The Curbsiders podcast

#94: Random Pearls: Microbiome, POTS, Gabapentin, and Leonardo Da Vinci

May 7, 2018 | By

A random serving of knowledge food for your brain hole with returning guest, Dr. Alan Dow, Professor of Internal Medicine at Virginia Commonwealth University School of Medicine. Our final live recap show from ACP 2018 covering: human microbiome, copper deficiency, POTS syndrome, substances of abuse, drugs for delirium and how to be more like Leonardo Da Vinci. Please let us know what you liked, didn’t like and how we can make the show better.

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“Don’t be afraid to use your talents to tackle the problems you see before you” -Alan Dow, MD
“Writing is easy. You just open up a vein and bleed.” Ernest Hemingway

Random Pearls
Dr. Dow gave us pearls from 5 lectures that he attended at ACP

The Human Microbiome

  • Fecal Matter Transplant Update: Microbiome research shows that people who get C. Diff have less heterogeneous microbiomes (JC Lagier Hum Microbiome J 2016). Next steps are to show how the microbiome relates to other clinical outcomes and tease out causality vs. association.

Thieves’ Market

  • A Unique Case: The market is a diagnostic case presentation format where people can shout out differential diagnoses as pieces of the case are presented. Patient presented with neuropathy with megaloblastic anemia from copper deficiency induced by zinc toxicity from denture cream. Here’s a case report of zinc-induced copper deficiency, from zinc supplements (J Johnsrud. Perm J 2017)

The Orthostatic Outpatient

  • Postural Orthostatic Tachycardia Syndrome: POTS physiology is similar to that of astronauts’: the left ventricle atrophies about 1% per day such that stroke volume decreases. When the heart has to work against gravity (standing), it must increase heart rate to maintain the same cardiac output.
  • A new name for POTS?! In POTS, the heart is “too small” and might be more aptly named “the Grinch syndrome” (Fu Q et al. JACC 2011)

Multiple Small Feedings of the Mind: Substance Use Disorder and Psychiatry


Time stamps:

  • 00:00 Disclaimer
  • 01:30 Guest bio
  • 03:19 Getting to know our guest, podcast, and book recommendations
  • 08:55 Human microbiome
  • 11:05 A case of anemia and neuropathy
  • 13:30 Physiology and treatment of POTS syndrome
  • 17:00 Novel substances of abuse
  • 20:17 Benzodiazepines for delirium
  • 24:00 Leonardo Da Vinci versus the modern physician
  • 27:18 Outro

Links from the show:

  1. Ezra Klein (podcast)
  2. Slow Burn: A podcast about Watergate.
  3. Eveningland: Stories (book) by Michael Knight
  4. The Flaming Lips – tour schedule
  5. Tim Ferriss (podcast) episode with Astro Teller of Google X
  6. Gut microbiota and Cdiff infections by JC Lagier. Human Microbiome J Dec 2016.
  7. Salt and the microbiome (paper) from Nature by Wilck, N et al. Nature volume 551, pages 585–589 (30 November 2017) doi:10.1038/nature24628
  8. Cardiac Origins of POTS, Grinch Syndrome by Q Fu et al. JACC 2011
  9. Standing up to POTS (Dr Levine’s exercise protocol)
  10. Exercise program to improve activity in POTS by Richardson MV et al Physiother Theory Pract. 2017 Aug;33(8):670-679. doi: 10.1080/09593985.2017.1328719. Epub 2017 Jun 7.
  11. Video call from family helps mitigate delirium by Waszynski CM et al. Int J Nurs Stud. 2018 Jan;77:154-161. doi: 10.1016/j.ijnurstu.2017.09.018. Epub 2017 Oct 7.
  12. PechaKucha from ACP 2018 Watch here, but not for free : (


  1. June 2, 2018, 6:48pm Jay Berger, MD, MPH,FACP writes:

    Discovered your podcast a few months ago while looking around for medical podcasts. You have vaulted to # 1 with your breezy style, ability to dig deeply while giving practical advice. Helps keep me sharp, especially since I sold my practice of 32 years last year. I now work for a company called NIA Magellan, We are contracted by insurance companies to review advanced imaging requests for mediical necessity. I get into a lot of interesting conversations. I have noticed a huge difference in how Docs comport themselves. Book recommendation- An Instance of the Fingerpost by Iain Pears; bets historical novel I've read. Good Luck and take care

    • June 3, 2018, 10:56pm Matthew Watto, MD writes:

      Hi Jay, Thanks for the great feedback and the book recommendation! We really appreciate your support and regard for the show. We are having a lot of fun and it is so great to hear how our listeners gain value from the show. Regards, Matt

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The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit and search for this episode to claim credit.

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