balances based on individual needs—a concept he describes as “carb appropriate” nutrition. Episode Highlights: Dr. Harvey explains his philosophy of bio-individuality and how understanding your unique metabolic needs can help you find the right macronutrient balance for optimal health and performance. • Keto for Fat Loss and Metabolic Health • The benefits of a ketogenic diet for fat loss and appetite control. • How ketones and a higher protein intake can support lean muscle preservation during weight loss. • The metabolic advantages of being fat-adapted. • Carb-Appropriate Diets for Lifters • Why keto isn't the only option: how moderate-carb and carb-appropriate approaches can support strength training and endurance performance. • The importance of timing and quality of carbohydrates for athletes. • Protein optimization • Why protein is essential for fat loss, muscle gain, and recovery. • Dr. Harvey shares insights on how much protein you really need and strategies to meet your daily intake goals. • Balancing Diets for Strength & Longevity • The role of ketones in satiety • Key Studies and Practical Takeaways Join the Community! Follow Vanessa on instagram to see her meals, recipes, informative posts and much more! Click here @ketogenicgirl Follow @optimalproteinpodcast on Instagram to see visuals and posts mentioned on this podcast. Link to join the facebook group for the podcast: https://www.facebook.com/groups/2017506024952802/   Thank you to our sponsor:   Bioptimizers Magnesium Breakthrough is one of the only supplements I take with me when I travel as it is so important to me! Save 10% OFF with the code VANESSA at bioptimizers.com/vanessa Dr. Harvey highlights some of the latest research supporting both ketogenic and carb-appropriate diets for weight loss, body recomposition, and athletic performance. Resources Mentioned in This Episode: • Dr. Cliff Harvey's website: cliffharvey.com • Books by Dr. Cliff Harvey: The Carb-Appropriate Diet, The Credo • Research studies on ketogenic diets and carb-appropriate approaches for athletes Connect with Dr. Cliff Harvey: • Instagram: @cliffharvey If you enjoyed this episode, make sure to subscribe and leave a review. Share your thoughts and questions with us on social media! Join the Community! Follow Vanessa on instagram to see her meals, recipes, informative posts and much more! Click here @ketogenicgirl Follow @optimalproteinpodcast on Instagram to see visuals and posts mentioned on this podcast. Link to join the facebook group for the podcast: https://www.facebook.com/groups/2017506024952802/   Thank you to our sponsor:   Bioptimizers Magnesium Breakthrough is one of the only supplements I take with me when I travel as it is so important to me! Save 10% OFF with the code VANESSA at bioptimizers.com/vanessa  

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Dan Atkins about Children's Hospital Colorado's multidisciplinary treatment program for eosinophilic gastrointestinal disorders (EGIDs).   In this episode, Ryan and Holly interview their friend, Dr. Dan Atkins. Ryan was a long-time patient of Dr. Atkins and Holly worked as a feeding specialist with Dr. Atkins at Children's Hospital Colorado. Together, Dr. Atkins and Dr. Glen Furuta developed the Gastrointestinal Eosinophilic Disease Program at Children's Hospital Colorado as a multidisciplinary treatment center for pediatric patients impacted by eosinophilic gastrointestinal diseases. They discuss how treatments and medicines have developed over the years. The clinic started with local patients but now also receives referrals from around the United States. Listen in for tips on identifying EGIDs and using multidisciplinary treatment. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Holly Knotowicz.   [1:19] Holly introduces today's topic, the evolution of eosinophilic gastrointestinal disorders, and the guest, Dr. Dan Atkins, a pediatric allergist at Children's Hospital Colorado.   [1:32] With more than 40 years of experience as an allergist, Dr. Atkins has seen the evolution of eosinophilic disease patient care first-hand and helped establish the Gastrointestinal Eosinophilic Disease Program at Children's Hospital Colorado.   [1:46] The Gastrointestinal Eosinophilic Disease Program is a multi-disciplinary program designed for the optimal evaluation and treatment of children with eosinophilic gastrointestinal disorders.   [2:10] Dr. Atkins thanks Holly, Ryan, and APFED for programs like this podcast to help educate the population of patients with eosinophilic gastrointestinal diseases.   [2:39] Dr. Atkins chose a pediatric residency. The last rotation was with an incredible allergist, Dr. Lenny Hoffman, in Houston. Dr. Atkins loved seeing patients with asthma, eczema, allergic rhinitis, food allergies, and anaphylaxis.   [2:59] The thing Dr. Atkins liked about it was he could take kids who had potentially life-threatening conditions, work with them, and stabilize things, and they did really well. He could see a change in their quality of life. That got him started.   [3:22] Dr. Atkins did an allergy and immunology fellowship in Buffalo, New York with Dr. Elliott Ellis and Dr. Elliott Middleton who had just written the Allergy: Principles and Practice text. They were incredible, brilliant mentors and wonderful people.   [3:55] Dr. Atkins went to the National Institutes of Health to do basic science research after learning of a double-blind, placebo-controlled food challenge by Dr. Allan Bock and Dr. May in Denver.   [4:27] Dr. Atkins did a clinical project on food allergy with Dr. Dean Metcalf, which was one of the first double-blind, placebo-controlled food challenges in adults. They published two papers on it.   [4:47] Then Dr. Atkins went to work on the faculty of National Jewish Health. He was there for 25 years.   [5:04] Dr. Atkins was invited to join the Children's Hospital of Colorado because they wanted to start an allergy program there.   [5:21] Dr. Atkins got interested in eosinophilic gastrointestinal diseases in 2006 after he saw a patient who had had difficulty eating, eosinophils in his esophagus, and food allergies. In another state, a doctor had put him on an elimination diet and he got better.   [5:42] The patient moved to Denver. Dr. Atkins saw him and found the case to be interesting. He looked in the literature and found an article on eosinophilic esophagitis by Dr. Alex Straumann.   [5:53] A gastroenterologist, Dr. Glen Furuta, came to Children's Hospital, looking to work with an allergist. Dr. Atkins met with him and they hit it off. They saw the need for a multidisciplinary program to take care of these patients.   [6:31] Dr. Atkins has always been interested in diseases that led to eosinophilia. Most of them were allergic diseases. Eosinophilic esophagitis and other eosinophilic gastrointestinal diseases came along with much more of a focus on eosinophils in the gut.   [6:45] The first case of eosinophilic esophagitis that Dr. Atkins treated was a patient in 2006. He believes he probably missed earlier cases just by not asking the right question, which is, “Does your child eat slower than everybody else?”   [7:18] Once Dr. Atkins started asking patients that question, it stunned him to find out how many patients said that was part of the issue. He followed up with testing and, sure enough, they had eosinophilic esophagitis.   [7:45] Dr. Atkins says that, in general, eosinophils are present in allergic conditions. If you look at “allergic snot,” and stain it up, it's full of eosinophils. If you have eosinophilic esophagitis and allergic rhinitis, if you swallow snot, it will impact your EoE.   [8:40] Dr. Atkins tends to be more aggressive with using a topical nasal steroid spray with patients who have allergic rhinitis because that decreases the eosinophils in the nose.   [8:50] Dr. Atkins says since eosinophils are on their way to areas that are involved in allergic inflammation, that's how Dr. Atkins got interested in eosinophils. It played out with the multidisciplinary group and eosinophilic esophagitis.    [9:07] Ryan went to see Drs. Atkins and Furuta when he was eight. Ryan is so thankful he was able to go to their clinic and is grateful that the doctors helped to create one of the first programs dedicated to treating EGIDs in the U.S.   [9:40] Dr. Atkins credits Dr. Furuta with the multidisciplinary program. They discussed who needed to be part of it. A gastroenterologist first but Dr. Atkins thought an allergist was also necessary. Treating other allergies helps the patient's eosinophilic condition.   [10:51] They decided they needed excellent nurses who loved working with kids. A lot of the kids had trouble eating, so the group needed feeding therapists and dieticians because these kids have a limited diet. They also needed a pathologist to read the slides.   [12:59] Because this is a burdensome disease, they needed psychologists for the child and the family. Learning coping mechanisms is a big part of the experience.   [14:20] As the program progressed, they saw they needed an endocrinologist to look at the children who weren't growing as expected. In clinic, they needed a child health person who could play games with the kids and keep them engaged during the long visits.   [14:44] That was how the program evolved. They had an idea but they had to show people it would be an active clinic that would grow and they had enough patients to warrant the program. It happened quickly.   [14:54] The program is fortunate to have a wonderful group of people who get along well and check their egos at the door. There are lots of conversations. Everybody's willing to listen and put their heads together. They compare notes and histories.   [15:46] Holly had been working as a feeding specialist at the hospital. Someone was on leave so Holly was put into the clinic. She had never heard of EoE; she didn't know she had it! Her first meeting was a roomful of professionals comparing notes on patients.   [16:31] Holly was in disbelief that these medical professionals met together for an hour weekly to discuss their patients with each other. Later, Holly followed a patient with Dr. Atkins, then Dr. Furuta, then a dietician, and then a nurse. [17:01] As she followed the patient, Holly listened and recognized the symptoms. She thought that she might have EoE! She introduced herself to Dr. Atkins and asked for a referral for a diagnosis. She was diagnosed that year with EoE.   [17:25] Holly sees many unique things about the program. She was impressed that they had the foresight to include a feeding specialist, not a common specialty at the time. Holly also thinks it's neat that the clinic sees patients from all over the country. [18:01] Dr. Atkins says the availability of care is improving across the country. When the program began, people had not heard of eosinophilic esophagitis, not even the local pediatricians. Allergists were just becoming aware of it. They had to be educated.   [18:29] There were people in other communities who didn't have access to multidisciplinary care. Over time the word has spread. Pediatricians are referring patients to the clinic for diagnosis. Care availability has improved.   [18:55] Not every patient needs a multidisciplinary program. If you have mild to moderate eosinophilic esophagitis and you're responding to a current therapy, are doing well, and are communicating well with your provider, that's great!   [19:10] If you need a second opinion or if you have a complicated case, there are some benefits to multidisciplinary care.   [19:33] The providers at the clinic listen to the children as well as to the parents. When a food is removed, a dietician can suggest an alternative the child might like.   [20:07] The clinic wanted to treat local patients but go beyond that, as well. They learn a lot from seeing patients from all over the country with different exposures and being treated by different doctors.   [20:17] When Ryan was young, he would go from his home in Georgia to Denver, yearly. He reflected it felt like summer camp. He got a scope one day and saw the full team of specialists the next few days. It was different from how he was treated before.   [21:06] Ryan says he was listened to and heard, and it was such a great experience for him as a patient to be seen in Dr. Atkins's clinic.   [21:46] Dr. Atkins says they are trying to teach children to be their own advocates. If the doctor does not listen to what the patients have to say, why should they be involved?   [22:50] A patient experience at the clinic starts with somebody deciding they need to go there and get a second opinion or a diagnosis. They get a referral to the clinic. Dr. Atkins mentions the need for administrative staff as part of the clinic team.   [23:40] The patient fills out forms and gives their records to be reviewed by a physician before being seen to see if the clinic is a good fit for them. If it is, the patient is scheduled with an appointment for each doctor and professional in the clinic.   [24:02] The patient records are seen by each professional on the team for how they relate to the professional's specialty. They decide what tests need to be done and if they are covered by insurance.    [24:27] The care team meets before clinic to talk about all new and follow-up patients. Then the patient comes in to see the providers, one after another. Patients don't see all the providers in the same order. The endocrinologist and psychologist are not in the clinic.   [25:39] The clinic visit takes three to four hours. It may involve skin testing for allergies or spirometry for lung function. The patient is scheduled for an endoscopy. When appropriate, they offer transnasal endoscopy, which takes only eight minutes and does not require anesthesia.   [27:11] If the patient has a stricture and the esophagus needs to be dilated, the patient is asleep for that. There is also the esophageal string test, developed by Dr. Furuta. It takes a little over an hour and tells whether there is active disease or not.   [28:02] Care has been made easier. Patients have different options for testing. Holly points out that the family is a part of the team and they are involved in every process and decision. Dr. Atkins says that shared decision-making is a cornerstone of care.   [29:31] Dr. Atkins says what happens in the room is the care provider and patient connect and the patient talks about their problems with somebody they trust. To get the patient to do what they need to do, they have to understand and feel understood.   [31:03] When Dr. Atkins started treating patients with asthma at National Jewish, patients came for a long evaluation, sometimes months. The only treatments were theophylline and steroids. There were side effects to those medications.   [31:39] Dr. Atkins says it has been wonderful to be involved while new treatments have evolved. For eosinophilic esophagitis, when diet works for people, it works. He shares the experience of a teen who is doing great on a diet eliminating milk and eggs.   [32:56] Don't discount diet. It's still up front. On the other hand, that doesn't work for some people. A metered dose inhaler with the puff swallowed may work for some. That's ideal for teenagers. There are other treatment choices like budesonide.   [34:14] Swallowed steroids go to the liver, where they are metabolized. Now biologics are revolutionizing treatment. Not everyone needs biologics but they're a great choice for some.   [35:30] A patient starting out doesn't need biologics as a first treatment. Other therapies may be effective and cheaper. If a patient doesn't respond, they can go to a biologic. More treatments are being developed.   [36:42] Dr. Atkins wishes for a way to determine the food trigger with a simple test.   [38:00] Dr. Altkins remembers Ryan as a little kid who should have gotten off of milk but he just wouldn't do it. He also recalls a patient who thrived when he was put on the right elimination diet, giving up only a couple of foods.   [38:33] Dr. Atkins doesn't want to diminish any of his patients. Every patient is an individual. It's so much fun working through the problems, the goal, and the adjustments to get there and how the patient is dealing with it, and then watching them do better!   [40:35] The hard part about eosinophilic esophagitis is that very few people outgrow it. It tends to be lifelong. But in the lifetime of patients he is seeing now, Dr. Atkins thinks we will see a cure, or at least, much easier, better treatments.   [40:56] In the population Dr. Atkins treats, they start treatment and all of a sudden, they're not having trouble swallowing. Everyone who had a dilation said they would do it again when needed. They can swallow better.   [41:44] But then, they have to maintain control of the inflammation. When people feel better, their impetus to take the medication drops off. If they stop taking their medications, a month later, they can't swallow their bagels.   [42:18] There are holidays, such as Halloween, that are challenging for kids who are on elimination diets. If they collect candy but can't eat any of it, that may be a problem.   [42:48] People who don't have EoE don't understand not being able to swallow. Dr. Atkins sees dads who have this but don't want to go get checked out. He tells them they need to be examples for their children and go get endoscopies to know if the condition is familial.   [43:53] Dr. Atkins says there are a number of other excellent programs in the country.   [44:24] Holly thanks Dr. Dan Atkins for sharing his expertise to help others and continually teaching the medical community how to recognize eosinophilic diseases and optimize care for all patients.   [44:40] Eosinophilic diseases are not going away. Allergists need to learn the ins and outs of all different eosinophilic disorders. The medications available to treat those disorders are increasing.    [45:02] Early in your career as an allergist, learn as much immunology as you can and how the biologics work and the newer medications coming out. Follow side effects so you know what to say to your patients and what to look for.   [45:20] A lot of EoE patients get picked up in the allergist's office because they have other allergic diseases. As an allergist, ask if the child or parent eats slower than everybody else.   [45:57] Ryan thanks Dr. Dan Atkins for joining today and personally, for all he has done to treat Ryan over the years. He thanks Dr. Atkins on behalf of APFED and for being instrumental in many APFED conferences and educational materials.   [46:30] Dr. Atkins's biggest hope is that people sort out the pathways that lead to eosinophilic esophagitis and that we will have an array of targeted treatments for individual patients to cure that disorder for that patient without side effects.   [47:50] Dr. Atkins thanks Ryan and Holly again for the opportunity to join them. It's been such a pleasure. He thanks APFED again. He has been a big fan for years. Giving patients a voice to share their stories is incredibly important.   [47:34] For our listeners who would like to learn more about eosinophilic disorders, please visit APFED.org and check out the links below.   [47:41] If you're looking to find a specialist who treats eosinophilic disorders, you can use APFED's Specialist Finder at APFED.org/specialist.   [47:51] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections/.   [48:07] Holly thanks Dan and also thanks APFED's Education Partner Bristol Myers Squibb, GSK, Sanofi, and Regeneron, who supported this episode.   Mentioned in This Episode: Dr. Dan Atkins, pediatric allergist Children's Hospital Colorado National Institutes of Health National Jewish Health Allergy: Principles and Practice, by Elliott Middleton Jr., Charles E. Reed, Elliot F. Ellis, N. Franklin Adkinson Jr., John W. Yunginger, and William W. Busse   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “I loved helping patients with asthma, eczema, allergic rhinitis, food allergies, and anaphylaxis. You could take these kids who had potentially life-threatening conditions, work with them, and stabilize things, and they did really well.” — Dr. Dan Atkins   “With patients who have allergic rhinitis, we tend to be more aggressive with using a topical nasal steroid spray because that decreases the eosinophils in the nose.” — Dr. Dan Atkins   “We are trying to teach children to be their own advocates. … If you don't listen to what the patients have to say, why should [the patients] be involved?” — Dr. Dan Atkins   “The hard part about eosinophilic esophagitis is that very few people outgrow it. It tends to be a lifelong phenomenon.” — Dr. Dan Atkins

Send us a textIn this episode of The Over 50 Health & Wellness Show, Kevin English sits down with Dr. Jim Polakof, an 86-year-old pioneer in holistic nutrition and healthy aging. Dr. Jim shares his wealth of knowledge and inspiring personal journey, offering actionable insights into living a long, vibrant life. Whether you're looking to improve your nutrition, incorporate movement into your daily routine, or build deeper connections with loved ones, this episode has something for everyone. Dr. Jim also introduces his latest book, Live Healthy Longer with Dr. Jim: How to Live a Long Life Filled with Intimacy and Good Health, a comprehensive guide for anyone seeking to age with grace and vitality. What You'll Learn in This Episode:Dr. Jim's Inspiring Journey: From Hollywood filmmaker to holistic health expert, learn how Dr. Jim discovered his passion for helping others live healthier lives.The Importance of Nutrition for Aging Well: Why so many people miss the mark on nutrition and how small changes, like reducing processed foods and eating whole, nourishing meals, can make a big difference.Movement Is Medicine: Why staying active is critical for healthy aging, plus simple exercise strategies—even for those who face physical limitations.The Role of Stress Management: How guided imagery, mindfulness, and other simple practices can help you manage stress in today's chaotic world.Combating Loneliness: The dangers of social isolation and practical ways to build meaningful connections as you age.Intimacy and Aging: Why physical touch and emotional closeness are vital for your health, happiness, and longevity—and how to cultivate intimacy at any age.Optimism for the Future: Dr. Jim's hopeful outlook on how we can improve our collective health, one habit at a time. Resources and Links Mentioned in This Episode:Visit Dr. Jim Polakof's website: www.jamespolakof.comGrab a copy of Dr. Jim's book: https://www.amazon.com/LIVE-HEALTHY-LONGER-Dr-Jim/dp/B0D95K56S2/Facebook: https://www.facebook.com/JamesPolakofPhd1Live Healthy Longer podcast: https://www.jamespolakof.com/podcasts Check Out the Over 50 Fit Foundations Workout Program: https://www.silveredgefitness.com/fit-foundations-1 Connect with Kevin & The silver Edge:Website: www.silveredgefitness.comInstagram:  @thesilver_edgeJoin the Over 50 Lean Body Blueprint Facebook group: https://www.facebook.com/groups/silveredgefitness Enjoyed This Episode?If you found this episode helpful, please subscribe to the podcast and leave a review! Your support helps us reach more listeners who are ready to transform their health and live their best lives after 50.Want to rewrite the narrative of your life and health? Visit the link below to see if our 1:1 coaching services are a perfect fit for your long term goals: https://calendly.com/thesilveredge/coaching-inquiry Want more over 50 health and wellness goodness? Check out our private Facebook group: https://www.facebook.com/groups/silveredgefitness

In this enlightening episode of Health Coach Conversations, Cathy Sykora welcomes Dr. Lynn Anderson, a renowned naturopath, yoga therapist, and holistic health expert. Dr. Anderson shares her extensive knowledge on holistic health, karma yoga, and the impact of lifestyle choices on well-being, drawing from over 40 years in the field. In this episode, you'll discover: What is Holistic Health? Dr. Anderson explains how true health encompasses the mind, body, and soul and the importance of balance in these areas. Understanding Karma Yoga: Discover the principles of karma yoga and how our actions impact our health through cause and effect. The Role of Diet in Wellness: Dr. Anderson discusses the concept of the “yoga of healthy nutrition” and shares her preference for the Mediterranean diet as a balanced approach to eating. Slowing the Aging Process: Tips on how to maintain a quality of life as we age, focusing on lifestyle practices that promote longevity and vitality. How to Start with Yoga: Advice for beginners on getting started with yoga, finding a certified instructor, and tailoring practice to individual needs. Memorable Quotes “Holistic health is about bringing together the body, mind, and soul. When one part is off-balance, the other parts are affected.” “Karma is cause and effect. If you want a vibrant life, you have to create the causes that lead to it.” Bio Dr. Lynn Anderson is a naturopath, yoga nutrition therapist, fitness professional, karma master, published author, international speaker, and video producer with over 40 years of experience in natural health and fitness. She has been featured in Redbook, Reader's Digest, Huffington Post, Shape, SELF, and various other national publications, TV networks, and podcasts. Dr. Anderson is the author and producer of the Soul Walking Series (Karma, Prosperity, Vitality) and The Naturopathic Wellness Series (The Yoga of Nutrition and Recipes for Health, Sex, Happiness and Love), along with Dr. Lynn's Proactive-Aging Workouts (DVDs and TV with international distribution). She also authored Burnout – It Happens to All of Us and conducts weekly online Zoom classes and therapy classes at SMH.   Mentioned in This Episode: Dr. Lynn Anderson's Website: Learn more about her holistic health offerings at drlynn.com. Links to Resources: Health Coach Group Website: thehealthcoachgroup.com Special Offer: Use code HCC50 to save $50 on the Health Coach Group website Leave a Review: If you enjoyed the podcast, please consider leaving a five-star rating or review on Apple Podcasts.

Welcome back to the Nifty Thrifty Dentists Podcast!

Are you or someone you know struggling with helping a loved one who resists treatment? In this insightful episode of Health Coach Conversations, host Cathy sits down with Dr. Brian Licuanan, a board-certified psychologist and author of How to Get Your Resisting Loved One into Treatment: A Step-by-Step Guide for Mental Health and Addiction Crisis. Dr. Licuanan shares strategies, insights, and compassionate advice on supporting loved ones who may be facing addiction or mental health challenges but are reluctant to seek help. In this episode, you'll discover: Understanding Resistance to Treatment: Dr. Licuanan discusses the complexities of getting someone into treatment and why loved ones often feel helpless in these situations. Setting Boundaries with Compassion: Learn about the role of healthy boundaries and how family members can support loved ones without enabling harmful behaviors. The Role of Hope and Neuroplasticity in Recovery: Dr. Licuanan explains the importance of hope and the science behind neuroplasticity, emphasizing that it's never too late to make a positive change. Dr. Licuanan's 25 Must-Knows for Families: Essential insights for anyone supporting someone with mental health or addiction struggles. Differentiating Between a Lapse and a Relapse: Understand the difference and how a strong recovery program can reduce the risk of relapses. The AD20 Model and H2O Principles: Discover Dr. Licuanan unique approach to managing addiction and mental health through honesty, humility, and openness to direction. Memorable Quotes “True recovery requires honesty, humility, and openness. When we approach recovery with these principles, we can overcome even the toughest challenges.” “Boundaries are not a punishment; they're a path to help loved ones find their own strength to seek help.” Guest Bio: Dr. Brian Licuanan is a leading psychologist specializing in addiction and family crisis interventions. With over 20 years of experience, Dr. Licuanan has helped countless individuals and families navigate the challenges of mental health and addiction recovery. He's been featured on The Doctors, Dr. Drew Midday Live, and Good Day LA, sharing his expertise on mental health. In his latest book, How to Get Your Resisting Loved One into Treatment, Dr. Laquanen provides practical steps to help families find hope and a path forward. Visit drbrianlaquanen.com for more resources and information.   Mentioned in This Episode: Dr. Licuanan's Book: How to Get Your Resisting Loved One into Treatment: A Step-by-Step Guide for Mental Health and Addiction Crisis – Available on Amazon and drbrianlicuanan.com. Health Coach Group: Join a community of health professionals dedicated to making a difference at thehealthcoachgroup.com.   Links to Resources: Health Coach Group Website
https://www.thehealthcoachgroup.com/

Use the code HCC50 to save $50 on our website   Leave a Review of the Podcast  

Raising healthy, resilient kids in today's world? It's no easy task, especially when antibiotics are prescribed for every other ailment. But Dr. Elisa Song is here to change the game. As a Stanford-trained integrative pediatrician, she's on a mission to help parents protect their children's gut microbiomes and overall health by avoiding unnecessary antibiotics. In this episode, Dr. Song shares the must-ask questions before giving your child antibiotics, the hidden dangers behind disrupted microbiomes, and how to safeguard your child's health naturally. Armed with knowledge from her book Healthy Kids, Happy Kids, Dr. Song offers practical advice on everything from probiotics and diet to vagus nerve engagement—all designed to support the gut and help your kids thrive in a toxic world.   Tune in to discover how you can take a proactive, holistic approach to your child's health.   “Our kids really are in crisis—from a physical health standpoint, immune standpoint, and mental health standpoint.” ~ Dr. Elisa Song   In This Episode: - Dr. Song's journey in integrative pediatrics - The crisis in children's health - Glyphosate and its impact on children's health - Antibiotic crisis: overuse, resistance, and long-term consequences - What happens after you take an antibiotic? - How to support your child's gut after antibiotics - Probiotic gummies: are they really beneficial? - Added sugars and mental health concerns - Reading food labels and making informed choices - Natural alternatives to antibiotics - Dr. Song's book: "Healthy Kids, Happy Kids" - Where to find Dr. Song and learn more For more information, visit https://www.myersdetox.com    Ready to discover your body's toxic burden and how it affects your health? Take my quiz to find out! http://www.heavymetalsquiz.com    Products Mentioned in This Episode: - Dr. Elisa Song's Book: Healthy Kids, Happy Kids—get your copy here: https://a.co/d/7eWk0zP  - Tru Energy Skin Care by Cathy Goldstein: Discover the magic of frequency-infused skincare—get yours here: https://store.truenergyskincare.com/aff/76D44761648F32018CF962E3661FD100/index.html?subid=wendy - Therasage Infrared Saunas: Explore Therasage's infrared sauna collection today at https://store.myersdetox.com/pages/therasage    About Dr. Elisa Song: Dr. Elisa Song is a Stanford, NYU, and UCSF-trained integrative pediatrician, pediatric functional medicine expert, and the best-selling author of Healthy Kids, Happy Kids. With over 20 years of experience, Dr. Song has helped thousands of children get to the root cause of their health concerns by blending conventional pediatrics with integrative approaches such as functional medicine, homeopathy, acupuncture, herbal medicine, and essential oils. She is the founder of the online platform Healthy Kids, Happy Kids, a holistic pediatric resource designed to empower parents and practitioners in bridging the gap between traditional and integrative care.   Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

Understanding Fat Oxidation and How to Improve It for Endurance Athletes In this episode, we dive into the critical role of fat oxidation for endurance athletes and explore practical strategies to enhance it. We also feature insights from Dr. Dan Plews of ENDURE IQ, a renowned expert in sports science and endurance training. What is Fat Oxidation? Fat oxidation is the process by which the body breaks down fats for energy. For endurance athletes, improving fat oxidation is crucial as it allows the body to rely on fat for fuel during prolonged exercise, sparing glycogen and enhancing performance. Key Points on Improving Fat Oxidation: Train at the Right Intensity: Incorporate low-intensity sessions (zone 2 peak fat max) to improve fat utilization. Increase Mitochondrial Density: Regular aerobic training boosts the body's ability to oxidize fat by increasing mitochondria in muscle cells. Utilize Specific Fueling Strategies: Experiment with fat-based fuels like medium-chain triglycerides (MCTs) to promote fat metabolism during training. Periodization of Training: Combine high-intensity and low-intensity sessions to improve metabolic flexibility. Nutrition Adjustments: Focus on a balanced diet that promotes fat metabolism, with adequate healthy fats and nutrient-dense foods. Hydration and Electrolyte Balance: Maintain proper hydration and electrolyte levels to support metabolic functions, including fat oxidation. Monitor and Adjust: Use metabolic testing to track fat oxidation rates and adjust training and nutrition based on performance data. Dr. Dan Plews & ENDURE IQ's Approach to Fat Adaptation: Dr. Plews highlights the importance of structured training and nutrition strategies to optimize fat oxidation. The ENDURE IQ 101 course includes phases like: Fat Oxidation Base Training  Incorporating fat-burning intervals Fueling experiments  Monitoring performance with tools like metabolic testing By focusing on individualized approaches and periodized training, athletes can enhance fat oxidation, metabolic flexibility, and overall endurance performance. Mentioned in This Episode: Dr. Dan Plews, researcher and coach at ENDURE IQ ENDURE IQ 101 Course for improving fat oxidation and fat adaptation in endurance athletes Listen to the full episode for a deep dive into the science behind fat oxidation and actionable tips to fuel your next race!  Check out the YouTube Channel for many videos on how to fuel and train as an endurance athlete here.

Do you struggle with falling asleep or staying asleep through the night? You are probably suffering from one of the 5 types of insomnia! But which one could it be, and how can you address it and sleep better…once and for all? In this episode, Dr. Wendy Myers interviews Dr. Damiana Corca, a doctor of acupuncture and Chinese medicine and a certified functional medicine practitioner specializing in sleep disorders. Dr. Corca shares insights from her new book, The Deep Blue Sleep, which distills wisdom from over a decade of clinical practice helping patients overcome sleep issues. Learn practical strategies for addressing the underlying causes of insomnia, how to optimize your sleep hygiene, balance your hormones, and support your body's natural sleep-wake cycle.   “Falling asleep within 10 to 20 minutes is ideal. If you fall asleep as soon as you hit the pillow, you're likely sleep deprived." ~ Dr. Damiana Corca   In This Episode: - Dr. Corca's background and her new book on sleep - Statistics on how many people struggle with sleep - Defining good sleep - what to aim for - The five types of insomnia - Hormonal balance and sleep, especially for women - EMF and sleep - Tips for optimizing your sleep environment - Top sleep supplements to consider - Liver health and sleep - Blood sugar and sleep: foods to avoid for better sleep - More about the book: The Deep Blue Sleep For more information, visit https://www.myersdetox.com    Ready to discover your body's toxic burden and how it affects your health? Take my quiz to find out! http://www.heavymetalsquiz.com    Product Mentioned in This Episode: - Dr. Damiana Corca's Book, The Deep Blue Sleep:  https://a.co/d/eGQyzxe - Solaris by Activation Products: Get yours today at https://tracking.activationproducts.com/JP56F381/295C1HL/?uid=178. - IonizeMe Maxx 5 Ionic Foot Baths: Check them out at https://offer.myersdetox.com/sp/ionizeme-maxx-foot-bath/.   About Dr. Damiana Corca: Dr. Damiana Corca is a doctor of acupuncture and Chinese medicine, as well as a certified functional medicine practitioner specializing in sleep disorders. Her new book, The Deep Blue Sleep, distills wisdom from over a decade of clinical practice helping patients overcome insomnia and improve their sleep. Dr. Corca brings a compassionate and realistic perspective, accounting for the diverse lifestyles and backgrounds of her patients and readers.   Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

Episode 22: Navigating Graduate School with Purpose: Key Strategies for Success with Dr. Justin Grimes Welcome back to another insightful episode of the Published and Paid Podcast! In this episode, I sit down with Dr. Justin Grimes, CEO of Apply to Graduate School and a member of our Published and Paid Mastermind. Dr. Grimes shares his incredible journey from a PhD student to a full-time entrepreneur dedicated to making graduate education more accessible and equitable. He opens up about his personal and professional challenges, including writing his book during a difficult time in his life, and the mindset shifts that propelled him toward success. We dive deep into the importance of having a clear purpose and goal before pursuing graduate education, the common mistakes that aspiring students make, and the steps you need to take to ensure your education aligns with your life. Whether you're considering going back to school or need some inspiration to pursue your dreams, this episode is packed with valuable advice that you won't want to miss. What You'll Learn in This Episode: Dr. Justin Grimes' inspiring story of turning personal challenges into professional success Key factors to consider before applying to graduate school How to avoid common pitfalls like “defaulting” to school without a plan The importance of having a clear goal and making your education fit into your life Practical steps to take when pursuing higher education or a new entrepreneurial venture Quotes: "Your why is what will sustain you to the end of this process." — Dr. Justin Grimes "If you're out of control in life, this might not be the move for you." — Dr. Justin Grimes "School will not circumvent life's challenges; life is going to happen regardless." — Dr. Justin Grimes Resources and Links: BOOK: Purchase a copy of Published and Paid: Write, Self Publish, and Launch Your Nonfiction Book in 90 Days or Less > https://a.co/d/95ckzMx LIVE EVENT: Published and Paid LIVE: October 11-12, 2024, Atlanta, GA: Virtual tickets available! www.publishedandpaidlive.com COMMUNITY: Published and Paid: The Community (Facebook Group) www.facebook.com/groups/publishedandpaidfree Jasmine Womack, M.Ed, EdS LinkedIn: linkedin.com/in/thejasminewomack IG: instagram.com/thejasminewomack FB: facebook.com/authorjasminewomack Youtube: youtube.com/thejasminewomack Subscribe: Don't forget to subscribe, share, and leave a comment to help us reach more listeners like you!

At the height of her worldly and academic success garnering three Harvard degrees, Martha Beck received life altering news, and discovered that maybe she didn't know everything. This set off a lifetime of pursuing ways to soothe her nervous system from anxiety and find freedom in a new purpose. In a world where anxiety seems to be spiraling out of control, Martha offers a revolutionary approach to understanding and befriending anxiety. Drawing from cutting-edge neuroscience and her years of experience coaching people through what she calls the “Change Cycle,” Martha shares: The four phases of the “Change Cycle” Why anxiety is on the rise and how it's affecting us all The unexpected connection between anxiety and creativity How to access your own creative genius You're also not going to want to miss Jen and Amy's discussions before the interview on embracing the mantra “it's never too late” and Jen's incurable attachment to an ancient email address. * * * Thought-Provoking Quotes: "Hold it [stability] very lightly. Let it go. Because everything is always moving and changing." - Dr. Martha Beck "If you try to speed yourself through the process of letting go, of grieving your losses, of at least giving a really deep, profound, heartfelt farewell to the life you used to have — if you don't go through that process, nothing good is going to come of it. You're going to end up in lifelong therapy." Dr. Martha Beck “There is a sensation deeper than the mind, more profound than anything we could think, and in some ways, far more powerful than emotion. It is a kind of stillness, a connection. I believe that this is what consciousness is. It behaves this way when it is neither us nor a substance. It is a vibrantly alive stillness that pervades the universe, however many there are. And we are part of it; we are indistinguishable from it.” - Dr. Martha Beck "The first step to getting out of anxiety is to recognize that an anxious brain is not a broken machine--it's a frightened animal." - Dr. Martha Beck “The moment you move into a place of compassion, you use your brain very differently than when you're in an anxiety spiral. This shift frees you to pull your attention away from the anxiety and begin being loving with yourself.” - Dr. Martha Beck "You were born a creative genius. Your mind is so capable of solving the problems that make you anxious, but only if you free that genius. And anxiety keeps it caged." - Dr. Martha Beck Resources Mentioned in This Episode: Dr. Becks Monthly O Magazine Column - https://www.oprah.com/spirit/martha-beck/all Bewildered Podcast with Dr. Martha Beck & Rowan Mangan - https://bit.ly/3zkyic2 The Gathering Room Podcast with Dr. Martha Beck - https://bit.ly/3XquFsV The Way of Integrity Finding the Path to Your True Self - https://bit.ly/3ziwm3F Nisargadatta Maharaj - https://en.wikipedia.org/wiki/Nisargadatta_Maharaj NASA's Creative Genius Study - https://bit.ly/4dSoFAl Wildr App - https://apps.apple.com/my/app/wildr/id1604130204 Guest's Links: Dr. Beck's Website: https://marthabeck.com Dr. Beck's Wayfinder Life Coach Training: https://marthabeck.com/life-coach-training/ Dr. Beck's Instagram: https://www.instagram.com/themarthabeck/ Dr. Beck's upcoming book: https://marthabeck.com/beyond-anxiety/ Courses & Retreats with Dr. Beck: https://marthabeck.com/courses-training/ Connect with Jen! Jen's website - https://jenhatmaker.com/ Jen's Instagram - https://instagram.com/jenhatmaker Jen's Twitter - https://twitter.com/jenHatmaker/ Jen's Facebook - https://facebook.com/jenhatmaker Jen's YouTube - https://www.youtube.com/user/JenHatmaker?sub_confirmation=1 The For the Love Podcast is a production of Four Eyes Media, presented by Audacy.  Four Eyes Media: https://www.iiiimedia.com/ To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

I'm takin' you BTS of the Warrior Queen Olympics – a 10-week challenge where warriors train like athletes in their chosen sport. I also had guest expert Dr. Stacy Sims join Warrior School to share her insights on the importance of being 'selfishly' committed to one's training and the concept of taking up space. I talk about the three biggest challenges you'll face when it comes to your training including managing your energy, and mindset and committing to the long-term process of building a strong foundation. Key Topics: The launch of the Warrior Queen Olympics and what's to come over the next 10 weeks. Testing week: Why trying new lifts and movements can be both humbling and incredibly empowering. Dr. Stacy Sims' insights on training, eating, and recovering like an athlete, particularly for women in their 30s and 40s. The importance of being selfish with your time and energy as an athlete, and taking up space in every aspect of your life. My reflections on Steven Pressfield's concept of "The Resistance" and the journey of the athlete. The three critical questions every warrior must ask: How much do you love it? How much do you want it? And how much are you willing to give? Why falling in love with the process and cultivating joy in training is crucial for long-term success. The three biggest challenges you'll face when it comes to your training If you're ready to push yourself, think like an athlete, and see what's truly possible, I invite you to check out WS. Resources Mentioned in This Episode: Dr. Stacy Sims' website – Learn more about training and nutrition for female athletes. Steven Pressfield – Check out his email series on "The Artist's Journey" and his book, The War of Art. Follow me on the gram or visit the Warrior School website. Quotes to Remember: "The difference between a recreational athlete and an elite athlete is that athletes are selfish. They're selfish with their time, their sleep, and their energy." – Dr. Stacy Sims "However hard you think it will be, it's 10 times harder. However long you think it will take, it's 10 times longer. And however much you think it will cost, the price is 10 times higher." – Steven Pressfield "We need to train for the rest of our lives – so, fall in love with the process and the practice." – Amy Bowe Take the Challenge: Share this Episode: Found this episode powerful? Share it with your fellow Warriors. Subscribe to the Podcast: Don't miss future episodes. Subscribe on Apple Podcasts, Spotify, or your favourite platform! Let's Connect: Instagram: https://www.instagram.com/amykatebowe/ Website: https://warriorschool.co/

This Episode Dr. Jenkins looks at the council of Ephesus of 449, its background, its consequences, and why it is called the Robber or Brigand council (from the Latin, latrocinium). Orthodoxy and Education: https://tinyurl.com/OrthodoxEducation Dr. Jenkins new website with the Atheism course: luxchristi.co/ (note, not .com).

Welcome to the Food Junkies Podcast! In today's episode, your host, Dr. Vera Tarman, and co-host, Clarissa Kennedy, are thrilled to welcome Dr. Èvelyne Bourdua-Roy to the show. Dr. Roy is a highly respected family medicine physician with a wealth of knowledge and experience in treating patients with various health concerns, including those related to food addiction and recovery. Dr. Roy graduated from the University of Montreal in 2015 and from LaValle University in 2012, bringing a rich educational background and a compassionate approach to her practice. In this episode, we dive deep into the world of food addiction recovery, exploring how positive and negative expectations can shape the journey to better health. Dr. Roy shares her insights on the importance of flipping expectations, patient challenges, and practical strategies for building new, adaptive expectations that support lasting recovery. Whether you're struggling with food addiction, supporting someone who is, or simply interested in learning more about this critical topic, this episode offers valuable perspectives and actionable advice. Tune in to discover how shifting your mindset can be a powerful tool in overcoming food addiction and reclaiming your health. What You'll Learn in This Episode: Dr. Èvelyne Bourdua-Roy's journey in medicine and her passion for helping patients overcome food addiction. The concept of flipping expectations and how it can transform the recovery process. Common challenges faced when trying to change expectations and how to overcome them. Practical tips for building realistic, adaptive expectations that support long-term recovery. The role of self-awareness, emotional regulation, and support systems in sustaining positive change. Find Dr. Èvelyne Bourdua-Roy: BOOKS  LinkedIn Twitter/X Connect with Us: Join our community on Facebook for ongoing support and discussions. Crush Your Cravings MasterClass Friday, August 23, 2024 https://crushyourcravings.institute/clarissa https://crushyourcravings.institute/molly Subscribe & Leave a Review: If you enjoyed this episode, please subscribe to the Food Junkies Podcast and leave us a review. Your feedback helps us reach more listeners and provide valuable content to those on their recovery journey. Thank You for Listening! We appreciate you tuning in and hope this episode helps you on your path to recovery. Stay strong, stay committed, and remember—you have the power to change your relationship with food and reclaim your life.   The content of our show is educational only. It does not supplement or supersede your healthcare provider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.

When you think of the word productivity, what is your first thought? Today, we're diving into a fascinating discussion on productivity, but not in the way you might expect. Recently, I had a conversation with one of my clients about what it means to raise productive children and the challenges parents face in this endeavor. Whether you have one child or several, the struggle to balance keeping them active and not overwhelming them is a familiar one. In this episode, I'll share my personal experiences with my four kids and the insights I've gathered from working with numerous families. We'll discuss the importance of helping our children find their intrinsic motivation and the potential pitfalls of over-scheduling. As always, I'm eager to hear your thoughts and strategies on this topic. Let's get started! Connect with Paul Contact Paul here or schedule a time to meet with Paul here. For resources discussed in this episode, visit tammacapital.com/podcast. Follow Paul on LinkedIn, Instagram, and Facebook. And feel free to email Paul at pfenner@tammacapital.com with any feedback, questions, or ideas for future guests and topics. Resources Featured in This Episode: Dr. Tracy Dennis-Tiwary – Parents & Kids Working Together to be Better Digital Citizens Cathy Adams – Parenting With No Age Limits Ben Feller – Big Problems, Little Problems; A Father & Son Journey

About 88% of adults have a degree of insulin resistance, which is a silent contributor to chronic health conditions, including Alzheimer's, obesity, type 2 diabetes, and cardiovascular diseases. The condition is both pervasive and easy to miss, making it a critical health issue to address.My guest today is Dr. Morgan Nolte, a board-certified clinical specialist in geriatric physical therapy and founder of Zivli, an online course and coaching program that helps adults reverse insulin resistance. We discuss the dangers of insulin resistance, its progression to type 2 diabetes, and its impact on longevity.Dr. Morgan explains the importance of understanding insulin levels and the relevance of different blood tests. We also cover lifestyle and dietary changes crucial for reversing insulin resistance, and overrated fears surrounding dietary fats, meat, and cholesterol. Tune in and learn how to test and reverse insulin resistance, prevent diabetes, and optimize your metabolic health.09:42 Dr. Morgan's journey and experience in handling insulin resistance12:45 What is insulin resistance? And why should we check our fasting insulin levels?17:57 Symptoms of insulin resistance19:39 Differences between insulin resistance, prediabetes, and type 2 diabetes22:45 Understanding what the blood glucose readings mean27:38 Lifestyle contributors to insulin resistance, prediabetes, and type 2 diabetes35:20 The impact of artificial sweeteners on insulin levels and gut health42:57 Impact of stress, physical activity, and sleep on insulin resistance45:42 The importance of strength training in reversing insulin resistance51:27 Understanding cholesterol and cardiovascular risk59:26 The benefits of eating meat and dietary fats1:03:04 How to reverse insulin resistance, prediabetes, and type 2 diabetesResources Mentioned in This Episode: Dr. Robert Lustig's book “Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine” - https://a.co/d/5EDcJHQ Dr. Casey Means' interview with Dr. Robert Lustig on understanding cholesterol - https://www.youtube.com/watch?v=C3rsNCFNAw8 Dr. Benjamin Bikman's book  “Why We Get Sick” - https://amzn.eu/d/6uFZ4AA Dr. Peter Attia's book “Outlive: The Science and Art of Longevity” - https://a.co/d/2VzzJrM Dr. Georgia Ede's book “Change Your Diet, Change Your Mind” - https://a.co/d/7gNtgew Subscribe and Listen on iTunes: https://podcasts.apple.com/ca/podcast/the-over-40-alpha-podcast/id1446632685 Listen to This Episode on Your Favourite Podcast Channel: www.over40alphapodcast.comYour support of the Over 40 Alpha Podcast helps to spread the word and ultimately change the lives of men worldwide over the age of 40, 50, and 60 who struggle with health and fitness.I want to give a MASSIVE thanks to everyone stepping up and leaving 5-star reviews.Please Review and Share the Podcast Here:Drop that 5-star review.https://podcasts.apple.com/us/podcast/the-over-40-alpha-podcast/id1446632685 Connect With Dr. Morgan Nolte:Website - https://www.zivli.com/ Facebook - https://www.facebook.com/drmorgannolte Instagram - https://www.instagram.com/drmorgannolte/ YouTube - https://www.youtube.com/channel/UCByB8-b3CnXYuuWWyJ_vgzA  Connect with Funk Roberts: Website -  https://www.over40alpha.com/Instagram - https://www.instagram.com/funkrobertsfitnessFunk's book ‘Nutrition for Men Over 40' - www.over40meals.com