Very good morning, and I especially thank the organizers for giving us the opportunity of this presentation first of all make the presentation and Earlier we had given the feedback country feedback rather. I should say To read the that what India requires and what are the gray areas and green green areas? So Yeah, so I'll be quite brief in my presentation. So this is basically the structure of my presentation These are the areas I'll be covering and So first of all, I'll be speaking about the strategy that is benefits and targets in the Indian context So our focus is on Transdisciplinary participation education and knowledge base coordination and Short Thank you preparing the regulatory guidelines and creating the infrastructure in the genomic area area genomic medicine area Now actually the here actually I highlight the areas likely to be benefited the diseases the predictions how it is going to benefit and the diagnostics and How increased knowledge is going to benefit us now here actually before I embark on this slide actually I would like to mention that from India. There are four major funding agencies one is the Department of Biotechnology from where I belong and another is Department of Science and Technology another is Department of Health Research which comes under Ministry of Health and Family Welfare and Another is Council of Scientific and Industrial Research that is again under a Centre Ministry so in this particular slide I mentioned about the DBT institutions and Particularly here. I would like to highlight the NIBMG and BMGC in the eastern part of our country Actually, this institution was established by the department. It has put about 50 million US dollar budget for the initial period of five years and It has a clinical attachment called biomedical genomic center in a clinical setup in Calcutta So NIBMG is located in Kalyani and its clinical wing is in Calcutta so both are functional at this point of time and in the next subsequent presentation Professor Partha will address what is doing in NIBMG So therefore I'm not elaborating on this and here I'd like to mention in the top of the area the RCB that is Regional Center for Biotechnology yesterday did mention that is UNESCO category 2 Center which has focused on education training and research and there is also an institution called Translational Health Science and Technology Institute and Also, you can see NBRC that is National Brain Research Center. So there is a cluster There and also the National Institute of Immunology. So they are all engaged in biomedical area and Recently we have embarked on a inter-institutional program on preterm birth So because India's burden is quite heavy. It's almost annually 3.5 million And there are other institutions down south and also western part of our country that that is National Center for Health Science and National Institute of Animal Biotechnology Center for DNA Fingerprinting and Diagnostics and Instem and that lowest one and the down more south is that is RGCV Tim Trivandrum Regional Rajiv Gandhi Center for Biotechnology Now in genetic cataloging of ethnic groups that these are the important areas actually data coordination Which in which will include the clinical data molecular involvement of molecular genesis geneticists and Anthropologists so creation of baseline data on various ethnic groups for disease susceptibility is very important that's what we consider and What are they actually our emphasis is on promoting translational research and That is towards diagnostic kids Then vaccine development using reverse genetics then molecular tool for surveillance and These are the some of the examples what we have been doing Now in the prenatal care area We This is also our focus and here actually On the third point we have mentioned initiating that is what I mentioned on preterm birth And we have genetic clinics at different clinical setups for screening the doing the prenatal diagnosis now in cancer genomics and Epigenomics of in genomics and epigenomics of cancer then transchromia transchromia of cancer and Nibmg is a part of international cancer genome consortium and India's Part is oral cancer which Professor Partha will be highlighting the other areas these are the areas which we want to highlight and here actually We are interested in harmonization With international ethical guidelines we have a national biotics committee and they are that department is the nodal agency Now what are the hurdles? Now these are the hurdles handling of large data set evidence for health Treatments are based on research goals Research waste due to lack of expertise lack of regulatory guidelines Incidental findings major Majority and lack of knowledge in primary health care providers So we need better technologies large data set for patients and lack of translational or interpretation and Last not the least the funding and political will Now what are the possible collaboration collaborative areas? So one comes tendering guidelines for implementation and preclinical and clinical trials This is number one number two is use of traditional knowledge and Integration into modern genetics Next one is cloud sourcing cloud sourcing for translation of genetic data Next is development of new methods of disease classification based on recently discovered genetic principles Next one is building community interest and participation Next is building data sharing capabilities Unify strategies on ongoing various places and set up biobank facilities and training of manpower and Building study cohorts That's all I want to stop at this stage now. I'll invite Professor Majumdar to Deliver his talk and together we can address the questions. Thank you All right Thank you. So you got an overview of what's going on in India in various areas of human genetics genomic medicine I just want to add a few sentences to what Mr. Sinha just spoke which is that in terms of Inter in terms of the past India did not participate in major international collaborative efforts But more recently in 2009 India did decide to participate in the international cancer genome consortium So what I'm going to talk to you about is primarily What what we've been doing in the international cancer genome consortium. So it's Probably going to be a little bit more scientific than policy or general general Discussions, I also wish to mention that there are other agencies aside from the Department of Biotechnology Such as the Council for Scientific and Industrial Research who also partner internationally and right now The CSIR the Council for Scientific and Industrial Research They have a major partnership with the Mayo Clinic on again in areas impinging on human health and and and genetics so we In India because there are multiple agencies that fund research It's a little difficult to find all of the information in one place But all that I'm trying to point out is that aside from Department of Biotechnology which was a major focus of Mr. Sinha's talk. There are other agencies He did mention some of them at the Indian Council of Medical Research Collaborates primary primarily with the World Health Organization and let me start with what the Indian Council of Medical Research has done over a 20-year period which is Which actually is the background of India's participation in the international cancer genome project so the cancer atlas of India which is primarily which is primarily an epidemiological atlas was created for a for a period of Spanning two decades and this was done in collaboration with the WHO What this has accomplished is a nationwide Epidemiological database and this goes to not to the village, but a cluster of villages. That's called a district for every every single district of India and what I'm going to try and show you are Those those graphs that pertain to oral cavity because I'm soon going to Sort of specialize in the oral cavity. So this is These these data sets are done by the ICD codes ICD 10 codes So this is cancer of the tongue and as you can see that the these are age-adjusted incident rates per hundred thousand population and As you can see that these data are primarily Done for every single district of India Clusters of villages there are certain areas that could not be covered because of political disturbance and other kinds of stuff But by and large, it's it's nearly complete. So we have this is cancer of the mouth This is cancer of the tonsil and in particular I would like to draw your attention to geographical differences even within India So for example cancer of the tonsil is has a very high incidence and prevalence in in the northeastern region of India This is cancer of the oropharynx gain fairly high There's a pharyngeal carcinoma is fairly high in the northeastern region of India The institutions that are primarily involved in cancer research To add to what Mrs. Sinha just said there are other institutions that that are outside of the Department of biotechnology who are into who are into clinical and basic research basic biology of cancers a number of institutions and then there are adjunct like technology platform facilities such as Center for whatever. I can't remember the acronym, but Molecular platform Center for advanced molecular platforms or something. It's called Then there's the Institute of Bioinformatics in in Bangalore and and CDAC in Pune. See a Center for Advanced Computing Then the focus of research is primarily Are several in terms of foresight some are based on disease burden So for example oral and head and neck cancer about which I'm going to talk to you about Cervical cancer has a major focus in India primarily because of its high prevalence Breast cancer is catching up in some areas breast cancer is even more prevalent than cervical cancer And so there is a lot of work that's going on in terms of the in with respect to breast cancer As I said the northeastern region of India. There's a very high prevalence of nasopharyngeal carcinoma gallbladder cancer, which is almost non-existent in most places of the world except that along the major river the River Ganges in In India in the Amazon basin and in the Nile Valley. You do find a lot of gallbladder cancer and so this Unique feature to gallbladder cancer in India. Well, not so unique But by and large it's focused in various geographical regions of the world India being one and so there's Some research that's going on in gallbladder cancer Gastric cancer some of the tribal populations From the from one of the northeastern states called Naga land has a very high prevalence of tribal gastric cancer And probably this is related to diet Or the microbiome. So there's some work that's that's emanating there This is a difficult region to collect data from but still some some institutions are taking major leads in collecting information on gastric cancer from there again, the gliomas has the center the Council for scientific and industrial research has a major funding as a major focus on the gliomas So the Department of Biotechnology usually Does not fund a fund glioma research because it's funded by the CSIR All right, so I will spend the next few minutes primarily on the international cancer genome consortium and India is participating with oral cancer of a specific variety called ginger buccal oral cancer And I'll tell you in the moment why we are Specifically talking about in ginger buccal oral cancer The entire project is funded by the Department of Biotechnology Which is under the Ministry of Science and Technology in India Squemacell car snow of the oral cavity is the eighth most common cancer about 250,000 new cases arise annually Two-third of them are in developing countries causes about 125,000 deaths annually It accounts for about a third of all tobacco related cancers in India The site to distribution of oral cancer is very interesting in the West predominantly what what one finds in terms of the Cancers the oral complex is that it's predominantly tongue cancer in the West and it's And and the ginger buccal complex is about a quarter In India three quarters is ginger buccal complex and only one quarter is tongue. So there is a huge difference in in inside presentation of Oral cancer the hazardous combination of course is tobacco Erica nut, which is a very highly psychoactive substance Calcium hydroxide on on a specific leaf called the beetle leaf, which is widely used So what we did was to select patients with oral cancer and do exome sequencing on the blood DNA and on the tumor DNA and I'm obviously don't have the time to describe to you in detail But these are the genes that that we found were significantly mutated Some of them are known known players some of these genes What are not known or at least until? We published our study or conducted our study these genes were not known to be associated with Head and neck cancer and we found them to be associated with the head and neck cancer and we actually the discovery sample size was 50 and we validated these results in 60 patients and This is these are the these are the genes that are significantly mutated the pathways That is most significantly mutated are of course p53 apoptosis pathway viral carcinogenesis about 20% of our Oral cancer patients also had HPV infection But so we looked at the data on those patients that had HPV infection, but we didn't find anything Anything fascinating or any anything that's deviant from the rest of the Oral cancer patients, so there was no specific association with HPV Neurotrophin signaling pathways a new pathway that seems to be altered in in ginger buccal oral cancer and Wind signaling pathway. I'm going to skip this slide. It's a slightly busy slide So essentially this is these are the genes that are that are significantly recurrently mutated in oral cancer These are the genes that where we found Copy number variations and these this is the mutational profile so you have some patients with very small number of mutations and Some with very high number of mutations and these are the sequence contexts in which the SNVs occur and If one looks at this closely, we do find Tobacco signatures in terms of the sequence context where SNVs tape or these alterations single nucleotide alterations take place The copy number variations those are the genes that are that that are recurrently found to have recurrent copy number variations In GST T1 is completely deleted in several of our oral cancer patients And the ones that are partially deleted genes that are partially deleted at these genes We obtain evidence of whole genome duplication in seven tumor samples if you look at patients and and look at profile these patients or Clustered these patients based on the mutational profiles Essentially what we find is that there is one cluster that comprises gas phase 8 and fat 1 mutations The second cluster the bigger cluster comprises p53 mutations and the third cluster contains A variety of genes that are mutated if you look at disease-free survival What you see is that there are differences in disease-free survival in these molecular subgroups if you if one Looks at patients one of those subgroups has patients with mutations in mll4 Although the sample size is small what we when we do the Kaplan-Meier we find that individuals who have the mutation Survive longer have disease-free survival of 20 months while the ones without mutation have a disease-free survival of 13 months so there is a seven month gaining of age when there is when the mll4 gene is mutated the article has just been published in nature communications and The one last point that I want to make with India's participation in the International Cancer Genome Consortium is that we have Not only contributed to the effort the international effort But I and my colleagues in the Institute and in the Tata Memorial Hospital, which is the clinical site for clinical collaborative site We've gained a lot by participating in this international consortium because we have we've been able to exchange protocols we've been able to exchange methodologies and Share data and resources so it's been it's been wonderful participating in this consortium And I do believe that when genomic medicine consortia are Cholest through the efforts of NHGRI and other international partners India will participate and will stand to gain. Thank you very much Maybe we have time for one question Which I will ask So as you know one of the focal points of what we're trying to do here is also Is on the implementation side and I didn't see but maybe it exists the linkage of the extensive cancer genome cancer sample cancer genome database to Anything that looks like an electronic medical record where you can you know about medication about treatments about outcomes and correlations presentially that would be useful for Understanding genetic backgrounds to correlate with response. Can you comment on that? So in India one of the biggest problems is that the largest patient pool Is in the government hospitals? That's where the vast majority of the patients irrespective of disease come in and that's where Electronic medical record keeping is pitiful So it's only in the private sector that there is some amount of electronic medical records But in the government hospitals virtually none the government is waking up to Understanding the importance of electronic medical keeping record keeping but it's The the this research that you're talking about is all in the government hospitals not in the private hospitals Which one well the this one the the cancer the broad based Cancer genomics program that you have is these are essentially yeah, so most of them are actually private hospitals And that's where the data are coming from because of the the quality of the data


Prime Minister and Minister for Finance, Honourable Philip J. Pierre, on July 11th, tabled a resolution in the parliament to provide additional economic relief to St. Lucien and spur economic development by removing value-added tax on select building materials. Leave the cost of materials that you buy to build your house. Cements, lumber, steel and plywood, Mr. Speaker. If the total comes to $2,000, Mr. Speaker. Before, second of August, you would have to pay an additional 12.5% on the $2,000, on the total price of the goods. You'd have to pay an additional 12.5% Mr. Speaker. But with the removal of that, when you get your invoice, that 12.5% will not be there and it will not be required to pay that 12.5% Mr. Speaker. The Lower House expressed support for the Prime Minister's resolution to suspend that charges on plywood, lumber, cement, steel, galvanized and solar PV systems for a period of two years from August 2nd, 2023 to August 1st, 2025. Even if the cost of these goods increase, even if they increase, at the end of the day, before August 2nd, you had to pay 12.5% more. With the removal of that, with the zero return on that, you'd have to pay 12.5% so you'll make a savings of 12.5% even if the price increases. Home remodeling and renovation projects will be more affordable for the average St. Lucien. Contractors will also benefit from the reduced cost of building materials for medium to larger construction projects. Consumers will benefit from a 12.5% reduction in the cost of building materials as a direct result of Prime Minister Pierre's vat amnesty. I hope, I really, really hope Mr. Speaker, that businesses work with us Mr. Speaker. We have shown good will. We're going to increase the time period for the tax amnesty. We've reduced interest on that, Mr. Speaker. We've said to you, if you lost tax, we'll waive all the interest on the penalties for the tax that you lost, Mr. Speaker. The social and economic realities of ordinary St. Lucien's continue to inspire the People First policies of the Pierre administration. This latest tax relief measure will increase consumer spending power at hardware stores and drive growth in the local construction sector. From the office of the Prime Minister, Rihanny Isidore.


So I'm going to talk about innovation in China, but without any irony at all, okay? So can China innovate? That's the key question here. Everyone hears about Chinese copycats, Chinese Facebook, Chinese Twitter, Chinese Google, right? And the question on everyone's minds then is can or will China innovate? When will maybe, you know, other people in other markets look at and want Chinese design, Chinese invention? Me, I think it's actually right around the corner. In fact, it's coming right away. I think that if we look at social innovation in particular, you can see that trends are happening where amazing transformations are happening to China and within China that will affect its standing in the world.  Can I explain how this is going to happen? Innovation to me is about doing something new, about doing something novel and different, but of course it has to be with practical application. It's not just new for Nuna's sake. It has to be useful. Innovation, therefore, actually has to find its way into the market and serve a need. What's often called product-market fit. Great startups live for product-market fit. Their singular pursuit from their beginning is finding a way to justify their existence and fit what is needed in the marketplace. I think this happens when you pair domain knowledge and expertise. When you pair domain knowledge and expertise with a passion to find a solution and in China, unfortunately, we're not seeing that happen enough. Too often we're finding that companies are trying to take foreign models and make them work in China. Too often what happens is we look at other markets and try to take their solutions and make them work here. Just because somebody else is using a hammer doesn't mean you need a hammer. Maybe you need a screwdriver, right? And so what I think really we're looking for now is Chinese companies that can break this mold of taking other people's ideas and trying to make them work here. Too often what's happened is people are thinking about not product-market fit, but product VC fit, trying to do something that they think is going to get funded. And they do that because they think that's both the best and safest way to get startup success or get filthy rich. But unfortunately, that's not the case. Even amongst the companies that are copying to China, we've seen thousands of Groupon clones, it doesn't work. More often than not, they'd still lead to failure, because ultimately starting up something, taking risks, is about embracing uncertainty. It's about being comfortable with the risk of failure, and it's about doing something brave and new. In fact, therefore, it's much more important that you care about what you do deeply, why you're doing it matters just as much about as what you're doing. And so if you can transform then into embracing these risks, disregard whether your parents, your friends, your family members, whatever they might think, and then try to embark on new embracing and listening to what's happening in the local market and the local needs, then you have the possibility of actually having real innovation. Unfortunately, too many Chinese startups know how to build something. They know the techniques, they have the technology, they have operational experience, but they don't really know why to build something. They're not committed to the vision and the clarity of what to build. But there is hope. There are more and more social entrepreneurs today who, with their definition of success, are embedding impact. And so for them, at their core, they know precisely who they serve and why they're building something. These social entrepreneurs are driven to embrace local needs, engage in design and creation processes, and actually their purposes are so important to them that they're willing to risk value in a way that the technology entrepreneurs are not. And so in my experience over the last five years, first from my own technology startup, where we crowdfunded student loans and now more recently investing in incubating in new social enterprises, I've seen that passion and commitment makes it possible for young projects to get over the hurdles of the beginning and create real market value. But nevertheless, these social entrepreneurs have the challenge of how to scale. So they again come across that problem of technology and operational capacity just like the technology entrepreneurs have the challenge of really understanding why they should exist. But I think both things can be taught. And what's more, by combining these two communities, I think there's fundamental learning that can happen and we can create real fundamental social innovation. When that happens, we're not going to just get product-market fit, we're going to go beyond that to product-society fit. Where the products not only serve customers and shareholders, but actually all stakeholders. And when that happens, what's going to happen in China is we're going to find real solutions to Chinese problems using our local knowledge and context. And and what's more, we're going to find that those solutions that we build for Chinese problems will have relevance around the world. Whether it's aged populations and overweight populations in the developed world or poor migrant populations elsewhere. And with that, I think Chinese social innovation has the opportunity to build products and services the whole world will admire, desire and acquire. Thanks.


Hi everybody it's Sam here and today I'm launching my shutter card collection. This is a style that's been around before some of you might be familiar with it but it was something that I was requested to bring out as a collection so this is how the card looks so you have a belly band that wraps around the front and you can decorate this embellish it as you wish. The theme around this collection is sweets and treats so you have your sweets and then you have your baked goods really fun stamps and you'll see those in a moment. On the front you've got an embossing folder you don't have to you could have the pattern paper which I will also be showing you and then as you open up the sides it will reveal your chosen message so it could be a written message it could be a stamped image or one of the sentiments that I also have in the new stamp sets so you can close it all up you could write something on the back if you would prefer and then it all folds up nicely into its belly band and you can either pop that then into an envelope or you can give it like this. So I will be live today on the craft stash and craft world facebook pages at 1230 BST I will link everything in the description box below along with the links to this collection. There's also 10% off if you use code MTS10 again that will all be linked below so you can enjoy an extra 10% off at the collection and I hope you enjoy it so I'm going to flip the camera around now and show you the whole collection. So this is my new shutter card collection now there is also a six by six die set but unfortunately there's an issue with the sizing of two of the dies so we have replacements being sent so we've just pulled that back and it's going to go on to pre-order until those come in and then we can just swap out the dies that are wrong. So for now I'm going to show you the five by seven and everything else that comes in the collection it's really fun really colorful I've loved putting these ones together so we'll start off with the main die so this is the five by seven shutter card die now you can make this as a single or a double aperture and I'll show you that in the samples in a moment so you can see all the dies there there's also step by step instructions but on the back here I've just popped all of mine onto my magnetic sheet that I like to keep my dies on and you can see all of the dies there. The larger circles are more for your belly band so this is a belly band die here the smaller ones are to create your aperture and to have a decorative frame with that you also then have the additions set which is this one here so this is the baked goods edition set and you'll see it says here that it coordinates with five by seven so with this one here you can create these decorative frames again I'll show you those in a moment you also have a cake you've got a fork and you've got all these different elements here in circles which will create lollipops and different sized apertures with the frames you've also got some bunting there and you've got some different biscuits you've got a candle some really little fun elements there that you can add to your cards. We've also kept the six by six editions because it's a lovely set on its own so if you like to create your own cards with apertures you like to just have different shaped circles then this is a really nice set so although it is meant to go with the six by six because the width of these apertures here fit perfectly within the six by six section that we have for it they do work on their own still nicely and you've got little lollipops here you can see the lovely frames that you have you've got a different bunting little bows that go on the lollipops and then you've got different designs for the lollipops you see there's like a pizza you've got the swirls it's not a pizza but that's how I describe it and you've got another swirl there and then you've got all these little suites and there's your circles obviously for your different aperture sizes and again you'll see on the back there it shows that it coordinates with the six by six but like I said it does work on its own so we've kept it in you then have the dies which will go with both sets of the stamps so the stamps you can buy separately because I know a lot of people have their digital cutting machines or they just like to fussy cut them so I do like to fussy cut but you do have the dies in this set that will coordinate with both of the stamp sets so you can see them all on there and then these are the stamp sets so I'll take them out mine have already been used because I made all my samples for Hachanda but if I just hold it up there you can see you've got oh you've got some lovely sentiments all you need is love and donuts then you have your donut here it's your birthday the cakes you've got different cakes here celebrate with cake calories don't count happy cake day and birthday wishes you've got biscuits you've got the little pretzel there gingerbread man different biscuits here little cupcake really really sweet love that set and then this is the sweets set so that's your baked goods this is your sweets so here you have one of the hearts and then you have these different sentiments that you can stamp inside the heart you then have your different sweets they're really fun to color love these ones you've got a little cake pop here color that any way you like you've got different lollies here that's like a marshmallow with some chocolate melted on the top of it you've got candy cane you've got little strawberry there you've got another candy cane style you've got your hard boiled sweets there as well and you've got some little kind of gummy bears as well you've got have a sweet birthday you're so sweet keep calm and eat the sweets happy birthday and home sweet home so you can really make some lovely cards with that set then i've also done two embossing folders i love these i've really enjoyed creating with these embossing folders and when i show you the samples and when you see my tutorials i think you'll really enjoy these ones you've got a five by seven and six by six six by six has all of those lollies and the kind of hard boiled sweets and things like that from the sweets stamp set and then on the five by seven you've just got these lovely words all related to your sweets you've got donuts lollipops sugar cake icing treat frosting biscuits dessert jam chocolate jelly bean icing i've probably missed some but there's loads on there yummy really really fun and that's going to work with lots of different cards as well so if you're someone that just likes to stamp and you like embossing folders then you've got that option here and then there's the paper pad again this is probably my favorite paper pad that i've done to date so this one is the shuttercard paper pad you get it's eight by eight you get four each of six designs and it's 180 gsm and it's actually a great weight to make 3d projects so i'm going to be sharing some photos of some of the samples because unfortunately i haven't got all my samples back from when i launched on the craft store so i have a few samples here with me but i'm going to pop in some photos of the other ones because i did make a little gift bag a little gift pouch and another little kind of gift bag as well using the papers just to show you that you can make them into 3d you know projects so you can see kind of an overview of the patterns that you get but you've got that lovely donut pattern which i just yeah love that one you've got this one here with these little swirls the lollipop one is brilliant that's the one i used to make one of the gift bags you've got this lovely pattern here jelly bean one is another favorite of mine i really like that one and then because i've already been using this you will also have another one but i'm going to go ahead i'm just going to flip through to the repeat it's this one here the sprinkles really love that one and it's actually surprisingly easy to match up the papers to these really well because there's so much color in the sheets and that works great with white so you know if you don't have many colored papers but you've got white it will work well with that but you've got the bright pinks and yellows they're quite easy to match this one here works great with white but you've also got your blues and the pinks again easy and yellow is an easy one to generally match up with this one here looks really striking against white along with this one but again you've got quite a few different colors there because you've got the different shades where they overlap and then this one will just go with pretty much any colored paper that you have so you've got a lot to choose from there and again the sprinkles i found worked really well against the white and it pulls out the white parts there but again the yellow and the turquoise it is it's surprisingly easy to match these colors up so that's everything in the collection what i'm going to do now is pop in some photos of the samples i've made so you can have a little look at them and then i'm just going to show you some that i've got with me now what i'd like to do is i cut and color lots of the stamped images and the die cuts you can see i've got all kinds of bits and pieces here i've kept all of the sweets together and all of the baked goods together i've gone very bright and vibrant that's kind of my style but i just thought it worked well with this release but i do plan to color these i guess in a more realistic way and you'll see that in future tutorials but some of the dies here you've got the biscuits i've just put glossy accents on them just so you can see kind of how they work and you've got some biscuits here and then this is the bunting and the bunting actually cuts out so you can paper piece different colors into these which i really like you can also see the fork there and i kept all the negative pieces because these are what you can paper piece back in and they've also come a lot of them from the frames so it just means that you can add lots of color and you can really kind of you know make them your own just pop all those in there so here is well i've actually done two so i've already filmed the tutorial for this one but these are my little donut boxes and i think they turned out so so well i just love them i've embossed the tissue paper here with the embossing folders you can just see some of the wording and then it just says on the front here on some heat-resist acetate all you need is love and donuts and you'll see them all there and i put glossy accents on the tops of them all and then it's just a top folding five by seven card which i've stuck together a little bit there but you can see inside and then i've done it again in the pink isn't that lovely really do like it i think it's just come together so well so i've done that one so just shows you how they look when they're colored i've used alcohol markers actually to color these ones in and then this is the five by seven shuttered eye so this is the belly band this is actually using the addition sets you can see that different circle shape that you get there and i'll just put happy cake day calories don't count i'll pop the donut in the middle you can see the embossing folder again on the front there and then this one when you open it up you have all you need is love and donuts and you've got the three donuts there that i've colored and that lovely donut patterned paper pop another mat layer on the back there which is the same size mat layer as this one you've got the dies for that and you'll be able to then write your message on there otherwise you may want to have your message revealed when the shutters kind of open you could you know certainly right inside there if you want this one here i have blended my own background again use the embossing folder and you can see the cake here with the candle and i've used the fork there as well and i've added some sparkle some glossy accents to the flame and i've just drawn a tiny little black line there just makes it a little bit more realistic and then this one here i've not put the belly band on i've just literally stuck it on one side and then when you open it up you've got your double so this one says it's birthday eat the cake you can see the cake there that i've stamped again that all closes up and then i've got this one here where i've stamped onto the embossing folder using the red ink and then when you pass it through it will transfer into the area obviously where you applied the ink but it will resist against all of the wording because that's obviously set back in the embossing folder just gives it a really nice effect you can see the top of there where i've built it up i've put glossy accents on everything that i think would shine i think they look really nice again you can slide the belly band off and then with this one when you open it it says have a sweet birthday and then the belly band just goes back on there so that is my new shutter card collection i hope you like the samples that i've shared and the pictures that i've popped up i will be launching this on craft stash later on today i will link the facebook and the craft world links in the description box below so head over there check out we will have competitions running there's competitions already on the craft stash page obviously this is as of the 9th of april 2021 so if you are watching this maybe a day or a couple of days later or even months later then obviously it will not be on anymore but i will update the links and i will share the launch so you can still watch that but i will also be sharing tutorials how to make these this one's already been filmed so that one will be coming up soon and yeah i hope you enjoy it so thanks for watching and i'll be back again very soon bye


She's just the greatest. She's driving me back to New York City. Oh my God, oh my God. All right, give it to me. What's the first person? Should we start off with a bae? Who is your favorite and least favorite boyfriend that I've had? You don't look probably like any of them. There's no favorite. They're all, they're all what? Wait, let me think. The ones that you've actually gone to spend time. Yeah, that's the thing. There's, you haven't had that many boyfriends and there haven't. I mean, I've had a few. Let's see. No. No. That'd be a no.  And of all of the terrible, what was your favorite? Like if I had to pick the best of the worst? Yes. I think I know your answer and you can just tell him. Be straight. Best of the worst. Well actually the best was probably someone you didn't date for that long that I only met him going bowling that one time. Who? Like your senior, your junior, your Burke. He was another skier. Who do we go bowling with? He like has- Just say names. I'll leave it. I can't remember his name. Bowling? Yeah. He put his brother- Oh! I think I know. Just say it. No, I really don't. They're all awful. But you kind of did. They all ruined it at the end. Let's say like in the peak of the good, which one did you like the best? You're really struggling with it. I am because they're just so fatal. When I was the happiest with them The person that you probably have been the happiest with at times, even though at times it was like the worst, would have been Cappy. Yeah, you agree. You were head times where you were very happy. For sure. Okay.  Remember when you started Instagram? How we had a rule? Yeah, the rule was no bikini pics. That was how Instagram- I mean you were what? 12. When did you start Instagram? I feel like I posted a bikini picture I feel like immediately. And I know, the rule was you can have an Instagram, you just can't post any bikini pics. But what do you think of my bikini pics now? You're a very- If you have it. Show it. Show it. I think I might- Period. I tell my mom everything and she also is on Instagram. Yeah, you're just with the times. You're with the times. I just don't think it's that big a deal. It's not. It's the most savage thing I did at Birk. Do you know the most savage thing I did at Birk? The whole like, skinny dipping thing was pretty. That? I mean that was just like the regular program. That's true. You don't know the most savage thing I did. Can I tell you? I don't know. I'm gonna leave it out. Can I tell you? I just wanna see your reaction. I've already told you. And that's not what you come with with the most savage thing. I just forgot. I just, you know- That's the most savage thing. Yeah, that's true. That was pretty savage. You definitely don't wanna put that in here. The wildest thing your mom has witnessed you doing. Kind of a wild person. So I feel like it's just the daily- Like nothing would shock you that I feel like. My personality is just a little bit like I've always been a little bit of like a wild child. Right. But you're not like over the top wild. So there's not any- No. Like that's shocking that- But like most moms would be like watching my daughter ski 80 miles per hour down a ski track is pretty wild. But for you that's like, okay. Yeah. Do you know what I'm saying? Your threshold for what wild is. Is love. It's probably very true.  I tell you everything. You really do. What would you do if you had a- Oh my God, this is such an amazing question. What would you do if you had a freaky Friday situation in switch places for a day? I would just go play tennis and live my best life. My mom's a really, really good tennis player. And that would be cool to be really good at tennis. I don't know. I would chill. I'm gonna go with what Harry said.  Oh, that's easy. Okay, go. Okay, so he is six two to six four. Athletic. He could be a professional athlete, but if he was a professional athlete, that would be- That doesn't hurt. He likes to ski. Not skis, you have to be like willing. Willing to ski. Willing to do everything, adventurous. Adventurous is more the word. You don't have to ski. I'm supposed to say this. You're kind of more like a brand. Over a brand. Yes, don't really love vlogs at all. Funny, likes to dance. Silly goose times. Silly goose times. Silly goose times. Doesn't take themselves too seriously. No. Yeah. What is the funniest childhood memory that you have of Gage? Oh, I know. Say it. That the one I looked up, girl kissing girl. Literally looked up girl kissing girl.  It wasn't even that. It was like, porn came up on the computer. Guys, I just didn't know what was going on. I was playing RuneScape.  And I was like, I'd never seen two girls kissing before. And I did a little bit of research and ended up on some sketchy websites and never cleared the history. This is so hard. Cause you're so funny all the time. Like you were just so funny. Describe me in three words. Or what? No, I'm gonna make that into my own question. What are your favorite things about me? You're funny. You're very empathetic. You're loving, family oriented. You are, what do I start with?  Almost to a flaw. You're very lovey. You're very sweet.  What's the worst date you've ever been on? The worst date I've ever been on? Yeah. Probably the first date with daddy. I gotta tell her. It was like good, I mean it was like great and bad. We met on a booze cruise in the Bahamas. And then we... That explains a lot about me. So basically we were on this like pontoon boat that some locals like basically put together for kids on the beach cause I was in college. And so then I met Mark on the booze cruise. Then we decided to meet up at this club later that night and he gets there and we're talking and he's looking a little bit green. And so... Green. Green.  Like he's not looking good. Like he kind of pale and like sickly. He's like, oh, I just gotta sit down. I'm like, okay. And then he proceeds to throw up on the table in front of me. But let's just say it had a little bit too much to drink. But it worked out. He threw up on the table. Yeah. And then like... And then how did you, how did you speak to him after that? I was like, okay, let's get you in a car. It's time to go home. So I get him a cab. I guess he ended up throwing up in the cab. Of course he did. We went, were you home with him? No, I just was like, he put him in a cab instead of home. I'm like, my night wasn't done yet.  And so then he like, the funniest part was he called me the next morning. Like... And this was before cell phones, right? So he had to like track down my hotel, call the hotel. And that was before they like had rules about telling you who was staying where cause they basically just patched up through to my room. It was like eight o'clock in the morning. I was like... Psycho. I'm like, who the hell is calling me at eight o'clock in the morning? No. But I mean, it was so funny, he called to apologize and then... And then what? You made another plan? Yeah, and then we spent the rest of the week together. And then, you know... So what, did you just think he was so cute that you didn't care that he threw up? Yeah, I was like, I just, because he was in med school, I was like, oh, he hasn't been partying much, you know? Oh! Well, you know, everybody has those nights, right? No, you're just a sweetheart.  Like, you're a very sweet. But it was like kind of gross, too, honestly. I mean, yeah. But it happens to the best of us. No, it does happen.  And I honestly will almost like love people more. Cause I'm like, no, like, it's all good. Like, it's cool. Like you don't have to be perfect. Exactly. Love that. Someone said, how does she feel about the fact that you are so reckless with the money she gives you iPhone story? I pay for everything on my own. So it's like reckless with my own money. Yeah, no, totally. For those of you who think, yeah, Paige is completely financially independent from us. So period makes us feel better, but she works hard and she is completely independent. What was Paige like as a teenager? The same as she is now. I mean, I feel like I've always been the same. And you weren't really like good of an old soul.  Like, no, I don't think I was moody. I think that I feel like I've learned lessons and grown up through my life lessons. But I feel like I've always really been pretty consistent. Like, great. And you also just have been very independent because of where you went to school. So it was very different. It was like a different high school. I was forced to grow up really fast cause I was living away from home at the young age from my sport. But I almost feel like a lot of like teenage eggs is like this fight with your parents to get that independence. I had so much independence, it wasn't like there was that kind of need to like pull away. It was more like you were so excited to see us when you did that. Yeah. I feel like I was also so honest with you guys about what I was doing at all times. I always let you have my location. I never fought you about that.  Yeah, that's true.  The only thing Paige does you just can't understand. The lip injections. I didn't understand it first, I have to say. She was not a fan of me getting lip filler but I also overlapped my lips. Like my lips right now are very overlapped. Right. Like I like them now. Like there's been a couple of times that I haven't liked them as much as I like. Okay. My mom is up and always a fan of my lip filler. I appreciate it. We love an honest queen and I'm not a huge tattoo fan either. Yeah. Okay, I'm gonna do one more. Who cooks better? Nancy or Paige? How Paige is a much better cook than I am. I am really passionate about cooking and I love cooking. I've always experimented with cooking. You're just not as into it as I am. Yeah. I think you have to have a passion for it to be really good at it. I think that's true.  Yes, that was horrifying. Wait, you did, when?  No. Oh my God. When? It was recent.


What's up everybody, it's Jason from jaskiescasebrakes.com. We're giving away the last nine spots in the Bowman mixer, round of team number five here in this one pack break of Jumbo Bowman, one pack break number 23. So again, 30 total spots, everybody randomizes those customer names, teams, distribute the hits out of the one jumbo pack, then at the end of the break we'll randomize the customer names, and top nine we'll win a spot each in the Bowman mixer, number five, which is $130 spot each. So you're paying a small fraction of the price to get a spot in the big break. So let's do the break first, dice roll it, and we got a five and a two, seven times. One, two, three, four, five, six, seven. Jason, the under threat. Five and a two, seven times. One, two, three, four, five, six, seven. Five, six, seven. He's an Astros, down with the Colorado Rockies. Jason, the Astros, Zach, Paul with the Pirates, Yirvan with the Mariners, Quinn with the Dodgers, Danny with the Rangers, DJ with the Reds, Danny with the National, David with the Angels, Jarell with the Twins, Adam with the Rays, Adam with the A's, Ryan with the Marlins, Dace with the Cubs, Adam with the Orioles, Jeremy with the D-bags, Jerry with the Mets, Zach with the Tigers, Wade with the Giants, Adam with the White Sox, Adam with the Indians, Andrew with the Phillies, Chris with the Brewers, Nicholas with the Cardinals, Adam, supper when you have the Yankees, Colin with the Rows, Scott with the Blue Jays, Ryan with the Braves, Adam with the Padres, Ryan Harrell with the Red Sox, and Fred with the Colorado Rockies. Alrighty guys, so let's just close the trade when no one's really gonna trade. But let me just title this page, and then we'll see who wins spots in that Bowman Pack. Break at the end of the break, there you go. I don't know what's been hit out of here, so we may get an autograph, we may not. Well, you gotta Anthony Mulfi to 250. All right, so there you go. I think it was no paper-based ships, yeah. Alrighty guys, let's roll the dice, and let's see who's gonna win spots in the mixer, five and a six, 11 times, number top nine, get in. One, two, three, four, five, six, seven, eight, 10, and 11 the final time. Top nine, get in. Stacy, you're in. Zach, you're in. Jeremy, Scott, Zach, David, Yervan, Adam, and Chris. There you go, congratulations guys. After 11 times, top nine, get in. As are now a part of the break, and coming up next is the Bowman mixer round of teams number five.


SCP-SPOOKY-J Item number SCP-SPOOKY-J Object Class, Spooklyd Spooky Containment Procedures SCP-SPOOKY-J cannot be faithfully contained due to the nature of its being. In the event that SCP-SPOOKY-J manifests outside of its containment chamber, it is to be escorted back to its chamber and recontained. SCP-SPOOKY-J's containment chamber is a standard humanoid containment chamber with a single locked security door to ensure simple recontainment. Description SCP-SPOOKY-J is visually identical to a typical human skeleton standing 1.72 meters in height and weighing 5.44 kilograms. The skull, face, and jaw structure of SCP-SPOOKY-J is completely flexible and grants us the ability to make a range of facial expressions despite its lack of muscles or flesh. As well, SCP-SPOOKY-J is capable of vocalization of sapient thought. SCP-SPOOKY-J is capable of vanishing and manifesting at will to any location within 66.6 meters from its original position during the month of any major commercial holiday. Individuals in the location of SCP-SPOOKY-J's manifestation often report a subtle rattling noise originating somewhere behind them. Individuals exposed to SCP-SPOOKY-J and its anomalous effects are to be administered class A amnestics prior to recontainment of the entity. When interacting with living human subjects, SCP-SPOOKY-J will typically display verbally aggressive behavior often in the form of insults and challenges to physical altercations. With this behavior, SCP-SPOOKY-J is yet to seriously or purposely injure a living subject out of observable malice. SCP-SPOOKY-J displays an anomalous understanding of individual subjects' mothers and sisters where these relations are applicable. Entry Incident October 28, 2016 The following incident took place between Dr. Randy M. Filler and SCP-SPOOKY-J prior to a recontainment incident.  SCP-SPOOKY-J, you insufferable fuck!   Do you even tear anymore? This is why nobody visits you anymore! Jesus!   You can't rattle these bones! You can't rustle these jimmies!   Kill me?   I'll no scope you! I swear to God! Why do you have to do this every year? Jesus!   Every Incident November 23rd, 2016 SCP-SPOOKY-J appeared in the cafeteria Site-12 and began to collect all the uneaten holiday food into several trash bags before disappearing from staff perception. It then appeared in the quarters of Dr. Randy M. Filler and smeared cranberry sauce across the surface of his desk before consuming large amounts of bread stuffing. It's Thanksgiving!   SCP-SPOOKY-J continues to consume excessive amounts of stuffing where it exits SCP-SPOOKY-J's body through its rib cage and is now coating the floor. Why are you doing this? You don't even have a stomach, you fuckwit! I do it because I love you, dad! SCP-SPOOKY-J throws the rest of the bag at the wall where it bursts open above Dr. Filler's bed and proceeds to run out of the room before security can arrive. Dr. Filler has hence requested a transfer to another site. Request pending. Entry Incident December 24th to 25th, 2016 1950 SCP-SPOOKY-J exits its containment chamber undetected. 2030 The hubcaps from all vehicles in Site-12's staff garage go missing and are not found for several hours. 2314 Dozens of large gift-wrapped boxes appear in the common area of Site-12 while the room is vacated. 110 SCP-SPOOKY-J reappears in its containment chamber displaying erratic excited behavior it is wearing a green Santa hat at this time. 1050 An announcement is made that staff vehicles have been vandalized and on-site personnel display warranted agitation. 1035 Various personnel enter the common area of Site-12 and discover the gift-wrapped boxes. On the wall further from the doorway, the statement, Merry Christmas, fuckboys, is painted in expired gravy. 1055 All gift-wrapped presents are opened by an EOD team and are all discovered to contain the stolen hubcaps from the staff garage. A request has been submitted to the Administrative Board on the topic of determination and archival SCP-SPOOKY-J to prevent future nuisances and possible hazards of Site-12. 1060 Entry Incident, February 14, 2017 Dr. Randy M. Filler receives an anonymous package containing a human tibia and a letter reading This Valentine's Day, I'd like to be your fuckboy. From your Spookily. 1060 Contents of the package have been moved to forensic storage. Dr. Filler has requested an indeterminate leave of absence after receiving this package. Request again denied. 1060


So, welcome to the Dr. Gundry podcast. You know, I'm willing to bet that just about everyone has woken up stiff, sore, or achy from time to time. In fact, according to the National Institutes of Health, 80% of adults experience lower back pain at some point in their lifetimes, 80%. And a quarter of adults have experienced lower back pain in just the last three months. Well, today's guest has spent his entire career helping thousands of patients reclaim their lives from chronic back pain. He's Dr. Vijay Vatt. And on today's episode, he and I will discuss why everything you've been told about back pain is wrong, how he treats his patients, and what you can do about back pain today without dangerous drugs. Dr. Vatt, welcome to the podcast. Thank you, Dr. Gundry. Nice to be here. So, your book, Back Rx, was just reissued this year. It was originally out in 2004, is that right? Yes, correct. That was my first, first attempt at writing a book. So, what's changed since you first wrote this book? This is totally revised and re-edited. What's happened in the 15 years since that book? Well, so I think in 15 years, there are a lot of simple things that we know now, you know, call it combining ancient wisdom of the East with scientific discipline of the West. And, you know, it's been my mission really to have simple, effective solutions for big issues like back pain. So, now we know, for example, simple things like vitamin D, for example, take an inadequate amount, keep your levels 50 plus if you have chronic back pain, because it has a big impact on not just reducing back pain, but potential depression that may sometimes present with back pain. So, you know, one of the things I'm impressed about you is that you're, you're willing to say that a lot has changed in the last 15 years since I wrote my first book, and I've learned things in the last 15 years, and I'm not afraid to say, you know, here's the new things, and I want to tell you what I've learned in 15 years. Well, yeah, first of all, in those 15 years, I've probably been blessed to gain knowledge from at least 10,000 extra patients suffering with back pain. So, that's always, you know, patients teach, as you know us every single day about little tidbits there, and hopefully that makes us better clinicians and better armed with knowledge. Also, I've learned a lot from my colleagues here at Cornell Medical Center in different disciplines, from cardiology to internal medicine. And, you know, being here, there's constant bombardment of knowledge from people that come and speak to us from all over the world. So, it's sort of that cumulative distillation effect of secrets, if you will, that I've been able to put together over the last 15 years, because I'm a quote-unquote season clinician now, whereas when I started out in 2004, I was only in practice a few years. Well, and one of the nice things, and you know, I dedicated one of my books to my patients, because if it really wasn't for my patients, I wouldn't know most of what I know. Among other things, they've taught me tips, and they've asked me questions that, quite frankly, I didn't have the answer to, or I needed a better answer than what I had been taught. So, you know, I congratulate you that you learned from your patients, and that's... You know, I think despite our degrees, we have to be open-minded, because patients can really... I mean, for example, about 2009, right after the stock market crash, one of my patients was suffering with a lot of back pain. He had arthritis in his facet joints, and we tried everything, you know? And I said, look, you're really a bad surgical candidate. And then he comes to me three months later, you know, I bought this $25 inversion table, and my pain is 80% better. And, you know, I hadn't even thought about inversion table till that point. So, it's that cute little experience. Now, it may not work for everybody, but it worked for him. And the $25 table saved him from expensive procedures and maybe lumbar fusion. Yeah, I think I'd probably rather spend $25 on an inversion table than lumbar fusion. And maybe we can get into that. And just to kind of continue that note, you know, you and I were taught that this is the practice of medicine. And I think the beauty of what you do and what I hope I do is our patients allow us to practice medicine.  And let's see what it works.  My back pain is 80% better. So, so good for you. I congratulate you on that. And that's why one of the reasons I wanted to have you on the podcast. So, thank you. You were one of the early voices about sounding the alarm about opioid painkiller addiction back then. What were you seeing in the early 2000s that, you know, that alarmed you and what's changed since that time? Boy, a lot has changed. So, you know, right around 2000 with the National Institutes of Health and National Academy of Medicine, you know, basically saying we're way under treating pain, that pain is a real symptom. So what happened, doctors took the prescription pads out and just started writing opiates left, right and center. And so we sort of are partially responsible for creating the opiate epidemic. But, but that epidemic really started at the federal government level. You know, it was message from there. And then the federal government realized that there were too many deaths, too many complications. And now we've done a 180 turnaround where there, where I think we are, there's a huge backlash against any opiate use whatsoever.  But we've gone the other direction that any opiates are bad now. So there's a huge shift from 2000 to 2019 with opiates. So in your practice, how do you make the decision of when you're going to use these or you're trying to get somebody off of these? I'm sure you're faced with this almost every day. You know, my battle last 20 years has been trying to get patients off opiates.   You know, if you have a chronic disc issue with back pain, walk every single day 30 minutes, take the vitamin D. You know, one thing you and I sort of share is food as medicine, the most most overlooked potent weapon we have, you know, good food is good medicine. And sometimes you just say to somebody with chronic discogenic back pain, don't sit too much, take your vitamin D, good, good ergonomics, vitamin D and good food. And that can sometimes have a dramatic impact on lowering their back pain where they don't need opiates long term.  So my goal has been to get patients off opiates as much as I can. Now, acute severe back pain five days of opiates are probably appropriate, but long term, I think the harm is more than the good. So in a similar vein, I really want to dive deep into your thoughts of food and the gut and the gut wall and back pain. I know a lot of particularly sports medicine and orthopedic physicians that I deal with give out NSAIDs like ibuprofen or naproxen like candy for back injuries. Any thoughts on the danger of just using these simple over the counter pain killers? Well, so I talk a lot about that in back RX, you know, the book, the old book and the new book, I've been on this, if you want to call it a crusade of not overly prescribing anti-inflammatories because they're 40,000 deaths a year just from going to your local CVS and buying Advil and a leave and taking it recklessly. So, you know, my philosophy has been if you want to take anti-inflammatories, take them in spurts. And to my physician colleagues, I say to them, you know, first do no harm. I mean, try not to cause the patient a bleeding ulcer that could potentially lead to death or kidney damage or high blood pressure or heart disease, which are all dangers of anti-inflammatories use long term. So I think we as physicians have to really be cognizant of that and stick to the first do no harm or that we took. Yeah, I've looked at the pharmaceutical literature about the dangers of, you know, simple NSAIDs. And it's shocking that they knew how dangerous ibuprofen or naproxen was to damaging the gut wall, even a few of them.  And it was really the FDA, the original warnings where you should only take it for two weeks because it was so dangerous. And, you know, now we have children's Advil and we, again, it's the most widely available, you know, painkiller in your drug store. 40,000 deaths a year. Yeah. Say that one more time. 40,000 deaths a year. 40,000 people die every single year by taking Advil, Aleve and those kind of over the counter drugs. Yeah. So yeah, you and I, you're right. We're on a crusade to really severely limit this. And my experience in treating autoimmune disease, and I've written about this, the number of people with autoimmune diseases that started with a sports injury or an injury that they were told to take, you know, ibuprofen and naproxen for a few weeks. And it literally, you know, perforated their gut wall and it released all of these problems. And you can, you could set the date and when this happened. And it's, it's scary. And the really scary thing is pharmaceutical companies researched this, they knew it was going to happen. And we physicians, unfortunately, weren't told about this. But it's there. So, okay, so let's go back to the gut now. And you talk about food as medicine as I do. So let's talk about pain and the gut microbiome and the gut wall. What's, what's your thoughts about the relationship of pain, the microbiome and the gut wall? Is there a relationship? Oh, there's a big relationship.  You know, and, you know, again, to me, good food is good medicine, you know, not necessarily food is medicine, but good food is good medicine. And if you get the microbiome altered in a positive way, then it can actually have an impact on decreasing pain sensitization. So if you have good gut microbiome, it will actually decrease your pain sensitivity. If you have a bad gut microbiome, then it will increase your pain sensitivity. So the same injury in your disc, let's say with good microbiome, if your pain level is three, the same disc injury in somebody with a bad microbiome, your pain level will be seven. So it definitely plays a pretty significant role in our opinion and can be an effective weapon in managing chronic back pain.   But there's literally plenty of research that proves this. Yeah, I mean, there's there's plenty of research and the research is going to come out in a big, big, big way now that the medical community has all of a sudden woken up and realized that the trillions of bugs in your stomach can have a profound impact on your health. I mean, finally, the tube I went on in our colleagues and said, hey, we need to look at what we're putting in our mouth. But look, I've had patients, I'll give you a prime example of a guy who had peripheral neuropathy and significant, ridiculous pain as well. So sciatica combined with peripheral neuropathy and he was on high doses of Lyrica couldn't tolerate high doses of Neurontin couldn't tolerate severe pain when he walked, you know, was recommended a fusion for his back and not to mention the peripheral neuropathy. They were doing this IVIG infusions possibly, gamma globular infusions. And I sent him to a nutritionist and she recommended, she said, you are gluten allergic.  And he was flabbergasted that simply using good food as good medicine as a tool can have that big of an impact on his quality of life. And by the way, there are numerous examples in my practice like that. So I wish it was pseudoscience. I mean, it is potent real science. Yeah. And, you know, unfortunately, you're right. I think we're the general medical community is beginning to wake up to this. But yes, just yesterday in my practice, I saw a 63 year old woman who literally arrived in a wheelchair brought in by her husband. And she had really profound muscle wasting in her thenar eminences. And she had a she had a duped ens contracture. And she literally wasn't able to walk. And she had been diagnosed with Parkinson's, and that this was a typical presentation for Parkinson's. And I say, you know, I see a lot of Parkinson's patients in my practice. And I can tell you that, you know, thenar eminence muscle wasting and duped ens contracture is not a presentation of Parkinson's. And she had no tremor, which is possible. And she really didn't have the flat affect of Parkinson's.  And she said, Well, no, they told me that she was an HMO, a very good HMO. And they said, no, that's not indicated in the diagnosis of what you have. It's classic Parkinson's. And she turns out her initial testing shows she carries the gluten intolerance gene. She has autoimmune markers of lupus. And no one had bothered to even consider that, you know, you have Parkinson's and try this drug. And you're right. It's just like astounding in almost 2020 that this still goes on. So I think yes, the point I think I want to make and you want to make is you got to, you got to find a healthcare provider that's going to take your issues seriously, whether it's your back, whether it's peripheral neuropathy. And don't keep looking for, you know, proper answers until you find someone who will listen to you. What are your colleagues there in orthopedics say, the spine surgeons tell you about what you're doing? Are they in favor of this?  You know, I'm a big believer that you got to do what's in the best interest of patients.  So when I initially invented back RX, simple 15 exercises for reducing back pain, you know, clinical trial results or clinical trial results, you know, we went through the whole IRB and rolling the patients and the results were amazing. You know, simple 15 mind body exercises done minimum three times a week had a profound impact on decreasing back pain, recurrence of back pain, use of opiates and medical procedures. So the proof is in the data, you know, I mean, so they can throw mud at me as much as they want. Look in this, you know, doctors, especially in a procedure driven place, they're not necessarily happy if you say to them that we have tools and ourselves to keep you, you know, simple solutions to keep you active that does not involve medical procedures or surgeries. You know, they feel threatened by that because medical economics is a sad part of medical practice. But I think if you're true to the principle of being a physician where you put the patient's interest first, there are a lot of simple solutions for staying active. And I think we have to arm patients with those tools to be able to take better care of themselves and rely less on the healthcare system. So that's, yeah, that's a great segue into back RX. So what are the most common issues that, you know, you see in the patient who comes to you and what causes them and we'll go from there? Well, so, you know, sitting is the new tobacco, right? So excessive flying, driving, sitting at work, then coming home sitting on a sofa, you know, that sitting is a number one reason for huge explosion in back pain. And that what that does is it puts a lot of stress on the disc and it predisposes the risk to get it to predisposes the disc to get injured because it's not getting in nutrition during the 24 hour cycle because so walking actually is very good for the disc because it does this kind of thing and bring nutrition to the inside of the disc. So I see a lot of disc issues, big time and especially nowadays in younger and younger population, you know, in their early twenties because people are just sitting more. And then at the other end of the spectrum, I see a lot of spinal stenosis is the general term, but I just call it wear and tear in your back from just living life where the disc wears out, the joints get arthritic, you get back pain or sciatic pain. So those are the two most common categories of people that I see. So what sort of, what kind of lifestyle changes can, you know, our listeners make to reduce their risk of these chronic forms or acute forms of back pain?  You know, if you can do that every 30 minutes to an hour, you're on your way to really reducing your risk of heart eating a disc. I mean, I can't think of anything more simple than that, get up every 30 minutes to an hour at work. You know, I think that's a great recommendation. I actually haven't heard it expressed that way and I love that.  I like that. I like that a lot. And I think given nutrition, actually, when you stand up in that position, you're bringing some nutrition into the disc. Fantastic. Okay. So computers aren't going away. Desk jobs aren't going to go away. You and I are, you know, seated usually when we're seeing our patients, other than just standing up every 30 minutes.  Well, that's, that's a big thing of mine in the last two or three years. And as there's a, as data mounts that those who stand more during their work day than sit, you know, they tend to have less chronic health issues. They enjoy better quality of life and potentially better longevity.  If you get used to having a standing work desk, great investment. Any tricks on a plane in an economy seat across country? You know, whether it's economy, business or first class, it's still the pressurized cabin is the big deal. Pressurized cabin with low oxygen content. Now that's changing as aviation changes with better ergonomics, better oxygenation and better humidity. So if you look at the new Dreamliners, you know, they have better ergonomics, better humidity and better oxygen content. But you know, not all of us have a luxury of always flying in a Dreamliner. Right. So, so I think you got to figure out a way to try to recline the seat back a bit that alone helps whenever you're allowed to do that. And then if possible, every hour and a half, two hours, just get up and just try to walk in the back and come back. Even if you do something as simple as that, it could really help save a lot of air travel related back issues. So if I'm on the windows seat, can I bring a prescription from Dr. Vadd says, excuse me, I have to get up to people sitting next to you. Yeah, I have to get up and walk for the sake of my back. Sorry, my destiny is oxygenation. You know, you can just stand up in place.  You just sit in your seat, you just get up and just do these single leg stands that are that we shown in the book as well. Just 10 count each leg and sit back down. Perfect. And maybe carry a note from you saying, I'm not crazy. This is what I'm supposed to do. Take a carry the book and shirt to the to the staff and say, look, it's right in the book. Yeah, even better. Okay. Yeah, everybody. So I'm holding up a copy of his book, back RX. So yeah, you have to carry this on the plane and just hold it up and saying, excuse me, you know, I'm protecting my back on this long flight. Great.  Okay, I like that.  You're going to get swollen ankles. And standing isn't such a good idea, because you're not walking. And there, there are certain people who obviously are not going to be able to stand for extended period of time. Any tricks for the seated individual? Well, so, you know, there are there are deaths that you can sort of go up and down, you know, so you could sit for 20, 30 minutes and you can stand for 20, 30 minutes. I mean, I think for them this, they called, you know, the variable deaths that go up and down could be a great solution.  Perfect. And I like hearing the way these deaths came about. They were actually two cardboard boxes on top of each other. And so if worse comes to worse, get yourself two cardboard boxes and you've got a standing desk. Don't want to take anything away from the designers, but they've actually. That's the Dr. Gundry under a dollar standing desk. That's right. The under the dollar standing desk. Okay, tell me about the relationship of weight gain and back pain. Is there any? Well, there's a there's a huge relationship between weight gain and back pain. So whether it comes to putting a tear and bulging the disc or the disc wearing out sooner and you get you getting arthritis in your spine in your 40s and 50s because of increased weight has a lot to do with it. So I think besides maintaining a good core, maintaining good body weight is is crucial for trying to minimize back pain. So, you know, I've heard and I know any pregnant woman knows this that particularly weight gain, particularly in your gut really changes your your posture and and how your back, the lordosis of the spine has changed. Are you do you see that as a factor? Is it more than that? I think it's that's a factor, definitely.  But if you're 25 pounds overweight, then the seated bent forward, the pressures are almost doubled even just by 25 pounds overweight. So, you know, but the good part about that is it's a four to one ratio. If you lose one pound, you take about four pounds per square inch pressure off the disc and the joints. So it's a 400% return. So not a bad deal. That's a very good deal. I used to a long ago when I was doing some early TV shows when I first changed my career, you know, I had lost 70 pounds and I would bring a 50 pound bag of dog food into the TV studio and I would ask my host to take and hold the 50 pound bag of dog food in front of him or her and start walking around the studio and see how they did. And it's, you know, when it creeps up on you slowly, you know, you don't notice it, but when you suddenly have 50 pounds or 40 pounds or 30 pounds, it's dramatic what you can feel in your back. Exactly. All of a sudden you realize, oh my God, I've been carrying around those 70 extra pounds for all those years. Imagine the tension on the back, the hips, the knees, the ankles. Yeah, and certainly in my practice, we've seen people who literally were scheduled for back works, spinal fusion, hip replacement and even knee replacement. When we got weighed off of them, they actually canceled their operations and it was, you know, it was the weight that was, you know, exacerbating these conditions. Absolutely. And certainly the weight, as you and I both know, contributes, particularly abdominal fat, contributes to inflammation to the entire inflammatory condition. Absolutely. You know, increased chronic inflammation that is associated with increased back pain, arthritis, heart disease, cancer, and on and on and on, you know, neurodegenerative issues. So it pays to keep the weight down and keep the inflammation down. Yeah. And, you know, getting back to what we talked about earlier, I mean, there is a very strong correlation to NSAID use and coronary artery disease and vascular disease in general. In fact, you know, many of us forget that several of the, you know, prescription NSAIDs were removed from the market because of this association with increased heart attack and stroke. And so all of these actually share a common factor. And there's really none of these that are safe for long-term use. That they're absolutely not. And that's one of them. That's one of the reasons, you know, I invented a medical food called Vanakvar. You know, it's highly absorbable curcumin that we just finished clinical trials showing that it's pain-reducing efficacy is similar to that of the proxen without having the side effects of the anti-inflammatories. As a matter of fact, this particular curcumin, the microactive formulation we have, the serendipity was, that it reduced high-sensitive CRP. So the corneal, cornealcardiologists are sort of salivating over this serendipitous discovery. That's great. Yeah. I'm a, I'm a big fan of curcumin and people who are listening to us. That's the active ingredient, if you will, in turmeric. But unfortunately, you and I both know that turmeric is very poorly absorbed. And that's why, you know, we have, my team in Boston put together technology to increase, not just absorption, but is, we call it bioactivity to get into the inflamed tissues. Yeah, exactly. Okay, shifting gears, every good old Dr. Sarno was famous for his claim that all back pain, back pain started in the mind. What say you about that? Well, so, you know, I used to invite John Sarno to come and give grand rounds at our hospital. And he was a positive influence on my journey. That I think his contribution was that the mind plays a big role in back pain. You know, after 9-11, I saw a big number of people with herniated, real herniated disc from the stress of 9-11. So there's a real relationship, the mind-body relationship. I think when he went a little bit overboard is that all back pain is tension myositis. Well, back pain, there are multiple diagnoses that can cause back pain. And whereas 10% of back pain could be the tension myositis that Dr. Sarno says, where there is nothing structurally wrong with you, the other 90% have structural issues. Maybe that the mind and the stress contributed to either the disc blowing out or the pain spiking up, but there was a real underlying structural issue. So, but I do believe his overall contribution is a good one. Despite sort of over going on one diagnosis as the end of the offer back pain. So are there any mental exercises that people with back pain can benefit from? Absolutely. You know, I mean, I tell patients with chronic back pain, do five minutes of meditation at night before going to sleep.  I mean, the book title is actually an exercise program where you do deep breathing combined with 15 postures. But to this date, I get letters from 2004 to 19, 15 years from patients saying just the breathing aspect of that exercise program had a profound impact on my pain. So I think control deep breathing, meditation, mind-body therapy, these all have a huge positive impact on back pain. And remember, often back pain can present with depression. So it can have a positive impact on both. Yeah. So, okay, so we've got, we've got the mind, we've got path posture, we've got your great exercises. You're in, you're in my food recommendations look very similar. And I think a lot of us working in this area for so long have very similar views. Give our listeners your thoughts on what foods in particular are really going to benefit them with back pain, for instance. Well, so, I mean, the anti-inflammatory foods, really. So, you know, in sort of corn oil, I'll try to use olive oil. You know, minimize intake of processed sugar. Now, if you have ice cream one day a week, it's probably not going to have any huge negative impact. But in general, minimize processed sugar as much as you can. But, you know, I'm a big believer in plant-based diet. So I think that has an impact.  But it means eating complex carbohydrates. So the more bulgur, the quinoa, those kind of complex greens. Obviously greens, you know, fish to me gets sort of a rare exception for meat that truly has very high anti-inflammatory properties with omega-3. But you got to be careful about lead poisoning and things like that with fish. Also, it's not a, it's not a gamey. But so I think the general recommendations are less processed sugar, less fatty meats, more greens, more complex carbohydrates, more complex greens, more things like olive oils, more berries, those kind of things. Great. Getting back to supplements, you started our conversation with mentioning how important vitamin D is. And I second that. I think it's number one, it's a hormone. It's not a vitamin. And I think it's probably essential. I'm glad to see there are a lot of labs in this country that are raising the normal vitamin D level up to about 120. And, you know, I, in my practice, try to get my patients somewhere between 80, 100, I'll take 120. I've run my vitamin D level greater than 120 for the last 17 years now to prove I'm not dead. And so, so far so good. Any other supplements that just as a general rule besides vitamin D3 that we should be thinking about?  You know, for me, I take daily vitamin D3 and I take curcumin. I mean, for me, curcumin has benefits of potentially reducing risk of Alzheimer's, potentially heart disease, colon cancer. I mean, outside of those two, I personally, I'm not a huge believer in taking up 18, 20 supplements every single day. But I think it's balanced diet, take things like vitamin D and curcumin. Try to exercise every day to keep your back pain and check, you know, sort of pragmatic sensible things. Okay. Well, Dr. Vatt, it's a pleasure to talk to you. And thanks so much for coming on the podcast. Where can listeners find out more about you and your work and where can they pick up the new edition of BackRx? Well, BackRx, new edition is available at Amazon, at Barnes and Noble, all that kind of places. And then, you know, more information about me is vjavad.com or hss.edu. That's Hospital for Special Surgery in New York. And hopefully, you know, I'll continue my work for finding simple, effective solutions for staying active. And please never retire and please keep seeing patients, because that's where people like you and me get all of our knowledge. And I congratulate you again on that. Yeah, patients keep me young and active. And I appreciate the tip about the vitamin D, whereas it was 50, was my personal bar for chronic back pain. Maybe I should consider raising that to 70 or 80. So, you know, learn something new every day. So I've learned something new. Yeah, and vitamin D actually is very essential for activating stem cells that line our gut that I reference in my latest book, The Longevity Paradox. It's very, was shocking to me to see how important high vitamin D levels are for sealing the wall of our gut and making stem cells grow. So love that. I love that hormone. That's great. All right. Thanks again. And we'll have you back again sometime soon for some more tips. Absolutely. All right. Thank you very much. Nice chatting with you. Okay, it's time for one of my favorite parts of the podcast, the audience question. And Ryan Smith, 394 on Instagram asks, Dr. G, does coffee or tea disrupt the autophagy taking place while in a fasted state? Absolutely not. First of all, for those of you who are wondering what the heck is autophagy? Autophagy is actually the cellular process when a cell is nearing the end of its lifespan. We actually have two things that can take place. We can actually recycle the cellular components and build a new cell. And that's called autophagy. And quite frankly, autophagy is incredibly good for your longevity. The other is the cell literally exploding kind of like a death star, as I tell my patients. And that's called apoptosis. And there won't be a test. So it's okay. So coffee and tea actually does not influence autophagy. In fact, there is some evidence that compounds in coffee and tea, as long as you drink them black, may actually stimulate autophagy. So yeah, have your coffee and tea. When I'm fasting during the day, I start with two cups of coffee in the morning, and then I have about five cups of green and poo air tea during the day, along with the mint tea mixed in with that. So and you can, I guess, see the effect on me, which is so far so good. So but that's a great question. So thanks very much. And another question I get all the time from my patients is, can I still take my supplements if I'm fasting? And absolutely, there's going to be no effect on taking supplements while you're fasting. In fact, I happen to think that there are certain supplements that will really benefit you during fasting. But now is not the time to talk about that. Okay, and here's our review for the week from Maria Mamina, who gave a review on Apple Podcast. I believe that we have the wisdom to cure all diseases and Mother Earth help is with that. This podcast shows we don't need medicine in order to be healthy. We need to be aware. Thank you, Maria. That's a great comment. And thanks again. All right, that's all for this week's episode of the Dr. Gundry Podcast. We'll see you next week. Bye for now. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts, because I'm Dr. Gundry, and I'm always looking out for you.


stress drunk Welcome back once again to snes drunk plays mega man x2. Let's move on to the next section What could it possibly be? It is the old mega man staple that is a been in every mega man game I believe as it's been in everyone up to this point It's where you have to wait for it Fight all the bosses all over again. You have to go in these capsules here Not sure what that one's all about. It's all empty. Oh, I'm not even in there yet. You have to Go in one of these. What's with this one? Anyway, it's wrong room spoiled the surprise You have to beat every boss all over again. There's capsules all over this freaking room and we start with Who do we start with?  There was actually somebody at the door. I had to edit my way Out of that situation there and as a result I am totally off my game God damn it. I've already touched on this, but how humiliating to be defeated by bubbles. I Mean if it were Michael Jackson's chimp or is it a chimp or? Need that he named bubbles. I think it was a chimpanzee Now that's something else because you know Monkeys are coordinated or monkey chimps are coordinated and smart Tactical and I'd like to see a chimp fight Mega Man be pretty cool. And now we have bubble crab. I Wonder what actor once if you missed the last episode I talked about a potential Mega Man TV show That I I came up with that Would be modeled after the old Batman TV series from the 60s And it would have Jeff Goldblum as as Mega Man because that would be completely stupid I'm trying to think of actors for these these Reploids some of the called replicants replicants is blade runners Like who does this guy look like he kind of bubble crab kind of looks like Wilfred brimley Wow, I took a lot of damage there So we've got Wilford Wilford brimley for bubble crab is he still alive? I don't know and then we have For the for the stag flame stag you could have I don't know think of an actor. That's really tall We can get Christopher Lloyd for that right just for Lloyd's a pretty tall guy I think That damn it get up there get up there Jesus. Oh There's life up there. I should probably do something about that Yeah, Christopher Lloyd is flame stag dressed in a completely hokey costume it doesn't look remotely realistic It's all I think Christopher Lloyd's like 65 70 years old All right now who plays who plays wire sponge How about good old-fashioned Gary Oldman he can give it a in English slant That Gary Oldman I read I read it on the internet. So it must be true That Gary Oldman had played so many American roles that required so many American accents Obviously, he's English That he forgot his original accent and voice and all that Shit. I'm gonna have to use another Subtank um Yeah, he forgot his own his original accent and he just started talking American all the time and he had to relearn How he used to talk which is really Interesting, I mean I just think it's fascinating that we may live to be we could live to be a thousand years old And we'll still never understand the human brain like barely at all Just very That spike on the wall is really Infuriating because I can't climb But it's a little too high for me to shoot and I don't want any others to accumulate There we go. Thank you for exploding that for me, sir Mr. Oldman So we got Gary Oldman as wire sponge.   You just go straight. I'm trying to like do all this like maneuvering Shit Who could be next yeah, we're just gonna go in order all the way around up here And we got to morph moth This is a tricky one because you know he has to be able to Change forms and begin as a whatever that is I don't even know what you call that the moths come from cocoons like The same way butterflies do I honestly don't know So who can play morph moth?  What if we had What what is her name she plays Queen Elizabeth she plays she's in Lord of the Rings Kate Blanchett We have Kate Blanchett as morph moth.  This is a Magnus centipede so it needs to be kind of a creepy crawly guy And when you think creepy crawly guy and acting in TV you think of Steve Busce me so Steve Busce me as it is gonna play a centipede in the Mega Man TV series. I think that's How does that miss?   God. I'm almost out of sub tanks.  It's the mega buster.   Okay. That's not the right way to do things I'm just being stubborn at this point and very frustrated Was it this jump there? Thank you jump again.


All this month, get up to $50 off any Android smartphone from Appalachian Wireless, any Android you desire. All $50 off with two-year agreement, better service, bigger savings, that's today's Appalachian Wireless and East Kentucky Network Company. This Saturday, families from all across our region will meet in the Pineville City Park to show their support for the March of Dimes. Without the support that the March of Dimes has received in the past, we wouldn't be here with three daughters, you know, we would probably have two and that's heartbreaking. The Goodsons from Pike County are this year's Ambassador Family for the Central Appalachian March for Babies. We had twins in December of 2016, Avery and Maisie. They were born about four weeks early. And that is when Melinda and Jeremy learned firsthand about the March of Dimes. Avery went on to develop PPHN which is Persistent Pulmonary Hypertension of the Neonate and she had to have nitric oxide and without that nitric oxide, my child would not be here and the March of Dimes funded the research for that treatment as well. The Goodsons will be sharing their story on Saturday along with Avery, Maisie and six-year-old Isla and the community is encouraged to come show their support for the March of Dimes.  After a short ceremony in the city park, everyone is invited to take a walk around town to march in support of families like the Goodsons who say they owe everything to the March of Dimes. The March of Dimes is a great thing and without it, my family wouldn't be complete. We're just so blessed with how far our girls have come from, you know, December, the end of December of last year until now.  Registration begins at noon and the March will begin at one. In Pikeville, I'm Shannon Deskins for EKB News.


Hi everyone, Joe for jaskiescasebrakes.com. We did it. We knocked out the the team random That'll unlock pick your team three. That's coming up in the next video So basically these team randoms in pick your team three we pulled the remaining 19 teams out and We're randomizing them to you So it's a random team break kind of because we're only just randomizing your names But not the teams that list remains the same Also, if you bought a full spot, you can win a free spot Buy a full spot win a full spot. So that means that group right there in this group right here bought their full spots Let's do that randomizer first, and then we'll sign you a team So name on top gets a little buy one get one scenario after seven times one and a six one two three And seventh and final time name on top after seven Jeff congrats to you. Thanks for buying some full spots You have been rewarded With an extra spot But that keep that rooftop next to your name. So you know you won that in that randomizer All right now we can assign you a team. So let's gather all these names right here There's the team list right there. We'll sign you a team Everyone get something now. Let's roll it randomize it names just names two and a two for the hard way one two three and Four good luck after Wow Jeff's name on top as well Jeff down a Logan So here's how it shakes out for everybody And we'll put a little rooftop next your name again to let you know let everybody know That's the team you won in this team random.