The People's Pharmacy – Détails, épisodes et analyse

This week, the topic is lead. A hundred years ago, chemists discovered that adding lead to gasoline decreased engine knock and gave the cars of the day more power. It remained a popular additive for decades. At the same time, companies were adding lead to house paint to help it last longer. We know now that lead exposure harms children, but what about adults? Could lead in our environment have contributed to the horrific toll of heart disease over the past century? Find out about the chemical roots of chronic disease on this week’s nationally syndicated radio show!

You could listen through your local public radio station or get the live stream on Saturday, May 31, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on June 2, 2025.

The Chemical Roots of Chronic Disease:

When the nascent automotive industry began adding tetraethyl lead to gasoline early in the 20th century, scientists did not fully understand the potential health impacts of this compound. They knew by 1889 that lead poisoning could result in saturnine (ie, lead-induced) gout, an inflammatory condition accompanied by atherosclerosis. And at first, public health officials worried that adding it to gasoline might not be safe, especially after large numbers of refinery workers suffered lead poisoning in 1924.

According to chemical warfare expert Yandell Henderson,

“The use of tetraethyl lead will cause vast numbers of the population to suffer from slow lead poisoning with hardening of the arteries.” (New England Journal of Medicine, Oct. 30, 2024).

He made that statement at a meeting in 1925. Why didn’t regulators pay attention?

The Kehoe Problem:

One reason there wasn’t more regulatory attention is that the industry was new and the government hadn’t figured out how to regulate it to make it safer. Another reason is a persuasive individual named Robert Kehoe. As the chief medical officer of the Ethyl Corporation, he had a substantial conflict of interest. But he argued that no one had the right to ban the use of lead in gasoline until someone had proven that it was dangerous. Mind you, not whether lead was dangerous, which scientists knew, “but whether a certain concentration of lead is dangerous.” Unfortunately, the Kehoe rule held sway and has helped shape the American approach to chemical regulation ever since.

Lead was used very widely during the 20th century. People put it in insecticide and in jet fuel. We already mentioned its use in paint. The 21st-century water disaster in Flint, Michigan, reminded the country that many cities still contain lead pipes as part of their plumbing infrastructure. In the 1960s, lead levels in the most recent layers of glacial core samples were 1000 times higher than those in more ancient pre-industrial cores. Moreover, people were also carrying around 1000 times more lead in their bones than skeletons from pre-industrial times. Even now, the total amount of lead in our bodies is 10 to 100 times higher than that of pre-industrial people.

How Does Lead Affect Health?

We asked our guest, Dr. Bruce Lanphear, whether public health improved when we got lead out of gasoline late in the 20th century. The answer is yes; blood lead levels have dropped dramatically. Consequently, many fewer children are dying of acute lead poisoning. But we are still underestimating the overall health effects of chronic low-level lead exposure.

Lead exposure, even at low levels, is linked to hypertension and heart disease. People who are exposed to lead have higher blood pressure. In addition, they are more likely to have damage to the endothelium of the blood vessels. This can result in plaques that cause heart attacks. Scientific assessments show that people with blood level levels at the 90th percentile have double the risk of death from cardiovascular disease as those at the 10th percentile. The conclusion is that chronic low-level lead exposure is a leading cause of heart disease. Worldwide, there are about 5.5 million deaths a year due to low-level lead poisoning.

How Do We Learn About the Chemical Roots of Chronic Disease?

Some critics have objected that association is not causation. That is certainly true. When we have the opportunity to use randomized placebo-controlled trials, we can have more confidence in the conclusions. Yet when there is an overwhelming amount of evidence, we should pay attention. Just as no one now doubts that tobacco harms health, we do not need to doubt the lasting harm caused by lead exposure.

We can learn from the lead saga and apply those lessons to other toxic chemicals. First off, lead poisoning is preventable. Cutting lead exposure reduces the harms. In general, chronic disease risk rises with environmental exposure. To prevent disease, we need to clean up the environment. Just as Robert Kehoe objected to eliminating lead from gasoline, current manufacturers defend their own toxic chemicals, whether those are PFAS, cadmium, arsenic, phthalates or the herbicide glyphosate. If we want a cleaner environment, resulting in less chronic disease, we need to demand action. This radio show is a wake-up call to all those politicians calling for less regulation.

This Week’s Guest:

Bruce Lanphear, MD, MPH, is Professor of Health Sciences at Simon Fraser University in Burnaby, British Columbia. Professor Lanphear’s research, at the intersection of preventive medicine, pediatrics, public health, toxicology, and infectious disease, is driven by a commitment to prevent death, disease, and disability. He has published over 350 peer-reviewed studies about the impact of toxic chemicals on intellectual deficits, behavioral problems, and brain structure in children. He is ranked among the top 1% of most-cited scientists globally. Bruce and his brother, Bob, co-founded Little Things Matter to make the science on toxic chemicals publicly accessible. They produce videos to show how human health is inextricably connected with exposures to toxic chemicals and to elevate efforts to prevent disease.

Professor Lanphear’s new video, Toxic Hearts, will soon be released. May 20th, 2025, was the 100th anniversary of the US Surgeon General’s report on the safety of tetraethyl lead. Follow Dr. Lanphear on Substack at https://blanphear.substack.com/

Bruce Lanphear, a health sciences professor at Simon Fraser University and an expert on lead toxicity.

Listen to the Podcast:

The podcast of this program will be available Monday, June 2, 2025, after broadcast on May 31. This week’s podcast has a more extended discussion of how industry tries to blame the victim. What is Dr. Lanphear doing to upset that dynamic? You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform.

You may also want to listen to a prior interview with Dr. Lanphear: Show 1418: More About the Pros and Cons of Water Fluoridation (Part 2). You can download the mp3 file at this link. There is also Show 1417: Examining the Pros and Cons of Water Fluoridation (Part 1). We try to bring you a variety of perspectives on The People’s Pharmacy. If you find this kind of balanced approach worthwhile, please consider a donation at this link. It will help us keep moving forward with our radio show, podcast, newsletter and this website. Thank you for your support.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

This week, two scientists discuss the evidence on using vitamin C to treat colds and as part of the treatment for cancer. For years, the medical establishment has maintained that such claims could not be considered seriously. But new studies vindicate Linus Pauling, the Nobel Prize winner who postulated that vitamin C would help.

You could listen through your local public radio station or get the live stream on Saturday, May 24, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on May 26, 2025.

Studies That Vindicate Linus Pauling:

In 1970 the Nobel Prize-winning chemist, Dr. Linus Pauling, published a paperback book titled Vitamin C and the Common Cold. Although this idea captured the public imagination, it got a lot of pushback from scientists. Most of the American medical establishment rejected Pauling’s claims that vitamin C could help people recover from the common cold. They were especially dismissive of the idea that vitamin C might be helpful in treating cancer.

However, there have been a number of studies conducted over the decades since then. The weight of the evidence now seems to vindicate Linus Pauling.

Does Vitamin C Help Recovery from the Common Cold?

Our first guest, Dr. Harri Hemilä of Helsinki, Finland, has done several meticulous systematic reviews of the research. Although some people expect supplemental vitamin C to prevent colds, it does not appear to prevent colds except among people doing extreme physical activity (Polish Archives of Internal Medicine, Jan. 30, 2025).

Instead, however, studies show that at doses considerably higher than the RDA vitamin C can reduce the duration and severity of these upper respiratory tract viral infections (BMC Public Health, Dec. 11, 2023). To achieve this, people take a dose of 6 to 8 grams per day. That is a lot more vitamin C than you would get from a morning glass of orange juice.

Of course, we worry about the potential harms of consuming an excessive dose of vitamin C. According to Dr. Hemilä, taking this amount for as long as a cold might last does not produce serious side effects. If one were to take it for a lot longer, that might not be the case. Some reports suggest that long-term high-dose vitamin C supplementation might trigger kidney stones.

Cancer Studies Vindicate Linus Pauling on Vitamin C:

We turn our attention next to a surgeon who treats patients with pancreatic cancer. This type of cancer usually has a grim prognosis. Dr. Joseph Cullen was intrigued by a report that high-dose vitamin C could inhibit the growth of cancer cells, so he and his team tested that possibility in tissue culture. They were impressed at the excellent results they achieved at this first step of the research. However, the benefits were only seen at extremely high doses of vitamin C. This is consistent with preliminary research conducted by Linus Pauling and a colleague testing intravenous (IV) administration of vitamin C in cancer patients. To get exposure to that level of vitamin C (ascorbate) requires IV dosing.

The next step in Dr. Cullen’s research was to test vitamin C in mice with experimentally induced cancer. His team administered vitamin C in conjunction with radiation. Once again, the results were promising.

How Does Vitamin C Affect Cancer Cells?

At low doses, such as those we can get by eating strawberries, bell peppers or oranges, vitamin C is an antioxidant. At the very high doses achieved only by IV administration of 75 grams of ascorbate, this compound acts as a pro-oxidant. It generates hydrogen peroxide that attacks cancer cells.

Dr. Cullen’s team continued their research with a preliminary clinical trial (Redox Biology, Nov. 2024). By administering IV vitamin C together with the usual chemotherapy drugs for pancreatic cancer, they were able to help those patients survive twice as long as those getting chemotherapy alone. Of course we asked about side effects; Dr. Cullen reports that people become very thirsty during the infusion. The scientists did not observe any serious adverse reactions.

Using IV Vitamin C for Other Cancers:

In addition to pancreatic cancer, Dr. Cullen and his collaborators have tested the effects of this treatment in another cancer that is notoriously difficult to treat. They found that cells of the brain cancer glioblastoma were far more vulnerable to radiation In the presence of high-dose ascorbate. On the other hand, normal cells suffered less radiation damage.

With such success, Dr. Cullen’s team and some others are conducting pre-clinical research on some other cancers. Not all types of cancer appear to respond to high-dose IV vitamin C. Apparently, a trial of prostate cancer was disappointing. However, there is now adequate evidence of the potential benefits of vitamin C when used properly to vindicate Linus Pauling and his conviction that this remarkable compound could contribute enormously to human health.

This Week’s Guests:

Harri Hemilä, MD, PhD, is an adjunct professor at the University of Helsinki in Finland. His research has focused on vitamin C, vitamin E, and zinc lozenges for respiratory infections, and he has also analyzed the effects of vitamin E on mortality.

Dr. Harri Hemilä

Joseph J. Cullen, MD, is Professor of Surgery, Gastrointestinal Surgery and Radiation Oncology at the University of Iowa College of Medicine. His website is https://surgery.medicine.uiowa.edu/profile/joseph-cullen

Listen to the Podcast:

The podcast of this program will be available Monday, May 26, 2025, after broadcast on May 24. This week’s podcast contains additional discussion with Dr. Hemilä about the use of zinc in treating the common cold. What type of zinc is best? Should you take tablets or suck on lozenges? Are there any worrisome side effects? We explore briefly the possibility of using both zinc and vitamin C to reduce the duration of a cold. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

This week, we talk with a pulmonologist–a doctor who takes care of people with lung problems. Our topics range from common respiratory infections to the hazards of breathing smoke from forest fires. We also discuss asthma and COPD. Listen to find out how you could be breathing better.

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on March 31, 2025.

Breathing Better Despite Infections:

We are finally emerging from an especially severe flu season. After a few years during and right after the pandemic in which there was relatively little influenza, this year was challenging. Preliminary data from the CDC suggest that between 40 million and 75 million Americans suffered from influenza or flu-like illnesses between October and March. As many as 1.2 million had to be hospitalized. The influenza viruses (there are many) are not the only pathogens that can cause coughing, fever or trouble breathing. Many others might also result in upper respiratory infections that can progress to bronchitis or lower respiratory infections and lead to wheezing or shortness of breath. A bad cold will do that for some people. Human metapneumovirus is not widely recognized and is difficult to pronounce. The infection with this virus starts like a bad cold but it produces a terrible cough that can last for weeks.

How can doctors help a patient with a respiratory infection? If the problem is influenza, they could prescribe a medicine such as oseltamivir (Tamiflu) or baloxavir (Xofluza). These medicines can shorten the duration of flu symptoms and possibly make them less severe. However, they work best when taken as soon as possible (within 48 hours) of the first symptoms appearing.

To learn whether that sore throat and sniffle is leading to flu, you might want to keep a test handy at home. There are several on the market that can determine if you have COVID-19 or influenza A. Then, if you have access to a patient portal, use it to communicate the results to your healthcare provider and get a prompt prescription.

What About a Cold?

While flu or COVID can be serious, colds are far more common. Doctors do not have much in their tool kits to help you recover from a cold, but there are a few things you can do for yourself. Spending some time in sunlight can be very useful. Dr. Seheult suspects that the benefits go beyond the amount of vitamin D you might make through that exposure. In addition, we have seen studies supporting the use of vitamin C supplements to recover from a cold more quickly.

Breathing Better with Improved Ventilation:

During the pandemic, air quality and ventilation got more attention than ever before. Now, although we may be less concerned about airborne pathogens, we still need to pay attention to air quality. Forest fires, whether in California, the Carolinas or any other part of the continent, can put out a lot of smoke. Wildfire smoke carries small particles that can penetrate deep in the lungs and do a lot of damage. Air conditioning may help clean indoor air. So can an inexpensive do-it-yourself air filtering system called a Corsi-Rosenthal box. Here is a link to the show in which we describe how to make one at home.

Struggling to Exhale:

Dr. Seheult also describes the Global Initiative for Asthma, or GINA.  Asthma is reversible airway inflammation. Sometimes this is caused by allergic reactions. Infections may also cause inflammation and lead to asthma exacerbations. In the presence of inflammation, the smooth muscle around the little airways deep in the lungs constrict. This makes it difficult to exhale and make room for the next fresh new breath.

The problem is similar in chronic obstructive pulmonary disease (COPD), in that inflammation tightens those critical small airways and interferes with exhalation. That in turn can keep the patient from being able to take a good breath in. In COPD, however, the inflammation is irreversible.

Both asthma and COPD may respond to drugs that activate beta receptors (“beta agonists”). The long-acting beta agonists (LABAs) are especially prominent. Inhaled steroids can calm the inflammation in both conditions so people can start breathing better. In some instances, an antibiotic like azithromycin can reduce exacerbations. We don’t know whether it is working by fighting off hidden pathogens, or whether it is also reducing inflammation. In COPD, anticholinergic drugs may be able to relax airways even beyond the effects of the beta agonists. If calming inflammation is not good enough, people may need a rescue inhaler.

When Should You Get Emergency Attention?

People experiencing shortness of breath, especially if they are also having fevers, chills or night sweats, should get medical attention promptly.

This Week’s Guest:

Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine, and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Seheult is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. HIs current practice is in Beaumont, California where he is a critical care physician, pulmonologist, and sleep physician at Optum California.

He lectures routinely across the country at conferences and for medical, PA, and RT societies, is the director of a sleep lab, and is the Medical Director for the Crafton Hills College Respiratory Care Program.

Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside

MedCram

In 2012 he and Kyle Allred founded MedCram L.L.C., a medical education company with CME-accredited videos that are utilized by hospitals, medical schools, and hundreds of thousands of medical professionals from all over the world (and over 1 million YouTube Subscribers). His passion is “demystifying” medical concepts and offering people the tools for staying healthy.

We have found Dr. Seheult’s MedCram videos amazing. He makes many complex medical topics understandable. This is a skill that few of Joe’s professors in the University of Michigan’s Department of Pharmacology could claim.

Dr. Seheult was the recipient of the 2021 San Bernardino County Medical Society’s William L. Cover MD Award for Outstanding Contribution to Medicine and the 2022 UnitedHealth Group’s The Sages of Clinical Service Award. In 2022 both Roger Seheult and Kyle Allred received the HRH Prince Salmon bin Hamad Al Khalifa Medical Merit Medal from the Kingdom of Bahrain for their contribution to health policy in the Kingdom of Bahrain.

Listen to the Podcast:

The podcast of this program will be available Monday, March 31, 2025, after broadcast on March 29. You can stream the show from this site and download the podcast for free. In addition to what you hear on the broadcast, the podcast also contains information about TRP channels and home remedies for coughs. We also discuss the heart drug amiodarone and its effects on the lung, along with the nature of interstitial lung disease and how to treat it. You’ll also learn about the pros and cons of OTC inhalers. Can they get you breathing better?

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Are you getting enough fresh air? More than a century ago, Florence Nightingale insisted that hospitals needed good ventilation to get lots of fresh air. That would keep patients from spreading dangerous respiratory infections like tuberculosis. Although she didn’t use the term, she was describing the concept of sick buildings.

Over the last year and a half, COVID-19 has driven that point home. Although experts didn’t realize at first that the disease could be airborne, they eventually recognized that it was spreading through invisible aerosols as well as by larger particles. And for aerosols, good ventilation is key.

The Role of Sick Buildings:

Long before COVID, epidemiologists identified the role of so-called sick buildings in spreading disease. Of course, the buildings themselves are not sick, but the people who work or live in them are. Forensic investigations can locate the source of the problem, whether it is a hidden reservoir of water harbor Legionella or an overgrowth of toxic mold.

How to Make Sick Buildings Healthy:

Our guest, Dr. Joe Allen, is an expert on sick buildings. As he notes, during the energy crisis of the 1970s, builders and building owners became much more concerned about energy efficiency than about the health effects of ventilation. To make sick buildings healthy, we have to examine the flow of fresh air and make sure it is adequate. People can use an inexpensive CO2 monitor to evaluate household air quality. Moisture also needs to be kept within a healthy range. You can monitor that with a humidity sensor (hygrometer), also available at reasonable cost. Of course, the building should not contain toxic materials.

What Are the Benefits of Healthy Buildings?

The focus is on “salutogenesis,” the production of good health. Research suggests that people who work in buildings that support their health are more productive than those who must deal with sick buildings. Excellent ventilation and filtration systems should not only protect people from the spread of COVID-19, but also from influenza and even colds. That could lead to fewer sick days.

Can You Do This at Home?

HEPA (high-efficiency particulate-arresting) filters have become more available in recent years. Homeowners with central heating and cooling can install them for the whole house. People using apartments or single rooms can now find portable HEPA filters that are useful. We discuss how to evaluate the filter, which should have a MERV 13 rating. An air purifier should have a clean air delivery rate (CADR) of 300 per 500 square feet.Finally, what changes in our building systems should we implement to ensure good health in the future?

This Week’s Guest:

Joseph G. Allen is Director of the Healthy Buildings program and an Associate Professor at Harvard’s T. H. Chan School of Public Health. Before joining the faculty at Harvard, he spent several years in the private sector leading teams of scientists and engineers to investigate and resolve hundreds of indoor environmental quality issues, including “sick buildings,” cancer clusters, and biological/chemical hazards. His academic research focuses on the critical role the indoor built environment plays in our overall health. One of the world’s leading experts on healthy buildings, Dr. Allen is a regular keynote speaker and advises leading global companies. He is the co-author of Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.

His website at Harvard is forhealth.org

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 4, 2021, after broadcast on October 2. You can stream the show from this site and download the podcast for free.

Download the mp3

For decades researchers have told us that beta amyloid accumulation in the brain causes Alzheimer disease (AD). The FDA has recently approved two new drugs, Aduhelm and Leqembi, based on this theory. There is a third drug, donanemab, waiting on the runway. All three medications are very good at removing amyloid plaque from the brain, but do they do anything meaningful to improve the clinical outcome of patients with Alzheimer disease? Perhaps it is time to think different…to quote an old Apple computer commercial.

Beta Amyloid and Alzheimer Disease:

What, you may wonder, is beta amyloid and why does it accumulate in the brain? Previous scientists have found that amyloid precursor protein (APP) becomes beta amyloid when pathogens attack the brain.

However, researchers have reacted in quite different ways to that information. Some have suggested that we should be looking at brain infections and ways to protect against them. The dominant approach, though, has been to try to get beta amyloid out of the brain.

Why Should We Think Different About Alzheimer Disease?

The 90+ Study was started in 2003. It enrolled over 2,000 volunteers. The goals of the research include:

• “Determine factors associated with longevity:  What makes people live to age 90 and beyond?  What types of food, activities or lifestyles are associated with living longer?
• Examine rates of cognitive and functional decline in the oldest-old: How do memory loss and disability affect those in their 90s?  How can people prevent memory loss and disability at this age?”

Neuroscience News (May 24, 2023) reports the latest discovery from the 90+ Study (Journal of Alzheimer’s Disease, (May 16, 2023):

“Summary: A new study found people who are 90+ and have superior cognitive skills have similar levels of brain pathology as Alzheimer’s patients.

“Key Facts:

• The study included 102 cognitively normal individuals who died at a mean age of 97.6 years.

• The researchers used autopsy data and cognitive test scores to assess the participants’ brain health and cognitive function.

• People who are 90+ and have superior cognitive skills have similar levels of brain pathology as Alzheimer’s patients.”

The authors of the research state:

“Our findings indicate that Alzheimer’s Disease pathology and vascular changes are common in the brains of 90+ people with excellent cognitive abilities, meaning they are resilient to such changes.”

Why Should Such a Finding Make Us Think Different?

If people in their late 90s have ugly looking brains upon autopsy but still have good cognitive ability up until the time of their deaths, we really need to rethink some of our basic beliefs about what causes AD. Perhaps amyloid is not the enemy we have always assumed.

On our nationally syndicated radio show, we consider the causes of Alzheimer disease. For decades, one theory has dominated. It suggests that the accumulation of beta-amyloid plaques found in the brains of people with dementia cause the problem. Is it time to think different about Alzheimer disease?

How to Think Different About Alzheimer Disease:

Our guest is a medicinal chemist as well as a respected neurologist. He and his team are working on developing medications that could help people prevent or overcome Alzheimer disease. His biggest contribution is finding a way to think different about Alzheimer disease and beta amyloid.

With all the evidence that has accumulated, it doesn’t make sense to dismiss beta amyloid as unimportant. On the other hand, research efforts concentrated solely on beta amyloid have not yielded treatments that are clearly safe and effective enough for most people. Instead, Dr. Donald Weaver suggests that we should look at this compound as a desperate attempt by the brain in the throes of an autoimmune disease.

Autoimmunity and the Brain:

So far, we have only a hypothesis that Alzheimer disease is the result of the body attacking the brain. However, many of the factors that can contribute to dementia are the sorts of insults that can kickstart an immune response. These include things like air pollutions, infection (such as with herpes virus) and head trauma from sports, accidents or domestic violence.

Dr. Weaver draws a distinction between autoimmunity related to the adaptive immune system and that linked to the innate immune system. We have many examples of the former, such as rheumatoid arthritis or systemic lupus erythematosus (SLE). We don’t yet have other examples of the innate immune system attacking to cause autoimmune conditions. We’ll be watching for more research.

Fighting Autoimmune Disease in the Brain:

Dr. Weaver and his lab hope that their research will lead to diagnostic approaches as well as therapeutics. He has been investigating the metabolism of tryptophan in the brain as a precursor of dementia and beta amyloid (Alzheimer’s & Dementia, April 6, 2022). If this approach as a way to think different about Alzheimer disease pans out, it could lead to blood tests many years before cognitive symptoms appear. In addition, scientists may be able to develop drugs that can calm the cytokine storm in the brain that appears to trigger the damage (Alzheimer’s & Dementia, Sep. 27, 2022).

This Guest:

Donald Weaver, MD, PhD, is both a medicinal chemist and clinical neurologist, focused on the design and development of new therapies for Alzheimer disease and related dementias. Dr. Weaver is Senior Scientist at the Krembil Brain Institute at the University Health Network, Toronto, Canada. He is a professor of Medicine (Neurology), Chemistry, and Pharmaceutical Sciences at the University of Toronto and a neurologist at the Toronto Western Hospital. Dr. Weaver is also Chief Medical Officer of Treventis Corporation and is the former President of Epilepsy Canada. His website is https://www.weaverlab.ca/drweaver/

https://www.peoplespharmacy.com/articles/show-1326-think-different-about-alzheimer-disease

Donald Weaver, MD, PhD, Senior Scientist at the Krembil Brain Institute at the University Health Network, Toronto, Canada.

Listen to the Podcast:

The podcast of this program will be available Monday, Jan. 16, 2023, after broadcast on Jan. 14. You can stream the show from this site and download the podcast for free.

Here is a link to our interview with Dr. Matthew Schrag of Vanderbilt University. He has also forced us to think different about the dogma of Azheimer Disease. We think you will find this radio show worth your time! His work also challenges the paradigm that beta amyloid is the key factor behind AD.

Download the mp3

You may not have thought much about long illness, but chances are you know someone who is suffering with one. The CDC estimates that some chronic condition afflicts as many as one in six American adults. That could be more than 130 million people.

What counts as a long illness? Now, as experts declare that the COVID-19 pandemic is no longer a global health emergency, you might think of long COVID. Add heart disease and cancer, and you have covered a large number of people. Arthritis, chronic kidney disease, emphysema and diabetes affect even more. There are also some conditions that are controversial because the medical profession has not recognized them officially–post-polio syndrome, chronic Lyme disease, and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

What Is the Problem with Long Illness?

You may have noticed that doctors treat some persistent conditions with a range of accepted modalities. They prescribe specific drugs for heart disease or arthritis and dialysis for chronic kidney disease. Unfortunately, though, health care practitioners don’t have good treatments for problems like dementia, CFS/ME or chronic Lyme disease. They may not even know precisely how to diagnose these conditions. When it comes to treatment, one size does not fit all. Long COVID has shown us that patients may need many different types of support for all the differing symptoms they suffer.

Integrative Medicine for Long Illness:

Our expert guest, Dr. Meghan Jobson, knows long illness from the inside out. She has a background in research as a neuroscientist as well as in internal medicine. Even more to the point, she herself is living with a long illness. She has found that exercise and movement as well as nutrition and dietary supplements may help her patients as much as prescription medications. Acupuncture or Ayurvedic medicine may aid others. When dealing with long illness, a personalized approach to care is essential.

Physical and Psychological Symptoms:

When healthcare providers cannot diagnose a condition, they may suspect that the patient is suffering from psychological problems. For a patient, hearing that your condition is psychosomatic feels invalidating. Yet the doctor or PA may not be completely mistaken. In some conditions, physical and psychological symptoms such as anxiety or depression are intimately interconnected.

The Importance of Attitude in Managing Long Illness:

People may adopt several different attitudes in the course of a long-lasting condition. Initially, patients seeking a diagnosis for mysterious symptoms (or getting a new and unwelcome diagnosis) will feel engulfed or overwhelmed. They may feel that their health problems have taken over their lives. This is a difficult position for coping with long illness.

Not uncommonly, people will try to deny their symptoms and/or their diagnosis. It’s easy to understand why patients might want to reject their illness, but this attitude can lead to complications later. Friends and family members may also find this approach challenging.

If people can manage to accept the reality of their persistent health challenges, they will be better able to seek treatments that can help. These may be conventional or complementary medical approaches or they may involve practices such as journaling or participating in support groups.

Beyond acceptance, some people are able to adapt to their situation. While in most cases, they would not have chosen it, they may perceive ways in which coping and adaptation have made their lives richer.

This Week’s Guest:

Meghan Jobson, MD, PhD, is an internist with specialized training in integrative and palliative medicine. She is also a neuroscientist and a practicing movement instructor. Dr. Jobson has a personal connection to this work, as a person who survives and thrives with a chronic long illness. In her clinical work she combines her diverse training in exercise and movement, nutrition, conventional medicine, neuroscience, and integrative medicine. With these interwoven techniques, she creates custom approaches to improving and maintaining the quality of life of her patients. Dr. Jobson, with Juliet Morgan, MD, is the author of Long Illness: A Practical Guide to Surviving, Healing, and Thriving. The photo of Dr. Jobson is by Soleil Konkel.

Listen to the Podcast:

The podcast of this program will be available Monday, May 22, 2023, after broadcast on May 20. You can stream the show from this site and download the podcast for free.

Download the mp3.

This week on our nationally syndicated radio show, we explore the ecology of our bodies, especially our skin. Our faces, our armpits and even our bellybuttons harbor a multitude of tiny animals that we don’t see most of the time. What are they doing on us?

The Fascinating World of the Tiny Animals Living on Us:

We begin our conversation about the Serengeti on our skin with face mites. Humans host two different species of face mites, tiny arachnids that live in our hair follicles. You might think that they are pretty closely related, since they both live on us. But genetic analysis show that these species actually diverged from their common ancestor 130 million years ago. They are barely related at all!

Mites in the Demodex genus are not the only tiny animals living on us. There are minuscule nematodes as well as a whole host of bacteria and Archaeans, along with viruses that feed on them (bacteriophages). How do they affect our health?

Everyone has an ecology of skin organisms; like our gut microbiome, they may be similar but not identical from person to person. Most people never notice their Demodex mites and couldn’t tell you whether they have any effects. However, some dermatologists attribute the pimple-like lesions of rosacea to Demodex directly or to our immune reactions to the mites or the bacteria they carry.

What can we do to restore our skin’s native ecological balance? We should be careful that if we use antimicrobial treatments, we don’t throw the entire system even further off balance.

The Tiny Animals and Microbes in Our Armpits:

What about our armpits? We may worry about underarm odor and, rightly, attribute it to the skin microbes that thrive there. In fact, the armpit is specially adapted to support certain types of microbes, particularly Corynebacteria.

What we call sweat glands are actually apocrine glands, specialized structures whose purpose is to feed the native inhabitants of our armpits. If we apply antiperspirants to shut those glands down, we can completely disrupt the ecological balance of our armpits. Instead of Corynebacteria, various forms of Staphylococcus start to dominate the Serengeti of our skin there. We may smell somewhat less stinky to a human, but we smell a whole lot more appetizing to a mosquito.

Maintaining the Ecology of Our Skin:

It may be helpful to consider the microbiome of our skin in a similar way to the microbiome of our digestive tract. If you have to take an antibiotic for ten days, there is a chance that it could cause collateral damage. In addition to killing the pathogen responsible for whatever infection you are treating, the antibiotic may also kill a lot of your gut bacteria. That leaves some ecological niches wide open, and a weak but fast-growing species takes advantage. Like a weed proliferating in your garden, Clostridioides difficile (C. diff) takes off and can cause a lot of trouble. We haven’t identified all the equivalents in our skin microbiome, but the process is similar, and the triggers–overused antibiotics–might be, as well.

An Effective Remedy from Viking Days:

Our ancestors may not have known anything about the tiny animals living on our skin, but they had a lot of practical wisdom about how to deal with them. Just as home bakers know a great deal about fermentation that you won’t find in textbooks, people developed quite a sophisticated knowledge of how to manage common infections. Dr. Dunn describes a Viking manuscript with an eye infection remedy. The researcher who encountered it put it to the test and found that it contains several ingredients that should make it effective against skin infections. We could benefit by paying more attention to the care and feeding of our skin microbes.

This Week’s Guest:

Rob Dunn, PhD, is an ecologist and evolutionary biologist, focusing on the biodiversity of humans. He is the William Neal Reynolds Distinguished Professor in the Department of Applied Ecology at North Carolina State University and Senior Vice Provost for University Interdisciplinary Programs. In addition, he is a visiting professor in the Center for Evolutionary Hologenomics at the University of Copenhagen.

Rob Dunn is the author of several books including his latest, Delicious: The Evolution of Flavor and How It Made Us Human (co-authored with Monica Sanchez)  and A Natural History of the Future: What the Laws of Biology Tell Us.

More of his books can be found on Amazon.

Listen to the Podcast:

The podcast of this program will be available Monday, May 15, 2023, after broadcast on May 13. You can stream the show from this site and download the podcast for free.

This week’s episode begins with an interview. We talk with Dr. Craig Hopp of the National Center for Complementary and Integrative Health about why doctors so often dismiss home remedies as old wives tales.

Then he describes how we could evaluate remedies without randomized controlled trials. Natural products may offer leads for new drug development. For some minor conditions, though, experimenting with home remedies makes sense. Do you have a favorite hiccup remedy, for example? Doctors don’t have a lot to offer in that regard. Parents may prefer natural cough remedies rather than OTC medicine for children. Have you found one that works? Email us [radio@PeoplesPharmacy.com] or call 888-472-3366 between 7:10 and 8:00 am EST on Saturday, May 6, 2023.

Are Natural Remedies Still Relevant?

A hundred years ago, the pharmacists’ pharmacopeia of medicines still had many botanical products listed as standard treatments for common ailments. By the end of the 20th century, almost all of these had fallen out of favor. Doctors learned in medical school that there was no evidence to support their use. In contrast, drug manufacturers conducted large randomized controlled trials on their synthetic products. Many people are unaware that some manufactured medicines are derived from natural products. However, many cancer therapies, as well as cromolyn for allergies and metformin for blood sugar control, got their start with the old wives’ plants.

Some common problems are annoying, but not serious enough to inspire a visit to the doctor. What do you do for occasional heartburn? What about a mosquito bite? A lot of people have a favorite remedy for a cold. Do you?

How Can We Tell If the Old Wives Were Right?

Of course, you wouldn’t want to use a treatment without some evidence. But you don’t have to have a rigorous experiment with placebo arms and double blinding to gather evidence for some approaches. One of our favorite remedies, ground black pepper on a cut to stop bleeding, is supported by nothing more than our experience. Have you tried it? Does it work for you?

If you have ever experienced a muscle cramp, either while exercising or later, interrupting your sleep, you probably welcome a home remedy that quickly stops the pain. We have tried several and found a number that work for us. Swallowing a teaspoonful of yellow mustard is easy and effective; sipping vinegar is more challenging but works just as well. We’d love to hear what you do to relieve a muscle cramp.

Do Home Remedies Work?

Most home remedies are not very fancy. Perhaps you’ve always heard that gargling with salt water will soothe a sore throat. You won’t know how well it works for you until you try it. When we have a troublesome cough left over from a cold, we like to sip a cup of thyme tea, flavored with lemon and honey. Another way to put the power of thymol to work against a cough is to smear Vicks VapoRub on the soles of the feet before getting into bed. Be sure to put on socks so you don’t mess up the sheets or slip on the bathroom floor.

What Did the Old Wives Suggest for Nail Fungus?

We started writing about readers’ remedies for nasty nail fungus years before the FDA approved expensive prescription drugs to treat this problem. The remedies certainly do not work every time–but then, neither do the medicines. The success rate of clearing nail fungus is modest for most.

Criteria for Home Remedies to Try:

We’ve already mentioned Vicks VapoRub on the soles of the feet for a cough. The nurse who told us about this suggested three criteria for a remedy worth trying:
1)   It might work.
2)   It won’t hurt.
3)   It doesn’t cost very much.

This Week’s Guest:

D. Craig Hopp, PhD, is deputy director of the Division of Extramural Research at the National Center for Complementary and Integrative Health (NCCIH).  In addition to serving as deputy director, Dr. Hopp continues to oversee the administration of the product integrity policy. This involves evaluation of proposed study materials to ensure they are safe and properly characterized. He also focuses on large-scale projects such as research on drug-natural product interactions, the innovation and technology research center, and the Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) program. Dr. Hopp uses his expertise and experience in the field of natural products to help shape research priorities at NCCIH. https://www.nccih.nih.gov/about/staff/d-craig-hopp

The photo of Dr. Hopp is by Lisa Helfert.

Craig Hopp, PhD

Listen to the Podcast:

The podcast of this program will be available Monday, May 8, 2023, after broadcast on May 6. You can stream the show from this site and download the podcast for free.

Download the mp3

We have multiple nervous systems. You are probably aware of the nerves that help move your arms to throw a ball or move your legs to jump. No doubt you also know about the fight-or-flight response triggered by a fright. The oddly named sympathetic nervous system is in charge of that. Many of us don’t pay much attention to the parasympathetic nervous system. When it is activated, it promotes a “rest and digest” response. The largest nerve involved in this is the vagus nerve. How can we harness its power?

What Is the Vagus Nerve?

The vagus nerve is surprisingly long. Though it is the tenth cranial nerve, it wanders far from the head and face, connecting the lungs, diaphragm, throat, inner ear and digestive tract together. This pillar of the parasympathetic nervous system influences memories, breathing, relaxation and inflammation.

The Power of the Vagus Nerve:

Because the vagus nerve can tone down inflammation, stimulating it can help reduce pain. The earliest approaches to this required surgical implantation of devices. More recently, however, scientists have been working with noninvasive (or transcutaneous) stimulators that work through the skin. Such devices can help prevent migraines, stop cluster headaches and reduce the severity of an evolving stroke. Moreover, some therapists find transcutaneous vagal stimulation helpful in managing post-traumatic stress disorder (PTSD).

Studies show that it may reduce severe gastroesophageal reflux symptoms (American Journal of Gastroenterology, July 1, 2021).  Clinicians are also considering it as a treatment for inflammatory bowel disease (Alimentary Pharmacology & Therapeutics, Oct. 2019). In addition, noninvasive vagal stimulation reduced inflammatory markers of patients with COVID-19 (Frontiers in Neurology, April 8, 2022).

Can You Stimulate the Vagus Nerve Without a Device?

Many well-known practices may actually work, at least in part, through vagal activation. People who practice meditation are probably strengthening the parasympathetic nervous system. Deep breathing exercises, particularly those with an emphasis on exhalation, can also help. Exercise and biofeedback are other routes to improved vagal tone. In addition, avoiding alcohol and following an anti-inflammatory diet are likely to help the parasympathetic system perform as it should.

Beyond that, singing, team sports and practicing coordinated movement with others through dance or play can also be beneficial. One guest plays the clarinet; with its emphasis on exhalation, this stimulates the vagus nerve. So does using a tilt table, which activates baroreceptors that are part of this nervous system.

This Week’s Guests:

Peter Staats, MD, is internationally recognized for his work in inventing, developing, and implementing minimally invasive procedures for pain and neuromodulation. He is currently Chief Medical Officer of National Spine and Pain Centers. Dr. Staats is a leader in vagal stimulation and is one of the founders of electroCore, which was instrumental in getting vagal nerve stimulation approved for emergency use for acute COVID19.
https://www.electrocore.com/aboutus/

Dr. Staats was founder of the Division of Pain Medicine at Johns Hopkins University, where he was the director for 10 years.
https://www.treatingpain.com/about-us/meet-our-leaders/peter-staats-m-d-/

Peter Staats, MD, Chief Medical Officer of National Spine and Pain Centers

Stephen W. Porges, PhD, is Distinguished University Scientist at Indiana University where he is the founding director of the Traumatic Stress Research Consortium and a Professor of Psychiatry at the University of North Carolina. He served as president of the Society for Psychophysiological Research and the Federation of Associations in Behavioral & Brain Sciences and is a former recipient of a National Institute of Mental Health Research Scientist Development Award. Dr. Porges has published more than 400 peer‐reviewed scientific papers across several disciplines that have been cited in more than 50,000 peer-reviewed papers. He holds several patents involved in monitoring and regulating autonomic state. Dr. Porges is the originator of the Polyvagal Theory, a theory that emphasizes the importance of physiological state in the expression of behavioral, mental, and health problems related to traumatic experiences.

Dr. Porges is the author of several books, including his most recent book, Polyvagal Safety: Attachment, Communication, Self-Regulation and a new book with his son, Our Polyvagal World: How Safety and Trauma Change Us, coming out in September.

Stephen Porges

Listen to the Podcast:

The podcast of this program will be available Monday, May 1, 2023, after broadcast on April 29. You can stream the show from this site and download the podcast for free.

Download the mp3

Do you love your hair the way it is? Many of us wish our hair were different–curlier, straighter, darker or lighter. But what people worry about most with their hair is when they lose it. Can you keep your hair from falling out? Why does hair loss affect some people, including women as well as men? Why do others seem relatively unaffected? What’s the latest update on low-dose oral minoxidil for hair loss?

While there is some familial component to male pattern baldness (despite the name, it affects women too), the exact genetics are unclear. Other causes of hair loss include autoimmune disease such as alopecia areata or hormone imbalance such as thyroid disorders. Pregnancy is a common cause of hair loss after delivery. That’s because the hair that has been in anagen phase (growing) shifts to telogen phase in which the hair follicle rests and the hair is no longer growing. Stress can also make hair fall out.

What Can You Do About Hair Loss?

This week’s New England Journal of Medicine (Oct. 15, 2025) has an article titled:

“Hair Loss in Women“

The author of this article is Dr. Elise A. Olsen, a dermatologist at Duke University. She is Founder and Director of the Duke Dermatopharmacology Study Center.

Here is how she introduces the problem:

“Female-pattern hair loss is the most common cause of hair loss in women. The prevalence of this condition is 3 to 12% among women of European descent in their 20s and 30s, 14 to 28% among those in their 50s, and 56% among those older than 70 years of age.”

In other words, women lose hair as they age just as many men do.

You will shortly read about some of the causes of hair loss. But in this update I want to cut right to the chase and tell you what Dr. Olsen recommends for treating “Female-Pattern Hair Loss.”

She first mentions 2% topical minoxidil solution applied two times a day or a 5% topical foam applied once a day. Dr. Olsen mentions side effects such as contact dermatitis or hair growth on the face.

She goes on to describe low-dose oral minoxidil (5 mg or less) on a daily basis. Dr. Olsen says that a 1 mg dose of oral minoxidil is “at least as effective as a daily application of a 5% topical minoxidil solution.”

She goes on to describe side effects:

“Although low-dose oral minoxidil has no substantial effect on blood pressure in most persons, women may benefit from starting at a dose of 1.25 mg per day or less and escalating slowly as long as unacceptable side effects do not occur. Peripheral edema [fluid accumulation and swelling] and hypertrichosis [unwanted hair growth], both of which can manifest after approximately 2 to 4 months of treatment and are dose related, have been reported in 1.1% and 15.1% of patients, respectively.”

If you would like to read Dr. Olsen’s entire article you will need access to the New England Journal of Medicine (Oct. 15, 2025). Your dermatologist may be able to provide you a copy. It is an excellent overview of Female-Pattern Hair Loss.

Your doctor may wish to read it herself. This overview goes on to discuss the use of the diuretic spironolactone and the antifungal agent ketoconazole. A ketoconazole shampoo is sold over the counter as Nizoral and Dr. Olsen states that a ketoconazole “shampoo is commonly prescribed for female-pattern hair loss.”

What Causes Hair Loss?

Treating the conditions that trigger hair loss can be helpful. That’s why the first test might be for thyroid function. Once a thyroid imbalance is corrected, the hair loss will generally improve.

Infection and fever can also lead to hair loss.

According to the American Academy of Dermatology:

“Most people see noticeable hair shedding two to three months after having a fever or illness. Handfuls of hair can come out when you shower or brush your hair. This hair shedding can last for six to nine months before it stops. Most people then see their hair start to look normal again and stop shedding.”

Telogen Effluvium:

Dermatologists call temporary hair loss due to stress or a shock to the system “telogen effluvium.” The word telogen means “resting.” Your hair goes through various cycles of growth. The “anagen” phase is active, when the follicle is working hard to create and grow a hair. It can last for years.

The “catagen” phase is a transition phase that just lasts a few weeks. It is followed by the “telogen” phase. Think of this stage a bit like resting or hibernation. The hair stays in the follicle, but is no longer growing. Eventually, the old hair falls out. That is called the “exogen” phase.

Effluvium is dermspeak for hair loss. So telogen effluvium means excessive hair shedding brought on by stress, infection, childbirth, weight loss, surgery, medications and a whole lot more.

Hair Loss from COVID-19?

We stumbled across an article in the journal of Medical Virology (Dec. 20, 2021) titled:

“A Systematic Review of Acute Telogen Effluvium, A Harrowing Post-COVID-19 Manifestation.”

The authors report that:

“The mean duration from COVID-19 symptom onset to the appearance of acute TE [telogen effluvium] was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress. “

Other authors have also reported hair loss after COVID infection.

Minoxidil to Keep Hair from Falling Out:

Perhaps you have heard of minoxidil (Rogaine) for hair loss. An oral version of minoxidil (Loniten) was first approved in 1979 to treat high blood pressure.

A “side effect” of excessive hair growth prompted the manufacturer to investigate the topical application against hair loss. The FDA approved prescription Rogaine in 1988. Later, the FDA allowed over-the-counter sale of this topical compound. It was never the kind of blockbuster success one might have anticipated. A drug that really keeps hair from falling out should be a billion dollar best seller!

But perhaps the problem was not with minoxidil itself. Maybe it was the topical application of the drug that led to disappointing results.

Here is a question from a reader:

Q. I am concerned about my thinning hair. I tried Rogaine and it worked well until I developed an allergic reaction.

I just read about low-dose oral minoxidil. What can you tell me about it?

A. Science writer Gina Kolata stirred up a lot of excitement in her New York Times article (Aug. 23, 2022). It was titled:

“An Old Medicine Grows New Hair for Pennies a Day, Doctors Say” “Dermatologists who specialize in hair loss say that the key ingredient in a topical treatment worked even better when taken orally at a low dose.”

Gina describes the off-label use of low-dose oral minoxidil as an alternative to topical Rogaine (minoxidil). Several dermatologists have reported success prescribing very low doses of this blood pressure pill for people with hair loss.

The usual oral dose ranges from 5 to 40 mg per day for hypertension. However, at those doses people may experience serious side effects.

Some dermatologists are prescribing amounts that range from 0.25 to 1.25 mg (Journal of the American Academy of Dermatology, March, 2021). They often add the diuretic spironolactone (25 mg) to reduce fluid retention and counteract facial hair growth.

Topical Minoxidil Can Help Keep Hair from Falling Out: One reader recently asked us:

Q. About two years ago, I was seriously considering a wig because I was losing so much hair above my forehead. My doctor suggested minoxidil.

The bottle says to use it twice a day for at least six months before you will see a difference. I was faithful about using it, and it does work. My hairdresser is amazed at the difference.

Now I have cut back to using it just once a day and it’s still working. I have heard that if I quit using it, I will lose my hair again. I am not willing to try that! Is there anything I should know about this OTC medicine?

A. While minoxidil does stimulate hair growth, there are some downsides. Skin irritation is one possible side effect.

An alternative to Rogaine is low-dose oral minoxidil.

The review described above concludes:

“Oral minoxidil was found to be an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations.”

This requires medical supervision because oral minoxidil, even in very low doses, may cause some side effects such as dizziness or fluid retention.

Another Option? Finasteride & Dutasteride:

Drugs that men use for enlarged prostate glands, finasteride and dutasteride, can also stop hair loss. They do have some sexual side effects, however, and they are inappropriate for pregnant women. How do these three oral medications stack up when it comes to preventing hair from falling out?

An article in the Journal of Dermatological Treatment (online, Aug. 15, 2022) is titled: “Comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia” The authors introduce their article this way:

“Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/d) is an FDA-approved treatment for male AGA, oral minoxidil and oral dutasteride are not approved yet. However, clinicians have been increasingly using these two drugs off-label for hair loss. Recently, Japan and South Korea have approved oral dutasteride (0.5 mg/d) for male AGA.”

Under the heading Efficacy and Safety they state:

“A probable efficacy ranking, in decreasing order, is – dutasteride 0.5 mg/d, finasteride 5 mg/d, minoxidil 5 mg/d, finasteride 1 mg/d, followed by minoxidil 0.25 mg/d. Oral minoxidil predominantly causes hypertrichosis and cardiovascular system (CVS) symptoms/signs in a dose-dependent manner, whereas oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects.”

A Drug for Eyelashes:

Ophthalmologists discovered some years ago that the bimatoprost eye drops they were prescribing to treat glaucoma could also make eyelashes grow thicker and fuller. The FDA subsequently approved this medication for eyelash growth under the brand name Latisse. The user applies it like eye liner and it works well for the lashes.

Drugs That Cause Hair Loss:

Certain medications may trigger hair loss, particularly in susceptible individuals. In most cases, the prescriber could find an alternative. For example, beta blockers such as metoprolol are known to cause this problem, but usually another medication could be used to control blood pressure or heart rhythm.

In the case of chemotherapy, people usually consider that the benefit of overcoming cancer far outweighs the distress of losing hair. Nonetheless, a new tactic may help counteract the hair loss due to chemo. It is a type of close-fitting cooling cap that constricts blood vessels so less of the medication gets to the hair follicles.

One thing to avoid: using oil with heat processing. This can actually damage and scar the follicle, preventing recovery.

Keep Your Hair from Falling Out:

Keeping your body and skin healthy with good nutrition, adequate sleep and stress control is also a good way to maintain a healthy head of hair. Crash diets or extreme calorie restriction can lead to hair loss. Essential fatty acids, including omega 3 fats found in fish oil, can be helpful. Zinc supplements may also be useful to keep hair from falling out.

Reducing inflammation can be helpful to prevent hair from falling out. In general, prevention is more preferable to finding ways to rejuvenate growth. The supplements Dr. Adigun mentions as possibly helpful, although incompletely tested, are Viviscal and Nutrafol. They contain marine complexes and ashwagandha.

Our Radio Show Guest:

Chris G. Adigun, MD, FAAD, is a board-certified dermatologist who practices at the Dermatology and Laser Center of Chapel Hill, NC. In the picture, she is standing in the WUNC studio with Joe (seated) and Terry Graedon, hosts of The People’s Pharmacy.

Listen to the Podcast:

The podcast of this program is available. The show can be streamed online by scrolling to the top of the page and clicking on the arrow inside the green circle under the photograph of Dr. Adigun, Joe and Terry. At the bottom of this page you can download the free mp3 file and listen at your leisure.

This interview with Dr. Adigun was recorded in 2019. We later interviewed her and Dr. Warren Heymann on a live People’s Pharmacy broadcast. Dr. Heymann is Professor of Medicine and Pediatrics and Head of the Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey and Clinical Professor of Dermatology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.

They were live in our studio on October 22, 2022. Dr. Heymann has written an article in the Journal of the American Academy of Dermatology (March, 2021) Titled:

“Coming full circle (almost): Low dose oral minoxidil for alopecia”

Download the free mp3 of our old interview with Dr. Adigun (Choose MP3 from the pulldown) or click on the arrow inside the green circle under the photo at the top of the page for the streaming audio.

The more recent interview with Dr. Adigun and Dr. Warren Heymann, focuses on oral minoxidil. You will want to listen to the streaming audio or download the free podcast at this link.

Alopecia Areata and Olumiant:

JAK (Janus kinase) inhibitors can be surprisingly effective for autoimmune hair loss. On June 13, 2022, the FDA announced the approval of baricitinib (Olumiant) for treating alopecia areata.

Here is how the FDA describes the new drug:

“Alopecia areata, commonly referred to as just alopecia, is an autoimmune disorder in which the body attacks its own hair follicles, causing hair to fall out, often in clumps. Olumiant is a Janus kinase (JAK) inhibitor which blocks the activity of one or more of a specific family of enzymes, interfering with the pathway that leads to inflammation.

“The efficacy and safety of Olumiant in alopecia areata was studied in two randomized, double-blind, placebo-controlled trials (Trial AA-1 and Trial AA-2) with patients who had at least 50% scalp hair loss as measured by the Severity of Alopecia Tool for more than six months. Patients in these trials received either a placebo, 2 milligrams of Olumiant, or 4 milligrams of Olumiant every day. The primary measurement of efficacy for both trials was the proportion of patients who achieved at least 80% scalp hair coverage at week 36.

“In Trial AA-1, 22% of the 184 patients who received 2 milligrams of Olumiant and 35% of the 281 patients who received 4 milligrams of Olumiant achieved adequate scalp hair coverage, compared to 5% of the 189 patients who received a placebo. In Trial AA-2, 17% of the 156 patients who received 2 milligrams of Olumiant and 32% of the 234 patients who received 4 milligrams of Olumiant achieved adequate scalp hair coverage, compared to 3% of the 156 patients who received a placebo.”

“The most common side effects associated with Olumiant include: upper respiratory tract infections, headache, acne, high cholesterol (hyperlipidemia), increase of an enzyme called creatinine phosphokinase,  urinary tract infection,  liver enzyme elevations, inflammation of hair follicles (folliculitis), fatigue, lower respiratory tract infections, nausea, genital yeast infections (Candida infections), anemia, low number of certain types of white blood cells (neutropenia), abdominal pain, shingles (herpes zoster) and weight increase.”

We cannot proclaim Olumiant a home run, given the number of side effects and the modest effectiveness of the drug. Nevertheless, it may be worth consideration given the challenges of alopecia areata.

There is one more recent podcast you may want to listen to. It was Show 1438: Bites, Burns, and Blisters? Solving Summer Skin Problems! At the end of the interview, Dr. Adigun offered an update on low-dose oral minoxidil for women as well as men. Here is a link.