Is routine Vitamin D testing necessary? Should you be taking a supplement? The 2024 Endocrine Society guidelines provide updates that may change the way you think about Vitamin D. In this episode of What’s the Proof?, we break down the latest evidence on Vitamin D supplementation, discuss who likely benefits, and clarify why routine testing is not needed for most people.

Join Dr. Bobby Scott, Dr. Dawn Caviness, and Dr. Sandy Robertson as they analyze the research, challenge outdated practices, and equip you with evidence-based insights to confidently answer patient questions.

🔎 Topics Covered:

✔️ Who should (and shouldn’t) take Vitamin D supplements

✔️ The evidence behind supplementation for children, pregnancy, older adults, and prediabetes

✔️ Why the guidelines now discourage routine Vitamin D testing

✔️ The truth about Vitamin D deficiency – do blood levels really matter?

✔️ How to determine whether a guideline is trustworthy using the G-TRUST tool

🎧 Tune in now for a deep dive into the science of Vitamin D and what it means for clinical practice!

Links from today's episode:

2024 Endocrine Society Guidelines

G-TRUST tool for evaluating the usefulness of clinical guidelines

📩 Have questions or comments? Email us at [email protected]

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In this special What's the Proof? EXTRA episode, recorded in September 2024, we dive into a candid conversation about our personal fitness journeys, the challenges we’ve faced, and how our exercise habits shape the way we teach and motivate patients. These EXTRA episodes are bonus content designed to explore important topics beyond the usual evidence-focused format of our regular episodes.

As we release this episode to close out Season 2 and welcome the new year, we hope it inspires you to reflect on your own health habits. Whether you’re looking for fresh ideas to set fitness goals, maintain motivation, or help others start their journey, this episode is packed with practical insights and relatable stories.

Find us on X @theproofpodcast or email us your thoughts and questions at [email protected] and join the conversation!

In this episode of "What's the Proof?" we uncover why exercise truly is the miracle treatment we've been searching for. Exercise can drastically reduce the risk of heart disease, diabetes, cancer,  dementia, and it has significant mortality benefits. Despite its profound impact, many physicians don't emphasize it enough in their practices. Join hosts Bobby, Dawn, and Sandy as they delve into the studies revealing the incredible health benefits of exercise and discuss practical ways to incorporate it into daily routines. Whether you're a clinician looking to motivate your patients or someone seeking to improve your own health, this episode is packed with valuable insights and evidence-based advice.

Episode Highlights:

[00:00] Introduction:

• Welcome and episode introduction by Bobby, Dawn, and Sandy.
• Discussion on the underutilization of exercise in medical practice despite its proven benefits.

[08:04] Exercise and the Effect on Major Diseases:

• Review of a 2013 BMJ study by on the dose-response relationship between physical activity and major disease risks.
• Explanation of MET minutes and their significance in quantifying physical activity levels.
• Discussion on how even moderate levels of physical activity can substantially reduce the risk of chronic diseases.

[12:02] Cardiorespiratory Fitness (CRF) and Mortality Risk:

• Overview of a 2018 JAMA study on CRF and all-cause mortality.
• Findings showing a strong linear inverse relationship between CRF levels and mortality rates.
• The importance of maintaining high fitness levels for reducing mortality risk.
• Insights on the impact of fitness at different periods of life, including midlife and later

[17:05] Strength Training Benefits:

• Analysis of a 2022  meta-analysis on muscle-strengthening activities and health outcomes.
• Discussion on the critical role of muscle strength in longevity and overall health.
• Practical advice for incorporating muscle-strengthening activities into daily routines.

[22:17] Practical Tips and Closing Remarks:

Episode Links:

• BMJ Study on Physical Activity
• JAMA Study on Cardiorespiratory Fitness
• CRF in Early Adulthood and Midlife
• Long-Term Change in CRF and Mortality
• Midlife CRF and Cancer Outcomes
• CRF and Dementia Benefits
• Br J Sports Med Strength Meta-Analysis
• Muscle Strength & Mortality

If you enjoyed this episode, please share it with your colleagues, friends, and patients! Subscribe here to "What's the Proof?" on YouTube for video content, and stay updated with the latest episodes! Share your thoughts and questions with us on Twitter @theproofpodcast or email us at [email protected].

Credits:

• Hosts: Bobby Scott, MD, FAAFP, DABFM; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN, DABFM
• Production & Cover Art: Bobby Scott, MD, FAAFP, DABFM
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

In this episode of "What's the Proof?" we delve into non-hormonal therapies for menopausal vasomotor symptoms (VMS), commonly known as hot flashes and night sweats. Hormone replacement therapy (HRT) is the most effective treatment for VMS, but it isn't suitable for everyone. Join Bobby, Dawn, and Sandy as they explore alternative treatment options for women who cannot or choose not to use HRT. From lifestyle interventions and mind-body techniques to dietary supplements and prescription medications, we break down the latest evidence and provide practical advice for managing these disruptive symptoms. Whether you're a clinician seeking to expand your treatment toolkit or a patient looking for more information, this episode offers valuable insights into improving quality of life during menopause.

Episode Highlights:

[00:00] Introduction and Overview:

• Welcome and episode introduction by Bobby, Dawn, and Sandy.
• Discussion on the significance of VMS during menopause and the limitations of hormone replacement therapy.
  

[05:50] Lifestyle Interventions

• Discussion on general health benefits and specific interventions like cooling techniques, avoiding triggers, and yoga.
• Evidence review showing limited effectiveness of these methods for reducing VMS.

[10:42] Mind-Body Techniques

• Examination of Cognitive-Behavioral Therapy (CBT) and its promising results for VMS management.
• Insights into clinical hypnosis as a potential therapy.
• Brief discussion on mindfulness and paced breathing, highlighting the lack of substantial evidence for VMS relief.

[17:05] Dietary Supplements

• Analysis of the mixed results for soy products and black cohosh.
• Summary of current recommendations against these supplements due to limited efficacy.
  

[19:52] Acupuncture

• Discussion on the effectiveness of acupuncture versus sham acupuncture.
• Conclusion that acupuncture is not recommended for VMS treatment based on current evidence.
  

[21:00] Prescription Medications

• Review of SSRIs, SNRIs, and gabapentin, discussing their varying degrees of effectiveness.
• Introduction to fezolinetant (Veozah), a new neurokinin B antagonist with promising results but higher costs.
• Practical advice on prescribing these medications and considerations for patient-specific factors.
  

[40:00] Practical Tips and Closing Remarks

Tune in to learn:

• The specific non-hormonal options available for VMS and their effectiveness based on recent studies.
• Practical tips for incorporating these alternatives into clinical practice.
• Personal insights from our hosts on managing VMS without hormones.

Episode Links:  

• NAMS Position Statement 
• MsFLASH Pooled Analysis 

If you liked this episode, please share it with your colleagues, friends, and patients! Subscribe here to "What's the Proof?" on YouTube for video content, and stay updated with the latest episodes! Share your thoughts and questions with us on Twitter @theproofpodcast or email [email protected].

Credits: 

• Hosts: Bobby Scott, MD, FAAFP, DABFM; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN, DABFM 
• Production & Cover Art: Bobby Scott, MD, FAAFP, DABFM 
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

The ASCVD Risk Estimator is OUT and PREVENT is IN!  Join us on this episode of 'What's the Proof?' where hosts Bobby Scott and Sandy Robertson explore the American Heart Association's revolutionary PREVENT calculator. This new tool not only replaces outdated risk calculators but also introduces the comprehensive Cardiovascular-Kidney-Metabolic (CKM) Syndrome framework, aimed at transforming the approach to cardiovascular disease prevention. Delve into how this innovative calculator incorporates a broader range of health determinants to assess cardiovascular risk more accurately and inclusively. We'll break down how to use the PREVENT calculator, discuss its impact on clinical practice, and illustrate its application with a case example. This episode is essential for clinicians striving to enhance their understanding of cardiovascular risk assessment and eager to apply these insights into their everyday clinical decision-making.

Episode Highlights:

• Introduction to PREVENT: Discover how the American Heart Association's new PREVENT calculator is set to replace the Pooled Cohort Equations for assessing cardiovascular risk - 03:32
• History of Risk Assessment Tools: Dive into the evolution of cardiovascular disease risk assessment tools from the Framingham score to the latest PREVENT calculator - 04:25
• Understanding Cardiovascular-Kidney-Metabolic (CKM) Syndrome: Explore how the AHA's new disease framework integrates heart, kidney, and metabolic health into a unified risk assessment and management approach - 07:42
• Case Example Discussion: Follow a detailed walkthrough of a case illustrating how the PREVENT calculator and CKM staging can guide clinical decisions - 11:20
• Comprehensive Risk Assessment with PREVENT: Explore the features of the PREVENT calculator, which assesses cardiovascular, heart failure, and composite CVD risks using not just traditional health factors like blood pressure and cholesterol, but also innovative elements such as the urine albumin-creatinine ratio and the social deprivation index based on patient's zip code - 14:29
• Future Directions and Clinical Implementation: Discuss the potential changes in clinical guidelines and practices with the integration of the PREVENT tool in cardiovascular disease prevention strategies - 19:22

Episode Links:

• PREVENT Online Calculator
• AHA Scientific Statement 
• Development/Validation Study

If you liked the episode, please follow us and tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on X @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP, DABFM; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN, DABFM
• Production & Cover Art: Bobby Scott, MD, FAAFP, DABFM
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

"One drug, three doses, one test.” In this episode of 'What's the Proof?', we are joined by our guest, Dr. Bobby Levy, who will be discussing the application of buprenorphine-naloxone in the treatment of opioid use disorder. Discover how personal experiences led Dr. Levy to become a passionate advocate for integrating opioid use disorder treatment into primary care.  Gain insights into the robust evidence supporting the use of buprenorphine, its practical dosing and initiation, and Dr. Levy's compelling counterpoints to common criticisms. This episode offers a unique perspective for any physician keen on confronting the opioid epidemic. Listen in and find out how you can make a life-saving impact in your community.

Episode Outline:

• Opening remarks - 00:35
• Introducing Dr. Levy and his journey to OBOT - 02:31
• The role of Primary Care Providers in OBOT - 09:42
• Evidence supporting buprenorphine-naloxone - 12:46
• Debunking the myth of "trading one addiction for another" - 20:52
• Harm reduction model - 22:48
• Potential challenges and downsides - 24:48
• Dosing and initiation - 28:00
• Key takeaways from interview - 33:26
• Host reflections and closing - 35:46

Episode Links:

• Questions for Dr. Levy - [email protected]
• NEJM RCT - https://pubmed.ncbi.nlm.nih.gov/12954743/
• Efficacy of Bup in primary care - https://pubmed.ncbi.nlm.nih.gov/19553061/
• Cochrane Review - https://pubmed.ncbi.nlm.nih.gov/15266465/
• BMJ Cohort Study on mortality - https://pubmed.ncbi.nlm.nih.gov/32234712/
• All-cause mortality benefit- https://pubmed.ncbi.nlm.nih.gov/34076676/

If you liked the episode, please follow us and tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on X @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

Are you checking eosinophil counts on your COPD patients?  If not, it's time to start!  Do you know which class of COPD medications have demonstrated a mortality benefit in RCTs?  If not, you don't want to miss this one!

In the premiere episode of Season Two, Bobby and Sandy review updates from the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.   We'll talk about some of the major changes, including the new and improved initial therapy diagram.  We delve into key learnings from the IMPACT and ETHOS trials, and discuss why the LABA+ICS regimens recommended in previous guidelines are now discouraged.

Episode Outline:

• Introduction - 01:35 
• The new and improved 2x2 therapy initiation table - 03:40
• Recommended initial treatment - 05:58
• Use of eosinophils to guide therapy - 09:12
• Factors to consider when adding ICS - 16:33
• Adjusting therapy in follow up - 18:20
• Studies showing mortality benefit with triple therapy - 22:05
• Potential downsides of triple therapy - 25:56
• Wrap up/key takeaways - 28:23

Key Takeaways:

• LABA+ICS is out, triple therapy is in!  In patients with frequent COPD exacerbations, consider triple therapy (especially if they have eosinophils>300) but beware if history of repeated pneumonia, history of mycobacterial infection, or eos <100.  
• Triple therapy is the only pharmacological intervention for COPD with an associated mortality benefit
• ABCD is gone, it’s now ABE.  Be sure that you are doing a formal symptom assessment like the mMRC or CAT!
• More patients are getting LAMA/LABA combination at start than previous guidelines.  Now for all group B and E patients

Episode Links:

• 2023 GOLD Pocket Guide https://goldcopd.org/wp-content/uploads/2023/03/POCKET-GUIDE-GOLD-2023-ver-1.2-17Feb2023_WMV.pdf
• IMPACT Trial (2018)  https://pubmed.ncbi.nlm.nih.gov/29668352/
• ETHOS Trial (2020) https://pubmed.ncbi.nlm.nih.gov/32579807/

If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

How can one class of medication be beneficial in treating type 2 diabetes, heart failure, and chronic kidney disease?  It may seem too good to be true, but your hosts welcome guest Austin Bush, MD to discuss the evidence and why family physicians should be regularly prescribing these medications.

We then introduce a new segment, "This Week in Placebo Effect," where we discuss the mysterious effects of placebo, even when study participants know they are taking a placebo!  We look at a trial where open-label placebo is used for treatment of pediatric functional abdominal pain and irritable bowel syndrome.

Episode Outline:

• Intro and welcoming Dr. Bush 00:36
• SGLT-2 inhibitors: Background and early CV outcome trials 02:56
• Use of SGLT-2 inhibitors in heart failure 05:57
• Use of SGLT-2 inhibitors in chronic kidney disease 08:26
• Potential harms of SGLT-2 inhibitors 10:32
• Which patients should be prescribed these medications? 14:02
• "This Week in Placebo Effect" 21:05

Links from this episode:

• Dapagliflozin in HF with reduced EF (DAPA-HF) https://pubmed.ncbi.nlm.nih.gov/31535829/
• Dapagliflozin in HF with preserved EF (DELIVER) https://pubmed.ncbi.nlm.nih.gov/36027570/
• Empagliflozin in HF with reduced EF (EMPEROR-Reduced) https://pubmed.ncbi.nlm.nih.gov/32865377/
• Empagliflozin in HF with preserved EF (EMPEROR-Preserved) https://pubmed.ncbi.nlm.nih.gov/34449189/
• Dapagliflozin in chronic kidney disease (DAPA-CKD) https://pubmed.ncbi.nlm.nih.gov/32970396/
• Empagliflozin in chronic kidney disease (EMPA-Kidney) https://pubmed.ncbi.nlm.nih.gov/36331190/
• Effects of open-label placebo in children with functional abdominal pain or IBS https://pubmed.ncbi.nlm.nih.gov/35099543/
• Effects of open-label placebo in adults with chronic back pain https://pubmed.ncbi.nlm.nih.gov/31479068/

If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

Insomnia is one of the most common conditions encountered in primary care.  In this episode, Drs. Scott & Robertson explore the evidence-based management of chronic insomnia, with some surprising revelations along the way!

Additionally, Episode #4 on Probiotics for the Prevention of Antibiotic-Associated Diarrhea provoked a lot of debate, and the What's the Proof team lets you in on the conversation.

Episode Outline:

• Follow-up discussion on probiotics and CDI prevention 00:53
• Cognitive Behavioral Therapy for Insomnia (CBT-I) 08:09
• Review of AASM and ACP clinical practice guidelines for insomnia medications 09:52
• Potential harms of sedative hypnotics 17:16
• How to handle the "Oh, by the way" request for sleep meds 23:00
• New data on dual-orexin receptor antagonists 25:30

Links from this episode:

• Effect of antibiotic stewardship on incidence of CDI https://pubmed.ncbi.nlm.nih.gov/28629876/
• Declining use of medications for insomnia https://pubmed.ncbi.nlm.nih.gov/35818727/
• Hypnotics’ associated with mortality or cancer https://pubmed.ncbi.nlm.nih.gov/22371848/
• SUNRISE 2 https://pubmed.ncbi.nlm.nih.gov/32585700/
• Daridorexant for insomnia https://pubmed.ncbi.nlm.nih.gov/35065036/
• AASM Insomnia Guideline https://jcsm.aasm.org/doi/10.5664/jcsm.6470#d45835e1
• ACP Insomnia Guideline https://www.acpjournals.org/doi/10.7326/m15-2175
• Simplified sleep restriction for insomnia https://pubmed.ncbi.nlm.nih.gov/26212846/

If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

In this episode, the What's the Proof team is shocked by the practice-changing evidence surrounding the use of probiotics in preventing antibiotic-associated diarrhea. 

Also, in "Residents Ask the Darnedest Things," Dr. Caviness shares what she learned when a medical student asked about co-testing for influenza along with COVID-19 in symptomatic patients.

Most Studied Probiotics:
In adults: Saccharomyces boulardii, Lactobacillus acidophilus, Lactobacillus casei

• Dose: 10 to 50 billion CFUs per day

In children: Lactobacillus rhamnosus, Saccharomyces boulardii

• "High-dose": >5 billion CFUs per day 

Episode Outline:

• Intro/background 02:00
• Evidence for use in adults 08:20
• Potential harms 15:29
• Which probiotics are recommended? 16:29
• Evidence for use in children 20:08
• "Residents Ask The Darnedest Things" 28:09

Links from this episode:

• 2017 Cochrane review "Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children" https://pubmed.ncbi.nlm.nih.gov/29257353/
• 2010 RCT on use of probiotics for AAD and CDAD in hospitalized adults https://pubmed.ncbi.nlm.nih.gov/29257353/
• 2019 Cochrane Review "Probiotics for the prevention of pediatric antibiotic-associated diarrhea" https://pubmed.ncbi.nlm.nih.gov/31039287/

If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at [email protected] or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay