The People's Pharmacy Podcast

Tick season is well underway in many parts of the country. It seems that a mild winter and a warm spring have brought the nymphs out seeking blood. If that blood is yours, you may be exposed to a range of pathogens. What's more, ticks are not the only creatures ready to bite you. Fleas are an even bigger problem when it comes to transmitting bacteria called Bartonella. That genus is responsible for cat scratch disease and trench fever. When the infection goes chronic, it's called bartonellosis. What are the dangers of flea and tick bites? 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. The Hazards of Flea and Tick Bites Ticks can transmit a dizzying number of pathogens, including viruses, bacteria and protozoa. Rocky Mountain Spotted Fever, for example, occurs when a tick injects Rickettsia rickettsii into a person through a bite. If not treated properly, it can be fatal. Fortunately, however, it usually responds to doxycycline. The NCSU laboratory has developed a reliable diagnostic test that picks it up quickly. Another tick-borne disease that has become familiar over the last few decades is Lyme disease. It is carried by deer ticks infected with Borrelia burgdorferi. If treated promptly, most people clear the disease, but sometimes it morphs into a stealth infection that is quite controversial. You may not think much about flea bites, but they too could be the source of a stealth infection. Fleas transmit Bartonella (and so do body lice, ants, pigeon mites, rat mites and sand flies). Cats can be infected (with three different species of Bartonella) and so can dogs (only two species). When people develop bartonellosis, it can cause liver disease and neurological problems such as headaches and memory loss. In some cases, infected people suffer seizures. Preventing Flea and Tick Bites Once Bartonella get into the body, it likes to hide. The bacteria can enter virtually any cell in the body and make itself at home. As a consequence, the immune system may have difficulty tracking it down and eliminating it. Antibiotics don't always get to it, either. Treatments of entrenched infections need to be very intensive. So it is better to prevent flea and tick bites. One way is to make sure that pets are protected. Veterinarians can prescribe preventive medicine for them, either oral or topical. Another important step is to protect yourself. Wear effective insect repellent when outside or cover your long pants with permethrin-treated gaiters. And absolutely do not skip the tick check when you come inside. If you find a tick that has bitten you, remove it with tweezers, seal it in a plastic bag, date the bag and put it in the refrigerator. That could provide useful identification if you begin to feel ill over the next several days. When the type of tick is identified, it helps to point the infectious disease expert in the correct direction for what condition you may have. This Week's Guest Dr. Edward B. Breitschwerdt is a professor of medicine and infectious diseases at North Carolina State University College of Veterinary Medicine. He is also an adjunct professor of medicine at Duke University Medical Center, and a Diplomate, American College of Veterinary Internal Medicine (ACVIM). Dr. Breitschwerdt directs the Intracellular Pathogens Research Laboratory in the Institute for Comparative Medicine at North Carolina State University. He also co-directs the Vector Borne Diseases Diagnostic Laboratory and is the director of the NCSU-CVM Biosafety Level 3 Laboratory. Dr. Breitschwerdt's clinical interests include infectious diseases, immunology, and nephrology. https://www.galaxydx.com/about-us/meet-the-team/edward-breitschwerdt-dvm-dacvim-saim/ Dr. Ed Breitschwerdt, NCSU College of Veterinary Medicine Listen to the Podcast The podcast of this program will be available Monday, May 11, 2026, after broadcast on May 9. In this week's podcast, we talk about developing treatments for these challenging conditions. A major focus for Dr. Breitschwerdt is prevention, so he and his colleagues are working on a vaccine that could prevent Bartonellosis. We also discuss the possibility that Bartonella might contribute to arthritis. Find out about the complications of another vector-borne infection, Babesiosis. You can stream the show from this site and download the podcast for free. This episode of our podcast was sponsored in part by MUD\WTR. Start your new morning ritual & get up to 43% off your @MUDWTR with code PPOD at mudwtr.com/PPOD

Americans often boast of having the best health care in the world. It is certainly the most expensive health care. We pay twice as much as people in many other industrialized nations. Are we getting our money's worth? Some population statistics, such as life expectancy, suggest we could be doing much better. How can we make sense of the complexity of American health care? 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. Why We Pay Twice as Much for Health Care One reason Americans pay twice as much is the complexity of our health care services. We often call it a health care "system," but it often doesn't feel as coordinated as a system ought to be. Many other countries have universal health insurance coverage in one form or another (and there are many). That means the government has an incentive for keeping costs down. With so many different payers and players in the US, the incentives frequently go in the other direction. You may notice this if you examine an explanation of benefits from Medicare or a private insurance company. There may be a sizable gap between what the provider charged and what insurance approved. Who pays the retail price? Only people who don't have insurance, who are usually those least able to manage a big bill. If you find yourself faced with a hospital bill and no insurance coverage, it is important to talk with the billing department. Nonprofit hospitals should have a mechanism for patients without coverage to negotiate a lower total or a longer time frame in which to pay. Even some for-profit hospitals and medical practices are open to negotiation, but starting the negotiation as early as possible is key. How Much Does an Emergency Cost? Nobody plans for a medical emergency. That is the nature of emergencies–they are unexpected. If you need an ambulance to get you there, if you have to be transferred to another hospital with a better ability to care for your problem, if the doctors must do multiple tests to make a diagnosis will all influence your bill. As a result, emergency visits could cost from tens of thousands of dollars to a million or so. With high-deductible health insurance, a person or their family could end up owing more than they can pay. That is how some cases of bankruptcy are rooted in high healthcare bills. We Pay Twice as Much Because Providers Make More In the US, doctors were once in the same category of professionals as teachers or firefighters. Those days are long gone. Healthcare providers here are compensated more generously than providers in many other places, such as Canada, Japan or Israel. Moreover, just as there are middlemen in the prescription insurance business (called pharmacy benefit managers, PBMs), health insurance has its own middlemen. The result is a great deal of complexity, very little transparency, and a lot of parties trying to make money on each transaction. That also leads to a great deal of administration, which further increases the cost. Why Don't Market Forces Control Costs? Some analysts suggest that the free market should be able to control costs. But for market forces to work, you need competition and transparency. Over the last decade or so, there has been increasing consolidation in every sector of health care. Competition is limited in most areas. Moreover, transparency is in very short supply in health care. For years we have been talking about how hard it is to do comparison shopping for health services like MRI scans or colonoscopies. If consumers cannot compare costs or value, they cannot make the rational decisions that would help moderate prices. How Administrative Costs Increase Bills Part of every insurance premium goes to paying administrative costs. Insurers pay people to review claims (and deny some). Preauthorization also adds to administrative costs. Manage the Hospital Bill So You Don't Pay Twice as Much as You Should Years ago, we interviewed Marshall Allen, who titled his book Never Pay the First Bill.  Our guest for the current episode counters always request an itemized bill. That way you can check it to make sure that simple items such as names, dates and insurance policy numbers are correct. Then look at whether the services billed are actually the services received. An estimated nine of ten hospital bills contain mistakes. The sooner you catch them and contest them, the less likely you are to have to pay them. To determine what you must pay, you may need to review the summary of benefits on your insurance policy. That lays out in detail exactly what the insurance will cover. What Can Patients Do So They Don't Pay Twice as Much? Ask for an itemized bill and check it carefully in every detail. If you find a mistake, contest it. Sooner is better, even though you may be trying to recover from a serious illness. Ask the billing office about patient assistance or a negotiated payment plan. Check with the Patient Advocate Foundation. They may be able to help in an individual case. Find out if your state has a consumer assistance program in the department of insurance. Notify an intractable billing department that your story will appear in your social media feed. This should probably be the last step if the previous ideas don't work. But hospitals really don't like bad publicity, so it might give you leverage you wouldn't have otherwise. This Week's Guest Linda J. Blumberg, PhD, is a research professor at Georgetown University's McCourt School of Public Policy. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform. [caption id="attachment_139784" align="alignnone" width="768"] Linda J. Blumberg, PhD, describes why we pay twice as much for healthcare[/caption]

If you had to name one thing that could contribute to better health throughout the lifespan, what would it be? We think exercise, or at least physical activity deserves the top spot. Yet in 2025, fewer than half of adults met the guidelines for aerobic physical activity. And less than one-quarter were doing both aerobic and muscle-strengthening exercises on a regular basis. Perhaps your doctor should prescribe exercise. What could we expect as the benefits? 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. Would Your Doctor Prescribe Exercise for Depression? Earlier this year, the Cochrane Collaboration published a review of 73 randomized clinical trials of exercise as a treatment for depression (Cochrane Database of Systematic Reviews, Jan. 8, 2026).  Most of these compared physical activity to antidepressants or to psychological therapy for depressed patients. Some of them compared the exercise prescription to no treatment or wait list. Comparing exercise to no treatment revealed an advantage for exercise, although the quality of the trials left something to be desired. Ten trials compared exercise to psychological therapy. In addition, five trials weighed exercise against antidepressant medication. Neither comparison showed a clear tilt for or against exercise as a superior intervention against depression. Exercise in the Cancer Center Dr. Claudio Battaglini of the University of North Carolina at Chapel Hill was not surprised by this finding. The exercise program he oversees for cancer patients often results in lifting their spirits as well as improving their health. That may help explain the very high adherence in his program. Will Physical Activity Reduce the Risk of Cancer? According to a review of the evidence, regular physical activity can reduce the number of people who die prematurely. In addition, it helps with weight control, quality of life and bone health. Older people are less likely to fall or experience declining cognition if they exercise regularly. The review found that physical activity improves quality of life and promotes emotional benefits (European Journal of Cancer Prevention, Jan. 1, 2025). If oncologists should prescribe exercise, don't cancer patients deserve to have their insurance company cover the cost? Insurers rarely blink twice at cardiac rehab. Although cancer rehab is also super-helpful, insurance companies often don't choose to pay for it. What Role Could Coaching Play in Guiding Physical Activity? Lots of doctors tell their patients to get more exercise. The patient wants to and intends to, but perhaps they just don't know how. What activity should they choose? What is the proper technique? How often and how much do you need to move? All these questions can be answered by a coach. The coach will take into account your objectives and preferences as well as your prior experience. What do you love doing? Are there any moves you should avoid to reduce the risk of injury? That's why when doctors prescribe exercise, they should include coaching to provide this sort of guidance. If Doctors Prescribe Exercise, Will That Help Motivation? Many of us know we should be active, but we don't always follow through. How can we get motivated to move? According to Dr. Jordan Metzl, the first step is to find something you love doing. For Joe, for instance, having the doctor prescribe exercise of runniing a mile a day is not going to work. But he'll cover much more than a mile–and quickly–if he is playing a competitive game of tennis. Joe loves tennis. Terry is not a runner either. On the other hand, karate club is a highlight of her week, and she has worked to achieve some skill in it. Dr. Metzl advocates for finding the activity that gets you excited and making it a priority in your life. If you are having fun, that is a great motivation. Reducing the Cost to Act Another thing to consider is overcoming the cost to act. If your activity requires a lot of preparation that feels like a chore, the cost to act is high. If you can make it easier and break down that barrier, you are much more likely to accomplish your exercise. External rewards can also play a role. Joe loves winning, so he likes to play with guys at about his same level of skill. That way, he has a chance to win if he tries. For Terry, there was a progression through belt levels in karate, from yellow to green to blue, and so on. Now, she looks forward to closing the rings in the fitness app on her watch. When Doctors Prescribe Exercise, Does That Give You a Push? For Dr. Metzl, the idea of pushing yourself and maybe your friends is a positive notion. We asked him about people who dig in their heels when pushed. What approach do they need to perceive and pursue their goals? He summarized the three ingredients of healthy motivation as knowledge, emotion and belief. That's knowledge of the benefits of activity, an emotional response of appreciating and enjoying activity and a belief that you can achieve your goal. This Week's Guests Claudio Battaglini, PhD., FACSM, is Professor in the Dept. of Exercise and Sport Science at The University of North Carolina at Chapel Hill. He is also Director Emeritus of the Get REAL & HEEL Breast Cancer Research Program and Co-Director of the Exercise Oncology Research Laboratory. Jordan D. Metzl, MD is an internationally recognized sports medicine physician, bestselling author, and fitness instructor who practices at the Hospital for Special Surgery in New York City. He lectures around the world and founded the first physician-led online fitness community, IronStrength, with more than 50,000 members. He created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. An elite athlete himself, Dr. Metzl is also a 40-time marathon runner and 14-time Ironman finisher. Dr. Jordan Metzl, author of Push, runs the New York City Marathon 2025 Dr.Metzl's latest book is Push: Unlock the Science of Fitness Motivation to Embrace Health and Longevity 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). Listen to the Podcast The podcast of this program will be available Monday, April 27, 2026, after broadcast on April 25. On this episode, Dr. Metzl talks about the joy of teaching medical students to offer an exercise prescription and the challenge of getting specialties other than cardiology to integrate physical activity into their rehab process. Dr. Battaglini discusses the contrast between cardiac rehab, which is covered by insurance, and cancer rehab, which is not. He also describes the value of swimming, especially for older people with sore joints. Walking is good exercise and easy for most people. What if the weather is bad? Perhaps an indoor walk around the mall would be a good alternative, and if you can recruit some friends to join you, so much the better. You can stream the show from this site and download the podcast for free. Citations Clegg AJ et al, "Exercise for depression." Cochrane Database of Systematic Reviews, Jan. 8, 2026. https://doi.org/10.1002/14651858.CD004366.pub7 Albini A et al, "Physical activity and exercise health benefits: cancer prevention, interception, and survival." European Journal of Cancer Prevention, Jan. 1, 2025. DOI: 10.1097/CEJ.0000000000000898  

Hospitals can be pretty overwhelming. Sometimes you may feel like you need a map to find your way around the maze, not to mention a trusty guide to get you to the department or health professional that could actually help you overcome illness. In addition, being hospitalized often means being deprived of fresh air & sunlight. Could that be a mistake for proper healing? 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, April 18, 2026, 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 April 20, 2026. Striving for Person-Centered Care Wouldn't it be great if healthcare facilities were specifically designed around the individuals they are supposed to serve? Fifty years ago, a group of physicians and former patients started Planetree to do exactly that. At first, Planetree provided information at a time when patients were rarely told what was wrong or how it could be addressed. There was also a Planetree ward in a hospital in the Bay Area that operated on principles of transparency and person-centered care. Over the next several decades, Planetree developed as a network of more than 300 health care facilities in 30 countries that strive to provide a home-like environment for healing. The main value is person-centered care, in which they strive to treat the whole person as well as that individual's family or significant others. We invited Planetree President Michael Giuliano to tell us about it. He mentioned that one feature is getting your care summary in real time, so you can ask questions and correct errors before you leave the clinic or office. Fresh Air & Sunlight Built In One of the things that sets a Planetree hospital apart from other facilities is the way the values are visible in the architecture. Planetree planners put a premium on access to nature and outdoor space, though of course each facility does it a bit differently, according to its own plan. Rooms are set up so that people have access to fresh air & sunlight. That makes them feel more comfortable, certainly. Might it also promote healing? How Do Fresh Air & Sunlight Promote Healing? More than 150 years ago, Florence Nightingale set standards based on what she observed of soldiers healing from battle wounds and horrible infections during the Crimean War. This was, of course, before the development of antibiotics, so nursing care was paramount. Nurse Nightingale insisted on the primacy of fresh air & sunlight for her patients. Was this just a quaint old-fashioned idea, or is there modern scientific support? The Power of Near-Infrared For more information on the science of fresh air & sunlight (yes, there is science), we turn to Dr. Roger Seheult of MedCram.com. https://www.medcram.com/ He began by describing the brand new Footscray Hospital in West Melbourne. The design is something of a modern take on Florence Nightingale's hospital plan, since the architects figured out how to get natural light and real ventilation in every room. They prioritized fresh air & sunlight in this $1.5 billion hospital because of their healing properties. People exposed to sunlight leave the hospital sooner because they recover more quickly. So the patient gets better and goes home faster, the hospital has a better bottom line and the insurance company pays less. Everybody wins! Probably a good part of the credit goes to near-infrared light. We can't see it, but it penetrates our bodies and they react. Exposure to near-infrared at 850 nanometers improves mitochondrial function. You could get this from a device, but it is cheaper and arguably more pleasant simply to go outside and allow sunlight to fall on your skin soon after sunrise (or before 10 am) or just before sunset (probably after 4 pm). An Amazing Story About Fresh Air & Sunlight We'd be tempted to call this an unbelievable story, but Dr. Seheult provided all the details and checked the medical records himself, so we believe it. He told us about a 15-year-old boy with a serious blood cancer, acute lymphoblastic leukemia, ALL. This type of cancer undermines the immune response, and this young man had come down with a terrible fungal infection, mucormycosis. The fungus did not respond to medication, and it rampaged through his left lung. Ultimately, his doctors proposed removing the lung as a last-ditch method of controlling the infection. Unfortunately, when they found that the fungus had invaded his right lung, they were out of options. They figured he probably couldn't survive much more than two days, so they asked him his last wishes. All he wanted was to go outside; at this point, he'd been cooped up in the hospital for two months. They fixed up a wheelchair to hold all his drips and took him outside. The next day, they did it again. The youth didn't die as expected. Instead, he recovered completely, over time. We can't put sunlight in a bottle, but perhaps oncologists and other doctors should consider writing prescriptions to cover it. This Week's Guests Michael Giuliano is the President of Planetree International, a mission-driven non-profit organization setting the global standard for person- centered excellence across the continuum of care. Michael joined Planetree in 2022 as Chief Operating Officer (COO) following a decade of leadership roles in Australia's public and private healthcare sectors. https://www.planetree.org/team-member/michael-giuliano Michael Giuliano, President of Planetree International Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He 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. He is a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for MedCram.com, a site that offers concise and easy-to-follow medical videos on a range of topics. Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside

Millions of Americans are in pain. Arthritic joints make exercise difficult, even though moving is one of the best things we can do for joint pain. Pinched nerves can cause excruciating, long-lasting pain. The usual treatments, such as NSAIDs, may help ease the pain momentarily, but do nothing to help heal the underlying condition. What do you know about the new science of regenerative therapies? 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. The New Science of Regenerative Therapies What is the price of pain relief for aching, arthritic joints? We're not talking about the drugstore sticker on a bottle of ibuprofen. Instead, we are referring to the potential negative consequences of utilizing such medicines for temporary symptomatic relief when the joint continues to hurt for weeks, months or years. Even more powerful treatments, such as corticosteroid injections into the sore joint, don't heal the cartilage. In fact, they may contribute to further deterioration as they suppress the immune system. Our guest offers other ways to treat joint pain with regenerative therapies. Immune Mechanisms That Resolve Inflammation Dr. Tom Buchheit is a pain management specialist who has worked with elite athletes as well as seniors to get them moving well again after an injury. One of the reasons exercise can be so helpful is that the right kind and amount of movement creates good inflammation. Unlike chronic inflammation that causes further harm, good inflammation helps the immune system switch to a different phase, one in which destructive pathways are resolved. The three pillars of exercise are aerobic exercise, muscle building exercise and exercise to improve balance. Together, these types of exercise help recovery and healing and can even help heal damaged nerves. NSAIDs like naproxen, celecoxib or ibuprofen can interfere with the good inflammation exercise creates. Rather than taking such a pill before a game or workout, it makes sense to wait and take it afterwards if you need it. Will Exercise Wear Out Your Joints? Injury can damage the joints, but the idea of osteoarthritis as a consequence of wear and tear seems to be a medical myth. Instead, we might think of osteoarthritis as a chronic wound that may need regenerative therapies to heal properly. Immune system building blocks like omega-3 fats in the diet and a wide palette of colorful produce can help with the healing. Movement itself is part of the healing process. What Are the Regenerative Therapies? PRP Some of the therapies we think of as "new" have actually been in use for several decades. One of these is platelet-rich plasma, which was initially developed to help wounds heal. In this treatment, the doctor uses the patient's own blood. The plasma with as many platelets as possible concentrated in it is then carefully injected into the painful joint. The idea, again, is to cause "good inflammation," alerting the immune system that healing is needed here and encouraging it to flip into inflammation resolution mode. Not all studies of platelet-rich plasma (PRP) have shown benefit, but some of that may be due to using plasma that is not truly rich in platelets. Properly prepared PRP works especially well for ligaments and tendons, according to Dr. Buchheit. MSC If you hear someone talk of getting a "stem cell" injection, they are talking about MSC. They were originally misnamed mesenchymal stem cells, but would be better termed medicinal signaling cells. They too are derived from the patient's own body. Rather than rebuilding cartilage, they also signal the immune system to switch from long-term damaging inflammation to short-term healing inflammation. This is also the idea behind prolotherapy, in which the therapist injects sugar water into the joint. That may sound like a placebo, but it can be effective at easing pain and helping healing. Autologous Conditioned Serum Dr. Buchheit describes another of the regenerative therapies, autologous conditioned serum. Blood is drawn and encouraged to clot; then the serum is injected into the troublesome joint. Clotting helps create powerful signals that healing is needed. This therapy is not widely available, as only about ten places in the US have the dedicated laboratories required to prepare ACS properly. Hydrodissection Dr. Buchheit also describes how to use injections to free up trapped nerves in a process called "hydrodissection." This is often very helpful in alleviating chronic neuropathy. We conclude the episode with a brief reminder of how to stay healthy once you get nerves and joints feeling good again. This Week's Guest Thomas Buchheit, MD, served as Chief of Pain Medicine at Duke from 2013-2019 and led several NIH- and DoD-funded research studies. His focus is on immune mechanisms that resolve inflammation and pain. In 2025, Dr. Buchheit completed his book, Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies, and founded Triangle Regen Medicine and Biologics Center. His overarching goal is to help patients understand and use regenerative therapies to activate their own healing and repair mechanisms. He continues to serve as adjunct associate professor at Duke and collaborates with colleagues at the Center for Translational Pain Medicine. His website is https://triregenmed.com/ Dr. Tom Buchheit

This week, Joe and Terry discuss liver health with two specialists. You may not have spent much time thinking about your liver. It is, however, an absolutely essential organ. When the liver is working properly, every part of the body gets the nutrients it needs and no parts are exposed to damaging toxins. These are among its superpowers. Find out why you should love your liver. 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. Love Your Liver: Nutrients don't go directly from the intestines to the rest of the body. Instead, they pass through the liver first. There, this master organ breaks them down into compounds that can be recognized and utilized by individual tissues and cells. Moreover, if it finds nasty chemicals that shouldn't be there, it utilizes its superpowers to transform them into less damaging compounds that can be more readily excreted. You should also love your liver because it can store nutrients for unanticipated periods of fasting and hold off starvation. This was a tremendous benefit during earlier periods of human evolution. These days, we have less need for a hedge against starvation. In fact, when we overload our livers with alcohol or sugar, even its superpowers may not be adequate. The liver's response to this kind of insult is fibrosis, a condition in which it stiffens and stores fat. Liver Disease: One of the liver's superpowers is that it can regenerate itself so long as we remove the source of injury. That's pretty remarkable! But what if we keep on eating ultra-processed foods (Nutrients, May 10, 2023) and drinking soda or alcohol?  In that case, the liver continues to try to repair itself. That can change the architecture of the tiny blood vessels that run through the liver, raising the pressure within them and ultimately leading to serious complications. Fatty liver disease, correctly termed metabolic-associated steatohepatitis (MASH), is the first step; cirrhosis and ultimately liver failure might follow. How Do You Know If Your Liver Is Healthy? The liver is so effective at maintaining the body in balance that most people don't develop symptoms of trouble until liver disease is quite advanced. As a result, the best way to keep tabs on liver health is through blood tests. Tests for the liver enzymes called ALT and AST are common and often used to assess liver health. Agents That Can Help or Harm the Liver: If you love your liver, consider drinking a cup or two of black coffee daily. This has been shown to help the liver fight inflammation and overcome early-stage liver fibrosis (Redox Biology, March 2025). Another precaution to take: avoid excess acetaminophen. This is the pain-relieving ingredient in Tylenol and hundreds of other over-the-counter medications. Doctors consider it safe for occasional use at doses under 4,000 mg in a day. Chronic use might call for lower doses yet. Because it is so widespread, people may mistakenly take several different medicines containing acetaminophen (paracetamol in the rest of the world) and end up exceeding the maximum dose by accident. Liver experts like our guest Dr. Ahmad treat such emergencies with a medicine called N-acetylcysteine. Other pain relievers, such as NSAIDs, are less likely than acetaminophen to damage the liver. Dangerous reactions to such drugs are unpredictable, however, which can make them harder to manage. Fluoroquinolone antibiotics such as Levaquin and corticosteroids like methylprednisolone also fall into this category. Oral antifungal drugs can also be very hard on the liver. Herbs That Can Challenge the Liver: Pharmaceuticals are not the only compounds that may test the liver's detoxifying superpowers. Botanical medicines can also cause challenges. Dr. Ahmad has treated people whose liver injuries were caused by green tea extract, turmeric, kratom or ashwagandha. Most people taking such supplements are attempting to improve their health, so discovering that instead they have developed liver damage is a nasty surprise. If you love your liver, stick with drinking green tea and eating curry rather than taking pills with concentrated extracts. This Week's Guests: Meena Bansal, MD, is Professor of Medicine, specializing in liver diseases, at the Icahn School of Medicine at Mount Sinai. She is System Chief of the Division of Liver Diseases and Director of the MASH/NASH Center of Excellence at Mount Sinai. Meena Bansal, MD, Professor of Medicine Mt. Sinai, photo courtesy of Mt. Sinai Jawad Ahmad, MD, is a professor of liver diseases at the Mount Sinai School of Medicine. He is co Primary Investigator on the NIH/NIDDK research initiative to study cases of severe liver injury caused by prescription drugs, over-the-counter drugs, and alternative medicines, such as herbal products and supplements. For more information on the Drug-Induced Liver Injury Network (DILIN) visit: https://researchfunding.duke.edu/drug-induced-liver-injury-network-dilin-clinical-centers-u01-clinical-trial-optional Jawad Ahmad, MD, Professor of Medicine at Mount Sinai, photo courtesy of Mt. Sinai Citations Henney AE et al, "Ultra-processed food intake Is associated with non-alcoholic fatty liver disease in adults: A systematic review and meta-analysis." Nutrients, May 10, 2023. DOI: 10.3390/nu15102266 Xin X et al, "Caffeine ameliorates metabolic-associated steatohepatitis by rescuing hepatic Dusp9." Redox Biology, March 2025. DOI: 10.1016/j.redox.2025.103499  

A chance encounter with a stranger on an airplane offers lessons for all of us in how to disagree without fighting. Infectious disease expert Morgan Goheen, MD, was wary when the person in the seat next to hers struck up a conversation with questions about the origins of Lyme disease and the value of being vaccinated against COVID. His views were quite different from hers. Yet they managed, in the course of the flight, to exchange perspectives in a respectful manner. Can we all learn how to do that? 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. Can You Disagree Without Fighting? Dr. Goheen did her best to answer the questions her seatmate had. She also listened carefully to his description of life during the pandemic, particularly his objections to mandatory vaccination and his fears of a reaction to the vaccine. As a health care provider, she had been working in a hospital that was overwhelmed with COVID-19 patients. Far too many of them died, and at the height of the pandemic, most died alone rather than with family nearby. She was able to recognize that this had colored her perception of the pandemic and had led her not to give enough attention to the real economic hardship some public health mandates triggered. The Value of Vaccines Before the polio vaccine was developed, parents lived in terror of polio epidemics that would tear through communities, leaving some children paralyzed and a few dead. We no longer have to fear polio, pertussis, diphtheria or measles because vaccines can protect children from these common diseases. In a sense, though, their very success has led to skepticism of their value. Most Americans do not know anyone who has died of pertussis (aka whooping cough) because the majority of children have been vaccinated against this pathogen. Recently, there have been few birth defects caused by rubella because pregnant women can be protected from the infection. Can Trust Be Regained? During the pandemic, opinions became polarized. People who would once have trusted the FDA or the CDC became suspicious. Public health messages about masking were initially based on conjecture, because no one had conducted actual studies until later in the pandemic. The nature of this new virus and its transmission was not yet well understood. Yet authorities occasionally made dogmatic pronouncements, possibly out of fear. Some opportunities to build trust were squandered, and it will take time and patience to get it back. Learning to disagree without fighting is a great place to start. Learning to Disagree Without Fighting After talking with Dr. Goheen, we turn to Dr. Laura Gilliom. She is a clinical psychologist active in the Braver Angels movement. This organization brings people together to bridge the partisan divide. The volunteers run workshops in which people with divergent viewpoints discuss issues of the day. They model basic approaches to good communication, including treating the other person in the conversation with respect. It is important to listen for understanding of the intellectual and emotional bases for their perspective. After all, people have reasons for their opinions. Even if you don't understand them, those reasons make a lot of sense to them and are usually the result of significant life experiences. When you speak, the aim is not to win the argument, but to be heard and understood. That is also the goal as you listen–to understand where the other person is coming from. When Braver Angels bring people together, all agree to state their views freely and without fear. That isn't always the case in other situations. Sometimes people fail to speak out because they are afraid of the possible reaction. Another rule for Braver Angels interactions is that people treat each other, including those who disagree, with honesty, dignity and respect. Curiosity and kindness are also critical when we talk with people whose views are very different from ours. In some situations, it may be appropriate to reflect back what you have heard and ask if that is a fair representation of what they said. Before sharing your own ideas, you might ask permission. One other point to keep in mind: humans sometimes make mistakes. That might apply to those on "our side" as well as to those on a different side. Humility can help. This Week's Guests Morgan Goheen, MD, PhD, serves as faculty Instructor in the Section of Infectious Diseases within the Department of Internal Medicine at Yale School of Medicine. As a physician scientist, her current research focuses on the mosquito vector's role in malaria transmission dynamics and drug resistance spread in sub-Saharan Africa with lab work based in the Epidemiology of Microbial Diseases Department in the Yale School of Public Health. Within her clinical specialty of infectious diseases, Dr. Goheen has specific interest in tropical medicine and helped start the Travel and Tropical Medicine Clinic at the Yale Center for Infectious Diseases. Dr. Goheen is a Public Voices Fellow of The OpEd Project in Partnership with Yale University. https://www.theopedproject.org/fellowships. https://www.huffpost.com/entry/infectious-disease-doctor-anti-vaccine-airplane_n_68d2e961e4b03fb4d93463e7 Laura Gilliom, PhD, is a licensed clinical psychologist in Chapel Hill, North Carolina, a State Coordinator for Braver Angels, and a member of the Central NC Alliance of Braver Angels. https://nc.braverangels.org/  

Chronic diseases make up the bulk of the problems that modern health care must address. Each condition seems to have its own drivers–cholesterol for heart disease, airway hyperreactivity for asthma, neurotransmitter imbalance for depression and other psychiatric disorders, a buildup of amyloid beta in the brain for Alzheimer disease. What if all these conditions had similar origins? Today we'll consider the evidence suggesting that hidden infections may be driving many chronic diseases. 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 Could Hidden Infections Be Driving Chronic Disease? Nikki's Story We begin this episode with the personal account of Nikki Schultek. She is a patient who has transformed herself into a research leader after a horrendous experience with unexplained chronic disease. She was a healthy active young mother whose lifelong well-controlled asthma suddenly took a dramatic turn for the worse. She then developed atypical pneumonia, heart arrhythmia and interstitial cystitis, along with a slew of autoimmune conditions. All the doctors could tell her was that these were idiopathic conditions driven by inflammation. As she notes, "idiopathic" basically is doctor-speak for we don't understand what is going on here. When she developed neurodegenerative symptoms that made her physician suspect MS, she was terrified. That low point became a turning point. Her background had equipped her to read scientific studies, so she began trying to figure out what was driving chronic disease in her own situation. A search linking atypical pneumonia and interstitial cystitis led her to the clinician who was able to help her regain her health, Dr. Charles Stratton. He had conducted a small study linking both conditions to a respiratory infection caused by Chlamydia pneumoniae. What Is When people hear "Chlamydia," they think immediately of the sexually transmitted infection caused by Chlamydia trachomatis. Although the organisms are related, they have completely different modes of transmission. People catch C. pneumoniae (Noo-mo-knee-eye) simply by breathing in air that contains infectious respiratory particles. These bacteria are extremely common, but it is difficult to detect an infection. That's because C. pneumoniae hides out inside human cells. It doesn't show up in blood tests or urine cultures. The study that caught Nikki's eye used PCR, polymerase chain reaction, which detects DNA. That analysis revealed that 80 percent of the women in the study with interstitial cystitis had C. pneumoniae. The researchers concluded that this sneaky pathogen can lead to chronic inflammation. The Link Between C. pneumoniae and Asthma Remember that Nikki's troubles started with a severe asthma exacerbation. Research has shown a link between that infection and hard-to-treat asthma (PLoS One, April 19, 2021). When Dr. Stratton tested Nikki, they discovered that she indeed harbored a C. pneumoniae infection. The treatment required multiple antibiotics over a prolonged period of time. Luckily, it eventually cleared the interstitial cystitis, the neurodegenerative symptoms, the other autoimmune problems and brought her asthma back under control. Other Pathogens Causing Trouble C. pneumoniae was not the only germ lurking in Nikki's body. She discovered that she also carried Borrelia burgdorferi, the organism that causes Lyme disease. In addition, an examination of her red blood cells revealed both Babesia and Bartonella, possibly transmitted by the same tick bite that gave her the Lyme disease. These experiences inspired Nikki to start the Intracell Research Group, the Pathobiome Research Center and the Alzheimer's Pathobiome Initiative. All are aimed at discovering if hidden infections such as C. pneumoniae or Babesia or Borrelia burgdorferi could be driving chronic disease such as dementia. More Research on Covert Pathogens Driving Chronic Disease One of Nikki's colleagues at the Alzheimer's Pathobiome Initiative as well as at the Philadelphia College of Osteopathic Medicine is Dr. Brian Balin. He has spent more than 25 years studying the connections between C. pneumoniae infections and brain inflammation. This, in turn, has been linked to neuroinflammation and dementia. Dr. Balin points out that respiratory pathogens like C. pneumoniae are accustomed to entering the body through the nose. The nose offers access not only to the respiratory tract, but also to the brain. However, it can be difficult to detect microbes in the brain while the patient remains alive. This has limited research on infection and cognitive impairment in the past (Alzheimer's & Dementia, Nov. 2023). The COVID pandemic poses another huge risk. Like C. pneumoniae, the SARS-CoV-2 virus often enters the body through the nose. From there, it has ready access to the brain (Frontiers in Aging Neuroscience, June 13, 2025). Further, when the immune cells called macrophages respond to these infections, they engulf the pathogen and may carry it throughout the body. Might long COVID be the latest example of unacknowledged infection driving chronic disease? What Are the Implications for Treatment? If it can be firmly established that pathogens trigger the inflammation driving chronic disease, that offers several different approaches for treatment. First, we would need to use a high level of suspicion and appropriate technology (such as PCR) to detect infection. These bugs don't show up through urine cultures or other typical diagnostic techniques. Secondly, we would need to figure out treatment strategies. Antibiotics can be useful, but they may not be the only tools. Vaccines could help the body fight off these pathogens. Specific antibodies might also be developed to block them. In addition, phage therapies targeted to specific bacteria may also work when antibiotics cannot. If you are unfamiliar with the idea of phage therapy, you might want to listen to our radio shows on this topic. Just think of these viruses the way you think of the enemy of my enemy. That entity becomes your friend! Here are some interviews you may find intriguing: Show 1155: Can Bacteriophages Save Your Life? Show 1407: Battling Superbugs with Nature's Viral Warriors This Week's Guests Nikki Schultek is Founding Director of the Pathobiome Research Center, and Research Assistant Professor at Philadelphia College of Osteopathic Medicine , Executive Director and Co-Founder of the Alzheimer's Pathobiome Initiative (AlzPI), and Principal and Founder of Intracell Research Group, LLC. A former life sciences professional with Pfizer and Genentech, she now works to unite global researchers studying infection-associated chronic illnesses, including Alzheimer's disease and other brain diseases. Following her own recovery from Lyme Disease, Chlamydia pneumoniae and co-infections, Nikki builds and leads patient-centered interdisciplinary research collaborations to examine microbial drivers of chronic diseases. She has catalyzed philanthropic funding to launch AlzPI research at multiple academic centers and co-lead authored a 2023 roadmap in Alzheimer's & Dementia outlining a rigorous strategy to investigate infections in brain disease. www.PCOM.edu/research/pbrc www.AlzPI.org www.IntracellResearchGroup.com Nikki Schultek, founder and director of Intracell Research Group, LLC Brian J. Balin, PhD, is a tenured Professor of Neuroscience and Neuropathology at the Philadelphia College of Osteopathic Medicine. He directs the Center for Chronic Disorders of Aging (an Osteopathic Heritage Foundation Endowed Center), and the Adolph and Rose Levis Foundation Laboratory for Alzheimer's Disease Research. An internationally recognized Alzheimer's researcher, Dr. Balin has spent over 25 years investigating links between infection—particularly Chlamydia pneumoniae—and neuroinflammation, blood–brain barrier dysfunction, and neurodegeneration. His NIH- and foundation-funded work has significantly advanced the "pathogen hypothesis" of Alzheimer's disease and Dr. Balin is regarded as a global expert and pioneer in this research field. Dr. Balin is a Co-Founder of The Alzheimer's Pathobiome Initiative (AlzPI). Brian Balin, PhD, Philadelphia College of Osteopathic Medicine Listen to the Podcast The podcast of this program will be available Monday, March 23, 2026, after broadcast on March 21. You can stream the show from this site and download the podcast for free. Citations Hahn DL, "Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk." PLoS One, April 19, 2021. DOI: 10.1371/journal.pone.0250034 Lathe R et al, "Establishment of a consensus protocol to explore the brain pathobiome in patients with mild cognitive impairment and Alzheimer's disease: Research outline and call for collaboration." Alzheimer's & Dementia, Nov. 2023. DOI: 10.1002/alz.13076 Romanella A et al, "Infections with Chlamydia pneumoniae and SARS-CoV-2 and Alzheimer's disease pathogenesis." Frontiers in Aging Neuroscience, June 13, 2025. DOI: 10.3389/fnagi.2025.1587782  

Every five years, the Departments of Agriculture and of Health and Human Services jointly issue guidelines on what we should eat. The most recent Dietary Guidelines for Americans (2025-2030) have been controversial. [Here is a link: https://www.dietaryguidelines.gov] Among other things, the administration decided to flip the food pyramid upside-down in illustrating its recommendations. Why did that cause such a stir, and what will it mean for you? 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. Why Flip the Food Pyramid? Nobody has actually explained to us why they decided to flip the food pyramid on its head. The food pyramid itself debuted in 1991 as an illustration of what we should eat, but many people found it confusing. In 2011, it was replaced by a MyPlate graphic. So why return to the food pyramid now, especially upside-down? Our guest, noted nutrition researcher Christopher Gardner, suggest that it might be a way of denoting dramatic changes from previous guidance. Spoiler alert: only a few details are dramatically different. The main changes are a commendable emphasis on eating real food and attention to red meat as a protein source and full-fat rather than low-fat dairy products. Do Americans Need More Protein? If you pay attention at the supermarket, you'll probably notice that a lot of product tout their protein content. Even things that don't seem like they'd stand out as sources of protein (granola, pancake mix) are being offered in containers emblazoned with the promise of protein. Surprisingly, though, this is not a response to an urgent need. Most Americans get adequate protein and don't need to concentrate on increasing their intake. Might it be a marketing tool? Should We Worry About Dairy as We Flip the Food Pyramid? Generally, public health experts recommend that we avoid foods high in saturated fat such as butter or cheese and opt instead for lower fat items, like skim milk. Consuming excessive amounts of saturated fat can raise blood levels of dangerous LDL cholesterol. On the other hand, Dr. Gardner points out that dairy fat differs in some ways from the saturated fats in meat, for instance. We don't have enough studies to evaluate health consequences of consuming full-fat dairy. Will that raise cholesterol? Might it increase the chance of heart disease? We still need more research to be able to tell. What About Eggs? Speaking of cholesterol, what about eggs? For decades, Americans were warned not to eat eggs. Experts thought these cholesterol-rich foods would raise the level of cholesterol in our blood. But although eggs are high in cholesterol, they are low in saturated fat. Joe describes an astonishing experiment in which a person ate two dozen eggs a day. After a month, his LDL cholesterol was lower than when he started. Dr. Gardner remarks that we need to know not only what we are eating, but also instead of what and with what. Eggs with sausage and cheese are quite different from a veggie frittata. What's for Breakfast? Let's consider what people might be eating for breakfast instead of eggs. Quick toaster pastries, sweetened cereal, orange juice and toast with jam are all popular options that are high in refined carbohydrates. At least for some people, such foods may make blood sugar and insulin spike. That could lead to a midmorning crash, which in turn could encourage someone to have a midmorning snack. Is that a bad idea? Maybe it is one reason to flip the food pyramid. If We Flip the Food Pyramid, Will It Help with Weight Loss? Dr. Gardner has run studies comparing the results of healthful low-carb diets to healthful low-fat diets. He and his colleagues found no significant difference in the weight loss people experienced on average. But none of us is an average person. The range of responses to these diets was huge, with some people losing a lot of weight and other losing none or even gaining. How to Lose Weight Based on this research, it seems no single diet will work for everyone. What makes a big difference is satiety. If what you eat makes you feel full and keeps you feeling full, it will help keep you from eating too much. No need to flip the food pyramid in that case. And, says Dr. Gardner, no need to rely on continuous glucose monitors unless your blood sugar is out of range. Just paying attention to how food makes you feel and to the maxim Eat Real Food will be a pretty good guide for most of us. Dietary Guidelines That Flip the Food Pyramid Shape Food for Kids One important way that the Dietary Guidelines for Americans are implemented is school lunch. Institutions receiving funds from the federal government must follow these guidelines. Substituting minimally processed foods for the inexpensive ultraprocessed foods that are currently found on many school menus will probably be more expensive. The new guidelines also recommend that kids not get any foods with added sugar until they are at least ten years old. That would be a big difference in children's diets, at as big as when we flip the food pyramid. Is it practical? This Week's Guest Christopher Gardner, PhD, is a nutrition researcher. He is the director of nutrition studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University. Christopher Gardner, PhD, director of nutrition studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University Listen to the Podcast The podcast of this program will be available Monday, March 16, 2026, after broadcast on March 14. You can stream the show from this site and download the podcast for free. In this episode, Dr. Gardner discusses the types of fat he uses in his kitchen and why. What oils does he choose for sautés or salad dressing? What is his perspective on olive oil? what does he eat for breakfast, lunch and dinner, and what is he buying at the market?

According to the Alzheimer's Association, nearly seven million Americans currently suffer from that type of dementia. Experts expect that more will be burdened with it in the future, as baby boomers continue to reach advanced ages. Many people are eager to protect the brain from deterioration. In this episode, we discuss an unexpected approach to lowering your risk for Alzheimer disease (AD) and other dementias–get a shingles shot! 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 to Protect the Brain with Vaccination Our guest, Dr. Pascal Geldsetzer, has led three impressive studies that took advantage of natural experiments to see if vaccination against shingles could protect the brain from dementia. The results were remarkably consistent and encouraging. What Is a Natural Experiment? In Wales, when the Zostavax shot against shingles first became available, public health authorities established eligibility criteria to get it through the national health system. Welsh citizens had to be born on or after September 2, 1933, to get the shot. This created a situation in which two groups of people differed only by birth date and by whether or not they were immunized. (Most people who were eligible for the shot got it.) This mimics a randomized clinical trial in which the only difference between two groups is the intervention. The absolute risk reduction over 7 years was 3.5%, which means that people who got the shot were 20% less likely (relative risk) to be diagnosed with dementia. That big difference is statistically significant (Nature, April 2, 2025). Wales is not the only country that set up eligibility requirements. Australia did, too. In Australia, everyone between 70 and 79 years old as of Nov. 1, 2016, could get a free shingles shot and many people did. Here, too, you have a group of senior citizens who differ from each other only by whether they got vaccinated and whether their birthdays were slightly earlier or later. In this case, the absolute reduction in risk of dementia over 7 years was 1.8% (JAMA, April 23, 2025).  This difference was also significant. One More Experiment Suggests Vaccination Can Protect the Brain Another natural experiment comes not from a nation, but from a province of our norther neighbor, Canada. The province of Ontario decided that people born on or after Jan. 1, 1946, could get a shingles vaccination. People just slightly older were not eligible. Do you recognize a pattern? When the investigators analyzed health records from 1990 to 2022, they found that people eligible for the vaccine based on their date of birth were 2% less likely to get a dementia diagnosis. In other provinces of Canada that had different rules for vaccination eligibility, people don't show a significant difference in dementia risk based on their birthday. (Lancet Neurology, Feb. 2026). Which Vaccine Were Scientists Studying? The original shingles vaccine, Zostavax, was the one available for all these natural experiments. For the most part it has now been replaced by a newer version called Shingrix, which uses different technology. Studies show that Shingrix is better at preventing shingles outbreaks and post-herpetic neuralgia, the lingering pain after shingles (Vaccines, April 28, 2025).  It is unclear whether it would also work better to protect the brain from Alzheimer disease. At least one study suggests it works quite well in reducing the risk of dementia (Vaccine, Feb. 5, 2025). Was the Single-Minded Pursuit of Amyloid Misguided? For decades, the pharmaceutical industry has focused its anti-Alzheimer efforts on amyloid plaques that are a pathological feature of brains afflicted with Alzheimer disease. They were apparent in the very first brain described by Alois Alzheimer at the turn of the 20th century. But the assumption that getting rid of amyloid plaque would solve the problem has not borne fruit. The FDA has approved three compounds that are quite effective at reducing amyloid plaque in the brain. Two, lecanemab (Leqembi) and donanemab (Kisunla), are still on the market. Their impact on cognitive decline and functionality of AD patients is unimpressive. Other Infections That May Harm the Brain It seems odd that neurologists might be resistant to the idea of an infection such as chickenpox (the virus behind shingles) or herpes (which causes cold sores and genital lesions) changing brain function. More than a hundred years ago, before the development of effective antibiotics, doctors were quite aware that tertiary syphilis could lead to dementia. Other infections such as Chlamydia pneumoniae may also interfere with brain function. The COVID pandemic demonstrated that the SARS CoV-2 virus can cause brain fog, and we worry that people with long COVID may be at higher risk for dementia. Can the Shingles Vaccine Help with Treatment? One immunization outcome that Dr. Geldsetzer's team uncovered may help with treatment. In Wales, people with dementia who got the shingles vaccine had a slower progression of their cognitive decline. (Cell, Dec. 11, 2025).  This suggests that whatever it is doing to protect the brain may extend into the disease process itself. This definitely deserves more research. Dr. Geldsetzer would like to conduct a true randomized clinical trial to explore this possibility and to tease the differences, if any, between Zostavax and Shingrix with respect to their effects on dementia prevention. This Week's Guest: Pascal Geldsetzer, MD, PhD, MPH is an Assistant Professor of Medicine at Stanford University and a Biohub Investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages. In 2026, he was named one of the 100 most influential people in health and medicine globally by TIME Magazine (The TIME100 Health list) for his work on the link between shingles vaccination and dementia. He is currently trying to raise funds from philanthropy for a large-scale clinical trial of shingles vaccination for dementia prevention. Pascal Geldsetzer, MD Courtesy Stanford Medicine Listen to the Podcast: The podcast of this program will be available Monday, March 9, 2026, after broadcast on March 7. You can stream the show from this site and download the podcast for free. You can also listen to our previous interview with Dr. Geldsetzer. It is Show 1394: Viruses, Vaccines and Alzheimer Disease. Citations Eyting M et al, "A natural experiment on the effect of herpes zoster vaccination on dementia." Nature, April 2, 2025. https://doi.org/10.1038/s41586-025-08800-x Pomirchy M et al, "Herpes zoster vaccination and dementia occurrence." JAMA, April 23, 2025. doi:10.1001/jama.2025.5013 Pomirchy M et al, "Herpes zoster vaccination and incident dementia in Canada: an analysis of natural experiments." Lancet Neurology, Feb. 2026. DOI: 10.1016/S1474-4422(25)00455-7 Oleszko M et al, "Herpes zoster vaccination: Insights into efficacy, safety, and guidelines." Vaccines, April 28, 2025. DOI: 10.3390/vaccines13050477 Tang E et al, "Recombinant zoster vaccine and the risk of dementia." Vaccine, Feb. 5, 2025. DOI: 10.1016/j.vaccine.2024.126673 Xie M et al, "The effect of shingles vaccination at different stages of the dementia disease course." Cell, Dec. 11, 2025. DOI: 10.1016/j.cell.2025.11.007  

Obesity is a big problem in the US. The National Institute of Diabetes and Digestive and Kidney Diseases says 2 out of every 5 American adults are obese. What's more, one in three is overweight, with only about 25 percent of us at a healthy weight. It's not just adults; children are increasingly suffering weight problems as well. In this episode, we ask why we eat too much and what we can do about it. 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. Why We Eat Too Much: Excess weight puts people at risk for premature death from cardiovascular disease, kidney problems and diabetes. Unfortunately, the standard advice from physicians to eat less and exercise more hasn't often been very helpful. That's because it doesn't take into account the reason we eat too much: we are hungry. There are at least three different types of hunger that we need to consider, though. Most people are familiar with homeostatic hunger. If you haven't eaten for hours, your stomach may grumble and complain. There is also hedonic hunger–eating because something tastes delicious. That's why you can usually find room for dessert, regardless of how much dinner you've eaten. Hedonic hunger is often linked to emotional eating because you feel bored or stressed or depressed. The third type of hunger is conditioned hunger. Think of Pavlov's dogs, who learned to salivate in expectation of food when they heard a bell. Some people react much the same way when they hear a dinner bell, or when lunchtime arrives, or when they get in the car. If you are accustomed to eating then, you'll expect food and become disappointed if it isn't available. But conditioned hunger can be addressed by deliberately changing your patterns. Set up the environment so the food is not so readily available at the times you have become conditioned to eat. Hedonic hunger yields best to figuring out the emotional basis for why we eat too much: boredom, stress, some other feeling. What other activities can help you cope with those feelings? For some people, it might be going for a walk. Others might find a different approach more helpful. How Do Weight Loss Drugs Make Us Not Eat Too Much? The most popular drugs on social media and in ads lately are the GLP-1 receptor agonists. That's a fancy name for weight loss drugs like semaglutide (Wegovy) and tirzepatide (Zepbound). These medicines blunt the reward center in the brain that responds to food and drives some people to eat too much. They do that by mimicking satiety hormones, essentially telling our bodies "You've had enough." They work pretty well for most people, at least in the short term. However, unless people retrain themselves regarding eating cues (for conditioned hunger) or emotional needs (for hedonic hunger), they are likely to gain the weight back when they stop taking the medication. For homeostatic hunger, making sure to get adequate protein and fiber in every meal can help. That tactic might not be very useful for hedonic hunger, though. Are you addicted to ultra-processed foods? That can be a challenge. On the other hand, many people who are addicted to nicotine do find ways to overcome that addiction. It is possible to overcome junk food addiction, too. Dr. Fung describes his patient Harry who used fasting, eating carbohydrates last instead of first in the meal, along with some acid such as vinegar, and was successful in losing weight and feeling better. The most important thing Harry did was to use social support from his friends. Social and environmental factors are critical in the development of obesity, so they are also paramount in overcoming it. Practical Advice to Help Us Not Eat Too Much: How do you stock up on what you need and avoid what you don't need at the supermarket? The usual advice is to shop the perimeter, where the fresh food like vegetables, fruit, eggs, meat and dairy products are located. The ultra-processed stuff is usually in the center aisles. You also want to read labels. If that food has ingredients you can't pronounce, you might want to put it back on the shelf. Later, you can look it up and learn if it is something you want to put in your body. Using Intermittent Fasting: Intermittent fasting can be a helpful tool, especially if you approach it as an opportunity rather than with a deprivation mindset. There are many ways to fast. Some people use time-restricted eating, eating only during the first 8 hours of the day, for example. Some skip eating every other day. It is helpful for the body to have an opportunity to burn fat from its stores. This can help regulate insulin as well as contribute to weight loss. We spoke with Dr. Fung shortly before publication of the Cochrane Collaboration's review of intermittent fasting. These experts found that in randomized control trials, intermittent fasting is no more effective than counting calories (Cochrane Database of Systematic Reviews, Feb. 16, 2025). We are sorry we didn't get to ask him about this. Dr. Fung's Three Golden Rules for Weight Loss: The first is simple, if not so easy: don't eat ultra-processed foods. The second: give your body an adequate fasting period every day. That might be at least 12 hours, but it could be longer. Each person may need to find their own "sweet spot." Finally, find or create a social environment that will allow you to succeed. Hang out with people doing something you enjoy that is not centered on eating. This Week's Guests: Dr. Jason Fung is the New York Times bestselling author of multiple critically acclaimed science and health books including The Obesity Code, The Diabetes Code, The Obesity Code Cookbook, The Diabetes Code Cookbook, The Diabetes Code Journal, and The Hunger Code. Dr. Fung is a Canadian nephrologist and co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity. Jason Fung, MD, author of The Hunger Code His most recent book is The Hunger Code: Resetting Your Body's Fat Thermostat in the Age of Ultra-Processed Food. 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).

Most medical interventions are either pharmacological–prescribe a drug–or surgical–remove or repair the offending body part. If those approaches are inappropriate, doctors long for a different technology. In this episode, we discuss the development of a relatively new noninvasive technology, focused ultrasound. Doctors use it to treat conditions such as Parkinson disease or essential tremor. It may also be used for tumors in other parts of the body. 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. Using Focused Ultrasound: Most people are familiar with ultrasound being used as a diagnostic tool. They also know about using a magnifying glass to focus a ray of sunlight. With the proper technique, this could light a small fire. In focused ultrasound, the surgeon uses an acoustic lens to target ultrasound waves very precisely inside the body. Dr. Neal Kassell, our guest expert in this episode, is a neurosurgeon. He has used focused ultrasound primarily to treat brain tumors. Treatments require from several hundred to several thousand ultrasound waves. But doctors have used focused ultrasound to treat over 180 medical conditions. Regulatory authorities around the world have approved its use to treat 35 different conditions. The first to get such approval was uterine fibroids. This technology has been used to offer noninvasive interventions for 22 years. Now, people with Parkinson disease could choose focused ultrasound as an alternative to deep brain stimulation. There are approximately 250 sites in the US that are able to offer this technology to patients. How Focused Ultrasound Works: Dr. Kassell described how ultrasound works for problems as dissimilar as liver tumors or essential tremor. There are multiple mechanisms, but scientists have concentrated on three: First, the beams of ultrasound generate heat that can destroy tissue where they are focused. So, tumor or tissue destruction is the first mode of action. Second, ultrasound involves the use of very tiny bubbles. These can be created to hold drugs. If a doctor were treating cancer, that might be a chemotherapeutic agent. But rather than exposing the entire body to the same level of medication, with focused ultrasound the microscopic bubbles trap the drug and release it only when exposed to the targeted beams. That means a high concentration of medicine where it is needed and very low concentrations elsewhere. Third, focused ultrasound appears to have an impact on the immune system. As a result, patients being treated with immunotherapy such as Keytruda get a much better result when it is combined with focused ultrasound. This approach has been shown to improve the response rate. Adopting Focused Ultrasound May Lag: Doctors and healthcare systems have customary patterns of practice, referral and reimbursement. Introducing focused ultrasound into the mix may disrupt these. Insurance companies might save money over the long run if they covered this long-lasting intervention. Perhaps they will find before long that they get a better outcome for a lower cost. Where focused ultrasound is finding more purchase is among veterinarians treating companion animals (dogs and cats) who also suffer from hard-to-treat malignancies. With the OneHealth approach, veterinary medicine shares what it learns from such treatments with healthcare providers treating humans. One might not imagine essential tremor as responding to this type of treatment, but 25,000 patients have already been cured. This entails separate treatments on two different sides of the brain, with the sessions separated by six to nine months. The durability of the effect is very good. Bobby Krause Describes His Patient Experience: Bobby Krause was dismayed to be diagnosed with young-onset Parkinson disease at the age of 42. The drugs his doctors prescribed had intolerable side effects, and he felt depressed at not being the father he wanted to be for his young sons. He was excited to learn that focused ultrasound treatments have been delivered to about 30,000 Parkinson disease patients around the world. At least 75 percent have experienced significant improvement that lasts at least five years. Although he was not eligible for the first clinical trial he heard about, he jumped at the chance to be treated a few years later at the University of Pennsylvania. In 2022, his doctors delivered three sonication treatments in one day. The results were amazing; among other visible effects, he regained an inch of height that had been compromised by the tight spasms of his back muscles. This is a story you will want to hear! This Week's Guests: Neal F. Kassell, MD is the founder and chairman of the Focused Ultrasound Foundation. https://www.fusfoundation.org/ This is a unique medical research, education, and advocacy organization created as the catalyst to accelerate the development and adoption of focused ultrasound and thereby reduce death, disability, and suffering for patients. He was a Professor of Neurosurgery at the University of Virginia from 1984 until 2016 and the co-chairman of the department until 2006. He has contributed more than 500 publications and book chapters to medical literature and is a member of numerous medical societies in the United States and abroad. In April 2016, Dr. Kassell was appointed by Vice President Joe Biden to the National Cancer Institute's Cancer Moonshot Blue Ribbon Panel. Dr. Neal Kassell, director of the Focused Ultrasound Foundation Bobby Krause is the founder of the Be Still Foundation, a nonprofit dedicated to empowering patients and families affected by Essential Tremor and Parkinson's disease. Inspired by his own journey with tremors, Bobby champions awareness, advocacy, and financial support for life-changing treatments like Focused Ultrasound, helping restore hope and dignity to those in need. https://youtu.be/LWOEwfcmLzk?si=hsB78j1BixZXBplY Bobby Krause, director of the BeStill Foundation

Medicine has changed enormously over the last several decades. As with other parts of society, digital technology has disrupted previous practices. Clinicians can now care for patients at home, monitoring them with sophisticated sensors for oxygen saturation, heart rhythm, blood pressure and much more. Even more significant, patients now have greater access to medical knowledge as well as to the state of their own bodies, measured through wearable tools such as smart watches or continuous glucose monitors. With the internet, they can connect with patient groups that offer valuable information as well as emotional support. Find out how patients are using technology to heal healthcare.   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 Technology Is Transforming Healthcare: When we spoke with Dr. Marschall Runge, we reminisced about the changes in medical care that have taken place since the time of his grandfather, a general practitioner. There is quite a contrast. While his grandfather made house calls, few doctors today would do so. However, some very modern medical centers now offer patients the option to recover at home from a major procedure. Dr. Runge describes his personal experience with at-home recovery following hip replacement surgery. The clinical staff was able to keep close tabs on his progress with the help of a variety of monitors, and a nurse was available to answer questions or provide advice until he was back on his feet. There are distinct advantages to the patient to be able to recover at home; among other things, he could sleep much better in his own bed.   What other digital technology will healthcare employ? One possibility is using AI conversational agents to assist with differential diagnosis. Some devices can detect depression based on a patient's speech. Others can pick up heart rate variability, an important parameter of heart health. Dr. Runge does not expect that robots will replace doctors. They could be very helpful in certain situations, though. How Patients Are Using Technology: We turn next to Susannah Fox, author of Rebel Health. She has been studying how patients are using technology to improve their health for decades. We first met Susannah through our mutual friend, Dr. Tom Ferguson. He was a staunch advocate for self-care and excited about the prospects for the internet. (His white paper, "e-Patients: How they can help us heal health care" is a classic. Look for it at the website of the Society for Participatory Medicine.) Not only do patients everywhere now have access to PubMed (the National Library of Congress), they can also connect with each other. Peer-to-peer advice and care is a topic Susannah knows well.   In some cases, patients have conducted research that is focused on the questions crucial to their lives; these are not always the same things that researchers want to study. One shining example of patient-initiated research is a paper in Nature on long COVID by the Patient-Led Research Collaborative (Nature Reviews Microbiology, April 17, 2023; initial publication Jan. 13, 2023).  This paper has been downloaded 2 million times, illustrating the value of patient-led research.   In addition to this outstanding example, some journals have adopted a policy of disclosing patient input into the research. Although very few studies report patient input, setting the expectation that they might make valuable contributions could help shape the perception of who ought to be involved in developing research protocols. Patients Using Technology to Access Medical Knowledge: PubMed is an impressive collection of published medical information because it is an online index of important research publications. Some of the journal articles could be difficult for patients to understand, however, as researchers are writing for other scientists and may often use specialized or complicated language. Now people are using LLMs like ChatGPT or Claude to summarize the articles in language they can understand. Indeed, these AI agents can translate articles into a different language if necessary for comprehension. With this technology, patients are better able to determine if their diagnosis makes sense and to search for potential interventions that might be useful in their specific case. Imbalances of Power and Attention: Despite these changes, there are still many medical systems that resist potential input from patients. Power is not evenly distributed, and Susannah Fox has found that many people are furious about it. We asked her to describe the schematic from Rebel Health that epitomizes where most attention is needed. It has two axes, one running from visible to invisible and the other from needs not met to needs met. A lot of medical care is devoted to the upper right quadrant–visible needs that are being met. The lower left quadrant, where the needs seem invisible and are not being met, is where patient frustration comes to a head. Rare diseases often fall into this category. Researchers and physicians need to know about patients' lived experiences so that invisible needs not being met can be addressed. Using Technology to Repurpose Old Drugs: One of the ways in which AI is contributing to important changes in medical care is the search for medicines that can treat inadequately treated diseases. Susannah Fox praised the efforts of Dr. David Fajgenbaum, whose EveryCure organization is using AI to uncover how old drugs can be used to treat cancers, rare diseases, immunologic disorders and other problems that don't yet have effective standards of care.   Other patients who are showing the way to using AI for improving patient experience and patient health are Dave deBronkart (epatient Dave) and Hugo Campos. They have found that using an agent like ChatGPT in a dialog can help them move forward a lot more quickly in solving patient problems. Online Prescribing and Dispensing: Around the turn of the 21st century, Joe and Dr. Tom Ferguson had a heated ongoing disagreement about the concept of online prescribing. Tom was enthusiastic and Joe was skeptical, to say the least. Susannah Fox weighs in on this argument supporting Tom's side at this point. With wearables like smart watches or continuous glucose monitors to track important markers of health, we see some patients using technology to follow up on how well their prescriptions are working, regardless of whether they were prescribed in the office or online.   We also asked Susannah to provide advice for how we can successfully advocate for our own health. Her most important nugget: ask good questions! Clinicians appreciate good questions that help them re-think the patient's situation or explain it more clearly. This Week's Guests: Marschall S. Runge, M.D., Ph.D., is the former executive vice president for Medical Affairs at the University of Michigan, dean of the Medical School, and CEO of Michigan Medicine. During his tenure in these leadership roles, Dr. Runge implemented transformative change and positioned Michigan Medicine and the Medical School internationally for continued success. He earned his doctorate in molecular biology at Vanderbilt University and his medical degree from Johns Hopkins School of Medicine, where he also completed a residency in internal medicine. He was a cardiology fellow at the Massachusetts General Hospital. Dr. Runge is the author of The Great Healthcare Disruption: Big Tech, Bold Policy, and the Future of American Medicine Marschall Runge, MD, PhD   Susannah Fox helps people navigate health and technology. She served as Chief Technology Officer for the US Department of Health and Human Services, where she led an open data and innovation lab. Prior to that, she was the entrepreneur-in-residence at the Robert Wood Johnson Foundation and directed the health portfolio at the Pew Research Center's Internet Project. She is the author of Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. Her website is https://susannahfox.com/ Susannah Fox, author of Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care   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).  

In this episode, we interview the doctor who first identified seasonal affective disorder (back in 1984!) and went on to develop treatments. Even when days are short (but getting longer, little by little) and skies are gray, you don't have to suffer with a bleak outlook. Find out what you can do to counteract this common but serious problem. 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. One of the most effective treatments for SAD and the similar but less severe winter blues is bright light therapy. Not all sufferers respond to light therapy alone, however. Dr. Rosenthal describes the additional approaches that improve people's response. 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 November 13, 2023. What Is Seasonal Affective Disorder? By now, many people are aware that some individuals have a hard time with short days and long nights. Their appetites and sleep patterns may change, and they may retreat from social activities because they can't get energized. They have trouble concentrating and may become irritable. It's as if they get depressed every year at the same time, on cue. Psychiatrists estimate that about 5 percent of the population experiences seasonal affective disorder, or SAD. That could be as many as 10 million Americans. At times, physicians may prescribe antidepressants, but usually the treatment that works best for SAD is light. Evidence suggests that the lack of sunlight, especially when someone feels stressed, is a prime trigger for seasonal affective disorder. Is SAD Linked to Latitude? The further from the equator you get, the more pronounced are seasonal differences in daylight. Think of a place above the Arctic Circle, for example, like Tromsø, Norway. In the summertime, they celebrate the midnight sun. In the winter, however, people in Tromsø see very little daylight. Unless they are uncommonly resilient, they could be susceptible to SAD. Light for Seasonal Affective Disorder: The principal treatment for SAD is light therapy, usually utilizing a light box. This must be a minimum of one foot square and supply at least 10,000 lux. That is the equivalent of being outside on a cloudy day. Generally, the prescription is for 20 to 30 minutes of exposure every morning. People who would rather not use a light box might be able to spend that time outdoors under the dome of the sky. A roof, awning or umbrella would undermine the treatment. Approximately 30 to 40 percent of people with seasonal affective disorder do not respond completely to light therapy. They need additional help beyond light exposure alone. Exercise has been shown to benefit them, especially if it is conducted outside. Cognitive behavior therapy is also extremely helpful, as is meditation. Lastly, people with SAD may want to pull back from their usual social activities. If they can maintain their social connections, this is very therapeutic in the effort to defeat seasonal affective disorder. The Autumn Checklist for Defeating Seasonal Affective Disorder: Those who know that they often experience SAD should get ready before winter. Dr. Rosenthal recommends addressing the following questions: 1. Have I purchased a light box for the winter? 2. Do I have at least one bright, inviting room in my home? 3. Have I made plans for at least one winter vacation in the sun? 4. Should I check in with my doctor since I am entering my season of risk? 5. Have I notified close family members and friends that I may need extra support? 6. Do I have a physical fitness program in place? (It's easier to keep exercising than to start.) 7. Could I reframe my attitude and look at winter as a challenge instead of an affront? 8. How can I find beauty in the colorful season of autumn, here and now? Although Dr. Rosenthal doesn't mention it, perhaps noticing signs of spring could instill hope. Our yard in North Carolina has both snowdrops and hellebores blooming in January, reminding us that spring blossoms will start up before too much longer. This Week's Guest: Norman E. Rosenthal, MD is a psychiatrist and scientist who first described SAD in 1984 and pioneered light therapy as a treatment. Dr. Rosenthal is currently Clinical Professor of Psychiatry at Georgetown University School of Medicine. Dr. Rosenthal is the author of several books, his most recent being Defeating SAD (Seasonal Affective Disorder): A Guide to Health and Happiness Through All Seasons His website is https://www.normanrosenthal.com/about/ Dr. Norman E. Rosenthal, author of Defeating SAD

Inflammation is a double-edged sword. When you have a sudden injury or infection, your body responds by calling immune cells to the site of the problem. It may become red, swollen and painful, but all that is supposed to be part of the healing process. What happens with chronic inflammation is more insidious. Many serious diseases, such as diabetes, depression or heart disease, feed off chronic inflammation. Anti-inflammatory drugs can control the problem temporarily, but they have drawbacks if they must be used continuously. How can we go about calming chronic inflammation without medication? 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 Inflammation Works: One of the hallmarks of modern life is the impact of stress on the digestive tract. Excess weight, unrelenting stress and environmental toxins can all contribute to an immune system that goes into overdrive. Sometimes the consequence will be an imbalance in the microbiota, with the result that the tight junctions of the gut are disrupted. That can lead to "leaky gut," more respectably termed "intestinal permeability." When pathogens or toxins that should be confined to the gastrointestinal tract start circulating elsewhere, the immune system reacts. If the process continues, the consequence is chronic inflammation. Are there natural approaches to calming chronic inflammation? Calming Chronic Inflammation: When we want to help our immune system so that it doesn't have to be hypervigilant all the time, we should start with our diet. If dysbiosis contributes to leaky gut and inflammation, the best approach might be to feed our gut microbes what they need. In most cases, that means increasing our fiber. Gut microbes thrive on fiber, and most Americans don't get close to eating enough. Another important aspect, of course, is to avoid foods that might cause trouble. According to Dr. Low Dog, fructose degrades tight junctions in the intestines and could contribute to intestinal permeability and inflammation. To reduce fructose, we just need to cut back on sweets Finding Fiber in our Food: Where can we find fiber in our diet? Starting with breakfast, a lot of folks enjoy cold cereal, pancakes or pastries. There's not much fiber in any of those, unless you've chosen bran cereal. But even a choice as simple as eating an apple with the skin on can provide a good amount of fiber. Do you like salmon for breakfast? That's a very anti-inflammatory choice. One worrisome development is the spread of microplastics throughout our diet. As a result, most of us have microplastics in our bodies. Some of the compounds in these little particles of plastic are endocrine disruptors that contribute to inflammation. Maintaining Healthy Barriers: The colon is not the only part of the digestive tract that provides an important barrier. The mouth is also susceptible. Brushing, flossing, dental care and a low-sugar diet are important steps to protecting our bodies against chronic inflammation. Periodontal disease contributes in a major way. To maintain good tight junctions, we need to eat about 20 grams of insoluble fiber and 8 grams of soluble fiber daily. Beans and vegetables are great sources of both. Nuts and seeds like sunflower seeds or walnuts are also good sources. So are whole grains. And if we have any trouble reaching our fiber goals with diet, there is nothing wrong with adding a daily dose of psyllium, which is mostly soluble fiber. It lowers cholesterol and can reduce the risk of diabetes as well as promote regularity. Herbs to Ease Inflammation: In addition to paying attention to a high-fiber anti-inflammatory diet, we can benefit by using certain herbs or spices to calm chronic inflammation. Green tea, garlic, onions, hot peppers and other flavorings all have anti-inflammatory power. Turmeric, the yellow spice in curry, is a potent anti-inflammatory. To get the best benefit from adding turmeric to food, it should be used to spice a meal with some fat in it. Black pepper as part of the spice profile also helps with the absorption of compounds from turmeric. Dr. Low Dog cautions us all to vet our turmeric carefully, though. Some brands are high in lead. She suggests that Simply Organic and McCormick are both brands that were relatively free of lead when tested by ConsumerLab.com or Consumer Reports. One supplement that may be unfamiliar to most listeners is nattokinase. It is derived from natto, a fermented soybean dish that is very popular in Japan. People who are taking anticoagulants should probably avoid nattokinase, even though it has anti-inflammatory activity. It could interact with anticoagulants and increase the danger of bleeding. We would add that precaution should also hold for curcumin supplements derived from turmeric. They should not be taken by anyone on an anticoagulant. Other Natural Approaches to Calming Chronic Inflammation: When we asked Dr. Low Dog about her favorite way to calm chronic inflammation, she mentioned walking in nature. High cortisol levels drive chronic inflammation, but green spaces reduce stress and help bring cortisol down. Other marvelous approaches include seeking out ways to embrace contentment and joy and humor. For some people, that will mean meditation. For others, it will mean hanging out with good friends or going for a run. Nourishing our mental and spiritual health with art and poetry help connect us with meaning and purpose in our lives. 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. Tieraona Low Dog, MD, author of Fortify Your Life 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 is eBook is Healing Heartburn Naturally. Physical copies are available for purchase via Amazon: Click here.
Her websites are drlowdog.com and https://www.medicinelodgeranch.com/ 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).

One of the most basic pillars of health is good nutrition. A range of eating patterns might all be considered balanced diets, but in general people do better when they eat less processed foods and more whole foods. Vegetables and fruits play a starring role in at least two diets that have been studied extensively, the DASH diet and the Mediterranean diet. Americans might be healthier if we followed these eating plans, but fresh veggies can be pricey. If your doctor were prescribing produce, would your insurance plan cover it? Might this make healthful eating more of a practical possibility? 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. Food Is Medicine: Increasingly, healthcare providers are recognizing the critical role of diet in the development of chronic disease. An entire movement is organizing around the concept of Food Is Medicine, both for prevention and for treatment of conditions like diabetes, obesity and heart failure. Scientists have shown that diet makes a difference. Studies have confirmed what many of our grandparents or great-grandparents intuited. On the other hand, translating that knowledge into action that benefits patients has been difficult. One important barrier is the cost of fresh fruits and vegetables. Doctors Prescribing Produce: People could get healthful food in a variety of ways. Past generations often had gardens and grew much of their own produce. That's not always practical in urban settings or for families with multiple jobs struggling to make ends meet. Our guests today have tested two ways to get fresh food into people's hands. One is a debit card that can be used to buy any WIC-approved food at more than 66,000 retail outlets across the country. WIC is the USDA supplemental nutrition program for Women, Infants and Children. WIC-approved foods include fresh fruits and vegetables with no added sugar or salt. In this model, the healthcare provider arranges for certain patients to get access to this debit card, providing $40 worth of purchasing power for healthy foods each month. They are essentially prescribing produce. The idea is to use a business model that supports good food and saves the health system money. This is termed a healthy food subsidy. The other approach is a food box. This includes vegetables and fruits, and possibly other foods, that providers decide the patients should get. In some initiatives, the person or agency deciding what goes in the food box might also take into account what is available from local farmers. The box may be distributed weekly, every two weeks or every month, but the individual who is going to be eating the food does not choose what is in it. How Does a Healthy Food Subsidy Compare to Food Boxes When Providers Are Prescribing Produce? When people don't know if they will be able to pay for the groceries they need, they are said to be "food insecure." This complicates a range of chronic conditions, making diabetes more challenging, for example. People with food insecurity have a harder time keeping their blood pressure under control. Our guests collaborated with other colleagues on a recent comparing the food box approach to the healthy food subsidy among North Carolina resident with high blood pressure and food insecurity (JAMA Internal Medicine, Dec. 1, 2025). The study enrolled 458 individuals. Everyone in the study had a provider prescribing produce. Half the volunteers got the food subsidy debit card and half were provided with food boxes. Those getting the food subsidy had moderately lower blood pressure after six months compared to those getting food boxes. Their blood pressure was also lower after a year and a half. Food insecurity decreased in both groups over time. Tackling Food Insecurity: One of the outcomes of food insecurity is that people are more likely to need emergency department services. This costs the insurance company dearly. If improving food security and diet quality could reduce ED visits, insurers might become quite interested in the food subsidy approach. This is currently being tested for participants with heart failure. Special Populations Who Might Need Providers Prescribing Produce: During this conversation, we expressed concern about vulnerable populations that might suffer especially from cuts in government spending. We asked about school lunches and we learned about pilot programs focusing on expectant mothers. Children in foster care are especially vulnerable; a food subsidy program taking a Food Is Medicine approach could be helpful for them. This Week's Guests: Seth A. Berkowitz, MD, MPH, is Associate Professor of Medicine at the University of North Carolina School of Medicine. He is also Section Chief for Research, General Medicine and Clinical Epidemiology. Dr. Berkowitz is a general internist and primary care doctor, studying how food and nutrition interventions can improve health. Dr. Berkowitz is the deputy scientific director of the American Heart Association's Food is Medicine initiative, Health Care by Food initiative. He is also the author of the recent book, 'Equal Care: Health Equity, Social Democracy, and the Egalitarian State.' 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). Dr. Seth Berkowitz of UNC promotes Food Is Medicine Peter Skillern has pursued a career dedicated to creatively and effectively addressing poverty and inequality in North Carolina and the nation. He serves as the CEO of Durham-based Reinvestment Partners, an innovative nonprofit that works with people, places and policy to foster healthy and just communities. Reinvestment Partners advocates for financial and health reforms to improve people's lives. The agency has won numerous accolades and is considered a state and national leader in its field. In recognition of his leadership, he was selected as a William Friday Fellow for Human Relations and as an Eisenhower Fellow for International Relations. He holds North Carolina General Contractor and Real Estate Broker licenses. He received his B.A. from the University of California Santa Cruz with Highest Honors. A 1991 graduate of the Department of City and Regional Planning at UNC Chapel Hill, he was recognized as a Distinguished Alumni by the UNC faculty in 2020. Peter Skillern, CEO of Reinvestment Partners

Millions of people are feeling apprehensive these days. The headlines are enough to make almost anyone feel anxious. People who are distressed may have a difficult time finding a therapist, however. There are too few, and consequently many are not taking new patients. Wait lists are long, often three to six months. Therapists who are accepting patients may not take insurance, and therapy can be pricey. A single session of gold-standard cognitive behavioral therapy can cost from $100 to $250. Could AI fill the therapy gap, offering psychotherapy online? 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. Can AI Fill the Therapy Gap? Conversational agents like ChatGPT, Gemini or Claude have become nearly ubiquitous. People use them to help write resumes, pitch stories, create images for web or social media posts and make financial projections. Using these chatbots to give feedback as in therapy is surprisingly popular. But how well can AI fill the therapy gap, really? Today's guest has been studying these interactions. Chatbots as Therapists: The conversational agents are also referred to as LLMs, for Large Language Models. It describes how they have been trained by scouring the internet. That allows them to predict the most likely word to come next in a sentence, or the probable next idea in a paragraph. They can't actually think, but if something has been posted online, they have access to it. At this point, the technology has become so refined that chatbots easily pass the Turing test; it is difficult to reliably distinguish AI from human responses. There are advantages to having "someone to talk to" any time, any place. Younger people in particular are digital natives and often feel more comfortable with technology than face-to-face with a human. What Are the Downsides of Having AI Fill the Therapy Gap? The training of AI agents as therapists, though, gives rise to some serious flaws. Because they are trained to elicit positive responses from humans to keep people engaged, they have a sycophancy bias. Have you noticed that most messages start by telling you your idea is great? That makes you feel good, and you are less likely to quit the conversation. But it isn't necessarily how therapy is supposed to work. If people are not challenged when appropriate, they may get stuck and not make any progress toward healthier attitudes or behaviors. They may fail to develop the critical skill of stress tolerance. In addition, chatbots are disconnected from reality. This could become a serious problem if a user starts to become delusional or is in an acute crisis. Anxiety as a Habit: Dr. Brewer suggests that we would do well to think of anxiety as a habit. He credits a 1985 paper by an investigator named Tom Borkovec suggesting that worry drives anxiety rather than being a mere symptom of anxiety. Worrying leads people to dwell on possible catastrophic outcomes, which understandably makes them more anxious. Treating anxiety as a habit, especially by finding a better reward than the illusion of control offered by worrying, could be effective. Responding with curiosity and kindness might offer a better outcome. He has studied this possibility. When you treat anxiety as a habit that can be changed, anxiety scores decline by 67%. That is quite impressive. Using Chatbots to Kick the Worry Habit Could Help AI Fill the Therapy Gap: One way to use AI effectively is to train conversational agents specifically to monitor for safety in other human-chatbot interactions. Given clear rules, they can do this very well. Also, chatbots could be used not so much as teaching assistants but as learning assistants. They could help people who are striving to change their anxiety habit. This might be integrated with video tutorials from an expert human, such as Dr. Brewer or one of his colleagues. They are testing this approach currently. Hopefully, it will prove more effective than the 20% response rate to SSRI medication for anxiety. This Week's Guest: Jud Brewer, MD, PhD, is an internationally renowned addiction psychiatrist and neuroscientist. He is a 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 more than 20 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, the New York Times best-seller, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind, and his latest book is The Hunger Habit: Why We Eat When We're Not Hungry and How to Stop. You can find more information on the skills-based program for anxiety that Dr. Brewer developed at www.goingbeyondanxiety.com Judson Brewer, MD, PhD, Brown University, author of Unwinding Anxiety 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).

Influenza usually starts in November, and cases increase throughout the winter, not fading until March or so. This year's flu season is especially severe. An awful lot of people are suffering with fever, cough, congestion, body aches, headaches and other symptoms of influenza. Of course, flu is not the only infection out there. Other viruses are also causing sniffles, coughs and pure misery. Is there any way to strengthen your immune system to be ready for cold and flu season? 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 to Strengthen Your Immune System: If you want to strengthen your immune system so it can fight off infections, the first rule is don't get in its way! In today's world, that is easier said than done. Drugstores are full of cold and flu remedies, and nearly all of those contain an ingredient designed to lower fevers. That is generally counterproductive. Fevers help the body in its battle against infection. In fact, you might want to induce a fever responsibly. Using Heat to Fight Flu: Numerous cultures have noted that people recover from respiratory infections like influenza more quickly if they are exposed to heat. They have developed myriad ways to accomplish this task. One that is accessible to most North Americans is hydrotherapy: application of heated, wet towels to the body for 20 minutes or so, followed by a brief exposure to cold such as a chilled-mitt rubdown. Take care not to burn the skin. Our guest, Dr. Roger Seheult, suggests that you can learn more about this approach from Bruce Thompson, an Australian physiotherapist whose website is https://www.traditionalhydrotherapy.com If hot wet towels do not appeal, getting into a sauna or even a hot tub for a short session might help. Pay attention to any contraindications, though. Above all, don't take medicines such as aspirin, ibuprofen, naproxen or acetaminophen. When they lower your fever, they are also reducing the effectiveness of interferon, which is one of the innate immune system's first lines of defense against viral infection. The widespread use of aspirin during the 1918 flu may have contributed to the horrifying death toll. Other Drugs That May Cause Trouble: Fever is not the only consideration. Many people now take powerful medicines to suppress their immune systems. These treatments alleviate the symptoms of autoimmune conditions such as Crohn's disease, ulcerative colitis, psoriasis, rheumatoid arthritis and eczema. Helpful as they are, though, they work in part by undermining the immune system. People on any of these meds are at higher risk for infection, and that is not good news during a bad flu season like this one. This might be a situation that calls for wearing an effective mask, such as an N95, when going out in public. Strengthen Your Immune System with NEWSTART: Paying attention to eight pillars of good health can help you strengthen your immune system. Dr. Seheult has offered a mnemonic he learned from a colleague, Dr. Neil Nedley of the Weimar Institute: NEWSTART. Let's find out what it stands for. Nutrition: Packing your diet with vegetables, fruits, whole grains and minimally processed proteins is smart prevention to strengthen your immune system any time of year. If you come down with the flu, you might want to consider chicken soup loaded with garlic. Garlic might be a good preventive measure also, while hot chicken soup can temporarily ease congestion and other symptoms. Nutritional supplements may also be worth consideration. Dr. Seheult cited a systematic review in the BMJ Global Health (Jan. 2021).  The authors found that vitamin D modestly reduced the risk of acute respiratory infections and shortened the duration of symptoms. So did vitamin C. Zinc supplements, on the other hand, did not prevent infection but they significantly shortened the duration. Zinc is most effective taken as a lozenge that dissolves gradually in the mouth rather than swallowed at once in a tablet. Dr. Seheult also uses N-acetylcysteine (600 mg twice daily) during cold and flu season to help his immune system stay effective. It has been shown to reduce inflammation in lung infections (International Journal of Molecular Sciences, March 15, 2025). He is also a fan of topical eucalyptus, a compound found in Vicks VapoRub and certain other products. You can recognize it from the aroma. Exercise: E is for exercise. Regular physical activity is a critical pillar of good health. If you are suffering from an acute infection like flu, though, give your body a break for a bit. Exercising to exhaustion is not a winning strategy when you're exhausted by flu before you even start. Water: Hydration is super important during influenza season. We've already described how to use water to raise the body temperature responsibly. That is one way to strengthen your immune system while you are fighting an infection. Drinking enough water when you have a fever is also crucial so that you don't get dehydrated. Sunlight: Morning exposure to sunlight helps keep the immune system in tune. Ideally, we would all have bright days and dark nights. Living indoors with artificial lighting means few of us meet that ideal. Nonetheless, getting sun exposure as possible, even just face and hands in northern areas, can be helpful. Among other things, it helps regulate natural production of melatonin. Mitochondria exposed to sunlight, especially infrared lengths, make their own essential melatonin. Temperance: This is not a term we use much any more, though it was once quite popular. It simply means moderation; more explicitly, it urges refraining from alcohol, tobacco and other toxins. We have explored some common toxins in other shows. Air: Florence Nightingale insisted on fresh air in hospitals. We should be equally adamant about having fresh air in our homes. Adequate ventilation significantly cuts the risk of infection with flu. We wish everyone paid more attention to this pillar. Rest: Getting enough sleep is an essential step to strengthen your immune system. But rest implies more than enough sleep. It also means rest and recharging with a weekly reset. Practicing the sabbath, whether within a religious context or a secular one, is a sound idea for maintaining good mental and physical health. Trust: This final piece of the NEWSTART mnemonic refers to social connections. Do you have a person you can trust? Are you a person someone else can trust? Being engaged in a social network that supports you is as important as exercise and nutrition for keeping your immune system healthy. 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 Listen to the Podcast: The podcast of this program will be available Monday, Jan. 12, 2026, after broadcast on Jan. 10. You can stream the show from this site and download the podcast for free. In this week's episode, we discuss the research suggesting that using Astepro, an OTC nasal spray, can reduce the risk of contracting COVID-19. Dr. Seheult also shares his vision of the innate and adaptive immune system working together in harmony like an orchestra.

This week, we dig into the cooking oil controversy. For decades, we've heard that we should be using vegetable oils rather than butter, lard or other fats (possibly even olive oil). Oils from corn, soybeans, sunflower or safflower seeds are rich in polyunsaturated fatty acids. Consequently, people consuming them may have lower cholesterol levels than those primarily using saturated fats. But could there be a downside? We hear from scientists who have found these seed oils may be linked to certain cancers. The Cooking Oil Controversy: The more we learn about fats, the more it seems that focusing on just one aspect may be too simplistic. In the 1990s, health experts told Americans to avoid all fat. When it became clear that low-fat diets were not necessarily making everyone healthy, we got the message that we needed to stick with polyunsaturated fatty acids (PUFAs) like those in corn or canola oil. There are, however, different types of PUFA. Chemists classify them as omega-3, omega-6 and omega-9 fatty acids. Only omega-3 and omega-6 are considered essential fatty acids. Current cooking oils have a preponderance of omega-6 fatty acids. As a result, the ratio of omega-6 to omega-3 in our blood has risen from a pre-industrial average of an estimated 4:1 to our current ratios of 20:1 (Missouri Medicine, Sep-Oct. 2021).  This could have biological consequences. Dietary Fat and Cancer: Dr. William Aronson has asked how different types of dietary fat affect the progression of prostate cancer. Laboratory studies show that a diet high in corn oil accelerates the growth of human prostate cancer tumors implanted under the skin of mice. That inspired him and his colleagues to conduct a randomized controlled trial (Journal of Clinical Oncology, Dec. 13, 2024). Fish Oil vs. Prostate Cancer: For their trial, they recruited 100 men diagnosed with prostate cancer who opted for active surveillance rather than immediate surgery or radiation. They assigned these volunteers to different diets for one year. One group followed their usual diet and did not take fish oil. The researchers instructed the other group in avoiding omega-6 fats in their diet, increasing the amount of omega-3 rich fish and taking fish oil supplements. Minimizing omega-6 fats meant staying away from fried foods, cooking oils, bottled salad dressing and mayonnaise. At the end of the year, there was a significant difference in an important prostate cancer biomarker called Ki-67. Does the Cooking Oil Controversy Extend to Other Cancers? We spoke with Dr. Timothy Yeatman about his research on colorectal tumors. His research was published in Gut, a leading journal for gastroenterologists (Dec. 20, 2024). He and his colleagues used a technique called lipidomics for their analysis. They found that the lipid profile of the tumors and their micro-environments is pro-inflammatory. They seem to lack the resolving mediators ("resolvins") that should normally accompany healing. The balance has been disrupted. Dr. Yeatman suspects that some of this disruption may be due to changes in the microbiome that constitutes a lot of the immediate environment for colorectal tumors. He suggests that extensive use of seed oils high in pro-inflammatory omega-6 fatty acids may contribute to the imbalance. You can find soybean oil, for example, in many foods where you might not expect it, such as breads, cakes, cookies, crackers, chips and even hummus. Cooking at home allows people to avoid seed oils, but it takes time, skills and resources that are not available to everyone. Can We Resolve the Cooking Oil Controversy? Neither of the studies we discuss during this episode is definitive. Scientists need more research to be able to make solidly evidence-based recommendations. However, both our guests would suggest we need not wait for the final word to reduce the inflammatory potential of our diets. Reading labels carefully is a good first step to avoiding some of the seed oils that provide excess omega-6 fats and gravitate more toward omega-3 fats. This Week's Guests: William Aronson, MD, is Professor in the Department of Urology of the David Geffen School of Medicine at the University of California, Los Angeles. He is also Chief of Urologic Oncology at the West Los Angeles Veterans Affairs Medical Center and Chief of Urology at the Olive View-UCLA Medical Center. Dr. William Aronson, UCLA Timothy Yeatman, MD, FACS, is Professor in the Dept of Surgery at the University of South Florida. He is also Associate Center Director for Translational Science and Innovation Tampa General Hospital Cancer Institute. His website is https://phenomehealth.org/c-suite/tim-yeatman-md-facs Timothy Yeatman, MD, University of South Florida Debora Melo vanLent, PhD, is Assistant Professor at the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health in San Antonio, TX. Her interview is part of the podcast. Listen to the Podcast: The podcast of this program will be available Monday, March 3, 2025, after broadcast on March 1. 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 also includes our discussion with Dr. Melo vanLent on her research into the link between dietary inflammation and dementia. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify. Citations DiNicolantonio JJ & O'Keefe J, "The importance of maintaining a low omega-6/omega-3 ratio for reducing the risk of autoimmune diseases, asthma, and allergies." Missouri Medicine, Sep-Oct. 2021. Aronson WJ et al, "High omega-3, low omega-6 diet with fish oil for men with prostate cancer on active surveillance: The CAPFISH-3 randomized clinical trial." Journal of Clinical Oncology, Dec. 13, 2024. DOI: 10.1200/JCO.24.00608 Soundararjan R et al, "Integration of lipidomics with targeted, single cell, and spatial transcriptomics defines an unresolved pro-inflammatory state in colon cancer." Gut, Dec. 20, 2024. DOI: 10.1136/gutjnl-2024-332535  

This week, our guest discusses how to prevent and treat a surprisingly common condition, chronic kidney disease. One in three Americans faces the risk factors for kidney disease; one in seven is actually living with the condition, although they may not be aware of it. 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. Could Your Kidneys Be Failing? According to the CDC, 36 million American adults have some form of chronic kidney disease. There are six stages of this condition, with stages 1 and 2 so mild that they don't warrant treatment. Doctors start paying attention to stages 3a and 3b. Dr. Emily Chang describes how kidney disease is diagnosed and why we need to pay attention. In the earlier stages, kidney disease does not cause symptoms, so doctors rely on blood and urine tests to monitor function. What Do Your Kidneys Do? Most people are aware that the kidneys produce urine, primarily by filtering the blood and removing chemicals that are not needed. However, the kidneys also have numerous other functions that are critical for our health. They are vital to blood pressure control, and they regulate hormones essential to the preservation of bone strength. Main Risk Factors for Kidney Disease: We wondered why the rates of chronic kidney disease are increasing. The answer is fairly simple. More people have one or more of the factors that increase a person's probability of experiencing kidney problems. These include high blood pressure and diabetes. In addition, there are numerous medications that can contribute to trouble for your kidneys. Just imagine how many of us take an NSAID such as ibuprofen or naproxen multiple times a week. That can put a significant strain on the kidneys. If ibuprofen upsets your stomach–as it could–you might turn to a PPI such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications can also pose challenges for the kidneys. "Sick Day" Meds: In general, blood pressure medicines are a help to the kidneys, because blood pressure control is so important. But certain blood pressure meds, especially ACE inhibitors like lisinopril or ramipril or ARBs like losartan or irbesartan, are considered "sick day meds." They should not be taken on days when a person is under the weather and may be dehydrated. Under those circumstances, they might do as much harm as good. Another potential hazard for the kidneys is the contrast medium used in medical imaging. Sometimes this can be tough on the kidneys. That's especially true for cardiac catheterization where the doses are higher and the exposure longer. Staying Hydrated to Protect Your Kidneys: Besides controlling risk factors, we can all help protect our kidneys by making sure we stay hydrated. What and how much should you drink? Plain water is always great. Caffeinated soft drinks are not particularly helpful, and neither are dark sodas or tonic water. As for how much, that is individual. Most people can rely on thirst, but as we age, thirst may be a less sensitive indicator. Older people may need to make sure they are drinking enough fluid to produce a reasonable amount of light-colored urine. What Diet Is Best for Your Kidneys? According to Dr. Chang, most of us don't need to obsess about the amount of protein in our diets. Except at the most severe stages of chronic kidney disease, your kidneys can handle the protein you need for good nutrition. She recommends that people follow a DASH diet or a Mediterranean diet. Both are loaded with fresh produce, low in salt and sugar, and rich in whole grains. Scientists have studied the effects of the DASH diet thoroughly, and they know that it can help with blood pressure control. Likewise, following a Mediterranean diet can also promote healthy blood pressure and blood sugar management. New Medications for Kidneys: Doctors are adopting a type of medicine called SGLT-2 inhibitors to treat chronic kidney disease. One example is dapagliflozin (Farxiga), a drug initially developed to treat type 2 diabetes. It may keep kidney disease from worsening. Other drugs in the same category may also prove helpful. Scientists are also looking at GLP-1 agonists like semaglutide (Ozempic, Wegovy) to see if they might also benefit your kidneys. The podcast includes a discussion with Dr. Glenn Preminger of Duke University Health System about a related topic, preventing and managing kidney stones. This Week's Guests: Emily Chang, MD, is Associate Professor of Medicine in the UNC School of Medicine Division of Nephrology and Hypertension. In addition, she is Co-director of the Kidney Palliative Care Clinic. Her research focuses on the application of ultrasound in all aspects of care for patients with chronic kidney disease. Emily Chang MD Glenn Preminger, MD, is the James F. Glenn, M.D. Distinguished Professor of Urology at Duke Medicine.  

Do you know someone who has struggled for years to meet deadlines or manage their time? Perhaps you have a smart friend who just never did well in school (or possibly at work) because they couldn't seem to turn papers (or reports) in on time. Such people might find a diagnosis of attention deficit hyperactivity is a relief. Could it free them to find new and hopeful ways to cope with challenges? In this episode, we explore the transformative power of diagnosis. 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. The Transformative Power of Diagnosis: Our first interview on this topic is with psychiatrist Awais Aftab. Dr. Aftab has written about "the Rumpelstiltskin effect," so we asked him to explain it to us (BJPsych Bulletin, Aug. 22, 2025).  He describes the relief and even therapeutic effect some people experience when their symptoms can be categorized by a diagnosis rather than as a character defect. This Rumpelstiltskin effect can be found in the folktales of a wide range of cultures as well as science fiction and fantasy. The idea that esoteric knowledge, even if it is only a name, can help offer a measure of control exemplifies the transformative power of diagnosis. The ritual of receiving a diagnosis may also give people relief from cognitive ambiguity. Some people find that a clinical diagnosis offers validation of their lived experience. In addition, getting a diagnosis may give them an avenue to connecting with others whose experience may be similar. Supportive communities have grown up around the diagnoses of autism spectrum disorder or Asberger's syndrome. Dr. Aftab views the transformative power of diagnosis alone, regardless of any treatment available, as similar to the power of placebo. Potential Downsides of a Diagnosis: Just as a placebo may relieve symptoms and also cause side effects, the transformative power of a diagnosis may sometimes work against a person. If the patient getting the diagnosis finds that it helps clarify new steps toward managing his or her discomfort, it is a benefit. But if instead it becomes an invitation to succumb to symptoms, then it could be harmful. Stepping into the sick role can become maladaptive. A Second View: We discussed this idea with another psychiatrist, Dr. Robert Waldinger. He pointed out that a person's previous experience and their family's expectations could have a significant impact on whether the transformative power of diagnosis works for good or for ill. One example might be hypertension. One person receiving that diagnosis might remember that his father had hypertension and took his blood pressure medicine conscientiously and lived to a ripe old age. Another person might get the same diagnosis and freak out because a grandfather with hypertension died of a stroke. Helping People Manage without a Diagnosis: When life is hard, people may become anxious or despondent without a clinical mental disorder. They still need support. How can we help people talk about their uncomfortable feelings? Even mental health professionals may need practice to feel comfortable actually talking about a person's authentic feelings. They may be frightened that the person will reveal despair that they don't know how to alleviate. Dr. Waldinger reminds us that we don't have to fix another person's feelings, but truly listening can itself help. Authentic communication is the heart of connection. As with the transformative power of diagnosis, simply being heard and acknowledged may make a person feel better. Dr. Waldinger is fond of this quote: "Attention is the most basic form of love." Relationships can help us in hard times. They also bring us joy. We also remind listeners of the crisis hotline 988 for those who are considering suicide. This Week's Guests: M. Awais Aftab, MD is a Clinical Associate Professor of Psychiatry at Case Western Reserve University. Psychiatry at the Margins is Dr. Aftab's Substack newsletter about exploring critical, philosophical, and scientific debates in psychiatric practice and the scientific study of psychology. [caption id="attachment_138067" align="alignnone" width="768"] Dr. Awais Aftab, Case Western Reserve University[/caption] 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. Along with being a practicing psychiatrist and psychoanalyst, Dr. Waldinger is also a Zen master (Roshi) and teaches meditation in New England and around the world. Dr. Waldinger, with co-author Marc Schulz, PhD, is the author of The Good Life: Lessons From the World's Longest Scientific Study on Happiness. 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). [caption id="attachment_125867" align="alignnone" width="768"] Robert Waldinger, MD, author of The Good Life[/caption] Listen to the Podcast: The podcast of this program will be available Monday, Dec. 22, 2025, after broadcast on Dec. 20. You can stream the show from this site and download the podcast for free. In this week's episode, Joe describes his experience with aphantasia and his relief at discovering there is a name for it. In the podcast, Dr. Waldinger discusses gratitude and how we can cultivate it, when it seems so easy to fall back on anger. One approach is the subtraction idea: we may feel irritated with our partner because of the way they load the dishwasher. But when we imagine what it would be like without them, we can experience gratitude that they are in our lives. We also consider the pain of estrangement and the difficulty of rebuilding relationships. Dr. Waldinger shares his personal story of estrangement and how it feels to make peace at last.

When doctors talk about infections, they are usually referring to acute situations in which the immune system gets overwhelmed by a virus such as influenza or chickenpox. Infections also result from the interaction of bacteria with the immune system, as in the case of pneumonia or sepsis. These can be crises, but they are relatively short-lived, resolving one way or the other within a few weeks or at most months. Could infections trigger chronic diseases? Our guest, evolutionary biologist Dr. Paul Ewald, thinks they do. 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 Infections Trigger Chronic Diseases: Investigating the origins of chronic diseases requires a great deal of patience and the ability to examine several different areas that might be relevant. Over the past few decades, the technology for evaluating genetic contributions has improved greatly. What we have learned is that most chronic conditions are associated with a range of genes that each add a small amount of risk. To get further insight, we have to look at the environment. This broad area includes topics as far ranging as sunshine, stress and nutrition. In particular, we need to look at the pathogens present in any given environment, as they could play an important role in our health. Scrutinizing the environment is not enough. To understand the impact on disease, we need to know more about human behavior within that environment. How much sun exposure do the patients get? Are they sleeping? Where do they spend most of their time, and with whom? These all will help us understand the link to pathogens. What We Have Learned About the Microbiome: Over the past several decades, scientists have learned a great deal about the microbiome. The original conception of gut bacteria has been enriched with the understanding that almost every part of the human body has its own microbiome, almost as unique as a fingerprint. These collections of microbes live in harmony–or disequilibrium–with microbes from the environment. Some of these may be beneficial. Others undoubtedly are harmful, and we call them pathogens. How do pathogens trigger chronic diseases? How Does the Body React to Pathogens? When pathogens are detected, the immune system responds. Often, that comes in the form of macrophages, immune cells that circulate in the blood and attack the pathogens. Even a type of microbe that normally cohabits peacefully with the others in its space can cause trouble if it becomes too numerous or goes out of bounds. One example is Porphyromonas gingivalis. It's usually found in the mouth. If it gets too exuberant there, it can cause gum disease. Worse, though, the macrophages dispatched to deal with P. ginigivalis anywhere in the body can end up collecting in atherosclerotic plaque in arteries (Signal Transduction and Targeted Therapy, May 23, 2025). Another example of pathogens causing unexpected trouble is Clostridium (or Clostridioides) difficile (C. diff). These bacteria can live among other gut microbes and you might not even know they were there. But if the microbiota become disturbed, from a course of antibiotic treatment, for example, C. diff can proliferate and cause terrible diarrhea that may be very difficult to treat. Studies indicate that C. diff has evolved so that the strains in hospitals are now more likely to be resistant to antibiotic medications. Alzheimer disease seems like a chronic condition rather than a complication of infection. Certainly, researchers have been examining genetic predispositions for the accumulation of beta-amyloid plaque in the brain. Yet Alzheimer disease is associated with microbes such as Chlamydia pneumoniae and P. gingivalis. Could flossing your teeth to reduce your chance of periodontal disease also help lower your risk of Alzheimer disease? Recent research has shown that older people receiving the shingles vaccine are less likely to be diagnosed with dementia. Perhaps amyloid plaques in the brain are part of an immune response to infection. Has Long COVID Shifted Our Perspective on Chronic Disease? Several decades ago, The People's Pharmacy interviewed Dr. Paul Cheney, then of Incline Village, Nevada, about his patients with chronic fatigue syndrome. He believed at the time that epidemiological patterns of this mysterious illness pointed to an infectious origin. Years have passed, and no pathogen has been identified to satisfy the criteria as THE cause of myalgic encephalomyelitis (ME/CFS). Recently, though, millions of Americans have been struggling with a condition that seems rather similar. The only difference is that we know their symptoms began with a COVID-19 infection. Long COVID is difficult to treat. Patients suffering with this condition appear to be afflicted with a serious chronic disease. Researchers have not always found evidence of persistent infection with the SARS-CoV-2 virus. Nonetheless, in most cases a COVID infection was clearly the origin. How has that changed our attitude toward the possibility that infections trigger chronic diseases? Other Mystery Conditions: As we contemplate the possibility that infections trigger chronic diseases, we should not overlook chronic Lyme disease. Most infectious disease experts insist it isn't an infection. Some even resist the idea that people are suffering. Dr. Ewald suggests that perhaps the inability to identify pathogens in the wake of Lyme disease is due to using old techniques. The pathogens don't show up on these tests, but that could be because they are hiding. Will newer techniques reveal them? What about the possibility that diseases like arthritis or schizophrenia are caused by pathogens in some cases? The evidence is tantalizing. Dr. Ewald urges us to look at the chronic phases of infection as well as the acute phases. This Week's Guest: Paul Ewald, PhD, is an evolutionary biologist, specializing in the evolutionary ecology of parasitism, evolutionary medicine, agonistic behavior, and pollination biology. He is currently a Professor of Biology at the University of Louisville. Professor Ewald is a pioneer in evolutionary medicine and infectious disease research. He has challenged conventional wisdom on the causes and prevention of many chronic diseases with his idea that many diseases of unknown origin are the result of chronic low-level infections, which has ultimately been shown to be correct for a wide range of diseases to date. He is the author of Evolution of Infectious Disease and Plague Time: The New Germ Theory of Disease. 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). Paul Ewald, PhD, describes how microbes evolve Citations Huang X et al, "Porphyromonas gingivalis aggravates atherosclerotic plaque instability by promoting lipid-laden macrophage necroptosis." Signal Transduction and Targeted Therapy, May 23, 2025. DOI: 10.1038/s41392-025-02251-6  

Do you worry about things you can't see, smell or taste? Most of us don't. Yet particles we can't detect with our five senses are often present in the air we breathe. They have the power to make us sick. How can we achieve cleaner indoor air so that we have less chance of coming down with a serious infection? 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. The Importance of Cleaner Indoor Air: When we talk about air pollution, the image that may arise is factories belching dark plumes of smoke. While the particles generated by industrial processes can indeed be dangerous for our health, sometimes the greatest danger is from particles we can't even see. The COVID-19 pandemic brought this into sharp focus, as we realized that people who had not yet begun to experience symptoms could be spreading infectious viruses. But the need for cleaner indoor air is not limited to COVID, or even to an epidemic like measles or the flu. Many infections spread primarily on viral particles wafting through the air. We are reminded of this every winter, as cases of influenza start to rise. But respiratory syncytial virus, human metapneumovirus and dozens of rhinoviruses and coronaviruses that cause colds also travel on the air. So do measles viruses. Our guest, Dr. Linsey Marr, is one of the country's leading environmental engineers. She got interested in airborne transmission of infection even before SARS-CoV-2 appeared. Then, with COVID, it became clear that the advice to the public about maintaining 6 feet of distance was inadequate to protect people from coming down with the infection. It was developed based on an outdated understanding of how infectious particles travel. Can You Tell If Indoor Air Is Contaminated? Given the extremely small size of viral particles, we might have to use our imagination to understand how they could be present. We can't smell viruses. But if you imagine someone smoking a cigar in the room, you know that the smell will linger for quite a while after the smoker has left. Viral particles can float around like the smell of cigar smoke, which is why they can still be present even after an infected person has left the space. This viral behavior means that the riskiest places are those where many people congregate, especially during a season when infections are spreading. Think of grocery stores, hospitals, or athletic event venues. Wearing a tightly fitted N95 or KN95 mask could provide some protection (especially if others also wore masks). It is not a magic bullet, though. Japanese people accept mask protocol during flu season, and they have still experienced the spread of influenza. In the US, it is very unlikely that most people will accept wearing masks, even if it could help reduce their risk of infection. While we can't measure viral particles in the air without complicated equipment, we can use a simple relatively inexpensive piece of equipment to check the ventilation in a space with multiple people. It is called a carbon dioxide (CO2) monitor. Because people exhale CO2, high levels of this harmless gas indicate lots of people breathing in the space without much ventilation. Fresh outdoor air runs about 400 ppm CO2; once indoor air reaches 1,000 ppm or higher, you may want to take action. Moving Toward Cleaner Indoor Air: Ventilation: Improving ventilation would be very advantageous. Most public places should strive to achieve at least 4 to 6 air exchanges per hour. More sensitive spaces such as health care facilities might benefit from a higher level of ventilation. Filtration: The other way to deal with airborne viruses is through filtration. Home air handling systems could be equipped with a high-efficiency particulate arresting (HEPA) filter. This is ideal, but it may not be practical in every space. Ordinary air filters carry a MERV number such as 8, 11 or 13. Higher numbers indicated better filtration capacity. In general, you'd want to use the highest MERV number your HVAC system will tolerate. Too high a number can create too much pressure and cause problems. What if you don't have access to the filters for your air? That is the case for many apartment dwellers who have to share their air with everyone else in the building. One affordable option is to build and use a Corsi-Rosenthal box. It can be assembled at home for $50 to $70 and it works quite well to provide cleaner indoor air in the space where it is operating. Dr. Marr describes how to build one. Here is a link to our interview with Dr. Corsi, including instructions on building a Corsi-Rosenthal box. Elimination: Another step toward cleaner indoor air might be to utilize ultraviolet (UV) light as a disinfectant. A unit that uses germicidal UV at a wavelength of 250 nanometers needs to be tucked into air ducts. That wavelength can damage eyes and skin. New technology is being developed using a slightly different wavelength of 222 nanometers. While still germicidal, it is supposed to be safe for human eyes. This Week's Guest: Linsey Marr, PhD, is a professor of civil and environmental engineering at Virginia Tech, where she leads the Applied Interdisciplinary Research in Air (AIR2) laboratory. Her research group focuses on the dynamics of biological aerosols like viruses, bacteria, and fungi in indoor and outdoor air. Marr teaches courses in environmental engineering and air quality, including topics in the context of global climate change, as well as health and ecosystem effects. She has been thinking and writing about how to avoid airborne viral transmission since the pandemic began, as in this article published in Environment International (Sep. 2020). Photo by Peter Means, courtesy of Virginia Tech. Dr. Linsey Marr of Virginia Tech. Photo by Peter Means, courtesy of Virginia Tech Dr. Marr mentioned her publication, with many colleagues, advocating for cleaner indoor air in public buildings. Here is a link. Joe Graedon conducted this interview, as Terry was unavailable. Listen to the Podcast: The podcast of this program will be available Monday, Dec. 8, 2025, after broadcast on Dec. 6. You can stream the show from this site and download the podcast for free. This week's episode contains some additional discussion of outside air, including the dangers of smoke from wildfires, along with particulates from car tires or microplastics. Citations Morawska L et al, "Mandating indoor air quality for public buildings." Science, March 29, 2024. DOI: 10.1126/science.adl0677  

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. 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. 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/

Diabetes is a serious metabolic disorder that affects close to 40 million Americans. Most of them have type 2 diabetes, which means their bodies produce insulin, but their cells are not very responsive to it. As a result, blood sugar builds up and people run the risk of cardiovascular complications like heart attacks or strokes, along with kidney disease or vision problems. Nerve damage and even dementia appear to be more common among people with diabetes. Should we be rethinking the way we treat diabetes? 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. Rethinking How We Treat Diabetes: Our guest, Dr. John Buse, is known for his decades of diabetes research. We began our conversation by asking about his most recent study, called CATALYST. It considered the effects of a medicine that is not usually thought of as a method to treat diabetes: mifepristone. This research highlighted the impact of high cortisol levels (Diabetes Care, Dec. 1, 2025). This placebo-controlled trial compared the effects of mifepristone, which moderates the effects of this stress hormone, to those of placebo. Although many people found that mifepristone (Korlym) was difficult to take because of side effects, those who stuck with it lowered their HbA1c significantly. That is a measure of blood glucose over weeks rather than an instantaneous read-out. They also lost weight and waist circumference, on average about two belt notches. That made it a bit easier for their bodies to control their blood sugar. Consequently, some needed lower doses or fewer diabetes medicines. One advantage of this study is that it may help explain why some people have hard-to-control diabetes. Until now, neither patients nor doctors knew why, even though they were trying hard, some patients couldn't make any progress. Dr. Buse admits that physicians used to blame patients, assuming they were not following their diet or taking their medicines. Now, seeing the dramatic effects of mitigating cortisol, they are starting to re-evaluate those assumptions. This could change how we treat diabetes. What Are the Side Effects of Mifepristone? Despite the benefits, nearly half of the study participants assigned to mifepristone missed out on them. They found the fatigue, nausea, vomiting, headaches joint pain and swelling intolerable. These are the consequences of interfering with cortisol. Some people experience dizziness or increased blood pressure. One particularly dangerous side effect is a drop in potassium, which could affect heart rhythm. People who are having trouble controlling their blood sugar despite their best efforts might ask their physician to check their cortisol levels. Where Does Lizard Spit Come In? Several years ago, Dr. Buse talked about lizard spit in one of our interviews. Why in the world would he mention lizard spit? It turns out that one of the components in the saliva of the Gila monster led to the first GLP-1 agonist. Rather than a monster, this is actually a very large venomous lizard native to the Sonora desert. It is illegal to capture or kill a Gila monster in Arizona. Researchers investigating the chemistry of its saliva developed the drug exenatide (Byetta). Subsequently, drug company researchers came up with a wide range of medications that work through GLP-1. You have probably heard of the best-known, which are semaglutide (Ozempic, Rybelsus, Wegovy) and tirzepatide (Mounjaro, Zepbound). These drugs are already changing the way we treat diabetes. Can You Reverse Prediabetes? The lifetime risk for prediabetes is one in three worldwide. Here is a short video clip of our guest, Dr. John Buse, describing the diabetes pandemic:     But if we could identify and intervene before people actually develop diabetes, we might be able to prevent it. Doctors have been testing lifestyle changes and medications that might be able to keep people with prediabetes from progressing any further down that path. Physical activity can make a big difference, as it changes how the muscles utilize glucose. Changes in diet are also promising, although certainly far from easy for most of us. Doctors can also prescribe drugs like metformin as an early intervention. It is almost as effective as exercise. Other drugs that are changing the way we treat diabetes include the glitazones (pioglitazone and rosiglitazone). Another category of diabetes drug, those similar to empagliflozin (Jardiance), is already making a difference. Of course, like all medicines, these also can cause adverse effects as well as benefits. One exciting treatment for the future will be gene-modifying technology to treat diabetes. Proof of concept studies have already been conducted. How should the American diet change to reduce our risk of diabetes? Here is a short video clip of our guest, Dr. John Buse, describing the three changes he recommends.     You will want to listen to the whole interview either live on Saturday morning or when it becomes available on this website Monday morning (11/24/2020). You can stream the audio by clicking on the white arrow inside the green circle under the photo of Armour Thyroid. You can also download the mp3 file by scrolling to the bottom of this article. Why not sign up for all our podcasts at this link so you will never miss another People's Pharmacy episode again? This Week's Guest: John Buse, MD, PhD, is the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill, School of Medicine. He has received international recognition for innovative clinical care and efforts at prevention of type 1 diabetes, type 2 diabetes and their complications.

When the thyroid gland stops working efficiently, the effects resound throughout the entire body. That's because this little gland controls metabolism in all our tissues. Before there was a treatment, thyroid disease was sometimes deadly. Doctors started prescribing natural desiccated thyroid derived from animals 130 years ago. This worked well. Synthetic levothyroxine (a thyroid hormone) was developed in 1970 and marketed aggressively. Now levothyroxine is one of the most commonly prescribed medications in the US. The FDA has announced that it plans to ban natural desiccated thyroid. What are the implications? We'll check in with two experts to find 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. What Should You Know about Natural Desiccated Thyroid? Thyroid extract from pigs contains two important thyroid hormones. Endocrinologists refer to them as T4, also called levothyroxine, and T3, known as liothyronine. The T4 molecule has 4 iodine atoms and is inactive. To activate it, the body uses an enzyme, deiodinase, that kicks off one iodine molecule resulting in activated T3 that does all the work in the tissue. When scientists discovered that T4 could be converted to T3, it opened the door to prescribing T4 alone, synthetic levothyroxine such as Levoxyl or Synthroid, to all hypothyroid patients. That became standard practice not long after Synthroid was introduced. There was a hitch, however. Some patients did not feel well even though they were taking levothyroxine. Until fairly recently, doctors downplayed these problems. Our guest, Dr. Antonio Bianco, helped conduct the research showing that some people have deiodinase enzymes that are less efficient at converting T4 to T3 (Current Opinion in Endocrinology, Diabetes, and Obesity, Oct. 2018). This enzyme activity seems to be under genetic control. As a result, endocrinologists may find it easier to understand why some patients don't respond to prescribed levothyroxine as expected. They may need liothyronine in addition. This could be provided with a separate prescription. On the other hand, people get both T3 and T4 when they take natural desiccated thyroid. You will want to listen to the whole interview either live on Saturday morning or when it becomes available on this website Monday morning (11/17/2020). You can stream the audio by clicking on the white arrow inside the green circle under the photo of Armour Thyroid. You can also download the mp3 file by scrolling to the bottom of this article. Why not sign up for all our podcasts at this link so you will never miss another People's Pharmacy episode again? What Symptoms Do People Suffer Without Natural Desiccated Thyroid? A majority of hypothyroid patients, perhaps 80 or 85 percent, are able to convert T4 to T3 well enough that they can use levothyroxine alone. The remainder, however, do not feel well on this regimen. They experience brain fog and low energy. They may also complain of other symptoms associated with undertreated hypothyroidism, such as difficulty with weight control, cold sensitivity and menstrual irregularities or fertility problems in women. An estimated 1.5 million Americans take natural desiccated thyroid. What will they do if the FDA bans this product? About half a million people take a combination of synthetic T4 and synthetic T3. That is one option, but some individuals prefer natural hormone. What Will Happen to Patients? We turn to patient advocate and activist Mary Shomon to learn about the patient perspective. She is concerned about the FDA's announced plan to take natural desiccated thyroid (NDT) off the market in August 2026. (NDT is sometimes referred to as DTE, desiccated thyroid extract. They are the same thing.) It is not clear that the agency has considered what will happen to people forced to take a medicine that most of them have already tried without success, levothyroxine. Rethinking Levothyroxine Treatment: Mary Shomon points to recent research by Dr. Bianco and his colleagues suggesting that levothyroxine alone may not be quite as effective as most endocrinologists believe. In this analysis of medical records, hypothyroid people taking levothyroxine alone were twice as likely to die during the study period and had a 40% higher risk for developing dementia compared to people getting T3 along with T4 (Journal of Clinical Endocrinology, June 20, 2025). These new findings underscore the importance of information from the large number of patients in touch with Mary. As she says, there is enormous individual variation in which treatments help people thrive. She recommends that everyone who relies on natural desiccated thyroid should contact the FDA (as well as their Congresspeople) to let them know how banning these products would affect their lives. This Week's Guests: Antonio Bianco, MD, PhD, is Senior Vice President of Health Affairs, Chief Research Officer and Dean of the John Sealy School of Medicine at the University of Texas Medical Branch at Galveston. Dr. Bianco is the author of Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do. Antonio Bianco, MD, PhD VP & Vice Provost Research & CRO, Research Services Mary Shomon is a patient advocate and author. Her books include the New York Times bestseller The Thyroid Diet and ten others. Her website is  https://www.mary-shomon.com She is also a Paloma Health Advisor & Patient Advocate. Find her online at https://www.palomahealth.com/authors/mary-shomon Her newsletter, Sticking Out Our Necks Hormonal Health News, is available on Substack. Here's the link: https://hormones.substack.com/ Patient advocate Mary Shomon

For decades, neurologists and pharmaceutical firms have been focused on amyloid plaque building up in the brains as the cause of Alzheimer disease. Drug companies have developed compounds to remove that plaque, and they have been successful. There are medicines, notably lecanemab and donanemab, that reduce the amount of amyloid plaque visible on a scan. But they don't seem to reverse the consequences of disease for the patient–confusion, memory loss, difficulty making decisions. Is it time for us to start rethinking dementia? 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 Should We Be Rethinking Dementia? America is aging. Baby boomers, who make up a disproportionately large segment of the population, will soon be turning 80. That could be bad news as we imagine an enormous number of people disabled by dementia. There is a silver lining to that cloud, though. Compared to individuals born in the 1920s and 1930s, those born in the 1940s and 1950s have a lower risk overall of Alzheimer disease and other types of dementia (JAMA, May 13, 2025). Are there steps we can all take to reduce our risk of dementia even further? The Disappointing Results of Plaque-Removing Drugs: As we mentioned above, the FDA approved lecanemab (Leqembi) and donanemab (Kisunla) to treat Alzheimer disease (AD) because they reduce plaque in the brain. Family members may have had high hopes, but the only impact these drugs have on cognition is a slight slowing of the inexorable decline. They are, moreover, quite pricey and the scans to monitor potentially serious side effects are also expensive. Some people on these meds experience brain swelling or hemorrhage. Over the long term, they may be associated with brain shrinkage. None of those reactions is desirable What Else Can We Do to Reduce Our Risk of AD? One approach we might consider as we start rethinking dementia is low-dose lithium. Lithium has long been used to treat bipolar disorder, but the doses used are large and can trigger adverse consequences, especially for kidney function. New research has shown that people with mild cognitive impairment, a possible precursor to AD, have low levels of lithium in their brains (Nature, Sep. 2025).  Studies in mice show that low lithium levels seem to lead to amyloid plaque and tau accumulation. These are signatures of Alzheimer disease. Can we prevent or reverse this with low-dose lithium? That remains to be tested in a randomized clinical trial. Rethinking Dementia May Mean Vaccines: An impressive body of epidemiological evidence links vaccination against influenza or shingles to a reduced risk for dementia. A natural experiment in Wales (Nature, May 2025) and another in Australia (JAMA, June 17, 2025) have confirmed the causal connection. Vaccination against shingles significantly reduces the chance of developing AD later.   People who get multiple vaccinations against the flu also get a measure of protection from dementia (Age and Ageing, July 1, 2025). What Is Amyloid Plaque Doing in the Brain? Right from the start in 1906, when Dr. Alois Alzheimer described the condition, he flagged amyloid plaque in the brain as a distinctive feature. No wonder people thought of it as the cause of the disease. More recently, though, scientists have been rethinking dementia. They have found that beta amyloid has antimicrobial activity. Might the buildup of plaque indicate an infectious process? We still don't know for sure, but it seems possible. Rethinking Dementia and Diet: Until now, scientists studying AD have paid very little attention to diet. They did not have much evidence that what we eat affects our risk for cognitive decline. There have been only a few randomized clinical trials of the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay [MIND] diet). So far, none has lasted long enough to tell whether it actually might help prevent dementia. That said, our guest suggests that the Mediterranean diet has ample evidence to support it. After all, what is good for the heart is also good for the brain. Physical Activity and the Risk of Dementia: There is very little doubt that aerobic exercise can help reduce your chance of an AD diagnosis. Recent research shows that people who consistently rack up 5,000 to 7,500 steps a day are much less likely to develop dementia than those who are sedentary (Nature Medicine, Nov. 3, 2025). Likewise, those who habitually walk at least 15 minutes at a time during the day appear to be somewhat protected from cognitive decline. Dr. Doraiswamy cautions, though, that we should avoid sports that increase the risk for concussion or head trauma such as boxing, mixed martial arts, football or even soccer. He generally recommends walking for seniors because it offers aerobic physical activity with minimal risk of head injury. In fact, he suggests a walking book club would be ideal. Not only do you get the body in motion, you engage the brain and practice social connection. All of these can be helpful in keeping our brains in shape. Dr. Doraiswamy's research shows solving crossword puzzles can improve their cognitive function over the course of more than a year (International Journal of Clinical Trials, April-June 2025). This could be an enjoyable approach to rethinking dementia and its prevention. Are There Drugs We Should Avoid? Certain medications work by interfering with acetylcholine, a crucial neurochemical. Such anticholinergic drugs, such as many urologists prescribe to treat overactive bladder, can impair cognition. One extremely common and potent anticholinergic is readily available without a prescription. Millions of seniors take it every night in the form of Tylenol PM, Advil PM or some other PM pain reliever. Diphenhydramine (Benadryl) makes people feel sleepy, so people often swallow it thinking that getting a good night's sleep will help them stay sharp. Everyone concerned about preventing dementia should check with prescribers and pharmacists about all the drugs they take, including OTC pills. Reducing the anticholinergic burden is an important step toward protecting the brain. This Week's Guest: Murali Doraiswamy, MD, is Professor of Psychiatry and Behavioral Sciences. He is Director of the Neurocognitive Disorders Program and a Professor in Medicine at Duke University Medical School. He is a faculty network member of the Duke Institute for Brain Sciences. Dr. Doraiswamy is a Senior Fellow of the Center for the Study of Aging and Human Development. In addition, Dr. Doraiswamy is an affiliate of the Duke Initiative for Science & Society and of the Duke Center for Applied Genomics and Precision Medicine.

Heart disease is still our number one killer, even though 50 million Americans have been prescribed a cholesterol-lowering statin. Cardiologists pay a lot of attention to cholesterol in all its variety: total cholesterol, LDL, HDL, VLDL. Even blood fats like triglycerides and lipoprotein a [Lp(a)] are getting some attention. What else do you need to know to reduce your risk of heart disease or stroke? 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. What Factors Shape Your Risk of Heart Disease? Our guest for this episode is a preventive cardiologist, a doctor whose practice is aimed at keeping people from getting heart disease. Even though heart disease ranks at the top of the list of reasons people die, it has been dropping. Dr. Michael Blaha points out that in some states heart disease has actually fallen below cancer as a cause of death. Presumably, that is not due to a dramatic increase in cancer mortality, but rather because we are successfully reducing the toll from cardiovascular disease. Cutting out smoking and removing trans fats from popular foods have helped a lot. Addressing obesity is also changing the equation. Treating Obesity Helps the Heart: We asked Dr. Blaha if the immensely popular GLP-1 drugs such as Ozempic, Wegovy, Mounjaro or Zepbound are making a difference in our risk of heart disease. He believes they are the biggest breakthrough since statins. Other medications that could help reduce obesity might also benefit the heart and cardiovascular system. Cardiologists have long been urging people to embrace physical activity and sensible diets. Now the medications can give them a head start on those efforts. What Can We Do About Lp(a)? About one-fifth of Americans have elevated levels of lipoprotein a, usually abbreviated Lp(a) and pronounced ell-pee-little-ay. This risk factor is considered stable and is an important predictor of cardiovascular complications. According to a meta-analysis of 18 studies, Lp(a) is an independent risk factor for calcified aortic valves (Frontiers in Cardiovascular Medicine, Oct. 13, 2025). Several pharmaceutical firms are actively developing agents that could lower Lp(a). That would certainly be welcome, since statins actually raise levels of this potentially troublesome blood fat. This means that many heart patients are in the uncomfortable position of driving with their feet on both the brake and the gas pedals. Getting Blood Pressure Right: High blood pressure is a very common risk factor for heart disease and stroke. Doctors need to pay attention to balancing control of hypertension with potential side effects. Especially for older patients, the risk of orthostatic hypotension could be serious. This happens when blood pressure drops suddenly after a person stands from a sitting or reclining position. If they faint and fall, the results can be serious. People with concerns about hypertension need to make sure their blood pressure is being measured correctly. Incorrect measurement techniques, possibly resulting in inaccurate readings, are shockingly common in busy clinics. Dr. Blaha discussed the correct procedures, along with the reasons that doctors may prescribe ACE inhibitors (such as lisinopril) or ARBs (such as losartan) as their first-line choice for blood pressure control. Using the Risk Calculator to Estimate Your Risk of Heart Disease: We asked Dr. Blaha about the new PREVENT risk calculator produced by the American Heart Association. The algorithms in this tool appear much less likely to overestimate a person's risk of heart disease than those that cardiologists used previously. All of the cardiology guidelines now recommend its use. You can find it here, although you may not know all the numbers to plug in. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator How Does CAC Score Illuminate Your Risk of Heart Disease? Lately, cardiologists have been turning to the coronary artery calcium score, or CAC, to help estimate patients' probability of developing circulatory problems. This is a CT scan of the heart that reveals the location of calcified plaque in the coronary arteries. In general, a higher CAC score indicates a higher level of cardiovascular risk. This measurement may be helpful in determining risk for people who aren't clearly in a very high-risk category (or a very low-risk category) already. Dr. Blaha suggests it may also serve as a motivator for people who need to change their lifestyles to ward off serious cardiovascular consequences. Can You Reduce Your Risk of Heart Disease? Dr. Blaha suggests that everyone can benefit from paying attention to lifestyle recommendations. Getting adequate physical activity is crucial. So is consuming a diet rich in vegetables and fruits, minimizing highly processed foods. But these recommendations are overly general. People at higher risk of cardiovascular complications need more personalized advice from their doctors. How can you remove the barriers to exercise? Does the diet need more soluble fiber? What nutrients might be needed in addition? Individuals with chronic infections such as HIV need even more personalized attention. For example, a person with high levels of inflammation may need an anti-inflammatory drug such as colchicine (American Heart Journal, Jan. 2025). This Week's Guest: Michael J. Blaha, MD, MPH, is Professor of Cardiology and Epidemiology at Johns Hopkins School of Medicine. He is the Director of Clinical Research for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Clinically, Dr.Blaha practices as a preventive cardiologist and in the interpretation of cardiac CT. Dr. Blaha has received multiple grant awards from the National Institutes of Health, FDA, American Heart Association, Amgen Foundation, and the Aetna Foundation.

The guest for this encore episode is sleep expert and medical communicator par excellence, Dr. Roger Seheult. With his certification in sleep medicine, he will tell you why you need to get enough sleep, along with how much is enough. If you find you have trouble sleeping, what can you do about it? Dr. Seheult has a lot of practical suggestions that go far beyond sleeping pills. 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 our goal with these conversations is 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. Why Is Sleep Important? Dr. Seheult likens our body to Disneyland. The Magic Kingdom requires a lot of upkeep–trash removed, rides inspected, shelves restocked, weeds pulled and so on–but it wouldn't be nearly as magical if workers tried to do those chores during the day when visitors are present. Instead, they take care of all that maintenance at night when the park is closed. Our bodies also need a certain amount of "trash removal" and other upkeep. Some of that happens while we are sleeping. Sleep is not the same throughout the night. We dream during REM sleep, but that doesn't happen until we have been sleeping for a while. Non-REM sleep includes deep sleep as well as an earlier phase. We cycle through these different types of sleep throughout the night, with more REM sleep near the morning before we wake. How Much Sleep Do We Need? We do need different amounts of sleep during the life cycle. Most everyone knows that babies need a lot, while children need less bit by bit as they grow older. Teenagers still need more sleep than adults, although they don't always get it. Often, their sleep cycles shift so they stay awake later and find it more difficult to get up early. Most adults need about seven hours of sleep a night, plus or minus an hour or so. You can tell if you are getting enough sleep if you feel refreshed when you wake up without an alarm clock. One health problem that can keep people from getting the sleep they need is sleep apnea. In this condition, the tissues of the throat relax and obstruct breathing. Doctors often recommend a CPAP machine for their patients with sleep apnea. This provides Continuous Positive Airway Pressure that keeps the airways open and prevents interruptions in breathing. Not everyone appreciates the CPAP, though. A good seal requires careful fitting. Insomnia Anxiety as a Vicious Cycle: Knowing how important sleep is for our health can cause some people to become very anxious if they aren't sleeping well. Anxiety is the enemy of sleep. Rather than stay in bed and worry about not being able to sleep, Dr. Seheult recommends getting up to do something not very exciting in another part of the home. The bedroom should be for only two activities, sex or sleep. Don't learn to associate "not sleeping" with the bedroom. Small Screens: One thing to avoid is checking email or watching video in bed or just before bedtime. Small screens, computers and televisions emit blue light that has the effect of putting the brain on alert. In addition, dealing with difficult problems or exciting plots just before retiring does not help you relax. Listening is another matter, though. Some people find that listening to music can be helpful, as long as it is not too rousing. This Week's 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. 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 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.

Losing weight is hard. That's probably why almost three-fourths of American adults are overweight or obese. On this episode, we speak with a distinguished doctor and former FDA commissioner who has personal experience struggling with the scale. In this discussion of popular weight-loss drugs like Wegovy, we tackle the biology of weight. We also interview an evolutionary anthropologist about some human populations that don't have problems with obesity. Is their active hunter-gatherer lifestyle burning more calories? 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. Has the Food Industry Hijacked the Biology of Weight? While Dr. David Kessler (our first guest on this episode) was FDA Commissioner, from 1990 to 1996, the agency made some major strides towards helping people understand what they are eating. That is when Nutrition Facts labels were standardized and required on all packaged food. In the US, if you buy food that is in a package, that Nutrition Facts label will tell you how big the serving is, how many calories per serving, and also data like the amounts of protein, carbohydrates, fat, and certain vitamins and minerals are supplied by each serving. If information were all that we needed to choose exactly what and how much to eat, there would be no weight problems. Yet Dr. Kessler's own difficulties with the 10 pm cravings will not sound strange to many of us. The biology of weight may appear straightforward, but the allure of fat, salt and sugar to our reward centers may bypass rational decision-making. One of Dr. Kessler's great achievements as FDA Commissioner was holding the tobacco industry to account. How has the food industry escaped similar scrutiny? It seems that the ultraprocessed foods that seem convenient and affordable are contributing to the toxic fat making us sick. GLP-1 Drugs to the Rescue: Given the difficulties people have trying to lose weight, it is no surprise that the GLP-1 receptor agonists like semaglutide (Wegovy and Ozempic) or tirzepatide (Zepbound and Mounjaro) have become popular. They seem to reduce the urge to eat and calm the food noise in people's heads. Those 10 pm cravings Dr. Kessler describes disappear under the influence of these weight loss drug. He has taken such a medication himself to drop the 40 pounds he gained during the intense work period of the COVID-19 pandemic. These medications will be very helpful for many people, but they do have some serious side effects. (You can learn more here.) Healthcare should utilize them as a powerful tool, but just one in a toolbox that should have several. How Does Exercise Affect the Biology of Weight? The famous mantra, calories in calories out, suggests that we might be able to exercise our way to a healthy weight. After all, if you burn more calories than you take in, you should lose weight. But anthropologist Herman Pontzer, PhD, has studied people's energy expenditures around the world. He and his colleagues used a sophisticated technique called double-labeled water to track the energy people burn. According to their data, humans' daily energy needs don't vary as much as we'd think, even when physical activity is vastly different. The Hadza, who get their dinner by tracking, hunting with bow and arrow and running after the injured animal, somehow use roughly the same amount of energy as Americans shopping at the grocery store. Their physical activity is enormously higher, though. (Check out this publication at the Proceedings of the National Academy of Sciences.) Apparently, we need to pay more attention to the calories (actually kilocalories) we consume if we want to understand the biology of weight. This Week's Guests: David A. Kessler, MD, served as chief science officer of the White House COVID-19 Response Team under President Joe Biden and previously served as commissioner of the US Food and Drug Administration under Presidents George H.W. Bush and Bill Clinton. Dr. Kessler is a pediatrician and has been the dean of the medical schools at Yale and the University of California, San Francisco. He is the author of the New York Times bestsellers The End of Overeating and Capture and two other books: Fast Carbs, Slow Carbs and A Question of Intent. Dr. Kessler's latest book is DIET, DRUGS, AND DOPAMINE: The New Science of Achieving a Healthy Weight. David A. Kessler, MD. Photo copyright Joy Asico Smith Herman Pontzer, PhD, is Professor of Evolutionary Anthropology and Global Health at the Duke Global Health Institute. Dr. Pontzer is the author of Burn: New Research Blows the Lid Off How We Really Burn Calories, Stay Healthy, and Lose Weight. His latest book is Adaptable: How Your Unique Body Really Works and Why Our Biology Unites Us. Herman Pontzer, PhD, Duke Global Health Institute

If you have ever suffered with sinusitis, you know how terrible it can make you feel. Breathing is difficult; smelling and tasting anything is impossible. What are the causes of sinusitis and what can you do about it? Joe and Terry talk with a leading physician who does research on how to treat sinusitis to find out how you can stop suffering with sinusitis. 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. Why Are You Suffering with Sinusitis? According to the CDC, almost 30 million American adults have been diagnosed with sinusitis. What are sinuses and why do they cause so much trouble? We asked Dr. Zara Patel to explain. She let us know that we have multiple sinus cavities within our skull filled with air and lined with mucus membranes. Sinusitis indicates that there is inflammation in those membranes. It might be caused by an allergic reaction or an infection. This may interfere with the ability to smell (and consequently, to taste). It might also lead to congestion, drainage or post-nasal drip. People feel crummy. They may have brain fog or low stamina. The cardinal symptom of sinusitis is a feeling of facial pressure. The suffering from chronic sinusitis is just as severe as that from heart failure or diabetes. Sinuses Have Their Own Microbiome: Just like most other parts of the human body, the sinuses are inhabited. Healthy sinuses have a microbiome of bacteria, viruses, fungi and archaea that stays in balance, more or less, and doesn't cause trouble. When that microbiome gets thrown out of whack for one reason or another, the result can be an infection. To determine that, doctors occasionally culture the drainage. That's not very accurate, however. A PCR test works better to find out what is in there that could be problematic. Infections are not the only cause of sinusitis, however. The mucus linings may be reacting to environmental irritants or pollutants. Small particulates such as those in automobile exhaust or wildfire smoke (PM2.5) can lead to a lot of inflammation. People who develop polyps in their sinuses may be especially vulnerable to some of these triggers. Irrigation to Stop Suffering with Sinusitis: One way of managing sinus problems is irrigation with clean water. (That would mean distilled water or water that has been sterilized by boiling before cooling to room temperature.) A neti pot is a very old-fashioned way of doing this, based on Ayurvedic medical tradition. That provides a low-pressure, high-volume irrigation in which water is poured into one nostril and exits the other, washing the sinuses along the way. For her patients with chronic sinusitis, Dr. Patel recommends irrigation with a squeeze bottle. (NeilMed would be one example.) This offers high-pressure, high-volume irrigation that can be very helpful in calming inflamed sinuses. She urges people to stay away from motorized devices. They may seem tempting, but it is far too difficult to clean them thoroughly. Other Medications That Can Help You Stop Suffering with Sinusitis: Dr. Patel may prescribe or recommend other medicines for her patients with sinusitis. Topical steroids such as fluticasone can be useful. Antibiotics are useful when there is an acute infection. In other cases, a medication like ipratropium could be called for. She warns, however, that some nasal sprays are bad for people with sinusitis. Decongestants could make a chronic condition worse, even though the immediate effect feels like relief. There are cases when sinus surgery is appropriate to help a patient who has been suffering with sinusitis. This should generally be a last resort, though. The surgeon should take into account how patients responded to medical treatment before surgery and will want to visualize the sinus with nasal endoscopy or a CT scan. The patient needs to understand that post-surgical care with rinses and sprays will be crucial for at least six months. This Week's Guest: Zara Patel, MD, is Director of Endoscopic Skull Base Surgery, Director of the Stanford Initiative to Cure Smell and Taste Loss, and Director of the Neurorhinology – Advanced Sinus and Skull Base Surgery Fellowship. She is Professor of Otolaryngology in the Dept. of Otolaryngology-Head and Neck Surgery at the Stanford School of Medicine.

This week, we start the show with an interview with epidemiologist Thomas Farley, MD, MPH. His essay in JAMA Health Forum (Aug. 8, 2025) describes why older Americans are dying of falls at an alarming rate.  Once you have a chance to hear why this problem is worse in the US than in comparable countries, we will welcome your calls and stories. Prescriptions for medicines that make people drowsy or unsteady play a major role. Are you taking any? 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. The Epidemic of Deaths from Falls: Dr. Thomas Farley wrote in JAMA Health Forum that falls kill more Americans over 65 than breast or prostate cancer. If you add up deaths due to car crashes, overdoses and other unintentional injuries in older people, the total is still below the number of deaths from falls. That toll was more than 41,000 in 2023. It has tripled over the past three decades. Why are elderly Americans (particularly those 85 and older) so much more vulnerable to dying because of a fall? Perhaps older people everywhere suffer the same fate. Dr. Farley considered that as a possible explanation. But in other high-income countries that might serve for comparison, the rate of deaths from falls has actually dropped over the past 30 years. One difference that might help us understand what is going on is the rate of prescriptions. After all, older people have always contended with vision problems, physical frailty, cognitive impairment or clutter that is a trip hazard. Those things probably haven't changed much since the year 2000. Today, though, older people are taking more medications. Older Americans take far more than those living elsewhere. Which Drugs Increase the Risk of Falls? Not all drugs increase the risk for falls. From 2017 to 2020, Dr. Farley points out, 90% of seniors were taking prescription meds, and 45% were taking drugs considered "potentially inappropriate." Many of those could be termed Fall-Risk Increasing Drugs, or FRIDs. Are you taking any? Any medicine that interferes with balance or causes drowsiness is probably a FRID. Dr. Farley points to four categories in particular: opioids to treat pain, benzodiazepines for anxiety, antidepressants and gabapentinoids used off label to treat pain. (These are gabapentin, aka Neurontin, and pregabalin, known by the brand name Lyrica.) Other medicines, such as beta-blockers for heart conditions or anticholinergic drugs like diphenhydramine, can also cause problems. The overwhelming majority of older folks injured during a fall were taking one or more FRID at the time. Some of the medicines we are discussing are also covered by the American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults.  Any prescriber caring for people over 65 should be able to check whether the drug they are contemplating is on the Beers list. They may also want to consider whether there might be a less risky alternative. If you are accompanying an older relative, you could ask about that. Occasionally older patients are reticent about asking questions for fear of offending the prescriber. Beyond the Usual Suspects: It is hardly surprising that opioids would be related to a risk of falls. There are, however, other medicines that might be a problem in some circumstances. Blood pressure pills may cause dizziness, especially when a person first stands up. Certainly high blood pressure needs to be treated, but perhaps patients should consider trade-offs in terms of how aggressively to pursue perfect blood pressure numbers. Another medication that has been associated with falls, surprisingly, is the combination of atorvastatin to lower cholesterol and insulin for diabetes (Gerontology, Sep. 2, 2025). We Answer Your Questions About FRIDs: Listen to Dr. Farley describe the problem. Then we answer listeners' calls. Have you taken a medicine that makes you drowsy or unsteady? Have you or an older relative taken a tumble you suspect was related to a medication? We want to hear about it. We spoke earlier with Dr. Farley. After we listen to his interview, Joe and Terry will try to answer your questions about medicines that might increase the risk for falls. Are there alternatives? What can you do? This Week's Guest: Thomas A. Farley, MD, MPH, has been a public health educator, researcher, and practitioner for more than three decades. Dr. Farley is a Professor of community health at Tulane University and has held positions in health agencies at the federal, state, and big city level. He is the author of Prescription for a Healthy Nation, Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives, and Prevention of Diseases in Populations: From Biology to Policy. Dr. Farley writes a newsletter on Substack called Healthscaping. https://medium.com/@DrTomFarley/about

Are you concerned about your bone health? Do you worry about osteoporosis? According to the CDC, more than 10 million Americans have low bone density that makes them more vulnerable to fractures. For many older people, a fracture can be devastating, reducing mobility and possibly even leading to death. What evidence can help you maintain strong bones? 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 on Saturday, Sept. 27, 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 Sept. 29, 2025. Strong Bones: You may have seen Halloween skeletons or even chewed the meat off a bone that you then dropped on a plate with a clatter. No wonder we usually think of bones as hard, unchanging objects. Dead bones are. But living bones are quite different. Strong bones are constantly undergoing change. Scientists call it remodeling. One set of specialized cells, osteoclasts, breaks bone tissue down and recycles it. Another set, the osteoblasts, builds bone back. Ideally, their activities are in balance. But if the osteoclasts start to get ahead, as they tend to do while we age, that can weaken bone. The result is low bone mass, known as osteopenia, or even serious bone loss called osteoporosis. This puts a person at risk for fractures. Who Gets Osteoporosis? Osteoporosis may have been less common a hundred years ago or more, when many people had to do manual labor that put stress on their bones. That helps for strong bones, so today's sedentary lifestyles can undermine bone health. Although we think of osteoporosis as typically affecting postmenopausal women, men can lose bone mass too. Medications may contribute to the risk for bone loss. Steroids such as prednisone or methylprednisolone are especially risky if taken for a long period of time. Androgen deprivation therapy for prostate cancer is a risk factor specifically for men. Diagnosing Osteoporosis: Doctors assess bone mineral density with imaging called dual-energy X-ray absorptiometry, or DEXA for short. Then they compare the results on the scan to the results they would expect from a 30-year-old person. Results more than 2.5 standard deviations from that could result in a diagnosis of osteoporosis. A person who experiences a fracture without trauma, such as falling from standing height, is also suspected and often diagnosed with osteoporosis. Non-Drug Approaches to Strong Bones: People who want to keep strong bones need to focus on exercise. High intensity exercise can be helpful, but brisk walking may be enough. Tai chi and yoga are also popular. If you have been diagnosed with osteoporosis, be sure to check in with your doctor before you start a new exercise program. Building balance and core strength without increasing your risk of a fall (and thus a fracture) would be ideal. Our guest expert, Dr. Kendall Moseley, says the jury is still out on technology such as vibrating platforms, weighted vests or vibrating belts. More studies should show how valuable these could be. Following a diet that supplies adequate protein, vitamin D and calcium is also crucial. If you must take a calcium supplement, calcium citrate may be well tolerated and absorbed. How Do Doctors Treat Osteoporosis? Physicians prescribe several different types of medications to help curb bone less and perhaps even build it back. Some of the oldest and least expensive are the bisphosphonates such as alendronate (Fosamax). These slow bone break down and give the osteoblasts a chance to catch up. They can be hard on the digestive tract, though, and they have been associated with a few rare but alarming side effects: jawbone deterioration and atypical thigh bone fracture. Most people seem to do well on them. Doctors generally prescribe them for up to five years. Did You Forget Evista? Another type of osteoporosis medicine is called raloxifene (Evista). It is appropriate only for women, because it is an estrogen modulator. It acts like estrogen in the bones and reduces bone loss. In the breast and uterus, it opposes estrogen activity. Raloxifene does double duty in reducing the risk of breast cancer as well as osteoporosis. Like all drugs, though, it has some worrisome side effects. It can increase the risk of blood clots that cause deep vein thromboses and strokes. What About Prolia? Denosumab (Prolia) is a monoclonal antibody that also interferes with osteoclasts. That is how it improves bone density. One thing to keep in mind about Prolia is that stopping it requires careful planning and backup medication. Otherwise, a patient can lose all the bone that was built rather quickly and may suffer debilitating fracture. This Week's Guest: Kendall Moseley, MD, is Associate Professor of Clinical Medicine in the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. She is also Clinical Director of the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. In addition, Dr. Moseley is Medical Director of the Johns Hopkins Metabolic Bone & Osteoporosis Center.

The statistics are shocking. At any given time, nearly one fourth of American adults are experiencing low back pain. Even worse, roughly one-third of the population will have to deal with chronic pain at some point in their lives. How does the brain react to pain? What can people with chronic pain do to alleviate their suffering? Our guest is a nationally recognized pain expert with a number of suggestions. 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. Chronic Pain: We are all familiar with the instantaneous pain of having your hand contact a hot pan. In that case, pain serves its most important function, warning us not to do that again! Many people have known the pain of a sprained ankle or a twisted knee. In most cases, we recover from such mishaps in time, and the pain becomes a memory. But sometimes, the brain circuits get stuck, so to speak, and we end up with ongoing chronic pain. That can last and cause suffering well after the original stimulus has disappeared. There is no evidence that suffering is good for the soul. The Experience of Pain Is Personal: It is critical to remember that pain is subjective. The nerves may carry a sensation of "heat" from that hot pan or "pressure" if you slam your thumb in the door. It isn't pain until the brain interprets it. And brain interpretations can and do vary from one person to the next. Past experience and levels of social support as well as expectations of relief influence the ways that people feel pain in response to injury. Personalizing Treatment of Chronic Pain: If the experience of pain, especially chronic pain, is highly individual, shouldn't treatments be individualized as well? Every pain patient deserves an individualized assessment, with particular attention to red flags that might be warning of an imminent medical emergency. Ruling that out must not invalidate the patient's experience. Then the patient and provider can proceed to work on a multi-modal approach to pain control. How Will the New FDA Opioid Guidelines Affect Patient Care? The FDA recently issued new guidelines on the use of opioid (narcotic) pain relievers.  The agency will require much clearer warnings about the risks of such medications, especially when used for longer periods of time. Prescribers will be reminded to use the lowest effective dose for the shortest time needed. They will also be reminded that these drugs should never be stopped suddenly, because that could trigger withdrawal symptoms. Should people be avoiding opioids? Dr. Mackey thinks the new guidelines are in line with precautions that responsible prescribers are already observing. What Non-Drug Approaches Can Help Chronic Pain? We asked Dr. Mackey when non-pharmacologic approaches are appropriate, and he responded that they are always appropriate, sometimes in conjunction with rather than instead of medication. There are at least six categories of tools for pain, including medical interventions (surgery, for example), mind-body approaches such as mindfulness-based stress reduction (MBSR), physical therapy, nutraceuticals, complementary and alternative therapies (such as acupuncture) and medications. Each of these categories might have only a small effect by itself but taken together they can provide substantial relief. What About Drugs? There are probably a couple of hundred drugs that could be helpful, only a handful of which are opioids. So even for people who don't tolerate opioids, there are plenty of tools to help alleviate pain. Dr. Mackey does prescribe opioids, but he also prescribes medicines such as topiramate, duloxetine, ketamine and low-dose naltrexone, among other medications. Keeping in mind that everyone is different, these will be used in a variety of methods and combinations, depending on patient response. How Can Patients Find a Pain Doctor? In some parts of the country, especially rural areas, it may be difficult to find a healthcare provider skilled at treating chronic pain. Dr. Mackey suggests utilizing the resources of the American Academy of Pain Medicine. Another resource, possibly more for providers than patients is Doximity. This Week's Guest: Sean Mackey, MD, PhD, is a pain management specialist and anesthesiologist. He holds the titles of Redlich Professor and Professor of Anesthesiology, Perioperative, and Pain Medicine (Adult Pain) and, by courtesy, of Neurology and Neurological Sciences, all at the Stanford University Medical School. Dr. Mackey is Chief of Stanford's Division of Pain Medicine and a past President of the American Academy of Pain Medicine. His website is https://seanmackey.people.stanford.edu/research Sean Mackey, MD, PhD, Stanford University Division of Pain Medicine

For the last several decades, nutrition scientists have been debating the pros and cons of various dietary approaches. The Mediterranean diet has a lot of proponents, and we have interviewed some of them on The People's Pharmacy. Dr. Barry Popkin and Dr. Walter Willett endorse olive oil, whole grains, fruits and vegetables with only small amounts of animal-sourced food. Listen to Show 1359: Is the Food on Your Plate Real or Fake? for more information. Dr. Will Bulsiewicz is a fiber evangelist. You can hear him on Show 1312: fiber, Phytonutrients and Healthy Soil. Plant-based diets can fall along a spectrum from mostly plants with some meat, fish and eggs to completely vegan. In contrast, there are experts who recommend a low-carb, high-fat ketogenic diet. Carnivore diets consisting of only animal products (meat, poultry, fish) are a subcategory of keto diets. That is the focus of this episode. Carnivore Controversy: We know that people have strong feelings about food. The DIETFITS study, one of the best randomized controlled trials comparing healthy low-carb to healthy low-fat diets found that both led to weight loss. Learn more by listening to our interview with lead investigator Dr. Christopher Gardner on Show 1126: Can You Find Your Best Diet? We have heard from fans of ultra-low-fat diets like those promoted by Pritikin or Dean Ornish, MD. We acknowledge that hearing about a carnivore diet may put their teeth on edge, at the very least. But information from knowledgeable sources about controversial topics is what we aim for, and this is indisputably controversial. 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, treatment, or diet. Ketogenic and Carnivore Diets: Doctors have long prescribed ketogenic diets to treat children with hard-to-treat epilepsy (Epilepsy & Behavior, Sep. 8, 2025).  Studies suggest that people with migraines or depression might benefit from a ketogenic diet (Brain and Behavior, Sep. 2025; Translational Psychiatry, Sep. 10, 2025). Most people now following carnivore diets, which are more extreme than ketogenic diets, began following this eating plan to lose weight and have more energy. Our co-host for this show, AAAS Mass Media Fellow Bianca Garcia, has done some investigation of this approach to nutrition, including a personal trial. She joined us in interviewing Dr. Eric Westman, an advocate for ketogenic and carnivore diets to help people with obesity and diabetes. What is a ketogenic diet? It minimizes the carbohydrate available as fuel by including only low-starch vegetables such as greens. High-fat food sources make up the bulk of the energy in the diet. This forces the body to burn ketones derived from body fat instead of glucose derived from sugar or starch. In a carnivore diet, the vegetables disappear completely and the high-fat food sources are all derived from animals. How Do Dietary Guidelines Mesh with Carnivore Diets? We asked Dr. Westman about changing dietary guidelines, and he pointed out that most of the national dietary guidelines have limited scientific support. Of course, randomized controlled trials of people following carnivore diets are also few and far between. A survey of more than 2,000 self-selected volunteers following the diet was published in 2021 (Current Developments in Nutrition, Nov. 2, 2021). The DIETFITS trial, which compared a healthy low-fat, high-carb regimen to one high in fat and low in carbs found no significant difference in weight loss over the course of a year (JAMA, Feb. 20, 2018). What Are the Effects of a High-Fat Diet? In the clinical trials he conducted, Dr. Westman found that blood insulin levels were lower as people followed a ketogenic diet (Expert Review of Endocrinology & Metabolism, Sep. 2018). The body does not require insulin to utilize ketones for fuel. As a result, people with type 2 diabetes have better control of their blood glucose when following a low-carbohydrate ketogenic diet (Nutrition & Metabolism, Dec. 19, 2008). He and his colleagues have published a case series suggesting that a ketogenic diet could help people with food addiction (Journal of Eating Disorders, Jan. 29, 2020). There are also hints that people with other psychiatric conditions might benefit from a ketogenic diet as well (Psychiatry Research, May 2024). What Is Driving the Interest in Carnivore Diets? Bianca Garcia and Dr. Eric Westman agree that the internet has a huge influence on people's interest in carnivore diets. Podcasters like Joe Rogan and multiple influencers have promoted this approach, especially to younger people. This can contribute to social pressure to try it. Dr. Westman warns listeners that adopting a ketogenic or carnivore diet should be undertaken under knowledgeable guidance. A drastic dietary change can alter how medications work, so people with chronic illness really need to work closely with health care professionals. That may require searching for someone who is open to this approach with the expertise to recommend when supplements or salt might be needed and provide information on doses. This Week's Guest: Eric Westman MD, MHS, is an Associate Professor of Medicine at Duke University. He is Board Certified in Obesity Medicine and Internal Medicine and founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. Dr. Westman is a past President and Master Fellow of the Obesity Medicine Association and Fellow of the Obesity Society. He is a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. In addition, he has written and edited numerous bestselling books and is a co-founder of Adapt Your Life Academy (www.adaptyourlifeacademy.com), which provides science-backed education on a range of subjects rooted in the therapeutic effects of dietary carbohydrate restriction… including his newest course, Carnivore Made Simple, which is open now for enrollment for a limited time. Eric Westman, MD, Duke University Our Co-Host: Bianca Garcia is a Filipina-American anthropologist, foodie, and radio person. She holds a master's degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She was a AAAS Mass Media Fellow covering health and science at WUNC, North Carolina Public Radio when we conducted the interview; her favorite stories to cover always involve what people eat, and why. Bianca Garcia, photo copyright Christina Thompson Lively Listen to the Podcast: The podcast of this program will be available Monday, Sept. 15, 2025, after broadcast on Sept. 13. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, you'll hear the real patient story of a doctor who weighed 350 pounds and suffered from POTS (postural orthostatic tachycardia syndrome). Do we have any idea of how a carnivore diet affects the gut microbiome? Dr. Westman describes his study on how a low-carb diet helps GERD (gastroesophageal reflux disease). Years ago, Joe looked for evidence on the traditional heartburn diet limiting fat, alcohol, coffee and tomatoes and couldn't find any. What we have found is that science changes as researchers pursue further studies and that is not a reason to mistrust science even though the changing recommendations may be frustrating. Dr. Westman offers a message to everyone trying to make the right dietary choices but feeling overwhelmed by many different messages about food. Citations Carroll JH et al, "Over twenty-five years of ketogenic diet therapy: Supporting children and adults with drug-resistant epilepsy using nutritionally complete ketogenic formulations: A scoping review." Epilepsy & Behavior, Sep. 8, 2025. DOI: 10.1016/j.yebeh.2025.110683 Gunasekera L et al, "The Hypometabolic State of the Migraine Brain: Is a Ketogenic Diet the Answer?" Brain and Behavior, Sep. 2025. DOI: 10.1002/brb3.70860 Decker DD et al, "A pilot study examining a ketogenic diet as an adjunct therapy in college students with major depressive disorder." Translational Psychiatry, Sep. 10, 2025. DOI: 10.1038/s41398-025-03544-8 Lennerz BS et al, "Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a "Carnivore Diet"." Current Developments in Nutrition, Nov. 2, 2021. DOI: 10.1093/cdn/nzab133 Gardner CD et al, "Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial." JAMA, Feb. 20, 2018. DOI: 10.1001/jama.2018.0245 Westman EC et al, "Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus." Expert Review of Endocrinology & Metabolism, Sep. 2018. DOI: 10.1080/17446651.2018.1523713 Westman EC et al, "The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus." Nutrition & Metabolism, Dec. 19, 2008. DOI: 10.1186/1743-7075-5-36 Carmen M et al, "Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series." Journal of Eating Disorders, Jan. 29, 2020. DOI: 10.1186/s40337-020-0278-7 Sethi S et al, "Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial." Psychiatry Research, May 2024. DOI: 10.1016/j.psychres.2024.115866  

Americans take a lot of medications. Luckily, the Food and Drug Administration only approves those that are safe and effective. However, the agency's definition of "safe" includes medicines that can harm or kill some people, and the definition of "effective" covers some drugs that only work a little better than placebo. Has the FDA changed its standards? Maybe we should be rethinking medications. Rethinking Medications: If you watch television or streaming video, you probably see a lot of commercials for prescription pharmaceuticals. Decades ago, prescription drugs weren't advertised on television, and the prices for prescriptions were much lower. How has the pharmaceutical industry changed? On this episode, we talk with an expert observer of the industry and its regulation. Dr. Jerry Avorn is one of the country's most respected pharmacoepidemiologists. He describes how the business of making and selling medicines has evolved. What Is the Role of Orphan Drugs? The Orphan Drug Act was passed in 1983. Its goal was to offer incentives to drug companies to develop medicines for rare diseases.  The FDA encouraged Congress in this, viewing these as "significant drugs of limited commercial value." The idea was to make sure that even though only a few hundred Americans might have leprosy, for example, that drugs would still be developed to treat their condition. Tax breaks, patent extensions and market exclusivity made the proposition more appealing. In fact, one of the reasons Americans spend twice as much on drugs per capita as citizens of Canada, Australia or other countries is the cost of orphan drugs. Although these compounds were seen as having "limited commercial value," the industry has figured out how to charge exceedingly high prices for anything considered an orphan drug. How Effective Is Your Medicine? When it comes to evaluating effectiveness, pharmaceutical firms have a powerful tool. Dr. Avorn considers it one of the best inventions of all time, although it is a concept rather than a thing. RCT stands for Randomized Controlled Trial, which in turn is shorthand for randomized placebo-controlled double-blind (or in the UK, double-dummy) clinical study. The idea is to take a group of people who are alike in some important ways, so that they are equally likely to develop some type of health problem. Divide them up using a random number generator or some other similar impersonal technique. Those on one side of the divide get the medicine, while those on the other side get an indistinguishable placebo. Neither the participants nor the investigators know who is in which group. At some pre-specified time, the researchers will check to make sure there have not been too many adverse reactions. They may also check that the intervention appears to be doing something. When the trial is over, the methods and results should be described in a publication so that doctors will know if they should incorporate the treatment into their practice. We love RCTs when the outcome is avoiding some serious problem such as a stroke or a cancer diagnosis. For us, biomarkers are less compelling, even though they have become far more common. What is a biomarker? It is easy to measure, like blood sugar or blood pressure. The biomarker is a stand-in or surrogate for a condition like diabetes or heart disease because they are often correlated. It is important to remember, though, that the biomarker is not the disease. Comparing Absolute and Relative Risk While Rethinking Medications: Once the company has completed its RCT, more than likely it will want to publicize the results to promote the drug. How it describes effectiveness can change the way people think about the medicine. One of our favorite examples comes from a print advertisement for Lipitor. It boasted that Lipitor (atorvastatin) lowered the risk of a heart attack (myocardial infarction) by 36 percent. That sounds great, doesn't it? There was an asterisk next to that number, and in small print lower on the page was an explanation. During a five-year trial, out of 100 people on Lipitor, two had heart attacks. Out of 100 people on placebo for that trial, three had heart attacks. So you can see the absolute difference between Lipitor and placebo was just one heart attack per hundred (the absolute risk reduction). That probably would not have sold many pills. But stated as a relative risk reduction of 1 fewer heart attack compared to the baseline of 3 (1/3), using larger numbers because there were thousands of people in the study, you get 36 percent. What Do We Know About Safety? When patients see multiple health care providers who don't talk with each other often, it may be difficult to detect serious safety problems. That was the case with the anti-inflammatory drug Vioxx. Early warning signs of cardiovascular problems resulting from this pain-reliever were overlooked for years. Researchers detected trouble as early as 2001, but the drug company resisted removing the drug until 2004. As a result, millions of people were needlessly exposed to danger and too many died. The silver lining to this cloud is stepped-up surveillance for side effects. Rethinking Medications with Respect to Side Effects: Some years ago, Dr. Avorn and his colleagues conducted a brilliant study (Drug Safety, 2009). They compared the side effect profiles from RCTs of different antidepressants. Mind you, they were not looking at the side effects of the drugs. They examined the side effects of the placebos in studies of tricyclic antidepressants and compared them to side effects of placebos in studies of SSRI antidepressants. All the participants had depression, so there should have been no differences due to the underlying condition. Yet the placebos had vastly different side effect profiles, mirroring the divergent side effects of the active agents. This striking difference might be due to changes in the way researchers elicited symptoms. Or it might be due to the nocebo effect, in which a person who expects to feel nauseated becomes queasy. Nocebo is like an inverse of the placebo effect. Either way, it suggests that when side effects of the placebo are similar to those of the investigational drug, we shouldn't assume that the drug has no side effects. How Can You Protect Yourself? In rethinking medications, it is important to make sure that you really need all the drugs you are taking. Dr. Avorn strongly recommends a brown bag review periodically, in which the patient brings in everything he or she is taking, including OTC meds and dietary supplements. The health care provider reviews them, looking for duplication or incompatibilities. If they find problems, it's time for a conversation about alternatives or deprescribing. Some medicines cannot be stopped suddenly, so the prescriber should provide detailed instructions about tapering and should monitor progress as the patient reduces the dose. This Week's Guest: Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies and developed the educational outreach approach known as "academic detailing," providing evidence-based information about medications to prescribers. One of the nation's most highly cited researchers, Dr. Avorn is the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, and he has written or cowritten over six hundred papers in the medical literature as well as opinion pieces in TheNew York Times, The Washington Post, JAMA, and The New England Journal of Medicine. Dr. Avorn's new book is Rethinking Medications: Truth, Power, and the Drugs You Take. His website is www.RethinkMeds.info

In this episode, our guest is a dermatologist who wants us to consider sunlight's health benefits. That is a minority opinion among dermatologists. Dr. Richard Weller tells us why vitamin D is overrated and not the most important aspect of sun exposure. The Secrets of Sunlight's Health Benefits: Dermatologists generally advise us to stay out of the sun as much as possible. After all, excessive sun exposure causes skin aging and skin cancer, conditions for which people frequently consult them. However, even if we could all live inside, wear protective clothing and high SPF sunscreen whenever we ventured out, would that be wise? According to our guest, Dr. Richard Weller, and his colleagues, "insufficient sun exposure has become a real public health problem" (International Journal of Environmental Research and Public Health, July 13, 2020). While this problem is more acute in Europe than the US, they still estimate that more than 300,000 Americans die each year due to inadequate sun on their skin. What is going on? How Does Sunlight Affect Skin? For decades, we have heard that the principal effect of sunlight on skin is the production of vitamin D. Therefore, the dermatologists have concluded, rather than take the risk of exposing skin to sunshine, why not just swallow vitamin D supplements? The problem with that proposal is that it hasn't worked very well. Many studies show that people with low levels of circulating vitamin D are more vulnerable to high blood pressure, atrial fibrillation, heart disease, diabetes and infections, among other problems. However, people who take vitamin D supplements don't always get the expected benefits.  Perhaps vitamin D is a marker for sun exposure rather than the most important outcome. Human Evolution and Skin Color: Humans evolved in Africa, where dark skin is an advantage, offering protection from the most harmful effects of ultraviolet radiation. By about 60,000 years ago, people were migrating to other parts of the world. Yet analyses suggest that although they arrived in Europe by about 40,000 years ago, genes for pale skin didn't become common until less than 10,000 years ago. Anthropologists have hypothesized that pale skin is an adaptation to inadequate sunlight in northern regions. Because vitamin D is a well-recognized consequence of sunlight on skin, they have assumed that was the driver. Dr. Weller suggests that nitric oxide was (and still is) more important. He notes that the evolution of pale skin happens around the same time that people begin to cluster together in farming communities, where they are more likely to be exposed to infectious diseases. Is Nitric Oxide the Source of Sunlight's Health Benefits? In 1996, Dr. Weller was the first scientist to find that human skin creates a compound called nitric oxide (NO) under sunlight. This compound is then absorbed into the skin, where it helps relax blood vessels and lower blood pressure. Here is a link to his TED talk on the topic. This is where Dr. Weller's approach differs from that of more conventional dermatologists. With proper caveats that the US is at much lower latitudes, in general, than most of Europe, he proposes that more sunlight, not less, could lower mortality rates. (Lower latitudes get more sunshine.) His analysis was just published in the prestigious Journal of Investigative Dermatology (August 2024). The data underpinning this claim are from an analysis of the UK Biobank, a remarkable treasure trove of information. Dr. Weller and his colleagues have found that in the UK, people who get more sunlight are less likely to die within a specified time frame. We call that lower all-cause mortality. You can read the research report here (Health & Place, Sept. 2024).  It was discussed in this article in The Economist (Aug. 12, 2024). This Week's Guest: Richard Weller, MD, FRCP(Ed), is Professor of Medical Dermatology at the University of Edinburgh. He holds the Personal Chair of Medical Dermatology in the Deanery of Clinical Sciences.  He is also Honorary Consultant Dermatologist at NHS Lothian and Principal Investigator at the Centre for Inflammation Research. Dr. Weller serves as Programme Director for the M Med Sci at the University of Edinburgh and is President of the Scottish Dermatology Society. He is the Clinical Lead for the Dermatology Speciality Group at NHS Research Scotland, the Global Health Academy and Edinburgh Imaging. Listen to the Podcast: The podcast of this program will be available Monday, Sept. 1, 2025, after broadcast on Aug. 30. You can stream the show from this site and download the podcast for free. Learn More: Dr. Weller kindly shared links to some research by his colleagues that he mentioned during the show. Here is an article by Joel Gelfland showing the benefits of home phototherapy for psoriasis. This article by Adewole Adamson presents evidence that dark skin is not susceptible to UV-induced melanoma. Download the mp3 of the show, or listen to the podcast on Apple Podcasts or Spotify. Citations Alfredsson L et al, "Insufficient Sun Exposure Has Become a Real Public Health Problem." International Journal of Environmental Research and Public Health, July 13, 2020. DOI: 10.3390/ijerph17145014 Weller RB, "Sunlight–Time for a Rethink?" Journal of Investigative Dermatology, August 2024. DOI:https://doi.org/10.1016/j.jid.2023.12.027 Stevenson AC et al, "Higher ultraviolet light exposure is associated with lower mortality: An analysis of data from the UK biobank cohort study." Health & Place, Sept. 2024. https://doi.org/10.1016/j.healthplace.2024.103328 "Exposure to the sun's UV radiation may be good for you." The Economist, Aug. 12, 2024.  

Exercise physiologist Claudio Battaglini, PhD, describes how exercise prescriptions can improve cancer patients' lives and life expectancy.   A randomized controlled trial published in the New England Journal of Medicine confirmed what some cancer specialists have long hoped: physical activity can prolong cancer patients' lives. Last week, we heard from the senior author of that study, medical oncologist Christopher Booth. In this episode, we hear from an exercise physiologist who has been helping cancer patients with exercise prescriptions. The goal was for them to feel better. Many also lived longer. Who Needs Exercise Prescriptions? We start our conversation with exercise physiologist Claudio Battaglini, PhD, by asking about his career trajectory. How did he go from playing soccer in Brazil to studying how to coach Olympic-level athletes to providing exercise prescriptions tailored to cancer patients' unique needs? You will want to hear his story. What Is the Cancer Gym? Dr. Battaglini describes how he initially resisted working with young cancer patients. How did that experience affect him? He eventually ended up setting up the cancer gym at the Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado (UNC for those in Greeley). After earning his doctoral degree there, he began teaching and research at a different UNC (the University of North Carolina at Chapel Hill). He established the Get REAL & HEEL Breast Cancer Rehabilitation Program and credits the breast cancer patients for pointing out the benefits of group exercise training. In addition to positive physiological effects, participants experience emotional support. This also helps motivate patients to continue their physical activity consistently. How to Motivate People to Exercise: Let's face it: most of us could benefit from exercise prescriptions. But would we follow through? It turns out that personal relationships are hugely important in helping to motivate people to show up. That could be with their personal trainer who is expecting them for their appointment. It could also be one or more friends counting on them to participate in the activity. If others are holding you accountable, you are far more likely to get with the program. Another important factor is matching the right kind of exercise to each patient. Most people are motivated to do what they enjoy. Do you love pickleball or swimming? Dancing or hikes in the woods? If the recommendation is right, staying motivated is far less of a problem. Physical Activity for Young People: Decades ago, physical education classes were mandatory in public schools. In recent years, some school boards have been tempted to drop them as too expensive. (North Carolina and some other states have statewide policies requiring all students in grades K-8 to have the opportunity of 30 minutes of exercise daily.) How important is it to encourage youngsters to be physically active? Do they need exercise prescriptions? Practical Advice for an Exercise Program: For those of us writing our own exercise prescriptions, we discussed the pros and cons of counting steps. Where can you find exercise programs suited to you? The YMCA might be one place to start. Dr. Battaglini also mentioned online resources and qualities to look for in a personal trainer. Above all, whatever you choose to do should feel like fun. This Week's Guest: Claudio L. Battaglini, PhD, FACSM, is a Professor of Exercise Physiology and the Director of the Graduate Exercise Physiology Program at the University of North Carolina at Chapel Hill. He is Co-Director of the Exercise Oncology Laboratory in the Department of Exercise and Sport Science at UNC Chapel Hill. Dr. Battaglini is also a member of the UNC Lineberger Comprehensive Cancer Center.

Physical activity, aka "exercise," is a cornerstone of good health, just like adequate sleep and a balanced diet. No one questions the benefits for people who are already healthy. But doctors may assume that cancer patients are too debilitated and demoralized to exercise. They may think physical activity wouldn't be much help to patients who have just suffered through radiation or chemotherapy. Such assumptions are wrong and could be harmful, as a recent study shows. In actuality, structured exercise can help cancer patients survive and even thrive. Does Exercise Belong in Cancer Treatment? An exciting study published in The New England Journal of Medicine demonstrates that a personalized exercise program can be an important component of the treatment for colorectal cancer (New England Journal of Medicine, July 3, 2025).  We spoke with the senior author, Dr. Christopher Booth, who explained that originally he and his colleagues wondered if exercise can help cancer patients feel less fatigued while undergoing chemo. Then they decided to design a trial that would go much further. They intended to answer two questions: can cancer patients exercise during treatment? And does that improve their likelihood of survival? Increasing Physical Activity Can Help Cancer Patients Survive Longer: The study, known as the CHALLENGE trial, hit a home run. The investigators recruited 889 people who had just had surgery and chemotherapy for their colorectal cancer. They randomly assigned half of them to get a health education booklet urging them to eat right and stay active. The other half got the booklet (usual care) PLUS a personalized exercise prescription designed to increase the amount of moderate to vigorous physical activity people did over the week. How Did This Challenge Work? The exercise prescriptions were devised by personal trainers who met with the "intervention" patients every two weeks for a year. Half of the meeting was devoted to motivational coaching and the other half to moving. Patients loved it. Increasing their fitness also improved their quality of life. In addition, patients in the exercise intervention group had better immune function and lower inflammation and less insulin-like growth factor, which can contribute to tumor expansion. Both men and women participated in this trial. During the follow-up period, women who were active were less likely to develop breast cancer than those in the control group. Similarly, men in the intervention group had a lower chance of a prostate cancer diagnosis. The most exciting part of the story, however, is about their colorectal cancer treatment. Not only did patients in the physically active group have longer overall survival, they also had longer disease-free survival. Remember, these two groups have the same type of cancer and got the same kind of treatment, except for the exercise prescription. The overall 8-year survival was 90.3% in the exercise group and 83.2% in the health education control group. That means the exercisers lowered their chance of dying during those eight years by 37%. The Number Needed to Treat (NNT) was 14 exercisers to prevent one death. That is a remarkable statistic. How Did Cancer Patients Get Motivated to Move? If you've ever started an exercise program only to drop it a few weeks later, you are not alone. Keeping ourselves motivated to stay active isn't always easy unless you really love what you are doing. (Joe needs no extra motivation to show up for tennis.) Consequently, it is impressive that a very high proportion of the cancer patients in the CHALLENGE trial kept exercising. Part of that perseverance might be due to the motivational coaching. No doubt another big part was the relationship with the personal trainer. Meeting with a person every two weeks for a year can help build friendships and creates a relationship in which accountability is a factor. After the first year, patients and trainers met every month for the next two years. Being able to increase physical activity was empowering for patients, giving them a sense of control that can otherwise be missing in a cancer patient's life. What Did Cancer Patients Do? The exercise prescriptions were personalized, so people undertook a wide range of activities. Jogging and walking were popular, but some people swam, and others kayaked. There were patients who bicycled, and possibly some who rode horses. (Dr. Booth does not mention that.) The point was to find an activity you love and stick with it religiously, which they did. The most popular activity by far was also the simplest: walking. The idea was to walk at a pace so you looked like you were late for a meeting. Is It Feasible to Help Cancer Patients Survive & Thrive? One of the most exciting aspects of the CHALLENGE trial was to see that people responded to coaching. Personalized exercise prescriptions with accountability could be instituted into many cancer treatment programs. After all, if insurance pays for cardiac rehab, why shouldn't it pay for cancer rehab? The cost of a personal trainer is about $3,000 to $5,000 over three years. That is a lot less than the next-level chemotherapy drug is likely to cost, and unlike chemo, the side effect is that the patient feels better. Not only is it feasible to help cancer patients survive through targeted exercise, it should be a part of most cancer treatment protocols, In Summary: Dr. Booth offered us this explanation of how the treatment works: "Exercise is inducing physiologic, hormonal, inflammatory, immunologic changes in the body that are helping the body eradicate a proportion of these cancer cells. ' Learn More: Dr. Booth is a medical oncologist. To complete this trial, he called on the expertise of a lot of colleagues, including exercise physiologists. Next week, we will speak with Claudio Battaglini, PhD, to get the exercise physiologist's perspective on this important approach. This Week's Guest: Christopher Booth, MD, is a medical oncologist and health services researcher at Queen's University in Kingston, Ontario, Canada. • Director, CCE Division, Queen's Cancer Research Institute (QCRI) • Medical Oncologist • Clinician-Scientist, Cancer Centre of Southeastern Ontario • Professor, Departments of Oncology and Medicine, Queen's University • Canada Research Chair in Population Cancer Care https://scri.queensu.ca/faculty-staff/christopher-booth

We may not often stop to think about it, but our water, food, furniture and other ordinary items are frequently contaminated with toxic chemicals. In this episode, Dr. Aly Cohen describes these threats to our health. You may have heard of compounds that can disrupt hormonal balance (endocrine disruptors). Everyday toxins like these can also interfere with the ability of the immune system to function properly. What can you do to reduce your exposure? Doing an Environmental Assessment: As a rheumatologist, Dr. Cohen frequently treats patients whose immune systems have turned on them to produce conditions like lupus or rheumatoid arthritis. As an integrative medicine practitioner, she has learned to look at the patient's environment for clues about the toxic compounds that may be causing the problem. The first environmental assessment she conducted was actually for her beloved family dog, Truxtan. When he developed autoimmune liver disease, she tried to figure out why. How Everyday Toxins Disrupt the Immune System: Dr. Cohen wasn't able to save her dog, but the experience made her realize just how many potentially toxic chemicals we are exposed to in the course of our daily lives. If you look around your kitchen, you may discover that most of your food containers might be suspect. Plastic is incredibly convenient, since it is lightweight, break-resistant and cheap. But it often contains plasticizers such as bisphenols or phthalates that are endocrine disruptors. Some can disrupt the immune system as well. After all, immune system cells interact with the endocrine system on a regular basis. The two are tightly linked. Other food packaging can also contribute undesirable compounds such as PFAS. Exposure to these may lead to chronic inflammation. Dr. Cohen tells about a patient, Massimo, who ran a pizza shop. A young man, he had troubling fatigue. Changing his routine so that he wore nitrile gloves while handling pizza boxes helped a lot. So did bicycling to work. Everyday Toxins in Our Water: How safe is your water? One of Dr. Cohen's patients had moved to New York from a Latin American country. Although she had filtered her water in her home country, she believed the tap water in New York was safe. It turned out the old plumbing in her building was contaminated with lead. In addition, she was relying on rice as a food staple, and it was contaminated with arsenic. Lead and arsenic are well-recognized as toxic chemicals. Filtering her water and washing her rice helped her feel much better. How do you make sure your water is free of everyday toxins? Dr. Cohen says several types of filtration devices can be useful, if they are used according to instructions. That means changing the filter medium on the recommended schedule. Any filter is better than no filter, but by far the best approach is known as reverse osmosis. This results in clean water you can trust to be free of toxins. Can You Avoid Plastic? The topic of water is almost inextricably linked to the question of plastic. Much of the water sold for consumption away from home is bottled in plastic. In addition to environmental considerations, this can expose us to plasticizers such as phthalates or even to tiny bits of plastic known as microplastics. These are accumulating in our bodies and may be harming our immune system. Bottles are not the only source of plastic in our food supply. Most cans are lined with a resin to prevent corrosion. This frequently contains BPA, bisphenol A, as a plasticizer. Some manufacturers have switched to another bisphenol instead. Thus, they can claim that the can is BPA-free, but it isn't necessarily safer. Don't Use Plastic Containers in the Microwave! One simple rule that can cut down on a lot of exposure to immune-disrupting plasticizers is don't microwave food in plastic containers. Heat tends to speed leaching of plasticizers from the containers into the contents. Yes, we know a lot of frozen meals come in plastic containers that are supposedly microwave-safe. Don't believe them. Instead, transfer the food to a glass or ceramic dish or bowl and heat it in that. That way you know you're not getting any extra plasticizer in your snack. Prioritize! Dr. Cohen points out that to get the best results from efforts to avoid everyday toxins, we need to figure out where the exposure is greatest. That's why she usually likes to start with cleaning up the water supply, since for most of us that is our top exposure. Analyzing your diet and focusing on foods you eat often is another way to prioritize. Those are the foods that should be free of toxins if at all possible. She recommends using the EWG (Environmental Working Group) lists of the "Dirty Dozen" foods that often contain pesticides and the "Clean Fifteen" foods that are generally safe.  For the Dirty Dozen, it makes sense to purchase USDA Organic produce whenever possible. Removing Pesticides: Dr. Cohen offers some simple, inexpensive ways to wash your produce and get the pesticide off. Add 1 part vinegar to 3 parts filtered water and let the fruit or vegetables soak in that for several minutes. Then rinse it off well with filtered water. The 21-Day Plan: To make it easier for people to implement the changes and avoid everyday toxins, Dr. Cohen offers a 21-day plan. It offers steps to avoid lots of harmful chemicals including obesogens (chemicals that make us fat). One simple way to take the first steps, after filtering the water you drink, is to carry a metal spoon and fork. That way you won't have to resort to using plastic utensils to eat hot food, especially soup. Another step is to be cautious with skin care products. Using the online EWG guide SkinDeep can help you find sunscreen or moisturizer that is mostly free of undesirable agents. When shopping, make it a habit to seek out USDA Organic certified products for those items you eat most. Learn More: Dr. Cohen is not the only doctor concerned about toxic exposures. A summary of research into the "exposome" was published in JAMA last spring. Here's a link. This Week's Guest: Dr. Aly Cohen is a board-certified rheumatologist and integrative medicine physician. A member of the faculty of the Academy of Integrative Health and Medicine, Southern California University of Health Sciences, and the University of California, Irvine, she is a leading medical and legal expert in environmental health. Dr. Cohen is creator of TheSmartHuman.com social media platform, and the co-author of the bestselling consumer guidebook Non-Toxic: Guide to Living Healthy in a Chemical World. Her latest book is Detoxify: The Everyday Toxins Harming Your Immune System and How to Defend Against Them. Her website is https://alycohenmd.com/

New advances mean that more men than ever before can overcome prostate cancer. Treatments can extend life and improve quality of life. In this episode, our guest, Dr. Andrew Armstrong of Duke University, discusses recent advances that men should know to overcome prostate cancer. We ask about former President Joe Biden's diagnosis. What does it mean to have Stage IV prostate cancer and a Gleason score of 9? News outlets have reported that Mr. Biden's previous prostate screening test was in 2014. How often should men be tested for this common cancer? What does the PSA (prostate specific antigen) test really tell us? How Do We Detect Prostate Cancer? Prostate cancer affects one man out of every eight in the course of a lifetime. Fortunately, if it is caught early and treated appropriately, most men do not die of this disease. They die of something else, even if they may still have prostate cancer cells. For years, the mainstay of prostate cancer screening has been the level of PSA, prostate specific antigen. Although it is specific to prostate, it is not really specific to prostate cancer. All prostate cells make it, so doctors watch for unusual increases in PSA. That suggests a rapid growth of the prostate, which could be caused by prostate cancer. Not every prostate cancer produces large amounts of PSA, though. That's why urologists watch for changes rather than using a threshold number. Men with a family history of prostate cancer are at higher risk for developing it themselves. Ideally, they would start screening at a younger age and possibly have it done more frequently. In men who have a limited life expectancy, doctors may not recommend prostate screening. PSA alone is just the first step. If PSA is elevated or if it is rising, men will need further workup. What Is Next to Overcome Prostate Cancer? Often the next step is imaging. Magnetic resonance imaging of the prostate can be very informative. If there is a suspicious area on the MRI, the doctor will schedule a biopsy. Current practice is to use the MRI and ultrasound to guide the biopsy, so that the tissue examined is from the area thought to harbor the tumor. Grading the Tumor: The tissue removed during the biopsy will be examined by a pathologist. That expert will use the characteristics of the cells in the tissue to assign it a Gleason score. These range from 6 (not very worrisome) to 10 (the most aggressive). Former President Biden's cancer had a Gleason score of 9, which is serious. Doctors also want to know if the tumor has spread beyond the prostate gland itself. To find out, they may conduct a PSMA PET scan. This picks up prostate-specific membrane antigen (hence PSMA) wherever it may be in the body. Stage IV, like former President Joe Biden's cancer, has spread outside the prostate to other parts of the body. In his case, the cancer has metastasized to his bones. In some cases, prostate tissue will be sent for genetic testing. BRCA2 is associated with breast and ovarian cancers, but men who carry this gene are more vulnerable to prostate cancer as well. Approaches to Preventing Prostate Cancer: The risk of prostate cancer appears to be roughly half hereditary and half environmental. That means there are things that men can do to reduce their risk. Avoiding environmental toxins is crucial. Plastics and plasticizers don't belong in our food or our bodies. Diet matters, of course. Not everyone loves broccoli, Brussels sprouts, cabbage and cauliflower, but getting plenty of these cruciferous vegetables can help reduce the risk of prostate cancer. Another important step is to focus on exercise. Not only can regular vigorous physical activity reduce the chance of developing prostate cancer, it also is very useful in counteracting the side effects of the powerful drugs used to overcome prostate cancer. Options for Treating Prostate Cancer: Blocking Testosterone: Often the doctor prescribes leuprolide (Lupron) to shut down testosterone production. That part of the protocol is referred to as "androgen deprivation therapy" or ADT for short. An even more powerful androgen blocker such as abiraterone (Zytiga), apalutamide (Erleada), darolutamide (Nubeqa) and enzalutamide (Xtandi) may be added. These drugs can help men overcome prostate cancer, which seems to thrive on testosterone. Blocking the androgen receptors with one of these medicines has made treatment for prostate cancer more effective. Androgen blockers stop testosterone formation even further and thus discourage the growth of the cancer. That's the benefit. The downside is that men suffer the effects of "low T." Here is where exercise stars, helping men feel better even when their testosterone levels are nonexistent. Other Treatments for Prostate Cancer: There are nonhormonal approaches to treating prostate cancer that may be used in conjunction with androgen blocking or in some cases independently. One is surgery, in which the prostate is removed. That used to be the standard treatment. With new approaches available, it is one option among many. Another is radiation. Dr. Armstrong describes some of the different types of radiation, which can be very effective when used together with androgen blocking medication. There are also immune therapies. One exciting new therapy, called Pluvicto uses radioligands that seek out and attach to PSMA. Because it can find prostate cancer cells wherever they are in the body, it is being considered for treating metastatic prostate cancer when ADT may no longer be working well. What to Know to Overcome Prostate Cancer: Dr. Armstrong wants men to know that prostate cancer can be detected early; when it is, it is often curable. Even in the case of advanced disease, there is hope. He urges men to ask for second opinions on treatment and take advantage of a multidisciplinary team when possible. Above all, he says: "The good news is that treatment can extend life often dramatically, and that many men, most men in fact with prostate cancer, don't die of prostate cancer. They die of other stuff." This Week's Guest: Andrew J Armstrong, MD, ScM, FACP, is Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. He is Director of Research at the Duke Cancer Institute Center for Prostate and Urologic Cancers. His appointments are in the Division of Medical Oncology in the Departments of Medicine and Urology at Duke University. Dr. Armstrong is one of the country's leading prostate cancer researchers.

Half a million people may suffer symptoms of Lyme disease this year. Learn about avoiding Lyme and other tick-borne diseases.   In this episode, two experts draw on the latest research about avoiding Lyme disease and other infections that may be transmitted through tick bites. Why are these conditions so difficult to diagnose? Most importantly, how can people with lingering symptoms from Lyme get help and start to feel better? We consider both conventional and alternative approaches. The Basics of Lyme Disease: We begin with a quick review of the history of Lyme disease, which was first identified in Old Lyme, Connecticut, in the 1970s. Researchers eventually identified the pathogen causing the symptoms as Borrelia burgdorferi and means of transmission as bites from a black-legged tick (aka deer tick). Even though it was originally thought to be limited to New England, epidemiologists now recognize that Lyme disease is widespread across the country. Half a million people will come down with Lyme disease this year. Many others will suffer symptoms from other pathogens transmitted through tick bites. Persistent Symptoms of Lyme Disease: For much too long, doctors thought that any symptoms persisting after a course of antibiotics were psychosomatic. Patients were understandably distressed by this dismissal of their suffering. Many people report fatigue, body aches and brain fog. Some have difficulties with balance or feeling weak or faint when they stand and have been diagnosed with POTS (postural orthostatic tachycardia syndrome). Headaches, rashes, heart palpitations and joint pain may also be part of the picture. If you think some of these symptoms ring a bell, you are right. Many people with long COVID or even chronic fatigue suffer with similar problems. Avoiding Lyme or Treating It Over the Long Term: One of our expert guests, Dr. John Aucott, does research on Lyme disease and directs the Johns Hopkins Lyme Disease Clinical Research Center. His study utilizing functional MRI was very revealing. When regular imaging studies are done on people with persistent Lyme disease symptoms, the results are not particularly striking. But functional MRI results, when people are asked to do cognitive tasks while undergoing magnetic resonance imaging, show a different picture. These people's brains are not functioning normally. No wonder they are upset about brain fog or struggling to concentrate! There are several possible explanations for why Lyme disease symptoms may persist. The spirochete responsible for these symptoms does not require oxygen and is very good at "hiding out" within tissues. When reactivated, it could cause symptoms. On the other hand, the immune system may become hyper-activated and have a hard time calming down. That too could contribute to symptoms. Non-governmental organizations have funded the Study of Lyme Immunology and Clinical Events (SLICE). In this trial, researchers have identified some risk factors associated with post-treatment Lyme disease (PTLD, aka long Lyme). They are also enrolling patients in a treatment trial. Standard of Care for Lyme Disease: Naturopathic doctor Alexis Chesney points out that there are different standards of care for Lyme disease. The CDC has published guidelines for treating "four important manifestations of Lyme disease." Those are erythema migrans (the classic "bulls-eye" rash), neurologic Lyme disease, Lyme carditis and Lyme arthritis. The International Lyme and Associated Diseases Society (ILADS) offers its own treatment guidelines. Both experts agree that early treatment is preferable to late treatment. Dr. Chesney describes the ability of the Borrelia spirochete to protect itself by changing to a "round form" as well as by forming a biofilm that wards off antibacterial medicines. One way to combat this is by utilizing herbs that can counteract biofilm formation, such as cats' claw or Japanese knotweed. She also pays attention to supporting patients experiencing a Herxheimer reaction, in which dying spirochetes release toxins. This can make a person feel very ill indeed. Natural ways to mitigate this response include milk thistle, burdock or Epsom salt baths. Avoiding Lyme Disease by Preventing Tick Bites: Even better than early treatment is prevention. The best prevention is to avoid tick bites. Wear shoes and socks that have been treated with permethrin. (Do not apply permethrin directly to the skin.) Using an effective insect repellent also helps, and a thorough tick check upon coming in from outdoors is indispensable. It takes ticks some time to transmit Borrelia, so prompt tick removal can help prevent illness. This Week's Guests: Dr. John Aucott is the Barbara Townsend Cromwell Professor in Lyme Disease and Tick-borne Illness at the Johns Hopkins University School of Medicine. An infectious diseases specialist and Lyme disease expert in the Division of Rheumatology, he is the director of the Johns Hopkins Lyme Disease Clinical Research Center. https://www.hopkinslyme.org/ Alexis Chesney, MS, ND, Lac, is a naturopathic physician, acupuncturist, author and educator. Since 2010, Dr. Chesney has worked with people of all ages on chronic disease, general wellness, nutrition and lifestyle counseling. She has dedicated herself to working with clients who have complex chronic illness, and who often have diagnoses such as Lyme and vector-borne diseases, mold toxicity, mast cell activation syndrome, among other conditions. Dr. Chesney is the author of Preventing Lyme & Other Tick-Borne Diseases: Control Ticks in the Home Landscape; Prevent Infection Using Herbal Protocols; Treat Tick Bites with Natural Remedies. Dr. Chesney offers an online course, Preventing Lyme and Tick-Borne Disease: Ticks and Tick-Borne Diseases, Prevention, and Acute Lyme & TBD Treatment. Here is the link: https://health-transformations.teachable.com/p/preventing-lyme-and-other-tick-borne-diseases. Her website is https://www.dralexischesney.com/

This week, we asked dermatologist Dr. Chris Adigun into our studio to answer your questions about summer skin problems. The Link Between Sun Exposure and Skin Cancer: Intense summer sunshine can cause sunburn and skin damage. The most worrisome consequences are skin cancers that may show up on cheeks, ears, noses, lips or other unexpected places. How can you recognize a potential skin cancer? What will the dermatologist do about it? Even more important, can you reduce your risk for basal or squamous cell carcinoma? (Those are technical terms to describe skin cancers that are not melanoma.) What are the best ways to avoid harming your skin while you are enjoying the great outdoors, whether you are at the beach or on the hiking trail? Are there criteria you can use to choose the best sunscreen without spending a fortune? How often do you need to apply it? Can you get enough vitamin D compounds if you wear a high SPF sunscreen? Are there skin conditions that might actually benefit from a bit of sun and salt water? Lowering Your Chance of Melanoma: The relationship between sun exposure and melanoma is less clear than that between sun and basal or squamous cell cancers. Find out what might make a spot suspicious. Where should you be checking your skin? What can a dermatologist do to help? Heat and Humidity Challenges: In addition to sun, heat and humidity can challenge our skin. Fungal infections may proliferate under those conditions, resulting in athlete's foot, jock itch or under-breast rash. Can we make our sweaty skin less hospitable to fungi? Have you been troubled with heat rash? We'll find out what it is and what to do to get rid of it. Other Summer Skin Problems: Long summer hikes can result in more trouble than sunburn or sore muscles. Unless you are very careful with your shoes, sweaty feet can develop blisters. Are there good preventive strategies? If you get a blister anyway, what can you do to ease the pain–and keep it from getting worse? Bug bites may also be the bane of your existence. Chiggers hang out in grass or brush waiting to take a bite of a tasty mammal walking by. Can you avoid or discourage them? And if you do get chigger bites, how can you manage the dreadful itch? We also want to avoid bites from ticks and mosquitoes. They may have different niches and behaviors, so avoiding them may require different tactics. What works best? How can you choose a good insect repellent for outdoor activities, and will it interact with your sunscreen? Poison Ivy and Its Cousins: Poison ivy, poison oak and poison sumac all contain the resin urushiol, which can be extremely irritating to sensitive skin. Do you know how to identify these plants so you can avoid them? If you find yourself in the middle of a poison ivy thicket, can you take quick action and reduce the chance of a rash? If you end up with a rash–it happens–we'll find out how you can ease the suffering. This Week's Guest: 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 specializes in both nail disorders and laser treatments.

We sometimes may feel that we are in a circumstance that breaks our brains and undermines our mental health. What skills provide resilience? In this episode, we acknowledge the many reasons that people may be feeling anxious or depressed. It often seems that current conditions are designed to break our brains. Perhaps that's why 60 million Americans suffer from depression or anxiety. Not everyone who might be feeling nervous or down in the dumps deserves a diagnosis. However, they can benefit from the practices we discuss in this hour. Pharmaceutical approaches such as antidepressants can be helpful for people with depression, especially in the short term. Over the long haul, though, we might want to consider whether changing our habits could help us develop the resilience we need. After all, antidepressants frequently result in side effects. Moreover, many people find it difficult to discontinue an antidepressant. Anti-anxiety agents carry similar risks. Scientific research has shown us the importance of neuroplasticity. Can we tweak our neurochemistry by embracing some simple tenets for living? We don't really have broken brains, but we might be lacking the skills we need to pursue robust mental fitness. Where will we learn them? Staying Connected Protects Our Brains: Good nutrition, adequate sleep and regular exercise are all pillars of mental as well as physical health. Our guest, integrative psychiatrist Drew Ramsey, says staying connected with others is equally important. Cultivating a variety of connections is crucial for our mental health, including friends, family and even casual acquaintances. We should keep in mind that building community is different from building friendships; we need both for mental fitness. Social isolation can be damaging both for teenagers and for older individuals. Can we use social media to bolster our support systems rather than allowing them to wither? What skills can we help our teens acquire? Dr. Ramsey described a study, the AMEND trial, that combined social connection through social media with learning to cook. The young men in the study posted their cooking experiments on Instagram and bonded with each other over the experience. Adopting a more healthful diet also reduced the youths' risk for depression. Maybe Ultra-Processed Food Breaks Our Brains: One aspect of nutrition that is important to consider is how our food affects our microbiota. Our gut microbiome has a powerful influence on inflammation in our bodies. After all, the immune system is in part anchored in the gut, especially in the gut microbiome. When the microbiome gets disrupted and inflammation rises, our mood and mental health can suffer. What should we be eating to feed our microbes and keep them happy? Dr. Ramsey offers a little rhyme as a mnemonic: "Seafood, greens, nuts & beans…and a little dark chocolate." We admit the last line breaks the rhyme, but it isn't too hard to remember! When we asked what foods to focus on for healthy gut microbes, he suggested lentils. Although they are not technically beans, as in the rhyme, they are legumes and contain lots of fiber that helps gut microbes flourish. Dr. Ramsey also extolls the benefits of microgreens, another food that gut microbes love. The microbiome acts as a master dial on our immune system and inflammation levels. Beyond Diet and Activity: Dr. Ramsey provides nine tenets for reclaiming robust mental health, even when we may feel like our situation breaks our brains. In addition to thoughtful nutrition, adequate sleep and reliable physical activity, he also stresses the importance of unburdening yourself of past trauma. This need not have been anything as major as a traffic accident or losing a parent, though such experiences are certainly traumatic and deserve attention. Even minor traumas like being picked on as a child can affect our sense of well-being. Unburdening is the process of acknowledging those and trying to understand where our past is tripping us and blocking our efforts to be mentally healthy in our present. Unburdening yourself can leave you feeling freer to pursue your goals. It helps ground you so that you can pursue your purpose. Journaling, therapy or creative pursuits could all help with unburdening. How Can You Find Your Purpose? Finding your purpose might not sound like a step towards better mental fitness, but it is. How do you know when you have found your purpose? Focusing on a sense of identity and of fulfillment will help you with this. Finding a sense of purpose is important at every stage of life, but it may be especially important for older individuals. A job is not synonymous with purpose, although at times they may overlap. Sometimes, people who have relied on work to provide their sense of purpose find themselves at loose ends when they retire. This Week's Guest: Drew Ramsey, MD, is a leading board-certified integrative psychiatrist, best-selling author and leading proponent of Nutritional Psychiatry and Mental Fitness. He served as an Assistant Clinical Professor of Psychiatry at Columbia University in the Vagelos College of Physicians and Surgeons for twenty years. Dr. Ramsey is founder of the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, WY. He is the author of several books, including his latest book, Healing the Modern Brain: Nine Tenets to Build Mental Fitness and Revitalize Your Mind.

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.

In this episode, Joe & Terry speak with two scientists studying mosquito preferences. Why are some people mosquito magnets while others barely get bitten? A range of factors influences mosquito behavior and may explain why mosquitoes bite you and leave your neighbor alone. Learn how to outsmart them. Why We Worry About Mosquito Bites: You may think of mosquitoes as annoying insects with itchy bites. That's certainly a reasonable summary in many places and times. But there are large swaths of the globe where mosquitoes carry deadly diseases. Malaria, for instance, kills an estimated 600,000 people a year. The majority of these victims are children under 5 years old living in sub-Saharan Africa. Even in the US, where malaria was eradicated in the mid-20th century, mosquitoes transmit some dangerous diseases, including dengue in some southern regions, West Nile virus, and in the northeast and the Gulf Coast, eastern equine encephalitis (EEE). The best prevention for these serious infections is to outsmart mosquitoes and avoid getting bitten. Depriving Mosquitoes of Breeding Grounds: One problem is that a few species of mosquito have evolved to live in close proximity to humans. They have adapted to breeding in standing water, but it doesn't take much. An upturned bottle cap, a saucer under a potted plant or leaves lying on the ground can all offer mosquito breeding opportunities. Emptying those saucers and raking away the leaves should be a priority to reduce the risk of mosquito bites. Do You Smell Delicious? Both our guests have been studying what makes some people more appealing than others. To that end, Dr. Conor McMeniman and his team have set up the world's largest multiple-choice smell test for mosquitoes in Zambia. They constructed a mesh greenhouse the size of two tennis courts that could be surrounded by eight single-person tents. A person sleeps in each tent and that person's scent is wafted into the enclosure where mosquitoes are given a chance to congregate where the preferred scent appears. This scent buffet for mosquitoes demonstrated that microbial metabolites from our skin microbiome have a significant impact on insect behavior. Mosquitoes seem to home in on short chain carboxylic acids as well as acetoin. How Can We Outsmart Mosquitoes? One simple and obvious step to avoid mosquito bites is to use window screens on our homes. That helps protect us inside. Air conditioning and ceiling fans also help. We asked Dr. McMeniman how he protects himself when he is outside and what we should do. He recommends repellents. DEET is the gold standard, but some people find it unpleasant. An effective alternative repellent is derived from plants. Whether you use oil of lemon eucalyptus or DEET, it is important to read the instructions for applying the product properly. How Do Mosquitoes Change Their Behavior? In addition to smell, mosquitoes also use vision and temperature sensing to find humans to bite. (Did you know mosquitoes sing to each other? It is part of their courtship behavior.) Dr. Clément Vinauger studies how mosquito brains react during different activities. They also pay attention to people who swat them and seem to avoid those individuals who come close to killing them. Mosquitoes can also change their behavior to adapt to human behavior. For example, a species of Anopheles mosquito that was nocturnal shifted to early morning biting over a period of a few years. That happened after the human population started using effective bed nets that protected them during sleep. More on How to Outsmart Mosquitoes: Dr. Vinauger made a casual observation that some soaps seemed to attract mosquitoes while others repel them. In a study, he found that most of the soaps his team examined appealed to mosquitoes. On the other hand, coconut scented soap (Native brand tested) kept them away. We asked him about Listerine. He has not studied it, nor has he studied some remedies that our listeners like such as eating garlic. However, he suggested consulting the local gardening center or nursery in selecting plantings around the home that are not attractive to mosquitoes. This Week's Guests: Conor McMeniman, PhD, is Associate Professor of Molecular Microbiology & Immunology at the Johns Hopkins Malaria Research Institute. Dr. McMeniman studies the molecular and cellular basis of mosquito attraction to humans. Conor McMeniman, PhD, Johns Hopkins Malaria Research Institute Clément Vinauger, PhD, is Associate Professor at Virginia Tech in the Department of Biochemistry. His research area is the molecular genetics of host-seeking behavior in insects. His website is:  https://www.vinaugerlab.com/ Clément Vinauger, PhD, Virginia Tech This week's podcast episode features bonus material from Dr. McMeniman, including exclusive content we couldn't fit into the radio broadcast.

This week, our guest in the studio is veterinarian Dr. Chuck Miller.  You may have already thought about One Health without realizing it has a name. This is an interdisciplinary approach to promoting the health of animals as well as humans that share an environment. If you have companion animals that move between inside and outside, your already know that protecting them from ticks and fleas also offers you a measure of protection. Another example of the importance of this approach would be control of bird flu. So far, we have paid it relatively little attention as it spread through cattle herds and to cats and other animals. If we learned more about its behavior in other animals, might we be able to reduce the impact on humans? Quite a bit of research has shown that having a pet present can help alleviate anxiety and lower blood pressure. One study examined the impact of therapy dogs on children's anxiety in the emergency department (JAMA Network Open, March 3, 2025). Children interacting with a therapy dog and its handler for 10 minutes in the ER had less anxiety than those whose emergency visits were dogless. A dear friend just sent us a very sad email. His golden retriever Abby just died after 13 joyful years together with him and his wife. Moreover, he noted, there will not be another dog in their family because they are both getting on in years. Adopting a dog that outlives you doesn't seem fair to the dog. When a pet dies first, the owner grieves. But if an owner dies first, someone must find the animal a new home. How do we do that? How many people make contingency plans for a surviving pet? Should we? What about grieving animals?

In this episode, Joe & Terry speak with two physicians who have examined ways that artificial intelligence might contribute to patient care. Can AI help with better diagnoses? Is robotic surgery better? Could AI save lives or is it more likely to cause trouble? We begin our conversation with Dr. Jonathan Chen, who has found that chatting with a robot made him a better doctor. (He challenged ChatGPT with an ethically difficult conversation and was surprised at the sensitivity of the observations it offered.) When researchers studied diagnostic acumen pitting human doctors against AI, the results were surprising. Some doctors did the diagnosis without help, while others used ChatGPT-4 to help them. The investigators also had the AI do the diagnosis unaided (or unhindered) by humans. Doctors got a score of 74 percent on their own and 76 percent when using AI. But ChatGPT by itself scored 90 percent. (JAMA Network Open, Oct. 28, 2024). AI is certainly not perfect, and there are times when it is not the appropriate tool to use. But results like this suggest that we should be learning more about when it might be an indispensable technology for improving patient care. After all, human doctors are not perfect, either. Health care professionals are not the only ones who are putting artificial intelligence to use in health care settings. Many physicians dread the patient who arrives with a large stack of papers printed off the internet. Our guests suggest that doctors should welcome these patients and collaborate with them. Pointing them to more reliable sites and better search strategies, if the healthcare provider is able to do so, could yield better results overall. Who is more motivated to spend time researching the details of an unusual syndrome or its treatment? It may well be the patient. There are, of course, some cautions that people should keep in mind. One is privacy. You may not want to disclose your medical history to the internet at large. Most sites are not constrained by HIPAA, which protects patient privacy in medical settings. Another consideration is the reliability of the information you find. Robots are designed to produce answers that will please the humans asking the questions. That might mean that they make things up. If the question is how to connect your camera to your computer, an invented ("hallucinated") answer is inconvenient. When it concerns your health, a fabricated answer could be dangerous. Our second guest, Dr. Art Papier, has been involved in developing large libraries of images of skin problems. With artificial intelligence powering it, VisualDx helps doctors recognize dermatological problems such as skin cancers. He describes one situation in which misdiagnosis is common and can cause harm. Cellulitis is a dangerous inflammation due to bacterial infection that can lead to sepsis. Red skin can be a signal of cellulitis, but sometimes it is caused by other problems. Misdiagnosis can lead to hospitalization and inappropriate antibiotics being administered. Utilizing a clinical decision tool like VisualDx reduced unnecessary hospital admission and antibiotic use (Journal of the American College of Emergency Physicians Open, June 8, 2023). Another strength of the system Dr. Papier has helped build is that it offers doctors views of atypical presentations of common problems. Hopefully, this keeps them from focusing on a single feature of an illness, such as a bulls-eye rash, as the only defining characteristic. The builders of VisualDx have deliberately included many images of skin of many different shades, as rashes sometimes look different depending upon the background coloration. Both our guests emphasize that AI is a tool. To get the best results, it must be used intelligently, not indiscriminately.

In this episode, our guest, award-winning science journalist Carl Zimmer, describes the hidden dangers in the air we breathe. He begins with the concept of the aerobiome–the collection of living things from ground level to the stratosphere. While that includes eagles and dragonflies, the most insidious inhabitants are those we can't see. Often, we are totally unaware of their presence. Yet bacteria like the one that causes tuberculosis or viruses like those that cause COVID or flu have the power to make us ill even if we don't know they are there. You have surely heard of the microbiome, but perhaps you thought it only applied to the microscopic beings living in our digestive tract. Lately, scientists have learned that humans have a microbiome for every different part of our bodies, including our eyes, ears, mouth and lungs. The air around us is also full of microorganisms. And even though we can't see them and we may not be able to smell or taste them, they can still have a big impact on our health. What are the hidden dangers in the air we breathe?

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? 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. 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. 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. 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.