Long-term methotrexate risks for psoriasis

Broadcast from KSQD, Santa Cruz on 10-09-2025:

• Dr. Dawn opens by addressing an emailer's question about safety of low-dose lithium for dementia prevention. She reports finding a two-year double-blind placebo-controlled trial of 61 patients with mild cognitive impairment that showed no kidney damage from therapeutic lithium doses. While low-dose lithium at 2-3 milligrams daily appears safe compared to therapeutic doses of 50-100 milligrams, she notes its calming effects may improve cognition.
• She discusses over-the-counter hearing aids now available without prescription, ranging from $98 to $999, representing significant savings compared to prescription models costing four times as much.
• An emailer asks about long-term methotrexate use for psoriasis, reporting declining white blood cell counts and slower healing. Dr. Dawn reviews studies showing that in 13-year rheumatoid arthritis trials, severe side effects occurred in only 3% of patients. She recommends monthly blood monitoring including comprehensive metabolic panels to check liver and kidney function. As an alternative, she suggests apremilast, which showed excellent long-term safety in pooled data from half a million patient years with virtually no liver, kidney, or blood count problems. She also recommends trying phototherapy with tuned red light frequencies and topical treatments before considering drugs like etanercept that carry leukemia and lymphoma risks.
• Dr. Dawn expands on ultra-processed food dangers, explaining how mechanical processing of carbohydrates accelerates digestion and causes blood sugar spikes that lead to insulin resistance. Steel-cut oatmeal and wheat berries digest slowly and accelerate glucose at a low rate, while instant oatmeal and white bread hit like loud spikes. She emphasizes that processing primarily affects carbohydrates, not proteins or fats. Whole fruits are vastly superior to juices because juicing makes fruit sugars unnaturally available to metabolism. She also warns about hidden microplastics entering food through processing equipment, transport tanks, and packaging, with longer processing and travel distances increasing contamination.
• Dr.Dawn discusses the health dangers of sedentary behavior, noting that simply walking 20 minutes daily can lower blood pressure without requiring intense exertion. Dr. Dawn offers creative exercise solutions including bouncing on inflatable exercise balls during screen time, keeping weights in bathrooms for tooth-brushing workouts or in other frequently used spaces, doing resistance band exercises while waiting in cars, and practicing single-leg squats for balance. She describes the geriatric "get up and go" test where inability to stand, walk 10 feet, return, and sit within 10 seconds predicts five-year mortality.
• A caller discusses motivation challenges with his unused NordicTrack equipment. Dr. Dawn suggests making exercise rewarding by listening to engaging podcasts exclusively during workouts, creating positive associations that build sustainable habits. She explains that five minutes daily for six days weekly, maintained for a month, typically becomes permanent. The caller correctly notes that exercise increases mitochondrial production, and Dr. Dawn expands on this, explaining how oxygen debt triggers DNA signals to build new muscle fibers and mitochondria, raising metabolic rate, improving glucose metabolism, and increasing brain-derived neurotrophic factor that promotes new neural connections, making exercise crucial for preventing cognitive decline.