رونوشت 🔗
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Hi, welcome to your checkup.
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We are the patient education podcast where we bring conversations from the doctor's office to your ears.
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On this podcast, we try to bring medicine closer to its patients.
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I'm Ed Delesky, a family medicine doctor and obesity medicine specialist in the Philadelphia area.
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And I'm Nicola Ruffel, I'm a nurse.
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And we are so excited you were able to join us here again today.
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So what are we going to talk about today, Nick?
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Today we're looking, well, we're talking about coffee and caffeine.
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And we're looking at why the same cup of coffee can feel completely different from one person to another.
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So one person has an afternoon coffee and sleeps normally.
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Someone else has the same amount at noon and is awake all night.
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And we like to think of a useful way to think about coffee is like a dose, a clock and a person.
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What you drink, when you drink it, and how does your biology and health affect the response?
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Those three questions take us beyond coffee is good or coffee is bad.
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We also need to separate coffee from caffeine.
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So caffeine is a drug with short-term effects, and coffee is a complex beverage studied in long-term health research.
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Those bodies of evidence overlap, but they are not interchangeable.
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So we're going to start exploring what caffeine actually changes.
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So as the day goes on, a molecule or a hormone, if you will, neurotransmitter called adenosine.
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It signals and helps build the feeling we call sleep pressure.
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And then caffeine occupies adenosine receptors, especially in the brain.
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So that sleepiness signal becomes less noticeable for a while.
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You may feel more alert, and reaction time or performance can improve in some situations.
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But caffeine has not removed your need for sleep or repaid lost sleep, if you will.
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One way I want you to think about this is a dashboard warning light becoming harder to see.
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Let's say that the fuel tank has not been refilled, but the light is just a little bit dimmer.
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Essentially, you know that the tank is empty, but you can't see that the light is on.
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We think that this distinction matters because if it's caffeine is helping you enjoy your morning or get through an occasional demanding day versus repeatedly covering major daytime sleepiness.
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Your body handles caffeine whether it comes from coffee, tea, or an energy drink, or even a supplement, but those products are not otherwise equivalent.
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Coffee itself contains compounds besides caffeine.
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An energy drink or supplement may differ by delivering caffeine in a very different dose or in a different form with different added ingredients.
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So we shouldn't transfer like every coffee finding to every caffeine-containing product.
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So Nikki, um, when in the the case that someone says that like they drink coffee and they feel normal drinking the caffe the coffee, does that mean that does that mean anything in particular?
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So it can reflect more than one thing.
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It can be an acute stimulant effect or relief of an overnight caffeine withdrawal or just the comfort in drinking the drink itself.
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Well, like that sensation of like it making you feel normal again doesn't necessarily tell us like which of those might be happening.
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Yeah.
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And I guess like feeling less sleepy may not be the same thing as being fully rested in and of itself, which is uh I think an important distinction.
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So Nikki, can you uh take us through we talked about the per we're gonna talk about the person later, but we kind of split this up into three ways.
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We talked about the person, the dose, and the clock.
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Can you kind of walk us through so Nikki, can you take us through the we have a three like three thing framework here the person, the dose, and the clock.
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We're gonna cover the person later, but can you take us through the dose first?
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I can.
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So the dose is a little tricky.
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The first problem is that we quote unquote a cup is not a dose.
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Um, the FDA lists a wide range for a typical 12-ounce brewed coffee, so that can range anywhere from roughly a 113 to 247 milligrams of caffeine.
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And specialty drinks can vary, can vary by recipe and size.
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If you want to understand understand your habit, look up your usual product when the information is available and count coffee, tea, soda, energy drinks, supplements, um, or even some caffeine-containing medicines.
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And also note that decaf is just much lower caffeine, but not necessarily zero.
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So, what does the FDA say about like an upper limit of dosing for caffeine?
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They cite
Load full transcript
about 400 milligrams per day as an amount that's not generally associated with negative side effects.
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And this is a population level benchmark, so this is not like a personal goal or guarantee for anyone.
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Yeah, like it you're not gonna like run out there and be like, oh, the FDA said that it's okay, so you should.
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Right.
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And so, like, if you're someone who may maybe feel jittery after they've had like 150 milligrams of caffeine, you don't need to work your way up to 400.
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Yeah.
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It's not gonna be good.
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Yeah, that's like that's what we mean by like population level and not not specific at all.
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And like we also might say that like 400 milligrams across the whole day isn't the same experience as a single large dose all at once.
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And I guess speaking of like the day, this kind of segues into our next part about like caffeine and the clock is our second arm that we're trying to go through.
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So, how like some people drink coffee earlier in the day, some people, like your dad, are able to like consider drinking it late at night and like technically be fine.
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What do we understand about that so far?
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So we do understand that caffeine can still be in your system after the obvious buzz has faded away.
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In a randomized crossover trial, a 100 milligram dose did not significantly disrupt sleep in that study when it was taken up to four hours before bed, while a 400 milligram dose affected sleep when it was taken within 12 hours.
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So much larger effect that crosses into bedtime.
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12 hours is kind of a long day.
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It's a whole day.
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And so this did not create a universal four-hour rule or 12-hour rule.
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It just shows that dose and timing do interact and a larger later dose.
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Yeah.
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So then when people like look at sleep, I think a lot of people tend to think about like sleep onset.
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But is that that it doesn't seem like that's all anyone should be considering.
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So in considering sleep, you should look at the full night.
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So how long did you sleep?
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How settled did you feel in your sleep?
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Did you wake at all or more often than usual?
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Because some of us do wake up in the middle of the night regularly.
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What were you doing at 3 a.m.
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the other night?
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Last night I wasn't doing anything.
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Oh, great.
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Well, we'll talk about it.
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Fell asleep.
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We'll talk about our morning later, guys.
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Um, and how you function the next day.
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And that's not the same for everyone, right?
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Like sleep like at night.
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Like some people do sleep during the day.
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It's like for a shift worker, that like a coffee after lunch really doesn't mean a whole lot because it's like not the same time at all.
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Um, the the relevant clock is time before a planned sleep.
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So if you want to test the timing, you keep the drink about the same, and you could move it earlier for several days and just change one variable so the result is you can interpret the result.
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That's like a little soft science that we're doing here.
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That's all we're really doing.
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We're doing little experiments all the time when we make these changes.
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The the 400 milligram study in that sleep study was a single large dose, and it was wasn't an instruction.
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Some results describe averages, and a small trial really can't give every listener a personal cutoff by any means.
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So essentially the practical conclusion is much narrower.
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Note the approximate dose, place it on your own sleep clock, and use your own response to refine your plan if you're using caffeine in a specific way.
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So now we're gonna talk a little bit more about the person.
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We're gonna explore some metabolism, sensitivity to caffeine, and tolerance buildup that people have.
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So caffeine is cleared mainly through liver enzymes, and the pace varies person to person.
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Genetics can play a role, but so can pregnancy, smoking status, liver health, and certain medicines.
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You literally don't need a genetic test to make a practical decision on this.
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You need to notice that another person's coffee schedule is reliably not necessarily a prescription for yours.
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If you've got a friend who's like, I mean, we even do this too.
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Like, I'm routinely having like two cups of coffee and bringing some to work and buying some from Acme and like drinking it all day.
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You drink coffee all day?
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Yeah, probably for different reasons that of course if anyone who listens to this podcast could
diagnose themselves, your stimulant.
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Yeah.
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You have like a cup of coffee in the morning.
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Hi, Papa.
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My little buddy.
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And that's like kind of what you do, but I think you're also very intentional because like your you tend to be very sensitive during the day to coffee and your sleep at night.
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I can be drinking it at 3 p.m.
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and it doesn't matter.
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So that's because you have ADHD.
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Maybe.
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Um so but never can't can't have what you haven't diagnosed.
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So um it's also hard to get a stimulant around here.
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So, you know, what we're saying here is that well, we can get back to it.
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So let me talk about clearance and sensitivity.
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They tend to be related but not identical.
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I'm talking about like how fast someone gets rid of caffeine from their body and when someone then when someone takes a dose, how much does that affect them?
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So, for example, like we did here, two people can have a similar amount of coffee in the body and experience it differently.
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And the fact that the buzz disappeared does not necessarily mean that the caffeine has disappeared either.
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So that's one reason that someone can say, coffee never keeps me awake, while still learning something when they move the last dose earlier in the day.
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Like they may feel a little bit something different if they moved it earlier in the day, even if they feel like they didn't, if they weren't kept awake.
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So then with repeated use, people can develop tolerance to some of caffeine's more noticeable effects.
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Regular users can develop withdrawal symptoms, and these commonly look like a headache, fatigue, sleepiness, or trouble concentrating.
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Oops, and when they suddenly stop.
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So part of the lift from the first coffee of the day may be relief of an overnight withdrawal.
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It would be too strong, though, to say that caffeine only reverses withdrawal.
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Studies don't necessarily re report that or support that as a universal explanation for why someone feels better in the morning after drinking coffee.
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But it is one reason to separate that, like I feel better after coffee from coffee is correcting an underlying deficiency that I have.
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And all of this to say, none of this makes regular coffee use a character flaw or necessarily a problem.
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It simply changes how you might cut back if you're looking to lessen your coffee use.
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A gradual reduction is usually more comfortable than stopping abruptly.
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A smaller serving, maybe, half calf, or moving one drink to decaf.
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The general benchmark also does not overrule symptoms.
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People who have jitters, anxiety, or disrupted sleep, palpitations, or stomach symptoms are all reasons to consider or reconsider the amount or timing of when drinking coffee works well for you.
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Nikki, what do um the pregnancy overlords ACOG say about the American College of Obstetrics and Gynecology say about caffeine in pregnancy?
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The pregnancy overlords are telling us to stay.
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I don't mean us as in like me included because she's not pregnant, um, are telling the royal us that staying below 200 milligrams per day during pregnancy is probably the advised number.
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That was awesome.
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There and there are other medical conditions and medicines that can also change that plan.
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So any any clinician or pharmacist can specifically help, but I do tend to notice that like sometimes people are just like drinking too much caffeine.
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Like there is one guy who he was just like he was young, he was like, Yeah, I'm doing zins and three energy drinks and coffee in the morning.
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And he's like, I feel like I'm like floating outside of my body.
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And I was like, Yeah, no kidding, brother.
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That's absolutely I think I know why.
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So, Nikki, can you help us understand?
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Like, there is some science.
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People have done some research on coffee, actually, lots.
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It goes back and forth.
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Um, can you tell us what coffee research can and cannot tell us?
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What was that coffee we had in Bali?
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Cat Poo Gino?
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Oh, what was there?
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Is it it was a specific cat.
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Oh, the um do you think they researched that?
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The luwak.
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Oh yeah, the luok.
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There have been long-term studies linked to moderate coffee consumption with a lower risk of several health outcomes, including some liver disease, type 2 diabetes, and all-cause mortality.
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This can be reassuring to people who enjoy coffee, but most of these findings are observational.
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Um, researchers
compare people with different habits, so they are not assigning people to either drink coffee or avoid it for decades.
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And coffee drinkers and non-drinkers can differ in can differ in many other ways.
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Yeah.
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So like an association isn't necessarily a prescription.
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Um we're not going around here saying like tell a non-coffee drinker to start for disease prevention by any means.
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And nor are we saying that we tell a coffee drinker that, well, if you drink more, it must be better.
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Some studies also find associations with decaf too.
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So it's another reason not to reduce every long-term finding to like it's the caffeine itself.
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It still does not prove the responsible compound or prove cause and effect.
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We've talked about research and we've talked about if you have followed along with the show, you know, that observational research is a nice thing, but it can only tell us so much.
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So, what can we really take away from this, Nikki?
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So the most useful takeaway is personal and practical.
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You have to ask yourself a couple questions.
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So, asking, what am I actually drinking and how much caffeine is in it?
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When am I drinking it relative to my planned sleep?
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Um, what job is it serving?
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So, is it just something you like to do in the morning?
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Um, because it's like a cozy warm drink in the morning.
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Is it for alertness by habit or a relief of withdrawal?
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And then what's happening after you drink it?
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So are you focusing better?
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Like someone here, um, or are you jittery, having palpitations, reflux, um, having like a shorter night's sleep?
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And then, of course, if there's like pregnancy medication, any other health things in there.
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And so at the end of the day, that kind of brings us back to the three questions or the three items we're trying to cover here: dose, clock, and person.
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If you enjoy coffee and you tolerate it and it works for you in your life, you don't need to feel guilty about it.
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And if you don't drink it, the research that we shared here isn't necessarily a reason to start.
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And if caffeine is costing you sleep or causing you symptoms, that might be some useful information, but it's not a failure of willpower by any means.
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So this week maybe you can take a look
at a coffee that you drink often, um, find the approximate caffeine amount.
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Ollie agrees.
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Um, place it on your sleep clock and see what you notice.
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And you may learn that nothing needs to change, or maybe your whole entire routine needs to change.
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Yeah.
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All right.
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So we can um thank you for hopefully you learned something about coffee here.
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We're gonna banterize here.
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I feel like you brought up a bali and the luwak coffee quite a bit that um we still haven't used that.
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I we have oodles now, and I think we're just gonna keep it at this point.
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Um, my hope is that it's good for a year.
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Because we're zooming up on that soon.
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Um that oh buddy.
00:17:43.519 --> 00:17:46.400
So that coffee was so interesting.
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Um, for those who don't know, do you would you like to think there's a dog outside who's communicating with him?
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It's another piranha.
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So they took this coffee.
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They um there were farmers, there were coffee bean farmers in Bali.
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I think we talked about this before.
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Oh, did we already?
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Yeah, like after we got back from Bali.
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Oh my gosh, we probably did.
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The loyal listeners will know we don't need to talk about it again.
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That's fair.
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All right, so there's cat poop coffee.
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They basically digest the beans.
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Go Google it.
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You can go Google, it's called luac coffee.
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Um, what's new and different?
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So we went to a new restaurant.
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Oh my gosh, we did.
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We need to talk about the waitress.
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Go ahead.
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What's your perspective?
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Uh share your perspective about the waitress.
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Well, we went to Dear Daphne and Britain House.
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It was like a Mediterranean slash like Middle Eastern-ish flair.
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Yeah, because I don't think that Afghanistan is in the Mediterranean.
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Yeah.
00:18:50.640 --> 00:18:54.880
I might feel I might seem unlearned at this point, but it was really good.
00:18:55.599 --> 00:18:56.240
It was good.
00:18:56.559 --> 00:18:58.319
Nothing beats like Soraya.
00:18:58.880 --> 00:19:00.079
But yeah, it's a tough one.
00:19:00.160 --> 00:19:03.039
I'm not, I wouldn't be like dying to go back there, but it was good.
00:19:03.359 --> 00:19:04.160
I'm glad we tried it.
00:19:04.319 --> 00:19:04.480
Yeah.
00:19:04.559 --> 00:19:05.359
I'm glad we went.
00:19:05.519 --> 00:19:06.480
It was really cute in there too.
00:19:06.720 --> 00:19:08.079
My little mocktail was cute.
00:19:08.319 --> 00:19:08.799
Yeah.
00:19:09.039 --> 00:19:13.680
Um, so then the waitress who was like, fine.
00:19:17.839 --> 00:19:22.720
She's like talking up Eddie, and then she's like, Oh, can I get you another drink love?
00:19:23.440 --> 00:19:23.839
Yeah.
00:19:24.079 --> 00:19:25.200
And then Eddie looks at me.
00:19:25.359 --> 00:19:26.000
I was like, oh.
00:19:26.240 --> 00:19:27.599
And I'm like, well, I gotta go.
00:19:27.839 --> 00:19:31.519
The rest of my night is booked and busy because I have to plan a murder now.
00:19:33.519 --> 00:19:37.680
But then she like called me love, and I was like, oh, this is just like who she is.
00:19:37.920 --> 00:19:39.680
This is the gender-neutral trope.
00:19:40.160 --> 00:19:40.799
Yeah.
00:19:41.440 --> 00:19:42.480
I was scared.
00:19:43.200 --> 00:19:43.920
It was so funny.
00:19:44.000 --> 00:19:57.039
Like, there's like women or like, I guess men too, who are like, oh, if my like husband or wife or like if I die, I would want my husband or wife to, you know, find someone in love again, not me.
00:19:58.000 --> 00:20:00.319
I'll rise from the dead and come haunt you.
00:20:00.559 --> 00:20:02.000
That was the real use in me.
00:20:03.200 --> 00:20:04.400
That was so funny.
00:20:04.640 --> 00:20:14.000
There was one that like I saw that I was like watching it and I was like, and I don't I don't watch reels that often, people, but when I was watching, I was like, that's so funny.
00:20:14.160 --> 00:20:16.000
That's definitely something Nikki would do.
00:20:16.160 --> 00:20:17.759
And you had reposted it.
00:20:18.000 --> 00:20:18.240
Yeah.
00:20:18.480 --> 00:20:28.079
If my like ghost is watching some girl touch your arm at my funeral, I'm I'm getting standing straight up out of that casket.
00:20:28.319 --> 00:20:32.240
It's like I'm here if you ever need me.
00:20:32.480 --> 00:20:32.799
Yeah.
00:20:33.039 --> 00:20:33.839
That was the thing.
00:20:34.160 --> 00:20:34.960
So funny.
00:20:35.279 --> 00:20:37.759
But she ain't going anywhere anytime soon, folks.
00:20:38.000 --> 00:20:38.720
Nope.
00:20:39.039 --> 00:20:40.240
The um I liked it.
00:20:40.319 --> 00:20:40.960
It was good.
00:20:41.119 --> 00:20:45.599
Uh we were big Himachi people, seemingly, because we enjoyed it in San Diego.
00:20:46.079 --> 00:20:46.960
Hamachi crudo.
00:20:47.680 --> 00:20:48.799
We enjoyed it here.
00:20:49.039 --> 00:20:49.759
It was so good.
00:20:49.839 --> 00:20:51.519
Well, is the crudo the sauce?
00:20:51.599 --> 00:20:58.640
The is that was like a now that I've tried it, because we got to do a fun
thing today that we'll talk about, but we tried chimchuri again.
00:20:59.039 --> 00:21:01.519
And I think now I have a or chutney.
00:21:02.000 --> 00:21:02.400
Wait.
00:21:02.559 --> 00:21:02.880
Uh-oh.
00:21:03.119 --> 00:21:04.480
Today at Dan and Mo's?
00:21:04.640 --> 00:21:05.279
Yeah.
00:21:07.359 --> 00:21:07.920
Uh-oh.
00:21:08.799 --> 00:21:10.079
I know it wasn't chutney.
00:21:10.400 --> 00:21:11.039
Chimchuri.
00:21:11.279 --> 00:21:11.839
Yeah.
00:21:12.400 --> 00:21:14.240
I'm like 85% sure.
00:21:14.720 --> 00:21:15.440
I don't know, but it was good.
00:21:15.920 --> 00:21:16.559
I'll take 85.
00:21:16.640 --> 00:21:17.599
It was delicious green.
00:21:17.839 --> 00:21:18.160
Yeah.
00:21:18.400 --> 00:21:19.440
So we did that.
00:21:19.599 --> 00:21:22.480
And I think that's what the the himachi was in.
00:21:22.960 --> 00:21:24.240
That some chives.
00:21:24.480 --> 00:21:24.640
Yeah.
00:21:24.799 --> 00:21:27.839
So I'm like, oh my, like that flavor profile was similar.
00:21:28.160 --> 00:21:29.119
Delicious.
00:21:29.359 --> 00:21:32.799
And then of course the like pita breads with all the dips.
00:21:32.960 --> 00:21:34.559
There were like I I thought there were nine.
00:21:34.640 --> 00:21:36.000
I think there were actually like 12.
00:21:36.160 --> 00:21:36.559
Yeah.
00:21:36.799 --> 00:21:37.519
A lot of dip.
00:21:37.680 --> 00:21:38.720
That hummus was really good.
00:21:38.880 --> 00:21:39.759
It's great hummus.
00:21:40.079 --> 00:21:45.440
And whatever that like Afghan one was, I have no idea what it was, but it was good.
00:21:45.680 --> 00:21:46.880
Yeah, that was delicious.
00:21:46.960 --> 00:21:48.160
I liked the beet one.
00:21:48.319 --> 00:21:53.279
And then there was one, it's a flavor, because we had it in Bali and it it tasted like it.
00:21:53.440 --> 00:21:56.000
And like I dipped in there and I was like, oh my god, I'm back there.
00:21:56.160 --> 00:21:56.480
Yeah.
00:21:56.880 --> 00:21:58.079
Which was so fun.
00:21:59.039 --> 00:21:59.759
Go if you can.
00:22:00.160 --> 00:22:01.200
Can guys, it was great.
00:22:01.519 --> 00:22:02.480
Yeah, it was good.
00:22:06.880 --> 00:22:09.119
Um, and then you enjoyed your mocktail.
00:22:09.200 --> 00:22:10.160
I should have gone with that one.
00:22:10.319 --> 00:22:12.559
I should have gone with the gin one.
00:22:12.720 --> 00:22:13.839
Yeah, that would have been good.
00:22:14.079 --> 00:22:19.519
I I don't know what I was thinking getting uh an espresso martini but at the beginning of a meal.
00:22:20.480 --> 00:22:22.160
That was yeah, it's like an after dinner drink.
00:22:22.400 --> 00:22:23.119
It's an after dinner drink.
00:22:23.200 --> 00:22:24.000
She sold me on it though.
00:22:24.079 --> 00:22:28.160
She was like, it's one of the best in the city, and like I don't know.
00:22:29.279 --> 00:22:30.319
Did you like her?
00:22:31.119 --> 00:22:32.480
Is that why you listened to her?
00:22:33.200 --> 00:22:34.079
No, no.
00:22:34.559 --> 00:22:36.880
I not that no shit.
00:22:37.119 --> 00:22:38.640
Actually, I I abstained.
00:22:38.799 --> 00:22:43.359
I played the fifth uh on this this this medium here.
00:22:43.599 --> 00:22:50.160
Um so that was great, and we kind of like oh gosh, we were supposed to go for ice cream last night.
00:22:51.039 --> 00:22:52.000
Oh my god.
00:22:52.319 --> 00:22:56.079
Oh yeah, because we were like in a walk back and we were getting ice cream, we were kind of full.
00:22:56.319 --> 00:22:56.640
Yeah.
00:22:56.799 --> 00:23:06.799
Oh, but the um merguez, the lamb merguez, it came in a skewer, which didn't not need to come in a skewer, but it was just like maybe like inch thick tube of lamb meat.
00:23:06.960 --> 00:23:11.599
Yeah, it was a kebab that would resemble a sausage, but it was a kebab.
00:23:12.079 --> 00:23:22.880
And you just kind of like we cut it because that's how we went about it, and I I couldn't see me like managing a kebab that like weighed a pound, basically.
00:23:23.119 --> 00:23:23.680
Yeah, it was big.
00:23:23.920 --> 00:23:24.799
That was really tasty.
00:23:25.119 --> 00:23:26.079
And then we got this other thing.
00:23:26.160 --> 00:23:29.759
It reminded it was like a fried cheese square.
00:23:30.400 --> 00:23:32.799
Yeah, and it had like honey and pistachios on it.
00:23:33.200 --> 00:23:35.119
It resembled baked brie, but it was more savory.
00:23:37.039 --> 00:23:41.359
Oh, it was Halloumi or whatever No, it wasn't that one.
00:23:41.920 --> 00:23:42.319
I don't know.
00:23:42.559 --> 00:23:43.119
But it was good.
00:23:43.359 --> 00:23:44.160
Yeah, it was tasty.
00:23:45.119 --> 00:23:45.839
That was good.
00:23:46.000 --> 00:23:51.839
And then should we um you have any other thoughts about the new restaurant that we tried?
00:23:52.559 --> 00:23:53.200
Restaurant.
00:23:53.599 --> 00:23:56.480
What about the uh gosh, the scary?
00:23:56.960 --> 00:24:00.720
Are you up to explaining what happened this morning or are you gonna save that?
00:24:02.079 --> 00:24:03.119
Oh yeah.
00:24:03.519 --> 00:24:08.160
Because I feel like it's a it's like ripe with imagery for you to describe.
00:24:08.559 --> 00:24:10.079
It was quite the morning.
00:24:12.079 --> 00:24:16.720
Basically, I was getting a bone out of Ollie's mouth on our walk this morning.
00:24:17.039 --> 00:24:17.839
You set the scene.
00:24:17.920 --> 00:24:18.319
It's dark.
00:24:18.720 --> 00:24:19.680
It's dark, it's raining.
00:24:20.640 --> 00:24:22.400
This is like 6 45 this morning.
00:24:22.640 --> 00:24:23.920
So the sun's not up yet, really.
00:24:24.079 --> 00:24:26.559
Yeah, it's dark and darker because it's raining.
00:24:26.640 --> 00:24:30.240
I'm like, all right, Ollie, let's just like go out and pay because I don't know when it's gonna stop raining.
00:24:30.319 --> 00:24:30.799
Like, whatever.
00:24:30.880 --> 00:24:33.680
We'll do a quick little like half-block loop.
00:24:34.160 --> 00:24:40.480
So he finds a bone, he I like hear it crunch,
and I'm like, oh God, it's like in pieces in his mouth.
00:24:40.559 --> 00:24:43.279
So I get the one piece out, he bites my finger.
00:24:43.440 --> 00:24:47.599
Okay, and then I go back in and he bites and like punctures my nail.
00:24:48.079 --> 00:24:48.880
And it hurt.
00:24:49.039 --> 00:24:51.920
Like, I like the base where it's like your nail meets like your cuticle.
00:24:52.160 --> 00:24:52.880
Uh huh.
00:24:53.279 --> 00:24:54.400
It hurts so bad.
00:24:54.480 --> 00:24:57.680
And I'm like, oh my god, my hand is just like pouring blood.
00:24:57.759 --> 00:24:58.319
It's raining.
00:24:58.400 --> 00:24:59.119
I'm like, oh my God.
00:24:59.200 --> 00:25:00.799
All right, like let's go back inside.
00:25:00.960 --> 00:25:01.920
So we come back in.
00:25:02.079 --> 00:25:05.200
I don't know how you made it down the street in this condition, how I found you.
00:25:05.359 --> 00:25:10.079
And I basically like vasovagled because the pain was so bad.
00:25:10.319 --> 00:25:14.079
Do you want to give a brief what vasovagal is for dummies?
00:25:14.400 --> 00:25:39.359
Yeah, so like if you when you experience such a stimulus that your rest and digest nervous system goes in overload and overshoots everything, so all your blood vessels dilate, everything becomes leakier, so you sweat, your blood pressure drops, and like all of a sudden you're feeling like you're gonna faint.
00:25:39.599 --> 00:25:44.960
Also, your like nausea system gets way thrown off whack.
00:25:45.039 --> 00:25:47.519
So if you've never thrown up in your life, you might.
00:25:47.839 --> 00:25:49.119
So then that's that's that.
00:25:49.359 --> 00:25:55.119
So, like, and I started like feeling it outside because I was like getting really hot, but it was humid.
00:25:55.279 --> 00:25:57.680
I had a raincoat on, so I was like, all right, whatever.
00:25:57.759 --> 00:26:06.160
It's just like humid and I have long sleeves, and then I came inside and I'm like holding like a wrapping like a paper towel over my finger.
00:26:06.240 --> 00:26:09.200
I'm like, oh my God, I'm like nauseous because this hurts so bad.
00:26:09.279 --> 00:26:10.240
Like, what the heck?
00:26:10.400 --> 00:26:17.119
And then, like, all within like seven seconds, I put two and two together and realized like what was probably happening.
00:26:17.599 --> 00:26:20.720
And then like my like head felt weird.
00:26:20.799 --> 00:26:21.839
I was getting sweatier.
00:26:22.160 --> 00:26:26.079
I had to run to the bathroom because I was gonna throw up, and I'm just like sitting there in front of the toilet.
00:26:26.160 --> 00:26:33.119
Like, one, I should have like grabbed something cold out of the freezer before I came in here, but then I call Eddie because he's still asleep.
00:26:33.359 --> 00:26:44.160
I get up early on the weekends and he's still asleep, so I call him because I'm like, well, if this is good, if what's happening or if what I think is happening is happening, I might pass out.
00:26:44.240 -->
00:26:53.119
So, like, I should probably tell my husband if like I'm gonna be passed out on the bathroom, let him know that he might find me passed out on the bathroom floor.
00:26:54.000 --> 00:26:57.200
So then I puke, he gets me something cold for my neck.
00:26:57.279 --> 00:27:04.160
I didn't pass out, so like maybe the cold thing worked, or it was I was or I wasn't going to, but never seen you puke before.
00:27:04.319 --> 00:27:04.799
Yeah.
00:27:05.119 --> 00:27:14.000
So my perspective is I'm like dead asleep in the world, and then I hear the I'm like, who's calling me?
00:27:14.160 --> 00:27:14.880
Oh my god.
00:27:15.039 --> 00:27:21.039
I did hear the door like close pretty quick, and I was like, oh, here comes the perpetrator.
00:27:21.119 --> 00:27:25.839
Um piranha, a little piranha, and I was like, Oh, all right, that's what's going on here.
00:27:26.000 --> 00:27:28.880
And oh, the poor girl is like distraught.
00:27:29.119 --> 00:27:32.720
And I was like, oh my God, but at this moment, I don't know what's happening.
00:27:32.880 --> 00:27:34.960
It's like, what am I walking into down here?
00:27:35.200 --> 00:27:38.240
Like there's a million awful thoughts are running through my head.
00:27:38.400 --> 00:27:41.440
And I get there and then I come to this site, her doubled over the toilet.
00:27:41.519 --> 00:27:43.440
I've never seen this woman puke.
00:27:43.519 --> 00:27:54.319
Her like body and like I hate not that people like throwing up, but like if I feel sick or like a little twinge of nausea, like I'm taking zoofrade, I am not throwing up.
00:27:54.400 --> 00:27:55.599
I hate throwing up.
00:27:55.759 --> 00:27:57.920
I do everything I can to avoid it.
00:27:58.240 --> 00:28:01.519
But that's just like it's just and I'm a pukey boy.
00:28:01.599 --> 00:28:02.720
Yeah, it's just like the opposite.
00:28:02.960 --> 00:28:05.200
You puke every other week, it seems.
00:28:05.519 --> 00:28:13.039
But you're you're like moniker, your gold star is like or tombstone, like Nicole Rufo, never puke.
00:28:13.359 --> 00:28:15.279
Yeah, rest in peace.
00:28:15.680 --> 00:28:17.519
There's a lot of your mother's not gonna like this.
00:28:17.599 --> 00:28:21.519
There's too much like end-of-life talk there.
00:28:21.680 --> 00:28:26.240
But um, yeah, no, you and you turned around real quick.
00:28:26.480 --> 00:28:27.519
Yeah, real quick.
00:28:27.759 --> 00:28:30.240
Once I had a blood pressure again, it felt great.
00:28:30.559 --> 00:28:31.440
Yeah, that was crazy.
00:28:31.599 --> 00:28:38.000
So then I kind of figured I was like, what if this scenario played out and like you didn't call me and let me know, or I like missed the phone call.
00:28:38.160 --> 00:28:41.119
And Nikki's been known to like go through a whole lot.
00:28:41.200 --> 00:28:42.240
I I live seven lives.
00:28:42.319 --> 00:28:44.960
I have a full day before Eddie wakes up.
00:28:45.119 --> 00:28:46.160
Yeah, it's true.
00:28:46.400 --> 00:28:48.559
And then like she'll be like, Oh, I did this.
00:28:48.720 --> 00:28:51.920
I I like I also like downplay things regularly.
00:28:52.000 --> 00:28:56.240
So I would have been like, oh, we went for a walk, I got the grocery order, I cleaned the entire house.
00:28:56.319 --> 00:28:59.039
I like passed out two hours ago, but it's fine now.
00:28:59.680 --> 00:29:07.680
She does, she just downplayed a lot, and I was I would not have put it past her um to do that at all.
00:29:08.079 --> 00:29:09.680
That was a spooky one.
00:29:09.759 --> 00:29:13.440
So then the tricky thing is that, and and this might help someone someday.
00:29:13.519 --> 00:29:32.559
This is not a nail traffic episode, but if you have a lot of blood under your fingernail, you can with a medical professional, of course, wink wink, um, you can actually like take a sharp sterilized object and like drill a nail, like a hole in your nail to relieve the pressure.
00:29:32.799 --> 00:29:35.839
This happened to me because a couple years ago, oh yeah.
00:29:36.319 --> 00:29:38.799
After Matt's bachelor party, this happened to me.
00:29:38.960 --> 00:29:40.079
And I was like, oh my god.
00:29:40.160 --> 00:29:49.839
And the very next day, I was heading to the procedure clinic in residency, and we had these things, and it's like a hot pen knife, and like they did it to my nail, and I was like, Oh, I feel so much better.
00:29:50.079 --> 00:29:52.720
So now I'm trying to convince Nikki to let me do this.
00:29:53.200 --> 00:29:54.559
It doesn't even look that bad.
00:29:54.880 --> 00:29:56.480
It's not like built up under my nail.
00:29:56.640 --> 00:29:58.000
Yeah, but you gotta do it promptly.
00:29:58.160 --> 00:29:58.799
Oh, okay.
00:29:59.119 --> 00:30:07.200
So I order stuff from Amazon to try to make it happen, but um, and some deodorant because we needed some, but and some augmentin.
00:30:07.359 --> 00:30:09.279
I got full service PCP.
00:30:09.440 --> 00:30:12.720
Yes, he orders the med, he goes to CVS to pick it up.
00:30:13.039 --> 00:30:15.920
I do pay for it as well.
00:30:16.480 --> 00:30:17.119
Lucky duck.
00:30:17.279 --> 00:30:18.319
Okay, it was like two dollars.
00:30:18.640 --> 00:30:19.200
That's fair.
00:30:19.359 --> 00:30:29.279
Um yeah, so sometimes if this a little educational here, a little splash, you can consider getting antibiotics to prevent infection ahead of time during a dog bite.
00:30:29.680 --> 00:30:36.079
Yeah, especially if your dog like occasionally eats poop sometimes on the streets of Philadelphia.
00:30:36.319 --> 00:30:39.440
And you don't know like who this came from.
00:30:39.599 --> 00:30:44.880
Was it a person, an animal, both?
00:30:46.799 --> 00:30:48.720
Who could it be?
00:30:51.200 --> 00:31:05.359
I always gotta like hunt for the little things that you say that I need to edit out that like if there was an unedited version that our show I'm sure our audience would love, but I have to play it straight for whoever Overlord is listening to me right
now and listening to us.
00:31:07.200 --> 00:31:08.319
Well that was fun.
00:31:08.559 --> 00:31:09.519
And now here we are.
00:31:10.640 --> 00:31:11.440
Now here we are.
00:31:15.039 --> 00:31:17.279
Wait, did we have something else funny to talk about?
00:31:17.599 --> 00:31:18.640
I can't remember.
00:31:20.079 --> 00:31:27.599
Oh well now I don't maybe this was more funny in the moment if you were there.
00:31:29.759 --> 00:31:31.440
The wartime lifeguard.
00:31:33.119 --> 00:31:38.240
Oh she's gonna she's gonna feel so bad about this.
00:31:38.400 --> 00:31:39.680
She was already sensitive.
00:31:40.000 --> 00:31:40.799
No, it was fun.
00:31:41.039 --> 00:31:48.480
It was funny because of our like and the her grandm her grandmother being a lifeguard was not funny.
00:31:48.799 --> 00:31:50.000
Not funny, very serious.
00:31:50.240 --> 00:31:58.720
So our loyal listener and close personal brother, Vanessa, we were talking about how like she and I were swimmers when we were younger, and then how I lifeguarded.
00:31:59.119 --> 00:32:00.799
We were all swimmers when we were younger.
00:32:01.039 --> 00:32:02.319
You're disgusting.
00:32:03.119 --> 00:32:15.839
And then she brings up how her grandmother used to lifeguard during the time where most grandparents are around and you know, young and sprightly during the time of World War II.
00:32:16.079 --> 00:32:23.039
And she said she was a lifeguard because all the men got drafted to war.
00:32:23.200 --> 00:32:29.359
So then she was a lifeguard at like this pool, like that, like we had been to that had like swimming there, whatever.
00:32:29.599 --> 00:32:35.039
But she specifically used the term my grandmother was a wartime lifeguard.
00:32:36.160 --> 00:32:45.119
So Ebbie and I are sitting here like rapping trying to rack our brains, how her grandmother was like lifeguarding like soldiers.
00:32:46.319 --> 00:32:50.240
I'm like, would she like watching like the navy and the ocean?
00:32:50.400 --> 00:32:51.920
Like, what do you mean?
00:32:52.960 --> 00:32:56.880
And we kept cracking up about it, and she seemed so confused why we thought it was funny.
00:32:57.039 --> 00:33:05.759
And then at some point I was like, I don't want to be, I'm not trying to be disrespectful, I just don't understand the like and she's like, no, you idiot.
00:33:05.920 --> 00:33:09.359
She was just a lifeguard when World War II was going on.
00:33:10.720 --> 00:33:12.559
Which is a really cool thing.
00:33:15.119 --> 00:33:21.680
Also, isn't it funny that like all like the men were lifeguards?
00:33:22.079 --> 00:33:26.240
I know like it was the dream back then, and like women didn't have to work.
00:33:27.279 --> 00:33:35.440
But now, like, at least when I was a lifeguard, it was like mostly girls, like there were guys, and now it's just like, well, why are the boys here?
00:33:35.759 --> 00:33:48.799
Perhaps there's been a big gender switch in the employment of I have a habit of female-dominated jobs, babysitting,
lifeguarding, nursing.
00:33:49.200 --> 00:33:50.000
Bing bang boom.
00:33:50.400 --> 00:33:51.680
We can't deal with the men.
00:33:53.119 --> 00:33:54.880
Unless you're at home, you got two.
00:33:56.720 --> 00:33:57.759
Two boys at home.
00:33:58.000 --> 00:33:58.400
Oh yeah.
00:33:58.480 --> 00:33:59.599
I thought that was funny.
00:33:59.839 --> 00:34:02.799
That because we're dumb, not because correct.
00:34:02.960 --> 00:34:03.200
Yeah.
00:34:03.920 --> 00:34:05.519
Sweet Virginia was a lifeguard.
00:34:06.079 --> 00:34:07.839
Sweet, sweet Virginia.
00:34:08.639 --> 00:34:10.880
I think that was her grandmother.
00:34:11.119 --> 00:34:12.480
Or her great grandmother.
00:34:12.960 --> 00:34:14.000
We're gonna get a correction.
00:34:14.239 --> 00:34:15.599
We are sorry, brother.
00:34:15.840 --> 00:34:17.519
Hopefully we'll get some fan mail.
00:34:17.840 --> 00:34:19.119
Because her sister's name is Virginia.
00:34:19.519 --> 00:34:23.519
Hopefully we can get some fan mail to then include a voice message.
00:34:23.679 --> 00:34:27.679
I really wish we could play our voice messages.
00:34:27.920 --> 00:34:28.000
Yeah.
00:34:28.400 --> 00:34:28.800
Fan mail.
00:34:29.199 --> 00:34:30.159
No, we can't.
00:34:31.760 --> 00:34:33.119
Unless people paid us.
00:34:34.800 --> 00:34:39.599
Then we could put some like guys, we're way funnier than we're allowed to be.
00:34:39.840 --> 00:34:40.960
Um yeah, we really are.
00:34:41.119 --> 00:34:59.280
It's a shame for anyone who doesn't know us personally on this PG family-friendly podcast that like if one were to suggest that they would give us three to five dollars a month to listen to premium unedited full bore content.
00:34:59.599 --> 00:35:01.199
I would I would set that up.
00:35:01.440 --> 00:35:01.840
I would.
00:35:01.920 --> 00:35:04.320
I would set that up in a separate place.
00:35:04.880 --> 00:35:06.000
We could do that.
00:35:06.159 --> 00:35:07.760
That is something that could happen.
00:35:08.000 --> 00:35:13.519
If anyone was interested, I know there are a certain number of you who are out there every single week tuning in.
00:35:13.760 --> 00:35:14.159
We see you.
00:35:14.320 --> 00:35:14.800
We see you.
00:35:14.960 --> 00:35:15.599
Well, I don't.
00:35:15.679 --> 00:35:16.079
He does.
00:35:16.239 --> 00:35:17.519
I see you every week.
00:35:17.760 --> 00:35:24.960
About the same number of people, and then people from our other audiences around the world who are interested in the medical stuff come in.
00:35:25.280 --> 00:35:31.039
But I see you people, and if you're interested, let me know.
00:35:31.280 --> 00:35:32.800
Give us your money.
00:35:33.679 --> 00:35:35.280
That's not what this is about, though.
00:35:35.440 --> 00:35:36.320
Um, how do you feel?
00:35:36.480 --> 00:35:38.320
You feel I feel energized after this.
00:35:38.400 --> 00:35:41.920
And you were kind of like in the beginning, you were like, but now I feel it.
00:35:42.639 --> 00:35:43.039
Feel good?
00:35:43.280 --> 00:35:43.840
I feel it, yeah.
00:35:44.000 --> 00:35:45.440
All right, let's end on the high.
00:35:45.679 --> 00:35:48.239
Thank you for coming back to another episode of Your Checkup.
00:35:48.320 --> 00:35:52.800
Hopefully, you were able to learn something for yourself, a loved one, or a neighbor.
00:35:53.119 --> 00:35:54.800
You could find us on Instagram.
00:35:54.960 --> 00:36:03.519
You can find us on Threads, you can also send us an email, yourcheckuppod at gmail.com, but most importantly, stay healthy, my friends.
00:36:03.679 --> 00:36:05.519
Until next time, I'm Ed Deleski.
00:36:05.679 --> 00:36:06.800
I'm Nicola Ruffo.
00:36:06.960 --> 00:36:07.920
Thank you and goodbye.
00:36:08.239 --> 00:36:08.800
Bye.
00:36:14.400 --> 00:36:18.639
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00:36:18.800 --> 00:36:22.719
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00:36:22.880 --> 00:36:27.440
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00:36:51.360 --> 00:36:52.159
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00:36:52.320 --> 00:36:56.000
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