The People's Pharmacy Podcast
Empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.
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Show 1444: The Food Fight Over Fat: Keto and Carnivore Diets
09/13/2025
Show 1444: The Food Fight Over Fat: Keto and Carnivore Diets
For the last several decades, nutrition scientists have been debating the pros and cons of various dietary approaches. The Mediterranean diet has a lot of proponents, and we have interviewed some of them on The People’s Pharmacy. Dr. Barry Popkin and Dr. Walter Willett endorse olive oil, whole grains, fruits and vegetables with only small amounts of animal-sourced food. Listen to for more information. Dr. Will Bulsiewicz is a fiber evangelist. You can hear him on . Plant-based diets can fall along a spectrum from mostly plants with some meat, fish and eggs to completely vegan. In contrast, there are experts who recommend a low-carb, high-fat ketogenic diet. Carnivore diets consisting of only animal products (meat, poultry, fish) are a subcategory of keto diets. That is the focus of this episode. Carnivore Controversy: We know that people have strong feelings about food. The DIETFITS study, one of the best randomized controlled trials comparing healthy low-carb to healthy low-fat diets found that both led to weight loss. Learn more by listening to our interview with lead investigator Dr. Christopher Gardner on We have heard from fans of ultra-low-fat diets like those promoted by Pritikin or Dean Ornish, MD. We acknowledge that hearing about a carnivore diet may put their teeth on edge, at the very least. But information from knowledgeable sources about controversial topics is what we aim for, and this is indisputably controversial. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care, treatment, or diet. Ketogenic and Carnivore Diets: Doctors have long prescribed ketogenic diets to treat children with hard-to-treat epilepsy (). Studies suggest that people with migraines or depression might benefit from a ketogenic diet (; ). Most people now following carnivore diets, which are more extreme than ketogenic diets, began following this eating plan to lose weight and have more energy. Our co-host for this show, AAAS Mass Media Fellow Bianca Garcia, has done some investigation of this approach to nutrition, including a personal trial. She joined us in interviewing Dr. Eric Westman, an advocate for ketogenic and carnivore diets to help people with obesity and diabetes. What is a ketogenic diet? It minimizes the carbohydrate available as fuel by including only low-starch vegetables such as greens. High-fat food sources make up the bulk of the energy in the diet. This forces the body to burn ketones derived from body fat instead of glucose derived from sugar or starch. In a carnivore diet, the vegetables disappear completely and the high-fat food sources are all derived from animals. How Do Dietary Guidelines Mesh with Carnivore Diets? We asked Dr. Westman about changing dietary guidelines, and he pointed out that most of the national dietary guidelines have limited scientific support. Of course, randomized controlled trials of people following carnivore diets are also few and far between. A survey of more than 2,000 self-selected volunteers following the diet was published in 2021 (). The DIETFITS trial, which compared a healthy low-fat, high-carb regimen to one high in fat and low in carbs found no significant difference in weight loss over the course of a year ). What Are the Effects of a High-Fat Diet? In the clinical trials he conducted, Dr. Westman found that blood insulin levels were lower as people followed a ketogenic diet (). The body does not require insulin to utilize ketones for fuel. As a result, people with type 2 diabetes have better control of their blood glucose when following a low-carbohydrate ketogenic diet (). He and his colleagues have published a case series suggesting that a ketogenic diet could help people with food addiction (). There are also hints that people with other psychiatric conditions might benefit from a ketogenic diet as well (). What Is Driving the Interest in Carnivore Diets? Bianca Garcia and Dr. Eric Westman agree that the internet has a huge influence on people’s interest in carnivore diets. Podcasters like Joe Rogan and multiple influencers have promoted this approach, especially to younger people. This can contribute to social pressure to try it. Dr. Westman warns listeners that adopting a ketogenic or carnivore diet should be undertaken under knowledgeable guidance. A drastic dietary change can alter how medications work, so people with chronic illness really need to work closely with health care professionals. That may require searching for someone who is open to this approach with the expertise to recommend when supplements or salt might be needed and provide information on doses. This Week’s Guest: Eric Westman MD, MHS, is an Associate Professor of Medicine at Duke University. He is Board Certified in Obesity Medicine and Internal Medicine and founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. Dr. Westman is a past President and Master Fellow of the Obesity Medicine Association and Fellow of the Obesity Society. He is a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. In addition, he has written and edited numerous bestselling books and is a co-founder of (), which provides science-backed education on a range of subjects rooted in the therapeutic effects of dietary carbohydrate restriction… including his newest course, , which is open now for enrollment for a limited time. Eric Westman, MD, Duke University Our Co-Host: Bianca Garcia is a Filipina-American anthropologist, foodie, and radio person. She holds a master’s degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She was a AAAS Mass Media Fellow covering health and science at WUNC, North Carolina Public Radio when we conducted the interview; her favorite stories to cover always involve what people eat, and why. Bianca Garcia, photo copyright Christina Thompson Lively Listen to the Podcast: The podcast of this program will be available Monday, Sept. 15, 2025, after broadcast on Sept. 13. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, you’ll hear the real patient story of a doctor who weighed 350 pounds and suffered from POTS (postural orthostatic tachycardia syndrome). Do we have any idea of how a carnivore diet affects the gut microbiome? Dr. Westman describes his study on how a low-carb diet helps GERD (gastroesophageal reflux disease). Years ago, Joe looked for evidence on the traditional heartburn diet limiting fat, alcohol, coffee and tomatoes and couldn’t find any. What we have found is that science changes as researchers pursue further studies and that is not a reason to mistrust science even though the changing recommendations may be frustrating. Dr. Westman offers a message to everyone trying to make the right dietary choices but feeling overwhelmed by many different messages about food. Citations Carroll JH et al, "Over twenty-five years of ketogenic diet therapy: Supporting children and adults with drug-resistant epilepsy using nutritionally complete ketogenic formulations: A scoping review." Epilepsy & Behavior, Sep. 8, 2025. DOI: 10.1016/j.yebeh.2025.110683 Gunasekera L et al, "The Hypometabolic State of the Migraine Brain: Is a Ketogenic Diet the Answer?" Brain and Behavior, Sep. 2025. DOI: 10.1002/brb3.70860 Decker DD et al, "A pilot study examining a ketogenic diet as an adjunct therapy in college students with major depressive disorder." Translational Psychiatry, Sep. 10, 2025. DOI: 10.1038/s41398-025-03544-8 Lennerz BS et al, "Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a "Carnivore Diet"." Current Developments in Nutrition, Nov. 2, 2021. DOI: 10.1093/cdn/nzab133 Gardner CD et al, "Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial." JAMA, Feb. 20, 2018. DOI: 10.1001/jama.2018.0245 Westman EC et al, "Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus." Expert Review of Endocrinology & Metabolism, Sep. 2018. DOI: 10.1080/17446651.2018.1523713 Westman EC et al, "The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus." Nutrition & Metabolism, Dec. 19, 2008. DOI: 10.1186/1743-7075-5-36 Carmen M et al, "Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series." Journal of Eating Disorders, Jan. 29, 2020. DOI: 10.1186/s40337-020-0278-7 Sethi S et al, "Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial." Psychiatry Research, May 2024. DOI: 10.1016/j.psychres.2024.115866
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Show 1443: Rethinking Medications: Uncovering the Truth About Common Drugs
09/06/2025
Show 1443: Rethinking Medications: Uncovering the Truth About Common Drugs
Americans take a lot of medications. Luckily, the Food and Drug Administration only approves those that are safe and effective. However, the agency’s definition of “safe” includes medicines that can harm or kill some people, and the definition of “effective” covers some drugs that only work a little better than placebo. Has the FDA changed its standards? Maybe we should be rethinking medications. Rethinking Medications: If you watch television or streaming video, you probably see a lot of commercials for prescription pharmaceuticals. Decades ago, prescription drugs weren’t advertised on television, and the prices for prescriptions were much lower. How has the pharmaceutical industry changed? On this episode, we talk with an expert observer of the industry and its regulation. Dr. Jerry Avorn is one of the country’s most respected pharmacoepidemiologists. He describes how the business of making and selling medicines has evolved. What Is the Role of Orphan Drugs? The Orphan Drug Act was passed in 1983. Its goal was to offer to develop medicines for rare diseases. The FDA encouraged Congress in this, viewing these as “significant drugs of limited commercial value.” The idea was to make sure that even though only a few hundred Americans might have leprosy, for example, that drugs would still be developed to treat their condition. Tax breaks, patent extensions and market exclusivity made the proposition more appealing. In fact, one of the reasons Americans spend twice as much on drugs per capita as citizens of Canada, Australia or other countries is the cost of orphan drugs. Although these compounds were seen as having “limited commercial value,” the industry has figured out how to charge exceedingly high prices for anything considered an orphan drug. How Effective Is Your Medicine? When it comes to evaluating effectiveness, pharmaceutical firms have a powerful tool. Dr. Avorn considers it one of the best inventions of all time, although it is a concept rather than a thing. RCT stands for Randomized Controlled Trial, which in turn is shorthand for randomized placebo-controlled double-blind (or in the UK, double-dummy) clinical study. The idea is to take a group of people who are alike in some important ways, so that they are equally likely to develop some type of health problem. Divide them up using a random number generator or some other similar impersonal technique. Those on one side of the divide get the medicine, while those on the other side get an indistinguishable placebo. Neither the participants nor the investigators know who is in which group. At some pre-specified time, the researchers will check to make sure there have not been too many adverse reactions. They may also check that the intervention appears to be doing something. When the trial is over, the methods and results should be described in a publication so that doctors will know if they should incorporate the treatment into their practice. We love RCTs when the outcome is avoiding some serious problem such as a stroke or a cancer diagnosis. For us, biomarkers are less compelling, even though they have become far more common. What is a biomarker? It is easy to measure, like blood sugar or blood pressure. The biomarker is a stand-in or surrogate for a condition like diabetes or heart disease because they are often correlated. It is important to remember, though, that the biomarker is not the disease. Comparing Absolute and Relative Risk While Rethinking Medications: Once the company has completed its RCT, more than likely it will want to publicize the results to promote the drug. How it describes effectiveness can change the way people think about the medicine. One of our favorite examples comes from a print advertisement for Lipitor. It boasted that Lipitor (atorvastatin) lowered the risk of a heart attack (myocardial infarction) by 36 percent. That sounds great, doesn’t it? There was an asterisk next to that number, and in small print lower on the page was an explanation. During a five-year trial, out of 100 people on Lipitor, two had heart attacks. Out of 100 people on placebo for that trial, three had heart attacks. So you can see the absolute difference between Lipitor and placebo was just one heart attack per hundred (the absolute risk reduction). That probably would not have sold many pills. But stated as a relative risk reduction of 1 fewer heart attack compared to the baseline of 3 (1/3), using larger numbers because there were thousands of people in the study, you get 36 percent. What Do We Know About Safety? When patients see multiple health care providers who don’t talk with each other often, it may be difficult to detect serious safety problems. That was the case with the anti-inflammatory drug Vioxx. Early warning signs of cardiovascular problems resulting from this pain-reliever were overlooked for years. Researchers detected trouble as early as 2001, but the drug company resisted removing the drug until 2004. As a result, millions of people were needlessly exposed to danger and too many died. The silver lining to this cloud is stepped-up surveillance for side effects. Rethinking Medications with Respect to Side Effects: Some years ago, Dr. Avorn and his colleagues conducted a brilliant study (. They compared the side effect profiles from RCTs of different antidepressants. Mind you, they were not looking at the side effects of the drugs. They examined the side effects of the placebos in studies of tricyclic antidepressants and compared them to side effects of placebos in studies of SSRI antidepressants. All the participants had depression, so there should have been no differences due to the underlying condition. Yet the placebos had vastly different side effect profiles, mirroring the divergent side effects of the active agents. This striking difference might be due to changes in the way researchers elicited symptoms. Or it might be due to the nocebo effect, in which a person who expects to feel nauseated becomes queasy. Nocebo is like an inverse of the placebo effect. Either way, it suggests that when side effects of the placebo are similar to those of the investigational drug, we shouldn’t assume that the drug has no side effects. How Can You Protect Yourself? In rethinking medications, it is important to make sure that you really need all the drugs you are taking. Dr. Avorn strongly recommends a brown bag review periodically, in which the patient brings in everything he or she is taking, including OTC meds and dietary supplements. The health care provider reviews them, looking for duplication or incompatibilities. If they find problems, it’s time for a conversation about alternatives or deprescribing. Some medicines cannot be stopped suddenly, so the prescriber should provide detailed instructions about tapering and should monitor progress as the patient reduces the dose. This Week’s Guest: Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies and developed the educational outreach approach known as “academic detailing,” providing evidence-based information about medications to prescribers. One of the nation’s most highly cited researchers, Dr. Avorn is the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, and he has written or cowritten over six hundred papers in the medical literature as well as opinion pieces in TheNew York Times, The Washington Post, JAMA, and The New England Journal of Medicine. Dr. Avorn’s new book is . His website is
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Show 1397: The Surprising Secrets of Sunlight’s Health Benefits (Archive)
08/30/2025
Show 1397: The Surprising Secrets of Sunlight’s Health Benefits (Archive)
In this episode, our guest is a dermatologist who wants us to consider sunlight’s health benefits. That is a minority opinion among dermatologists. Dr. Richard Weller tells us why vitamin D is overrated and not the most important aspect of sun exposure. The Secrets of Sunlight’s Health Benefits: Dermatologists generally advise us to stay out of the sun as much as possible. After all, excessive sun exposure causes skin aging and skin cancer, conditions for which people frequently consult them. However, even if we could all live inside, wear protective clothing and high SPF sunscreen whenever we ventured out, would that be wise? According to our guest, Dr. Richard Weller, and his colleagues, “insufficient sun exposure has become a real public health problem” (). While this problem is more acute in Europe than the US, they still estimate that more than 300,000 Americans die each year due to inadequate sun on their skin. What is going on? How Does Sunlight Affect Skin? For decades, we have heard that the principal effect of sunlight on skin is the production of vitamin D. Therefore, the dermatologists have concluded, rather than take the risk of exposing skin to sunshine, why not just swallow vitamin D supplements? The problem with that proposal is that it hasn’t worked very well. Many studies show that people with low levels of circulating vitamin D are more vulnerable to high blood pressure, , heart disease, diabetes and , among other problems. However, people who take always get the expected benefits. Perhaps vitamin D is a marker for sun exposure rather than the most important outcome. Human Evolution and Skin Color: Humans evolved in Africa, where dark skin is an advantage, offering protection from the most harmful effects of ultraviolet radiation. By about 60,000 years ago, people were migrating to other parts of the world. Yet analyses suggest that although they arrived in Europe by about 40,000 years ago, genes for pale skin didn’t become common until less than 10,000 years ago. Anthropologists have hypothesized that pale skin is an adaptation to inadequate sunlight in northern regions. Because vitamin D is a well-recognized consequence of sunlight on skin, they have assumed that was the driver. Dr. Weller suggests that nitric oxide was (and still is) more important. He notes that the evolution of pale skin happens around the same time that people begin to cluster together in farming communities, where they are more likely to be exposed to infectious diseases. Is Nitric Oxide the Source of Sunlight’s Health Benefits? In 1996, Dr. Weller was the first scientist to find that human skin creates a compound called nitric oxide (NO) under sunlight. This compound is then absorbed into the skin, where it helps relax blood vessels and lower blood pressure. Here is a on the topic. This is where Dr. Weller’s approach differs from that of more conventional dermatologists. With proper caveats that the US is at much lower latitudes, in general, than most of Europe, he proposes that more sunlight, not less, could lower mortality rates. (Lower latitudes get more sunshine.) His analysis was just published in the prestigious ). The data underpinning this claim are from an analysis of the UK Biobank, a remarkable treasure trove of information. Dr. Weller and his colleagues have found that in the UK, people who get more sunlight are less likely to die within a specified time frame. We call that lower all-cause mortality. You can read the research report here (). It was discussed in this article in ). This Week’s Guest: Richard Weller, MD, FRCP(Ed), is Professor of Medical Dermatology at the University of Edinburgh. He holds the Personal Chair of Medical Dermatology in the He is also Honorary Consultant Dermatologist at NHS Lothian and h. Dr. Weller serves as Programme Director for the M Med Sci at the University of Edinburgh and is President of the Scottish Dermatology Society. He is the Clinical Lead for the Dermatology Speciality Group at NHS Research Scotland, the and . Listen to the Podcast: The podcast of this program will be available Monday, Sept. 1, 2025, after broadcast on Aug. 30. You can stream the show from this site and download the podcast for free. Learn More: Dr. Weller kindly shared links to some research by his colleagues that he mentioned during the show. Here is an showing the benefits of home phototherapy for psoriasis. presents evidence that dark skin is not susceptible to UV-induced melanoma. , or listen to the podcast on or . Citations Alfredsson L et al, "Insufficient Sun Exposure Has Become a Real Public Health Problem." International Journal of Environmental Research and Public Health, July 13, 2020. DOI: 10.3390/ijerph17145014 Weller RB, "Sunlight–Time for a Rethink?" Journal of Investigative Dermatology, August 2024. DOI:https://doi.org/10.1016/j.jid.2023.12.027 Stevenson AC et al, "Higher ultraviolet light exposure is associated with lower mortality: An analysis of data from the UK biobank cohort study." Health & Place, Sept. 2024. https://doi.org/10.1016/j.healthplace.2024.103328 "Exposure to the sun’s UV radiation may be good for you." The Economist, Aug. 12, 2024.
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Show 1442: The Healing Power of Exercise Prescriptions
08/23/2025
Show 1442: The Healing Power of Exercise Prescriptions
Exercise physiologist Claudio Battaglini, PhD, describes how exercise prescriptions can improve cancer patients' lives and life expectancy. A randomized controlled trial published in the confirmed what some cancer specialists have long hoped: physical activity can prolong cancer patients’ lives. we heard from the senior author of that study, medical oncologist Christopher Booth. In this episode, we hear from an exercise physiologist who has been helping cancer patients with exercise prescriptions. The goal was for them to feel better. Many also lived longer. Who Needs Exercise Prescriptions? We start our conversation with exercise physiologist Claudio Battaglini, PhD, by asking about his career trajectory. How did he go from playing soccer in Brazil to studying how to coach Olympic-level athletes to providing exercise prescriptions tailored to cancer patients’ unique needs? You will want to hear his story. What Is the Cancer Gym? Dr. Battaglini describes how he initially resisted working with young cancer patients. How did that experience affect him? He eventually ended up setting up the cancer gym at the Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado (UNC for those in Greeley). After earning his doctoral degree there, he began teaching and research at a different UNC (the University of North Carolina at Chapel Hill). He established the Get REAL & HEEL Breast Cancer Rehabilitation Program and credits the breast cancer patients for pointing out the benefits of group exercise training. In addition to positive physiological effects, participants experience emotional support. This also helps motivate patients to continue their physical activity consistently. How to Motivate People to Exercise: Let’s face it: most of us could benefit from exercise prescriptions. But would we follow through? It turns out that personal relationships are hugely important in helping to motivate people to show up. That could be with their personal trainer who is expecting them for their appointment. It could also be one or more friends counting on them to participate in the activity. If others are holding you accountable, you are far more likely to get with the program. Another important factor is matching the right kind of exercise to each patient. Most people are motivated to do what they enjoy. Do you love pickleball or swimming? Dancing or hikes in the woods? If the recommendation is right, staying motivated is far less of a problem. Physical Activity for Young People: Decades ago, physical education classes were mandatory in public schools. In recent years, some school boards have been tempted to drop them as too expensive. (North Carolina and some other states have statewide policies requiring all students in grades K-8 to have the opportunity of 30 minutes of exercise daily.) How important is it to encourage youngsters to be physically active? Do they need exercise prescriptions? Practical Advice for an Exercise Program: For those of us writing our own exercise prescriptions, we discussed the pros and cons of counting steps. Where can you find exercise programs suited to you? The YMCA might be one place to start. Dr. Battaglini also mentioned online resources and qualities to look for in a personal trainer. Above all, whatever you choose to do should feel like fun. This Week’s Guest: Claudio L. Battaglini, PhD, FACSM, is a Professor of Exercise Physiology and the Director of the Graduate Exercise Physiology Program at the University of North Carolina at Chapel Hill. He is Co-Director of the Exercise Oncology Laboratory in the Department of Exercise and Sport Science at UNC Chapel Hill. Dr. Battaglini is also a member of the UNC Lineberger Comprehensive Cancer Center.
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Show 1441: How Exercise Can Help Cancer Patients Survive & Thrive
08/16/2025
Show 1441: How Exercise Can Help Cancer Patients Survive & Thrive
Physical activity, aka “exercise,” is a cornerstone of good health, just like adequate sleep and a balanced diet. No one questions the benefits for people who are already healthy. But doctors may assume that cancer patients are too debilitated and demoralized to exercise. They may think physical activity wouldn’t be much help to patients who have just suffered through radiation or chemotherapy. Such assumptions are wrong and could be harmful, as a recent study shows. In actuality, structured exercise can help cancer patients survive and even thrive. Does Exercise Belong in Cancer Treatment? An exciting study published in The New England Journal of Medicine demonstrates that a personalized exercise program can be an important component of the treatment for colorectal cancer (). We spoke with the senior author, Dr. Christopher Booth, who explained that originally he and his colleagues wondered if exercise can help cancer patients feel less fatigued while undergoing chemo. Then they decided to design a trial that would go much further. They intended to answer two questions: can cancer patients exercise during treatment? And does that improve their likelihood of survival? Increasing Physical Activity Can Help Cancer Patients Survive Longer: The study, known as the CHALLENGE trial, hit a home run. The investigators recruited 889 people who had just had surgery and chemotherapy for their colorectal cancer. They randomly assigned half of them to get a health education booklet urging them to eat right and stay active. The other half got the booklet (usual care) PLUS a personalized exercise prescription designed to increase the amount of moderate to vigorous physical activity people did over the week. How Did This Challenge Work? The exercise prescriptions were devised by personal trainers who met with the “intervention” patients every two weeks for a year. Half of the meeting was devoted to motivational coaching and the other half to moving. Patients loved it. Increasing their fitness also improved their quality of life. In addition, patients in the exercise intervention group had better immune function and lower inflammation and less insulin-like growth factor, which can contribute to tumor expansion. Both men and women participated in this trial. During the follow-up period, women who were active were less likely to develop breast cancer than those in the control group. Similarly, men in the intervention group had a lower chance of a prostate cancer diagnosis. The most exciting part of the story, however, is about their colorectal cancer treatment. Not only did patients in the physically active group have longer overall survival, they also had longer disease-free survival. Remember, these two groups have the same type of cancer and got the same kind of treatment, except for the exercise prescription. The overall 8-year survival was 90.3% in the exercise group and 83.2% in the health education control group. That means the exercisers lowered their chance of dying during those eight years by 37%. The Number Needed to Treat (NNT) was 14 exercisers to prevent one death. That is a remarkable statistic. How Did Cancer Patients Get Motivated to Move? If you’ve ever started an exercise program only to drop it a few weeks later, you are not alone. Keeping ourselves motivated to stay active isn’t always easy unless you really love what you are doing. (Joe needs no extra motivation to show up for tennis.) Consequently, it is impressive that a very high proportion of the cancer patients in the CHALLENGE trial kept exercising. Part of that perseverance might be due to the motivational coaching. No doubt another big part was the relationship with the personal trainer. Meeting with a person every two weeks for a year can help build friendships and creates a relationship in which accountability is a factor. After the first year, patients and trainers met every month for the next two years. Being able to increase physical activity was empowering for patients, giving them a sense of control that can otherwise be missing in a cancer patient’s life. What Did Cancer Patients Do? The exercise prescriptions were personalized, so people undertook a wide range of activities. Jogging and walking were popular, but some people swam, and others kayaked. There were patients who bicycled, and possibly some who rode horses. (Dr. Booth does not mention that.) The point was to find an activity you love and stick with it religiously, which they did. The most popular activity by far was also the simplest: walking. The idea was to walk at a pace so you looked like you were late for a meeting. Is It Feasible to Help Cancer Patients Survive & Thrive? One of the most exciting aspects of the CHALLENGE trial was to see that people responded to coaching. Personalized exercise prescriptions with accountability could be instituted into many cancer treatment programs. After all, if insurance pays for cardiac rehab, why shouldn’t it pay for cancer rehab? The cost of a personal trainer is about $3,000 to $5,000 over three years. That is a lot less than the next-level chemotherapy drug is likely to cost, and unlike chemo, the side effect is that the patient feels better. Not only is it feasible to help cancer patients survive through targeted exercise, it should be a part of most cancer treatment protocols, In Summary: Dr. Booth offered us this explanation of how the treatment works: “Exercise is inducing physiologic, hormonal, inflammatory, immunologic changes in the body that are helping the body eradicate a proportion of these cancer cells. ‘ Learn More: Dr. Booth is a medical oncologist. To complete this trial, he called on the expertise of a lot of colleagues, including exercise physiologists. Next week, we will speak with Claudio Battaglini, PhD, to get the exercise physiologist’s perspective on this important approach. This Week’s Guest: Christopher Booth, MD, is a medical oncologist and health services researcher at Queen’s University in Kingston, Ontario, Canada. • Director, CCE Division, Queen’s Cancer Research Institute (QCRI) • Medical Oncologist • Clinician-Scientist, Cancer Centre of Southeastern Ontario • Professor, Departments of Oncology and Medicine, Queen’s University • Canada Research Chair in Population Cancer Care
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Show 1440: Protecting Your Immune System from Everyday Toxins
08/09/2025
Show 1440: Protecting Your Immune System from Everyday Toxins
We may not often stop to think about it, but our water, food, furniture and other ordinary items are frequently contaminated with toxic chemicals. In this episode, Dr. Aly Cohen describes these threats to our health. You may have heard of compounds that can disrupt hormonal balance (endocrine disruptors). Everyday toxins like these can also interfere with the ability of the immune system to function properly. What can you do to reduce your exposure? Doing an Environmental Assessment: As a rheumatologist, Dr. Cohen frequently treats patients whose immune systems have turned on them to produce conditions like lupus or rheumatoid arthritis. As an integrative medicine practitioner, she has learned to look at the patient’s environment for clues about the toxic compounds that may be causing the problem. The first environmental assessment she conducted was actually for her beloved family dog, Truxtan. When he developed autoimmune liver disease, she tried to figure out why. How Everyday Toxins Disrupt the Immune System: Dr. Cohen wasn’t able to save her dog, but the experience made her realize just how many potentially toxic chemicals we are exposed to in the course of our daily lives. If you look around your kitchen, you may discover that most of your food containers might be suspect. Plastic is incredibly convenient, since it is lightweight, break-resistant and cheap. But it often contains plasticizers such as bisphenols or phthalates that are endocrine disruptors. Some can disrupt the immune system as well. After all, immune system cells interact with the endocrine system on a regular basis. The two are tightly linked. Other food packaging can also contribute undesirable compounds such as PFAS. Exposure to these may lead to chronic inflammation. Dr. Cohen tells about a patient, Massimo, who ran a pizza shop. A young man, he had troubling fatigue. Changing his routine so that he wore nitrile gloves while handling pizza boxes helped a lot. So did bicycling to work. Everyday Toxins in Our Water: How safe is your water? One of Dr. Cohen’s patients had moved to New York from a Latin American country. Although she had filtered her water in her home country, she believed the tap water in New York was safe. It turned out the old plumbing in her building was contaminated with lead. In addition, she was relying on rice as a food staple, and it was contaminated with arsenic. Lead and arsenic are well-recognized as toxic chemicals. Filtering her water and washing her rice helped her feel much better. How do you make sure your water is free of everyday toxins? Dr. Cohen says several types of filtration devices can be useful, if they are used according to instructions. That means changing the filter medium on the recommended schedule. Any filter is better than no filter, but by far the best approach is known as reverse osmosis. This results in clean water you can trust to be free of toxins. Can You Avoid Plastic? The topic of water is almost inextricably linked to the question of plastic. Much of the water sold for consumption away from home is bottled in plastic. In addition to environmental considerations, this can expose us to plasticizers such as phthalates or even to tiny bits of plastic known as microplastics. These are accumulating in our bodies and may be harming our immune system. Bottles are not the only source of plastic in our food supply. Most cans are lined with a resin to prevent corrosion. This frequently contains BPA, bisphenol A, as a plasticizer. Some manufacturers have switched to another bisphenol instead. Thus, they can claim that the can is BPA-free, but it isn’t necessarily safer. Don’t Use Plastic Containers in the Microwave! One simple rule that can cut down on a lot of exposure to immune-disrupting plasticizers is don’t microwave food in plastic containers. Heat tends to speed leaching of plasticizers from the containers into the contents. Yes, we know a lot of frozen meals come in plastic containers that are supposedly microwave-safe. Don’t believe them. Instead, transfer the food to a glass or ceramic dish or bowl and heat it in that. That way you know you’re not getting any extra plasticizer in your snack. Prioritize! Dr. Cohen points out that to get the best results from efforts to avoid everyday toxins, we need to figure out where the exposure is greatest. That’s why she usually likes to start with cleaning up the water supply, since for most of us that is our top exposure. Analyzing your diet and focusing on foods you eat often is another way to prioritize. Those are the foods that should be free of toxins if at all possible. She recommends using the of the “Dirty Dozen” foods that often contain pesticides and the “Clean Fifteen” foods that are generally safe. For the Dirty Dozen, it makes sense to purchase USDA Organic produce whenever possible. Removing Pesticides: Dr. Cohen offers some simple, inexpensive ways to wash your produce and get the pesticide off. Add 1 part vinegar to 3 parts filtered water and let the fruit or vegetables soak in that for several minutes. Then rinse it off well with filtered water. The 21-Day Plan: To make it easier for people to implement the changes and avoid everyday toxins, Dr. Cohen offers a 21-day plan. It offers steps to avoid lots of harmful chemicals including obesogens (chemicals that make us fat). One simple way to take the first steps, after filtering the water you drink, is to carry a metal spoon and fork. That way you won’t have to resort to using plastic utensils to eat hot food, especially soup. Another step is to be cautious with skin care products. Using the online EWG guide SkinDeep can help you find sunscreen or moisturizer that is mostly free of undesirable agents. When shopping, make it a habit to seek out USDA Organic certified products for those items you eat most. Learn More: Dr. Cohen is not the only doctor concerned about toxic exposures. A summary of research into the “exposome” was published in JAMA last spring. . This Week’s Guest: Dr. Aly Cohen is a board-certified rheumatologist and integrative medicine physician. A member of the faculty of the Academy of Integrative Health and Medicine, Southern California University of Health Sciences, and the University of California, Irvine, she is a leading medical and legal expert in environmental health. Dr. Cohen is creator of social media platform, and the co-author of the bestselling consumer guidebook . Her latest book is . Her website is
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Show 1439: What Men Need to Know to Overcome Prostate Cancer
08/02/2025
Show 1439: What Men Need to Know to Overcome Prostate Cancer
New advances mean that more men than ever before can overcome prostate cancer. Treatments can extend life and improve quality of life. In this episode, our guest, Dr. Andrew Armstrong of Duke University, discusses recent advances that men should know to overcome prostate cancer. We ask about former President Joe Biden’s diagnosis. What does it mean to have Stage IV prostate cancer and a Gleason score of 9? News outlets have reported that Mr. Biden’s previous prostate screening test was in 2014. How often should men be tested for this common cancer? What does the PSA (prostate specific antigen) test really tell us? How Do We Detect Prostate Cancer? Prostate cancer affects one man out of every eight in the course of a lifetime. Fortunately, if it is caught early and treated appropriately, most men do not die of this disease. They die of something else, even if they may still have prostate cancer cells. For years, the mainstay of prostate cancer screening has been the level of PSA, prostate specific antigen. Although it is specific to prostate, it is not really specific to prostate cancer. All prostate cells make it, so doctors watch for unusual increases in PSA. That suggests a rapid growth of the prostate, which could be caused by prostate cancer. Not every prostate cancer produces large amounts of PSA, though. That’s why urologists watch for changes rather than using a threshold number. Men with a family history of prostate cancer are at higher risk for developing it themselves. Ideally, they would start screening at a younger age and possibly have it done more frequently. In men who have a limited life expectancy, doctors may not recommend prostate screening. PSA alone is just the first step. If PSA is elevated or if it is rising, men will need further workup. What Is Next to Overcome Prostate Cancer? Often the next step is imaging. Magnetic resonance imaging of the prostate can be very informative. If there is a suspicious area on the MRI, the doctor will schedule a biopsy. Current practice is to use the MRI and ultrasound to guide the biopsy, so that the tissue examined is from the area thought to harbor the tumor. Grading the Tumor: The tissue removed during the biopsy will be examined by a pathologist. That expert will use the characteristics of the cells in the tissue to assign it a Gleason score. These range from 6 (not very worrisome) to 10 (the most aggressive). Former President Biden’s cancer had a Gleason score of 9, which is serious. Doctors also want to know if the tumor has spread beyond the prostate gland itself. To find out, they may conduct a PSMA PET scan. This picks up prostate-specific membrane antigen (hence PSMA) wherever it may be in the body. Stage IV, like former President Joe Biden’s cancer, has spread outside the prostate to other parts of the body. In his case, the cancer has metastasized to his bones. In some cases, prostate tissue will be sent for genetic testing. BRCA2 is associated with breast and ovarian cancers, but men who carry this gene are more vulnerable to prostate cancer as well. Approaches to Preventing Prostate Cancer: The risk of prostate cancer appears to be roughly half hereditary and half environmental. That means there are things that men can do to reduce their risk. Avoiding environmental toxins is crucial. Plastics and plasticizers don’t belong in our food or our bodies. Diet matters, of course. Not everyone loves broccoli, Brussels sprouts, cabbage and cauliflower, but getting plenty of these cruciferous vegetables can help reduce the risk of prostate cancer. Another important step is to focus on exercise. Not only can regular vigorous physical activity reduce the chance of developing prostate cancer, it also is very useful in counteracting the side effects of the powerful drugs used to overcome prostate cancer. Options for Treating Prostate Cancer: Blocking Testosterone: Often the doctor prescribes leuprolide (Lupron) to shut down testosterone production. That part of the protocol is referred to as “androgen deprivation therapy” or ADT for short. An even more powerful androgen blocker such as abiraterone (Zytiga), apalutamide (Erleada), darolutamide (Nubeqa) and enzalutamide (Xtandi) may be added. These drugs can help men overcome prostate cancer, which seems to thrive on testosterone. Blocking the androgen receptors with one of these medicines has made treatment for prostate cancer more effective. Androgen blockers stop testosterone formation even further and thus discourage the growth of the cancer. That’s the benefit. The downside is that men suffer the effects of “low T.” Here is where exercise stars, helping men feel better even when their testosterone levels are nonexistent. Other Treatments for Prostate Cancer: There are nonhormonal approaches to treating prostate cancer that may be used in conjunction with androgen blocking or in some cases independently. One is surgery, in which the prostate is removed. That used to be the standard treatment. With new approaches available, it is one option among many. Another is radiation. Dr. Armstrong describes some of the different types of radiation, which can be very effective when used together with androgen blocking medication. There are also immune therapies. One exciting new therapy, called Pluvicto uses radioligands that seek out and attach to PSMA. Because it can find prostate cancer cells wherever they are in the body, it is being considered for treating metastatic prostate cancer when ADT may no longer be working well. What to Know to Overcome Prostate Cancer: Dr. Armstrong wants men to know that prostate cancer can be detected early; when it is, it is often curable. Even in the case of advanced disease, there is hope. He urges men to ask for second opinions on treatment and take advantage of a multidisciplinary team when possible. Above all, he says: “The good news is that treatment can extend life often dramatically, and that many men, most men in fact with prostate cancer, don’t die of prostate cancer. They die of other stuff.” This Week’s Guest: Andrew J Armstrong, MD, ScM, FACP, is Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. He is Director of Research at the Duke Cancer Institute Center for Prostate and Urologic Cancers. His appointments are in the Division of Medical Oncology in the Departments of Medicine and Urology at Duke University. Dr. Armstrong is one of the country’s leading prostate cancer researchers.
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Show 1380: Avoiding Lyme and Other Tick-Borne Diseases (Archive)
07/25/2025
Show 1380: Avoiding Lyme and Other Tick-Borne Diseases (Archive)
Half a million people may suffer symptoms of Lyme disease this year. Learn about avoiding Lyme and other tick-borne diseases. In this episode, two experts draw on the latest research about avoiding Lyme disease and other infections that may be transmitted through tick bites. Why are these conditions so difficult to diagnose? Most importantly, how can people with lingering symptoms from Lyme get help and start to feel better? We consider both conventional and alternative approaches. The Basics of Lyme Disease: We begin with a quick review of the history of Lyme disease, which was first identified in Old Lyme, Connecticut, in the 1970s. Researchers eventually identified the pathogen causing the symptoms as Borrelia burgdorferi and means of transmission as bites from a black-legged tick (aka deer tick). Even though it was originally thought to be limited to New England, epidemiologists now recognize that Lyme disease is widespread across the country. Half a million people will come down with Lyme disease this year. Many others will suffer symptoms from other pathogens transmitted through tick bites. Persistent Symptoms of Lyme Disease: For much too long, doctors thought that any symptoms persisting after a course of antibiotics were psychosomatic. Patients were understandably distressed by this dismissal of their suffering. Many people report fatigue, body aches and brain fog. Some have difficulties with balance or feeling weak or faint when they stand and have been diagnosed with POTS (postural orthostatic tachycardia syndrome). Headaches, rashes, heart palpitations and joint pain may also be part of the picture. If you think some of these symptoms ring a bell, you are right. Many people with long COVID or even chronic fatigue suffer with similar problems. Avoiding Lyme or Treating It Over the Long Term: One of our expert guests, Dr. John Aucott, does research on Lyme disease and directs the Johns Hopkins Lyme Disease Clinical Research Center. His study utilizing functional MRI was very revealing. When regular imaging studies are done on people with persistent Lyme disease symptoms, the results are not particularly striking. But functional MRI results, when people are asked to do cognitive tasks while undergoing magnetic resonance imaging, show a different picture. These people’s brains are not functioning normally. No wonder they are upset about brain fog or struggling to concentrate! There are several possible explanations for why Lyme disease symptoms may persist. The spirochete responsible for these symptoms does not require oxygen and is very good at “hiding out” within tissues. When reactivated, it could cause symptoms. On the other hand, the immune system may become hyper-activated and have a hard time calming down. That too could contribute to symptoms. Non-governmental organizations have funded the Study of Lyme Immunology and Clinical Events (). In this trial, researchers have identified some risk factors associated with post-treatment Lyme disease (PTLD, aka long Lyme). They are also enrolling patients in a treatment trial. Standard of Care for Lyme Disease: Naturopathic doctor Alexis Chesney points out that there are different standards of care for Lyme disease. The for treating “four important manifestations of Lyme disease.” Those are erythema migrans (the classic “bulls-eye” rash), neurologic Lyme disease, Lyme carditis and Lyme arthritis. The International Lyme and Associated Diseases Society () offers its own treatment guidelines. Both experts agree that early treatment is preferable to late treatment. Dr. Chesney describes the ability of the Borrelia spirochete to protect itself by changing to a “round form” as well as by forming a biofilm that wards off antibacterial medicines. One way to combat this is by utilizing herbs that can counteract biofilm formation, such as cats’ claw or Japanese knotweed. She also pays attention to supporting patients experiencing a Herxheimer reaction, in which dying spirochetes release toxins. This can make a person feel very ill indeed. Natural ways to mitigate this response include milk thistle, burdock or Epsom salt baths. Avoiding Lyme Disease by Preventing Tick Bites: Even better than early treatment is prevention. The best prevention is to avoid tick bites. Wear shoes and socks that have been treated with permethrin. (Do not apply permethrin directly to the skin.) Using an effective insect repellent also helps, and a thorough tick check upon coming in from outdoors is indispensable. It takes ticks some time to transmit Borrelia, so prompt tick removal can help prevent illness. This Week’s Guests: Dr. John Aucott is the Barbara Townsend Cromwell Professor in Lyme Disease and Tick-borne Illness at the Johns Hopkins University School of Medicine. An infectious diseases specialist and Lyme disease expert in the , he is the director of the . Alexis Chesney, MS, ND, Lac, is a naturopathic physician, acupuncturist, author and educator. Since 2010, Dr. Chesney has worked with people of all ages on chronic disease, general wellness, nutrition and lifestyle counseling. She has dedicated herself to working with clients who have complex chronic illness, and who often have diagnoses such as Lyme and vector-borne diseases, mold toxicity, mast cell activation syndrome, among other conditions. Dr. Chesney is the author of . Dr. Chesney offers an online course, . Here is the link: . Her website is
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Show 1438: Bites, Burns, and Blisters? Solving Summer Skin Problems!
07/19/2025
Show 1438: Bites, Burns, and Blisters? Solving Summer Skin Problems!
This week, we asked dermatologist Dr. Chris Adigun into our studio to answer your questions about summer skin problems. The Link Between Sun Exposure and Skin Cancer: Intense summer sunshine can cause sunburn and skin damage. The most worrisome consequences are skin cancers that may show up on cheeks, ears, noses, lips or other unexpected places. How can you recognize a potential skin cancer? What will the dermatologist do about it? Even more important, can you reduce your risk for basal or squamous cell carcinoma? (Those are technical terms to describe skin cancers that are not melanoma.) What are the best ways to avoid harming your skin while you are enjoying the great outdoors, whether you are at the beach or on the hiking trail? Are there criteria you can use to choose the best sunscreen without spending a fortune? How often do you need to apply it? Can you get enough vitamin D compounds if you wear a high SPF sunscreen? Are there skin conditions that might actually benefit from a bit of sun and salt water? Lowering Your Chance of Melanoma: The relationship between sun exposure and melanoma is less clear than that between sun and basal or squamous cell cancers. Find out what might make a spot suspicious. Where should you be checking your skin? What can a dermatologist do to help? Heat and Humidity Challenges: In addition to sun, heat and humidity can challenge our skin. Fungal infections may proliferate under those conditions, resulting in athlete’s foot, jock itch or under-breast rash. Can we make our sweaty skin less hospitable to fungi? Have you been troubled with heat rash? We’ll find out what it is and what to do to get rid of it. Other Summer Skin Problems: Long summer hikes can result in more trouble than sunburn or sore muscles. Unless you are very careful with your shoes, sweaty feet can develop blisters. Are there good preventive strategies? If you get a blister anyway, what can you do to ease the pain–and keep it from getting worse? Bug bites may also be the bane of your existence. Chiggers hang out in grass or brush waiting to take a bite of a tasty mammal walking by. Can you avoid or discourage them? And if you do get chigger bites, how can you manage the dreadful itch? We also want to avoid bites from ticks and mosquitoes. They may have different niches and behaviors, so avoiding them may require different tactics. What works best? How can you choose a good insect repellent for outdoor activities, and will it interact with your sunscreen? Poison Ivy and Its Cousins: Poison ivy, poison oak and poison sumac all contain the resin urushiol, which can be extremely irritating to sensitive skin. Do you know how to identify these plants so you can avoid them? If you find yourself in the middle of a poison ivy thicket, can you take quick action and reduce the chance of a rash? If you end up with a rash–it happens–we’ll find out how you can ease the suffering. This Week’s Guest: Chris G. Adigun, MD, FAAD, is a board-certified dermatologist who practices both general dermatology and cosmetic dermatology at the Dermatology and Laser Center of Chapel Hill, NC. Dr. Adigun is devoted to increasing public awareness of skin cancer and the harmful effects of UV rays—both medical and cosmetic. She specializes in both nail disorders and laser treatments.
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Show 1437: Why Modern Life Breaks Our Brains and What We Can Do About It
07/11/2025
Show 1437: Why Modern Life Breaks Our Brains and What We Can Do About It
We sometimes may feel that we are in a circumstance that breaks our brains and undermines our mental health. What skills provide resilience? In this episode, we acknowledge the many reasons that people may be feeling anxious or depressed. It often seems that current conditions are designed to break our brains. Perhaps that’s why 60 million Americans suffer from depression or anxiety. Not everyone who might be feeling nervous or down in the dumps deserves a diagnosis. However, they can benefit from the practices we discuss in this hour. Pharmaceutical approaches such as antidepressants can be helpful for people with depression, especially in the short term. Over the long haul, though, we might want to consider whether changing our habits could help us develop the resilience we need. After all, antidepressants frequently result in side effects. Moreover, many people find it difficult to discontinue an antidepressant. Anti-anxiety agents carry similar risks. Scientific research has shown us the importance of neuroplasticity. Can we tweak our neurochemistry by embracing some simple tenets for living? We don’t really have broken brains, but we might be lacking the skills we need to pursue robust mental fitness. Where will we learn them? Staying Connected Protects Our Brains: Good nutrition, adequate sleep and regular exercise are all pillars of mental as well as physical health. Our guest, integrative psychiatrist Drew Ramsey, says staying connected with others is equally important. Cultivating a variety of connections is crucial for our mental health, including friends, family and even casual acquaintances. We should keep in mind that building community is different from building friendships; we need both for mental fitness. Social isolation can be damaging both for teenagers and for older individuals. Can we use social media to bolster our support systems rather than allowing them to wither? What skills can we help our teens acquire? Dr. Ramsey described a study, the AMEND trial, that combined social connection through social media with learning to cook. The young men in the study posted their cooking experiments on Instagram and bonded with each other over the experience. Adopting a more healthful diet also reduced the youths’ risk for depression. Maybe Ultra-Processed Food Breaks Our Brains: One aspect of nutrition that is important to consider is how our food affects our microbiota. Our gut microbiome has a powerful influence on inflammation in our bodies. After all, the immune system is in part anchored in the gut, especially in the gut microbiome. When the microbiome gets disrupted and inflammation rises, our mood and mental health can suffer. What should we be eating to feed our microbes and keep them happy? Dr. Ramsey offers a little rhyme as a mnemonic: “Seafood, greens, nuts & beans…and a little dark chocolate.” We admit the last line breaks the rhyme, but it isn’t too hard to remember! When we asked what foods to focus on for healthy gut microbes, he suggested lentils. Although they are not technically beans, as in the rhyme, they are legumes and contain lots of fiber that helps gut microbes flourish. Dr. Ramsey also extolls the benefits of microgreens, another food that gut microbes love. The microbiome acts as a master dial on our immune system and inflammation levels. Beyond Diet and Activity: Dr. Ramsey provides nine tenets for reclaiming robust mental health, even when we may feel like our situation breaks our brains. In addition to thoughtful nutrition, adequate sleep and reliable physical activity, he also stresses the importance of unburdening yourself of past trauma. This need not have been anything as major as a traffic accident or losing a parent, though such experiences are certainly traumatic and deserve attention. Even minor traumas like being picked on as a child can affect our sense of well-being. Unburdening is the process of acknowledging those and trying to understand where our past is tripping us and blocking our efforts to be mentally healthy in our present. Unburdening yourself can leave you feeling freer to pursue your goals. It helps ground you so that you can pursue your purpose. Journaling, therapy or creative pursuits could all help with unburdening. How Can You Find Your Purpose? Finding your purpose might not sound like a step towards better mental fitness, but it is. How do you know when you have found your purpose? Focusing on a sense of identity and of fulfillment will help you with this. Finding a sense of purpose is important at every stage of life, but it may be especially important for older individuals. A job is not synonymous with purpose, although at times they may overlap. Sometimes, people who have relied on work to provide their sense of purpose find themselves at loose ends when they retire. This Week’s Guest: Drew Ramsey, MD, is a leading board-certified integrative psychiatrist, best-selling author and leading proponent of Nutritional Psychiatry and Mental Fitness. He served as an Assistant Clinical Professor of Psychiatry at Columbia University in the Vagelos College of Physicians and Surgeons for twenty years. Dr. Ramsey is founder of the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, WY. He is the author of several books, including his latest book, .
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Show 1330: Rethinking Hypothyroidism (Archive)
07/07/2025
Show 1330: Rethinking Hypothyroidism (Archive)
In this week’s episode, our guest explains why treating hypothyroidism isn’t always as simple as it seems. He is a leading researcher on questions relating to thyroid hormones. What Is Hypothyroidism? Hypothyroidism, a condition in which the thyroid gland doesn’t make enough thyroid hormone, is one of the most common hormonal disorders. It was first identified near the end of the 19th century but is far more widely recognized now. More than 20 million Americans produce too little thyroid hormone for their needs, either because their thyroid glands have been removed or because they are under attack from the immune system. Inadequate thyroid hormone has an impact on every cell in the body. As a result, the symptoms are wide-ranging, from lethargy and cognitive troubles to hair loss and constipation. Why Should We Be Rethinking Hypothyroidism? Most medical students learn that this is a simple straightforward condition to diagnose and treat. For decades, doctors used a single test–the TSH, or thyroid-stimulating hormone–for diagnosis. In addition, they learn that a single medication, the hormone called levothyroxine, is the sole treatment. People may know levothyroxine by its brand names, such as Synthroid or Levoxyl. Doctors often refer to it as T4, because the molecule contains four atoms of iodine. Not everyone knows that T4 itself is not biologically active. Enzymes within the cells must remove one of those iodine atoms to create the active hormone, T3. You might recognize it by its generic name, liothyronine, or by the brand name Cytomel. What’s Wrong with Levothyroxine Only? Back in 1970, researchers discovered the enzymes that convert T4 to T3. That’s when doctors decided that patients would do well on a simple synthetic form of T4. In fact, 80 to 85 percent of patients with hypothyroidism have no great difficulties with this treatment. However, about 15 to 20 percent continue to suffer despite treatment. Some feel infuriated when the doctor tells them that their normal TSH levels mean they are fine. They don’t feel fine. They still feel exhausted, confused and miserable. Researchers, including our guest, have begun to recognize that people who do not convert T4 to T3 efficiently may suffer from residual symptoms of hypothyroidism. How Should We Be Rethinking Hypothyroidism? Lingering symptoms of hypothyroidism, such as fatigue or brain fog, are not very specific. As a result, doctors may need to utilize more sophisticated testing techniques. Moreover, rethinking hypothyroidism means considering different forms of treatment. A person who has residual symptoms despite a normal TSH level might need a trial of combination therapy. This might be in the form of desiccated thyroid extract such as Armour or Westhroid. An alternative would be a prescription for both T4 (levothyroxine) and T3 (liothyronine) as combination therapy. Doctors making such a change to their prescription need to adjust the dose carefully so that the patient does not end up with too much thyroid hormone. They also need to make sure during the diagnostic workup that the problem truly is hypothyroidism. Symptoms such as low energy don’t go away with thyroid hormone treatment unless that is the underlying problem. What Should Patients Do? For too long, patients have heard that their residual symptoms are psychological in nature. A doctor might have insisted that a normalized TSH on treatment means nothing is wrong with the thyroid gland. People who still feel bad despite such treatment may need to hunt for a clinician willing to explore ways to address those residual symptoms. This Week’s Guest: Antonio C. Bianco, MD, PhD, was professor of medicine and a member of the Committee on Molecular Metabolism and Nutrition at the University of Chicago at the time this episode first aired. He ran a laboratory funded by the National Institutes of Health to study thyroid hormones. Dr. Bianco is a former president of the American Thyroid Association and author of . Twitter handle is @Bianco_Lab.
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Show 1436: Why Mosquitoes Bite You and How to Outsmart Them
06/27/2025
Show 1436: Why Mosquitoes Bite You and How to Outsmart Them
In this episode, Joe & Terry speak with two scientists studying mosquito preferences. Why are some people mosquito magnets while others barely get bitten? A range of factors influences mosquito behavior and may explain why mosquitoes bite you and leave your neighbor alone. Learn how to outsmart them. Why We Worry About Mosquito Bites: You may think of mosquitoes as annoying insects with itchy bites. That’s certainly a reasonable summary in many places and times. But there are large swaths of the globe where mosquitoes carry deadly diseases. Malaria, for instance, kills an estimated 600,000 people a year. The majority of these victims are children under 5 years old living in sub-Saharan Africa. Even in the US, where malaria was eradicated in the mid-20th century, , including dengue in some southern regions, West Nile virus, and in the northeast and the Gulf Coast, eastern equine encephalitis (EEE). The best prevention for these serious infections is to outsmart mosquitoes and avoid getting bitten. Depriving Mosquitoes of Breeding Grounds: One problem is that a few species of mosquito have evolved to live in close proximity to humans. They have adapted to breeding in standing water, but it doesn’t take much. An upturned bottle cap, a saucer under a potted plant or leaves lying on the ground can all offer mosquito breeding opportunities. Emptying those saucers and raking away the leaves should be a priority to reduce the risk of mosquito bites. Do You Smell Delicious? Both our guests have been studying what makes some people more appealing than others. To that end, Dr. Conor McMeniman and his team have set up the world’s largest multiple-choice smell test for mosquitoes in Zambia. They constructed a mesh greenhouse the size of two tennis courts that could be surrounded by eight single-person tents. A person sleeps in each tent and that person’s scent is wafted into the enclosure where mosquitoes are given a chance to congregate where the preferred scent appears. This scent buffet for mosquitoes demonstrated that microbial metabolites from our skin microbiome have a significant impact on insect behavior. Mosquitoes seem to home in on short chain carboxylic acids as well as acetoin. How Can We Outsmart Mosquitoes? One simple and obvious step to avoid mosquito bites is to use window screens on our homes. That helps protect us inside. Air conditioning and ceiling fans also help. We asked Dr. McMeniman how he protects himself when he is outside and what we should do. He recommends repellents. DEET is the gold standard, but some people find it unpleasant. An effective alternative repellent is derived from plants. Whether you use oil of lemon eucalyptus or DEET, it is important to read the instructions for applying the product properly. How Do Mosquitoes Change Their Behavior? In addition to smell, mosquitoes also use vision and temperature sensing to find humans to bite. (Did you know mosquitoes sing to each other? It is part of their courtship behavior.) Dr. Clément Vinauger studies how mosquito brains react during different activities. They also pay attention to people who swat them and seem to avoid those individuals who come close to killing them. Mosquitoes can also change their behavior to adapt to human behavior. For example, a species of Anopheles mosquito that was nocturnal shifted to early morning biting over a period of a few years. That happened after the human population started using effective bed nets that protected them during sleep. More on How to Outsmart Mosquitoes: Dr. Vinauger made a casual observation that some soaps seemed to attract mosquitoes while others repel them. In a study, he found that most of the soaps his team examined appealed to mosquitoes. On the other hand, coconut scented soap (Native brand tested) kept them away. We asked him about Listerine. He has not studied it, nor has he studied some remedies that our listeners like such as eating garlic. However, he suggested consulting the local gardening center or nursery in selecting plantings around the home that are not attractive to mosquitoes. This Week’s Guests: Conor McMeniman, PhD, is Associate Professor of Molecular Microbiology & Immunology at the Johns Hopkins Malaria Research Institute. Dr. McMeniman studies the molecular and cellular basis of mosquito attraction to humans. Conor McMeniman, PhD, Johns Hopkins Malaria Research Institute Clément Vinauger, PhD, is Associate Professor at Virginia Tech in the Department of Biochemistry. His research area is the molecular genetics of host-seeking behavior in insects. His website is: Clément Vinauger, PhD, Virginia Tech This week’s podcast episode features bonus material from Dr. McMeniman, including exclusive content we couldn’t fit into the radio broadcast.
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Show 1435: Beyond Companionship: A Veterinarian's Take on the Pet-Human Health Connection
06/21/2025
Show 1435: Beyond Companionship: A Veterinarian's Take on the Pet-Human Health Connection
This week, our guest in the studio is veterinarian Dr. Chuck Miller. You may have already thought about One Health without realizing it has a name. This is an interdisciplinary approach to promoting the health of animals as well as humans that share an environment. If you have companion animals that move between inside and outside, your already know that protecting them from ticks and fleas also offers you a measure of protection. Another example of the importance of this approach would be control of bird flu. So far, we have paid it relatively little attention as it spread through cattle herds and to cats and other animals. If we learned more about its behavior in other animals, might we be able to reduce the impact on humans? Quite a bit of research has shown that having a pet present can help alleviate anxiety and lower blood pressure. One study examined the impact of therapy dogs on children’s anxiety in the emergency department (). Children interacting with a therapy dog and its handler for 10 minutes in the ER had less anxiety than those whose emergency visits were dogless. A dear friend just sent us a very sad email. His golden retriever Abby just died after 13 joyful years together with him and his wife. Moreover, he noted, there will not be another dog in their family because they are both getting on in years. Adopting a dog that outlives you doesn’t seem fair to the dog. When a pet dies first, the owner grieves. But if an owner dies first, someone must find the animal a new home. How do we do that? How many people make contingency plans for a surviving pet? Should we? What about grieving animals?
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Show 1434: Digital Doctoring: Will AI Save Lives or Cause Medical Mayhem?
06/13/2025
Show 1434: Digital Doctoring: Will AI Save Lives or Cause Medical Mayhem?
In this episode, Joe & Terry speak with two physicians who have examined ways that artificial intelligence might contribute to patient care. Can AI help with better diagnoses? Is robotic surgery better? Could AI save lives or is it more likely to cause trouble? We begin our conversation with Dr. Jonathan Chen, who has found that chatting with a robot made him a better doctor. (He challenged ChatGPT with an ethically difficult conversation and was surprised at the sensitivity of the observations it offered.) When researchers studied diagnostic acumen pitting human doctors against AI, the results were surprising. Some doctors did the diagnosis without help, while others used ChatGPT-4 to help them. The investigators also had the AI do the diagnosis unaided (or unhindered) by humans. Doctors got a score of 74 percent on their own and 76 percent when using AI. But ChatGPT by itself scored 90 percent. (). AI is certainly not perfect, and there are times when it is not the appropriate tool to use. But results like this suggest that we should be learning more about when it might be an indispensable technology for improving patient care. After all, human doctors are not perfect, either. Health care professionals are not the only ones who are putting artificial intelligence to use in health care settings. Many physicians dread the patient who arrives with a large stack of papers printed off the internet. Our guests suggest that doctors should welcome these patients and collaborate with them. Pointing them to more reliable sites and better search strategies, if the healthcare provider is able to do so, could yield better results overall. Who is more motivated to spend time researching the details of an unusual syndrome or its treatment? It may well be the patient. There are, of course, some cautions that people should keep in mind. One is privacy. You may not want to disclose your medical history to the internet at large. Most sites are not constrained by HIPAA, which protects patient privacy in medical settings. Another consideration is the reliability of the information you find. Robots are designed to produce answers that will please the humans asking the questions. That might mean that they make things up. If the question is how to connect your camera to your computer, an invented (“hallucinated”) answer is inconvenient. When it concerns your health, a fabricated answer could be dangerous. Our second guest, Dr. Art Papier, has been involved in developing large libraries of images of skin problems. With artificial intelligence powering it, VisualDx helps doctors recognize dermatological problems such as skin cancers. He describes one situation in which misdiagnosis is common and can cause harm. Cellulitis is a dangerous inflammation due to bacterial infection that can lead to sepsis. Red skin can be a signal of cellulitis, but sometimes it is caused by other problems. Misdiagnosis can lead to hospitalization and inappropriate antibiotics being administered. Utilizing a clinical decision tool like VisualDx reduced unnecessary hospital admission and antibiotic use (). Another strength of the system Dr. Papier has helped build is that it offers doctors views of atypical presentations of common problems. Hopefully, this keeps them from focusing on a single feature of an illness, such as a bulls-eye rash, as the only defining characteristic. The builders of VisualDx have deliberately included many images of skin of many different shades, as rashes sometimes look different depending upon the background coloration. Both our guests emphasize that AI is a tool. To get the best results, it must be used intelligently, not indiscriminately.
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Show 1433: What Are the Hidden Dangers in the Air We Breathe?
06/06/2025
Show 1433: What Are the Hidden Dangers in the Air We Breathe?
In this episode, our guest, award-winning science journalist Carl Zimmer, describes the hidden dangers in the air we breathe. He begins with the concept of the aerobiome–the collection of living things from ground level to the stratosphere. While that includes eagles and dragonflies, the most insidious inhabitants are those we can’t see. Often, we are totally unaware of their presence. Yet bacteria like the one that causes tuberculosis or viruses like those that cause COVID or flu have the power to make us ill even if we don’t know they are there. You have surely heard of the microbiome, but perhaps you thought it only applied to the microscopic beings living in our digestive tract. Lately, scientists have learned that humans have a microbiome for every different part of our bodies, including our eyes, ears, mouth and lungs. The air around us is also full of microorganisms. And even though we can’t see them and we may not be able to smell or taste them, they can still have a big impact on our health. What are the hidden dangers in the air we breathe?
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Show 1432: Lead, Lies and Lasting Harm: The Chemical Roots of Chronic Disease
05/30/2025
Show 1432: Lead, Lies and Lasting Harm: The Chemical Roots of Chronic Disease
This week, the topic is lead. A hundred years ago, chemists discovered that adding lead to gasoline decreased engine knock and gave the cars of the day more power. It remained a popular additive for decades. At the same time, companies were adding lead to house paint to help it last longer. We know now that lead exposure harms children, but what about adults? Could lead in our environment have contributed to the horrific toll of heart disease over the past century? When the nascent automotive industry began adding tetraethyl lead to gasoline early in the 20th century, scientists did not fully understand the potential health impacts of this compound. They knew by 1889 that lead poisoning could result in saturnine (ie, lead-induced) gout, an inflammatory condition accompanied by atherosclerosis. And at first, public health officials worried that adding it to gasoline might not be safe, especially after large numbers of refinery workers suffered lead poisoning in 1924. One reason there wasn’t more regulatory attention is that the industry was new and the government hadn’t figured out how to regulate it to make it safer. Another reason is a persuasive individual named Robert Kehoe. As the chief medical officer of the Ethyl Corporation, he had a substantial conflict of interest. But he argued that no one had the right to ban the use of lead in gasoline until someone had proven that it was dangerous. Mind you, not whether lead was dangerous, which scientists knew, “but whether a certain concentration of lead is dangerous.” Unfortunately, the Kehoe rule held sway and has helped shape the American approach to chemical regulation ever since. We asked our guest, Dr. Bruce Lanphear, whether public health improved when we got lead out of gasoline late in the 20th century. The answer is yes; blood lead levels have dropped dramatically. Consequently, many fewer children are dying of acute lead poisoning. But we are still underestimating the overall health effects of chronic low-level lead exposure. Lead exposure, even at low levels, is linked to hypertension and heart disease. People who are exposed to lead have higher blood pressure. In addition, they are more likely to have damage to the endothelium of the blood vessels. This can result in plaques that cause heart attacks. Scientific assessments show that people with blood level levels at the 90th percentile have double the risk of death from cardiovascular disease as those at the 10th percentile. The conclusion is that chronic low-level lead exposure is a leading cause of heart disease. Worldwide, there are about 5.5 million deaths a year due to low-level lead poisoning. Some critics have objected that association is not causation. That is certainly true. When we have the opportunity to use randomized placebo-controlled trials, we can have more confidence in the conclusions. Yet when there is an overwhelming amount of evidence, we should pay attention. Just as no one now doubts that tobacco harms health, we do not need to doubt the lasting harm caused by lead exposure. We can learn from the lead saga and apply those lessons to other toxic chemicals. First off, lead poisoning is preventable. Cutting lead exposure reduces the harms. In general, chronic disease risk rises with environmental exposure. To prevent disease, we need to clean up the environment. Just as Robert Kehoe objected to eliminating lead from gasoline, current manufacturers defend their own toxic chemicals, whether those are PFAS, cadmium, arsenic, phthalates or the herbicide glyphosate. If we want a cleaner environment, resulting in less chronic disease, we need to demand action. This radio show is a wake-up call to all those politicians calling for less regulation.
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Show 1431: Vitamin C Studies on Colds & Cancer Vindicate Linus Pauling
05/23/2025
Show 1431: Vitamin C Studies on Colds & Cancer Vindicate Linus Pauling
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. In 1970 the Nobel Prize-winning chemist, Dr. Linus Pauling, published a paperback book titled Vitamin C and the Common Cold. Although this idea captured the public imagination, it got a lot of pushback from scientists. Most of the American medical establishment rejected Pauling’s claims that vitamin C could help people recover from the common cold. They were especially dismissive of the idea that vitamin C might be helpful in treating cancer. However, there have been a number of studies conducted over the decades since then. The weight of the evidence now seems to vindicate Linus Pauling. Our first guest, Dr. Harri Hemilä of Helsinki, Finland, has done several meticulous systematic reviews of the research. Although some people expect supplemental vitamin C to prevent colds, it does not appear to prevent colds except among people doing extreme physical activity ). Instead, however, studies show that at doses considerably higher than the RDA vitamin C can reduce the duration and severity of these upper respiratory tract viral infections (). To achieve this, people take a dose of 6 to 8 grams per day. That is a lot more vitamin C than you would get from a morning glass of orange juice. Of course, we worry about the potential harms of consuming an excessive dose of vitamin C. According to Dr. Hemilä, taking this amount for as long as a cold might last does not produce serious side effects. If one were to take it for a lot longer, that might not be the case. Some reports suggest that long-term high-dose vitamin C supplementation might trigger kidney stones. We turn our attention next to a surgeon who treats patients with pancreatic cancer. This type of cancer usually has a grim prognosis. Dr. Joseph Cullen was intrigued by a report that high-dose vitamin C could inhibit the growth of cancer cells, so he and his team tested that possibility in tissue culture. They were impressed at the excellent results they achieved at this first step of the research. However, the benefits were only seen at extremely high doses of vitamin C. This is consistent with preliminary research conducted by Linus Pauling and a colleague testing intravenous (IV) administration of vitamin C in cancer patients. To get exposure to that level of vitamin C (ascorbate) requires IV dosing. The next step in Dr. Cullen’s research was to test vitamin C in mice with experimentally induced cancer. His team administered vitamin C in conjunction with radiation. Once again, the results were promising. In addition to pancreatic cancer, Dr. Cullen and his collaborators have tested the effects of this treatment in another cancer that is notoriously difficult to treat. They found that cells of the brain cancer glioblastoma were far more vulnerable to radiation In the presence of high-dose ascorbate. On the other hand, normal cells suffered less radiation damage. With such success, Dr. Cullen’s team and some others are conducting pre-clinical research on some other cancers. Not all types of cancer appear to respond to high-dose IV vitamin C. Apparently, a trial of prostate cancer was disappointing. However, there is now adequate evidence of the potential benefits of vitamin C when used properly to vindicate Linus Pauling and his conviction that this remarkable compound could contribute enormously to human health.
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Show 1332: What Everyone Gets Wrong About Weight Loss (Archive)
05/16/2025
Show 1332: What Everyone Gets Wrong About Weight Loss (Archive)
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? With nearly three-fourths of American adults either overweight or obese, we can’t ignore the problem any longer. For decades, people have acted as though packing on extra pounds was simply a matter of poor willpower. “Eat less and exercise more” is the standard mantra. But that is just one of the things we get wrong about weight loss. In truth, obesity is far more complex than we may imagine. In fact, neuroendocrinologist Robert Lustig has spent decades studying obesity and diabetes in children. During the past 25 years, the weight of newborn babies has risen by about 200 grams. No reasonable person could imagine this is the babies’ fault! As a result, he says we need to grapple with the concept of different obesities with different causes and diverse consequences. When we come to terms with what we get wrong about weight loss, we may be able to start helping people achieve it.
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Show 1430: Uncovering the Dark Secrets of Johnson & Johnson
05/09/2025
Show 1430: Uncovering the Dark Secrets of Johnson & Johnson
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? Johnson’s Baby Powder was as American as apple pie. The company counted on the emotional associations with its baby products. The fragrance of its Baby Powder was linked to feelings of love and security. That was smart marketing. Continuing to sell a product contaminated with asbestos was something else, though. How did the company deal with this problem? And what did it tell the FDA? This Week’s Guest: Gardiner Harris previously served as the public health and pharmaceutical reporter for The New York Times and is now a freelance investigative journalist. He also served as a White House, South Asia, and international diplomacy reporter for the Times. Before that, he was a reporter for The Wall Street Journal, covering the pharmaceutical industry. His investigations there led to what was then the largest fine in the history of the Securities and Exchange Commission. He won the Robert Worth Bingham Prize for investigative journalism and the George Polk Award for environmental reporting after revealing that coal companies deliberately and illegally exposed miners to toxic levels of coal dust. Harris’s novel, Hazard, draws on his experience investigating these conditions. His latest book is .
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Show 1429: How to Love Your Liver and Protect its Superpowers
05/02/2025
Show 1429: How to Love Your Liver and Protect its Superpowers
This week, Joe and Terry discuss liver health with two specialists. You may not have spent much time thinking about your liver. It is, however, an absolutely essential organ. When the liver is working properly, every part of the body gets the nutrients it needs and no parts are exposed to damaging toxins. These are among its superpowers. Find out why you should love your liver. Nutrients don’t go directly from the intestines to the rest of the body. Instead, they pass through the liver first. There, this master organ breaks them down into compounds that can be recognized and utilized by individual tissues and cells. Moreover, if it finds nasty chemicals that shouldn’t be there, it utilizes its superpowers to transform them into less damaging compounds that can be more readily excreted. You should also love your liver because it can store nutrients for unanticipated periods of fasting and hold off starvation. This was a tremendous benefit during earlier periods of human evolution. These days, we have less need for a hedge against starvation. In fact, when we overload our livers with alcohol or sugar, even its superpowers may not be adequate. The liver’s response to this kind of insult is fibrosis, a condition in which it stiffens and stores fat. One of the liver’s superpowers is that it can regenerate itself so long as we remove the source of injury. That’s pretty remarkable! But what if we keep on eating ultra-processed foods () and drinking soda or alcohol? In that case, the liver continues to try to repair itself. That can change the architecture of the tiny blood vessels that run through the liver, raising the pressure within them and ultimately leading to serious complications. Fatty liver disease, correctly termed metabolic-associated steatohepatitis (MASH), is the first step; cirrhosis and ultimately liver failure might follow.
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Show 1428: The Hidden Power of the Unconscious Brain
04/25/2025
Show 1428: The Hidden Power of the Unconscious Brain
Our senses feed us a tremendous amount of information all the time, but we don’t have the bandwidth to pay attention to more than a small fraction of it. That’s where the unconscious brain is so valuable, juggling millions of bits of information while we focus our conscious attention on what seems important. 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 approximately 200 bits per second (bps) of information. Our unconscious brain deals with as much as 11 million bps. One surprising outcome of the research on how our brains function is a re-assessment of what is going on when people are unconscious. For centuries, doctors thought there was really no brain activity while a person was comatose. Then, a few decades ago, a scientist was recording the brain waves of a patient in a coma. The activity was very peculiar, as if the person were watching a ball being lobbed back and forth across a tennis court. In actuality, a television set in the room was broadcasting a world championship match between Roger Federer and Rafael Nadal. The neuroscientist recognized that this individual was following the match and was not nearly as deeply unconscious as had been thought. Further research showed that this kind of unconscious brain activity is not uncommon. It may hold keys to determining who has the best potential for recovering from their coma.
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Show 1427: Dr. Mark Hyman's Secrets for Living Your Longest, Healthiest Life
04/18/2025
Show 1427: Dr. Mark Hyman's Secrets for Living Your Longest, Healthiest Life
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? Your Longest, Healthiest Life: The idea that food is a powerful tool to transform our health is not new, but for years it’s been addressed with perfunctory advice to “eat a well-balanced diet.” Now researchers have found evidence that up to 40 percent of cancers might be attributed to preventable causes, including diet. That suggests we should be paying much closer attention. Our guest, Dr. Mark Hyman, has indeed been paying attention for years. His recent book, Young Forever, describes how to lower the risks for chronic disease with lifestyle and dietary changes. Some people have even been able to reverse conditions such as type 2 diabetes or psoriatic arthritis. Inflammation is the driver of many chronic conditions, and we can reduce inflammation with appropriate food choices, adequate physical activity and healthful doses of stress (not too much or too little). Embracing these changes can help us towards our longest, healthiest life.
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Show 1426: Why You Feel Dizzy and What You Can Do About It
04/13/2025
Show 1426: Why You Feel Dizzy and What You Can Do About It
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. Dr. Kaylie is a neuro-otologist who manages the whole range of disorders of the ear, hearing and balance. He is particularly interested in the impact balance disorders have on patients’ perceptions of their well-being and interactions with the world. Why are balance disorders so disruptive to patients’ lives and what can doctors do to better understand their condition? One possible cause of dizziness is Menière disease. People with this condition often have unpredictable episodes in which they feel like they are spinning. They may also have hearing loss or tinnitus that comes and goes at first. Menière disease happens when fluid builds up in the inner ear, but doctors don’t know the underlying reasons for that. Another reason many people feel dizzy is benign paroxysmal positional vertigo, or BPPV. This produces a spinning sensation whenever the person moves their head. It occurs when little pieces of calcium carbonate get dislodged from their normal position and move into the semicircular canals. As these inner ear structures are crucial for balance, disrupting them with wandering crystals can cause vertigo. The inner ear is also the source of some other balance problems. An inner ear infection could cause trouble. Inflammation of the labyrinth, which includes the semicircular canal along with the otolith organs, can disrupt balance, as can inflammation of the nerves. For some people, dizziness can be a symptom of migraine. The headache may follow later, or there may not be any actual pain, just lightheadedness or dizziness. Dehydration might trigger the attack, but not everyone can identify a recurrent trigger. Medications can occasionally cause lightheadedness that can be troubling. If they lower blood pressure too much, an individual may need to be careful about standing up too quickly. Doctors call this reaction “orthostatic hypotension.” Another condition that can throw people off balance is “postural orthostatic tachycardia syndrome,” or POTS for short. In addition to lightheadedness–feeling as if they might faint–people with POTS may find that their heart rates zoom when they stand up. The doctor will find it easier to diagnose why you feel dizzy if you can be precise about the symptoms. When do they happen? Does anything make them stop? Do you feel like you are spinning, or is the sensation more like you are about to faint? Nausea is common with balance disorders, so reporting it won’t help much with the diagnosis but it will help the doctor understand your experience.
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Show 1425: How Can You Combine Supplements, Herbs and Medicines Safely?
04/04/2025
Show 1425: How Can You Combine Supplements, Herbs and Medicines Safely?
Pharmacists stand ready to help people review their supplements, herbs and medicines to see if there are potential interactions, redundancies, adverse reactions or other problems. Technically, everyone on Medicare is entitled to a comprehensive medication review annually. Some pharmacists like to conduct that as a “brown bag review,” in which the patient brings in everything they are taking–OTC med, prescription drugs, herbs, vitamins and other dietary supplements–so the pharmacist gets a complete picture. 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 which pills don’t get along well
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Show 1424: Breathing Better Despite Pollution, Infections, Asthma or COPD
03/28/2025
Show 1424: Breathing Better Despite Pollution, Infections, Asthma or COPD
We are finally emerging from an especially severe flu season. After a few years during and right after the pandemic in which there was relatively little influenza, this year was challenging. suggest that between 40 million and 75 million Americans suffered from influenza or flu-like illnesses between October and March. As many as 1.2 million had to be hospitalized. The influenza viruses (there are many) are not the only pathogens that can cause coughing, fever or trouble breathing. Many others might also result in upper respiratory infections that can progress to bronchitis or lower respiratory infections and lead to wheezing or shortness of breath. A bad cold will do that for some people. Human metapneumovirus is not widely recognized and is difficult to pronounce. The infection with this virus starts like a bad cold but it produces a terrible cough that can last for weeks. 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.
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Show 1423: How to Fix Your Foot Pain
03/22/2025
Show 1423: How to Fix Your Foot Pain
If your feet don’t feel good, you won’t either. Just imagine stubbing your toe. Ouch, that hurt! But stubbed toes generally recover fairly quickly. Some other common foot problems are likely to cause more long-lasting pain. Some of these may result from participation in sports, such as sprained ankles or stress fractures. What is the best way to handle these injuries so they won’t cause persistent problems? 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.
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Show 1422: Can You Regain Your Sense of Smell After Illness?
03/16/2025
Show 1422: Can You Regain Your Sense of Smell After Illness?
Of all our senses, the sense of smell often gets short shrift. Aside from Marcel Proust’s evocative description of the link between odor and memory, we don’t think much about smell. Scientists have discovered, however, that much of our social interaction relies on olfaction at a subconscious level. It plays a largely unconscious role in our choice of mates as well as in the timing of sexual activity. It is also important for the bonding between mothers and their infants. Consequently, the sense of smell is crucial for the survival of our species, even when we aren’t paying attention. Losing our sense of smell can be devastating, as too many people learned by experience during the COVID-19 pandemic. Not only did they miss out on pleasant aromas like fresh-brewed coffee or newly mown grass, but they also were at a disadvantage in detecting if there might be gas leaking in the kitchen or a fire smoldering somewhere in the house. Although some of those who lost their sense of smell during an acute infection subsequently regained it, others did not. Too many people are still suffering from anosmia. Is there anything that can be done to help them? 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.
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Show 1421: Is Lp(a) the Heart Risk No One Talks About?
03/07/2025
Show 1421: Is Lp(a) the Heart Risk No One Talks About?
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. While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level?
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Show 1420: The Cooking Oil Controversy Spotlights Cancer
02/28/2025
Show 1420: The Cooking Oil Controversy Spotlights Cancer
This week, we dig into the cooking oil controversy. For decades, we’ve heard that we should be using vegetable oils rather than butter, lard or other fats (possibly even olive oil). Oils from corn, soybeans, sunflower or safflower seeds are rich in polyunsaturated fatty acids. Consequently, people consuming them may have lower cholesterol levels than those primarily using saturated fats. But could there be a downside? We hear from scientists who have found these seed oils may be linked to certain cancers.
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Show 1419: Restless Legs, Muscle Cramps and Sleepless Nights
02/22/2025
Show 1419: Restless Legs, Muscle Cramps and Sleepless Nights
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? Restless legs are not usually painful, so pain that keeps a person awake might be due to neuropathy. Another condition that often bothers a bed partner more than the patient is periodic limb movements of sleep. The name is descriptive, and because the person doesn’t wake up and isn’t troubled by unpleasant sensations, it is different from restless legs. We'll discuss RLS, muscle cramps, and their treatments—including prescription options and some favorite home remedies from our listeners.
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