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.

Have you ever wondered what makes for a meaningful life? Philosophers have debated this for centuries, but now science has something to add. The current director of the Harvard Study of Adult Development shares the findings from this long-running, in-depth research on the factors that lead to happiness and a meaningful life.

80+ Years of Science:

The Harvard Study of Adult Development started with Harvard undergraduates in 1938. Before too long, the study expanded to include young men from underprivileged families in Boston. Over the decades, the researchers contacted not only the 724 original volunteers, but also their partners and their children to invite them to participate as well. The detailed questionnaires they filled out periodically provide a great deal of data on the factors that make for a good life. As the study proceeded, new methods also became available. In addition to chronicling the volunteers’ physical and mental health, their work life and relationships, the researchers also collected information on the performance of their hearts on a stress test, the length of their telomeres and their DNA.

Can Money Buy Happiness?

Having such different sources for the initial cohorts allowed the scientists to examine the role of resources in shaping a meaningful life. What they found is that once basic needs are met, having more money does not make a person happier. As the Beatles sang, “Money can’t buy me love.”  Consequently, privilege does not determine happiness.

Defining Happiness:

There are at least two common ways to understand happiness. The first is the delight you might find in a hot fudge sundae. While hot fudge might not be your thing, everyone appreciates a bit of pleasure from time to time, whether it is the sight of sun shining through green leaves or the sound of a perfectly tuned wind chime. This hedonic happiness is short-lived.

Another approach is eudaimonic happiness. This is longer-term, and might best be explained as finding a way to make life meaningful. For the participants in the study, connections with other people were a keystone.

Nurturing Relationships Is the Secret to Happiness:

Some of the most miserable people in the study found ways to blame their partners or colleagues for their disappointments. Others derived great satisfaction from their relationships. Although the investigators found that trauma can take away our trust in the world, that can be restored if people have supportive relationships later with trustworthy people.

Generalizing broadly, study volunteers have two important pieces of advice for the rest of us:
1. Take care of your body as if you’ll need it for 100 years.
2. Take care of your relationships and remember that the community depends upon each of us.

Are We in Control of our Own Happiness?

Our culture glorifies extroverts, especially when the topic is relationships. Even though the party animals may do well in building lots of relationships, quieter, more introverted people with a few strong friendships can also thrive.

Dr. Sonja Lyubomirsky has examined the question of what accounts for happiness. Her research indicates that perhaps 50 percent can be attributed to inborn temperament, while at least 40 percent is under our own control. Luck also plays a role. Happiness is an accident, but we can make ourselves more accident-prone in this regard.

This Week’s Guest:

Robert Waldinger, MD, is a professor of psychiatry at Harvard Medical School, director of the Harvard Study of Adult Development at Massachusetts General Hospital, and cofounder of the Lifespan Research Foundation. Dr. Waldinger received his AB from Harvard College and his MD from Harvard Medical School. He is a practicing psychiatrist and psychoanalyst, and he directs a psychotherapy teaching program for Harvard psychiatry residents. He is also a Zen master (Roshi) and teaches meditation in New England and around the world. Robert is the co-author, with Marc Schulz, PhD, of the book The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.

Listen to the Podcast:

The podcast of this program will be available Monday, April 24, 2023, after broadcast on April 22. You can stream the show from this site and download the podcast for free.

Download the mp3.

In this episode, four guests share their diverse perspectives on LASIK eye surgery. This procedure surgically changes the shape of the cornea with the goal of helping people see better, ideally without eyeglasses or contact lenses. Experts estimate that ophthalmologists perform about 700,000 of these in the US each year. We are told that most patients are satisfied with the outcomes. As with all surgeries, however, there are risks. What do we know about them?

FDA Considers New Warnings on LASIK Eye Surgery:

The FDA first approved the laser devices for this procedure in 1999. (LASIK is an acronym for Laser-Assisted In Situ Keratomileusis.) At that time, Dr. Morris Waxler was Branch Chief for the agency. By 2011, Dr. Waxler had changed his mind about the safety of the procedure. Consequently, he petitioned the FDA to issue a Public Health Advisory regarding LASIK-related injuries. He explains his thinking in this interview.

A Patient Who Had Problems with LASIK Eye Surgery:

More than 20 years ago, Paula Cofer had refractive surgery. It seemed that it would be a good fit with her active lifestyle, which included scuba diving. Her results were disastrous, however. She was left with pain and impaired vision, especially in low light. Ms. Cofer tells her story, including her testimony to the FDA and her experience as the Patient Representative at an advisory panel meeting for the agency in 2008.

An Optometrist Helps Patients Who Have Had Bad Outcomes:

Dr. Edward Boshnick, an optometrist in private practice in Miami, Florida, specializes in helping people who are struggling with the results of their LASIK eye surgery. Some have severe dry eye, while others have persistent pain or visual abnormalities. In many cases, Dr. Boshnick provides them with special scleral lenses that provide the cornea with constant moisture. They may also help correct vision distorted by a weakened cornea. Dr. Boshnick describes his approach with passion.

An Ophthalmologist Provides His Perspective:

Dr. Alan Carlson of Duke University School of Medicine is very familiar with LASIK eye surgery. In the course of his career, he has performed more of these procedures than anyone else at his institution. He points out, however, that he has also sent more patients away without surgery than anyone else. Dr. Carlson, who does not currently perform this procedure, offers his viewpoint on the proposed guideline changes from the FDA. In addition, he discusses his conservative perspective on who can get the most benefit from LASIK–people such as military personnel, police or elite athletes for whom glasses or even contact lenses might be a hazard. He also outlines eye conditions such as glaucoma that could make refractive surgery riskier.

Refractive Surgery Council Statement:

In the interests of providing the fullest possible range of viewpoints for our listeners, our producer approached the Refractive Surgery Council, a group of ophthalmologists who regularly perform LASIK eye surgery.

They declined an interview but offered this statement:

February 24, 2023:
Statement from The Refractive Surgery Council (RSC) for The People’s Pharmacy with Joe and Terry Graedon

LASIK is both safe and effective for those who are good candidates, a fact the FDA has reaffirmed repeatedly. In fact, the FDA’s own independent clinical study, PROWL, reported very high levels of patient satisfaction between 96 and 99 percent.

The risks and side effects from LASIK are very well understood based upon an enormous volume of clinical data amassed over 25+ years and more than 7,000 studies.
The FDA understands LASIK is safe and effective for those who are good candidates. In July 2022, the FDA said it had “issued a draft guidance to help ensure that information is available to patients and healthcare professionals to clearly communicate the benefits and risks of LASIK devices.”

Patients should be presented with the facts about the risks and benefits of any procedure, which should reflect the clinical, evidenced-based experience. For a patient to make a well-informed decision, both the risks and the benefits must be carefully articulated and understood.

Importantly, RSC believes it is the doctor’s role to discuss whether any patient, considering their individual needs and medical conditions, is a candidate for any medical treatment, including LASIK surgery. Patients considering LASIK are encouraged to do their own independent research, using credible, clinically accurate, and updated sources of information, such as the resources provided by RSC and the American Academy of Ophthalmology, and have a thorough discussion with their doctor to help inform their decisions. Achieving informed consent is the work of the doctor-patient relationship and each surgeon is required to provide patients with an informed consent form to review and sign.

LASIK devices have continued to incorporate advances, improvements, and refinements since the FDA began its post-market LASIK surveillance activity in 2008 resulting in a significantly improved risk profile. According to the FDA’s Total Product Life Cycle database, the number of adverse events reported with LASIK surgery is low and has declined each year from 2018 to 2021, an indication that modern technology and techniques have improved what is already a safe and effective procedure.

The Refractive Surgery Council (RSC) was created in 2010 through a collaboration of the American Society of Cataract and Refractive Surgery (ASCRS) and refractive device manufacturers working together to provide a comprehensive, independent source for patient education. As a leading authority, RSC offers individuals researching laser vision correction procedures medically reviewed and clinically accurate information to help make confident, informed decisions about vision correction procedures. For RSC’s full response to the FDA’s Draft Guidance, please visit https://www.regulations.gov/comment/FDA-2022-D-1253-0468.

HELPFUL TAKEAWAY POINTS FOR THOSE EVALUATING WHETHER LASIK IS RIGHT FOR THEM:

1. Ask yourself what you want out of LASIK. Are you active and your glasses get in the way? Are contact lenses bothering you?
2. Thoroughly research everything from how LASIK works to recovery, risks, and potential complications, and then write down your questions.
3. Make an appointment with a board-certified ophthalmologist for a thorough medical evaluation. Share your full health history including your medications and health conditions.
4. Discuss your specific risks with your surgeon so you understand what to expect if you should be one of the rare few who have a complication, the treatment protocols, and how you and your eye doctor will work together to ensure your best outcome.
5. Once your questions are answered and you understand you are a good candidate, take time to thoroughly review, discuss, and sign the informed consent with your surgeon. You shouldn’t feel rushed or pressured through this important step.

This Week’s Guests: Dr. Waxler:

Morris Waxler, PhD, was the Branch Chief at the FDA from 1996 to 2000 who oversaw the original approval of the devices used for LASIK surgery in the USA. Soon coming to believe that the real risks associated with these devices are far higher than the FDA would have originally approved, and that important data had been distorted or withheld, on January 6, 2011 Dr. Waxler petitioned the Food and Drug Administration (FDA) to issue a Public Health Advisory to halt the epidemic of LASIK injuries.
https://lasikcomplications.com/Morris_Waxler_letter_to_injured_LASIK_patients_7Mar2012.pdf

Ms. Cofer:

Paula Cofer suffered life-long complications from LASIK surgery nearly 23 years ago. Since that time she has devoted herself to educating prospective LASIK patients on the risks and long-term consequences of LASIK and advocating for LASIK patients with bad outcomes. In 2008, she served as the Patient Representative at an FDA advisory panel meeting on LASIK issues. In 2014, she started the LASIK COMPLICATIONS SUPPORT GROUP on Facebook, which currently has close to 8,000 members.
https://www.facebook.com/groups/LasikComplicationsFaceBookGroup

Dr. Boshnick:

Edward Boshnick, OD, maintains a cutting-edge practice in Miami, FL, devoted to the restoration of vision and comfort lost from LASIK damage as a result of refractive eye surgery (including LASIK and radial keratotomy), keratoconus, corneal transplant surgery, pellucid marginal degeneration, extreme dry eye, corneal dystrophies, corneal trauma and Stevens-Johnson Syndrome. Dr. Boshnick has been a clinical investigator for both the FDA and several major contact lens manufacturers for over 20 years. His website is https://eyefreedom.com/

Dr. Carlson:

Alan N. Carlson, MD, serves as Professor of Ophthalmology at Duke University School of Medicine, specializing in cataract, refractive and corneal surgery. Dr. Carlson was selected among the top 6 refractive surgeons in university settings and is an active member in over a dozen professional societies and one of the most experienced anterior segment surgeons in the country having performed over 52,500 successful surgical procedures, including 18,500 LASER vision correction procedures in his ophthalmic career. Dr. Carlson has conducted over 55 television and radio interviews and performed the first televised LASIK procedure in this region.
https://dukeeyecenter.duke.edu/profile/alan-neil-carlson

Listen to the Podcast:

The podcast of this program will be available Monday, April 17, 2023, after broadcast on April 15. 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 power of cocoa compounds to help heart health. Our first guest is Harvard’s Dr. JoAnn Manson, lead investigator of the COSMOS trial. That stands for Cocoa Supplement and Multivitamin Outcomes Study. This very large, randomized placebo-controlled study looked at the effects of a multivitamin or cocoa extract on cancer or cardiovascular health.

What Did COSMOS Reveal About Cocoa Compounds?

This double-blind study with more than 20,000 participants had four arms. One-fourth of the volunteers took a placebo multivitamin and placebo cocoa extract pills for three and a half years. Another quarter of the volunteers took active pills, both multivitamin and cocoa compounds. In addition, one quarter got a real multivitamin and placebo cocoa capsules, while the remainder got real cocoa compounds and a placebo multivitamin. Of course, the scientists carefully tallied every cardiovascular event, from angina to death by heart attack. They also scoured the participants’ medical records and self-reports for evidence of new cancer diagnoses.

People who took actual cocoa compounds had 10 percent fewer cardiovascular events than those taking placebo. Given the very large number of participants, that difference was not statistically significant.

The mortality statistics were more interesting, however. People taking cocoa compounds were 27 percent less likely to die from a heart attack or stroke than those taking the dummy capsules. That difference was significant. Nonetheless, this was a secondary outcome, so the researchers are cautious about proclaiming that it is a clear benefit of consuming cocoa compounds.

Did Multivitamins Help?

The scientists had hypothesized that multivitamins might reduce the risk of cancer. However, there were no significant differences in rates of cancer diagnosis between multivitamin and placebo recipients. The exception is lung cancer, which was less frequent among multivitamin users than among those taking placebo vitamin tablets.

How Could Cocoa Compounds Protect the Cardiovascular System?

For years, scientists have known that cocoa flavanols can help the blood vessels relax, allowing them to expand their diameter. This in turn lowers blood pressure modestly but consistently. At a population level, this could have a beneficial effect. Dr. Manson and her colleagues are planning future studies to confirm and extend the findings from COSMOS.

What Supplements Might You Take?

Many health care professionals dismiss dietary supplements as useless. Dr. Manson suggested that might be due in part to the fact that there are no agencies ensuring the quality of dietary supplements. In fact, some studies have shown unacceptable variation in dose or content of certain supplements. Consequently, we asked her how we might be able to get the benefits of these supplements at home. People in the COSMOS trial on the active multivitamin were taking Centrum Silver, a commercially available supplement for people over 50. Those taking the cocoa extract were on a formulation made by Mars, very similar to the CocoaVia Cardio Health product, with 500 mg of cocoa flavanols. Both supplements were very safe.

Our Disclosure:

CocoaVia supports The People’s Pharmacy radio show and podcast, as it has for a long time. The company had no influence on our interview with Dr. Manson.

Chocolate and Cocoa Compounds:

Cacao is the source of both cocoa compounds and of chocolate. So does chocolate contain healthful chemicals? We speak with Dr. Joe Vinson about polyphenols found in foods such as grapes, coffee, tea or cranberries. Dr. Vinson describes some important differences in cacao use. Indigenous peoples of the Americas domesticated the plant and consumed it as a bitter beverage. When Europeans adopted it, they added sugar and started eating it in solid chocolate form.

We learn how to choose chocolate that is likely to have good polyphenol content and we discuss the range of health benefits they may offer. Look for a high-quality cocoa that is not Dutch processed (aka alkali processed), because the alkali can damage flavonoids. Starting with plain cocoa powder rather than a drink mix allows you to control how much and what kind of sweetener you use as well as whether you use milk, water or a milk substitute such as almond milk to make the cocoa you prefer for daily quaffing.

This Week’s Guests:

JoAnn E. Manson, MD, DrPH, MACP, is Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital. She is Professor of Medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School. You can read the report on cocoa flavanol supplementation here.

The website is https://cosmostrial.org/

Joe Vinson, PhD, is an emeritus professor of chemistry at the University of Scranton. He is best known for his work with chocolate, tea, coffee, grape juice, cranberry juice, popcorn, and marijuana. His current research interests include the effect of foods, vitamins, and antioxidants on nutrition and health. Dr. Vinson is an Editor for Foods journal, and is a reviewer for multiple journals.

Listen to the Podcast:

The podcast of this program will be available Monday, April 10, 2023, after broadcast on April 8. You can stream the show from this site and download the podcast for free.

Download the mp3

This week, Dr. Jane Andersen joins Joe and Terry in the studio to answer listeners’ questions about foot problems. Do you have bunions or plantar fasciitis? Dr. Andersen has tips on how to fix your foot pain. We invite you to call and tell us about it. You can call 888-472-3366 between 7 and 8 am EDT. Or email us: radio@PeoplesPharmacy.com.

You could listen through your local public radio station or get the live stream at 7 am EST 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 24, 2025.

How Can You Fix Your Foot Pain?

If your feet don’t feel good, you won’t either. Just imagine stubbing your toe. Ouch, that hurt! But stubbed toes generally recover fairly quickly. Some other common foot problems are likely to cause more long-lasting pain. Some of these may result from participation in sports, such as sprained ankles or stress fractures. What is the best way to handle these injuries so they won’t cause persistent problems?

Preventing Foot Pain:

Are your feet flat? Find out what exercises may help and which shoes you should choose to fix your foot pain from flat feet.

Heel pain is another common problem. Inflammation of the Achilles tendon is one possible cause. Perhaps more often, plantar fasciitis triggers heel pain. That is an inflammation of the tissue connecting the heel and the ball of the foot, and special stretches can often help.

If you have wondered about heel spurs or neuromas, tell us what you would like to know. Restoring feet to good health can cover a lot of different areas.

Toes and Toenails:

How about toes? Find out what to do about hammertoes, mallet toes or claw toes, as well as bunions. Are you worried about gout? It may affect the toes first, before causing pain in other parts of the body.

With warmer weather on the way, you may be interested in learning how to prevent athletes foot or eliminate toenail fungus. Do you have corns or calluses on your feet? What is the difference between them, and do the treatments differ?

The questions listeners ask drive the topics we discuss in this show. You can email questions ahead of time to: radio@peoplespharmacy.com.

This Week’s Guest:

Dr. Jane Andersen, Board Certified, American Board of Foot and Ankle Surgery, is in practice at Chapel Hill Foot and Ankle, part of FASMA, Foot and Ankle specialists of the Mid Atlantic, in Chapel Hill, North Carolina. Dr. Andersen specializes in Foot and ankle care for Children, Adults, Athletes and Geriatric Patients including surgery and conservative care. She is a Trustee of the American Podiatric Medical Association. January 18, 2025, Jane Andersen, DPM, was awarded the Edwin B. Martin, Jr., Award for Podiatrist of the Year.

Dr. Jane Andersen can help you manage your foot problems.

Listen to the Podcast:

The podcast of this program will be available Monday, March 24, 2025, after broadcast on March 22. You can stream the show from this site and download the podcast for free.

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

This week our guest is gastroenterologist Robynne Chutkan. She explains how keeping our digestive microbiota in good health can help our immune systems fight off pathogens from the inside out.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Nov. 29, 2025, through 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 December 1, 2025. You will find this show well worth your time!

What Determines Host Health?

During the COVID-19 pandemic, we could all see big differences in who got sick and who seemed more resilient. Our immune systems are critical in determining just how susceptible we may be to infectious viruses like SARS-CoV-2. But what shapes our immune response?

What we need is an immune system that reacts just the right amount. This “Goldilocks immune system” meets both internal and external threats without becoming overly exuberant. If the immune system fails to react adequately to external threats, like germs, we come down with an infection.

Conversely, if it overreacts, we end up with allergies, sometimes very severe allergic reactions. In the case of internal threats, an overreaction leads to autoimmune conditions like Crohn’s disease. Lax response to an internal threat could allow a tumor to get out of hand.

A hefty proportion of the immune system is localized in the vicinity of the digestive tract. As it turns out, the balance of microbes inside the gut has a significant impact on how the immune cells just outside the gut behave. Keeping the microbes balanced can help the immune system control pathogens from the inside out.

Tackling Pathogens from the Inside Out:

Even before the pandemic, lots of people wanted to know how to optimize their immune systems. That desire is only stronger now. Surprisingly, we can make a lot of progress with some very simple steps.

Check the Medicine Chest:

To start with, we should all be considering the medications we take. Quite a few common medicines can disrupt the gut microbiota. Proton pump inhibitors like omeprazole (Prilosec) or esomeprazole (Nexium) are not kind to digestive microbes. Neither are pain relievers like ibuprofen or naproxen. Besides disrupting the microbes, NSAIDs like these can irritate the lining of the gastrointestinal tract. Sometimes they are necessary. When they are not, they should be avoided. We could say the same for antibiotics.

Our guest is a gastroenterologist. She understands the impact of pharmaceuticals on our digestive tracts better than most other physicians we have talked to. You will not want to miss her insights!

Feed Them Fiber:

Feeding our microbes what they need is crucial to keeping them healthy so that they can signal our immune systems properly. What microbes like is fiber, so a diet that leans heavily on plants is best. They also like variety.

According to Dr. Chutkan, one study found that people who consume foods containing at least 30 different types of plants each week have the healthiest balance of microbes. She gives an example of oatmeal (one plant) with blueberries, coconut and walnuts (three more plants), served with almond milk (one more plant) and cinnamon (another plant). That brings the total up to six types of plants in one bowl. (Adding maple syrup gives one extra!)

Other Essentials:

There are some other practices that are crucial for keeping our immune systems in tune so they can manage pathogens from the inside out. Getting enough sleep helps reboot the immune system. So does physical activity, especially when it takes you into nature. Exposure to dirt sounds counterintuitive, but it can really help your immune system hum. Moreover, being outside is often a good way to address your stress. Dr. Chutkan cited the Japanese practice of “forest bathing” as a good way of de-stressing and helping the immune system.

Healthy and Delicious:

Finally, Dr. Chutkan shares some of her favorite recipes with us. There are lots more in her wonderful book, The Antiviral Gut, with its detailed plan for improving our microbial balance and immune response.

This Week’s Guest:

Robynne Chutkan, MD, a board-certified gastroenterologist, is a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington DC. Dr. Chutkan is the author of the digestive health books Gutbliss, The Microbiome Solution, The Bloat Cure and The Anti-Viral Gut: Tackling Pathogens from the Inside Out.

https://www.peoplespharmacy.com/articles/show-1336-how-the-antiviral-gut-tackles-pathogens-from-the-inside-out

Robynne Chutkan, MD, author of The Anti-Viral Gut: Tackling Pathogens from the Inside Out

An avid squash player, runner and yogi, Dr. Chutkan is passionate about introducing more dirt, sweat and vegetables into people’s lives. She also hosts the marvelous Gutbliss Podcast:

The Gutbliss Podcast

https://robynnechutkan.com/about/robynne-chutkan-md/

Listen to the Podcast:

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

Transcript of Show 1336:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Some people are resilient and resist infections. Others are especially vulnerable to colds, flu, and COVID. This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:46

What accounts for the differences in our immune systems? Why are some people so prone to infection, while others have an overactive immune response that causes damage? Does our digestive tract play any role?

Joe

00:47-00:56

Dr. Robynne Chutkan is a gastroenterologist who’s been asking these questions for years. Her book, “The Antiviral Gut,” offers advice.

Terry

00:57-01:03

Why is gut health so important to immunity? How can we eat to enhance our digestive microbes?

Joe

01:03-01:09

Coming up on The People’s Pharmacy, tackling pathogens from the inside out.

Terry

01:14-02:28

In The People’s Pharmacy health headlines: Many women would appreciate a little help losing the baby weight after giving birth. A Danish study shows that they are increasingly turning to GLP-1 drugs like semaglutide during the postpartum period.

The scientists analyzed records on almost 400,000 pregnancies in Denmark between 2018 and 2024. During that time, use of a GLP-1 medication within the first six months after giving birth increased quite markedly. By 2023 and later, about 90% of these prescriptions were for the weight loss formulation, Wegovy. Earlier in the study, women who had diabetes prior to pregnancy were most likely to have a prescription. In the later part of the study, the motivation for taking semaglutide appears to be weight loss.

The researchers caution that this early postpartum period is one of physiological and hormonal transition for the mother. The safety of semaglutide for breastfeeding infants has not been well studied. They urge their colleagues to conduct targeted studies on the best use of these medications for postpartum weight loss.

Joe

02:29-03:27

The makers of GLP-1 receptor agonists have been expanding their horizons. Research has suggested that drugs such as liraglutide, semaglutide, and tirzepatide may be helpful against a wide range of health conditions, including cardiovascular disease, chronic kidney disease, polycystic ovary syndrome, and non-alcoholic fatty liver disease.

The maker of Ozempic and Wegovy was also hoping that its semaglutide medication might help ward off Alzheimer disease. That’s because animal studies and epidemiological data had suggested such a possibility. But two new studies failed to demonstrate benefit for people with dementia. Volunteers were given oral semaglutide or placebo and tracked for about three years. People taking semaglutide did not fare better than those on placebo.

Terry

03:28-04:46

Cardiology experts have spent a great deal of time coming up with risk calculators. These are supposed to predict a patient’s likelihood of a heart attack. A new study of people who had heart attacks suggests, though, that atherosclerotic cardiovascular risk calculators are not as helpful as expected. The idea was that these tools would allow cardiologists to focus on people most likely to benefit from treatment such as statins.

But analyzing medical records of 465 people, 65 years old or younger, who had experienced a heart attack showed that only 10% of them fit the high-risk category before the event. A newer, different risk calculator called PREVENT would have identified only 3% as high-risk, although 23% were at intermediate risk. Most patients experience symptoms such as chest pain or shortness of breath only shortly before the event. If they’d been evaluated more than two days before their heart attack, the doctor would not have predicted the pending event.

According to the authors, these risk assessment tools are good at the population level, but they may not help doctors treat individual patients more effectively.

Joe

04:47-05:55

Doctors often perform surgery or place stents in patients with blocked carotid arteries. The surgical procedure is called an endarterectomy. It’s frequently performed on patients who have not experienced symptoms even though the blockage is visible on scans. Two large studies published in the New England Journal of Medicine compared stenting and surgery to medical therapy.

Both trials lasted four years, and each contained over 1,200 patients with asymptomatic but substantial blockage in their neck arteries. Patients who received stents had significantly fewer strokes than those who received medications, but there was no significant difference in stroke outcomes between surgery and medical therapy.

An editorial that accompanied the research concluded that there is no longer a role for routine carotid endarterectomy in persons with asymptomatic stenosis.

And that’s the health news from the People’s Pharmacy this week.

Terry

06:14-06:17

Welcome to the People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:32

And I’m Joe Graedon. Why did some people seem especially vulnerable to COVID-19 while others barely experienced any symptoms? What factors determine who’s susceptible to various infections and who is resistant?

Terry

06:33-06:44

Our immune systems play a crucial role in establishing our vulnerability. But what influences our immunity? How do our diet and lifestyle impact our immune systems?

Joe

06:45-07:20

To learn more about the immune system and how it’s affected by our GI tract, we are talking with Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Dr. Chutkan is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington, D.C.

Dr. Chutkan is the author of the digestive health books, “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and most recently, “The Antiviral Gut: Tackling Pathogens from the Inside Out.”

Terry

07:22-07:25

Welcome back to the People’s Pharmacy, Dr. Robynne Chutkan.

Dr. Robynne Chutkan

07:26-07:28

Thank you so much for having me. It’s great to be back.

Joe

07:29-08:23

Dr. Chutkan, we just love your new book, The Antiviral Gut. And I have to say, when I was in graduate school, I remember one lecture in particular on immunology. And the professor said, well, if we were to infuse rhinoviruses into the heating and air conditioning system of this room so that those viruses were spread out across the entire room, everybody was breathing in rhinoviruses. Not everybody would catch a cold.

Our immune systems are amazing, but some people are more vulnerable than others. Can you tell us about this idea of why some people rarely get sick or barely have symptoms and others seem to catch just about everything that comes down the pike?

Dr. Robynne Chutkan

08:24-09:51

Well, you hit the nail on the head with the entire theme of the book. And if I could sum it up in one sentence, it would be that host health matters, that we as the hosts who are hosting these viruses, our health, the strength of our immune system and other things going on in our body, many of them located in our gut, actually determine who gets sick when exposed to a virus. And that’s true of rhinovirus, it’s true of SARS-CoV-2, it’s true of HIV, Ebola, our immune system and other host defenses determine whether we’ll even become infected when we get exposed. And if we do get infected, also determine whether we’ll be mildly [symptomatic], have no symptoms, have severe symptoms, or possibly even succumb, and who will end up with post-viral symptoms.

So all of this isn’t random. And it’s not due to the virulence of the virus. In your professor’s case with that experiment, he’s talking about the same rhinovirus that everybody would be exposed to. And we see within populations, everybody exposed to the same SARS-CoV-2, the same variant with the same degree of virulence, but we see widely varying degrees of host resilience and host susceptibility.

And so really the whole point of this book was to highlight for people that there are things that we can do to be healthier hosts and to be more resilient to viruses.

Terry

09:53-10:04

Dr. Chutkan, I wonder if we have any idea what the most important factors are to determine who is resilient and who is really susceptible.

Dr. Robynne Chutkan

10:06-15:04

Terry, it’s such a great question. And a lot of the answers lie within that gut immune connection.

So when I was in medical school, I didn’t really have a very good sense of what the immune system was. It was a sort of ethereal concept of like immune factors and cells floating around somewhere in the body. But I don’t think any of us were really sure where that was. It turns out that the vast majority of the immune system, about 70 to 80% of it is located in the gut. It is literally along the gut lining.

So you have the trillions of microbes on the inside of the gut, which of course is outside of the body. And then just across that razor thin lining, one cell thick, you have all these immune cells and processes.

And it really is a hand and glove relationship. Those microbes are communicating with the immune cells across the gut lining. And they’re literally guiding and modulating the immune system. They’re telling them when to react, when to stand down, when to mount a big response versus a little response.

And so you start to see that if you have a disruption in the microbiome or a disruption in the gut lining across which they’re communicating, you’re going to end up with a disrupted immune system.

And so that gut-immune connection is really key. There are other important host defenses, stomach acid that doesn’t just help digest food. It also unravels viral protein that gets into the body. We often, we swallow these viruses as a very common, you know, we can breathe them in and they get into our lungs or we can swallow them.

And in fact, we have about 100 times more of those ACE2 receptors that bind SARS-CoV-2 in our GI tract compared to in our lungs. So it’s a common, the GI tract is a common portal of entry, if you will. And it explains why so many people with COVID have GI symptoms. So if you have stomach acid, that affords you an additional layer of protection.

There was a study that came out in 2020, a population-based study looking at 53,000 people. And that study asked a simple question. Does being on an acid-blocking drug like a proton pump inhibitor increase your risk of COVID? And the overwhelming answer was yes. And in fact, people taking a proton pump inhibitor once a day had double the risk. And people taking a proton pump inhibitor twice a day, as many people do, had three to four times the risk.

And while that seems sort of like, you know, wow, hot off the press, we’ve known for decades that these drugs, these acid blocking drugs, and the three of us have had many conversations about acid blocking drugs.

So we’ve known for decades that they increase the risk of certain infections, enteric infections, meaning infections that affect the gut. So not just SARS-CoV-2, but other viral infections, foodborne bacterial infections, because that stomach acid is really a critical host defense for unraveling viral protein, for killing unwanted bacteria that can get into our bodies through our GI tract. So there are other considerations like that.

The gut lining, you know, it’s this one cell thick lining, but it’s really the only thing protecting us from the outside environment because our GI tracts, and you know, this is such an interesting concept. I didn’t think about this at all when I was in my GI training. I have to admit, it was only about a decade or so ago that I began to realize that when you eat food and it travels down through, you know, down that digestive superhighway, those products of digestion that are in our gut are not in our body. They’re in this hollow tunnel that runs from our mouth all the way down to our anus. And food has to get absorbed through the gut lining to get into our bodies, to get assimilated inside.

And so the point of that gut lining is to act as a selective barrier to allow those important nutrients, once they’re properly broken down, to be assimilated into our body. Waste from cells gets excreted through the gut lining in the other direction. And of course, dead red blood cells, bacteria, et cetera, everything gets excreted out. And so toxins, viruses, pathogens from the environment that we swallow are in that gut lining. And a big role of the gut lining is to keep them out of the body, to keep them just there in the GI tract so they can be excreted.

And we know that we excrete SARS-CoV-2. In fact, we see fecal shedding of the virus, meaning we’re excreting it in stool, much, much long after we are able to detect it from the nose. So it continues to be excreted in the stool in people who have COVID after a nasal swab, et cetera, would be negative. And so we want that intact gut lining to make sure that these pathogens that we swallow end up in the toilet bowl and not inside our bodies.

Joe

15:05-15:48

You know what I found so interesting in reading your book, because you described the immune system so beautifully, the adaptive versus the innate immune system. But I begin to think about it a little as threading a needle or Goldilocks, not too hot, not too cold, because if your immune system isn’t up to snuff, you’re going to get sick.

But if it’s too active, you’re going to also get sick, you may have immune reactions. It’s like, how does it know just the right amount of reaction and not too much or too little?

Dr. Robynne Chutkan

15:49-17:48

Well, I’m so glad you mentioned that concept because I think that if you understand that concept, you probably understand 75% of immunology. And I think it’s so important that I just want to go over it a little bit more, and then we’ll talk about how to get the Goldilocks immune system.

So I like to divide it up just as you did, Joe. So overactive immune system versus underactive immune system. But I like to divide it further.

So think of that as there’s a line on a piece of paper and everything above that line is an overactive immune system and everything below that line is an underactive immune system. But I want you to draw another line in the paper, this one, a vertical line, not a horizontal line. And everything to the left of that line is internal threats in our body and everything to the right of the line is external threats.

So now we have four quadrants. But let’s start with the internal-external discussion. Internal threats with an overactive immune system. So you’re in that top left-hand quadrant of your grid now of the four boxes we’ve drawn. So overactive immune system, internal threats. We’re our body responding inappropriately, overreacting to our body’s own normal tissue. In the case of rheumatoid arthritis, it’s the joints. In the case of psoriasis and eczema, it’s the skin. In the case of Crohn’s and ulcerative colitis, it’s our gut bacteria.

So our body is mounting an abnormal high immune response to our own normal tissue. It’s treating our normal tissue as foreign, as a foreign invader and attacking it. And we have over 100 different autoimmune diseases now. One in four Americans, more than 50 million people. And many people have more than one because, of course, there’s sort of a common cause of these things.

So autoimmune diseases are sort of modern day diseases, if you will, and they really are a sign of dysregulation of the immune system. It’s an overactive immune system responding to internal threats.

Joe

17:48-17:58

Now, Dr. Chutkan, I’m going to ask you to hold that thought. We’re going to take a break, and when you come back, we’re going to talk about the under-reacting immune system.

Terry

17:59-18:07

You’re listening to Dr. Robynne Chutkan. She’s the author of “The Antiviral Gut: Tackling Pathogens from the Inside Out.”

Joe

18:08-18:14

After the break, we’ll find out more about what happens when the immune system is under- or over-active.

Terry

18:14-18:21

Too much and too little are both problems. How can we help our bodies get this just right, like Goldilocks?

Joe

18:21-18:27

We’ll also learn how a patient with Crohn’s disease tackled her condition with food.

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

18:51-18:54

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

18:54-19:50

And I’m Terry Graedon. How can you fine-tune your immune system so that it neither runs too hot nor too cold? In other words, is there something you can do to find the sweet spot where you’re protected from pathogens but not suffering from autoimmune attacks?

Joe

19:50-20:22

We are talking with Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Dr. Chutkan is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington, D.C.

Dr. Chutkan is the author of the digestive health books: “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and most recently, “The Antiviral Gut: Tackling Pathogens from the Inside Out.”

Terry

20:24-20:59

Dr. Chutkan, you’ve just described a graph in which we have a horizontal line and above the line, the immune system is overactive. Below the line, the immune system is underactive. And we have a vertical axis, which divides our immune system from internal threats to the left, external threats to the right.

We’ve just talked about the upper left quadrant in which we get autoimmune diseases because the immune system is overreacting to what it perceives as internal threats. So tell us about the other three quadrants, please.

Dr. Robynne Chutkan

21:00-29:17

What a beautiful summary. Thank you so much for that. So if we go to the other side of the overactive immune system, so now we’re talking about external threats. We’re talking about allergies, allergies to bees or wasps or seasonal allergies. And I think back to when I was in elementary school, there was one kid in my entire school who had a food allergy. Everybody knew him. He was kind of famous because he was allergic to peanuts and nobody else was allergic to anything. Now it’s rare to find a kid who isn’t allergic to something.

So we’ve seen this explosion of allergies. And again, that is a sign of immune dysregulation, dysregulated immune system overreacting, but to external threats in the environment, whether it’s an insect to food, et cetera. So now let’s travel down to the underactive immune system. And on the left side, internal threats, we’re talking about cancer, because our immune system doesn’t just protect us from infection and pathogens. It’s also our cancer surveillance system. It goes about our body and it weeds out cells that are starting to divide a little precariously where the genetic material is not being reproduced properly. Maybe it’s starting to develop a malignant cell line.

And a big job of our immune system, a big role is to weed out those cells and make sure they’re destroyed. So when you have an immune system that’s underactive, it means that that cancer surveillance isn’t happening and we’re at risk for cancer.

On the other side of the vertical axis for external threats, this is where we’re talking about infection, an immune system that is not strong enough to clear infection. So the really interesting thing here is that if we look at deaths during the COVID pandemic, we see that a large percentage of them weren’t really due to the virus itself, They were due to the immune response. People suffering from what we call ARDS, acute respiratory distress syndrome, where they had an overblown response to the virus.

The immune response was so active that it destroyed normal lung tissue in the process. And people ended up on ventilators. Tragically, people ended up dying. But again, as a result of the immune dysregulation, we saw other people who weren’t able to clear the virus. And we worried a lot about people on immune suppressive drugs like steroids and biologics because those drugs suppress the immune system.

The interesting thing is those people didn’t seem to do as badly. People who were immune suppressed and, you know, all of us in the medical community typically have patients who are on immunosuppressive medication. We worried about those patients, but they seemed to do okay. It was really the patients who had the overblown immune response who seemed to do worse.

So to get back to your really important question, how do we cultivate a Goldilocks immune system? It turns out, again, that these gut bacteria are essential. They’re a critical part of the response. So you want to maintain a healthy microbiome. How do you do that? Well, you make sure you’re not killing off your microbes with unnecessary antibiotics and other medications that are disruptive to the microbiome. You eat a high fiber diet because what are those healthy microbes like to eat? They like to eat plant fiber.

And you know, you don’t have to be a vegan, but you got to get those fruits, vegetables, whole grains, nuts, seeds, you want to get all of that in. And we know from a very important study in 2018 by the American Gut Project, a nonprofit doing wonderful microbiome research, their study in 2018 was the largest microbiome study done globally. They looked at over 10,000 people in more than 40 different countries. And they found that the most reliable predictor of a healthy microbiome was the number of different plants people ate, with the magic number being more than 30 per week.

And so when I say plants, not just vegetables or fruits, but also whole grains, legumes, beans, nuts, seeds, herbs, spices, you get credit for all of it. And so that really was one of the most potent indicators of a healthy microbiome.

So that’s something that, you know, people listening can do right away. You can start thinking about those 30 different plants. And it might sound daunting, but I like to take a bowl of oatmeal as an example and say, okay, let’s say you use some almond milk to make your oatmeal. That’s one. The oats, two. Walnuts, three. Pumpkin seeds, four. Raisins, five. Blueberries, six. Little maple syrup, seven. You get credit for that, too. I love to add a little shaved coconut, eight. Cinnamon, nine. You can get nine different plant foods in a bowl of oatmeal.

You can easily get another 10 in a salad. You can throw in your lettuce, tomato, cucumber, olives, cabbage, broccoli, chickpeas. Just start throwing it in. So if you try hard, you can get to 30 in a day, but 30 per week.

And one of the really important things about that concept is I have patients who are vegans but they’re only eating four or five different plants a week. They’re stuck in that same peas, carrot, broccoli, and sweet potato rotation. So variety is very important.

But when you increase your consumption of plant fiber, what happens is that you increase the amount of certain healthy bacteria in your gut. F. prausnitzii is one of those important species. It’s important because it is one of the main producers of short chain fatty acids, things like butyrate, sometimes called butyric acid, propionic acid, acetate, acetic acid. And what these short chain fatty acids do is they regulate the immune system. They help you get to that Goldilocks immune response. And they also keep the gut lining healthy. And they also feed the gut bacteria themselves that are producing them. So it’s this incredibly synergistic cycle of events.

And so patients come to see me and they want to know, what can I do to improve my gut immune connection? Is there a supplement? What should I do? What complicated steps do I need to take? And I remind them, you just need to eat more plants as the number one step that you need to do. And then you need to have a careful look in your medicine cabinet and think about medications you might be taking that could be harmful to either the microbiome or the gut lining or stomach acid.

So are you taking non-steroidal anti-inflammatory drugs that are making little holes in your gut lining? Are you taking not just antibiotics, but any of the list of more than 42 different classes of medications that have been shown to be disruptive to the microbiome?

Antidepressants, artificial sweeteners, laxatives, there are many of them. So you’ve got to be judicious about what you’re taking from a medication point of view. And then the other thing I like to remind people is where do we get our microbes from? Well, after we’re born and we get them from our mothers, particularly those of us who are lucky enough to be born coming out through the birth canal rather than a C-section, after that, we get them from our environment. We get them from soil.

So exposure to nature is a really, really important way for us to replenish our microbes and have a healthy microbiome. So that refers to us being out in nature as well as eating food that’s grown in nature, not food that’s grown in a warehouse somewhere, not the sort of industrial organic food.

So the steps to have a Goldilocks immune system are fairly straightforward. And then there are some other add-ons that are important too, like sleep, because we know sleep reboots the immune system like a computer and that it’s really essential.

We have a very important study from the British Medical Journal that showed that people who were chronically sleep deprived had an 88% increase in risk of COVID. So sleep is essential. We know that controlling stress is important. We see stress as a risk factor for morbidity and mortality with this pandemic. So there are other things too that are maybe not directly related to the gut, but that are really important for keeping it all humming along and functioning well.

Terry

29:17-29:42

And of course, getting out in nature might help you control your stress. I do want to ask about medications. You said you need to pay attention to what’s in your medicine cabinet. And I want to ask you about a patient that you treated early in your career, a woman with severe Crohn’s disease.

She came to you and you prescribed medications because that’s what you would learn to do. Can you tell us what happened?

Dr. Robynne Chutkan

29:43-36:47

Yes, yes. I remember her so well. And gosh, it’s so great that you’re bringing up her story. So I was a young gastroenterologist just in my first or second year on faculty at Georgetown. And as you said, doing what I was trained to do, which is to prescribe medication.

She was around my age, and she actually worked at the hospital in the radiology department. And she left, she moved to New Jersey for a couple years. And then she decided to come back. She came back to the Washington area. And she came to see me. And as you said, she’d had Crohn’s disease and quite severe Crohn’s disease. And I had been up close and personal with her Crohn’s disease doing her colonoscopy several times in the past.

So she came to see me in the clinic. And I remember we caught up. And I asked her, okay, ‘So tell me, you know, what are you on?’ And I got out my pen, because at that time, we didn’t have an electronic medical record, got out my pen to write a note. And she said, ‘Nothing.’ And I remember I froze. I was like, ‘What do you mean, nothing?’ And she said, ‘I’m not taking anything.’ And I gave her my little spiel about, oh, that’s like driving a car with no insurance. You know, things could go terribly wrong.

And I was literally frightened for her because the idea that you could treat or control a serious autoimmune disease like Crohn’s without medication was just, I mean, that was frightening. It was a frightening idea to me.

And she told me what she was doing. And at the time, you know, the diet didn’t necessarily have a formal name, but it was a variation of a diet called the Specific Carbohydrate Diet, which is a low complex carb diet, but not a low carb diet specifically, but it takes out a lot of the processed carbohydrates, like, you know, the baked goods and so on. The dairy other than on that diet, people can make their own yogurt, but takes out the processed dairy and the refined sugars and a lot of the processed grains. And she was having great results with it clinically.

So I said to myself, okay, well, she’s feeling good, but that’s probably placebo effect. Let’s see what’s really going on in her colon. And I did her colonoscopy a few weeks later, and it was normal. Her severe ulceration from her Crohn’s disease had healed completely, completely.

I mean, I remember thinking, this is magic. Like, how can this be? And I think back now, you know, 25 years later, and I think, no, it’s magic the other way. It’s magic to not consider the role of what we eat and how we feel and specifically on what’s going on in our guts. But I had been so trained and indoctrinated, quite frankly, to think that medication was the only path.

And to be clear, the medications are fabulous. I’m glad we have them. We’re in an era of really effective medications for these diseases, but here’s a problem: when you treat a disease that is an overactive immune system, like Crohn’s, it’s an autoimmune disease, you treat it by suppressing the immune system.

So now you’re down in that, below that horizontal line. And now you’re at risk for cancer and infection. And that is indeed exactly the risk factors of these medications. They all carry the risk of serious infection, viral, bacterial, fungal, et cetera, as well as cancer. And autoimmune diseases affect a wide range of people, but the ones I treat primarily, Crohn’s and ulcerative colitis, affect young people.

And so we’re talking about putting people in their teens and early 20s and 30s on medications for life that have these potentially very deleterious side effects. So this patient was the first person who really opened my eyes to what was possible and sort of, you know, began my journey to see how we could treat these diseases with a food as medicine approach.

And I’ll tell you, I saw a young man yesterday in my office, a new patient with ulcerative colitis, really lovely young man. And his mother was with him. He’s in law school. And he had been on these drugs for a long time. And he said, ‘You know, the drugs really helped me, particularly in high school when I was diagnosed. I just wanted to be a kid and, you know, do what the other kids were doing. And I didn’t want to be having 20 bloody bowel movements a day and, you know, having accidents.’ So he said, ‘I was very grateful to the drugs.’ He was on Remicade initially, infliximab, one of the first monoclonal antibody biologic drugs that we had for inflammatory bowel disease.

So he said he was very grateful. But what he has noticed over the last decade is that he’s just not well. He’s sick all the time. I mean, yes, his colitis has improved a lot, but he’s sickly. He has colds, his skin, he’s gotten really bad acne. He’s sick all the time. He had COVID twice, serious episodes both times.

And so he can feel that his immune system is suppressed, where he’s sort of half-masked. And one of the things, it’s really important to make sure people are good candidates for a food as medicine approach. Some people, quite frankly, are just too sick. There are many patients who I say, you know, you actually would probably benefit from going on a bigger gun medication like a biologic to get your disease inactive enough to a point where we can treat it nutritionally.

Or sometimes people have strictures. If you have Crohn’s, you can have narrowing in the intestine. And so it’s a mechanical narrowing. And I explain, you know, no amount of kale is going to open this back up. You probably need to have this addressed surgically. And then we can really think about nutritional therapy to prevent recurrence. So just as we need to be judicious with our pharmaceuticals, we need to be judicious and realistic about what food can do.

Food can do a lot, but it is also not magic. And in this particular case with this young man, he was a great candidate. He was already a pretty good eater. He was very committed to making some changes to his diet. And his disease at this point was just at the bottom part of the colon and not in terrible shape. So he’s a really good candidate. And I’m so excited to be working with him to see if we can get him off the biologic.

But I never want people to feel like there’s a wrong or right path. There’s a path that’s right for them. And if you’re at the point in your life where you sort of, you know, you just need the quick fix to get this taken care of, you can’t maybe make that commitment to diet and lifestyle, that’s not wrong.

But it is also important for people to know that there are other paths out there for treating these diseases without the immunosuppression. We have other medications for autoimmune diseases that don’t suppress the immune system. They tend to be not as efficacious, but sometimes using one of those medications with the diet and lifestyle can really get people where they need to go.

So I always want people to know there are lots of options out there. We have a lot of tools in our toolbox and trying to find the right tool for people and particularly the tools where the side effects aren’t worse than the actual disease. That’s important.

Terry

36:47-37:01

You’re listening to Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Her most recent book is “The Antiviral Gut: Tackling Pathogens from the Inside Out.”

Joe

37:01-37:09

After the break, we’ll find out  why the mucin lining your digestive tract is critical in protecting you from viruses.

Terry

37:09-37:16

How do microbes interact with mucus? And how do medications affect our digestive lining?

Joe

37:16-37:30

When the gastrointestinal tract loses integrity, the leaky gut that results can have serious consequences. Dr. Chutkan shares her plan for supporting an antiviral gut. She also tells us about some of her favorite foods to help.

Terry

37:39-37:55

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

37:55-38:17

And I’m Joe Graedon.

Joe

38:31-38:46

Today, we are talking about supporting your digestive tract so that it can protect you from invading pathogens. The lining of your digestive tract is especially important, but we don’t often think about it. What should we be doing differently?

Terry

38:46-39:16

For answers, we’re talking with Dr. Robynne Chutkan, a board-certified gastroenterologist. She’s a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice in Washington, D.C.

Dr. Chutkan is the author of the digestive health books, “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and “The Antiviral Gut: Tackling Pathogens From the Inside Out.”

Joe

39:18-40:48

Dr. Chutkan, you’ve just been explaining the benefits and risks of some of the most popular pharmaceuticals in the pharmacy. I mean, we’re talking about billion-dollar drugs, Enbrel, Humira, these biologics, and they do work very well, but they do have an impact on the immune system. And so we hear on those commercials things like lymphoma, and we hear about other infections, and watch out for tuberculosis.

And so I guess they’re double-edged swords, as are so many of the medications that we rely on on a daily basis, like the NSAIDs, ibuprofen, naproxen that people take for their aches and pains. But I’ve got a different question for you. When I was in graduate school, the head of the physiology department at the University of Michigan was a famous researcher by the name of Davenport. And he was particularly interested in the gastrointestinal system.

And I remember he was really focused on mucus. And he asked us, as pharmacology graduate students, well, why doesn’t the stomach digest itself? It’s like battery acid. It’s so powerful. And there it is just sitting in your stomach and it’s not doing any damage. It’s all about mucus and the mucin lining. It is all about mucus. Tell us about it.

Dr. Robynne Chutkan

40:50-45:17

Mucus is like a cross between jello and glue. And it’s this sticky polymer. And people think of mucus, first of all, as coming from the lungs. But the reality is most of the mucus in our body is made in our GI tract, about one and a half liters a day.

And mucus serves a couple functions. One of them is just as a lubricant. So it lines all those organs that are in contact with the environment, our mouth, our nose, our upper, our oropharynx, if you will, our mouth and airway, our reproductive organs like the vagina, even the inside the urethra, and of course, the GI tract. So it helps to lubricate things. And in the case of the GI tract, it helps to lubricate the gut so that the products of digestion can move smoothly from north to south.

But it also has another purpose. One purpose is a barrier. So between the microbes that are floating around in the gut and the gut lining is a thick layer of mucus. And so that helps to protect the gut lining. And the other is that mucus has enzymes in it that can actually degrade viruses that get in.

So mucus traps viruses like SARS-CoV-2 in its sticky matrix. And then it has enzymes that will degrade and sort of dissolve the virus. And then, of course, you have those cilia, those finger-like projections in the lungs that can move the virus up and out. And if you swallow it, ideally stomach acid works on it some more.

So you see how this is all designed to work together. So it’s like your body’s internal flypaper that catches these viruses. And, you know, there’s this, when we think about this concept of super spreaders, we know that super spreader events aren’t explained by differences in the virus. They’re not based on viral behavior. You can have a large gathering where few people, if any, get a virus, or you can have a small event where everybody gets it.

And of course, there are things like how close you’re in contact with people, whether you’re indoors or outdoors. But it turns out that when some people sneeze on you and transmit a virus versus somebody else who’s infected sneezes on you and doesn’t, it has to do with the mucus of the person who’s sneezing on you. Because if you have somebody whose mucus is very potent and it has trapped the virus and the mucins, the proteins in their mucus, have killed the virus, they’re going to sneeze on you and they’re going to transmit dead virus and you’re not going to get infected.

But if somebody sneezes on you whose mucus is a little less potent and the mucins in their [mucus] may not have done as good a job as trapping and killing the virus, they are going to infect you.

And what’s really interesting is that we, in addition, so the mucus can physically trap viral invaders. It has enzymes that degrade viral proteins and it has antibodies that can neutralize them. And mucins in saliva and breast milk also have antiviral activity that can inhibit even potent viruses like HIV.

So again, you know, the quality of these host defenses is really important. And so when we think about something like mucus, we know that people who smoke, for example, have mucus that is much, much less potent in terms of its ability to protect us from pathogens. Being dehydrated would also affect your mucus.

And so, again, there are, you know, there are some genetic factors with all of these things that many of these things are things that we can improve ourselves. We can drink more water. We can stop smoking. These are really important things. And along the line of mucus and pharmaceuticals, we know that cough syrups and these cough suppressants are really problematic because they prevent you from being able to expel these pathogens.

We want to produce mucus and we want to cough it up so we can get rid of the pathogens. And so when you take these different cough syrups that suppress your cough reflex and or things like antihistamines that can dry you out and decrease your mucus production, you’re really sabotaging your host defenses.

Terry

45:17-45:33

So Dr. Chutkan, if most of the mucus is actually in your digestive tract, it’s in there interacting with all the microbes in your digestive tract. What’s the impact of the microbes?

Dr. Robynne Chutkan

45:33-47:23

Well, the microbes have to, you know, we don’t want those microbes to penetrate through the gut lining. They’re in the gut lumen for a reason. That’s where we want to keep them. And so it provides, you know, the intestinal epithelial barrier is only one cell thick.

So the mucus really buffs up that barrier and provides an additional zone of protection. Because when we look at, for example, there was a study, a microbiome study done at University of Massachusetts in 2021. And that study found that the most important predictor of outcome from COVID was actually the composition of the microbiome.

They found high levels of a bacteria called Enterococcus faecalis was associated with worse outcomes and death. And high levels, conversely, of the bacteria referred to earlier, Faecalibacterium prausnitzii was associated with good outcomes. Enterococcus faecalis is a bacteria that is also associated with post-op infections, and it can penetrate the gut lining and get into the body and get into the bloodstream and cause problems.

So that protective barrier that mucus provides, I have an analogy in the book that I’ll share with you. It’s 5,000 times the diameter of a viral particle like SARS-CoV-2. So the analogy is a human wading through 150 gel-filled football fields to reach the end zone and score a touchdown.

So it creates that buffer so that bacteria like Enterococcus faecalis have a difficult time penetrating that intestinal epithelial barrier, that gut lining. So it’s so beautifully and cleverly designed. And the main thing we have to do is not mess it up.

Terry

47:24-47:38

And if we do mess it up somehow, then we run into problems with what the gastroenterologists like to call intestinal permeability and what the rest of us call leaky gut, right?

Dr. Robynne Chutkan

47:39-48:36

That’s right. That’s right. And one of the most important points I want to make to people is that these are not things that you fix by taking a supplement. These are things that you primarily fix by not taking things. You know, people want a pharmaceutical fix, whether that’s a prescription, over-the-counter, or a supplement. But these are things that are mostly created as a result of too many of these pharmaceuticals, whether a prescription, over-the-counter, or supplement.

So rather than, you know, telling people or people want advice about what probiotic, what supplement, I get them to bring all their pharmaceuticals and lay them out on my office table. And then I pull out my rubbish bin and one by one, I usually drop them in and explain, you know, why they shouldn’t be taking this. And of course, particularly for a prescription drug, this needs to be done in concert with your healthcare provider. Please don’t just start getting rid of, you know, putting medications in the rubbish bin without checking with your physician.

Joe

48:37-49:15

Dr. Chutkan, and a lot of people like to, dare I say it, play doctor by going to the pharmacy and buying over-the-counter medications. And now, of course, NSAIDs, non-steroidal anti-inflammatory drugs, are incredibly popular because everybody seems to have an ache or a pain or a fever or a headache. And so they’re taking Aleve. They’re taking Advil. They’re taking ibuprofen over the counter generically or naproxen. And then their doctors are prescribing these. So tens of millions of people are taking these drugs on a daily basis. And they’re affecting intestinal permeability.

Dr. Robynne Chutkan

49:16-50:57

Yeah, they are. It’s not just the NSAIDs. It’s also you think about the antipyretics. So the things we take for fever, which would be NSAIDs, but also Tylenol. It turns out fever is one of our body’s most important host defenses. So if we look at poliovirus, poliovirus replicates 250 times faster at normal body temperature compared to when we have a fever.

So a fever is our body’s way of trying to slow down viral replication, trying to keep us safe. But what do we do? We suppress a fever. And so, you know, the pediatric guidelines for a while now have talked about, you know, not using cough suppressants, not using antipyretics, fever medication, but we still intrinsically reach for them.

And we reach for them because we don’t understand the feedback our body’s giving us. So we confuse a physiological response like a fever. We think it’s an illness. We confuse a physiological response like a hangover, a physiological response like reflux. Reflux is our body’s way of telling us you have overfilled your stomach, you have eaten too late, you have eaten too much fatty food, whatever it is. And that’s why this stuff is coming up. And I’m giving you feedback.

And so again, we’ve got to understand the feedback our body’s trying to give us and not just suppress all these symptoms with pharmaceuticals without understanding the messages, the important information that’s contained in them. I mean, I said to a friend the other day, imagine if people didn’t get a hangover, how many people would die from alcohol poisoning because they just keep drinking.

Terry

50:57-50:58

Right.

Dr. Robynne Chutkan

50:58-51:07

And they wouldn’t get that terrible, you know, headache and you feel horrible and you’re like, oh, oh, that’s what happens when I do that. Maybe I should do less of that.

Terry

51:07-51:24

Not do that in the future. Dr. Chutkan, we have just a few minutes and I’m hoping that you’ll walk us through, briskly, your plan for an antiviral gut to protect us from infections.

Dr. Robynne Chutkan

51:26-53:34

Absolutely. The difference with this book, and I’m proud of all of them, all four of them, but the difference with this book is that the plan is really a little over half the book because I wanted to be sure to give people the information, the practical steps, not just to say here’s what can go wrong, but to tell them here’s what you can do about it.

So the plan is really divided into several chapters, the antiviral gut plan, and I consider sort of “strengthening-from-within” plan. So in the first chapter of the plan is called Securing Defenses. And it talks about how you can optimize your body’s innate capacity to neutralize viruses with stomach acid, to trap with mucus, to burn with fever, to wall off viruses with your gut lining, while simultaneously improving your reflux, your digestion, your overall gut health.

The second chapter in the plan is called Mastering Your Mind. And that really focuses on stress and sleep and what you can do to improve those things, improve your sleep hygiene, improve your stress response so that you can be more resilient. The next chapter is Changing Your Environment.

And I talk about the Japanese practice of shinrin yoku or forest bathing and how that can reduce stress hormone production, enhance your immune system, and what we touched on earlier, the importance of exposure to soil microbes.

Chapter 12 in the plan is being Thoughtful About Therapeutics. So I go through each of the classes of medications that is sort of a threat to your gut health, I talk about potential alternatives, and I give people questions to ask their doctor. So I literally have the list of questions. You know, if you’re on this drug, here are the five questions you should ask your doctor, here are four or five alternatives.

And then chapter 13 is a plan at a glance. It’s putting it all together with a kind of snapshot glance at what your daily antiviral gut routine would look like. And then the last section is recipes with some really simple, delicious food. Nothing in there is difficult to make and it’s all really quite delicious. So that’s a plan in a nutshell.

Joe

53:35-53:49

In the minute we have left, Dr. Chutkan, some of your favorite foods. If we were to go out to lunch with you today, if we were to have dinner with you on Saturday night, what would be on the menu?

Dr. Robynne Chutkan

53:50-54:14

I, you know, beans and greens are two of the things I really focus on. So, and I have to admit that my husband is a lentil maker in the house. So he makes delicious curry lentils and there’s lots of onion and garlic and different spices and curry and coconut milk would be lentils, curry lentils, some brown rice, and I would probably do some sauteed spinach with that.

Terry

54:14-54:18

You’re already getting halfway to your 30 plants a week.

Dr. Robynne Chutkan

54:18-54:31

Yeah, and exactly. So with the lentils, again, there’s ginger and onion and garlic and leeks and curry powder and bay leaves. So there’s probably six or seven different plants in there along with the lentils.

Terry

54:31-54:39

It sounds nutritious as well as delicious. Dr. Robynne Chutkan, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Robynne Chutkan

54:40-54:46

Always such a pleasure to be with you on The People’s Pharmacy. I love the work you do. Wonderful to be a part of this.

Terry

54:47-55:14

You’ve been listening to gastroenterologist Robynne Chutkan. She’s a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice in Washington, D.C.

Dr. Chutkan is the author of the Digestive Health books, Gutbliss, The Microbiome Solution, The Bloat Cure, and “The Antiviral Gut: Tackling Pathogens from the Inside Out.”

Joe

55:15-55:23

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

55:23-55:30

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

56:09-56:19

Today’s show is number 1,336. You can find it online at peoplespharmacy.com. That’s where you can share your comments.

Terry

56:20-56:26

Our interviews are available through your favorite podcast provider. You’ll find the show on our website on Monday morning.

Joe

56:27-56:48

At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. By subscribing to our newsletter, you will also have regular access to our weekly podcast and find out ahead of time which topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon.

Terry

56:48-57:28

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

57:29-57:38

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

57:39-57:43

All you have to do is go to peoplespharmacy.com/donate.

Joe

57:44-57:57

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

This week, we talk with renowned author Temple Grandin. She reveals why she thinks visual thinking is underappreciated. Most importantly, she describes how we could change our educational system to better utilize a wide range of mental skills.

Practical Applications of Visual Thinking:

Most of us are not aware of how our brains work. Often, we assume that everyone thinks the same way we do. As an autistic person, Dr. Temple Grandin had reason to question that assumption. When she took a closer look, she found that people could be categorized as those who think in pictures, as she does, those who think in patterns and those who think in words. If you wonder what type of thinker you are, imagine you are putting together a piece of furniture. Do you read the instructions–or do you just refer to the pictures?

Object visualizers, like Dr. Grandin, rely on the pictures and understand things best when they can conjure up photorealistic images of them. These are people who build things like trains.

To be sure, spatial visualizers also like pictures, but the pictures they prefer are patterns and abstractions. They may be brilliant at presenting data in graphs. These folks are good at making the trains run.

People who think in words may dominate the educational system. They write books, stories and poems. While we certainly need people whose brains work like this, we could miss out if we don’t also educate visualizers of all varieties. We need people who think in a variety of ways contributing their special talents.

Spotting the Potential for Disaster with Visual Thinking:

Dr. Grandin suggests that the visual thinkers–the industrial designers, electricians and mechanics–can often spot weak points in a system. If we pay attention to their warnings, we might avoid disasters like the Fukushima nuclear meltdown. Had object visualizers been involved in the design of that power plant, they might well have realized that the basement, where the cooling system pump was located, needed to be sealed with waterproof doors. That could have prevented or greatly mitigated the problem that arose from the tsunami.

The Boeing 737 MAX jet is another example. The sensor that failed in two tragic accidents is small and fragile. A person who thinks by visualizing objects might well have wondered about that and recommended back-up. Following the crashes, the aircraft was taken out of service for extensive testing. We can hope that people with the ability to think in pictures participated in that process.

The Value of Neurodiversity: Dr. Grandin has written:

“When we fail to encourage and develop the talents and skills of people who think in different ways, we fail to integrate ways of learning and thinking that benefit and enrich society.”

To learn more about the value of neurodiversity, we spoke with neurologist Lawrence Fung. He is the Director of the Stanford Neurodiversity Project and explained what people mean by neurodiversity. When we characterize someone as being “on the [autism] spectrum,” what are we communicating?

Dr. Fung discusses ways in which we can nurture and tap the talents of people with autism or other neurodiverse conditions, such as Tourette’s syndrome or ADHD. In the podcast, we review Dr. Oliver Sacks’s appreciation of people with Tourette’s syndrome. In an unusual twist, Dr. Fung describes an autistic person who does not speak, but who was valedictorian of her college class and offered a moving presentation at graduation.

This Week’s Guests:

Temple Grandin, PhD, is a Professor of Animal Science at Colorado State University. Facilities she has designed for handling livestock are used by many companies around the world. Her books include: Thinking in Pictures, Livestock Handling and Transport and The Autistic Brain. Her books Animals in Translation and Visual Thinking have been on the New York Times Bestseller List.

Temple was inducted into the National Women’s Hall of Fame in September 2017 and in 2022 was named a Colorado State University Distinguished Professor. Dr. Grandin’s newest book is Visual Thinking: The Hidden Gifts of People Who Think in Pictures, Patterns, and Abstractions. Her website is https://www.templegrandin.com/  Kelly Buster holds the copyright to the photo of Dr. Grandin.

https://www.peoplespharmacy.com/articles/show-1335-visual-thinking-and-the-value-of-neurodiversity

Dr. Temple Grandin, author of Visual Thinking

Lawrence Fung, MD, PhD, is Director of the Stanford Neurodiversity Project, Director of the Neurodiversity Clinic and Co-Director of Grand Rounds. He is the Principal Investigator at the Fung Lab. Dr. Fung is an assistant professor at Stanford University School of Medicine in the Department of Psychiatry & Behavioral Science.

https://www.peoplespharmacy.com/articles/show-1335-visual-thinking-and-the-value-of-neurodiversity

Dr. Lawrence Fung, director of the Stanford Neurodiversity Project

Listen to the Podcast:

The podcast of this program will be available Monday, March 27, 2023, after broadcast on March 25. You can stream the show from this site and download the podcast for free.

Download the mp3

In this week’s episode, learn about healthy eating for two. Most people realize that diet is especially important during pregnancy, but they may not know which foods are most nutritious. Researchers report that following a Mediterranean diet and practicing mindfulness around meals can both have health benefits during pregnancy.

Mediterranean Diet for Those Eating for Two:

New research shows that good nutrition during pregnancy goes way beyond taking prenatal vitamins. One study shows that women following a Mediterranean diet are less likely to experience complications such as hypertension, pre-eclampsia, gestational diabetes, pre-term birth or stillbirth (JAMA Network Open, Dec. 22, 2022).  We talk with one of the scientists conducting the study, a cardiologist who notes that avoiding such problems seems to help women stay healthier even when the baby grows up.

Benefits of Mindfulness:

Many people have heard that cravings can crop up during pregnancy. Is there a way to respond to such feelings without wrecking a healthy diet? Our second guest has conducted a long-running study that found learning mindful eating during pregnancy has lasting benefits for children as well as their mothers.

In this quasi-experimental Mindful Moms Training study, the women who attended mindfulness sessions for eight weeks had lower measures of stress, were slightly less likely to gain excess weight and were less likely to have impaired glucose tolerance (International Journal of Behavioral Medicine, Oct. 2019). Follow-up studies on mothers and children found benefits as much as eight years later.

This Week’s Guests:

Natalie Bello, MD, MPH, is an associate professor of Cardiology and director of Hypertension Research in the Smidt Heart Institute at Cedars-Sinai. Her research focuses on better understanding the relationship between hypertensive disorders of pregnancy and cardiovascular risk—and her latest study found an association between the Mediterranean diet and pregnancy outcomes.
Her study is: Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women

Elissa Epel, PhD, is a Professor and Vice Chair in the Department of Psychiatry & Behavioral Sciences, at University of California, San Francisco. Her research aims to elucidate mechanisms of healthy aging, and to apply this basic science to scalable interventions to reach vulnerable populations. She is the Director of the Aging, Metabolism, and Emotions Center. She is a member of the National Academy of Medicine. Dr. Epel ranks in the top 1% of scientists for publication impact. Dr. Epel is the author of New York Times best-seller The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer. Her latest book is The Stress Prescription: Seven Days to More Joy and Ease and is an Independent Bookstore best-seller.

Listen to the Podcast:

The podcast of this program will be available Monday, March 20, 2023, after broadcast on March 18. You can stream the show from this site and download the podcast for free.

Download the mp3

Whether we call it indigestion, reflux, sour stomach or heartburn, this condition is painful. When acid from the stomach splashes up into the lower esophagus, it burns. Even though heartburn doesn’t actually have anything to do with the heart, the name makes sense. The pain is generally behind the sternum, in the center of the chest, and it is often if not always a burning type of pain. Doctors used to prescribe medications like esomeprazole, lansoprazole and omeprazole to treat this problem. Now these proton pump inhibitors are available over the counter with brand names like Nexium, Prevacid and Prilosec. Are there natural ways to treat heartburn? This week on our nationally syndicated public radio show (The People’s Pharmacy), you’ll hear from Dr. Tieraona Low Dog, author of the eBook, Healing Heartburn Naturally.

Pros and Cons of Proton Pump Inhibitors:

PPIs are usually effective for short-term relief of heartburn. But if you read the label on your OTC omeprazole, you’ll find that it is not intended for immediate symptom relief; it may take one to four days for the effects to kick in. Moreover, if you need it for more than two weeks, you should be under a doctor’s care.

You WON’T find a list of side effects from extended use, but some can be quite troubling. People who take PPIs on a regular basis for an extended time are more susceptible to respiratory tract and digestive tract infections, including C. diff that can cause terrible diarrhea. They may be more likely to experience cardiovascular complications like heart attacks or kidney injury. Weakened bones or even osteoporosis may result form reduced absorption of nutrients such as calcium, magnesium or zinc. Changes in the gut microbiota and liver inflammation are other potential problems. No wonder some heartburn sufferers are looking for natural ways to treat heartburn!

Evidence for the Heartburn Diet:

If you have had frequent heartburn, chances are your doctor has suggested you should be careful with your diet. Frequently, people are urged to avoid tomatoes, citrus fruits, spicy foods, coffee, alcohol, fried foods, cheese and other foods high in fat. Chocolate, garlic, onion and peppermint are often forbidden. When we looked for scientific data supporting these recommendations, though, we couldn’t find much. What we did find were studies demonstrating that people following a low-carb diet are less likely to suffer from heartburn.

Problems Quitting PPIs:

People who have been taking a PPI for some time may find it difficult to stop. Rebound acid can cause a lot of discomfort. Utilizing natural ways to treat heartburn can help as people slowly discontinue their PPI. Find out what Dr. Tieraona Low Dog recommends for this process.

Natural Ways to Treat Heartburn:

A number of herbs have soothing properties that can help heartburn. Many people appreciate aloe vera, especially when the laxative portion has been removed. Licorice root is beneficial, but heartburn sufferers should look for DGL (deglycyrrhizinated licorice). Glycyrrhizin can raise blood pressure, so it is inappropriate for long-term use. You may never have heard of the Indian herb amla, but Dr. Low Dog is enthusiastic about it for stomach problems. Marshmallow (the plant, not the candy) is also quite effective, according to Dr. Low Dog.

She also describes how probiotics can be helpful. When gut microbes get out of balance (a condition termed dysbiosis), probiotics may help them recover. If you must take an antibiotic for a bacterial infection, a probiotic might help protect the gut microbes or encourage their restoration. Dr. Low Dog suggests checking USProbioticGuide.com for more details. To maintain good digestive health, consider Dr. Low Dog’s natural ways to treat heartburn.

This Week’s Guest:

Tieraona Low Dog, MD, is a founding member of the American Board of Physician Specialties, American Board of Integrative Medicine and the Academy of Women’s Health. She was elected Chair of the US Pharmacopeia Dietary Supplements/Botanicals Expert Committee and was appointed to the Scientific Advisory Council for the National Center for Complementary and Alternative Medicine. Her books include: Women’s Health in Complementary and Integrative Medicine; Life Is Your Best Medicine and Fortify Your Life: Your Guide to Vitamins, Minerals and More. Dr. Low Dog’s latest eBook is Healing Heartburn Naturally. We recommend it highly.

Her website is drlowdog.com  She also provides a wealth of information at MedicineLodgeRanch.com

Listen to the Podcast:

The podcast of this program will be available Monday, March 13, 2023, after broadcast on March 11. You can stream the show from this site and download the podcast for free.

Download the mp3

In this week’s episode, sleep expert Dr. Jade Wu will join us in the studio to answer your questions about overcoming insomnia without medication. Email us [radio@PeoplesPharmacy.com] or call 888-472-3366 between 7:10 and 8:00 am EST on Saturday, March 4, 2023.

Why Does Sleep Matter?

Adequate sleep is a critical pillar of good health. During that time, the body is able to “flush out” the brain by increasing the flow of cerebrospinal fluid. It repairs damaged tissues and releases certain hormones necessary for healthy functioning. In addition, it offers the brain an opportunity to practice new skills and review new information. People who report irregular or inadequate sleep are more susceptible to cardiovascular complications or even dementia.

No wonder, then, that people may become anxious when they fear that they may not be getting enough sleep. Experts define insomnia as the perception of having trouble falling or staying asleep. When this happens night after night, we call it chronic insomnia. Roughly 24 million American adults are troubled with this condition, which affects life and health during the day as well as at night. The problem is that worrying about falling asleep can interfere with actual sleep. Learn what sleep myths we should discard so we can ruminate less and sleep better.

Will “Good Sleep Hygiene” Help with Overcoming Insomnia?

People who have had insomnia for a while are probably familiar with the usual recommendations for sleep hygiene: keep the bedroom cool and dark. Don’t use the bedroom for anything but sleeping (and sex). Go to bed and get up at the same time every day. Don’t drink caffeinated beverages after lunch, and don’t drink alcohol in the evening.

While some of these ideas make sense, sleep experts like Dr. Wu say they won’t help a person with chronic insomnia. The best way to do that, she says, is to change your relationship with sleep. Giving up the idea that you can control your sleep and embracing the idea of sleep as a friend is key to overcoming insomnia.

What Perpetuates Chronic Insomnia?

As counterintuitive as it seems, spending too much time in bed can help stoke chronic insomnia. It doesn’t matter whether you go to bed too early or stay in bed too long in the morning, being in bed trying to sleep when your body isn’t sleepy only causes trouble. So does trying to “make up” for a bad night by trying to sleep longer the next night. Whether or not you are successful, “trying to sleep” is more likely to perpetuate than to cure insomnia.

Following a regular routine, especially a rhythm that is comfortable for you, can be very helpful. Night owls don’t do well if they try to get up with the early birds, and vice versa.

The Beauty of Sunlight:

Dr. Wu suggests that sunlight is among the most underrated sleep aids. Getting exposure to natural sunlight during the day can help entrain the body’s circadian rhythm. Avoiding bright lights at night is also important, so that you don’t send your brain a “wake up” message just as you are trying to prepare for sleep. What’s more, being physically active outside while you are enjoying the sunshine can increase your sleep drive and make it easier for your body to fall asleep when it is time to get into bed.

Cognitive Behavioral Therapy Designed for Overcoming Insomnia:

Dr. Wu’s special expertise is cognitive behavioral therapy for insomnia, aka CBT-I. Studies have shown that this is the most effective approach for overcoming insomnia. Like any tool, it works only where it is appropriate. Some sleep disorders, such as sleep apnea or restless leg syndrome, require other types of treatment.

This Week’s Guest:

Jade Wu, PhD, is a Board-certified behavioral sleep medicine psychologist and researcher at Duke University School of Medicine. Dr. Wu uses evidence-based non-medication treatments to help people improve their sleep (and waking life). She is especially passionate about helping new parents navigate sleep challenges during pregnancy and postpartum. She is the author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications.
Her websites are https://drjadewu.com/blog and https://drjadewu.com/clinic  Alisha White Photography holds the copyright to the photograph of Dr. Wu.

https://www.peoplespharmacy.com/articles/show-1333-overcoming-insomnia-without-medication

Dr. Jade Wu, author of Hello Sleep:The Science and Art of Overcoming Insomnia Without Medications

Listen to the Podcast:

The podcast of this program will be available Monday, March 6, 2023, after broadcast on March 4. You can stream the show from this site and download the podcast for free.

Download the mp3

In this week’s episode, we explore a range of practical approaches to staying healthy even in the midst of an epidemic or pandemic like COVID. Our guest offers evidence-based advice on what lifestyle changes can make a difference.

Practical Strategies for Staying Healthy:

Dr. Roger Seheult was already scouring the medical literature even before COVID-19. Once the pandemic hit, he focused on what recommendations he and his colleagues could offer patients so that they could stay as healthy as possible. These tactics grounded in science work against most viral infections, including the common cold as well as COVID. They should be easy and scalable.

Dr. Seheult uses the abbreviation NEWSTART to remind us of the basics: Nutrition, Exercise, Water, Sleep, Temperance (in the sense of moderation), Air, Rest (which goes beyond simply getting adequate sleep) and Trust in a higher being.

Light as Medicine:

Most of us are aware that we need vitamin D for a healthy immune response. And probably we know that we can make vitamin D if we expose our skin to sunshine. Dr. Seheult suggests that the benefits of getting outside for some natural light every day go far beyond vitamin D.

We rarely think about near-infrared light, but these wave lengths have a profound impact on the mitochondria that power our cells. Among other things, regular light exposure helps keep our circadian rhythms in line. When these are working well, they can help guide our sleep and our eating patterns to promote our health.

Not everyone has access to daytime light exposure. What should shift workers do? Dr. Seheult suggests that completely changing the daily rhythm so that it is consistent, even on days off, is most likely to be successful.

Do you have trouble sleeping? A strong circadian rhythm will help the body learn when to produce melatonin, which is important for sleep and also for fighting off infection. Avoiding light at night and skipping screens with blue light near bedtime can help encourage appropriate melatonin production.

In addition, it makes sense to pay attention to using your bedroom only for sleeping. If you possibly can, avoid working or watching TV in the bedroom. What’s more, if you find yourself tossing and turning, get up and go to another room for a quiet activity until you feel drowsy. That way, your body won’t learn to associate the bedroom with fighting to try to sleep.

Circadian Rhythm and Intermittent Fasting:

Research shows that giving the body time every day when it is not actively involved in metabolizing food and can spend energy repairing tissues. Intermittent fasting gives it a chance. A pattern of going for 15 to 16 hours without eating anything can be helpful for the metabolism, especially if the hours for eating come earlier in the day. People following such a pattern are more likely to make the BDNF (brain-derived neurotrophic factor) and other factors that they need.

Water as Therapy:

Dr. Seheult notes that most traditional cultures use techniques to warm people up when they are sick. During the 1918 flu pandemic, doctors frequently prescribed hot-water soaks. The Nobel Prize recognized the value of heating up the body to fight off an infection in 1927. That was the year the Nobel Committee awarded the Prize to Dr. Julius Wagner-Jauregg, who treated patients with syphilis by inducing fevers.

We now know that our bodies produce ten times more virus-fighting interferon when the temperature goes up to 39 C (102 degrees F). Soaking in a hot spring is much more feasible than spiking a fever! Sitting in a sauna is another popular option. Leaving the heat for a brief exposure to cold seems to increase its power.

Dietary Supplements That Make a Difference:

In his MedCram videos, Dr. Seheult reviews a range of dietary supplements and the science explaining why they are important for staying healthy. We asked him about his favorites, especially while facing the possibility of COVID infection. One that many people don’t know is NAC (n-acetylcysteine). Taking it can greatly reduce the severity of infection. Dr. Seheult likes 600 mg twice daily for six months, and then six months without.

Vitamin C is familiar and popular, but people prone to kidney stones need to be cautious about it. To determine the appropriate dose of vitamin D, you should check your blood level of 25-hydroxyvitamin D. Keeping it near 50 ng/mL should maximize its benefits for the immune system.

Finally, two other supplements you may not have considered: zinc and quercetin. Zinc can inhibit viral replication, and quercetin is a zinc ionophore–a compound that helps zinc get into the cells where it can do its work.

This Week’s Radio Guest:

Dr. 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.

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 has done an extraordinary job explaining COVID and the science behind various treatments. But he also makes many other complex medical topics understandable. This is a skill that few of my 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.

https://www.peoplespharmacy.com/articles/show-1331-staying-healthy-during-and-after-covid

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

Listen to the Podcast:

The podcast of this program will be available Monday, Feb. 20, 2023, after broadcast on Feb. 18. You can stream the show from this site and download the podcast for free. We think you will find this podcast loaded with practical information you can use as soon as you listen. Chances are you will want to take notes or stop the podcast so you replay what you just heard. Let us know what you think. We hope to have Dr. Seheult back on the show sometime soon to talk about a range of other important medical topics.

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In this week’s episode, our guest explains why treating hypothyroidism isn’t always as simple as it seems. He is a leading researcher on questions relating to thyroid hormones.

What Is Hypothyroidism?

Hypothyroidism, a condition in which the thyroid gland doesn’t make enough thyroid hormone, is one of the most common hormonal disorders. It was first identified near the end of the 19th century but is far more widely recognized now. More than 20 million Americans produce too little thyroid hormone for their needs, either because their thyroid glands have been removed or because they are under attack from the immune system. Inadequate thyroid hormone has an impact on every cell in the body. As a result, the symptoms are wide-ranging, from lethargy and cognitive troubles to hair loss and constipation.

Why Should We Be Rethinking Hypothyroidism?

Most medical students learn that this is a simple straightforward condition to diagnose and treat. For decades, doctors used a single test–the TSH, or thyroid-stimulating hormone–for diagnosis. In addition, they learn that a single medication, the hormone called levothyroxine, is the sole treatment. People may know levothyroxine by its brand names, such as Synthroid or Levoxyl. Doctors often refer to it as T4, because the molecule contains four atoms of iodine.

Not everyone knows that T4 itself is not biologically active. Enzymes within the cells must remove one of those iodine atoms to create the active hormone, T3. You might recognize it by its generic name, liothyronine, or by the brand name Cytomel.

What’s Wrong with Levothyroxine Only?

Back in 1970, researchers discovered the enzymes that convert T4 to T3. That’s when doctors decided that patients would do well on a simple synthetic form of T4. In fact, 80 to 85 percent of patients with hypothyroidism have no great difficulties with this treatment.

However, about 15 to 20 percent continue to suffer despite treatment. Some feel infuriated when the doctor tells them that their normal TSH levels mean they are fine. They don’t feel fine. They still feel exhausted, confused and miserable. Researchers, including our guest, have begun to recognize that people who do not convert T4 to T3 efficiently may suffer from residual symptoms of hypothyroidism.

How Should We Be Rethinking Hypothyroidism?

Lingering symptoms of hypothyroidism, such as fatigue or brain fog, are not very specific. As a result, doctors may need to utilize more sophisticated testing techniques. Moreover, rethinking hypothyroidism means considering different forms of treatment. A person who has residual symptoms despite a normal TSH level might need a trial of combination therapy. This might be in the form of desiccated thyroid extract such as Armour or Westhroid. An alternative would be a prescription for both T4 (levothyroxine) and T3 (liothyronine) as combination therapy.

Doctors making such a change to their prescription need to adjust the dose carefully so that the patient does not end up with too much thyroid hormone. They also need to make sure during the diagnostic workup that the problem truly is hypothyroidism. Symptoms such as low energy don’t go away with thyroid hormone treatment unless that is the underlying problem.

What Should Patients Do?

For too long, patients have heard that their residual symptoms are psychological in nature. A doctor might have insisted that a normalized TSH on treatment means nothing is wrong with the thyroid gland. People who still feel bad despite such treatment may need to hunt for a clinician willing to explore ways to address those residual symptoms.

This Week’s Guest:

Antonio C. Bianco, MD, PhD, was professor of medicine and a member of the Committee on Molecular Metabolism and Nutrition at the University of Chicago at the time this episode first aired. He ran a laboratory funded by the National Institutes of Health to study thyroid hormones. Dr. Bianco is a former president of the American Thyroid Association and author of Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do.
Twitter handle is @Bianco_Lab.

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Antonio Bianco, MD, PhD, is now The Nelda C and H.J Lutcher Stark Professor in internal medicine. VP, Vice-Provost for research and Chief research officer university of Texas Medical Branch, Galveston, Texas.

https://www.peoplespharmacy.com/articles/show-1196-what-to-do-if-thyroid-treatment-doesnt-work-for-you

Antonio Bianco, MD, PhD, University of Chicago

Listen to the Podcast:

The podcast of this program will be available Monday, July 7, 2025, after re-broadcast on July 5. You can stream the show from this site and download the podcast for free.

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

In this week’s episode, food allergy expert Dr. Edwin Kim will join us in the studio to answer your questions about dangerous food allergies in real time. Email us [radio@PeoplesPharmacy.com] or call 888-472-3366 between 7:10 and 8:00 am EST on Saturday, Feb. 4, 2023.

Dealing with Dangerous Food Allergies:

Dangerous food allergies have been increasing at a rapid rate. According to the CDC, these immunological problems became 50 percent more common in kids between 1997 and 2011. Even more alarming, medical emergencies due to anaphylaxis rose by 200 percent between 2005 and 2014. Anaphylaxis is a life-threatening allergic reaction that may show up first as a rash or hives. Trouble breathing and even shock may follow.

What is a food allergy? We will discuss the differences between allergies, sensitivities and intolerances. Dr. Kim will offer some scientific hypotheses about why food allergies have mushroomed.

Allergist and Dad:

Dr. Kim treats lots of children with food allergies. Peanuts are a common culprit. Nonetheless, he was shocked when his own baby reacted badly to a smidgen of peanut butter. After that frightening episode, he dedicated himself even more strongly to helping parents deal with dangerous food allergies.

Frequent Triggers of Dangerous Food Allergies:

In addition to peanuts, several other foods often cause allergic reactions. Doctors are wary of milk, eggs, tree nuts, fish, shellfish, wheat, soy and sesame seeds. How can people with allergies avoid contact with these allergens? Do exposures through the skin make a person more susceptible to problems?

Signs of Serious Allergy Problems:

Dr. Kim will describe the signs that should set off a parent’s alarm bells. How can you tell if your child has a food allergy? When do you need to talk to the pediatrician, and when should dangerous food allergies prompt a quick trip to the emergency department?

New Treatments for Allergies:

Not long ago, the FDA approved a prescription medication to treat peanut allergies. It works on the principle of oral tolerization. Bit by bit, the immune system “learns” that the peanut allergen is not harmful. The goal is to avoid an anaphylactic reaction in the event of an accidental exposure in the classroom or at a birthday party. What other treatments are in the pipeline?

Not Just Kids:

Much of the attention has been on children. Dangerous food allergies appear somewhat less common among adults. Do people outgrow their reactions, or do they just become more sophisticated at avoiding allergens? We’ll find out what adults should be doing to prevent serious problems.

This Week’s Guest:

Edwin Kim, MD, MS, is Associate Professor of Pediatrics & Medicine at the University of North Carolina at Chapel Hill. He is Division Chief for UNC Pediatric Allergy & Immunology and Director of the UNC Allergy & Immunology Fellowship Program. Dr. Kim is also Director of the UNC Food Allergy Initiative. More information at his website: https://www.med.unc.edu/medicine/rheumatology-allergy-immunology/people/edwin-h-kim-md-ms/

https://www.peoplespharmacy.com/articles/show-1329-dealing-with-dangerous-food-allergies

Edwin Kim, MD, MS, UNC

Listen to the Podcast:

The podcast of this program will be available Monday, Feb. 6, 2023, after broadcast on Feb. 4. You can stream the show from this site and download the podcast for free.

Our interview this week is all about repurposing medications. Hundreds of rare diseases don’t have effective treatments. Even some common conditions lack approved therapies. The research to develop new medications to manage or cure them is costly and time-consuming. Is there a way to teach old drugs new tricks? That could allow us to repurpose existing pharmaceuticals for hard-to-treat conditions.

Finding a Treatment for Castleman Disease:

Our guest, Dr. David Fajgenbaum, was a healthy young medical student who inexplicably became deathly ill. Multiple organ systems were failing, and his doctors did not know why. (You can listen to the full story here.)

Eventually, they did reach a diagnosis: idiopathic multicentric Castleman disease. Essentially, his immune system had turned against him and was attacking his organs. But diagnosis was not enough. Castleman disease is rare, and the treatment his doctors prescribed was not effective for Dr. Fajgenbaum. He nearly died four times.

That convinced him to try to find a medication that would work to keep his condition under control, even if the FDA has not approved its use against Castleman disease. He was successful in repurposing a drug used to prevent organ transplant rejection, sirolimus. It has now helped him stay alive and productive for years.

Repurposing Old Drugs to Treat COVID-19:

When the world-wide pandemic of COVID-19 appeared, there were no drugs approved to treat it. The infection had never been studied before. As a result, scientists scrambled to come up with ways to control the coronavirus. Two existing medications, dexamethasone and tocilizumab, turned out to be life savers.

The steroid dexamethasone reduced the death rate of hospitalized patients on oxygen (NEJM, Feb. 25, 2021). It was readily available and inexpensive.

The immune-suppressing medicine tocilizumab, while pricier and less dramatic than dexamethasone, also lowered mortality. That was among hospitalized patients needing ventilation who were also getting steroid treatment (JAMA Network Open, Feb. 28, 2022).

Can We Teach Other Old Drugs New Tricks?

Dr. Fajgenbaum and his colleagues are studying nine drugs that may end up being very helpful against disorders that need better treatments. Not all of them are as old as sirolimus or dexamethasone. One example is pembrolizumab, also known by its brand name Keytruda.

The FDA has approved this monoclonal antibody for treating several malignancies, including melanoma, non-small cell lung cancer, Hodgkin lymphoma and several others. Because it works, in part, by suppressing PD-L1, they suspected that it might help a person who sought their help for a life-threatening angiosarcoma. Fortunately, it worked for this patient. But to find out if it will work for others, they will need to conduct a clinical trial. Keytruda is not a benign drug. A clinical trial is the only to find out if the benefits outweigh the risks.

During our interview with Dr. Fajgenbaum, we discussed BCG (Bacille Calmette-Guérin), a hundred-year-old vaccine against tuberculosis. Could it be helpful for COVID-19 or other infections? As we noted, it is already approved for treating bladder cancer. Might it be helpful against other tumors?

Barriers to Teaching Old Drugs New Tricks:

Investigators will need to overcome several barriers to make the dream of repurposing old drugs a reality. Currently, there is no central data repository on drug trials. The manufacturers may keep their own databases, but they don’t share with other scientists. As a result, it was partly luck that led Dr. Fajgenbaum and his colleagues to consider Keytruda for the angiosarcoma patient.

Another barrier is the lack of a business model that will reward the research. Once a drug goes off patent, usually generic manufacturers bring out their versions at a lower price. While this is helpful for patients, it means the manufacturer has no interest in pursuing research that could teach their old drugs new tricks.

In addition, no organization is responsible for overseeing this “post-hoc” drug development. The FDA is primarily focused on new drug approvals. In the US, we do not have an agency or administration devoted to making sure that all of our medications reach their full potential. Dr. Fajgenbaum is hoping that his nonprofit organization EveryCure can pick up the slack in this area.

This Week’s Guest:

David Fajgenbaum, MD, MBA, MSc, is Assistant Professor of Medicine at the Perelman School of Medicine of the University of Pennsylvania. He is Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL) and Associate Director for Patient Impact of the Orphan Disease Center at the University of Pennsylvania. In addition, Dr. Fajgenbaum is Co-Founder & President of the Castleman Disease Collaborative Network (CDCN).

Dr. Fajgenbaum is a physician-scientist of immunology and co-founder of the non-profit EveryCure, www.everycure.org. His book Chasing My Cure: A Doctor’s Race to Turn Hope Into Action. The photo of Dr. Fajgenbaum is by Rebecca McAlpin.

Listen to the Podcast:

The podcast of this program will be available Monday, Jan. 30, 2023, after broadcast on Jan. 28. You can stream the show from this site and download the podcast for free.

When the COVID-19 pandemic began, it seemed there were only two outcomes from an infection. Either you died (as far too many people did) or you survived and moved on. Now, physicians, researchers and a growing number of patients are coming to grips with symptoms that persist months or possibly years after the initial infection. What have we learned about long COVID? We talk with two scientists about their research initiatives.

Possible Causes of Long COVID:

There are so many possible symptoms of long COVID that we may eventually need to break it into multiple different conditions, for easier diagnosis and more effective treatment. Among the 200-plus symptoms that have been identified, multiple organ systems are affected. Some symptoms are related to the circulatory system, while others are neurological in nature. Some people develop symptoms of autoimmune conditions, and even autoantibodies. Many victims experience overwhelming exhaustion and post-exertional malaise similar to that reported by people suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). What do the conditions have in common?

What Have We Learned About Long COVID?

Scientists are collecting information on how many people end up with long COVID. They are still attempting to figure out whether certain characteristics make patients more vulnerable to persistent problems. They have found that even people who had mild or nearly asymptomatic infections can suffer from long COVID later. However, those who had severe infections or needed hospitalization appear to be at higher risk. Vaccines appear to lower the risk somewhat, possibly because they reduce the likelihood of serious infections. The National Institutes of Health are collecting information for future analysis through their RECOVER Initiative. It aims to understand the long-term implications of long COVID.

How to Find Pathogens Causing Chronic Problems:

Long COVID is not the first condition to appear after an acute infection. Although some infectious disease experts are skeptical, gradually many have begun to accept that ME/CFS seems to be a reaction to a viral infection. Lyme disease is another controversial topic, yet some people who have had an infection end up suffering for an extended period of time.

One guest, microbiologist Amy Proal, suggests that we should not be looking for pathogens in the blood. Viruses and bacteria are far more likely to be hiding out in cells and tissues where the immune system is less likely to encounter them. One well-known example of a virus that does this is herpes. Herpes zoster can cause shingles decades after a chickenpox infection. We may need an entirely new way to think about clearing such pathogens from the body.

Will What We Have Learned About Long COVID Help with Treatment?

We are only at the beginning of finding treatments effective for this condition. So far, most clinics refer patients to treatment for specific symptoms. However, scientists are beginning to consider treatments like antivirals and anticoagulants. (Some of the lasting damage from COVID is thought to be due to microscopic clots and damage to the lining of blood vessels.) Other suggestions are less mainstream. For example, some physicians are stimulating the vagus nerve that connects gut and brain. Others are considering glycyrrhizin, a compound in licorice with effects on inflammation. Naltrexone, a drug that interferes with opioid activity, may help at very low doses, but no one understands exactly how. Yet another approach might include rebuilding the body’s microbiota after it has been disrupted by COVID.

If you have found a practice or medication that helps you with symptoms of long COVID, please leave us a comment. We’re very interested in your experience and what you have learned about long COVID.

This Week’s Guests:

Leora Horwitz, MD, is Professor in the Department of Population Health at NYU Grossman School of Medicine at NYU Langone Health. She is also Professor in the Department of Medicine at NYU Grossman School of Medicine and Director of the Division of Healthcare Delivery Science. In addition, she is Director of the Center for Healthcare Innovation and Delivery Science.

Dr. Horwitz is part of the U.S. National Institutes of Health’s RECOVER initiative that aims to understand the long-term impacts of COVID-19. The website is https://recovercovid.org/

https://www.peoplespharmacy.com/articles/show-1327-what-have-we-learned-about-long-covid

Leora Horwitz, MD, NYU Grossman School of Medicine

Amy D. Proal, PhD, is a microbiologist who studies the molecular mechanisms by which bacterial, fungal and viral pathogens dysregulate human gene expression, immunity and metabolism. Dr. Proal is the founder of the PolyBio Foundation and the chief science officer and co-founder of the Long COVID Research Initiative.

Listen to the Podcast:

The podcast of this program will be available Monday, Jan. 23, 2023, after broadcast on Jan. 21. You can stream the show from this site and download the podcast for free.

Download the mp3

This week, our guests take two different approaches to the sense of smell. We talk with a surgeon who treats people having difficulties with that sense. In addition, a nurse describes utilizing the sense of smell for aromatherapy in integrative healing. Learn about the fascinating science of smell.

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 17, 2025.

The Science of Smell:

Of all our senses, the sense of smell often gets short shrift. Aside from Marcel Proust’s evocative description of the link between odor and memory, we don’t think much about smell. Scientists have discovered, however, that much of our social interaction relies on olfaction at a subconscious level. It plays a largely unconscious role in our choice of mates as well as in the timing of sexual activity. It is also important for the bonding between mothers and their infants. Consequently, the sense of smell is crucial for the survival of our species, even when we aren’t paying attention.

Losing our sense of smell can be devastating, as too many people learned by experience during the COVID-19 pandemic. Not only did they miss out on pleasant aromas like fresh-brewed coffee or newly mown grass, but they also were at a disadvantage in detecting if there might be gas leaking in the kitchen or a fire smoldering somewhere in the house.

Although some of those who lost their sense of smell during an acute infection subsequently regained it, others did not. Too many people are still suffering from anosmia. Is there anything that can be done to help them?

Regenerating Nerves in the Nose:

Many viruses can cause inflammation in nasal tissue and potentially damage the sense of smell. During COVID-19, the SARS-CoV-2 virus attacked ACE receptors on cells in the olfactory epithelium of the nose. These cells are not the nerve cells themselves, but support cells (called, if you must know, sustentacular cells). Fortunately, these cells can regenerate, although it takes time.

The Science of Smell Recovery–Olfactory Training:

The first step in recovering the sense of smell is olfactory training. It could be considered something like physical therapy for the nose. In this structured smelling protocol, people are exposed to one of four distinctive aromas from essential oils: lemon, rose, eucalyptus or clove. As they attempt to discern the scent, they remember how they used to experience those odors. As part of the protocol, they also irrigate their nasal passages with high-dose steroids in saline solution (International Forum of Allergy & Rhinology, Sep. 2018).  Over many months, this concerted effort is able to help 30 to 50 percent of patients recover their sense of smell to a satisfactory degree.

The Science of Smell Recovery–Platelet-Rich Plasma:

To help people who are not successful enough with olfactory training, Dr. Zara Patel has pioneered the use of platelet-rich plasma. PRP injections have been used to help athletes recover from injury. Since it can be helpful in situations where inflammation is high, she tried PRP injections for people with difficulty smelling. A randomized controlled trial showed that the injection is safe and may be effective in helping people recover their sense of smell after COVID-19 (International Forum of Allergy & Rhinology, June 2023).  She hopes to conduct a larger study that would be more conclusive.

Harnessing the Sense of Smell with Aromatherapy:

Dr. Patel was careful to point out the distinction between olfactory training, based on the science of smell, and aromatherapy. Our other guest, an integrative care nurse, utilizes aromatherapy to help people in post-anesthesia care units. There is some evidence, for example, that the aroma of lavender essential oil can help anxious patients relax and get to sleep, but better studies are necessary (Phytomedicine, Dec. 2019).

Plants use the volatile compounds in their essential oils for communication. In addition, some terpenes in juniper or pine have antiviral activity, while components in clary sage or bergamot have antifungal properties. Nurses in some cancer hospitals utilize aromatherapy to help patients overcome nausea and pain associated with chemotherapy. This is an area of the science of smell in which our guest Kathy Fritze has special expertise.

This Week’s Guests:

Zara M. Patel, MD, is Professor of Otolaryngology-Head and Neck Surgery at the Stanford School of Medicine. Her website is https://profiles.stanford.edu/zara-patel

Zara Patel, MD, Stanford School of Medicine

Kathy Fritze, RN, BSN, is a holistic and integrative care nurse in the Wellness & Support Center at the University of Maryland St. Joseph Medical Center.

Kathryn Fritze RN, BSN

Listen to the Podcast:

The podcast of this program will be available Monday, March 17, 2025, after broadcast on March 15. You can stream the show from this site and download the podcast for free. In addition to what you heard in the broadcast, the podcast includes additional information on why people sometimes detect strange odors that others don’t perceive. We also discuss people who have strong reactions to odors in perfume or detergent, such that they become physically ill when they smell them.

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

This week on our nationally syndicated radio show, our guest describes the causes and consequences of silent inflammation. Usually, inflammation (redness, swelling, heat, pain) is a tool the immune system uses to fight infection. But what happens when it gets out of control?

The Dangers of Silent Inflammation:

A number of factors might help explain how an immune system creating acute inflammation in response to infection might not be able to calm itself afterwards. Viruses or bacteria can trigger a cytokine storm that may throw the body out of balance. Air and water pollution or exposure to chemicals in common products such as fast food packaging may also encourage this trend. In addition, our modern American lifestyle, with too little physical activity and too much ultra-processed foods, probably contributes. What can we do to recognize and counteract this problem?

Recognizing the Ravages of Silent Inflammation:

Our guest, Dr. Shilpa Ravella, shares a story about a close friend from medical school who suddenly developed an alarming condition. He ultimately became unable to hold up his head and required a brace from his waist to his skull. Doctors had difficulty diagnosing the problem, which was eventually declared an atypical autoimmune disease. It seems he was the victim of an especially vicious case of silent inflammation.

Chronic Conditions Linked to Inflammation:

Although the story focused on a very unusual case, hidden, lingering inflammation is at the root of many of our most common chronic conditions. When the lining of blood vessels (endothelium) becomes inflamed, the consequence can be cardiovascular complications, including heart disease and stroke. Statins may benefit heart patients partly because they reduce inflammation.

When our digestive tracts become chronically inflamed, the results can be devastating…from irritable bowel syndrome to inflammatory bowel diseases like Crohn’s disease or ulcerative colitis. In the brain, inflammation may contribute to dementia.

The Role of Diet:

The microbes that populate our digestive tracts are in a constant, intimate conversation with the immune system cells that surround it. Consequently, our dietary choices are critical. Maintaining a healthy and diverse microbiota is key to keeping inflammation under control.

An American diet full of meat and ultra-processed foods leads to an impoverished microbiota. Investigators demonstrated this when they had two groups of people swap diets for two weeks. When people from Pittsburgh ate the kind of food popular in South Africa, full of whole grains and vegetables, they increased their microbial diversity. On the other hand, the South Africans who consumed burgers and French fries, among other foods, for two weeks ended up with less diverse microbes. Scientists are still exploring how this affects silent inflammation. Most agree, though, that a diet consisting mostly of whole foods, as unprocessed as possible, rich in fiber, offers significant advantages.

Controlling Silent Inflammation:

Doctors don’t often test for silent inflammation because it is difficult to measure. However, cardiologists may test for high-sensitivity C-reactive protein (hs-CRP), a way of assessing how inflammation may be affecting the blood vessels and the heart. Other red flags include belly fat. This indicates visceral fat that acts to ramp up inflammation in many cases. Another clue: high blood sugar. When the pancreas isn’t able to produce enough insulin to lower circulating glucose, it is often a signal that it is struggling with inflammation.

This Week’s Guest:

Shilpa Ravella, MD, is a transplant gastroenterologist with expertise in nutrition and an Assistant Professor of Medicine in the Division of Digestive and Liver Diseases at Columbia University Medical Center. Her TED-Ed lesson, ‘How the Food You Eat Affects Your Gut,’ has garnered over five million views.

Dr. Ravella is the author of A Silent Fire: The Story of Inflammation, Diet, and Disease.
Her website is: shilparavella.com     The photograph of Dr. Ravella is copyright Anshul Mathur.

Listen to the Podcast:

The podcast of this program will be available Monday, Jan. 9, 2023, after broadcast on Jan. 7. You can stream the show from this site and download the podcast for free.

Download the mp3

More than two years of living through a pandemic has really increased anxiety for a lot of people. If we define anxiety as worry or unease about an imminent event with an uncertain outcome, it’s easy to see why. However, it really isn’t healthy to feel anxious all the time, even when outcomes are uncertain. Anxiety started rising even before the start of 2020, though.

Anxiety as a Survival Tactic:

Evolution gave us the ability to remember where food is, so we can find it, and where danger is, so we can avoid it. But the cerebral cortex, which is presumably more recently evolved, tries to overcome uncertainty by hunting for additional information. We could lean into uncertainty, especially where it is likely. However, sometimes we start to obsess on worst-case scenarios instead. Rather than helping you manage your anxiety, that could make it worse.

Identifying Chronic Anxiety:

Our guest tells the story of developing irritable bowel syndrome in college. He couldn’t imagine that it was due to anxiety until after several other types of treatments failed to resolve the symptoms.

In addition, anxiety hides in our habits as well as in our bodies. Habits like overeating or alcohol misuse can be ways that we try to manage our anxiety. In fact, sometimes anxiety itself can become a habit. We may use it as a way to try to deal with anxiety, but unfortunately it isn’t any more effective than eating or drinking too much.

What You Can Do to Manage Your Anxiety:

Do you like to hope for the best and plan for the worst? A lot of us do, but we need to make sure that we truly are planning and not just worrying. Going over something for the fifth or sixth time is not really helpful. Instead, it’s a sign of anxiety.

Three Gears to Help You Manage Your Anxiety:

Habit loops can be hard to identify. But once you are able to spot how the trigger is driving your behavior, you can see the result. That identification is the first gear.

The second gear is to change the value of the reward that results from the behavior. One person who found that he was stress-eating realized that it wasn’t helping his anxiety. That helped him stopped. The question to ask: what am I getting from this?

The third gear is to find something that has a higher reward value. Dr. Brewer looks for a bigger better offer (BBO) for the brain. BBOs often involve either curiosity or kindness. In addition to helping overcome anxiety-driven habits, these tools can help us improve our relationships as well. Instead of self-judgment, imagine trying kindness towards yourself.

Mindfulness Apps Can Help Manage Your Anxiety:

Dr. Brewer’s research lab has created a couple of mindfulness apps that are very helpful in breaking anxiety-driven habit loops. One is designed to help with stress eating: Eat Right Now. The other is Unwinding Anxiety. Once you’ve listened to the show, you’ll know exactly what that one is for.

This Week’s Guest:

Dr. Judson Brewer is an internationally renowned addiction psychiatrist and neuroscientist. He is an associate professor in the School of Public Health, and Medical School at Brown University. His 2016 TED talk, “A Simple Way to Break a Bad Habit,” has been viewed over 16 million times. He has trained Olympic athletes and coaches, government ministers and business leaders. Dr. Brewer is the author of The Craving Mind: From Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits, and his latest book is Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind.

Listen to the Podcast:

The podcast of this program will be available Monday, January 2, 2023, after broadcast on Dec. 31. The show can be streamed online from this site and podcasts can be downloaded for free. In the podcast, Dr. Brewer explains why we can’t count on willpower. You didn’t hear that on the radio.

Download the free mp3

Virtually everyone in the US has been exposed to PFAS chemicals. That stands for per- and polyfluoroalkyl substances found in fire-fighting foam, nonstick coatings, food packaging and waterproofing or stain resistant chemicals used on clothing, furniture and carpets. Pesticides are also an important source. These are also referred to as “forever chemicals” because they persist in the environment for so long.

The EPA (Environmental Protection Agency) announced  on June 15, 2022, that you should worry about PFAS chemicals. These compounds end up in the air we breathe, the dust in our homes, the food we eat and the water we drink. They are suspected of disrupting our hormones as well as negatively affecting many other health systems in our bodies.

Limiting PFAS in Drinking Water:

The EPA is expected to set standards soon limiting the amount of forever chemicals in drinking water. An analysis by the Waterkeeper Alliance this year found PFAS in 83 percent of the waterways analyzed. With such broad exposure, more than 98 percent of Americans have detectable levels in their blood. The EPA will propose standards for only two of these compounds, PFOA and PFOS.

People who live on or near military bases, where firefighting foams are used in training, and those near chemical plants are highly exposed, but most of the rest of us have also been exposed to PFAS. These chemicals may disrupt hormones. In addition, scientists have linked PFAS exposure to kidney and testicular cancer, pregnancy-induced hypertension, thyroid disease, ulcerative colitis and high cholesterol.

The compounds are difficult to remove and will require water treatment plants to invest in new technologies. Two major manufacturers, 3M and Monsanto, have recently announced intentions to stop making PFAS compounds in the future. Even then, however, reducing exposure will be an ongoing challenge that will probably take years to achieve.

PFAS in Your Home?

Where would you find forever chemicals in your house or your car? Let’s start with carpets, furniture and mattress pads. Remember, PFAS compounds are great at resisting stains. As a result, many fabrics get treated with these chemicals to make life “easier.” Some clothing, shoes and boots are treated with water and stain-resistant PFAS products.

There are nonstick frying pans that contain forever chemicals. Certain products are advertised as being PFOA- or Teflon-free. But there are thousands of PFAS chemicals. Companies can substitute compounds that are not on a hit list, but that does not mean they are PFAS-free.

The FDA points out that:

“Certain PFAS are also intentionally added as ingredients in some cosmetic products, including lotions, cleansers, nail polish, shaving cream, foundation, lipstick, eyeliner, eyeshadow, and mascara. These PFAS are used in cosmetics to condition and smooth the skin, making it appear shiny, or to affect product consistency and texture.”

PFAS in Your Tap Water?

The EPA announced this week that forever chemicals are more dangerous than scientists once believed. In particular, PFOA and PFOS levels in drinking water could have negative health consequences even at very low levels.

Scientists are warning that such compounds could impact the immune system as well as the cardiovascular system. That brings us to a new study suggesting that forever chemicals could have an impact on blood pressure.

PFAS and Hypertension:

A new study (Hypertension, June 13, 2022) reveals a connection between high levels of PFAS chemicals and high blood pressure in women. More than 1,000 middle-aged women participated in the Study of Women’s Health Across the Nation (SWAN) for 20 years. Those with the highest levels of PFAS compounds in their blood stream were at greatest risk for hypertension.

The conclusions of the study:

“Several PFAS showed positive associations with incident hypertension. These findings suggest that PFAS might be an underappreciated contributing factor to women’s cardiovascular disease risk.”

The senior author goes on to emphasize:

“We hope that these findings alert clinicians about the importance of PFAS and that they need to understand and recognize PFAS as an important potential risk factor for blood pressure control.”

National Institute of Environmental Health Sciences:

One of the Institutes under the umbrella of the US National Institutes of Health studies whether man-made compounds in our environment have deleterious effects on our health. The National Institute of Environmental Health Sciences strives to understand how the environment affects human disease so that it can promote human health. Until her recent retirement, Dr. Linda Birnbaum directed the NIEHS. We interviewed Dr. Birnbaum about PFAS chemicals for our syndicated public radio show. Here are some of the things we discussed.

Does Dose Matter?

The sixteenth-century alchemist Paracelsus famously said, “Solely the dose determines that a thing is not a poison.” In most cases we are familiar with in everyday life, a lower dose of a dangerous compound might be less dangerous. Is that true for the PFAs, or could they still cause trouble even at low levels?

Other Compounds in Our Daily Lives:

Scientists have studied one chemical very well. Bisphenol A was first synthesized more than a hundred years ago. Its estrogenic activity was noted in the 1930s. But it wasn’t until about three decades ago that scientists realized the BPA used in hard clear plastics like laboratory flasks and baby bottles was leaching into the foods and liquids in these containers. Because it can mimic estrogen, it has the potential to disrupt the balance and activity of hormones in the human body.

Consumer alarm has led many manufacturers to replace BPA in their polycarbonate containers with other compounds. Are they any safer?

The Precautionary Principle:

Many European countries utilize the precautionary principle when regulating manmade compounds. Manufacturers are expected to demonstrate that a compound is actually safe before large groups of people are exposed. In the US, on the other hand, scientists or the government have to demonstrate that a compound is harmful before it is regulated.

Other Compounds of Concern:

Toxicologists are examining other agents beyond BPA and the forever chemicals. They have been debating the safety of the herbicide glyphosate (known by its trade name Roundup). An insecticide known as chlorpyrifos has also generated controversy. How do scientists assess the benefits and harms of such chemicals?

Our Guest Expert:

Linda S. Birnbaum, Ph.D., D.A.B.T., A.T.S, is Scientist Emeritus (Retired) and Former Director of the National Institute of Environmental Health Sciences and the National Toxicology Program. In addition, Dr. Birnbaum served previously as president of the Society of Toxicology. She was elected to the Institute of Medicine in 2010.

Listen to the Podcast:

The show can be streamed online from this site and podcasts can be downloaded for free. We interviewed Dr. Birnbaum again several weeks ago along with a reporter from Consumer Reports. You will be surprised to learn that PFAS chemicals are also found in lots of food packaging! Here is a link to Show 1301.

Download the mp3 for Show 1212

Jane Goodall is an eminent naturalist who spent years studying chimpanzees in their natural habitat. It was she who first reported that we humans are not the only primates to make and use tools. She transformed our understanding of these animals. Now she is an elder stateswoman speaking out for action to help reverse climate change. Over the last few years, she and author Doug Abrams had in-depth conversations about her reasons for hope that we can act in time.

The Book of Hope:

Jane Goodall warns that we should not confuse hope with wishful thinking. Turning to fantasy won’t help, nor will wallowing in fear. But with hope, we can identify realistic goals and a possible pathway to reach them. We also need confidence and social support. According to Jane Goodall, hope is a survival trait. It is also a social gift.

Four Reasons for Hope:

The Book of Hope explores in depth the four reasons that Jane Goodall holds up for hope that we can make change in time. They include the amazing human intellect that could be deployed in the service of positive change. She also sees the resilience of nature, the power of young people and the indomitable human spirit as factors that can help us. When we combine the powers of head and heart, we end up with wisdom.

Eco-grief is essential to allow us to process our pain and motivate action. When we rise to our human potential, we can look to a future that is better than the present. What we are learning now is crucial to allow us to face our challenges with grit and courage. Both the book and the conversation are uplifting.

This Week’s Guest:

Douglas Abrams is co-author of the New York Times bestseller, The Book of Joy: Lasting Happiness in a Changing World, with the Dalai Lama and Desmond Tutu. His latest book, co-authored with Jane Goodall, is The Book of Hope: A Survival Guide for Trying Times. Douglas is also the founder and president of Idea Architects, a literary agency and media development company helping visionaries to create a wiser, healthier, and more just world. The photo of Mr. Abrams is by Dina Scoppettone.

Listen to the Podcast:

The podcast of this program will be available Monday, Dec. 26, 2022, after broadcast on Dec. 24. You can stream the show from this site and download the podcast for free.

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In our nationally syndicated radio show this week, we talk with two scientists who have been studying how eating cherries affects our physiology. Both are experts in sports medicine who have done some intriguing research that may convince you to include tart cherries in your diet.

Tart Cherries for Precovery:

First we speak with Dr. Malachy McHugh about the concept of “precovery.” His studies have shown that consuming 50 to 100 cherries or the equivalent in juice prior to strenuous exercise such as a long run speeds muscle recovery.

In addition, there is evidence that cherry consumption lowers systemic inflammation and uric acid. Reduced uric acid means that a person is less prone to the painful joint inflammation called gout. Clinical trials on this effect are sparse, however. A British research group has published a protocol for a randomized controlled trial of tart cherry juice against gout (BMJ Open, March 15, 2020). However, they have not yet published results.

Tart Cherries for Cognition:

One of Dr. McHugh’s colleagues, a British exercise physiologist, wondered whether the antioxidant and anti-inflammatory properties of cherries would boost brain power. Dr. Glyn Howatson and his co-investigators recruited 50 middle-aged people and assigned them randomly to Montmorency cherry concentrate or cherry-flavored placebo. The volunteers performed computerized tests before and after the three-month trial. The researchers also measured their cerebral blood flow and analyzed blood samples (British Journal of Nutrition, Feb. 2022).

People getting the cherry concentrate were more alert and accurate. They also reported less mental fatigue than those on placebo. The researchers detected different amino acids in the blood of those supplemented with tart cherries.

They also noted:

“the ability to improve sustained attention during times of high cognitive demand…”

The dose in this study was 30 ml of concentrate (two tablespoons) twice a day. That’s the equivalent of 90 fresh cherries.

Dr. Howatson notes that tart cherries are not the only source of beneficial phytonutrients. Other foods, such as high-flavanol cocoa extract, also show benefit.

This Week’s Guests:

Dr. Malachy McHugh has been the Director of Research at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) at Lenox Hill Hospital in New York City since 1999. He leads a multidisciplinary research team including orthopaedic surgeons, physical therapists, exercise physiologists, nutritionists, biomechanists, medical engineers and athletic trainers. You can read his recent research on cherry juice and exercise recovery here: https://onlinelibrary.wiley.com/doi/full/10.1111/sms.14141 The photo is of Dr. McHugh.

Professor Glyn Howatson is a Fellow of the American College of Sports Medicine and the British Association of Sport and Exercise Sciences (BASES). He is on the Editorial Board for the Scandinavian Journal of Medicine & Science in Sports and the European Journal of Sport Sciences. His research interests predominantly lie in the optimization of human performance where he focuses efforts on understanding the stress-recovery-adaptation continuum using training and nutritional interventions to manipulate human physiology. You will find his recent study here: https://pubmed.ncbi.nlm.nih.gov/35109960/

Listen to the Podcast:

The podcast of this program will be available Monday, December 12, 2022, after broadcast on December 10. You can stream the show from this site and download the podcast for free.

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We hear a lot about the obesity epidemic in the United States and around the world. Scientists acknowledge that this has occurred too rapidly to be explained by changes in genetics. Instead, nutrition scientists often turn to the energy balance model: people eating more calories than they expend. However, this dietary dogma on weight gain leaves too many questions unanswered, according to our guests. Instead, they’d like to see a change in the paradigm regarding weight gain.

Pandemic Weight Gain:

Many people report that they have gained weight during the pandemic. In fact, a survey from the American Psychological Association found that 42 percent of adults reported gaining weight, an average of about 29 pounds.

In addition, a small study published in JAMA Network Open used more than 7,000 measurements from 269 participants between February and June 2020. A lot of people were in lockdown during that time, and participants gained an average of 1.5 pounds per month. But why? Was it the restriction on activity outside the home? Did people snack more due to anxiety or boredom? Or did the type of food they were eating encourage weight gain?

Challenging Dietary Dogma on Weight Gain:

Most nutrition experts blame weight gain on people eating too much and being too sedentary–calories in exceeding calories out. However, a group of eminent nutrition researchers and commentators have recently questioned that model as too simplistic. They published their commentary in the American Journal of Clinical Nutrition as “The carbohydrate-insulin model: a physiological perspective on the obesity pandemic” (September 13, 2021). In it, they suggested that the old energy balance model (calories in vs. calories out) should be compared to the carbohydrate-insulin model.

Carbohydrate-Insulin Model Counters Dietary Dogma on Weight Gain:

This model posits that highly processed carbohydrates (think Halloween candy) drives blood sugar up so rapidly that insulin responds by stashing the energy in fat cells. As a result, people might feel hungry even though they are adding fat.

We talk with two of the authors of this review, which calls for rigorous research “to compare the validity of these 2 models, which have substantially different implications for obesity management…” How does challenging dietary dogma on weight gain affect what you might eat?

This Week’s Guests:

David S. Ludwig, MD, PhD, is an endocrinologist and researcher. He is Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at the Harvard T.H. Chan School of Public Health. Dr. Ludwig also co-directs the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. His research focuses on how food affects hormones, metabolism, body weight, and well-being. Dr. Ludwig is the author of several books, including the NYTs bestseller Always Hungry?
Dr. Ludwig’s website is https://www.childrenshospital.org/research/researchers/l/david-ludwig  The link to the paper is: https://doi.org/10.1093/ajcn/nqab270  The photograph is of Dr. Ludwig.

Walter C. Willett, MD, DrPH, is a physician and epidemiologist. He is Professor of Epidemiology and Nutrition at the Harvard T.H. Chan School of Public Health, where he served as Chair of the Department of Nutrition for 25 years. He is also Professor of Medicine at Harvard Medical School.

Much of his work has been on the development of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. Dr. Willett has published over 2,000 research papers, primarily on lifestyle risk factors for heart disease and cancer, and has written the textbook, Nutritional Epidemiology, published by Oxford University Press. He also has written four books for the general public, including Eat, Drink and Be Healthy. Dr. Willett is the most cited nutritional scientist internationally.

He is a member of the National Academy of Medicine and the recipient of many national and international awards for his research. Dr. Willett was the very first to receive The People’s Pharmacy Award for Excellence in Research and Communication for the Public Health. Dr. Willett’s website is https://www.hsph.harvard.edu/walter-willett/

Listen to the Podcast:

The podcast of this program will be available Monday, Nov. 8, 2021, after broadcast on Nov. 6. You can stream the show from this site and download the podcast for free. This week, the podcast contains additional information that wouldn’t fit in the radio broadcast.

Dr. Ludwig discusses weight problems in children and offers advice for parents. He also offers his ideas on why the diet wars are so emotional and how we could have a constructive debate about diet. We also discuss his recently published randomized controlled trial.

Dr. Willett reviews the consequences of the obesity epidemic and compares the toll internationally. We also get his ideas on how the food industry has affected thought leaders in academia. Best of all, he describes how we can use mindfulness in assessing the quality of our diet.

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According to the Centers for Disease Control and Prevention, approximately 50 million American suffer from debilitating chronic pain. Despite that number, in 2016 the agency issued stringent guidelines limiting opioid prescriptions to a bare minimum. Such drugs are often the first line for treating pain. Unfortunately, although this was an effort to reduce drug overdose deaths, it was unsuccessful. New guidelines offer prescribers much more leeway to use their judgment in managing chronic pain.

Chronic Pain Due to Lyme Disease:

The potential causes of chronic pain are too numerous to list. Lyme disease is probably not the first source that comes to mind. Nonetheless, it was a Lyme disease infection that threw columnist Ross Douthat into a desperate downward spiral. He describes the experience of pain along with the difficulties of getting a diagnosis of his Lyme disease.

Lyme disease is a particularly controversial topic. Sadly, the medical profession has become polarized over the treatment of patients who, like Ross Douthat, have persistent symptoms from the infection. In addition, the topic of managing chronic pain is divisive as well.

N of 1 Experiment:

Mr. Douthat offers his advice for other patients who are suffering from chronic pain or an undiagnosed disease. With the physician’s support, the best approach might be conduction one or several experiments to discover just what actually helps a given patient feel better. Such so-called N of 1 experiments give priority to the patient’s empirical experience.

Other Approaches to Managing Chronic Pain:

To get a different perspective on managing chronic pain, we turn to pain expert Dr. Sean Mackey. He specializes in treating patients who are suffering with persistent pain. Dr. Mackey describes a two-fold approach of alleviating the pain and uncovering the source. Given this information, the cause can be treated. Pain that has not been well controlled has a devastating impact on patients’ lives, even impacting their families and their other relationships.

According to Dr. Mackey, the best pain management utilizes individual plans tailored to each patient rather than trying to make patients fit the guidelines. Opioids can certainly be useful, but most people benefit from a range of strategies for managing chronic pain. These may include medications that were initially developed for purposes other than pain relief, procedures such as nerve blocks or implantable devices, pain psychology, physical rehabilitation, integrative approaches including acupuncture or nutraceuticals and self-empowerment. Non-drug approaches can be surprisingly helpful, especially if combined with medications when appropriate.

This Week’s Guests:

Ross Douthat joined The New York Times as an Opinion columnist in April 2009. His column appears every Tuesday and Sunday. Previously, he was a senior editor at The Atlantic and a blogger on its website.

Ross Douthat is the author of several books, his most recent being The Deep Places: A Memoir of Illness and Discovery. The photograph of Ross Douthat is copyright of Abigail Douthat.

Sean Mackey, M.D., Ph.D. is Redlich Professor and Chief of the Division of Pain Medicine at Stanford University Medical School. He is Director of the Stanford Systems Neuroscience and Pain Lab and past president of the American Academy of Pain Medicine.
His website is https://med.stanford.edu/profiles/sean-mackey

Listen to the Podcast:

The podcast of this program will be available Monday, Nov. 13, 2022, after broadcast on Nov. 11. You can stream the show from this site and download the podcast for free.

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This week on our nationally syndicated radio show, we consider how to maintain a healthy balance in our gut microbiome. Each of us carries a vast collection of microbes in our digestive tracts. Although we usually think first of bacteria, there’s also an enormous number of viruses that feed on the bacteria. Could these bacteriophages, as they are called, help with rebalancing our microbiome to a healthier state?

Rebalancing Our Microbiome:

In this conversation, we look at two different avenues of research about rebalancing our microbiome. Needless to say, when one or another type of bacteria starts to dominate in our intestinal ecosystem, the results can get ugly. Our guest expert, Dr. Eran Elinav, spent years tracking down a connection between intestinal imbalance and inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis.

After analyzing the microbiomes of healthy people as well as those suffering from inflammatory bowel disease, Dr. Elinav and his colleagues identified one particular bacterial strain, a form of Klebsiella pneumoniae, linked to digestive tract inflammation. Introducing this specific microbe, called Kp2, to healthy mice resulted in them developing gut inflammation. That’s very strong evidence for a connection. You can find the research report in Clinical Microbiology and Infection, Sept. 30, 2022.

What About Treating IBD?

Gastroenterologists have a number of drugs that can help calm the symptoms of inflammation in IBD. Until now, however, they have not had treatments to address the root cause. Dr. Elinav and the researchers working with him have identified five different bacteriophage viruses that can knock down numbers of Kp2.

Bacteria readily develop resistance to a single bacteriophage, but this multi-phage cocktail demonstrated efficacy in mice. Not only did it reduce intestinal symptoms, but it also reduced extra-intestinal inflammation. It seems very likely it accomplishes this by rebalancing our microbiome. The scientists are preparing to launch clinical trials to see if this works as well in humans as in mice. In the future, we may discover how phages could change the microbiome of travelers and use that information to prevent travelers’ diarrhea.

Could Sugar Substitutes Be Rebalancing Our Microbiome?

Dr. Elinav co-directs the Personalized Nutrition Project, and his laboratory has worked on determining how we react to certain foods. One of the most interesting discoveries involves the effects of non-sugar sweeteners on blood sugar control. Millions of people around the world drink diet beverages containing saccharin, sucralose, aspartame or stevia as a way to avoid excess sugar. For years, people have assumed that these non-nutritive sweeteners have no impact on blood sugar and that they might help people lose weight.

In a randomized controlled trial, 120 volunteers consumed saccharin, sucralose, aspartame, or stevia packets every day for two weeks. There was also a group of participants that consumed an equal amount of sugar and one group that consumed no additional sweetener. The investigators observed changes in the microbial balance of people getting each of the sugar substitutes. None of these changes were beneficial. In fact, both saccharin and sucralose interfered with proper blood sugar control. The results varied quite clearly between volunteers, however, with some people reacting very strongly and others hardly reacting at all.

To find out if these changes were due undesirable changes in the microbiome, the scientists administered gut bacteria from the volunteers to previously germ-free mice. The mice demonstrated the same reactions that the humans had. You may wish to read the report in Cell, Aug. 19, 2022.

The Take Home Message:

No one could or would argue that we should be consuming unlimited amounts of sugar. However, urges Dr. Elinav, let’s not replace sugar with these non-nutritive sweeteners. There is too much risk that they could alter the balance of our microbiome in some unanticipated ways. We have asked him how we can apply his findings in our own diet selections. He pointed to some machine learning (AI) apps that are being developed. However, although these will be convenient, they are also likely to be pricey. Instead, measuring our own blood sugar before and after test meals can give each of us valuable information. Of course, recording the results carefully is essential for analyzing our personalized nutritional needs. In fact, such practices may even help in rebalancing our microbiome in the future.

This Week’s Guest:

Eran Elinav, MD, PhD, is a professor of immunology and principal investigator at the Weizmann Institute of Science in Tel Aviv, Israel, where he co-directs the Personalized Nutrition Project. Dr. Elinav is also a principal investigator at the German Cancer Research Center in Heidelberg, Germany. His research focuses on understanding the complex interactions between humans and the bacteria that reside in their gut and how these interactions shape human health and disease. His labs at the Weizmann Institute and DKFZ focus on deciphering the molecular basis of host-microbiome interactions and their effects on health and disease, with a goal of personalizing medicine and nutrition.

Dr. Elinav’s website: http://www.weizmann. His book, co-authored with Dr. Eran Segal, is The Personalized Diet, The Pioneering Program to Lose Weight and Prevent Disease.

Listen to the Podcast:

The podcast of this program will be available Monday, Nov. 7, 2022, after broadcast on Nov. 5. You can stream the show from this site and download the podcast for free.

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In our nationally syndicated radio show this week we’ll be taking your questions live. We have invited two distinguished dermatologists to discuss problems affecting the hair and nails and tell you how to have healthy hair and nails.

Green Nail Syndrome:

For years, listeners have been calling in questions about nail fungus that makes toenails too thick to clip. We’ve also heard about a lot of home remedies for weird nails during that time. Some of them work, at least for some people, some of the time.

When the problem is caused by a fungal infection, prescription antifungal medicines can be helpful. But what about green nail syndrome? What causes this unusual coloration, and what can be done to treat the condition? (You can learn a lot more and see a picture in Dr. Heymann’s article here.)

We’ll discuss a range of problems that can affect toenails and fingernails. Be sure to share your questions about achieving healthy hair and nails so our guests can address them.

Thinning Hair:

People may fuss about frizz or color or style. But unquestionably the hair problem that bothers them most is hair loss. Back in 1988, the FDA approved topical minoxidil (Rogaine) to reduce hair thinning. First it was available by prescription (and was one of the first prescription drugs advertised on television). Later, the company took it over the counter.

Despite its wide availability, Rogaine has not satisfied everyone concerned about hair loss. Perhaps that is why the idea of low-dose oral minoxidil for hair loss has generated such excitement. Science writer Gina Kolata wrote about this off-label use in The New York Times (August 23, 2022). What are the pros and cons of using a pill instead of a lotion to try to ward off hair loss?

Male Pattern Baldness:

Many people trying to hang on to their hair are battling male pattern baldness. What other options do they have? How do finasteride (Propecia) and dutasteride (Avodart) work? Are any of these treatments appropriate for women, and what precautions are necessary?

Alopecia Areata:

One of the most devastating hair-related problems is alopecia areata. In this autoimmune condition, large areas of hair fall out, sometimes all over the body. Losing eyebrows and eyelashes can be just as distressing as losing clumps of scalp hair. What new treatments are available? How well do they work?

Join the Conversation About Healthy Hair and Nails:

We welcome your questions about green nail syndrome, spoon-shaped nails or nails that start to separate from the bed. Likewise, we’re interested in your questions about hair, especially various forms of hair loss. Send an email to radio@peoplespharmacy.com or post to our Facebook page. On Saturday morning (October 22, 2022), you can give us a call between 7:15 and 8:00 am EDT: 888-472-3366.

What nail problems have been bothering you? How have you tried to treat them?

Is your hairline receding? When would you turn to a pill instead of a topical medication?

Has a doctor told you that your nail or hair problem was due to a more serious health condition? Would you share that experience with our listeners?

This Week’s Guests:

Warren R. Heymann, MD, is the Head of the Division of Dermatology at Cooper Medical School of Rowan University, where he is Professor of Medicine and Pediatrics and Head of the Division of Dermatology. He is also Clinical Professor of Dermatology at the Perelman School of Medicine of the University of Pennsylvania, and serves as a Director of the American Board of Dermatology. Dr. Heymann is the editor of DermWorld Insights & Inquiries.
https://www.cooperhealth.org/doctors/warren-heymann-md

https://www.peoplespharmacy.com/articles/show-1181-how-to-keep-your-hair-from-falling-out

Dr. Chris Adigun, dermatologist, with People’s Pharmacy hosts Joe & Terry Graedon

Chris G. Adigun, MD, FAAD, is a board-certified dermatologist who practices both general dermatology and cosmetic dermatology at the Dermatology and Laser Center of Chapel Hill, NC. Dr. Adigun is devoted to increasing public awareness of skin cancer and the harmful effects of UV rays—both medical and cosmetic. She has an academic specialty in nail disorders.

Listen to the Podcast:

The podcast of this program will be available Monday, October 24, 2022, after broadcast on October 22. You can stream the show from this site and download the podcast for free.

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Examining the Basis of Neuroscience Dogma:

This week on our nationally syndicated radio show, our guests discuss the evidence supporting widely accepted ideas about Alzheimer disease and depression. Neuroscience dogma holds that Alzheimer disease results from the accumulation of beta-amyloid plaque in the brain. Moreover, nearly any psychiatrist, when asked, will tell you that SSRI antidepressants such as fluoxetine (Prozac) or sertraline (Zoloft) work by increasing the neurochemical serotonin available to neurons. How good is the evidence supporting these ideas?

Beta-Amyloid and Alzheimer Disease Dogma:

Alzheimer disease was first described early in the 20th century by neuroanatomist Alois Alzheimer. He noted confusion and memory problems along with paranoia, aggression and sleep disturbances in a 50-year-old patient. When she died five years later, Dr. Alzheimer conducted an autopsy and reported unusual plaques and neurofibrillary tangles in her brain. Others named this unfortunate condition “Alzheimer’s disease” (Dialogues in Clinical Neuroscience, March 2003).  By the end of the 20th century, researchers accepted the concept that the distinctive plaques, composed of beta-amyloid protein, are the cause of this common dementia. They devoted a tremendous amount of effort to unraveling the exact mechanisms, but so far the resulting drugs have not been entirely exciting.

One of the papers that has been very influential in shaping subsequent research was published in the prestigious journal Nature in 2006. Fifteen years later, another neuroscientist noticed something odd about the crucial images underpinning the scientific argument in this paper. How might this affect the beta-amyloid dogma of Alzheimer disease? Dr. Matthew Schrag describes what he found and what it might mean.

The Serotonin Theory of Depression:

We also examine the role of the serotonin theory of depression. For more than 60 years, neuroscientists have focused on this neurotransmitter as a potential cause of this psychiatric disorder (Current Pharmaceutical Design, 2016).  When fluoxetine, the first of a new class of antidepressants, was introduced in the late 1980s, it was as a selective serotonin reuptake inhibitor (Drugs, Dec. 1986).  Most psychiatrists would still tell you that is how fluoxetine and other SSRI drugs work to fight depression.

What data supports this dogma? A group of psychiatrists has examined relevant studies and concluded that the evidence is not there. Dr. Joanna Moncrieff describes their investigation.

Examining Dogma on Psychiatric Drugs:

Both Dr. Schrag and Dr. Moncrieff have created controversy by challenging existing dogma on the drugs used to treat these devastating conditions. Please note that neither is asserting that the relevant drugs do not work. Rather, they are asking questions about the underlying assumptions of how they work. Unquestioning acceptance of such dogma is not in the interests of science or medicine.

What Are the Consequences of Accepting Neuroscience Dogma?

In the case of Alzheimer disease, an almost exclusive research focus on beta-amyloid has not yet resulted in drugs that help patients function independently, maintain their cognitive capacity or stay out of institutional care. We don’t know whether a wider research net would have produced such treatments.

When it comes to the serotonin theory, Dr. Moncrieff and her colleagues have identified a number of drawbacks when patients believe that their depression is caused by a chemical imbalance in their brains. Most importantly, this belief leads them to take a pessimistic outlook on their depression and to doubt that they can learn to regulate their emotions themselves.

The dominance of this theory affects patients’ willingness to rely on antidepressant drugs. In particular, their beliefs affect the decision of whether to continue or stop taking them. Many people find it quite difficult to stop these medications. Consequently, patients deserve far more guidance in this process than most get.

This Week’s Guests:

Matthew Schrag MD, PhD, is Assistant Professor of Neurology at Vanderbilt University School of Medicine and Director of the Cerebral Amyloid Angiopathy Clinic. The Schrag Lab is focused on discovering shared molecular pathways between Alzheimer’s disease and cerebral amyloid angiopathy. His website is https://medschool.vanderbilt.edu/brain-institute/person/matthew-schrag-m-d-ph-d/

You can find the Science article describing his work on Western blot images here.

https://www.peoplespharmacy.com/articles/show-1318-challenging-dogma-about-alzheimer-disease-and-depression

Joanna Moncrieff, MD, University College London

Joanna Moncrieff, MD, is Professor of Critical and Social Psychiatry at University College London and works as a consultant in community psychiatry in London. She is one of the founders and the co-chairperson of the Critical Psychiatry Network. She has authored numerous papers and several books including The Myth of the Chemical Cure, The Bitterest Pills: The Troubling Story of Antipsychotic Drugs and A Straight-Talking Introduction to Psychiatric Drugs. Dr. Moncrieff’s article on the serotonin theory of depression is here. Her website is https://joannamoncrieff.com/about/

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 17, 2022, after broadcast on October 15. You can stream the show from this site and download the podcast for free.

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This week, we get in-depth information on Lp(a), the heart risk no one talks about. You have heard of cholesterol, and you may even know what your cholesterol level is. The compound lipoprotein a may be equally dangerous when it is elevated, but you have probably heard very little about it.

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 10, 2025.

What Is Lp(a)?

Lipoprotein a, or L-P-little a for short, circulates in the bloodstream, where it picks up and carries cholesterol and oxidized phospholipids. Scientists believe that blood levels are determined mostly by genetics and change very little over the course of our lives. Roughly 20 percent of people have high levels of Lp(a), above 30 ng/dL or 75 nmol/L. The two different figures are because tests use different units to measure the blood concentration, either nanograms per deciliter or nanomols per liter.

While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level?

Is Lp(a) the Heart Risk Doctors Can’t Treat?

Perhaps doctors have been reluctant to measure or discuss lipoprotein a because they don’t have good interventions. That is beginning to change with the development of antisense oligonucleotides, a new category of prescription drugs that can cut levels sharply. The FDA has not yet approved any of these new medications, though. The first of these, pelacarsen, is still in Phase 3 trials needed before the agency can consider the evidence. However, it can bring down lipoprotein a by an estimated 80 percent.

Cardiologists’ favorite drugs, statins, do not help Lp(a) levels. In fact, Lp(a) the heart risk rises when people are taking statins to lower their cholesterol. Other cholesterol-lowering drugs such as evolocumab (Repatha) and alirocumab (Praluent) can bring Lp(a) levels down modestly. One really old cholesterol-lowering drug, high-dose niacin, also helps moderate Lp(a). Some people do not tolerate it, however, as it can cause very uncomfortable flushing. So far as we know, no scientists have run studies to see whether niacin reduces the risk of heart attacks and other complications because of its effects on Lp(a).

Other Complications of Lp(a):

Our guest, Dr. Sam Tsimikas, is among the country’s leading experts on lipoprotein a. We asked him whether Lp(a) the heart risk factor causes other problems as well. Dr. Tsimikas described heart failure, potentially resulting from a heart attack, as well as peripheral artery disease (PAD), which can make it painful to walk. Lp(a) seems to cause plaque in arteries throughout the body. As a result, it can increase the chance of a stroke. In addition, it contributes to calcification of the heart valves. This condition interferes with their ability to function properly.

What Can We Do If Lp(a) Is Too High?

Dr. Tsimikas runs a unique clinic for cardiology patients with high levels of Lp(a). We asked him how he helps them. One approach is to collect additional information about their level of risk. A coronary calcium score can be a useful indicator. If it is high, he and his patients work to control all the potential risk factors that they can. He discusses the potential benefit of aspirin with them. Because Lp(a) the heart risk factor increases the chance of dangerous blood clots, the anti-clotting activity of aspirin can sometimes be helpful.

Offering dietary advice can be tricky if a patient has high cholesterol as well as elevated Lp(a), since the ideal diets for each are nearly opposite each other. A ketogenic diet tends to raise LDL cholesterol, for example, while it may modestly lower Lp(a). We think by the end of this episode, you’ll join us in hoping that scientists can learn a lot more about Lp(a) in the next few years.

This Week’s Guest:

Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, is Professor of Medicine/Cardiology and Director of Vascular Medicine at the Sulpizio Cardiovascular Center. That is part of the Division of Cardiovascular Medicine at the University of California, San Diego. His website is https://profiles.ucsd.edu/sotirios.tsimikas

Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, UCSD

Listen to the Podcast:

The podcast of this program will be available Monday, March 10, 2025, after broadcast on March 8. You can stream the show from this site and download the podcast for free. In addition to what you heard in the broadcast, the podcast includes additional information on calcium scores and the benefits and risks of statins to lower cholesterol.

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

This week, an exciting interview from our archive airs on Oct. 8, 2022. A healthy young medical student, David Fajgenbaum, had been a student athlete in college and maintained his extraordinary level of fitness through much of medical school. Because of his enthusiasm and athleticism, his friends called him The Beast. When he suddenly found himself deathly ill with an undiagnosed condition, it was a real shock.

Although it took a long time, eventually his doctors figured out what was wrong with him. It was an unusual variant of a rare disease called Castleman disease, a condition that affects the lymph nodes. This can cause fever, night sweats, debilitating fatigue, unexplained weight loss and a host of other symptoms.

After it nearly killed him, he started studying idiopathic multicentric Castleman disease to find out what was known about it. Needless to say, Dr. Fajgenbaum was dismayed to learn that very little is known about the disease. Worse yet, hardly any researchers were working on developing a cure.

Turning Hopes and Prayers into Action:

Dr. Fajgenbaum realized that if he wanted to be able to achieve his life goals (starting with living another week), he would need to jump into research himself. Unfortunately, the drug that the FDA had recently approved for Castleman disease did not benefit him for very long. This setback emphasized that was time to turn his hopes and prayers into action.

Dr. Fajgenbaum started the Castleman Disease Collaborative Network to bring researchers working on the condition into contact with each other. In addition, it helps them connect with physicians and patients who need the fruits of their research. He also began his own research program at the University of Pennsylvania.

Putting an Old Drug to a New Use:

Dr. Fajgenbaum realized that a 25-year-old anti-rejection drug called sirolimus might be able to activate appropriate pathways in his body to fight Castleman disease. Fortunately, that turned out to be true. Now he is preparing to run a clinical trial to see if sirolimus can help others with this rare disease. The drug is also known as rapamycin. Dr. Fajgenbaum wants to turn hopes and prayers into action.

Ultimately, he will not be the only one to benefit. So will many other patients who currently have nowhere else to turn.

This Week’s Guest:

David Fajgenbaum, MD, MBA, MSc, is a physician-scientist at the University of Pennsylvania, where he is one of the youngest individuals ever appointed to the faculty. Co-founder and executive director of the Castleman Disease Collaborative Network, Dr. Fajgenbaum is also a patient battling the same disease that he studies. He is alive thanks to a drug that he identified and began taking. Dr. Fajgenbaum has been profiled on Forbes “30 Under 30” list and a cover story by the New York Times, among others. He is the author of Chasing My Cure: A Doctor’s Race to Turn Hope Into Action. This fascinating book is now out in paperback.

Learn More:

You can visit https://chasingmycure.com/ for more information. Dr. Fajgenbaum recently spoke to the Clinton Global Initiative. Here is a link to the YouTube: https://www.youtube.com/watch?v=3FzWOd6l15I

You may also wish to review these recent stories on his Every Cure initiative (www.everycure.org):

https://www.usatoday.com/story/news/health/2022/09/18/clinton-initiative-every-cure-generic-drugs-rare-diseases/10359380002/

https://abc7ny.com/amp/every-cure-rare-disease-nonprofit-clinton/12240968/

The photograph of Dr. Fajgenbaum is by Rebecca McAlpin.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. You can stream the show online from this site and download the podcast for free.

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This week on our nationally syndicated radio show, we speak with scientists studying the potential of psychedelic compounds to help heal mental illness. Recreational use of drugs like LSD during the 1960s gave these compounds a bad reputation. As a result, funding disappeared, and research withered. Over the last decade or so, however, investigators have been examining possible uses of these compounds. Many feel they could revolutionize the treatment of some mental illnesses.

The History of Psychedelic Compounds:

Healers around the world have been using plants and fungi with psychoactive properties for millennia. Shamans utilized psilocybin-containing species of mushroom for their rituals. In South America, healers were combining plants to produce ayahuasca for healing. Throughout the Americas (and in some other parts of the world), colonizers worked hard to suppress the use of psychedelics. The first scientific research that we know of was Heffter’s work on peyote cactus in which he identified mescaline. He completed that in the late 19th century.

Current Research on Psychedelic Drugs:

So far, studies on psilocybin and other psychedelic compounds have been focused more on safety and dose-finding. Scientists are starting to determine efficacy, but the work is preliminary and more suggestive than definitive. We don’t yet know whether the hallucinations these compounds produce are intrinsic to their healing properties. Psilocybin appears to have a remarkable effect on depression, offering rapid enduring recovery with just one or two therapeutic sessions including drug administration in a special setting. Although investigators have not identified serious side effects yet, they warn that people with a personal or family history of schizophrenia should avoid psychedelic drugs. They worry that the compounds might trigger psychotic reactions for such individuals.

Conditions That May Respond to Psychedelic Compounds: Cluster Headaches:

People who suffer from cluster headaches are desperate for relief. They have begun to offer each other online support (Clusterbusters)  for using psychedelic drugs to treat this horrendous pain. A phase 2 trial of microdosed psilocybin is underway at Yale.

Substance Use Disorders:

Giving up smoking or excessive drinking can be extremely difficult. However, researchers report that people treated with consciousness-altering compounds are often able to overcome their reliance on nicotine or alcohol. In the course of a psychedelic therapeutic experience, people seem to learn how to approach the problem.

Depression and Distress:

The best evidence on the effectiveness of psychedelic drugs relates to the distress that many cancer patients feel. In at least three randomized controlled trials, the therapeutic experience associated with psychedelics was able to radically alter those feelings. Some psychiatrists are also optimistic about their potential for treating major depressive disorder, possibly with fewer side effects than current antidepressants. They also hope to be able to treat post-traumatic stress disorder far more effectively. Healing appears to be taking place at the intersection of the psychological and pharmacological levels. It is surprisingly long-lasting.

The Nature of Consciousness:

We think of these compounds as mind-altering drugs. Studies suggest that they also change participants’ view of consciousness. When people experienced timelessness and sacredness as part of the psychedelic experience, their beliefs about consciousness shifted. They were far more likely to attribute consciousness to non-human beings or even inanimate objects. What implications does this have for human behavior?

This Week’s Guests:

Bryan Roth, MD, PhD, is the Michael Hooker Distinguished Professor of Pharmacology at the University of North Carolina School of Medicine. He is also director of the NIMH Psychoactive Drug Screening Program at the UNC Eshelman School of Pharmacy. https://www.med.unc.edu/pharm/directory/bryan-roth-md-phd/

Dr. Roth is a Fellow of the American Academy of Arts and Sciences, a member of the National Academy of Medicine of the National Academy of Sciences and a member of the Lineberger Comprehensive Cancer Center. The photograph is of Dr. Roth.

Matthew W. Johnson, PhD, is Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. He is the Susan Hill Ward Professor in Psychedelics and Consciousness. https://www.hopkinsmedicine.org/profiles/details/matthew-johnson

Sandeep Nayak, MD, is Assistant Professor at the Johns Hopkins Center for Psychedelics and Consciousness Research. Dr. Nayak’s research is primarily focused on investigating psychedelics as treatments for psychiatric conditions, particularly substance use disorders and mood disorders. https://hopkinspsychedelic.org/nayak

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 3, 2022, after broadcast on October 1. You can stream the show from this site and download the podcast for free. The podcast contains additional information from our interview with Dr. Johnson as well as the interview with Dr. Nayak.

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This week on our nationally syndicated public radio show, we invite gastroenterologist Nicholas Shaheen into our studio to answer your questions about protecting your digestive tract. He is a nationally recognized expert in esophageal diseases and has helped write numerous treatment guidelines for gastrointestinal illnesses.

Detecting Digestive Tract Tumors:

Two of the most common cancers that affect Americans are colorectal cancer and esophageal cancer. Colorectal cancer, for example, is the third most common cancer diagnosis in the US. Approximately 4 percent of us will develop it at some point during our lifetimes. However, the death rate from this type of cancer has been declining, in part because screening via colonoscopy has been so effective. During this procedure, polyps that could become troublesome are found and removed.

Colorectal Cancer:

The only difficulty with colonoscopies is that they are unpopular. Preparation for the procedure requires cleaning the colon so that the doctor performing the procedure can see the walls clearly. Now there are new approaches that make it easier to prepare for a colonoscopy. In addition, there are other technologies such as FIT (fecal immunochemical test) that some people could use for cancer screening. How do they compare?

Esophageal Cancer:

At the other end of the digestive tract, esophageal cancer is far less common, but doctors have more trouble detecting it. Because it is relatively rare, most people don’t need to be screened for esophageal cancer. On the other hand, people with Barrett’s esophagus are at higher risk for this tumor. New technology has made it much easier for gastroenterologists to screen for esophageal cancer. They can also treat Barrett’s esophagus so that it doesn’t progress to cause problems.

New Ways to Treat Barrett’s Esophagus:

Dr. Shaheen has pioneered a number of ways to treat Barrett’s esophagus so that it is far less likely to develop into esophageal cancer. He will describe the research on radiofrequency ablation as well as the much newer cryoballoon ablation. This latest technique uses targeted cold to reverse the precancerous nature of the cells lining the esophagus (American Journal of Gastroenterology, Nov. 2020). When is this approach most helpful for protecting your digestive tract?

Are there ways to detect Barrett’s esophagus without endoscopy? The answer is yes. Gastroenterologists have identified DNA methylation markers. These can be retrieved from a small balloon swallowed by a potential patient (Science Translational Medicine, Jan. 17, 2018).  In most case, patients prefer this approach over endoscopy (Digestive Diseases and Sciences, Jan. 2022).

Here is a picture of this new balloon technology, with the balloon expanded:

How Can You Overcome Heartburn?

One way of protecting your digestive tract is to reduce your experience of heartburn. Usually, this discomfort is caused by stomach acid splashing up into the esophagus where it can harm delicate tissue. While occasional heartburn is probably not dangerous, it is unpleasant. And frequent heartburn, also called reflux, may trigger Barrett’s esophagus. Are there ways to reduce your chance of heartburn? If you have been relying on a proton-pump inhibitor (PPI) such as omeprazole or esomeprazole for months, are there ways to discontinue the drug with minimal suffering?

What Are Your Concerns About Protecting Your Digestive Tract?

Having Dr. Shaheen in the studio during the show offers a unique opportunity for you to ask the questions that have been troubling you. Add your comment below or send us your question through email: radio@PeoplesPharmacy.com. You can also contact us through Facebook or Twitter. We’ll try to get to as many of your questions as we can. Between 7 and 8 am EDT on Sept. 24, 2022, you can call 888-472-3366 with your questions.

This Week’s Guest:

Nicholas J. Shaheen, MD, MPH, is the Bozymski-Heizer Distinguished Professor of Medicine at the University of North Carolina School of Medicine, and Chief of the Division of Gastroenterology and Hepatology at UNC. He also holds a position in the Department of Epidemiology at the Gillings School of Global Public Health of UNC. Dr. Shaheen is a recognized expert in esophageal diseases and endoscopy. He is author of multiple treatment guidelines for gastrointestinal illnesses.

Listen to the Podcast:

The podcast of this program will be available Monday, Sept. 26, 2022, after broadcast on September 24. You can stream the show from this site and download the podcast for free. The mp3 link is always found at the bottom of this page on Monday morning.

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This week on our nationally syndicated radio show, we talk with Pulitzer Prize-winning journalist Matt Richtel. His latest series for The New York Times takes a long look at the mental health crisis affecting American teenagers. This is not a tale of COVID disruption, although COVID has made it worse. This is a story of a generation, starting around age 10 and continuing through college graduation at least a decade older.

Changing Public Health Risks:

Matt Richtel points out that the public health risks for adolescents in the US were predictable until a few decades ago. Health authorities worried about teen pregnancy, alcohol misuse and potentially dangerous experiments with marijuana and other drugs.

The risk landscape has shifted dramatically in the 21st century. Fewer teens than ever report having drunk alcohol or smoked marijuana lately. Even rates of teen pregnancy have fallen. But our adolescents are struggling terribly with depression and anxiety. Some have turned to self-harm or find themselves obsessing about suicide. Suicide rates are also up dramatically.

How Do We Know There Is a Mental Health Crisis?

Matt spent a year interviewing adolescents and their families. Teenagers told him about cutting themselves in seeking to relieve their distress. Parents shared their frustration of not knowing how to help their youngsters effectively. He found that pediatricians’ offices have been overwhelmed with young people in crisis. Moreover, he learned that hundreds of suicidal teens sleep in emergency rooms for days or weeks on end because they cannot be discharged safely. At a time when we need facilities to treat mental illness more urgently than ever, a large number of these institutions have closed their doors.

The Latest Data on Mental Health in Adolescents:

After we talked with Matt early this summer, two new studies came out corroborating his findings. Over the last couple of decades, depression has been increasing. The pandemic appears to have made this trend worse. A national survey in carried out in 2020 finds that nearly 1 in 10 adults and almost 1 in 5 adolescents and young adults report experiencing major depression (American Journal of Preventive Medicine, Sept. 19, 2022). Most of these young people went untreated. either with therapy or medications.

Another report titled “The Kids Are Not Alright” also found a high rate of mental health problems among adolescents. Inpatient admission for mental health problems in youngsters between 12 and 15 rose more than 80 percent in the five years from 2016 to 2021. Experts express concern that the need for mental health services is increasing far more rapidly than it can be met (Clarify Health Institute, Sept. 2022).

What Is Driving the Mental Health Crisis?

We asked Matt what might be driving the crisis. One contributor to the problems we are seeing is that kids are entering puberty at younger and younger ages. No one knows quite why that is. Nutrition may be playing a role. Exposure to certain environmental chemicals might also be encouraging early puberty. But although the body and the reproductive system appears to be maturing more quickly, the brain has not kept up. Figuring out how you fit in to society is just as important as ever, if not more so, but it’s more difficult with a disjunction between body and mind. In addition, the big changes in society over the last several decades also make it more challenging for young people to get a clear picture of their possible path.

Is digital technology to blame? The science is not clear. What seems most likely is that, like the pandemic, social media and online offerings may exacerbate an existing problem. When they spend a lot of time online, kids are sleeping less and having less in-person interaction. They spend less time outdoors, which otherwise could be a good safety valve to help manage stress and anxiety.

The Story of M:

Matt interviewed a Milwaukee teenager he calls M, a person who prefers to be referred to as “they” or “them.” Although M is an intelligent person who did well in grade school, high school led to severe anxiety about school as well as social isolation. The consequences were severe depression, self-harm and a suicide attempt. M’s parents were at their wits’ end, frightened and frustrated because they did not know how to help their child.

What Can We Do for Adolescents’ Mental Health?

Youngsters in the midst of a mental health crisis need coping skills. Learning ways to cope is probably going to be easier when a person is not in crisis mode, so it makes sense to figure out how to teach all young people the coping skills they need. We also need to create ways for youngsters to access therapies that work, such as CBT (cognitive behavioral therapy) or DBT (dialectical behavioral therapy). Currently, there are not enough therapists trained in these modalities to treat everyone who could benefit. We’ll need to put our creativity to work figuring out how to change that.

This Week’s Guest:

Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter for The New York Times. He is the author of several books, including his most recent, Inspired: Understanding Creativity: A Journey Through Art, Science, and the Soul.

His Amazon page is here and his website is here:
https://www.mattrichtel.com/

Here are some of the articles in his series:

‘It’s Life or Death’: The Mental Health Crisis Among U.S. Teens

Teens in Distress Are Swamping Pediatricians

On the Phone, Alone 

Hundreds of Suicidal Teens Sleep in Emergency Rooms. Every Night.

How to Help Teens Struggling With Mental Health 

Listen to the Podcast:

The podcast of this program will be available Monday, June 6, 2022, after broadcast on June 4. 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 talk with one of the world’s leading experts on indoor air quality. If we had been paying more attention to air when the COVID-19 pandemic began, we might have saved millions of lives. Improving air quality is still critical to our health. Not only is SARS-CoV-2, the virus that causes COVID-19, still an airborne disease, but so are influenza and numerous other viruses.

Better Air Quality Through Ventilation and Filtration:

Dr. Richard Corsi has spent much of his illustrious career studying ways to improve indoor air quality. Two of the most important factors are ventilation and filtration. (Removing the source of the problem is also key. He reminded us that reducing COVID-19 transmission in public indoor spaces starts with people staying home when they are sick.)

How many homes, schools and offices have upgraded their air handling systems during the pandemic? Some have, but for many the logistics or the expense proved daunting. HEPA (high-efficiency particulate arresting) filters can make a difference, but the cost of $300 to $500 for one that can clean a room’s air might be an obstacle.

The Corsi-Rosenthal Box:

As Dr. Corsi considered ways to provide an affordable approach to better indoor air, he envisioned a way of moving a lot of air through inexpensive filters. When he described his concept of a box fan pulling air through a cube with filters on four sides, Jim Rosenthal (CEO of Tex-Air Filters) assembled one to do some tests. The resulting Corsi-Rosenthal box is effective and affordable, running between $60 and $150, depending upon the price of the materials.

Here is a picture of the Corsi-Rosenthal box:

https://www.peoplespharmacy.com/articles/show-1314-better-air-quality-through-ventilation-and-filtration

Corsi-Rosenthal box

Here is a link to a YouTube video with Dr. Corsi demonstrating how to make one.

In addition to removing dust and virus particles from the air, a Corsi-Rosenthal box made, as recommended, with MERV 13 filters can also help remove particles of smoke from wildfires. One box can help to improve the air quality in an average size classroom, offering the equivalent of 7 to 8 air changes an hour.

Other Approaches to Better Air Quality:

You might not need a Corsi-Rosenthal box at home if you are already using high-MERV filters (11 or 13) in your HVAC system. Some systems have HEPA filters built into them. As long as the filters are changed regularly and the fan is running to circulate the air, your system might be good enough, at least most of the time. If you have company, you might want to set up a C-R box shortly before they arrive and run it throughout the visit.

Ultraviolet light can kill viruses. If an ultraviolet light system is set up thoughtfully, in the upper part of a well-ventilated room, possibly above a dropped ceiling, it can help reduce the potential for disease transmission. However, the ultraviolet source must be shielded so that it does not damage people’s skin or eyes. This solution is more likely to be practical in public spaces such as restaurants.

Other concerns for indoor air include gas stoves. These can generate lots of very small particles as well as carbon monoxide. Luckily, most homes have an exhaust fan. Use it every time you turn your stove on to reduce the indoor air pollution it may cause.

Latex paint, carpet fibers, cleaning chemicals and air fresheners can all release volatile organic compounds (VOCs) that can damage the lungs over time. Good ventilation and filtration is essential to avoid these.

Avoiding COVID-19:

Dr. Corsi reminded us that we have the tools available to drastically reduce transmission of COVID-19. First, of course, is vaccination. In addition, we should use tests to determine if we have COVID and isolate ourselves if we are ill. Wearing a good-fitting N95 mask whenever we are with people outside our household can make a big difference. So can being smart about how we use public spaces.

This Week’s Guest:

Richard Corsi, PhD, is Dean of the College of Engineering of the University of California, Davis. Prior to his current position, Dr. Corsi spent most of his career as a faculty member, department chair, and endowed research chair at the University of Texas at Austin in the Department of Civil, Architectural and Environmental Engineering.

Dr. Corsi is an internationally recognized expert in the field of indoor air quality, with a specific interest in physical and chemical interactions between pollutants and indoor materials. His concept for a low-cost, accessible, and effective air cleaner, the Corsi-Rosenthal box, is now being used as an open-source do-it-yourself approach world-wide for reducing exposure to the SARS-CoV-2 virus, wildfire smoke, and more. Dr. Corsi was inducted into the International Society of Indoor Air Quality and Climate’s Academy of Fellows in 2008 and is immediate past president of the Academy. This website has more information:
https://engineering.ucdavis.edu/directory/richard-corsi

Listen to the Podcast:

The podcast of this program will be available Monday, Sept. 12, 2022, after broadcast on September 10. You can stream the show from this site and download the podcast for free.

Cassandra Quave is an explorer and an ethnobotanist uncovering potential ways that plants can benefit human health. She has a particular interest in multi-antibiotic resistant infections. Not only do these pose a grave risk for people around the world; her professional interest is also personal. When she was three years old, she suffered a post-surgical infection that very nearly took her life. As she grew older, she learned about both medicine and anthropology. A research trip to Peru started her lifelong quest for nature’s next medicines from plants.

The Quest for Nature’s Next Medicines:

Science does not happen only in laboratories. Moreover, knowledge is not limited to scientists. Indigenous people around the world have developed detailed plant-based pharmacopeias. This could be essential to those in the industrialized world, since superbugs threaten to overwhelm us. We need a paradigm shift away from ever stronger antibiotics. As the microbes are developing resistance at a terrifying pace, our economic model for antibiotic development is foundering.

Plants may offer part of the solution. We know of approximately 374,000 species. Of these, about 33,000 are used by humans for their healing power. Even those with no antimicrobial properties may help fight infections. In particular, plants that disrupt biofilm formation, such as the Brazilian pepper tree, can be useful in this regard.

The Power of Ethnobotany:

The history of utilizing plants as medicine is rich and deep. In fact, some of the most important drugs we use on a regular basis were initially derived from plants. For example, artemisinin and quinine compounds are prescribed for malaria. It would be difficult to treat pain adequately without aspirin or opioids, also from plants. Digoxin is an old-fashioned medication from foxglove (digitalis) that helps to combat heart failure. Paclitaxel, on the other hand, is a relative newcomer for fighting a range of cancers. However, it too is a plant derivative.

The quest for nature’s next medicines has taken Dr. Quave around the world. The work is urgent, as biodiversity shrinks. In addition, traditional knowledge is dynamic. As the speakers of indigenous languages die out, their ecological understanding and plant-oriented wisdom is dying with them. It is crucial to learn how to benefit from their knowledge without taking unfair advantage of them. That is a critical part of Dr. Quave’s quest for nature’s next medicines. She also shares some of the cool discoveries that she and her colleagues and students have made in her lab.

This Week’s Guest:

Cassandra Quave, PhD, is the herbarium curator and an associate professor of dermatology in the School of Medicine as well as associated professor in the Center for the Study of Human Health in the College of Arts and Sciences at Emory University. There, she leads anti-infective drug discovery research initiatives and teaches courses on medicinal plants, food, and health. Dr. Quave is the author of The Plant Hunter: A Scientist’s Quest for Nature’s Next Medicines. The photograph is copyright Kemi Griffin.

Listen to the Podcast:

The podcast of this program will be available Monday, September 5, 2022, after broadcast on Sept. 3. 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 learn where the most germs are lurking in our homes and workplaces. Public toilets often make people nervous, but in fact, says Dr. Chuck Gerba, cafeterias and break rooms are much more likely to harbor dangerous pathogens. What will help us in avoiding germs? Hint–keep on washing your hands! 80 percent of infections are transmitted hand-to-mouth.

The Bottom Line on Bathrooms:

The reason we might be concerned about public restrooms is the aerosol plume created when a toilet flushes. That problem is especially serious when the toilet lacks a lid to lower, as most public toilets do. Powerful water pressure can lead to greater aerosol dispersion, and each tiny droplet of water may be carrying invisible pathogens. As a result, surfaces like seats and counters may become contaminated.

Dr. Gerba has a couple of specific, and possibly surprising, recommendations. If you have a choice, avoid the middle stalls. Those are the ones more people use. When it comes to drying your hands, paper towels are better than air dryers. Again, that’s if you have the choice. Powerful air dryers blow droplets of water all over the bathroom.

Newer restrooms have made strides in reducing the number of surfaces people have to touch. Toilets may flush automatically, and taps may turn on when you wave your hands in front of them. During the pandemic, we all learned to wash our hands for 20 seconds, front, back and in between the fingers. But if somebody skipped that step, you might still not be avoiding germs when you use the door handle to exit. That’s why Dr. Gerba recommends that the last step, after you’re out of the room, be dousing your hands with sanitizer.

Sewage Surveillance:

Many microbes, including the viruses that cause polio or COVID-19, pass through the body into our waste. That’s why the public health practice of wastewater surveillance can be so useful. Dr. Gerba helped develop its use on the University of Arizona campus. Tracking pathogens in wastewater allows scientists to detect infections 4 to 10 days earlier than if they wait for someone to show symptoms.

Avoiding Germs Beyond the Bathroom:

Public (and private) bathrooms are not the only sources of microbial contamination. When Dr. Gerba analyzes workplaces, he finds one infected person can spread a lot of germs around quickly. The most contaminated spot, though, is the break room. People don’t necessarily think of sanitizing break room tables frequently, but a lot of people touch them. High-touch surfaces are great ways to transmit microbes.

In the same vein, the cafeteria is among the most contaminated spots in the hospital. Certainly, patient rooms can easily become covered in bacteria or viruses. However, in the cafeteria, people from all over come together, bringing their own private collections of microbes. All the surfaces they touch, including the tables, may pick up these hitchhikers that mingle with microbes from other people. Avoiding germs requires washing hands before and after a visit to the hospital cafeteria.

In general, washing before eating is a principle your mother or grandmother probably promoted. Pay attention! Better sanitation and greater care with handwashing helped cut down on colds and flu during the pandemic as well as COVID-19.

What About Sexually Transmitted Infections?

One durable myth that makes many people leery of public restrooms is that you could catch a sexually transmitted infection from a toilet seat. To find out if that is true, we spoke with Dr. Ina Park, a specialist in STIs. The short and reassuring answer is: you can’t catch an STI by sitting on a toilet seat. If you have a skin rash or broken skin on your bottom, you might want to protect yourself and others from a possible MRSA infection by using a disposable seat cover. That is one way of avoiding germs. Otherwise, the hazards of STIs lie elsewhere.

Dr. Park discusses a range of other sexually transmitted infections. Monkeypox is not technically an STI, but people can catch this virus through close personal contact. Dr. Park explains the risks in thoughtful detail. She also reviews important safe sex principles now that we are seeing a rise in STIs as fears about catching COVID seem to be receding.

This Week’s Guests:

Charles P. Gerba is a professor of virology in the Dept of Environmental Science. He has authored over 500 journal articles, books and has been featured on numerous television programs and magazines. Dr. Gerba has an international reputation for his methodologies for pathogen detection in water and food, pathogen occurrence in households, and risk assessment. Dr. Gerba is the author of The Germ Freak’s Guide to Outwitting Colds and Flu: Guerilla Tactics to Keep Yourself Healthy at Home, at Work and in the World.

Ina Park MD, MS, is an Associate Professor in the Department of Family and Community Medicine at the University of California San Francisco School of Medicine. Her website is https://www.inapark.net

Dr. Park is the author of Strange Bedfellows: Adventures in the Science, History,and Surprising Secrets of STDs.

Listen to the Podcast:

The podcast of this program will be available Tuesday, August 30, 2022, after broadcast on August 27. You can stream the show from this site and download the podcast for free. In this week’s podcast, Dr. Gerba reveals the most contaminated item in a hotel room. What could it be?

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Modern medicine looks back on many old treatments with a great deal of disdain. A classic example is the lobotomy. In the mid-twentieth century, lobotomy was employed to treat serious mental illness. One of the earliest developers of this procedure, Dr. Egas Moniz, received the Nobel Prize in 1949 for this approach to treating depression, agitation and schizophrenia. Some psychiatrists used an ice pick-like device inserted through the orbit of the eye to sever connections in the prefrontal cortex of the brain. Today, psychiatrists remember that time with dismay and point to evidence-based medicine with pride.

There are lots of other old-fashioned treatments that have fallen into disrepute. They include tobacco smoke enemas. European physicians were literally blowing smoke up someone’s bottom to treat headaches, colds, digestive distress and drowsiness. I am guessing that getting smoke blown up your butt might wake you up pretty fast. Other long-forgotten treatments included mercury, arsenic and strychnine–all poisons.

Evidence-Based Medicine Takes Center Stage:

The term “evidence-based medicine” was coined by the Canadian physician, Dr. Gordon Guyatt in 1990.

Not long after, Dr. David Sackett and colleagues defined evidence-based medicine (EBM) (BMJ, Jan 13, 1996) as:

“…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

Is Modern Medicine Based On Solid Evidence?

Most 21st century physicians believe they are practicing evidence-based medicine. Medical students have learned this mantra for decades: trust only evidence-based medicine. The goal is to use medical treatments that have been proven through solid research.

How well do drugs and procedures actually work? It will come as a great surprise to healthcare professionals to learn that:

“Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence.”

That is the title of an article in the Journal of Clinical Epidemiology (April 18, 2022).

The authors analyzed more than 2,400 Cochrane Reviews published between 2008 and 2021. These are undertaken as unbiased, independent evaluations of medical treatments. Usually the highly qualified volunteers who conduct the reviews survey the medical literature and do a systematic review and/or meta-analysis of the data from randomized controlled trials.

According to the rules for Cochrane reviews, the evaluators must rate the quality of the studies objectively. This should yield the highest level of evidence to support or refute a medical therapy.

Is Evidence-Based Medicine a Misnomer?

This recent study drops a bombshell.

Of the 1,567 interventions studied:

“…only 5.6 percent were supported by high quality evidence.”

Moreover, potential harms from various treatments “were measured more rarely than benefits.”

The authors conclude that:

“More than 9 in 10 healthcare interventions studied within recent Cochrane Reviews are not supported by high-quality evidence, and harms are under-reported.

“The problem with unreliable, low-quality evidence is greater than was previously believed.”

Why Should You Care About Evidence?

Why does this matter? If doctors and patients intend to make informed decisions about surgery or medications, they need trustworthy evidence about both benefits and harms. Before you take any medication you should know how well it works.

Specifically, what are your chances of getting benefit–1 out of 10, 1 out of 50 or 1 out of 100? Most people might think twice if they learned that their likelihood of having a positive outcome would only be 1% of the time.

The authors add that:

“…there is not good evidence regarding the benefits or harms of most currently used interventions…more than 9 in 10 healthcare interventions studied within Cochrane Reviews do not have high-quality evidence to support their effectiveness and safety.”

Antibiotics Before Dental Work:

One example involves whether people should take antibiotics before “invasive dental procedures.” Many dentists routinely prescribe such drugs hoping to prevent bacterial infections of the heart. That is an admirable goal. How well do the antibiotics work?

Cochrane reviewers conclude (Cochrane Database of Systematic Reviews, May 10, 2022):

“It is unclear whether taking antibiotics as a preventive measure before undergoing invasive dental procedures is effective or ineffective against bacterial endocarditis in people at increased risk.”

What’s more, they couldn’t tell whether the possible risks of taking antibiotics outweigh the benefits. Overall, they said, they had very little confidence in the evidence that they reviewed.

Antidepressants vs. Pain:

Another analysis asked whether SSRI-type antidepressants can ease the pain of fibromyalgia (Cochrane Database of Systematic Reviews, June 5, 2015). People with this condition suffer chronic pain, brain fog, fatigue and insomnia. Doctors prescribe drugs such as duloxetine (Cymbalta), fluoxetine (Prozac) and sertraline (Zoloft) in an attempt to ease the distress.

The authors conclude that:

“There is no unbiased evidence that SSRIs are superior to placebo in treating the key symptoms of fibromyalgia, namely pain, fatigue and sleep problems.”

It is discouraging that the evidence to support an FDA-approved indication is flimsy. Even more disappointing is the discovery that so many other trusted treatments lack high-quality evidence of effectiveness.

Please Listen to a Thoughtful Podcast About Evidence-Based Medicine:

In our nationally syndicated public radio show, we consider the strengths and shortcomings of evidence-based medicine. Compared to the alternatives–basing medical care on opinion or tradition–evidence-based medicine sounds like a great idea. As currently practiced, however, it falls far short of its potential.

What Is Evidence-Based Medicine?

Philosopher and bioethicist Leemon McHenry describes the ideal of evidence-based medicine. Randomized controlled trials are the gold standard of evidence-based drug research. However, they don’t always tell us what we want to know.

Sometimes that is because researchers design them specifically to help the drugs being tested show up at their best, downplaying side effects. Unfortunately, that benefits the drug company that pays for the trial, but it doesn’t forward the cause of public health.

Where Is the FDA?

Many people assume that the FDA is busy testing medications to see whether they are safe and effective. In actuality, the FDA reviews data from the trial sponsor.

As a result, medication manufacturers exercise a great deal of control over what the FDA knows. Needless to say, that also has a major impact on the data available for doctors and patients as well.

What Is the Illusion?

When it comes to drugs, too often marketing masquerades as research. One example is a common practice in which a drug company employee prepares most of the report on a drug trial, and the academic who is its official author gives it a minor tweak or two.

Dr. McHenry describes the efforts that pharmaceutical manufacturers expended in disguising suicidal thoughts and behaviors associated with antidepressants by calling them “emotional lability.” That sounds a lot less threatening, and it took the FDA quite a while to require black box warnings regarding suicide on SSRI and SNRI antidepressants.

Sue the Manufacturers?

Quite a bit of Dr. McHenry’s information comes from his work with a law firm. In the course of a lawsuit, drug companies may have to reveal information that they would otherwise keep secret.

Why doesn’t the threat of litigation discourage misleading behaviors? Essentially, says McHenry, the manufacturers calculate even the expense of a large lawsuit as part of the cost of doing business.

Can We Restore Evidence-Based Medicine?

Evidence-based medicine is a good idea. How can we restore the practices behind it so we can all trust the evidence it produces?

Dr. McHenry has a few suggestions.

1. Don’t let the firms test their own drugs. Testing should be conducted by an independent, objective entity, separate from the manufacturer and from the FDA.
2. Cultivate independent funding for drug research. When pharmaceutical firms no longer sponsor the lion’s share of investigations, the public will have much better access to the evidence.
3. Make unpublished and abandoned trials available for analysis. That reduces the “cherry-picking” effect.
4. When firms are found in violation of the law, currently they pay fines. Instead, or in addition, the executives responsible for the company during that violation should face imprisonment. Very few companies or boards of directors would consider that a simple cost of doing business.

The Guest:

Leemon McHenry, PhD, is a bioethicist and Emeritus Professor of Philosophy at California State University, Northridge. He is the author, with Dr. Jon Jureidini, of The Illusion of Evidence-Based Medicine: Exposing the crisis of credibility in clinical research.

Disclosure: Dr. McHenry is a research consultant for the Los Angeles law firm, Baum, Hedlund, Aristei & Goldman. It is through the law firm that he became aware of the problems with evidence-based medicine and worked with Dr. Jureidini.

Listen to the Podcast:

The podcast of this program became available Monday, May 2, 2022, after broadcast on April 30. You can stream the show from this site by clicking on the arrow inside the green circle under the photo of the shushing doctor at this link.

You can also download the podcast for free:

Download the mp3

You may even want to share it with your friends and family. We suspect that many people do not appreciate how inadequate the evidence is for many of the medicines they are taking. You can send them a link to this article by scrolling to the top of the page and clicking on the icons for email, Facebook or Twitter. You may also want to encourage them to subscribe to our free newsletter by clicking on this link.

Thank you for supporting our work. Google continues to make it very hard for people to find our independent voices amidst all the Pharma advertising at the front of every drug search. Our articles about adverse drug reactions have disappeared almost without a trace.

This week on our nationally syndicated radio show, we explore the impacts of negative attitudes toward aging and how to fight back against ageism. In the US, many people hold negative stereotypes about growing older. These beliefs can affect our health as we age.

Why Are Negative Stereotypes About Aging So Destructive?

Psychiatrist Robert Butler coined the term “ageism” in 1969. Officials had proposed transforming an apartment building in a  Washington, DC, suburb into senior housing. Sadly, other residents were protesting. Their negative attitudes reminded him of racism or sexism and were equally ill-founded. He described ageism as a “process of systematic stereotyping or discrimination against people because they are old.”

Even if we acknowledge that demeaning stereotypes of older people as clueless and incapable are inaccurate, does that make any difference? According to researcher Becca Levy, it does. People exposed to negative concepts about growing older tend to lose confidence in their own abilities, possibly restricting their activities. In fact, data from the Baltimore Longitudinal Study of Aging, show that people with negative age beliefs are more likely to develop the neurological plaques and tangles associated with Alzheimer disease.

Those who harbor positive ideas about aging as a time when they have better understanding and can more readily embrace their passions recover more quickly from injury. In Dr. Levy’s study, people who view aging as a time for growth lived an average of 7.5 years longer (in better health) than individuals who look upon aging with fear.

How Can We Fight Back Against Ageism?

According to Dr. Levy, we can chalk ageism up to “lizard brains and corporate greed.” (Now, you’ll really need to listen to the interview to find out what she means.)

Here’s a hint, though. It’s linked to one of our pet peeves: drug ads on TV. The idea that a pill will make you just like the happy people in the ads–beautiful and vivacious, enjoying life–is certainly appealing. (Just don’t listen to the list of side effects read quickly while people on the screen are having a wonderful time.) Such ads may be cleverly constructed to imply that without whichever pill the ad is selling, the viewer will be relegated to the dust bin of age.

We don’t have to put up with doctors treating older patients as unable to understand the details of diagnosis and treatment. While many of us would appreciate information that we can consult again later, that isn’t limited to people over 50. As Maggie Kuhn, the founder of the Gray Panthers said, “Old age is an excellent time for outrage.”

The ABC Method to Fight Ageism:

Dr. Levy suggests that to fight ageism, we have to follow the ABCs. A is for awareness of ageism wherever we encounter it. By the way, people with ageist attitudes may also harbor beliefs that border on racism or sexism as well. Spaces without older people because they are not included are examples of ageism as much as derogatory birthday cards for those turning 40, 50 or 65.

B is for blame. Put it where it belongs–on ageism, not on older adults. Having a health care professional dismiss a patient’s complaint with “What do you expect at your age?” is a prime example of unacceptable ageism. So is talking to an older patient’s adult child instead of to the patient herself.

C stands for challenge. When you encounter ageism, no matter what your age may be, it’s appropriate to point it out. You don’t have to blame the person making the remark. Very often they haven’t given ageism much thought. But suggesting another approach might be useful.

Dr. Levy includes exercises on the ABC method to bolster positive age beliefs in the appendix to her book. They are well worth considering.

This Week’s Guest:

Becca Levy, PhD, is Professor of Epidemiology in the Social and Behavioral Sciences Department at the Yale School of Public Health. She is also Professor of Psychology in the Department of Psychology at Yale University and part of the Affiliated Faculty of the Yale Institute for Global Health.

Dr. Levy’s research explores psychosocial factors that influence older individuals’ cognitive and physical functioning, as well as their longevity. She is credited with creating a field of study that focuses on how positive and negative age stereotypes, which are assimilated from the culture, can have beneficial and adverse effects, respectively, on the health of older individuals. Her studies have been conducted by longitudinal, experimental, and cross-cultural methods.

Her new book is Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live. Dr. Levy’s website is https://becca-levy.com/

The photo of Dr. Levy is by Julia Gerace.

Listen to the Podcast:

The podcast of this program will be available Monday, August 15, 2022, after broadcast on August 13. You can stream the show from this site and download the podcast for free.

Download the mp3

This week on our nationally syndicated public radio show, Dr. John Abramson describes the impact of Big Pharma on American health care. In the US, we spend more on healthcare than any other country (both overall and per capita). However, our health metrics are mostly mediocre. Compared to other wealthy countries, they are abysmal!

Big Pharma Controls Medical Research:

Starting several decades ago, medical researchers increasingly get their funding for studies from the pharmaceutical industry. As a result, they conduct trials with the primary goal of developing new drugs. While this can encourage innovation in some instances, it leaves big gaps in other areas.

If studies truly illuminated best practices for health care, many or most of them would compare healthy lifestyle practices to medications. That almost never happens.

Sharing Medical Knowledge:

According to Dr. Abramson, Big Pharma controls the way medical knowledge is shared. Unfortunately, this has an insidious effect on medical journals. Health care reporters, doctors and patients all look to peer-reviewed medical journals and trust the reports published there. Is that trust misplaced? Dr. Abramson suggests that peer review has been hamstrung by those funding the studies.

Drug Ads on TV Serve Big Pharma:

The US is one of only two countries in the world that allows direct-to-consumer advertising for prescription drugs. (The other is the tiny island nation of New Zealand.) How do these commercials affect our health care?

One clear impact is demand. The ads are designed to highlight the benefits of the drugs and downplay any risks. Perhaps you’ve noticed that the announcer runs through the list of serious side effects pretty rapidly, while the people on screen are having a wonderful time. (Obviously, we find this irritating; that’s why we keep mentioning it.) As a result, consumers get a prejudiced view of the medication and end up believing it is much more helpful than it may actually be.

We are probably stuck with prescription drug ads for the foreseeable future. However, Big Pharma should be required to provide the Number Needed to Treat (NNT) in every ad. Not only would this help patients weigh the benefits and risks of the advertised medicines; it would also speak to the other very important audience for these ads, the doctors. Drug companies are well aware that physicians watch television, too. A big part of the intended effect of the ad is to get the healthcare provider to start prescribing the drug.

Another possible effect of overpowering presence of drug commercials may be that on-air discussion is stifled. What producer wants to run a critique of Big Pharma between two appealing ads for pricey prescription drugs?

What About Statin Statistics?

Dr. Abramson has crunched the numbers on statins. Most physicians and patients believe that statins are extraordinarily effective at preventing heart attacks and deaths.

Dr. Abramson shares some startling stats about the number of people that need to take a statin for five years to prevent one heart attack. This information is essential for health professionals and patients to better understand the true effectiveness of the drugs they take for granted.

How Big Pharma Influences Practice Guidelines:

The pharmaceutical industry had the money and the political influence to help determine who serves on the committees that design practice guidelines. These influential doctors tell their peers how important health problems should be handled.

Ideally, the guidelines would be based on the evidence. However, Dr. Abramson says, evidence-based medicine isn’t based on the evidence. It is based instead on the carefully controlled results of studies that the industry has funded and helped design.

How We Can Repair the Damage:

Dr. Abramson has a few suggestions for how we can fix the current situation. First, we need to make sure that the market for prescription drugs is based on fair competition with unbiased evaluation of drug effectiveness, safety and value. That crucial step is going to require some important changes in the way medical research is conducted and the results are disseminated.

In addition, all Americans must have health insurance. We should ensure that the purchasers of health care–the employers, unions, Medicare, the VA, and so on–demand a fair market.

At the same time, we consumers need to recognize that we are paying too much for substandard care. To change that and to re-institute meaningful government oversight, Dr. Abramson believes we’ll need to recreate a functional democracy. Currently, the pharmaceutical industry spends a great deal of money on every side of Congress to protect its interests from legislation and regulation.

This Week’s Guest:

John Abramson, MD, MSc, has been on the faculty of Harvard Medical School for twenty-five years, where he teaches health care policy. He also served as a family physician for 22 years, during which he was named a “top doctor” six times in local, state, and national surveys.

Dr. Abramson has served as an expert in national pharmaceutical litigation and as an unpaid consultant to the FBI and Department of Justice, including in a case that resulted in the largest criminal fine in U.S. history. In addition to many academic articles and op-eds in the New York Times and other publications, he is the author of Overdosed America: The Broken Promise of American Medicine. Dr. Abramson’s latest book is Sickening: How Big Pharma Broke American Health Care. and How We Can Repair It.

Listen to the Podcast:

The podcast of this program includes an extra question and answer not in the broadcast. It will be available Monday, August 8, 2022, after broadcast on August 6. You can stream the show from this site and download the podcast for free. You will not want to miss this interview!

Download the mp3

On our nationally syndicated radio show we take questions from listeners about how to save money on prescription medications. As with nearly everything else, drug prices have been rising. First, we speak with health and medicine investigative reporter for Consumer Reports Lisa Gill about five ways to save on prescription drugs. How many of her tips have you tried?

Five Tips for Saving Money on Prescription Medications:

In her article for Consumer Reports and her interview with us, Lisa Gill mentioned a number of new entries in the online pharmacy space. In addition to Amazon and Costco.com, bargain hunters may want to check prices at ScriptCo Pharmacy, Honeybee Health, Mark Cuban Cost Plus Drug Co. and GeniusRx. Keep in mind that purchasing medicines outside your insurance plan usually does not count toward the deductible.

GoodRx

GoodRx offers coupons for drugstores in your area. The comparison prices can be especially helpful in deciding where to shop. While many prices tend to be similar, we have been surprised by some large price differences between chains.

One reader of our newspaper column shares this story about saving money on prescription medications with a coupon:

Q. One of the drugs I need is very expensive. The pharmacist told me about a website that offered a coupon. When I did, my cost for a 90-day supply went from $500 to $30! Now I know to look for coupons with expensive drugs.

A. Several organizations now offer coupons to save money on prescription medicines. The best known may be GoodRx. The biggest discounts are on generic drugs.

Keep in mind that if you use a coupon, your insurance (and Medicare) will not contribute. You will be paying out of pocket. Moreover, anything you spend through a coupon won’t count towards your deductible.

Coupons can make a big difference with generic drugs. Brand name medications may be a different matter, though. For example, GoodRx offers the following price information for a drug being advertised on TV called Rinvoq:

“UPADACITINIB treats rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, and ankylosing spondylitits. It is also used to treat ulcerative colitis. It works on the immune system. It belongs to a group of medications called JAK inhibitors. The lowest GoodRx price for the most common version of Rinvoq is around $5,575.30, 43% off the average retail price of $9,877.22.”

That is for 30 pills…about a month’s supply. You might say that the coupon is great and it could save you over $4,300 a month. That’s the glass half full approach. Or, you could say that you would have to spend over $5,500 out of pocket. That’s the half empty approach. Bottom line, the coupon might not save you enough if you have to spend thousands out of pocket each month.

Discount Programs:

Walmart and Walgreens have discount programs. If you must buy medicines regularly, especially if your insurance doesn’t cover them, you might benefit from one of these. Your usual pharmacy might also have a discount program that would be worth checking.

Don’t overlook the possibility of discounts on generic drugs through your insurance. Some plans offer pharmacy discount cards so long as you use participating pharmacies.

Patient Assistance Programs:

Most of the previous ideas work for generic drugs. While about 80 percent of the prescription medications we take are generic, brand name drugs can be far more expensive. Some pharmaceutical manufacturers have programs to help people with pricey copays or even to help low-income patients without insurance. You can learn more at needymeds.org

Join the Conversation:

We’d love to hear your stories about saving money on prescription drugs. Send an email to radio@peoplespharmacy.com or post to our Facebook page. On Saturday morning (July 16, 2022), you can give us a call between 7:15 and 8:00 am EDT: 888-472-3366.

• What lengths have you had to go to for affordable prescription medications? Have you traveled to another country? Where did you go and how did it work out?
• Have you gone to pick up a prescription at the pharmacy only to find that you couldn’t afford it? What did you do then?
• Have you bought prescription drugs online? Did that work? How much do you think you saved? And how did you make sure the medication was authentic and not counterfeit?
• Have you ever used a coupon to buy a prescription medicine? How much did you save?
• Has your doctor ever had to go to bat for you to get your insurance company to cover a medication?
• Have you considered buying brand-name medicines from a legitimate Canadian online pharmacy? How much did you save?

We would really like to share your story during our live radio show this Saturday morning. You can remain totally anonymous. The easiest way to tell your story is to email: radio@PeoplesPharmacy.com. Or, call in to the live show at 888-472-3366 between 7:15 and 8:00. You can also ask a question in the comment section below this article. We will do our best to answer it on the radio.

This Week’s Guest:

Lisa Gill is a Health & Medicine Investigative Reporter at Consumer Reports. Her article is: 5 Ways to Save on Prescription Drugs – Consumer Reports.

Listen to the Podcast:

The podcast of this program will be available Monday, July 18, 2022, after broadcast on July 16. You can stream the show from this site and download the podcast for free.

Download the mp3

Learn More:

You may be interested in reading our eGuide to Saving Money on Medicines.

This week on our nationally syndicated radio show, learn how to cope with tear problems. This is an extremely common eye disease, but that doesn’t mean it is trivial. An estimated 16 million adults in the US suffer with dry eyes, and suffer is the right verb for many of them.

What Is Dry Eye Syndrome?

The usual symptoms of dry eyes include irritation or a gritty feeling, redness and fluctuations in vision. Generally speaking, this is associated with an imbalance in the tear system. Tears have three components, water, mucus and oil. If these get out of balance, tear problems and dry eyes result. This problem appears to become more common as we age, and women are more susceptible to it than men. Perhaps a link with autoimmune conditions explains the gender imbalance, as women are also more prone to Hashimoto’s, rheumatoid arthritis and other autoimmune problems. Rosacea can also manifest as dry eye disease. Doctors have a fancy term for dry eyes: keratoconjunctivitis sicca.

Intensive use of computer screens may contribute to dry eyes, as frequently people immersed in their work or social media forget to blink as often as they would otherwise. Other contributors can include medications. Hydrochlorothiazide (HCTZ), a common diuretic prescribed to control blood pressure, is often a culprit. Anxiety medications and some drugs used to treat depression may also upset the balance of tears. Anticholinergic medicines of any type could contribute, especially if a person were taking two or three different ones. People taking antihistamines or decongestants for allergies may be dismayed to learn these medications can aggravate tear problems. To find a list of anticholinergic drugs, click here.

Surgery May Lead to Tear Problems:

Before you volunteer for LASIK refractive surgery or cataract removal, be sure to discuss your risk for dry eye with the surgeon. For some individuals, this complication becomes so unpleasant that they wish they had not undergone the procedures. But most people do not suffer such extreme tear problems.

How Can You Treat Dry Eye Syndrome?

The first step most people take is to use artificial tears. While this can be helpful, it is important to avoid the preservatives found in many such products. Our guest expert, Dr. Preeya Gupta, recommends Systane Complete or Refresh Relieva PF as preservative-free eye drops. These over-the-counter products can be quite soothing.

When the problem is primarily due to a failure of the meibomian glands in the eyelid that produce the oil film, warm compresses can sometimes help. These are most appropriate when the condition is mild.

Supplements That Might Help:

We asked about other nonprescription approaches, and specifically about omega-3 supplements. Although there is a paucity of studies showing that fish oil or krill oil can alleviate irritation or improve tear problems, Dr. Gupta says some patients find these supplements useful.

Prescription Interventions:

As we mentioned, warm compresses or heated eye packs containing seeds or plastic beads are likely to work best for mild symptoms. When meibomian gland dysfunction is more advanced, the eye doctor may recommend a few sessions with complex machines that provide more sustained and controlled warmth and pressure. These include LipiFlow, TearCare and iLux systems. Unfortunately, such sessions are pricey and insurance does not always cover them. When the underlying condition is ocular rosacea, intense pulsed light therapy is useful.

Prescription medications can be effective against dry eyes. The most common would be eye drops to fight inflammation, such as Restasis (cyclosporine) or Xiidra (lifitegrast). A new nasal spray, Tyrvaya (varenicline), works through its action on the trigeminal nerve.

This Week’s Guest:

Preeya K. Gupta, MD, is the Managing Director of Triangle Eye Consultants (www.TriangleEyeNC.com) in Raleigh, NC. Dr. Gupta specializes in cataract, cornea and refractive surgery, and is an international expert in dry eye disease.

She is an Adjunct Associate Professor of Ophthalmology at Tulane University School of Medicine, and previously served on the faculty at Duke University Eye Center in Durham, North Carolina as an Associate Professor of Ophthalmology from 2011-2021. Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology and Journal of Refractive Surgery.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee. She has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.

Listen to the Podcast:

The podcast of this program will be available Monday, August 1, 2022, after broadcast on July 30. You can stream the show from this site and download the podcast for free.

Download the mp3

Dr. Robert Lustig has been warning us all about the hazards of sugar since 2009, when his YouTube lecture “Sugar: The Bitter Truth” went viral. As a pediatric neuroendocrinologist, he spent much of his career treating the causes of obesity in children. Now, he turns his impressive expertise to helping adults as well as children. Metabolic syndrome contributes to the chronic diseases like diabetes and heart disease that kill most Americans. But what is causing the metabolic syndrome? Could it be the American diet?

Addressing the Roots of Disease:

Heart disease and diabetes kill millions of Americans. If you ask doctors why, they point to obesity. But Dr. Lustig says obesity is not actually the problem; instead, it is a symptom of the problem. The true cause is subcellular dysfunction. Eight different pathologies are difficult for doctors to diagnose and even harder to treat with medication. But the right food (real food, not processed food) can correct the pathologies and lead to good health.

Is Disease Genetic?

According to genome-wide association studies (GWAS), about 15% of the risk of chronic disease is attributable to genes. But that means the vast majority of our risk is related to how we live and particularly how we eat.

How Should We Eat?

Dr. Lustig has simple advice: Feed your gut and protect your liver. We need to eat in ways that keep insulin under control. That means avoiding added sugar and highly processed carbohydrates–crackers, cookies, pizza and other treats.

The Hateful 8:

The cellular pathologies include glycation, oxidative stress, mitochondrial dysfunction, insulin resistance, inflammation, methylation, and autophagy. These are the sources of metabolic syndrome.

While we don’t have drugs to treat these processes, we can alter them by eating foods that are minimally processed and rich in fiber, vitamins, minerals and phytonutrients. But eating a highly processed diet can lead to non-alcoholic fatty liver disease. That’s because the liver metabolizes sugar to fat that is stored in the liver, and processed food has a lot of sugar. This explains why children are now developing fatty liver disease, which was once a condition affecting older people, especially alcoholics.

Do You Have Fat in Your Liver?

Dr. Lustig describes how you can use a tape measure around your waist to see if you have fatty liver disease. He also discusses the lab values of ALT that indicate a problem. Intermittent fasting can help reduce liver fat, so long as you are not eating food full of sugar. Getting added sugar out of your diet is the most powerful way to reverse all these problems. Protecting the liver with real food is also a good way to help your body fight off COVID-19.

Is Breakfast Helping or Hurting?

You may have heard that breakfast is the most important meal of the day, but there is relatively little scientific evidence to support that statement. What’s more, many popular breakfast choices drive insulin up and aggravate the subcellular pathologies. Instead, we should strive for breakfasts of real food, low in sugar and high in fiber. According to Dr. Lustig, “Breakfast could be the most important meal of the day, if there wasn’t any sugar in it.”

The articles demonstrating that some groups at high risk for COVID-19 tend to consume more processed food are published in the British Journal of Nutrition, Feb. 26, 2021 and Public Health Nutrition, Jan. 27, 2021.

This Week’s Guest:

Robert H. Lustig, MD, MSL, is a pediatric neuroendocrinologist, an emeritus professor of pediatrics in the Division of Endocrinology, and member of the Institute for Health Policy Studies at the University of California, San Francisco. He has authored 130 peer-reviewed articles, 80 academic chapters and reviews, and dozens of op-eds for the public. He is the former chairman of the Obesity Task Force of the Pediatric Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, and a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration.

Dr. Lustig is also the Chief Science Officer of the nonprofit Eat REAL, dedicated to reversing childhood obesity and type 2 diabetes by bringing real food into schools. He has never taken money from the food industry, so has no conflicts of interest. His new book is Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. The photograph of Dr. Lustig is by Roberto Candia.

Listen to the Podcast:

The podcast of this program will be available Monday, May 10, 2021, after broadcast on May 8. In this extended podcast, Dr. Lustig discusses the pros and cons of statins as well as the addictive nature of sugar-laden foods and how dentists have turned away from warning against sugar. The show can be streamed online from this site and podcasts can be downloaded for free.

Download the free mp3

For many months now, people have been dealing with the pandemic, which has brought both grief for the lives lost and anxiety about the threat of infection. At the same time, fires and floods have made it clear that climate change is not a fuzzy future concern, but an urgent issue. The economic impact of all these problems has also been challenging. It is little wonder then, that rates of anxiety and depression have been rising. What are the new approaches to managing depression?

Defining Depression:

The first step to managing depression is understanding what we are talking about. Grief is a normal response to loss, and anxiety is not an unusual response to stress. What distinguishes major depression from ordinary sadness? We discuss the symptoms, such as changes in sleep patterns or appetite, along with irritability, that could signal someone is suffering from depression.

Our guest, Dr. Andy Nierenberg, describes the difference between bipolar disorder and depression. He also points out that seasonal depression is not limited to winter. Some people have predictable symptoms of depression in the summer. They also tend to have trouble with jet lag, so they may be especially sensitive to changes in light exposure and timing. We also learn about the signals that a young person might be depressed. Whereas a few decades ago, psychiatrists were not sure that children suffered from depression, now scientists have evidence that they do. Consequently, doctors have developed ways to help with managing depression in youngsters.

Treatments for Managing Depression:

Certain forms of therapy have excellent evidence to support their usefulness. Cognitive behavioral therapy, behavioral activation therapy and mindfulness-based cognitive therapy can all be very helpful. The challenge is finding a qualified therapist who has the appropriate training and experience.

Serotonin is a neurochemical that cells in the brain use to communicate with one another. Many of the most popular antidepressants such as fluoxetine (Prozac) or sertraline (Zoloft) work through serotonin. There are other medications for managing depression as well. For the most part, doctors try to pay attention to side effect profiles to find the drug that will be most helpful for a specific patient. The SSRI (selective serotonin re-uptake inhibitors) often have sexual side effects that can be quite distressing.

We don’t know exactly how the brain works nor how antidepressants affect it. The Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital is systematically studying whether drugs approved for other uses can be repurposed for treating depression. Surprisingly, fenofibrate, an older medication that was once used to control blood lipids seems to be promising for people who have not responded well to conventional antidepressants.

Other Treatments That May Help in Managing Depression:

Older medications such as monoamine oxidase inhibitors (MAOi) have fallen out of favor because patients need to pay close attention to diet and other medications. Nonetheless, they can be quite effective. Lithium has been used for bipolar disorder for years, and it is still one of the best treatments for this condition. Approaches that reduce stress, including meditation, forest bathing and exercise, can help boost the power of other treatments. In fact, there is evidence that exercise can affect one of the same pathways as fenofibrate. It also increases the output of brain-derived neurotrophic factor, BDNF, which also helps in managing depression.

Dr. Jerry Rosenbaum points out that some people who have not responded well to conventional antidepressants need more than one medication. That is because of the significant differences among individuals. It can be difficult, however, to predict which therapy will be most useful for a given patient. Device-based treatments such as TMS (transcrancial magnetic stimulation) or ECT (electroconvulsive therapy) are useful additions to the armamentarium. Rapid treatments such as esketamine (Spravato) and ketamine also hold promise for some patients. In addition, some psychiatrists are investigating the potential benefits of psychedelic drugs for managing depression.

This Week’s Guests:

Andrew Nierenberg, MD, is the Director of the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital. He is also Professor of Psychiatry at Harvard Medical School, where he holds the Thomas P. Hackett MD Endowed Chair. He is a leader in Clinical Studies of Depression & Bipolar Disorder. Dr. Nierenberg is Associate Director of the Depression Clinical and Research Program. He is also Director of the Training and Education program at the Massachusetts General Hospital Research Institute. Dr. Nierenberg’s primary interests are depression, bipolar depression, and novel treatments for mood disorders. The photo is of Dr. Nierenberg. His website is https://dautenbipolarcenter.org/about/our-team

Jerrold F. Rosenbaum, MD, is psychiatrist-in-chief emeritus and director of the Center for Anxiety and Traumatic Stress Disorders and director of the Center for Neuroscience of Psychedelics at the Massachusetts General Hospital and Stanley Cobb Professor of Psychiatry at Harvard Medical School. His career has focused on mood and anxiety disorders, with a special emphasis on pharmacotherapy of those conditions.

Listen to the Podcast:

The podcast of this program will be available Monday, July. 11, 2022, after broadcast on July 9. You can stream the show from this site and download the podcast for free.

Download the podcast