Vital Discourse is a new weekly podcast that provides deep dives into important health-related topics.

On Vital Discourse, two surgeons and friends—Dr. Ben Cilento, M.D. and Dr. Lee Mandel, M.D., J.D., F.A.C.S., F.A.R.S.—help listeners start making sense of their health.

Tune in each week to get the inside scoop on issues concerning health, policy, and law, with advice, interviews, debates, and straight talk you won’t find anywhere else.

With backgrounds in military and law, Dr. Ben and Dr. Lee cut through the noise to bring you the guidance you need. In every episode, they help their audience navigate the healthcare system, find answers to their most pressing questions, and take steps to start feeling great, with lots of laughs along the way.

No appointment necessary—the doctors are in.

The first episode is coming soon.

Snoring and sleep apnea remain among the most misunderstood health problems in modern medicine. They are not harmless habits but airway disorders linked to cardiovascular risk, cognitive decline, and chronic fatigue. In this first episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how modern medicine approaches snoring, why anatomy matters more than gadgets, and how real treatment plans are built through clinical data and patient-specific design. Listeners will gain clarity on nasal airflow, home sleep testing, CPAP therapy, oral appliances, and hypoglossal nerve stimulation while learning how to protect their own sleep and overall health.

Chapters:

00:00 Intro – Why Vital Discourse Exists

08:14 Dr Lee’s Journey Through Medicine and Law

17:02 The Medical and Legal Disclaimer – Framing the Conversation

20:01 What ENTs Actually Do and Why the Airway Matters

35:21 Why “Quick Fix” Culture Misleads Patients

55:33 Launching Episode 1 – Why Start with Snoring and Sleep Apnea

58:41 Understanding the Three Levels of the Airway

1:01:57 What Sleep Apnea Really Is and Why It Matters

1:03:39 Home Sleep Tests vs Lab Studies – Measuring Real Sleep

1:11:55 From CPAP to Surgery – Matching Treatment to Anatomy

1:18:14 The Power of Nasal Airflow and Why It Shapes Every Outcome

1:24:57 Inspire and Genio Implants – The Future of Sleep-Apnea Therapy

1:39:15 Inside an ENT Evaluation – What Patients Can Expect

1:45:16 The Hidden Costs of Ignoring Sleep Apnea

1:56:19 Final Takeaways – Clear Steps Toward Better Breathing and Sleep

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Obesity and sleep apnea create a loop that reshapes metabolism, hormones, and airway function long before most patients notice the signs. In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how fragmented REM sleep disrupts growth hormone, leptin, and ghrelin, lowers metabolic rate, and drives weight gain that feels impossible to reverse. They break down how fat in the tongue, neck, and belly changes airway physics, how inflammation and insulin resistance add strain, and how GLP-1 medications, testosterone, CPAP, surgery, and weight programs fit into a coordinated plan designed to restore both breathing and metabolic health.

Chapters:

00:00 - Introduction

00:00 - Welcome & Episode Overview

00:36 - Understanding Sleep Apnea

00:36 - What is Sleep Apnea?

01:14 - The Paper Straw Analogy

02:23 - Recognizing Sleep Apnea Symptoms

03:14 - Snoring vs. Obstruction

04:30 - Sleep Study Diagnostics & Severity Levels

05:57 - The Sleep Apnea-Obesity Connection

05:57 - Common Medical Advice About Weight Loss

06:39 - The Truth About Correlation

07:24 - Why Weight Gain Comes First

07:48 - How Sleep Apnea Prevents Weight Loss

07:48 - Sleep Disruption & REM Sleep

08:11 - Understanding REM Sleep & Muscle Relaxation

09:30 - Growth Hormone & Metabolic Changes

10:29 - Leptin & Ghrelin: The Hunger Hormones

11:49 - The Vicious Cycle Explained

12:20 - How Obesity Worsens Sleep Apnea

12:20 - Anatomical & Mechanical Effects

12:43 - Fat Deposits in the Tongue & Throat Muscles

13:32 - Critical Closing Pressure & Airway Physics

14:40 - Impact on Lung Function & Oxygen Saturation

16:27 - Heart Health Complications

16:52 - Neuromuscular & Inflammatory Effects

16:52 - Fat's Impact on Muscle Control

18:04 - Inflammation & Sleep Apnea

19:23 - Why Weight Makes Treatment Harder

19:51 - Treatment Approaches

19:51 - The Multi-Pronged Approach to Weight Loss

21:03 - GLP-1s: Benefits & Risks 22:00 - The Testosterone Trap

24:06 - Comprehensive Treatment Strategy

25:26 - Key Takeaways 25:26 - Vital Point: Weight Doesn't Define Sleep Apnea Risk

26:32 - Importance of Professional Help

27:33 - Closing Thoughts & Call to Action

Nasal obstruction is one of the most overlooked forces behind sleep apnea. In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how nasal resistance, negative pressure, childhood mouth breathing, turbinates, and the nasal valve all influence airway collapse at night. Listeners learn how to recognize hidden nasal issues, why dry mouth signals nocturnal obstruction, and how procedures like septoplasty, turbinate reduction, valve reconstruction, and laser-based reshaping improve sleep-apnea treatment across CPAP, oral appliances, and Inspire.

Chronic sinusitis and allergies share overlapping symptoms, which leaves many patients misdiagnosed and stuck in cycles of antihistamines, decongestants, and steroids without lasting relief. In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how to distinguish persistent bacterial or structural sinus disease from allergic inflammation and why treatment depends on identifying airflow obstruction, duration, CT scan patterns, and response to medical therapy. They break down the 12-week definition of chronic sinusitis, why CT scans often under-call real disease, and how structural issues like deviated septums and narrowed sinus openings trap fluid and fuel infection. The doctors walk through allergy testing, immunotherapy, minimally-invasive sinus surgery, balloon dilation, and the real role of medications.

The 2025-2030 Dietary Guidelines represent the biggest shift in American nutrition policy in 35 years. In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel sit down with nutrition expert Brandon Ward to break down what changed, why it matters, and how to actually apply these guidelines to everyday eating. The new food pyramid inverts decades of grain-heavy recommendations, prioritizing animal protein (1.2-1.6 grams per kilogram of body weight), healthy fats, and fibrous vegetables while significantly reducing refined carbohydrates. Listeners will learn what a "serving" actually means, how to navigate grocery stores that were designed around the old pyramid, why the 1992 guidelines contributed to America's obesity crisis, and how schools, food manufacturers, and families can adapt. The doctors and Brandon also address common criticisms around saturated fat, sustainability concerns, and implementation challenges.

Chapters:

00:00 Intro – Why the New Food Pyramid Is a Game-Changer

11:04 Introducing Brandon Ward – Nutrition Expert and Performance Coach

12:30 What Is the New Food Pyramid and How Does It Compare?

16:40 Understanding Servings – What Does "One Serving" Actually Mean?

18:41 The Mediterranean Diet Connection – Why Experts Have Known This for Years

20:08 How Brandon and His Clients Have Been Eating This Way All Along

21:16 How the Old Food Pyramid Created the Obesity Crisis

22:20 The Fat-Carb Relationship – Why Low-Fat Diets Failed

23:18 What Happens When You Eat Carbohydrates Without Fat

24:26 The Grocery Store Problem – How Food Aisles Reflect the Old Pyramid

25:46 Fruits Aren't All Created Equal – Why Berries Beat Bananas

27:31 The Avocado Exception – Why This Fruit Breaks the Rules

29:08 Fish and Omega-3s – The Benefits of Wild-Caught vs. Farm-Raised

32:40 Do You Need to Eat Vegetables Every Single Meal?

38:18 Why Variety in Vegetables Matters More Than You Think

41:00 Protein Timing – Does It Matter When You Eat Your Protein?

46:14 Balance, Moderation, and the Takeaway Message

47:15 Addressing the Criticisms of the New Food Pyramid

48:08 Saturated Fat and Cardiovascular Health – Debunking the Myth

49:04 Animal Protein vs. Plant Protein – What the Evidence Actually Says

51:18 Sustainability Concerns – Can We Produce Enough Animal Protein?

53:47 Environmental Impact – The Methane Argument and Real Solutions

56:04 Implementation in Schools – Why This Is Actually a Benefit, Not a Burden

57:51 Final Thoughts – Building Lifelong Healthy Habits

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Fasting has become one of the hottest topics in nutrition—but is it truly a game-changer for weight loss, metabolic health, and longevity, or just overhyped? In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel sit down with nutrition expert Brandon Ward to separate fasting facts from fiction. Brandon breaks down what intermittent fasting actually is, why our bodies are evolutionarily designed for it, and the proven benefits including cellular autophagy, improved insulin sensitivity, reduced inflammation, and enhanced cognitive clarity. The conversation explores different fasting protocols (12, 16, 24, 48, and 72-hour fasts), what to expect at each stage, and why fasting outperforms simple calorie restriction for weight management. They debunk common myths—no, fasting won't tank your metabolism or cause muscle loss—and provide practical guidance on hydration, electrolytes, workout timing, and what to eat when breaking a fast. Dr. Ben shares his personal experience with 72-hour fasts, explaining the physiological shifts from glucose-burning to ketogenesis to autophagy, where damaged cells are eliminated and cancer risk may be reduced. Whether you're curious about starting a 16-hour daily fast or considering extended fasting for cellular rejuvenation, this episode delivers evidence-based insights you can actually use.