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Copyright: © Richard Jacobs
Society often treats obesity as a character flaw rather than a disease, says researcher Michelle Cardel, and that needs to change. This podcast explores productive treatments and effective therapies for obesity with a focus on adolescents. Listen and learn
Michelle Cardel is an assistant professor with the University of Florida Department of Health Outcomes and Biomedical Informatics and has a background in nutrition, obesity, and health. She discusses her current focus on adolescents, a program that explores the social, environmental, and behavioral risk factors of obesity in order to develop healthy lifestyle interventions for adolescents. One unique element in their approach is the degree to which they investigated what they teens themselves wanted from the program. Focus groups offered clear information about the degree of parental intervention, for example, and helped the researchers understand that obligatory parental involvement can open the door to voices of shame and guilt.
Professor Cardel also explains their therapy approach. Acceptance-based therapy focuses on elements like self-regulation skills, mindfulness, and acceptance of uncomfortable internal experiences. She adds that they emphasize a willingness to be open to how experiences feel, focusing on accepting the discomfort of, for example, a diet to reduce obesity or a long walk versus a Netflix session. They then emphasize choosing to have these uncomfortable or difficult behaviors despite these feelings. Recognizing that discomfort makes for a more successful experience when one chooses to engage in behaviors that help reach goals, she adds.
For more about her work, find her on major social media outlets, which she uses to stay active in science communication. Available on Apple Podcasts: apple.co/2Os0myK
"Your mom was right," says Maria Geisinger, our mouths really can be bacteria factories. This podcast provides listeners with a comprehensive discussion about how periodontitis progresses and why there's a feedback loop between diabetes and dental health. Listeners will learn
Maria Geisinger is a professor and director of the Advanced Education Program in Periodontology at the University of Alabama at Birmingham. She helps listeners understand how periodontal disease relates to overall wellness as well as why regular dental management of a diabetic patient is important. As with numerous other health concerns, inflammation is a central factor. Professor Geisinger explains that not only does an inflammatory burden result from the effect of diabetes on periodontium, the resulting inflammation can in turn affect glycemic control.
It's pretty simple to identify basic periodontitis symptoms, she adds. The number one indicator is gum bleeding with brushing or flossing. Determining the depth of disease progression takes a visit to the periodontist, who will determine if there's accompanying bone loss and other issues. How does the disease initiate? When bacteria are allowed to accumulate along the gum line, your body senses these toxins and responds by retreating: gum tissue starts to "unzip" from the tooth root. Preventions include regular dental cleaning in addition to brushing and flossing teeth. She makes a helpful analogy between flossing teeth benefits and gym visits and provides other incentives for effective dental care, especially for diabetic patients.
To learn more about her work, she suggests finding her on ResearchGate. Available on Apple Podcasts: apple.co/2Os0myK
People diagnosed with Type 1 Diabetes depend on insulin to stay alive. This podcast investigates what that means on a global level for low and middle-income communities. Listen in for how researchers like David Beran work to increase access to these tools necessary for life. He explains
David Beran is a researcher and lecturer at the Geneva University Hospitals and has join forces with Health Action International to better serve global citizens with type 1 diabetes mellitus who lack adequate health care access and means to pay for supplies. His three areas of focus include researching and improving access to insulin on a world-wide level, assessing health systems and their delivery of diabetes care, and how this care works on a daily, individual level. He explains that most of the management of this disease is outside the clinic, with around-the-clock care and attention. A type 1's daily routine requires them to find the right balance between what they eat and how physically active they are, and how much insulin to deliver with both in mind: it's a challenging balance that requires constant management.
He's focused specifically on low and middle-income countries, where many people don't have access to insulin. He's working with his colleagues on getting these people the basics of survival, namely insulin, a means of injection, and a blood glucose monitor. He explains how varied this can be from country to country. For example, Nicaragua, the second poorest country in the Americas after Haiti, provides insulin to its people for free. However, access to care and the monitoring equipment still pose challenges. On the other extreme, in sub-Saharan Africa everything is paid for out of pocket. People have to buy their insulin and supplies and pay doctor costs. He explains how various initiatives and NGOs are trying to address these problems and what challenges lay ahead. Listen in to hear about substantial and exciting work to help those that suffer from this disease.
For more information, email him with questions at david.beran@unige.ch and see Health Action International. Available on Apple Podcasts: apple.co/2Os0myK
This podcast explores how one doctor is working toward better health for diabetics. Effects of high blood sugar, or hyperglycemia, is well-studied in diabetic patients, often considered the dominant endocrinology, diabetes, and metabolism impact factor to control. But Dr. Ahmed Iqbal is examining the role low blood sugar may play in heart attacks and sudden cardiac death. Listen and learn
Ahmed Iqbal is a NIHR Academic Clinical Lecturer in Diabetes and Endocrinology at the University of Sheffield and studies endocrinology diseases. He specializes in the effects of hypoglycemia on type 1 and 2 diabetics. He offers listeners a baseline of how both diseases work biochemically in the human endocrine system and what role hormones like adrenaline play. Because glucose is an obligate fuel for the brain, its dips and rises can have an impact on how the body works. He lays out the role of liver and counter regulations of glycogen, explaining the mismatch between amount of carbohydrates taken in and amount of insulin delivery that leads to hypoglycemia in type 1 diabetics and a slightly different issue in type 2 regulation, which serves as a diminished or blunted response.
He explains the basis of his study, which involves subjects with both continuous glucose monitors and heart monitors, looking at the effect of hypoglycemia on the heart. He explains that scientists know that a key defense of the body against hypoglycemia is the release of catecholamines, like adrenaline and noradrenaline, to correct blood values. However, high adrenaline is not necessarily good for the heart: such hormones can increase heart rate and the resistance against which the heart has to pump. This increases the demand on the heart, which can be problematic for those with existing heart issues. These hormones also lower potassium, which can lead to dangerous heart rhythm values. Finally, they can make platelets stickier and release immune cells, which may travel to the heart and release plaque already in the coronary arteries. His goal is to come up with mitigating strategies for these hypoglycemic effects on the heart.
For more, see his web page and contact him through twitter at @Ahmed742Iqbal. Available on Apple Podcasts: apple.co/2Os0myK
A winner of an episode, this is the last in a series of interviews for Richard's upcoming Understanding Viruses book. Professor James A. Shapiro treats listeners to his thoughts on virus behaviors and characteristics gleaned from researching virus-host relationships and virus-cell interactions. Listen and learn
James Shapiro is a professor in the Department of Biochemistry and Molecular Biology at the University of Chicago. In addition to numerous publications, he's a part of the website The Third Way of Evolution, which considers evolution in the era of genomics and epigenomics. As Richard holds this final interview to investigate how viruses persist, James Shapiro offers his own fascinating answers to questions such as are viruses alive, do they participate in quorum-sensing, and why so many differing incubation periods. For example, not only are endogenous retroviruses responsible for mammal placenta formation, these retroviral proteins are unique for each order of mammal. This diverges from the classic view of evolution that starts with a characteristic branching out into other organisms. It's as if "the placenta was invented over and over again," he adds.
As he addresses the huge variety in viral behavior, he says that many factors determine this variety—viruses can recombine with each other, for example, and produce recombinant viruses. The holobiont model exemplifies this: a large organism like a human isn't just human cells but also microbial cells living on and in us. We can think of viruses in our genome as holobiont elements: we should take a systemic view of entity development, with mosaics and amalgams determining multiple aspects of life. He adds, "we can't reduce what happens in life to some simple formula that is good for every from of life, because variety is an inherent aspect of the living world." Listen in for more rich conversation about the stuff of life.
For more about James A. Shapiro, see his website: shapiro.bsd.uchicago.edu. Available on Apple Podcasts: apple.co/2Os0myK
This special episode highlights a new way to understand the evolution of life on earth. Willian B Miller, Jr., takes Darwinism's theory of evolution as a jumping point for this evolved theory based on cellular intelligence. Listen in for an enriching and moving conversation about the origin and evolution of life. Richard and Bill Miller discuss
William B. Miller, Jr., left a career in radiology to become an evolutionary biologist. His ideas have helped Richard, who's interviewed thousands of scientists, understand evolution in a fundamentally different way—a step beyond Darwinism theory. Miller has a publication in Progress in Biophysics and Molecular Biology called "Cellular senomic measurements in Cognition-Based Evolution," which establishes this evolutionary concept. This podcast explains in clear and understandable language the gist of the article and where these ideas stands in the era of biological evolution. "It's not your father's evolution," jokes Miller. Richard replies with the opening line of the abstract: "all living entities are cognitive," and this is the center of Miller's article.
Miller asserts that scientific examinations have proven that all cells are intelligent: a cell can take in information, process it, and make decisions: in other words, it can adapt. As Stephen Hawking said, intelligence is the ability to adapt. Furthermore, it can communicate to other cells purposefully what it has measured and why. Cellular intelligence may differ than human intelligence, but it is complex, able to solve a maze, retain memory, and collectively work together with other entities. He emphasizes that cells work together, and not just haphazardly, to get better information; in fact, he says that "each cell is in service to other cells," and this is central to cognition-based evolution. Their conversation takes a deep dive into the essentials of this concept with concrete examples, from our immune system to breast feeding to biofilm construction. Listen in for a fascinating exploration of one of the most revolutionary scientific theories of our time. Available on Apple Podcasts: apple.co/2Os0myK
Almost 500,000 Americans utilize the dialysis process to stay alive and even more face a disease of the kidney, yet rarely can we get a close look at how this dialysis process works. This podcast provides just such an opportunity as Dr. Stephen Gluck takes us through the methods and goals. Listen and learn
Stephen Gluck is a professor in the Division of Nephrology at UCSF. He shares his expertise with listeners, providing a helpful overview as well as a detailed look at how dialysis works and happens during those hours by the machine. He offers a general comparison of acute and chronic kidney disease differences and says that the number one cause for dialysis is diabetic kidney disease. However, he adds that there are exciting new drugs on the horizon that may change this over the next few years.
Dialysis is indicated when the kidney struggles to filter and control extracellular fluid composition, often through reduced nephron function. Most patients who do out-patient dialysis come in three times a week for several hours. The dialysis machine cycles the patient's blood, passing it through a filter and treating it with cleansing fluid. This allows waste products to pass across a membrane, using negative pressure to draw out excess fluid. The clean blood goes back to the patient. Dr. Gluck explains exactly what the machine cleans from the blood and why, but also describes peritoneal dialysis, which is a more common at-home system and usually is used overnight. He explains the differences and applicability for each. Listen in for a helpful perspective on what these processes look like and ways kidney disease cures are progressing.
For more about him, see his website at UCSF: profiles.ucsf.edu/stephen.gluck. Available on Apple Podcasts: apple.co/2Os0myK
Joseph R. Masci began his time at Mt. Sinai when doctors were first confronted with HIV patients who had developed AIDs. He brings his intimate knowledge of this treatment and its evolving history to listeners in this episode. Listeners will learn
Joseph R Masci is a clinical professor in the Infectious Diseases, Environmental Medicine and Public Health, and Global Health divisions at Mount Sinai. He started his training at Mount Sinai in 1980 when experts in infectious diseases were first confronted with a rapidly expanding population of AIDs patients. Imagine facing large numbers of HIV patients with no antiretroviral drugs available and no effective treatment for at least 10 years down the road. He and his colleagues offered emotional support in addition to soothing the opportunistic infections that the virus enabled. They created a special area, a "living room" in their hospital for these patients who were isolated from their families and became their second families. They put on concerts and memorial services for them. He says that the epidemic was "sudden, tragic and not treatable like today."
Because Dr. Masci was in it for the long haul, he's able to explain to listeners each stage of advancing treatment and an eventual measure for preventing the transmission of HIV. Along the way he explains the mechanics of infectious viruses, how HIV has especially insidious traits through its ability to become part of infected person's DNA and its long latency period. As with other common infectious diseases like Epstein Barr, once a person has it, they can't get rid of it. He talks listeners through treatments like AZT, nucleosides, and the effective protease inhibitor drugs. He makes the vital point that much of the world doesn't have access to these very effective drugs and that many still die from AIDs in low income countries. He then is able to take the basics he's established through the podcast and establish some comparisons with COVID-19 and its treatment. Listen in for some of the most important medical history of our time.
For more about his work, find his publications in PubMed and ResearchGate. Available on Apple Podcasts: apple.co/2Os0myK
This podcast addresses a new tool in the arsenal for thyroid cancer treatment through precision medicine. It also indicates exciting possibilities in the treatment for other forms of cancer. Eli Lilly has a treatment called Retevmo that has shown remarkable success. Listen and learn
Maura Dickler is Vice President of Oncology, Late Phase Development, at Eli Lilly. Richard has invited her to today's show because he is one of many who've been diagnosed with and successfully treated for papillary thyroid carcinoma. Maura Dickler, a medical oncologist, describes in particular two types of thyroid cancer that their new medication treats: advanced medullary thyroid cancer and metastatic papillary thyroid cancer. The medication is a selective RET kinase inhibitor. Over-proliferation of RET in either of these cancers causes metastases and is caused by a mutation. She gives listeners specific ways to ask their doctor about testing for this mutation. The most efficient way, she explains, is through next-generation sequencing on a biopsy, or pathology sample when the thyroid is removed, to detect this RET mutation. She adds that it can be detected through other methods if next-generation sequencing is not available.
This genomic sequencing would indicate RET gene fusions in papillary thyroid cancer or RET point mutations in medullary thyroid cancer, and this patient would be eligible for Retevmo. Furthermore, this medication provides exciting news for the treatment of multiple cancers. As we better understand the drivers of cancer, she explains, the medical community will be better able to design medications that can shut off these proteins that are on overdrive, causing tumors. This is why Retevmo is so successful for papillary thyroid cancer treatment when it has metastasized, for example. Scientists often refer to these genomic alterations and tumors as oncogene-addicted and these new specialized medications inhibit the proteins that are driving these tumors. Listen in to learn an especially hopeful story about a young man named Tanner who faced stage 4 medullary thyroid cancer.
For more information, she suggests talking to your doctor about Retevmo. Available on Apple Podcasts: apple.co/2Os0myK
While the symptoms and treatment of type 1 and 2 diabetes may overlap, the origins of each significantly diverge. Type 1 diabetes pathogenesis is an autoimmune-driven story, and in this podcast, Todd Brusko offers listeners a clear and precise description of the latest understanding of the disease and how scientists are working for a type 1 diabetes cure. Listen and learn
Todd M. Brusko is an associate professor within the Diabetes Institute at the University of Florida. He and Richard have an enriching and lively conversation in this podcast about Dr. Brusko's field of study: the genes and biomarkers involved in type 1 diabetes and how the immune system responds in people with higher risk. He says that the most apparent biomarkers are antibodies, but they're not the end of the story. As a T-cell–driven autoimmune disease, it's vital to assess how T-cells develop and understand the part they play. So, like most diseases that have stayed with us, researchers must grapple with these complex and different paths to disease diagnosis.
The variability of when one can develop these autoimmune type 1 diabetes symptoms is immense—from early childhood to old age. Typically, doctors see a peak in diagnosis right before puberty. But it's complicated: the biomarkers are usually present well before the disease exhibits symptoms and there's usually a triggering event that causes the disease to fully present itself. He says researchers have followed a long-standing interest in viral infections as a triggering factor, acting to break the autoimmune tolerance. Something occurs, he adds, whether an underlying genetic susceptibility or an environmental event that triggers this autoimmune attack. Studies show that at inception, the insulin-producing beta cells have their "flags up," and the immune system reacts. He also describes promising research into type 1 diabetes treatments, from delaying the disease to prevention and cures.
For more, see his lab's website: bruskolab.diabetes.ufl.edu. Available on Apple Podcasts: apple.co/2Os0myK
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