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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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Dec. 20, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Dec. 22, 2025. 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. Dr. Awais Aftab, Case Western Reserve University 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). Robert Waldinger, MD, author of The Good Life 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. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1456: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:26 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Many people struggle for years with time management and deadlines. Could a proper diagnosis be liberating? This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:45 Some people find that a diagnosis of attention deficit hyperactivity disorder could explain a lot about their behavior. It may come as a relief to know why deadlines are so difficult. Joe 00:46-00:51 When you experience the world differently from others, it can help to know why. Terry 00:52-01:02 How can we really connect with people to find out how they’re feeling beyond the usual question, how are you? Why do relationships matter? Joe 01:03-01:09 Coming up on The People’s Pharmacy, relationships and the transformative power of diagnosis. Terry 01:14-02:25 In The People’s Pharmacy Health Headlines: Cases of influenza are starting to rise. If the UK is any indicator, we could be in for a bad flu season. That’s because British health authorities are reporting a wave of super flu infections. Hospitalizations for flu are up 50% there over last week, straining facilities. Presumably, some of the increasing cases is due to the mutation in influenza A last summer that created subclade K. That happened after the strains for vaccinations this year had already been selected. In the UK, the medical director for the National Health Service said, the numbers of patients in hospital with flu is extremely high for this time of year. The head of the Children’s Hospital of Eastern Ontario in Canada reports an early and intense start to flu season that has stretched capacity to the limit in pediatric emergency departments. That’s not yet the case in the US, where rates of flu are in line with last year’s influenza outbreak. Keep in mind, though, that last year’s flu season was nasty. Joe 02:26-03:22 Researchers are beginning to get a better understanding of the cellular pathways contributing to long COVID. A new research paper published in the journal Nature Immunology found that people with long COVID had persistently high inflammatory markers. The SARS-CoV-2 virus seemingly triggered an immune reaction that did not fade as most reactions normally do. This leads to a chronic inflammatory condition that causes extreme fatigue, brain fog, heart palpitations, dizziness, and exhaustion after modest exercise. The investigators are testing a biologic drug called abrocitinib that targets one inflammatory pathway and is used to treat eczema. If this research holds up, it may provide clinicians new tools for easing the devastating symptoms of long COVID. Terry 03:23-04:10 This is the time of year that a lot of people are bundled up against frigid temperatures. But some people crave sunshine. Often they turn to tanning beds for ultraviolet exposure. A new study, published in the journal Science Advances, reveals that tanning bed use increases the risk of melanoma, the most dangerous form of skin cancer. What’s surprising about this data is the location of the melanomas. They often occur in body sites that don’t get much sun. The researchers hypothesized that during tanning sessions, people expose places on their bodies such as the lower back and buttocks that aren’t usually out in the sun. Tanning beds could lead to more mutations and a three times higher risk of cancer. Joe 04:11-05:04 Back in 2015, the FDA approved a pill called flibanserin for premenopausal women who complained of low sexual desire. The brand name is Addyi. Now, the agency has approved it for use by post-menopausal women. This certainly increases the number of women who might get a prescription, as low sexual interest is a relatively common complaint during and after menopause. Oddly, the data that FDA relied on for this approval came from the same trials that supported approval for pre-menopausal women back in 2015. Side effects include dizziness, fatigue, nausea, sleep disturbances, and dry mouth. Fainting is rare, but taking the pill in combination with alcohol increases the risk. That could have an important impact on date night. Terry 05:05-06:17 The sexually transmitted disease, gonorrhea, has become more difficult to control. The pathogens that cause it have become resistant to many antibiotics. So it’s good news that the FDA has just approved two new antibiotics against gonorrhea. They’re both in the same new class of drugs. Zoliflodacin will be sold as brand-name Nuzolvence. It was developed through a public-private partnership. The FDA also approved a new indication for gepotidacin, sold as Blujepa. Its previous approval was for uncomplicated urinary tract infections. Now it’s also used for uncomplicated gonorrhea. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:36 And I’m Joe Graedon. Could getting an accurate diagnosis be transformative? I, for one, can attest to the power of learning why my experience is so different from nearly everyone else in the world. That’s because I have a rare neurological quirk called aphantasia. Terry 06:37-07:04 Some people have found that receiving a correct diagnosis of, for example, attention deficit hyperactivity disorder is a relief. It helps explain that they’re not lazy or stupid. Instead, their brains work differently. Dr. Ned Hallowell once described ADHD as having a Ferrari brain with bicycle brakes. To get the most out of it, you really have to learn how to use it skillfully. Joe 07:04-07:37 Today, we are exploring the transformative power of a correct diagnosis. Later, we’ll be talking with Dr. Robert Waldinger, Professor of Psychiatry at Harvard Medical School and Director of the Harvard Study of Adult Development at Mass General Hospital. First, though, we turn to Dr. Awais Aftab. He is a Clinical Associate Professor of Psychiatry at Case Western Reserve University. His Substack newsletter is “Psychiatry at the Margins.” Terry 07:37-07:40 Welcome to the People’s Pharmacy, Dr. Awais Aftab. Dr. Awais Aftab 07:41-07:42 Good to be here. Joe 07:43-08:08 Dr. Aftab, I wonder if you could tell our listeners the story of Rumpelstiltskin. I remember hearing this Grimm’s fairy tale when I was a kid, but I suspect that a lot of listeners have kind of forgotten what this folktale was about. So if you tell us the story and also why it illustrates the importance of getting a correct diagnosis. Dr. Awais Aftab 08:09-09:59 Yeah, certainly. So in the classic Grimm’s folktale, Rumpelstiltskin, a young woman promises her firstborn child to a little man in exchange for the ability to spin straw into gold. And when he comes to collect, she begs for mercy and he offers her a way out. She must guess his name. Now, at this point, she’s a queen, and she… the woman runs through every name in the German language that she can think of, every colloquial nickname. Nothing works. Finally, her servant discovers the little man’s highly esoteric name, Rumpelstiltskin, and she says the name and she’s released from the obligation. Now, this illustrates a number of more important things. You know, the source of [the] queen’s distress, it does not have a familiar name and she can’t really substitute it with a layperson description either. She can’t say “funny-little-man” that won’t do the job. In fact, so what is needed is esoteric knowledge. And that knowledge kind of gives her control over what ails her over her problem. And as soon as she knows the name, the problem takes care of itself. This kind of folktale exists in many numerous cultures. It exists in modern sci-fi. It exists in fantasy where kind of knowing certain esoteric words gives you [the] ability to control magic, gives you [the] ability to do things. And we suspect, me and my co-author, Dr. Ellen Levinovitz, that something similar is going on in medical settings where official medical diagnosis serves as providing that esoteric knowledge. And when people’s distress and their difficult experiences are conceptualized using medical terminology, it offers them a kind of relief that they would not get from just the layperson description of their problems. Terry 10:00-10:29 Dr. Aftab, you suggested that some patients who get a diagnosis, and the article that you’ve written, it’s about psychiatric diagnoses, feel better just because they have some kind of explanation. And presumably, it’s because that makes them feel like they have a little more control. Could you tell us at least one and maybe even two stories about people who had this experience? Dr. Awais Aftab 10:30-13:02 Yes. So the article focuses on mental health disorders, but we believe that the phenomena itself exists across medicine and we see it play out in many areas such as, you know, headache, chronic fatigue, restless leg syndrome, irritable bowel syndrome, etc. But it is more prominent and more vivid when it comes to mental health problems. A good example of this, for example, is ADHD, especially when the diagnosis is given in adulthood. And when people who are in their 30s and 40s, when they have lived with these difficulties in focus and attention and impulse control for much of their life, and they have negative self-esteem because of that, they have had work issues, relationship issues. And when they finally, in the middle age, learned that they qualify for a diagnosis of ADHD, they often describe a profound emotional relief. People sometimes cry. They say things like, you know, I know I’m not crazy now. I know I wasn’t broken or I wasn’t a failure. I wasn’t lazy, but rather I had this medical condition that I had been struggling with my whole life. I think another good example is autism, where people who have lived with undiagnosed autism, when they learn that they qualify for that medical diagnosis, it changes their self-conception and it gives them a kind of psychological relief about their difficulties that they didn’t have. The curious thing about these diagnoses is that they are descriptive in nature. They are describing their symptoms and they’re describing their difficult experiences. They don’t tell us what the cause is. We, for example, don’t know what the biological and psychological mechanisms of ADHD or autism are. So even though these diagnoses are a complicated and somewhat fancy way of repackaging the emotional difficulties and behavioral difficulties in medical language, just kind of having that medical language accessible provides a tremendous amount of relief. A similar kind of thing happened a few decades ago when there wasn’t a lot of awareness about postpartum depression. And women used to struggle with kind of that phase of their life. And when the idea of postpartum depression became more widespread and women started learning that this exists as a medical condition, they often found tremendous relief in having access to that vocabulary and that concept. Joe 13:02-13:41 Well, I can imagine someone who is disorganized and always late and has difficulty completing tasks. And we could run down a whole bunch of other examples of someone who might have ADHD, but just always gets criticized by coworkers or the boss or a partner. And then all of a sudden somebody says, well, hey, you might have ADHD and there’s something that you could do about it, that that would be this huge flood of relief. Oh, now I know why I can’t get tasks completed on time. Is that what you’re suggesting? Dr. Awais Aftab 13:41-15:55 Yes. Yeah. And I think a similar kind of thing is going on. Now, there are a number of different mechanisms through which this relief and benefit from a diagnosis can happen. And in the paper we published, we discussed these different mechanisms. One is this idea of switching from an everyday lens of understanding to a clinical lens of understanding or a medical lens of understanding. Our everyday language often characterizes problems as personal inadequacies and personal deficiencies. And when people switch from that kind of, you know, everyday language to our medical language, which often focuses on kind of mechanisms and causes and treatments, and has a less direct relationship with agency, that can be really helpful. And sometimes just having the words to talk about experiences can be helpful. The other possible mechanisms are that, you know, what happens in medicine is a type of ritual. It’s a very powerful ritual, the same kind of ritual that healers and shamans and other things have engaged in throughout history. And participating in that process of going through a medical evaluation, you know, answering a set of questions, doing biological tests or psychological tests. And then, you know, by virtue of getting the diagnosis, you know, being seen as having a sick role in certain situations, that itself can bring relief, that can bring positive associations. In general, in many cases, when we get diagnosed with a medical condition, some form of treatment or help is available. So there is this learned association that if a medical diagnosis is made or offered, then something can be done about it. And even if treatment is not available, there is this idea that the medical community is researching it and studying it and working towards finding something that helped. And one final thing I’ll say is that there’s also this sense of relief from cognitive ambiguity. I think a lot of people lived with unexplained and puzzling experiences, and the diagnostic label can provide them a way of making sense of those puzzling experiences. Terry 15:55-15:59 I’m wondering why you have compared it to the placebo effect. Dr. Awais Aftab 16:00-17:21 So there’s a good reason for that. You know, if you think about what happens with medical treatments, think of medication treatment, people take medications and, you know, they get better. You know, there are positive effects or benefit from that. But a curious thing is that even when people take inactive medications, if they take, let’s say, you know, a sugar pill that doesn’t have the active medication ingredient, they still get better from that. And the reasons for that are complicated. Some of them have to do with expectancy. You know, people are expecting to get better and they receive a medication, they do that. But it’s also the, you know, the process of participating in medical ritual and clinical trial and getting the help. So we wanted to create that analogy that just as an inactive medication can create positive benefits, we can have a situation where a diagnosis that does not tell us what the cause is, you know, for example, ADHD doesn’t tell us what the cause is, or a situation where we don’t have effective treatments for something. So autism, for example, we don’t have effective medical treatments. You know, even in those cases, just as an inactive pill can be helpful, this kind of descriptive inactive diagnosis can be very helpful for psychological reasons. So that was the basis of the analogy between the placebo effect and the Rumpelstiltskin effect. Terry 17:22-17:35 You’re listening to Dr. Awais Aftab, Clinical Associate Professor of Psychiatry at Case Western Reserve University. He writes a substack newsletter called Psychiatry at the Margins. Joe 17:35-17:55 Terry, I really love the idea of the Rumpelstiltskin effect because it really does describe liberation when you really know what the name is. Well, after the break, we’ll hear about the possibility that getting a diagnosis might have downsides as well as benefits. Terry 17:55-17:59 Could offering some people a label actually make their problems worse? Joe 18:00-18:10 We’ll also talk with Dr. Bob Waldinger about the tricky business of diagnoses. How might a diagnosis of ADHD be helpful and how might it be harmful? Terry 18:11-18:19 How can family and friends support people who are having a hard time, regardless of whether anyone knows a diagnosis or not? Joe 18:20-18:27 Really paying attention to a person’s concerns can sometimes be helpful, even if you don’t have any wise advice to offer. Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:09 And I’m Terry Graedon. Joe 19:10-19:20 Getting a correct diagnosis after years of struggle can help some people feel less like they are deficient and perhaps more understanding of their differences. Terry 19:20-19:29 People may feel validated and vindicated, but could there be a downside to being labeled? Could it lead some people to feel handicapped? Joe 19:29-19:44 To find out, we’re talking with Dr. Awais Aftab. He is a clinical associate professor of psychiatry at Case Western Reserve University. His substack newsletter is “Psychiatry at the Margins.” Terry 19:45-20:04 Dr. Aftab, a placebo-we were just talking about placebos can have benefits-but some placebos can also cause side effects. I’m wondering if the analogy with a diagnosis reaches that far. Could a diagnosis be harmful? Joe 20:04-20:53 And let me give you an example. There was an Australian study of high blood pressure some time ago in which patients were labeled high normal. And that actually led to increased worry and risk perceptions and increased negative emotions such as depression and anxiety, because they compared the patients who were labeled kind of high normal blood pressure to people who were not labeled. And they found that labeling low-risk people hypertensive may be more likely to harm than to benefit. So could labeling something or diagnosing something make some people worse? Dr. Awais Aftab 20:53-23:30 Yes, this is a genuine risk and a genuine concern. So, um, you know, just as we know that inactive medications or placebos can cause side effects, you know, we see that in clinical trials and we call that a placebo effect. Similarly, we know from existing research on medical diagnoses that people sometimes have negative experiences and, you know, what we might even call iatrogenic harm from them. A diagnosis can threaten and devalue a person’s self-identity. It can lead to stigmatization. It can lead to social alienation. And what happens is that due to the medical diagnosis, patients can interpret their moods, thoughts, and actions through the lens of that diagnostic category in a manner that’s too expansive and unwarranted. And it can trap them in a self-fulfilling prophecy of sorts. So for example, think of someone who has mild difficulties with anxiety, if they are given a diagnosis of an anxiety disorder, it might lead them to think that they have this permanent deficits, that they’re going to struggle with social interactions, they’re going to struggle with stressful situations, and mistakenly believing that they’ll be overwhelmed, they can start avoiding situations that make them anxious. But anxiety feeds on avoidance, and the more they avoid things that stress them or make them anxious, this will create a vicious cycle of persisting anxiety that may not have happened had they not thought of themselves as having an anxiety disorder. Similarly, people who have mild difficulties with social interactions, they’re awkward, so to speak, if they start thinking of themselves as being on the autism spectrum, they might think that their social difficulties are permanent and fixed and cannot be changed versus in reality, if they were to engage in efforts to improve their social communication and social interactions, they might be able to make progress in that regard. So there is this interaction and this feedback loop between a diagnostic label and a person’s behavior. And, you know, usually when medicine does this job right, we see positive effects. But in some cases, the narratives we offer around diagnosis can be unhelpful, and they can keep people entrenched in behaviors that worsen their problems and, you know, take away hope instead of making things better. Joe 23:31-23:52 Dr. Aftab, I have a personal story to share with you, and I’d love your interpretation. So I have lived with a rare, I’ll call it psychological condition my entire life. And I only learned about it, I’d say what, Terry, about 10 or 15 years ago? Terry 23:53-23:55 At least 15, maybe 20. Joe 23:55-25:30 Maybe 20. It’s called aphantasia. I don’t know if you’ve ever heard of it, but what it represents is about 3% to 4% of the population has this condition in which I cannot see things when I close my eyes. In other words, when I close my eyes, it’s dark, it’s black. There’s nothing there. And when people talk about their mind’s eye or they can imagine something, literally they can see it even if their eyes are closed. I’m astonished. I’m amazed. I’m puzzled because I just can’t conceive of such a thing. And there’s also the condition where people complain about an earworm, where they get a song stuck in their head and they can hear that song. And I go, what are you talking about? Because I cannot imagine such a thing. So for most of my life, I’ve suffered from this thing called aphantasia. And it’s not been paralyzing. It’s not like a terrible handicap. But I’ve not been able to understand how the rest of the world imagines things like when they close their eyes. So it was sort of a relief to learn, yeah, that I have this different wiring in my brain from most people. Terry 25:31-25:35 I think what was the biggest relief was finding out that you’re not the only person in the world like that. Joe 25:36-25:50 Right. That there are other people like me. But it sort of makes me sad because I can’t visualize anything in my mind and people have a hard time understanding what I’m describing. Dr. Awais Aftab 25:51-28:20 Yeah, thank you for sharing that experience. It’s a fascinating phenomena, and we have only started paying attention to it in recent years. I myself learned about aphantasia, I think, about probably two or three years ago, so relatively recently. And I think it’s a good reminder that there’s a tremendous amount of richness and complexity in our mental lives and psychological lives. And a lot of it is still unexplored or under-explored, and we’re still identifying and naming many of these phenomena. Now, we do have to distinguish between different kinds of psychological conditions that are present relatively commonly, and they don’t cause a lot of impairment or disability, so to speak. With the conditions that cause significant impairment and that we usually refer to as mental disorders. And so even in the realm of mental disorders, we’re still discovering new phenomena and giving names to new conditions. But even outside of it, kind of things like aphantasia, we are researching. And I just don’t want readers to think that just because a psychological condition has been named, it means that it is necessarily abnormal or defective in some way. And I think another similar kind of example would be a condition called misophonia, where there are some people, they are really sensitive to certain kinds of sounds. For example, sounds of other people chewing. And it drives them, it makes them really irritated and they can barely tolerate it. And this phenomenon also was very poorly understood and very poorly studied until it was formally named. And when people realized, you know, who do experience that kind of irritation with a certain kind of sound, they were like, oh, finally, you know, I can talk about what I have. And I realize I’m not the only one. And once you have a name for something like that, people across the world, they can connect on the basis of that name. And so new forms of new communities open up and people get together and they share their experiences. And I think that’s the social bar of having, you know, names like this for different facets of our psychological life. Joe 28:21-28:52 Well, I do know that once aphantasia was actually described, and it’s relatively recently, that people from all over the world connected with one another, just as you describe, through self-help groups or through online chats. And they went, oh, I’m not alone. There are other people out there, and that’s a very kind of reinforcing and validating process. So thank you so much for sharing with us. Dr. Awais Aftab 28:53-29:30 Yeah, I would say a similar kind of thing happened in the 90s with Asperger’s syndrome and autism, where this was traditionally believed to be a very uncommon and rare condition. But once Asperger’s syndrome, which refers to high-functioning autism, it was named, you know, these were also the early days of the internet. And people who kind of related to that description, they started kind of connecting online. And a very vibrant Asperger’s community arose. And the clinicians realized that the diagnosis is much more common than had been traditionally believed. Terry 29:31-29:37 Dr. Awais Aftab, thank you so much for talking with us on The People’s Pharmacy today. Dr. Awais Aftab 29:38-29:39 Thanks for having me. Terry 29:40-29:53 You’ve been listening to Dr. Awais Aftab, Clinical Associate Professor of Psychiatry at Case Western Reserve University. He writes a substack newsletter called “Psychiatry at the Margins.” Joe 29:53-30:23 We turn now to Dr. Robert Waldinger, Professor of Psychiatry at Harvard Medical School, Director of the Harvard Study of Adult Development at Mass General Hospital, and co-founder of the Lifespan Research Foundation. Dr. Waldinger directs a psychotherapy teaching program for Harvard psychiatry residents. He’s the co-author with Dr. Mark Schultz of the book, “The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.” Terry 30:24-30:28 Welcome back to The People’s Pharmacy, Dr. Bob Waldinger. Dr. Robert Waldinger 30:29-30:30 It’s great to be here again. Joe 30:31-32:06 Dr. Waldinger, we’ve been talking about the benefits of getting a diagnosis so we can better understand what’s going on inside our brains, our situation. For example, I have a really rare condition called aphantasia. And I didn’t learn about that until maybe about five or 10 years ago. So most of my life, I’ve had aphantasia and I didn’t know why I was different from most other people. I cannot visualize anything. When I close my eyes, it’s black. There’s nothing there. And I also can’t hear music in my head. And so the idea that somebody could actually hear a song astonished me. And when I had a name for what I have, aphantasia, it was a great relief because all of a sudden I could understand better about myself and I could understand why I was different. And I could better understand how other people could do things that I can’t do. So I guess the question is: how can a diagnosis like aphantasia in my case, or ADHD, or somebody being on the spectrum, [how] might [that] be helpful for them, for their family, for their employer, for everybody around them? Why is diagnosis beneficial? Dr. Robert Waldinger 32:08-33:55 Well, diagnosis is really a shorthand. It’s a label for a condition, right? Often it’s a set of symptoms or it’s a way you operate. Like in your case, it’s the way your brain works. And it’s different from the way many other people’s brains work. And so to have that as a way to understand what is happening to you can be an enormous relief, enormous relief. In fact, it’s interesting because my younger son has a rare condition that makes his walk funny. He has a funny walk. He has a gait disturbance that was increasing as he got into young adulthood. And we kept saying, this is really something you ought to check out. And other people kept saying, why do you have this funny walk? And so he searched for months. Actually, it got into years, went to different doctors and physical therapists. And finally, one doctor saw him at a specialty clinic and said, I know exactly what you have. Here’s what it is. Here’s how it works. This is what you’ve been experiencing. And my son started to cry. This grown man in his 30s started to cry because it was such a relief to have an explanation for these baffling symptoms that nobody understood. So I understand the quality of relief that many people experience when they get this kind of explanatory framework at last after searching. Joe 33:56-34:20 And I guess for people with, let’s say, ADHD, getting a name for why their brains are a little different than everybody else is not only helpful for them, but also for the people around them who may become frustrated because they may not finish tasks [in] a timely fashion that they were expecting. Dr. Robert Waldinger 34:20-35:44 Absolutely. I mean, I work in psychotherapy with a number of people who had ADHD as kids, but it wasn’t diagnosed. In fact, it really wasn’t known about. So the generation of people who are now, say, in their 60s, 70s, grew up with difficulties reading, difficulties doing math, not being able to learn a language, learning disabilities. And people would say to them, you’re perfectly bright. You’re just not working hard enough. Your study habits are not good. You need to sit after school. You can’t go out to play because you’re not reading, right? And what it does is it engenders this feeling of I’m defective. Everybody else can do this. Everybody else is learning to read in the first grade. Why can’t I? Right? And so what you take in is not just, “I’m having trouble with reading,” as a child, you often take in, “I’m defective. There’s something wrong with me as a human being.” And other people can give you that feeling without meaning to so that you can emerge as an adult feeling defective as a human being, not just, oh, I’m reading problems, right? Terry 35:45-36:04 And as I think back, people who are now in their 60s and 70s, other people could easily have given them that feeling, not necessarily without meaning to. Some people just did that because they weren’t thinking. Dr. Robert Waldinger 36:04-36:32 Right. Also, let’s say you come from a family that really prizes education, you know, and the thing you want the most is for your kids to do well in school, then you are personally more disappointed if your kids have it in trouble reading. And so depending on the families we are born into, the particular problems we have may be more or less acceptable. Terry 36:32-36:48 Exactly. That makes a huge difference. Let me ask you also, is there a downside to getting a diagnosis, especially considering this idea of the families that we’re born into may have different reactions? Dr. Robert Waldinger 36:49-38:56 Oh, yeah, of course. And again, that depends on the families we’re born into sometimes. So let’s say that you had an uncle with depression, who had depression, who suffered from it, and your uncle killed himself. And you start to have symptoms that might be depression. The last thing you want to believe is, “Oh my gosh, I’m just like my uncle.” So a diagnosis that your family has some experience with can make you afraid that you’re going to end up just like Uncle Joe, right? When most of the time that doesn’t happen. Most of the time someone gets a depression and depression is not most of the time lethal at all and very treatable. But you can be afraid based on what you’ve known in your family of someone with similar difficulties. So that’s one way that a diagnosis can be scary, can make people turn away and not want to know anything about it. Another is if you feel like it sentences you to a life that you don’t want. So let’s say I’m a person with ADHD, and that means there are certain jobs I can’t do. I don’t know what they might be. Maybe it’s being an airline pilot. I don’t know. I’m making this up. But let’s say you really want to do something with your life, and a diagnosis suggests you won’t be able to do that. That’s another way. Now, diagnoses are just labels, and they are imprecise labels. No two people show up the same way with the same diagnostic issue, right? We’re all different. And so no two people have the same ADHD. No two people have the same depression. But those labels can make us think that it’s a certain thing with a certain outcome and there’s no escaping it. And that’s where diagnosis can be scary. Joe 38:57-39:04 I’d like to talk about your area of expertise, Dr. Waldinger, and that is mental health issues. Dr. Robert Waldinger 39:04-39:04 Sure. Joe 39:05-39:45 Because these days, there just aren’t enough mental health experts available. And so a lot of times people will go to their family practice physician or maybe even a psychiatrist such as yourself. And they say, oh, I’m feeling so anxious, Dr. Waldinger. I’m a little depressed. I mean, times are tough. And because there’s so little time, out comes the prescription pad, or these days, of course, it’s an electronic prescription. And here’s an antidepressant. Here’s an anti-anxiety agent. You’ve had 10 minutes of my time. Good luck and goodbye, and I’ll see you in six months or maybe a year. Dr. Robert Waldinger 39:47-39:47 Yeah. Joe 39:47-40:11 And we haven’t dealt with the issues that are causing the anxiety or, in some cases, the depression. How can people, families, friends help someone who is feeling anxious or perhaps a little depressed, these are tough times, without necessarily immediately going to a prescription? Dr. Robert Waldinger 40:12-42:08 That’s such an important question because we’re trained to recognize certain things and then we’re trained to do what we do about them. So if all you have is a hammer, everything looks like a nail. If all you’re trained in is prescribing medication for mental health issues, then that’s what you go to. It’s natural. It’s not that these are bad doctors. It’s just that’s naturally what they see they have at the ready. And medications really help, by the way. So let me lay that out there. I’m so glad that medications are there in the world for me to use, even though I’m primarily psychotherapist in the practice that I do. And I think that the question is: how do you help someone talk about what they’re feeling? Because psychiatrists have this problem too. I have to train… I teach young psychiatrists. I lead a program in psychotherapy at Mass General Hospital in Boston. And one of the things that we know is that people are afraid, even psychiatrists are afraid to talk about the nitty gritty of someone’s anxiety or someone’s depression, because they’re afraid they won’t know what to do with the answers to their questions. So if I ask you, oh, “Tell me about the anxiety,” or “Tell me you’re saying you’re really depressed, are you thinking you might be better off dead?” Well, what do I do with the answer is yes. And so a lot of the training that we need to give our young psychiatrists and young doctors and nurses is what do you do with the answer, including an answer that scares you. There are ways to know what to do with that so you’re not afraid to ask the questions in the first place. Terry 42:09-42:40 You’re listening to Dr. Bob Waldinger, professor of psychiatry at Harvard Medical School and director of the Harvard Study of Adult Development at Massachusetts General Hospital. He is co-founder of the Lifespan Research Foundation and co-author with Dr. Mark Schultz of the book The Good Life. Dr. Waldinger directs a psychotherapy teaching program for Harvard psychiatry residents. And as a Zen master, he also teaches meditation. Joe 42:41-42:48 After the break, we’ll learn how trained mental health professionals can help people who are in crisis. Terry 42:49-43:01 And we should mention here that if you are in crisis or if you know someone else who is, you can call 988 for support. That’s 988 for the crisis line. Joe 43:02-43:06 How do you go beyond a casual, “How are you doing?” Terry 43:07-43:14 As we pay more attention to our relationships, we should be teaching our children how to be a friend. That’s how you have a friend. Joe 43:15-43:25 Dr. Waldinger will give us some ideas on how to turn down the noise from social media and pay attention to real live humans. Terry 43:41-43:44 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 43:53-43:56 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 43:56-44:12 And I’m Terry Graedon. Joe 44:12-44:21 How can you support friends and family who may be having a hard time? The holidays can be especially challenging for a lot of people. Terry 44:22-44:29 When everyone around you seems to be feeling festive and you’re feeling overwhelmed, it can be hard to cope. Joe 44:29-44:57 To learn more about how to support friends and family and the importance of relationships, we’re talking with Dr. Bob Waldinger. He’s a professor of psychiatry at Harvard Medical School, director of the Harvard Study of Adult Development at Mass General Hospital, and co-founder of the Lifespan Research Foundation. His book is “The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.” Terry 44:59-45:35 Dr. Waldinger, you have just described how a trained mental health professional can support and assist a person who is feeling pretty desperate. What about the rest of us who have not had that kind of training? Family members, friends, even acquaintances. How do we approach supporting a person we may know? How do we ask the appropriate question? Joe 45:35-45:47 How do we not freak out? How do we get past how you doing? Yeah, yeah. And then not really want to get an answer that’s honest. Dr. Robert Waldinger 45:47-47:13 Right, right, right. Please just say fine and let’s move on, right? Don’t tell me how you’re really doing. Right, so I think the first thing is to start with what you can see. So sometimes it’s helpful to say, you know, you look kind of down. How are you feeling? Just to notice. And someone is free to say, no, I’m really not feeling down. Okay. But at least you’ve noticed, right? Or you seem kind of sad or you don’t seem to have your usual energy or your usual sense of humor. What’s going on? That, that, it doesn’t pull for the… because “How are you?” pulls for the automatic “fine.” And actually, when someone asks me, how am I, I have to stop. Am I going to answer anything but fine? It’s a disturbance in the field almost. So I don’t ask that question. I will try to ask something else that invites a less automatic answer, including if I can notice something. Because people really appreciate when you notice them, and any of us can do that. The other thing is that it could be very helpful to ask that kind of question. Like, you’re looking down, how are you feeling? Don’t ask it at the dinner table in front of a lot of people. Terry 47:14-47:15 Ah, right. Good point. Dr. Robert Waldinger 47:15-47:44 Right? Ask it. Say, you know, do you want to take a walk, right? After Thanksgiving dinner or after a holiday meal? Do you want to, you know, let’s go out for a chat or let’s just, you know, and then ask. Ask when you’re sort of alone, just the two of you. And if someone wants to admit that they’re feeling bad, they can do that without a whole audience involved. Joe 47:44-48:48 Dr. Waldinger, I think of you as the relationship doctor. The person who really, really emphasizes the importance of relationship. We are in anxious times. I don’t care whether it’s political or whether it’s work or whatever it is. We are, I think, a nation that’s kind of freaking out over all of the social media and all of the news and all of the input just never, never stops. And I wonder if at this time of year you can tell us about why relationships are so important and how we can reestablish relationships, sometimes with perhaps a family member who we’ve been distant from for not just a few weeks or months, but maybe years, how we can reconnect with old friends. Give us that DNA of relationships and why it’s so critical. Dr. Robert Waldinger 48:48-52:19 Hmm. Right. The why. Well, one of the things we know from really good research, and I bet all of your listeners know this, is that relationships help us with the slings and arrows of life. Relationships help us through hard times. Something upsetting happens during the day. If you have somebody you can talk to about it, you can feel yourself calm down. You can feel yourself lighten. And so we know that relationships help us through hard times, including literally like I’ll loan you my truck when you’re stuck and you need to go somewhere. I’ll drive you to the doctor when nobody else can take you. All those things. Relationships matter. But they also bring joy. One of the things that we know is that having a good conversation, an authentic conversation with another person makes us feel more connected. And it gives us more of a sense of kind of belonging and warmth that we matter. And so both on the upside and the downside of life, relationships amplify the upside and they help soften the downside of life. So we know they work. And then you’re asking, well, then how do you work with relationships to allow them to give us this kind of help. And certainly with the relationships we already have, no relationship is without difficulty. If it’s an important relationship, you’re going to have disagreements. You’re going to annoy each other. That’s just the truth of it. But I think what we can do is spend more time reminding ourselves of what we appreciate about the other person. It’s so easy to dwell on what we don’t like. And it’s really hard to remember, oh my gosh, but yeah, I don’t like the way my wife loads the dishwasher, but my God, what if she weren’t in my life? What if I didn’t have her? I mean, when you do that kind of gratitude practice, it becomes really clear why these people matter. And it really makes you feel different about the relationship. So that’s one way to work with it. Another is to spend more time staying connected. A friend just sent me an email today saying, you know, it’s been a while since we got together. Do you want to take a walk this weekend? And I realized, oh my gosh, I haven’t been paying attention to that relationship. He’s absolutely right. So I wrote him right back and said, yeah, let’s take a walk on Sunday. We could do that. It’s small actions that keep us connected to each other. And one more thing I could think of for people we care about, let’s say you’re going to be at holiday gatherings. Maybe you could think in advance, there’s this one niece or there’s this one cousin or there’s this one friend who I don’t get to see. Maybe I could make it a point to spend time at this holiday party with that person and really reconnect. That’s an intention you could set before you even go. Terry 52:20-52:41 I like that idea. And as we started talking about relationships just now, I was thinking, is anyone these days teaching kids that to have a friend, you have to be a friend? I mean, it seems totally obvious, but I don’t know how well we’re modeling that for the young people in our lives. Joe 52:41-52:43 Where’s Mr. Rogers when we need him? Dr. Robert Waldinger 52:44-53:39 Oh, you’re right. You’re right. Where is he when we need him? But yeah, to be a friend, which means, I think, really paying attention to the other person. What’s this person going through? What’s happening in their life? And maybe how could I help? So I will say my wife is the best person at this. She’ll say, so-and-so’s surgery is next Wednesday. So I want to be sure to call and find out how they’re doing. So-and-so, I wonder if they need a meal because they’re recovering from something. She holds other people’s lives in her mind. She holds what’s happening to them in her mind. I think that’s something we can all get better at. I wish I were as good as my wife is at doing that, but I really admire her capacity to do that. I think we can all do it if we try. Joe 53:39-54:03 One of the things that you have told us about in the past is when you give a talk, you sometimes suggest that the audience text a friend that they haven’t been in touch with for a long time and then see by the end of the talk how many folks actually respond. Tell us a little bit about that process. Dr. Robert Waldinger 54:05-55:30 It’s fun. I did it last week. I gave a talk. The process is really to help people see that this idea of tending to our relationships is not as much of a heavy lift as you could imagine. Because when you hear me talk about the importance of relationships, you could think, oh my God, I have so much going on in my life. Now I’m supposed to spend hours each day taking care of my friends and family and those relationships? It can feel overwhelming. And so by doing this, I say to people, think of somebody you miss or you’d like to connect with and just take out your phone and send them a little text saying, hi, I’m just thinking of you and wanted to connect. And it takes all of one to two minutes during my talk. And then during the Q&A, I will ask, did anybody get anything back? And all these hands shoot up. You know, people say, oh, my friend was so glad I reached out and we made a dinner date for next Tuesday. Right. You know, it’s like people get these little hits of joy because they realize, oh, yeah, this person is happy to hear from me. And and actually we’re going to reconnect. So that’s that’s what I do. And it’s a way to demonstrate that this is not difficult. It just requires paying attention to it. Terry 55:32-56:11 One of the things that we tend to pay more attention to these days are the social media feeds, the headlines, the this, the that, which are actually designed to make us feel anxious or scared or something. Well, do you have some suggestions as to how we can turn down the noise and address our lives without that constant buzz of what’s going to happen to everything? Joe 56:11-56:33 Well, I don’t know that our listeners realize that you, in addition to being a psychoanalyst, a professor of psychiatry, you are also a Zen master. So could you give us a little Zen insight into all of the overwhelming messages we get on a not just daily basis, but a minute by minute basis? Dr. Robert Waldinger 56:35-58:40 Okay, I’ll go back to my Zen teacher, John Tarrant, who said something I come back to all the time. He said, attention is the most basic form of love. Let me repeat it. Attention is the most basic form of love. Because, you know, if you think about it, giving another person our undivided attention is probably the greatest gift we’ve got to offer. Now, in this era when social media compete for our attention, right, because it makes them money. If they grab our attention and hold on to it and don’t let us go, they make more money. They sell more ads. We are less able to give our undivided attention to each other in real time. And that’s why you’ll see teenagers sitting around a table at a restaurant, all looking at their phones, sometimes texting each other, but not looking at each other, not really giving each other their full attention. And we as adults do this too, of course. So what I would say is that, first of all, know that when we go down the rabbit hole of clicking on all these clickbaits, right, that we are letting the social media companies train our brains. We’re letting them win for their own profit. And that what we can do instead is be very mindful and curated about it. We can say, okay, I’m going to be on my social media feed for 10 minutes a day or 20 minutes a day, and then I’m turning it off. Or I’m going to take a holiday from the social media feeds and see how I feel. That it requires being really intentional about where we’re deploying our attention, because otherwise our attention is going to get hijacked all day long. Joe 58:43-59:00 Dr. Waldinger, we have just a minute and a half left. And I want to tell you personally how grateful we are for your role in our lives. We only get to talk to you every once in a while, but your message. Dr. Robert Waldinger 59:00-59:03 I love talking to you guys. You guys are the best. Joe 59:03-59:13 Your messaging, your books, your work has just been such an inspiration. In the minute we have left, can you tell us the importance of gratitude in our lives? Dr. Robert Waldinger 59:15-01:00:04 Sure. So gratitude is almost like a corrective for what our brains are wired to do. Our brains are wired to pay attention to what’s wrong because we think we evolved to look for threats on the horizon because it helps us survive, but it doesn’t help us be happy. So we’re more likely to pay attention to those negative headlines than we are to what’s positive in the world. What gratitude practice does is it says, let’s reverse this. Let’s stop and think about the good stuff in our lives, the things we are so glad we have, and that it is literally a corrective for the ways that our brains evolved maybe to help us survive better, but they evolved to make us less happy. Joe 01:00:06-01:00:52 Dr. Waldinger, you have emphasized the importance of relationships and gratitude. We can reach out to friends, family members, acquaintances that we haven’t been close to. How do we practice gratitude? How do we make that a part of our lives when it’s so easy to fall back on anger, disappointment, being upset? Oh, the trains aren’t running on time. The plane is delayed. My friend is not responding in a way I would hope. Help us really get some concrete steps down the path of gratitude. Dr. Robert Waldinger 01:00:53-01:01:56 Sure. So gratitude actually is a feeling. And so in some ways, it’s not a great label for the practice because we can’t make ourselves feel gratitude, but we can set ourselves up to make it likely we’re going to feel gratitude. And so it’s a fine distinction, but the practice is not to fake it till you make it, it’s really not. It’s sometimes called a subtraction practice. So let’s say, okay, the train is late and you can be really annoyed and yeah, I’m going to be late to work or my friend’s going to be waiting for me. All right. But then do the subtraction practice. Think to yourself, what would it be like if there were no trains? What would it be like if I couldn’t, you know, in 20 minutes go all this distance and to be able to see people and to do things that I want to do in my life. So you’re not dwelling then on the late train this morning, you’re dwelling on the very existence of trains. Terry 01:01:56-01:02:05 So it’s, yeah. So it’s a little bit like the angel talking to Bailey in It’s a Wonderful Life. Dr. Robert Waldinger 01:02:05-01:02:46 Exactly. Exactly. Exactly. That is it. It’s a wonderful life. It’s a movie that brings me to tears. And it’s just because that angel gets George Bailey to do the gratitude practice, where he looks at what life would have been like if George Bailey had never lived, right, in this town. And, you know, I think about this, boy, I think about this with my wife all the time when I get annoyed. And, you know, because I get annoyed with my wife and she gets annoyed with me because we lived together for 40 years. But, you know, but boy, when I do that, when I like, what if she was never in my life? Whoa, the gratitude just kind of comes rushing in. Joe 01:02:46-01:03:07 Well, I think about the airplane that’s delayed by half an hour or an hour, you know, oh man, I’m going to be late. Oh, that’s terrible. What’s the matter with this airline? And then all of a sudden, if you stop and think, well, how would I get from Boston to San Francisco if there were no airplanes? Dr. Robert Waldinger 01:03:07-01:03:21 Exactly. Exactly. And how often would you ever be able to do that, right? You know, it would be a major trip. Terry 1:03:17-1:03:18] Oh, exactly. Dr. Robert Waldinger 01:03:19-01:03:21 Yeah. That most people would never make in their lives. Joe 01:03:24-01:04:08 Dr. Waldinger, I think one of the most painful experiences that people can go through in life is estrangement from a family member or a friend. Because here is an important relationship that has somehow fallen on really hard times. And I suspect in many cases, both parties would like to solve the problem, but they just don’t know how to communicate anymore. Do you have any thoughts about estrangement and how people can rebuild relationships that have ended up on the shoals? Dr. Robert Waldinger 01:04:10-01:06:43 Yes, because estrangements, as you say, are really common in families. Some families more than others, because some families, just the tradition is if you have a big disagreement, you just don’t talk to that person again. Well, one of the things that we can ask listeners to tune into is, is there somebody you’re estranged from or you’re just so mad at you’re just not going to deal with anymore? How much space does that take up in your mind? Right? How much energy does it sap from you? So I’ll tell you, I was estranged, actually from one of my former teachers, a very important teacher, and we had a falling out. And this was unusual, fortunately for me, but it was terrible. I was estranged and I kept thinking about it. I couldn’t let it go. And it was a source of pain because we knew people in common. And it was just kind of there, this thing that sat on the sidelines, sapping my energy. And at one point, we both ended up at the same gathering. And we looked at each other. And I walked over. And she said to me, could we start over? And we both just hugged each other. And it was like that metaphor of the weight being lifted off your shoulders. I almost could literally feel weight coming off my shoulders. It was like, and now we’re not the best of friends again, but we’re in regular touch. And we both say, oh my God, it is so great that we’re no longer mad at each other, right? That we’re no longer holding this grudge. And so what I would say is do it for yourself. If you have the courage to reach out to the person you’re having a feud with, do it for yourself. Say, I would love to talk with you. I’d love to find a way for us to make peace, to be okay with each other again. Just offer that. And offer some of how you think you’ve played a role in it. Not assuming, well, you have to apologize to me. But really know that in every feud, there are two sides, multiple sides, if you will. And that when each person acknowledges more of how they have contributed, it really makes a difference toward healing those rifts. Terry 01:06:44-01:06:50 Dr. Bob Waldinger, thank you so much for talking with us on The People’s Pharmacy today. Dr. Robert Waldinger 01:06:51-01:06:53 Oh, this was my pleasure. Terry 01:06:54-01:07:20 You’ve been listening to Dr. Bob Waldinger, Professor of Psychiatry at Harvard Medical School, Director of the Harvard Study of Adult Development at Massachusetts General Hospital. Dr. Waldinger directs a psychotherapy teaching program for Harvard psychiatry residents. His book is “The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.” Joe 01:07:20-01:07:35 We spoke earlier with Dr. Awais Aftab, Clinical Associate Professor of Psychiatry at Case Western Reserve University. He writes a substack newsletter called Psychiatry at the Margins. Terry 01:07:36-01:07:53 Remember, the crisis number, if you need it, is 988 anywhere in the country. Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 01:07:53-01:08:01 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Terry 01:08:01-01:08:19 Today’s show is number 1,456. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You could also reach us through email, radio at peoplespharmacy.com. Joe 01:08:20-01:08:34 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. This week, the podcast has video. How about that, Terry? Terry 01:08:34-01:08:40 Well, not if you’re listening on your podcast platform, but if you go to the website, there will be video. Joe 01:08:40–01:09:03 Video, and it’s also on YouTube. You’ll hear about supportive communities that have formed around certain diagnoses. In addition, we talk about the pain of estrangement from someone near and dear to you. Reestablishing contact can be challenging, but Dr. Waldinger offers some interesting ideas about how to do that. Terry 01:09:04-01:09:32 You can find that at peoplespharmacy.com and you could sign up for our free online newsletter and get the latest news about important health stories. When you subscribe, you also get regular access to information about the weekly podcast. We’d be grateful if you’d consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. If you find our topics interesting, please do share them with friends and family. Joe 01:09:33-01:09:35 In Durham, North Carolina, I’m Joe Graedon. Terry 01:09:35-01:10:08 And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:10:09-01:10:18 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:10:19-01:10:23 All you have to do is go to peoplespharmacy.com/donate. Joe 01:10:24-01:10:37 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Dec 11

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 You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Dec. 13, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the live 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 streaming audio on this post starting on Dec. 15, 2025. It can be found under the photo at the top of the page. 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. gingivali s. 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 Listen to the Podcast: The podcast of this program will be available Monday, Dec. 15, 2025, after broadcast on Dec. 13. You can stream the show from this site (the arrow inside the green circle under the photo at the top of the page) and download the podcast for free. In this week’s extra episode, Joe asks Dr. Ewald how to get specialists to consider the possibility that infections may be at the root of many chronic conditions. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1455: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Heart disease, diabetes, asthma, Alzheimer’s disease, and arthritis are challenging diseases. Could pathogens be responsible? This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:43 Our guest today, Dr. Paul Ewald, is an evolutionary biologist who’s been studying how pathogens could spark some of our most vexing chronic diseases. Joe 00:44-00:53 Whether it’s Alzheimer’s disease, rheumatoid arthritis, heart disease, or chronic fatigue syndrome, the cause might be an unsuspected infectious process. Terry 00:54-01:05 If infections are responsible for a wide range of chronic conditions, treating symptoms might not be effective. How can we treat the cause of many of our most serious and challenging disorders? Joe 01:06-01:10 Coming up on The People’s Pharmacy, how infections trigger chronic diseases. Terry 01:14-02:40 In The People’s Pharmacy Health Headlines: Health insurance companies are struggling with their budgets. The enormous popularity of the GLP-1 drugs, such as semaglutide and tirzepatide, is a big part of the reason. These weight loss medications sold under the brand names Wegovy and Zepbound, respectively, are pricey. So the large numbers of people taking them has increased expenses more than expected. According to stats, some insurers have already spent more in nine months of 2025 than they did in all of 2024. Perhaps as a consequence, some employers are considering leaving these meds off the formulary. Certain states have also dropped them from their Medicaid programs. Although most states still cover semaglutide for diabetes, North Carolina, California, New Hampshire, and South Carolina are dropping coverage for obesity treatment. In Michigan, Medicaid will cover GLP-1 obesity drugs only for patients who are classified as morbidly obese. Health plans for state workers are also reassessing coverage of these medicines. Some physicians are concerned because people who had lost significant weight are now starting to regain it without their medication. Along with excess weight come additional health risks. Joe 02:41-03:52 Tattooing dates back thousands of years. Historically, body art served a variety of purposes from religious to healing ceremonies or rites of passage or as an indicator of group identity. In recent years, social media and celebrity influencers have popularized tattoos for millions. But are they safe? A new study in the Proceedings of the National Academy of Sciences links tattoo ink to inflammation in lymph nodes. The investigator studied the biological reaction to tattoo ink in humans and mice. The dyes that are used accumulate in the lymph nodes and appear to trigger long-term inflammation. The pigments can also be found in the spleen, liver, and kidneys. This study looked at the impact of tattoo dyes on the immune system. The researchers found that following tattooing, the macrophages were less capable of responding to a number of viruses. The COVID-19 vaccine appears to be less effective for tattooed individuals. The authors call for long-term research into the health effects of tattoos, including the risk of cancer. Terry 03:52-04:46 There are new data on the benefits of a shingles vaccination against dementia. Shingles is a painful outbreak on the skin of people who had chickenpox earlier in life, often many decades before. The shingles vaccine reduces the likelihood that older people will experience such an outbreak. Previous studies took advantage of natural experiments in Wales and Australia to determine that the original shingles vaccine, Zostavax, could lower a person’s chance of a dementia diagnosis. Further analysis of these data showed that this vaccination also slows the progression of cognitive impairment in people already living with dementia. People with dementia who received the shingles vaccine were almost 30% less likely to die from their disease over a nine-year period. People with more advanced dementia appeared to benefit the most. Joe 04:47-05:23 The flu is back, and it could be an especially challenging season. That’s because the flu virus mutated this year after manufacturers locked in the formula for the vaccine. Canada has seen a dramatic 61 percent increase in flu cases in November. Now, states such as Colorado, Michigan, and Massachusetts are reporting increased cases and hospitalizations for influenza-like illnesses. If the U.S. follows in the footsteps of countries in the southern hemisphere, such as Australia, New Zealand, and South Africa, we’re likely to see an early and severe flu season. Terry 05:24-06:17 Intermittent fasting has long been a popular weight loss strategy. Chinese researchers report it also shifts connections between the gut and the brain. They recruited 25 obese individuals for a two-month study with every other day fasting. Volunteers also provided stool samples at the beginning and end of the study. This regimen resulted in weight loss and also changes in brain activities seen on fMRI. This was correlated to alterations in the gut microbes. The researchers conclude that intermittent fasting altered the gut microbiome, and that in turn provoked changes in brain regions associated with appetite and addiction. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:33 And I’m Joe Graedon. If you ask a cardiologist what causes heart disease, chances are good you’ll hear about LDL cholesterol. Likewise, if you ask a neurologist about Alzheimer’s disease, you’re likely to hear that the culprit is beta-amyloid plaque. Terry 06:33-06:41 But what if these and many chronic diseases result in part from infections? Would that change the practice of medicine? Joe 06:42-07:06 To help us answer such questions, we turn to Dr. Paul Ewald, professor of biology at the University of Louisville. He is a pioneer in evolutionary medicine and infectious disease research. Dr. Ewald is the author of “Evolution of Infectious Disease” and “Plague Time: The New Germ Theory of Disease.” Terry was working remotely when we recorded this interview. Terry 07:08-07:11 Welcome back to The People’s Pharmacy, Dr. Paul Ewald. Dr. Paul Ewald 07:12-07:14 It’s great to be back to join you again. Joe 07:15-08:05 Dr. Ewald, I looked back in our calendar and it shows you joining the People’s Pharmacy in April of 1999, show number 263, talking about the evolution of infectious diseases. And then we had you back again in March of 2001, show number 350, “Plague Time: The New Germ Theory of Disease,” which was your second book. We called that show How Germs Shape Your Destiny. I guess it must be astonishing to you to look back over 25 years and how things have changed. But before you tell us that, please share what is an evolutionary biologist. Dr. Paul Ewald 08:07-08:34 Well, an evolutionary biologist is someone who just looks at the biological changes of organisms over time. And you can look at it in terms of how they’re adapted to particular environments, or you can do that descriptively, just describing which organisms evolved from what other ones and what characteristics evolved. My focus tends to be more on the former. I’m interested in how it is that organisms adapt to particular environmental conditions. Joe 08:35-09:03 So looking back over the last two or three decades, especially with COVID in the mirror, it seems like the kinds of problems that you predicted decades ago have kind of come to pass. Tell us about your view of the world and how pathogens have impacted us since your two books. Dr. Paul Ewald 09:04-10:21 Well, I would say over the last two decades, the information that’s become available has reinforced the idea that pathogens are pretty much important in almost every aspect of our lives. I was working largely on understanding the causes of chronic diseases. And over the last two decades, a lot of information has come out that has very gradually indicated that infections are much more important in chronic diseases than we thought. But the way in which they’re important involves interactions between infectious organisms and mutualistic organisms, and also between the genetics of people in the case of human diseases, the genetics of the organisms, and also the non-infectious environmental factors. So all of these three categories come together, the microbes, the non-microbial environments, things like, you know, do we exercise or do we not? What’s our diet like? And then the genetics, which determines what kinds of things we’re vulnerable to, what kinds of negative things we’re vulnerable to, and what kinds of characteristics we have in place to stay healthy. Terry 10:22-11:14 Well, it all sounds rather complicated if we have to look at genetics and behavior and environment and pathogens, these infectious organisms. And one of the things that Joe and I have noted is that the infectious disease specialists, the doctors who specialize in treating infectious diseases, they know a lot about antiviral drugs and antibiotics, but they don’t seem that interested in your idea that some of these infectious agents, these pathogens, might be behind chronic diseases like cardiovascular disease or Alzheimer disease. How come? Dr. Paul Ewald 11:14-12:29 Well, I think that physicians are trained to diagnose and treat. And so we can’t expect that they’re necessarily going to have a focus on this bigger picture of what actually causes disease. They have particular protocols for treating disease once they diagnose them. And, you know, there’s some pressure on them to do that. If they deviate from the standard protocols, they could be liable for malpractice. And so I think what basically we have to realize is that physicians are trained to do one thing in a clinical setting, diagnose and treat. And what an evolutionary biologist is interested in doing is trying to understand how all of this fits together. In other words, trying to understand how evolutionary forces shaping humans influence disease, how evolutionary forces shaping microbes influence disease, and how all of that depends on the environments we’re in. And often that involves noticing that there are mismatches between our current environments and the environments in we evolved and those are the environments in which we generated the adaptations to deal with health and disease. Joe 12:29-13:50 Dr. Ewald, when we spoke to you two decades ago, I don’t think we had heard of the term microbiome. I mean, everybody knew that there are bacteria and fungi and such organisms in our digestive tract, but microbiome was not a term that was used very much. Now it seems like everybody’s talking about the microbiome, and it’s not just of the digestive tract. There’s a microbiome of the lungs. There’s a microbiome of the skin. There’s a microbiome of the brain. And the idea that there are pathogens that are living in our bodies, it seems alien to most people, but we’re beginning to gradually recognize, yes, we’re living in quote-unquote harmony or disharmony with a lot of different bugs. So I’m curious as to how this concept of the microbiome throughout our body is affecting your work in evolutionary biology and the idea that there are a lot of germs, viruses, and bacteria that have set up housekeeping in us and may sometimes cause problems. Dr. Paul Ewald 13:51-15:47 Well, I think we overlook the microbiome because the members of the microbiome are very small. We don’t see them, okay? So once we recognize that they’re there, then our task is to figure out which of these microorganisms are beneficial to us, actually helping us, and which ones are harmful. And this problem has been a little bit clouded by some of the terminology. So once microbiome was recognized as being important potentially for our health, then people who are studying this tended to use this term commensal for any organism that wasn’t overtly negative or positive. But in an evolutionary context and in biological context, a commensal is something that neither harms nor helps the host. And so basically, if we really could measure the net effect of all these different organisms, we would classify them all as either parasitic or mutualistic, neither unbalance their net harming us or unbalance their net helping us. And that seems like sort of an academic distinction, but it’s a really important one because if we’re thinking about supplementing our microbiome, then we want to be supplementing it with mutualists. We don’t want to supplement it with an organism that is slightly pathogenic, especially because sometimes we supplement the microbiome for people who are in particularly vulnerable situations. And so we’ve learned sort of the hard way that some of the things that look like they’d be good to supplement our microbiome with ended up not being so great, but others ended up being fantastic. And so I think that there’s a bit of a problem in the way in which this has been addressed. But the basic idea is really good, that we’re recognizing that we are not just individuals walking around in an environment. We have our own ecology of organisms in and on us. And we need to understand that if we want to be able to improve health and avoid disease. Terry 15:49-16:33 Dr. Ewald, I wonder if you could give us an example of one of those microorganisms that we’ve discovered is actually unexpectedly helpful. Sometimes a microorganism that we think is just kind of neutral turns out to be maybe just fine as long as the rest of the microbiome is in balance. But if the microbiome gets out of balance, that neutral guy sitting in there can get out of control. And I’m thinking of Clostridioides difficile, I think. Dr. Paul Ewald 16:34-17:38 Yes. Well, that is a really great point that we need to be thinking about the effects of the organisms in the context of all the other organisms that are there. And sometimes an organism that is going to be helpful in one context will actually be harmful if the microbiome has changed. Clostridium difficile is a very interesting example because interest started on this organism about 30 years ago when it was recognized it was causing some problems in hospital settings. And so people found that a lot of individuals are carrying Clostridium difficile without any problem, but they were causing problems in hospital settings. And so they jumped to the conclusion this organism was a commensal or a very mild pathogen, maybe even a mutualist, without enough data. When you look at Clostridium difficile in a general population, it really doesn’t cause noticeable harm, but that doesn’t mean it doesn’t cause some harm. Joe 17:38-17:48 Dr. Ewald, we are going to take a break. But when we come back, what we want to do is find out when it causes problems and how to get rid of it. Terry 17:49-18:05 You are listening to Dr. Paul Ewald. He’s an evolutionary biologist and professor of biology at the University of Louisville. Dr. Ewald is the author of “Evolution of Infectious Disease” and “Plague Time: The New Germ Theory of Disease.” Joe 18:05-18:09 After the break, we’ll learn how C. diff infections can start to overwhelm hospitals. Terry 18:10-18:17 Cardiologists pay a lot of attention to cholesterol levels. Should they also keep an eye out for pathogens in the arteries or even the mouth? Joe 18:18-18:25 We also worry about Alzheimer’s disease. Are there germs that might contribute to its development? Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:11 And I’m Terry Graedon. Joe 19:12-19:27 Modern medicine has a tremendous number of specialties and subspecialties. There are not just cardiologists, but interventional cardiologists who perform angioplasty and place stents in coronary arteries. Terry 19:28-19:37 Neuroimmunologists study multiple sclerosis and neuromyelitis. Such subspecialties may focus very narrowly on a small range of symptoms. Joe 19:38-19:50 When specialists are stuck in silos, they may not consider the bigger picture. The idea that infections might trigger a number of hard-to-treat chronic diseases is somewhat foreign to them. Terry 19:50-20:18 We’re speaking with Professor Paul Ewald. He is an evolutionary biologist specializing in evolutionary medicine and pollination biology. He is professor of biology at the University of Louisville. Professor Ewald is a pioneer in evolutionary medicine and infectious disease research. His books include “Evolution of Infectious Disease” and “Plague Time: The New Germ Theory of Disease.” Joe 20:20-20:29 Dr. Ewald, you were just talking about C. diff infections, and it’s my understanding that they can be really hard to get rid of once they take hold. Dr. Paul Ewald 20:30-22:03 Yes, and the C. difficile infections are very problematic in hospitals. It used to be thought that they were just causing problems because a person’s microbiome was upset or a person was vulnerable in one way or another because they’re in the hospital. But when you look at the strains that are in hospitals and the strains in the outside community, you find the strains in hospitals are actually more severe. And this was not recognized for a while. Over the last 10 years, it’s gradually become recognized. And so what looks like it’s happening is this Clostridium difficile organism is actually evolving increased virulence in hospitals where it can get from one patient to another, even if the patient’s sick. It gets transmitted between patients on the hands of attendants. So it is resistant to antibiotics. Antibiotics are not as effective as we would like them to be. But there are a lot of ways in which we can deal with C. difficile. And one of the best ways is improving hygiene so that you actually don’t get attendants transmitting the organism from an infected individual to a susceptible individual. And if you do prevent that kind of transmission, you’ll do two things. One, you’ll actually protect individuals who become infected, but also you should actually turn down that evolutionary pressure in the hospital environment favoring the harmful strains. And so you’ll get a gradual leakage of the milder strains into these hospital environments, and they can protect against the harmful strains through cross-protection immunologically. Joe 22:04-23:01 Dr. Ewald, I’d like to change gears a little bit now and go back to some of the what were really radical ideas that you were expressing 25 years ago. And let’s just start with heart disease because it is the number one killer in America, if not in the world. And if you were to talk to most cardiologists, they would say, well, the number one killer is caused by cholesterol, in particular, bad LDL cholesterol. And statins are the savior. And along comes Dr. Ewald and he says, yes, but there are some bacteria that might be responsible and possibly even other pathogens. And I think that’s a hard sell for most specialists in the field of cardiology. So how is it possible that pathogens could be causing heart disease? Dr. Paul Ewald 23:02-27:38 Well, pathogens invade our blood system, and they can be transported in cells, macrophages, and they can get into the insides of these blood vessels. And when I talked last time, or not last time, but 20 years ago when I was talking with you, I was mentioning some pathogens that had been identified in these lesions, these cardiovascular lesions. One of them is Chlamydia pneumoniae. And there are pathogens from the oral cavity that cause gingivitis and periodontitis that are found there. And at that point, there were a few studies indicating that there were these associations. People did more studies and some of the studies didn’t agree. And so people sort of lost interest. People tried to treat with antibiotics and the antibiotics weren’t effective in remedying cardiovascular disease. But the microbiologists say, of course, they weren’t. These microorganisms by that time are living sort of encrusted in all of this decayed tissue. And so the antibiotics aren’t going to get to them. So the flash forward 20 years, what [has] now been recognized is that with many different studies that are done, mostly outside the United States, because the United States sort of stopped funding this work about 20 years ago. Now, if you look at all those studies together, there’s a very robust trend for chlamydia pneumonia, this respiratory tract pathogen that gets into the vessels of the arteries, the arterial vessels, to be strongly associated with cardiovascular disease. So people that dismiss that, my response is just look at the literature. The literature has changed so much. It’s become so developed over the last 20 years that now there should be no argument about whether those organisms are there. The only argument is the extent to which they’re actually causing the disease. But there are more data indicating that there’s an answer to that question as well. And one of the best batches of data has come out of Taiwan, which has this health system where they’re keeping track of everybody’s health records. And what people did in Taiwan was to look to see whether people who came in with Chlamydia pneumoniae pneumonia, that is pneumonia caused by this organism, were, if they were treated, were they less likely to come down, in this case, with Alzheimer’s disease? Because the argument about chlamydia pneumonia applies to Alzheimer’s disease as well as cardiovascular disease. And so what they found is those individuals that came in with pneumonia caused by Chlamydia pneumoniae, they were treated, did not have an association with Alzheimer’s later on, whereas the ones who came in with chlamydia pneumonia that were not treated did. Okay, so you’ve got this, what’s getting close to an experiment. You couldn’t run an experiment on people for ethical reasons, but this is pretty darn close. So you’ve got the evidence now for cardiovascular disease and also for Alzheimer’s really being quite overwhelming that this organism’s associated with these diseases. Now, a similar situation has occurred with the oral pathogens, things like Porphyromonas gingivalis, which is also not only causing periodontal disease, but is associated probably causally with Alzheimer’s disease and with cardiovascular disease. So going back to the original point about cholesterol and statins, the evidence on cholesterol indicates that, yes, that’s contributing as well. But the actual degree to which cholesterol is contributing looks like it’s modest, but it’s something that’s easy to measure. And so I think what happened historically is that people measure what they could measure. They can take a blood test. They can easily measure cholesterol and they could find that association. And so they sort of hung a lot of their advice on that association. But just because something’s easy to identify doesn’t mean it’s the main player. And so when you look at some of these organisms, you find that they actually do better when people have higher fat and cholesterol in their blood. And some of them, like chlamydia and pneumonia, actually increase the amount of cholesterol. So when you find that cholesterol is associated, you have to say, okay, so what’s causing the increase in cholesterol? And you have to reopen the idea that it could be a very complicated set of factors, including microorganisms that are, they are sort of upsetting the system. Terry 27:38-28:01 Well, Dr. Ewald, you did mention Alzheimer’s disease with reference to Taiwan, where they do have excellent healthcare records. And I think you suggested that people with Chlamydia pneumoniae infections were more prone later to develop Alzheimer disease. Did I get that right? Dr. Paul Ewald 28:02-28:02 Yeah. Terry 28:04-28:37 So what I want to ask you about is what we’ve been hearing from the Alzheimer’s disease researchers, not necessarily the ones we’ve been talking to most, but the most prevalent ones, the most prominent ones, is Alzheimer’s disease is caused by buildup of amyloid plaque in the brain. Some of the researchers we’ve been talking to say, yes, but amyloid plaque is actually a response to infection. What’s your take on that? Dr. Paul Ewald 28:37-29:50 Well, we now know that beta amyloid is a protein that actually is antimicrobial. So if you’ve got infections in the brain, you’re going to have amyloid beta being produced, and that is going to be associated with the degree of threat. So the real problem is thinking about the correlation between the amyloid plaques and the damage to the brain in Alzheimer’s and trying to figure out how much of that is a response to something else and how much of that is actually creating the problem of Alzheimer’s. And the bottom line, it’s a little bit of both. It looks like the amyloid proteins do have some negative effects, but it is clear that they’re also antimicrobial and they’re elevated. And the particular subsets of amyloid beta are elevated in response to infection and they actually control the infection. So that’s been pretty well looked at for one of these organisms of the oral cavity, periodontal pathogens, in particular, Porphyromonas gingivalis. So it’s been looked at in animal models. Joe 29:50-30:39 Dr. Ewald, the idea that Alzheimer’s disease or dementia might somehow be precipitated by infection is still pretty radical. And there have been papers about herpes simplex virus as one possible contributor. You’ve now suggested Chlamydia pneumoniae as another possible [contributor]. There may be a whole bunch of infectious agents that are contributing to Alzheimer’s disease. And I’m just wondering, well, patients want to know, well, what can I do about it? You know, how can I prevent Alzheimer’s disease? How can I prevent heart disease? How can I get rid of those infectious agents that might be contributing to these very serious chronic conditions? Dr. Paul Ewald 30:41-31:15 Yes, I think you’re exactly right. The emerging trend is that there are a lot of organisms that are involved, including herpes simplex and Porphyromonas gingivalis and Chlamydia pneumoniae. So there are a number of ways in which we can actually prevent this damage. One way that has been very slow to be assessed, but now it looks like it’s actually having a big effect, is taking better care of your oral cavity. Flossing, for example, looks like it has been associated with a much lower rate of Alzheimer’s. And so… Joe 31:15-31:26 Whoa, whoa, whoa, wait a minute. Are you telling me that flossing your teeth on a regular basis might reduce your risk of Alzheimer’s disease? Dr. Paul Ewald 31:26-34:16 That’s what you wanted, Joe. We wanted some practical applications. So let me tell you the mechanism that is almost certainly the right mechanism. When you floss, you take care of your oral health. This could also involve use of antibiotics to control periodontal disease. You’re controlling organisms that are found in the brain and are associated with Alzheimer’s. And you’re also controlling organisms that are found in the artery walls that are associated with atherosclerosis. And you’re also controlling one of the big bad guys I mentioned before, Porphyromonas gingivalis, which contributes to diabetes. And it looks like that’s a two-way street. Diabetes contributes to porphyromonas growth. Porphyromonas growth contributes to diabetes. And the whole thing is related to these other diseases because diabetes, when it’s bad, is related to bad cardiovascular disease. It’s also related to Alzheimer’s. And almost certainly the mechanism is that when you’ve got high blood sugar, then organisms that are normally sort of kept in check by the immune system are not so easily kept in check. So these organisms that are contributing to cardiovascular disease and to Alzheimer’s, at least in theory, and probably in practice in reality, they’re not controlled as well by the immune system when you’ve got high blood sugar. And so diabetes then exacerbates these other diseases. Now, if you ask people, you know, sort of that are not thinking about this in a broad, integrative way, so why is it that people with diabetes have more heart attacks and have more Alzheimer’s and have more periodontal disease? They’ll often say, well, it just messes everything up. Well, this is a very different view. It says that when we understand what the actual causal mechanisms are, we see connections. And that explains why diabetes is so associated with so many of these other chronic illnesses. They’re actually exacerbating the situation by favoring microorganisms that look like they’re involved in the pathology of these chronic diseases. And so I would just come back to your original point, Joe, and I would just say when people are skeptical, my response is dig deeply into the literature. Look at this information and you’ll see these connections. People are just working in such isolated ways that they’re not seeing these connections. And Terry, as you said, it is complicated. It takes work. And I am sympathetic to physicians, for example, who may not have the time to look at it. But if you don’t have the time to look at this vast literature that’s emerging, then I would think a little circumspection is in order to say, well, you know, I haven’t looked at the literature. It’s an idea worth considering. Let’s look at the evidence. Joe 34:16-34:16 Terry? Terry 34:17-34:52 One thing we do see in the literature in terms of how can we reduce our risk for coming down with Alzheimer’s disease is related to viruses. It turns out that people who are vaccinated against shingles, which is of course caused by the chickenpox virus, are at a significantly reduced risk, not perfectly protected, but significantly reduced risk of developing Alzheimer’s disease or other dementias. You want to comment on that? You know, viruses, they’re pretty important too. Dr. Paul Ewald 34:53-35:18 Yeah, that was my next point. You beat me to it. I was just going to talk about the varicella zoster virus and how evidence now is really clear, based on a lot of studies, that vaccination against the varicella zoster virus, a shingles vaccination is associated with a quite dramatic decline in the probability of developing Alzheimer’s. Joe 35:18-35:54 So, Dr. Ewald, it seems like a lot of the specialists, I don’t care whether they’re cardiologists or gastroenterologists, psychiatrists, rheumatologists, they just don’t think about pathogens. They think about blood sugar or they think about cholesterol, but you’re sort of suggesting that they’ve got it backwards, that we need to start looking at the pathogens as the causative agents and everything else is secondary. And you have about 30 seconds to respond before the break. Dr. Paul Ewald 35:54-36:15 Okay. Well, I think you hit it, the nail on the head. They’re specialists and specialists aren’t thinking about how all these things are connected. But when you look at it, you see that there are these connections, very strong connections, that are generating explanations that really are robust as opposed to explanations that are just dealing with one little part of the problem. Terry 36:16-36:38 You’re listening to Dr. Paul Ewald. He is a professor of biology at the University of Louisville. Professor Ewald is a pioneer in evolutionary medicine and infectious disease research. He’s the author of Evolution of Infectious Disease and Plague Time, the New Germ Theory of Disease. Joe 36:39-36:58 After the break, we’ll be talking about some ancient history. When chronic fatigue syndrome first showed up, it seemed to be connected to an infection. Scientists have never identified a single pathogen that’s responsible for this devastating condition. How do they think about it now? Terry 36:59-37:06 Long COVID has some similarities to chronic fatigue. Is that changing how we understand these problems? Joe 37:07-37:17 Lyme disease can also cause trouble for a long time, even though tests don’t always show pathogens. Could they be in hiding? Terry 37:18-37:24 One surprising link is between infection and schizophrenia. What should you know? Joe 37:24-37:31 Another potential connection is between arthritis and infection. Might it change how we treat joint pain? Terry 37:39-37:43 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 37:52-37:55 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 37:55-38:12 And I’m Terry Graedon. The People’s Pharmacy is brought to you in part by Spatial Sleep, a non-drug approach to help you fall asleep and stay asleep without medications. More information at SpatialSleep, S-P-A-T-I-A-L, sleep.com. Joe 38:13-38:23 When Dr. Paul Chaney described the first outbreak of chronic fatigue syndrome, he suggested an infectious origin. His colleagues were skeptical. Terry 38:24-38:42 Our guest today, Dr. Paul Ewald, proposes that many chronic conditions could be rooted in infections. He is professor of biology at the University of Louisville and author of Evolution of Infectious Disease and Plague Time, the New Germ Theory of Disease. Joe 38:44-39:57 Dr. Ewald, many decades ago, even before we spoke with you, we talked with Dr. Paul Cheney, who was, I think, an internist in Nevada. And he saw a bunch of people who had come down with a rather odd condition where they had terrible fatigue and couldn’t think very clearly after they came down with an infection of some sort. And he basically was the first clinician, as far as I can tell, who identified what we now call chronic fatigue syndrome or ME/CFS, as some people refer to it. And that idea that you could have this rather nasty upper respiratory tract infection, kind of like the flu, but it never completely goes away. And you’re kind of left with, you know, exhaustion on exercise and brain fog and a whole bunch of other symptoms. And that seems a little reminiscent of long COVID. How has COVID changed the way we think about these kinds of problems? Dr. Paul Ewald 39:57-44:07 Well, I would first say that the idea of looking for infectious causes of chronic fatigue syndrome makes a tremendous amount of sense because we know that when infections occur, one of the things the brain does is makes us feel fatigued. And so if you have a persistent infection, you’re likely to feel fatigued for a longer period of time, depending on how persistent it is. Now, if we flash forward to SARS-CoV-2, and what has become apparent is that the acute phase is part of it, and then there’s a long chronic phase, and people disagree about whether the organism’s still there. I suspect it still is, in refugia–it’s hard to find out whether it’s there or not, if it’s there in very low densities. I would, in answer [to] your question, what has COVID told us about or informed us about, I would say it’s informed us about a lot, but not enough. Okay. I think there are a lot more lessons. And one of the lessons is that we need to be thinking about infectious diseases much more in the context of both acute and chronic phases, because the acute phase is just part of the story. As soon as you start looking at a chronic phase, people will start saying, oh, well, we don’t see the organism. Well, the organism’s not as abundant in the chronic phase if it’s there. Also [it] may be causing problems much more indirectly. And so we have the same kind of problem with Lyme disease, where people are arguing that a lot of these chronic correlates of Lyme disease are not because the organism’s still there because their tests don’t show it. Well, again and again, over the last few decades, we’ve found that people are dismissive of infectious causes because they’re using the old techniques that are not sensitive enough, when you start using new techniques and you start thinking more broadly about the ways in which disease organisms can be causing chronic disease, then things appear that you didn’t think were there. So I would argue that for COVID, we need to really be focusing on thinking about detecting pathogens, the virus that could be there in the long run, and then thinking about how we would combat that. The other lesson from COVID is one that I think we may have talked about the last time I was talking with you, which is that evolutionary thinking informs us that organisms like the coronavirus that causes COVID, those viruses are dependent on hosts being not healthy, but not terribly sick for transmission because they’re moderately durable in the external environment. And the evolutionary theory, which is really supported by a comprehensive evaluation of all human diseases, indicate that if a pathogen is really durable, it’s likely to evolve to be very harmful. If it’s very non-durable in the external environment, it’s likely to be mild. And if it’s in between, it’ll evolve to be in between. And so one of the points I was making back in 2020 was that we can expect that SARS-CoV-2 is going to be evolving towards a level of virulence that is very much like influenza because that’s how durable is the external environment. And unlike what a lot of people, most people would argue that, oh, it could just become virulent again with a new mutation, I would argue that it will not become more virulent with new mutations over the broad population because those variants will be too harmful for the mode of transmission of this virus. And so that’s a test we can look at. I made that prediction 2020. So far, it’s held up. The organism over about a year evolved to be more mild and it has not evolved to be more severe like the earlier strains were. And so it’s a prediction from evolutionary thinking that we will be able to evaluate as time goes on. And hopefully people will look back and see that the evolutionary perspective generated these predictions. And if the predictions don’t hold up, then we can say the evolutionary perspective is not great. But if they do hold up, then it lends credibility to this evolutionary perspective. Joe 44:07-44:10 Well, we certainly hope you’re right. Terry, you have another question? Terry 44:10-44:35 I do. I’m wondering, Dr. Ewald, you say that we’re using old techniques, old technology, presumably, to look for these pathogens that have caused an infection, and we assume the person is now recovered, and yet they still are feeling bad. The tests that we use don’t show that the pathogen is there. Could a pathogen be hiding? Dr. Paul Ewald 44:35-48:40 Yes. Well, I think that’s exactly why they’re hard to detect. They’re essentially hiding. They’re in places where the immune system can’t get to them, and so it’s harder for us to identify them because it’s harder for us to get to those places. [They] may not be as abundant in the body and they also might be much more hidden. So if the immune system can’t get to them, that’s why they’re persisting. We may not have an antibody response that’s very high. And so people say, well, there’s a slight antibody response, but it doesn’t really look like an active infection, but it’s very well likely to be a moderate antibody response. This is associated with, like you say, a hiding infection. And this is really quite important because what it means is we have to be able to generate tools that will identify pathogens that are there in much lower density and in tissues where they’re not so obvious. And this is very apparent in cancer, for example, because it used to be thought that if a pathogen was causing a cancer, you would see it in essentially all cells in the tumor, right? And it makes sense. And the first cancers that were accepted as caused by infection did have pathogens that were present in virtually all cells. And so people then presume that that would be the model for all viral-induced cancers. But now we know that some cancers are caused by viruses that are only present with about 1% of the cells in the tumor. So Hodgkin’s lymphoma is an example of that. And so what that means is we have to be looking much more carefully at all of those cells. And there are techniques now: you can do techniques that involve looking at single cells and then putting all of those cells together, let’s say in a tumor, to see what the overall structure is. And then you can assess whether just a few of those cells are actually cancer cells. And other cells might be infiltrating cells. There might be cells that have lost a virus and therefore are not infected anymore. So I think that this is a really important issue. People have rejected the idea that infections are causing cancers because they’re found in, let’s say, only 1% of the cells. But now we know that cancers can be caused by viruses that are only affecting 1% of the cells. In the case of Hodgkin’s lymphoma, where this has been accepted, it was a little more obvious because those cancer cells look different. Okay. And so people [say], what are those cells doing? They found out that those cells were the ones who were infected with the Epstein-Barr virus. Other cells in the tumor were not, and those were the cells that are cancerous. Okay. So you have a clue, it’s kind of conspicuousness of infectious causation. And what we have to remember is we’ll identify and accept infectious causation for diseases in which the infectious causation is more conspicuous than it is in other diseases that are caused by infection, right? Because we will, if it’s conspicuously caused by infection, then everybody can agree on it faster. If it’s inconspicuously caused by infection, then people are going to argue about it. And so that actually has been the history of the germ theory for the last 130 years, is that we’ve identified the infectious agents that are conspicuously causing infection. And then we’ve argued about the ones that are less conspicuously caused, and then we solve those. And then we argue about the other ones because they’re even less conspicuously caused. And so now we’re arguing about things like cancer in which you have only a few cells that may be infected in a tumor, a few cancerous cells in the tumor. And we’re dealing with cancers like breast cancer, for which there are six different viruses that have been rigorously associated with breast cancer. This is with multiple analyses and looking at the various studies and using meta-analyses to see what the overall trend is. And so if you’re looking to see whether one virus is associated with breast cancer, it might not be in that population, but another virus might. You have to be thinking about all five, I’m saying all six viruses that have been significantly associated with breast cancer and probably more that haven’t yet been associated. Joe 48:40-48:42 Dr. Ewald, we are running out of time. Dr. Paul Ewald 48:42-48:42 Okay. Joe 48:43-49:47 And I’d like to ask you about schizophrenia. Dr. Paul Ewald 48:47-48:47 Yes. Joe 48:47-49:41 Because when you mentioned that a couple of decades ago, I think it came as a real shock to our listeners. How could mental illness, something severe like schizophrenia, be caused by a pathogen? And just in the last several months, there’s a story in the popular media of a woman who was diagnosed with schizophrenia for many, many years. And then she came down with something that required an antibiotic. And after a course of treatment for whatever infection she had, all of a sudden, her schizophrenia disappeared for good. And it was like, how could that possibly happen? And so can you give us, in a short period of time, your overview of schizophrenia in particular and how there might be an infectious cause? Dr. Paul Ewald 49:43-51:43 Okay. So schizophrenia is a great example of a disease entity that’s an umbrella category. And that category used to be embedded in an even bigger category, which included syphilitic insanity. And your question was, how could a pathogen cause such severe mental illness? Well, syphilis, the syphilis organism does it. It was recognized. And as soon as they recognized it, they separated it off from what we now call schizophrenia. And so for the last hundred years, we’ve been dealing with this term schizophrenia. And I think we’re poised on the edge of making some more divisions, taking away what we’re calling schizophrenia and putting it in another category. So one big advance was to recognize that a lot of schizophrenia really has mood associations. And so in the last 10 years, there’s been a tendency to talk about schizoaffective disorder. And when we look at pathogens, one thing we find is now with many studies, there’s a highly significant association between Toxoplasma gondii, this cat-rat pathogen, and schizophrenia. But in particular, it seems to be associated with schizoaffective disorder. So I think what we’re poised on doing now is looking at schizophrenia and saying, we want to take off certain parts, carve out certain parts of what we’re calling schizophrenia, and we’ll put it into, make a new category, and then we’ll be left with a smaller category. And this has been happening, as I said, for over 100 years for psychoses. And so what we can imagine is a new category that we can call ‘toxoplasmal schizoaffective disorder,’ which will be maybe as much as a third of what we’ve called schizophrenia out and put it into this new category. Then we’ll be left with two thirds of something we don’t understand very well. And we have to look carefully at it and figure out whether there are other subsets that we can carve out in a more realistic category that represents an understanding of the causation of those problems. Joe 51:45-52:00 Dr. Ewald, we only have two minutes left, could you quickly squeeze in something about arthritis, especially rheumatoid arthritis, and then sum up what people should learn from your books and from your research? Dr. Paul Ewald 52:02-54:50 Well, arthritis is, again, a big umbrella category. We’ve recognized that some arthritis is caused by infection. And when we recognize it, we carve off that aspect of arthritis and give it a new name. So we’ve given some arthritis a new name, reactive arthritis, which indicates that it is associated with and caused by infection with, in this case, bacteria. And particularly infection with Chlamydia trachomatis, a sexually transmitted pathogen also associated with Neisseria gonorrhoeae. And so that’s an example of what has happened in this process in which we take these umbrella categories and subdivide off. I think we’ll see more of that kind of subdivision. In the case of rheumatoid arthritis, we know that this is an antibody-mediated disease. The antibody is causing a lot of problems. So what is causing the antibodies to misbehave? Okay. We don’t expect the immune system just to misbehave on its own. Something’s got to be pushing it. And so there are pathogens that look like they’re associated with rheumatoid arthritis, and we need to really look at them. So Epstein-Barr virus, one that is associated with Hodgkin’s lymphoma, looks like it’s associated with rheumatoid arthritis. Also, the one I mentioned before, the periodontal pathogen, Porphyromonas gingivalis, looks like it’s associated. And the details really look like those associations are causal. So I think it comes back to what can you do to reduce the chance of having these infections? And the Porphyromonas [gingivalis] comes back to flossing, weirdly. How would you ever expect that flossing would be related to protecting yourself against rheumatoid arthritis? But it also raises a general question, which is really important now in this atmosphere of our politics, our governments, and our social setting. And that is that there’s this tendency among some people to think that vaccines aren’t extraordinary tools that have helped the medical sciences to combat diseases. And I think, again, looking at the evidence, you have to realize it’s one of the great categories of advancement. And it’s likely to be even greater in the future as we recognize a lot of these pathogens we don’t have vaccines for are causing chronic diseases. And some of the pathogens that we have vaccines for are causing more problems than we thought they were causing. So I think that a shout out to the idea that we really have to be thinking clearly about the value of vaccines. Vaccines do have some side effects, but the side effects are so rare compared to the benefits that I think we really should be hesitant to act against the administration of vaccines and also the support for vaccine research. Joe 54:52-56:06 Dr. Ewald, you have described a whole bunch of chronic conditions that could be triggered by pathogens, by bacteria, viruses, perhaps some other organisms, whether it’s cancer or whether it’s schizophrenia or whether it’s heart disease. And it feels like we’ve just scratched the surface. If you could pull together all of the specialists, the cardiologists, the pulmonologists, the psychiatrists, the gastroenterologists, and put them in a room and say, hey, guys, hey, women, all of you professionals, you need to start looking at the causes of the conditions that you’ve been diagnosing and treating for decades. And some of those causes, many of those causes, may be pathogens. And until you start killing off or preventing those pathogens from causing the diseases that you’re treating, you’re fighting a losing battle. How could you ever accomplish that huge feat? Dr. Paul Ewald 56:10-58:11 I have been trying to work towards that end by sort of continuing to write on these issues, continuing to show how certain explanations are missing certain things and how those missing parts are filled in. And you look at interconnections between genes, environment, and infection. And so I would just say that this is nothing. This slowness is nothing new. It’s been happening for over 100 years. And we just have to have patience. And I don’t think that getting everybody in the room is going to do it. I think we’ve got to actually have papers written, books written, that actually people can take time to read and ponder. And then people who tend to be leaders in these areas will say, hey, wait a minute, I think we have been a little bit wrong. And then the people that tend to be followers will say, well, this leader said that we’ve been wrong in neglecting this interface between genetics and infection and environment. And so maybe it makes sense. And so then the default, as people shift, is to then give some credibility to these arguments. But, you know, progress happens. It’s just very slow. It’s like slow motion germ theory of disease. You know, the germ theory started millennia ago, actually, but certainly centuries ago. So and then the progress has been very slow. And the slow progress has been because the things that are to be discovered in the future are less obviously caused by infection. We just have to get people to realize that. And I think, I’m thinking the best way is by writing books and papers that people can read, take their time with and ponder rather than trying to get people in a room and sort of make arguments based on evidence that then goes by so fast. And the meeting would go by so fast that people then leave and they’re not changed by it. That’s my sense. And also, I think it’s good to have shows like your show where we can actually get these ideas out. Terry 58:12-58:18 Dr. Paul Ewald, thank you so much for talking with us on The People’s Pharmacy today. Dr. Paul Ewald 58:19-58:20 Thank you for having me. It’s been a pleasure. Joe 58:22-58:48 You’ve been listening to Dr. Paul Ewald, professor of biology at the University of Louisville. He’s a pioneer in evolutionary medicine and infectious disease research. Professor Ewald has challenged conventional wisdom on the causes and prevention of many chronic diseases. He’s the author of “Evolution of Infectious Disease,” and “Plague Time: The New Germ Theory of Disease.” Terry 58:49-58:57 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 58:58-59:05 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Terry 59:06-59:22 Today’s show is number 1,455. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com. Joe 59:23-59:39 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. The podcast this week has additional information on how to consider the possibility that many chronic diseases are caused by pathogens. Terry 59:40-01:00:10 At peoplespharmacy.com, you could sign up for our free online newsletter. And that way, you can get the latest news about important health stories. When you subscribe, you also get regular access to information about the weekly podcast. We’d be grateful if you’d consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. If you find our topics interesting, please share them with friends and family. Joe 01:00:11-01:00:14 In Durham, North Carolina, I’m Joe Graedon. Terry 01:00:14-01:00:49 And I’m Terry Graedon. Thank you for listening. Please do join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. 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Dec 4

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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Dec. 6, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Dec. 8, 2025. 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 be dangerous for our health, sometimes the greatest danger is from particles we can’t 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. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1454: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. How do you catch the flu, COVID, or cold? Such respiratory infections are transmitted through airborne viruses. This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:46 Dr. Linsey Marr is one of the country’s leading experts on air quality. She was among the first scientists to identify airborne transmission as a problem during the COVID pandemic. Joe 00:46-00:51 Dr. Marr will tell us how we can improve the quality of the air we breathe. Terry 00:51-00:58 Do you know how well the air in your home is filtered? What about the air quality at school, at work, or in your doctor’s office? Joe 00:59-01:07 Coming up on The People’s Pharmacy, how cleaner indoor air reduces your risk of infection. Terry 01:14-02:16 In the People’s Pharmacy Health Headlines: viruses are on the move, through the air and on surfaces. Subclade K type A H3N2 influenza is spreading. People catch it primarily by inhaling invisible viral particles. Public health authorities are worried that current influenza vaccines may not protect well against this new variant. The other virus that’s causing a lot of misery is norovirus, also known as stomach flu, the cruise ship virus, or the winter vomiting bug. It’s one of the most easily transmitted infections because just a few particles can make you very sick. Wastewater scan shows a significant uptick in the last couple of weeks. If anyone in your household starts throwing up or having diarrhea, you’re at risk of catching this virus. That’s because it can be transmitted through the air. There is no vaccine or effective treatment against norovirus. Joe 02:17-03:31 Nutrition experts have been arguing about fat for decades. Starting in the 1980s, Americans were encouraged to follow a low-fat diet. Instead of using butter, people were told to use vegetable oil. Saturated fat was the enemy because it was thought to clog coronary arteries. Hydrogenated vegetable oils were promoted because they had no cholesterol. And seed oils, such as peanut, corn, and safflower oils, became popular because they, too, were low in saturated fat. In recent years, though, researchers became concerned that hydrogenated vegetable oils contributed to atherosclerosis. And now, researchers at the University of California, Riverside, report on an experiment with soybean oil. Mice fed on soybean oil developed obesity more easily than those fed coconut oil. The investigators identified a liver protein that determines how the body handles linoleic acid, a major component of soybean oil and some other vegetable oils. They point out that many processed foods contain soybean oil, which could be contributing to the obesity epidemic. Terry 03:32-04:51 Diet can play an important role in controlling blood sugar for people with type 2 diabetes. A study published in the American Journal of Clinical Nutrition demonstrates that slowly digestible starch can be very helpful. Because this slowly digestible starch is metabolized over a long time, it does not lead to spikes in blood glucose or insulin. Investigators recruited 51 people with type 2 diabetes and randomly assigned them to diets either high or low in slowly digestible starch. For three months, the volunteers kept track of their blood sugar with continuous glucose monitors. They also met with dietitians for nutritional and culinary counseling. Those whose diets were high in slowly digestible starches such as peas and beans, nuts and seeds, and whole grains had less dramatic changes in blood sugar. Both groups lowered their levels of HbA1c, a medium-term measure of blood sugar. Those on the diets rich in slowly digestible starches actually got their A1c below 7%, which was the target. The researchers believe this offers an effective and accessible strategy to help people with type 2 diabetes gain control. Joe 04:52-05:44 Australia’s equivalent to the Food and Drug Administration is called the Therapeutic Goods Administration, or TGA. Like the FDA, it monitors drug safety. Recently, the TGA issued a new safety warning to people using GLP-1 drugs such as semaglutide, tirzepatide, liraglutide, and dulaglutide. These drugs have become household names such as Ozempic, Wegovy, Mounjaro, and Zepbound. The TGA is concerned about reports of suicidal thoughts and behaviors associated with these medications. The regulatory agency is urging doctors to monitor patients for the emergence or worsening of depression, suicidal thoughts, or behaviors, and or any unusual changes in mood or behavior. Terry 05:45-06:17 Residents of several states are being warned to stay indoors because of poor air quality. High levels of ozone or fine particulates too small to see are making breathing dangerous in many places. You can check your local air quality index at the website airnow.gov. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:27 And I’m Joe Graedon. We’re entering cold and flu season, except there are lots of other pathogens circulating in the air we breathe. Terry 06:27-06:41 We can’t see them because they’re much too little. Infectious agents such as respiratory syncytial virus, human metapneumovirus, pertussis, and mycoplasma pneumoniae can cause a lot of misery. Joe 06:42-06:57 And let’s not forget that SARS-CoV-2 has not disappeared. This year, a new variant of influenza A, subclade K, is making people sick, and the flu shot may not protect us as well as we’d hoped. Terry 06:58-07:26 To find out why air quality matters, especially when pathogens are circulating, Joe talked to Dr. Linsey Marr. She’s a professor of civil and environmental engineering at Virginia Tech, where she leads the Applied Interdisciplinary Research in Air Laboratory. Her research group focuses on the dynamics of biological aerosols like viruses, bacteria, and fungi in indoor and outdoor air. Joe 07:28-07:32 Welcome to the People’s Pharmacy. It’s so nice to have you back, Dr. Linsey Marr. Dr. Linsey Marr 07:33-07:37 I am thrilled to be here, to be back on the People’s Pharmacy. Thanks so much for having me again. Joe 07:37-08:21 Well, you know, unfortunately, Terry can’t be with us today, but I am so pleased to find that you have received so many awards and recognition for the work that you have put in over the last five years, especially with regard to COVID. I mean, you are an environmental engineer, you’ve been involved in bioengineering for a long time. And it seemed like COVID was just waiting for somebody with your expertise to come along. Can you tell our listeners what is an environmental engineer and how did you get interested in aerosol viruses? Cause you were into this field before there was COVID-19. Dr. Linsey Marr 08:23-09:22 Right. Environmental engineers dedicate their careers to ensuring that we have a clean and healthy environment, whether it’s in the natural environment and also in the built environment. The built environment [is] buildings and roads and other infrastructure. And so, for example, some environmental engineers focus on clean water. You know, we take it for granted that you can turn on your tap and get clean water that is safe to drink. But that wasn’t always true. And that development was thanks to the work of environmental engineers. Another example is that of clean air. Air in the U.S. used to be much dirtier in the 1970s. It was heavily polluted by dirty cars and the steel industry and other sources. And environmental engineers are the ones who kind of recognize this and helped lead, I guess, research and actions to help clean it up. Joe 09:22-09:36 Now, I’m saying that COVID changed your world, but you were already in this field. You were already interested. Tell us how COVID did make a difference in your life. Dr. Linsey Marr 09:37-10:51 Yeah, I had been studying viruses in the air since about 2008 or 2009. And I got into it mainly, well, for a couple reasons. One, I had been studying traditional particulate pollution in the air. As I mentioned, environmental engineers study air pollution. And then a second reason is that I had a child in the end of 2007, and he had started daycare and was getting sick all the time. So I really became both fascinated and frustrated by the rapid spread of disease in daycare centers. And so I started reading up on this and found out that we really didn’t know as much as it seemed. And what I did read about how the flu spreads between people, some of it just didn’t really make sense with my understanding of how particles move through the air. And so my research group started out by going into daycare centers, a health center on campus, and airplanes. We collected air samples, really particles in the air, and analyzed those and found the flu virus present in like half of them. And it was in small enough particles that they would stay in the air for a long period of time, float around, and people could breathe them in. And after several hours, they could breathe in enough to become infected. Joe 10:51-11:15 So you were already beginning to suspect that viruses could float on the air. And then along comes COVID. And the CDC and the World Health Organization, all these public health experts were saying six feet. As long as you’re, you know, eight feet away from somebody who’s infected, you’re home free, no worries. And you are going, whoa, whoa, wait a minute. Dr. Linsey Marr 11:16-13:01 Yeah. All of a sudden, all the research I had been doing for the previous 10 years really was here. And I had been studying this because I was worried about a new flu pandemic. It wasn’t flu, but it turned out to be a coronavirus. And then there was this constant messaging about, oh, stay six feet away from people and that’ll protect you. And I knew from what I had been studying that that was likely not true. And it was based on some older, let’s say, kind of dogma or kind of, yeah, just dogma about how respiratory viruses transmitted, that it was mainly in these large droplets that people cough or sneeze into your face big enough to see. And they’re large enough and heavy enough to fall to the ground within six feet of anyone who coughed them out. So that, if that were true, then if you stayed at least six feet away, then there would be no way that you could come in contact with these, the viruses being emitted by other people. But it turns out that, you know, based on research I had done earlier and putting together a lot of studies that other people had done, even going back to the 1940s, I knew that people, whether they’re infected with a respiratory virus or not, but that they emit respiratory particles of all sizes, both those large wet ones when you cough, but also smaller stuff when you talk. And even some people when they breathe. And based on older studies, I knew that the virus could be present in those across the whole size range and could also survive in those. And so the idea of the six-foot distancing, to me, it just didn’t sound like enough. I think it was due to a misunderstanding about how this type of virus would transmit. Joe 13:02-13:43 What surprises me in retrospect is that the six-foot rule kind of lasted a long time. It made no sense. And I kept wondering, well, where did it even come from? But I think your research and your colleagues’ work demonstrated pretty effectively that these viral particles could float through the air not for a few minutes and not for six feet, but for a long time and a greater distance, a much greater distance. So when did we finally begin to recognize that, Yeah, six feet wasn’t going to be the answer. Dr. Linsey Marr 13:44-16:17 I think it was a gradual series of kind of research studies and also observations of super spreading and other types of events that helped us realize that six feet wasn’t enough. And I should say that six feet is helpful because it does keep you kind of farther away from the most concentrated plume. If you imagine somebody’s talking, there’s a kind of a plume of air coming out as if they’re smoking a cigarette and you want to stay away from that. So six feet is good for staying away from that, but it’s not going to absolutely protect you from breathing in those smoke or other respiratory particles. But there were a number of things that happened. So one was that there was that the outbreak in the Skagit Valley Chorale in early March of 2020, I believe, where there was a choir that went through a rehearsal and maybe one or two people were were infected. They didn’t feel quite well. The group, you know, knew that there was this new virus around. And so they avoided shaking hands, touching each other. And yet still something like over 80% of the members of the choir became infected after that practice. So that to me was one sign of, oh, this thing is probably in the air because it’s really hard to infect that many people just by touching the same doorknob. Even if everybody did touch the same doorknob, you know, after the first few people touch it, you know, any virus that was on there will probably be gone, have been removed. So that was one thing. And then there was a study that came out of China in a hospital where they did aerosol particle sampling with the types of instruments, the same types of instruments that my group uses, and they found virus in the very small particles. Now, it was the viral RNA, like its genetic signature, it wasn’t infectious virus. And so some people said, oh, well, it’s not infectious. That doesn’t prove anything. But, you know, we know that it’s hard to, it’s really hard to maintain infectious virus when you’re sampling from air. So that was another hint that it could be there. And then there were, there were additional studies. Finally, I think later that summer, there was a group that sampled air in a hospital where there were patients, and it was more than six feet away from their beds. And they used a newer sampling device that is gentler and help better keep the virus infectious. And they discovered a lot of infectious virus in the air in those samples. Joe 16:18-16:59 So there was enough evidence that accumulated over those first year or two that people began to recognize. But they didn’t really want to believe it. And in a sense, there was like, well, we don’t want a mask because that’s a pain in the neck. And we aren’t going to change our heating and air conditioning systems. And so nobody really knew what to do about it, including, I think, a lot of the public health people. We just have about a minute left before we take a break. But have we learned from COVID? Have we made changes that are significant so that it won’t happen again? Dr. Linsey Marr 16:59-17:33 I think we have learned there’s a totally new discussion about transmission of viruses through the air that used to be completely absent or was reserved for really special cases. But I think now it’s understood to be widely applicable to colds and flus. And then, for example, I think the CDC, Centers for Disease Control, had a new website where they recommended a certain amount of ventilation, minimum ventilation in rooms. And so that’s progress. That’s something that did not exist before. Joe 17:34-17:45 Well, when we come back after this break, let’s talk about progress and what we need to do in the future to prevent another pandemic. Terry 17:45-18:02 You’re listening to Dr. Linsey Marr, Professor of Civil and Environmental Engineering at Virginia Tech. She leads the AIR2 Laboratory, which focuses on the dynamics of biological aerosols, like viruses, bacteria, and fungi, in indoor and outdoor air. Joe 18:02-18:07 After the break, we’ll learn about other pathogens in the air besides viruses. Terry 18:07-18:13 Researchers pay attention to the size of the particles that are wafted around indoors. How do they affect our health? Joe 18:13-18:19 If you have to spend time where there might be a lot of pathogens in the air, are there ways to protect yourself? Terry 18:19-18:25 Which places are especially dangerous? Are some public places we should be extra cautious? Joe 18:25-18:29 Air filters might help. How could we improve ventilation and filtration? Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 20:40-20:43 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 20:43-21:01 And I’m Terry Graedon. Joe 21:01-21:20 Air quality is important for health, but public health experts have not required landlords to install high-efficiency filters or UV lights to eradicate pathogens. Is there anything we can do to monitor air quality and protect ourselves from airborne pathogens? Terry 21:21-21:47 I was on assignment out of town and could not participate in this interview with Dr. Linsey Marr. She is one of the country’s leading experts on indoor air quality. She’s focused her research on the dynamics of biological aerosols such as viruses, bacteria, and fungi. Dr. Marr is professor of civil and environmental engineering at Virginia Tech and leads the AIR2 Laboratory. Joe 21:48-22:24 Dr. Linsey Marr, we’ve been talking about COVID, a virus, but there are all kinds of pathogens that float in the air besides viruses like influenza and COVID, SARS-CoV-2. Tell us about the size of the particles, whether it’s a bacteria or whether we’re talking fungi or some other pathogen, and how all of the stuff that’s in our environment, whether it’s inside or outside, may affect our health. Dr. Linsey Marr 22:26-23:54 Yeah, there’s a whole… world of microscopic organisms in the air around us. And bacteria are around one micron in size. And to put that in perspective, a strand of your hair is probably 50 to 100 microns in diameter. So imagine something that’s one-fiftieth to one-hundredth that size. Fungi might be that size or a little bigger. Viruses are maybe smaller than that bacterium. Maybe like the coronavirus and flu viruses are around 0.1 microns. So one-tenth the size of the bacterium. But those things do not float around naked. They’re released from a respiratory tract or with bacteria. It might be splashed out of water somewhere, blown out of soil. And so it’s carrying, there’s a particle that is carrying the virus or bacterium or fungi, but often it also, usually it carries other things from that fluid. So like our respiratory fluid, your saliva, sure, it’s liquidy, but if all that water evaporates, you’re left behind with a lot of salts and proteins and other organic material. And in fact, that amount of material, you would have almost like 100,000 times as much of that other material, mucousy, salty stuff, than you would the amount of virus in it. And so these things are all around us. They’re very tiny. We can’t see them, but they’re there. Joe 23:55-25:53 Well, you know, you’ve used the metaphor of smoke. And I think it’s really, you know, it’s a great example. If you enter a room where somebody has been smoking a cigar, you will know it instantly because it smells. You probably won’t see the smoke, especially if they were in the room maybe 30 minutes before you walked in and they had left. But the idea that there are still those smoke particles floating through the air and you can smell them, that kind of is a wake-up call that whenever we walk into any room, almost anywhere, there are going to be particles, especially if there are a lot of people in that room. And I think of concerts. I think of sporting events, basketball season, and thousands of people all screaming their lungs out, some of them sneezing. And I’ve seen your video that you’ve shown with people sneezing, and it’s really scary. And so there are a lot of venues where you’re going to be breathing in a lot of different pathogens. And the question is, why are some people more likely to get sick than others? We got a lot of email from people who said, oh, I don’t worry about that stuff because my immune system is so good. I take lots of vitamins and nutrients and I can ward off anything. And then I’m thinking, yeah, but what about norovirus? If you walk into a bathroom where somebody threw up or had diarrhea, there are going to be norovirus particles floating through that public restroom. Or what about influenza? Or just, you know, there are so many kinds of pathogens out there. So I guess the question becomes one of, we can’t see this stuff, but it’s there, how do we protect ourselves? Dr. Linsey Marr 25:54-27:53 We covered a lot in that question. So let me, that’s a great question. Let me go back to the cigar. So what we are smelling is often the gases that are in there, not the actual particles. Although if the gases are present, there may still be a few smoke particles around. And then in terms of kind of particles in the air all around us, there’s even in a room that appears clean, a typical amount of particles in the air, and this is not just like microbial stuff, but just total particles of all kinds, is you would have like a thousand particles per cubic centimeter. And a cubic centimeter is roughly the size of a sugar cube. So you take a big deep breath in and you’re breathing in like a million particles. And a lot of those come back out, but some of them do deposit. And some of them are salts and other organic material and lots of different materials. Only a small fraction of them are actually microbes. And an even smaller fraction of those are actually pathogens. And so how do we protect ourselves in these types of places where they’re all around us? Well, the fact that the pathogen is in the air and you breathe it in is only one part of the equation of whether you’re going to get infected and sick or not. Because indeed, your immune system plays a big role here in trying to fight off these pathogens. And that response is going to vary hugely from individual to individual. And that’s outside my area of expertise. But, you know, I work with people who know a lot more about that. And that certainly plays a big role. And then, you know, how do you protect yourself if you are, let’s say, immunocompromised or you’re on a big, important trip and you don’t want to get sick? Well, you know, for things in the air, you would want to wear a high quality mask, a respirator, something like an N95 that, you know, fits well, especially when you’re in around other people and in crowded, poorly ventilated areas. Joe 27:55-29:02 And then, let me interrupt… let me interrupt you right there, Dr. Marr, because Americans hate masks. That’s pretty clear. People in other countries, South Korea, for example, China, they’re more than happy to wear masks. But here it’s like, no way. It’s an invasion of my personal freedom. And, you know, when you get on an airplane, you have to walk through that passageway where I suspect there’s very little in the way of ventilation. And if there are a lot of people getting on the plane, you’re going to be standing in line and you’re breathing everybody’s air. And even on the airplane, it may not be as well filtered as a lot of people would like it to be. So the culture of masking seems not going to work here in the United States. As soon as people could stop wearing a mask, they did. And people who do wear masks, people sometimes look at them like, “What’s the matter with you?” So how do we change that culture, or is it impossible? Dr. Linsey Marr 29:03-29:55 Yeah, clearly, you know, American culture is not into wearing masks. That’s for sure. There’s other things we, you know, I don’t know if we how to change that culture, you know, that maybe if we get celebrities wearing them and it becomes cool, that would help get some, you know, advertisers on this to shift the view. But in the meantime, there are a lot of other things that we can do regarding cleaning the air. As you mentioned, you know, when you’re in the jetway, I’ve, you know, I’ve carried around a little sensor to kind of get a sense for where, where’s the air best ventilated or not. And actually on the jetway, I think because one end is pretty open to the air, you do get decent airflow through there. On the airplane, of course, it’s recirculated, but it’s also very well filtered at the same time. Joe 29:56-30:19 What are the most dangerous places? Since I assume you’ve been using a CO2, a carbon dioxide monitor, what have you discovered in supermarkets, in doctor’s offices, in pharmacies, wherever you may go and test? Where do we need to be especially cautious? Dr. Linsey Marr 30:19-31:06 Yeah, I’ve seen the highest numbers in things like restaurants, certain types of restaurants, poorly ventilated ones and crowded ones. Supermarkets, not so much, although I tend to go to the big stores that have really high ceilings and they’re not totally packed with people. Buses, I would say, I see higher levels. Some classrooms, I’ll see higher levels. So the higher level is an indicator of poor ventilation because carbon dioxide is in our exhaled breath. You do see higher levels on airplanes, but you have to remember that that air is running through filters every two or three minutes. And those filters will remove particles. Joe 31:07-31:47 Well, speaking of filters, because obviously there are a lot of places where we go where you really can’t test the way you have with your portable CO2 monitor. When you walk into a restaurant, what would you like to see if you had the power to influence public health authorities to actually improve filtration? And then maybe we can talk about how we can start using ultraviolet to kill some of these viruses and bacteria that are floating in the air. Dr. Linsey Marr 31:48-32:16 I would like to see, and maybe you wouldn’t be able to see it because it would be hidden in the docks and also in the walls, but good filtration systems with the air being circulated a lot of times through that filtration system, and open windows if the weather’s conducive to it so that the air in that restaurant feels as fresh as it does outdoors. Joe 32:18-32:27 It sounds like Florence Nightingale, you’re sort of adopting her recommendations from more than 100 years ago. Dr. Linsey Marr 32:28-32:36 She was onto it. She knew what she was talking about. I mean, she observed people getting sick in hospitals and knew how to reduce that. Joe 32:36-33:05 The only trouble is that most of our public buildings these days are sealed very tight to be energy efficient. And so it’s not always possible to open those windows. Should public health authorities be testing, investigating, making recommendations, and then perhaps requiring public establishments to actually improve filtration and ventilation? Dr. Linsey Marr 33:06-34:23 Yeah, this is something that a group of scientists and other organizations are working on. I mentioned earlier that the CDC now recommends a minimum ventilation rate of four to six air changes per hour in public spaces. And there was a, I attended an event at the United Nations General Assembly a couple of weeks ago that was intended to raise the profile and spur more action for cleaner indoor air. And so that, you know, some places will do this voluntarily, but really the way that we get it more broadly installed is through standards and regulations like we do for fire safety. And so we have, you know, a group of scientists has talked about and written a paper that appears in Science about the need for air quality, indoor air quality guidelines and regulations that are widely implemented. You know, it’s not going to change overnight, but I’m hoping that this starts the discussion and that maybe, you know, 10, 20, 30 years from now, our building stock takes a long time to turn over, but we’ll start designing buildings that are designed not just for energy savings and thermal comfort, but also for good indoor air quality. Joe 34:23-34:46 Well, at the present time, we can’t always tell. And so what about one of those portable carbon dioxide monitors? Should people be carrying them around with them when they go, for example, into a restaurant or into their local pharmacy? And if the numbers are too high, and what would that be? Maybe turn around and change their mind about going in. Dr. Linsey Marr 34:48-35:34 Yeah, if you’re someone who’s really concerned about getting sick from respiratory viruses, you could carry one of those around and keep an eye on it for numbers over roughly 1,000 parts per billion. That would be an indicator that the place is not well ventilated. They could, though, have good filtration, which would remove pathogens from the air. So maybe you see that high number, you turn around and go out, or maybe you carry a mask with you and you put on your mask. So I did hear that I think stores in Japan were required to display their CO2 levels in the window. Something like that would be really helpful for people to be able to see from the outside, oh, what’s it like in there? And then they can decide whether to go in or not. Joe 35:35-35:56 Oh, that’s a cool idea. I love that idea. You know, having a little electronic sign that says, OK, your CO2 levels here are under 600. It’s like breathing outside air. And then everybody feels, okay, I can go in. And if they’re over 1,000 or 1,500, you say, uh-uh, I’m not coming in today. Don’t thank you. Dr. Linsey Marr 35:56-36:01 Yeah, I should correct myself also. I think I meant 1,000 parts per million PPM. Joe 36:01-36:19 That sounds right. Now, one of your colleagues, Dr. Corsi, has come up with a filtration system that’s inexpensive. Not something you can carry around with you, mind you, but something that people could have in their homes or in their offices. Tell us a little bit about that. Dr. Linsey Marr 36:19-38:01 Yeah, it’s called the Corsi-Rosenthal box, and it acts as a very effective portable air cleaner or filtration unit. Some people call them air purifiers. But it basically mimics what a $200 piece of equipment does for, I don’t know, $60 or so to buy what you need. So one item is a box fan. And then you would also need, let’s see, that’s one, four filters, like kind of those rectangular HVAC filters that you might put into your air conditioning system, you might replace them. And then you tape them together, and you set it on the floor. So you have this box, this cube, that’s where it’s like the box fan is sitting on top. And it’s pulling air through those filters and then ejecting it out of the top. And what you’re getting out of the top is pretty clean air. And what’s interesting is that those filters do not have to be HEPA level. So HEPA is high efficiency particulate air filters. Those remove 99.9% or more of particles in the air. They can be slightly less efficient because this thing moves so much air. So even if I have, let’s say I do have a HEPA filter, If I’m barely moving any air through it or trickling a little bit of air through it, it’s not actually cleaning that much air. But with the Corsi-Rosenthal box, also called the CR box, it’s moving a ton of air through there. So even if it’s only filtering out like 95% of particles, that air is going to go back through the filter and it’ll remove another 95% of the particles. So you get this, you get a benefit of having a high airflow rate through those. And again, it’s inexpensive and you can make it yourself. Terry 38:01-38:42 You’re listening to Dr. Linsey Marr, Professor of Civil and Environmental Engineering at Virginia Tech. She leads the Applied Interdisciplinary Research in Air, the AIR2 Laboratory. It focuses on the dynamics of biological aerosols like viruses, bacteria, and fungi in indoor and outdoor air. Dr. 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’s been thinking and writing about how to avoid airborne viral transmission since before the pandemic began. Joe 38:43-38:54 After the break, we’ll find out about the air filters in your home. Do you have a HEPA filter? We’ll also find out about how to interpret MERV numbers. Terry 38:54-38:59 How well do HEPA filters work? And how often do we need to change them? Joe 38:59-39:05 Could you kill airborne viruses with UV radiation or ozone? Is that a practical and safe way to go? Terry 39:05-39:10 Are there any UV systems commercially available for places like hospitals? What about homes? Joe 39:11-39:18 Dr. Marr will share her list of worrisome airborne pathogens. Flu and measles are obvious. What about norovirus or TB? Terry 39:28-39:31 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 39:40-39:43 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 39:43-40:01 And I’m Terry Graedon. Joe 40:01-40:18 Air quality is always important for good health, but because we can’t see pollution or pathogens, we tend to ignore the air we breathe. How would you know about the quality of the air you breathe in your local supermarket, bank, or pharmacy? Terry 40:18-40:40 Ventilation and filtration are the cornerstones for maintaining air quality indoors. Do you know what kind of filter your air handling system uses? What about at your doctor’s office? When asked why he robbed banks, Willie Sutton said that’s where the money is. When you go to an urgent care clinic or a doctor’s office, that’s where the germs are. Joe 40:41-40:56 Most people have stopped wearing face masks, and they’re optional at many health facilities. But COVID is still with us, along with influenza, RSV, metapneumovirus, and many other airborne pathogens. Terry 40:57-41:43 To learn how to improve air quality indoors, Joe spoke with Dr. Linsey Marr. She’s 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. Dr. 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’s been thinking and writing about how to avoid airborne viral transmission since before the pandemic began. Joe 41:44-42:25 Dr. Marr, you were talking a little bit about the Corsi… is it Rosenthal box? And how you can do it yourself for a relatively modest amount of money, but you could also put a better filter in your heating and air conditioning system, whether it’s an office building where there are lots of people or whether it’s your home. What are the best filters? You’ve mentioned the HEPA filter, H-E-P-A, but there are also MERV filters. And I’ve never quite got the numbers right. So if you could explain filtration a little more, we’d be grateful. Dr. Linsey Marr 42:25-44:23 Yeah. MERV stands for Minimum Efficiency Reporting [Value]. I can’t remember exactly what it is. Everyone just calls it MERV. And if you go to a big box store like Home Depot or Lowe’s, they’re going to have filters with their own numbering system on them in terms of how good the filters are. But they should also, you should be able to correlate that with the MERV scale. And the MERV scale is kind of standardized and a higher number is better. And so it goes all the way up to, I think, 17, which is like HEPA equivalent, um, it starts at one. So I would say, you know, kind of your, and the higher number indicates that it’s going to remove more particles. It has higher filtration efficiency. So the highest ones are going to remove over 99% of particles. And then the lower MERV numbers are really just there to protect your HVAC system from leaves and other big, you know, maybe hairballs from your cat and prevent those from going in. And so, you know, home systems might have something like a MERV 4 or 8 filter. If you’re getting into commercial buildings, they might have had 8 or 11. But since the pandemic, I think we’ve realized that, oh, having a higher filtration efficiency or better quality filter is, you know, going to give us healthier air for people. And so I think buildings that can are moving more towards MERV 13 or MERV 14 filters. Now, one caveat here is that the higher efficient, the higher MERV filters that are better removing particles also create a bigger pressure drop. It’s a little harder to push air through those, pull air through those. And so your air handling system needs to be able to handle whatever that filter you put in. So you need to kind of check and make sure your air handling unit is okay. So for example, we tried this in my house. We tried to put in a higher MERV number filter, but then the system stopped running. It gave me a fault. And so I realized, okay, we’re creating too much pressure drop. We’re asking our fan to do too much work. And so we had to go back down. Joe 44:25-45:04 So as people begin reinstalling new HVAC systems, whether it’s in an office building, in a supermarket, in a big box store, or at home, they should in the future, hopefully with public health encouragement, design systems that can handle those higher efficiency MERV filters so that we’re up around MERV 13 or above. And how well do they work? Do they really capture enough, let’s say, viruses and bacteria to make a difference? And then how often do they need to be changed? Dr. Linsey Marr 45:06-46:16 Yeah, once you get up into MERV 13, 14, you’re removing over 80 percent, 90% of particles in the air. And so that’s helpful. But that’s kind of in the mixed air that’s throughout the whole room and throughout the whole building. Now, we think it’s not clear, but it’s some of the research we’re doing with humans and animals. We think that in a lot of cases, transmission occurs in these closer face-to-face interactions. And in that case, the filter doesn’t help as much because that’s like the whole room air. It’s got to go through the HVAC system and come back before the, and it doesn’t have the chance to do that when you’re talking face-to-face with someone. So in that case, you need other strategies. But as far as the filters, yes, absolutely. If you’re upgrading your HVAC system, you should be thinking about getting one that can handle the higher efficiency, higher MERV number filters. And then depending on the system. They may recommend filter changes every quarterly, every three months, or maybe semi-annually, so every six months, but it depends on the system. Yeah. Joe 46:16-46:41 Let’s move beyond filtration and ventilation because that goes along with the filtration. You want to have fresh air being introduced into your system, but let’s talk about killing those bacteria and viruses. What about ultraviolet light? Are there safer systems? What about ozone? Give us an update on how we can purify the air. Dr. Linsey Marr 46:43-49:11 Right. You had mentioned UV before. And so UV works by killing the viruses or bacteria. It actually messes up their genetic material, DNA or RNA. And so this has been used for decades, a certain type of UV light called germicidal UV, which is at a certain wavelength, 254 nanometers for those who are interested. The issue with that type of UV light is that it is dangerous for us to look at and it’s bad for our skin to be exposed to it. So those types of systems can only be installed inside air ducts where people are not going to be seeing it and their skin won’t be exposed to it. Or they’ll install it in kind of these upper air systems at the ceiling if they have a high enough ceiling and it’s pointing upward so nobody gets directly exposed to the light. Now, there’s a newer technology called FAR-UV, and that’s at a different wavelength, 222 nanometers instead of 254. And that is really intriguing because it still kills off viruses and bacteria. And it’s also considered to be eye safe and skin safe. Like it can’t penetrate through the very outer layer of cells in our eyes and skin. And you mentioned ozone. So UV of any kind can generate ozone also because UV, you’re adding UV light and that generate that kind of can can photolyze or cause chemical reactions with the oxygen and other compounds in the air. Ozone is bad for us. We have health standards for ozone. And so there’s there’s kind of a trade off here of, well, you have the benefit of killing off pathogens, but you may be generating a small amount of ozone. And, you know, it’s still in the research phases of whether there’s a net benefit and what any long-term effects might be of exposure to far UV. But it does show a lot of promise. Certainly in laboratory studies, it really effectively kills off pathogens. And, you know, I think of it like we use UV in our drinking water for drinking water treatment in some places instead of chlorination to kill off pathogens. And so this is something, oh, well, we do that in our water. We could do that in our air to kill off pathogens in the air so that we don’t have to breathe them in. Joe 49:12-49:27 Are there systems now available for, let’s just say, hospitals, for example, or for people’s homes if they wanted to install a UV system? And how would they know if they’re safe? That is to say, not putting out too much ozone. Dr. Linsey Marr 49:28-50:25 Yeah, I’ve seen there are vendors out there selling far UV lights that you can put in your home. They do recommend that you put them in certain locations in the room. And they have been testing them for ozone. There’s ways you can estimate through there. I know one has a kind of a model where you could put in the dimensions of your room and how many lights you want to put in and what the resulting increase in ozone would be. So again, we still don’t know what that trade-off is between, okay, you’re removing pathogens from the air, but you’re increasing ozone a little bit. And it’s not just ozone, but the ozone can react and other things that the UV light generates can react with things in the air and produce byproducts that maybe are potentially more harmful and can also produce particles in the air, interestingly. Joe 50:26-51:10 So it sounds like we don’t yet have a magic wand to be able to purify our air and make everybody safe so they don’t have to think about transmission of pathogens. And while we’re talking about pathogens, if you could just run down the list of things that concern you, because we’ve heard a lot about measles over the last couple of years and how there’s been quite a spread of measles. I do worry about norovirus. I know a lot of people go, oh, that’s just a cruise ship thing, and you can’t possibly get it by breathing. It’s just by touching handrails, for example. But if you could run through some of the pathogens that concern you, please. Dr. Linsey Marr 51:11-52:59 Certainly. Norovirus is, oh, it’s memorable. I think we don’t know if norovirus transmits through the air. There have been some interesting studies where there was one in Australia in a performing arts locale where the students were going and someone threw up on the carpet. And the next day, a group of students went there and they walked past this spot on the carpet, which had been dried, but I guess not fully cleaned up. And then several students got sick the next day from that stomach bug. So yeah, we don’t know. I wouldn’t be surprised if [norovirus] can transmit through the air. I’m guessing because it’s a gastrointestinal thing, it’s more from touching, but again, we don’t really know. Other things that are, you know, things that cause the common cold are rhinovirus and adenovirus. Those almost certainly go through the air, although adenovirus can also cause gastrointestinal issues. There’s other coronaviruses. There’s four seasonal types of coronaviruses in addition to SARS-CoV-2, which caused COVID-19. Those can cause colds. We’ve also recently discovered that something called human metapneumovirus is more prevalent than we thought. And that’s just another one of these respiratory viruses that causes colds. Flu, we should definitely not ignore because that still leads to an average of over 30,000 deaths per year. I think last year was bad. There were 100 or 200 maybe kids who died from it. So we should not forget about flu. Measles, unfortunately, is making a resurgence due to under-vaccination. And that, everyone knows, travels through the air and is very, very contagious. Joe 53:00-53:21 And I worry about something that seems out of the ancient past, and that’s tuberculosis. I remember talking to an infectious disease expert who said, yeah, TB is not gone. And if somebody is infected, they can spread it pretty fast. Thoughts about tuberculosis? Dr. Linsey Marr 53:22-54:45 Yeah, I think, you know, I have heard of some cases in the U.S. It’s often in those living in less sanitary conditions and who don’t have regular access to health care because there are treatments, but it requires vigilance, I would say, for the treatments. And so tuberculosis is caused by a bacteria, bacterium that travels through the air. For sure, we know that this is one of the kind of very well-known, well-accepted airborne diseases because the way it infects is that it has to get down to deep in the lungs because that’s the only place where there’s the right types of cells with the right types of receptors for the tuberculosis, for the bacterium to infect. Now, another one that we, you haven’t mentioned is Legionella, which I think cases are increasing that’s partly due to greater awareness of it. But this is something that transmits from, not from person to person, but more from water and you inhale it. And so that can be through, you know, it was named after an event in a meeting of the Legionnaires, I think in Philadelphia in the 1970s, but that can be through water that’s contaminated. There’s outbreaks that have been noted in New York City that are linked to cooling towers on top of buildings where the bacteria grows and then it gets aerosolized in the cooling tower and then can spread throughout the neighborhood. Joe 54:45-55:02 Dr. Marr, we’re just about out of time. We have about two minutes left. What are you doing for your family and for your students? And what are you recommending to your colleagues when it comes to reducing the likelihood of catching some of these pathogens that we’ve been talking about today? Dr. Linsey Marr 55:04-55:45 As we mentioned, the carbon dioxide sensor is a good tool. I recently had a colleague who asked me about high levels he was seeing in his office. And we did a little bit of investigation, were able to figure out that air was coming from the hallway and classrooms into his office. And so, you know, they consulted with the facilities department to try to look into that. They talked about potentially installing an exhaust fan. So, you know, if someone in my family is sick, we will often try to run the exhaust fans, we bring out our portable air cleaner, the HEPA filter unit and kind of it follows that sick person around the house, wherever they happen to be, to try to clean the air and reduce the chances of other people getting sick. Joe 55:47-56:00 And recommending our listeners should be masking when they’re going into places where there’s the likelihood of people having influenza and colds and other kind of respiratory infections? Dr. Linsey Marr 56:01-56:27 Certainly during the respiratory season, if you want in the wintertime, if you’re really concerned about getting flus or colds, you’ve got an important event coming up. Masking is going to be probably one of your best defenses, whether that’s traveling on an airplane or you’re in a really crowded area, dense with people. And it seems like the it’s small, the space is small and it’s poorly ventilated, that that will definitely help reduce your risk. Joe 56:29-57:06 Dr. Marr, we’ve been talking about inside air. Let’s talk about outside air. There’s been a lot of smoke in the air because of forest fires. There has been a lot of other kinds of contaminations. You have looked at a lot of kinds of contaminants in a lot of other places, whether it’s ozone or particulates, even [fluorocarbons or] hydrocarbons. Tell us about outside air and why we should be concerned about it. Dr. Linsey Marr 57:07-58:13 Outside air is, you know, obviously when we’re outside, we’re breathing that. And a lot of our indoor air actually comes from outdoors. And so, you know, highly polluted outdoor air can come indoors and then we’re breathing it indoors. So outdoors, there’s things like ozone in the summertime is generated from industrial emissions and also things from motor vehicles and even vegetation contributes to that. We have particles, which are probably the biggest cause of health, have the biggest health impacts in the U.S. and many parts of the world. And those can be generated by combustion and other processes. Interestingly, a lot of them are generated also by reactions involving gases that form particles. And let’s see, you mentioned fluorocarbons. Those are not directly, they don’t directly impact our health, but they can get high into the atmosphere and react with ozone that’s protective, that’s good up there. And so reduce our protective layer of the ozone. Joe 58:14-58:50 I’ve got one that just struck me a couple of weeks ago: Tires. I mean, you know, there are millions of automobiles and trucks on the road, and we always have to replace our tires after 30, 40, 50,000 miles. And I got to thinking, well, what happens to all of those chemicals and all of that material that is in our automobile tires? Where do they end up? Do they end up in the air? Do they end up in the earth? And how far are they? Dr. Linsey Marr 58:50-59:34 That’s a great question. In fact, one of my colleagues here at Virginia Tech is looking at that exact question. And he told me a startling statistic about the number of pounds that your tires reduce because of all the tire wear particles when it’s running on the road. And so a lot of that, if it’s big, chunky, that’s just going to stay on the ground and then it gets washed into our soils or into our bodies of water. Some of it does get into the air. We know that. And so it contains organic compounds and metals and other things. It’s not going to stay in the air forever. Everything in the air eventually has to come back to Earth. But yeah, people are breathing that stuff in, especially, I think, near roadways. But it’s and I think we don’t it’s something we’re still learning more about. Joe 59:35-01:00:01 And last, microplastic or nanoparticles of plastic or those itsy bitsy little tiny pieces of plastic are everywhere, and they’re in us. Your thoughts about plastic as part of the air, we don’t think of it as something that we breathe because we think, oh, they’re too big, but it seems like plastic is just pervasive. Dr. Linsey Marr 01:00:02-01:00:37 Yeah, the microplastics are definitely there. They’re going to be worn down into pieces smaller than we can see. They’ve been detected. I had a student who was doing a project in a school and collected dust samples and found lots of microplastics in them. I think I’m concerned about those, especially because of some of the health studies I’ve seen where you find plastics in the brain and it might be associated with dementia. This is, yeah, it’s an emerging pollutant that I think deserves a lot more attention because it’s something new that we didn’t have nearly as much 50 years ago and really none of 100 years ago. Joe 01:00:38-01:00:43 Dr. Linsey Marr, thank you so much for talking with us on The People’s Pharmacy today. Dr. Linsey Marr 01:00:44-01:00:46 Thanks so much for having me. It’s been a real pleasure. Joe 01:00:47-01:01:27 You’ve been listening to Dr. Linsey Marr, Professor of Civil and Environmental Engineering at Virginia Tech. She leads the Applied Interdisciplinary Research in Air, AIR2 Laboratory, which focuses on the dynamics of biological aerosols like viruses, bacteria, and fungi in indoor and outdoor air. Dr. 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’s been thinking and writing about how to avoid airborne viral transmission since the pandemic began. Terry 01:01:28-01:01:37 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 01:01:37-01:01:45 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Terry 01:01:45-01:02:03 Today’s show is number 1,454. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com. Joe 01:02:04-01:02:24 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. The podcast this week has some extra information about outdoor air, especially when it comes to smoke or forest fires. You’ll also hear about particulates from car tires and microplastics. Terry 01:02:25-01:02:47 At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you get regular access to information about our weekly podcast. We’d be grateful if you’d consider writing a review of the People’s Pharmacy and putting it on the podcast platform you prefer. Joe 01:02:47-01:02:50 In Durham, North Carolina, I’m Joe Graedon. Terry 01:02:50-01:03:26 And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:03:27-01:03:36 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:03:37-01:03:41 All you have to do is go to peoplespharmacy.com/donate. Joe 01:03:41-01:03:55 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Nov 27

This week our guest is gastroenterologist Robynne Chutkan. She explains how keeping our digestive microbiota in good health can help our immune systems fight off pathogens from the inside out . At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Nov. 29, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 1, 2025. You will find this show well worth your time! What Determines Host Health? During the COVID-19 pandemic, we could all see big differences in who got sick and who seemed more resilient. Our immune systems are critical in determining just how susceptible we may be to infectious viruses like SARS-CoV-2. But what shapes our immune response? What we need is an immune system that reacts just the right amount. This “Goldilocks immune system” meets both internal and external threats without becoming overly exuberant. If the immune system fails to react adequately to external threats, like germs, we come down with an infection. Conversely, if it overreacts, we end up with allergies, sometimes very severe allergic reactions. In the case of internal threats, an overreaction leads to autoimmune conditions like Crohn’s disease. Lax response to an internal threat could allow a tumor to get out of hand. A hefty proportion of the immune system is localized in the vicinity of the digestive tract. As it turns out, the balance of microbes inside the gut has a significant impact on how the immune cells just outside the gut behave. Keeping the microbes balanced can help the immune system control pathogens from the inside out. Tackling Pathogens from the Inside Out: Even before the pandemic, lots of people wanted to know how to optimize their immune systems. That desire is only stronger now. Surprisingly, we can make a lot of progress with some very simple steps. Check the Medicine Chest: To start with, we should all be considering the medications we take. Quite a few common medicines can disrupt the gut microbiota. Proton pump inhibitors like omeprazole ( Prilosec ) or esomeprazole ( Nexium ) are not kind to digestive microbes. Neither are pain relievers like ibuprofen or naproxen. Besides disrupting the microbes, NSAIDs like these can irritate the lining of the gastrointestinal tract. Sometimes they are necessary. When they are not, they should be avoided. We could say the same for antibiotics. Our guest is a gastroenterologist. She understands the impact of pharmaceuticals on our digestive tracts better than most other physicians we have talked to. You will not want to miss her insights! Feed Them Fiber: Feeding our microbes what they need is crucial to keeping them healthy so that they can signal our immune systems properly. What microbes like is fiber, so a diet that leans heavily on plants is best. They also like variety. According to Dr. Chutkan, one study found that people who consume foods containing at least 30 different types of plants each week have the healthiest balance of microbes. She gives an example of oatmeal (one plant) with blueberries, coconut and walnuts (three more plants), served with almond milk (one more plant) and cinnamon (another plant). That brings the total up to six types of plants in one bowl. (Adding maple syrup gives one extra!) Other Essentials: There are some other practices that are crucial for keeping our immune systems in tune so they can manage pathogens from the inside out. Getting enough sleep helps reboot the immune system. So does physical activity, especially when it takes you into nature. Exposure to dirt sounds counterintuitive, but it can really help your immune system hum. Moreover, being outside is often a good way to address your stress. Dr. Chutkan cited the Japanese practice of “forest bathing” as a good way of de-stressing and helping the immune system. Healthy and Delicious: Finally, Dr. Chutkan shares some of her favorite recipes with us. There are lots more in her wonderful book, The Antiviral Gut , with its detailed plan for improving our microbial balance and immune response. This Week’s Guest: Robynne Chutkan, MD, a board-certified gastroenterologist, is a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington DC. Dr. Chutkan is the author of the digestive health books Gutbliss , The Microbiome Solution , The Bloat Cure and The Anti-Viral Gut: Tackling Pathogens from the Inside Out . Robynne Chutkan, MD, author of The Anti-Viral Gut: Tackling Pathogens from the Inside Out An avid squash player, runner and yogi, Dr. Chutkan is passionate about introducing more dirt, sweat and vegetables into people’s lives. She also hosts the marvelous Gutbliss Podcast: The Gutbliss Podcast https://robynnechutkan.com/about/robynne-chutkan-md/ Listen to the Podcast: Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1336: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:26 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Some people are resilient and resist infections. Others are especially vulnerable to colds, flu, and COVID. This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:46 What accounts for the differences in our immune systems? Why are some people so prone to infection, while others have an overactive immune response that causes damage? Does our digestive tract play any role? Joe 00:47-00:56 Dr. Robynne Chutkan is a gastroenterologist who’s been asking these questions for years. Her book, “The Antiviral Gut,” offers advice. Terry 00:57-01:03 Why is gut health so important to immunity? How can we eat to enhance our digestive microbes? Joe 01:03-01:09 Coming up on The People’s Pharmacy, tackling pathogens from the inside out. Terry 01:14-02:28 In The People’s Pharmacy health headlines: Many women would appreciate a little help losing the baby weight after giving birth. A Danish study shows that they are increasingly turning to GLP-1 drugs like semaglutide during the postpartum period. The scientists analyzed records on almost 400,000 pregnancies in Denmark between 2018 and 2024. During that time, use of a GLP-1 medication within the first six months after giving birth increased quite markedly. By 2023 and later, about 90% of these prescriptions were for the weight loss formulation, Wegovy. Earlier in the study, women who had diabetes prior to pregnancy were most likely to have a prescription. In the later part of the study, the motivation for taking semaglutide appears to be weight loss. The researchers caution that this early postpartum period is one of physiological and hormonal transition for the mother. The safety of semaglutide for breastfeeding infants has not been well studied. They urge their colleagues to conduct targeted studies on the best use of these medications for postpartum weight loss. Joe 02:29-03:27 The makers of GLP-1 receptor agonists have been expanding their horizons. Research has suggested that drugs such as liraglutide, semaglutide, and tirzepatide may be helpful against a wide range of health conditions, including cardiovascular disease, chronic kidney disease, polycystic ovary syndrome, and non-alcoholic fatty liver disease. The maker of Ozempic and Wegovy was also hoping that its semaglutide medication might help ward off Alzheimer disease. That’s because animal studies and epidemiological data had suggested such a possibility. But two new studies failed to demonstrate benefit for people with dementia. Volunteers were given oral semaglutide or placebo and tracked for about three years. People taking semaglutide did not fare better than those on placebo. Terry 03:28-04:46 Cardiology experts have spent a great deal of time coming up with risk calculators. These are supposed to predict a patient’s likelihood of a heart attack. A new study of people who had heart attacks suggests, though, that atherosclerotic cardiovascular risk calculators are not as helpful as expected. The idea was that these tools would allow cardiologists to focus on people most likely to benefit from treatment such as statins. But analyzing medical records of 465 people, 65 years old or younger, who had experienced a heart attack showed that only 10% of them fit the high-risk category before the event. A newer, different risk calculator called PREVENT would have identified only 3% as high-risk, although 23% were at intermediate risk. Most patients experience symptoms such as chest pain or shortness of breath only shortly before the event. If they’d been evaluated more than two days before their heart attack, the doctor would not have predicted the pending event. According to the authors, these risk assessment tools are good at the population level, but they may not help doctors treat individual patients more effectively. Joe 04:47-05:55 Doctors often perform surgery or place stents in patients with blocked carotid arteries. The surgical procedure is called an endarterectomy. It’s frequently performed on patients who have not experienced symptoms even though the blockage is visible on scans. Two large studies published in the New England Journal of Medicine compared stenting and surgery to medical therapy. Both trials lasted four years, and each contained over 1,200 patients with asymptomatic but substantial blockage in their neck arteries. Patients who received stents had significantly fewer strokes than those who received medications, but there was no significant difference in stroke outcomes between surgery and medical therapy. An editorial that accompanied the research concluded that there is no longer a role for routine carotid endarterectomy in persons with asymptomatic stenosis. And that’s the health news from the People’s Pharmacy this week. Terry 06:14-06:17 Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:32 And I’m Joe Graedon. Why did some people seem especially vulnerable to COVID-19 while others barely experienced any symptoms? What factors determine who’s susceptible to various infections and who is resistant? Terry 06:33-06:44 Our immune systems play a crucial role in establishing our vulnerability. But what influences our immunity? How do our diet and lifestyle impact our immune systems? Joe 06:45-07:20 To learn more about the immune system and how it’s affected by our GI tract, we are talking with Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Dr. Chutkan is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington, D.C. Dr. Chutkan is the author of the digestive health books, “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and most recently, “The Antiviral Gut: Tackling Pathogens from the Inside Out.” Terry 07:22-07:25 Welcome back to the People’s Pharmacy, Dr. Robynne Chutkan. Dr. Robynne Chutkan 07:26-07:28 Thank you so much for having me. It’s great to be back. Joe 07:29-08:23 Dr. Chutkan, we just love your new book, The Antiviral Gut. And I have to say, when I was in graduate school, I remember one lecture in particular on immunology. And the professor said, well, if we were to infuse rhinoviruses into the heating and air conditioning system of this room so that those viruses were spread out across the entire room, everybody was breathing in rhinoviruses. Not everybody would catch a cold. Our immune systems are amazing, but some people are more vulnerable than others. Can you tell us about this idea of why some people rarely get sick or barely have symptoms and others seem to catch just about everything that comes down the pike? Dr. Robynne Chutkan 08:24-09:51 Well, you hit the nail on the head with the entire theme of the book. And if I could sum it up in one sentence, it would be that host health matters, that we as the hosts who are hosting these viruses, our health, the strength of our immune system and other things going on in our body, many of them located in our gut, actually determine who gets sick when exposed to a virus. And that’s true of rhinovirus, it’s true of SARS-CoV-2, it’s true of HIV, Ebola, our immune system and other host defenses determine whether we’ll even become infected when we get exposed. And if we do get infected, also determine whether we’ll be mildly [symptomatic], have no symptoms, have severe symptoms, or possibly even succumb, and who will end up with post-viral symptoms. So all of this isn’t random. And it’s not due to the virulence of the virus. In your professor’s case with that experiment, he’s talking about the same rhinovirus that everybody would be exposed to. And we see within populations, everybody exposed to the same SARS-CoV-2, the same variant with the same degree of virulence, but we see widely varying degrees of host resilience and host susceptibility. And so really the whole point of this book was to highlight for people that there are things that we can do to be healthier hosts and to be more resilient to viruses. Terry 09:53-10:04 Dr. Chutkan, I wonder if we have any idea what the most important factors are to determine who is resilient and who is really susceptible. Dr. Robynne Chutkan 10:06-15:04 Terry, it’s such a great question. And a lot of the answers lie within that gut immune connection. So when I was in medical school, I didn’t really have a very good sense of what the immune system was. It was a sort of ethereal concept of like immune factors and cells floating around somewhere in the body. But I don’t think any of us were really sure where that was. It turns out that the vast majority of the immune system, about 70 to 80% of it is located in the gut. It is literally along the gut lining. So you have the trillions of microbes on the inside of the gut, which of course is outside of the body. And then just across that razor thin lining, one cell thick, you have all these immune cells and processes. And it really is a hand and glove relationship. Those microbes are communicating with the immune cells across the gut lining. And they’re literally guiding and modulating the immune system. They’re telling them when to react, when to stand down, when to mount a big response versus a little response. And so you start to see that if you have a disruption in the microbiome or a disruption in the gut lining across which they’re communicating, you’re going to end up with a disrupted immune system. And so that gut-immune connection is really key. There are other important host defenses, stomach acid that doesn’t just help digest food. It also unravels viral protein that gets into the body. We often, we swallow these viruses as a very common, you know, we can breathe them in and they get into our lungs or we can swallow them. And in fact, we have about 100 times more of those ACE2 receptors that bind SARS-CoV-2 in our GI tract compared to in our lungs. So it’s a common, the GI tract is a common portal of entry, if you will. And it explains why so many people with COVID have GI symptoms. So if you have stomach acid, that affords you an additional layer of protection. There was a study that came out in 2020, a population-based study looking at 53,000 people. And that study asked a simple question. Does being on an acid-blocking drug like a proton pump inhibitor increase your risk of COVID? And the overwhelming answer was yes. And in fact, people taking a proton pump inhibitor once a day had double the risk. And people taking a proton pump inhibitor twice a day, as many people do, had three to four times the risk. And while that seems sort of like, you know, wow, hot off the press, we’ve known for decades that these drugs, these acid blocking drugs, and the three of us have had many conversations about acid blocking drugs. So we’ve known for decades that they increase the risk of certain infections, enteric infections, meaning infections that affect the gut. So not just SARS-CoV-2, but other viral infections, foodborne bacterial infections, because that stomach acid is really a critical host defense for unraveling viral protein, for killing unwanted bacteria that can get into our bodies through our GI tract. So there are other considerations like that. The gut lining, you know, it’s this one cell thick lining, but it’s really the only thing protecting us from the outside environment because our GI tracts, and you know, this is such an interesting concept. I didn’t think about this at all when I was in my GI training. I have to admit, it was only about a decade or so ago that I began to realize that when you eat food and it travels down through, you know, down that digestive superhighway, those products of digestion that are in our gut are not in our body. They’re in this hollow tunnel that runs from our mouth all the way down to our anus. And food has to get absorbed through the gut lining to get into our bodies, to get assimilated inside. And so the point of that gut lining is to act as a selective barrier to allow those important nutrients, once they’re properly broken down, to be assimilated into our body. Waste from cells gets excreted through the gut lining in the other direction. And of course, dead red blood cells, bacteria, et cetera, everything gets excreted out. And so toxins, viruses, pathogens from the environment that we swallow are in that gut lining. And a big role of the gut lining is to keep them out of the body, to keep them just there in the GI tract so they can be excreted. And we know that we excrete SARS-CoV-2. In fact, we see fecal shedding of the virus, meaning we’re excreting it in stool, much, much long after we are able to detect it from the nose. So it continues to be excreted in the stool in people who have COVID after a nasal swab, et cetera, would be negative. And so we want that intact gut lining to make sure that these pathogens that we swallow end up in the toilet bowl and not inside our bodies. Joe 15:05-15:48 You know what I found so interesting in reading your book, because you described the immune system so beautifully, the adaptive versus the innate immune system. But I begin to think about it a little as threading a needle or Goldilocks, not too hot, not too cold, because if your immune system isn’t up to snuff, you’re going to get sick. But if it’s too active, you’re going to also get sick, you may have immune reactions. It’s like, how does it know just the right amount of reaction and not too much or too little? Dr. Robynne Chutkan 15:49-17:48 Well, I’m so glad you mentioned that concept because I think that if you understand that concept, you probably understand 75% of immunology. And I think it’s so important that I just want to go over it a little bit more, and then we’ll talk about how to get the Goldilocks immune system. So I like to divide it up just as you did, Joe. So overactive immune system versus underactive immune system. But I like to divide it further. So think of that as there’s a line on a piece of paper and everything above that line is an overactive immune system and everything below that line is an underactive immune system. But I want you to draw another line in the paper, this one, a vertical line, not a horizontal line. And everything to the left of that line is internal threats in our body and everything to the right of the line is external threats. So now we have four quadrants. But let’s start with the internal-external discussion. Internal threats with an overactive immune system. So you’re in that top left-hand quadrant of your grid now of the four boxes we’ve drawn. So overactive immune system, internal threats. We’re our body responding inappropriately, overreacting to our body’s own normal tissue. In the case of rheumatoid arthritis, it’s the joints. In the case of psoriasis and eczema, it’s the skin. In the case of Crohn’s and ulcerative colitis, it’s our gut bacteria. So our body is mounting an abnormal high immune response to our own normal tissue. It’s treating our normal tissue as foreign, as a foreign invader and attacking it. And we have over 100 different autoimmune diseases now. One in four Americans, more than 50 million people. And many people have more than one because, of course, there’s sort of a common cause of these things. So autoimmune diseases are sort of modern day diseases, if you will, and they really are a sign of dysregulation of the immune system. It’s an overactive immune system responding to internal threats. Joe 17:48-17:58 Now, Dr. Chutkan, I’m going to ask you to hold that thought. We’re going to take a break, and when you come back, we’re going to talk about the under-reacting immune system. Terry 17:59-18:07 You’re listening to Dr. Robynne Chutkan. She’s the author of “The Antiviral Gut: Tackling Pathogens from the Inside Out.” Joe 18:08-18:14 After the break, we’ll find out more about what happens when the immune system is under- or over-active. Terry 18:14-18:21 Too much and too little are both problems. How can we help our bodies get this just right, like Goldilocks? Joe 18:21-18:27 We’ll also learn how a patient with Crohn’s disease tackled her condition with food. Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:50 And I’m Terry Graedon. How can you fine-tune your immune system so that it neither runs too hot nor too cold? In other words, is there something you can do to find the sweet spot where you’re protected from pathogens but not suffering from autoimmune attacks? Joe 19:50-20:22 We are talking with Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Dr. Chutkan is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington, D.C. Dr. Chutkan is the author of the digestive health books: “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and most recently, “The Antiviral Gut: Tackling Pathogens from the Inside Out.” Terry 20:24-20:59 Dr. Chutkan, you’ve just described a graph in which we have a horizontal line and above the line, the immune system is overactive. Below the line, the immune system is underactive. And we have a vertical axis, which divides our immune system from internal threats to the left, external threats to the right. We’ve just talked about the upper left quadrant in which we get autoimmune diseases because the immune system is overreacting to what it perceives as internal threats. So tell us about the other three quadrants, please. Dr. Robynne Chutkan 21:00-29:17 What a beautiful summary. Thank you so much for that. So if we go to the other side of the overactive immune system, so now we’re talking about external threats. We’re talking about allergies, allergies to bees or wasps or seasonal allergies. And I think back to when I was in elementary school, there was one kid in my entire school who had a food allergy. Everybody knew him. He was kind of famous because he was allergic to peanuts and nobody else was allergic to anything. Now it’s rare to find a kid who isn’t allergic to something. So we’ve seen this explosion of allergies. And again, that is a sign of immune dysregulation, dysregulated immune system overreacting, but to external threats in the environment, whether it’s an insect to food, et cetera. So now let’s travel down to the underactive immune system. And on the left side, internal threats, we’re talking about cancer, because our immune system doesn’t just protect us from infection and pathogens. It’s also our cancer surveillance system. It goes about our body and it weeds out cells that are starting to divide a little precariously where the genetic material is not being reproduced properly. Maybe it’s starting to develop a malignant cell line. And a big job of our immune system, a big role is to weed out those cells and make sure they’re destroyed. So when you have an immune system that’s underactive, it means that that cancer surveillance isn’t happening and we’re at risk for cancer. On the other side of the vertical axis for external threats, this is where we’re talking about infection, an immune system that is not strong enough to clear infection. So the really interesting thing here is that if we look at deaths during the COVID pandemic, we see that a large percentage of them weren’t really due to the virus itself, They were due to the immune response. People suffering from what we call ARDS, acute respiratory distress syndrome, where they had an overblown response to the virus. The immune response was so active that it destroyed normal lung tissue in the process. And people ended up on ventilators. Tragically, people ended up dying. But again, as a result of the immune dysregulation, we saw other people who weren’t able to clear the virus. And we worried a lot about people on immune suppressive drugs like steroids and biologics because those drugs suppress the immune system. The interesting thing is those people didn’t seem to do as badly. People who were immune suppressed and, you know, all of us in the medical community typically have patients who are on immunosuppressive medication. We worried about those patients, but they seemed to do okay. It was really the patients who had the overblown immune response who seemed to do worse. So to get back to your really important question, how do we cultivate a Goldilocks immune system? It turns out, again, that these gut bacteria are essential. They’re a critical part of the response. So you want to maintain a healthy microbiome. How do you do that? Well, you make sure you’re not killing off your microbes with unnecessary antibiotics and other medications that are disruptive to the microbiome. You eat a high fiber diet because what are those healthy microbes like to eat? They like to eat plant fiber. And you know, you don’t have to be a vegan, but you got to get those fruits, vegetables, whole grains, nuts, seeds, you want to get all of that in. And we know from a very important study in 2018 by the American Gut Project, a nonprofit doing wonderful microbiome research, their study in 2018 was the largest microbiome study done globally. They looked at over 10,000 people in more than 40 different countries. And they found that the most reliable predictor of a healthy microbiome was the number of different plants people ate, with the magic number being more than 30 per week. And so when I say plants, not just vegetables or fruits, but also whole grains, legumes, beans, nuts, seeds, herbs, spices, you get credit for all of it. And so that really was one of the most potent indicators of a healthy microbiome. So that’s something that, you know, people listening can do right away. You can start thinking about those 30 different plants. And it might sound daunting, but I like to take a bowl of oatmeal as an example and say, okay, let’s say you use some almond milk to make your oatmeal. That’s one. The oats, two. Walnuts, three. Pumpkin seeds, four. Raisins, five. Blueberries, six. Little maple syrup, seven. You get credit for that, too. I love to add a little shaved coconut, eight. Cinnamon, nine. You can get nine different plant foods in a bowl of oatmeal. You can easily get another 10 in a salad. You can throw in your lettuce, tomato, cucumber, olives, cabbage, broccoli, chickpeas. Just start throwing it in. So if you try hard, you can get to 30 in a day, but 30 per week. And one of the really important things about that concept is I have patients who are vegans but they’re only eating four or five different plants a week. They’re stuck in that same peas, carrot, broccoli, and sweet potato rotation. So variety is very important. But when you increase your consumption of plant fiber, what happens is that you increase the amount of certain healthy bacteria in your gut. F. prausnitzii is one of those important species. It’s important because it is one of the main producers of short chain fatty acids, things like butyrate, sometimes called butyric acid, propionic acid, acetate, acetic acid. And what these short chain fatty acids do is they regulate the immune system. They help you get to that Goldilocks immune response. And they also keep the gut lining healthy. And they also feed the gut bacteria themselves that are producing them. So it’s this incredibly synergistic cycle of events. And so patients come to see me and they want to know, what can I do to improve my gut immune connection? Is there a supplement? What should I do? What complicated steps do I need to take? And I remind them, you just need to eat more plants as the number one step that you need to do. And then you need to have a careful look in your medicine cabinet and think about medications you might be taking that could be harmful to either the microbiome or the gut lining or stomach acid. So are you taking non-steroidal anti-inflammatory drugs that are making little holes in your gut lining? Are you taking not just antibiotics, but any of the list of more than 42 different classes of medications that have been shown to be disruptive to the microbiome? Antidepressants, artificial sweeteners, laxatives, there are many of them. So you’ve got to be judicious about what you’re taking from a medication point of view. And then the other thing I like to remind people is where do we get our microbes from? Well, after we’re born and we get them from our mothers, particularly those of us who are lucky enough to be born coming out through the birth canal rather than a C-section, after that, we get them from our environment. We get them from soil. So exposure to nature is a really, really important way for us to replenish our microbes and have a healthy microbiome. So that refers to us being out in nature as well as eating food that’s grown in nature, not food that’s grown in a warehouse somewhere, not the sort of industrial organic food. So the steps to have a Goldilocks immune system are fairly straightforward. And then there are some other add-ons that are important too, like sleep, because we know sleep reboots the immune system like a computer and that it’s really essential. We have a very important study from the British Medical Journal that showed that people who were chronically sleep deprived had an 88% increase in risk of COVID. So sleep is essential. We know that controlling stress is important. We see stress as a risk factor for morbidity and mortality with this pandemic. So there are other things too that are maybe not directly related to the gut, but that are really important for keeping it all humming along and functioning well. Terry 29:17-29:42 And of course, getting out in nature might help you control your stress. I do want to ask about medications. You said you need to pay attention to what’s in your medicine cabinet. And I want to ask you about a patient that you treated early in your career, a woman with severe Crohn’s disease. She came to you and you prescribed medications because that’s what you would learn to do. Can you tell us what happened? Dr. Robynne Chutkan 29:43-36:47 Yes, yes. I remember her so well. And gosh, it’s so great that you’re bringing up her story. So I was a young gastroenterologist just in my first or second year on faculty at Georgetown. And as you said, doing what I was trained to do, which is to prescribe medication. She was around my age, and she actually worked at the hospital in the radiology department. And she left, she moved to New Jersey for a couple years. And then she decided to come back. She came back to the Washington area. And she came to see me. And as you said, she’d had Crohn’s disease and quite severe Crohn’s disease. And I had been up close and personal with her Crohn’s disease doing her colonoscopy several times in the past. So she came to see me in the clinic. And I remember we caught up. And I asked her, okay, ‘So tell me, you know, what are you on?’ And I got out my pen, because at that time, we didn’t have an electronic medical record, got out my pen to write a note. And she said, ‘Nothing.’ And I remember I froze. I was like, ‘What do you mean, nothing?’ And she said, ‘I’m not taking anything.’ And I gave her my little spiel about, oh, that’s like driving a car with no insurance. You know, things could go terribly wrong. And I was literally frightened for her because the idea that you could treat or control a serious autoimmune disease like Crohn’s without medication was just, I mean, that was frightening. It was a frightening idea to me. And she told me what she was doing. And at the time, you know, the diet didn’t necessarily have a formal name, but it was a variation of a diet called the Specific Carbohydrate Diet, which is a low complex carb diet, but not a low carb diet specifically, but it takes out a lot of the processed carbohydrates, like, you know, the baked goods and so on. The dairy other than on that diet, people can make their own yogurt, but takes out the processed dairy and the refined sugars and a lot of the processed grains. And she was having great results with it clinically. So I said to myself, okay, well, she’s feeling good, but that’s probably placebo effect. Let’s see what’s really going on in her colon. And I did her colonoscopy a few weeks later, and it was normal. Her severe ulceration from her Crohn’s disease had healed completely, completely. I mean, I remember thinking, this is magic. Like, how can this be? And I think back now, you know, 25 years later, and I think, no, it’s magic the other way. It’s magic to not consider the role of what we eat and how we feel and specifically on what’s going on in our guts. But I had been so trained and indoctrinated, quite frankly, to think that medication was the only path. And to be clear, the medications are fabulous. I’m glad we have them. We’re in an era of really effective medications for these diseases, but here’s a problem: when you treat a disease that is an overactive immune system, like Crohn’s, it’s an autoimmune disease, you treat it by suppressing the immune system. So now you’re down in that, below that horizontal line. And now you’re at risk for cancer and infection. And that is indeed exactly the risk factors of these medications. They all carry the risk of serious infection, viral, bacterial, fungal, et cetera, as well as cancer. And autoimmune diseases affect a wide range of people, but the ones I treat primarily, Crohn’s and ulcerative colitis, affect young people. And so we’re talking about putting people in their teens and early 20s and 30s on medications for life that have these potentially very deleterious side effects. So this patient was the first person who really opened my eyes to what was possible and sort of, you know, began my journey to see how we could treat these diseases with a food as medicine approach. And I’ll tell you, I saw a young man yesterday in my office, a new patient with ulcerative colitis, really lovely young man. And his mother was with him. He’s in law school. And he had been on these drugs for a long time. And he said, ‘You know, the drugs really helped me, particularly in high school when I was diagnosed. I just wanted to be a kid and, you know, do what the other kids were doing. And I didn’t want to be having 20 bloody bowel movements a day and, you know, having accidents.’ So he said, ‘I was very grateful to the drugs.’ He was on Remicade initially, infliximab, one of the first monoclonal antibody biologic drugs that we had for inflammatory bowel disease. So he said he was very grateful. But what he has noticed over the last decade is that he’s just not well. He’s sick all the time. I mean, yes, his colitis has improved a lot, but he’s sickly. He has colds, his skin, he’s gotten really bad acne. He’s sick all the time. He had COVID twice, serious episodes both times. And so he can feel that his immune system is suppressed, where he’s sort of half-masked. And one of the things, it’s really important to make sure people are good candidates for a food as medicine approach. Some people, quite frankly, are just too sick. There are many patients who I say, you know, you actually would probably benefit from going on a bigger gun medication like a biologic to get your disease inactive enough to a point where we can treat it nutritionally. Or sometimes people have strictures. If you have Crohn’s, you can have narrowing in the intestine. And so it’s a mechanical narrowing. And I explain, you know, no amount of kale is going to open this back up. You probably need to have this addressed surgically. And then we can really think about nutritional therapy to prevent recurrence. So just as we need to be judicious with our pharmaceuticals, we need to be judicious and realistic about what food can do. Food can do a lot, but it is also not magic. And in this particular case with this young man, he was a great candidate. He was already a pretty good eater. He was very committed to making some changes to his diet. And his disease at this point was just at the bottom part of the colon and not in terrible shape. So he’s a really good candidate. And I’m so excited to be working with him to see if we can get him off the biologic. But I never want people to feel like there’s a wrong or right path. There’s a path that’s right for them. And if you’re at the point in your life where you sort of, you know, you just need the quick fix to get this taken care of, you can’t maybe make that commitment to diet and lifestyle, that’s not wrong. But it is also important for people to know that there are other paths out there for treating these diseases without the immunosuppression. We have other medications for autoimmune diseases that don’t suppress the immune system. They tend to be not as efficacious, but sometimes using one of those medications with the diet and lifestyle can really get people where they need to go. So I always want people to know there are lots of options out there. We have a lot of tools in our toolbox and trying to find the right tool for people and particularly the tools where the side effects aren’t worse than the actual disease. That’s important. Terry 36:47-37:01 You’re listening to Dr. Robynne Chutkan. She’s a gastroenterologist and a faculty member at Georgetown University Hospital. Her most recent book is “The Antiviral Gut: Tackling Pathogens from the Inside Out.” Joe 37:01-37:09 After the break, we’ll find out why the mucin lining your digestive tract is critical in protecting you from viruses. Terry 37:09-37:16 How do microbes interact with mucus? And how do medications affect our digestive lining? Joe 37:16-37:30 When the gastrointestinal tract loses integrity, the leaky gut that results can have serious consequences. Dr. Chutkan shares her plan for supporting an antiviral gut. She also tells us about some of her favorite foods to help. Terry 37:39-37:55 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon. Joe 37:55-38:17 And I’m Joe Graedon. Joe 38:31-38:46 Today, we are talking about supporting your digestive tract so that it can protect you from invading pathogens. The lining of your digestive tract is especially important, but we don’t often think about it. What should we be doing differently? Terry 38:46-39:16 For answers, we’re talking with Dr. Robynne Chutkan, a board-certified gastroenterologist. She’s a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice in Washington, D.C. Dr. Chutkan is the author of the digestive health books, “Gutbliss,” “The Microbiome Solution,” “The Bloat Cure,” and “The Antiviral Gut: Tackling Pathogens From the Inside Out.” Joe 39:18-40:48 Dr. Chutkan, you’ve just been explaining the benefits and risks of some of the most popular pharmaceuticals in the pharmacy. I mean, we’re talking about billion-dollar drugs, Enbrel, Humira, these biologics, and they do work very well, but they do have an impact on the immune system. And so we hear on those commercials things like lymphoma, and we hear about other infections, and watch out for tuberculosis. And so I guess they’re double-edged swords, as are so many of the medications that we rely on on a daily basis, like the NSAIDs, ibuprofen, naproxen that people take for their aches and pains. But I’ve got a different question for you. When I was in graduate school, the head of the physiology department at the University of Michigan was a famous researcher by the name of Davenport. And he was particularly interested in the gastrointestinal system. And I remember he was really focused on mucus. And he asked us, as pharmacology graduate students, well, why doesn’t the stomach digest itself? It’s like battery acid. It’s so powerful. And there it is just sitting in your stomach and it’s not doing any damage. It’s all about mucus and the mucin lining. It is all about mucus. Tell us about it. Dr. Robynne Chutkan 40:50-45:17 Mucus is like a cross between jello and glue. And it’s this sticky polymer. And people think of mucus, first of all, as coming from the lungs. But the reality is most of the mucus in our body is made in our GI tract, about one and a half liters a day. And mucus serves a couple functions. One of them is just as a lubricant. So it lines all those organs that are in contact with the environment, our mouth, our nose, our upper, our oropharynx, if you will, our mouth and airway, our reproductive organs like the vagina, even the inside the urethra, and of course, the GI tract. So it helps to lubricate things. And in the case of the GI tract, it helps to lubricate the gut so that the products of digestion can move smoothly from north to south. But it also has another purpose. One purpose is a barrier. So between the microbes that are floating around in the gut and the gut lining is a thick layer of mucus. And so that helps to protect the gut lining. And the other is that mucus has enzymes in it that can actually degrade viruses that get in. So mucus traps viruses like SARS-CoV-2 in its sticky matrix. And then it has enzymes that will degrade and sort of dissolve the virus. And then, of course, you have those cilia, those finger-like projections in the lungs that can move the virus up and out. And if you swallow it, ideally stomach acid works on it some more. So you see how this is all designed to work together. So it’s like your body’s internal flypaper that catches these viruses. And, you know, there’s this, when we think about this concept of super spreaders, we know that super spreader events aren’t explained by differences in the virus. They’re not based on viral behavior. You can have a large gathering where few people, if any, get a virus, or you can have a small event where everybody gets it. And of course, there are things like how close you’re in contact with people, whether you’re indoors or outdoors. But it turns out that when some people sneeze on you and transmit a virus versus somebody else who’s infected sneezes on you and doesn’t, it has to do with the mucus of the person who’s sneezing on you. Because if you have somebody whose mucus is very potent and it has trapped the virus and the mucins, the proteins in their mucus, have killed the virus, they’re going to sneeze on you and they’re going to transmit dead virus and you’re not going to get infected. But if somebody sneezes on you whose mucus is a little less potent and the mucins in their [mucus] may not have done as good a job as trapping and killing the virus, they are going to infect you. And what’s really interesting is that we, in addition, so the mucus can physically trap viral invaders. It has enzymes that degrade viral proteins and it has antibodies that can neutralize them. And mucins in saliva and breast milk also have antiviral activity that can inhibit even potent viruses like HIV. So again, you know, the quality of these host defenses is really important. And so when we think about something like mucus, we know that people who smoke, for example, have mucus that is much, much less potent in terms of its ability to protect us from pathogens. Being dehydrated would also affect your mucus. And so, again, there are, you know, there are some genetic factors with all of these things that many of these things are things that we can improve ourselves. We can drink more water. We can stop smoking. These are really important things. And along the line of mucus and pharmaceuticals, we know that cough syrups and these cough suppressants are really problematic because they prevent you from being able to expel these pathogens. We want to produce mucus and we want to cough it up so we can get rid of the pathogens. And so when you take these different cough syrups that suppress your cough reflex and or things like antihistamines that can dry you out and decrease your mucus production, you’re really sabotaging your host defenses. Terry 45:17-45:33 So Dr. Chutkan, if most of the mucus is actually in your digestive tract, it’s in there interacting with all the microbes in your digestive tract. What’s the impact of the microbes? Dr. Robynne Chutkan 45:33-47:23 Well, the microbes have to, you know, we don’t want those microbes to penetrate through the gut lining. They’re in the gut lumen for a reason. That’s where we want to keep them. And so it provides, you know, the intestinal epithelial barrier is only one cell thick. So the mucus really buffs up that barrier and provides an additional zone of protection. Because when we look at, for example, there was a study, a microbiome study done at University of Massachusetts in 2021. And that study found that the most important predictor of outcome from COVID was actually the composition of the microbiome. They found high levels of a bacteria called Enterococcus faecalis was associated with worse outcomes and death. And high levels, conversely, of the bacteria referred to earlier, Faecalibacterium prausnitzii was associated with good outcomes. Enterococcus faecalis is a bacteria that is also associated with post-op infections, and it can penetrate the gut lining and get into the body and get into the bloodstream and cause problems. So that protective barrier that mucus provides, I have an analogy in the book that I’ll share with you. It’s 5,000 times the diameter of a viral particle like SARS-CoV-2. So the analogy is a human wading through 150 gel-filled football fields to reach the end zone and score a touchdown. So it creates that buffer so that bacteria like Enterococcus faecalis have a difficult time penetrating that intestinal epithelial barrier, that gut lining. So it’s so beautifully and cleverly designed. And the main thing we have to do is not mess it up. Terry 47:24-47:38 And if we do mess it up somehow, then we run into problems with what the gastroenterologists like to call intestinal permeability and what the rest of us call leaky gut, right? Dr. Robynne Chutkan 47:39-48:36 That’s right. That’s right. And one of the most important points I want to make to people is that these are not things that you fix by taking a supplement. These are things that you primarily fix by not taking things. You know, people want a pharmaceutical fix, whether that’s a prescription, over-the-counter, or a supplement. But these are things that are mostly created as a result of too many of these pharmaceuticals, whether a prescription, over-the-counter, or supplement. So rather than, you know, telling people or people want advice about what probiotic, what supplement, I get them to bring all their pharmaceuticals and lay them out on my office table. And then I pull out my rubbish bin and one by one, I usually drop them in and explain, you know, why they shouldn’t be taking this. And of course, particularly for a prescription drug, this needs to be done in concert with your healthcare provider. Please don’t just start getting rid of, you know, putting medications in the rubbish bin without checking with your physician. Joe 48:37-49:15 Dr. Chutkan, and a lot of people like to, dare I say it, play doctor by going to the pharmacy and buying over-the-counter medications. And now, of course, NSAIDs, non-steroidal anti-inflammatory drugs, are incredibly popular because everybody seems to have an ache or a pain or a fever or a headache. And so they’re taking Aleve. They’re taking Advil. They’re taking ibuprofen over the counter generically or naproxen. And then their doctors are prescribing these. So tens of millions of people are taking these drugs on a daily basis. And they’re affecting intestinal permeability. Dr. Robynne Chutkan 49:16-50:57 Yeah, they are. It’s not just the NSAIDs. It’s also you think about the antipyretics. So the things we take for fever, which would be NSAIDs, but also Tylenol. It turns out fever is one of our body’s most important host defenses. So if we look at poliovirus, poliovirus replicates 250 times faster at normal body temperature compared to when we have a fever. So a fever is our body’s way of trying to slow down viral replication, trying to keep us safe. But what do we do? We suppress a fever. And so, you know, the pediatric guidelines for a while now have talked about, you know, not using cough suppressants, not using antipyretics, fever medication, but we still intrinsically reach for them. And we reach for them because we don’t understand the feedback our body’s giving us. So we confuse a physiological response like a fever. We think it’s an illness. We confuse a physiological response like a hangover, a physiological response like reflux. Reflux is our body’s way of telling us you have overfilled your stomach, you have eaten too late, you have eaten too much fatty food, whatever it is. And that’s why this stuff is coming up. And I’m giving you feedback. And so again, we’ve got to understand the feedback our body’s trying to give us and not just suppress all these symptoms with pharmaceuticals without understanding the messages, the important information that’s contained in them. I mean, I said to a friend the other day, imagine if people didn’t get a hangover, how many people would die from alcohol poisoning because they just keep drinking. Terry 50:57-50:58 Right. Dr. Robynne Chutkan 50:58-51:07 And they wouldn’t get that terrible, you know, headache and you feel horrible and you’re like, oh, oh, that’s what happens when I do that. Maybe I should do less of that. Terry 51:07-51:24 Not do that in the future. Dr. Chutkan, we have just a few minutes and I’m hoping that you’ll walk us through, briskly, your plan for an antiviral gut to protect us from infections. Dr. Robynne Chutkan 51:26-53:34 Absolutely. The difference with this book, and I’m proud of all of them, all four of them, but the difference with this book is that the plan is really a little over half the book because I wanted to be sure to give people the information, the practical steps, not just to say here’s what can go wrong, but to tell them here’s what you can do about it. So the plan is really divided into several chapters, the antiviral gut plan, and I consider sort of “strengthening-from-within” plan. So in the first chapter of the plan is called Securing Defenses. And it talks about how you can optimize your body’s innate capacity to neutralize viruses with stomach acid, to trap with mucus, to burn with fever, to wall off viruses with your gut lining, while simultaneously improving your reflux, your digestion, your overall gut health. The second chapter in the plan is called Mastering Your Mind. And that really focuses on stress and sleep and what you can do to improve those things, improve your sleep hygiene, improve your stress response so that you can be more resilient. The next chapter is Changing Your Environment. And I talk about the Japanese practice of shinrin yoku or forest bathing and how that can reduce stress hormone production, enhance your immune system, and what we touched on earlier, the importance of exposure to soil microbes. Chapter 12 in the plan is being Thoughtful About Therapeutics. So I go through each of the classes of medications that is sort of a threat to your gut health, I talk about potential alternatives, and I give people questions to ask their doctor. So I literally have the list of questions. You know, if you’re on this drug, here are the five questions you should ask your doctor, here are four or five alternatives. And then chapter 13 is a plan at a glance. It’s putting it all together with a kind of snapshot glance at what your daily antiviral gut routine would look like. And then the last section is recipes with some really simple, delicious food. Nothing in there is difficult to make and it’s all really quite delicious. So that’s a plan in a nutshell. Joe 53:35-53:49 In the minute we have left, Dr. Chutkan, some of your favorite foods. If we were to go out to lunch with you today, if we were to have dinner with you on Saturday night, what would be on the menu? Dr. Robynne Chutkan 53:50-54:14 I, you know, beans and greens are two of the things I really focus on. So, and I have to admit that my husband is a lentil maker in the house. So he makes delicious curry lentils and there’s lots of onion and garlic and different spices and curry and coconut milk would be lentils, curry lentils, some brown rice, and I would probably do some sauteed spinach with that. Terry 54:14-54:18 You’re already getting halfway to your 30 plants a week. Dr. Robynne Chutkan 54:18-54:31 Yeah, and exactly. So with the lentils, again, there’s ginger and onion and garlic and leeks and curry powder and bay leaves. So there’s probably six or seven different plants in there along with the lentils. Terry 54:31-54:39 It sounds nutritious as well as delicious. Dr. Robynne Chutkan, thank you so much for talking with us on The People’s Pharmacy today. Dr. Robynne Chutkan 54:40-54:46 Always such a pleasure to be with you on The People’s Pharmacy. I love the work you do. Wonderful to be a part of this. Terry 54:47-55:14 You’ve been listening to gastroenterologist Robynne Chutkan. She’s a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice in Washington, D.C. Dr. Chutkan is the author of the Digestive Health books, Gutbliss, The Microbiome Solution, The Bloat Cure, and “The Antiviral Gut: Tackling Pathogens from the Inside Out.” Joe 55:15-55:23 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Terry 55:23-55:30 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Joe 56:09-56:19 Today’s show is number 1,336. You can find it online at peoplespharmacy.com. That’s where you can share your comments. Terry 56:20-56:26 Our interviews are available through your favorite podcast provider. You’ll find the show on our website on Monday morning. Joe 56:27-56:48 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. By subscribing to our newsletter, you will also have regular access to our weekly podcast and find out ahead of time which topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon. Terry 56:48-57:28 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 57:29-57:38 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 57:39-57:43 All you have to do is go to peoplespharmacy.com/donate. Joe 57:44-57:57 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Nov 21

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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Nov. 22, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 24, 2025. 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. Dr. John Buse, UNC School of Medicine, Chapel Hill, NC Listen to the Podcast: The podcast of this program will be available Monday, Nov. 24, 2025, after broadcast on Nov. 8. You can stream the show from this site and download the podcast for free. This week’s episode contains some additional discussion of the GLP-1 agonists, as well as the phenomenon of coffee to prevent diabetes. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1453: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01: I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy. com. Diabetes remains one of our most prevalent and challenging health problems. What does the latest research show? This is the People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:46 Our guest today is one of the country’s leading diabetes researchers. He’ll share some exciting news about a study called Catalyst. It used an old drug for a new use against type 2 diabetes. Joe 00:47-00:56 What about the GLP-1 agonist medications like Ozempic and Mounjaro? How are they changing the treatment of diabetes? Terry 00:56-01:01 We’ll also discuss the importance of lifestyle in controlling blood sugar. Joe 01:01-01:08 Coming up on The People’s Pharmacy, new research points to advances in treating diabetes. Terry 01:14-02:26 In The People’s Pharmacy Health Headlines: The CDC originally told Americans that this would be a mild flu season, but after more than six weeks of a government shutdown, the agency is detecting an upward trend in cases of H3N2 influenza. The southern hemisphere is six months ahead of us when it comes to winter respiratory infections. Australia, South Africa, Chile, and New Zealand all reported a severe flu season. Now, public health authorities in Japan, South Korea, Great Britain, and Canada are also reporting an early and severe start to the season. There’s growing concern that the H3N2 strain that’s circulating has mutated. That could mean that the flu shots will be less effective than previously hoped. Dr. William Schaffner at Vanderbilt University Medical Center is a renowned expert on influenza. He notes that even if there is not a close match, use of the vaccine continues to prevent hospitalizations, intensive care unit admissions, and continues to help keep people out of the cemetery. Joe 02:27-03:01 For decades, cardiologists, nutrition scientists, and public health authorities have been warning Americans to avoid saturated fat. Now, though, the head of Health and Human Services, Robert F. Kennedy Jr., is planning to release new dietary guidelines that will end the war on saturated fats. Instead, HHS will promote full-fat dairy, including butter, milk, yogurt, and cheese. It will also recommend red meat. These guidelines will shape school lunches for 30 million children. Terry 03:03-03:48 Increasingly, health experts are acknowledging that food is medicine. Figuring out how to operationalize that insight is tough, though. A state-level incentive program in Rhode Island called “Eat Well, Be Well” offered SNAP recipients 50 cents of credit for every dollar spent on fruits and vegetables. Two statewide grocery chains participated. Investigators hoped that this incentive would increase the consumption of fruits and vegetables among low-income plan participants. It worked, but only for those who already were consuming more produce. Those who weren’t eating many vegetables or fruits at the start of the program didn’t increase their consumption very much. Joe 03:49-04:58 There’s growing interest in lifestyle interventions to reduce the risk of dementia. A new study published in JAMA Network Open used data from the ongoing large-scale Framingham Heart Study. Investigators collected data on physical activity from people as young adults, middle-aged individuals, or late-life participants. These volunteers were followed for many years. The researchers report that higher levels of physical activity in middle age and later life were associated with significantly lower risk for developing dementia. They hypothesize that physical activity may slow amyloid beta production or reduce tau phosphorylation. They think that physical activity might also improve brain structure and function along with blood flow. In addition, physical activity has anti-inflammatory effects. And fourth, physical activity improves glucose metabolism and may reduce stress. Terry 05:00-06:17 GLP-1 receptor agonists like Ozempic and Wegovy have been getting a lot of attention for their ability to control blood sugar and help people lose weight. Now, a new study points to a different advantage. A study of 6,871 colon cancer patients found that those taking one of these drugs were half as likely to die as those not on a GLP-1 agonist. The five-year mortality rate for people taking such drugs was 15.5%. Those not taking a GLP-1 drug had a five-year mortality rate of 37.1%. This advantage was seen almost exclusively in people who were obese when they were diagnosed with colon cancer, as it was restricted to those with a BMI of 35 or greater. Not only were people taking a GLP-1 drug less likely to die of colon cancer, they were also less likely to have fatal heart attacks. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:45 And I’m Joe Graedon. According to the CDC, nearly 40 million Americans have diabetes. The overwhelming majority have type 2, which means they produce insulin, but it just doesn’t control their blood sugar adequately. Insulin resistance occurs when the cells cannot utilize glucose effectively. This condition can result in prediabetes, which may precede a diagnosis of diabetes. Terry 06:45-07:11 When blood glucose is not well controlled over a long period of time, people are at risk for many serious health consequences. Those can include cardiovascular disease, vision problems, nerve damage, and kidney disease. People may also be at a higher risk for dementia. But we now have many new strategies for controlling type 2 diabetes. What does the new research reveal? Joe 07:12-07:26 One of the country’s leading diabetes researchers is Dr. John Buse. He’s the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill School of Medicine. Terry 07:27-07:31 Welcome back to the People’s Pharmacy. Dr. John Buse. Dr. John Buse 07:31-07:33 It’s a pleasure to be with you again. Joe 07:34-07:40 Dr. Buse, you have been involved in diabetes research for, dare I say, decades? Dr. John Buse 07:41-07:52 Yeah. You know, it depends on when you make the starting line. But my first job in a lab was when I was 14 years old, and I just had my 67th birthday. Joe 07:52-08:05 Wow. So it’s been a while. A long time. And the most recent study that you’ve been involved with is called Catalyst. And it is amazing. Tell us how it got started and what you’re learning. Dr. John Buse 08:06-08:31 Yeah. So it’s been known for a long time that high levels of steroids in the blood, and particularly what we call glucocorticoids, the medications would be medicines like prednisone, that that causes, you know, can cause diabetes to manifest itself. Or in people who have diabetes, it can make their diabetes care much more complicated. Joe 08:31-08:53 Well, let me share a quick story with you: my mom, in her 80s, was diagnosed with polymyalgia rheumatica. And for the first time in her life, they put her on a corticosteroid prednisone. And not long after, I’d say within about a year or less, she had type 2 diabetes. Dr. John Buse 08:54-08:54 Exactly. Joe 08:55-09:01 And it was a shock to her. And we were like, oh, but there’s no diabetes in the family. But it was the prednisone. Dr. John Buse 09:02-09:55 Right. So, you know, it’s not that everybody who takes prednisone gets diabetes. But the idea behind the Catalyst study was to specifically examine how common was high cortisol an issue for people with, quote, poorly controlled or difficult to control type 2 diabetes. That was the entire premise of the study. It was divided into two parts. The first part was to find out the prevalence or the frequency of hypercortisolism in difficult to control type 2 diabetes. And the second part was a study to see if mifepristone, a cortisol receptor antagonist, it doesn’t block the cortisol receptor, but it makes it harder for cortisol to work. Would that improve blood sugar control and other things in people with, quote, difficult to control type 2 diabetes? Terry 09:57-10:10 Well, I do want to ask about difficult to control type 2 diabetes. But first, I want to know the answer. How common is this problem, and how well did the mifepristone work? Dr. John Buse 10:10-10:51 Right. So the problem is quite common. It was nearly 25% of the people with difficult to control, type 2 diabetes, had an abnormal result on the so-called one milligram overnight dexamethasone suppression test. So that’s the test that was used. And another 25% had a value that was greater than the 95th percentile for the normal range. So technically, the right answer on your board exam is going to be one in four. But there’s some evidence of a problem in half. At least. Terry 10:51-10:54 That’s a lot. That’s really a lot. Dr. John Buse 10:54-11:20 It is far in excess of anything that we expected, the investigators involved in the study. Though, you know, if we’d been a little bit more trusting of some international studies that were smaller, where the definitions they used for hypercortisolism were a bit different, etc., etc., there are other studies that suggest that that number is probably right all around the world. Joe 11:21-11:44 So all of a sudden, there’s a light bulb that goes off and you say, aha, there’s something going on here. Let’s move on to the second phase of the study. Now, let’s be honest, mifepristone, most people, they’ve never heard of it, but it is a highly controversial drug. Tell us about it. Dr. John Buse 11:44-13:19 Well, the controversy is around the fact that it is part of tablet medication to terminate a pregnancy. And this is a completely different use and, frankly, a completely different product. This product that we used, the generic name for the drug is mifepristone. The brand name for the drug is Korlym. And we administered a 300 milligram tablet or a matching placebo. So nobody knew what people were getting. After a few weeks, they could increase the dose to 600 milligrams if tolerated. And then they could increase again to 900 milligrams as tolerated. What we found was from a baseline hemoglobin A1C, an index of overall blood sugar control of 8.5, which is not great. people came down to about 7% on mifepristone, which is the general target for adults, despite the fact that more than half had some reduction of their pre-existing diabetes medications and almost half stopped taking the drug because of side effects. So even though not everybody took the drug, on average, It was a 1.5% reduction in A1C and very small reduction, a 0.15 reduction with placebo. Joe 13:21-13:28 You know, 1.5% doesn’t sound like that big a deal. But the numbers you’re citing are extraordinary. Terry 13:29-13:37 Well, Joe, 1.5% on the HbA1c is actually a big deal. Joe 13:37-13:44 But I’m just saying for the average person, they’re listening and they’re going, oh, 1.5% reduction. Uh, who cares? Dr. John Buse 13:44-13:53 But that’s not like going from $1 to 98.5. This is a scale where 7% is the goal. Joe 13:54-14:00 5% is pretty much the normal, normal, normal. Dr. John Buse 14:01-14:05 And a world record high would be 15% to 18%. Joe 14:05-14:07 An 8.5% is high. Dr. John Buse 14:08-14:27 Yeah, and we would say an 8.5%, if you were going to give somebody an old school A, B, C, D, F grade, an 8.5%, some people would say it’s a C. Some people might say it’s a B minus. But a 7, you know, where we got is definitely at worst an A minus. Some people say it really should be less than 7. Joe 14:29-14:30 But stunning results. Dr. John Buse 14:31-14:47 Stunning results. And people lost on average 5 kilos or 12 pounds in 24 weeks. And the weight was continuing to come down over that period of time. They lost two notches in their belt in their waist size. Terry 14:48-14:53 It was pretty impressive. They weren’t just losing weight. They were losing waist as well. Dr. John Buse 14:54-15:38 Right. And hypercortisolism, I’m glad you mentioned that, hypercortisolism is a disease where we talk about central obesity. But the strange thing here is a lot of people with hypercortisolism, they’re not technically obese, but they’re round. And so the quintessential case, the one that was described by Harvey Cushing’s – Cushing, you know, 70 years ago, when you look at a picture of her, you’d say, oh, she’s really, you know, really round. Her BMI was actually around 23, but she had massive central obesity. And so this was really a waist approach. Joe 15:38-16:05 Now, there are a lot of people who have hard-to-control diabetes. And, you know, they take not one but two or three different diabetes medicines. They’re trying to lose weight. They’re doing everything that their doctor says, and they’re still having trouble. And nobody knows why, why isn’t this working? Your discovery would answer that question for a substantial number of people. Dr. John Buse 16:05-16:46 Right. And it is such a relief to providers and to patients to get this answer, because I think the usual thought process among patients was, you know, I know I’m trying as hard as I can, but my family is disappointed in my results. My doctor is disappointed in my results. They think I’m not really paying attention to my diabetes. Obviously, I could do more with regards to diet and exercise, but I’m doing the best I can. And the doctor has the same kind of feeling. You know, why am I failing Mrs. Jones? You know, I usually can handle this problem, but obviously I haven’t come up with the right solution. And then sometimes the doctor blames Mrs. Jones. Terry 16:47-16:48 Exactly what I was thinking. Dr. John Buse 16:47-17:13 Now, less so now. When I first met with you guys 30 years ago, that was rampant. You know, we called it non-adherence, non-compliance. I think now the understanding is that most people with diabetes actually do the best they can. You know, they’re not perfect. None of us are. And it’s a very challenging disease to manage. But we have great drugs. And now we have this new insight. Terry 17:14-17:26 Well, we do have a lot more drugs now than we did the last time we talked to you. Diabetes research has really produced a lot of potential treatments. Joe 17:27-17:49 We’re going to take a short break. But when we come back, how does mifepristone work? This miracle, that’s A, do you know? And then we’re going to talk about the GLP-1 agonists, you know, Ozempic, Wegovy, Mounjaro. All of these drugs are taken the country by storm. Terry 17:50-17:59 You’re listening to Dr. John Buse, the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill School of Medicine. Joe 18:00-18:05 After the break, we’ll learn more about the study Dr. Buse conducted, Catalyst. Terry 18:06-18:14 Even though the drug was helpful, a lot of people had to drop out due to side effects. Which side effects were most troublesome? Joe 18:15-18:19 Are diabetes doctors ready to prescribe mifepristone? Terry 18:19-18:24 Should patients be asking for this drug? What would suggest that it might be beneficial? Joe 18:24-18:33 We’ll also learn about semaglutide, known as Ozempic, and Wegovy. Could you take it in a pill to treat diabetes or obesity? Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Terry 20:40-20:43 Welcome back to The People’s Pharmacy. I’m Terry Graedon. Joe 20:44-21:00 And I’m Joe Graedon. The People’s Pharmacy is brought to you in part by Sonu, an FDA-approved drug-free treatment for nasal congestion and runny nose, using sound instead of steroids. More at GetSonu.com. That’s GetS-O-N-U dot com. Terry 21:00-21:31 Today, we’re talking about research that may lead to new advances in treating diabetes. Our guest is one of the country’s leading diabetes researchers. Dr. John Buse 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. Joe 21:33-21:50 Dr. Buse, you’ve described this amazing clinical trial called Catalyst with a drug called mifepristone. The brand name is Koryn? Dr. John Buse 21:46-21:46 Korlym. Joe 21:46-21:50 Korlym, K-O-R-L-Y-M. Dr. John Buse 21:51-21:51 Exactly. Joe 21:51-21:53 How does it work, this miracle? Dr. John Buse 21:53-22:30 Well, it works to normally cortisol, the hormone, or prednisone, the drug. It works by binding to receptors that bind to DNA in the nucleus of our cells. And that’s why it has such broad effects. The mifepristone interferes with that interaction. It’s a competitive agonist or antagonist. So it binds to the place where the cortisol is supposed to bind, and that way diminishes the effect of cortisol. Joe 22:30-22:33 And has this profound impact on blood sugar. Dr. John Buse 22:34-23:46 Right. And how does that happen? That’s another question. And we don’t know all the how for that. But I will tell you the one thing that we don’t know yet is, you know, we know in the people who have the overnight dexamethasone suppression test with a value greater than 1.8, those people that were treated with mifepristone did very well from a blood sugar lowering and weight lowering perspective. We don’t know for the people that have medium high levels what would happen for them. And frankly, we don’t know what would happen is if we put it – if we gave it to every person with diabetes, it wasn’t doing well. And namely, it’s possible that cortisol is so important for many different mechanisms in diabetes that it would work for everybody. Now, hopefully, we’ll do a study in the near future. There’s a follow-on drug that’s being developed and could be available as early as next year. It’s much better tolerated. And as I mentioned before, that was the fly in the ointment of this study is that a lot of people stopped the drug. Terry 23:46-24:01 Well, that really is my next question. You mentioned that almost half of your people who were taking the drug had to stop it because they couldn’t deal with the side effects. Tell us about those side effects. Dr. John Buse 24:01-25:39 Yeah. So it’s interesting. Whether you have surgery to remove a tumor, usually from the adrenal, that makes excess cortisol, or whether you take any drug that interferes with cortisol action, you have something called glucocorticoid withdrawal syndrome or cortisol withdrawal syndrome. So the body gets used to being exposed to extra cortisol. And when they take the drug that blocks or interferes with the action of cortisol, people start to feel bad. The most common feeling is nausea. Some people just have terrible fatigue. Some people have headaches. They really don’t feel well at all. Usually that goes away after five to 15 days or it gets better. But you do have to sort of tough people through the process. And then the other thing I would mention, in this study, we didn’t know whether people were getting the drug or the placebo. And already a lot of the people were on GLP-1 receptor agonists, you know, these drugs that we’ll talk about nausea for them. And so it was a little bit confusing what we really should tell the patients and what they should expect. So I think my clinical practice is in clinic you can do better with patient counseling and support. You can fool around by having people instead of taking it every day, take it every other day and make the symptoms a little bit less worse. But maybe they last a little bit longer. There was a second side effect, though, that’s a little bit more worrisome, and that’s hypokalemia. Terry 25:40-25:41 So low potassium. Dr. John Buse 25:42-26:06 And that is something that’s very well described with the drug. It’s expected. Normally, in clinic, you would use a drug that would interfere with hypokalemia like spironolactone, quite cheap blood pressure medicine, in advance of using the mifepristone here because we didn’t know were they going to get placebo or drug. We didn’t do that. Joe 26:06-26:26 So here’s a question. This is exciting research. Your colleagues, diabetologists all around the world are going to be shaking their head going, hmm, what about this? Are we ready to start prescribing mifepristone? This is very new and different. Dr. John Buse 26:27-27:34 Yeah. And to be honest, it’s a great question, right? I want my colleagues to think extra hard about that. Today, I would strongly advocate for looking for hypercortisolism, and when you find it, you know that you’re dealing with a different bear. You can’t fight this battle in the same way. There are other treatments that can be used and I didn’t mention that in a quarter of the patients that had hypercortisolism, we did adrenal CT scans in everyone. A quarter of them had a tumor in their adrenal that theoretically could be surgically removed. So that’s a potential surgical cure. And secondly, there are new medicines that are being studied and new medicines that may be approved by the FDA in the next few months that are much better tolerated and easier to use. And so making the diagnosis, I think, is really important to do today. Treating with mifepristone, it’s not the easiest drug to use. Joe 27:34-27:43 So people who are having a hard time controlling their type 2 diabetes should definitely bring up the possibility that they might have a cortisol problem. Joe 27:44-27:45 Let’s change gears, Terry. Terry 27:45-28:28 Well, before we switch away from Catalyst, you mentioned, of course, the drop in blood sugar in HbA1c from 8.5% to 7%, which is excellent. That’s what you were hoping for. you mentioned that some people were losing weight, which, you know, I don’t think mifepristone is thought of as a weight loss agent, but evidently it has that effect. But one of the reasons that we wanted to talk with you about it is that somebody posted a comment on our website saying they found that blood pressure went down. Was this person misunderstanding what she heard? Dr. John Buse 28:29-29:05 Right. So blood pressure did not go down. And we kind of thought that it might, but there’s an effect that when you block the action of cortisol with mifepristone, that the cortisol is metabolized to cortisone, which has a variety of actions, blah, blah, blah, blah, blah. So there is a mechanism by which blood pressure could go up. On average, the blood pressure went up a tiny bit on average. So that’s something that needs to be monitored as well. But blood pressure definitely did not go down on average. Joe 29:05-29:31 So now we can change gears. Yes. GLP-1 agonists, Ozempic, Wegovy, semaglutide. And then, of course, there’s Mounjaro and Zepbound, a little bit different because there are two blockers in there. Has this represented a sea change in your world of diabetes control? Dr. John Buse 29:32-29:40 Absolutely. And I’m pretty sure if you check back in your archives, I came here and talked to you once about lizard spit. Terry 29:40-29:41 Yes. Joe 29:41-29:42 You did. Terry 29:42-29:42 Yes. Dr. John Buse 29:42-29:53 And there was the first drug in this class, exenatide. And the very first study of exenatide in people with diabetes was done here at UNC. Joe 29:54-29:56 Now, why did you say lizard spit? Dr. John Buse 29:56-31:30 Well, it was a peptide, a small protein, a hormone that was discovered from the saliva of the Gila monster, a pretty big, very attractive lizard that lives in the Gila River Valley of Arizona. And this guy, John Eng, discovered the peptide. It was developed into a drug. So literally you were injecting a thing that is in the saliva of the Gila monster. But in any case, that drug showed good effect on lowering blood sugar. And it did so without promoting weight gain, which is not, you know, at least in that day, not the usual thing with diabetes drugs. The more effective drugs that lasted longer seem to have this effect on weight loss. And then semaglutide and tirzepatide, the current hot products, have even more effect on weight loss. So people without diabetes are losing 25%, 20%, 25% weight with the most effective of these agents. People with diabetes are improving their blood sugar control and losing 10% to 15% of body weight, which is a big deal— mostly for diabetes because that is a setting where if you lose 10 to 15 percent of your body weight, basically you can functionally get rid of diabetes. You’re taking a medicine, but the diabetes is gone. Joe 31:30-31:44 Terry, we just saw a study this week that involved oral semaglutide. Do you remember where it was published? Was it New England Journal of Medicine or JAMA? It was someplace pretty prominent. Dr. John Buse 31:44-31:47 I think it was Lancet Diabetes and Endocrinology. I think I’m an author. Terry 31:47-31:49 I think it was the New England Journal. Joe 31:49-31:52 But regardless, what did they find? Terry 31:53-32:24 Well, what they found, they used a dose of 25 milligrams per day oral semaglutide. And when you talk about semaglutide, almost all the time, what we’re talking about is an injection, like a once-a-week injection. So this once-a-day pill is a different way for people to get their semaglutide. And what they found, it was a weight loss, it was a weight loss application for people who did not have diabetes. And it did, it was effective. Joe 32:24-32:37 A lot of people don’t like shots, let’s be honest. And plus, it has to be refrigerated. So it means, you know, if it’s shipped to your home in the summertime, that’s a bit of a problem. But oral medicine, that could be a game changer. Dr. John Buse 32:39-33:06 Absolutely. You know, this medicine is not the easiest oral medicine to take. It has to be taken on an empty stomach with a small swallow of water and eat or drink absolutely nothing for 30 minutes. So it’s not ‘pop this in before the shower and when you get out of the shower, have your cup of coffee.’ No, you cannot eat or drink anything for 30 minutes. So at least in my clinic, you know, most people find taking a shot once a week. Terry 33:06-33:07 Easier. Dr. John Buse 33:08-33:11 Arguably easier. Less complicated, let’s put it that way. Terry 33:11-33:12 Sure. Dr. John Buse 33:12-33:30 But you have to kind of get over that shot thing. Now, sometimes we encourage people to have their spouse give them the shot because it is kind of a weird thing to put a needle into your own flesh. But most spouses like the opportunity of putting a needle into their spouse’s flesh. Terry 33:31-33:32 Well, they know they’re being helpful. Dr. John Buse 33:33-33:33 Right, exactly. Terry 33:34-33:35 Even if it hurts. Dr. John Buse 33:35-33:36 Right, exactly. Terry 33:36-33:36 Okay. Dr. John Buse 33:37-33:38 It’s a win-win situation. Terry 33:39-33:55 And now I’d like to follow up on this idea that you could medicate your way out of diabetes. So we’re talking type 2 diabetes here. So let’s please first explain what are the differences between type 1 and type 2 diabetes. Dr. John Buse 33:56-35:39 So type 1 diabetes proportionally is more common in younger people, but can occur at any age. And the process is one by which the cells that make insulin, specifically just this one cell type called a beta cell, is destroyed usually by an immune process. Rheumatoid arthritis destroys joints. Type 1 diabetes destroys beta cells. So the treatment for type 1 diabetes is basically just insulin. You just have to replace the insulin production of the body with sophisticated and precise administration of insulin. Completely different game than type 2 diabetes, which is the more common disease in older adults, generally associated with overweight or obesity. And in type 2 diabetes, there are multiple defects. But the big two are insulin resistance, meaning insulin doesn’t work quite as well as it does in normal people. And then insulin deficiency. Not absolute insulin deficiency, but relative insulin deficiency. So they need this bigger need for insulin because of the insulin resistance, but they’re not able to produce that. So they make enough insulin for a non-diabetic person to be perfectly fine. They just don’t make enough insulin for themselves. And one thing that’s commonly misunderstood about type 2 diabetes, there are people who are very, very, very heavy, you know, 300, 400, 500 pounds, whose blood sugars are completely normal because they’re able to make enough insulin. So diabetes and obesity or overweight are not tightly linked. They do go commonly together. Joe 35:40-35:55 We’ve heard that type 2 diabetes has become a pandemic. It’s not just in the United States. It’s in India. It’s all over the world. Why? Why has it become such a problem? Dr. John Buse 35:55-37:47 Yeah. You know, it’s another great question. So there are many, many, many, many genes that contribute to type 2 diabetes. It’s likely that every little tribe on earth, every village and hamlet, they tend to be, you know, a little bit interbred. You know, they would marry the people in the neighborhood, that they developed adaptations that allow them to thrive with their food sources and activity levels. And through multiple different genetic mechanisms, this ability to thrive was very productive thousands of years ago. So specifically, people were able to gain weight when food was plentiful and then lose it slowly when there were lean times. That’s maladaptive today. So there are many, many, many genes. There’s about 10 mechanisms that have been well described that contribute to mainstream diabetes, but there’s probably hundreds, if not thousands, of mechanisms. So now we create an environment where there is very little scarcity of food. Frankly, we have food everywhere. We’re having messages pushing us towards eating this food. It’s delicious. It’s easy to eat in bulk. And so people have gotten heavy. And that promotes the insulin resistance. And so these defects in insulin production and other defects sort of come out and express themselves as diabetes. The reason why we say it’s a pandemic, it used to be that the U.S. led the way. Now the Middle East is probably the highest, but all across the globe. And the lifetime risk on this planet of developing diabetes is about one in three. Terry 37:48-38:10 You’re listening to Dr. John Buse, the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill School of Medicine. Dr. Buse works with teams of investigators in diabetes clinical trials, comparative effectiveness research, and translation of basic science research towards clinical application. Joe 38:11-38:16 After the break, we will talk about pre-diabetes. What is it and what can we do about it? Terry 38:16-38:24 How well do lifestyle interventions and medicines work to reduce the risk of developing diabetes if you have prediabetes? Joe 38:25-38:28 How good is exercise as an intervention? Terry 38:28-38:36 Metformin is currently prescribed to people who already have diabetes. Could metformin help us prevent the development of diabetes? Joe 38:37-38:53 There are other medications that people take to control their type 2 diabetes, like glitazones or gliflozins, not to mention drugs like semaglutide or tirzepatide, what should we know about them? Can they be used for prevention? Terry 38:54-39:05 We’ll also find out if continuous glucose monitors could help people who don’t have diabetes. If they could help you change the way you eat, that might make a difference. Joe 39:06-39:15 The American diet is widely recognized as problematic. If we could change three things about it, what should they be? Terry 39:28-39:31 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 39:40-39:43 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 39:43-40:02 And I’m Terry Graedon. Joe 40:03-40:25 The CDC estimates that nearly 100 million Americans have prediabetes. The overwhelming majority don’t know they have this metabolic disorder. There is growing interest in keeping prediabetes from turning into type 2 diabetes. What kinds of interventions could make a difference? Terry 40:25-40:58 One of the more controversial strategies for detecting prediabetes is for people to wear a continuous glucose monitor, or CGM. The FDA originally approved these devices to help people with diabetes track their response to meals. They were only available by prescription. But now the agency allows the sale of CGMs over-the-counter. Many people with prediabetes are using continuous glucose monitors to track their blood sugar throughout the day. Is that a good idea? Joe 40:58-41:13 We are talking with one of the country’s leading diabetes experts. Dr. John Buse is the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill School of Medicine. Terry 41:15-41:50 Dr. Buse, we are interested in this idea of prediabetes, that people may have a condition that could be identified before they develop actual type 2 diabetes. We have heard of people being diagnosed, oh, you have prediabetes. So what is prediabetes and what can we do about it? Because if I were diagnosed with prediabetes, I would want to do something so I didn’t get diabetes. Dr. John Buse 41:50-43:09 Exactly. So prediabetes is an attempt to communicate something relatively complicated concisely. The important thing to realize is that prediabetes, like pre-malignant, is not a guarantee. Meaning if you have prediabetes, it means that you’re at increased risk of developing diabetes, but it’s not a guarantee at all. And you can intervene to reduce those risks. So there have been about five studies done with lifestyle intervention that have shown about a 50% reduction in risk over three to five years. And there have been about 10 studies done with drugs that have shown between 20% and 95% reduction in the risk of developing diabetes over similar periods of time. Generally shorter in the drug studies, let’s say one to three years. The risk for developing diabetes when you have prediabetes is determined by the elevation of the test. So for instance, with the A1C test, a 6.5 gets you a diagnosis of diabetes. A 6.4 is not diabetes. It’s pre-diabetes. Terry 43:09-43:12 Pre-diabetes. So that’s not a big difference. Dr. John Buse 43:12-43:39 Right. A 5.7 is also pre-diabetes. But your risk of developing diabetes if your A1C is 5.7 is modest, probably on the order of 10% in 20 years. If your A1C is 6.4, your chances of getting diabetes in the next three years is probably nearly 100%. But you can intervene and make that go away. Terry 43:39-43:59 Let’s talk about those interventions. I know that for a long time, the research has shown that people taking metformin reduce their risk of going from prediabetes to diabetes. What are the other interventions that people have used? Dr. John Buse 43:59-44:02 Well, I think first it’s important to talk about lifestyle intervention. Terry 44:02-44:03 Absolutely. Dr. John Buse 44:03-44:04 Diet and exercise. Terry 44:06-44:11 But just saying diet and exercise, that’s not quite enough. So please do tell us. Dr. John Buse 44:11-44:21 It’s 150 minutes a week of moderately vigorous physical activity. So this is brisk walking. 150 minutes a week is 30 minutes, five days a week. Joe 44:21-44:27 And somebody once said, it’s like you’re late to an appointment or to your flight. You’ve got to really move along. Dr. John Buse 44:28-44:48 Right. I mean, you know, you don’t have to be huffing and puffing, but it’s not a mosey. And then that coupled with calorie restriction to produce at least 5% and 10% is more than twice as good. So if you can lose 10% of your body weight, your chances of developing diabetes is reduced by 60%. Terry 44:49-45:01 Let me just throw in one little caveat here. That’s for most of the people we’re talking about because most of them are heavy. But not everyone with prediabetes is overweight, right? Dr. John Buse 45:02-46:41 Exactly. So that’s a point well taken. Metformin was studied in some of the studies that lifestyle therapy was also studied in. And in general, lifestyle therapy beat metformin. But metformin was just as good at lifestyle therapy in younger patients under the age of 45, in people with higher glucose levels, you know, the higher A1Cs, the higher fasting glucose levels, in women with prior gestational diabetes that are very high risk for developing future diabetes. So there were settings where metformin worked quite well. Other drugs that have been studied are the glitazones, pioglitazone [Actos] and rosiglitazone [Avandia], quite effective on the order of 60, 70 percent. These drugs have more safety concerns. The big one is probably bone health. The scarier one is bladder cancer, which is quite rare. I mean, the risks to an individual taking pioglitazone for bladder cancer is quite rare, quite low. But then the new studies with these highly effective GLP-1 receptor agonists have been spectacular. Now, they’re controversial because the patients didn’t come off the GLP-1 receptor agonist for a long time, just for a short time. So you don’t really know whether you’re masking the diabetes with a diabetes drug or whether you’re actually preventing diabetes. But the top line result was a 95% reduction in risk. The sort of more gorier details, it’s probably not quite that high. Joe 46:41-47:17 What I want to talk about is diet, cause everybody always says, yeah, diet and exercise, but they don’t ever really tell you what to eat or what not to eat. And we’ve had some controversy with you in the past about the American Diabetes Association and the Feinstein Diet and all the other diets. But I want to talk specifically about CGMs, continuous glucose monitors. For decades, they’ve been around and they were prescription only. You had to have a diagnosis of type 2 before you could get a little thing that you could slap on your arm and actually monitor your blood glucose. Dr. John Buse 47:18-47:28 Well, actually, more than that, you had to be on insulin usually or a sulfonylurea drug. You had to have a risk of hypoglycemia, and that was what you were really monitoring for. Terry 47:29-47:36 And that’s what the insurance companies required so that it would be paid for, and otherwise you probably couldn’t afford it. Dr. John Buse 47:37-47:37 Right. Joe 47:37-48:01 Now you can buy them “over the counter” in quotes. I mean, you don’t need a prescription. You do have to pay out of pocket, and most insurance companies aren’t going to pay for them. But I’m guessing around $40 or $50 a month. And I’ve used them, and they’re incredibly revealing. I mean, I discovered, for example, that oatmeal, which is supposed to be this absolutely wonderful, healthy breakfast. Terry 48:02-48:07 And I do use steel-cut oats. We’re not using the quick and dirty oatmeal. Joe 48:08-48:29 But it really pushed my blood sugar up to around 140. And it’s like, what? The oatmeal is supposed to be good. Why is that happening? Whereas if I have eggs, it doesn’t go up hardly at all. So what about the value of CGMs for people who have prediabetes or just concerned about their blood glucose? Dr. John Buse 48:30-50:21 Yeah. You know, this is like the nuclear arms race of the 1970s. So in medicine, in society, there’s sort of a bit of a tendency if you can do a little, you could do more. And if a little is good, then more is better. I would just caution people that I’m not sure that a blood sugar of 140 after oatmeal is a problem. And if you’re changing your life to eating eggs and bacon, I’m not sure that’s a good solution either. So just be aware this is just another piece of information. It’s not been studied in a way that we really can tell you how that revelation might be beneficial to you. I tend to discourage people from going wild with using technology to monitor every aspect of their life. I think we know what a healthful diet is. We have some good ideas. You know, the idea of less processed food, a variety of foods from a variety of different categories, cereals, nuts, fruits, vegetables, meats— you know eating a variety of foods in moderation. And at the end of the day people have appetites and um, if you like oatmeal you should eat oatmeal. You know life is too short to deprive yourself of everything. Um, now if you like eggs and bacon and you want to use this as an excuse to eat eggs and bacon, go for it. Joe 50:20-50:40 Well, that does bring up a very controversial issue. We interviewed Dr. Eric Westman recently. He is renowned as the ketogenic diet guy, and now he’s moving into the carnivore diet approach. And he maintains that the ketogenic diet will get you off your diabetes drugs. Dr. John Buse 50:41-51:17 For people that can persist with that kind of diet, it generally is associated with a reduction in the amount of drugs that they need. But it’s a big sacrifice. And what we don’t know yet is that people that eat a ketogenic diet and specifically a carnivore diet, whether that’s associated with enhanced longevity, is it associated with a higher risk of kidney disease, of bone disease. And there’s a number of unknown issues with these kinds of diets. Terry 51:18-51:43 So more data needed. We’ve talked a little bit about the GLP-1 agonists, which is a fancy way of saying Ozempic and Mounjaro. I would like to ask about another category of diabetes drugs. And that’s the category that Jardiance is in, empagliflozin, all the “flozins,” there’s lots of “flozins.” What should we know about them? Dr. John Buse 51:44-52:54 Yeah, so they’re really miraculous drugs that soon will be generic and in five years they’ll be dirt cheap because there’ll be multiple generics on the market. These drugs work basically to make you pee sugar. So whatever food you eat, some of it is excreted in the urine when you take the flozins, drugs like Jardiance or empagliflozin. So there’s some weight loss. With that loss of glucose, there’s also a bit of loss of sodium. So you have some blood pressure reduction. And then there’s some magical things that happen within the kidney and within the heart. So it is associated with dramatic improvements in kidney outcomes and heart outcomes, particularly in people who have heart failure or kidney disease. But that is really common in overweight and obese people, particularly with diabetes. Now they’re actually approved for the use of people in general, whether they have diabetes or not, who have kidney disease or heart failure. A really remarkable class of drugs, and the best thing about them is they’re going to be cheap. Joe 52:55-53:20 Dr. Buse, we’re hearing rumors about something called ‘micro dosing.’ We’re not talking about psilocybin or LSD or any of those hallucinogens. We’re talking about micro dosing the GLP-1 agonist, the drugs like Ozempic, like Mounjaro. What the heck is micro dosing and why would it be interesting? Dr. John Buse 53:20-54:46 Yeah. So the GLP-1 agonists we’ve known for a while are associated with nausea, vomiting, various kinds of GI side effects. If you start with a really low dose and you go up slowly, you tend to have much less of those side effects is the first thing. The second thing is that for some people, they are very sensitive to the drug. And while they’re going up slowly on the dose, they may lose substantial amounts of weight. And I have patients that are able to get by with a 20th of the normal dose with consistent, though generally relatively slow weight loss. I think that’s a really healthy way of losing weight. It takes people decades to gain weight. We should take years in getting people to lose substantial amounts of weight. So it’s just it’s an alternative technique that works out quite well in some people. It’s easiest to do with Ozempic because that pen has clicks in it. The other drugs are largely administered as so-called single-use pens where you just push a button and it gives you the dose. So there isn’t really a way to do it. If you buy the vials, which are now available, you can also micro dose. It’s a little bit more complicated because you have to use a needle and syringe. Terry 54:46-54:55 Now, you mentioned that you have patients who are doing this, they are losing weight. Are they also gaining better control of their blood sugar at these very low doses? Dr. John Buse 54:56-55:46 Yes. In general, the GLP-1 receptor agonists provide for what we call a dose-response curve. As the dose goes up, you have a bigger effect on blood sugar lowering than you have on weight. And as you get to higher and higher doses, you get less additional benefit for glucose lowering and more benefit for weight on average. Now, what I’m mostly talking about here is people where overweight and obesity are the main problems is where the micro dosing is worked out. Or in people who have tried GLP-1 receptor agonists in the past and had a rough time with regards to nausea, vomiting and stopped. So I think that’s where the biggest opportunity is. Joe 55:47-55:52 Dr. Buse, one last question: coffee and diabetes. Dr. John Buse 55:54-56:55 It’s like my pet peeve. And the reason is there are probably a thousand papers that have been written about coffee. It takes time to review them, time to publish them, time to read them. And it’s not quite a 50-50 split that coffee is good for diabetes, but it’s pretty close to a 50-50 split. I think it’s inherently a problem with this kind of food epidemiology research that, you know, coffee drinkers are just different than people who don’t drink coffee, right? And particularly people who drink six cups of coffee a day are different than people who drink one cup of coffee a day. So it’s just a really hard study to do. So now that said, you know, if a patient says, ‘You know, I love my coffee’ and I said, ‘Well, that’s great. You should have it just because you love it. And maybe it’s even good for your diabetes.’ And if they say, ‘You know, somebody told me I should drink coffee for my diabetes, but I hate it.’ I say, ‘Do not drink coffee for your diabetes.’ Joe 56:57-57:25 Thank you. We are almost out of time. If you could change three things about the American diet, what would it be? And then what does your crystal ball hold for the future of diabetes research and especially for type 1 diabetes? Cause, you know, as you said: insulin, insulin, insulin. We haven’t had any breakthroughs. We don’t have any cures yet. So: diet and crystal ball? Dr. John Buse 57:25-58:06 Yeah, I think the most important thing about the diet in America is we do need to eat less processed foods. That’s a big ask. It’s easy to eat processed foods. But I think that is number one on my list. And then secondly, a wide variety of foods. You know, I went through my list before. I think those are number one and number two. And then if you’re going to lose weight, if you’re aiming to lose weight, make sure not to forget exercise as part of your, quote, diet, close quotes. Because if you don’t exercise and you start, you know, you’re losing weight and you don’t feel energetic, you will lose muscle mass. And that’s not a good thing. Joe 58:06-58:06 Crystal Ball? Dr. John Buse 58:07-59:28 Crystal Ball in type 1 diabetes, we’re working on a lot of adjunctive therapies using the same drugs that we’ve used in type 2 diabetes and then developing novel adjunctive therapies. So in our clinical trials program, we’re studying GLP-1 receptor agonists in type 1 diabetes. There are major programs from at least two pharmaceutical companies. We’re studying a new class of drugs called glucokinase activators in type 1 diabetes. And then the sort of prevention strategies, generally immune-modifying strategies, are super exciting. And lastly, stem cell-derived therapies. So these would be cells that you can make billions of beta cells, the insulin-producing cells, and infuse them back into people with immunosuppression. And then in the last month in the New England Journal, cadaveric donors, you know, organ donors, their pancreases were disassembled, the islets taken out. They were genetically modified to make them non-immune, and they actually did a sort of proof of concept in a single case, do a transplant for type 1 diabetes reversal without any immunosuppression, so without the dangerous drugs that come along with islet transplantation. Terry 59:28-59:48 So they had somebody who had died in an accident or something. They had signed the form that says, yes, I’m donating my organs. The organ they donated was a pancreas, and the part of the pancreas that the researchers took were the islets that contained beta cells. Is that right? Dr. John Buse 59:48-59:50 Right. Right. Terry 59:49-59:55 And so they put them through the wash, as it were, so they didn’t have immune markers on the surface. Dr. John Buse 59:55-01:00:02 No, no. They used CRISPR-Cas9, a gene-modifying technique… Terry 01:00:02-01:00:03 Okay. Dr. John Buse 01:00:03-01:00:07 …to change a couple of genes within these cells. Joe 01:00:07-01:00:08 And the result was? Dr. John Buse 01:00:10-01:00:14 So this wasn’t a clinical stage. But the cells lived. Joe 01:00:15-01:00:20 So it’s entirely possible that we could have a cure for type 1 diabetes in the future. Dr. John Buse 01:00:21-01:00:43 Well, what I would say is I almost didn’t go back to medical school in 1984 when I was finishing my PhD because I was so sure we were going to cure diabetes then. So we have been at the cusp of a cure for a long time. We keep coming up with these great ideas and Mother Nature is really hard to fool. Terry 01:00:44-01:00:49 Dr. John Buse, thank you so much for talking with us on The People’s Pharmacy today. Dr. John Buse 01:00:50-01:00:52 It’s always a pleasure visiting with you guys. Joe 01:00:53-01:01:03 You’ve been listening to Dr. John Buse, the Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina at Chapel Hill School of Medicine. Terry 01:01:04-01:01:13 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 01:01:14-01:01:20 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Terry 01:01:20-01:01:38 Today’s show is number 1,453. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com. Joe 01:01:38-01:02:01 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. The podcast this week has some extra information about people experimenting with micro dosing of GLP-1 drugs like Ozempic or Mounjaro to prevent diabetes. Does this make sense? Also, what’s the story on coffee and diabetes? Terry 01:02:02-01:02:21 Well, epidemiological evidence over the past few decades has suggested that coffee drinkers have a lower risk of developing diabetes compared to non-coffee drinkers. A lot of people with AFib have been told coffee’s off-limits, but new research shows coffee drinkers have a lower likelihood of AFib recurrence. Joe 01:02:22-01:02:44 At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to our weekly podcast. We’d be grateful if you would consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. In Durham, North Carolina, I’m Joe Graedon. Terry 01:02:44-01:03:20 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:03:20-01:03:30 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:03:30-01:03:35 All you have to do is go to peoplespharmacy.com/donate. Joe 01:03:35-01:03:48 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Nov 14

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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Nov. 15, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 17, 2025. 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. We think that Dr. Bianco is one of the leading thyroid researchers in the world. Here is a very short video clip from our interview with him: 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 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, Nov. 17, 2025, after broadcast on Nov. 8. You can stream the show from this site and download the podcast for free. This week’s episode contains additional discussion with Dr. Bianco of his research on the consequences of treating with levothyroxine alone. We also consider the FDA’s claim that natural desiccated thyroid suffers from inconsistent quality and dosing. Mary Shomon offers basic information on what the numbers from a thyroid test mean, especially the goals for T3 and T4. We also review the most common symptoms of hypothyroidism. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1452: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:26 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. The FDA has announced a ban on natural thyroid extracts like Armour that will impact over a million people. This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:44 Most people with under-active thyroid glands take synthetic levothyroxine, but many patients feel much better if they take a natural desiccated thyroid instead. Joe 00:45-00:51 How will the FDA’s ban affect them? What could they do if their medicines were pulled off the market? Terry 00:51-00:57 We speak with an endocrinologist and a patient advocate about the possible ways people might deal with this situation. Joe 00:58-01:05 Coming up on The People’s Pharmacy, why is the FDA planning to ban natural desiccated thyroid? Terry 01:14-02:28 In The People’s Pharmacy health headlines: the FDA has just announced a change to prescribing information for hormone replacement therapy. For many years, this treatment for menopausal symptoms like hot flashes and night sweats has carried a black box warning. This warned women and their doctors that estrogen could increase the risk for endometrial cancer and could increase the risk for blood clots and cardiovascular problems. FDA Commissioner [Dr.] Marty Makary has expressed his belief that the boxed warning frightened women away from a treatment that could help them. He thinks that HRT might reduce the risk of bone fractures, dementia, and even heart disease in women who start taking it at menopause. According to Dr. Makary, with the exception of antibiotics and vaccines, there may be no medication in the modern world that can improve the health outcomes of older women on a population level more than hormone therapy. Some critics are concerned that this action, which was not vetted by an official FDA advisory panel, may undermine the agency’s credibility. Apparently, the warning about the risk for endometrial cancer will remain for products that contain estrogen alone. Joe 02:29-03:39 For years, cardiologists have warned patients with atrial fibrillation to avoid coffee. That’s because they worried that caffeine would aggravate heart arrhythmias. A new study titled DECAF, which stands for Does Eliminating Coffee Avoid Fibrillation, has produced surprising results. The study published in JAMA recruited 200 coffee drinkers with AFib. Half were assigned to drink at least one cup of caffeinated coffee daily. The other half were required to abstain from coffee or any other caffeinated beverages. The study lasted six months. The results were unexpected. Coffee drinkers had a significantly lower likelihood of recurrent atrial fibrillation. One possible explanation is that coffee has anti-inflammatory properties. Because some research suggests that chronic inflammation contributes to AFib, lowering inflammation might be beneficial. The authors conclude that one cup of coffee daily was associated with a lower risk of atrial fibrillation and atrial flutter recurrence. Terry 03:40-04:47 Cardiologists have long known that low levels of circulating vitamin D may increase the risk for a heart attack. A study presented at the American Heart Association’s scientific sessions showed that people taking vitamin D supplements to raise their blood levels to at least 40 nanograms per milliliter significantly reduced their chance of a second heart attack. The study included 630 people who had suffered a heart attack less than a month before entering the trial. Such individuals are at risk for a second heart attack. Investigators assigned them to a control group that received no vitamin D management or an intervention group that had regular measurement of vitamin D and adjustment of their supplements to reach the target blood level. When the study began, 85% of the volunteers were below target. Many required supplements of 5,000 international units of vitamin D3 daily to reach 40 nanograms per milliliter. Those taking supplements were half as likely to experience a second heart attack compared to those not receiving supplements. Joe 04:48-05:20 Metabolic syndrome is a cluster of three or more risk factors that increase the chance for cardiovascular complications such as heart attacks, strokes, peripheral artery disease, along with diabetes. Risk factors for metabolic syndrome include high blood pressure, abdominal adiposity, elevated blood sugar, and high triglycerides. A new study has found that six months of lifestyle interventions to encourage new habits of healthier eating and greater physical activity led to long-term benefits. Terry 05:21-05:53 Following a DASH diet rich in vegetables and fruits and low in processed foods can help lower blood pressure. But what about people who live in food deserts where fresh produce is not readily available? A study compared home-delivered DASH-type groceries and dietary advice to monetary stipends for groceries. Three months of DASH grocery delivery lowered blood pressure and LDL cholesterol levels more than the $500 monthly stipends. And that’s the health news from the People’s Pharmacy this week. Joe 06:14-06:17 Welcome to the People’s Pharmacy. I’m Joe Graedon. Terry 06:17-06:47 And I’m Terry Graedon. Hypothyroidism is surprisingly common, affecting over 20 million Americans. In this condition, the thyroid gland does not produce an appropriate amount of thyroid hormone. This leads to a wide range of uncomfortable symptoms and some serious health consequences. Treatment is thought to be simple, but not everyone responds to the standard therapy. What can people do if they still feel bad while taking their prescribed medication? Joe 06:48-07:21 To help us understand the complexity of treating hypothyroidism, we turn to one of the country’s leading experts. Dr. Antonio Bianco is professor of medicine and a member of the Committee on Molecular Metabolism and Nutrition at the University of Chicago, where he runs 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.” Terry 07:23-07:26 Welcome back to The People’s Pharmacy, Dr. Antonio Bianco. Dr. Antonio Bianco 07:27-07:29 Thank you. I’m glad to be here. Joe 07:29-07:45 Dr. Bianco, a lot of your colleagues, endocrinologists, family practice physicians, internists, they think that thyroid disorders are easy to treat. Why is that a mistake? Dr. Antonio Bianco 07:46-08:29 Well, the most common disease of the thyroid gland is hypothyroidism. And it is true that for the last 50 years, we have been treating patients with hypothyroidism with the daily tablet of what’s called levothyroxine. And the dose is easily adjusted. And usually we tell patients, come back in six months, come back in a year. And this is sort of very straightforward to the point that it doesn’t have to be even treated by an endocrinologist. They can be treated by a primary care physician, a gynecologist, a geriatrician. I mean, most internists can treat hypothyroidism. Joe 08:31-08:34 But you suggest it’s not as easy as that. Dr. Antonio Bianco 08:36-09:54 That’s right. And that has been a mistake that we did in the last 50 years, again. We assumed that once we achieved the dose of this magical drug called levothyroxine, patients will feel without symptoms, would be relieved of their symptoms. And in fact, it is true for most patients. We estimate that about 80%, maybe 85% of the patients are treated with this approach and they feel fine. However, we do have a substantial number of patients that it seemed small, 15%, but hypothyroidism is so prevalent. We have about 20 million people living in the U.S. with hypothyroidism. So if you estimate about 10%, 20%, we’re talking about 3 to 4 million people. And for those individuals, treatment is not as straightforward. Even though the doctor thinks that the treatment is okay, it’s as it should be, they remain symptomatic. They still have symptoms. Terry 09:55-10:48 Dr. Bianco, we have been hearing from people with hypothyroidism for decades ourselves. They write into The People’s Pharmacy or they call and they say, ‘I am taking Synthroid or Levoxyl, one of those T4 drugs, levothyroxine, and I still feel awful. I still feel tired, I still feel cold.’ Women still say, ‘I still am having problems with my menstrual cycles.’ Many people say, ‘I still can’t lose weight, in fact, I keep gaining weight even though I’m trying hard to lose it.’ They have many symptoms and they don’t feel good and they say, ‘My doctor doesn’t seem interested.’ Joe 10:49-11:03 Well, not only that, they say, ‘My doctor says I’m doing great. My TSH level, this monitor for my thyroid, is perfect. No problems, be happy, don’t worry.’ Dr. Antonio Bianco 11:04-11:40 In a nutshell, you capture exactly what the problem is. That’s exactly right. And so what we think is the problem is that these Synthroid or Levoxyl, they contain this molecule called levothyroxine, which is the thyroid hormone. And levothyroxine is not active, meaning when a patient takes a tablet of levothyroxine, levothyroxine by itself cannot relieve symptoms of hypothyroid. It just doesn’t do anything. Terry 11:41-11:46 I think that’s a really important point. That isn’t adequately appreciated. Say it again, please. Dr. Antonio Bianco 11:45-12:53 That’s correct. Yes. The substance contained in those tablets, either Levoxyl or Synthroid or any generic form of levothyroxine, it’s not active. It’s a dead molecule. And we rely on our body to take that molecule and activate, to process it, to transform it into a molecule that is biologically active, meaning can relieve symptoms of hypothyroidism. And some of us do their job very well. Unfortunately, some of us don’t do that. And those individuals that remain symptomatic. We believe they have a sort of a problem in activating the molecule, the T4, to this other molecule called T3. And so they live in a state of chronic T3 insufficiency. And it so happens T3 is the molecule that relieves symptoms of hypothyroidism. Joe 12:54-13:13 Perhaps we could take just a moment to review the physiology of the thyroid gland. Why is the thyroid, and in particular, that active form, T3, so crucial to every cell in our body? Dr. Antonio Bianco 13:14-15:17 The thyroid mostly makes T4, which again is this molecule that is not active. But T4 remains in the circulation, in the blood. A little bit of T4 goes into the cells. Most T4, it’s in the circulation. Now, once T4 gets into the cells and tissues and organs, T4 is rapidly activated in T3. So that inside that organ, T3 can act and relieve symptoms of hypothyroidism. Now, when doctors look at the TSH, and you mentioned TSH, TSH is this hormone that controls the thyroid gland. TSH likes to see T3 in the circulation within the normal range, so that if you have a healthy thyroid, the TSH controls the thyroid gland to the point that T3 in the circulation is normal. Now, when a patient has hypothyroidism and we give the patient T4, only T4, and rely on the TSH to estimate how much T4 we should give, then the system gets confused because TSH regulates the T3 levels in the circulation, and yet we’re giving a lot of T4 to the patient. Yes, we can regulate TSH with T4, but it’s not the same as having an intact thyroid. And that has been the mistake we’ve done over the last 50 years. We relied on TSH and treated patients with only one hormone. And all along, we needed two hormones to treat these patients. I mean, we believe that this T3 insufficiency should be fixed by adding a second hormone to the treatment. Terry 15:19-16:10 Now, Dr. Bianco, a little bit of personal information here: I am one of those people with hypothyroidism. I have had it since 1974. I am part of your 80% of people who actually feel pretty good on T4 alone. So I’ve been taking Synthroid all these years. When I go to my physician for a checkup and she orders a blood test to see how my thyroid is doing, the only thing she’s looking at is TSH. Is that a problem? When Joe gets his blood tested for his hyperthyroidism condition, his doctor is looking at T4, T3, all kinds of different thyroid hormone levels, not just TSH. Dr. Antonio Bianco 16:11-16:49 That is a problem. And that is part of that, I think that’s a big part of the problem. We got used to just looking at TSH to adjust the dose of levothyroxine. And we were missing the big picture, which is a relative T3 deficiency that these patients experience. And you’re right, some patients or most patients can cope with that. You know, they just don’t feel bothered by that. But there’s a small minority that those symptoms are really important. Joe 16:46-16:48 Whoa whoa, Dr. Bianco- Terry 16:49-16:51 15% is not a small minority. Dr. Antonio Bianco 16:49-16:52 Oh, yeah. No, that’s right. Joe 16:51-16:56 I mean, you’ve already, you’ve already said over a million, maybe as many as two or three million. Dr. Antonio Bianco 16:55-16:56 No, that’s correct. Joe 16:56-16:58 This is not a minority. Dr. Antonio Bianco 16:57-17:06 Oh yes, absolutely. Percentage-wise, yes. Percentage-wise, yes, but it is a vocal and it’s a very important minority. Joe 17:07-17:13 What else should doctors be testing for besides TSH? Dr. Antonio Bianco 17:15-17:39 Uh, T4 and T3. They have to control… the purpose of the treatment of hypothyroidism has been to normalize TSH. And I advocate that we have to look at T3 levels because T3 is the hormone that relieves symptoms. T3 is the hormone that actually [does] things. And we should be looking at normalizing those levels. Terry 17:41-18:07 You’re listening to Dr. Antonio Bianco, professor of medicine at the University of Chicago. He’s a member of the Committee on Molecular Metabolism and Nutrition there, and he runs a laboratory that studies 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.” Joe 18:07-18:14 After the break, we’ll learn about the symptoms troubling some patients even though they’re being treated for hypothyroidism. Terry 18:14-18:21 Low energy and brain fog are not very specific. What should make us suspect they could be due to thyroid problems? Joe 18:21-18:28 Dr. Bianco is challenging the usual approach to hypothyroidism. How are his colleagues reacting? Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:14 And I’m Terry Graedon. Today we’re analyzing the FDA’s plan to withdraw permission for natural thyroid extract, also referred to as desiccated thyroid. What will happen to patients who rely on products like Armour Thyroid if they can no longer access the medications their doctors have prescribed? Joe 19:15-19:36 We’re talking with Dr. Antonio Bianco. He 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. His book is “Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do.” Terry 19:38-20:38 Dr. Bianco, we really appreciate the overview and the history that we have gotten now. The reason we’re talking with you is that the FDA has announced that it is going to withdraw its permission from suppliers of desiccated thyroid extract. I’m not quite sure what the timeline is. I think they suggested perhaps about a year from last August. But thyroid patients who are relying on desiccated thyroid extract to treat their hypothyroid condition are worried that they are going to be left out in the cold. And because they are hypothyroid, they are really going to feel that cold. Can you fill us in on what the FDA has in mind, if you have any insight into that, and what people might be able to do? Dr. Antonio Bianco 20:39-22:19 Yeah, well, that is a problem. I agree with you. We have 1.5 million patients taking this drug. And the FDA just announced that in 12 months, starting in August, that drug is not going to be available. And what the FDA is asking physicians is to switch those patients that are taking desiccated thyroid extract to take levothyroxine, which is the recognized standard of care. But the problem is these patients are on desiccated thyroid extract most likely because they tried levothyroxine before and the levothyroxine was not sufficient to resolve all their symptoms. That’s why they were switched to desiccated thyroid extract. That’s the recommendation that the clinical professional societies are providing. You start treatment with levothyroxine, and if that doesn’t resolve all the symptoms, you can try combination therapy for these patients, either with desiccated thyroid extract or synthetic combination of levothyroxine and liothyronine. So these patients have tried levothyroxine, and levothyroxine failed them. And that’s why they’re happy on desiccated thyroid extract. So the idea that we should all move our patients to taking levothyroxine now, it’s a little bit concerning because it is my experience that these patients rely on that drug. Their lives are many times miserable without the desiccated thyroid extract or the synthetic combination. Joe 22:19-22:49 Let me interrupt you right there. Again, Dr. Bianco, what do you think will happen if a million to a million and a half people are switched from desiccated or natural thyroid to levothyroxine, people who have failed in the past on levothyroxine? What are some of the symptoms that they may encounter when they’re switched back to the pure synthetic levothyroxine? Dr. Antonio Bianco 22:50-23:40 Yeah, the main symptoms include brain fog, the inability to function normally. And I had many patients that complained of brain fog, patients that lost their jobs because they couldn’t focus. I have high school teachers that were functioning well. They were diagnosed with hypothyroidism, they were treated with levothyroxine, and by all accounts, they were okay, biochemically okay. The lab tests were okay, but they did not feel well. They had brain fog, they couldn’t focus, they lost their jobs. I have countless, countless stories, and my colleagues do too. So I think that if they are forced to go back to levothyroxine, it will be a problem for their lives. Joe 23:40-23:47 What are some of the other symptoms? Because we’ve heard of people who say, I just couldn’t lose weight on levothyroxine. Dr. Antonio Bianco 23:47-23:48 That’s right. Yes. Joe 23:48-23:49 And I feel cold. Dr. Antonio Bianco 23:50-23:50 Yes. Joe 23:50-23:52 And I’m constipated. Dr. Antonio Bianco 23:53-24:22 Yes. All the symptoms. The symptoms are very similar to the symptoms of hypothyroidism in lesser intensity. So the second most common is low energy: patients feel very tired, no motivation to do things. And that is very helpful. The third one is difficulty managing body weight, that’s also a major problem. So this is going to be very inconvenient for those patients. Terry 24:23-24:41 And that, I think, is why patients are really, I might say, alarmed at the prospect. Is there any possibility that a desiccated thyroid extract might actually be approved by the FDA? Dr. Antonio Bianco 24:41-25:29 Well, yes, that would be terrific. So we have, I’m aware of about two or three pharmaceutical companies that are currently running clinical trials in communication with the FDA. They are in constant communication with the FDA. The FDA knows about their results and they have these clinical trials that are ongoing and they are in the process of getting this drug approved. So it’s not that they’re doing it without the knowledge of the FDA. No, they know very well what they’re doing. But of course, it takes time because it involves hundreds, sometimes thousands of patients that have to be studied on trial. So it takes time. It’s a long process. Joe 25:30-26:41 Well, you know, I find it rather paradoxical that the overarching company that makes Synthroid, which is the best-selling brand name Levothyroxine, is AbbVie. And the same company, AbbVie, owns the company that creates the best-selling desiccated thyroid, Armour Thyroid. So you have AbbVie with its tentacles, so to speak, in both the brand name synthetic levothyroxine and the natural combination of desiccated thyroid. And so presumably they have enough money, resources, and expertise to be able to run the clinical trials that you’ve described. But the question is, will they be able to meet the timetable of the Food and Drug Administration? And what will patients do if for some reason, for example, they cannot access Armour or any other desiccated thyroid? Dr. Antonio Bianco 26:41-27:41 Right. No, that’s quite interesting. You pointed to a very interesting thing by, you know, it was fate that levothyroxine was going to be manufactured and sold by the same company that makes desiccated thyroid extract. That’s quite interesting. Now, they are running, they are one of the companies that are running clinical trials. They already have actually presented the results of their trial in the meeting of the American Thyroid Association two or three years ago in Montreal. And the results were quite satisfactory, meaning that following the guidance from the FDA, they were able to show scientifically that patients can effectively and safely be treated with desiccated thyroid extract. The results were presented in the American Thyroid Association meeting. Obviously, that’s the first step. Now they’re working with the FDA into the second step of the study, which involves a much larger number of patients. Joe 27:43-27:57 Dr. Bianco, perhaps you can give us an update on your latest research. We have been following you for a very long time, and we’d like to know what you have in the pipeline or what you have recently published. Dr. Antonio Bianco 27:58-28:36 Yes, thank you. So this is, we got very interesting results. So recently I moved to the University of Texas in Galveston. And here we have access to something unique, which is a computer network of electronic medical records. It’s called TriNetX. And once I moved here, I gained access to this network, which involves about 140 hospitals throughout the world, mostly in the United States. And we have access to more than 100 million patients’ electronic medical records. Joe 28:36-28:37 Wow. Dr. Antonio Bianco 28:37-31:02 So obviously, yeah, that’s amazing. My first question is that let’s look at patients with hypothyroidism. And so we were able to identify 1.2 million patients with hypothyroidism that were being treated. So we compared these patients with healthy patients that had a healthy thyroid. So we properly matched them for age, sex. We used about 20 variables to make sure we have two equivalent populations. And much to my surprise, we saw that patients, even though they are being properly treated, They have a higher incidence of dementia, and they have a higher mortality. Mortality is almost double in patients that have hypothyroidism, even though they are being appropriately treated. So that was very concerning to us. Now, the second question is, well, what if the patients were treated with combination therapy as opposed to levothyroxine? So out of these 1.2 million patients, we separated about 90,000 patients that were being treated with combination therapy. Half of them were taking desiccated thyroid extract, and the other half were taking synthetic combination, 90,000. And then we matched those 90,000 patients with 90,000 patients only taking levothyroxine. And we looked at [them] retrospectively for 20 years, how did these patients do? So first, we were expecting, with all honesty, that patients taking the combination therapy, the therapy that contains T3, were perhaps not doing so well as the ones taking levothyroxine. After all, there’s some concern that combination therapy could not be a safe route. Even in the letter of the FDA, they say that desiccated thyroid extract is not safe. So by looking at this population, seeing a very appropriate way of comparing combination therapy, desiccated thyroid extract or synthetic with levothyroxine. Much to our surprise, those individuals taking combination therapy, they had a reduction in mortality of about 30%. Joe 31:02-31:02 Wow! Dr. Antonio Bianco 31:02-31:48 They had a, yes, a reduction in the diagnosis of dementia over these 20 years. So not only the combination therapy were safe, but actually it showed to be slightly safer than levothyroxine alone. And again, this is not one site study. This is not a study that was done here in Texas. No, this was done in more than 100 hospitals across the country. So this is really a multi-center study. It’s a retrospective study. It’s not a prospective study. You can’t just follow 90,000 patients prospectively for 20 years. But even considering that is retrospective, the data is amazing. Terry 31:49-32:21 Dr. Bianco, this brings up a question to my mind, a very personal question. I have been taking levothyroxine in the form of Synthroid since about 1974 or 1975. I don’t remember if it was the end of 74 or the beginning of 75 when I started on it. But all this time, and I’ve counted myself as among that 80% of patients who do fine on synthetic levothyroxine. Dr. Antonio Bianco 32:22-32:22 Right. Terry 32:23-32:32 But what you’re suggesting is perhaps I could do even better if I also had a little bit of T3 in my treatment mix. Dr. Antonio Bianco 32:32-33:43 That’s correct, absolutely. And I think that my research in the laboratory now shows that there’s some clues to why this is. I think that when we treat patients with levothyroxine alone, we do not restore thyroid hormone action in all tissues. And it looks like the liver is one of the tissues that might remain slightly hypothyroid, even though the TSH levels are normal. Remember, the TSH is that hormone that doctors use to control the amount of the dose of levothyroxine that we give to patients. So the goal is to normalize TSH. So it turns out that even though TSH is normal, the liver may remain slightly hypothyroid. And why do I say this? Because patients with hypothyroidism that take levothyroxine, they have slightly elevated levels of cholesterol. Even though the TSH is normal, cholesterol remains slightly elevated. And you know what doctors do? They give statin. Terry 33:43-33:45 Yes, I do know that. Dr. Antonio Bianco 33:45-34:34 Exactly. So it turns out the number one co-prescription medication of levothyroxine is statin. Because, you know, you’re a doctor, you’re treating your patient, you’re giving levothyroxine, you normalize TSH, cholesterol remains elevated. Okay, I’m going to prescribe statin now. So it seems that we are creating patients that have a liver that’s slightly hypothyroid. Statin helps, but statin does not resolve all the problems. And therefore, that creates a risk factor for cardio-metabolic diseases. So these patients are dying of cardio-metabolic diseases. And I’m not surprised that when you use combination therapy, you actually improve a little bit. Joe 34:34-34:37 Dr. Bianco, have you published this new research? Dr. Antonio Bianco 34:38-34:44 Yes, it is published in the Journal of Clinical Endocrinology and Metabolism about two months ago. Joe 34:44-35:12 Well, it seems to me that if you were to present this data to the Food and Drug Administration, that is to say that people actually are doing better on desiccated thyroid, natural thyroid, in the long run with regard to key factors that people really care about. You know, they don’t care about lab values. What they care about is how they feel… Dr. Antonio Bianco 35:12-35:13 That’s exactly right. Joe 35:12-35:16 …and whether they’re living longer and healthier. Dr. Antonio Bianco 34:16-34:16 Yep. Joe 35:16-35:37 It seems like if you were to present this data to the Food and Drug Administration, they might say, ‘Oops, we just made a colossal mistake, we should be allowing natural desiccated thyroid on the market and maybe questioning the value of synthetic T4 levothyroxine.’ Dr. Antonio Bianco 35:38-36:29 Yeah, I agree 100% with you. Including in the letter, the FDA says, we are unaware of any studies demonstrating the safety and effectiveness of desiccated thyroid extract, which is, I mean, absolutely incorrect. There are several studies that have been published and are available on PubMed. There are two clinical trials that were done at the Walter Reed Medical Center, you know, in Washington. And, and uh, proving that this desiccated thyroid extract is effective and is safe. And you don’t even need to look at this study that we just published. The study that we published is powerful because it involves 90,000 patients for over 20 years. So that is very important, I think. Joe 36:29-37:00 I’m curious about your colleagues. I mean, you are one of the world’s foremost researchers in the field of thyroid physiology. Are other endocrinologists concerned about the FDA’s, shall we say, well, it’s just Joe speaking now, short-sighted decision to withdraw approval of desiccated thyroid? Are you hearing from any of your colleagues who are a little bit worried? Dr. Antonio Bianco 37:01-38:02 Yes. I think that I just recently went to the meeting of the American Thyroid Association in Arizona, and that was the conversation that we had with multiple individuals, colleagues of mine, very concerned. In fact, [AACE], the American [Association of] Clinical Endocrinology, put out a statement saying that they are supportive of the patients and they are stressing the FDA to reconsider and make sure that desiccated thyroid extract will remain available until the drugs are approved by the FDA. Because the companies are on track to get this drug approved by the FDA. Also, the American Thyroid Association put out a statement saying that they support the availability of desiccated thyroid extract at the same time that they support the companies going through the approval process. So I think that professional societies and my colleagues are very concerned with this move by the FDA. Joe 38:02-38:56 I do have one other question, and that has to do with quality. One of the concerns that the FDA has suggested is that, well, this natural thyroid stuff, this desiccated thyroid, it might be variable from one batch to another or from one company to another. And therefore, it might be unreliable. And what has me concerned about that perspective from the FDA is that we have received an awful lot of complaints from people who say, you know, generic levothyroxine that may be made in China or India or Thailand or Brazil. We have some problems with that generic thyroid. Terry 38:57-39:21 Well, the problem is that from one month to the next, when you get your prescription filled, you don’t know that the pharmacy is going to be using the same generic company to fill your prescription. And we have heard from people who said it was fine for, you know, three or four months, and then I got switched, and it really was not the same. Joe 39:22-39:42 So it seems a little, you know, I won’t say disingenuous of the FDA to be so worried about quality of the desiccated thyroid, but seemingly says, oh, all the generic levothyroxine is the same. Don’t worry. Everything’s fine and dandy when patients are saying it’s not. Dr. Antonio Bianco 39:44-43:27 Yeah. So you touched on two important problems. One is the variable potency of desiccated thyroid. The other one is the consistency of exchanging levothyroxine formulations. So the first one, it is true that desiccated thyroid extract was, there was this problem of inconsistency, but that was resolved in 1985. And if you look at the FDA letter, all the references that they quoted to support the idea that desiccated thyroid extract is inconsistent. They dated before 1985. I’m looking at the letter and it starts by 1978. So what happened in 1985? The United States pharmacopoeia changed the recommendation for how this desiccated thyroid extract is standardized. And they moved from measuring just iodine in those tablets by measuring T3 and T4 by HPLC. So now, since 1985, everyone, the pharmaceutical companies use HPLC to do this. And by doing that, the standardization became so much better, right? So the potency issue has basically been resolved. Of course, there are recalls. Yes, levothyroxine is also recalled all the time. If you go to the FDA website, drugs are recalled. Lots of drugs are recalled, you know, different lots. Because, and actually I’m happy when I see a recall, because it means someone is looking at it, someone is actually measuring it, and making sure that whatever remains available for the public is within the recommendations. So, recalls are normal. And I think that it means we are looking at, but if it’s not recalled, it’s consistent. It’s within the recommendations that we give by, that are given by the [USP], the United States Pharmacopeia. Now, generic versus brand and multiple generic formats for levothyroxine. Yes, this is an issue that has been in discussion for a number of years. And I have to tell you that most publications, or at least two major publications that I know that have been published in JAMA, show that it is totally possible for patients to switch from one brand to the other, from one generic to the other, because they are all equivalent. I know there are anecdotal reports by patients saying that they don’t feel well once they change, that might be because of the filler or the excipient that contain, [that] different formulations have. But as far as the hormones in the blood, the TSH, and as far, if you look at those, those drugs are interchangeable. So, and I, you know, this is, you cannot control that. That’s beyond our control. We did recently a study in which we saw that about 40% of the prescriptions are switched at the pharmacy level within the first year that patients started taking levothyroxine. If you go to the next second year, the number is even higher. So the exchange happens no matter what because pharmacists are allowed to do that. Joe 43:29-43:55 Now, for somebody who panics and they say, well, what will I do? They could ask their family physician or their endocrinologist to prescribe the synthetic versions. How different is it likely to be clinically if someone were to receive both levothyroxine and liothyronine? Dr. Antonio Bianco 43:56-43:56 Right. Joe 43:56-44:05 Two synthetic [hormones], the brand name, by the way, is Cytomel for that liothyronine T3. Just give us a clinical overview. Dr. Antonio Bianco 44:06-45:42 Yeah. I mean, I think that from a clinical point of view, that would essentially be the best alternative available. The physician will, obviously, it’s not going to be a primary care physician because they will have to refer these patients to the endocrinologist. I don’t think primary care physicians or family physicians will feel comfortable prescribing a combination of levothyroxine and liothyronine. So endocrinologists will be swamped with 1.5 million patients in this country that will be switching to synthetic combination of T4 and T3. Now, this is totally feasible, and I think it’s going to resolve most of the problems if that’s the route. However, two drugs requires two copayments in most cases, and it requires taking two tablets. And some patients, they say that they don’t do well with synthetic levothyroxine. So they just prefer the natural thing. They will tell you, my body does not accept the synthetic levothyroxine. Although I don’t see a scientific reason for that to be the case, the patients are adamant and they really feel the difference. So I’ve been wrong in the past, and I’d rather listen to what the patients are telling me and how they feel about it. And I would rather maintain them on the desiccated thyroid extract if that is the case. Terry 45:43-46:18 Well, we know that there are a lot of patients who would prefer that route as well. I don’t know if this has any relevance for how people might feel, but I know that some versions of levothyroxine– Synthroid, for example– does contain lactose as a filler. And if people were extremely lactose sensitive, it’s a small amount, so they’d have to be very extra lactose sensitive, that might be a problem for them. Dr. Antonio Bianco, thank you so much for talking with us on The People’s Pharmacy today. Dr. Antonio Bianco 46:18-46:21 That was my pleasure. Thank you very much for having me back. Terry 46:22-46:43 You’ve been listening to Dr. Antonio Bianco, 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. His book is “Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do.” Joe 46:44-47:05 We turn now to patient advocate Mary Shoman to get some perspective from people who rely on natural desiccated thyroid for their treatment. She’s the author of The Thyroid Diet and 10 other books and a Paloma Health Advisor. You can find her newsletter Sticking Out Our Necks: Hormonal Health News, on Substack. Terry 47:06-47:09 Welcome back to the People’s Pharmacy, Mary Shoman. Mary Shomon 47:10-47:12 Thank you so much. I’m so excited to be here. Joe 47:13-48:02 Mary, we’ve just had an opportunity to talk with Dr. Antonio Bianco, and he shares with us that many of his colleagues who he has talked to, endocrinologists, are concerned about the Food and Drug Administration’s decision to, in a sense, eliminate the DTE, the desiccated thyroid extract, which is kind of shocking, I think, to a lot of us. So both the endocrinology community and, I suspect, patients are kind of worried. What are you hearing from your colleagues, your patients, the people who have been following you for many years? Mary Shomon 48:03-50:04 I am hearing a lot of confusion. As Dr. Bianco has said, there just is not enough information and that there is no real clarity coming out of the FDA and the Department of Health and Human Services. So it feels a little bit like a roller coaster for patients and for their providers, because we are in a situation where we have probably at least a million or more thyroid patients who rely on natural desiccated thyroid or DTE in order to treat their hypothyroidism. Yet the FDA, which we thought was giving us till the end of the decade to get this NDT, DTE situation sorted out, has now narrowed the timeframe, declared this drug to be a biologic after a hundred and some years on the market and has basically left us wondering, are they going to pull it off the market with no approved alternatives for us, which would force patients either to go without medication or to take medication that for many of us, we have taken in the past and it has failed us. It has not worked for us to serve as a thyroid hormone replacement. So it’s confusion on the part of the patients, the doctors and practitioners that prescribed for these patients are confused because they don’t know what to do to protect their patients’ continuity of treatment. And then we get mixed messages coming out of the FDA. You’ve got some of them saying, oh, we’re getting rid of it. We hate it. Dr. Tidwell apparently just can’t stand this, and he has made it very clear. Then we’ve got Dr. Makary, and we have Robert F. Kennedy, the secretary, saying, ‘Oh, no, we’re going to save it. We’re going to keep it. We’re going to make sure it’s available.’ What’s the actual plan? Right now, we think it’s going off the market in about a year, and that’s what we know. And that is a frightening concept for most thyroid patients who rely on it. Terry 50:05-50:21 Mary, I would like to just have you clarify for people who are listening and might not be aware of the abbreviations that we’ve been using, NDT and DTE, they’re really the same thing. Would you explain what those abbreviations mean? Mary Shomon 50:21-51:18 Sure. NDT is the abbreviation for natural desiccated thyroid, and DTE is desiccated thyroid extract. They’re basically synonymous or equivalent, and they are referring to a form of thyroid hormone replacement that comes currently from porcine or pig thyroid glands that have been prepared and dried and created into a thyroid hormone replacement that contains both T4 and T3, the two primary thyroid hormones that are needed to replace missing thyroid hormone in the body. They are different from the prevailing or most popular thyroid drug, which is levothyroxine, which is a synthetic form of only the T4 hormone, whereas the NDT or DTE contains both T4 and T3, but it’s coming from natural sources rather than synthesized. Joe 51:19-51:33 And it’s my understanding, Mary, that if the FDA follows through on its plan, the natural or desiccated thyroid extract will disappear from the market August of 2026. Is that right? Mary Shomon 51:34-52:38 Well, this is at least what the official statements have said. But we have posts on X, formerly Twitter, that suggest otherwise, that, oh, we’re going to ensure that patients still have access to their medication. But that has not been formalized with any releases or official guidance or official policy decisions that have come out from the FDA. So that’s all basically just a promise on social media, but nothing more. Currently, I’m operating as if the policies that are issued by the FDA are the ones that are going to be honored, in which case we’re looking at NDT going off the market sometime next year, probably late summer, as you said. Unless someone miraculously is able to get through the very onerous and expensive and time-consuming process of a biologic license approval to get the NDT approved as a biologic drug, which is what they are requiring for this drug to be able to be sold on the market and prescribed by doctors in the United States. Terry 52:40-52:47 You’re listening to Mary Shoman, patient advocate and author of numerous books about thyroid disease. You can find her newsletter on Substack. Joe 52:47-52:54 After the break, we’ll learn more about Mary Shoman’s 30 years as a patient advocate and her experience with Hashimoto’s disease. Terry 52:54-53:01 Dr. Bianco said that people on levothyroxine alone don’t do as well as those on DTE in controlling their cholesterol. Joe 53:02-53:07 Why hasn’t the endocrinology community taken that discrepancy more seriously? Terry 53:07-53:12 We’ll find out what steps Mary Shoman is taking to advocate for all thyroid patients. Joe 53:12-53:16 What about importing DTE from Canada? Is that feasible? Terry 53:26-53:29 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 53:38-53:41 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 53:41-53:58 And I’m Terry Graedon. Joe 53:59-54:13 Many people who have done well on natural desiccated thyroid extract are worried that the FDA is planning to eliminate these products. Most have already tried synthetic levothyroxine with limited success. Terry 54:14-54:17 What will they do if the FDA’s ban goes into effect? Joe 54:18-54:34 Our guest is Mary Shoman. She’s a patient advocate and the author of “The Thyroid Diet” and 10 other books. Mary is a Paloma Health Advisor. You can find her newsletter, Sticking Out Our Necks: Hormonal Health News, on Substack. Terry 54:35-55:08 Mary Shomon, you are widely recognized as an advocate for people with thyroid problems, especially hypothyroidism. Part of that is because you yourself have had a long-term personal experience with Hashimoto’s disease, which leads, can lead to hypothyroidism. Would you recap for us briefly, please, some of the milestones of your 30-year journey with Hashimoto’s? Mary Shomon 55:09-58:04 Absolutely. When I was first diagnosed with hypothyroidism and Hashimoto’s, it was really not very well known to me. I was in the process of getting married. I was engaged. I kept going for dress fittings. And every time I went for a fitting, instead of taking the dress in, as they often do, because brides are always eager to lose weight, they had to keep letting my dress out, which was unusual because I had always had a normal metabolism. I was fairly slender, I felt great, and all of a sudden, my dress is getting let out and I’m tired and I’m feeling kind of blue and depressed, which is not the norm for a bride to be. So I went to my doctor and I told her what was going on. And luckily, I had a very good integrative physician who immediately decided to go ahead and check my thyroid. And it came back that I was slightly hypothyroid and had slightly elevated thyroid antibodies. And so she said, we’ll put you on some medication. And I thought, OK, great. This is going to solve the problem because I really didn’t know anything about thyroid disease. She put me on the meds and things didn’t get better. I kept gaining weight, I was more depressed, my hair started falling out, I was tired and brain fogged and all of the symptoms that are characteristically associated with hypothyroidism. And I eventually went back to her. We worked on this multiple times and really got to a place where we were able to start changing around, switching over. I started out by taking a T4, T3 combination drug that is not on the market at present called Thyrolar. That was a synthetic combo of the two hormones. Then we switched over to natural thyroid. And at that time I was taking Armour Thyroid and I started to feel better. I also started to learn more, which back in those days, this is the very earliest days of the internet, was an adventure. There was not a lot of attention paid to thyroid. And doctors often said, oh, it’s easy to diagnose, easy to treat. Just take one pill every day. Don’t worry about it. Well, I discovered after talking with other thyroid patients and connecting and forming community with them. Not the case. A lot of people still were struggling. And that was really the beginning of my journey into patient advocacy and writing books and articles and providing information and creating support groups and other components to really help empower thyroid patients to develop their own information, empowerment, and to seek out and work with the physicians who really understood hypothyroidism. So it’s been a 30-year journey, and I’m still on it and still working to advocate for myself and helping others stay well because that’s really the goal is we want to feel well, we want to live well. Joe 58:04-59:56 And you have done an extraordinary job educating not just patients, but also I think a lot of healthcare professionals. One of the things that Dr. Bianco shared with us just blew my mind, just to be honest with you. I was like, oh my goodness, that’s extraordinary. He looked at this gigantic database that he has, and apparently he and his colleagues have just published this data a couple of months back. And it showed that people who are on standard levothyroxine, Synthroid and other products, they don’t do as well as the, I think, endocrinology community thought they were doing in terms of things like mortality, in things like dementia. I mean, so, you know, the stuff that people really care about, these patients weren’t doing as well, even though their thyroid levels seem to be, quote unquote, in the normal range. And Dr. Bianco then compared the outcome of these patients over a long period of time with people who were on desiccated thyroid extract, natural thyroid. And those people did better. They did better than the people on synthetic thyroid in terms of longevity, in terms of brain fog, in terms of just cholesterol levels in the liver. And when I got done listening to him, I thought, wow, why hasn’t the endocrinology community recognized that there are long-term consequences in terms of general mortality rates and how people are feeling? And why hasn’t the FDA recognized what Dr. Bianco has discovered? Mary Shomon 59:58-01:03:02 It’s a good question. And I have to say, I have the most incredible respect for Dr. Bianco because he has been out there for decades, really thinking outside the box from the endocrinologist standpoint, because endocrinologists tend to be fairly hidebound. They stick with what they know. They’re slow to change. They’re slow to move into new ways of thinking. I mean, think about how it’s taken decades for the medical establishment to accept that blood sugar levels over 100 are problematic and that we need to watch those because people are on the way to potential type 2 diabetes. It used to be unless your blood sugar was over a certain level, you were fine. Now we know there are gradations on the way to blood sugar problems. And I think it’s the same thing for thyroid. We are just now starting to see the endocrinology community accept that there is a subset of patients who absolutely need the two hormones rather than just the T4 hormone. The understanding was always, oh, patients get T4, their body converts it to T3. Everything’s great. We’re copacetic. Now we do know that there are problems with genetic changes. There are incapacity to convert T4 into T3 that’s built in genetically in some people. And they’re just now starting to say, okay, well, that makes sense. It’s not just a patient preference issue. Well, they’re going to be moving slowly in this direction towards understanding that the T4-T3 combination therapy may in fact be better for the majority of patients. But that said, my philosophy for 30 years has been the best thyroid medication or best thyroid hormone replacement for you is the one that works best and safely for you. And having been in touch with thousands and thousands of patients over the years, I can tell you that there is a patient for every possible permutation and combination where that has been the best choice for them. For some, synthetic is perfect. For others, they need a particular brand of whatever drug they’re taking. Others do better on combinations. Some people need compounded mixtures. Some people like the T4 and T3. Others do well with T4. And we have a small subset that do better with just T3. So safest and best relief of symptoms for you is ultimately the best option for patients. And the key for me is making sure that the medical world makes those options available to us and doesn’t take away options that we may need, at least a subset of us, me included, because I’m a desiccated thyroid patient. I use desiccated thyroid for my hormone replacement. Don’t take away options that work for me and for other thyroid patients. Make sure we have options and let us know what the different pros and cons are of the different options. Terry 01:03:04-01:03:18 Mary, I wonder if you can tell us what you are doing as an activist to see if this action of the FDA, this proposed action, it can be counteracted. Mary Shomon 01:03:19-01:05:17 Well, I have been talking with several of the drug manufacturers, number one, because they are all obviously quite interested in trying to, in some cases, they’re applying for their BLAs, but the biologic license applications for their formulations of natural desiccated thyroid. But that is going to be a lengthy process. Some of them are already in progress, but it’s probably not going to come early enough if the FDA does in fact pull the medication off the market in a few months into the summer of 2026. But what we’re doing is I’m talking with the manufacturers, we’re talking with the patient organizations, other patient advocates, and we’ve got patients reaching out to their representatives, to the FDA itself, writing in, making complaints, talking about and sharing their stories. Because there are patients who have done every possible trial in the world on all of the different options, and natural desiccated thyroid is the only thing that has worked for them. And I’m an advisor with Paloma Health, which is a large medical practice that focuses on hypothyroidism, and our team of doctors have also been reaching out to explain situations, obviously without violating patient confidentiality, but saying, look, I have patients that will not survive if you take natural desiccated thyroid off the market because we’ve tried them on synthetics. We’ve tried them on every option and it doesn’t work for them. So I need this as an available option for some of my patients that rely on it for their very survival. Because for those of us who are hypothyroid, thyroid medication is not an option. We have to have it in order to function for our body to function, all of our organs, tissues, glands, and cells. Terry 01:05:17-01:05:39 Mary, I wonder if you could tell us a story about one or two of those people who are going to be just completely in terrible trouble if the FDA completes its action as proposed and the companies don’t yet have their biologic license in place. Mary Shomon 01:05:40-01:07:32 Absolutely. I’m thinking of one patient that I know who’s also a friend of mine, and she’s in her early 70s. She’s a widow, and she has tried every possible thyroid medication. She got no response taking synthetics. The doctors haven’t really ever figured out why her body would not absorb them. We’re not sure if it was a malabsorption or ingredient allergy or sensitivity. But once she started taking natural thyroid, which was more than 10 years ago, she was able to get her thyroid levels under control. The blood tests showed that the thyroid hormone was getting into her system, which it had not been doing on the Synthroid. It helped relieve depression, fatigue, exhaustion, brain fog, muscle pain, and weakness. And she basically said to me, if they take my natural thyroid away, I think I’m just going to let myself die. She’s that depressed about the concept of having her medication taken away. And I don’t blame her because it took her a long time. She went probably a decade or more trying to find something that worked and was dragging herself along, trying to function on a daily basis, barely. Once she got the natural thyroid, it felt like her life had come back. And she’s like, don’t take my life away from me again. So she’s one of the people I know who has been most active. I think she has called every member of Congress, every one of her representatives multiple times. She’s talked with them multiple times. She has sent letters to everyone at the FDA. She is a one-woman advocacy campaign unto herself because it’s so important to her. It is her life. And so I think she’s a good example of how passionate patients can be when we know that this is something we rely on. We cannot function without it. Joe 01:07:33-01:08:09 Mary, I wonder if you would be kind enough to just run through some of the very confusing numbers that people need to know about when it comes to assessing their thyroid function, because a lot of times they get a lab report. It’s confusing to them. Their doctor may not explain it. So what would you consider, based on all of your research and experience, normal or achievable goals for people who are using a natural thyroid, desiccated thyroid extract so that they feel well? Mary Shomon 01:08:10-01:11:32 Well, typically, we want to look at, I think, four numbers. Most of the physicians that I have worked with over the last 35 years that are really knowledgeable about thyroid will focus in on four particular parameters. They’re going to look at the TSH, which is thyroid stimulating hormone. This is a brain hormone, not a thyroid hormone, but it is a messenger to the thyroid gland telling it to make more or less hormone. We’re going to look really carefully at the free T4 and the free T3. That’s free thyroxine and free triiodothyronine. And there we’re looking at the actual available circulating amounts of thyroid hormone going through the bloodstream. And in many cases, because Hashimoto’s autoimmune thyroiditis is the primary cause of hypothyroidism in the United States, we’re going to look at Hashimoto’s antibodies or thyroid peroxidase antibody levels. And so that set of four tests is really the basics. And for most people that are dealing with autoimmune Hashimoto’s or hypothyroidism, that’s going to cover most of the bases. We’re looking for a TSH that is going to be in the reference range. And the reference range, depending on the lab, typically runs from about 0.3 to 4 or 4.5, but with the understanding that the majority of the population is not walking around with a TSH at the high end of that range. Most people feel best when it’s under 2.5 or under 2. The free T4 and the free T3, those are usually, we want to see those levels in the middle point or maybe a little bit higher of the reference range. But the free T4 can sometimes be a little bit lower in some people, the free T3 a little bit higher when they’re taking a natural desiccated thyroid because it does contain some extra T3 in it. So that helps to bump those T3 levels up a little bit. And then the thyroid peroxidase antibodies or TPO antibodies, we typically are looking for those ideally to be in the reference range, which means there’s no active autoimmune disease, or if they’re elevated, we want to be watching them so that any dietary medication, thyroid treatment, lifestyle changes are bringing them down slowly and to a lower level. I think the cutoff, it depends on the lab, but cutoff is like 32, 35. Anything above that is considered active evidence of thyroid antibodies. But as they creep up towards that cutoff point, that can sometimes be the indications that autoimmune activity is already starting to take place. So there’s this concept of the reference range or the normal range, but what most of the really savvy practitioners are using is what they consider the optimal range. So that would be the lower end of the reference range for TSH and the midpoint to the upper end of the range for the free T4 and free T3. And again, with antibodies, getting them down as low as possible. Joe 01:11:32-01:11:41 And what would those free T3, free T4 levels be in general to be on the optimal side? Mary Shomon 01:11:42-01:13:03 Well, it depends on the lab that you go to, but let’s see. I believe that free T4, if I’m remembering correctly, runs about 0.8 to like 2.2 at many range. That’s many labs have a range of that. And we’d like to see that like at about the midpoint there. But typically with people taking natural desiccated thyroid, you would see levels maybe in the 1.2, 1.3 level. And with the free T3 levels, typically there we, I believe they run from like 2.2 to 4.3, give or take, depending on the lab. And there, a lot of people are walking around with 2.4, 2.5. They’re at the very low end of the range and they don’t feel well. The people that feel the best tend to be 3.2, 3.3, 3.4, up in the upper half of the reference range, up to maybe about the 75th percentile. Too high of free T3, and you can start to feel like you’ve had too many espressos, and you can get jittery, you can feel nervous, your heart rate can go up, which is a sign that maybe there’s too much T3 on board. So we want people to be at a place where their T3 is good, but not that they’re getting over-medicated to a point where they’re feeling overstimulated. Joe 01:13:04-01:13:14 And just to remind people, what are some of the most common symptoms of hypothyroidism, the people that you serve most frequently? Mary Shomon 01:13:15-01:15:28 The most common symptoms are fatigue. And when we say fatigue, we’re not talking about, oh, I’ve had a busy day. I’m a little bit tired. We’re talking about having to go sleep in your car for 30 minutes at lunchtime to get through the rest of the day or having to have a nap when you come home because you can’t get up to make dinner. Uh, we’re talking about people that sleep 15 hours on the Saturdays, uh, mornings in order to get back to some level of energy after a busy week. This is bone numbing fatigue for many people. Uh, we also see brain fog, cognitive changes, difficulty remembering things, wondering, oh my gosh, do I have Alzheimer? Why am I having so much trouble remembering a particular word or a particular thing? People often see some weight gain, especially if there’s no change to diet and exercise like I did when I was first diagnosed. Just no change, but all of a sudden gaining weight. People will also have dry skin. They can lose hair. They can often lose, one of the most characteristic signs is the outer edge of the eyebrows will disappear, and they’ll have to be penciling it in. I always say to women, if you’re penciling in your eyebrows, I want you to get your thyroid checked. Dry skin, constipation, feeling depressed, sometimes anxiety. People can have a lot of, their nails can break. Their nails become brittle, dry. They don’t grow, they break. And this is just the tip of the iceberg. There are dozens and dozens of other signs and symptoms. For younger women, we can see fertility issues, menstrual changes. For women going into perimenopause, we can see issues with worsening perimenopausal symptoms. There’s a whole range of different types of symptoms. For men, we can see low libido and women too, but low libido is often a complaint in men along with hair loss. So there’s a whole range. It’s essentially anything that slows down your thinking, your processing, your organs, tissues, glands, and cells can be a symptom of hypothyroidism because [the thyroid hormone] is helping to provide energy to all of those components of your physiology. Joe 01:15:28-01:15:49 I’m wondering, Mary, if people will be able to access natural thyroid from Canada once the ban goes into effect. A lot of people do buy their medications from Canada online, and the FDA hasn’t prevented that. But in this case, what are you hearing? Mary Shomon 01:15:51-01:18:23 Well, what I’m hearing is that there is a lot of confusion about it, but that because in the past, it was that the Canadian drugs were allowed to come in, the Canadian natural thyroid was allowed to be imported for personal use. I believe that is the language that the cross-border medication issue was you can’t bring in giant volumes and truckloads of it, but you can bring in enough for your personal use and you can get it in Canada with a prescription. But now that it is going to be designated as a biologic, unapproved, non-approved natural desiccated thyroid will technically be illegal. And so I’ve heard that there may be a crackdown on trying to import Canadian or potentially natural thyroid from other countries that might potentially try to fill the gap. So it’s really up in the air. And that’s part of the big problem with this entire issue is what are they going to do? Are they going to enforce it in 2026? Are they going to let it slide? Are they going to keep us from importing meds from outside or from Canada? Or are they going to crack down and say, no, nope, or maybe say, yeah, we’ll let you do it until things change. It’s really a question mark. And the question mark also goes into the motivations of the government, because we know that we have a new HHS secretary that’s focused on more natural approaches to things, a little bit of a battle with the drug companies to some extent that we’re seeing between the FDA and the HHS and the pharma industry. And so I’ve heard some patients say, I don’t understand this. I thought they would like a natural, inexpensive drug that seems to work pretty well for us for over 100 years. Now they’re putting it in for this biologic status. And frankly, that’s one of the other concerns I have is how much is it going to cost? Because biologic drugs in general are extremely expensive. These are the ones we see advertised on TV all the time. The Humira and Stellara and all these drugs that sometimes can cost thousands of dollars a month. How much is natural desiccated thyroid, which most of us can get for $30, $40, $50 a month, how much is it going to cost once it’s gone through this big approval and becomes a biologic drug? Who knows? It could be many times the price that we’re paying now, or potentially it may be priced out to a point where it’s unaffordable for most people. Joe 1:18:23-1:18:23 Right. Terry 01:18:24-01:18:32 Mary Shoman, thank you so much for talking with us on The People’s Pharmacy today and for leading the charge. Mary Shomon 01:18:32-01:18:40 Thank you so much and appreciate getting the word out because patients need to be informed in order to feel well and live well. Terry 01:18:41-01:18:56 You’ve been listening to patient advocate Mary Shoman. She’s the author of “The Thyroid Diet” and 10 other books. She’s also a Paloma Health Advisor. You can find her newsletter: Sticking Out Our Necks: Hormonal Health News on Substack. Joe 01:18:56-01:19:16 We spoke earlier with Dr. Antonio Bianco, Senior Vice President of Health Affairs and Dean of the John Sealy School of Medicine at the University of Texas Medical Branch at Galveston. He’s the author of “Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do.” Terry 01:19:16-01:19:25 Lyn Siegel produced today’s show, Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 01:19:26-01:19:33 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Terry 01:19:33-01:19:51 Today’s show is number 1,452. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You could also reach us through email, radio at peoplespharmacy.com. Joe 01:19:52-01:20:09 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. The podcast this week has additional information we couldn’t squeeze into the broadcast with updates on Dr. Bianco’s latest research showing that people on natural thyroid live longer. Terry 01:20:10-01:20:33 At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also get regular access to information about our weekly podcast. We’d be grateful if you would consider writing a review of The People’s Pharmacy and posting it to the podcast platform you use. Joe 01:20:34-01:20:36 In Durham, North Carolina, I’m Joe Graedon. Terry 01:20:36-01:21:12 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:21:12-01:21:22 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:21:22-01:21:27 All you have to do is go to peoplespharmacy.com/donate . Joe 01:21:27-01:21:40 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Nov 7

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. They may also slow the rate of cognitive decline somewhat. But they may not make a substantial difference in problems patients and their families care most about–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 You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, Nov. 8, 2025, through your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 10, 2025. 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 whole brain shrinkage, although they seem to spare the hippocampus, known as the memory center. 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, using a nontoxic formulation? That remains to be tested in a randomized clinical trial. Dr. Doraiswamy emphasizes that no one should be taking lithium, even at low doses, outside the context of a controlled study. Don’t try this at home. 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. However, results from a trial of an antiviral medication were presented at a recent conference. Unfortunately, the medicine was not effective in preventing AD. Consequently, this strategy may not be as promising as we would like. People who get multiple vaccinations against the flu get a measure of protection from dementia, however ( Age and Ageing , July 1, 2025 ). Another natural experiment in East and West Germany demonstrated that the BCG vaccine against tuberculosis unexpectedly led to “lower incidence of lymphomas and acute lymphoblastic leukemia in cohorts immunized by BCG compared to those non-immunized by this vaccine” ( Frontiers in Pediatrics , July 31, 2025 ). There is also tantalizing evidence that people treated with BCG for bladder cancer are less likely to develop AD ( PLoS One , Nov. 7, 2019 ). 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 specific components of diet. They did not have much evidence that what we eat affects our risk for cognitive decline. There have been only a few large randomized clinical trials of diet. A recent trial of the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay [MIND] diet) was disappointing. So far, none has lasted long enough to tell whether dietary changes in midlife might help prevent dementia. That said, Dr. Doraiswamy suggests that the Mediterranean diet has some supporting evidence. After all, what is good for the heart is also good for the brain. Physical Activity and the Risk of Dementia: There is some evidence 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. These results are from observational studies, however. Randomized clinical trials of movement to reduce the chance of dementia have not found benefits for memory. Executive function may improve, though. Dr. Doraiswamy cautions, in addition, 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, MBBS, FRCP, is Professor of Psychiatry and Behavioral Sciences. He is Director of the Neurocognitive Disorders Program in the Department of Psychiatry and a Professor in Medicine at Duke University Medical School. He is a faculty network member of the Duke Institute for Brain Sciences. P. Murali Doraiswamy, MBBS, FRCP, Duke University Listen to the Podcast: The podcast of this program will be available Monday, Nov. 10, 2025, after broadcast on Nov. 8. You can stream the show from this site and download the podcast for free. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1451: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. The CDC says nearly 7 million people in the U.S. currently have Alzheimer’s disease. How can we prevent it? This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:44 Medications the FDA approved in the last few years have been disappointing. They are pricey, risky, and not very effective against Alzheimer’s disease. Joe 00:45-00:52 What else can we do to lower our chances of developing dementia? How could low-dose lithium be helpful? Terry 00:53-01:02 Could a vaccine against shingles help delay cognitive decline? What about diet and exercise? How many steps do we need every day to keep our brains healthy? Joe 01:03-01:10 Coming up on The People’s Pharmacy, Rethinking dementia: Is what we believe all wrong? Terry 01:14-02:42 In The People’s Pharmacy health headlines, scientists have long suspected that physical activity might help reduce the risk for dementia. Now they have proof, and it doesn’t take that much effort. A study published in Nature Medicine followed nearly 300 older Americans for almost 14 years. None of them had measurable cognitive problems at the start of the study. They wore pedometers to measure the number of steps they took. All the participants took tests to assess their problem-solving skills and memory at several points during the study. The researchers also scanned their brains to evaluate their levels of amyloid and tau. Over the course of the study, people who took at least 5,000 steps a day were significantly less likely than sedentary seniors to develop Alzheimer’s disease. People with relatively high levels of amyloid at the outset benefited most, but not because amyloid levels changed. Instead, more active people had significantly less tau accumulation, accounting for the benefits seen. Aiming for 5,000 to 7,500 steps daily is something most older people can manage to reduce their chance of cognitive and functional decline. According to the researchers, that level of activity slowed cognitive decline by the equivalent of seven years. Joe 02:43-03:33 Exercise may also be beneficial for people with knee osteoarthritis. According to the CDC, over 30 million Americans have some degree of pain, stiffness, and swelling in their joints. Nearly half have some discomfort in their knees. A systematic review in the BMJ analyzed over 200 studies and concluded that in patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life with moderate certainty. The authors go on to specify that patients should engage regularly in structured aerobic activities such as walking, cycling, or swimming to optimize symptom management. Terry 03:34-04:23 Many people take melatonin as a supplement to help them sleep. This hormone, which is available without a prescription, has been widely seen as innocuous, even if it doesn’t ward off insomnia. Now researchers are taking a new look at the supplement. An analysis of health records from several different countries identified some 65,000 people taking melatonin for at least a year. In a span of five years, 3,000 melatonin users were diagnosed with heart failure. That comes to about 4.6%, compared to 2.7% of non-users. The findings have been presented at the American Heart Association scientific sessions and have not been published in a peer-reviewed journal. Joe 04:24-05:09 Treating diabetes with a GLP-1 agonist seems to protect the heart. Previous research has found benefit with the use of injectable semaglutide sold under the brand names Ozempic and Wegovy. A new study demonstrates that the same semaglutide in pill form sold under the brand name Rybelsus also prevents cardiovascular complications. A sub-analysis of the SELECT trial found that the benefits of semaglutide do not depend upon weight loss. Even people who did not lose significant weight had lower risks of heart attacks and strokes. A decrease in weight size, however, was associated with the protective cardiovascular effect. Terry 05:10-06:17 Researchers have been considering how to keep people with prediabetes from developing the full-blown metabolic disorder. In a new study published in JAMA, investigators assigned over 300 participants to either an artificial intelligence-powered diabetes prevention program or a human-coach-led similar prevention program. The AI-powered invention involved a mobile app and a Bluetooth-powered digital scale. The goal was to get the volunteers to HbA1c below 6.5%. Roughly 32% of the participants in each group achieved the goal. The researchers concluded no significant difference between the two programs. And that’s the health news from the People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:31 And I’m Joe Graedon. As America ages, people worry about their health. Of course, they think of heart disease and cancer, the two biggest killers, but many people are even more afraid of dementia. Terry 06:31-06:54 Today, we’re discussing how we can treat or possibly even prevent memory loss. What should we know about the drugs that FDA has recently approved to clear amyloid plaque out of our brains? Are there non-drug approaches that might reduce our risk for dementia in the first place? Is what we believed about Alzheimer’s wrong? Joe 06:54-07:23 Our guest today is an outstanding researcher in the field of cognitive decline. Dr. Murali Doraiswamy is professor of psychiatry and behavioral sciences. He’s the director of the Neurocognitive Disorders Program and a professor in medicine at Duke University Medical School. He’s a 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. Terry 07:24-07:28 Welcome back to The People’s Pharmacy, Dr. Murali Doraiswamy. Dr. Murali Doraiswamy 07:29-07:30 Thank you. Pleasure to be here always. Joe 07:31-08:01 Dr. Doraiswamy, I have to tell you, you are a specialist in the brain, especially neurocognitive disorders, whatever that means. But basically, you’re trying to figure out, A, what causes dementia and then what to do about it. But before we get into that really important subject, I would love to get your sense of how serious is this problem? It seems like America is getting older fast. Dr. Murali Doraiswamy 08:01-08:02 Absolutely. Joe 08:02-08:04 What does that mean for society? Dr. Murali Doraiswamy 08:05-08:57 Well, it’s not good news. As we get older, the risk for dementia disproportionately increases, so there’s fears of what we call a silver tsunami. So the original projections were that the number of cases of dementia, which is somewhere around 6 to 7 million today, might triple over the next 20, 25 years. But there’s a sliver of good news. We recently pointed out that there was an error in the projections. With consecutive birth cohorts, we’re getting healthier. Our cardiovascular risks are declining. Some of our risks for Alzheimer’s are also declining, but new risks may be emerging, such as obesity, diabetes, etc. But we believe the rate of increase over the next 20, 25 years is not going to be as high as feared, but it’s still going to go up. So we have to be very, very vigilant and invest in research. Terry 08:57-09:05 So it goes up in part just because there are so many more older people as the baby boomer moves into its 80s. Dr. Murali Doraiswamy 09:05-09:06 Correct. Terry 09:05-09:08 And later, even more. Dr. Murali Doraiswamy 09:08-09:09 Correct. Terry 09:09-09:16 But we baby boomers are not quite as likely as our parents or our grandparents were to develop dementia. Dr. Murali Doraiswamy 09:17-09:28 Absolutely. I think the risk for those born, like, say, in the 1920s or 30s was far higher than the risk for those born, say, 10, 20 years later for a variety of reasons. Joe 09:29-09:47 Now, Dr. Doraiswamy, the drug companies have seen a pot of gold. I mean, when you talk about 7, 10, 15 million Americans with this devastating condition called dementia, they go, well, let’s get some new drugs out there. Terry 09:48-09:49 We’re all for that, right? Joe 09:50-09:51 Absolutely. Dr. Murali Doraiswamy 09:51-09:52 100% We need it. Joe 09:51-10:09 We’re desperate, desperate for something that really, really works. They’ve been all in on amyloid: amyloid being the cause, and if we could just get amyloid out of the brain, problem solved. It hasn’t worked that way, has it? Dr. Murali Doraiswamy 10:09-10:31 It hasn’t, unfortunately. Probably about 30 to 40 failed trials. And for the first time, we have two drugs that were efficacious in clinical trials, but the degree of benefit is extremely small, and they come with a lot of risks. So we still haven’t achieved drugs that are highly efficacious and safe. Terry 10:31-10:38 So let’s talk a little bit more about these medications. They are effective at removing amyloid plaque from the brain, correct? Dr. Murali Doraiswamy 10:38-10:55 Correct. Very effective. Almost 70, 80, 90% clearance to the point where some people’s brains are free of amyloid. Technically, if you base it on the definition that you have to have amyloid to have Alzheimer’s, they would have essentially have been cured of Alzheimer’s pathologically, but nothing has improved in their cognition. Terry 10:56-11:00 So their brains are beautiful, but they’re still demented. Dr. Murali Doraiswamy 11:00-11:00 Correct. Terry 11:01-11:08 They still can’t do the things that ordinary people can and want to do. Dr. Murali Doraiswamy 11:08-11:35 Absolutely. So there are two ways of interpreting this. The skeptic would say this flatly disproves the amyloid hypothesis because if you cannot show that removing amyloid produces an improvement in cognition or slows the degeneration of the brain or slows the deterioration of cognition, then the hypothesis is wrong. But those who support the hypothesis say, oh, we’re giving these drugs too late. Had we given the drugs a lot earlier before the brain had been damaged, we might have seen a greater benefit. Terry 11:37-11:43 Now, there was a trial, wasn’t there, in which they gave, which one? Donanemab? Lecanemab? Joe 11:44-11:55 Well, it was one of the MABs, and they said, even before people really have symptoms, they’re just at potential risk, we’re going to start giving the drug early, early. Terry 11:56-11:57 And it was a big disappointment. Dr. Murali Doraiswamy 11:58-11:59 Yes, it was. Joe 12:00-12:14 So at the moment, let’s just say that the amyloid hypothesis hasn’t panned out the way we would have hoped if these drugs worked. What about side effects? Because the FDA has now issued some new cautions. Dr. Murali Doraiswamy 12:16-13:25 So the amyloid drugs have some very serious side effects. For the vast majority of people, fortunately, our tolerance levels are high. So they may just have infusion reactions. These drugs are given by infusion. We just reported a case that’s coming out this week on somebody who had severe urinary incontinence, almost permanent urinary incontinence as a result of one of these infusions. The most serious side effects are fortunately somewhat rare, even though we don’t know the exact rate at which they occur. The two most serious side effects are bleeding in the brain. They either take the form of what we call macrohemorrhages, means overt strokes, leading to serious clinical symptoms, or microhemorrhages, meaning small ditzels in the brain, which are areas of like ruptured blood vessels. We don’t exactly know what the consequences are. They may have cognitive symptoms, but in many of these people, they’re silent because we’re not testing them serially. And then the second type of side effect is called edema or swelling of the brain. And there have been several deaths. The FDA recently tightened the warnings because of six deaths. Terry 13:25-13:27 How did they tighten the warnings? Dr. Murali Doraiswamy 13:27-14:07 They require more frequent MRI scans to monitor the brain and at earlier time points to see if someone’s having these areas of small bleeding or edema. And if you spot those, then you’re supposed to either lower the dose, stop the dose temporarily till the person gets better. But the reality is we don’t know what to do. We don’t know when a bleed has totally gone away because the MRI only picks up like really, it’s a very crude indicator of if the brain has fully recovered from a bleed. And in many of these cases, probably the prudent thing to do is to stop their infusions and not treat them. We don’t have a good way of also predicting who is going to get it. That’s the other thing we’re shooting in the dark. Joe 14:07-14:27 These are pricey drugs. They cost twenty-some-thousand dollars, but the scans are also expensive. So these PET scans, which have to be done before you start treatment, and now the FDA is saying during treatment just to make sure something bad isn’t happening, the costs start to really add up. Dr. Murali Doraiswamy 14:27-14:44 Well, the costs definitely add up. Just to clarify, yes, the PET scans only need to be done before treatment to ensure that they have plaque buildup in the brain. The monitoring for bleeding is done using regular MRI scans. They’re not done using PET scans. Joe 14:44-14:45 But MRIs are not cheap. Dr. Murali Doraiswamy 14:45-14:51 They’re not cheap, and the average person has to have four, five, six MRI scans. That adds up quite dramatically. Joe 14:52-15:17 So let’s switch gears for a moment because clearly the anti-amyloid drugs have not been a revolution, and they do have side effects. There have been some new studies that are quite fascinating. And I know that you have been looking at lithium, not just for a few weeks or months or years, but going way back. Tell us what is lithium and why are you paying attention to this mineral? Dr. Murali Doraiswamy 15:18-16:40 Yeah. So, you know, lithium is absolutely fascinating. And, you know, America’s fascination with lithium goes back almost 80, 90 years, I think. So lithium, you know, for people who don’t know, is a metal, and it’s a very soft metal, like cheese that can be cut. It’s found in almost every body tissue. It’s found in rocks. It’s found in lots of water sources. Many of us are consuming large amounts of lithium without even knowing it. In fact, I just read an article that in Chile, South America, which is a very rich source of lithium batteries, everyone’s fighting for lithium batteries from there. The average person gets almost five or six times more lithium than, say, the average American. Almost at sub-therapeutic medical doses, that’s what that person in Chile is getting. So fascination with lithium started around 1940s when it was discovered that lithium can calm the brain and can be a useful treatment for people with manic depression, especially people who are very euphoric, very agitated, are hallucinating. It can calm them down. It was completely accidental discovery. And then America went crazy for lithium, and they started putting it in every soft drink imaginable. That’s how 7-Up came about, because one of the isotopes of lithium exists. 7-Lithium is the molecular isotope, and so 7-Up is lithiated lime soda. Joe 16:40-16:41 But no more. Dr. Murali Doraiswamy 16:42-16:57 No more. Well, yes, more, because every water contains lithium. So, yes, it just has very small amounts, but not the slightly bigger amounts that it used to contain. Coca-Cola used to have, there was a version of Coke that had lithium, and doctors used to prescribe it for all kinds of conditions. Joe 16:57-17:01 So, Coca-Cola had cocaine and lithium? Dr. Murali Doraiswamy 17:01-17:13 Well, okay, I don’t know about the, let’s skip the cocaine part. There was a version of cola with lithium marketed by that company. It was not called Coca-Cola, but it was a lithiated cola. Joe 17:15-17:32 So we’ve had a lot of experience. We just have about 30 seconds before we go to the break. There certainly is a lot of data to suggest that very high doses can be extremely helpful for people with manic depression, or what we now call bipolar disorder. Terry 17:32-17:33 But also toxic. Joe 17:34-17:55 Lots of side effects. And you can tell us more about those in a moment. Kidneys can be affected, a number of other organs. But low-dose lithium, that’s where all the excitement is right now. And when we come back from the break, let’s talk about the newest research. I think it was published in Nature, is that right? Dr. Murali Doraiswamy 17:55-17:56 Correct. Joe 17:56-18:00 Looking very promising, at least in an animal model. Terry 18:01-18:11 You’re listening to Dr. Murali Doraiswamy, Professor of Psychiatry and Director of the Neurocognitive Disorders Program at Duke University School of Medicine. Joe 18:11-18:19 After the break, we’ll learn more about lithium and its application against dementia. What are low doses of lithium compared to standard doses? Terry 18:20-18:24 We’ve just alluded to a study published in Nature. Why are people so excited about it? Joe 18:25-18:33 Is it a good idea for people to start taking low-dose lithium as a supplement, or do we need to wait for more definitive studies? Terry 18:39-18:55 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon. Joe 18:55-19:12 And I’m Joe Graedon. Terry 19:12-19:27 Today, our topic is dementia. How can you reduce your risk of losing your memory? What can we do to keep our brains as healthy as possible as we age? Are there supplements that could be helpful or perhaps dietary choices? Joe 19:28-20:00 To learn more about preventing and treating Alzheimer’s disease and other dementias, we’re talking with Dr. Murali Doraiswamy. He’s professor of psychiatry and behavioral sciences. He’s director of the Neurocognitive Disorders Program and is a professor in medicine at Duke University School of Medicine. He’s a 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. Terry 20:01-20:13 Dr. Doraiswamy, we were just discussing lithium, and I’m hoping that you’ll be able to tell us about low-dose lithium and why it might be of interest against dementia. Dr. Murali Doraiswamy 20:14-20:44 Low-dose lithium has been of great interest to researchers because observational studies, what we call as epidemiological studies, have shown that people who live around certain water sources that contain naturally high levels of lithium have reduced rates of suicide, reduced rates of drug abuse, and even potentially reduced rates of dementia. So these suggest that it might have therapeutic effects at sub-threshold doses, not the high doses we use to treat bipolar depression. Joe 20:44-20:55 And let’s get some sense because as a psychiatrist, you are prescribing big doses. What do we mean when we say big for people who have bipolar disorder? Dr. Murali Doraiswamy 20:56-21:29 So, lihtium as lithium carbonate is usually given two or three times a day. So, we might give somebody 900 milligrams, 1,200 milligrams a day. So, a lower dose may be something a fifth of that or even lower. One of the problems has been that these forms of lithium that we use to treat psychiatric illness don’t get into the body and the brain. They’re not as bioabsorbable. So we needed different formulations of lithium that are more easily absorbed at lower doses so that they also don’t produce the same side effects. Joe 21:29-21:36 So tell us about this study in Nature and why people have gotten very excited. Dr. Murali Doraiswamy 21:36-22:43 So we’ve known about the links between metals in the brain and dementia for a long time, right? We originally thought it came from pots and pans. And then in the 90s, there were links between iron, copper, zinc, and Alzheimer’s disease. But more recently, there’s been a lot of excitement about lithium being an essential nutrient in the brain. And these researchers, it was a tour de force, their paper in Nature. They first showed that deficiency of lithium resulted in buildup of Alzheimer type pathology. The second thing they showed was that replacing or correcting that deficiency with a special form of lithium that is available over the counter that can be given in low doses that is easily bio-absorbable reversed some of those deficits. And which form is that? It’s called lithium orotate. And this is available over the counter. It’s, you know, you can give it at maybe like a fifth or a fifth of the dose that you would give and it’s, anyone can buy it, but it’s not recommended, of course, for manic depression. Joe 22:43-22:56 Right. But the side effects presumably would be much lower if you’re only taking, you know, two or three milligrams or five or 10 milligrams compared to 800 milligrams or in some cases even 1800 milligrams. Dr. Murali Doraiswamy 22:56-23:31 Correct. Now, of course, where you’re talking about the dose of elemental lithium, which has to be, which is what you’re talking about, when you eventually combine it as a salt, the dose becomes much higher, even for lithium orotated can be 100 milligrams, for example. So yes, the presumption and the hope is that the side effects are much lower and the tolerability is much greater because you want to treat someone with, say, at risk for dementia, you could be treating them for 10 years, 15 years. So you want a drug that’s really safe for an older person to take. Joe 23:31-23:33 Now, we need clinical trials. Dr. Murali Doraiswamy 23:33-23:33 Correct. Joe 23:34-23:39 Nobody can patent lithium. It’s out there. Who’s going to do the study? Dr. Murali Doraiswamy 23:39-24:10 There are actually companies that have come up with proprietary formulations of synthetic lithium that’s combined with other ingredients. So you can patent those versions. And, of course, if they do the study and the study is successful, somebody may say, well, why not just take the cheap version that’s available for pennies? But so the short answer is, yes, there are studies being done. There’s at least one company I know that has a proprietary formulation. And then government agencies can always fund studies of the generic version of lithium, which I hope that they do. Joe 24:10-24:11 That would be wonderful. Terry 24:11-24:20 It seems that it might be very tempting for people to start taking low-dose lithium on their own, but it sounds as though that might be premature. Dr. Murali Doraiswamy 24:21-24:33 I think it’s completely premature because we have more than 200 drugs to cure Alzheimer’s in mice, but none of them have worked so far, including the amyloid antibodies that are currently on the market. Joe 24:33-24:37 Let’s talk about another area that’s fascinating: vaccines. Terry 24:38-25:03 Well, we have seen a couple of studies now that demonstrate that specifically the shingles vaccine, and it wasn’t the newest shingles vaccine, the Shingrix, but rather the previous iteration, Zostavax, that quite significantly lowered the risk of people coming down with dementia. Can you tell us about that, please? Dr. Murali Doraiswamy 25:03-26:41 Yeah, it’s a very plausible study, and I’m very excited about it. I truly believe that there is an infectious particle that probably underlies dementia, especially Alzheimer’s disease. We know, for example, syphilis can cause a type of dementia. We know HIV, the AIDS virus, can cause a type of dementia. We know herpes encephalitis, which is a type of herpes virus that goes and attacks the memory centers in the brain. So it’s completely plausible that herpes zoster virus may be involved in Alzheimer’s. So this study that was done in the United Kingdom and one in Taiwan, both of which are quite convincing, again, amazing studies. They looked at a whole bunch of different explanations as to why someone getting the Shingrix vaccine had a lower risk for dementia. And they ruled out many of the spurious epiphenomenon type of causes. They were able to show that these people had a lower risk than those who had gotten a previous version of the vaccine, which was not the same, and also people who were unvaccinated. And they showed that they were not due to other explanations, such as simply getting better health care or leading healthier lives. So, I think it’s plausible. It still has to be demonstrated in a randomized controlled trial, but that’s going to prove very difficult because how do you stop someone in a placebo arm for three or four years from not getting a zoster vaccine? It’s possible, but I’m hoping that someone will do such a trial. Joe 26:41-27:20 Now, it’s not just Zoster, as you refer to it. We’re talking here about the virus that causes chicken pox and shingles. But there are some studies that suggest that BCG, which is a really old vaccine, probably one of the very first vaccines ever developed, might be beneficial as well. And there’s just something new that’s come out with RSV vaccine. So give us this sense of infections and dementia and vaccines. It seems like a whole new way of thinking about Alzheimer’s disease and dementia. Dr. Murali Doraiswamy 27:20-29:01 It is. If you look at the pathology in the Alzheimer’s brain, there are two types of pathology, the plaques and tangles. And both seem to propagate in the brain as though they were like infectious particles. The only thing different about Alzheimer’s, unlike, say, tuberculosis, You don’t catch it by standing next to someone and breathing the air that they are breathing or, you know, by having sex with that individual. You don’t catch it. It’s transmitted and propagates internally. We know that brain-specific viruses can hide in nerve cell ganglions for long periods of time and then suddenly get reactivated. We’ve known that about mad cow disease, for example. So could Alzheimer’s be caused by a slow-growing virus like that? It’s entirely possible. Last month at a conference, they just presented the results of a drug against herpes simplex virus, valacyclovir, and that study was negative. It was a randomized trial. There was similar evidence suggesting that people who took valacyclovir may have a lower risk, but in the randomized trial, it did not prove effective. Now, the BCG for bladder cancer, now BCG is used against tuberculosis traditionally, but in this case, it’s infused locally into the bladder to stimulate the immune system to attack cancer cells. And they found that people with bladder cancer who had received BCG had a much lower risk of developing dementia. So again, this is all very promising approaches. I’m hopeful that we can develop a vaccine to stimulate innate immunity to fight a viral etiology. We’re not there yet, but I think that’s where the cure is going to come from. Joe 29:02-29:03 Terry, let’s talk about diet. Terry 29:04-29:05 Well, let’s do it. Dr. Murali Doraiswamy 29:04-29:26 By the way, there is also a rich body of work suggesting that amyloid builds up in the brain and it’s antiviral and antibacterial, that it’s there not so much as the cause of the disease, but as a defense mechanism in the brain. That somehow this defense mechanism goes awry and overreacts and causes a friendly fire. Joe 29:26-29:30 So trying to get rid of amyloid in the long run. Dr. Murali Doraiswamy 29:30-29:31 Might be friendly fire. Joe 29:32-29:37 Right. It might be a mistake. So we’ve been hearing about the Mediterranean diet. Terry 29:38-30:38 Yes. There was a recent study showing that the closer people come to following, these are American people. This is the Health Professionals Follow-Up Study and the Nurses Health Study. So many, many people followed for three decades. And the researchers at Harvard who run this study check in with these people every couple years to say, how’s your health? And by the way, what are you eating? Fill out this very detailed dietary questionnaire for us. So what they have just recently published shows that people who come closest to following a Mediterranean diet, even though they’re living in Boston or Cincinnati or wherever they might happen to be, they’re not in the Mediterranean, they’re here in the U.S., those folks are less likely to be diagnosed with dementia. What can you tell us about diet and dementia? Dr. Murali Doraiswamy 30:38-32:00 Yeah, I’m not surprised by that finding. You know, the old adage, what’s good for the heart is good for the brain is true here for dementia as well. I believe Alzheimer’s and all types of dementias have a very strong vascular contribution. If you have blockages in your blood vessels, you’re much more likely to be diagnosed with dementia and cognitive impairment. So anything you can do to clear atherosclerotic plaques from building up in your blood vessels helps. And the Mediterranean diet has been shown to help in that regard, both in terms of body weight in terms of your risk for diabetes, in terms of your risk for hypertension, in terms of your risk for high cholesterol levels. Now, there is a slight twist there. There are two newer trials. There’s a large randomized trial of something called the MIND diet. The MIND diet is a version of the Mediterranean diet, but also includes components of the DASH diet, which is used to treat hypertension. So it’s kind of a hybrid. That large randomized trial did not find a protective benefit, even though a number of epidemiological studies had shown that. And more recently, an even larger trial called the POINTER study was just published in JAMA last year, and they found that combining the MIND diet with an active social lifestyle and aerobic exercise three or four times a week does help. It adds an extra one to two years of your cognitive longevity. Terry 32:00-32:03 So it can delay the onset of dementia. Joe 32:04-32:14 So let’s talk about exercise because people always ask us, well, what should I do for good health? And the one thing that always seems to stand out is exercise. Dr. Murali Doraiswamy 32:16-33:00 Yes. A little bit of exercise is great, [a] moderate amount. Too much is probably not good. And let me tell you, so the best exercise I recommend for people is a walking book club because you want to exercise your body and your brain. And you want to exercise at a level that, you know, is not stressful for your body. So, you know, the average 75-year-old, I’m not going to encourage them to run on a treadmill and then they slip one day and fall and break their hip or something. And there goes exercise for the next two years. So, yes, aerobic, moderate aerobic activity three to four times a week is very important. But also exercising your brain is equally important through cognitive training. Joe 32:58-33:03 Well, let’s talk about your research and crossword puzzles. Dr. Murali Doraiswamy 33:03-33:04 Yes. Joe 33:04-33:06 Exercising your brain. Dr. Murali Doraiswamy 33:06-34:23 Thank you. So, you know, the old thinking was that the brain in older ages cannot be changed. It doesn’t have neuroplasticity is the term we use to see if the brain can change and grow. And studies have shown that the older brain, the aging brain, retains its capacity to change. So then the question is, what is the best kind of exercise? Should we do these computerized video games where you’re, you know, like paying a monthly subscription and doing, you know, sitting in front of the computer? Or do you do more natural things that you, you know, been doing for a long time, like a hundred-year-old pastime, like crossword puzzles or bridge or, you know, Sudoku or whatever. So we did this randomized trial, and we found that if you already had memory impairment, we’re not talking about normal older people with healthy cognitive abilities. If you already had mild cognitive impairment, then doing something like bridge or crossword puzzles is better than playing video games because a lot of people struggle with the computer. They struggle with learning how these games play, and they’re not technologically savvy. And we found crossword puzzles actually beat those computerized video games. Now we’re doing a second study to see what is the ideal dose of crossword puzzles. Terry 34:23-34:24 Oh, I like it. Dr. Murali Doraiswamy 34:24-34:40 Do we do it four times a week? Do we do it just once a week? Do we do the Monday New York Times, which is easy, or the Thursday New York Times puzzle, which is challenging? So we’re trying to understand, you know, how do we actually scale it so that people don’t quit? Terry 34:40-35:10 Well, I think that’s a very interesting concept because we know that if you want to build muscle. In physical exercise, you need to take it right up to the limit and then keep expanding your limit a little bit. So if you could walk 15 minutes the first day, you might then the next week want to be walking 20 or 25 minutes. Is the same thing hold for cognitive exercise? Dr. Murali Doraiswamy 35:11-35:39 Yes, beautifully put, because you have to personalize it also for each individual, right? Because some people come with an eighth grade education and some people come with a PhD degree. So the crossword puzzle is not the same. How do you design the right words for that individual so that it challenges them and they continue to learn and grow? So that’s why we’re doing it through the computer, where the computer has an algorithm that automatically selects the right words and phrases based on their previous crossword puzzle completion and makes it challenging the next time around. Terry 35:40-35:51 Well, I know my mother loved doing the crossword puzzle, and she hoped that it would keep her from getting dementia. Sadly, she did develop dementia at the end of her life, but she was also quite old. Joe 35:52-36:05 Well, she was in her mid-90s, and she did very well in her early 90s. So maybe it was the crossword puzzles, maybe it was her excellent diet, maybe it was her exercise. It’s a package, isn’t it? Dr. Murali Doraiswamy 36:05-36:05 100%. Joe 36:05-36:09 It’s all these things together not just one single thing. Dr. Murali Doraiswamy 36:05-36:15 Correct, we call it multi-domain intervention. So yes, it’s the package. Terry 36:15-36:40 You’re listening to Dr. Murali Doraiswamy, professor of psychiatry and director of the Neurocognitive Disorders Program at Duke University School of Medicine. He’s a professor in medicine and a faculty network member of the Duke Institute for Brain Sciences. Dr. Doraiswamy is also an affiliate in the Duke Center for Applied Genomics and Precision Medicine. Joe 36:41-36:52 You know, Terry, it’s not just the package. It’s also the genes. And, you know, your dad was not a big crossword puzzle guy, but he lived into his late 90s as well. Terry 36:52-36:55 He did. And for much of that time, his brain was good. Joe 36:56-37:04 We’ve just discussed how exercise benefits the brain. After the break, we’ll find out about exercise that might be bad for our brains. Terry 37:04-37:15 We always think about traumatic brain injury from football or boxing or soccer. But what about less obvious pursuits like tennis or pickleball? Joe 37:15-37:21 There are medications that can be harmful as well. Anticholinergics have been linked with cognitive difficulties. Terry 37:22-37:31 I think that’s why we discourage people from long-term use of PM pain medicines or the antihistamine diphenhydramine, aka Benadryl Joe 37:32-37:34 Do sleeping pills increase the risk of dementia? Terry 37:39-37:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 37:52-37:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 37:55-38:14 And I’m Terry Graedon. Joe 38:15-38:47 Recently, a study published in Nature Medicine showed that older people who are more physically active have less cognitive and physical decline. That held even for those who already had amyloid buildup in their brains, apparent on scans. The amount of physical activity wasn’t extreme. People took at least 5,000 steps a day to 7,500 steps. The amyloid in their brains didn’t change, but with that activity, they had less tau accumulation. Terry 38:49-39:05 Walking seems like a pretty safe activity, as long as we can manage it without risking a fall. Some other physical activities may be riskier for the brain. We’ll find out about the dangers of football or soccer, in which there are repeated blows to the head. Joe 39:06-39:23 In addition to non-drug approaches to reducing the likelihood of dementia, we should also look at drugs. In particular, which drugs should we avoid? You might be surprised how many common medications may impact the brain. Terry 39:23-39:49 Our guest is Dr. Murali Doraiswamy, 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’s a 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. Joe 39:51-40:25 Dr. Doraiswamy, we’ve been talking about the benefits of exercise, among other things, for the brain. But there are some things that might be bad for the brain when it comes to exercise. And I’m thinking about football for younger kids, even with a helmet on. I’m thinking about soccer and heading the ball. I’m thinking about boxing, especially, or any place where you might injure your brain. It just doesn’t seem like such a great idea. What does the science say? Dr. Murali Doraiswamy 40:26-41:40 I think you’re absolutely right, because we don’t have any way to grow new brain cells once the brain’s been damaged, and we don’t convey that information with enough urgency to our children and athletes, frankly. So I would say boxing and mixed martial arts are obviously the most dangerous. It’s a well-known phenomenon called dementia pugilistica, where virtually a very high proportion of boxers end up with either Parkinson’s or some form of dementia later in life. The same, I think, the frequency is not as high with soccer and with American football. But still, people who have had multiple concussions definitely have a higher risk for a type of dementia that’s caused by a traumatic brain injury. And we don’t have a cure or a treatment for it. So 100%, I would recommend wear a helmet. Protect your head. You know, try to avoid high-risk sports. Even bicycling without a helmet, if you press the brake in the wrong place, you can do a cartwheel and fall over and hit your head. So you have to be really careful. And that’s another reason why I recommend walking for seniors. Joe 41:41-41:42 I’m thinking tennis. Dr. Murali Doraiswamy 41:43-42:17 Tennis is fabulous sport. You know, of course, tennis, you can have other kinds of injuries and, you know, but tennis is perfect. I think for a senior pickleball to me, especially if you can move from start with doubles playing, you know, gently and then move to singles and then, you know, maybe move from there to paddle or something like that. Because they’re more likely to engage and persist with it rather than tennis. If you’re starting late in life, it’s really hard. Now, ultramarathons is another. There’s some new findings suggesting that if you do ultramarathons, the shrinkage of the brain. Terry 42:18-42:22 So you’d say don’t do an ultramarathon. Dr. Murali Doraiswamy 42:23-42:39 Well, I mean, do it once in a while. It’s okay. Like it would be like going on a binge drinking episode once. You’ve got to do it in college as a rite of passage maybe to run the New York Marathon. So I’m not telling anyone don’t do it, but don’t do it super regularly because it’s a stressful experience for your body. Joe 42:40-43:13 I’d like to ask you about medications because we’ve talked about some of the medications that have been developed for dealing with Alzheimer’s. They haven’t been very effective, but we have a whole slew of drugs, some of which are available over the counter, that might not be good for the brain. So perhaps you could start with what we call anticholinergics. What are they and why might they be deleterious? Dr. Murali Doraiswamy 43:14-44:29 Sure. You know, anticholinergics are called that because they block the actions of a system in the brain called the cholinergic system. The cholinergic system is highly prevalent throughout the body. In fact, the vagus nerve is called the vagus because it’s a vagabond. It runs throughout the entire body. It controls your memory in your brain. It controls your breathing. It controls your heart. It controls the movement of your intestinal tract. It controls how often you’re constipated or how often you move bowels. It controls the contractions of your muscle, everything, right? So, acetylcholine, the chemical that’s used by this system, is crucial for memory in the brain. And anticholinergic drugs, if they block this chemical, they impact your memory. Many of the older medicines, especially older antidepressants, some of the older, sleeping aids, medicines that are used by a urologist to control frequent urination. All of these can have friendly fire on the brain. And so those are some examples of drugs that we, you know, it’s very hard because as a urologist, you want to give them to help a person with an enlarged prostate. But then as a brain doctor, you want to take people off these drugs to improve their memory. So there’s a constant tug of war. Let’s talk about antihistamines. Joe 44:29-45:28 There is what we call the first generation antihistamines. One of them is chlorpheniramine, but the one that is so popular these days is diphenhydramine. It’s the ingredient in Benadryl. And it has become so popular in all of the over-the-counter PM pain medicines because it makes people drowsy. Anybody who’s taken Benadryl during the day will often complain, yeah, it makes me sluggish. I can’t think as clearly. But now millions of people are taking Advil and Aleve and you name it with diphenhydramine. It’s a low dose, but it’s day in and day out. Because once you get into a sleeping pill cycle, you just take it in case I might not fall asleep tonight. So your thoughts about diphenhydramine? Well, I think you stated it pretty well. Dr. Murali Doraiswamy 45:28-46:23 I think if you use it persistently for long periods of time, it’s going to have deleterious [inaudible]. And whether or not the effects are reversible still are not fully proven. But generally, we believe that with anticholinergic drugs, if you can stop using it, you can reverse the drugs for the most part. You may not get back to where you were. But while you’re taking them, you know, you’re probably performing at 15, 20% lower than what you ought to be. So it could impact your driving, it could impact operating heavy machinery. If you’re taking an exam or a test or mission critical like a pilot, you know, you need to be extremely careful with these drugs. The same may also be true for some over-the-counter, you know, what shall I call it, herbal products that claim to mimic some of these antihistamines. Terry 46:24-46:28 So perhaps you don’t want to be taking an herb that is supposed to put you to sleep. Dr. Murali Doraiswamy 46:29-46:36 Yeah. We don’t know. I mean, it depends on the herb, but yes, some of them, yes. Like Valerian, for example, could potentially do the same thing. Terry 46:38-46:52 And my question is about prescription sleeping pills. I know it’s been controversial. Do they or do they not increase a person’s risk for developing dementia? And perhaps you have some insight on that. Dr. Murali Doraiswamy 46:53-47:55 I don’t have any additional insight. It still remains somewhat controversial and unproven. There’s a big range of sleeping pills, the newer sleeping pills versus the older ones. And of course, some of the antihistamines are used as sleeping pills as well. And some of the antidepressants are used as sleeping pills as well. So I would say, you know, the evidence is mixed. We continue to have to use them because on the one hand, sleep we know is crucial for memory archival. Sleep we know is crucial for immunity. There’s even new evidence suggesting that if you don’t sleep well, then the clearance of some of the toxic products in the brain is impaired through the glymphatic channel. So you want people to sleep well. And we don’t have a great choice. Some of the newer sleeping pills that are more expensive, so people who can’t afford them need to take the older version. So it’s a constant battle. Joe 47:56-48:21 There is a lot of controversy around the benzodiazepines, the benzos, anti-anxiety agents. Also, the proton pump inhibitors, the PPIs that you can now buy over-the-counter, omeprazole, esomeprazole, lansoprazole. And doctors are now prescribing the gabapentinoids, the gabapentin and the pregabalin for pain. Dr. Murali Doraiswamy 48:21-48:22 Correct. Joe 48:23-48:37 We want to caution people, never stop any of these drugs suddenly because it can precipitate something called discontinuation syndrome. That’s the sanitized version. It’s otherwise known as withdrawal. Dr. Murali Doraiswamy 48:38-48:39 Sure. Joe 48:39-48:51 So give us a quick understanding that even though there is a bit of a cloud on some of these drugs when it comes to cognitive function, no one should undertake stopping these drugs because they’re a little concerned. Dr. Murali Doraiswamy 48:51-49:23 Yes, absolutely. Drugs like this should be tapered off. You should talk to your clinician, physician, and gradually taper them off. It’s a little bit like if someone’s been drinking for a long period of time, the chronic alcoholic, we never advise them to go cold turkey. I know we usually have them come in, put them on a regimen of a taper before they go cold turkey. So I think it’s somewhat similar to this because you don’t want your brain to go from one state to another state when it’s dependent on a medicine like abruptly. Joe 49:23-49:26 Now, I will challenge you on that taper problem. Dr. Murali Doraiswamy 49:26-49:26 Yeah. Joe 49:27-49:43 We have been complaining for years that the drug companies haven’t come up with guidance. The FDA hasn’t come up with guidance. And many of the professional organizations haven’t come up with guidance. As everybody says, yes, slow taper. Terry 49:43-49:59 Well, the drug companies have no incentive to help people get off their drugs. FDA, on the other hand, you know, you could argue that it is a public health question, that perhaps they should have done it, but they have not. Joe 49:59-50:27 And the FDA would say, well, it’s not our job. So how does a psychiatrist such as yourself, who is treating a patient with an SSRI-type antidepressant or perhaps a gabapentinoid for some nerve pain or fill in the blank drug, and somebody says, well, yeah, I really would like to stop taking my sertraline. There’s no cookbook. How do you advise them? Dr. Murali Doraiswamy 50:27-51:09 Yeah, it’s a huge gap. Even more fundamental is that physicians need to know what is the half-life of a particular drug before they counsel people on how to taper. And most doctors, because there’s so many drugs now, nobody even remembers. So you almost have to ask AI for how do I taper off this person. That’s the only solution. Somebody has to build an AI chatbot into your electronic health record. So just how I do it, for a drug with a very long half-life, it’ll taper itself out of your body. Because if it has a 30, 40-day half-life, you don’t need to worry as much about a drug as with a short half-life causing abrupt withdrawal symptoms. Terry 51:09-51:19 So that would be, for example, the antidepressant fluoxetine, which is not nearly as difficult to discontinue as a short-acting drug like venlafaxine. Dr. Murali Doraiswamy 51:20-51:30 That’s right. Beautifully put it. I love the way you give these concrete examples. Yes. I think AI is going to take over all of these solutions that the drug companies and FDA don’t want to tackle. Terry 51:32-51:48 Well, what about the potential for AI to help people in your situation who are trying to help people with psychiatric problems or with dementia? What do you see as the role for AI? Dr. Murali Doraiswamy 51:48-52:36 I think it’s going to transform the field. Just in mental health, for example, children. I have seen surveys would say 80-90% of kids would rather talk to a bot rather than a human who is judging them, especially an older human that’s judging them. That’s one. A lot of crises that kids have happen late at night or teens and college students. There’s nobody for them to talk to. And in terms of dementia, you know, I mean, look, people want cognitive testing in the comfort of their home. It’s too intrusive to go to a clinic and have someone poke and prod you and ask questions like this. If you can get tested in the comfort of your home with a reliable evidence-based test, and then it tells you, you know, here’s what you need to do, then people can decide with their family. I think that’s where we’re headed. Joe 52:37-53:01 Dr. Doraiswamy, we are almost out of time. As you look into your crystal ball, what do you see for the future, especially when it comes to Alzheimer’s disease or dementia? What would your hopes be over the next decade or two for better treatments, new ways of thinking, perhaps some kind of a breakthrough? Dr. Murali Doraiswamy 53:03-54:10 Well, I think the first thing I would hope for is there are five or six million people in the U.S. and maybe 30 million people around the world already living with dementia. We shouldn’t ignore these people. Even some of the people who are advanced stages, there’s a human still in there. We need to make sure that we have adequate resources to provide for them, to support their caregiver, to make sure that their lives have high quality. We should not neglect them because a lot of the drug discovery is moving to earlier and earlier and earlier stages, neglecting the later stages. So that’s one. So the human element needs to be brought back in. Second is we need to really set the bar for drug development so that it’s unambiguous. A very high bar for efficacy and a bar for safety so that we don’t have to be doing regular PET scans and MRI scans to monitor people. Ultimately, I think we need more investment from society because it’s a huge problem. I think we’re going to have a combination of drugs, much like cancer and other specialties. I’m not optimistic we’ll find a cure, but I’m hopeful that we’ll have a lot of very, very highly efficacious drugs in the next five to 10 years. Joe 54:10-54:17 And in the one minute we have left, your recommendations for people who want to try and prevent the development of dementia? Dr. Murali Doraiswamy 54:19-54:30 What’s good for the heart is good for the brain. Heart healthy diet, exercise regularly, get seven, eight hours of sleep, be socially and cognitively very active. Terry 54:31-54:38 Dr. Murali Doraiswamy, thank you so much for coming to talk with us today on The People’s Pharmacy. Dr. Murali Doraiswamy 54:38-54:39 You’re welcome. Always a pleasure. Terry 54:40-55:05 You’ve been listening to Dr. Murali Doraiswamy, Professor of Psychiatry and Director of the Neurocognitive Disorders Program at Duke University School of Medicine. He’s a professor in medicine and a faculty network member of the Duke Institute for Brain Sciences. Dr. Doraiswamy is also an affiliate of the Duke Initiative for Science and Society. Joe 55:05-55:14 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Terry 55:15-55:23 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Joe 55:23-55:42 Today’s show is number 1,451. You can find it online at peoplespharmacy.com. At peoplespharmacy.com, you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com. Terry 55:42-56:16 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. There, you can also find our posts on the week’s health news. We’ve included links to articles that we’ve written about the possible association between some infections and the risk of dementia. Could vaccines against shingles, influenza, or tuberculosis help slow cognitive decline? Might amyloid plaque be part of the brain’s immune defense against infection? Joe 56:17-56:37 You know, Terry, I have been so fascinated with BCG. This is a vaccine that’s over 100 years old, but there was a recent study, sort of an analysis overview from Frontiers in Pediatrics last summer. And it really suggested that BCG might have an important role against some dementias. Terry 56:38-56:40 We’ll put a link to that on the website as well. Joe 56:40-56:55 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. In Durham, North Carolina, I’m Joe Graedon. Terry 56:55-57:28 And I’m Terry Graedon. Thanks for listening. Please join us next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 57:29-57:38 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 57:39-57:43 All you have to do is go to peoplespharmacy.com/donate . Joe 57:43-57:57 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Oct 30

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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 3, 2025. 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. Michael J. Blaha, MD, MPH, Johns Hopkins University School of Medicine Listen to the Podcast: The podcast of this program will be available Monday, Nov. 3, 2025, after broadcast on Nov. 1. You can stream the show from this site and download the podcast for free. This week’s podcast contains a discussion of diuretics and their effects on critical minerals, home ECGs and Afib detection with smart phones, more details on the colchicine study he mentioned and further information on the hypertension drug the FDA just approved , aprocitentan ( Tryvio ). Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1449: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Fewer Americans are dying of heart attacks these days, but cardiovascular disease is still our number one killer. This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:42 We’ll take a fresh look at blood pressure, cholesterol, calcium, and other risk factors for heart disease. Have you had a coronary artery calcium scan? Joe 00:42-00:51 Do you know what your blood pressure is? Was the measurement done properly? It’s surprisingly easy to make mistakes. Terry 00:52-00:59 Inflammation plays a significant role in heart disease. Could an anti-inflammatory drug usually prescribed for gout be helpful? Joe 01:00-01:08 Coming up on The People’s Pharmacy, Beyond Cholesterol. Rethinking your risk of heart disease. Terry 01:14-02:26 In The People’s Pharmacy health headlines. For a long time, American parents were careful to protect their infants from peanut-containing products for fear of triggering a potentially lethal allergy. Nevertheless, peanut allergies continued to rise. Then in 2015, a carefully conducted scientific study showed that infants introduced to small amounts of peanuts between four and six months were less likely to react badly to them. Pediatricians changed their recommendations after that. Now, a study of health records of children under 3 shows that the rate of peanut allergies has dropped pretty dramatically, from 0.8% in 2012 to 0.5% in 2019. That may not sound like much, but it is statistically significant and represents a 43% reduction in relative risk. Pediatricians are still cautious about advising parents on feeding peanut butter to babies who seem likely to develop allergies. But fewer peanut allergies could definitely make life less stressful for many youngsters and their families. Joe 02:27-03:56 Researchers have been arguing about how many steps you need to prevent cardiovascular disease. For years, we were told that 10,000 steps should be the goal. Then, scientists reported that 7,000 might be enough for older adults. Now, a new study in the Annals of Internal Medicine reports that getting your steps in a single long walk is better for cardiovascular health than accumulating steps in many shorter walks. The investigators analyzed data from more than 33,000 participants in the UK Biobank database. These healthy people averaged 62 years of age at the start of the review and were taking fewer than 8,000 steps daily. The periods of physical activity were classified as shorter than 5 minutes, 5 to 10 minutes, 10 to 15 minutes, or 15 minutes or longer. After 8 years, the volunteers who regularly walked more than 15 minutes at a time were 80% less likely to have died. They were 70% less likely to have a heart attack or stroke than the people who took shorter walks. 4.4% of people who took very short walks died during the 10 years of follow-up. Fewer than 1% of those taking long walks died during that time. The authors conclude that when people get most of their daily steps from longer walks, they do better. Terry 03:57-04:46 Some people like to sleep in total darkness, while others prefer to keep a nightlight on so they can see the path to the bathroom if they need to use it. A study of health records from the UK Biobank covered more than 88,000 people over nearly 10 years. The participants wore light sensors on their wrists for a week near the start of the study. Researchers compared outcomes for people with dark nights to those for people with the brightest nights. People exposed to bright light at night were significantly more likely to develop coronary artery disease, heart attacks, heart failure, atrial fibrillation, and stroke. Increased light exposure boosted the risk for women more than for men. The investigators recommend avoiding light at night. Joe 04:48-05:37 It’s estimated that nearly 400 million people suffer from knee osteoarthritis worldwide. Exercise is considered a cornerstone of knee osteoarthritis management, but what exercise is helpful and won’t damage sore joints? A new study randomized patients with knee arthritis to receive either online information about the benefits of exercise for arthritis or a Tai Chi program with a mobile app encouraging adherence to this kind of gentle exercise. The investigators report that this randomized clinical trial found that this unsupervised multimodal online Tai Chi intervention improved knee pain and function compared with control at 12 weeks. Terry 05:38-06:17 Irritable bowel syndrome can make life very uncomfortable. People often request dietary advice, and they’re told to avoid foods that bacteria can ferment, the so-called low FODMAP diet. Now scientists report that following a Mediterranean diet, which is easier, offers just as much relief. And that’s the health news from The People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:35 And I’m Joe Graedon. Heart disease has been our number one killer for decades. We’ve got dozens of highly effective drugs to lower cholesterol. What else should we be doing to overcome this widespread threat to public health beyond simply swallowing a pill? Terry 06:36-06:47 Today, we’ll be discussing ways for you to reduce the likelihood that you’ll have a heart attack or other serious heart problem. What should you know about keeping your heart healthy? Joe 06:47-07:28 Our guest today is an expert in preventing heart problems. To find out how you can reduce your risk of heart disease, we turn to Dr. Michael Blaha. He’s professor of cardiology and epidemiology at Johns Hopkins School of Medicine. Dr. Blaha 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. He’s received multiple grant awards from the National Institutes of Health, the FDA, and the American Heart Association. Terry 07:29-07:33 Welcome back to the People’s Pharmacy, Dr. Michael Blaha. Dr. Michael Blaha 07:34-07:35 Thanks for having me back. Joe 07:36-08:13 Dr. Blaha, the American Heart Association just recently reported that heart disease is still the number one killer in America. And that’s after almost 40 years of statins and all kinds of other cholesterol-lowering drugs. Atorvastatin is the most prescribed drug in America. It’s big number one at 30 million Americans taking that medication. What else should we be doing to reduce our risk of having a heart attack or other cardiovascular diseases like stroke? Dr. Michael Blaha 08:14-09:16 Well, there’s no doubt we’ve made tremendous progress over the last several decades, three to four decades, really driven by smoking reductions, more attention to blood pressure, as you mentioned, cholesterol reduction, both from diet, a reduction in trans fats, but as well as statins. But of course, residual risk remains. And as you mentioned, atheroscrotic cardiovascular disease remains the number one killer, really close to cancer now. In fact, some states, cancer is higher than ASCVD than atheroscrotic cardiovascular disease. But in general, atheroscrotic cardiovascular disease remains the number one killer. And really, the epidemic now is one of metabolic disease driven by obesity and diabetes. Those are the risk factors that we have yet had as big of a breakthrough on. So while statins are helpful, blood pressure reduction is helpful, of course, what we’ve learned about diet and exercise, we still need to do more about obesity and diabetes. Joe 09:17-09:31 Has Ozempic and Wegovy and Mounjaro and Zepbound, the GLP-1 agonists, changed the equation? There are a lot of people who say, wow, it’s like a miracle. Dr. Michael Blaha 09:32-10:51 Yeah, they’ve completely changed the equation. It’s probably the biggest breakthrough since statins as far as pharmacologic prevention goes. Yes, we’ve never been able to have meaningful weight loss in the office before with really with the diet and exercise strategy that’s consistent or with the drug. Now that we’ve learned more about the behavior of hormones from the gut and the way they interact with the brain, we’ve shifted the thinking around obesity towards one of a chronic disease rather than just a willpower problem. We understand some of the brain chemistry. It’s unlocked the ability to make meaningful weight loss. So these, yeah, these therapies can induce significant weight loss, significant fat cell reduction, fat mass reduction. They’re anti-inflammatory. Yeah, and they have cardiovascular benefits, but also benefits on the liver, on sleep and other things. So, yeah, this is that we’ve started to make progress in this regard. Of course, we need to still work on diet and exercise and how that fits in with these GLP-1 and the next generation of incretin-based therapies. But absolutely, the future is bright as far as treating obesity, but we need to prevent it in the first place, too. Terry 10:53-11:17 When it comes to heart disease, there’s another risk factor that we will soon be able to treat with medications. I don’t think that the FDA has approved any of these medicines yet, but pharmaceutical firms are working on drugs that will lower LP little a. Is that going to make a difference? Dr. Michael Blaha 11:18-12:33 Yeah, I hope so. So a quick primer on lipoprotein(a). So this is a cholesterol carrying moiety that when you measure your LDL cholesterol, it’s hidden within that LDL cholesterol measurement. To actually get your LP(a) levels, your lipoprotein(a) levels, you need to also measure it directly in the bloodstream, and it’s a measure really of genetic cholesterol risk. Your levels are 90% determined by your genetics, so it’s not much that you can do about it as far as diet and exercise goes. You inherit it from your family and it is causal and causing atherosclerotic cardiovascular disease and it’s the explanation of some of the heart disease that we see that happens in patients with no other risk factors, but this hiding behind the normal lipid profile, the lipoprotein(a) levels. But one in five patients in the world has an elevated lipoprotein(a) level. It can be higher in certain populations like South Asians, for example. So it’s common, it’s genetic, and it’s not treatable right now. And it’s a cause of, once again, some, not all, but some of the unexplained heart disease that we see. Joe 12:33-12:40 Well, hang on a sec, Dr. Blaha, 20%, one out of five, that’s a lot. Dr. Michael Blaha 12:40-13:08 It is a lot. Yeah, there’s no doubt about it. About four out of five patients have very low levels, but one in five can have extraordinarily high levels. And once again, you don’t know it unless you measure it. And as you mentioned, many pharmaceutical companies are working on therapies that do indeed successfully lower lipoprotein(a) levels. We won’t know until next year if those therapies actually reduce cardiovascular risk. We’ll know soon, though. Joe 13:09-13:46 You know, we have talked to Dr. Tsimikas, who has been studying LP little a for quite a long time, and he actually wrote a, I would say, a somewhat controversial article in one of the heart journals, an inconvenient truth regarding statins in that statins raise LP little a, not a whole lot, but a little bit. And so I’ve always been a little confused. It seems like you’re driving with your foot on the brake and the gas simultaneously. If you’re trying to reduce your risk of heart disease, but a statin is raising your LP little a levels. Your thoughts? Dr. Michael Blaha 13:48-14:38 Yeah, it’s true. These processes are quite complicated. So both LPA-lowering drugs, and it looks like many anti-inflammatory drugs can raise your LDL a little bit. This just goes to show the interconnection between inflammation, lipoprotein(a), and LDL, for example. So it’s true. Now, the good thing is the statins lower the LDL way more than the LPA-lowering drugs raise the LDL, And still, clearly, there’s a net benefit, hopefully, of both of these drug classes. But we’re going to have to understand how all these things interact. So once again, we’ll have to wait for the trials. And we’ll know as soon as next year if these drugs lower cardiovascular risk, despite raising LDL a little bit. Now, all of these studies of the LPA drugs are in patients taking statins. Right. Joe 14:39-15:13 I’ve got another question before the break. And it has to do with another class of drugs called beta blockers. They’re among the most prescribed drugs in America. There was a Nobel Prize to Dr. Black. He developed the first one, propranolol. But there’s a whole bunch of others. Metoprolol, there’s, let’s see, atenolol, there’s carvedilol. There are lots of beta blockers. Terry 15:13-15:15 Sotolol. There’s lot of ‘-olols.’ Joe 15:15-15:32 And, you know, there was a time, I’m sure, that you absolutely prescribed the beta blocker for just about everybody who had a heart attack. And it was like, if you don’t prescribe a beta blocker after someone has a heart attack, that would be considered malpractice. Dr. Michael Blaha 15:32-15:33 Yeah. Joe 15:33-15:56 The New England Journal of Medicine has just added to the literature that suggests if people have good heart function after a heart attack, and you’ll have to explain ejection fraction, that maybe a beta blocker is not such a great idea after all. Some patients will benefit if their hearts are damaged severely, but others, not so much. Could you give us a quick two-minute overview? Dr. Michael Blaha 15:57-16:16 Sure. Yeah, beta blockers are absolutely important drugs. You know, they reduce the autonomic nervous system stress on the heart, let’s call it. They reduce the impact of sympathomimetics, the neurotransmitters that stimulate the heart, so they relax the heart. Joe 16:16-16:20 You’re talking about the fight or flight reaction, the adrenaline reaction. Dr. Michael Blaha 16:20-17:36 Yeah, they start to blunt that, which helps to reduce the stress on the heart, which certainly is good, generally speaking, after a heart attack. But the way it turns out is these drugs really exert their effect by reducing that stress on the heart and reducing the subsequent risk of heart failure or ventricular arrhythmias after a heart attack. And those predominantly occur in people with substantial damage to the heart tissue. So if you’ve had a heart attack and your heart function is reduced, your ejection fraction, your heart squeeze is reduced, you’re at risk for heart failure and ventricular arrhythmias. And the beta blockers probably have a role there. In fact, they definitely have a role there. But there’s a lot of patients nowadays who have small heart attacks treated very well with a stent and other medicines, and they do extremely well. And they’re not really at risk for heart failure or arrhythmias, at least in the short term. And it turns out after a short course of beta blockers, these patients probably don’t need to stay on beta blockers long term because they’re not at high risk of heart failure, not at high risk of arrhythmias. And beta blockers can have side effects. So really, after maybe a year of a beta blocker, in the chronic phase of atherosclerotic cardiovascular disease, we probably don’t need beta blockers in most patients who have normal heart squeeze, normal heart function. Terry 17:37-17:53 You’re listening to Dr. Michael Blaha, professor of cardiology and epidemiology at the Johns Hopkins School of Medicine. He’s the director of clinical research for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Joe 17:54-17:58 After the break, we’ll talk about blood pressure. It’s an important risk factor, Terry 17:58-18:07 but how low should it go? Sometimes when blood pressure medicines work too well, people may get faint and fall when they stand up from sitting or lying down. Joe 18:08-18:14 Blood pressure measurement can be trickier than it seems. Is the clinic doing it correctly? Terry 18:14-18:31 Do you have white coat hypertension? Find out about the best technique for blood pressure measurement. Is your arm supported? Joe 18:22-18:25 Is the clinic using the right size cuff? Terry 18:25-18:31 New machines have the guidelines built in. Joe 18:32-18:33 The AHA recently introduced a new risk calculator. Why does it matter? Terry 18:39-18:55 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon. Joe 18:55-19:12 And I’m Joe Graedon. Terry 19:12-19:30 Today, we’re talking about how to reduce your chances of developing heart disease. One important risk factor is blood pressure. The CDC estimates that nearly half of all American adults have hypertension. That’s about 120 million people. Are you one of them? Joe 19:30-19:58 To learn more about preventing heart disease, we turn back to Dr. Michael Blaha, professor of cardiology and epidemiology at Johns Hopkins School of Medicine. He’s 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. Terry 19:59-21:17 Dr. Blaha, we know that one of the risk factors that we’re always reminded we need to keep under control is blood pressure. And we can ask, and probably will, about the various levels of blood pressure and exactly what is a really good blood pressure. Does it vary from one age to another? But what I’d like to ask you about right now is balancing blood pressure control against the potential side effect of someone feeling dizzy. Especially, there’s something that doctors call orthostatic hypotension. And what it amounts to is a person on such a medication stands up from sitting or from lying down, and they just basically fall over. They get faint. And that clearly is not a desirable situation. Can you tell us a bit, please, about how a doctor and patient can work together to balance these risks? Dr. Michael Blaha 21:19-23:22 Yeah, you bring up a really important point. And one of the longstanding debates in cardiovascular disease is what’s the best blood pressure? And clearly, we’ve decided that the higher your risk of atherosclerotic cardiovascular disease, the lower your blood pressure [should] be or the tighter your blood pressure control should be. And we’re really looking for in our high risk patients, normalization of the blood pressure. This reduces cognitive problems later on, reduces heart failure and heart disease risk over time, but it does come with side effects. Blood pressure drugs do blunt auto-regulation of the blood pressure. As you mentioned, when you stand, part of that auto-regulatory response is blunted and you can get dizzy. You can get low blood pressure when you stand. And this is something that we are always working with our patients. It’s something we talk to our patients about when they start blood pressure drugs. It’s something we talk about when we set aggressive blood pressure goals, and it’s a common reason we have to back off on blood pressure therapy too. So you’re right, we need to talk to our patients about what our blood pressure goal will be. If your risk is not so high, your blood pressure can be more lenient. If your risk of cardiovascular disease is high, we need to be very aggressive with the blood pressure and really need to talk about potential for orthostatic hypotension. We do tend to avoid the beta blockers just for blood pressure. They’re not really good antihypertensive drugs. They’re a fourth or fifth line choice. They can cause orthostatic hypotension, but really any blood pressure drug can cause orthostatic hypotension. So it’s part of the discussion and it’s part of the complex juggling act, as you mentioned, between getting the lowest blood pressure we can to reduce your risk while balancing side effects. And some patients are just going to have to deal with a little bit of orthostatic hypotension, which means when you rise from standing, you wait for a moment before you walk. You rise from standing a little slower. You maintain hydration. And this is some of the give and the take of everyday blood pressure management. Joe 23:23-23:27 Dr. Blaha, I’d like to talk about blood pressure measurement for a minute. Terry 23:28-23:29 Measurement rather than management. Joe 23:29-24:55 Exactly. Because we get a lot of messages on our website from people who say, holy cow, you know, I’ve seen the American Heart Association’s guidelines. These are people who are really dedicated to getting their blood pressure correct. And they’re taking their blood pressure at home and following the guidelines. But when I go to the clinic, the first thing that happens is I’m stuck in traffic and I’m almost always getting late and I’m always feeling rushed and I’m always a little anxious. And then as soon as I get taken back from the waiting room, the technician or the nurse, they immediately take my blood pressure. I don’t get to relax. I don’t get to go to the bathroom. And they sometimes put me on the exam table and my legs are dangling and my arm is dangling and they’re talking to me. And all of those things mess my blood pressure up. I have this thing called white coat hypertension anyway, and that just makes it worse. And so my blood pressure may be 150 or 160 over 95 in the doctor’s office. But as soon as I get home, it’s back around 120 over 80. So can you share with us the correct way to have a blood pressure taken when you’re at a clinic? Dr. Michael Blaha 24:55-26:56 Yeah, this is an enormously important question because blood pressures commonly aren’t checked well in the clinic, and it’s the result of a busy practice. Really, it takes a lot of time to make a good blood pressure measurement. And a quick segue to saying this is why we find home blood pressures from patients extraordinarily important. We always want our patients checking their blood pressure at home and bringing in a home blood pressure log. But when you come to the office, yeah, the ideal way of checking the blood pressure is being put in a quiet room, sitting down, waiting for three to five minutes before anything is done in this quiet room, and then using an automated blood pressure cuff with your feet on the ground and your heart, excuse me, your arm at the heart level, so elevated but at the level of your heart and checking that blood pressure probably in duplicate and checking for consistency of that blood pressure across two measurements and either averaging them or taking the latter of the two measurements. And honestly, in most patients or in many patients with hypertension, we should be checking that blood pressure in both arms. Now, the reality is we can’t do this in every busy practice. That alone will take 10 minutes, but we should be doing it more often than we are now. But what we should also be doing is encouraging all of our patients to take these high quality blood pressure measurements at home too. You check it at home, you can check it with less stress. You can check it in that quiet situation. You can check it at the same time every day. So they’re more comparable measurements compared to the random blood pressure that you get in the office. And the reality is the physician, the patient should be making decisions based on all the above information. The blood pressure in the clinic and the blood pressure at home and the blood pressures throughout the day, whether it be morning, night, or afternoon. All of these add up to what your true blood pressure really is. And in my clinic, I’m routinely making blood pressure decisions with a combination of all these data points. One single blood pressure measurement in the office is insufficient to characterize someone’s blood pressure trajectory. Terry 26:56-27:36 I think that’s really important for people to know. And there are a couple of other questions or issues about blood pressure measurement that I’d like us to touch on. When I take my blood pressure at home, Dr. Blaha, I have a piece of furniture nearby that supports my arm at exactly the level of my heart or close enough. When it’s taken in the clinic, the last time I had my blood pressure taken at my doctor’s office, the nurse just had me hold my arm out. It was not supported at all. What difference does that make? Dr. Michael Blaha 27:38-28:21 Yeah, these probably make small differences, but all of these little elements that we talk about add up to potentially making big differences. If you talk about supporting your arm, if you talk about resting, if you talk about feet on the floor, all these can add up to substantial blood pressure variation. So you’re hitting at really important points. And I think we both want to measure the blood pressure well, but we also want to measure it consistently. So when we compare measurements from visit to visit or morning to afternoon or day to day, we’re measuring it the same way each time. That can be as important as doing the blood pressure in the perfect way. But you’re absolutely right. Feet on the ground, arm supported at the level of the heart is the ideal way to measure the blood pressure. Terry 28:21-28:41 And one other thing I could do at home is make sure my blood pressure cuff is the right size. If my arm is super skinny or extra fat, I can get a cuff that is adjusted to my arm size. In the clinic, they’re much less likely to change those cuffs when a patient has a non-standard size arm. Dr. Michael Blaha 28:41-29:13 Yeah, absolutely. Another critically important point, arm size varies tremendously. We try to change the cuff as much as we can in practice. We try to supplement this with a manual blood pressure check, but we can’t do it in reality in every situation. But blood pressure cuff size is another extremely important variable. Blood pressure is extremely hard to measure. I think we consider it sometimes as one number, but really it needs to be averaged. It’s the area under the curve, so to speak, of your blood pressure over your entire week, your entire month, your entire lifetime that matters the most. Joe 29:14-29:55 You know what really drives me a little crazy, Dr. Blaha? The new blood pressure machines have built into them what I’ll call the guideline targets. And every once in a while, well, if I take my blood pressure and it shows up at, let’s just say, 121 over 79, which I think, yeah, that’s pretty good. It says stage one hypertension. And I go, whoa, that’s just not fair. Come on, guys. But it’s like if you’re not below 120 over 80, you get dinged. What’s the deal with that? Dr. Michael Blaha 29:56-30:52 Hmm. Well, you raise an important point about these normal values. It’s the same thing on your lab slip, when it shows your LDL cholesterol being too low, or maybe your LDL cholesterol too high when it’s actually fine for your risk level. Tricky. These things are tricky. Yeah, I prefer probably if you didn’t, if it didn’t say something like stage one hypertension, it just said you’re in the yellow zone, perhaps not the green zone on that measurement. But yes, it gets to the main point that is really about the integration of many blood pressure checks. If you check it again and you don’t have stage one hypertension anymore, of course, you don’t indeed have a clinical diagnosis. You just had one blood pressure measurement that was high. So yeah, I think we could probably use different terminology there. I like the color coding of blood pressure measurements. You had a yellow, or I’m consistently in the yellow. I’m certainly not want to be in the red, but you’re right. We can’t be making diagnoses based on one measurement. We never do that. Joe 30:53-32:04 Let’s switch gears a bit and talk about blood pressure medications. The number one blood pressure pill in America is lisinopril. It’s what we call an ACE inhibitor, angiotensin converting enzyme inhibitor. These were originally derived from the jararaca snake in Brazil, if I’m not mistaken. I think Captopril was the very first one. And they are extraordinarily effective. And most people do really well on them. But there are some side effects. So tell us about the lisinopril cough. And I have to tell you, we have heard from people who say, oh, man, I went to my doctor. I got lisinopril. Six weeks later, I started coughing my head off. And then I was referred to an allergist. And then I had to go see an asthma expert. And then, and then, and then, and I was taking all these other drugs for the cough when it was really the lisinopril. So tell us about that cough and then tell us about something called angioedema, rare, but potentially deadly. Dr. Michael Blaha 32:04-34:11 Yeah. The ACE inhibitors are a good class of medications for blood pressure. They reduce the blood pressure. They protect the kidneys. They can protect the heart. They reduce cardiovascular events when you lower the blood pressure using them. But like any medicine, they have side effects. And the number one side effect with the ACE inhibitors besides hypotension, besides low blood pressure, can be this cough. Turns out the way that these drugs influence metabolism of hormones in the body, they do increase a moiety called bradykinin. This can cause cough. So this is well known that it can cause cough. And I don’t know, 5% to 10% of patients, probably in my experience, can develop a cough. It can be subtle, as you mentioned. It’s not obvious. It doesn’t pop up the first dose you take the pill. It can be subtle and a very kind of a light cough that gets misinterpreted as other things. It doesn’t get connected with the ACE inhibitor always because it doesn’t always pop up on that first or second dose. It usually goes away when you switch to a different blood pressure class of drugs like angiotensin receptor blocker or another class of medications. But yeah, this is something we should think about when we give our patients ACE inhibitors. Now, in some patients, you can get a more extreme reaction, almost like an allergic reaction called angioedema, where you don’t just get a cough, but you actually get swelling of the face, hands. You can even get swelling of the airway, which can be a high risk. This occurs more often in black patients than other race, ethnic groups. This is something to be aware of. And it’s one of the reasons why most of us for blood pressure, at least select an ARB, an ARB instead of an ACE inhibitor as the first choice. But both of them are similar and both great blood pressure drugs, but like any drug, it doesn’t come free. It always comes with some risk of side effects and low blood pressure and cough and rare risk of angioedema is the thing to be worried about when you start an ACE inhibitor like lisinopril. Terry 34:11-34:35 Dr. Blaha, you’ve mentioned a couple times that the patient’s overall risk has an impact on the selection of intervention. And I think that recently that risk calculator has been updated. Can you tell us briefly about that, please? Dr. Michael Blaha 34:35-36:10 Yes. Risk is the number one concept in preventive medicine. We want to make sure all of our therapies are selected based on risk. We don’t want to overtreat low-risk people. We want to treat our patients that are high-risk more aggressively. So risk is everything, but risk can be hard to estimate. We start with doing something called a risk calculator, as you mentioned, and the most recent one is called the PREVENT risk calculator, PREVENT, P-R-E-V-E-N-T, like PREVENT. And this calculates the 10-year risk of both atherosclerotic cardiovascular disease or total cardiovascular disease, including heart failure. And there’s also an option of including a measurement for 30-year risk. And it’s really using traditional risk factors that we measure in the clinic, but also can add in the hemoglobin A1C, urine albuminuria, also includes your zip code. It can include your zip code because it turns out where you live influences your risk. And it takes race, ethnicity out of the equation that was in prior equations. And it calculates your 10-year risk. Now, honestly, the prevent equations aren’t that different than our prior set of equations, the pooled cohort equations. But for some patients, they can be more accurate. But most importantly, they don’t overestimate the risk like our prior calculators do. This one is better what we call calibrated, so that the risk estimates actually numerically match what we observe in the real world better. That’s the biggest innovation with the PREVENT risk score. It’s a better calibrated risk score, and it’s now recommended across all the ACC/AHA guidelines. Terry 36:10-36:48 You’re listening to Dr. Michael Blaha, professor of cardiology and epidemiology at the Johns Hopkins School of Medicine. He’s 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, the FDA, the American Heart Association, the Amgen Foundation, and the Aetna Foundation. Joe 36:49-36:59 After the break, we’re going to talk about a different risk factor for heart disease, coronary artery calcium score, or CAC. Terry 37:00-37:03 What is it, and why is it important? Joe 37:03-37:13 You can see calcium on a scan, but should you worry more about the plaques with calcium or the goo inside the lining of the arteries? Terry 37:14-37:18 What should we all be doing to reduce our risk of heart disease? Joe 37:19-37:26 What lessons should we take from people who have heart attacks, even though they’ve seemingly done everything right? Terry 37:39-37:43 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 37:52-37:55 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 37:55-38:13 And I’m Terry Graedon. Joe 38:14-38:31 Most people have had blood tests to determine their total cholesterol, their LDL cholesterol, their HDL cholesterol, and triglycerides. Some have even had a test for lipoprotein(a) or LP-little-a [LP(a)]. Terry 38:32-38:47 Others may have had a CAC scan. That stands for coronary artery calcium, and it shows up on a CT scan of the heart. What does a CAC score tell you about the health of your heart? Joe 38:47-39:13 To find out, we’re talking with Dr. Michael Blaha. He’s professor of cardiology and epidemiology at Johns Hopkins School of Medicine. He’s 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. Terry 39:14-39:37 Dr. Blaha, one of the factors that we sometimes hear recommended to help us determine our risk is the calcium, let’s see, coronary artery calcium, the CAC score. Can you tell us what is it and is it important? Dr. Michael Blaha 39:38-40:49 Yeah, the calcium score is super important. It’s guideline recommended now across the world. In fact, new guidelines are embracing it more than ever before. And what it is, it’s a simple, rapid CT scan of the heart. It’s so-called gated to the cardiac cycle. In other words, you put electrodes on your chest. So it takes the pictures only during part of your heart cycle when the heart’s in between pumping. So you can get a still image of the heart, even though your heart is active. And that picture of the heart reveals the heart anatomy. But it also reveals calcium within the heart, because the calcium stands out on x-rays on CT scans. It stands out. It’s easy to see. So on these heart scans, we look for calcium deposits within the coronary arteries because we know that as plaque in the arteries ages, it becomes calcified. So if we see calcium within the coronary arteries on one of these simple rapid CT scans, we know that you have plaque in the arteries. In fact, the more calcium you have, the more plaque you have in the arteries. So effectively, this is a simple test for how much plaque you have in your arteries. The calcium score is a plaque burden test for the heart. Terry 40:49-40:59 Who needs a calcium artery score? Who needs to undergo this test? Because I’m assuming it’s not appropriate for everyone. Dr. Michael Blaha 41:00-43:40 Yeah, it’s not appropriate for everyone. It really needs to be done in the setting of risk assessment. I mean, if you don’t need your risk further assessed, you’re either a very low risk patient or you’re already a very high risk patient that’s being treated aggressively, you don’t need this test. This is a great test for initial risk assessment as we’re deciding on both the initiation or intensity of preventive therapies, or even the intensity of lifestyle recommendations. So it’s a great way to figure out your personalized risk. The risk scores that we talked about give a population risk estimate. If there was a thousand patients like you, what percent of them would develop disease. This is a test actually of your arteries. So it tells you in your body, in your arteries, how much plaque do you have? In other words, all those risk elements, risk factors, how do they impact your arteries? So it’s really a personalized risk assessment of you, of how much plaque you have in your arteries. And it’s appropriate for patients who are either borderline to intermediate risk with one of these risk scores where they’re in the middle, so to speak. It’s appropriate for patients who have so-called risk-enhancing factors, factors that aren’t accounted for in these risk scores, but are common, like family history, South Asian ancestry, the metabolic syndrome, chronic kidney disease, inflammatory disorders like rheumatoid arthritis, elevated lipoprotein(a), which we talked about earlier, all risk-enhancing factors that indicate a calcium score could be helpful. Calcium score can also be helpful in patients who are uncertain about therapy. Let’s say that the risk score says they probably should be on therapy, but they’re uncertain. They say, well, I don’t know. I want to get a better assessment of my risk and how likely I am to benefit. That’s a great reason. Calcium score can also be motivating. It can change a patient’s perspective on their lifestyle and maybe motivate lifestyle change. That’s actually a good reason for a calcium score too. So whenever it might change your lifestyle, change your treatment decisions, change the intensity of treatment decisions, that could be cholesterol, that could be aspirin, blood pressure, and the risk is uncertain, it’s indicated. And currently in the guidelines, there’s a so-called class 2A recommendation for these patients to get a calcium score. That means it’s favorable to do a calcium score, but it’s not mandatory. So just as you mentioned, it should be part of the physician-patient risk discussion. And if a patient says, I don’t want to take a medicine regardless of my risk, they don’t need a calcium score. But the more common scenario is a patient says, I really want to know what my risk is, doc. How can I figure that out? And a calcium score is one of the best ways of doing that. Joe 43:40-44:32 Now doctor, Dr. Blaha, we spoke with a cardiologist several years ago who said, you know, calcium, calcium carbonate, it’s like chalk. It’s hard. And yeah, it’s in that artery plaque, but it’s not that big a problem. The problem is in the softer tissue. And so it’s like when the plaque fractures and that goo that’s inside the coronary artery oozes out, that’s what causes the clot. And he was making the case for, you know, don’t worry so much about the calcium in your arteries, it’s the other stuff that’s inflammatory. How would you respond to him? Dr. Michael Blaha 44:33-45:51 Well, the good thing is I can counter that by citing international guidelines around the world that recommend the calcium score. So this is really a minority opinion, but actually there’s a lot of truth to that too. It’s true that it’s the soft plaque or it’s the partially calcified plaque that tends to rupture and cause heart attacks. So it’s true that we don’t fixate on the calcium so much, but we use calcium as a marker of your total plaque burden. You know, you can’t see soft plaque on a routine x-ray. You need a more sophisticated scan to see that, but you can see calcium on a simple scan. You can see it even on a chest CT that you get to rule out pneumonia. So we use calcium as a marker of your total plaque burden, realizing that we can’t see the non-calcified plaque. But if you have calcified plaque, you have the non-calcified plaque too. We can guarantee you that. So yes, it’s a good marker of risk. It’s a good marker of your total plaque burden, but it shouldn’t be fixated on. The calcium isn’t the problem. In other words, it’s not like how much calcium you’re eating in your diet, or I need to avoid drinking milk. That has nothing to do with it. The calcium is just a marker of your total plaque burden. It just happens to be the best marker, the most successful and cheap marker that we can use in practice. That’s why we use it. And that’s why the guidelines recommend it. Terry 45:51-46:13 Dr. Blaha, you have mentioned that one of the reasons that people might want to know their CAC score is so that they can adjust their lifestyle. And I’d really like to ask about lifestyle. What are the non-drug approaches we should all be doing to lower our risk of heart disease? Dr. Michael Blaha 46:15-47:56 Great question. I mean, I like to think of lifestyle as a two-staged approach. I mean, there are certain things that everyone should be doing, right? Everyone should be eating a generally heart-healthy diet. Everyone should be getting appropriate amounts of physical activity. Everyone should be at least conducting some moderate to vigorous physical activity. This is something that everyone should be doing. Now, I recommend this to all of my patients regardless. But really, there’s a second tier, so to speak, a second level of lifestyle intervention, right? So if a patient comes to me and they get a calcium score done and it’s very high, I’m going to sit them down and say, well, let’s really revisit that lifestyle. Let’s talk about specific ways of improving your lifestyle. Let’s talk about going further. Let’s dig into the diet and talk about specific additional changes you can make beyond the general heart healthy diet. Do we need to be moving more towards plant-based? Do we need to be removing more saturated fat from the diet? Do we need to be getting a physical trainer or a dietitian to look at you and figure out how to lower your risk? Do we need to increase your physical activity with a step counter or get some more feedback on your physical activity levels? Do you need to be increasing the soluble fiber in your diet, which can also lower the LDL? So I like to think of it as recommendations we make for everyone, and then in-depth, detailed recommendations we make for our high-risk patients. So yes, even lifestyle, we’re going to cater to the risk of the patient. High-risk patients, we’re going to do everything we can to dive into that lifestyle, to make all the recommendations to improve that risk. Now, if a patient’s low risk, we’ll probably just stick with the basics. Heart-healthy diet, get your exercise, and just maintain that for life. Joe 47:57-49:18 What I’d like to ask you about is very controversial, and it has to do with people who have done everything right. I can’t tell you how many messages we get from people who say, you know, I’m a vegetarian or I eat very, very healthy food. I exercise, I walk or I run on a regular basis. I don’t smoke. I never have smoked. My cholesterol levels are fabulous. but I had a heart attack last year. How could that be? And when we’ve heard from other people who say, I’ve been taking statins for 30 years and I had a heart attack. Come on, that wasn’t supposed to happen. And I guess, you know, I think about James [Jim] Fixx, the runner who, you know, had really cleaned up his lifestyle and he was running and boom, he dropped dead of a heart attack almost instantly. And there are a lot of people who do experience what’s called cardiac arrest with no chest pain, no elephant on the chest, no jaw pain. Can you tell us about those, what I would call sudden onset heart attacks where you can’t get them to the emergency department in time and theoretically they were doing everything right? Dr. Michael Blaha 49:18-50:50 Yeah. These are really important. This is really the goal of the preventive cardiologist. I’m a preventive cardiologist, is to reduce these life-changing heart attacks that were so-called unexpected. Now, it turns out, of course, that many heart attacks are preceded by risk factors. But some heart attacks do occur in patients without risk factors. But patients almost never experience heart attacks like this if they have no plaque in their arteries. This is why we need to use, in most patients, both risk factors and an assessment of their plaque burden, like a calcium score, for example, for risk assessment. Because we’ll see this. We’ve done studies in populations of people with no risk factors. And you know what? Some people still have highly elevated calcium scores. We’ve done calcium scores in groups of patients who have multiple risk factors. Some of them have no calcium in their arteries at all. The reality is at the individual patient level, it’s still extremely complex. And complex environment, gene, risk factor interactions that lead to your vulnerability. And that’s why we like to personalize that risk assessment with imaging. Now, there’s even a few patients who will have events even without any plaque in their arteries, but that is rare. The combination of knowing your risk factors and knowing how much plaque is in your arteries will give us the best chance of preventing these sorts of heart attacks. In our population studies, when we follow patients up and find these patients who’ve died suddenly, nearly all of them had significant plaque in their arteries up to a decade or even two decades earlier. Joe 50:50-51:47 Well, let me ask you about one other risk factor that cardiologists don’t always talk about, infections. There are now a substantial number of studies that have demonstrated that upper respiratory tract infections like COVID or influenza or pneumonia or even other infections like, oh, you might run into it with a urinary tract infection or periodontal disease where you have a gum inflammation infection. And the researchers say, well, it’s an inflammatory reaction from the infection. And that kicks off a cascade of events that leads to heart attacks and even strokes. That’s not something that cardiologists usually think about that they can do anything about, you know, preventing pneumonia or preventing the flu. Terry 51:48-52:01 But there is some data suggesting that getting vaccinated against the flu or getting vaccinated against RSV can actually lower your risk for heart disease. Dr. Blaha? Dr. Michael Blaha 52:02-53:18 Yeah, you’re speaking to really this kind of inflammatory hypothesis of cardiovascular disease, which is definitely maturing. And there’s just no doubt about it, that low-grade inflammation is a risk factor for heart disease. And I would say actually the paradigm of what you’re talking about really comes from the HIV literature. Patients with HIV have an increased risk of cardiovascular disease. And that seems to be largely explained by low-grade inflammation. So HIV is considered a risk factor for heart disease. Now, and we will treat it with a statin in all cases of HIV, regardless of other risk factors, because we know that HIV puts you at risk for cardiovascular disease. Now, it’s harder to piece together these acute infections, like you mentioned, for example, a respiratory infection or kidney infection, but multiple acute infections probably do something similar to a chronic infection or something like HIV. Put it this way: inflammation, chronic inflammation, or multiple bouts of acute inflammation are not good for the body. They raise the risk of cardiovascular disease. So to make a quick segue there, of course, one of the next big generations of therapies that hopefully will come to fruition for cardiovascular disease are the specific targeted anti-inflammatory therapies that are under development right now. Joe 53:18-53:26 I was hoping you’d say that. We only have a minute left. Can you give us a quick overview in about 30 seconds about your study of colchicine? Dr. Michael Blaha 53:26-54:05 Well, colchicine is one of those, and there’s multiple biologics on the way for inflammation. But yeah, colchicine is a drug that interacts with the so-called NLRP3 inflammasome. It’s a kind of an organelle that forms in the body in response to stress and inflammation. And this chronic inflammation can be suppressed by colchicine, and you can lower your cardiovascular risk. You also lower your risk of gout and even your risk of needing a hip replacement or osteoarthritis. So it’s linking together all this chronic wear and tear, this inflammation and cardiovascular disease together. And there’s many therapies beyond colchicine, which is great, coming for potentially be the next wave of new cardiovascular therapies. Joe 54:06-55:40 Well, colchicine has been around for decades. It’s been used for gout for a very long time. And it’s cool that you’ve done some research showing it may be beneficial for cardiovascular disease as well. Dr. Blaha, I’d like to ask you about a category of medications that people pretty much take for granted. And I won’t say everyone with high blood pressure gets put on a diuretic, but boy, a lot of people do. And they’re often combined with drugs like lisinopril, for example, or as you mentioned earlier in the show, the ARBs. So we’re talking about hydrochlorothiazide and other thiazides. There are several other kinds of diuretics as well. The idea of sodium and potassium and other minerals, which may be depleted, zinc, magnesium, when you take these diuretics, it’s a very complicated story. And it’s been our experience that not everybody gets monitored on a regular basis. They may see their doctor once a year, and they might get a blood test just before they see their doctor, but then they may go for six months or a year without getting checked for their, for example, potassium levels. And as a cardiologist, you are very much aware of what happens when potassium gets too low or too high. So tell us about diuretics and some of the possible side effects, including skin cancer. Dr. Michael Blaha 55:41-56:54 Yeah, diuretics are an important part of blood pressure therapy because many times patients with high blood pressure have so-called volume expansion. They essentially have too much volume, too much pressure, water within the vasculature, and it needs to be depleted. And a diuretic, by inducing the kidney to essentially pee out water and salt, can decrease the blood pressure. But like anything, that can come with side effects, particularly patients who have kidney disease or patients who have pre-existing electrolyte disorders. You can either be depleted in your sodium, you can retain potassium depending on the diuretic we’re talking about. All these things do need to be monitored. Usually those show up within the first several months of taking the therapy, but they can show up later too. They’re generally safe. Millions of patients take diuretics safely, but it should be checked after you start one of these therapies, your electrolyte should be checked– and should be checked on a routine basis going forward with routine labs. Once again, all medications have side effects. And with diuretics, we need to be aware of the higher risk of electrolyte disorders. And with the hydrochlorothiazide, a rare instance of skin disorders can happen. That’s also true. Joe 56:54-57:01 Can you share with us what the symptoms of low potassium and high potassium would be? Because they’re very similar. Dr. Michael Blaha 57:02-57:40 Yeah. And most of the time talk about low-grade reductions in potassium or elevations of potassium, which can be asymptomatic, but they can cause gastrointestinal problems. They can cause neurologic problems or problems with sensation. They show up with things like changes on the electrocardiogram as well. But I think I really want to make the point here that low-grade changes in your electrolytes are usually asymptomatic. So we can’t rely on symptoms to tell us. We need to check our labs. In patients on diuretics to make sure that these electrolytes aren’t getting out of whack. There can be symptoms, but there can be no symptoms too. Joe 57:40-58:25 Dr. Blaha, a lot of people have seen commercials for what I’ll call home electrocardiograms without mentioning any brands, but even the phone, iPhones, for example, can measure for something called atrial fibrillation. Sure. Why is it important to, number one, detect AFib, and B, what are the possible complications of AFib? And if you can, what can you as an interventional cardiologist do to prevent something bad happening if somebody does have AFib? Dr. Michael Blaha 58:26-01:00:16 Yeah, so atrial fibrillation is the most common arrhythmia in older adults. It’s when the top chamber of the heart starts beating irregularly, erratically. It’s fibrillating. And in some patients can cause palpitations or rapid heart rate. But in a lot of patients, actually, atrial fibrillation is asymptomatic. We have to stress that. In many patients, atrial fibrillation is asymptomatic. Now, atrial fibrillation can cause blood clots in the heart and can cause, by virtue of those blood clots going to the brain, they can cause stroke. In fact, it’s one of the largest risk factors for stroke. So this is a tricky situation. We have a very common arrhythmia that can be asymptomatic, but is associated with stroke, which is why we go out of our way to try to identify it. We’re trying to find new ways of identifying atrial fibrillation in asymptomatic patients. But this is tricky too. So things like home EKG monitors can find atrial fibrillation. They can be extremely helpful in certain patients. But in other patients, they can lead to false positive results, too. So we need to recognize all these home measurements are not as good as the EKG in the office. But many patients can show up and say, hey, I’ve seen atrial fibrillation on my home monitor, let’s check it out. I might need to be on a blood thinner. That’s what we do. For patients with atrial fibrillation, they need to be on a blood thinner to reduce that risk of stroke. It dramatically reduces the risk of stroke. But of course, it doesn’t reduce the risk of stroke if you don’t know you have AFib and you’re not taking a blood thinner. So early detection of AFib is very important. But there’s caveats there. We don’t routinely recommend low-risk patients check their heart rhythm at home. That’s probably not useful. But if you’re higher risk, or maybe you have some early palpitations, we do think it’s a reasonable idea to come get an EKG or check your rhythm at home and share that with your doctor. Joe 01:00:16-01:00:27 Dr. Blaha, can you tell us a little bit more about colchicine, this gout medicine that’s been around for decades? What did you find? Dr. Michael Blaha 01:00:28-01:01:41 Yeah, low-dose colchicine taken at a low dose in a chronic way, as opposed to the acute bouts of colchicine you take for gout, can suppress inflammation and appears to lower cardiovascular risk. One of the studies we’ve done most recently after the FDA approval of colchicine for cardiovascular risk reduction is to look to see how many patients are taking it. And it turns out colchicine has been very slowly uptaken by physicians. I think they’re still trying to get their mind around this idea of an anti-inflammatory drug for cardiovascular disease, but it appears to work on top of things like a statin and blood pressure control. So low-dose colchicine is a good option for patients who have inflammation, high cardiovascular risk, and they want to reduce their risk further. Now, there’s some side effects with colchicine too. Some patients get gastrointestinal upset. You can’t take it if you have severe kidney disease, but for other patients, the low-dose daily colchicine is a great way of lowering cardiovascular risk, but it’s not being used much. We’re still doing studies on it to understand it more. It’s in the guidelines, it’s FDA approved, but it’s still so new. We’re trying to get used to who benefits the most from this really exciting old therapy. Terry 01:01:41-01:01:51 Dr. Blaha, we understand that the FDA has recently approved a blood pressure medicine in an entirely new category. What can you tell us about it? Dr. Michael Blaha 01:01:52-01:03:08 Yeah, this is pretty exciting because we haven’t had a new mechanism of action for blood pressure in a long time. So particularly in patients with resistant hypertension who need the fourth or fifth drug, we didn’t really have any new innovations. So aprocitentan is a dual endothelin receptor antagonist. It blocks a mechanism in the body that raises blood pressure in a new way. And it lowers blood pressure, even in patients taking three or four drugs who are still having elevated blood pressure. So really it’s a resistant hypertension drug, a brand new class when we’re looking for new options. You can pick a drug like this and we have another couple drugs coming down the pipeline for resistant hypertension. So patients who have a hard time getting to go on multiple drugs didn’t used to have many good options. They could lean on an old drug or they could try to change within classes, but they didn’t have any new mechanisms of action. Now with aprocitentan or new drugs coming for aldosterone synthase inhibitors, they’re going to have new options for resistant hypertension. So resistant hypertension is in a hot new area. We’re going to have brand new options, new ways to get patients to goal. Joe 01:03:08-01:03:22 Dr. Blaha, our listeners want to know what medicine you’re talking about. Those generic names can be hard to pronounce and hard to spell. Is there a brand name associated with this new blood pressure pill? Dr. Michael Blaha 01:03:22-01:03:39 Yes, absolutely. This drug that’s a dual endothelin receptor antagonist is called Tryvio. Tryvio, T-R-Y-V-I-O. Joe 1:03:30-1:03:33 T-R-Y-V-I-O. Terry 1:03:33-1:03:36 Because you’re going to try to get your blood pressure down. Joe 1:03:36-1:03:37 Right. Dr. Michael Blaha 1:03:36-1:03:39 I guess so. I guess we all need to get more experience with this brand new drug. Terry 01:03:40-01:03:46 Dr. Michael Blaha, thank you so much for talking with us on The People’s Pharmacy today. Dr. Michael Blaha 01:03:47-01:03:48 My pleasure. Thanks for having me. Terry 01:03:50-01:04:29 You’ve been listening to Dr. Michael Blaha. He is professor of cardiology and epidemiology at the Johns Hopkins School of Medicine. He’s 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, the FDA, the American Heart Association, the Amgen Foundation, and the Aetna Foundation. Joe 01:04:29-01:04:38 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. BJ Leiderman composed our theme music. Terry 01:04:38-01:04:46 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Joe 01:04:47-01:05:04 Today’s show is number 1,450. You can find it online at peoplespharmacy.com. At peoplespharmacy.com, you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com. Terry 01:05:04-01:05:47 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In the podcast this week, there’s some information that wouldn’t fit in this broadcast. You’ll hear about the pros and cons of diuretics, especially their impact on minerals like sodium and potassium. Can you detect AFib at home? And should you? We discuss the technology that could make this possible. We also get more details on the colchicine study, as well as the new drug FDA recently approved for hypertension. What makes it different from other blood pressure pills? Joe 01:05:47-01:06:13 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. And we’d be grateful if you would consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. In Durham, North Carolina, I’m Joe Graedon. Terry 01:06:13-01:06:50 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:06:51-01:07:00 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:07:01-01:07:05 All you have to do is go to peoplespharmacy.com/donate. Joe 01:07:06-01:07:19 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Oct 22

The guest for this 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. How to Listen: You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 27, 2025. 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. Listen to the Podcast: The podcast of this program will be available Monday, Oct. 27, 2025, after broadcast on October 25. You can stream the show from this site and download the podcast for free. The podcast contains some additional information on cataplexy, sleep paralysis and kicking or moving in your sleep. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1393: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:26 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Do you wake up feeling refreshed and ready to take on the world? Or do you have to drag yourself out of bed each morning? This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:41 More than one-third of Americans say they get less than seven hours of sleep a night. Where do you fall on that spectrum? Joe 00:43-00:54 Why is it so important to get a good night’s sleep? Are sleeping pills like Ambien a good solution to insomnia? What about PM pain relievers? Terry 00:55-01:02 Some people prefer a natural approach like melatonin. Are there any downsides to taking this hormone as a supplement? Joe 01:03-01:08 Coming up on The People’s Pharmacy, how to get the sleep you need. Terry 01:14-02:39 In The People’s Pharmacy health headlines, popular drugs approved for diabetes control and weight loss have many other effects on the body as well, according to a study of veterans. The scientists analyzed health records of nearly 2 million veterans with diabetes. Approximately 216,000 of them started on a drug like semaglutide, known as Ozempic or Wegovy, or tirzepatide, known as Mounjaro or Zepbound. The database in the analysis included an average of about four years of health care, offering the opportunity to see if some conditions were less common for people on these medications, called GLP-1 agonists. The investigators looked at 175 different health outcomes. In addition to cardiometabolic disorders, the drugs were associated with a lower likelihood of clotting problems, dementia, and other neurocognitive disorders, substance use and psychotic disorders, seizures, infectious illness, and respiratory problems. On the other hand, men taking these medicines were more susceptible to kidney problems, including kidney stones, digestive disorders, including pancreatitis and gastroparesis, arthritic disorders, and low blood pressure or fainting. Joe 02:39-03:31 We don’t usually think of Alzheimer’s disease as infectious. New research suggests, though, that certain common infections may increase the risk of this degenerative condition. A study published in Cell Reports shows that a protein from the herpes simplex virus that causes cold sores increases with abnormal levels of tau. This is one marker for Alzheimer’s disease. In laboratory experiments using brain organoids, cells that produce P-tau, that’s phosphorylated tau, help protect neurons from this infection. The researchers suggest that tau phosphorylation may be part of the brain’s innate immune response to infection. Neurofibrillary tangles made of phosphorylated tau are typical of Alzheimer’s disease pathology. Terry 03:32-04:27 Household products, personal care products like body wash and shampoo, even dietary supplements contain compounds that can mimic our hormones and cause trouble. A team of researchers in Nevada asked 140 adults to collect their urine for 24 hours. Then they analyzed the samples for endocrine-disrupting compounds. People who used more products with ingredients of concern had higher levels of a specific phthalate in their urine. Those who took more supplements had higher levels of methylparaben. The people who reported their health as fair or poor had higher levels of such compounds in their urine than those who said their health is good. The scientists concluded more education among the general public is needed to make people aware of the presence of these chemicals in their everyday products so they can make efforts to avoid them. Joe 04:28-05:21 When people, especially elite athletes, exercise vigorously, they may damage muscle tissue that can lead to pain and loss of strength in the affected muscles. It can take time for the inflammation to ease and for the muscles to recover. A systematic review has found that athletes taking curcumin, the active ingredient in turmeric, recovered more quickly. Investigators included studies that featured either pre- or post-exercise curcumin consumption. Studies demonstrated better muscle recovery compared to placebo among people taking 1 to 4 grams of curcumin after exercise. The researchers conclude that curcumin demonstrates a significant potential to relieve muscle-related symptoms. It also appears to have the capability to lower biomarkers associated with inflammation and boost antioxidant levels. Terry 05:22-05:58 British researchers report that oral health appears to be associated with a lower risk of dementia. They analyzed bacteria living in the mouths of 115 older individuals. 55 of the participants were experiencing mild cognitive impairment, or MCI. Those with more Neisseria bacteria in their mouths had better visual attention and executive function, despite MCI. These bacteria were associated with better working memory among volunteers without cognitive difficulties. And that’s the health news from the People’s Pharmacy this week. Joe 06:14-06:17 Welcome to The People’s Pharmacy. I’m Joe Graedon. Terry 06:17-06:37 And I’m Terry Graedon. The National Council on Aging reports that roughly one-third of Americans have symptoms of insomnia. About 15% of us have difficulty falling asleep, and more than 20% of us have trouble staying asleep. That means millions of people feel tired most days. Joe 06:38-07:18 To learn more about how to get the sleep you need, we turn to Dr. Roger Seheult. He’s 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’s a critical care physician, pulmonologist, and sleep physician at Optum California. Terry 07:19-07:22 Welcome back to The People’s Pharmacy, Dr. Roger Seheult. Dr. Roger Seheult 07:23-07:25 Good to be here. Thanks for having me. Joe 07:25-07:43 Dr. Seheult, you are renowned as a teacher of complex medical issues, but one of the things that really surprised us was to discover that you are a specialist in sleep medicine. Could you please give us some insight as to how you got interested in this particular field? Dr. Roger Seheult 07:44-08:34 Well, it was almost out of necessity. I was a pulmonary and critical care graduate, went to a new job, and they said, you know, we need you to be basically competent in sleep medicine because of the amount of sleep medicine work that we have. So a colleague of mine helped me in terms of over-reading studies and getting me board eligible, and I took boards, and I’m board certified now in sleep medicine. But here’s the interesting thing about that is that I didn’t really think sleep medicine was that important, but when I started to study it because I needed to know it, those sleep journals became far more interesting. And it just it taught me something that things that don’t seem interesting are usually that way because we don’t personally know a lot about them. But once we study those things and start to investigate, those things become a lot more interesting. Terry 08:35-08:54 Well, Dr. Seheult, whenever we talk to generalists about what should you do to stay healthy? They always tell us that getting a good night’s sleep is essential, just like our grandmothers told us. Why? Why is getting enough sleep so important? Dr. Roger Seheult 08:55-09:32 You know, in a nutshell, I would say it’s because the actions, the properties, the reactions, the chemical reactions that occur in the body are not sustainable for a continuous amount of time. And there are many reasons why that is the case. And so what the body needs is a period to readjust, to replenish, to renew, so that it can do the same level of intensity at another period of time at some point in the future. And that’s really it in a nutshell, if we look at why people need to sleep. Joe 09:32-09:41 Well, you have used the Disneyland analogy to great effect. Could you explain why that’s relevant to sleep? Dr. Roger Seheult 09:42-11:09 Yeah, I think that’s a great analogy in a number of ways. Like if you were to go to Disneyland or it’s any amusement park for that matter, you’ll find that there are all sorts of things that are going on in during the day, during the business hours and things like the rides are working. The people are buying things from the store. The flowers are blooming. The weeds are also growing as well. All these things are not sustainable continuously, right? So if you were to go to a gift shop, you can buy things off the shelf, but somebody has to replenish those things. The rides can only run so many times before the engineers need to test it and make sure that it’s safe. The weeds can only grow so many hours before they have to be removed. And so again, it’s a situation where there is things that are happening that cannot continue on a continuous basis unless something has an intervention. And I brought this up because my friend used to work at Disneyland and he worked at night. It’s kind of an interesting thing. He would work at night after the park closed. And during that process of renewal, it was a complete transformation of the park. There were people such as engineers working on the rides. There were gardeners coming in, trash people were emptying the cash registers, replenishing the stock on the shelves. All of these things were essential if you wanted the park to open up the next day at eight o’clock in the morning, brand new, ready for visitors. Terry 11:10-11:25 Well, Disneyland has at least those two different phases of daytime and nighttime, but we understand that sleep has separate stages as well. Could you briefly review those for us? Dr. Roger Seheult 11:25-11:39 Yes. So sleep is basically divided into two major categories. There’s REM sleep and there is non-REM sleep. And that’s just to show you how important REM sleep is, is because there’s REM sleep and then there’s everything else. Joe 11:39-11:42 And what does REM stand for, please? Dr. Roger Seheult 11:42-13:09 Yeah. REM sleep stands for rapid eye movement. And it was named that because that was the most obvious thing to researchers when they first started to look, is that patients when they were in REM sleep had this rapid eye movement that they could see very clearly through the eyelids. But a lot more is going on in REM sleep. And that’s not to say that non-REM sleep is unimportant. In fact, it’s extremely important, as we’ll talk about. But those are the two major phases of sleep. And even to just back up even more in terms of talking about this idea of Disneyland and there’s a nighttime and a daytime. And this goes to an even bigger issue or idea, and that is of circadian rhythm. If you can imagine that there’s an orchestra and there’s a conductor conducting the different players in the orchestra, sleep would be one section of the orchestra, but there’s a whole host of other players in that orchestra that are supposed to be doing things exactly in time with what is going on with sleep. And so the conductor is conducting these things. Sleep is essential to have. You can’t play Beethoven’s Ninth Symphony without the string section, But on the other hand, you also need the choir to be singing. And these are other processes that are occurring in the body that work best when sleep is occurring. And it maximizes the regenerative effects of all of these things. Joe 13:10-13:29 Well, you mentioned REM, rapid eye movement sleep. And I think a lot of us associate REM sleep with dreaming sleep. And then there’s these other stages of sleep, deeper sleep. Give us a little background on all the different stages and what’s going on. Dr. Roger Seheult 13:30-16:47 Yes. So there’s a stage of sleep that you go into immediately right under the surface when you’re sort of in that twilight that has what we call alpha waves and it’s stage one. It’s sort of a transitory sleep and usually lasts just a brief moment before it goes into something more substantial. And that would be stage two sleep. Now, stage two sleep is a non-REM sleep, but it’s kind of a boring type of sleep where yes, you are asleep, but you’re not really getting the effects of REM sleep or even this deeper sleep that we’re about to talk about, which is slow wave sleep. So slow wave sleep would be like a stage three or known as N3. And this slow wave sleep is a type of non-REM sleep where you have a lot of physical restorative functions. This is where, for instance, growth hormone is released and it has an effect on the human body. This is the type of sleep that you get that makes you feel well-rested. It gives you that feeling of being well-rested when you get up in the morning. And unfortunately, this type of sleep gets more rare as you get older. It’s very abundant in children, infants, teenagers even. But as you start to get into your 20s, 30s, 40s, it starts to decrease substantially. And that’s a normal thing to have happened. Finally, there’s REM sleep. Now, REM sleep is very unusual to people looking at it electrically. If you were to look at the electrical signals of the brain, REM sleep actually looks very similar to being awake. As you mentioned, it’s when you dream. And as a result of you dreaming, you don’t want to be acting out your dreams. And so one of the principal characteristics of REM sleep is paralysis. So the patient doesn’t move. They may think that they’re trying to move, but they don’t move. And this paralysis, this relaxation of the muscles is a very good thing because you don’t want to be acting out dreams. But on the other hand, it can also cause issues with people, for instance, with sleep apnea who really depend on the tension or the tone in their airway muscles to keep the airway open. And that’s another topic that we can talk about with sleep apnea. But these are all things that are associated with these different stages of sleep. Now, just to further on that understanding of sleep, there’s a specific cycle that one goes through as they sleep normally. And that would typically be stage one, stage two, and then it might go to stage three, and then maybe back up to stage two. And then eventually, probably usually about 90 minutes or so into sleep, you’ll hit your first REM sleep, which is very, very short. And then you do these cycles throughout the night, like I just mentioned. And as the cycles go through the night, the deep wave sleep, the slow wave sleep, the N3 becomes less and less common. However, the REM sleep as you go throughout the night becomes more and more common. And this is the reason why, for instance, your dreams, you typically are what you experience in the morning hours right before you wake up. Joe 16:48-17:06 Dr. Seheult, you have referred to this Disneyland analogy of getting rid of the, for example, the garbage is picked up at night and the weeds are removed. Is there something similar during sleep? Is that garbage removal going on? Dr. Roger Seheult 17:06-17:39 Oh, absolutely. Yeah. So there is lymph that is the byproduct, sort of the sewer system of the cells of the brain. And there are proteins. You might have heard of these type of proteins that’s involved with Alzheimer’s disease. Sleep is a time where the brain and its lymphatic system is able to get rid of those byproducts of thinking, those byproducts that can accumulate if they are not taken care of. There is definitely a very good analogy in terms of taking out the trash. Absolutely. Terry 17:40-18:15 You’re listening to Dr. Roger Seheult. He’s 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 practices in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. He’s co-founder of MedCram.com, where he presents complex medical concepts with clarity for both health care providers and patients. Joe 18:16-18:19 After the break, we’ll explore the side effects of some sleeping pills. Terry 18:20-18:22 If a medicine suppresses REM sleep, is that a problem? Joe 18:23-18:25 We’ll also find out how much sleep we really need. Terry 18:25-18:28 Sleep apnea can disrupt sleep. What are the best treatments? Joe 18:29-18:33 Does worrying about getting enough sleep keep you awake? Terry 18:39-18:43 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:16 And I’m Terry Graedon. Joe 19:16-19:27 How would you know if you’re sleep-deprived? Do you wake up feeling refreshed, or do you have trouble dragging yourself out of bed most days? Does it even matter? Terry 19:28-20:02 To learn more about how to get the sleep you need, we’re talking with Dr. Roger Seheult. He’s 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. His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult is also co-founder of MedCram.com. Joe 20:04-20:20 Dr. Seheult, there is a side effect of some medications. I think if my memory serves me correct, it would be the SSRI-type antidepressants, that they can actually suppress dreaming–or REM sleep. Are there any consequences to that? Dr. Roger Seheult 20:21-21:43 Yes. So SSRIs are one type of medication that can do that. There are others like benzodiazepines that can also do that. And they will suppress REM sleep. And in fact, there is actually a therapeutic use of these medications in that type of situation. If a patient, for instance, has an issue with a REM sleep disorder, and that would be a situation, for instance, where they’re not paralyzed and they act out their dreams, this may be an indication where you want to give a medication that suppresses REM sleep in that particular situation. But outside of that rare situation, we look at the ability of SSRIs and benzodiazepines of suppressing REM sleep, not as a good thing, but as a bad thing, but not necessarily absolutely contraindicating in that situation. We might notice that the patient may dream less, but I don’t believe there’s been any studies that have correlated a chronic reduction of REM sleep to any long-term effects down the road, which is interesting. And it could be simply because we don’t have the right studies or we don’t have enough studies to show that type of detriment to chronically suppressing REM sleep. Terry 21:44-21:52 Dr. Seheult, we’ve talked a bit about why sleep is so important. How much sleep do we actually need? Dr. Roger Seheult 21:53-23:06 Well, that’s a very good question. We have done studies that have looked at how long someone sleeps and the type of outcomes that occur from that. Now, you should realize, of course, that that’s a correlation type of study and not a causation because we’re not randomizing and doing it prospectively. We’re looking at who has what type of lifestyle in terms of sleep and what are the outcomes? And what we find actually, interestingly, is a bell-shaped distribution. We find that people who sleep too little have poor outcomes–they don’t live as long. But we also notice on the flip side that people who sleep too long can actually have the same effect. We believe that’s because these people are medically ill to begin with, and they may sleep quite a lot because of that. But if you look right in the middle, the people that seem to live the longest have the least amount of issues are the ones in terms of adults who sleep between seven and eight hours a night. And that seems like a lot, but according to research, about 50 to 60% of the population get about that amount of sleep, which is not much. Joe 23:06-23:21 That suggests that a lot of people are not getting enough sleep. And you mentioned that they may not live as long as those who do get enough sleep. And I’m curious, what are some of the other negative outcomes of not getting adequate sleep? Dr. Roger Seheult 23:21-24:21 Oh, yeah, this is a very wide list. I mean, cardiovascular, immune, let’s talk about immune system. We have very good studies and they’re actually randomized and controlled that show that even one night of loss of sleep can completely change hundreds of proteins in the body that regulate immune system, that regulate your metabolic health, et cetera. We know that, for instance, here’s a study that was done out of the University of Pittsburgh where they took people who were about to get the flu vaccine and they basically looked at how many hours of sleep they had gotten in the last week or so. And those that had gotten seven to eight hours of sleep at least had twice the levels of antibodies against the flu vaccine after vaccination than those that did not get seven hours of sleep. Terry 24:22-24:24 How can you tell if you’re getting enough sleep? Dr. Roger Seheult 24:26-25:33 It’s hard. It’s easier, interestingly, when you’re young, because young people don’t mask the effects of lack of sleep as well as older people. That may be an advantage for older people because we seem to mask it better. We’re seeing the cope better with lack of sleep. But if you’re trying to see whether or not you have a lack of sleep, it may actually not be a good idea to see and use that by itself. So the bottom answer is basically it’s hard to tell. There are a number of questionnaires that you can take that are available online. One of them is called the Epworth Sleepiness Scale. That’s one way of looking at it. And they just basically ask you what is the likelihood that you would fall asleep in certain situations. And you add up the numbers and you get a number and you can look at the scale to see if that is excessive or regular or even not too excessive. But it’s not as direct and distinct as one might think. It’s possible to have a normal Epworth sleepiness scale score and still have some chronic sleep deprivation. Terry 25:34-25:47 Do we need different amounts of sleep at different times of our life. For example, I’m assuming that we all know that babies need a lot of sleep. Do older people need a lot less sleep? What about teenagers? Dr. Roger Seheult 25:47-26:27 Yeah, exactly. Great question. So once you hit adulthood, like 18, generally the recommendations based on the data recommend seven to eight hours of sleep per night. And that goes throughout the life. But you’re absolutely right. So newborns need probably about 14 hours of sleep based on the recommendations. And from there, it goes down so that when you’re school age, you’re talking 10 hours, 12 hours of sleep, which is, if you think about some of the kids that we have in school today, I know my kids, they would be hard pressed to routinely get 10 to 12 hours of sleep, but yet that’s what the data shows. Joe 26:27-26:36 How about these older folks who say, well, I only need five or six hours of sleep a night. I’m doing fine. Or are they kidding themselves? Dr. Roger Seheult 26:37-27:36 Yeah. So I see this all the time and I have people in my sleep lab, sleep clinic, and for instance, with sleep apnea, which not only impedes, could impede the quantity, but also the quality of sleep. And for whatever reason, They don’t feel that they are that sleepy. But when we make the diagnosis and they’re able to get on treatments and we’re able to get them the sleep that they need, they tell me, they say, I never realized how sleep deprived I actually was until I was able to treat it and see what life was like before. It’s very easy to assume that the feelings that you’re having of sleep deprivation, which would be fatigue, inability to concentrate. These are very mild symptoms, but add it all up, they can really impede our quality of life. And until you actually show that that is not necessarily something that goes along with age, but lack of sleep, it’s very difficult to demonstrate that. Terry 27:37-27:47 Well, you have just mentioned sleep apnea, and I hope that you will tell us what that is and what anyone could do about it. Dr. Roger Seheult 27:47-28:47 Yeah, so sleep apnea is quite a common problem. It’s becoming an increasing problem. And it’s basically where when you are sleeping at night, the airway muscles that are responsible for keeping the airway open, they relax to the point that they collapse and close off. And usually they can become very close to each other right before they collapse. And as air is being sucked into the lung, they’ll cause a vibration that we commonly know as snoring. So people who snore may be at increased risk for sleep apnea. But sleep apnea specifically is where no air is going into the lungs for a long period of time. And this can cause a drop in oxygenation, which then excites the brain because it doesn’t like to see that. And that causes a sympathetic release of things like norepinephrine, epinephrine. And this down the line causes cardiovascular consequences, which can lead to an early death, cardiovascular disease, things of that nature. Joe 28:48-29:26 And what to do about it? I mean, I’ve got a dear friend who had a major jaw surgery. I mean, he had to eat out of a straw because his jaw was wired shut for many, many, many weeks. But I know that there are sleep apnea machines, CPAP machines, and there’s been a lot of controversy about one particular company and how there were particles of the foam that’s keeping the sound down that where people were inhaling them and there were lawsuits. Give us the quick overview of what you do for your sleep apnea patients. Dr. Roger Seheult 29:26-31:16 Yeah. So there are a variety of things that can fix sleep apnea or at least treat it. And it all boils down to the issue that in most cases, the tongue or the tissue is falling back into the back of the throat and it’s causing the area to collapse. So because the tongue is attached to the jaw, the lower jaw, if we were to advance the jaw forward and either allow more room for the tongue or to pull the tongue forward or to put a basically a mask over the person’s nose or mouth or both to gently put air in to open up that airway and the patient to breathe, all of these are ways of overcoming the collapsing of that upper airway. And so if that is done, the patient is then able to breathe without oxygen desaturation. You don’t get the arousals coming out of sleep. You don’t get the cardiovascular consequences. Now, the CPAP machine, which is one of those most common actually used and probably the most effective, is a machine that does that. It basically, thinking about inflating a flat tire: So you plug the hole, you put the machine on, and it gently puts in enough pressure just to keep the anterior portion of your airway off the posterior portion of your airway so that air can come in and out without being obstructed. And so, yeah, there was a issue with the CPAP machine, some of them, where there was a foam that was breaking down and there was a possibility that these particles were going into the lungs and causing issues. I think that that is still theoretical. I haven’t seen any hard data that shows that that is actually happening, but it is a possibility. Joe 31:17-31:28 A lot of people complain that they don’t much like their CPAP machine and they give up on it. Do you have any brands or any products that you especially like and are there any other strategies that also work? Dr. Roger Seheult 31:28-32:37 Yeah. So I believe that the best way to overcome those is to dig down deep and to find out exactly what the issues are. Some people have issues with the CPAP machine because they don’t like the sensation of breathing against pressure. And there are ways of helping that where you can actually reduce the pressure at the end of exhalation to allow it to be more comfortable. Other times people have air escaping around the mask and blowing into their face. Well, there we just need to work on a fit. So there’s a number of different complaints and it’s not just one issue. Now, if a patient completely doesn’t want to use a CPAP mask, there is for some people a dental device that we can use where we can advance the jaw forward as we’re mentioning. There are some side effects to that, but that’s another option. There’s even an option that uses an implantable device that stimulates the nerve that goes to the muscle that protrudes your tongue so that when you are sleeping, this electrical stimulation will move the tongue forward off the back of the throat. That requires implantation of a device and some surgery. Joe 32:38-33:20 Now, I do have one other question, and that has to do with what I call the trouble sleeping and the worry that goes with trouble sleeping. And that applies to people with sleep apnea, but it also applies to a lot of people with insomnia. In other words, I’m trying to fall asleep. I’m trying to fall asleep because if I don’t sleep, I’m going to have all these health problems. And now I can’t sleep because I’m worrying about falling asleep. Or if I wake up at three in the morning, I go, oh, no. It’s three in the morning. I got to go to sleep. I’ve got a busy day tomorrow. And now I’m worrying about not getting enough sleep. So it’s the worry part of it. How do you handle that for your patients? Dr. Roger Seheult 33:21-36:23 Yeah, this is a common problem. It’s known as psychophysiological insomnia. And the way I analogize this is imagine you’re going onto the stage of Carnegie Hall. And instead of playing the Moonlight Sonata in front of a packed house, there’s a bed on stage and you’re asked to go into that bed and fall asleep. That’s what it’s like. That’s what you’re describing. It’s like there’s a performance that you’re about to have and you’re very anxious about this performance. But unfortunately, the performance is sleep and anxiety is the absolute worst thing to have. The reason why this happens, and by the way, one of the symptoms of this that’s very common is someone might feel very sleepy in their kitchen or in their living room and say, it’s time for me to get to bed. And as soon as they walk into their bedroom, they are wide awake and they can’t fall asleep. And this has something to do with behavior that has antedated this, that has happened before, where people might have had some sort of an issue in their life, some sort of stressor. And what they did was they tried to go to sleep earlier and they went to the bedroom when it wasn’t time to sleep or they brought something else into the room to do so that they could try to get better sleep or get more sleep. And it’s because of this idea that the more sleep that they get, the healthier they’re going to be. And they’re very fixated on that, as you described. The problem with this is that whenever you try to go into that bedroom and you’re going to be set up for failure, you’re going to associate those failures with the surroundings in your bedroom. It’s sort of a subconscious issue so that whenever you walk into that bedroom, all of those subconscious fears, anxieties are going to come back. And so the way we deconstruct that is, first of all, that term is actually known as cognitive behavioral therapy for insomnia, or CBTI. And this is what we do on patients that have this issue is we decatastrophize the issue. For instance, if they said, I know that sleep is very important for my life. And if I don’t get enough sleep, I’m going to die if I don’t get sleep. And then I would just simply ask them, how long have you not been able to sleep? And they would say something like, oh, it’s been two years, three years. And then I would say, and you’re not dead yet. You’re still here. And so we tried to show that we’re taking away a lot of the excessive anxiety associated with trying to go to sleep. And then, of course, we try to deconstruct the subconscious so that we only have successes in the bedroom. So in other words, we take out all of the things that they would normally be doing in the bedroom, like working on a laptop, watching television. And we say that if you can’t sleep, then you need to get out of the bedroom, go to another part of the house so that when you’re ready to go to sleep, you can come back to the bedroom. And then what we start to do is associate successes with the bedroom so that when they walk in the next time, they’re not going to be having these flood of subconscious thoughts of anxiety. Terry 36:23-36:58 You’re listening to Dr. Roger Seheult, Associate Clinical Professor at the University of California Riverside School of Medicine and Assistant Clinical Professor at the School of Medicine, and Allied Health at Loma Linda University. Dr. Seheult is certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine through the American Board of Internal Medicine. Dr. Seheult is co-founder of MedCram.com, where he presents complex medical concepts with clarity. Joe 36:59-37:07 After the break, we’ll find out about some common behaviors that are not helpful for sleeping. Are any of them keeping you awake? Terry 37:08-37:11 How can you use melatonin to work with your circadian rhythm? Joe 37:12-37:19 Some things like vigorous exercise or a big meal should be managed earlier in the day rather than just before bed. Terry 37:20-37:25 Are over-the-counter sleep aids safer or better than prescription sleeping pills? Joe 37:25-37:31 We’ll also find out what to do if you wake up too early and can’t get back to sleep. Terry 37:39-37:55 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon. Joe 37:55-38:18 And I’m Joe Graedon. Terry 38:19-38:39 We’re trying to help you get a good night’s sleep today on The People’s Pharmacy. Have you been taking a PM pain reliever to help you get to sleep? Millions of Americans have turned to over-the-counter medications such as Advil PM, Aleve PM, or Tylenol PM. What else could you use for better sleep? Joe 38:39-39:18 We’re talking with Dr. Roger Seheult. He 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. His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult is co-founder of MedCram, an online resource that explains complex medical conditions in understandable language. Dr. Seheult developed an impressive following for his COVID-19 presentations. Terry 39:19-39:56 Dr. Seheult, I want to ask you about some behaviors that I think have become pretty common, and I read that they’re not very helpful for sleep. What’s your take? One is watching our little screens, our tablets or our phones, watching something interesting on the screen. And the other is using those very same devices just to listen. A lot of people say, oh, I woke up in the middle of the night, I couldn’t get back to sleep, so I started to listen, and it put me to sleep. Dr. Roger Seheult 39:57-41:15 Yeah, so those are two very different sensory inputs to our brain. The first one being vision is unfortunate because there are ganglion cells in the retina that when they are stimulated at a particular time of your circadian rhythm, at night particularly, it’s going to inhibit the secretion of melatonin, which is a very important antioxidant that the brain and the body uses at night. So that’s one reason why that’s a bad idea. The other reason is, is that in doing so, in visualizing bright light, especially after nine o’clock at night, it tends to delay your circadian rhythm, which means that things that would normally happen at nine are eventually going to happen at 10 and 11. And that’s a recipe for falling asleep naturally later, which means that if you wanted to go to sleep earlier, you would not be able to, and that might cause you some insomnia. Now, in terms of listening to things, I think that that’s fine. Some people need white noise to fall asleep. I used to fall asleep listening to classical music, which I loved. And I don’t think there’s a lot of evidence that shows that that’s detrimental. We do have lots of data showing that light exposure, light pollution, light surroundings at night, is not good. Terry 41:15-41:22 Let’s talk a little bit about melatonin, which you just mentioned, and circadian rhythm. What should we know about this? Joe 41:22-41:41 There are an awful lot of people who think, oh, I’ll just take 3 milligrams. Oh, if 3 milligrams is good, I’ll take 5 milligrams. Oh, wait a minute. Now there’s a 10 milligram melatonin pill or a gummy. And I know a lot of parents are giving their kids melatonin. So give us the melatonin upbeat. Dr. Roger Seheult 41:42-42:39 So yes, melatonin is not, the adage that if a little is good, more is better does not work with melatonin. In fact, it actually makes it less effective. So the most effective doses are actually the lower doses. And giving melatonin is not a bad idea if you want to change your circadian rhythm. If you want to advance it, for instance, taking about 3, 5 milligrams, even less in the evening is actually very helpful for jet lag, especially if you’re going to travel east. We actually talk about that in our MedCram channel. The thing about melatonin is that less is better and more is not generally as good. The other thing I would mention too about melatonin is that it’s not controlled by the FDA. So if you’re going to get melatonin, make sure you get it from a reputable corporation or company that it gets third-party testing that shows that what you’re actually getting is melatonin. Terry 42:40-42:54 Dr. Seheult, on your MedCram channel, you have talked about a “zeitgeber,” which sounds like a fancy German word. Maybe you could explain to us what it is and how we should approach it. Dr. Roger Seheult 42:55-43:39 A zeitgeber, yes. A zeitgeber is something that affects your circadian rhythm. Your circadian rhythm is this thing that is running. It’s the conductor in your brain that is conducting the orchestra. And it needs cues from its environment to make sure that it is setting things off at the right time. Well, it needs to know when it’s day and when it’s night. So the biggest zeitgeber is actually the light in your eyes. But there are other zeitgebers. For instance, when you eat, when you do social things, these are all cues– not as strong as light though is. And that’s why it’s important that if you want to maintain a very sound circadian rhythm, that you don’t confuse it by giving light to your eyes when the sun is down or vice versa. Joe 43:40-44:29 Well, let’s talk a little bit about that cycling stuff because we’ve been told that intermittent fasting is good for us, helps us lose weight, might be good for cardiovascular functioning. And I’m just wondering, well, when should we stop eating before bedtime? Dagwood Bumstead used to make his famous sandwiches in the middle of the night. What happens if we eat right before bed? And then what about exercise? A lot of people think, well, I’ll just hop on the stationary bike before I climb in the shower or maybe whenever just to get a little, you know, that extra time on my smartwatch, and complete all my rings. So exercise and food. Dr. Roger Seheult 44:29-46:40 Yeah. So, and this again gets back to what we were saying with the orchestra and the conductor. So the string section is sleep and the circadian rhythm. The conductor is the circadian rhythm. And then the other players of the orchestra are like the metabolic factors. And so what you want to do is you want everyone playing at the same time. That’s when you are in concert, literally when everyone is playing together. And so there are processes that occur in the human body that happen best and most when you’re sleeping, and they correspond best to processes that are regenerative at night and when you’re sleeping. The problem is, is that that regenerative force, for instance, the regenerative processes are shut down when the body is digesting. And so there’s this understanding that it is best to not be digesting food or storing that food when you are sleeping. Because it takes about four or five hours for food that is ingested to pass through the system and to make sure that that is dealt with, there is this understanding that it’s best not to be eating after five or six o’clock in the evening. For some people, maybe seven. And that concentrating calorie intake in the morning is best to allow the processes that occur at night to occur maximally and to do what needs to happen. There’s actually some really good research on this in terms of cancer, in terms of metabolic health. We know, for instance, that the time of day that the body is most sensitive to insulin is in the morning time. In other words, you can have a calorie in the morning and it is metabolized differently than a calorie in the evening. We know that, for instance, women who have had breast cancer and are looking to see if they’re going to get a recurrence in breast cancer have a 30% reduction in breast cancer recurrence if they intermittently fast for at least 13 and a half hours a day. And so there is some of these study endpoints, but this is the understanding and the idea behind intermittent fasting and making sure that things are lined up in a circadian way. Joe 46:41-46:42 And what about exercise? Dr. Roger Seheult 46:43-47:24 Oh yeah. So exercise goes perfectly along with that. Exercise, interestingly, we used to say that exercise any time of day that you want, but we’re now understanding that the best time of day to exercise based on circadian rhythm and the benefits of that is actually in the morning time. That’s when cortisol levels are the highest. That’s when your body is set up for that. But I would add, and the studies have shown this, that not exercising at all is worse than exercising in the evening. So if it’s the only time that you have to exercise because of your schedule, I would definitely not drop exercise if the evening time is the only time you can do that. Terry 47:25-47:52 So it sounds like the deck is stacked in favor of the people who can leap out of bed, enjoy their breakfast, go out and exercise, and not so much for those who drag themselves out of bed and aren’t hungry until the middle of the afternoon. Let me ask about people who have a hard time falling asleep. There are a lot of them. What can you do to help them? Dr. Roger Seheult 47:53-49:52 Yes. So it depends on what the issue is with their sleep. For some people who have difficulty falling asleep, oftentimes their mind is racing and they cannot fall asleep because they have so many things on their mind. Other times it’s related to pain or it could be their environment or surroundings. So what we do is a very detailed inventory of what’s going on, but here’s some general things that we can do. If you have a lot of things on your mind, write them down, put them on a piece of paper next to your bedside. This gives you permission, your brain almost, to put those aside and to put them out of your brain because you know that you’re going to pick them up again in the morning time. Other things that you can do to make sure that you can fall asleep well is to increase the drive subconsciously that your bedroom is time to sleep. So I would often tell my patients this, and it’s kind of humorous, but really the only two things that you ought to be doing in the bedroom is sleep and sex. That’s it. And if you go into the bedroom and you can’t sleep, hey, the alternative is not so bad. That usually gets a chuckle out of them. But what we’re saying here is that what we want to do is that when you walk into that bedroom, we don’t want to distract you with things like, oh, it’s time to maybe open my laptop or it’s maybe time to watch television or maybe I’m going to work on that book a little bit. For people who have no problem falling asleep, knock yourselves out. That’s fine. But for people who do have an issue falling asleep, these are some things that you can do to stack the deck in your favor. And for those who still have issues after these type of lifestyle changes, there are things that we can do, but usually it has to be supervised by physicians visit to visit. One of those things is called sleep restriction therapy, where we actually basically sleep deprive someone so much so that they start to fall asleep. And when they start to fall asleep quickly, they start to get confidence that they can fall asleep. The anxiety goes away and then the issue goes away. Terry 49:54-50:07 Well, one thing that a lot of people do if they’re having trouble falling asleep is take a medication. Some of those medications are prescribed by doctors. Some are over the counter. Give us your evaluation, please. Joe 50:07-50:20 And in particular, Dr. Seheult, those PM pain relievers, Tylenol PM, Advil PM, Aleve PM, there’s so many PMs out there and they all contain diphenhydramine. Dr. Roger Seheult 50:21-51:16 Yes, they do. And this is the bane of our existence is people who have difficulty falling asleep and they’re almost all of them are on some sort of sleep aid at night. And I’ll tell you, honestly, it’s the last thing that I change because if I take that away, it’s going to make them less likely to fall asleep. But it is one thing that I do eventually do when they are able to fall asleep. My goal is to get them off of those sleeping medications. Now, specifically, when you are talking about things like diphenhydramine, these are antihistamines. I hate these with a passion. They may give you the sensation of falling asleep and feeling sleepy, but we do have some evidence that chronic antihistamine use over a long period of time can lead to things like dementia. And we do have evidence of that. And I would not recommend long-term use of Benadryl, antihistamines, things of that nature. Joe 51:17-51:44 Very briefly, Dr. Seheult, you have talked about the value of heat for immune stimulation. And saunas, for example, and they even used to have that therapy when people came down with influenza during the big flu epidemic. What about heat prior to bedtime, like a hot shower, and then you cool down just before getting into bed? Dr. Roger Seheult 51:44-52:24 Yeah, this is something that works very well. Actually, there’s been some recent research on this. The idea of this is that your core body temperature cools down to a level that is the lowest at around, for those who have a normal circadian rhythm, at about three, four o’clock in the morning. And so by heating the body up and then cooling it down and being in a room that is generally cooler than when you started, the idea is to help the body get to that point and to improve sleep. If you’re sleeping in a room that is warmer than usual, then that could impede the body’s ability to get to that sleep state. Terry 52:24-52:34 Speaking of three or four o’clock in the morning, a lot of people complain that they go to sleep just fine, but they wake up and they can’t get back to sleep. Any help for them? Dr. Roger Seheult 52:34-53:34 Yeah. So this takes some investigation. Oftentimes it may be, and I see this quite often, that they will only have sleep apnea with REM sleep. As we talked about, REM sleep is when you become paralyzed. And if the patient is going into REM sleep and causing the airways to become even more relaxed, maybe that’s when they’re getting the sleep apneas that are waking them up. And because REM sleep typically happens in its largest amounts and frequency at around three or four o’clock in the morning, that would be one of the things that I would consider in those type of patients. The other thing that also is a possibility is that they could be very sleep shifted. So in other words, their circadian rhythm could be shifted very early. We see this often in elderly patients. They fall asleep at 7 or 8 o’clock at night, and they might feel like they need to wake up at 3 or 4 o’clock in the morning. By getting that type of history, we can actually shift their circadian rhythm so that they get into a more normal circulatory system. Terry 53:35-54:11 Dr. Seheult, you have just suggested that during REM sleep when we’re dreaming, our bodies are not moving because we have to be paralyzed so that we’re not up and running around and doing all the things our brain thinks we’re doing during that dream. We don’t want to hurt ourselves running into walls or doors or anything like that. What about people who aren’t perfectly paralyzed during their dreams? Who do punch or kick or move around, is there anything that can be done for them? Dr. Roger Seheult 54:12-55:27 Yes. This is a condition known as REM behavior sleep disorder. And this is usually diagnosed with a sleep study that shows unequivocally that the patient is in REM sleep, but there is still movement and motion and activity. The first thing that I do in these patients is to make sure that they’re safe. I usually have them sleep in a sleeping bag as a precaution until we can get them the proper treatment. Now, it used to be that we would put these patients on benzodiazepines, particularly clonidine, usually, sorry, Klonopin [clonazepam], half a milligram to one milligram every evening. But the evidence seems to be showing now that actually, believe it or not, melatonin is actually quite effective for these patients. The caveat here is that many of these patients who develop this REM behavior sleep disorder on some cohorts and some studies have shown that they’ve gone on later in life to develop Parkinson’s disease. And so this may be a early signal of some degeneration of the neurons that are keeping the patient paralyzed. And this may be a sign of further degenerative disease down the road. Terry 55:28-55:33 What kind of workup would a person in this situation ideally get? Dr. Roger Seheult 55:34-55:59 I think the first thing to do would be to take a history. And if the history is suggestive, then the next thing would be is to order a polysomnogram, which is a look at specifically them at night. And I would add a video as well so that the scorer or the person reading the study would be able to correlate the movement of the patient while they’re in REM sleep. Joe 56:01-56:19 Dr. Seheult, sleep paralysis: some people wake up, but their body is paralyzed. It can be a very scary experience. What’s that about? And is there anything that can be done about it? Dr. Roger Seheult 56:20-57:16 Yes. So this is almost the opposite problem of what we were just discussing. This was an issue where someone was asleep and not paralyzed. And what you’re referring to is when someone is awake and paralyzed. And it has to do, again, with REM. REM sleep is where someone is asleep and they are paralyzed. And what’s going on here is that there is a dysregulation of the entrance of REM sleep into the patient so that here the patient is waking up, but one aspect of REM sleep is allowed to continue and the other part is not. In other words, the paralyzation portion of REM sleep is allowed to continue, but not the sleep portion of REM. And that’s something that we would see in, for instance, somebody with narcolepsy, but it is not specific to narcolepsy. You can also see that in people who are just very sleep deprived, for instance, or other medical conditions. Joe 57:18-57:19 And is there anything that can be done for them? Dr. Roger Seheult 57:20-58:23 Yes. So REM suppressive medications will work in this type of a situation. If it is narcolepsy, there are a number of strategies for treating that. If the patient also has cataplexy, then sodium oxybate is a treatment that has been used for many years with good success. And not only treating cataplexy, which is this idea of paralysis. Again, cataplexy would be this type of symptom where someone is awake, alert, they’re walking around. And there’s a trigger that causes that aspect of the neurons of REM sleep to kick in where they start to feel weak and they’re ready to collapse. So dropping a cup when someone says a joke or falling to their knees when someone says something funny or emotional, this would be a trigger and that would be diagnosed as cataplexy. That is very specific actually for narcolepsy, so much so that you could almost actually just make the diagnosis of narcolepsy based on that symptom alone. Joe 58:23-58:31 We’ve heard of people falling asleep, walking across the street and collapsing in front of traffic. Pretty scary stuff. Dr. Roger Seheult 58:32-58:43 Yes, it is. Although it’s pretty rare for someone to actually fall asleep. It’s usually uh, collapsing but still being awake. But yes, it’s possible. Joe 58:44-58:54 We just have one minute left, Dr. Seheult. Your overview, the importance of sleep and what people can do if they’re having problems. Who do they go to? Dr. Roger Seheult 58:54-59:34 Yeah, so sleep is important. It’s something that you do for a third of your life, hopefully. If you’re not doing it, you’re not getting the restore to benefits of it. Look, we all have issues trying to get enough sleep. We live in a technological society where it seems as though everything is working against us getting a good night’s sleep. But if we prioritize it, we can make some inroads and have better health. If you’re not getting enough sleep, you need to talk to your doctor and let them know that you’re not getting enough sleep if the things that we’ve discussed and regular lifestyle changes that you can do in your own life aren’t working. And if they can’t help, then you can also be referred to a sleep specialist if there needs to be further testing done. Terry 59:35-59:40 Dr. Roger Seheult, thank you very much for talking with us on The People’s Pharmacy today. Dr. Roger Seheult 59:41-59:41 Thank you so much. Joe 59:42-01:00:33 You’ve been listening to Dr. Roger Seheult, and let me spell that. It’s S-E-H-E-U-L-T, Seheult. He’s 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’s a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult is co-founder of MedCram.com. Terry 01:00:34-01:00:43 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Joe 01:00:43-01:00:50 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Joe 01:01:12-01:01:28 Today’s show is number 1,393. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interviews. You can also reach us through email radio at peoplespharmacy.com. Terry 01:01:29-01:01:46 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning with additional information on why people kick or move in their sleep, as well as sleep paralysis and what can be done for that. Joe 01:01:46-01:02:04 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast so you can find out ahead of time what topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon. Terry 01:02:05-01:02:38 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:02:39-01:02:48 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:02:49-01:02:53 All you have to do is go to peoplespharmacy.com/donate . Joe 01:02:54-01:03:07 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Oct 16

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. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 20, 2025. 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 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, Oct. 20, 2025, after broadcast on Oct. 18. You can stream the show from this site and download the podcast for free. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript of Show 1449: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Have you ever worried about your weight? Have you considered the new GLP-1 drugs? Do they help control cravings? This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:46 Today we talk with a former FDA commissioner. Like many of us, Dr. David Kessler has had trouble controlling his weight over the years. He’s utilized the new drugs to overcome his nighttime food cravings. Joe 00:47-00:53 Dr. Kessler’s new book is Diet, Drugs, and Dopamine, the New Science of Achieving a Healthy Weight. Terry 00:53-01:01 You’ll also hear from anthropologist Dr. Herman Pontzer. His research shows that people around the world have very similar energy needs. Joe 01:02-01:10 Coming up on The People’s Pharmacy, the biology of weight. Insights from the GLP-1 drugs and hunter-gatherers. Terry 01:14-02:28 In The People’s Pharmacy Health Headlines: If the U.S. follows the epidemiological patterns from Japan and Great Britain, we should expect flu season to go into overdrive soon. Japan is experiencing an early and unexpectedly severe start to its flu season. By early October, more than 4,000 people had been hospitalized with influenza, and many schools and daycare centers were closed to slow the spread of the virus among children. Some health experts worried that the virus is mutating to become more of a threat. The early arrival of influenza in Japan should not have come as a big surprise. That’s because Australia also experienced an early and severe flu season. It peaked between June and July much earlier than usual. RSV, or respiratory syncytial virus, and SARS-CoV-2 were also rampant at the same time, putting the health care system under stress. British authorities report that the viruses that cause colds are also prevalent in the UK. Flu is on the rise there. As infections rise in Europe and Asia, America may not be far behind. Joe 02:29-03:10 Viruses are not the only pathogens worrying public health authorities. The World Health Organization released a report this week alerting doctors that common bacterial infections are increasingly resistant to antibiotics. One in six bacterial infections in the study were no longer susceptible to the usual medications. More than 40% of antibiotics have lost potency over the last seven years. Infections that are harder to treat include gonorrhea, urinary tract infections, and some GI infections such as E. coli. If we don’t develop new ways of treating these pathogens, millions are likely to die in the coming years. Terry 03:10-04:03 Measles is spreading around the country. Cases reached a three-decade high this week. The very large outbreak in Texas has been declared over. However, there are pockets of infection in Minnesota, South Carolina, Utah, and Arizona. In several communities, students are being quarantined to prevent the spread of infection. In South Carolina, for example, 150 school kids have been quarantined because children in Spartanburg and Greenville counties were exposed to kids with measles. There have been nearly 1,600 cases reported in the U.S. this year. That’s the highest number in three decades. This virus is highly contagious, and vaccination is the only way to prevent its spread. The MMR vaccine against measles, mumps, and rubella is 97% effective against measles. Joe 04:04-04:50 New guidelines for COVID vaccinations have a lot of people confused, including pharmacists who administer the shots. At first, the FDA only approved the new immunizations for people at very high risk, or those over 65. Then, the CDC suggested that anyone who wanted a COVID vaccine would need to consult a healthcare professional first to learn about risks and benefits. Some pharmacists interpreted that guidance as meaning that people would need a prescription before a shot could be administered. Then there was confusion as to whether insurance companies would pay for COVID vaccines. To make matters worse, different states may be adopting different guidelines. At the moment, though, most insurance companies are paying for COVID jabs. Terry 04:51-05:35 Life expectancy has returned to pre-COVID levels. That’s because COVID deaths have fallen from the number one cause of mortality in 2021 to number 20 in 2023. Worldwide, life expectancy is now 76.3 years for women and 71.5 years for men. In 1951, female global life expectancy at birth was 51.2 years, and male life expectancy was 47.9 years. So we have made progress over the last 70 years, but there is an alarming trend. Death rates are climbing among young adults and adolescents. This increase appears to be linked to depression, anxiety, suicide, alcohol, and drug abuse. Joe 05:35-05:57 A new study in JAMA suggests that preteens who spend more time engaged with social media have a harder time learning in school. Those who increase their time on social media had more difficulty with reading, memory, and vocabulary as assessed by standardized tests. And that’s the health news from the People’s Pharmacy this week. Terry 06:14-06:17 Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:33 And I’m Joe Graedon. For the last several decades, Americans have been getting heavier. Nearly three-fourths of adults have been categorized as overweight, with 40% of us in the obese range. Why do we have so much trouble managing our weight? Terry 06:33-06:55 We’ll be talking today about the biology of weight. The enormous popularity of GLP-1 drugs like Wegovy or Ozempic can shed some light on this question. We’ll also hear from an anthropologist whose research shows that our couch potato ways may be bad for our health, but they’re not solely responsible for our weight problems. Joe 06:55-07:26 First, though, we’re talking with Dr. David Kessler. He served as chief science officer of the White House COVID-19 response team under President Joe Biden and previously served as commissioner of the Food and Drug Administration under Presidents George H.W. Bush and Bill Clinton. Dr. Kessler is the author of “The End of Overeating” and “Fast Carbs, Slow Carbs.” His latest book is “Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight.” Terry 07:28-07:31 Welcome to The People’s Pharmacy, Dr. David Kessler. Dr. David Kessler 07:32-07:33 Thanks for having me. Joe 07:34-08:26 Dr. Kessler, it is such an honor to be speaking with you, but I would like to take issue with the very first sentence of your new book. You state, and I quote, “I am average.” And I would argue that you are far, far from average. You are a pediatrician. You’re also an attorney. And you have been commissioner of the Food and Drug Administration under President George H.W. Bush. And you’ve been chief science officer of the White House COVID-19 response team. And that’s just for starters. You’ve also been dean of medical schools. So far from average. But I suspect that in that first sentence, you’re talking about body weight. So what do you mean when you say you are average? Dr. David Kessler 08:26-09:22 I’ve struggled with my weight my entire life. I have suits in every size. I’ve gained and lost my weight at the end of, you know, had the privilege of, as you mentioned, co-leading Operation Warp Speed. COVID was an intense period of time. You know, I was working seven days a week, 18 hours a day. I turned around and I found myself 40 pounds heavier. And I had, you know, I had gained weight. I had lost weight. But this mystery of weight, why was it so hard? You know, no one could say, I think, you know, I was able, you know, to do these other jobs. I mean, no one ever accused me of not having, you know, adequate discipline. But when it came to weight, there I was, I think like many other people, this struggle, this mystery. Terry 09:24-09:32 Dr. Kessler, you suggest that the food industry has hijacked our health. Would you expound on that a little bit, please? Dr. David Kessler 09:33-10:57 Well, certainly, you know, let’s just start with what I think you mentioned, which is the real key for me. You know, it’s about our health. This is not about our weight. The fact is the American body is ill. Only 12% of Americans are healthy. Only 12% when you look at measures of blood pressure, blood lipids, waist circumference, glucose, just basic metabolic measurements. And the culprit there, I mean, again, this is not about weight. right? I mean, it’s about toxic fat. That fat that accumulates around our abdomen, that invades our liver, our pancreas, our heart, our skeletal muscle, that toxic fat is causing many cardiac, renal, metabolic diseases that lead to chronic disease. I knew that weight wasn’t good for us. Even as a doc, I knew it wasn’t good for us, but I didn’t know it was causing these chronic diseases. So the problem is this toxic fat. And then the question is, what causes that toxic fat? And that gets in to, you go back upstream to that, that’s our diet, that’s the food supply, that’s the food industry. Joe 10:59-11:38 Well, you know, Dr. Kessler, you’ve given us a statistic that is mind-boggling because you’re saying that most of us are not healthy, the overwhelming majority of us. I mean, we have, as you pointed out, hypertension. Half of the population, adult population has high blood pressure, but we also have blood sugar problems. We also have all kinds of other metabolic issues going on. Is that true in some of the places that you’ve visited around the world? Are other countries also suffering the way we are? Dr. David Kessler 11:38-13:55 I think, I mean, it’s fair. We’ve always led the world when it comes to public health in good ways. And I think we’ve also leading the world when it comes to, you know, this issue. I think many, many countries are maybe not quite at the extent of the morbidity and mortality that we have, but I think, unfortunately, they’re catching up. Understand, in our lifetime, right, in our lifetime, 25% of us are going to go on to develop heart failure. You know, some 30 to 40% of us are going to go on to develop diabetes. 25%, you know, are going to have a stroke. And, you know, much of that, all those major killers, that chronic disease, right, those things that cause in our senior years, you know, yes, we may live as long, but we’re going to be in a more disabled state because of that. We’re not going to be as productive. You know, that is all, I mean, we are coming to realize, I think medicine is waking up to the fact. I mean, cardiologists, endocrinologists, obesity medicine, doctors, you know, I mean, some neurologists, even oncologists. Many of these diseases, cardiac, kidney, endocrinological, metabolic, about 13 forms of cancer, some of the neurodegenerative diseases, they have a common core. And it’s this metabolic adiposity, this metabolic toxic fat that is causing it. And for the first time, I mean, the good news is for the first time, we have the tools that can fix that. No magic answers, right? No magic pills, right? But we do have tools that we can reclaim our health if you want to. Terry 13:56-14:27 Well, we do want to talk about that in just a moment, but I asked you about the food industry, and we actually have a government agency that is supposed to be looking out over oversight, supposed to be doing oversight on the food industry. It’s an agency you’re very familiar with. We call it the Food and Drug Agents Administration. So what did the FDA get wrong about public health and nutrition? Dr. David Kessler 14:28-15:36 So back in the 90s, when we had the opportunity to be at the agency, you’ll remember we did, you may remember that we did the nutrition facts panel, right? I mean, go pick up any, I don’t know if there’s any packaged food in the studio, but that nutrition facts panel, that few inches has calories, fat, sugar, protein. And it was hailed as a major advance, right? And it was for its day, right? And still many people rely on that when they look at food that they buy. What they did not, what we didn’t get, and I don’t think anyone really got, were the consequences, the biological effects of that fat, sugar, and salt in our bodies. What was it doing to our insulin levels? What was it doing to the way we deposited fat? We didn’t understand the consequences fully of what we were putting in our bodies. Joe 15:37-16:00 Dr. Kessler, you are renowned for going after the tobacco industry and the impact of nicotine. Tell us how the food industry evolved its own, shall we say, addictive power when it came to food. And we just have a couple of minutes before the break. Dr. David Kessler 16:02-17:09 So in order to feed a hungry nation back in 1930s, 1940s, food industry learned to process food, to create this sort of alternative food system, this industrial food. It was able to extend shelf life. It extracted certain very cheap chemicals from food ingredients, took those, took out the water, were able to ship things over long distance, added in palatability, added fat, sugar, and salt. These other modified starches and other chemical ingredients, right. And this was the modern industrial processed ultra food supply. And the advantage, it was cheap, it fed a hungry nation, it was convenient, and it replaced traditional foods. We took fat, sugar, and salt, put it on every corner, made it available 24-7, made it socially acceptable to eat anytime while living in a food circus. And the consequences? Consequences is this toxic fat. Terry 17:10-17:12 And what makes that fat so toxic? Dr. David Kessler 17:14-17:48 It gets into your organs. It gets into your pancreas. It gets into your liver. That liver releases these inflammatory substances and hormones and free fatty acids. And fat goes in places where it’s not supposed to be. It’s not supposed to be in your heart. It’s supposed to be a little in your liver, but it gets into your muscles and your pancreas. And it causes major significant cardiac endocrinological renal disease. Terry 17:50-18:12 You’re listening to Dr. David Kessler. He’s a former commissioner of the Food and Drug Administration under President George H.W. Bush. Dr. Kessler has also been dean of the medical schools at Yale University and the University of California, San Francisco. His most recent book is “Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight.” Joe 18:12-18:18 After the break, we’ll find out what Dr. Kessler means by the 10 p.m. cravings and why they’re so dangerous. Terry 18:18-18:21 How do GLP-1 drugs help people achieve their desired weight? Joe 18:22-18:28 How can we make choices today that will help us achieve a healthy weight in the future? Terry 18:39-18:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 18:51-18:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Terry 18:54-19:04 And I’m Terry Graedon. Today, we’re talking about the biology of weight. Why are so many of us having trouble achieving and maintaining a healthy weight? Joe 19:04-19:23 Americans have fallen in love with GLP-1 receptor agonist medications. You’ve probably heard of drugs like Ozempic, Wegovy, Mounjaro, and Zepbound. They’ve captured the imagination of millions of people. How do they help people lose weight? Terry 19:23-19:53 We’re talking with Dr. David Kessler, who served as chief science officer for the White House COVID-19 response team under President Joe Biden. He’s a former commissioner of the Food and Drug Administration under President George H.W. Bush, and he’s also been dean of the medical schools at Yale University and at the University of California, San Francisco. His most recent book is “Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight.” Joe 19:55-20:19 Dr. Kessler, we’re going to talk in a moment about this revolution called GLP-1 drugs. But first, you are very personal in your book, and you talk a little bit about this idea of 10 p.m. cravings that was your enemy. Tell us what happened at 10 p.m. for you. Dr. David Kessler 20:19-22:20 For me, 10 o’clock at night, if I’m working 18, 19-hour days, certainly during COVID, or even going back to when I was in school, I think many of us can remember medical school. I had to study for the next exam or do that paper, and at 10 o’clock, I’m tired, I’m fatigued. I need to make it through the next three or four hours. And I go, yeah, should I go down to the refrigerator? Should I have something? Maybe it’s not so good for me. This struggle, right? So, I mean, there are these, understand that these are, I’m not, 10 o’clock at night, I had just eaten dinner. I mean, I wasn’t doing this for fuel. I was doing this to change how I feel. I mean, and I think that’s what is so important to understand that food, I mean, in essence, I mean, changes how we feel. I mean, it works on the reward centers of the brain. I mean, it’s psychoactive. Those reward centers of the brain, you know, are really, they are the addictive centers of the brain. We think about addiction as for the weak or the downtrodden, but the human brain evolved to deal with scarcity, not abundance. And for much of human history, there was no guarantee when our next meal would come, when it would arrive. So our biological systems are designed to seek out that sweetness, that most energy-dense food. And we’re wired to focus on the most salient stimuli. And the way this works, I mean, when you think about, when you understand addiction, we have just, I mean, addiction is part of all of us, those circuits. It’s this cue-induced wanting. So 10 o’clock became the cue, right? That fatigue became the cue. So that 10 o’clock at night, I’m not eating for fuel. I’m eating to change how I feel. Terry 22:21-22:28 So Dr. Kessler, how do these GLP-1 drugs help people achieve their desired weight? Dr. David Kessler 22:29-24:39 They are highly effective. But bottom line is they work. there’s no real magic, right, to them. I mean, they work by keeping food in our stomach longer. You know, there is this spectrum, right? I mean, we’ve all, this sort of satiety spectrum. And I think we’ve all experienced this. You get the flu, your GI tract doesn’t work as well, food’s staying in there. When food stays in my stomach longer, I don’t want to put anything else in. I mean, look, the thing, whether it’s diet or drugs or surgery, get you to lose weight, they all do it by decreasing appetizing, getting us to eat, put less in our mouths to eat less. Look, that mantra, that fail, eat less, exercise more. Absolute failure, right? Didn’t work. It didn’t work because of the addictive circuits. But what these drugs do is they help you to eat less. How do they do that? Right? I mean, it’s these addictive reward circuits that are at play, this wanting this 10 o’clock at night. But those feelings, right? I mean, these feelings, the GI brain access, I mean, there’s another set of circuits beyond the addictive circuits. They’re called the aversive circuits. I mean, so this food staying into my stomach longer, that’s in part controlled by the hindbrain, not the reward circuits, the area postrema, the nucleus solitarius, those circuits counterbalance. So those feelings counterbalance, those aversive feelings counterbalance to reward circuits. I don’t want to put anything else in my stomach. I learn to eat smaller. Maybe I do that unconsciously. But you have this balancing, these aversive circuits, these reward circuits, and they dictate how I feel at the moment and whether I want to eat or not. Joe 24:40-25:30 Dr. Kessler, a lot of people now, because, well, Novo Nordisk, the manufacturer of Ozempic and Wegovy, has made billions and billions of dollars. There are a lot of people who say, well, this is simple, all I have to do is take the shot. Or in the case of some of these drugs, now they’re taking the pill. I don’t have to think about food choices, I don’t have to think about exercise. All I need is a GLP-1 agonist. So it seems like this is just part of the equation. It may be the dopamine part. You feel that satiety. You don’t feel like I need to snack at 10 p.m. But what about the food choices and the exercise? Dr. David Kessler 25:31-27:39 So how long are you going to stay on that pill for? That drug is going to work while you’re on it. Now, look, it has, let’s just agree, these drugs have real adverse events, right? I mean, this is no walk in the park. This notion that these are not be-all and end-all, right? The fact is that if you look, the average person is on these drugs today for about eight, nine months, right? These drugs work while you’re on them. They don’t work. You don’t expect them to work when you go off them. But what’s going to happen? People are going to spend thousands of dollars, go on these drugs, lose this weight, stay on this for eight to nine months. When you lose weight, you lose muscle also. You go off these drugs and then people are going to gain back that weight and say, we’re going to turn around in three, five years and go, hey, this is one big, massive failure. So what are you going to do? There is no end game when it comes to weight. It’s a chronic, relapsing condition. Once you’ve gained that, yes, let’s protect that next generation from this. But if I’m going to go off these drugs, or if I don’t want to be at a dose, we’ve got to get the information how these drugs can be used in the real world. But what are you going to do when you go off these drugs? And that’s why what these drugs, the greatness about these drugs is they allow you to recondition your relationship with food. So while you’re on these drugs, you can learn to eat. And what you hope is that if you want to go off them, maybe you want to stay on them, but if you want to go off them, you’ve changed that relationship with food, right? So that you then off these drugs can maintain the weight because losing the weight is not the hard part. It’s maintaining that weight. Terry 27:41-27:51 So, Dr. Kessler, how do we reshape our relationship with food during the nine or ten months that we are using Ozempic or Wegovy, for example? Dr. David Kessler 27:52-29:40 That’s one of the great questions we’re learning a lot. Watch people on these drugs. Ask them how their food preferences change. I mean, if you don’t want to put, you know, imagine this now. You feel like there’s a lot more in your stomach, you’re satiated much quicker. So you don’t want to put certain foods in your stomach. But the taste preferences, you know, for me, I mean, it was the first time I was eating vegetables, right? I just did for some reason, and I’m not sure I fully understand the biology, these taste preferences change for some people. Look, I am humbled because the one thing we have to recognize is there’s great variability, great variability in responses, how much people wait, what their adverse events are, what do they feel? I mean, does it make them, does it push them to the edge of nausea? Do they feel anything? Do they not feel anything? We all, I mean, are different, but there is, there’s something about when you’re, when you’re, for me, I was just eating much smaller portions. And I learned to want to do that. I didn’t like eating large portions while I’m on this because I wouldn’t feel good. And I try to carry that over. But understand that can fade. You go off these drugs, you condition yourself, you have that new learning. But over time in this environment of fat, sugar, and salt on every corner, those addictive circuits are going to pop back up and maybe I have to go back on these drugs. But again, my old agency has to do a better job working with the companies to get data on how can we use these drugs in the real world. Can I use these intermittently? Will they work intermittently? Terry 29:40-30:02 Dr. Kessler, I would love to spend the next 10 minutes or so just talking about how people can use these marvelous new tools to actually get healthier. So let me ask you, how can we optimize nutritional quality while we’re cutting calories? Dr. David Kessler 30:04-32:26 Once you start, once you’ve gained weight, right, and have the weight to lose, right, your body’s going to work against you. Those reward circuits, those metabolic circuits, right, are there, right? And you have to understand you’re trying to get the body to do something it doesn’t want to do, right? I mean, and so those addictive circuits are at play, right? And I mean, if those addictive circuits want it, I have to, I really have to, in the end, change my relationship with food. I got to change what we want. What was the, I mean, if you look at the great public health success, right? I mean, certainly of our lifetime was cigarettes. The great public health failure? Obesity. What did we do in cigarettes? I mean, at the turn of the previous century, the fact is that the cigarette industry took these products and made it seem sexy and glamorous and adventuresome. There was a march down Fifth Avenue for emancipation, women’s rights, voting rights. Right? Um, that they so these were positively valence what did we do in tobacco what we we changed the valence of that product we had this critical perceptual shift we began as a country to look at these products not as something that was sexy glamorous something that I wanted something that was going to make me feel better but for what they were they were deadly disgusting addictive you know products and you know if something’s sexy and and it’s positively valence I’m going to approach it. If it’s negatively valanced, I’m going to avoid it. Food is much harder. The problem is not food. The problem is this ultra processed food, this industrial food, these large portions. I got to change what I want. I got to change how I perceive it. Once you understand that food is going to result in that heart failure, is going to result in that diabetes, is going to result that I can’t pick up my grandkids. It’s going to result in years of disability later on in life. I mean, that’s the goal. We have to change what we want. Terry 32:29-32:46 Of course, humans are not that great at imagining what we’re going to want in the future and making that overcome what we’re doing right now. The potato chips right now might sing a little louder than the idea of picking up your grandchild in 10 or 15 years. Dr. David Kessler 32:48-33:50 Well, you know, you’ve just, that whole field of behavioral economics, delayed discounting, you’ve just summarized and just perfectly in 10 seconds. Look, the fact is, I mean, we didn’t get this as docs. Medicine didn’t get this. Again, we always thought weight just wasn’t good for us. We didn’t understand this toxic fat is causal. Once we wake up to that fact, once we see, and I think this is starting to occur. I think that people really understand the diet and what we’re eating. This ultra-formulated food is at the core of this. Again, these drugs can be one tool to get us to eat less, exercise more. They help with it. They calm down those addictive circuits. But we really have to change. Look, if someone came down from Mars and looked at what we were doing, We have one industry making billions of dollars that make us sick. And we have another industry making equal profits, trying to treat what that former industry does. Something’s wrong with that picture. We got to get to the root cause. But I can’t wait for the food industry or for people to change my food environment. We got to be able, the real choice, you talk about willpower, is do you want to make a decision? Do you want to reclaim your health? Because if you do, then get help, right? I mean, these addictive circuits, you can’t expect to do these yourself. Get a good dietician. Get somebody who is skilled in taking care of this toxic fat, I mean, who understands about obesity and weight. Joe 34:34-35:05 And Dr. Kessler, I know that our listeners want to know, how are you doing? You gained weight, understandably, during the COVID crisis when you were working 18 hours a day and trying to make a difference in the public health of the American population and the world. So now that you’ve actually tried the GLP-1 agonist-type drugs, what does the new Dr. David Kessler look like in the mirror? Dr. David Kessler 35:06-36:11 I’m good for now. I’m good today, you know, dramatically reduced my percent body fat, but it’s a journey. I can’t tell you about tomorrow. But I think, you know, my percent body fat right now, again, as I said, it’s about half. Metabolically, much better. I mean, that 40 pounds is gone, and an additional 20 pounds is off. Is it easier? Sure, but it’s no picnic. For me, I mean, I was sick, my body was sick. You looked at all metabolic, I was pre-diabetic. I didn’t want to be there. But that’s a choice. I mean, the most important thing is can we prevent, can we give our children the gift of not having gained the weight in the first place, gaining this toxic fat in the first place, so they don’t have to struggle with it? That’s our job. Terry 36:12-36:18 Dr. David Kessler, thank you very much for talking with us on The People’s Pharmacy today. Dr. David Kessler 36:19-36:19 Thank you. Terry 36:20-36:58 You’ve been listening to Dr. David Kessler, who served as chief science officer for the White House COVID-19 response team under President Joe Biden. He’s a former commissioner of the Food and Drug Administration under President George H.W. Bush, and he has also been dean of the medical schools at Yale University and at the University of California, San Francisco. He has written several books, including “The End of Overeating,” “Fast Carbs, Slow Carbs,” and his most recent, “Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight.” Joe 36:59-37:07 After the break, we’ll hear from an anthropologist. His intriguing research suggests that people around the world use roughly the same amount of energy a day. Terry 37:08-37:14 Some of the people in his study hunt their own meat and gather their own plant foods. Doesn’t that take a lot of energy? Joe 37:14-37:20 If you were a hunter-gatherer tracking antelope across the savanna, how many more calories would you burn? Terry 37:21-37:26 His study suggests that the main cause of obesity in America is what we’re eating. Joe 37:26-37:32 What should we be doing for our health? Are there lessons from anthropology that can help us achieving a healthy weight? Terry 37:39-37:42 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Joe 37:51-37:54 Welcome back to The People’s Pharmacy. I’m Joe Graedon. Joe 38:12-38:24 We’re considering the biology of weight today. Usually, any discussion of weight has to include the idea that calories in and calories out must balance. Terry 38:24-38:36 That has led to suggestions that we need to be more active. If only we walked or ran or cycled a lot more instead of riding or sitting, wouldn’t we be able to manage our excess pounds? Joe 38:36-39:06 To find out, we turn now to Dr. Herman Pontzer. He 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.” Terry 39:07-39:10 Welcome to The People’s Pharmacy, Dr. Herman Pontzer. Dr. Herman Pontzer 39:10-39:11 It’s great to be with you. Joe 39:12-40:07 Thank you, Dr. Pontzer. It’s nice to have you here. We just got done talking with Dr. David Kessler. He was former FDA commissioner, and he is author of “Diet, Drugs, and Dopamine, The New Science of Achieving a Healthy Weight.” But we’d like your perspective on this issue. You’ve tackled this controversial topic of weight control by traveling to Hadzaland in Tanzania. Please, can you explain why you went all that way to understand the balance between energy intake and energy expenditure? You know, I think a lot of us who don’t really understand all this metabolism stuff very well just call it calories in, calories out. Why did you go so far away and what did you do? Dr. Herman Pontzer 40:07-41:15 Yeah, thanks. So, you know, my training is as an anthropologist. I’m interested in how our bodies evolved, how they got to be the way they are today, and then how that kind of interaction between our evolved bodies and our modern lifestyles plays out for each of us in terms of health and the way our bodies work today. And I focus, you know, my lab focuses on energy expenditure, calories in, calories out, because that is the currency of life, right? The game of life for any organism is to take energy from its environment and survive and reproduce. That’s the game of life that all organisms play. Now, our species, we evolved as hunter-gatherers, right? So for over 2 million years, we’ve been hunting and gathering. And that’s the lifestyle in which our bodies evolved. So that’s kind of the ecologically relevant context to understand our bodies. And for a long time, up until we did this work with the Hadza in northern Tanzania, we didn’t understand how our metabolisms looked in a hunting and gathering lifestyle, right? We had some data from the U.S., Europe, you know, westernized, industrialized places. But we didn’t have any data on the most relevant context for our species, hunting and gathering. Terry 41:15-41:29 And there really aren’t that many places on Earth where people are still doing hunting and gathering. The opportunity to study it, as well as the opportunity to live that way, has diminished a lot. Dr. Herman Pontzer 41:29-41:33 That’s right. Most of these populations have been moved to cities or towns. They’ve been developed. Joe 41:34-41:36 Tell us a little bit about the Hadza. Dr. Herman Pontzer 41:36-42:16 Yeah. So they’re a hunting and gathering community in northern Tanzania. Now, what does that mean? That means every morning they wake up and men hunt for wild game, or sometimes they go and collect wild honey. The women go out and collect wild plant food. So sometimes that’s picking berries. Sometimes that’s digging for wild tubers. And they do that every day. They don’t have any cars or electricity or plumbing or anything like that. They live in grass houses in the middle of the open savanna in northern Tanzania. So they’re focused on food. That’s right. Their whole economy, their daily life is focused around getting calories, right? And then, of course, living their lives, burning those calories on all the things they do all day. Joe 42:16-42:20 And I suspect that getting food takes a lot of calories. Dr. Herman Pontzer 42:20-42:33 Well, that’s exactly it. So we had this idea when we started this project that being so active as they are, right, they get more physical activity in a day than most Americans get in a week, right? We know that. Men get 19,000 steps a day. Joe 42:33-42:34 Whoa! Dr. Herman Pontzer 42:35-43:05 Women get 13,000 steps a day and often with a kid on their back, right? So it’s a really physically active way to make a living. And all hunting and gathering groups, we think that’s pretty typical for them. And then that means it’s pretty typical for us in the pretty recent past. And so we wanted to ask the question, is that more traditional lifestyle, does it burn a lot more calories every day than our modern lifestyle does? Because we’ve all heard the story. These modern lifestyles that we live in, you know, they’re too comfortable. They’re too easy. We don’t get enough activity, and that’s leading to obesity, perhaps, because we’re not burning enough calories. Terry 43:06-43:07 We’re couch potatoes. Joe 43:06-43:11 Yeah, sitting or lying down or just not doing anything. Dr. Herman Pontzer 43:12-43:48 That’s exactly right. So we wanted to understand what that gap is. How many more calories do you burn as a hunter-gatherer? And so we use this state-of-the-art technique called doubly labeled water. It’s this isotope tracking technique that allows us to really measure how much carbon dioxide the body makes all day. You can’t burn calories without making carbon dioxide. You can’t make carbon dioxide without burning calories. So it’s a really accurate physiological way of measuring calories burned. And we do it over about a week or 10 days. And we went there to kind of document how many more calories they’re burning because, again, they’re so physically active. And the shock was we got home and we analyzed our data. They don’t burn any more calories. Joe 43:48-43:49 Whoa, wait a minute. Dr. Herman Pontzer 43:50-43:56 I know it. I couldn’t believe it either. And, you know, we did all the the first thing we assumed was that we’d gotten it wrong. Right. Terry 43:56-43:57 That would be a logical assumption. Dr. Herman Pontzer 43:58-44:26 That’s right. So we have other ways of double checking these data. We had a heart rate monitoring project that we did along with this. We had a whole other way of estimating energy expenditures. Everything lined up to where these are solid data, right? For this hunting and gathering population, something that looked a little bit like the past would have looked like for all of us and what traditional lifestyles look like, you know, the world around. They are burning no more calories every day than folks in the U.S. and Europe and other industrialized countries. Terry 44:27-44:29 So we’re very profligate with our calories. Dr. Herman Pontzer 44:30-44:44 Well, that’s right. I mean, what it suggests is our bodies are adjusting to lifestyle in interesting ways, in ways that we kind of hadn’t appreciated before this study. So you and I, and well, I don’t know about your lifestyle, but I know mine. I’m not as physically active as a Hadza man. I don’t get 19,000 steps every day. Terry 44:44-44:45 Definitely nowhere close. Dr. Herman Pontzer 44:46-45:34 And so my body is burning energy on physiological tasks that their bodies are not. I’ve re-juggled the way I spend my calories, right? It’s like living on a fixed economy. It’s the same number of calories coming in and out. We’re just spending them on different things. And so if you’re a Hadza man or woman, you’re spending more of that energy on physical activity. That’s definitely true. We measured some, we did some tests to study like the cost of walking, for example. There’s no magic going on. They’re still burning those calories walking. But they’re burning more on walking and more on activity and less on other things. And we’re doing the opposite. We’re spending more energy on things like perhaps things like inflammation, things like stress response, things like having reproductive hormone levels that are quite high. All these things kind of ramp your body’s metabolism up. And we can do that here in this lifestyle, but we’re not doing it if we were in that lifestyle. Joe 45:34-45:58 Let me see if I’ve got this right. So here are these people who are, in the case of men, nearly 20,000 steps a day, every day, day in and day out. And yet the calorie expenditure is very similar to ours where we may only be walking 5,000 or 6,000 steps a day. We’re sitting in front of our computers. Terry 45:59-46:02 And if you hit 10,000 steps a day, you pat yourself on the back. Joe 46:02-46:25 Yeah, it’s like, oh, yeah, I played tennis and then I went for a walk and then, oh, boy, 12,000 steps, I’m great. But let’s cut to the chase: It’s really about the weight. That’s what we’re concerned about. It’s about the obesity epidemic in the United States. Were there very many obese Hadza? Yeah, there’s none, as you can imagine. Dr. Herman Pontzer 46:25-47:13 Now, they’re not, you know, they’re a healthy weight, right? So there’s not malnutrition or anything like that. There’s a healthy weight population. But yes, obesity, non-existent in this group. You know, people often ask if there are periods when the Hadza are starving, basically, they don’t have any food. And you might think that if you look at the pictures there, you see an empty landscape. And that’s what I see, too. But they don’t see that. They see a landscape that’s full of food if you know what to look for. Now, so they might not have access to their favorite foods all the time. They like to eat meat. They like to eat particular kinds of plant foods that taste nice. So they don’t always have their preferred foods all the time. But they can always get food. I’ve never seen a Hadza camp that wasn’t, you know, where the people were unable to get enough to eat every day. Terry 47:13-47:16 So you haven’t seen malnourished children, et cetera? Dr. Herman Pontzer 47:17-47:32 No, you really don’t see that. And in fact, we’ve done things like we’ve tested for ketone levels in urine tests, right? Which would be one indicator, physiological indicator of starvation. We’d never see that. We never see ketone bodies in the urine. Now, that’s not the most precise test. Terry 47:32-47:33 But it is an indication. Dr. Herman Pontzer 47:33-47:38 But it’s an indication for sure. If you just look at heights and weights of kids and adults, these are healthy folks. Joe 47:39-47:42 So the difference, please, open that envelope. Dr. Herman Pontzer 47:42-48:05 Right. Obesity in the U.S. has to be a question of diet, right? That has to be the main problem. We’re bringing too many calories in. Because if the energy expenditure that we’re all experiencing, no matter what our lifestyle is, is kind of all the same. If you can’t move the needle on energy expenditure, then obesity, which is this balance between energy in and energy out, has to be about your diet and taking too many calories in. Terry 48:05-48:25 Now, Dr. Pontzer, you and your colleagues have just published a paper in the Proceedings of the National Academy of Sciences, looking at this same question, but with a bigger data set. You didn’t just look at the Hadza, you looked at a bunch of other groups as well. Tell us about it, please. Dr. Herman Pontzer 48:26-50:04 Yeah, that’s right. So, you know, in the years since that Hadza study, we’ve had the chance to do this with a couple other populations here and there around the world. And we find similar results in sort of isolated other populations. But we didn’t have an opportunity to ask, OK, let’s put our arms around all the populations that we have data for, try to get a really broad idea of energy expenditure versus lifestyle across the whole globe. And the reason we hadn’t done that before, nobody had done that before, was that this isotope tracking technique we use to measure energy expenditure, it’s expensive and it’s technically a challenging thing to do. There aren’t many labs that do it. And so there had been no huge multi-population study to look at this yet because it just wasn’t feasible. Since about 2016, my lab and several others across the globe have collaborated, put all of our data together from all the studies that we’ve done over the years. And now finally, we have this huge data set, 10,000 plus individuals total, that we can ask questions with big samples, looking across lifestyle, across age, all these sort of big data kind of questions we can finally ask using this technique. For this study, we had 34 populations. The Hadza were there, U.S. is there, countries in Europe, Asia, countries that have low economic development, middle, rich countries, farming communities, really the full economic spectrum of human existence. And we could ask the question, OK, with a really broad sample, with a really big data set, can we see an effective lifestyle and especially economic development on energy expenditure and obesity risk? Joe 50:05-50:06 And the envelope, please? Dr. Herman Pontzer 50:06-50:41 Right. So just like the Hadza study, we don’t see a big effect of economic development on expenditure. In fact, if you just look at total calories burned per day, people in rich countries burn more. Why is that? Because they’re bigger, right? We tend to be bigger in more developed countries. And your total body size is the biggest predictor of how many calories you burn. If there’s more of you, you’re going to burn more calories. But even after we correct for body size—which we always do in these analyses—we see the same things we saw with the Hadza study. No effect of economic development on energy expenditure, hardly at all. Joe 50:41-50:44 And so what really matters is? Dr. Herman Pontzer 50:44-51:17 It is diet, right? The big driver of obesity across these 34 populations has to be the calories that we’re eating. And we were able to do additional analyses asking things like, well, what is it about the diet? Maybe it’s the amount of meat that people are eating. That doesn’t seem to be a factor. What is it? Maybe it’s the amount of ultra-processed foods. And there we do see an effect that populations that are eating more ultra-processed foods tend to be the populations with the highest levels of obesity in our sample set. So, you know, the study wasn’t designed to look at that specifically, but it’s a good direction to go next. Joe 51:18-51:43 So what can we learn from this research? Because, like you say, I mean, no one has ever done anything of this size before across this many cultures. Is there a take-home message about the food? And what should we and what shouldn’t we as a population be doing? Well, let’s start with the exercise portion first, right? Dr. Herman Pontzer 51:44-51:57 It’s still important to exercise and get physical activity. There’s nothing about the study that says exercise doesn’t matter. On the contrary, we know exercise is still really important. It’s good for us. It’s good as we age. It’s good for mental health. There’s so many good things about exercise. But… Terry 51:57-52:00 Because human bodies were meant to move. Dr. Herman Pontzer 52:00-52:47 That’s exactly right. That hunting and gathering past that we all share, when our ancestors were getting 10 or 20,000 steps a day, that is the way that we evolve. That’s what our bodies expect. And so if we don’t do that in our lives today, we set ourselves up for illness. Okay, but exercise is not going to fix the obesity crisis. And the obesity crisis is not because of a change in physical activity and lifestyle. It’s because of a change in diet. And so when we want to tackle obesity specifically, we need to be focused on diet. What are we putting in our supermarkets? What are we putting in our school cafeterias? What are we putting in our baskets as we go shopping? What are we putting in our cupboards, right? We have to think about diet and controlling, trying to find a way to eat healthier and limit how many calories we eat so that we don’t over-consume. Joe 52:49-53:49 Dr. Herman Pontzer, you look fabulous. I mean, you are a thin guy, but you’re not scrawny. You look like you’ve been practicing what you’ve been studying. That is to say, you look like you’ve been careful about what you eat for a long time. When we spoke with David Kessler, he sort of admitted as how he’s been overweight for most of his life and that it’s been a challenge. And he has been a, I’d say, an advocate for the GLP-1 agonist drugs. You know, you’ve all heard about the Ozempics and the Zepbounds and the Wegovys. And, you know, these drugs have, quote, unquote, revolutionized weight control. So just on a personal level, how do you maintain your excellent body weight? Dr. Herman Pontzer 53:49-54:04 Well, I appreciate that. You know, I like to be physically active, I like to run, I like to rock climb. Those are my two big outlets for getting activity in. I like to be outdoors. So that’s never been, you know, it’s never been hard to push myself out the door. Terry 54:04-54:08 But based on your research, that’s not the primary thing, right? Dr. Herman Pontzer 54:08-54:37 No, that’s right. So that’s not what’s keeping me thin. What’s keeping me thin is that I also have been lucky to have a pretty good relationship with food. I am not the kind of person who has food cravings all day. I know some people who do, people close to me who do. And that sounds like a much harder way to sort of manage what you’re eating. I enjoy food. Of course, I enjoy food with friends most of all, but I don’t feel pushed to over-consume. And so I’ve been lucky that way because I know that not everybody has that same wiring. Joe 54:38-54:44 So you’re not tempted to have seconds, or thirds, or another dessert? Dr. Herman Pontzer 54:44-54:46 Not particularly. And if I miss lunch, I don’t mind. Joe 54:48-55:01 So what can we learn from your example, especially when it comes to that really big deal these days about ultra-processed foods? Dr. Herman Pontzer 55:01-55:10 Yeah, well, you know, I think everybody loves snack foods and junk foods. I mean, come on, they’ve been chemically engineered and focus group tested to be delicious. Terry 55:10-55:23 You don’t even have to be human to love a snack food. Our dogs like those crunchy things that we get in packages, cod crisps. Dr. Herman Pontzer 55:23-55:23 Oh, yeah. Terry 55:24-55:27 They like these things. I think it’s just cods and fruit. Dr. Herman Pontzer 55:27-55:28 Yeah. Terry 55:28-55:32 But they crunch, very satisfying for dogs. Dr. Herman Pontzer 55:32-55:32 Yeah. Terry 55:33-55:36 And, you know, a lot of crunchy stuff is satisfying for humans, too. Dr. Herman Pontzer 55:36-56:19 That’s right. So, you know, what I’ve noticed, so, you know, I’m 48 years old. I have certainly noticed the last 10 or 15 years that I appreciate you saying I look good, but I feel a lot different than I did in my 20s. That’s for sure. And so, you know, I have made an effort to say, well, look, I can’t control what they put in the supermarket, but I can control what I put in my basket. And I’m not going to have a lot of soda and, you know, snack foods that I know I’ll eat the whole thing in my house, right? And, you know, I’m lucky enough to have good supermarkets nearby that I can make those decisions. But I do that so that my personal environment doesn’t tempt me to over-consume, because there are certainly foods that I would absolutely love to over-consume. Joe 56:20-57:05 Dr. Pontzer, I would love to get a sense of what it was like to hang out with the Hadza. These people are, as you have described them, real hunter-gatherers. Food is critical to their survival. And so they spend a lot of time going out and searching for food. What are they eating first? And how close to the edge are they? In other words, do they have times when it’s kind of hard to find food and other times when it’s plentiful? Give us some sense because you kind of went back in time. Dr. Herman Pontzer 57:05-57:26 Hmm. Well, I’m going to push back a little bit there and just say, I know what you mean by that. But I think some people listening to this would think, oh, well, that means the Hadza are some kind of, you know, stuck in amber kind of, you know, community from the past. And of course, you know, that’s not true. Every culture today is we’re all equally here. We’re all equally modern. Terry 57:25-57:26 It’s today. Dr. Herman Pontzer 57:26-59:34 And with us today. But, you know, you’re absolutely right that a population like the Hadza provide an opportunity to ask, you know, what it was like back then because they share so many elements of a lifestyle that we think was common in the past. And so what’s it like? Well, you know, if you’ve been able to travel and see other cultures internationally, you’ve probably had this experience. The first thing you notice are all the differences, right? It’s a different language. It’s a different way they’re dressed. It’s a different kind of, you know, all the differences. And then if you have a chance to stay there for a while, pretty soon you start to notice, oh, wait, that looks, you know, this is like, you know, kids playing kids games is the same no matter where you are on Earth. Husbands and wives arguing about something, that’s the same no matter where you are on Earth. Friends telling stories is the same everywhere. Even if you don’t understand the language, you understand the laughter, right. So I think that’s what I take away when I go now is they feel like it feels a little bit more like home. And I see our commonalities. I see what’s shared there. Now, what’s absolutely not shared is that when they wake up in the morning, they have to find their breakfast, right? I mean, maybe they have some stuff left over from the night before, but they don’t just crack open the fridge and have a yogurt, right? That doesn’t happen. And so what kind of foods are they eating? Well, men are eating wild game. And so in that part of the world, you’re talking about zebra, giraffe, different kinds of antelope, smaller game as well. Men also, when they’re not hunting, they’ll bring home, they’ll kind of chop into this. Every hodge a man leaves the camp with a bone arrow that they make themselves and a hatchet. And so if they’re not hunting with the bone arrow, they’re using the hatchet to chop into trees and get at wild honey. The bees make their hives in trees there. And so honey is a big part of the diet. It’s delicious. Meat is, you know, maybe sort of 40 or 60 percent of the diet, depending on the time of year and that kind of thing. And then the women are getting plant food. So that could be wild tubers. That could be berries. That’s kind of baobab fruits, that kind of thing. Terry 59:34-59:44 Now, you said that the men are hunting and they’re eating wild meat. I’m assuming, and I shouldn’t assume. So let me ask you, are they sharing the food with the women? Dr. Herman Pontzer 59:45-01:00:39 Thank you so much for that. Yes, everything is shared, right? And that’s a real commonality that we see across hunting and gathering groups. Sharing is what makes it work. I’ve been teaching anthropology and human evolution for a couple decades now. What I always tell my students is the big change that put us on our path to being human and not being like the other apes is hunting and gathering. And it’s not the hunting or the gathering that’s so important in that equation. It’s the ‘and,’ right? And by having some folks hunt and some folks gather and you share the food at the end of the day, you get the advantages of being, you know, thinking about this sort of ecologically, the advantages of being a plant eater and the advantage of being a carnivore, you get them together. And that’s why our species and our ancestors have been so successful because that’s, you know, it’s unlike any other species in the way that we make a living. Joe 01:00:39-01:00:57 Tell me about the hunting piece, because I’ve seen the arrows, which are really cool, and the bows and how good they are with the bow and arrow. So you’ve been out on a hunting expedition. Give us a description. Dr. Herman Pontzer 01:00:58-01:01:01 It’s remarkable. So it’s a lot of walking. You walk and walk and walk. Joe 01:01:01-01:01:02 And there are dogs. Dr. Herman Pontzer 01:01:0301:01-56 Sometimes. So that’s, yes, sometimes they have dogs. I would say maybe 10 or 20 percent of the time that I’ve been in Hadza camps, there have been dogs. Often it’s just a man that’s just walking. They typically go out alone unless, you know, you’re able to talk your way along with them. And, you know, they’re very good at what they’re doing. So they’re very quiet. They’re very attentive. They’re seeing things that you’re not seeing on that landscape. And they notice the game before the game notices them. And then they’ll stalk and try to get a shot. They’re so good with their bows and arrows. It’s a fun one. When my first trip to Hadza camps, of course, it’s a big camping trip for us, basically. We fill a couple Land Rovers with camping gear and science gear for, you know, maybe you’re there for a couple weeks or a couple months. And so one of the essential pieces of camping gear is a tin full of instant coffee. Terry 01:01:56-01:01:57 Okay Dr. Herman Pontzer 01:01-57-01:03:25 That’s an absolutely essential piece of research gear there because you can’t get up in the mornings without some instant coffee. And so we had this empty tin of instant coffee. It’s called Africafe. And I don’t know, we got into our heads one day. Let’s have a—because we were so impressed at watching these guys shoot bow and arrow—let’s do a competition to see, you know, who can hit the can from pretty far away. And, you know, whoever wins, you know, they can keep the can or whatever, because it’s a nice tin can. It’s a valuable thing to have. And so we set it up while the guys were all out hunting, and we set it up was probably 20 or maybe even 30 yards away. It was a good distance. I grew up, you know, in a rural part of Pennsylvania hunting and shooting bow and arrow a little bit. And so it looked to me to be a very far distance to hit a pretty small tin. And before the guys even came back from camp, their kids were lining up and having a laugh and hitting that can every time they shot these bows. And I thought, oh my God. And so we had to move it twice as far out to hold the actual competition. And even then the guy, it was like, it was, it was too easy. So, you know, these, they’re remarkable shots. They’re remarkable trackers. They, you know, if you think about it this way, they’re remarkable ecologists, biologists. They know each of those species so well and they know their habits and it’s, it’s just, it’s feels so special and you feel so lucky to be able to hang out with them. Joe 01:03:25-01:03:51 What was it like to hang out with the Hadza? I found one of your sub-chapters very intriguing. It’s titled, “Urine for a Surprise.” And urine was U-R-I-N-E. How in the world did you get people to give you urine samples? Dr. Herman Pontzer 01:03:51-01:04:44 Yeah. Well, that brings up a larger issue is how do you do community work ever in these, you know, it’s not my community, right? We travel there. And so the answer is you have to build up a relationship. And so I’m lucky to work with a guy, Brian Wood, another anthropologist at UCLA. And he’s been doing work with the Hadza his whole career. And he speaks Hadza. I should say that when we would go and work with the community, we typically speak Swahili. So you have to learn Swahili to go there. And they grow up speaking both their own Hadza language and Swahili. And so, you know, you have to build these personal relationships and these community relationships. And then once you’ve got that and you’ve got these sort of friendships and people you know, then they’ll trust you like any community would to, you know, if you want to do these research projects that they can kind of get behind, then that’s how that works. You don’t ever just parachute in. You can’t do that. That’s not how it works. Terry 01:04:45-01:04:56 I think you probably have some sense of that, Joe, based on our initial exposure to field work, which was in Santo Tomas, Mazaltepec in the Oaxaca Valley. Joe 01:04:57-01:04:58 In Mexico. Terry 01:04:58-01:05:30 Yes, in Mexico. And they grow up speaking both Spanish and Zapotec because the Zapotec is the mother tongue. But nowadays, I think pretty much everybody speaks Spanish as well. When in the early 1970s, when Joe and I stayed there, there were a lot of the older women who didn’t speak Spanish, which was a little inconvenient for me because I hadn’t yet learned Zapotec. The only thing we learned really in Zapotec was how to drink. Joe 01:05:31-01:05:34 [phonetic Zapotec] “Los-en chute juba umbali.” Terry 01:05:34-01:05:35 [phonetic Zapotec] “Kee-in juba umbali.” Joe 01:05:37-01:05:56 Drink up. But I am curious how you convinced folks to give you a urine sample, to participate in your study, to even begin to comprehend what it was that you were trying to do. Dr. Herman Pontzer 01:05:56-01:07:58 Sure. So, you know, anthropologists have been working with the Hadza community for decades now. You know, that goes back to the 1960s even. And so they’re used to people showing up in Land Rovers and saying, ‘Hey, I’d love to hang out with you guys in your community for a few weeks. And do you mind? And here’s what we’d like to do.’ And they understand, too, that they’re a special community. I think the closest thing we have in the States is something like the Amish, right, who are very aware that the people that they live around are not Amish, but who are very proud, and rightfully so of their lifestyle and want to maintain that culture. And so, you know, in the same way that the Hadza know that other groups around them are not hunting and gathering, they know that that makes them special. And they understand when somebody says, look, you know, this is so unique what you’re doing. We’d love to understand, how do you make it work? How do you make a living doing this? So having people follow along on hunting trips or on gathering trips or, you know, we often write down and weigh the foods that come into camp, for example. And we, of course, we explain all this and we ask permissions to get all and we compensate them for their time, to say too. We’re not just, you know, taking advantage. And so they’re kind of used to folks wanting to come up and work with them. This particular study of asking for urine samples, which is part of this isotope tracking technique we use to measure calories. Look, if you can explain, look, we want to understand how your bodies use the food that you collect to burn off by walking, moving, surviving. They get that immediately. I mean, that’s an easy conversation because it’s a calorie economy, right? They’re used to, they know that they have to wake up in the morning and get those calories. They know that their bodies are burning them all day. Of course, they have not had any formal schooling, many of them, or not much, but just intuitively they understand that. And so that’s actually a pretty easy conversation to have. The urine, you know, anytime you get asked for a urine sample in a doctor’s office, anything like that, that’s always a little weird. I imagine it’s a little weird for them too, but they are able to understand that for sure. Joe 01:07:59-01:08:04 And did you eat with them? And if so, what were you eating and how was it? Dr. Herman Pontzer 01:08:04-01:08:44 So we bring our own food because we don’t want to, you know, burden them by expecting them to sort of feed us. But I have tried a number of Hadza foods: zebra, you know, different kinds of antelope, all the different kinds of plant foods, the tubers, the berries. It’s all pretty good, I guess. I don’t know, it’s not very flavorful. They don’t really use much, you know, there’s hardly any spices or anything like that. Salt is one thing that we actually use to compensate them because it’s what they would trade for, but they’re pretty sparing with it. So it’s not like a typical steak you’d get here at a restaurant in the States, something like that. It’s pretty, you know, tough. Often it’s a few days old. They don’t have any refrigeration, right? Terry 01:08:44-01:08:45 Right, right. Dr. Herman Pontzer 01:08:46-01:08:59 Often they’ll, they’ll, so if it’s a big animal, like a zebra, they’ll eat a lot right when it’s killed. Of course, they cook their food, but then the stuff that’s not eaten gets cut into strips and hung over tree branches to kind of dry. Terry 01:09:00-01:09:02 So it comes out a little bit like jerky. Dr. Herman Pontzer 01:09:03-01:09:11 A little bit. A little too soft and pink for my taste, frankly. But, you know, I’ve never gotten sick eating Hadza food, I’ll say that. Terry 01:09:13-01:09:50 One of the topics that you broach in your book, “Adaptable,” is how our lifespans affect our health. And you describe the results of the famine that the Dutch suffered at the very end of World War II when the Germans were punishing the entire population. And there was tremendous famine. Babies born during that time had a different health career than babies born before or after. Can you tell us about that, please? Dr. Herman Pontzer 01:09:50-01:10:19 That’s exactly right. So the context is, you know, you’re in the Netherlands in World War II. They get cut off from all food supply into the country. And, you know, people are starving. And mothers are starving, too, of course. Pregnant mothers are starving. And that experience of starvation in the womb affected those babies into the whole course of their whole lives. So those babies are now, they’re born in the 40s. Terry 01:10:19-01:10:22 So they’re 80 or getting close. Dr. Herman Pontzer 01:10:21-01:10:57 Something like that, now. Right. And people have been tracking their health outcomes since the 90s, at least. And so we know that those babies born in what’s called the Dutch hunger winter were more likely to develop heart disease, cancers, other medical problems that you normally wouldn’t assume have anything to do with you know, what happened in the womb, right? These are things that manifest in your 60s, 70s, 80s often. And you think it’s lifestyle and your adult choices that you make. And of course, we know that it does affect it. But there is an echo of what happened very early in life, that somehow that programmed the way that their bodies are working. Joe 01:10:58-01:11:09 Well, I think we’re talking about epigenetics. And I’m curious as to whether or not those changes were passed on to their kids. Dr. Herman Pontzer 01:11:09-01:12:06 Yes! So that is the big question. So epigenetics is, if people haven’t heard of that or heard the term and don’t know what it is, basically your genes aren’t getting changed themselves, but they’re getting turned on or off. So there’s these little chemical markers that will turn a gene off or even can also turn it on. And those epigenetic changes are the environment kind of pushing your genes around. And so we think that’s happened to the babies that were born in the Dutch hunger winter. And we think it was passed on to their kids because those kids are now often in their 30s or 40s, right, that generation. And we do see higher BMI, some more obesity in that group. These are now the grandkids of the mothers who were starving in the 1940s, right? So their grandchildren are showing some effects of this. One particular event over the course of one year in the 1940s, we’re seeing those. Again, it’s sort of an echo of the past in the way that these people’s bodies are working today. Joe 01:12:07-01:12:11 So what lesson can we learn from that experience? Dr. Herman Pontzer 01:12:13-01:13:30 Well, there’s so much to learn from that. One is that our environments affect the way our bodies work probably more than we appreciate. And it doesn’t just affect, you know, did I eat too much or did I exercise enough? Those are ways that we know that we can affect our environments. But they can also, our environments can affect the way our genetics are expressed. And those effects can last at least a whole lifetime and perhaps even get passed on. So what that means from a kind of societal point of view is that, you know, let’s think about trying to solve, you know, health differences between communities here in the States. We have people, you know, minorities, other groups who have been disadvantaged. And we try to, there’s a big civil rights, of course, movement to try to address a lot of that in the 1960s. We might think, oh, well, you know, we fixed those problems in the 60s. So by now, everything should be fine. No, because if something that happened in the 60s can be echoing, sorry, if something that happened in the 1940s can be echoing still today, then surely things that began to change, of course, it didn’t completely change in the 1960s. We can still be dealing with those environmental effects, even though we’ve done a, you know, we can be happy with the progress we’ve made. But it’s not going to erase the past in a way that we often think it might. Terry 01:13:30-01:13:37 And we know we still have food deserts and so forth. So that is probably still having an impact. Dr. Herman Pontzer 01:13:38-01:13:49 For sure. For sure. And so, you know, it isn’t just one thing, but that’s right. So we have to be aware, of course, the modern environments, of course, but, you know, also cognizant of these past effects that we’re still dealing with. Joe 01:13:50-01:14:45 So this is a little off track, and you may not have an answer. I think of you as anthropologist slash biologist because you really do pay very close attention to the biology of calories in and calories out and exercise and all the rest of it. What about psychology? The Hadza, in particular, it’s a very close-knit community, and there are social interactions. And I’m curious about how that experience during the end of the Second World War affected people, not just biologically, but psychologically, and how that might be passed along epigenetically. Dr. Herman Pontzer 01:14:45-01:15:53 Yeah, I’m glad you brought that up. I often wonder how much the kind of the psychological health of the Hodge community, which seems to be very robust, very good, plays into the fact that we don’t see heart disease there. We don’t see diabetes there. We don’t see obesity there. You know, the factors that we know can push people to overeat and develop other unhealthy habits here in the States, loneliness, stress, you know, feeling of being kind of left behind and it’s kind of social inequality, that kind of thing. We know that those are factors that push people to make unhealthy choices. We don’t see those in a Hadza camp. You don’t see that in a community that’s egalitarian. Right. Nobody really has more than somebody else. Those differences are really small. They’re socially connected. You never go a day without having a good conversation with somebody you’ve known for a long time. You are physically active in getting the health and psychological benefits of that activity every day. You never feel like you’re alone or left out. And those are all really important, too. And it’s not something that my research focuses on. But, of course, you can’t help but be aware of that when you’re there. Joe 01:15:55-01:16:05 My last question has to do with how your research, how your interaction with people all over the world has impacted you personally. Dr. Herman Pontzer 01:16:08-01:16:43 It has made me just feel incredibly lucky both to be able to have those experiences. I mean, I can’t imagine a better job, but it also makes me feel really fortunate to be here in the States. You know, I mean, I think we have a lot of debate and angst about the state of things in this country today. And I get that. But I feel a lot of those things, too. But we are pretty darn lucky to be here and to have the resources available to fix a lot of these issues and deal with them. And so it makes me optimistic and happy to be where I am. Joe 01:16:44-01:17:48 Dr. Pontzer, I have to tell you that our time in Mexico was magical. We were there for almost two years. And it changed my attitude and perspective about a lot of things. And I thought a lot about Peace Corps volunteers and other anthropologists who travel the world and hang out with people in all kinds of different places. And sometimes I think, you know, if we could just give people that experience so that more Americans could see the world maybe from a slightly different perspective by just hanging out with people, whether it’s the Hadza or whether it’s somebody in New Zealand or, you know, the Maori, whatever, that it might change the way in which we think about the other and ourselves. Have you had an opportunity to reflect on that? Dr. Herman Pontzer 01:17:49-01:18:48 Absolutely. And I think it’s one of the things I try to share in my writing and in my classes I teach and opportunities like this is to kind of share that broad perspective that you get from travel. And again, when you go to these communities, you have a chance to live there for a while. At first you notice the differences and then you notice all the shared humanity and you bring all those threads and those pieces back with you and you see home again in a different way right that’s I forget what the famous line is to travel is to come home and see it with new eyes something like that and i think that’s exactly right you know maybe we could do a better job making that a possibility for more folks here in the states or maybe uh social media will do a good job advertising the rest of the world to everybody. I’m not so optimistic about that. But no, I agree with you that travel really makes that, broadens your perspective on this and gives you a new appreciation for what you have here and also what we can sort of learn. Terry 01:18:49-01:18:59 Well, certainly Americans are not going to be able to eat the way the Hadza eat. We are not going to go out and dig up tubers that we will be consuming as our main staple. Dr. Herman Pontzer 01:19:01-01:19:09 No, that’s right. And, you know, not only that, but you couldn’t live like that. We couldn’t live on wild foods if we wanted to because there’s no wild foods in your supermarket. Terry 01:19:09-01:19:24 Exactly right. And there’s not enough wild land for us to collect wild foods from, even if we knew how, which we don’t, most of us. So what should we be doing for our health and to maintain a healthy weight? Dr. Herman Pontzer 01:19:24-01:20:18 No, that’s right. I really appreciate you bringing that up because, you know, the importance of doing this work across cultures isn’t that we’re going to somehow, you know, try to bring those cultures home, right? Every culture kind of fits into its own space. We don’t have to pretend to be hunter-gatherers. What we do is we have to learn the lessons that they’re teaching us. And the lessons that populations like the Hadza are teaching us are these. You know, try to eat whole foods that you recognize as whole foods. Try to stay away from the, you know, modern engineered foods that push us to overeat. Make sure you’re getting physical activity every day. Anything counts. It doesn’t have to be the kind of things that they’re doing. Any activity is good activity. And, you know, that sounds simple and it sounds like the story you’ve heard before and you probably have. But I think, you know, what this does is it clarifies, okay, the exercise is good for a lot of aspects of our health. The diet is what we really need to focus on for obesity. These are two different tools for two different jobs. Joe 01:20:18-01:20:28 And if we can’t pronounce those chemical names on the label, and there are like a dozen of them, maybe we should avoid those foods. Dr. Herman Pontzer 01:20:28-01:20:42 Yeah, people always ask, well, what’s an ultra-processed food? And, you know, I think, well, if it’s got a shiny package and an advertising campaign, it’s probably an ultra-processed food. And if the ingredients list is a paragraph long, that’s another clue. Terry 01:20:42-01:20:50 Yeah, that’s a pretty good clue. Dr. Herman Pontzer, thank you so much for talking with us on The People’s Pharmacy today. Dr. Herman Pontzer 01:20:50-01:20:51 Thank you for having me. Terry 01:20:53-01:21:22 You’ve been listening to Dr. Herman Pontzer. He 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.” Joe 01:21:23-01:21:32 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Terry 01:21:32-01:21:40 This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy. Joe 01:21:40-01:21:58 Today’s show is number 1,449. You can find it online at peoplespharmacy.com. At peoplespharmacy.com, you can share your comments about this episode. You can also reach us through email, radio, at peoplespharmacy.com. Terry 01:21:58-01:22:34 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In the podcast this week, there’s some information that would not fit into this broadcast. You’ll hear about a healthy relationship with food, as well as what it’s like to work with the Hadza. How did Dr. Pontzer convince people to provide urine samples? We also discuss how food deprivation at certain critical points in life, such as in utero, can affect health in adulthood and even the next generation. Joe 01:22:34-01:22:56 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We’d be grateful if you would consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. In Durham, North Carolina, I’m Joe Graedon. Terry 01:22:56-01:23:28 And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:23:29-01:23:38 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in. Terry 01:23:39-01:23:43 All you have to do is go to peoplespharmacy.com slash donate. Joe 01:23:44-01:23:57 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

Oct 15

Do you love your hair the way it is? Many of us wish our hair were different–curlier, straighter, darker or lighter. But what people worry about most with their hair is when they lose it. Can you keep your hair from falling out? Why does hair loss affect some people, including women as well as […]

Oct 10

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 […]

Oct 6

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, […]

Sep 29

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 does the latest medical science […]

Sep 18

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 […]

Sep 12

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 […]

Sep 5

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 […]

Aug 28

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. At The People’s Pharmacy, we bring you the latest research-backed insights on health, […]

Aug 21

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 […]

Aug 15

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 […]

Aug 7

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 […]

Aug 1

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 […]

Jul 24

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 […]

Jul 18

This week, we welcome dermatologist Dr. Chris Adigun to our studio to answer your questions about summer skin problems. You can call in your stories and questions about bites, burns and blisters between 7 and 8 am EDT on Saturday, June 21, 2025, at 888-472-3366. Or you can send us your question or story ahead […]

Jul 10

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, […]

Jul 3

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 […]

Jun 26

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. You could listen through your local public […]

Jun 19

This week, our guest in the studio is veterinarian Dr. Chuck Miller. You can call in your stories and questions about the animals in your life between 7 and 8 am EDT on Saturday, June 21, 2025, at 888-472-3366. Or you can send us email: radio@peoplespharmacy.com. We’ll be focusing on transforming relationships between humans and […]

Jun 12

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? You could listen through your local public radio station or get […]

Jun 5

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 […]

May 29

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 […]

May 21

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

May 15

In this week’s episode, find out what everyone gets wrong about weight loss. Why don’t diet and exercise work very well? Do official guidelines and weight loss drugs offer a clearer path to success? Health Consequences of Excess Weight: With nearly three-fourths of American adults either overweight or obese, we can’t ignore the problem any […]

May 8

In this episode, investigative journalist Gardiner Harris delves into the dark secrets of one of the country’s most admired pharmaceutical firms. Johnson & Johnson sold talcum powder–Johnson’s Baby Powder–for decades even though it contained asbestos, an acknowledged carcinogen. How did the company maintain its superb reputation for so long? You could listen through your local […]

May 2

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 […]

Apr 24

This week, a renowned neurosurgeon shares what he has learned in decades of working to restore ailing brains. His new book covers a vast range of neuroscience. Our dilemma was what to pay attention to in all those options. In a sense, that is always the human situation. We are capable of conscious processing of […]

Apr 17

In this week’s episode, a functional medicine expert will describe how to adjust your lifestyle to achieve the longest healthiest life possible. Is your biological age greater or less than your chronological age—the one you celebrate with birthday cake? How can you increase your chance of enjoying vibrant good health as you grow older? You […]

Apr 17

Many indigenous peoples around the world have developed traditional uses for psychedelic compounds. In Western medicine, these were mostly unknown until Albert Hoffmann synthesized LSD (lysergic acid diethylamide) in 1938. He later tried to figure out how it might be used after having an extraordinary personal experience. By the mid to late 1960s, psychedelic drugs […]

Apr 10

This week, neuro-otologist David Kaylie of Duke Health will help us understand how balance disorders disrupt patients’ lives and what doctors can do to help. If you have felt lightheaded or been bothered with vertigo, call in your questions between 7 and 8 am EDT on Saturday, April 12, 2025, at 888-472-3366. Or you can […]

Apr 3

This week, two pharmacists describe why you should check with a pharmacist about possible problems when you combine supplements, herbs and medicines. In some cases, a supplement might interfere with your prescription drug. In other situations, an herb might slow metabolism of the medicine and increase the possibility of side effects. It’s better to know […]

Mar 27

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

Mar 20

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

Mar 14

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

Mar 7

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

Feb 26

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 […]

Feb 20

This week, Terry and Joe welcome Dr. Andrew Spector to the studio to share his expertise with listeners. Restless legs syndrome (RLS) is a relatively common problem that can really wreak havoc on a good night’s sleep. Have you experienced this problem? How do you manage it? We invite you to call and tell us […]

Feb 13

This week, we offer the second of a two-part series on the pros and cons of water fluoridation. Last week we discussed the practice of adding fluoride to drinking water to prevent tooth decay. This week we hear from a researcher who has found that early exposure to fluoridated water may affect youngsters’ IQ. You […]

Feb 7

This week, we offer the first of a two-part series on water fluoridation. The practice of adding fluoride to drinking water to prevent tooth decay has been controversial for some time. Why? What should we know about it? You could listen through your local public radio station or get the live stream at 7 am […]

Jan 30

This week, we explore the evidence that some respected researchers in the field of Alzheimer’s disease took shortcut or even manipulated their data to get the results they wanted. How did our guests detect fraud and arrogance in this research? You could listen through your local public radio station or get the live stream at […]

Jan 24

This week, Joe & Terry invite listeners to share their favorite home remedies for colds. No one expects a remedy to shorten the duration of a cold–although perhaps one or two could! But many may help people feel better for a few hours if they alleviate symptoms. You can call in your suggestions to 888-472-3366 […]

Jan 16

This week, two distinguished exercise physiologists tell us why we each need an exercise prescription for life. Dr. Benjamin Levine has worked with the Dallas Bed Rest and Training Study to discover that three weeks of bed rest hurt fitness more than 30 years of normal life. Dr. Claudio Battaglini provides exercise prescriptions for cancer […]

Jan 10

This week, we hear a first-hand account of what a stroke feels like, from neuroanatomist Dr. Jill Bolte Taylor. Then we learn from a neurologist, Dr. Matthew Schrag, about the risk factors for such a brain attack. What treatments could be helpful? You could listen through your local public radio station or get the live […]

Jan 2

This week, we hear from pulmonologist Roger Seheult, MD, about ways we can strengthen our immune responses to respiratory infections. Seasonal influenza activity is high and still rising in most parts of the country. In addition, wastewater surveillance shows that COVID-19 cases are on the rise. Cold viruses are also circulating. Find out what strategies […]

Dec 26, 2024

This week on our nationally syndicated radio show, we discuss the importance of fiber and phytonutrients in our food for keeping our intestinal microbes healthy. We’ll also find out why encouraging a varied and thriving microbiome in the soil is critical for producing healthy food crops. Fiber and Phytonutrients: Do you know what is the […]

Dec 20, 2024

This week, we look at the new pharmaceuticals that the FDA has approved for treating Alzheimer disease. Although they are effective at removing amyloid plaques from the brain, they don’t seem to help patients function better. Is it time to turn away from an exclusive focus on amyloid to consider other factors that might affect […]

Dec 12, 2024

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. You could listen through your local public radio station or […]

Dec 6, 2024

This week, we talk with an expert on cancer epidemiology. Surprisingly, though, our discussion centers on the health aspects of practicing kindness and compassion. In our polarized world, anger and hostility are rampant. But kindness is not only good for the person who receives a kind gesture. It also has a biological impact on the […]

Nov 28, 2024

In this week’s interview, Dr. Robert Waldinger of Harvard University explains why overcoming loneliness is essential for our health. His research, summarized in The Good Life, shows that close relationships are crucial for a satisfying life. In addition, the Surgeon General has issued a comprehensive report on the epidemic of loneliness and its effects on […]

Nov 21, 2024

This Saturday morning, November 23, 2024, an expert from Australia helps us examine the hidden risks of healthcare. Healthcare providers have the best of intentions, but they simply cannot truly uphold the (apocryphal) part of the Hippocratic oath that urges “First, do no harm.” How can patients and their families become more familiar with the […]

Nov 14, 2024

This week, we discuss how making your own herbal medicine at home can provide you with safe, inexpensive and effective ways to ease symptoms of common problems like colds, cuts and scrapes or heartburn. Our guest is a long-time People’s Pharmacy favorite, Dr. Tieraona Low Dog. Learn about leaves and roots in remedies you can […]

Nov 7, 2024

This week, we consider whether viruses might be able to overcome bacterial infections that resist all antibiotics. We start with a thrilling story from a few years ago in which a scientist saved her husband’s life with bacteriophages. Then we turn to a journalist who grew up in Russia where bacteriophages are common remedies. She […]

Oct 31, 2024

This week, a nationally-renowned expert on hypnotherapy describes how this tool can be used to help people heal from stress or pain. Have you tried it? You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link […]

Oct 23, 2024

This week, we’ll dive into the research on how emotions affect your heart health. Specifically, we talk with two scientists who have studied the impact of anger on blood vessels. How might that shape your risk of a heart attack? Can you change your impulse to react with anger when somebody else is thoughtless or […]

Oct 17, 2024

This week, an eminent toxicologist, now retired, describes the concerns about PFAS compounds, also known as forever chemicals. Although scientists have known for decades that they get into our bodies readily, the apparent benefits led to their widespread use. These are compounds that do a wonderful job keeping your boots and rain gear dry, keeping […]

Oct 10, 2024

This week, our guests share their expertise on how to deal with sniffles and congestion, whether you are reacting to seasonal triggers or suffer from year-round allergies. Can you reduce the amount of allergen you are exposed to? Which medications could help, and what are the downsides? We’ll also discuss some herbs that can help […]

Oct 3, 2024

This week, Joe and Terry Graedon welcome your calls about how you can protect your precious eyesight. Have you been struggling with dry eyes or diagnosed with glaucoma? You can share your experience or ask your questions at 888-472-3366 between 7 and 8 am EDT on Saturday, October 5, 2024. We also invite you to […]

Sep 26, 2024

This week, we talk with a physician who was struck with a catastrophic illness as a medical student. He nearly died from it; in fact, a priest administered last rites. But David Fajgenbaum wouldn’t give up. He helped find the treatment–an existing drug for a different health condition–that has kept him alive for more than […]

Sep 19, 2024

This week, our guest calls attention to beliefs and practices in medicine that are based on dogma rather than data. Why don’t doctors or researchers question these blind spots? You’ll hear about some of the most striking myths, and maybe you’ll be surprised. You could listen through your local public radio station or get the […]

Sep 13, 2024

This week, we talk with a sociologist and a neurologist about the extremely painful condition known as cluster headaches. The sociologist has studied how patients have sought out relief that the medical profession could not provide. They found it in magic mushrooms and shared the details among patient groups termed ClusterBusters. The neurologist has studied […]

Sep 5, 2024

This week, we talk with the People’s Pharmacy Pediatrician, Dr. Alan Greene, about the incredible proliferation of plastic particles in our environment and our bodies. Children are especially vulnerable, as their bodies and brains are still developing. Find out about protecting children from plastic microparticles. You could listen through your local public radio station or […]

Aug 28, 2024

This week, our guest is renowned addiction psychiatrist Jud Brewer. He teaches at Brown University in both the School of Public Health and the Medical School, and he has developed programs that utilize mindfulness to help us figure out why we overeat, get hooked on social media or drink too much. His approach has helped […]

Aug 15, 2024

This week, Joe and Terry Graedon welcome your calls about your favorite home remedies. Which ones really work to solve common health problems? You can share your experience at 888-472-3366 between 7 and 8 am EDT. We also invite you to send your comments in beforehand to radio@peoplespharmacy.com. You could listen through your local public […]

Aug 8, 2024

This week, we talk with integrative gastroenterologist Robynne Chutkan about why our digestive health is so important. Of course, our digestion provides us with the nutrients that power our bodies, including our muscles, hearts and brains. There is also crucial two-way communication between the gut and the brain. You could listen through your local public […]

Aug 1, 2024

This week, we explore the role viruses may play in the development of dementia. That certainly sounds like a downer, but here is the brighter side: vaccines can significantly lower the risk! Joe and Terry talk to two leading researchers about their findings and the implications of antivirals or vaccines and Alzheimer Disease. You could […]

Jul 17, 2024

Our interviews this week focus on what is known and what is still being discovered about the mysteries of long COVID. We speak with a physician heading the long COVID Care Center at Yale University and with a microbiologist heading up a multidisciplinary research initiative. You could listen through your local public radio station or […]

Jul 11, 2024

This week, Joe and Terry Graedon welcome your questions about keeping your feet healthy. Dr. Jane Andersen is a foot and ankle specialist who will take your calls about a range of podiatric problems. Have you had trouble with plantar fasciitis? You can ask your questions about foot health and share your experience at 888-472-3366 […]

Jul 4, 2024

This week, we talk with 4th-generation herbalist, research scientist and mycologist, Dr. Christopher Hobbs. He extolls the benefits of mushrooms not only as nutritious foods, but also as important components of natural medicine. What should you know about marvelous medicinal mushrooms? You may want to listen through your local public radio station or get the […]

Jun 27, 2024

If you need surgery, medication or some other medical intervention, you count on your health insurance company to pay the bill. When the treatment is unusual or the expected cost is especially high, it seems reasonable to ask for prior approval. Increasingly, though, insurance companies are denying those requests and not paying the claims. How […]

Jun 19, 2024

Would you be surprised to learn that hypnosis is a powerful tool for healing? If your primary exposure to this practice has been in books and movies, you may have a few misconceptions about how it works and what it can do. Some people imagine that when you are hypnotized, you lose control. Instead, it […]

Jun 13, 2024

This week, Joe and Terry Graedon welcome your questions and stories about difficulties in stopping medicines, whether prescription or OTC. Dr. Richard Friedman, an expert on drugs to treat anxiety and mood disorders, describes the symptoms of discontinuing such an agent too suddenly. Have you had trouble getting off the medication treadmill? You can ask […]

Jun 6, 2024

Our culture tends to avoid thinking about death. Even though we know it is inevitable, we tend to act as though it doesn’t actually pertain to us. As a result, most of us have spent little time learning how people find hope and meaning at life’s end. The intense dreams and visions that dying people […]

May 29, 2024

For years, the reigning paradigm in health care has been “Doctor knows best.” Providers rarely sought input from patients about their needs or experience. That picture has been changing, though, as more people have been using online tools to band together and find solutions for themselves and their loved ones. Susannah Fox describes the patient-led […]

May 24, 2024

The term “homeostasis” was coined about a hundred years ago. What does it mean? Essentially, it is a way of describing how various systems in the body work together to maintain internal equilibrium even in the face of a changing environment. This concept is crucial to good health, as healers have known intuitively for millennia. […]

May 16, 2024

This week, Joe and Terry Graedon welcome your questions and stories about the dangers of overdosing on OTC meds. Dr. Lisa Sanders, an acknowledged expert on medical diagnosis, starts us off with a story about a patient’s mysterious illness. How was it linked to the medicine he was taking? You can ask your questions about […]

May 9, 2024

This week on our nationally syndicated radio show, we examine the consequences of prescriptions for anxiety or grief. All of us, at some point in our lives, will experience some of these emotions. If we discuss them with a healthcare provider, there’s a chance we’ll end up with a prescription. When are medications helpful and […]

May 3, 2024

. Decades ago, people trusted their doctors and assumed that physicians always had the patient’s best interests in mind. That belief has faded and trust in medicine seems to be in tatters following the divisive battles of the pandemic. In this episode, we consider how doctors might rebuild faith in medicine. You may want to […]

Apr 25, 2024

Plenty of issues in the public eye could well make anyone anxious. Some people suffer more than others, however. What we feed our gut microbes–and ourselves–can make a big difference. In this episode, a nutritional psychiatrist and professional chef explains how to calm your mind with smart food choices. You may want to listen through […]

Apr 24, 2024

Everyone is weary of the coronavirus pandemic and ready to be done with it. So the news that a new pandemic is already slowly unfolding is unwelcome. But unless we pay attention and do what we can to reverse the growing trend of antimicrobial resistant infections, they could end up causing even more death and […]

Apr 18, 2024

What do you want to know about prostate cancer? This week, Joe and Terry Graedon welcome your questions about the latest screening tools and treatments for prostate cancer. Almost 300,000 men are diagnosed with prostate cancer each year, but stigma keeps many from discussing it. As a result, they may not learn about the latest […]

Apr 10, 2024

Chemists use compounds such as bisphenols and phthalates to help make plastic packaging strong and durable. In this episode, two experts describe how these chemicals get into our food and how we can minimize our exposure. They share their advice on how to eat less plastic. You may want to listen through your local public […]

Mar 29, 2024

If you tell your healthcare provider that you’re feeling anxious or depressed, chances are they will prescribe you a medication. Millions of people take anti-anxiety pills or antidepressants, and many find that the medicine makes life more bearable. But can you understand what makes your life meaningful? For that, you might need to tell your […]

Mar 21, 2024

This week, Joe and Terry Graedon welcome your stories and questions about living with animals. Does a cat purring on your lap help you calm down after a hectic day? Has walking the dog become a part of your exercise routine? Tell us about your pets at 888-472-3366 between 7 and 8 am EST. Or […]

Mar 15, 2024

This week, two guests describe their work with the healing power of medicinal herbs. They draw upon family histories of herbalism along with their own studies of how to use botanical medicines. You may want to listen through your local public radio station or get the live stream at 7 am EDT on your computer […]

Mar 8, 2024

This week, we talk with Dr. Paul Offit, author of the new book, Tell Me When It’s Over. Most of us are more than ready to move on from the COVID-19 pandemic. We’ll discuss how public health officials could regain our trust. In addition, we consider what lessons we should take away from this experience. […]

Feb 28, 2024

This week, our guests examine the quality of medications. Does importing a majority of our medicines from plants in places like India or China compromise our national security? Just how well does the FDA monitor drug quality? You may want to listen through your local public radio station or get the live stream at 7 […]

Feb 22, 2024

This week, Joe and Terry Graedon entertain your questions and stories about home remedies. What do you do for leg cramps or heartburn? Call in your favorites at 888-472-3366 between 7 and 8 am EST, or send us an email beforehand: radio@peoplespharmacy.com. We’ll explore whether there is science supporting home remedies. You could listen through […]

Feb 7, 2024

This week, our guest is one of the country’s leading experts on schizophrenia, Dr. Jeffrey Lieberman. He teaches at the Vagelos College of Physicians and Surgeons, part of Columbia University, where he studies the treatment of mental illness. His research led to the therapeutic strategy of early detection and intervention for a malady of the […]

Jan 25, 2024

This week, we talk with America’s Pharmacist, Suzy Cohen, about the effectiveness of medications and natural healing. Suzy has a multimedia presence in newspapers and on television. Millions of people trust her advice on over-the-counter and prescription medicines. She is also a strong advocate for natural approaches. You may want to listen through your local […]

Jan 18, 2024

This week, dermatologist Chris Adigun joins us live in the studio to answer your questions about how to treat your skin and hair when the weather gets cold. Cold wind, low humidity and forced hot air indoors can all conspire to dry out your skin. Call in your questions about winterizing your skin at 888-472-3366 […]

Dec 28, 2023

Too many of us assume that aging automatically brings debility and cognitive decline. So it is a pleasure to talk with a centenarian who is ready to share the secrets to living a long healthy life. Secrets to Living a Long Healthy Life: Dr. Gladys McGarey is 102 years old. She spent her childhood in […]

Dec 21, 2023

This week on our nationally syndicated radio show, you’ll hear an internationally recognized expert on overcoming eating disorders. There are several different types of eating disorders, and they are far more common than most people realize. With so much emotion surrounding food and body image, you might have a hard time understanding how to help […]

Dec 15, 2023

In this week’s interview, Dr. Aaron Carroll of Indiana University discusses what we should take into account when we evaluate prescription drugs. How can we tell if the benefits would outweigh the risks for us? You may want to listen to it through your local public radio station or get the live stream at 7 […]

Dec 8, 2023

In this week’s interview, a board-certified geriatric pharmacist explains why taking an older person off a medication might be just as important as putting them on one. In fact, since prescriptions tend to accumulate over time, the delicate art of deprescribing is even more essential. This pharmacist helps physicians determine how to reduce the number […]

Dec 1, 2023

This week’s interview is on an underappreciated killer, sudden cardiac death. This is not the same thing as a heart attack. Our guest, Dr. Zian Tseng, has been studying cardiac arrest for years to learn why it happens and what to do about it. You may want to listen to it through your local public […]

Nov 23, 2023

This week’s interviews focus on the benefits of better hearing. Dr. Frank Lin describes the results of the ACHIEVE study, in which some participants got a very significant delay in the onset of cognitive decline if they were provided with needed hearing aids. We also talk with a reporter about recently introduced over-the-counter devices. You […]

Nov 16, 2023

In this episode of our nationally syndicated radio show, we talk with two physicians who have looked closely at the research on using herbs for healing. Sometimes, people dismiss the medicines we can find in plants as old wives’ tales or silly home remedies. Increasingly, however, scientists are confirming that certain herbs can be very […]

Nov 9, 2023

This week, we interview the doctor who first identified seasonal affective disorder (back in 1984!) and went on to develop treatments. You may want to listen to it through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so […]

Nov 2, 2023

This week’s radio show is the second of a two-part series on new medicines for treating obesity. This episode features Dr. Robert Lustig, neuroendocrinologist and anti-obesity crusader. He discusses the uses and disadvantages of drugs such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro). In addition, he offers a completely different way to combat obesity. You […]

Oct 26, 2023

This week’s radio show is the first of a two-part series on new medicines for treating obesity. This episode features obesity expert Dr. Jamy Ard. He’ll describe how he uses drugs such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro). What are the pros and cons of these medications, and what other approaches are available? You […]

Oct 20, 2023

In this broadcast, we answer listeners’ questions about over-the-counter drugs. If you have bought a medicine without a prescription, how do you use it wisely? Dr. Stefanie Ferreri, Distinguished Professor in Pharmacy Practice at the UNC Eshelman School of Pharmacy is standing by, along with Joe and Terry, to answer your questions about the pros […]

Oct 12, 2023

This week’s radio show features two of the country’s leading nutritional epidemiologists, Dr. Walter Willett of Harvard and Dr. Barry Popkin of the University of North Carolina. They discuss some of the challenges with the food on our grocery shelves and advise us on how to tell if the food we choose is real or […]

Oct 6, 2023

This week’s radio show features one of our favorite guests, Dr. Robynne Chutkan. She is a gastroenterologist in Washington, DC and is a brilliant communicator. You may want to listen to it through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here […]

Sep 27, 2023

This week on our nationally syndicated radio show, we talk with one of the authors of Wonder Drug: 7 scientifically proven ways that serving others is the best medicine for yourself. A self-proclaimed data nerd, Dr. Steve Trzeciak and his coauthor were charged with improving performance and patient satisfaction for a large hospital. The consultants […]

Sep 22, 2023

According to the CDC, cases of COVID-19 have been rising in several parts of the country. Cases of hospitalization for COVID are also up. One way to protect ourselves from airborne germs like the SARS-CoV-2 virus is through better ventilation and air filtration. How well are we using these techniques? Maximizing Ventilation to Avoid Airborne […]

Sep 14, 2023

Since at least the 16th century, people have suggested that the eyes are the windows to the soul. In the 21st century, ophthalmologists have developed technology that allows them to assess our health beyond our eyes. What do they see when they look through these windows to the brain? Eyes as the Windows to the […]

Sep 8, 2023

When you develop a health problem with symptoms that trouble you, the first step is to find out what it is. Diagnosis may be the most basic task a doctor or other healthcare provider undertakes. That doesn’t mean it is easy, though. New research is uncovering the shocking dangers of misdiagnosis. The Dangers of Misdiagnosis […]

Aug 24, 2023

When you think of preventing heart disease, what comes to mind? We hope you envision regular exercise and a healthful diet (whatever that means to you). Perhaps you also plan for regular checkups and know what your cholesterol levels are. If they have been high, you may be taking a statin cholesterol-lowering drug to get […]

Aug 17, 2023

Only a few decades ago, most households had very limited ways of measuring their members’ health. There were thermometers to tell if someone had a fever. A bathroom scale could tell if you were losing or gaining weight. For quite a while, if you wanted to know about your blood sugar or your blood pressure, […]

Aug 10, 2023

Have you ever taken a package out of your mailbox on a hot day and noticed that it was warm to the touch? If the pouch contained a tee shirt or a pair of sneakers, you probably didn’t think much more of it. But millions of people get their medications by mail, and some medicines […]

Jul 27, 2023

No question about it, sunshine and heat can be stressful for your skin. This episode is all about solutions to summer skin problems. Sunscreens offer the promise of protection from sunburn, but are they as good as we think they are? Does sunscreen block vitamin D formation? Find out which sunscreen ingredients work best and […]

Jul 20, 2023

It’s way too hot, not just in the United States, but in other parts of the world as well. The temperature in Rome this week was 107 degrees Fahrenheit. It is anticipated that the islands of Sicily and Sardinia could reach as high as 118. Temperatures were also dangerously high in Athens, leading authorities there […]

Jul 14, 2023

You are probably familiar with adrenaline, the hormone that jolts through your body in an emergency. As a result, your heart beats faster and harder, your hands shake, your pupils dilate and your muscles are mobilized for fast action. This is extremely useful in a crisis. But what if your body goes into crisis mode […]

Jul 6, 2023

This week on our nationally syndicated radio show, our topic is evolution and the role of delicious flavors. We talk with Dr. Rob Dunn, ecologist and evolutionary biologist, about how the search for food with delicious flavors as well as high nutrient content might have shaped our behavior as we evolved. How Humans Define Delicious […]

Jun 29, 2023

Until 1994, when Congress passed legislation on dietary supplements, most people using herbal medicine made it themselves or got it from a friend or family member with a green thumb. Before that time, most stores selling herbs in tinctures, capsules and tea bags were small, and so were the companies supplying them. Now, though, the […]

Jun 16, 2023

If you are like us, you welcome the first warm days of the season with joy. And then you start to fret. How can you avoid tick bites? Many people recognize Lyme disease as a serious health threat from deer tick bites. However, fewer are aware that a bite from a completely different tick, the […]

Jun 9, 2023

Millions of Americans take dietary supplements, and most of us assume that they are safe. While that is probably a reasonable rule of thumb, there are some situations that require more vigilance. In particular, we need to beware of herb and drug interactions. Even your doctor may not know about the hidden harms. How Risky […]

Jun 1, 2023

Physical activity is a key pillar of good health. Fewer than a fourth of American adults move their bodies enough to keep them healthy. The rest of us may spend too much time sitting in front of a computer or television screen. We recognize we need more exercise. But just as we wouldn’t try to […]

May 26, 2023

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

May 25, 2023

For decades researchers have told us that beta amyloid accumulation in the brain causes Alzheimer disease (AD). The FDA has recently approved two new drugs, Aduhelm and Leqembi, based on this theory. There is a third drug, donanemab, waiting on the runway. All three medications are very good at removing amyloid plaque from the brain, […]

May 19, 2023

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

May 11, 2023

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

May 4, 2023

This week’s episode begins with an interview. We talk with Dr. Craig Hopp of the National Center for Complementary and Integrative Health about why doctors so often dismiss home remedies as old wives tales. Then he describes how we could evaluate remedies without randomized controlled trials. Natural products may offer leads for new drug development. […]

Apr 27, 2023

We have multiple nervous systems. You are probably aware of the nerves that help move your arms to throw a ball or move your legs to jump. No doubt you also know about the fight-or-flight response triggered by a fright. The oddly named sympathetic nervous system is in charge of that. Many of us don’t […]

Apr 20, 2023

Have you ever wondered what makes for a meaningful life? Philosophers have debated this for centuries, but now science has something to add. The current director of the Harvard Study of Adult Development shares the findings from this long-running, in-depth research on the factors that lead to happiness and a meaningful life. 80+ Years of […]

Apr 13, 2023

In this episode, four guests share their diverse perspectives on LASIK eye surgery. This procedure surgically changes the shape of the cornea with the goal of helping people see better, ideally without eyeglasses or contact lenses. Experts estimate that ophthalmologists perform about 700,000 of these in the US each year. We are told that most […]

Apr 6, 2023

This week on our nationally syndicated radio show, we explore the power of cocoa compounds to help heart health. Our first guest is Harvard’s Dr. JoAnn Manson, lead investigator of the COSMOS trial. That stands for Cocoa Supplement and Multivitamin Outcomes Study. This very large, randomized placebo-controlled study looked at the effects of a multivitamin […]

Mar 24, 2023

This week, we talk with renowned author Temple Grandin. She reveals why she thinks visual thinking is underappreciated. Most importantly, she describes how we could change our educational system to better utilize a wide range of mental skills. Practical Applications of Visual Thinking: Most of us are not aware of how our brains work. Often, […]

Mar 17, 2023

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

Mar 8, 2023

Whether we call it indigestion, reflux, sour stomach or heartburn, this condition is painful. When acid from the stomach splashes up into the lower esophagus, it burns. Even though heartburn doesn’t actually have anything to do with the heart, the name makes sense. The pain is generally behind the sternum, in the center of the […]

Mar 2, 2023

In this week’s episode, sleep expert Dr. Jade Wu will join us in the studio to answer your questions about overcoming insomnia without medication. Email us [radio@PeoplesPharmacy.com] or call 888-472-3366 between 7:10 and 8:00 am EST on Saturday, March 4, 2023. Why Does Sleep Matter? Adequate sleep is a critical pillar of good health. During […]

Feb 17, 2023

In this week’s episode, we explore a range of practical approaches to staying healthy even in the midst of an epidemic or pandemic like COVID. Our guest offers evidence-based advice on what lifestyle changes can make a difference. Practical Strategies for Staying Healthy: Dr. Roger Seheult was already scouring the medical literature even before COVID-19. […]

Feb 3, 2023

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

Jan 27, 2023

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

Jan 19, 2023

When the COVID-19 pandemic began, it seemed there were only two outcomes from an infection. Either you died (as far too many people did) or you survived and moved on. Now, physicians, researchers and a growing number of patients are coming to grips with symptoms that persist months or possibly years after the initial infection. […]

Jan 6, 2023

This week on our nationally syndicated radio show, our guest describes the causes and consequences of silent inflammation. Usually, inflammation (redness, swelling, heat, pain) is a tool the immune system uses to fight infection. But what happens when it gets out of control? The Dangers of Silent Inflammation: A number of factors might help explain […]

Dec 30, 2022

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

Dec 29, 2022

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

Dec 22, 2022

Jane Goodall is an eminent naturalist who spent years studying chimpanzees in their natural habitat. It was she who first reported that we humans are not the only primates to make and use tools. She transformed our understanding of these animals. Now she is an elder stateswoman speaking out for action to help reverse climate […]

Dec 8, 2022

In our nationally syndicated radio show this week, we talk with two scientists who have been studying how eating cherries affects our physiology. Both are experts in sports medicine who have done some intriguing research that may convince you to include tart cherries in your diet. Tart Cherries for Precovery: First we speak with Dr. […]

Nov 17, 2022

We hear a lot about the obesity epidemic in the United States and around the world. Scientists acknowledge that this has occurred too rapidly to be explained by changes in genetics. Instead, nutrition scientists often turn to the energy balance model: people eating more calories than they expend. However, this dietary dogma on weight gain […]

Nov 9, 2022

According to the Centers for Disease Control and Prevention, approximately 50 million American suffer from debilitating chronic pain. Despite that number, in 2016 the agency issued stringent guidelines limiting opioid prescriptions to a bare minimum. Such drugs are often the first line for treating pain. Unfortunately, although this was an effort to reduce drug overdose […]

Nov 4, 2022

This week on our nationally syndicated radio show, we consider how to maintain a healthy balance in our gut microbiome. Each of us carries a vast collection of microbes in our digestive tracts. Although we usually think first of bacteria, there’s also an enormous number of viruses that feed on the bacteria. Could these bacteriophages, […]

Oct 21, 2022

In our nationally syndicated radio show this week we’ll be taking your questions live. We have invited two distinguished dermatologists to discuss problems affecting the hair and nails and tell you how to have healthy hair and nails. Green Nail Syndrome: For years, listeners have been calling in questions about nail fungus that makes toenails […]

Oct 13, 2022

Examining the Basis of Neuroscience Dogma: This week on our nationally syndicated radio show, our guests discuss the evidence supporting widely accepted ideas about Alzheimer disease and depression. Neuroscience dogma holds that Alzheimer disease results from the accumulation of beta-amyloid plaque in the brain. Moreover, nearly any psychiatrist, when asked, will tell you that SSRI […]

Oct 6, 2022

This week, an exciting interview from our archive airs on Oct. 8, 2022. A healthy young medical student, David Fajgenbaum, had been a student athlete in college and maintained his extraordinary level of fitness through much of medical school. Because of his enthusiasm and athleticism, his friends called him The Beast. When he suddenly found […]

Sep 30, 2022

This week on our nationally syndicated radio show, we speak with scientists studying the potential of psychedelic compounds to help heal mental illness. Recreational use of drugs like LSD during the 1960s gave these compounds a bad reputation. As a result, funding disappeared, and research withered. Over the last decade or so, however, investigators have […]

Sep 22, 2022

This week on our nationally syndicated public radio show, we invite gastroenterologist Nicholas Shaheen into our studio to answer your questions about protecting your digestive tract. He is a nationally recognized expert in esophageal diseases and has helped write numerous treatment guidelines for gastrointestinal illnesses. Detecting Digestive Tract Tumors: Two of the most common cancers […]

Sep 21, 2022

This week on our nationally syndicated radio show, we talk with Pulitzer Prize-winning journalist Matt Richtel. His latest series for The New York Times takes a long look at the mental health crisis affecting American teenagers. This is not a tale of COVID disruption, although COVID has made it worse. This is a story of […]

Sep 8, 2022

This week on our nationally syndicated radio show, we talk with one of the world’s leading experts on indoor air quality. If we had been paying more attention to air when the COVID-19 pandemic began, we might have saved millions of lives. Improving air quality is still critical to our health. Not only is SARS-CoV-2, […]

Sep 1, 2022

Cassandra Quave is an explorer and an ethnobotanist uncovering potential ways that plants can benefit human health. She has a particular interest in multi-antibiotic resistant infections. Not only do these pose a grave risk for people around the world; her professional interest is also personal. When she was three years old, she suffered a post-surgical […]

Aug 25, 2022

This week on our nationally syndicated radio show, we learn where the most germs are lurking in our homes and workplaces. Public toilets often make people nervous, but in fact, says Dr. Chuck Gerba, cafeterias and break rooms are much more likely to harbor dangerous pathogens. What will help us in avoiding germs? Hint–keep on […]

Aug 22, 2022

Modern medicine looks back on many old treatments with a great deal of disdain. A classic example is the lobotomy. In the mid-twentieth century, lobotomy was employed to treat serious mental illness. One of the earliest developers of this procedure, Dr. Egas Moniz, received the Nobel Prize in 1949 for this approach to treating depression, […]

Aug 11, 2022

This week on our nationally syndicated radio show, we explore the impacts of negative attitudes toward aging and how to fight back against ageism. In the US, many people hold negative stereotypes about growing older. These beliefs can affect our health as we age. Why Are Negative Stereotypes About Aging So Destructive? Psychiatrist Robert Butler […]

Aug 5, 2022

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

Aug 1, 2022

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

Jul 28, 2022

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

Jul 21, 2022

Dr. Robert Lustig has been warning us all about the hazards of sugar since 2009, when his YouTube lecture “Sugar: The Bitter Truth” went viral. As a pediatric neuroendocrinologist, he spent much of his career treating the causes of obesity in children. Now, he turns his impressive expertise to helping adults as well as children. […]

Jul 6, 2022

For many months now, people have been dealing with the pandemic, which has brought both grief for the lives lost and anxiety about the threat of infection. At the same time, fires and floods have made it clear that climate change is not a fuzzy future concern, but an urgent issue. The economic impact of […]

Jun 23, 2022

In our nationally syndicated radio show this week you’ll learn about a cardiac risk factor you may never have heard mentioned. Although scientists identified lipoprotein a as an important problem in the 1970s, your doctor may never have measured your level. We ask one of the country’s leading experts why Lp(a) has been overlooked for […]

Jun 16, 2022

In our nationally syndicated radio show this week, we talk with Dr. Aaron Carroll, who is a Distinguished Professor of Pediatrics at Indiana University School of Medicine and the Chief Health Officer of Indiana University. Despite rising infection rates, many of the precautions common last summer are melting away. There are no mask mandates on […]

Jun 9, 2022

In our nationally syndicated radio show this week, we have a guest live in the studio. Podiatrist Jane Andersen will be ready to answer your questions about foot problems and what you can do about them. Fixing Your Foot Problems: Has the pandemic been hard on your feet? Some foot doctors report seeing 20 to […]

Jun 9, 2022

After more than two and a half years have we learned anything about how an airborne virus like SARS-CoV-2 is transmitted? Judging from the way people have been acting lately and the way public health authorities have been responding to the latest COVID-19 surges, the answer is not much! An article in JAMA (June 7, […]

May 26, 2022

In our nationally syndicated radio show this week, we with an international expert about managing the microbiome. How does the microbiome interact with our immune system? Each of us has trillions of microbes living in our digestive tract. The exact number and type of species varies from one person to the next, so in essence […]

May 19, 2022

We are heartbroken that Dr. Paul Farmer, with whom we spoke in this episode, died suddenly on Feb. 21, 2022. He was a true hero. Our condolences to his family and colleagues. We are airing this interview in memoriam. In 2014, an Ebola epidemic broke out in three countries of West Africa–Liberia, Guinea and Sierra […]

May 13, 2022

In our nationally syndicated radio show this week, our guests discuss “forever chemicals” (PFAS) used in a wide range of products. How do they affect our health? What Are PFAS, or Forever Chemicals? Scientists refer to a large class of synthetic chemicals, per- and poly-fluoroalkyl substances, or PFAS, as “forever chemicals.” A Dupont chemist created […]

May 5, 2022

In our nationally syndicated radio show this week, we consider the benefits of two dietary supplements against autoimmune diseases. Although health care providers are sometimes skeptical about the value of supplements, the VITAL trial represents gold-standard research. In fact, this large, double-blind, placebo-controlled trial demonstrated that vitamin D and marine omega-3 fatty acids each reduce […]

Apr 14, 2022

For many years, possibly even centuries, some people who unexpectedly survived a life-threatening event have recounted amazing experiences. Between the time they appeared to die and when they revived, they often encountered places and beings unlike those of everyday life. What should we make of such near death experiences? Reports from the Operating Room: Occasionally, […]

Apr 14, 2022

In the midst of a pandemic, many people feel isolated. When you are not even supposed to shake hands, much less hug or kiss, how can those who live alone meet their needs for sexual intimacy? Is it possible to date without running a high risk for COVID-19–or a sexually transmitted infection? How can people […]

Apr 11, 2022

In our nationally syndicated radio show we are live this week for the first time in more than two years. First, we speak with biologist Simone Pika about her very interesting observations of chimpanzees treating wounds. Wild chimps at the Ozouga Chimpanzee Project in Gabon have been observed catching insects, mashing them between their lips […]

Mar 31, 2022

Our nationally syndicated radio show this week (initial broadcast 4/2/22) offers interviews with two guests who have thought deeply about addiction. In the US, this is a serious public health problem. We have been fighting the war on drugs since the early 1970s. However, we haven’t seen much benefit from this effort. More people die […]

Mar 24, 2022

There are at least two pandemics raging through the world at this time. The first is obesity. The second is, of course, COVID-19. Diabetes sits uncomfortably at their intersection. In a vicious cycle, diabetes makes COVID-19 infections more likely and more dangerous. Meanwhile, COVID-19 can trigger diabetes or make it worse. A new study in […]

Mar 17, 2022

This week on our nationally syndicated radio show, we learn about the most common neurological disease humans suffer. Just in time for the Migraine World Summit, we will discuss new treatments for migraine headaches. Recent advances include methods for prevention as well as relieving symptoms. What Are the New Treatments for Migraine Headaches? For decades, […]

Mar 10, 2022

This week on our nationally syndicated radio show, we learn how heartbreak can have physiological consequences on the heart and other organ systems. Broken Heart Syndrome, also called Takotsubo, is a form of stress cardiomyopathy. The effects of stress hormones due to an emotional blow or a serious illness can weaken the heart muscle. A […]

Feb 24, 2022

Do you add thyme to your chicken soup? Basil and oregano to your pasta sauce? These herbs are staples in most kitchens, and they help good cooks make their meals extra-tasty. We love using herbs and spices ourselves when we cook. Consequently, we were dismayed to read that some cooking spices are contaminated with heavy […]

Feb 10, 2022

For such a small organ, your thyroid gland has an outsize impact. It controls energy utilization throughout every tissue in your body. When the thyroid gland isn’t working well, you may notice changes in your digestion, your heart rate, your skin, hair, muscles and your weight. A faltering thyroid may even have an impact on […]

Feb 3, 2022

Research over the past few decades has revealed that we humans host a bewildering variety of invisible creatures, our microbiota. We can almost envision the collective genome of all these microbes, the microbiome, as a sort of second genome for human individuals. Unlike our human genome, the microbiome can be altered based on our diet […]

Jan 27, 2022

Have you ever put mushrooms in a salad? Might you add them to an appetizer? Stir-fries and frittatas with mushrooms are no longer surprising. Which mushrooms would you select for those dishes? You can find out in a gorgeous cookbook called The Fantastic Fungi Community Cookbook. Editor Eugenia Bone describes her fascination with fungi and […]

Jan 20, 2022

The COVID-19 pandemic has been dragging on for longer than most people imagined possible. With each new variant, cases surge and people need to make complex risk calculations about school, work and social interactions. Needless to say, all this can create a great deal of anxiety. Health care workers are under enormous strain. So are […]

Jan 14, 2022

We have heard that some people used their time locked down at home during the pandemic to clean out their closets and clear away the clutter. For others, though, we suspect that such projects would have been overwhelming or possibly even undesirable. Perhaps you know someone with hoarding symptoms such as excessive acquiring activities, difficulty […]

Dec 30, 2021

More Americans are living to old ages, but frequently their later years are plagued with chronic diseases. Is there a way to stay healthy into the ninth and tenth decade of life? To find out, we take a virtual trip to visit centenarians in a remote village in southern China. Visit to Longevity Village: Dr. […]

Dec 23, 2021

Can you have too much togetherness? After a year of pandemic restrictions that kept many couples cooped up together for months, some have discovered that minor annoyances loom larger. Couples have had to negotiate their roles and responsibilities more intensely than ever. This has put quite a strain on some relationships. Pre-existing problems have been […]

Dec 10, 2021

Almost thirty years ago, Laurie Garrett published The Coming Plague: Newly Emerging Diseases in a World Out of Balance. In this thorough, carefully researched analysis, she laid out why public health authorities should be watching for new pathogens and how they should respond if that happened. Since then, of course, a number of bacteria and […]

Dec 2, 2021

In September, more than 200 top medical journals around the world took the unprecedented step of publishing the same editorial. It was “Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health.” In it, editors of various journals identify climate change as the greatest threat to global health. As a consequence, […]

Nov 25, 2021

Doctors rarely study spontaneous remissions from serious diseases. Why not? They are unpredictable, for one thing. For another, they are said to be exceedingly rare. Despite this, Dr. Jeffrey Rediger has found that most of his colleagues are aware of at least one case that defies explanation by conventional science. He set out to learn […]

Nov 18, 2021

Before this pandemic began, a small group of researchers were already paying close attention to coronaviruses and their potential for causing serious illness. Virus experts around the world recognized our guest, Dr. Ralph Baric, as the coronavirus hunter for his outstanding work in this area. In this episode, he joins us to discuss the future […]

Nov 12, 2021

The COVID-19 pandemic has been overwhelming, not only in terms of the huge numbers of people who have gotten sick or died. We have also been engulfed with information about the virus, the infection, the risk factors, what we should do and what we can expect. Much of this information has been contradictory. We turn […]

Oct 28, 2021

Everyone gets excited about the idea of medical breakthroughs. Fewer of us, if we are honest, are anxious to be the first one to benefit. After all, if you are the first, you know nothing about the potential harms, and neither does the person offering you the experience. Medical innovation is necessarily fraught with uncertainty. […]

Oct 21, 2021

Over the last year and a half, while the nation endured a terrible pandemic, patients with COVID-19 were treated even if they couldn’t foot the bills themselves. Will the high cost of COVID break the bank? Now that people will end up paying for treatment out of their own pockets, will more Americans than ever […]

Oct 15, 2021

How do you decide what you should do in a health crisis? Over the past year and a half, many people have faced this problem. Do you go to the hospital for treatment in the midst of a pandemic? What medications or supplements might be helpful and which are more likely to be harmful? We […]

Sep 23, 2021

When the COVID pandemic began, doctors thought that patients either recovered fairly quickly or they died. Before long, though, some patients identified themselves as “long haulers” because they were suffering debilitating symptoms for months after their diagnoses, neither dying nor recovering. There are people who become short of breath just walking up a few steps, […]

Sep 16, 2021

You may have heard that the eyes are the window to the soul. That could be difficult to prove, but scientists have now shown that the eyes offer significant clues to your overall health. Most exciting is the possibility of assessing brain health based on special imaging of the retina. We speak with a leading […]

Sep 2, 2021

At a time when opinions about nearly everything are highly polarized, how can you have a civil discussion? What do we do when we encounter a person who is extremely angry? For that matter, how do we handle our own emotions? What works to defuse anger and what sorts of responses just make it worse? […]

Aug 26, 2021

In the middle of a pandemic, you probably want to know how well your immune system is functioning. Even more important, what if anything can you do to support it? Scientists have found that the microbes in the digestive tract communicate closely with the brain. What’s more, they now have evidence that the gut microbiome […]

Aug 19, 2021

For more than a century, people diagnosed with Alzheimer’s disease have been condemned to a relentless slide into dementia. Experts stress that there is no cure for this devastating condition. Even the drugs that FDA has approved for treatment help only a little, slowing the progression of cognitive decline. Although the agency approved a new […]

Aug 12, 2021

Are we in the midst of a Great Sleep Recession? Sleep deprivation is common and serious but not always appreciated. One of the tipoffs that people may not be getting adequate shut-eye is that they wake up tired, have difficulties paying attention and may frequently be in a bad mood. But can people really learn […]

Aug 6, 2021

Medical bills are notorious for being difficult to understand as well as expensive. Most people are intimidated by medical professionals and the bureaucracy. But we can and should fight back, according to our guest Marshall Allen. Errors in medical bills are common, and fraud is not unheard of. Why does Allen urge us never to […]

Jul 30, 2021

Hormones are essential to every cell in our bodies, but most of us don’t know much about them. We might recognize estrogen and testosterone as sex hormones, but these crucial compounds go far beyond that. Endocrinologists specialize in treating hormonally-related problems, but even they may not be focused on the hidden hormone epidemic we are […]

Jul 23, 2021

Is it true that we only use 10 percent of our brains? That seems to be a myth, along with the relegation of logic to the left brain and emotion to the right. How can we engage in whole brain living? How a Stroke Led to Insights: Years ago, Dr. Jill Bolte Taylor suffered a […]

Jul 15, 2021

In your great-grandparents’ day, hardly anybody exercised. There were sports enthusiasts who raced or danced or rode horses, played ball or rowed for fun. But then, as throughout evolution, very few people went to the gym. Still, they stayed physically active, either because their work required it or because they had found something, such as […]

Jul 8, 2021

Bellyaches and heartburn are among the most common problems driving people to the pharmacy to seek relief. Heartburn, a burning sensation behind the sternum, happens when acid escapes from the stomach up into the esophagus where it doesn’t belong. People used to chew antacids like Tums or Rolaids to neutralize the acid. Do you know […]

Jul 1, 2021

Pain is a difficult topic. To begin with, the experience of pain is completely subjective. There are no independent objective measures that doctors can use to assess a patient’s pain. They have to take her word for it. Second, pain has a very significant emotional component that must be addressed along with any physical causes. […]

Jun 28, 2021

In addition to our interviews with Dr. David Sinclair and Dr. Terrie Moffitt in Show 1263, we also spoke recently with Erin Sharoni. In this conversation, the entrepreneur (co-founder of Juvicell) discusses the importance of epigenetics. She also addresses the evidence on several of the ingredients in the Juvicell supplement and describes some simple approaches […]

Jun 25, 2021

Can you reset your biological clock? You can’t make time run backward, but you may be able to slow or even reverse the aging process. Dr. David Sinclair believes that aging is far more reversible than we thought. He told the New York Times, “Cells can clean themselves up, they can get rid of old […]

Jun 10, 2021

Hearing loss is a common problem, but many people with difficulties don’t know how to address it. Not everyone who has trouble hearing in noisy spots like restaurants or busy workplaces needs hearing aids. However, they need ways to manage a situation when they can’t hear what people are saying. Reducing background noise–which might be […]

Jun 3, 2021

Last year, just when more people than ever needed the help of a therapist, stay-at-home restrictions made it difficult or impossible to get face-to-face counseling. Moreover, most therapists were completely booked and couldn’t accept new patients. As a result, people increasingly turned to online therapy, either with apps, online support groups or one on one. […]

May 27, 2021

Cases of Parkinson’s disease have been rising steeply, but what we see now could be just the tip of the iceberg. The accumulation of certain chemicals in the environment may be contributing to an increased risk of this neuromuscular disorder. Pesticides such as chlorpyrifos appear to increase the risk for farmers and farm workers, while […]

May 27, 2021

Integrative gastroenterology combines the perspective of conventional allopathic medicine with a holistic approach to patients and their lives–mind, body and soul. Sometimes adjusting diet or lifestyle can be even more effective than using medications, especially when it comes to establishing a healthy gut balance. COVID-19 and the Digestive Tract: Although we think of SARS-CoV-2 as […]

May 14, 2021

During the pandemic, fewer people by far have been making ordinary appointments with the dermatologist to have their skin checked. However, some skin conditions can become much worse if they are neglected. Summer-stressed skin may also need attention. In general, people should consult a dermatologist if there is a persistent change in a spot on […]

Apr 30, 2021

Dr. Peter Hotez has been working on vaccine development and the treatment of neglected tropical diseases for decades. Now that vaccines are the key to returning to something like normal life, his expertise is greatly sought after. A History of Vaccines: Dr. Hotez describes the first vaccines that were useful in Western society. In fact, […]

Apr 23, 2021

In the middle of a pandemic, it’s important to know how to stay healthy. Sleep, stress management, handwashing, exercise and a healthful diet (cutting back on refined flour and sugar) are all crucial. In addition, supplements and herbs might help maintain a robust immune response. The Value of Vitamin D: There is significant evidence that […]

Apr 16, 2021

The experience of COVID is highly variable, as we have all learned by now. For some people, the infection is so mild they may not even notice the symptoms, while for others the virus wreaks devastating havoc. The post-COVID syndrome may afflict even those who had mild infections initially, and it can make life very […]

Apr 8, 2021

Over the past year, the world has faced a global pandemic due to a previously unknown virus. People wanted and needed to know how the virus spread from person to person. At first, the focus was on fomites. Consequently, people spent a lot of time wiping down groceries and sanitizing surfaces. Gradually, it became clear […]

Apr 1, 2021

Have you ever had horrible heartburn or a really bad bellyache? Most of us have experienced digestive distress at one time or another. When do you need to seek medical attention for your problem? What Causes Digestive Distress? When the gastrointestinal tract is working as it should, you chew your food and swallow it. Then […]

Mar 29, 2021

Over the last year, hospitals and their intensive care units have been stretched to the breaking point caring for the huge number of people desperately ill with the coronavirus. What is the impact of COVID-19 on American health care? Will the changes we have seen to date continue? Who Pays for COVID Care? Days and […]

Mar 25, 2021

Hand sanitizers have become ubiquitous in homes, doctors’ offices, supermarkets, banks and dozens of other establishments. There have been problems with some products that were contaminated with methanol, also known as wood alcohol. Read about this known problem here. Now a new impurity has surfaced. A surprising number of hand sanitizers are contaminated with the […]

Mar 19, 2021

Sperm counts have been falling for decades. In fact, they’re down 50 percent over the last four decades. Should we worry about young men’s health and fertility? How can we explain this trend? Threats to Health and Fertility: Sperm counts are not alone in their decline. Men’s levels of testosterone have also been dropping steadily, […]

Feb 26, 2021

COVID-19 restrictions have interfered with the way many of us exercise. Yet the benefits of moving, for both our physical and mental health, are more important than ever. How can we keep moving to feel better, despite the pandemic? Moving at Home to Feel Better: You may not have a home gym, but there are […]

Feb 19, 2021

After a year of COVID-19, the country (and the world) is in a race to get people vaccinated before the new, more transmissible variants of the coronavirus can gain the upper hand. We talk with two experts on these COVID-19 vaccines and variants of the SARS-CoV-2 virus to get you the information you need. New […]

Feb 11, 2021

Adequate sleep is essential to good health. That is not a news flash; your grandmother and great-grandmother knew it. It’s simply become more difficult to get the sleep you need in these anxious times. An ongoing pandemic and all the disruptions it has caused to work, school and other aspects of life could keep millions […]

Feb 5, 2021

The COVID-19 pandemic has been raging through the world for more than a year. More than 455,000 people have died in the US, but the vast majority of people who become infected survive. Unfortunately, for a significant proportion, symptoms associated with COVID-19 may last for weeks or months. Physicians have dubbed this post-COVID syndrome, or […]

Jan 22, 2021

There’s an old saying that a lie can travel halfway around the world while the truth is still putting on its boots. This possibility is especially noticeable and potentially harmful when it comes to health claims. How do medical myths get such widespread credence? Why We Fall for Medical Myths: The COVID-19 pandemic has brought […]

Jan 14, 2021

Imagine a dental diet designed to keep your teeth and gums in good health. What does it look like? Does it have any impact on your health beyond the limit of your tongue? A Dentist Champions the Dental Diet for Overall Health: Few people realize that there is a strong connection between gum infection (periodontitis) […]

Jan 7, 2021

Whoever said growing old isn’t for sissies really got it right. But not everyone has the same experience with aging. Why do some people do well up to and into their 90s, while others are over the hill in their 70s? Genetics certainly plays a role, but it is not the whole story by any […]

Dec 31, 2020

Do your New Year’s resolutions include getting more exercise? By now, everybody knows exercise is good for us. But a lot of people view it as a chore or a bore instead of a delight. How can you experience the joy of movement? Humans are built to move, and anthropologists have offered a hypothesis that […]

Dec 24, 2020

The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has dominated life around the world this year. Now, the FDA has granted Emergency Use Authorization for two vaccines, one from Pfizer/BioNTech and one from Moderna. How will they alter the course of the pandemic? We offer listeners a coronavirus update for the close of this pandemic […]

Dec 18, 2020

Scientists have long suspected that vitamin D is crucial for the immune system to function properly. Presumably, that is why cod liver oil was utilized as a tonic to ward off colds and flu in northern climes. After all, as you get farther from the equator, you get less sunshine during the winter. Consequently, you […]

Dec 11, 2020

It seems obvious that to provide the proper treatment, a doctor first needs to know what is wrong. However, although medical experts have been focusing on improving diagnosis in medicine for more than a decade, people still suffer from delayed or incorrect diagnoses. In some cases, these result in diagnostic disasters. We hear from a […]

Dec 4, 2020

These are stressful times. Many people are grieving the death of a loved one, while others are struggling with working or studying from home. Being separated from loved ones can be emotionally draining. How are you dealing with the mental health challenges of the COVID-19 pandemic? Trauma and Kids’ Mental Health: Trauma, like that experienced […]

Nov 27, 2020

Working from home during the pandemic has wrought havoc with a lot of healthy eating habits. It’s harder to shop safely, and minimizing time in the grocery store may mean people have stocked up on shelf-stable highly processed foods. What’s more, lots of us have been responding to stress by eating sweet or salty treats […]

Nov 24, 2020

SARS-CoV-2, the coronavirus responsible for COVID-19, has infected many millions of people both in the United States and around the world. The death toll is horrifying, with more than a quarter of a million people in the US alone. With infections soaring as we head into winter, the news that a couple of vaccines against […]

Nov 6, 2020

The SARS-CoV-2 coronavirus behind COVID-19 is changing. This should not be a surprise, since microbes evolve by nature. What implications might this have for the infection in future months? We speak with an evolutionary biologist to see how his perspective can illuminate the pandemic. How Do Microbes Evolve? SARS-CoV-2 is a coronavirus that evolved initially […]

Oct 30, 2020

One of the striking things about the COVID-19 pandemic is how differently people respond. Some people contract the virus but never really have symptoms, while others land in the hospital struggling for breath. More than a million people around the world have died from the infection, with about a quarter of those in the US. […]

Oct 27, 2020

The conventional view of the digestive system was that it took care of digestion and wasn’t involved very much with the rest of the body’s systems. Now, though, science has shown that the gut and the millions of microbes that live in it have a profound impact on other aspects of our body, from immune […]

Oct 23, 2020

Far too many Americans have died of COVID-19 during 2020, but heart disease is still the number one killer. Moreover, people with heart disease are more vulnerable to complications from the coronavirus. What should they do to protect their hearts? How People Can Protect Their Hearts: There are a few things that everyone can and […]

Oct 15, 2020

Two out three people with Alzheimer disease are women. Why are they at higher risk for this devastating condition than men? Even more important, how can they reduce their risk for dementia? Many of the usual explanations for this imbalance don’t stand up well to scrutiny. Too many of them have been accepted without much […]

Oct 8, 2020

Experts estimate that 30 million people worldwide have had COVID-19. More than a million have died, and approximately 20 million have recovered. However, while health professionals usually think of this as an acute illness, recovery may be far slower than anticipated. The CDC has found that 35% of adults who tested positive for SARS-CoV-2 still […]

Oct 1, 2020

Very likely you have heard of children who are allergic to peanuts. Sometimes the tiniest whiff of peanut dust can trigger a frightening reaction. Food allergies have been increasing dramatically among American children. In fact, one in 13 is vulnerable to a serious or life-threatening consequence if they accidentally consume the wrong food. The rate […]

Sep 25, 2020

Until December of 2019, doctors had no experience with pandemic that has now killed hundreds of thousands of people around the world. As the infection raced from country to country, they tried a lot of different treatments that seemed promising. But in many places, the onslaught of serious cases was so extreme that scientists couldn’t […]

Sep 11, 2020

Kidney stones afflict an estimated three million Americans each year, resulting in at least half a million trips to the emergency department. But what are they and what can you do about them? How do they form and how might you prevent them? We hear from a listener who has first-hand experience of the pain […]

Sep 4, 2020

Back in May, 2020, we spoke with a scientist known internationally as the coronavirus hunter. Dr. Ralph Baric has been studying coronaviruses for more than three decades. He was involved in the early research on some possible drugs to treat people with COVID-19. Five months is a short time under normal circumstances, but the pandemic […]

Aug 27, 2020

This show first aired in June, 2019, before anyone had heard of SARS-CoV-2 or COVID-19. Today, understanding how your immune system works to overcome an infection is more important than ever. Just how does your immune system manage to ward off unwanted bacteria or viruses? This “elegant defense” is sometimes described as though it were […]

Aug 21, 2020

We have had eight months of COVID-19 pandemic, and there is nobody anywhere who isn’t ready for it to be over. That is why there is quite a bit of excitement about the potential for vaccines. Several have started phase 3 trials already. What does that mean and what can we expect? Where Will We […]

Jul 30, 2020

The microbiome–the genome of our collective microbiota–has become a trendy topic in medicine lately. With more microbial than human cells in our bodies, it’s becoming clear we should think of ourselves as collectives. Citizen scientists have been contributing to the understanding of microbiota biodiversity through the American Gut Project. Yet most of us don’t really […]

Jul 24, 2020

A couple of decades ago, most people had never heard of celiac disease. Many doctors had never diagnosed a case, and they had often learned it was an extremely rare condition. Following a gluten-free diet, the only treatment, was really difficult. Today, millions of people avoid gluten in their diets. Not all of them have […]

Jul 17, 2020

When Jim Kwik was a little boy, he had a bad fall that resulted in a concussion. He struggled with learning problems throughout elementary school and even later. But he eventually learned to stop thinking of himself as the boy with the broken brain. In fact, he now has mastered accelerated learning and teaches the […]

Jul 10, 2020

In these challenging times, keeping our brains healthy and working well is important. Social isolation can be debilitating, but there are approaches that can help counteract these difficulties. Research on Maintaining Memory: What does new research tell us about achieving maximum memory fitness? How important is it for us to take care of conditions like […]

Jul 3, 2020

Antibiotic-resistant bacteria have been cropping up around the world. These superbugs cause serious problems, especially when they fail to respond to increasingly potent medications. One approach may be to put a very old, natural treatment to work. The theory is that the enemy of my enemy is my friend. Enlist viruses that infect these bacteria. […]

Jun 26, 2020

For decades, the tobacco industry was able to ward off anti-smoking policy by claiming that science did not support it. In hindsight, it is clear that most epidemiologists came to the conclusion that smoking is bad for health without much delay. But tobacco companies were able to exploit disagreements over a few facts to sow […]

Jun 19, 2020

The COVID-19 pandemic has underscored the importance of having a healthy immune system. It appears that more than three-fourths of the people who contract the infection recover without hospitalization or obvious lingering effects. The others, however, get really sick. We can assume that our immune systems mediate our response to the virus. We want it […]

Jun 11, 2020

The telomeres that cap our chromosomes are a good way to gauge biological aging. Dr. Elissa Epel, who studies aging and metabolism at UCSF, has found a link between soda consumption and cellular aging, even in young children (Childhood Obesity, April 2018). She and her colleagues took advantage of a natural experiment at the University […]

Jun 8, 2020

Dr. David Fajgenbaum was a medical student in excellent health when he was struck with a mysterious disease. He nearly died before his doctors finally diagnosed him with a rare condition known as idiopathic multicentric Castleman disease. They hardly knew anything about it, and the few treatments that were available didn’t work for him. So […]

May 29, 2020

For decades, neurologists have been telling us that Alzheimer disease is driven largely by the accumulation of beta-amyloid plaque in the brain. They have suspected that this is determined in large measure by genetics, and they’ve been searching for medications that can clear beta-amyloid out of the brain. But what if beta-amyloid is actually an […]

May 22, 2020

What comes to mind when you think of COVID-19, the disease caused by the SARS-CoV-2 virus? Chances are, you think of the lungs. There’s been a tremendous amount of attention to the breathing difficulties the disease can cause. Hospitals in northern Italy and New York City have been overwhelmed because they didn’t have enough ventilators. […]

May 8, 2020

Dr. Ralph Baric has been studying coronaviruses for 35 years and is one of the world’s leading experts on these pathogens. In this interview, you will learn how the virus jumped from bats to people and how it replicates. Moreover, Dr. Baric was already studying remdesivir, a medication being utilized against this infection. He will […]

May 1, 2020

Are you drinking too much coffee? Is coffee actually bad for you anyway, or might a few cups have health benefits? Have you heard about the health benefits of tea? Dr. Tieraona Low Dog delves into the plant compounds contained in our favorite beverages. How do they affect our physiology? Green, Black and White Tea: […]

Apr 23, 2020

When hospitals are overstressed and understaffed, as they have been during the COVID-19 pandemic, medical errors are hardly surprising. Back in 2016, a group of doctors published an analysis in the BMJ claiming that medical errors are the third leading cause of death in the US. Could this really be true? Learn how a thoughtful […]

Apr 17, 2020

Schools are closed and kids are home so that they don’t catch COVID-19 and spread it to family members. Of course, parents don’t want their children to get sick, either. How are we keeping kids healthy in the age of coronavirus? Why Are Children Less Likely to Become Very Ill? Most infectious diseases, especially respiratory […]

Apr 9, 2020

With nearly six million Americans living with Alzheimer disease, this condition is a serious public health problem. It robs people of their memories, their ability to function independently and even their very identities. When Alois Alzheimer published the first report on the brain disease that was later named for him, he described distinctive plaques and […]

Apr 2, 2020

Staying at home and maintaining safe physical distance means that some primary care practices are not functioning normally during the pandemic. However, you may still want to connect with your doctor. In fact, you may have urgent questions about how to stay healthy or what to do if you become ill. Do you have a […]

Mar 27, 2020

Information on the coronavirus pandemic is changing hourly. The US now has more COVID-19 cases than any other country. For this live coronavirus update on March 28, 2020, we have asked infectious disease expert and epidemiologist Dr. David Weber to answer your questions about COVID-19. Learn how you can protect yourself and your family. To […]

Mar 19, 2020

How do doctors figure out what is wrong with a person and how they can be treated effectively? Traditionally, medicine has put great emphasis on the patient’s history, which usually means the patient has to tell a story. What hurts? When did it start? What happened next? One drawback of the way medicine is currently […]

Mar 13, 2020

Mental health problems cause widespread disability in today’s world. Large numbers of people suffer with depression or severe anxiety. While these ailments are real, we may not be considering their causes carefully enough. Our guest, Dr. Daniel Amen, suggests that the trouble underlying most mental illness is disrupted brain function–poor brain health. SPECT Scans of […]

Mar 6, 2020

Stress is nearly ubiquitous in modern life. We all know it isn’t healthy, but we may not have a lot of tools for escaping or alleviating it. People under stress may feel they don’t have enough time for yoga. Just trying to meditate may send their minds spinning into overdrive about everything waiting to be […]

Feb 27, 2020

In our modern world, many people have become disconnected from the source of their food. Unlike our distant ancestors, who hunted and foraged for their meals, or even our great-grandparents who raised their food on farms, most folks now eat out of the supermarket. Following a diet full of highly processed foods can result poor […]

Feb 20, 2020

Diagnosis is a crucial first step for medical treatment. In some situations, recognizing the condition as soon as possible makes a big difference in the outcome. However, doctors may have difficulty with certain diagnoses. If patients can help recognize when they are in trouble and ask questions, certain hard-to-diagnose conditions may be identified more quickly. […]

Feb 14, 2020

Why is nutrition advice so controversial? Often, it seems as if food fights are the fiercest disagreements in medicine. Have you had trouble making sense of changing nutritional guidelines? Changing Nutritional Guidelines: For years, nutrition scientists have been telling us that people who eat red meat are putting their health in danger. Then a few […]

Jan 24, 2020

Have your pharmacy bills been going up? When Consumer Reports surveyed its readers, 30 percent of them reported that their cost for a drug they take on a regular basis rose during 2019. About 12 percent of readers said their costs had soared by at least $100. What is going on here, and how can […]

Jan 17, 2020

Low thyroid function is a very common problem, affecting an estimated 20 million Americans. That is nearly 12 percent of the population. Most doctors are convinced that all they need is one lab test–TSH–and one medication–levothyroxine–to treat hypothyroidism. Why don’t all patients agree? The Problem with Thyroid Treatment: The thyroid gland produces at least two […]

Jan 9, 2020

People who have suffered with back pain for a long time may be told that spine surgery is their last resort. But far too often, spine surgery does not relieve back pain. Sometimes, people even feel worse afterwards. How can you tell if spine surgery would be right for you? Mark Owens’s Story: Mark Owens […]

Dec 27, 2019

Angiogenesis–the growth and development of blood vessels in the body–may seem like an obscure topic. However, angiogenesis is a critical phase in the development of tumors. If it can be blocked when it is inappropriate, we don’t get cancer. If not, we may need all the resources of modern oncology to help us recover. Is […]

Dec 13, 2019

You may have heard about antibiotic-resistant bacteria. They can greatly complicate the treatment of infections. But have you ever heard of antifungal-resistant fungus? Infectious disease experts knew nothing about a scary fungus, Candida auris, less than two decades ago. It has acquired resistance to a number of potent antifungal medications. Consequently, it now poses threats […]

Dec 6, 2019

For centuries, people have been using home remedies as their first treatment for common ailments. With easy access to over-the-counter drugs, though, people have turned away from home remedies in the last several decades. There are still plenty of inexpensive options that work well, however. Which are your favorite home remedies? Apple Cider Vinegar: One […]

Nov 29, 2019

A national survey just a few years ago showed that Americans fear losing their vision more than they fear losing a limb, their hearing, their ability to speak or even their memory (Scott et al, JAMA Ophthalmology, October 2016). What do you know about how to take good care of your eyesight? What Can You […]

Nov 15, 2019

If you like to cook, you are no doubt aware that favorite recipes change with the times, just like fashions in clothing. But a lot of Americans don’t like to cook. They may not have tried acquiring the skills or even more likely, they don’t have the time to do anything very complicated in the […]

Nov 1, 2019

Last summer, a major review of research on supplements to improve heart health concluded that most do nothing to prevent heart attacks, strokes or premature death from cardiovascular causes (Annals of Internal Medicine, Aug. 6, 2019). In other words, they are a waste of time and money. (The possible exceptions include omega-3 fats and folate.) […]

Oct 31, 2019

The People’s Pharmacy radio show and podcast appreciates support from its sponsors. One of our sponsors is KayaBiotics, a German company that makes high-quality probiotics from all-organic ingredients. Germany exercises rigorous oversight of supplement manufacturing, and we are pleased that our listeners can purchase such products. The pandemic interrupted supply chains and manufacturing for numerous […]

Oct 24, 2019

When you get sick, you need a diagnosis. If the diagnosis is wrong, the treatment won’t be appropriate. What happens when doctors make diagnostic errors? We talk with a leader in the Society to Improve Diagnosis in Medicine about his recent research. What Diagnostic Errors Are Most Serious? Clinicians make an estimated 12 million diagnostic […]

Oct 18, 2019

Every day, an average of 750 senior Americans are hospitalized as a result of medication reactions and interactions. Part of the problem is that as we grow older and accumulate more health conditions, we also end up with longer lists of prescription drugs for them. In addition, many of us also take medicines to prevent […]

Oct 10, 2019

Marvelous technology like CT and MRI imaging, genotyping and microbiome analysis have given health professionals more power than ever to learn what is going wrong with an individual. Special tools like robotic surgery can help doctors treat complex problems. Highly advanced prosthetics can help people recover from devastating accidents or radical operations. Problems with Technology: […]

Oct 3, 2019

Do your feet hurt? Foot problems can interfere with both work and leisure time activities. You won’t want to walk the dog or go dancing, not to mention stand at a cash register or move about a clinic with foot pain. What can you do about it? How Dangerous Could a Pedicure Be? A pedicure […]

Sep 26, 2019

Does medicine mean “drugs and surgery” to you? That is certainly how a lot of people see it. However, physical activity–exercise–has powerful abilities to help us heal. How can we use exercise as medicine? What does it mean to use exercise as medicine? The concept may seem a bit strange unless you have encountered cardiovascular […]

Sep 12, 2019

You know your body needs food to fuel it. You’ve probably thought about whether you should be eating more fat or less, how much protein you might need and if you are getting enough vegetables and fruits. But have you thought about how you should eat to nourish your brain? Managing Your Mood: Millions of […]

Aug 22, 2019

Are there toxins in your home? As it turns out, many houses hold furniture, electronics and other products that have been treated with toxic chemicals such as stain repellents and flame retardants. Some of these are there because of misguided legislation requiring them in the past. What are the consequences of chronic exposure to compounds […]

Aug 16, 2019

Can you tell what your dog is thinking? Chances are, you have a good idea much of the time. And likewise, your dog pays close attention to your expressions and behaviors to decipher your mood. What are the health implications of our relationships with animals? Empathy Cements Our Relationships with Animals: The capacity for empathy […]

Aug 8, 2019

When a doctor is diagnosed with cancer, you can bet he will try to find the best possible treatments for the disease. Dr. Timothy McCall has long added yoga and Ayurvedic medicine to his standard medical toolkit. So when he was diagnosed with neck cancer and couldn’t schedule the first allopathic (Western medicine) treatment right […]

Aug 2, 2019

Have your summer evenings outside been spoiled by the whine of a mosquito coming in for a bite? How do you deal with the resulting itch? Mosquito bites usually itch for a while and then go away, but some people suffer excessively. Do you have skeeter syndrome? Although it sounds fanciful, we actually found this […]

Jul 24, 2019

Diabetes has nearly become an epidemic, both in the US and around the world. This metabolic disorder interferes with the way the body processes energy and affects more than 30 million Americans. That’s approximately one person out of every ten. Type 1 and Type 2: Do you know the difference between type 1 diabetes (once […]

Jul 18, 2019

The distinction between pleasure and happiness might seem like a philosopher’s quibble. Fat Chance author Dr. Robert Lustig tells us why this difference is vitally important to our national wellbeing. Corporations are hacking the American mind because of our ignorance about the difference between them. Pleasure vs. Happiness: Dr. Lustig describes the neurochemical foundations behind […]

Jul 12, 2019

Antibiotics are crucial for treating serious infections, but the specter of bacterial resistance to antibiotics is scary. Many public health experts have called for more diligent antibiotic stewardship to protect the usefulness of these medication. How Might Antibiotics Affect Your Brain? Some physicians point to other, equally compelling reasons to use antibiotics more judiciously. They […]

Jul 4, 2019

The American health care system is a $3 trillion mess. Although it has significant technological sophistication, this big business doesn’t seem consistently able to get appropriate treatments to the patients who need them. Millions of people have no insurance, or the insurance they have doesn’t cover the care they need. Increasing premiums and unexpected bills […]

Jun 28, 2019

Diverticulitis can cause excruciating pain. What causes this problem, and how can you prevent it? As we grow older, many of us acquire little pouches, pockets or potholes in the large intestine. Doctors have a term for the presence of these diverticula: they call the condition diverticulosis. However, if food or feces get trapped in […]

Jun 13, 2019

You may not be aware that the vast majority of medications Americans take are generic drugs. This helps hold down the costs that patients have to pay, especially if you are taking one of the medicines offered for an extra-low rate, like $4 a month, at a big-box store. That certainly sounds great, unless you […]

Jun 6, 2019

When you think about heart health, you may not think about any gender differences in symptoms or treatment. Most doctors don’t, so why would patients? However, women don’t always experience the classic symptoms of crushing chest pain that we expect from tales of men’s heart attacks. Sometimes, they may be bothered with back or jaw […]

May 30, 2019

For some years, emergency doctors and allergists were puzzled by people who started having extremely serious allergic reactions in the middle of the night, a long time after they had eaten or drunk anything or had any contact with obvious allergens. Smart sleuthing from our guest and his colleagues determined that a tick bite can […]

May 24, 2019

Do you sniffle through spring or feel crummy in the fall? Many people suffer with seasonal allergies, and trying to figure out which medicines make sense is no easy task. To start with, how do you know if you are sneezing from a cold or from hay fever? Why does the answer change the kind […]

May 17, 2019

We all prefer to interact with people who are friendly, supportive and helpful. But when it comes to health care providers, does “bedside manner” really make a difference? Or is a doctor’s positive attitude irrelevant to the medical outcome? Does Your Doctor’s Positive Attitude Affect Your Health? We talk with a scientist who has looked […]

May 9, 2019

Dr. Alexander Fleming discovered penicillin in 1928, after observing horrific lethal infections on the battlefields of the first World War. It was the first antibiotic to defeat a wide range of terrifying diseases. Today, however, there are frequently shortages of this critical medication. In addition, penicillin and related antibiotics may not kill emerging superbugs. Less […]

May 3, 2019

Do you use mail order for your prescription drugs to get a better price? Many insurance companies strongly encourage people to order online from preferred sources so they can control how much they have to pay. Most of us like to save money. However, are there any downsides to getting your medicines mailed instead of […]

Apr 26, 2019

The thyroid gland on your neck is not very big, but it is super important. It secretes hormones that control the activity of every cell in your body. Consequently, the thyroid regulates your metabolism, your heart beats, your bowels and even your thinking. What happens when the thyroid doesn’t work as it should? How do […]

Apr 12, 2019

For decades, public health experts have been admonishing Americans to cut the salt in our diets. In fact, the American Heart Association recommends that we limit ourselves to 2,300 mg of sodium daily. That’s about one teaspoon. Ideally, the AHA says, we would get less than 1,500 mg of this crucial mineral every day. Should […]

Apr 4, 2019

You may have read or heard that adequate sleep is a pillar of good health, like exercise and a healthy diet. Sleep affects blood pressure and heart disease, metabolism and obesity, the immune system, cognitive function and mood. But if you can’t get enough sleep, that information is more frustrating than helpful. What is interfering […]

Mar 29, 2019

The past few months have produced some fascinating science stories from international sources. We interviewed two scientists in far-flung places to learn more about unexpected ways that microbes interact with us and affect our health. One researcher has developed some unique ways to study the microbiome of our digestive tract. Another is examining whether the […]

Mar 21, 2019

Over the last several decades, our environment has changed enormously. Comparing a playground in 1962 to the same playground in 2019 gives some sense of how thoroughly we have surrounded ourselves and our children with chemicals that may have profound impacts on the hormones in our bodies. As just one example, bisphenol A found in […]

Mar 15, 2019

You may think your home is sparkling clean. But even a clean house harbors a host of small creatures that have a fascinating web of interactions with each other and with the humans who live there. What do you know about the ecology of your home? How does the dust that accumulates in the corners […]

Feb 15, 2019

If you watch television, you can’t avoid TV drug commercials for maladies from type 2 diabetes to auto-immune diseases like psoriasis or rheumatoid arthritis to refractory cancers. Do you see these ads as providing the information you need about your medicines? Or do you perceive them as pushing viewers to request drugs that they may […]

Feb 8, 2019

Have you ever thought about how a bad habit gets started? You can blame the neural wiring and chemistry we share with all animals. When we do something that feels good in the moment, we remember it and are likely to repeat that action. But “feels good” doesn’t always translate into “good for you.” How […]

Feb 1, 2019

Back at the turn of the 20th century, the only treatment for most types of cancer was surgery. When a young New York doctor lost his first patient to sarcoma despite treating her by the book, he began to look for other approaches. What he came up with was actually the first immunotherapy for cancer. […]

Jan 25, 2019

Decades ago, the relationship between a patient and a doctor was often asymmetrical. The doctor decided what treatment was needed and issued “doctor’s orders.” Patients were expected to follow through, no questions. In most cases, they couldn’t ask questions because they didn’t have access to enough information to formulate reasonable queries. How 20th century! Today, […]

Jan 18, 2019

The diet wars have been raging for years. Each side has ardent proponents–those who insist that a low-fat diet is the best way to control weight and those who are convinced that a low-carb diet is better have had a hard time finding common ground. Even those who endorse a more moderate approach can be […]

Jan 3, 2019

What causes heart disease? There are a number of risk factors, including cigarette smoking, sedentary lifestyle, high blood pressure, diabetes and others. One well-known risk is high cholesterol. Has your doctor told you that you need to control your cholesterol? New Guidelines for Cholesterol Control: The principal cardiologists’ organizations in the US recently updated their […]

Dec 27, 2018

Life is never completely smooth and easy. Along with bruised shins and skinned knees, we all experience hurt feelings from time to time. Perhaps we got left out of the game, or our best friend decided to hang out with somebody else. What do you do in a situation like this? How can you learn to […]

Dec 20, 2018

Millions of people take medicines like Prevacid, Prilosec or Nexium every day. But while such proton pump inhibitors may ease symptoms of heartburn, they can also lead to serious side effects. Dr. Philip Gorelick, spokesperson for the American Heart Association, describes the research linking these heartburn drugs to an increased risk of stroke. Alternatives to PPIs? What […]

Dec 14, 2018

Facts are essential for scientific understanding. Stories are critical for wisdom, understanding the arc and meaning of our lives. Dr. Rachel Naomi Remen, author of two wonderful books about stories, describes how some stories can diminish us and our view of ourselves. Others give us strength and hope. Stories can reveal deep meaning in our […]

Nov 30, 2018

Heartburn is a common problem. Many people take powerful acid-suppressing drugs like Nexium or Prilosec every day to treat gastro-esophageal reflux disease or GERD. If untreated, chronic irritation of the swallowing tube can lead to Barrett’s esophagus. Do you have to take medications forever to treat this condition? Are there better ways to heal your […]

Nov 22, 2018

In a cruel world, compassion might seem like a frivolous pursuit. But our guest expert argues convincingly that we need this emotion now more than ever, if only to keep from falling into despair. What is compassion, and what does science have to do with it? The Science of Compassion: Compassion is a response to […]

Nov 16, 2018

Type 2 diabetes has reached epidemic levels in the US and around the world. Although endocrinologists consider it a chronic, progressive disorder, some experts have seen that it is potentially reversible and may be preventable. What approaches are helpful? What role could fasting play? Nephrologist Jason Fung, MD, says that you can’t manage a dietary […]

Nov 8, 2018

Over the years, we have heard about scores upon scores of home remedies for everything from arthritis to warts. Some make sense intuitively, while others seem silly. Most have never been subjected to scientific scrutiny. Is there any science behind home remedies? We may never know the full answer to that question, but occasionally we […]

Nov 1, 2018

Do you enjoy a glass of wine from time to time? If so, were you alarmed to read headlines last fall announcing that ANY amount of alcohol is problematic? Here’s how those headlines came about. The researchers wrote in The Lancet (Sept. 22, 2018), in their interpretation of their meta-analysis of the health risks, world-wide, […]

Oct 25, 2018

More than 50 million adult Americans have been diagnosed with arthritis. While osteoarthritis is the most common form, there are many others, including rheumatoid arthritis, gout, psoriatic arthritis and even fibromyalgia. What are the similarities and differences between these various inflammatory conditions? What are the best ways to manage arthritis pain? How Does Arthritis Affect […]

Oct 19, 2018

For years, people were urged to take calcium supplements to avoid losing bone density. This advice was aimed particularly at menopausal and postmenopausal women because they are especially susceptible to bone fragility and fractures. All the same, calcium supplements were often recommended to all older adults. Will taking calcium pills really keep your bones strong? Seniors […]

Oct 15, 2018

Yoga has become extremely popular over the last few decades. You have probably seen photographs of fit-looking young people in stretchy clothing and improbable poses and wondered why they are so enthusiastic about this practice. However, yoga is not about extreme poses or looking good. Practicing yoga is a path to good health. What exactly […]

Oct 5, 2018

Viagra became a household name almost as soon as the drug was introduced. Before that, though, few men were willing to talk about erectile dysfunction. When it comes to women’s sexual health, we seem to still be in the whispering stage. The only drug to have been approved for women’s sexual function, Addyi, is largely […]

Sep 27, 2018

Americans take a lot of medications. We appear to have adopted the advertising-based attitude that there is a pill for every ill. But while some medicines may be helpful or even essential in some circumstances, a lot of people end up taking too many of them. Sometimes doctors end up prescribing one drug to counteract […]

Sep 21, 2018

Doctors have been advocating evidence-based medicine for a few decades, but a surprising amount of medical practice is based on tradition. How can you sort out the value of evidence-based medicine from eminence-based medicine? (That is, what the most influential experts recommend, based on their own experience or beliefs.) The Fate of Medical Mythbusters: Collecting […]

Sep 13, 2018

Nails rarely get much medical attention. They just don’t seem as urgent as high blood pressure or diabetes. Despite this, nails are part of the way we present ourselves socially. Consequently, most people are quite concerned about the appearance of their nails. What should you know about keeping them healthy? Nail Problems as Red Flags: […]

Sep 6, 2018

High blood pressure is an important risk factor for heart attacks and strokes. A recent change in guidelines urges doctors to treat people whose blood pressure would not have been considered particularly high a few years ago. (Here is a link to the guidelines, published in March 2018.) Most of the time, that treatment consists […]

Aug 30, 2018

Plant-based oils often carry the scent of the plant. Plants may use them to attract insects, but people have found numerous uses for them as well. Some can be used in skin care, while others may be used for relaxation or to improve digestion. What Are Essential Oils? The volatile aromatic compounds found in plants […]

Aug 23, 2018

At one time, doctors believed that celiac disease was extremely rare, that the few children who had it would outgrow it and that the symptoms were primarily digestive. We now know that none of these axioms are true and the story on celiac disease is different. What is it now, and why does it matter? […]

Aug 17, 2018

Nearly 40 million Americans know the nausea and throbbing pain of migraine headaches. This debilitating condition that can create one-sided head pain may make it difficult or impossible to carry on with work or everyday tasks. How Can You Prevent Migraine Headaches? There are drugs that can be used to treat migraine headaches, but the […]

Aug 3, 2018

Do you know where your medicines come from? It can actually be something of a challenge to find out, because unlike shirts or apples, drugs do not have to be labeled with country of origin. As it turns out, over the past two decades, the pharmaceutical manufacturing industry has followed the same route as many […]

Jul 27, 2018

Have you ever thought of your body as a machine and the doctor as its mechanic? It’s a common metaphor, but one that can get us into a lot of trouble. Machines can’t heal themselves, but our bodies have superb capacities to do so, if we help them. It turns out that there is more […]

Jul 19, 2018

Complementary medicine has become popular in the US. Many people pay out of pocket for treatment by Ayurveda practitioners, massage therapists or chiropractors. Others take a range of herbs and other natural products as dietary supplements. Some of these practices are controversial, but conventional physicians are beginning to integrate some ideas, such as dietary advice […]

Jul 13, 2018

If you’ve spent time out in the woods this summer, or if you hope to hike or bike outside, you need to know about ticks. Ticks are not just icky; they can also carry dangerous diseases. In fact, tick-borne diseases are increasing as ticks increase their range. Tick-Borne Diseases: Not all tick bites lead to […]

Jul 6, 2018

Since 1995, the world has experienced twenty of the hottest years on record. The wildfires raging across western states are expected to burn more acreage than last year’s devastating fires. Hurricanes like Sandy, Harvey, Irma and Maria have caused enormous destruction. And less conspicuously but just as ominous, carbon dioxide levels in the atmosphere have […]

Jun 28, 2018

What could be more natural than eating when you are hungry and stopping when you are full? That simple approach is far from easy for many people. Hunger and eating get disconnected in eating disorders. How can these complex problems be recognized and treated? How Common Are Eating Disorders? Many people think of anorexia nervosa […]

Jun 23, 2018

People around the world have learned how to use the plants in their vicinity to heal themselves and make life better. Not surprisingly, many cultures have found plants that can improve your sex life. What are they? The Medicine Hunter: Our guest is Chris Kilham, known as the Medicine Hunter. He travels to remote locations […]

Jun 14, 2018

People get excited about their favorite diets. Maybe you do, too. Are you a low-carb champion or a low-fat fan? Which one really is your best diet? The DIETFITS Study: A big study from the Stanford Prevention Research Center assigned 600 people to either a healthy low-fat diet or a healthy low-carb diet. (No junk […]

May 31, 2018

What is the value of vitamin supplements? There is no consensus on whether most people would benefit. Much of the research on multivitamins does not show a strong effect in preventing cardiovascular disease or cancer. Consequently, doctors often conclude that vitamin supplements are unnecessary. What Is a Well-Balanced Diet? Instead, they suggest that everyone follow […]

May 24, 2018

Medical devices are far more common than you might imagine. One American in ten has an implanted defibrillator, pacemaker, artificial hip or knee joint, surgical mesh or other device. How rigorously are such devices tested before they can be used? How Does the FDA Regulate Medical Devices? You would imagine that the Food and Drug […]

May 18, 2018

Fast food is taking over the American diet, and the effects are deadly. Processed meats, such as pepperoni or bologna, could be considered carcinogenic. Moreover, highly processed foods and fried foods set us up for heart disease and dementia. All the foods in bags and boxes with white flour and synthetic ingredients are a major […]

May 11, 2018

Since the middle of the last century, more than 85,000 chemicals have been developed and used. In many cases, they persist in the environment long after their immediate utility has vanished. The World Health Organization attributes more than one-third of childhood mortality to environmental causes. Are environmental poisons contributing to the troublesome rise in childhood […]

May 3, 2018

Prescription drugs cost more in the US than in any other country. Prices have been rising far more quickly than the cost of living, and the proportion people must pay out of pocket has also been increasing. As a result, many patients are finding it difficult to afford their medicines. Are you among them? Is […]

Apr 26, 2018

Chances are you know someone who has had difficulty conceiving a child, though you may not be aware of their struggle. Endocrine disruptors are widespread in our environment, and may be affecting sperm counts or female fertility. Modern medicine has a lot to offer couples who are having trouble with fertility. Men with low sperm […]

Apr 20, 2018

Lithium rich water from hot springs such as those at Lithia Springs, GA, have long been sought after for their healing properties. This element was used for decades to treat some forms of mental illness, but high doses can be dangerous. As a result, this treatment fell out of favor although it can be effective […]

Apr 6, 2018

About 15 percent of American adults have problems with their balance. Even children are not exempt, with about 5 percent suffering from dizziness. What causes dizziness, and what can be done about it? A Definition of Dizziness: Dizziness is a terrible term because it doesn’t actually tell the doctor what the patient is feeling. It […]

Mar 29, 2018

Why do some people appear to age more rapidly than others? Not only might they look older, they actually feel older as well. A check of their telomeres indicates that they are aging more rapidly at the cellular levels. Their telomeres are shrinking. Small telomeres foretell a shortened healthspan. Learning About Telomeres: So what is […]

Mar 22, 2018

Americans love laxatives. Millions of people rely on such products to stay regular. But you can conquer constipation without depending on these medications. Medications That Cause Constipation: A surprising number of common medicines can cause constipation as a side effect. Opiates are notorious for this, of course, but people may not think about the antihistamine […]

Mar 9, 2018

It is hard to feel good if your feet hurt. Dancing, running, playing golf or tennis and many other forms of recreation are no fun if you have painful bunions or plantar fasciitis. So how can you keep your feet happy and healthy? And what can you do about common foot problems? Ask the Podiatrist: […]

Mar 2, 2018

Nutrition experts have demonized a lot of foods over the past several decades. Eggs, shrimp, butter, cheese and meat were all taken off the table because they are rich in fat and cholesterol. No cholesterol, but too much fat doomed nuts, coconut and avocados. More recently, wheat and foods made from it, like bread, crackers, […]

Feb 21, 2018

How should you be keeping your heart healthy? Recent headlines have brought some controversies in cardiology to public attention. Defining High Blood Pressure: The American College of Cardiology and the American Heart Association issued guidelines on blood pressure control in 2017 (Hypertension, online Nov. 13, 2017). These cardiology groups recommend that anyone with blood pressure […]

Feb 15, 2018

Many families struggle to get their children and teens to follow healthful diets. But there is a good reason that grandmothers have been urging kids to eat their vegetables, going back at least a century. Poor eating habits contribute to many health problems. How can we get children to love healthy food? Dr. Yum to […]

Feb 9, 2018

When you go to see the doctor because you are sick, the first order of business is to get a diagnosis. How does the doctor arrive at that? What does she need to know? And is there any way you can help your doctors with diagnostic challenges? Meeting Diagnostic Challenges: Getting the right diagnosis is […]

Feb 1, 2018

Do you wish you could hear better? Do you have trouble hearing what others are saying? Many people find it difficult to follow a conversation with multiple voices, especially in a crowded restaurant. In fact, by 2060, more than 70 million Americans will probably be experiencing hearing loss. Most of them will be over 70. […]

Jan 25, 2018

When a child is diagnosed with attention deficit hyperactivity disorder (ADHD), many parents are faced with a difficult dilemma. They want their child to be able to focus in school and at home, but they may be uneasy about the medications the doctor is prescribing. While stimulant medicines can sometimes be very helpful for people […]

Jan 19, 2018

Experts agree that exercise is crucial for good health, especially when it comes to preventing chronic diseases. Movement helps every bodily system function better. So why do so many people find it difficult to make the time to exercise? Our technology has lured many of us into a sedentary lifestyle sitting at a computer. Dr. […]

Jan 11, 2018

Spine surgeon David Hanscom does some of the most complicated surgery you can imagine on bad backs. But his patients get even more relief from chronic pain by employing the nonsurgical techniques he offers them in preparation for surgery. Sometimes they feel so much better they don’t even need to go under the knife. How […]

Dec 29, 2017

At midcareer, neuroscientist Wendy Suzuki had numerous scientific awards and accomplishments. She was studying what makes a brain healthy. But she didn’t have much of a life outside of the lab, and she wasn’t happy. She decided to make some changes, starting with a stop at the gym. How Does Moving Your Body Make Your Brain […]

Dec 22, 2017

For decades, we’ve been told that we need to avoid fat if we want to lose weight. So Americans turned to highly-processed low-fat foods that are full of sugar. Is it a coincidence that we are fatter than before? More than two-thirds of American adults are overweight or obese. Turning the Food Pyramid Upside Down: […]

Dec 8, 2017

Why do some relationships last for decades and just seem to get stronger, while others wither? Is there a secret to lasting relationships? Kindness, Generosity and Science: Decades ago, psychologist John Gottman began studying how newlyweds interacted with each other. He and his colleagues created a “Love Lab” in which they took careful notes and […]

Dec 1, 2017

Sperm counts have been falling around the world for the last several decades. In some regions, such as Europe and North America, the counts are down as much as 60 percent. What could account for this dramatic drop? Are Endocrine Disruptors to Blame? Compounds in many ubiquitous products, such as the BPA found in hard […]

Nov 23, 2017

Dr. Allan Hamilton is a neurosurgeon, a teacher and a horse trainer. Those activities may not seem to have much to do with each other, but Dr. Hamilton has found that horses have a lot to teach us about life and health. Lead with Your Heart: His book on the wisdom of horses, Lead with […]

Oct 26, 2017

For years, we’ve been hearing from listeners who swallow a shotglass of pickle juice or a spoonful of yellow mustard to make a muscle cramp disappear. They often report relief within a few minutes. How could such a weird remedy work so quickly to alleviate muscle contraction? Muscle Cramps Strike at Sea: Neurobiologists Rod McKinnon […]

Oct 20, 2017

Consumer Reports recently had a cover story on “Too Many Meds? America’s Love Affair with Prescription Medication.” It turns out that half of American adults take at least one prescription drug. Actually, the average number of prescriptions is four. That’s a lot more pills than people in other countries, and it is more than we […]

Oct 12, 2017

Although lifespans have been increasing, so has the burden of chronic disease. When a person is diagnosed with a serious illness such as cancer, cirrhosis, kidney disease, heart failure or Parkinson’s, medical science may not have a cure. But doctors shouldn’t say, there’s nothing more we can do. Instead, they should ask, how can we […]

Oct 5, 2017

Being able to see is something most of us treasure, especially if we imagine being deprived of good vision. But do we know how to take care of our eyes to keep them healthy and working well? Our guest, Dr. Peter McDonnell, is an ophthalmologist. He describes the most common problems that can rob us […]

Sep 29, 2017

An estimated 20 million Americans have trouble with their thyroid glands. Doctors have become accustomed to making the diagnosis of hypothyroidism based on a single blood test. Often they prescribe just one medication for treating thyroid disease. But does that work equally well for everyone? Genetic Variations That Make a Difference: New research shows that […]

Sep 22, 2017

Heart Disease and Inflammation: Is cholesterol the main problem leading to clogged arteries and heart attacks? It certainly is important, but a brand-new study suggests that inflammation may also be critical. The study was called CANTOS (for Canakinumab Antiinflammatory Thrombosis Outcome Study). Canakinumab (Ilaris) is a medication that is approved for treating inflammatory diseases such […]

Sep 14, 2017

For decades, epidemiologists have noted that people who eat breakfast seem to weigh less and live longer. But it hasn’t been clear if eating breakfast helps people stay healthy, or if healthy people tend to eat breakfast. How much does that matter when people in the US appear to have switched from eating three meals […]

Sep 5, 2017

Osteoporosis, weakened bones, affects about 10 million Americans. But low bone density is even more common. According to the National Osteoporosis Foundation, about half of adults over 50 are at risk for a fracture. How can you minimize your risk and keep your bones strong? Preventing Osteoporosis: Some of the factors that lead to osteoporosis […]

Aug 31, 2017

Do home remedies have a role in skin care? Dan Siegel, MD, says that dermatologists can find a lot of medicinal uses for botanical products, and that helpful home remedies are great. Hemp Oil for the Skin: Find out about the benefits of hemp oil. Although it is related to marijuana, this product is not […]

Aug 24, 2017

More than 5 million Americans have Alzheimer disease and are gradually losing their abilities to think and remember. Most of the medications that are available to treat this degenerative condition are unimpressive at best. Is there any way to overcome Alzheimer disease? The Shortcomings of Medication for Alzheimer Disease: Most of the medicines that doctors […]

Aug 17, 2017

Summer is a great time to enjoy being outdoors. But vacation travel and playing in the back yard both offer potential hazards, such as sunburn, bug bites, poison ivy or blisters. How do you handle such everyday problems? We’ll take your calls and questions about common summertime troubles and home remedies that can help ease […]

Aug 11, 2017

Parkinson’s disease makes it difficult for people to move. In addition to tremors or twitches, people with Parkinson’s often feel stiff and find it difficult to walk easily. Their handwriting shrinks, and their voice may become hoarse or soft. How Intense Exercise Affects Symptoms: While there are medications to treat Parkinson’s disease, recent research suggests […]

Jul 28, 2017

When your doctor speaks, do you understand what you are hearing? Do you know how to describe your health problem so your doctor will “get it”? Why Communication Is Critical: Communication between doctors and patients is at the heart of health care. It is essential for accurate diagnosis, and crucial for patients to understand the […]

Jul 20, 2017

If you’ve ever found yourself ruminating over mistakes you made during the day and wishing for a do-over, you might want to change your perspective. In traditional psychiatry, you might focus on problems in your relationship and learn how to fight fair. Positive psychology, a science supporting health and wellness, would teach you how to […]

Jul 13, 2017

Dogs and Babies’ Health: Most young kids love their dogs. New research shows that even babies too young to play with the pet benefit from a dog in the house. What is the story on pets as probiotics? How do dogs affect the microbiome of a household, and how does that help babies’ health? What Are […]

Jul 7, 2017

Cardiologists agree that we should all be getting regular exercise and eating a healthful diet with lots of vegetables and fruits. But they don’t agree on which of us should be taking statins to protect our hearts. Just how much do these cholesterol-lowering drugs actually reduce the risk of a heart attack? The answer to […]

Jun 29, 2017

Our daytime functioning depends in large measure on the sleep we get at night. No doubt that helps explain why we spend approximately 36 percent of our lifetimes sleeping. How can we embrace bedtime instead of resenting it? Can you reset your body clock along with your alarm clock? How to Set Your Body Clock: […]

Jun 22, 2017

People facing a life-threatening cancer diagnosis may struggle with more than the medical treatment. They sometimes experience an existential crisis, in which life loses its meaning. In such situations, anxiety and depression may overwhelm and paralyze them. To address this problem, some psychiatrists decided to see whether the hallucinogenic compound psilocybin could make a difference. […]

Jun 15, 2017

You’ve probably heard that lifestyle is the most important factor in keeping your heart healthy. Don’t smoke, exercise, and eat right seem simple. But what does it really mean to eat right? Should you be avoiding sat fat? How Big a Problem Is Sat Fat? Experts have been telling us for decades that we must […]

Jun 8, 2017

When you listen to bird song, smell pine needles or watch tree branches swaying in the wind, what is happening in your brain? For that matter, what is happening in your body? Does your level of stress drop when you are out in nature? The Nature Fix: When writer Florence Williams moved from Boulder, Colorado, to […]

Jun 2, 2017

There’s been a big increase in mouse populations in many places over the past year. As a result, the number of ticks is booming, and you have a greater chance of being bitten when you go outside. Could a bite put you in danger from Lyme disease? The Basics of Lyme Disease: Lyme disease is […]

May 25, 2017

Most Americans are not familiar with the principles of Ayurvedic medicine. Despite its thousands of years of tradition, it seems exotic and possibly irrelevant for today. How Ayurvedic Medicine Principles Can Be Integrated into Neurology: Learn how a neurologist re-discovered the importance of Ayurvedic approaches when she found that her own migraines did not respond […]

May 19, 2017

Pain is one of the most common reasons people seek medical care. But physicians often face a dilemma when they treat joint pain, back pain or muscle spasms with prescription pills. Drugs that relieve pain effectively frequently carry frightening side effects, especially over the long term. Problems with NSAIDs for Pain Relief: Doctors usually rely on a nonsteroidal anti-inflammatory […]

May 12, 2017

Which fabulous foods can make a difference for our health? There might be too many to count. For this show, we are focusing on the science supporting the health benefits of just three power-packed foods: olive oil, curcumin and cherries. Extra-Virgin Olive Oil Is One of the Fabulous Foods: Olive oil is a pillar of the Mediterranean […]

Apr 27, 2017

Americans are taking more pills than ever before. Last year we shelled out more than $400 billion for prescription drugs alone. Over-the-counter medicines are also extremely popular. But all those drugs also carry some risks. Around half a million people suffer serious adverse drug reactions every year. Are there drug-free alternatives that would help many common […]

Apr 21, 2017

Stiff painful joints can interfere with activities like gardening, cooking, playing tennis, climbing stairs or walking the dog. While we think of osteoarthritis as a condition that primarily affects older people, it turns out that most people with this condition aren’t yet eligible for Medicare. As many as 30 million people may suffer with this condition. How […]

Apr 13, 2017

Many of us are aware we could be at a healthier weight. Perhaps we’ve even tried to drop some pounds but found that we were always feeling hungry and grumpy on a diet. Perhaps counting calories could help us lose weight for a while, but we gained it back again. Why Is a Low-Fat Diet […]

Apr 7, 2017

The FDA is charged with making sure that prescription drugs are both safe and effective. But questions have been raised about antidepressants and other drugs for mental illness. Exactly how effective are these medications to treat psychiatric conditions? Are they safe? How Well Do Antidepressants Work? Dr. Peter Gøtzsche, a founder of the nonprofit Cochrane […]

Mar 31, 2017

Medical errors and misadventures account for surprisingly high mortality in the U.S. Some experts estimate that they should be considered the third leading cause of death in this country. Many such mistakes could be prevented. How can you protect yourself or a family member from becoming a victim of medical errors? Many major causes of […]

Mar 16, 2017

Dan Ariely is a behavioral economist with a genius for figuring out why we do the things we do. His popular column in The Wall Street Journal is called “Ask Dan.” Listeners have the chance to do just that this week. What’s Your Motivation? Dr. Ariely’s latest book is Payoff: The Hidden Logic That Shapes […]

Mar 2, 2017

We rely on our feet to carry us throughout life, every day. What should we do to keep them from complaining? Taking Care of Your Feet: Podiatrist Georgeanne Botek explains how to manage warts, bunions, hammertoes and other common foot problems. Plantar fasciitis is a common cause of heel pain. What causes it, and how can […]

Feb 23, 2017

The treatment of mental illness has a discouraging history in this country. Even in the 21st century, psychiatrists rely principally on antipsychotic medications without much else in the way of support. These drugs have serious side effects, and although they are helpful for those who truly need them, they are too often prescribed inappropriately. Finding […]

Feb 17, 2017

We often associate the term “Post-Traumatic Stress Disorder” with military veterans. Indeed, war creates many traumatic experiences, but it is not the only source of reactions that may cause people to shut down or blow up. Car, train or plane crashes, a life-threatening illness episode, family violence or other events can create a dysfunctional reaction […]

Feb 10, 2017

If you were to list the organs of the body, would it occur to you to include fat? Most people think of fat as a nuisance, an intruder or even an enemy to be overcome. But fat is crucial for normal physiological processes. What should you know about the secret life of fat? Discovering the […]

Feb 2, 2017

In this show, we explore the stories behind some health headlines: the drawbacks of OTC sleeping pills and the best way to use them; whether arthritis drugs cause heart attacks; and how to afford a drug with a narrow therapeutic index. When researchers discovered that the pain reliever Vioxx was associated with an increased risk of […]

Jan 26, 2017

Have you ever started taking a medication and discovered that it produced an unpleasant side effect? That’s not uncommon. Sometimes the doctor responds by prescribing an additional drug to manage a side effect from the first one. Occasionally a person will get caught in a cascade that results in several drugs to treat side effects caused […]

Jan 19, 2017

The idea of yoga classes usually brings to mind images of young, fit people twisting their bodies into difficult poses while breathing deeply. But does yoga benefit people who don’t fit that stereotype? Yoga for People with Pain or Disability: Both our guests teach yoga to people who are neither young nor fit. These are […]

Jan 12, 2017

Medications are often crucial for maintaining our health, but every drug you take has potential side effects and may interact with other medicines. What do you know about these hazards? Understanding Benefits and Risks: Our guest, Dr. Russ Altman, suggests that physicians should exercise more restraint in prescribing and patients should ask more questions about […]

Dec 29, 2016

Habits-things you do on a regular basis without even thinking about them-can have a huge impact on our health. But it isn’t easy to drop old habits that aren’t serving us well, like eating a pint of ice cream every night. Nor is it always easy to adopt healthier habits that could be more helpful, like […]

Dec 23, 2016

Dr. Andrew Weil, the country’s leading expert in integrative medicine, believes that good health begins in the kitchen. It’s hardly revolutionary to propose that diet matters when it comes to our health, but so many people feel that eating delicious, healthy home-cooked meals isn’t possible for them. They don’t have time, they say, or they […]

Dec 9, 2016

Occasionally a medication that has been on the market for some time is found to do unexpected harm. That happened with Vioxx, and led researchers to take a closer look at all NSAIDS. A large trial showed that the NSAID pain reliever celecoxib (Celebrex) is no worse than naproxen in raising the risk of heart attacks. […]

Dec 2, 2016

When two people join to form a family, they bring with them lots of habits and expectations based on the families they grew up in. Sometimes these constitute big differences, but more often they are little things. Who does the dishes? Do you agree on how that should be done? How can you keep those […]

Nov 23, 2016

In the recent election, voters in several more states approved the use of medical marijuana. Now more than half the states in the US accept the medicinal use of cannabis, but the federal government does not. As a recent New York Times article about a cannabis company in California illustrates, that creates a certain amount […]

Nov 17, 2016

Nearly half of all marriages end in divorce, if we are to believe the statistics. Despite that, there is significant social pressure on married couples to stay together, even though the relationship may be unraveling. What Are Sacred Cows? Our guests examine the rationalizations the friends and family members often employ when a marriage starts […]

Nov 10, 2016

This show will be broadcast live on November 12, 2016, at 7 am EST. We discuss a number of fascinating health news stories from recent weeks. Fidgeting: If you find yourself tapping your foot or jiggling your knee, you just might be doing your legs a favor. We talk with a researcher who found that […]

Nov 3, 2016

The original air date for this radio show is November 5, 2016, at 0700 EDT. In this season of colds, do you know how to improve your immune response and lower your susceptibility? Dr. Tieraona Low Dog discusses a wide range of natural approaches to improving your immunity to respiratory viruses. You could start with simple steps like […]

Oct 27, 2016

Parsley, Sage, Rosemary & Thyme: Could rosemary in your food be part of the secret to long life? Will sage make you smarter? Will garlic, leeks and onions help you keep your heart healthy? Cinnamon, fenugreek and turmeric all appear to help regulate blood sugar. Could they be useful in warding off type 2 diabetes? […]

Oct 20, 2016

Do you know how to treat a headache, beyond taking aspirin or acetaminophen? Can you get into trouble by taking your medication too frequently? (The answer is yes; this can make headaches worse.) Ways to Treat Serious Headaches: Cluster Headaches: Cluster headaches recur with such extreme pain that they are sometimes termed “suicide headaches.” There are […]

Oct 6, 2016

There is considerable confusion over cholesterol and its connection to heart health and longevity. Should cholesterol be lowered at all costs? We’ll discuss the evidence for and against focusing on cholesterol. We also get good advice on the best lifestyle practices for maintaining a healthy heart. What Are the Benefits and Risks of Statin Drugs? […]

Sep 28, 2016

Ever since penicillin was discovered, scientists have realized that bacteria could develop resistance to antibiotics. In the last decade or so, these fears have become more acute. Many dangerous pathogens have evolved to become resistant to multiple antibiotics. Some have become impervious to drugs that are generally reserved for last-resort use. With the common use of many antibiotics to promote […]

Sep 22, 2016

Research makes it clear that what we eat makes a difference for our health. But there are many different diet patterns that have been promoted as healthy. Some people are vegetarians, while others embrace a high-fat, low-carb Atkins-type eating pattern. Is there one that is optimal for you? What Should Vegetarians Consider for Complete Nutrition? […]

Sep 8, 2016

Years ago, doctors thought that celiac disease was incredibly rare among Americans. In this auto-immune condition, exposure to gluten found in barley, rye and wheat causes the body to attack the lining of the digestive tract. The damage that is done interferes with the ability of the intestines to absorb nutrients properly and that can […]

Sep 1, 2016

For millennia, when people stopped breathing, they stopped living. The classic test for determining whether people were asleep or dead was whether they could fog a mirror. Resuscitating the Drowned: In the eighteenth century, the citizens of Amsterdam became alarmed at the number of residents perishing by drowning in the canals. They started a Society for […]

Aug 18, 2016

The Zone diet popularized by Dr. Barry Sears was one of the earliest to emphasize the importance of balancing protein, fat and carbohydrate consumption at every meal. Dr. Sears pioneered the idea that the food we eat is more powerful than any drug in controlling the activity of multiple hormones in our bodies. Many studies […]

Aug 11, 2016

Prescription medications cost more in the US than anywhere else in the world. What’s behind the high cost of these drugs? How are insurance companies and other payers coping with costs? Is there any way to save money on a prescription? How Can You Save Money on Your Prescriptions? With the price of medicines rising […]

Aug 5, 2016

Montmorency cherries are rich in polyphenols. Scientists in England have been studying their ability to help athletes recover more quickly from strenuous exercise. The latest research was conducted with soccer players and published in Nutrients (online July 22, 2016). Do you ever get muscle cramps, either during athletic activity or in the middle of the […]

Jul 28, 2016

What do you know about the popular cholesterol-lowering drugs known as statins? Are they miracle medicines that save lives, or do they represent a menace to health because of possible side effects? Get the truth on statins and heart disease. Two Views on Statins: We speak with two experts on statins and heart disease to get […]

Jul 21, 2016

Do you think of yoga as exercise? Many people don’t. Yoga doesn’t seem like exercise that can combat osteoporosis. Yet physiatrist Loren Fishman, MD, has shown that certain yoga poses can improve bone mineral density and reduce fractures. People do need to practice these poses conscientiously. When they do, they experience virtually no side effects-except they stand […]

Jul 14, 2016

An ancient Chinese medical modality is gradually gaining converts in the US. In acupuncture, a skilled practitioner inserts thin needles into specific points on the body. The problems that may be treated this way range from allergies and sinusitis to heartburn, PMS, menstrual problems and hot flashes. In addition, this approach is frequently helpful for painful conditions such as headaches, tender […]

Jul 7, 2016

If you are hiking in the hinterlands this summer, what first aid should you take along? We talk with Dr. Jim Hubbard, author of The Survival Doctor’s Complete Handbook, about what to do when you can’t get to the doctor. Home Remedies for Summertime Maladies: Dr. Hubbard also shares some of his favorite home remedies. […]

Jun 30, 2016

Stress is bad for our health, isn’t it? It has been linked to everything from psoriasis to asthma to heart disease. It may even make us more susceptible to cancer. Is the Emphasis on Stress Reduction Misplaced? It is no wonder, then, that wellness advocates emphasize stress reduction, whether it is yoga, meditation, a walk […]

Jun 16, 2016

As we grow older, the risk of two different cancers looms ever larger: breast cancer for women and prostate cancer for men. Whether you are a woman or a man, how can you reduce your risk from breast or prostate cancer? Unscrambling the Controversies: There have been controversies over the best methods for detecting and […]

Jun 9, 2016

Americans have been admonished to reduce the amount of sodium in our food. In fact, the American Heart Association has said that all of us should be cutting the salt we eat and aiming for 1500 mg of sodium daily, if not less. That is an amount that is achieved by only a few hardy […]

Jun 3, 2016

More children than ever suffer with allergies, asthma, ADHD or eczema. Sometimes these allergies can affect their ability to focus in school or get along with friends. It might be hard to see what is causing these problems. Could it be something they are eating? Do they need the dirt cure? A pediatric neurologist who […]

May 26, 2016

An increasing proportion of Americans are at risk for type 2 diabetes. In 2012, 86 million adults had prediabetes, which is elevated blood sugar that doesn’t quite reach the cut-off for a diabetes diagnosis. Frequently, people with prediabetes go on to develop type 2 diabetes, but they don’t have to. You can reverse prediabetes by […]

May 19, 2016

People who have had difficulty getting an accurate diagnosis of their ailments may feel that their doctors are not taking them seriously. Perhaps if they had MD degrees themselves, they imagine, the diagnostic process would be more productive. A Medical Mystery This is not always the case, however. Our guest, Neil Spector, MD, is a […]

May 12, 2016

Why do couples who love each other often experience diminished desire? Relationship expert Esther Perel says that achieving intimacy sometimes removes the mystery that makes sex so exciting. Keep the Spark: Drawing upon her decades of experience as a couples and family therapist, the author of Mating in Captivity tells how to keep the spark […]

May 5, 2016

Why can’t the medical experts make up their minds? That’s a question we hear often when the guidelines for eating a healthy diet, treating high blood pressure or lowering the risk of heart attacks suddenly change. Many people complain about medical flip-flops. How Medical Flip-Flops Affect Medical Practice: It isn’t only patients who become frustrated about […]

Apr 28, 2016

Americans take a lot of pills with the goal of staying healthy-pills to lower cholesterol, pills to control blood pressure, even pills to keep bones strong. How can we use fewer pills but still maximize our health? What Is Exercise Good For? It shouldn’t be surprising to learn that both diet and exercise are important […]

Apr 14, 2016

You may not think of bees as domestic animals, but any beekeeper would set you straight. Bees range far and wide when they forage for nectar and pollen, but they return home to the bee hive. Products of the hive have long been used for healing. Healing with Products of the Bee Hive: We get […]

Apr 7, 2016

How Helpful Is Lowering Cholesterol? This week, the American College of Cardiology met and revealed surprising data on some new studies. What is the best way to lower cholesterol? Do healthy people get any benefit from taking cholesterol-lowering drugs? How did doctors determine that some patients really do suffer from muscle problems when they take […]

Mar 24, 2016

Our immune systems are supposed to protect us from attack. Viruses, bacteria and fungi that try to invade can all trip alarm signals that awaken the body’s natural defenses. Cancer is not an invader, however. A tumor is made of our own cells, although they are growing out of control. Sparking the Immune System into Action […]

Mar 17, 2016

How can animals break through the barriers created by traumatic events and help people heal? We’ll learn about horses that interact with people with dementia, and dogs who visit patients in hospitals. Therapy Animals and Service Dogs: We’ll also find out how service dogs can improve life for people with disabilities. If you have a story […]

Mar 4, 2016

Alzheimer’s disease is a prospect as frightening to many of us as cancer, and the treatment options are not promising. Most of the costly medications used in treating this type of dementia do little more than delay its progression by a few weeks or months. The idea that anything might be done to turn back […]

Feb 25, 2016

Heart disease is still the number one killer of women in the US, though the words “heart attack” usually conjure up an image of a gray-haired man. The symptom of chest pain or tightness is the most common signal of a heart attack in either males or females, but the American Heart Association says women […]

Feb 19, 2016

When computer game expert Jane McGonigal suffered a concussion, she had a hard time recovering from the constant headaches, fatigue, confusion and depression. To give herself achievable goals and make her recovery more attainable, she invented a game she calls SuperBetter. The Benefits of a Gameful Mindset: You can use the gameful approach she describes […]

Feb 11, 2016

America’s most popular heartburn drugs might be harming our kidneys. Research published in the February issue of JAMA Internal Medicine suggests that regular use of drugs like Nexium, Prevacid or Prilosec is associated with a higher risk of chronic kidney disease. While the research shows an association and doesn’t establish that the drugs are causing kidney […]

Feb 4, 2016

What do you know about your digestive tract bacteria? Normally, a wide range of bacteria helps us digest our food and works together to keep us healthy. But when infections or antibiotics intervene, the variety of beneficial bacteria drops and undesirable strains like Clostridium difficile can gain the upper hand. What About Probiotics? Could probiotics […]

Jan 28, 2016

Are you getting all the nutrients you need from the food you eat? We are often advised to eat a well-balanced diet, but many people find that difficult. In today’s fast-paced world, it can be hard even to know what it means. Should You Take Dietary Supplements? Dr. Tieraona Low Dog suggests that many of […]

Jan 21, 2016

Chronic pain is often invisible, but it undermines the quality of life of a hundred million Americans. Many of these people face a terrible dilemma: without medication, they suffer dreadfully. But if they use narcotics to control chronic pain, they may be treated with suspicion or disdain. Measures designed to reduce drug abuse put many […]

Jan 7, 2016

As we start the new year, many of us use the opportunity to try to change the habits that affect our health. Last week we heard from Gretchen Rubin, author of the book Better Than Before. How to Change Our Bad Habits: This week, we touch base with Dr. Wendy Wood, whose research focuses on […]

Dec 24, 2015

Chocolate has long been considered a sinful indulgence, definitely not a food that belongs in any “healthy” diet. But over the past few decades, evidence has been building that consuming chocolate actually offers specific health benefits. What are they, and what is the best way to get your dose of beneficial cocoa compounds? What Are […]

Dec 17, 2015

We are accustomed to hearing, “Eat this, don’t eat that.” Nearly everyone who makes such a pronouncement is convinced that he or she has discovered the one and only diet that will solve the problem of obesity in America and help all of us avoid weight gain. If only it were that simple! The US […]

Dec 10, 2015

The tropical rainforest of Belize is full of medicinal plants. The knowledge of these plants and their uses has been considered secret, closely guarded by the traditional Mayan practitioners of shamanism. Rosita Arvigo and Remedies from the Rainforest: But several decades ago, an inquisitive, well-prepared and persistent American woman showed up and became a shaman’s […]

Dec 3, 2015

The thyroid medicine levothyroxine (Synthroid) is among the top ten drugs dispensed in the US. The inevitable conclusion is that thyroid malfunction is extremely common. Even after diagnosis and treatment, however, many people continue to feel bad. Research has found a genetic basis that explains some people’s problems with levothyroxine. Would a new approach to […]

Nov 27, 2015

Does your mood affect how much you eat? While serious depression or anxiety are known to change appetite, even milder changes in mood can have surprising effects. You might be surprised to learn that food rituals, such as saying grace, can also alter our eating behavior. Expressing gratitude before starting a meal helps people moderate […]

Nov 12, 2015

Bacon and Cancer: Not long ago, the World Health Organization’s International Agency for Cancer Research stirred up a lot of controversy by announcing that processed meats such as bacon or hot dogs should be classified as human carcinogens. What does this pronouncement actually mean? Has it changed the way you cook or eat, and should […]

Nov 5, 2015

Head injuries are all too common, affecting millions of Americans every year. They can result in brain injury if the brain gets jostled inside the skull. This can be a problem even if the incident did not result in a loss of consciousness (a “blackout”). Around 5,000 people daily experience a concussion as a result […]

Oct 30, 2015

Sports are a great way for kids to get physical activity and learn teamwork. But how vulnerable are kids’ brains when they play sports? In many popular sports such as football, soccer or lacrosse, players may collide with each other or with the ball. How could a bump on the head affect the brain? What […]

Oct 22, 2015

We air this show in memory of Dr. Mitchell Gaynor, who died last month. He was a frequent guest on The People’s Pharmacy and we are sorry to learn of his unexpected death. Genetic Destiny: We are all born with certain genes that help determine our height and the color of our eyes as well […]

Oct 15, 2015

It may sound far-fetched to propose that someone has an addiction to candy or soft drinks. But brain scans show that some of the reward pathways associated with a sweet taste are very similar to those linked to addictive substances. Might you be addicted to sugar? People at Risk for Sugar Addiction: Dr. Jacob Teitelbaum […]

Oct 1, 2015

The proportion of children with autism has increased dramatically over the last several decades. The CDC estimates that 1 out of every 68 American youngsters could be diagnosed as belonging on the autism spectrum. While most parents assume that this disorder is irreversible, there are some children who no longer fit the diagnostic criteria after early, intensive […]

Sep 24, 2015

The Institute of Medicine released an important report on diagnostic error this week, Improving Diagnosis in Medicine. The issue of medical mistakes is a serious problem that has not disappeared. Admitting Medical Mistakes: If a doctor or a hospital makes a mistake, will it be admitted? Research shows that many health care providers are not […]

Sep 17, 2015

Once fall begins, lots of Americans start to suffer. Up to a third of us struggle with sneezing, sniffling, congestion, itchy eyes and post-nasal drip as a result of hay fever (really ragweed pollen reaction) or other allergies. Avoiding Allergy Triggers: The best chance for managing allergies is to identify and avoid the triggers. But […]

Sep 10, 2015

Millions of Americans rely on popular pain relievers such as celecoxib, diclofenac, ibuprofen, meloxicam, naproxen and other NSAIDs (nonsteroidal anti-inflammatory drugs). The fact that some of these medications are available without prescription in products such as Advil, Aleve or Motrin IB gives many of us the impression that they must be safe. Balancing Benefit & […]

Sep 3, 2015

Dr. Oliver Sacks was much more than a neurologist. In his books, he invited us to imagine the world from wildly different perspectives than our own. When he described individuals with neurological differences (that would be termed “deficits” by most doctors and other people), he helped his readers recognize the special gifts these people were […]

Aug 28, 2015

Have you ever wondered about the big words your doctor uses? Physicians have a language all their own. Not only do they have specialized technical terminology, but they also have their own slang. What Should Patients Know About Doctors’ Secret Language? Find out about the argot, jargon and slang that abounds in hospital settings. What […]

Aug 20, 2015

If you have ever wondered whether there is a good way to take fewer prescription medicines and treat more of your everyday ailments with natural approaches, Dr. Tieraona Low Dog has good news for you. She reviews the evidence on herbal and botanical remedies and reassures us that many common health complaints are best treated […]

Aug 13, 2015

Tick-borne diseases are extremely widespread, but they seem to be difficult to diagnose and hard to treat. Science has now recognized many more conditions that result from tick bites than were known even a decade ago. Lyme Disease: The diagnosis and treatment of Lyme disease, caused by Borrelia burgdorferi and transmitted by a deer tick […]

Aug 6, 2015

Until fairly recently, no one was really interested in the denizens of the digestive tract except for a few gastroenterologists and a few more microbiologists. But now research has shown that the bacteria in our bowels form complex ecological systems, and interest in the microbiome has gone mainstream. Bowel Bacteria as a Source of Inflammation: […]

Jul 30, 2015

People have been using plants to take care of skin problems for hundreds or thousands of years. Which natural products really work? Our expert guests discuss the power of a fresh aloe vera leaf to help soothe a burn, including a sunburn. You’ll also find out how to prevent sunburn naturally. Some plants (tomatoes, chocolate, […]

Jul 23, 2015

This is the thousandth episode of The People’s Pharmacy, and we are celebrating. We invited local listeners who support our host station, North Carolina Public Radio, WUNC, to join us for a live performance of the show. BJ Leiderman Played our Theme: Adding to the celebratory mood, we were joined by noted NPR composer BJ […]

Jul 16, 2015

At one time, most Americans were mystified by meditation and wary of yoga. There is now increasing recognition that both meditation and yoga can have profound health effects. Meditation and the Brain How does meditation alter the brain? Our expert guests explain the significant physiological changes that happen at the level of the neurons, genes […]

Jul 9, 2015

Inflammation is a primary cause of many chronic conditions, from Alzheimer’s disease and arthritis to asthma and inflammatory bowel disease. But what causes the inflammation? Could infectious agents be the root of most of our chronic disease–including cancer? The New Germ Theory: Find out about the new germ theory linking infections and mental illness. Is […]

Jul 1, 2015

Diagnosis is the very foundation of medical care. Without an accurate diagnosis, doctors have no way of determining the appropriate treatment. Decades ago, doctors used to rely heavily on the patient’s account of her problem (called the “history”) and the doctor’s direct physical examination of the patient. Medical students still learn these skills, but in […]

Jun 25, 2015

We don’t always pay attention to our sense of touch, though it is critical to survival. Sensations of pain, heat or cold protect us from injury. But the importance of touch goes far beyond that. Pain and Pleasure: Our sense of touch also provides us with great pleasure. Caress is an essential element of bonding […]

Jun 18, 2015

Dr. Peter Gøtzsche worked for the pharmaceutical industry years ago supervising clinical trials and working in regulatory affairs. But this industry insider has become the toughest of critics. Dr. Gøtzsche is concerned about the impact that big pharma exerts on health care. Pharmaceutical firms are among the most profitable in the world. In the US […]

Jun 4, 2015

Most of us know what we should do to clean up our lifestyles–eat right, exercise, get enough sleep, and so on ad nauseum. You’ve heard it all before. But we don’t necessarily do the things we know that we ought to. Perhaps we think it doesn’t really matter for us, at least not right now. […]

May 14, 2015

Americans frequently boast that we have the best health care in the world. While that may be debated in some quarters, no one doubts that our health care system is the most expensive. What makes American health care so pricey, and is there anything that could be done about it? Evaluating Obamacare One approach that […]

May 7, 2015

Dizziness is a common problem, but not easily diagnosed. A little lightheadedness could be a reaction to dehydration or blood pressure medication. But when the room is spinning, walking can become difficult or even dangerous. A fall, especially for an older person, can have very serious consequences. When Is Dizziness Dangerous? When does vertigo signal […]

Apr 30, 2015

Every five years, the US Departments of Agriculture and Health and Human Services collaborate on producing Dietary Guidelines for Americans. These are supposed to tell us what we should be eating. They are also used to shape institutional food choices, such as those in schools or prisons. Changes Expected Will there be any changes in […]

Apr 9, 2015

Turmeric, the yellow spice in curry and yellow mustard, has an active component called curcumin. This compound is the subject of more than 7,500 studies that show it has anti-inflammatory and anti-cancer activity. How Does Curcumin Work? Recently scientists discovered exactly how it boosts the activity of a treatment for colorectal cancer. We talk with […]

Apr 4, 2015

An ever-increasing appreciation of the complexity of ecosystems has begun to change farming practices so that they become more sustainable. Science is demonstrating that our human bodies are also complex ecosystems, made up of more microbes than human cells. Could some of the principles of sustainable farming help us stay healthy too? Dr. Daphne Miller […]

Mar 26, 2015

Heated disagreements about whether or not Americans all need to reduce their salt intake have reached the Wall Street Journal. Many public health agencies recommend that we cut back on salt to lower blood pressure and reduce the risk of heart attacks and strokes. But how well does that approach work? We talk with contrarian […]

Mar 19, 2015

An amazing number of American youngsters is considered to have attention deficit hyperactivity disorder (ADHD). In some states, CDC data show that more than 10 percent of school children carries this diagnosis. You will find a thorough discussion of the symptoms, diagnosis, treatment and potential consequences of ADHD here. Alternatives to Ritalin The usual treatments for […]

Mar 12, 2015

A recent investigation by the New York Attorney General’s office provoked scandalized headlines. They indicated that important herbal supplements from four major retailers did not actually contain the herbs they purported to provide. What was detected by the DNA barcode test was rice, soy or wheat, possibly used as fillers. But was the DNA barcode […]

Mar 5, 2015

Americans tend to equate more tests and more aggressive treatment with better quality care. This approach does result in more expensive care. The US spends more on health care per capita than any other country in the world. But we lag behind other industrialized nations on important measures of public health. Challenging Assumptions Many of […]

Mar 1, 2015

Antidepressant medications have become part of popular culture ever since Prozac came on the market in the mid-1980s. Only those who have weathered a suicidal crisis themselves or watched a loved one face such an emergency may truly appreciate how inadequate our current antidepressants are in such circumstances. Ketamine An old drug, ketamine, is now […]

Feb 19, 2015

Many people currently carry around tiny but powerful computers in their hip pockets or pocketbooks. We use our smart phones to check our bank accounts, keep up with our friends or get a weather report. Apps are also proving as good as dedicated fitness trackers at telling us how much we are moving. Before long, […]

Feb 12, 2015

For decades, the diet dictocrats have warned us to back away from the butter, minimize the meat and skimp on the salt. The recommended menu might not taste terrific, but it was supposed to prevent heart disease, diabetes and other chronic conditions. Unfortunately, the evidence to back these dietary policies up has never been supported […]

Jan 29, 2015

Taking medications that affect brain chemicals can alter our risk of developing dementia. Find out which prescription and over-the-counter drugs are associated with a greater risk of an Alzheimer’s disease diagnosis. There is a list of common anticholinergic drugs here. Stroke Treatment A Dutch study last month showed that using a special device to reach […]

Jan 22, 2015

We often take our sight for granted, and wrongly assume that there is nothing that can be done to keep vision problems from occurring. Our guest has combed the medical literature to find ways to prevent or even reverse conditions such as cataracts, macular degeneration and glaucoma with natural approaches. Myopic Youngsters Around the world, […]

Jan 15, 2015

The flu season started early this year and is now in full swing. What do you need to know about influenza to keep from becoming a sad statistic? Anti-Anxiety Medicines and the Alternatives Doctors prescribe anti-anxiety drugs in huge numbers. When does anxiety need treatment, and what can be done besides take a pill? What […]

Jan 1, 2015

Television ads warning men of the dangers of “low T” (inadequate testosterone) have become commonplace, but they rarely explore the risks of taking testosterone replacement medications. That may be partly because, like hormone replacement therapy for women years ago that supplied estrogen and progesterone, testosterone treatment has not been fully studied. It isn’t necessary to […]

Dec 25, 2014

We often think of vulnerability as a weakness, but being open and vulnerable with those we care about actually requires courage and strength. When we manage it, vulnerability also strengthens our most precious human connections. Dr. Brené Brown has inspired millions of people with her TED talks on the power of vulnerability. Learn why striving […]

Dec 18, 2014

Living in the modern world means being exposed to a great many chemical compounds, from those in our shampoo to the ones that make up that unforgettable new-car smell. The safety of many of these compounds is unknown, but others have recognized toxicity. And simple actions, like eating soup from a can, could raise our […]

Dec 11, 2014

The FDA has insisted for years that generic drugs are identical to their brand-name counterparts. Physician and medical historian Jeremy Greene writes: “Generic drugs never were–and still are not–exactly the same as their brand-name counterparts, but they are similar in ways we deem to be important.” We discuss the value of generic drugs and the […]

Dec 4, 2014

At some point during our lives, most of us will have at least one episode of back pain. Sharp or dull, the pain can come on at an unexpected moment and dominate our lives for days or weeks, until it disappears as mysteriously as it came. When Pain Becomes Chronic For some people, however, low […]

Nov 26, 2014

Is rest a waste of time? Many of us think so, but burning the candle at both ends has its costs. Eventually, the result is burnout along with physical and emotional exhaustion. Balancing Rest and Activity While sleep is crucial for good health, sleep alone may not suffice to restore health. Dr. Matthew Edlund believes […]

Nov 20, 2014

According to a new global survey, older adults in the United States take more drugs for more chronic health problems than seniors in ten other countries. Why do so many people suffer with chronic illnesses as they age? The diseases that afflict them are due in part to genetic susceptibility for heart disease, diabetes or […]

Nov 13, 2014

Hydrocodone Painkillers Last month, the Drug Enforcement Administration changed its classification of hydrocodone containing pain relievers. The new rules will make it more difficult for some patients to get their medications. What will they mean for you? Movember By now, everyone is pretty well aware that October is colored pink to draw attention to breast […]

Nov 6, 2014

Are you deficient in magnesium? Chances are you’ve never thought about it. Magnesium is a fascinating mineral that every cell in the body uses for a variety of activities. Yet very little attention is paid to this nutrient. Learn why magnesium is so vital and how to tell if your levels might be low. Which […]

Oct 30, 2014

Many couples struggle to conceive. Even healthy young couples may be less likely to have success with conception than is commonly believed. Without using protection of any kind, such a couple might expect to conceive in one cycle out of five. While most healthy couples do manage a pregnancy over the course of a year, […]

Oct 23, 2014

More than 30 million Americans have trouble hearing as well as they would like. Some assume there is nothing that can be done to help them, while others imagine that their hearing loss is not so great that it needs to be addressed. Are they mistaken? Hearing aids are expensive and somewhat mysterious. Technological Advances […]

Oct 15, 2014

For decades, Americans have been warned to step away from the cheese and leave the butter untouched. Saturated fat was believed to clog the arteries and lead to heart attacks and early death. But what was the basis for those admonitions? Where’s the science? The science of the popular prescriptions for a low-fat diet is […]

Oct 9, 2014

Dishonesty in Health Care Health care, it seems, is not immune to the dishonesty that prevails in many other parts of society, whether it is the polite lie that someone looks good (despite a hospital pallor) or a more serious deception or omission, such as a provider’s financial relationship with a drug or device manufacturer. […]

Oct 1, 2014

Gluten has become a household name in the last few years, with many crackers, cereals and other food products advertised as gluten free. What Is Gluten, and Should You Be Avoiding It? In the past, the only people who paid much attention to gluten were those with celiac disease. This condition was thought to be […]

Sep 25, 2014

Playing a sport, leading an active lifestyle or taking an unexpected tumble can lead to joint injuries such as a sprained ankle or a torn rotator cuff in the shoulder. Sometimes joints just start complaining because of accumulated wear and tear. Sports medicine specialists often need to evaluate the best methods for overcoming pain and […]

Sep 22, 2014

More than a million Americans suffer from inflammatory bowel disease (IBD). Crohn’s disease and ulcerative colitis are usually considered autoimmune conditions, although it is not necessarily clear what may trigger the immune system to attack the lining of the digestive tract. Find out about the symptoms of IBD and how it is distinguished from IBS, […]

Sep 6, 2014

Most of us have experienced the frustration of a phone tree that seems designed to keep us from speaking to the person who could actually do what needs to be done. Have you ever considered the impact of an insurance pre-authorization requirement on a physician’s work day? We speak with Dr. Danielle Ofri about a […]

Aug 30, 2014

Most people are familiar with tick-borne diseases such as Rocky Mountain Spotted Fever or Lyme disease. But other diseases transmitted by ticks and fleas and biting flies may be flying under the radar. One such organism is called Bartonella. More Than Cat Scratch Fever Bartonella is known as the cause of cat scratch fever, but […]

Aug 16, 2014

People often hold fast to their favorite dietary dogma and get annoyed if it is challenged. But lately there has been a great deal of controversy about the best diet for good health, especially for people with diabetes or heart disease. One sign of a possible paradigm shift is the publication of three different articles […]

Aug 9, 2014

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about: Amyotrophic lateral sclerosis (ALS) is better known as Lou Gehrig’s disease. What does a diagnosis of ALS mean, and how do doctors and patients work together to improve […]

Aug 2, 2014

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about: Hot summer temperatures can be uncomfortable for anybody, but for some folks they may be downright dangerous. Which drugs require extra caution because they make a person more […]

Jul 26, 2014

What can we learn from people who have experienced spontaneous remissions of serious cancers? Doctors recognize that such remissions sometimes occur, but they rarely study them. The problem is that remissions are uncommon and unpredictable, and consequently difficult to study. The Research Psychotherapist Kelly Turner interviewed more than a thousand people who had undergone a […]

Jun 7, 2014

Do you take antibiotics for granted? Many of us do. After all, these drugs have been saving lives for decades, serving as magic bullets against deadly infections such as pneumonia, gangrene or blood poisoning since the middle of the 20th century. Superbugs Sneer at Antibiotics: Unfortunately, the bacteria that cause infections have been evolving and […]

May 31, 2014

Susannah Meadows’s son was only three years old when he developed terrifying symptoms of a disabling disease, juvenile idiopathic arthritis. His parents were frantic to help him feel better, but conventional medicine was slow to go into effect. Could a Leaky Gut Have Activated His Immune System? They decided to explore an alternative approach as well. […]