In episode 361, James and Mike pull out the PREMIUM card and we digest two recent publications – a cohort study looking at the relation between percent of macronutrients ingested and CVD and mortality and then a much smaller trial of intensive lifestyle in T2DM. At the end we realize that if nutrition guidelines just stuck to looking at the evidence all would be good in the world – at least around eating.

Show notes

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.

Lancet 2017 Aug 28

Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial

JAMA 2017 Aug 15;318:637-46

In episode 360, Mike and James finally get to the end of their agitating three part series on treating agitation in dementia. In this episode we talk about the evidence for the non-drug treatments like group or individual activities, music therapy and sensory interventions. Sadly, there is still real uncertainty if these interventions work reliably.

Show notes

Handout

In episode 359, Mike and James continue to agitate over the evidence for treating agitation in dementia. We talk about the use of benzodiazepines, antidepressants cholinesterase inhibitors for this difficult to treat condition. The evidence ends up just increasing our level of agitation as these agents unfortunately really don’t do a heck of a lot for many people.

Show notes

Handout

In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?

Show notes

Handout

In episode 357. Mike and James invite Adrienne to help us work through all the studies that have looked at using riboflavin to prevent migraines. Unfortunately, the impact of riboflavin on migraines is consistently inconsistent and most RCTs found no reduction in migraine frequency. At least we have evidence for low-dose propranolol and amitriptyline.

Show notes

Tools for Practice

Riboflavin for Migraine Prophylaxis: Something “2-B” excited about?

In episode 356, Mike and James welcome Jamal Ramji to the podcast because we really needed to do something PREMIUM. We discuss a study of subclinical hypothyroidism and a low FODMAP diet for IBS. At the end we figure out that TSH is a no, but that the low FODMAP is a yes at least for 1 in 5-10 people.

Show notes

1) Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

N Engl J Med 2017;376:2534-4

2) A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D

Am J Gastroenterol 2016;111:1824-32

In episode 355, James and Mike finish delving into the issues around lab reporting and measurements. We finally get to some potential solutions (sort of) with how to deal with the variation seen around all lab values/measurements. We focus primarily by describing the variation around the top 20-30 lab tests because there is no way to get away from the inherent biologic variation seen with all these tests. Hopefully, if one appreciates the variation, one can use good clinical skills and judgment when it comes to interpreting lab tests. Or maybe the entire podcast series  just makes your blood pressure up – which as we talk about in the podcast, BP changes are difficult to evaluate. 

Show notes

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Lab Test Variation Table

In episode 354, James and Mike continue to delve into the issues around lab reporting and measurements. In this part, we talk about the variation seen with blood pressure measurements, glucose and Vitamin D as further examples of what clinicians need to be aware. Having this insight should give you more confidence to interpret lab values, or just frustrate the heck out of you. You decide. 

Show notes

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In episode 353, James and Mike continue to delve into the issues around lab reporting. In this part, we talk about the variation seen with every measurement. We talk about reference change values and what they mean for clinical practice. We use examples of bone density and cholesterol to explain some of the nuances and problems associated with test variance. The bottom line is that cholesterol and BMD measurements, with rare exception, are of no clinical value. Yikes!

Show notes

Handout

In episode 352, James and Mike start to delve into the issues around lab reporting and the numbers that are reported and what the numbers really mean. We talk about the highs and the lows and the variability associated with measurement and realize at the end that, while lab tests may have important variability, the quality of our podcasts never varies – which may or may not be a good thing.

Show notes

Handout