35 Burst results for "Cardiovascular Disease"
Why Is Obesity Such a Serious Condition?
"Today. We look at a condition that comes with a multitude of serious health issues. Obesity and we start with the best ways to figure out our optimal weight based on our height. We seem to become inured to the mortal threat of obesity. Go back medical issue. A half century or so when obesity wasn't just run of the mill. The descriptions are much more grim. Obesity is always tragic and its hazards are terrify but it's not just obesity of four million deaths every year tribute excess by nearly forty percent of the victim are just overweight or obese. According to two famous. Harvard studies weight gain of as little as eleven pounds from early adulthood through middle age increases risk of major chronic diseases such as diabetes cardiovascular disease and cancer the flip side though is that even modest weight loss can major health benefits. What's the optimal bmi The largest is in the united states and around the world found that having a normal body mass index a bmi from twenty to twenty five associate with the longest lifespan. Put all the best available stays with the longest follow up together and that can be narrowed down even further to a bmi of twenty two twenty two. that'd be about between one hundred and twenty four hundred thirty six pounds for someone who stands five foot six but even with a normal bmi the risk of developing chronic diseases such as type two diabetes heart disease and several types of cancer starts to rise towards the upper end even starting as low as a bmi one a bmi five eighteen point five and twenty four point five or both considered within the normal range but a bmi five maybe shared with twice the heart disease risk compared eighteen point for just as there are gradations risk within a normal bmi range their spectrum with an
The Functional Medicine Approach To Oral Health with Dr. Todd LePine
"People who go to medical school. We don't really learn much about the mouth gum disease or you can have sores in your mouth and we a few things here and there. But it's just amazing. How much of a vacuum and our education or health is but in the turns out it's been linked to everything from alzheimer's to heart disease to cancer and to autoimmune diseases and on and on and on and the question is you know what is going on with abs the connection between our oral health and overall so take us down that pathway. Then we'll talk about you know. Basically how to address dental health a functional medicine perspective. Yeah so mark Just a just a little bit of background. Probably have mentioned this before. But i come from family of dentists so my grandfather was a dentist. He went to the university of maryland in the late eighteen. Hundreds my father went to university of maryland. Nineteen four days. My brother went to u. penn dental school and then his two sons are dentists and my two sisters are dental hygiene. So this is a topic. That's near and dear to me. And i'm sure the black sheep of the family and we know that in functional medicine the gut is sort of where everything starts and it can either lead you down the path of health or can lead you down the path of disease and the beginning of the gut the mouth so as you mentioned you know in in medical school. We didn't learn anything about them out. That was like for the dentist. We'll just ignore that and the dentist just basically stay them out and they don't really realize that there's a whole body connected mild or some of the dentist don't and this is where i think. A lot of even functional medicine physicians and dentists really miss a connection. So unless you're working with a a holistic Smart dentist or a functional medicine doctor. Who's aware of the connection between on the mouth in the gut ends systemic the yoon system You're going to be missing a lot of things and and as you mentioned before You know there are a host of conditions including premature birth obesity diabetes cardiovascular disease rheumatoid arthritis inflammatory bowel disease and even dementia that are directly connected to poor or health.
Managing Atrial Fibrillation With Lifestyle Changes Dr. Christine Albert
"Thought we could start by discussing some of your major contributions to the management of atrial fibrillation even since my medical school days. It seems like the emphasis. On lifestyle management for diseases such as atrial fibrillation has increased exponentially as we learn more about arrhythmia mechanisms and now we specifically screen patients for sleep apnea diet alcohol use et cetera. So from all of the landmark clinical research that you've conducted over your career. That's far could you. Maybe summarize for us. What you feel are the biggest takeaways whether in eighth hundred prevention or in any of your other areas that sudden cardiac death. Thank you when i started doing. Research on the epidemiology of heart rhythm disorders really wasn't an emphasis as you say on. Risk factors for h. fibrillation or sudden cardiac death. And then you know a group of us not just myself but amelia benjamin in the premium study and patrick eleanor. We all started to get interested in looking at atrial fibrillation as you would cardiovascular disease and some of the major findings are really related to lifestyle and how it can impact each relation including body mass index. And wait and wait reduction. We've done several studies. One who first authors tetreault who's also electro physiologist at brigham women's hospital and she published a very important study in jack. Where we showed in bunks women. Even being slightly overweight had elevated to risk of fibrillation. And then if you lost weight you lower that risk. And in addition some of the other research we did was around. Exercise and showing that exercise is beneficial to atrial fibrillation. But as we all know too much. Exercise can actually have an adverse effect and this again was a study that was done by tony acer who was also an electro physiologist and his now at nyu worked with me for a while. So both of those manuscripts were very important. With regards management of atrial fibrillation. In addition we also published one of the first studies looking at alcohol intake and h fibrillation. Now there have been multiple multiple studies showing that alcohol is related to atrial fibrillation. And as you know a randomized trial now that shows that if you abstained from alcohol you lower your risk of atrial fibrillation so all of these studies are not just by myself but multiple. Investigators have really changed the practice where we as clinicians think about lowering. Risk factors as electra physiologists event and approach sanders. Work in australia really took it to another level by actually doing clinical trial in showing that reduction of weight and modifying risk factors lowers incidence of atrial fibrillation. So now it's really one of our pillars of treatment and it is rewarding to see something go from observational research to clinical trials in actually to
The Problem of Gestational Diabetes With Dr. Elizabeth Boham
"We're gonna be talking about conditions pretty common This one hundred percent preventable. A hundred percent reversible that is managed often in very weird ways by traditional medicine and something that's called just station diabetes which is essentially diabetes of pregnancy. So liz tell us how common is this problem. And why should we even care. Be worried about it. Yeah well thanks mark. thanks for having me. It's great to be on with you again and It's really common actually say up to ten percent of women have diabetes which means their blood. Sugar is too high during pregnancy and as a result. What happens when their blood sugar too high during pregnancy is the babies grow too big right so they will get. They will get over weight when they're born so they can grow big. Those offspring often have increased risk of insulin resistance and diabetes and waking when they're adults so when women have just diabetes during their pregnancy. It makes it harder for that baby to maintain healthy weight. When they're an adult so it's trans-generational absolutely not only. Is it dangerous for the baby. During that pregnancy they have a higher rate of of problems with birth. They've increased rate of c-section but their metabolism is damaged. So they have a harder. Time with maintaining normal weight as an adult. They have an increased risk of obesity. They have an increased risk of insulin. Resistance and For that mother to if they had just stations diabetes they have a much higher rates of diabetes post pregnancy. Both type one and type two which is interesting. So they also have a higher rate of cardiovascular disease. they say that a third will develop metabolic syndrome when the within the next five years. So you know it's it is definitely a risk so if if you were told during your pregnancy that you had just diabetes or you you're at risk for just station diabetes. It's important that you are paying attention to your blood sugar to your insulin level to that waist to hip ratio postpartum. Because because you don't want you wanna be be picking this up early. 'cause it's really much easier to reverse if you pick it up early. Imposed ten percent of women who have pregnancies have this problem which is a lot At but when you think about the fact that one and two americans has prediabetes or type two diabetes. You know that's pretty significant. And the question i am is if ten percent have actual just diabetes which means your blood sugar is over a hundred forty after a glucose tolerance test one hundred. Twenty six fasting. How many have prediabetes. Who are pregnant. Yeah because it might be the same ratio as with regular dhabi might be like ten percent and another forty percent of the population might have prediabetes pregnant and that also comes with risks.
Eating this ratio of fruit and veggies could help you live longer, study suggests
"Your mom probably told you to eat your fruits and veggies to stay healthy. Now there's new evidence showing she was right. The American Heart Association study took about 30 years and 29 countries that it shows those who ate more fruits and veggies reduce the risk of dying related to cancer, cardiovascular disease, potentially respiratory disease. Harvard Medical school doctor and Thorndike says Not all veggies are created equal. For example, starches you want to get these other types of more healthful fruits and vegetables, and then you can also eat the potatoes or corn or Pete. If you choose, study says to daily servings of fruit. Three of veggies could help you live
What’s considered ‘high’ blood pressure may be different for women and men, new research reveals
"High blood pressure? Well, there's new research out that suggests the answer to that depends on your gender. A lot of what we do in medicine is based on large studies that may not have traditionally included. Women Cardiologists Rachel Burger with Virginia Heart and women, as opposed to men may have different goals. Blood pressure, for example, lower than 1 20 over a V is considered normal, but new Findings based on 30. Years of data evaluated by the Smith Heart Institute at Cedars Sinai finds women who have blood pressures of even 110 over 80 may be at increased risk for cardiovascular disease. Later on, consult with your Doctor Christi King. W T o P News.
Going red for women and heart health, raising awareness
"Today is national Wear Red Day It's aimed at raising awareness of women's heart health. Cardiovascular disease is the number one killer of women in the U. S. And effects about 44 million people. CBS views. Senior medical correspondent Dr Terror in the ruler who's a cardiologists and a spokesperson for the American Heart Association, appeared on CBS this morning with more on women's heart health. If a woman arrives at the hospital, she's going to wait longer than a man to be seen for chest pain Less often, she's going to get aspirin or guideline directed medical therapy or diagnostic testing. This is a big problem. I have a lot of patients telling me my doctor told me I'm just anxious. I'm just stressed out when in fact they have a real problem. Alarming new survey by the Cleveland Clinic found coronavirus confront Could coronavirus concerns Rather are preventing some heart disease patients from going to the doctor?
Tapping Psychedelics for their Anti-Inflammatory Powers
"Joining us daniel pleasure. We're going to talk about the therapeutic. Potential of psychedelics loose and it's pipelines experimental therapies that extend well beyond mental health indications. There's a growing interest in psychedelics. as medicines what's led to the transformation of this area from one of illicit substances to wonder drugs. Well i think that science has led the way And really it's been clinical research conducted at the top universities around the world Principally johns hopkins to start and now all over imperial college yale university new york university etc Very much led by the science. I i think that When you the question of wonder drugs though is interesting because i think that Silla sabin like ketamine are drugs that have a tremendous amount of promise for the treatment of depression within psychiatry and these drugs have therapeutic potential and other drugs beyond psychiatry but The classification wonder always brings the kind of and probably justifiable skepticism of Is the hype real. And what's really kind of the fundamental Potential and also what are the stumbling blocks for these therapies. And so all of those things are really the focus of the company in in in looking to develop These therapies both within and beyond psychiatry. How restrictive an area is this to work in today. And historically how hampered his research been it has never been more easy to do research in this area You know over the last forty fifty years. Things have dramatically changed. I think that What's what's really notable is the amount of knowledge that the regulators have in this space. The fda ema are very well informed about both the therapeutic potential of these drugs as well as the the risks associated with their development and use. And so i think you have a very informed regulatory audience and you also have increasingly Investors and other sources of capital that are willing to explore and develop these therapies. So i don't see really the limitation being that of a regulatory or legal wine and it's much more about The you know the the aspects of clinical development and really how do you take something with potential and translate that into a solution to address. Unmet needs there's long been interest in the potential of these substances to treat depression and addiction. But you're looking at a broader range of diseases. Among other things you're looking at these substances potential anti inflammatories. What's understood about the potential use of these drugs as anti inflammatories. I think that you know. Our company is is really notable for the fact that we have the the world's leading scientists and clinical developers focused on the full range of potential. Both within and beyond psychiatry. Interestingly when people think about serotonin they think about it in the context of depression they think about it in the context of psychiatry but actually serotonin is a modulator of basic function throughout the body And in fact there's more serotonin in our in our gut than in our brain and in particular the primary target of psychedelics. The new the The primary receptor which mediates the psychedelic effects of serotonin. Two a receptor is ubiquitously expressed throughout the body. It's on all immune cells. It's on all major organ systems and so fundamentally We have been away dazzled and and a bit distracted by the profound psychiatric potential of these drugs and certainly their perceptual effects. But in reality there is a much broader potential because these appear to modulate Stress response in a variety of ways. You know you if you think of it in the context of psychiatry than depression or anxiety or substance abuse are all in a way related to the kind of inappropriate or maladaptive response to stress in the rest of the body. You know whether it's Due to aging whether it's due to an inappropriate immune response we see. Similar type of modulating where the serotonin receptor seems to be implicated in a variety of chronic. Inflammatory diseases the initial discovery of the potent anti inflammatory effects of some psychedelic. Compounds was was. I made by our scientific founder. Professor charles nichols at lsu. The that research That kind of kicked off a long Research campaign in the development of anti of the anti inflammatory potential psychedelics has less through A number of very interesting discovery specifically that some psychedelics are potently anti inflammatory in models of allergic asthma in cardiovascular disease and in a variety of different models of of inflammatory disease associated with ophthalmology related to diabetic. Retinopathy macular degeneration in addition to which there is potential in neuro degeneration and a variety of other conditions and so fundamentally the potential is massive and the key. Question is and really. I think we've addressed this and we're we're very excited to kind of take the next is. How do you bias the psychedelic from its perceptual effects. And make it purely a anti-inflammatory or immunomodulators medicine and that's something that we are
Reviewing Dapagliflozin For Chronic Kidney Disease With Dr. Jennifer N. Clements
"In the commentary wrote for i former ex. You reviewed the study entitled deputy flows in patients with chronic kidney disease which was published in the new england journal of medicine in late september. Two thousand and twenty. And while i think everyone in our audiences should read the paper for themselves. We provide a link to the paper on her. I former x website. But can you give us a brief synopsis of the study methods and results. The data stay k. D. trial was an international double blind placebo. Controlled trial conducted to assess the efficacy and safety of day Ten milligrams orly once-daily among participants with chronic kidney disease with or without type two diabetes to elaborate on chronic kidney disease participants had macro albumen urea and stage two through four kidney disease following one. To one random association each group received stable doses of either an ace inhibitor or arb for at least four weeks. The primary outcome was composite endpoint of a time to event analysis and included declined of gfr fifty percent in stage kidney disease and reno or cardiovascular death. There was a secondary composite outcome. In this included the primary outcome with cardiovascular death or hospitalization for heart failure when looking at baseline characteristics both groups were similar in terms of age females race. Gfr as far as cardiovascular disease and standard of care the gfr main was about forty three and a majority of these participants could be classified as stage three. B in addition thirty seven percent of these participants had cardiovascular disease and ninety eight percent. Did receive the ace inhibitor. Or a are now after three years dabba cliff flows and reduce the primary composite outcome by thirty nine percent with a benefit. Sharon individual outcomes of decline jeff for fifty percent in stage kidney disease and long-term dialysis as saying other trials with dabba gla flows in. There was a reduction of nine percent in the composite of cardiovascular endpoint of cardiovascular death or hospitalization for heart failure now discontinuation was low and similar between both groups. But it's important to look at some safety outcomes volume. Depletion was statistically higher with dabba in than placebo even though there was no statistically significant finding placebo group did have a higher percentage of participants experiencing a reno related adverse event than compared to flows in and lastly there was no cases of you. Glycemic kato acidosis among those. That received
No limit to cardiovascular benefits of exercise, study finds
"Keep your heart healthy and moderate exercise has been considered the healthiest. But now, British researchers say there appears to be no limit to the benefits of exercise. Their five year study found them or exercise people got those smaller, their chances of developing cardiovascular disease. Those in the most active 25% Reduce that risk by about 50% Vicki Barker, CBS News London
Is Optimism a Luxury Good?
"Angela. I'd like to ask you a question today. Sent in by listener named ben all right and this is about something that i feel. We've discussed on the show at least once or twice which is the power of optimism. I think it's safe to say that. You and i are both all things considered optimistic people. Yes so in a way benz question is a challenge to that which i like he writes. How do you square the benefits of with the harsh realities. That might make any reasonable person. A pessimist so look. I think this is a great question. A couple of levels. I think we should appeal it by first asking about the supposed benefits of optimism as ben puts it. Wasn't you first house. What litter tries to say about that. So optimism can be defined in different ways but the way that is often defined is the tendency to look for in a way biased by information. That things are going to get better and that you can make them better and the benefits are enormous. And i wanna say ubiquitous just in the sense that when you think about all the possible life outcomes like doing well at work making more money living longer having more friends being happier. These are all koretz of optimism. So first of all. I have to say your claim about. The benefits of optimism sounds really enthusiastic. Like optimistically enthusiastic. Tuesday sounds like you say. They are enormous and ubiquitous. But when i look into the literature which you know much better than i. Here's one paper. I see optimism is associated with exceptional longevity in two epidemiologic cohorts of men and women. So that sounds good. But then i read a little bit of it. It makes the claim that optimistic people have reduced risk for cardiovascular disease mortality compared with their less optimistic peers but to me this sounds like potentially classic example of correlation without causality. It could be that the same behaviors that result in or drive optimism. Also result in dr healthy behaviors. It could be that healthier. People have more reason to be optimistic. Because they're healthy. Yeah the causal arrow could go the other way like. Wow your life is great. No wonder you're an optimist so persuade me some of those correlates for some of the outcomes of optimism. Get into the causal. Okay and let me also say even that when i say enormous i mean you can't take back enormous. You said it. I might need to take back. Are you gonna take back ubiquitous to now. I'm going to go with ubiquitous. Let's leave that one but you know. Listeners should know that nothing predicts anything with truly norm or enormous food. Life is complicated right so relatively speaking these effects are really impressive. But i don't want to exaggerate too much there. Okay so first. Let me just say you're right. Correlation is not causation. Can you say that again. Look you have a point. I'm going to back down from that too. It's quite obvious that the causal aero could go the opposite way. You're having a great life therefore you're optimistic. It's also possible that some third variable like being rich or something drives it. But here's some evidence to suggest that the causal arrow is also from optimism to outcomes one example. Is that when you look at the relationship to an optimism and health outcomes one reason that we think that this is really optimists doing something differently. Is that when you actually measure. How physically active. They use to be what they eat whether they smoke. It turns out that optimist tend to engage in healthy behaviors. So optimism can drive behaviors that have better health outcomes. That's still correlation evidence by the way it's just that it's a little more of a satisfying story. It is satisfying and one can imagine the mechanism by which that's true. One can say. If i feel like the activity that i do is going to have a real result like feel optimistic about my leverage their then i'm probably more likely to do as opposed to. I can do this all day long. It's not gonna help. Yeah like my life is terrible and it's not gonna change. I'll stay in bed and smoke the cigarette. Let's flip it for a second and talk about what the listener ben wrote in about the harsh realities of life. That would make any reasonable person a pessimist. This calls to mind a famous. Ish story called the stockdale paradox. You familiar with this. Just vaguely admiral. James stockdale when he was in captivity in vietnam. I think in the famous hanoi hilton which was not a hotel by the way it was prison. That the american prisoners called the hanoi hilton. He was years later. Asked what he had learned from that experience about dealing with helplessness and torture and imprisonment. He said i can tell you who didn't survive. It was the optimists and his argument. Was that the optimist. Felt like oh. We're going to be out by christmas. And then chris would come and go and you were now and as he put it they died of a broken heart which i think is probably not exactly what happened. False hope right. And that's where. i think. This question is really interesting for all of us. Because i think these are natural tendency to reach for optimism but there should be a natural cautionary vibe against letting your optimism become delusion. I don't know the story very well. And certainly never interviewed stockdale. But i don't know that optimism. Like i know by christmas. Everyone's going to be vaccinated kind of optimism. I don't know that that's truly at the core of these findings. I think the best kind of optimism. Is you know what. There's gotta be something that i can do here. It's just that of all the things you could pay attention to. Should you pay attention to the things you can't control or should he try to pay attention to things that you can. So couple your optimism with agency. You're saying yeah in fact if you want to say that. Optimism of the a gigantic flavor is the optimism that angela duckworth really likes. That's the phrase was reaching for optimism of the genetic flavor. Yes i thought so.
"cardiovascular disease" Discussed on 860AM The Answer
"Cardiovascular disease, kidney disease, obesity, hypertension is probably leading risk factor in that regard on alert. Yeah, there are a number of them, but you know, one of the other lessons of it is that it's really not about stimulating the immune system. We're seeing that people were wondering why people who Had very strong, very hearty immune systems were having oftentimes of really bad reaction to the virus and things because the immune system is really about balance is about immune modulation is about being able turn on and off and react appropriately rather than overreact. You know, That's how we I'm sure everybody's heard Maura about side of kind storms in the last six months, but they probably have in the last decades of their life and things and that's that overreaction of the immune system, and that's what I think sets apart the immune health basics product. From many of the others, If not most of the other immune products out there is that it's an immune modulator is activating the immune system. So you know if we think of our immune cells as as troops What it's doing is putting the troops on alert. It's reading them getting them prepared, so if something happens, they can respond immediately. It's not stimulating them. It's not like you know, making him charge down. You know, down the field or anything or launch attacks and things like that which gets into that overreaction is all about activating the immune system. The other thing That's really interesting about it, sticking with the analogy of being troops, you know our immune cells being troops is that it actually activate the immune cells called neutrophils and neutrophils are the the ground troops, so to speak of our immune system is what we have more of than any other type of immune cells. It could be anywhere from like 40 to 80% of our immune cells or neutrophils. Jenny, these immune cells have a fairly limited the activity range. They're very primitive, so called immune cells, so to speak. And that they deal with, you know, fungal infections and things of that sort. What? Taking the immune health basics product with activates these neutrophils but also activates him against a greater range of things. So they're now they're gonna get involved in Bali in all sorts of other immune disorders, not just the limited range. Of immunity. So many different things that you know that it brings to the table. It's been shown DA increase the numbers of these active immune cells and increases mobilization. So troops get to the site that you know the battle site more quickly more easily. It increases the process called Fabulous I toeses which is ah, basically, the your immune cells appetite, you know, so they give yourselves actually eat more invaders or, in this case, more virus cells or whatever they may be. It could improve. The removal of the virus is their passages from the body, which is really important cause even dead viruses. They're dead cells infected with virus ran through her body can be problematic. They reduce inflammation, so there are a number of benefits that brings to the table. It's really all about making your are immune system operate in a more balanced man or being prepared for when things do. Come along. You know when you're Besides someone who sneezes or whatever it may be, or you don't get enough sleep in your music room gets a little suppressed. You know, it's just in the sense of prepping your immune system in a healthy manner so that we don't have to worry about That overreaction, which again I think is one of the lessons. That code has taught us that the immune system is really about and, most importantly, about balance about, you know the proper reaction. The proper response. Right right now. Dr Canter. We need to balance our content with the commercials and, uh, advertorial, if you will s O. We need to take a brief commercial break, but we'll be back with more information for your good health. You're on Dr Health with my guest, Dr. Mark Taylor. If you're just joining us, we're talking about community and how to enhance yours Not necessarily overstimulated, but enhance it to its to the greatest degree possible. And we'll tell you how to, um, are the doses that Dr Kayla is talking about? Well, I wanna ask him about that on this particular supplements, which is available over the counter without a prescription. So we'll be back with more information on immune health here on Dr L don't go anywhere if you want to stay healthy. After this, As Dr Health Radio continues,.
Diabetes Mellitus with Dr. Dennis Bruemmer
"Take hardy and hurts summit clear so excited for this installment of our cardiovascular prevention series with the deep dive into diabetes. Which i think you'll learn by the end of the episode is so important for us. Be attention to. We're joined by a phenomenal and true. Genuine in the field. Dr dennis brumer hughes. The director of the center for cardia met about health in the section of preventive cardiology and rehabilitation. At the cleveland clinic. Dr boomer earned his md and degrees from the university of hamburg in germany following residency training in internal medicine and cardiology in berlin docker boomer completed a research fellowship as the diabetes center fellow in the department at ucla. He is board certified in internal medicine and chronology hardy vascular disease and cardiac graffiti quite a unique combination. Dr boomers research is focused on mechanisms of atherosclerosis and risk factor intervention for the prevention of coronary artery disease soccer. It's such a pleasure to invite you to the show success. have you on. And as i invite you. I'm going to just reflect on your unique training path and we were just discussing before we started recording. Here that there's going to be a probably a lot of interest. In pursuing some sort of combined die batali cardiovascular education for court in the future. But would you mind just telling us how you got interested in really devoting yourself to cardio metabolic disease and diabetes in general. Absolutely am so first of all i. I'm super thrilled to be here. And i i'm so excited to be talking to the nerds here tonight so i. I think it's phenomenal. What you guys are doing and again. I very much appreciate the opportunity here so so i was. I'm kind of bridge between endocrinology in cardiology back in germany. I did my thesis. Actually in endocrinology lie protein metabolism. And that kind of got me interested in cardiology. I went to pursue cardiology training back in germany and then research fellowship at ucla. I was supposed to go back after that to germany. But i decided to stay and then obviously being a foreign Repeated training and i was always torn between the endocrine in preventive cardiology aspect than truecar ideologies. So i ultimately decided. I'm just gonna do both so. I did endocrinology fellowship and cardiologist fellowship by the university of kentucky. I had a phenomenal time. There and kind of still even now much of what we do in cardiology is really prevention. And that much of it. This endocrinology so i think these sub specialties really are complementary in or very closely together but let me say on behalf of everyone here at the clinic. How glad we are that. You decided not to go back and stayed here. Join us over here as a faculty because you've just added tremendous value to the program and you've been such an incredible resource for all of us. Thank you for being here. Yes dr burin. And i extend that thank you. Because you know you've stayed here. We are talking to the nerds. I think this is a totally fortunate. And i am really happy to benefit from your stay here now. We are very excited to dive into cardio dive tallahassee which begs the question dr boomer we are cardio nerds why should cardiologists focus on diabetes. I mean why not. Just refer are diabetic patients to endocrinologist or leave the to their primary care doctors. Yeah i think. I think that's kind of the common theme and that is the current care. We leave it to others in cardiology. Now i think that is sub optimal. I think we as cardiologists we see these patients all the time i mean when is ever a patient. In the cath. Lab that presents with an semi or stemming that doesn't have diabetes so we do see the far spectrum of this disease of cardiovascular complications that arise of having ama- diagnosis of diabetes. So i think we have to be involved in managing this. I think to a minimum. We should referred patients to primary care or make sure that the diabetes is. What managed or console endocrinology now as as we all know as physicians quite frequently. Not even that happens so and there's good evidence for that if you look at registries just about six percent of diabetic patients with cardiovascular disease actually get appropriate care for their diabetes and cardiovascular conditions as you know that vitas says associated with the two to four fold increase in risk it is a cardiovascular risk equivalent termed many many years ago seventy percent of our acute coronary syndrome patients have diabetes. So you you could argue. Yes we leave it to primary care but or the endocrinologist but keep in mind that endocrinologists currently see about five percent of the patient population with diabetes.
"cardiovascular disease" Discussed on NewsRadio WIOD
"Cardiovascular disease? And is it does it have to do a genetics? Is it more with what you do in the environment? Is it a combination of both? But how does the disease actually progress which could become life threatening? It's a very complex question to answer scientifically with this venue. But what I can tell you is that disease process specifically, heart disease is related to multiple risks. And so it's not that one risk that you have means you will have the disease. It just increases your probability. And so we know they're multiple risk that can increase your risk for coronary heart disease or cardiovascular disease and inclusion, ethics, family history, They kind of lifestyle you have and the amount of stress I'm safe family history. Is that going back to just your parents? You try look across generational or 100 that war because they always ask that question. You know your dad have this or did you have that? Usually For most part, it's probably immediately one or two levels of ancestry. There are some diseases that are genetic that could potentially skip Shouldn't a level of passage. In other words, Your father might have not had it, but your grandfather might have had it. So they are some diseases like that. But generally speaking, we look directly at your siblings and your mother and father to see what processes they had, such as heart disease, cholesterol, diabetes or coronary disease. Well, you know, it seems like there's new medications coming. We're gonna talk about that a little bit later. But getting back to cardiovascular disease and right now we're going to the Corona pandemic. We're gonna talk about that future program. But I think would really help people to take ownership of their health. And as you got, he said, to go out and say, Listen, I haven't had a check up in a year or two. But I feel great. But you don't know what star could be behind this below the surface. Do you? Absolutely nothing. It's interested. You you're brought up covert 19 little bit over a week ago, I was the invited guest speaker to speak for cardiovascular issues, according basket disease. To a general audience of physicians for their annual medical conference. And so the lecture I gave did focus on Kubrick. But one of its greatest focus for the physicians were where the underlying calm abilities that we saw patients who suffered the most tragic consequences of covert 19 and why it's important to know those camo babies. Because perhaps before they become infected, But covert 19. We can be very aggressive and addressing those things with them both with pharmacologically, you know medicines, in other words, or what they could do it home to improve their odds s o that if they do come down with covert 19 dead, the highest level of survival. And getting through it successfully. Well, you mentioned risk people at risk of having a risky lifestyle. Some people don't really realize the food that they're eating or what they're doing. Their environment during has are putting their entire body under risk, especially for cardiovascular disease. So what are some of the I said you mentioned a few of them. But what are some of the most direct Risk factors for developing cardiovascular disease. Absolutely. We are under the assumption that people are aware of what is risk. But believe it or not, Many people are not aware of what is risk and we think it's common sense so we can touch on that family history. There is nothing You can probably do about it. But.
How Much Do Your Friends Affect Your Future?
"Stephen. I have a question that was tweeted at us by at death by four. Is the correlation of your five closest friends. A real predictor of success. And where you're going in life. Oh a lake the question. I can see why you like the question to because i know that you care about in study friendship so to me there to central questions. We need to try to answer. Their one is whether there is a strong correlation between your friend group and your future and if so whether there's something about that friend group that significantly causes your future to change or whether you choose friends who will fit the future that you're planning yes. I think that we should get to cause -ality once we get beyond correlation. That's i think the most interesting this question because there is this expression. Look at your five closest friends. That's who you are. And that's you're going to be but this is saying but i've always been very suspicious about saying have you not well if i think of my closest friends whenever by. That's all i care about eighteen. I make the top twelve year number. One always okay. My other rents okay. First of all. They're a lot like me so my friends are all practically manic there so like they're all women they're all around my age. They're all around my educational demographic. I think it's interesting to observe that are closest friends are so much like us. Okay so if that observation is accurate. Let's say in the aggregate then. I would have to think that that's a strike against the argument. In the question. I would think it's more a byproduct of the fact that you choose people to be friends who were kind of moving in the direction that you're moving in. Yeah and it's often called him. Awfully bird's feather tend to flock together. And if that's really the heart of the correlation that because we're so similar we aggregate than that does argue against your friends having a causal effect on your outcome because that's not really what's going on but there is evidence and i'm sure you're familiar with by nicholas kristof focus. Who runs the human nature lab at yale. He's the co author of a book called connect the surprising power of our social networks. And how they shape our lives. He makes an argument that our social circles influence us greatly in terms of emotions and behaviors everything from health politics etcetera and his argument. Is that really what we think of as the individual is actually much more compounded result of the people that we know and listen to. So what do you think of that. Research and argument yeah. Nick is probably the most famous researcher on this idea that our social networks are not only reflection of ourselves but actually cause changes in ourselves and he has this data from the framingham heart. Study which by the way was about as it suggests heart health and cardiovascular disease and so forth but it's also been mined by researchers just because it was a really robust set of data. yes opportunistically. Yeah i believe framingham. Is this little town in massachusetts. And i think the interesting feature of the data set is that because it was in this one geographic location. The people in the data set happen to know each other. And you can map out. Who's friends with whom who's relatives of whom who's married to whom who's tutors. Three degrees of separation et cetera and when nick analyzed this one of the famous findings was the finding that obesity is contagious. In the sense that your weight and your weight change was predicted. Not only by the people you know but the more startling finding is it's not even necessarily the there in your direct circle but maybe the outer circle. Goodbye influence you. Stephen and you happen to know someone else. And i don't even have to know them but my politics or the way. I eat or anything else could go viral as it were in the same way that actual virus goes viral.
Do Artificial Sweeteners Cause Heart Disease?
"There i'm monica rhino. And you are. Listening to the nutrition diva podcast. Welcome this week. We're talking about the latest study to throw shade on artificial sweeteners. A study published last month in the journal of the american college of cardiology found. That soda drinkers have a higher risk of heart disease than those who do not drink sweetened beverages now the association between sugar consumption and heart disease risk is not new as a person's sugar intake increases so does their risk of cardiovascular disease and this association by the way is seen regardless of the age the body weight or the exercise habits of the person even among those with otherwise healthy diets. Lots of fruits and vegetables lean meat whole grains and that sort of thing heart disease risk increases with added sugar intake. The more surprising thing about this study however was that those who drank a lot of sweden soda had the same elevated risk as people who drank a lot of sugar sweetened soda. The risk of heart disease was about one third higher among those who were high consumers of either type of soda compared to low consumers that means if ten out of one hundred low consumers developed heart disease than thirteen out of one hundred high consumer would. So let's talk a little bit about how sugar can hurt your health. Those who consume more added. Sugars are more likely to be overweight. And that certainly contributes to heart disease risk. But even when you're not overweight a diet high in sugar can raise your triglycerides levels. That's the amount of fat that is circulating in your bloodstream. It may also lead to fatty deposits in the liver and these could be some of the mechanisms that would explain the link between sugar intake and heart disease risk but none of that explains how artificial sweeteners might increase cardiovascular risk. And that's the real mystery here. There's no obvious mechanism to explain how artificial sweeteners might hurt. Your heart and this is not the first mystery regarding zero calorie sweeteners. Despite being low in sugar and calories artificial sweetener us has been linked with increasing rates of diabetes and obesity. Now early on theories were proposed to try to explain this. Maybe we thought the sweet taste somehow tricks the body into responding as if it is actually sugar or perhaps artificial sweeteners. Increase our appetite or make us crave sugar research designed to test. Those theories has so far. Come up empty handed. Well not completely empty handed but as is so often. The case research in humans fails to bear out preliminary findings in lab rats. The best theory. We have at the moment to explain. This apparent paradox is that the artificial sweeteners might change the makeup of our gut. Microbiome in ways that promote weight gain or diabetes and unlike the other hypotheses there is some human research to support this and perhaps something similar is underlying this latest finding regarding heart disease. But i think the larger point here is that the data consistently contradict the notion that artificial sweeteners are somehow healthier or perhaps less unhealthy than sugar. Both are fine in moderation of course but high consumption of either one. Either sugar or artificial sweeteners is linked to poorer health outcomes. The keyword here of course is linked as the artificial sweetener industry would very much like to remind everyone correlation is not causation and most of the data that we have on this question our observational. They come from big epidemiological studies that look at dietary patterns and health outcomes over long stretches of time and that sort of steady cannot prove that artificial sweeteners cause any of those health problems but they do often seem to be nearby when these problems occur so should we quit drinking soda. Do we need to change what we're doing based on this latest research. I think that really depends on what you're doing if you occasionally have a diet soda. I don't think you have anything to worry about for that matter if you occasionally have a regular soda. I don't think that's cause for alarm either. But if you're drinking soda whether regular or diet on a daily basis that might be more of a concern aside from whatever affects the sugar or the artificial. Sweeteners are having on your body. Sweetened foods and beverages whether they're sweetened with sugar or with artificial sweeteners. Don't contribute much nutrition to your diet and they may easily crowd more nutritious foods out of your diet. The point is that reaching pry diet soda instead of a regular soda doesn't really constitute a nutritional upgrade if you really want a healthier alternative choose water or sparkling water and by the same token if you're looking for a healthier sweet treat a piece of fresh or dried fruit is going to be a choice than an artificially sweetened brownie or ice cream. My advice is to exercise the same degree of moderation with sweeteners. As you would with added sugars now as you recall the guidelines for added sugars are to limit them to about twenty five grams per day. And remember we don't count the naturally occurring sugars in fruit or dairy products towards that total. But we do include honey molasses maple syrup and other so-called natural sweeteners. So what does that translate to in terms of artificial sweeteners. The equivalent of twenty five grams per day in a non caloric sweetener would be about three packets or one diet soda per day
Is Sugar Bad For You?
"Without further ado, I'm going to bring in our guest today. She is our registered Dietitian joining us on the show again is Debbie James how're you doing debbie I am grand. Thank you very much. All right. Good. Thanks for joining us on the phone here. So I guess right off the bat will jump into it. The big one that people ask is sugar bad for you. Is it bad? Loaded question. I like to give you the loaded one's. GonNa break it down. I'm going to say sugar naturally present in foods is usually fine but the over consumption of added sugar that linked to cardiovascular disease and obesity and cholesterol of not to mention inflammation oxidative stress. So those types of conditions are what added sugar is related to as far as the research goes Particularly, you know pretty vascular disease and it's really oftentimes the higher percentage of calories from added sugar. It's not just that you had them at how much that you had or that the sweet and beverages like seven servings or more per week. That are linked with the mortality from cardiovascular disease. So it matters when we're talking about what kind of sugar and how much right. So you could say excess sugar is bad for you. Can you say that we're yeah, you can say that but natural sugar. So I don't think that there are too many people that have just had an overabundance of raw fruit. that. Were hard pressed because you're getting the antioxidants and you're getting fiber and you're you get all those other things that are beneficial right? Right. The kind of bounce it out and it's probably hard to eat so much food that you would like just way go in excess of your sugar needs. It is so low in calories. Oh my gosh. I went to get like a smoothie. One of the you know maybe places in it a sixteen ounce smoothie had three hundred, sixty calories mike well, definitely not going to be sitting down eating eight apple. You know if I were to just turn to some raw fruit and sit down and chew, it's Never I. It's just not gonna add up that. Much right. Right. So are there are there are there different types of sugars though I there's like the wall stuff you get out of fruits and vegetables but is there you know like what's the additive the different ones? Are there different types early, those are those are like big picture group, their sugars I'm going to narrow it down and get a little. So chemically speaking sugar is either just one like ring of carbohydrate called a Amano ride or sugar also refers to some are two of linked together called a Diet Thac. Hope I hope our listeners at home or taking notes. Okay. We're be a quiz at the end for sure. It only makes little difference because let's say that that glucose blood sugar okay. Brick brick toast is fruit. Sugar. But sucrose table sugar the white crystalline stuff on your table it made of Glucose and fructose. The competent. Okay. That's one of the double sugars right So the reason that makes a difference. Is that the single sugars? They get a short they just they don't need to be broken down or anything. Whereas if you eat a longer sugar, we still call him simple sugar in the Diet but if you need a longer sugar or if you eat a complex carbohydrate like dark from rice or pasta corn potatoes. Your system needs to take time to break that down into its individual tiniest a small little piece to get gored and guess what? That's a sugar interesting. Okay. So because you got because it all right interesting. It's almost like how you just broke down sugar. It took a little longer. But it wasn't as simple to digest as but it was but it did make sense in the end. Okay. That's interesting. So like the if it's the combination, it almost like your body has to pull that apart and then digested. So it's like all right we gotta we gotta take this bar before we can use it. If. It's already we're calling it a sugar whether it's from honey or maple syrup or whatever it like a fraction leg. It is so so so fat birth is you had a bowl of cereal and you're gonNA break down that brand flake that takes a lot longer. Right, okay. It turns it turns to blood sugar even if there's no sugar in it. I don't know if that. Hydrate confused. That's true though you can look at your label of I have some Rice Pilau and it says zero grams of sugar. But I know that it will raise my blood sugar. Two cups of it. You know. Because your body breaks it down digestion. You've got them in time, and then like I said, you clean it down to its very smallest. Piece Particle and Adore Bet and that you're. Going Okay So are there with when it comes to sugars? Are there actually could you deem some sugars healthy for you? Or is it just? are between the different sugars are some more healthy for you than others Okay well, we mentioned natural sugar I think I should Kinda sorta define what what added sugar is. Okay. So if you think of added sugar as something as an ingredient that that's in food in the processing and preparation or added to the food at the table that's really meant as as a sweetener sweetener. Okay. The things that things on the label you might see they could be dextrose could be brown sugar it could be powdered sugar, corn syrup it could be invert sugar lactose, all these names. that. Are within the food those are added but let's say you're looking at fruited yogurt and you feed that there's milk and there's strawberries and boo, there are going to be some grams of sugar. Those are the natural one from the milk and the strawberry, but there may also be some of these other dextrose and. added. In addition to really didn't. Make it a more pleasurable eating experience or drinking experience off to make it. Yeah. To make you crave it. Provides structure and baked good. They, they actually have a a role to play and architecture if you will. I was just thinking been. Yes. I was GONNA use that word. That's funny. Yeah. That's interesting So going. So that's the definition but going back to your question are some like better for you than others are considered healthy. So if you think of natural sugars, they're better for you consumed in their original food source but just bruder milk because of the other nutrition you get with them like I mentioned, fiber calcium, protein, vitamin, C, or D. And you could even say, okay well, what about more purified natural sources like honey or maple syrup are Garvey there's still condiments but. let's say honey it's known to have antimicrobial antioxidant properties and it's a natural cough remedy though if I was going to put them sweetener mit then. I might preference choose honey. Okay. So that's okay that kind of I think touches on like whether. Natural, Rossouw, better for you. But how how much sugar are we talking about that? You should have on a daily basis? What how much should be in your daily Diet? In. General. Okay their recommendation, Perm, lots of different. You know organizations so and and it's because we have found that American adults and children. We consume more than fifty percent of our calories from added sugars and mostly it's from sweetened beverages followed by credited desserts and baked good categories so. I thought. That percents champion many. Oh I it's taking the place of nutrition food right. Did you. Did you say fifteen percent or fifty percent. Keen fifteen. Okay. The first time I heard fifty and I was just like what? Okay fifteen still high feel high. Yeah Okay I'm glad we clarify that. Okay. Continue to help the another would be extraordinary. So the Institute of Medicine, they recommend that added sugar take up less than twenty five percent or a quarter of your total calorie rich like you know it's up there the American Heart Association recommends limiting your added sugar. They offer it a different way. They do it less than a hundred calories per day for women. So that's about sixty spoon or a hundred and fifty calories a day for men, which is about ninety burns. Yet the World Health Organization they recently issued new guidelines stating that only five percent of a person to total daily calories should come from sugar
Is Sugar Bad For You?
"Guys and welcome back to another episode of the Living Healthy podcast presented by la fist. I'm your host Ngoga Bell and I am alone again today because we were recording couple episodes back to back and so Brittany can't join us on the phone at the moment just GonNa be me but we are going to be talking today about sugar. That's right. Sugar is it good for you is bad for You, how much should you have hopefully all the questions you have about sugar when the myths maybe you've heard about sugar are going to be settled here today. So without further ado, I'm going to bring in our guest today. She is our registered Dietitian joining us on the show again is Debbie James how're you doing debbie I am grand. Thank you very much. All right. Good. Thanks for joining us on the phone here. So I guess right off the bat will jump into it. The big one that people ask is sugar bad for you. Is it bad? Loaded question. I like to give you the loaded one's. GonNa break it down. I'm going to say sugar naturally present in foods is usually fine but the over consumption of added sugar that linked to cardiovascular disease and obesity and cholesterol of not to mention inflammation oxidative stress. So those types of conditions are what added sugar is related to as far as the research goes Particularly, you know pretty vascular disease and it's really oftentimes the higher percentage of calories from added sugar. It's not just that you had them at how much that you had or that the sweet and beverages like seven servings or more per week. That are linked with the mortality from cardiovascular disease. So it matters when we're talking about what kind of sugar and how much right. So you could say excess sugar is bad for you. Can you say that we're yeah, you can say that but natural sugar. So I don't think that there are too many people that have just had an overabundance of raw fruit. that. Were hard pressed because you're getting the antioxidants and you're getting fiber and you're you get all those other things that are beneficial right? Right. The kind of bounce it out and it's probably hard to eat so much food that you would like just way go in excess of your sugar needs. It is so low in calories. Oh my gosh. I went to get like a smoothie. One of the you know maybe places in it a sixteen ounce smoothie had three hundred, sixty calories mike well, definitely not going to be sitting down eating eight apple. You know if I were to just turn to some raw fruit and sit down and chew, it's Never I. It's just not gonna add up that. Much right. Right. So are there are there are there different types of sugars though I there's like the wall stuff you get out of fruits and vegetables but is there you know like what's the additive the different ones? Are there different types early, those are those are like big picture group, their sugars I'm going to narrow it down and get a little. So chemically speaking sugar is either just one like ring of carbohydrate called a Amano ride or sugar also refers to some are two of linked together called a Diet Thac. Hope I hope our listeners at home or taking notes. Okay. We're be a quiz at the end for sure. It only makes little difference because let's say that that glucose blood sugar okay. Brick brick toast is fruit. Sugar. But sucrose table sugar the white crystalline stuff on your table it made of Glucose and fructose. The competent. Okay. That's one of the double sugars right So the reason that makes a difference. Is that the single sugars? They get a short they just they don't need to be broken down or anything. Whereas if you eat a longer sugar, we still call him simple sugar in the Diet but if you need a longer sugar or if you eat a complex carbohydrate like dark from rice or pasta corn potatoes. Your system needs to take time to break that down into its individual tiniest a small little piece to get gored and guess what? That's a sugar interesting. Okay. So because you got because it all right interesting. It's almost like how you just broke down sugar. It took a little longer. But it wasn't as simple to digest as but it was but it did make sense in the end. Okay. That's interesting. So like the if it's the combination, it almost like your body has to pull that apart and then digested. So it's like all right we gotta we gotta take this bar before we can use it. If. It's already we're calling it a sugar whether it's from honey or maple syrup or whatever it like a fraction leg. It is so so so fat birth is you had a bowl of cereal and you're gonNA break down that brand flake that takes a lot longer.
"cardiovascular disease" Discussed on The Peter Attia Drive
"I. Mean. Sometimes I get excited about the state of natural knowledge and how it continues to evolve and I. Can't wait to see five years from now what we know on this question because I was a bit surprised by the combined EPA trial I really expected that to be a favorable response especially in light of what we saw in the four Graham. EPA VIS EPA trial. So again, we just have to see where this thing goes but but I agree with. Trial you're talking about. That's right. There was halted early. Yeah. So it might be that four grams of EPA in concentrated form is the way to go in a super high risk person for cardiovascular disease. But a combination of EPA DHA through food. Oily fish as you said, might be what's conferring the real benefit. That's how we got it in nature. I think the broader question always comes to is there harm of higher doses of EPA in Dha and I I feel very confident now that answer that question is no provided, you're getting your product through a clean source, the answer's No, and so we have zero affiliation with any companies that produce any of these products. and. We had a third party, do a validation of Carlson's, which is the one that we have preferred for our patients. And we found it to be pure without contaminant and it contained what it said it contained. So I'm always happy to pay that little bit of a premium for that product to at least get over the counter version. That's that's good. So I don't have to fork over for a prescription version. I'm the chief medical officer for a company called Cardio Tabs We. Don't get paid anything from them but that's kind of my goal with them to be also sourced from. Norway, they know more about purifying, concentrating, detoxifying Omega three than anybody in the world stars unconcerned usually over to Scandinavia there and visit with lesion that just to say what they're lacing greatest stuff is but yeah, this is a food and I think it's super important not only for against the health but Peter the latest data. On mental health is is really important. Again, this is a fundamental component of so membranes that most Americans upwards of ninety percent of Americans aren't getting enough will make it three in their diet and it poorly, it's depression adhd suicide cognition dementia, all those things, I? mean. This is like super easy way to markedly improve mental health my wife Charles Constantly Harping on that you know there's all this violence and suicide and depression and The basic thing do is take nice high dose of Omega three, every day it's harmless it's cheap and it has profound benefits lots of times you can keep people. Off of antidepressant medications. Like welds ORBS curcumin with. Mega three is as good as or better than any other depressant out there in, and they also help to improve brain function and again docket wall prescribed. These are very, very effective ways to improve mood cognition. In probably reduced dimension, we have paper coming out central copy of the journal Alzheimer's Disease Show in the highly durable curcumin In. Trial the study was a chin- elephant in addition for preventing dementia. Anti, NFL phone as you know, is this master hormone inflammation in some really fascinating which we outlined in this systematic review that the biologics that reduced. Alpha like Catan out is the best it's decoy receptor for the NFL. and. So it reduces inflammation and there's multiple big studies of millions of people in databases. observational data buffeted reduces risk of Alzheimer's Disease Sixteen seventy percent. Now, those are expensive biologics sometimes caused serious side effects of. Curcumin is active turmeric use a highly absorbed one. You get some pretty impressive reductions in NFL, Alpha that have been correlated in small round amounts trials with reduction, and there's good animal models on It's the most exciting things to me right now I, really think this is easily the most exciting effort for maintaining ignition ending Alzheimer's disease and it's still needs to be flushed out. But there are some very good biological plausibility behind it and some fascinated animal data, human data, and even some small small randomized trials. Working with Richard Isaacs who I've interviewed for this podcast and I'll be interviewing again shortly. We've sort of put together. Our our in house can play playlist for basically once we identify patients that we deem high risk for Alzheimer's disease, which we define his age over sixty, a relative that has a history of Alzheimer's disease or at least one copy of April. We've four gene or some other gene such as an anti NF gene or Tom Forty or one of these other genes that that tends to be associated with Alzheimer's disease plus or minus eight before. We just have sort of a full court press approach and one of the things on that list is indeed Thera- cumin for exactly the reasons you stated I became pretty impressed with those date about two years ago and So I was excited when you sent over that manuscript last week. You notice that Richard is extend was a CO author on that paper Asthma's Gary Small from Ucla in my opinion, those guys to top brain scientists in the country for things like preserving preserving competition. So yeah, I mean I think that the people who are best informed on that would agree with you on that approach you I guess closing thought James, is. I'm impressed by the breadth of your sort of curiosity and obsession you know about. Interventional Cardiology is a niche sport, right? It's a you know you're a cath jockey at that point and Sort of left that behind in the world has become your oyster. So to speak and you're now interested in the role that thera cumin can play in inhibiting tumor necrosis factor in the development of dementia. I mean you kind of look back and reflect on the journey of your career pas there before asking another question. I just followed my heart and what I was most interested in and. Highlights joke I mean I I've been doing the same thing right now I wasn't getting paid him their love what I do. And I think of life as you know like this gift of we have our time here on earth and it's about like helping others and making a positive difference on just so grateful that we live. Now where we have all these tools like you say, it's just so exciting all this emerging data for people who are trying to pay attention. kind of like that line from. Dickens. It was the best of times. It was the worst of times. This law of people out there that off suffered from all sorts of terrible things alive is lifestyle related and it's not their fault I mean, it's like this whole world is set up to minimize. And Maximize Calorie consumption. But there's also people who are paying close attention and in have all his power tools in use information, help each other and to live not longer but more sort of act of fulfilling and enjoyable lots to me. It's just a blast. My last question then James would be if there's somebody listening to this who wants to go into medicine. And feels or is in medicine for that matter and and kind of feels the same conviction you do, which is the real answer is in preventing disease, and whether that's their passion is in cancer or cardiovascular disease or neurodegenerative disease diabetes whatever the case might be. You know you said at the outset nobody's reimbursing really for prevention. You've got to kind of create your own path. What would your advice be to somebody who wants to become a preventative oncologist a preventative cardiologists a preventative neurologist how would you advise them to craft their way? That's difficult question but I can just tell you that it doesn't have to be all or nothing. You know even like the Cath- junkies like this you know some McKnight organs are Catholic you're very located Butler and and you know not yourself you have to do it all the time, but you need to be able to be well versed enough to strongly endorsed and. In a big group of sixty five cardiologists with the won't another fifty nurse practitioners or physician's assistants. So I can kind of carve out that live.
"cardiovascular disease" Discussed on The Peter Attia Drive
"Works Reduces. The risk. Papal people on gop one agonists tend to complain of some when I started in Munya. Does Tiger did every week some constipation? Nausea but those go away with time and it is FDA approved for weight losses in at least one of them is right is. Laura tide is success. But it's a once a day draw this. You know the settled blue tie will be approved in the next year. As once a week dropped, we use it for diabetes and higher dose two point four milligrams rather than one more room for the top dose in you know it's shown was just best ever way to and. Turn it Tive to bear to after surgery for these young really overweight patients. While I didn't realize that. So you're telling me that you can now take a gop one agonised once a week with a sub Q. Injection and achieve comparable levels to normal daily injected routine because that's historically been one of the barriers batter better pony events reduction. It reduces heart attacks throughout vascular death better than the daily one, the rule Raglan. These are also revolutionary drugs but the cool thing they're very safe other you know. Whereas SGLT, two neighbors. Do you kind of reduce heart failure and we know failure and overall cardiovascular mortality and mortality in sicker people. This reduces more atherosclerotic cardiovascular disease. It's it's strong effect M. I stroke and you know those ruptured plaques talked at the beginning they cause weight reduction from different mechanisms of action they improved mechanisms faction and they've really work. Well, together is a phenomenal combination. Well we can't have a discussion about medications and cardiovascular disease without talking about statins which you've written about a lot certainly would have to be in the top three most prescribed classes of medications out there. You know I'm kind of a five status guy. There's a lot out there but there's probably only five that I'm that I'll use in patients and I every physician I think who prescribes these has their own little secret alchemy around it. You know when they're using LILLO versus private staten versus kress store harasses lipitor et CETERA. But let's talk broadly about them as a class. So obviously, a type of drug that inhibits the synthesis of cholesterol, which is its direct action, but the money may come more from its indirect action which increases the ldl receptor on the on the liver, and you're pulling that APE OB bearing particle out of circulation, and you're having this pretty pronounced effect in terms of LDL. See an APE appleby reduction second really now only to PCs canine inhibitors. But rather than talk about that although I'm happy to hear your thoughts on that I wanNA talk a little bit more about the potential other benefits of statins. This is where. Most people do believe there are ple- traffic benefits of statins but they're harder to quantify and I'm sort of curious as to what you're thinking is. When you WANNA bring a staten in Is it. Also something you use in patients whose might not be that high, but for whom you're looking for this other benefit. Latest traffic effect if you will on staten studied just this week came out that people who are on Stanton's seemed to have some better sort of resistance to severe cova infection. And it may be you know the people that get a lot of inflammation are the ones who were likely to have a bad outcome action in any event, they do have anti inflammatory effects. And we use them a lot in always arguing with allegations about statins Anta you know they'll say, have you read about these things on the Internet? These are like A point out to them in the history against signs in the history of medicine Fatima's trials, there's never been a class of medication have been so thoroughly tested in gold. randomized placebo controlled trials lasting at use, there's like five, hundred, thousand, half a million people in various randomized trials. Showing that if you have heart disease or especially if you've had they will help improve your promptness reduce Astro corvettes for death probably all cause mortality high-risk people pause for one second James I agree with you completely, there is no drug no class of drug I spend more time defending than statins. Why is that? Why is it that the Internet is absolutely crazy with this obsession that the staten is a drug planted here by foreign operatives designed specifically to kill us. Yeah. It's crazy. It's a combination of things number one. An honest kind of skeptical about this. But the nicer taking a stand back about you know rows. Ahead that the Johnson score and when you when I was working at hard like read like muscles refer harder you know I mean like they they would. They would make worse after a hard workout and and then just taking. Tenants switched over to more of a less potent while insurance they got better. So frequently are socio with these new side like like muscle aches and some people swear the puzzle, some rain fog, some sort of mild cognitive impairment. But alive it to is. The no CBO affects the Voodoo effect. You know they've read about this also people you know trying to capitalize on. Selling people, alternatives to stats that being said. I argue with people about statins who really need the fifty five old just how Egmont who tells me? I'll do anything takes out unfortunately now we do have. Other options that Ahmad Lowers cholesterol by reducing absorption by blocking the Niemann. Pick. Center and PCS Canine, which just prolong the life of the receptors of really elegant ways to lower cholesterol by removing from circulation without poising the sales ability to make. So that's really really important and I know you're talking about today spring about that and I completely agree. So we have an option for those people who are stabbing tort because out my of a pcs can ever work synergistically statins and PCs would statins But for people who have zero calcium, school For a relatively low risk, we do the May service calculator, AFC tenure in their under seven. Let's one or two or three. Like it's hard to improve somebody who's got such a low risk an saying you know, let's not get overly shook up a budget ldl, and let's just you don't need to stand and can stop yourself. We don't to start wherever and we'll folks dot next tried lifestyle. But in middle.
How to Improve Cultural Competence in Dermatology and Skincare with Dr. Susan Taylor
"Okay. So we're here with Dr Taylor, don't worry we gave a nice bio on you before you came on the line do truly one of the most amazing dermatologist in the United States like I'm so excited you're here we want to hear about your career little bit before we start talking about the issues of the day that we brought you on to talk about. So first off what made you want to become dermatologist well, you know. When I went to medical school, I. wanted to be an interest and I wanted to treat people from the inner city with hypertension and diabetes and cardiovascular disease. But then during my fourth year medical school did my very first dermatology rotation and I loved everything about the specialty The fact that he could range from Piatra patients to you know those in their eighties and nineties the fact that there was a little bit of surgery. Pediatrics was cosmetic. Dermatology in general dermatology. The fact that you could actually see in feel in touch the pathology as opposed to like pretending, you can hear it you know through the stethoscope so that really changed my whole focus. Now when I graduated I decided nonetheless to do a internal medicine residency. But halfway through I said, you know you've got to remain true to yourself and what are you gonna be happy you know thirty years from now practicing so I went back and did another residency in dermatology in here we are. Also, that added a little bit of time onto your career. It did. Yes it was so worth it. Yeah, and so you I know you're the founder of many amazing things that I've gotten many resources from one of the things that you're known for is. Working at the skin of Color Center can you and you co-founded that ready did yes. So I'm back with that is when that started back in nineteen ninety eight I did my dermatology residency at Columbia. Presbyterian. Medical Center in about ten years after I had finished I got a call from one of my professors who said you know here in New York, there's the need for a center that specializes in skin disorders for people with darker skin tones, and he said, this was my my mentor. Dr Deleo. He says, you know they say to me you're a nice guy but I want someone who looks like made and so he called me one day and said, would you be interested in coming to New York in creating some type of center and for me it was an incredible challenge an incredible need. This type of center didn't exist anywhere in the world and my mandate was to name it started to figure out what the mission was and that was a wonderful wonderful challenge. So what I decided was. This would be a center for. Instance in clinical dermatology, we would also perform clinical trials, research trials, and at that point, many dermatologists were very afraid of doing any types of cosmetic procedures on people with darker skin tones. So we wanted to really gorge path that. So that's Why we created the skin of Color Center, I am delighted to report it still in existence. Now, it's now affiliated with Mount Sinai and there's a new wonderful director WHO's there? Can, I just ask Dr Leo was he a White Guy? Dr Dalil I didn't know you. Know can Dr till now goes bad. You know I'm a tall white guy and they don't want to see a tall white guy. They want someone who looks like you and you know he's just been a wonderful inspiration over all of these years I'm very fortunate to have had him as a mentor Academic Sense. So when you let your medical residency, did you feel like you were prepared to treat all the patients that you were about to say is at the level of care that they are. Yeah. So I had the distinct honor and privilege of a doing my dermatology residency New York City in Manhattan like one of the most diverse places on earth. So from the time I was the first year. Dermatology residents I saw people with all skin tones. And all ethnicities and racial groups. So when I completed three years of residency, I did indeed the very prepared in diagnosing and treating disorders in people with darker skin tones. Then I opened up a private practice in Philadelphia, which is my hometown and I found that over time many women and men of color sought me out because you know it's not just the skin tone, but it's also the customs habits. Women did not have to explain to me what they do with their hair because I have the same hair and so there is a cultural competence and we wanted to create a center were all the doctors no matter what their race or ethnicity was culturally competent.
Dr. Richard A. Van Etten: Cancer
"Please welcome to the show Dr Rick van how you doing. Thank you very much Andrew and Brittany I greatly appreciate the opportunity to be able to come and talk to your talk your listeners today. Yeah. Well, thank you for taking the time out of your busy schedule to talk to us. So we're GONNA be talking about obviously cancer and how you can prevent cancer do your best to prevent it. But as I mentioned in the Intro, most likely someone knows someone who's had cancer or they've had cancer themselves even it's pretty it seems like it's touches a lot of people but can you kind of tell me how many people does cancer impact on a yearly basis? Well. Thank you for the question Andrew. The lifetime risk of getting cancer is approaching thirty eight or thirty, nine percent. So more than one in three Americans will get cancer during their lifetime. So that explains what you said that basically almost everybody is either been personally. Involved with cancer knows a close family member or a loved one that's been stricken by cancer. So some of the statistics nationwide in the United States, there's about one point seven million people diagnosed each year with cancer. And they'll be about unfortunately six hundred thousand Americans will die every year of cancer. Here in Orange County it's interesting that cancer has overtaken cart diseases, the number one killer, and as soon gonNA happen nationwide. So a very very. Prevalent disease what kind of has led to what's led to that trajectory? Why is that happening? Well, actually the the the death rate from cancer has been falling and it's been falling significantly over the past fifteen or twenty years, which is a success basically for the research that's gone into it through the National Cancer Institute and other mechanisms. But the fact that cancer is now the number one killer has actually also reflected progress in cardiovascular disease. So doing which used to be the number one killer. So we're doing a better job at preventing. Heart disease through the things that you know about treatment of the risk factors like high lipids, blood pressure, diabetes et CETERA. Right? Interesting. Okay. All right. So we got some work to do on the cancer and Kinda catch up. And, that generally, like I mentioned usually happens through education funding, which we'll talk about in a little bit What types of cancers are the most prevalent today? I know that you specialize are a believe in like blood cancers by what are the most prevalent that people run into so we can talk both about incidents, which is the new diagnosis that we have each year and prevalence, which is the number of people living with the disease at any given time. But the top four in both categories are pretty similar. So there's breast cancer which obviously predominantly affects women but also can affect men. Then there's lung cancer there's prostate cancer which obviously is a male cancer and the last one is colorectal cancer. Those are the big four. Close on their heels are diseases like skin cancer and melanoma that's particularly relevant for Orange County where we have two hundred and eight, hundred, ninety days per year rate. And after that come some blood cancers that I specialize in, which is mainly things like leukemia lymphoma and Myeloma Okay. What kind of leads to these types of cancers occurring out of those top four that you mentioned, what? What's the biggest contributor to people getting? Is it? Is it just genetics you got bad genes or something in your lifestyle or in your the world around you I guess causing it. So they're. Probably, equal contributions both from genetics and from lifestyle. Okay. When I say genetics I mean the cancer is principally in the opinion of a lot of primarily a genetic disease in the cancer cells have acquired mutations that contribute to their malignant or cancerous phenotype, their ability to grow and attack the body. Most of those mutations are acquired in other words they happened just within the cancer cell and they're not inherited. So you don't get them from your mother or your father. Now there are exceptions there are well defined cancer susceptibility syndromes the most the one that may be most familiar to your listeners is the bracket jeans Brca which segregating families particularly people, of Ashkenazi, Jewish descent that are inherited either from your mother or your father, and greatly increase your risk for developing breast cancer or ovarian cancer so that the risk for women who doesn't ever bracken gene mutation is about one about eleven percent or one in nine during your lifetime. If you inherit one of these genes, it's virtually almost everybody will get breast cancer ninety percent risk over your lifetime. So, this cancer susceptibility syndromes are very important the need. For instance when there's a new cancer diagnosis, you need to take a careful family history and in some cases be referred to a genetic counselor to determine whether testing family members is indicated. Yeah. Well, that's interesting that you bring that up because my wife actually we went through that process, and so she was found her mother had breast cancer and through that process they found out, she had the bracket gene Brac to and then and so my wife decided because they kind of give you choice like do you want to get screened? Do you not like you kind of have? Do you want to know more or or like not and stay naive to it I guess and so what I've discovered, we went through it and is interesting out of the split my wife got it and her sister didn't so the fifty, fifty there and. It. Seems like. It's I think my opinion is it's good to know because now they're just more aggressively screening her and is that typically the case when you find out about something like that, you're more your screened even more regularly than the average person should be. That's right. A change basically changes the surveillance. In it not to make it more complicated. But there are some genes like the broncos where the penetrates which means that the chance of actually getting breast cancer. If you have the have, the mutation is very high I think there it's pretty straightforward to decide whether to get screened. Right. There are other mutations that can be inherited that don't increase the risk that much increase it above the background, but it's not nearly as high and there it's more complicated to try to decide what to do about that. But. My advice to your listeners is to seek the advice of a NCI cancer center in a a qualified genetic counselor. Those are the people best qualified to help guide you through that decision making process right? Right. When you're going through like you said they ramp up the screening process if you had the genetic mutation but how does how did we get to discovering these genetic mutations I? It sounds like you kind of have somewhat of a background like you discovered or help discover this protein that was causing leukemia right and. How does that process even work? How do we make these discoveries? How do you make these? Discovery I was involved in is one of these acquired mutations not inherited, but it came about from studies done many many years ago actually nineteen sixty that showed that patients with this particular type of leukemia had an abnormal chromosome in their blood cells. And when to make a very long story short when that was tracked down, it was shown that the chromosome was actually an a Barrett. That was acquired in these cancer cells that lead to the expression of this abnormal protein. And that protein. Hasn't is an enzyme which means that it has a ability to catalyze chemical reactions. Okay and that particular reaction stimulated the growth of those blood cancer cells. So. That led a drug company, which is today is no artis to develop us a drug a small molecule inhibited the action of that protein. And that That drug which has the trade name GLIVEC revolutionized the treatment of that leukemia so that in the past everybody died of this leukemia, unless you had a bone marrow or stem cell transplant. Today everybody takes a drug likely. And most people go into remission and when they do, they have normal age adjusted life expectancy. That's example would that's Therapy likely that can do to cancer right? So does this all come from these discoveries? Does it come from just? Tons of data over decades like this one you're saying, it came from research started in the sixties and this didn't have until the early nineties. Is that right or wealth the the The structure of the protein was discovered. I'm saying Circa Nineteen, eighty-four which I got involved. The drug development efforts took place shortly thereafter I'm and the was FDA approved in two thousand one. So it's been on the market now for almost nineteen years I and there are many many other efforts in other cancers that are parallel parallel that. The thing that's happened today is because of our new technology and the genomics and the ability to determine, for instance, the genome sequence very quickly that's accelerated the progress that we can make. So what took forty years from sixty two to the drug being approved now can be done in a couple of years. Wow. Everything's happening much much faster. That's awesome. That's great news for those of US living right now.
"cardiovascular disease" Discussed on The Peter Attia Drive
"The particle count via anymore Peter Dating mentioned quest has a particle number technique called ion mobility transfer that people they're not comparable all biomarkers you should consistently try and use of course, the same lab not always possible but the same ass say able be immunoassays pretty standard throughout the industry. It's not like everybody's got their own April Bsa Deanna Mark Vary widely the other big reason to do that consistency of results over time. Is SORTA. Later yourself you're going to read the guideline or maybe your patients are going to go all the guidelines talk about April. Be there is no guideline telling you to do a anamour l the L. P. or an im ability of the LP. So it's another reason to just stick with the April Bay and I think there are less false positives with the be it's just been my personal experience I've been in guy life and as we got better and better we just so often saw totally unexplainable discordance between L., D. L. P. N. April Bay The DAD is overwhelming for April base. I think that's where you should be in today's world as your marker of Atherogenic Lipoprotein. Yeah I think we saw that especially with the second generation and Amar, it was almost like it had become too sensitive. We were seeing discordance that far exceeded what the Framingham or Mesa data predicted the discordance should have been. and. That's really actually what took us to the ion mobility, ass say. But again I'm I'm actually very from a diagnostic and management standpoint. I'm actually quite comfortable with where we are I think the final point I'd add to that Tom is just the economic one. You know frankly I think the cost of APO be is at least in Canada and the only reason know that is because Allen's Neiderman is at McGill and you know he's been pounding this for awhile. I mean we're talking about a three or four dollar test. So there is no excuse for any physician to say we're not going to order your fancy ape ob because. It costs too much. I'm going to order the LDL cholesterol I think that excuse has lost all of its water. It's show true in Allen. Just published a beautiful paper where he's researched the cost of April essays 'cause you know even some of the people in the guidelines always Oh, we can't able be it so expensive that's an old excuse that is no longer applicable to two, thousand and twenty. So of all the technologies to quantity eight ATHEROGENIC TYPO proteins April be is the most affordable and even in a look lab sometimes change crazy. But if you tell a lab, you want to pay a cash price it's really pretty cheap. Let's go back to Canada macro point here around APE OB, which is a greater coalescing around the idea that that AP concentration matters so. I think it's very well understood that two of the biggest risk factors for cardiovascular disease are smoking and hypertension I. Don't think there is any ambiguity that cigarette smoking and high blood pressure increase the risk of cardiovascular disease and they both appear to do. So through a mechanism that weakens the NFL Liam or creates an injury to the helium. The question now becomes as you put it Tom. How Ironclad is the story that it's the AB bearing particle in the presence of injured endothelium that is the Trojan horse that begins this destructive trajectory of taking that cholesterol into the sub endothelial space becoming retained undergoing this chemical oxidation process, which then kicks off an inflammatory response that paradoxically as an attempt. To repair the damage results in what can be a fatal injury there are other hypotheses. For example, there are people who note, and we have I mean look I have a patient in our practice Tom you've weighed in on her case walks around with a total cholesterol of three hundred and something in ldl cholesterol of two hundred and twenty milligrams per deciliter. NATO be a hundred and seventy milligrams per deciliter. She's in her late sixties and coronary artery calcium score is zero. We have elected to not treat her with any lipid lowering therapy. In other words, there are exceptions to this. How do we reconcile that? Well let's the human body in medicine. As you know, not all smokers are gonNA come down one cancer chronic obstructive lung disease. Why not? If that's such horrible risk factor. I try to explain this and I've certainly seen cases like you say where all my God if I was just going to say, give me your April be or whatever cholesterol metric you're going on three drugs right now you've got no choice and maybe the old days we approach people that way but no more I think you have to individualize your whatever risk factors you discover that might wind up causing atherogenic and then figure it out. So particle number is. Certainly, a major factor that might force it in, but not always ended Delia function although you can certainly, if you review the history this and how do you really determine endothelial function? Not Everybody has serious endothelial dysfunction who winds up with de-subscribe particle number itself in some people can just make the particles go and I think if we take Moshe Dole who's not going to have a little bit of to deal dysfunction. So I agree with you, it's a combination of. Something about atherogenic particles be their number and dysfunction but I'm talking more and more. Now, when I discuss any TYPO protein I don't care which subgroup you want to talk about I. Think we certainly have to know it's particle concentration, but I like to talk about Parka quality. So what are the other attribute of any leipold protein that might contribute to? Its ather jainism earns in some perhaps not understood Ming re make it relatively. It's not going to generate atherosclerosis in our certainly have to be things like that going on. So as we're getting smarter, we're looking at other components of the life. Oh proteins that could be other proteins that are on that could be their complex Lipa Dome and trying to see. Connect- help us discern whether in you a given particle concentration is more worrisome than it is in the next and the next person. So there's a lot going on and also from the justice conversation listeners will know atherosclerosis after genesis is a multi complex multisectoral disease and that's why even when Peter and if we consult on a case and we Realize. In this person, we have to beat up April and get their particle numbers to more physiologic range with don't stop. Once we do that we examined in great detail for other things that might be injuring the entity Liam or the arterial wall and see are any of those treatable or so. So we're getting a little bit smarter than lie proteins, but there certainly is more to it than just particle number. Do we think that there's a limit to where the benefit of reduction becomes diminishing or even J. Curves in the other direction. So we discussed it in the first episode significantly we did. So again with Ron Krauss it wouldn't be you know the worst idea in the world a couple of years from now to sit down and do it again, reexamine the data but but again, I think the causal relationship between Appleby Atherosclerosis is as strong as virtually anything we see in medicine. for which you can't do the perfect experiment where you have to rely on natural experiments..
"cardiovascular disease" Discussed on The Peter Attia Drive
"How long are they in your system because that's important because these are the particles have the potential to crash your artery wall and traffic star roles and whatever else into the artery walked. The. Calamar. Cons mentioned are half life is in minutes. Their plasma residents time a few hours the via the L. particles their half-life is. Four to six hours depending on how rapidly their catabolism is. The ideal particles are transient in between particle between a Vod Al Anon LDL DR around for an hour or two. They're not uttered an unusual genetic condition a player. In this April be game we're talking about, and finally we have the LDL family now the. have a plasma residence time of two to five days, and there are other attributes. City ldl let determines it gone I just hang around for two days or five days. Clarity to longer hangs around. You'RE GONNA have a lot more ldl particles than if you could rapidly clear them. So when we talk about whatever able being metric you're doing, technically you are measuring via LDL's their remnants they're smaller V ldl's. Plus LDL's. Little A, but because of the half-life Ninety to ninety, five percent of your April be particles are ldl particles. So that's why many people say, hey AP's just another way of getting ill ldl part account and that's true. Even people who might have a lot of remnants the remnants particle numbers quite small. It is still way more ldl particles floating around in these. People who might have these remnant VOC causes issue not to say a V. L. Remnant might not be a very injurious April be containing particle. It certainly isn't some people but if we're looking at the number, which is the primary driving force as to how in be park enters the artery wall ldl is king and that's why our metrics of able be or. LDL Particle Cal are water at the top of all the guidelines in. Of course, the metric most people use your ldl cholesterol and non HBO cholesterol. I. Mean Tom on a personal level the reason I have switched to be in our practice, which is obviously heavily influenced by the work that you've discussed the work that people like Alan Schneiderman have been doing for. Many years frankly comes down to a consistency factor. So we had historically relied on L. D. L. P. ldl particle number as a concentration count but frankly in the span of eight years went through three technologies to do that right two generations of 'em are coupled with electro for recess, and while in the end, we felt the electrophoresis provided the most accurate measurement. You always have a problem when you don't know what you're comparing it to. So if we have JEN ONE MR, which is probably still being used by labcorp quest today, that is probably quite inaccurate compared to jen to Anamar. But the percentiles meaning the populations of people that were measured are still what we use to understand where someone lies. It puts you in a bit of a dilemma as a clinician or as a patient, you want to continually upgrade your technology in other words. If you're talking about getting a new iphone, you don't really care that your phone is so much better than two generations ago phone because all your metrics are better and there's nothing to be gained by comparing yourself to how much better you are. But when you're talking about diagnostics, it does. Matter where your reference ranges and if you're moving it so do you agree with my logic for switching to be a year ago as now being a much more homogeneous way to assess patients even across labs? So especially now in light of Covid, we can always use the same lab to measure a be. So I might be sending a patient to one lab has another lab and I just feel like we're getting better results..
"cardiovascular disease" Discussed on The Peter Attia Drive
"Tom thanks so much for making time to sit down again and talk about lipids it's been almost two years since we sat down for what still remains the longest podcast I've ever done nearly eight hours which I believe was divided into a five part series that is still very popular podcast series and don't take this the wrong way. But I'm Kinda surprised at the popularity of that episode given that I thought it was really geared only towards people that were really really die hard lipid fanatics but it's had a broad enough appeal that I think we've agreed neutrally that it makes sense to sit down again. That was amazing. First of all, it's always great to sit down with you, Peter Chad about my little lipid world. But yeah, I'm shocked every time somebody tells me we've listened to the whole series and I've done it three times and I just can't imagine that but I'm glad it came across pretty good. You know one of the things I want to do today Tom and I can promise you all the listeners. We are not going to do this for another eight hours today. But what I WANNA do today is sort of I. Think kind of pick up the mantle from where we were a couple years ago and talk about what's different since then I think the last two years has seen a number of things that are actually pretty exciting in the in the field of lipid algae in the field of cardiovascular disease. Some of it's been what the really nuanced level scientifically, others have been frankly at the broader level in terms of recognition of certain things that you know you've been talking about and many others people a gallon Schneiderman have been talking about. A lot of this stuff is very clinically relevant. The way I posed this to you and I think this unless you're opposed to it the way I'd love to kind of go through this is. Maybe use our time today to talk about things that are different today than perhaps they were a few years ago and dive into those things in enough depth that everybody from the the lay person to the AFICIONADO will have something to chew on. Yeah, that's a perfect strategy for today now. No doubt will reiterate some concepts that we went over in great get back then, but we won't have that opportunity today, but and you know me Peter of always lived on the cutting edge of lipid science leading the charge try and understand new concepts that come down. But one of the great satisfactions of my career is much of what I've promulgated for the longest time has come to fruition and that's what's really happened in the last two years. There are certainly. Some new concepts and some abandon of some other issues but it's just the you know my whole mantra for a long time. You know we've known each other decade probably is that Atherogenic leipold proteins are really the issue behind clinical atherosclerotic vascular disease and although many of us have known for awhile the data has just become. So overwhelming that's really all of the guidelines have signed onto that premise. Now that Athar Genesis is certainly star all mediated disease but sterols are trafficked. Within appleby containing PIPO proteins, which provides the vehicle that transports them into the wall where they can in some start pathological process show the recognition of atherogenic light Bo protein such is now in the guidelines and you know Atherogenic hypo proteins are still diagnosed using various cholesterol metrics but there are things beyond ldl cholesterol in the gun and even April be is certainly within every of. The contemporary guidelines in the last two years, and that's of course ti Neiderman. Thing that he's been harping about for a long time. So it's Atherogenic lipoprotein proteins within that category though the things that are also emerging is what contributes to the ethridge necessity of appleby particle triglycerides has really taken center stage how they affect leipold protein concentration and quality or functionality whatever adjective you want. To ascribe to it's the loss of the ability of at least the HDL. Cholesterol metric to be terribly informative to us, and it's the emerging significance for lots of reasons of life. Oh, protein little A. so those are the big areas where changes really become important in is really useful at the bedside of course, pharmacology intensity of pharmacology has also advanced and we'll touch A. Little Bit on that today I'm sure to sort of summarize that we're gonNA talk about kind of double clicking on Ape ob slash ldl particle basically the Atherogenic Leiper proteins, front and center in the pathogenesis of Cardiovascular Disease. We're going to talk about the modification of our risk assessment and I like that you brought up hdl because I want to have a pretty interesting discussion about that. And obviously, we're going to talk about what's happened in therapies there have been actually quite a number of things including the continuation. More data around is am I and PCS canine inhibitors much more data since we last spoke around omega three fatty acids. I spoke with Bill Harris about that. But I think we can go a little bit further and there are a couple of other therapy. So let's start with maybe a little bit of a reminder for people as to what APE OB is people like you and I sometimes use ape ob an ldl p. interchangeably as shorthand that's not entirely correct and when we last we. Probably disproportionately spoke about the number of ldl particles and now we're gonNA focus on ape obese. So do you mind explaining what the differences both from a biology standpoint but also from a laboratory standpoint and those are critical points Peter because it's one thing to talk about appleby but almost what you're saying about it depends, how did you analyze it? What laboratory metric do you water that you think is telling you something about April be whatever that encompasses so to make a story very simple ensure. Lipids go nowhere in equis plasma because are hydrophobic. So for Lipid to be traffic throughout plasma has to attached to a protein now few molecules at any lipid can attach to albumen, but that's not the primary way lipids get anywhere. Serious collections of Lipids Hydrophobic Substances attached to fairly significant proteins which utilized them and these April proteins as they're called proteins that rap collections of lipids provides structure and stability to this macro molecule that we're gonNA call a life. Oh protein. So the main structural protein Eddin wraps lipids in our body is able leiper protein-based. It's a hundred Dalton molecular weight proteins. So it's pretty big and it has a great ability to attract a of lipids to bind to it, but once the lipids are bound to it. This is a water soluble Lipa transportation vehicle. There's basically one other class of Aleppo proteins and the HDL particles that you mentioned and they have no April on them their structural protein is April I protein, a one capital, a dash eater Arabic aroma number one. So right away we have a double classification of life. Oh proteins, the appleby containing they're often called Beta proteins or the the aibo a one are called the Alpha Lipoprotein. So now within that APE be family. It always gets a little more complex than lipid dodgy the tissues in your body that can make obey are the liver. Pata sites, and of course, the small intestine which is absorbing lot lipid. So has to put them in something if those lipids are going to get into your plasma. So the April beat, it's made delivers a big. Five. Hundred Dalton. Protein that I mentioned and it's called April be one hundred. Now, why do they add one hundred on it 'cause the intestine also produces ape obey but it produces a truncated version that has forty eight percent of the molecular weight of the hypnotic produce ape obey. So that's called April forty eight. So if the liver makes a NAPE OB particle full of lipids, it's got one molecule of able be one hundred on it. If the intestine makes a big leipold protein in it does called column microns that has one molecule April be forty eight. The intestine can putting your lymphatic and enter systemic circulation deliver Jesse creates it directly. So those are the two types, of April, but we're not going to talk a lot about column microns there in most people without a pathological genetic pathological issue, it's not your microns that are the the major problem here. There are post-prandial life protein. So the liver makes these April be one hundred particles and they can go out the liver can secrete. Dan. But some of the particles at deliver secrets can be catabolism into. Smaller and smaller versions even though they're still able be proteins. So we're GONNA talk about the April be one hundred family and I'm probably not going to use the term one hundred anymore we're talking about very low density life. Oh, proteins, intermediate density, lightbulb proteins, and low density, leipold proteins, and of course, part of the LDL family is why protein little a if you happen to produce that not everybody does to significant amounts. The names of those particles you know they were originally discovered via ultrasound affiliation. So the ones that floated on top of the tube with a very low density, the ones sanctity bottom where the high density the in between where the ideals in LDL's. Now, so the able be family is via Leo's plus ideals plus ldl's plus LP little a if you have. Well, that's true. But here's the reality we have to look at plasma residents times. How long do these things float around? How long are they in your system because that's important because these are the particles have the potential to crash your artery wall and traffic star roles and whatever else into the artery walked..
"cardiovascular disease" Discussed on The Peter Attia Drive
"Now, without further delay, here's Today's episode. I guess this week is Dr Tom as spring. This name is probably familiar to some of you because back in October of two thousand eighteen, we released a five part series with Tom in that. Set of episodes despite being quite technical or some of the most popular episodes we've released especially amongst people who really liked to get serious about their understanding of cardiovascular disease. So we wanted to have tom back basically to pick it up where we left off, and in this episode, we try to focus on things that have changed in the last couple of years in that kind of loosely fell into three categories that we probe the first is. Digging really deeper into the recognition of the importance of atherogenic protein. So Kind of revisiting the idea of what APE OB is why it makes and both Tom and I discuss a little bit about how our views have changed with respect to the use of as a laboratory surrogate over ldl, p., and we get into all of the nuance around that with respectively ldl's triglycerides L. P. Little A. We also get into why HDL cholesterol is a far less relevant metric at least why we believe that to be the case. Within pivot a little bit and talk about Risk Assessment. Basically, how do you understand these metrics? How do you use these metrics? This is a lot of the clinician type stuff here around APOB and travelers rich lie proteins again, revisit the idea of LP Little A., and then finally we bring home with some discussion around therapies, and in particular, we talk about the continued evolution of the PCS K nine's the evolving data around. Omega three fatty acids in particular some of the controversy between EPA VERSUS EPA and Dha, and obviously we talk about the most recent addition to the Lipid drug story, which is a drug called Bendik which has not been around very long and probably many people are not going to be familiar with that. But Tom does a great job explaining that Tom's a diplomat of both the American board of Internal Medicine and the American board. Of Clinical Lipid Allergy. He practiced internal medicine in New Jersey for thirty seven years. The last seventeen of which was devoted to consulting patients with Lipid and Cardio Metabolic Disorders Between Twenty twelve and twenty nineteen. He served as a chief secretary officer to major cardiovascular biomarker laboratories. Since that time he has been working with us in our practice primarily on the research side of things but also as a consultant advising on most of our. Cardiovascular cases. He's a fellow of the American College of Physicians and the National Lipid Association the NFL A. and he's an associate editor. At the Journal of Clinical Pathology he was also the recipient of the National Lipid Association Two Thousand Eleven Presidents Said Sword he's authored an illuminated more manuscript in book traffickers related to Lipids Than I can count, and so without further delay please enjoy my conversation with my mentor and friend. Tom Days. Hey.
"cardiovascular disease" Discussed on KSFO-AM
"Of cardiovascular disease nerve and kidney damage and problems with the eyes and feet one is a disease in which the you're already immune system destroys the insulin secreting cells in your pancreas are called beta cells type two is a disease in which a variety of factors combination and barman jeans conspire so that you're no longer able to secrete enough insulin in the operative word is enough but you may be heavy maybe centers your body needs more but for some reason your papers can compensate the problem according to endocrinologist Dr Robert Rizza is that you can have diabetes and not know it that's why he encourages folks to be tested this is using a blood test and if you have a elevated watcher denture things you can do to stop it but you Gardendale for more information talk with your healthcare provider or visit Mayo Clinic dot org no broadcasting from the underground command post from the files of the heaven somewhere under the brick and steel over nondescript building we once again made contact without a leader hello everybody mark living here are number eight seven seven three eight one three eight one one eight seven seven three eight one three eight one one as.
"cardiovascular disease" Discussed on 77WABC Radio
"Of cardiovascular disease nerve and kidney damage and problems with the eyes and feet one is a disease in which the Europort immune system destroys the insulin secreting cells in your pancreas are called beta cells type two is a disease in which a variety of factors combination and barman in jeans conspire so that you're no longer able to secrete enough insulin in the operative word is enough but you may be heavy maybe centers your body needs more but for some reason your papers can compensate the problem according to endocrinologist Dr Robert Rizza is that you can have diabetes and not know it that's why he encourages folks to be tested this is using a blood test and if you have a elevated watcher denture things you can do to stop it but you gotta know for more information talk with your healthcare provider or visit Mayo Clinic dot org great news we found a pot at the end of the rainbow but it wasn't full of gold it was full of four thousand dollars in cash and we want to give it to you I think you have the luck of the Irish teacher to win the luck of the Irish giveaway today and you could win our pot full of cash this will be a Saint paddy's day holiday you'll never forget to add or stop by our site today and try your luck at winning the luck of the Irish giveaway fans try to take part in the envelope was your mother had to yell back at this lady what happened in Raleigh mark Titus and Tate Frazier are two basketball die hards talking NBA NC double a and all things sports you don't know anyone yes they don't know anything what is wrong with these guys into that we would say listen and subscribe to Titus and Tate free wherever you get your podcasts for the Westwood One podcast network where the conversation starts great news we found a pot at the end of the rainbow but it wasn't full of gold it was full of four thousand dollars in cash and we want to give it to you I think you have the luck of the Irish teacher to win the luck of the.
"cardiovascular disease" Discussed on The Peter Attia Drive
"Not protected their part to your brain. is for the US this information and the materials linked to the podcast is at the user's own risk the content of this podcast is not intended to be a substitute for professional medical advice diagnosis or tree users should not disregard delay in obtaining medical advice.
"cardiovascular disease" Discussed on The Peter Attia Drive
"Except some like the famous or shrunk ridiculously the kidney shrinks which you wouldn't expect the heart shrinks the rain nothing now clearly probably if you can't do that extreme fast and so the body protects the brain neutral point of view yet Amtrak one activity is high clearly we know that we have to modulate toffee so something must be inhibiting Amtrak wants whether this is my peripheral argument for why and I'm in the huge minority sure I do not think the brain is really the appellative center I think it's the modulator but I for that exact reason think it wouldn't make sense for evolution to put our appetite senator in our brain and should be in the periphery it should be in the liver. I think Liverpool argue the things that are on the periphery right because they're like the hypothalamus the the point I think it has to be your appetite center needs to be regulated to something that senses very rapidly outside waiting for sure yeah for sure in an exactly where it is and you know the bottom line is probably I never thought of it through the Lens that you just explained which was the implication of for tours enormous so tore look print in the brain or obviously protein won't but do the cofactors around it let's really You know we keep talking we have never done trumbull biochemistry out of the brain it's something that'd be really interesting to go and do now I think now it's something we talked quite a bit lab to do we haven't quite done at all but then what actually regulates I it's very within neuronal activity does but are there are there like as you're suggesting maybe neuronal specific factors regularly I think that's a completely open air I've tried to get some of my students interested nine brothers and neuroscientist he's argued we should really do some work there we just haven't maybe when we run out of sensors in the periphery we'll go to the to the brain there and that's that's why purified emperors there's a ton of 'em during the brain did that not because I was like whatever measure how much there was and it was clear that brain had about how if you enjoyed today's qualley now sit tight for that legal disclaimer this podcast is general informational purposes only and does not constitute the actors have medicine nursing or other professional healthcare services including the giving of medical advice and note no doctor patient relationship.
"cardiovascular disease" Discussed on The Peter Attia Drive
"Cardiovascular disease, sleep loss and metabolic syndrome Guinness starts to feel very very uncomfortable. And then when suicide came on the table it pulled it. So in other words, think about this. You know, there was gentlemen, Felix pound gardener. I think his name was who sponsored by red bull went up in a capsule in Hotta balloon to the outer surface of all planets. This was about four years as remarkable he opened the door, and then he jumped out and he fell back down to earth at over thousand kilometers. Our using his body alone. He broke this out Baria, and he successfully came out and now Guinness says for that just fine. However. To sleep deprive yourself know, much more on safe when not going to let it happen. You are allowed to put it in context, you're near a lot up to twelve jumps off Niagara Falls, basically. But that's okay. No, no, you're not gonna that's such a great point. I want to go back to one other thing too close loop on this. And again, I the listener may say boy, this is there's a lot of stuff going on here. But but there really is like this is I think you have to have. And I'm trying to think about all the questions I can ask that others would have if you took two individuals who were sleeping six hours a night. If you have one person who just for argument's sake is doing it from nine pm to three AM and another person's doing it for midnight to six AM, would you expect or even if it were let's make it even more clear, it's the same individual. But you do it over a period of weeks. You transition them from nine to three versus midnight to six would.
"cardiovascular disease" Discussed on The Bio Report
"Levels. Most of the time had an elevated level and thanks to our new approach to treat hypertension, and as a city cardiovascular disease. I mean, that's type attention hurts fater, but there is also potential for although indication we seamlessly decrees the person released we decrease the sympathy sympathetic nerve activity and wing pries, the Bowery flex. So at the end of the day, we have three actions if I miss it that wing priest diaries, which is unitary enemy nation. We lower vascular Ariston's, and we control it hurts. Right. So that's why this innovative drying target new Suntron from a digital pathway. Leading to both, hyper anti-impotency, fakes and call you protection. And is there a way you can actually test a patient to determine whether this would be the best approach for them. Can you tell if they have an elevated level of this enzyme to to begin with? There is not the compensatory misty for that. But we don't need that. Because you know, the resistant hypertension patient is a patient treated by sweet products as I mentioned before one of them being Darah, dick. And then this is very simply in a way that if the patient is not a target and the target is hundred forty for the study blood pressure, and and many megrim. Macrey? I'm sorry ninety. I read it year, and I'm forty and ninety then if the patient is not the tar head then absolutely mandatory to initiate treatment, you know, to treat the patient. I think of most treatments having a systemic of vent are rather systemic affect your training, the an enzyme in the brain here does this have to cross the blood brain barrier to to work. You are absolutely right. And this is what's Siri bus that that they have to work a lot or on three because when we defined let's say the palm and it started with a neuro biology person at Sunday insurrection, which is researching student France. And then we had a lot of chemistry development in order. To make sure that our product here that was patriot in the brain. I how exactly does the product work. Simply maybe shown of the fifty a in the brand, which will let's say blocks the conversion offense in to enjoy having two hundred three. So that's very eighteen. Even they will blocking in the cascade. Also, one of the enzyme what's different with our product is that we act in the brain. And this is the first unique product controlling hypertension, and many resistant, hypertension, right anyting design at the Brian Little you actually got multiple products in your pipeline. What's the pipeline? Look like an and where's your lead therapeutic product in development? So the league countdown is furious tax. I spent thirty years in the in different the pharma company, and it's you know, it's very common to Evelyn count on and backup program. So we also working on different backup products being more protests or cheaper to prove that sorta ten me we in hypertension difficult to treat patients and hurt tater while lead compound, which is very best that so we just finished, by the way, the new hope study. The study was run only in the US in soda yet centers. And I were PI was to kiss Fairview. No way the purpose of medicine at the University School of medicine in New Orleans, and and not to be consistent with what I told you before they say to be clinical try on unroll, overweight or obese patient with prime very happen. Tensions station known to have increased incidence of treatment resistant, hypertension, such as black Hispanic has and senior population. And we got extremely good reasons. And then have two common those results if you one, and that's the reason why now we will initiate the people face retrial in registering, hypertension, which will lead to restrain him. What about the? Protest from a clinical point of view in terms of safety or efficacy. When we got. Extremely good. If he gets that. And we had a very good safety profile interface in the in the new study again and this product is. Product. We were we had OB station we tension and to station. I mean, we know that obesity increased by five phone the risk to be resistant to the treatment. And in those patients, we had the six month. Let's say we were six months and schedule, and we were able to use the offices to blood pressure from baseline Vina's, racial nine point six meter of macrey, which was highly significant because the target was defined by the and I were steering committee or target was to decrease the office pressure by sentiment of. So we've nine point six we were we happy with the results, and what will actually mentioned. So here is that we that. She could see was also senior in the black and then black populations the contrary to of on T, hypertensive classes, and this is what you'll be the the the arts. They don't work in such relation. And we were also weta righted and we were able to demonstrate an accent on metabolic, and and the safety profile. So that's why they on the results we will initiate face repeal. Don't try in eastern, hypertension, and we very you're also developing a treatment for heart failure, this is using the same platform of the same drug. Yes. This is this is a sensory we based on the exit. If she gets that in animals and good fifty profane pilots today. We will initiate this is working progress face to betrayal, and that would be without if he can see and sixteen patients with reduced ejection fraction after acute myocardial infarction and head to head the versus the reference therapy and the restaurants there is and as a hummy premium what happens in heart failure. And why does this mechanism mechanism of action seemed to if at these patients? Where you know in her chair? It's it's difficult is many many products of try and the simply not succeed because the nicotine is my action. I would say is not as simple as it is in hypertension. Most of the time the patients are suffering from different disease, which was switch more competed to treat the patient. What we have demonstrated is our TV on the Reynolds synthetic nerve activity and also our TV on the exemption fraction wearing that's different TV. What we want to to months writing in heart failure. And how's the the company finance to date and how far will confronting take? You. Well. We have I would say enough money in the Bank to finance all our project this year in twenty nineteen. So the project is to finance the face to be proof consensus in heart failure, the people try to face three in resistant. Hypertension will also working on the ones that they formulation today. We have the ID twice a day, and for resistant, hypertension, it's very important to have once formulation. So we're also working on that. And and we have enough money in the dank to silence all those projects at the same. Time Wong, Chris contact with a lot of pharma companies who have demonstrated an interest in our product because I want tension is to to sign the punisher. And if all goes, well, what's the? The path to market has soon might you be able to file. And by the end of twenty twenty two JP moth CEO of quantum genomics, J P. Thanks so much for your time today. Thank. Any? Thanks
"cardiovascular disease" Discussed on The Bio Report
"Leading a startup team whether delivering a sugar rush stocking coffee or getting a regular delivery of snacks. Office Depot has solutions that fit every startup culture from getting those first business cards and stationery to ordering fleece pullovers with your new logo to learn. How Office Depot and the California technology council. Have partnered to bring you savings on all of these startup essentials and more go to California technology dot org forward slash member benefits. I'm Daniel Levin. And this is the bio report. One third of the dull suffer from high blood pressure and nine point four million people a year will die from complications relating to the condition. In fact, cardiovascular disease remains the leading cause of death worldwide. Quantum genomics is developing a new class of drugs that target an enzyme in the brain for the treatment of high blood pressure and the prevention of related cardiovascular disease. We spoke to P Milan CEO of quantum genomics about its platform technology, how it works and why it may have promise as an approach to treating both, hypertension and heart failure. JP? Thanks for joining us today. Good were gonna talk about quantum genomics. It's that by platform and its efforts to develop a new class of therapeutics to treat cardiovascular disease were in a world where a lot of the efforts that develop innovative therapies are are geared towards cancer. Nevertheless, cardiovascular disease remains the leading cause of death. How big a problem is hypertension and related cardiovascular disease today. Well, treatment resistant have tension affects misdemeanor often and fifty million people worldwide and visiting almost ten million. This from complications U2. to the pressure each year. Nonetheless, there is currently MU accepted pharmacological stand out for tweet Mond and with limited treatment options available for treatment regimen act attention. They should women at increased cardiovascular risk and susceptible to the compensation socio with chronic hypertension include an increased risk of Pataudi. The number of therapeutic strategies for treating hypertension that was either tension generally treated today. Why are you have today? A lot of different vegetable treatments. You are. Absolutely. Right. That this back that resistant, hypertension, twenty with sweep products, and they either at an arm custom Shannon, Bricker, bataille broker and loose of the deficient. They have sweet products one of them being one, directing and Steed. Unfortunately, there there is currently no available treatment to treat hypertensive patients. The one who are resistant, and as I mentioned before fifteen percent of them are suffering from registered. More common or so in in minorities such as that act, Hispanic she met and obese populations when you think about the problems with existing therapies today. What what's wrong? Well, I think the the problem is mainly that some products like the HEB there's and the art this simply don't work in black patients, for example. She's very well. None. So this is one example of why people are seeing dang from resistant, hypertension. Genomics is working on a platform called that pay of. That's an acronym. What does it stand for? States for brand petty does any bitter, and that's a total new mechanism of action and the new therapy class and Parnham, Geno. Mix is the only company developing product in this new therapeutic class. So this is definitively. Let's say new because ferry fat our product works by crossing the brand very air and mother being the rice and restaurants. For raining engines is time so motivating the rest locally to limit vasoconstriction and promote visitation thereby decreasing pressure. This is totally new because if you work at the brand level with feared that and in the brand sooner best that causes the of the in the name of this enzyme is. I mean. Oh pity. Hey. So we blocked his online. So the name of the platform is brand. I mean pitchy. Does innovator and innovating this? I'm fifty a fear best that decreased levels of hundred in three in the brand. Which is a key in that dries vessel constriction. This is a normally occurring enzyme what's normal function. What's its relationship to elevated blood pressure, and cardiovascular disease and do people with this problem have elevated levels. There's just just the way to to lower hypertension in people with elevated levels.
"cardiovascular disease" Discussed on AP News
"To cardiovascular disease and stroke and the pathway back might lead you to trans fats. It won't be easy. Getting rid of trans fats their common in baked and processed foods, and they're naturally found in meat and dairy products. But they're not healthy, according to statistics more than five hundred thousand people die from heart disease every year, Denmark, AM several other countries have a head start on the WHO plan. They've virtually eliminated trans fats in their countries by setting legal limits on the oils. The life story of singer. Tina Turner is coming to Broadway, AP entertainment. Correspondent Margie's are letter reports. The producers of the musical Tina say they are bringing the show to New York in the fall of two thousand nineteen specific dates and casting if yet to be announced the musical made its world premiere in London in April Tina is one of a long line of stage productions based on the music of an artist Donna summer share Carole, king, Gloria and Amelio Estefan and the four seasons have jukebox musicals as well. I'm Archie zaraleta? A Florida gas station owner says he's sick and tired of people using his stores microwave to warm up urine his shop in Jacksonville now has a sign. He says a woman became aggressive a few months ago when he asked her not to warm urine. She asked to see a sign that says it's not for their purpose, though, he made one the owner says the people who used his microwave to warm urine walk in off the street microwave their urine containers. Then leave the store is within walking distance of two labs that offer drug testing services and collect urine samples. I call for an end of the nation's deep divide. I'm Tim Maguire within AP news minute. The Senate votes. Tomorrow on bread Kavanagh's nomination to the supreme court ended appears he has the votes to be confirmed, but the bitter confirmation fight leaves the political parties even more sharply divided and supporters of those parties, even more entrenched. Alaska, Republican Senator Lisa Murkowski who voted against sending Kavanagh's nomination to the full Senate says the vitriol has to end for the sake of the nation, truly. Truly awful manner. Which with? So many. Are are acting now. Got to end Murkowski will vote present tomorrow as a courtesy to cavenaugh supporter, Montana, Republican Steve Daines who's attending his daughter's wedding back home. She's using a procedure that lets one Senator offset the absence of another without affecting the outcome of a vote. I'm Tim Maguire. More news right after this. Whether it's our hearts lungs or other organs were diagnosis tends to make us uneasy at Kaiser Permanente our.
"cardiovascular disease" Discussed on WVNJ 1160 AM
"Benefits that include a reduced risk of cardiovascular disease this is what the researchers looked our shame and i want to say and if you actually suffered a stroke regularly indulging in cocoa before the stroke lowers your risk of doping the good news centers around two new studies from our researchers are first study found out of forty five thousand people who had cocoa at least one serving per week lowered their risk of having a stroke by twenty two percent compared to people who did not have cocoa so fortyfive thousand people having coq au even once a week lowered their risk of a stroke by twenty two percent compared to people who never akoko a second study found that of um that if you had cocoa once a week and you actually suffered a stroke at cut your risk of dying from the stroke by forty six percent i mean this is real so here's a brand new review of human clinical trials edson nutrition journal it should nutrition trolla just came out nutrition journals a great nonbiased journal sixteen uelmen clinical trials having cocoa reduces you risk of cardiovascular disease by 23 percent okay reduces your risk of cardiovascular disease that's the biggest killer in america by 23 percent cocoa decreases your risk of heart attack or stroke heart failure heart disease and the general population cocoa decreases the risk of cardio cerebrovascular disease okay that's the damage to the heart damage to the brain and a decrease the risk of a heart attack by twenty two percent and this effect is real so here's an amazing stunt.