The People's Pharmacy

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. You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 1, 2025. The Secrets of Sunlight’s Health Benefits: Dermatologists generally advise us to stay out of the sun as much as possible. After all, excessive sun exposure causes skin aging and skin cancer, conditions for which people frequently consult them. However, even if we could all live inside, wear protective clothing and high SPF sunscreen whenever we ventured out, would that be wise? According to our guest, Dr. Richard Weller, and his colleagues, “insufficient sun exposure has become a real public health problem” (International Journal of Environmental Research and Public Health, July 13, 2020). While this problem is more acute in Europe than the US, they still estimate that more than 300,000 Americans die each year due to inadequate sun on their skin. What is going on? How Does Sunlight Affect Skin? For decades, we have heard that the principal effect of sunlight on skin is the production of vitamin D. Therefore, the dermatologists have concluded, rather than take the risk of exposing skin to sunshine, why not just swallow vitamin D supplements? The problem with that proposal is that it hasn’t worked very well. Many studies show that people with low levels of circulating vitamin D are more vulnerable to high blood pressure, atrial fibrillation, heart disease, diabetes and infections, among other problems. However, people who take vitamin D supplements don’t always get the expected benefits.  Perhaps vitamin D is a marker for sun exposure rather than the most important outcome. Human Evolution and Skin Color: Humans evolved in Africa, where dark skin is an advantage, offering protection from the most harmful effects of ultraviolet radiation. By about 60,000 years ago, people were migrating to other parts of the world. Yet analyses suggest that although they arrived in Europe by about 40,000 years ago, genes for pale skin didn’t become common until less than 10,000 years ago. Anthropologists have hypothesized that pale skin is an adaptation to inadequate sunlight in northern regions. Because vitamin D is a well-recognized consequence of sunlight on skin, they have assumed that was the driver. Dr. Weller suggests that nitric oxide was (and still is) more important. He notes that the evolution of pale skin happens around the same time that people begin to cluster together in farming communities, where they are more likely to be exposed to infectious diseases. Is Nitric Oxide the Source of Sunlight’s Health Benefits? In 1996, Dr. Weller was the first scientist to find that human skin creates a compound called nitric oxide (NO) under sunlight. This compound is then absorbed into the skin, where it helps relax blood vessels and lower blood pressure. Here is a link to his TED talk on the topic. This is where Dr. Weller’s approach differs from that of more conventional dermatologists. With proper caveats that the US is at much lower latitudes, in general, than most of Europe, he proposes that more sunlight, not less, could lower mortality rates. (Lower latitudes get more sunshine.) His analysis was just published in the prestigious Journal of Investigative Dermatology (August 2024). The data underpinning this claim are from an analysis of the UK Biobank, a remarkable treasure trove of information. Dr. Weller and his colleagues have found that in the UK, people who get more sunlight are less likely to die within a specified time frame. We call that lower all-cause mortality. You can read the research report here (Health & Place, Sept. 2024).  It was discussed in this article in The Economist (Aug. 12, 2024). This Week’s Guest: Richard Weller, MD, FRCP(Ed), is Professor of Medical Dermatology at the University of Edinburgh. He holds the Personal Chair of Medical Dermatology in the Deanery of Clinical Sciences.  He is also Honorary Consultant Dermatologist at NHS Lothian and Principal Investigator at the Centre for Inflammation Research. Dr. Weller serves as Programme Director for the M Med Sci at the University of Edinburgh and is President of the Scottish Dermatology Society. He is the Clinical Lead for the Dermatology Speciality Group at NHS Research Scotland, the Global Health Academy and Edinburgh Imaging. Listen to the Podcast: The podcast of this program will be available Monday, Sept. 1, 2025, after broadcast on Aug. 30. You can stream the show from this site and download the podcast for free. Learn More: Dr. Weller kindly shared links to some research by his colleagues that he mentioned during the show. Here is an article by Joel Gelfland showing the benefits of home phototherapy for psoriasis. This article by Adewole Adamson presents evidence that dark skin is not susceptible to UV-induced melanoma. Download the mp3 of the show, or listen to the podcast on Apple Podcasts or Spotify. Transcript of Show 1397: The Surprising Secrets of Sunlight’s Health Benefits A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Do you avoid the sun? We’ve all heard that we should wear sunscreen all the time and stay inside from 10 till 2. This is the People’s Pharmacy with Terry and Joe Graedon. Terry 00:33-00:45 Are there hidden health benefits from sunlight? Is it all about vitamin D? Why don’t supplements protect people against heart disease, cancer, diabetes, or depression? Joe 00:45-00:52 New research suggests that some sun exposure may be helpful. Our dermatologist guest has done fascinating research. Dr. Richard Weller 00:53-01:04 We have showed in Britain that after accounting for confounding factors, other factors, the more sunlight people have, the longer they live. Joe 01:04-01:10 Coming up on the People’s Pharmacy, the surprising secrets of sunlight’s health benefits. Terry 01:14-02:31 In the People’s Pharmacy Health Headlines, following a Mediterranean-type diet may help lower the risk of dementia in vulnerable people. People who carry a gene called APOE4 are particularly susceptible to developing Alzheimer disease. But an analysis of the Nurses’ Health Study and the Health Professionals Follow-up study published in Nature Medicine shows that those who come closest to a Mediterranean eating plan are less likely to come down with Alzheimer’s disease. There were more than 4,000 women and nearly 1,500 men included in the analysis, which covered three decades of data. People with two ApoE4 genes lowered their risk by 35% if they followed a Mediterranean diet high in vegetables, fruits, whole grains, fish, and olive oil. The lead author, Dr. Yuxi Liu, told CNN, “Not only did following a baseline Mediterranean diet reduce the probability of developing dementia by 35% in people with two APOE-e4 genes, but higher adherence to the diet further reduced their risk.” Joe 02:30-03:36 The anti-vax movement has been gaining momentum, but there’s growing evidence that the shingles vaccine offers benefit far beyond protection against shingles. Several studies have demonstrated that the shingles vaccine can reduce the risk for dementia. A new study published in the journal Clinical Infectious Diseases reports that the recombinant herpes zoster vaccine Shingrix can reduce the risk of heart attack, stroke, and herpes zoster ophthalmicus, a potentially vision-robbing eye infection. The researchers compared over 100,000 vaccinated patients to over 400,000 unvaccinated patients. The median age was 68 years old. The average follow-up was two and a half years. The investigators concluded that two doses of Shingrix vaccine “were effective in preventing herpes zoster ophthalmicus in adults over 50, and were associated with significantly reduced risk of hospitalized acute myocardial infarction and stroke compared to unvaccinated individuals.” Terry 03:36-04:27 The FDA has just approved a new and far more general indication for evolocumab, known by its brand name Repatha. Back in 2015, the agency approved this powerful injectable medication for lowering LDL cholesterol. At first it was used primarily for patients at high risk who couldn’t tolerate statins, or who didn’t respond adequately to statins for lowering cholesterol. Then the use was expanded to cover people with cardiovascular disease. Now, doctors can prescribe this medicine for any adult at risk for heart attacks, strokes, unstable angina, or other cardiovascular complications. Occasionally, people react to evolocumab with angioedema, which can be life-threatening. Such individuals will not be able to use it. Joe 04:28-06:18 At one time, x-rays were the only tool doctors had to see inside the body. Since then, MRIs and CT or CAT scans have become widely available. Computed tomography imaging is performed on over sixty million patients annually. That number has increased by over thirty percent since 2007. Such images can be extremely helpful in making a diagnosis, but there are risks that many patients may not realize. The name CAT scan sounds innocuous, but in fact it represents ionizing radiation similar to X-rays. An investigation published in JAMA Internal Medicine projected the number of future cancers due to this radiation exposure. The researchers used data from the University of California, San Francisco International CT Dose Registry and modeled the effects of the radiation. They estimated that approximately 103,000 cancers are likely to result from the 93 million scans conducted in 2023 on 60 million people. The risks are highest in children and adolescents, but many more adults undergo CT scans. The scientists conclude that if current practices persist, CT associated cancer could eventually account for 5% of all new cancer diagnoses annually. And that’s the health news from the People’s Pharmacy this week. Joe 06:15-06:17 Welcome to the People’s Pharmacy. I’m Joe Graedon. Terry 06:18-06:35 And I’m Terry Graedon. For decades we’ve been told to stay out of the sun, especially in the summertime. If we venture out, we need to be wearing protective clothing, including a hat and high-SPF sunscreen. If we’re good, we’ll never get a tan in the summer. Joe 06:36-06:51 Dermatologists worry about sun exposure because ultraviolet radiation is damaging to the skin. It causes premature aging and is linked to various forms of skin cancer, including the most dangerous, melanoma. Terry 06:52-06:57 But could sunlight be more complicated? Does it have hidden health benefits? Joe 06:58-07:24 To learn more about this very controversial topic, we turn to Dr. Richard Weller. He is a professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology at the Deanery of Clinical Sciences. His research interests include eczema, psoriasis, and the effects of sunlight on human skin. Terry 07:24-07:28 Welcome to the People’s Pharmacy, Dr. Richard Weller. Dr. Richard Weller 07:29-07:32 Hello, it’s very nice to be talking to you today. Joe 07:32-07:40 Dr. Weller, there’s a rumor that you are a dermatologist. Do I have that right? Dr. Richard Weller 07:41-07:52 I am. I’m perhaps not a conventional dermatologist in some of my views, but those have really developed over the years as a consequence of my research. Joe 07:53-08:43 Well, speaking of your research, it kind of contradicts what American dermatologists have come to believe, which is: If you could just live in a cave, that would be ideal because that way you would never be exposed to ultraviolet radiation. In other words, sunlight. And the only time you’re allowed to go out in the sun is if you have slathered on a high SPF sunscreen, 50 or above. And definitely avoid being outside between 10 and 2 because sun is your enemy. It’ll cause cancer, it’ll cause wrinkling, it’ll mess up your life. Terry 08:42-08:43 You are exaggerating. Joe 08:44-08:44 Of course. Terry 08:44-08:46 But not by very much. Joe 08:46-08:58 So you’ve kind of come up with a different perspective, Dr. Weller. Can you tell us a little bit about your time in Australia and why that started you down this path in part? Dr. Richard Weller 08:59-10:30 Sure. I mean, I think you’re you’re pretty accurate about the American dermatology view to sunlight. And I think what I really want to say is we need a more nuanced view on sunlight. And of course, the second thing to say to you is that I’m speaking to you from Scotland, and people forget how much further north Europe is than Scotland [Scotland is than the US]. So you know, the further away you are from the equator, the less sunlight there is. And as an example, if you live in the cold woolly fringes of Maine or New England, you’re actually at the same latitude as the Côte d’Azur, as Cannes, right down on the Mediterranean coast of France. And if you live in Florida, you’re on the same latitude as the Sahara. So the amount of sunlight Americans are getting is way more than we North Europeans are getting. So I’m speaking to you with someone from Scotland and probably what I see is different from what my American colleagues see. Nonetheless, sunlight has significant health benefits, as my research and that of other colleagues around the world is now showing.  There has to be more to the message we give than just ‘sunlight is bad’ because that’s becoming outdated. And that’s really the message I’d like to get across. Terry 10:31-10:38 I wonder if you could summarize for us, Dr. Weller, what some of those benefits of sun exposure might be. Joe 10:38-10:45 And in particular, can you tell us a bit about Australia and cardiovascular disease? Dr. Richard Weller 10:46-11:46 Sure. So yeah, I mean so look, I I suppose a bit about my career. I’m an academic dermatologist. I’ve been a dermatologist for about 30 years. Before I became a dermatologist, I did an internal medicine training and as part of that I worked in Australia, in Northern Australia and Queensland for a year. And Australia is much sunnier than the UK. So in Cairns, where I was living- the UV index is seven or above every single day of the year. So in mid-winter, the UV index, which is a measure for the burning ability of the sunshine, hits about seven, you know, for an hour or so around midday, and it rises to fourteen in midsummer. So in Scotland last year, the UV index hit seven for ten minutes. It was just after lunchtime on the 24th of June, if you want to know exactly when. Terry 11:47-11:47 Okay. Dr. Richard Weller 11:48-13:58 And yet we are given sunlight protection advice copied directly from the historical Australian advice. Designed for white Australians, you know, Australians of North European heritage who’ve moved to somewhere hugely sunnier and that is inappropriate [in Scotland]. You know, skin color is an evolutionary adaptation to sunlight. So, you know, Homo sapiens, that’s us, we’re about 160, 200,000 years old as a species. Non-African humans are the descendants of people who left Africa about 60,000 years ago And what is interesting is those humans who’ve moved to high latitude, so Europe and China, modern China have independently evolved pale skin repeatedly on moving to low light environments. So the pale skin gene variants that we see in Europe, um SLC 45A2 in particular, arose about 8,000 years ago. Independently pale skin gene variants arose in humans who had moved to high latitude modern China. So skin color determines your response to sunlight. That’s that’s what it’s about. And what’s happened is repeatedly humans who’ve lived in low-light areas have there’s been an evolutionary fitness advantage to getting to to developing pale skin which allows you to get more of sunlight’s benefits. But at the same time, if you fly down to or go by convict ship from Britain to Australia you’re very suddenly moving to somewhere with way more sunlight than your skin um is adapted to manage. And that’s when you see the problems of skin cancer and and sunburn and so on. Texas is the same as Australia in that sense. Terry 13:59-14:38 Now, Dr. Weller, as an anthropologist, I’m familiar with what I guess is uh the hypothesis that as you say, uh, pale skin is an evolutionary adaptation to not getting enough sunlight, and therefore when we expose our pale skin to the uh sunlight that we can get in uh you know, North Carolina or New Jersey or France or where have you, we’re able to make the vitamin D we need. Are there other considerations beyond vitamin D? Dr. Richard Weller 14:39-17:39 Yes, very much so. And of course the key question is, you know, that there must be a benefit because it keeps occurring. What are those benefits? And I and I have to say straight off, I think the benefits of vitamin D are hugely overstated. Vitamin D is less important than we have thought for much of the last hundred years. So we look, it may have played a part in the development of pale skin. We know that people with darker skin need more sunlight to get the rise, same rise in vitamin D. But you know, we don’t in Britain nowadays see rickets or problems that associate with vitamin D deficiency in African, you know, British African communities, for instance. And actually, skin color doesn’t enormously affect vitamin D synthesis. A lot of my research about sunlight has been looking at cardiovascular disease. We find that sunlight lowers blood pressure independently of vitamin D. There’s a substance called nitric oxide, which my research has shown is stored in the skin, and when sunlight hits the skin, it releases that nitric oxide, the circulation where it dilates blood vessels and lowers your blood pressure. And that has really quite a big effect at population level. So again hit here in Britain The average blood pressure is six millimeters of mercury systolic lower in summer than winter. And that appears, that’s probably a nitric oxide effect. It’s definitely not a vitamin D effect. In terms of the evolutionary history of skin, that gets more interesting. My feeling is that heart disease, blood pressure, high blood pressure related disease like heart attacks and strokes is unlikely to have been a problem in evolutionary times. You know, chasing after woolly mammoths, running away from saber toothed tigers. Pre-the invention of cigarettes, I think it is unlikely that heart disease was a big problem. What I’m looking at now with my research is we wonder if infection may have played a role. Because what’s fascinating is humans have been in Europe for about 40,000 years, been in Asia for about 60,000 years. And yet the development of those pale skin gene variants in Europe only starts about eight thousand years ago, and initially the that the that the white skin gene variants arise in in the fertile crescent, you know. Anatolia. And those white skin gene variants arise in East Asia around eleven thousand years ago. And it it arises at the time when we make the shift from being hunter-gatherers to farmers. Terry 17:40-17:57 You’re listening to Dr. Richard Weller, Professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. Joe 17:58-18:07 After the break, we’ll find out more about how farming might have contributed to evolutionary changes in skin color. Terry 18:07-18:11 Dr. Weller offers us a summary of the health benefits sunlight can provide. Joe 18:12-18:16 Lack of sun exposure is actually associated with some health problems. Terry 18:17-18:22 Studies on sunshine are mostly being done in the UK and Europe, not in the US. Joe 18:22-18:31 Dermatologists sometimes suggest we could just take vitamin D supplements to make up for lack of sunlight. Why isn’t that adequate? Terry 19:45-19:48 Welcome back to the People’s Pharmacy. I’m Terry Graedon. Joe 19:49-20:12 And I’m Joe Graedon. Terry 20:13-20:28 Why do people who live in northern latitudes tend to have pale skin? Presumably, there’s some evolutionary advantage. Anthropologists have suggested that pale skin is better at making vitamin D when sunlight is scarce. Joe 20:29-20:49 Many dermatologists encourage people to avoid the sun as much as possible. To make up for the possible lack of vitamin D, they suggest taking vitamin D supplements. But research on vitamin D pills or injections has been strangely disappointing. Why would that be? Terry 20:49-21:18 Does sun exposure have any other physiological effects beyond triggering vitamin D synthesis? Dermatologist Steve Feldman of Wake Forest University has found that Ultraviolet exposure can boost psychological mood, making people feel more relaxed. He also found it can help people with chronic pain such as fibromyalgia feel more comfortable. Our guest today has also been studying the impact of sunlight on skin for years. Joe 21:18-21:40 We’re talking with Dr. Richard Weller. He’s professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology at the Deanery of Clinical Sciences. His research interests include eczema, psoriasis, and the effects of sunlight on human skin. Terry 21:41-21:55 Dr. Weller, how would the rise of uh domestication and farming tie in to a change in skin color? How does that make sense? Dr. Richard Weller 21:56-24:58 Yeah well this is the really interesting thing because being at high latitude, low light, by itself has not driven a move to pale skin. Because humans have been 40,000, you know, I mean if you go to the Dordogne in France, the amazing cave art, you know, the wonderful pictures of woolly mammoths and so on and ancient animals on the roofs of the caves, dates back twenty thousand years ago, when actually the people who painted that were dark-skinned. So this this move to, so it’s not just being at high latitude, because most of the time that Europe’s been inhabited, it’s been inhabited by dark-skinned people. And it’s not just being a farmer, because farming has arisen independently. I mean farming arose independently in what’s now Mexico, maize; it’s arisen independently in India; it’s arisen independently in Papua New Guinea. So either by themselves does not precipitate that move to pale skin. It’s when the two come together. It’s when you’re a farmer in a low light environment that pale skin arises. So that sort of information sets the question. It doesn’t give the answer. It is possible that part of it’s dietary, you know, we know that that Neolithic transition from being a hunter-gatherer to a farmer actually led to a poorer diet. shorter people, probably higher infant mortality. You know, it wasn’t all milk and honey when we moved to being farmers. So it could be a dietary factor, it could be related to vitamin D. Sorry, vitamin D for an American audience. My but I have to say my feeling is it may be or it is likely to be infection. Because the thing that really happens when you make that Neolithic transition shift is that’s the advent of infectious disease. Because most infectious disease comes from animals, what we call zoonotic. You know, COVID comes from bats, TB comes from cows, influenza comes, you know, most infectious disease comes from animals. And when you’re a farmer, you’re living with animals. And the other thing, of course, is when you’re a farmer, you’re living in communities, you’re living in villages close to other people, rather than being hunter-gatherer bands dispersed across the landscape. And so most infectious disease arises from that time, we think. And I suspect that there are UV-driven processes which reduce infection. And that’s what we’re really looking at at the moment. And the point about skin color is it mediates your response to sunlight. It’s not pale skin itself that prevents you get infections. It’s the fact that pale skin allows you to maximize the biological effects of sunlight. Joe 24:58-26:23 Dr. Weller, I’d like to go back and sort of summarize, if you don’t mind, all of the benefits of exposure to sunlight, because as I introduced a little bit tongue in cheek, American dermatologists believe that that sunlight is problematic, that it will cause all kinds of problems, and that we need to use these high SPF sunscreens or better yet stay out of the sun completely. So you’ve already suggested that blood pressure is affected by exposure to sunlight. You’re now alluding to the possibility that our immune system may be enhanced by sunlight, but there are a whole lot of other conditions as well. I think about inflammatory conditions like arthritis. I think about autoimmune conditions like eczema. I think about kidney disease and osteoporosis and diabetes. So can you just sort of summarize all of the potential health problems associated with lack of exposure to sunlight? How people in Australia may be quite different from people in Greenland,  in terms of their risk of heart disease? So give us that big perspective. Dr. Richard Weller 26:23-32:25 Yeah, look, I’m delighted to and of course I’ve start I’ve jumped straight into where my my current research is because that’s really exciting. So so sunlight’s got ups and downs, got a good side and a bad side. So look with my dermatologist hat on broad brimmed shady hat. Sunlight is a risk factor for skin cancer and it is a risk and it leads to skin aging. So that’s the kind of downside. But it’s also got an upside. There is a wonderful means about looking at how do these risks and benefits weigh out. And that’s what we call all-cause mortality: death from any cause. And that gives you very robustly a summation of those two factors, the pluses and the minus. So we have a paper coming out actually next week. We’re just uh arranging uh stuff with the journal at the moment. which touches on this subject, but the first person to look at it uh was a colleague and friend of mine, Pelle Lindqvist, who is an obstetrician in Sweden. And he did a wonderful study called the Melanoma or the Melanoma in Southern Sweden study. So this was set up in 1990. It was designed, as the name suggests, to find what causes melanoma, and how does it kill people. And 30,000 Swedish women, 30,000 middle-aged Swedish women in southern Sweden. So that that at the time was a quarter of the population of southern Swedish and middle-aged women were recruited in 1990 and they were asked a series of questions about how much sunlight they got. But they were also asked an extensive range of other questions asking about lifestyle factors, education, income, health, you know, other smoking habits, medical conditions. So the baseline information was taken, they were then followed for 25 years, and then the investigators went back to find out what had happened to them. And the first thing to say is that those had most sunlight were more likely to have had a case of melanoma. But Pelle’s interest and my interest is what about the deaths? I’m not interested in cases of the diseases. I’m interested in death from any cause. And there, much to the surprise of the dermatologists who set the study up, the direction was in the opposite direction to melanoma cases. They found that the women who had the most sunlight after correcting for all of these other factors, you know, income, education, smoking, etc. , etc. , those that had the most sunlight were half as likely to be dead. 25 years after the study started, as those who had the least sunlight. So that’s the first study. We have just done a much larger study looking at the UK Biobank. So the UK Biobank, uh half a million middle aged people in Britain were recruited (I was one of them) and examined in great depth over about it took about four years to recruit the whole cohort, um, all around Britain. And every subject went up to an investigation center where there was about three hours of questionnaires, investigations, measurements, you know, mass of information taken. And that was back in 2000 and uh, anyway, about about 20 years ago. And those people have followed up long term. And we have gone into that database and we’ve taken 400,000 people from that, and we have looked at measures of sunlight exposure. So the measures of sunlight exposure we have used have been how far south people live in Britain, because the further south you live, the more sunlight you get. And our other measure actually was people who use sun beds, not so much because of the sun beds themselves as because behaviorally we know that people that use sun beds sunbathe more, actively seek the sun more. Now, we then had to correct for all the confounders. You know, sun bed users are younger, more female, less educated, more likely to come from Manchester, etc etc and we had to correct for the same factors the further south people lived. And what we find is that the more sunlight people get the longer they live. They have a reduced all-cause mortality. They have a reduced cancer mortality. Melanoma is an interesting one. There was an increase in diagnoses of melanoma in those that got more sun, but no increase in mortality from melanoma and pretty much all the other cancers had a reduced mortality. And cardiovascular mortality was also greatly reduced. So just as Pelle showed in Sweden, we have showed in Britain that after accounting for confounding factors, other factors, the more sunlight people have the longer they live. Now one big caveat I’m gonna throw in for your audience is these are North European studies. And our sunlight levels here are much lower than your levels in America. You know, white skin has developed in Europe because we don’t have much sunlight. And this data applies here. I’m not sure how much it’s going to apply in America. And of course the studies haven’t been done because all people have thought about sunlight is oh gosh, it’s dangerous, it’s bad. But really interesting. Certainly for us in northern Europe, I think a really important, really important finding. Terry 32:26-32:46 So you’re not aware of any American colleagues who are doing anything similar? Of course, we don’t have a resource like the UK Biobank, which is an extraordinary resource of a huge amount of information, I don’t believe anything of that sort has been collected in the US. Dr. Richard Weller 32:47-35:46 No, I mean these studies can’t really be done in America. I mean most of these studies come out of Scandinavia and Britain because we have universal health systems. So if you get sick or have disease or die, you know, all our data are collected centrally.  America has such a bizarre health system and it’s so fractured and broken up into small things, it’s not really possible to do there. What America has been very good at at doing though is things like clinical trials and I need to mention vitamin D, vitamin D. Because the other thing to say here is vitamin D’s benefits have been vastly overplayed. Now we know that so sunlight is responsible for making vitamin D. Vitamin D has some important benefits, rickets, you know, it prevents rickets. And we know that when you measure vitamin D People with higher measured vitamin D levels are healthier in almost every way you can mention. Less heart disease, less strokes, less multiple sclerosis, less diabetes, etc. , etc., etc. The problem is when you give vitamin D, there are you know, it prevents rickets, which we’ve known for a hundred years. And there is an enormous rearguard action going on by the vitamin D industry saying, oh, well, what about this? What about this? What about this? Um and the vitamin D industry, I mean it’s a it’s worth, I think, it’s about two billion dollars a year. It is a huge industry. The biggest study of all on vitamin D supplementation was run in America. You’re fantastic at this, you know, NIH comes in with its funding. And there was a study called the Vital Study, run by Joanne Manson 25,000 Americans, 25,000 adult Americans were recruited. Half of them were given vitamin D supplements for five years and half of them were given a placebo, a sham control. And at the end of five years and really the study has now ended, but the patients are being followed up. And what it confirms, and it confirms the findings from lots of other smaller studies, is vitamin D has absolutely no effect on heart disease, on strokes. Probably doesn’t do much for cancers. Um, you know, the results came back negative, negative, negative. And there was an editorial in the New England Journal of Medicine 18 months ago. summarizing all this saying stop taking vitamin D supplements. You know, unless you are one of those very few people with incredibly low levels of vitamin D, it’s not doing anything. And people come up saying I’ve got vitamin D deficiency. And you say, what do you mean? Oh, I had a blood test. Doctors do not treat blood tests. We treat disease. A blood test is not a disease. You know, you wouldn’t know if you hadn’t had it done. But there is a huge industry out there pushing this. Terry 35:46-36:11 So, Dr. Weller, we actually have spoken with uh Dr. Manson and with one of her colleagues, and there was one area in which the VITAL study showed some benefit for vitamin D supplements and that was it reduced the likelihood that someone would be diagnosed with a new autoimmune condition. So you know… Dr. Richard Weller 36:12-37:16 Yes, I look I’m I am not saying vitamin D is absolutely irrelevant. I think we know about rickets, the autoimmune condition is is interesting. But the vast array of benefits that have been claimed for vitamin D are not held up by that amazing study. So what is interesting is that sunlight acts in multiple ways. Now a bit of it is vitamin D. but there’s so many other areas by vitamin D independent mechanisms. And that’s really exciting. And the problem is our focus has been so much exclusively on vitamin D. We have just ignored this. We’ve said, oh yeah, I know the fact that people are healthier. It’s vitamin D. Live in a cave, take vitamin D supplements. And those vitamin D supplements only account for some of sunlight’s benefits. And we need to move on and look for what the other mechanisms are. Terry 37:17-37:36 You’re listening to Dr. Richard Weller, Professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. Joe 37:36-37:42 After the break: Why can’t we compensate for sun exposure by taking vitamin D supplements? Terry 37:43-37:48 Well, could it be that maybe, as doctor Weller says, vitamin D is just a marker for sun exposure? Joe 37:49-37:51 What exactly does that mean, a marker? Terry 37:52-37:58 Well, it means we can measure vitamin D, and there are things we can’t measure. We don’t measure nitric oxide that well. Joe 37:59-38:02 Well, what’s a reasonable amount of sun exposure? Terry 38:02-38:10 We’ll also find out more about Dr. Weller’s research on how sunlight triggers nitric oxide formation and how that affects us. Joe 38:10-38:15 What does nitric oxide do for the immune system? Terry 38:32-38:37 You’re listening to the People’s Pharmacy with Joe and Terry Graedon. Joe 38:45-38:48 Welcome back to the People’s Pharmacy. I’m Joe Graedon. Terry 38:48-39:13 And I’m Terry Graedon, Joe 39:13-39:34 Today on the People’s Pharmacy, we are exploring the controversial concept that some sun exposure might have hidden health benefits. Of course, we want to emphasize that no one should get burned by the sun. In addition to being painful, sunburn creates the risk for melanomas. Terry 39:34-40:04 To find out more about phototherapy and how ultraviolet light acts to produce nitric oxide in the skin, we turn back to our conversation with Dr. Richard Weller. He’s a professor at the University of Edinburgh College of Medicine and Veterinary Medicine, and holds the personal chair of medical dermatology in the Deanery of Clinical Sciences. He also participates in the Center for Inflammation Research. Joe 40:05-40:59 So Dr. Weller, you have just put into perspective the fact that vitamin D is not the answer to lack of sun exposure. And I want to just quickly go back and summarize all of the benefits of sunlight And what happens when you don’t get exposed to sunlight? And you’ve alluded to things like hypertension, cardiovascular disease, cancer. You’ve mentioned kidneys, you’ve mentioned diabetes. What about autoimmune conditions such as multiple sclerosis? What about eczema, which I believe is something that you have a lot of experience with? Tell us why sunlight is so important for our body’s health. Dr. Richard Weller 40:59-45:54 Yeah, great question, thank you. And I’m delighted you bring multiple sclerosis up. So multiple sclerosis It is the classic sunlight deprivation disease. So, you know, even when I was at medical school, and that was a frighteningly long time ago, We knew that MS was a disease that was most common in people who grew up in areas without much sunlight. So I’m in Scotland and we have the highest rates of MS in the world here. And in fact, the highest of the highest is the Orkney Islands, which are just off the north of Scotland. Beautiful place. But something like I think about one in eight hundred people there has MS. Incredibly common. So a colleague and friend of mine, Prue Hart in Australia. And so and again, the classic story. people with low measured vitamin D levels are more likely to get MS. You give vitamin D you know, kinda iffy you know, the the observational effect is huge. This huge great relationship measured vitamin D. You give vitamin D supplements, not very much happens. So it’s got to be more than just the vitamin D. And I might say there’s a super company in America, Cytokines,  led by a wonderful guy John McMahon, which is setting up a phototherapy study of MS in the United States. So there’s really good preliminary work done in Australia where people who when they had their very first diagnosis of MS, their very first demyelinating episode, were randomized either to get phototherapy, the kind of stuff that dermatologists use on their offices, well established, incredibly safe treatments, They were randomized either to get phototherapy or to get a control. And there was a really strong move towards a reduction in progress of MS, and a really marked improvement in the the biomarkers that are a good indicator of whether people are going to progress or not. Really exciting. The big problem, of course, was it was done in Australia. So your control group not getting phototherapy, well, they’re still in Australia under quite a bit of sunlight. And of course the other reason there isn’t much MS in Australia. It’s a very sunny country. There’s masses in Britain. So John McMahon and his company are leading this to me really exciting trial of phototherapy for MS in America. And I am watching with huge, I mean just really exciting, because here is a disease which should absolutely go along with phototherapy. And also the narrowband UVB phototherapy that we dermatologists use to treat eczema and psoriasis. has been around for twenty or thirty years incredibly safe. I think utterly over-medicalized. I mean It’s been around for 20 or 30 years. There’s no signal for skin cancer being found in Britain for people having UVB phototherapy. So it’s sunlight. We don’t see a skin cancer signal. And yet you have to see a doctor. You have to see a dermatologist to get it. Um, I think it should be used far more widely. Great American dermatologist called Joel Gelfland, again, fantastic guy. Has just done a wonderful trial of home phototherapy, people with phototherapy lamps at home. And he’s compared how well they do to people who go to their dermatologist office to get phototherapy. And he finds people with their lamps at home do amazingly well. They do as well in terms of reduction in their psoriasis as patients receiving these biologic treatments, these incredibly expensive but highly effective monoclonal antibody treatments. Well actually phototherapy, Joel showed, is as good. And I might say a fraction of the cost and, you know, I mean basically it’s it’s sunlight in a box. And I think we greatly underuse it. And we underuse it because we’ve demonized sunlight. So here is a sunlight-based treatment. And of course, that really threw dermatologists in the quandary. Hang on. We run around saying Don’t go in the sun. And then suddenly we’ve got a treatment which is based on ultraviolet. What do we do? What are oh no, we’re gonna surround it with caveats and cautions and warning signs. I think we’ve gone completely overboard with that and it means we are not using this safe and effective and clean treatment nearly as much as we should be. So I’m delighted that people like Joel Gelflands as a dermatologist and John McMahon with his MS studies is really restoring, you know, kind of rejuvenating this wonderful and underused treatment modality. Joe 45:54-47:02 Dr. Weller, I want to come back to your research with nitric oxide, because I’ve been fascinated by nitric oxide for decades. But first, you know, w we’ve been talking about sunlight exposure, and for the most part Americans have a kind of love-hate relationship with the sun. They want to go out to the beaches, they wanna play outside, they wanna be golfing and playing tennis and going for hikes. But they wouldn’t dare go out without their SPF 50 or 100. I’m just wondering, can you give us some practical guidelines about how we can expose our skin to sunlight for a quote unquote reasonable or safe amount of time that won’t do damage, that won’t burn our skin and lead to wrinkling and squamous or basal cell carcinomas. How do we use the sun without getting into the sunbox that you were talking about a moment ago in in a safe way? Dr. Richard Weller 47:02-48:45 Yeah, I mean a really good question. I mean the really key thing is to avoid sunburn and particularly for children to avoid sunburn because it’s sunburn particularly in children which is the major risk factor for melanoma, the serious skin cancer. Sunlight is photoaging. Sunlight is a risk factor for skin cancer. And you know, non-melanoma with skin cancers in particular, the more sunlight you get, the greater your risk. Look, I uh you know I have a kind of conflict of interest in here because I have, I’ve developed a a a compound you can add to sunscreen that will release nitric oxide in the sunscreen. You know, it’s it’s sort of in development. We’d love to get it out there. I I think sunscreens could be better than they are. I mean at the moment sunscreens are all about blocking sunlight, and blocking the sunlight will reduce the aging, it will reduce the burning, it will reduce the cancer. My concern is it’s also going to block the good things. I think sunscreens could be better than they are. It certainly my, in Britain I am pretty quite relaxed about sunscreen use because we live in a much less sunny place than it than America. Um in America you do have an awful lot of sunlight. Now I suppose what I’m going to say is more research is needed. I think sunscreens could be better. I think we haven’t looked hard enough at the benefits of sunlight and how much sunlight is required to get them to be able to give a really robust answer. And the reason we haven’t done that is because we’ve purely been focused on sunlight is bad, vitamin D will make up for the absence of it. And clearly the story is much more nuanced and complex than that. Joe 48:46-49:07 Well, even if you are unwilling to make a recommendation because there’s a lack of science. What would be a reasonable amount of sun exposure, and at what time should we contemplate that sun exposure if we want to avoid sunburn and some of those damages you mentioned? Dr. Richard Weller 49:07-51:42 Well if you live in Florida or Texas you’re gonna need some protection. You’re living in an African latitude, and if you’ve got white skin, you’ve got you I think you’ve just got to be protecting your skin a great deal out around the middle of the day. If you’re farther north, you know, it gets less of an issue, but you’re still in a very sunny climate I think Americans do need more sun protection than Europeans because you live so far south. And of course the other thing is skin color. Because um so really I work in Ethiopia a lot, although sadly with the political situation there, uh not for the last three or four years. So UV-induced melanoma really does not occur in dark-skinned people. Jay Adamson, a wonderful dermatologist, American dermatologist in Texas, has really shown that UV-induced melanoma does not occur in African Americans. When I work in Ethiopia, we do not see UV-induced melanoma. On at two and a half thousand meters altitude, eight thousand feet, in the tropics in Ethiopia. Incredibly sunny is the point. Dark-skinned Ethiopians do not get UV-induced melanoma. They get these rare subtypes of melanoma, not related to sunlight, but but skin color really determines your risks of of skin cancer. And I am concerned by the way that the American Academy of Dermatology regards all skin types as the same when it comes to sun protection Because certainly the work that we have done uh in America. So we looked at how sunlight lowers blood pressure in America, a big study on three hundred and thirty thousand Americans. And we showed that African Americans need more sunlight to lower their blood pressure than white Americans. So just as skin color determines your risks of getting skin cancer, It also determines how much UV you need to get the benefits of sunlight. You know, skin color is all about response to UV. And I am concerned that by putting out the same message to everyone of every skin color, that’s not wise because that risk-benefit ratio for sunlight is absolutely determined by your by your skin color. And it needs to be a different message dependent on your skin color. Joe 51:42-51:56 Dr. Weller, we just have a couple of minutes left. I wonder if you could briefly summarize your research with nitric oxide and why it’s so incredibly important for so many physiologic functions. Dr. Richard Weller 51:56-53:20 Yeah. Well the biggest killer in the world today is heart disease. So half, basically half of deaths in the world are caused by high blood pressure-related diseases, heart attacks and strokes. Sunlight lowers blood pressure and with it the risk of having a stroke or a heart attack. And the mechanism by which it does it is release of nitric oxide from the skin into the circulation. Hugely important. If you’re a male in Scotland, you are 30% more likely to drop dead of any cause in a week in December than a week in July. I’m pretty mellow at the moment, It’s July, It’s a good time of year. I’ll get through to the end of the week. I start getting a little nervous as the year gets later. And a lot of that is driven by nitric oxide from the skin and its effects on the cardiovascular system. So it’s not sunlight has benefits as well as risks. Those benefits are not just vitamin D. There’s other mechanisms. The mechanisms include importantly for cardiovascular disease, nitric oxide, but also I suspect other mechanisms that really just started to look at, like immune function in particular. So I really think we need to be reconsidering our approach to sunlight in a more balanced way, considering benefits and not just risks. Joe 53:21-53:47 And Dr. Weller, in the one minute we have left, the role of sunlight and perhaps nitric oxide on the immune system, because goodness knows, we have certainly learned a lot from COVID-19 and the pandemic. A lot of people would prefer to reduce their risk from infection. How does sunlight help there? Dr. Richard Weller 53:47-55:33 So well so interesting. So, so we looked at so we um at at the same time as, uh as a rival group in Harvard were looking at the effects of sunlight on COVID mortality. And we found in the very first three months of the pandemic that the sunnier it was after accounting for other factors, the less deaths there were from uh COVID. And that the Harvard group showed that the more sunlight there was, the less growth in cases. Now that’s observational studies, but we uh colleagues in America ran a pilot study in Louisiana giving phototherapy or, or a control to patients admitted to hospital with COVID. And it was a small study, only fifteen in each group, but they found a trend to reduce deaths in the sunlight group. And the third bit of evidence is people with high measured levels of vitamin D were less likely to get COVID or die of it, but multiple trials giving people vitamin D supplements, it had no effect. The usual story, measured vitamin D is a marker for sunlight exposure, not necessarily causative. So look, so I think there’s some really interesting data there suggesting that sunlight is driving processes which we’re now looking at that reduce your risk um of death from COVID. And that may apply to other infectious diseases, but the work needs to be done. And I suspect in evolutionary terms, that’s what has driven this move to pale skin in humans who move to low light areas. Joe 55:33-56:04 So, Dr. Weller, you’ve described the benefits of sunlight as being more than just vitamin D. Dr. Richard Weller 55:42-55:43 Yep. Joe 55:43-56:04 That nitric oxide is also a critical factor, and it’s manufactured in the skin and then circulates in the bloodstream and lowers blood pressure and probably has a lot of other benefits as well. What else is going on? Do we know what sunlight exposure does beyond vitamin D and nitric oxide? Dr. Richard Weller 56:04-59:08 Yeah, uh well I, I strongly suspect it’s having effects on the immune system and and in fact we’ve got f Pretty good evidence showing that. And that’s what I’m actually looking at at the moment with my current PhD student. So we’re so a really good early study in this area which we’re building on now by a chap called Dopico in Cambridge. Came to I think into Edinburgh actually. And he did one of these studies where you use other people’s data um very well. And they looked at um gene expression patterns in blood. Now what they did was they used about eight studies where people had had blood, and the studies have been done for various reasons. Everybody had their blood taken throughout the year during these studies, and the gene expression pattern, what genes were turned on and off in the whole blood, um, was looked at. And what Dopico and colleagues did was they looked, they analyzed the gene expression in these data sets by the month of the year in which the blood was taken. The studies were done for different reasons, but they happened to run over 12 months. And so he went in and thought, gosh, I’ll just analyze it by month of the year. And what he showed was that 30% of all the genes in your blood, you know, which are uh immune genes are very important there, show seasonal variation. So there is a huge uh seasonal variation, possibly I would imagine sparked off by UV, uh which occurs in immune cells. And broadly what he found was that inflammatory genes were turned on in winter and anti-inflammatory genes in summer. And the the, they suggest that maybe, you know, infectious disease flies around in winter. Maybe your body turns up the immune system to be able to jump on infectious disease. That was the hypothesis. So there’s now a technique called single cell RNA sequencing where you can look at every single individual cell, and so you can take, draw blood, you can look at ten thousand different cells, and you can look at every single gene turned on in every single cell. So the experiments I’m doing at the moment we do in winter. We take healthy volunteers. We load them up with vitamin D at the beginning, so they’re full of vitamin D at the start. Take their blood, look at all of their gene expression pattern, we then give them two weeks of daily solar-simulated UV, as if they were on in the Mediterranean, and we then repeat it. And we’re early days, don’t want to talk about the results yet, but we’re getting very interesting effects on gene expression patterns in in immune genes, T cell genes in particular. So it looks as if sunlight has significant effects on the immune system. And we’re really we’ll see where it takes us, but but really exciting stuff. Joe 59:08-59:53 Dr. Weller, if we were to dial back, what, 100, maybe 150 years to a day when tuberculosis was rampant and a terrible killer around the world. There were sanatoriums where people would go and they were often exposed to sunlight. Even in the winter, they would take people outside, bundle them up and exposed them to the sun, they somehow thought that exposure to sunlight could help people dealing with tuberculosis recover or at the very least survive better. Did they know something we didn’t know? Dr. Richard Weller 59:53-01:02:34 Yeah, I mean it’s really interesting and and I think sadly they never did, they had not yet invented robust, placebo-controlled clinical trials as we would understand them. But they weren’t fools. And of course, places like Davos, now an expensive ski resort and uh financial center. Davos was set up initially as a heliotherapy center, a center where people would go to get the sunlight for their tuberculosis. I I gave the opening address at the meeting of the Swiss the annual meeting of the Swiss Dermatology Association last year. And I pointed out and I was talking about the work we’ve been discussing today, and I pointed out to them that had I been there a hundred years ago, I would have been going as a disciple of the great Rollier, you know, the Swiss doctors who developed heliotherapy to treat tuberculosis. And instead, here I was a hundred years later, coming along to remind them of what they’d done previously. So absolutely, you know, we had it, you had it in America, we had it here in Britain. That was before antibiotics, the treatment for tuberculosis. And of course, and then for tuberculosis of the skin, a chap called Finsen in Denmark, developed ultraviolet lamp treatment for treatment of lupus vulgaris, tuberculosis of the skin. And he actually got the Nobel Prize for Medicine for this in I think it was 1904, really one of the very early Nobel Prizes for Medicine. So there is actually a history of UV having been used to treat infectious disease. And certainly since then we’ve had antibiotics and vaccines and we’ve had sewers and we’ve had clean airs, you know, we’ve had all of these measures that have reduced infectious disease death now. You know, the miracle of vaccination has basically eradicated infectious disease from our day-to-day life. So COVID was, I mean it was very tragic. It was also scientifically very interesting because suddenly you had a new infectious disease against which we had none of our usual defenses. You know, before the vaccines came, it was us and the virus. And you began to be able to see what happens to populations with a new virus. And it certainly looks as if those that had more sunlight had less deaths from COVID. And that for me was really very interesting. What the mechanisms are, we don’t yet know, and that’s what we’re looking for now. Terry 01:02:34-01:02:41 Dr. Richard Weller, thank you so much for talking with us on the People’s Pharmacy today. Dr. Richard Weller 01:02:41-01:02:44 Well thank you. I’ve enjoyed the conversation. Joe 01:02:44-01:03:15 You’ve been listening to Dr. Richard Weller, professor at the University of Edinburgh, College of Medicine, and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. The show notes for today’s show have a link to the recent article in The Economist about his research and a link to his paper in the Journal of Investigative Dermatology. Terry 01:03:15-01:03:26 Lynn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B. J. Leiderman composed our theme music. Joe 01:03:26-01:03:32 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Joe 01:03:57-01:04:12 Today’s show is number 1397. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s show. You can also reach us through email radio at peoplespharmacy.com. Terry 01:04:12-01:04:32 Our interviews are available through your favorite podcast provider, and now you can find them on YouTube as well. You’ll find the podcast on our website on Monday morning, and this week it’ll have some extra information about Dr. Weller’s research on sunlight, vitamin D and nitric oxide. Joe 01:04:32-01:04:50 At peoplespharmacy.com you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe you can also have regular access to information about our weekly podcasts so you can find out ahead of time what topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon. Terry 01:04:50-01:05:24 And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:05:25-01:05:34 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism please consider chipping in. Terry 01:05:35-01:05:39 All you have to do is go to peoplespharmacy.com/donate. Joe 01:05:40-01:05:53 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you. Citations

A randomized controlled trial published in the New England Journal of Medicine confirmed what some cancer specialists have long hoped: physical activity can prolong cancer patients’ lives. Last week, we heard from the senior author of that study, medical oncologist Christopher Booth. In this episode, we hear from an exercise physiologist who has been helping cancer patients with exercise prescriptions. The goal was for them to feel better. Many also lived longer. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 23, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 25, 2025 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. Listen to the Podcast: The podcast of this program will be available Monday, August 25, 2025, after broadcast on August 23. 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 find information about walking speed and how much it matters. We also discuss swimming or cycling as ways to protect your joints if walking is difficult. Does cross-training become more important as you grow older? What kinds of activities can slow osteoporosis? Be sure to tune in if you are interested in the importance of family and friends supporting our exercise goals. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

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. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 16, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link  so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 18, 2025. Does Exercise Belong in Cancer Treatment? An exciting study published in The New England Journal of Medicine demonstrates that a personalized exercise program can be an important component of the treatment for colorectal cancer (New England Journal of Medicine, July 3, 2025).  We spoke with the senior author, Dr. Christopher Booth, who explained that originally he and his colleagues wondered if exercise can help cancer patients feel less fatigued while undergoing chemo. Then they decided to design a trial that would go much further. They intended to answer two questions: can cancer patients exercise during treatment? And does that improve their likelihood of survival? Increasing Physical Activity Can Help Cancer Patients Survive Longer: The study, known as the CHALLENGE trial, hit a home run. The investigators recruited 889 people who had just had surgery and chemotherapy for their colorectal cancer. They randomly assigned half of them to get a health education booklet urging them to eat right and stay active. The other half got the booklet (usual care) PLUS a personalized exercise prescription designed to increase the amount of moderate to vigorous physical activity people did over the week. How Did This Challenge Work? The exercise prescriptions were devised by personal trainers who met with the “intervention” patients every two weeks for a year. Half of the meeting was devoted to motivational coaching and the other half to moving. Patients loved it. Increasing their fitness also improved their quality of life. In addition, patients in the exercise intervention group had better immune function and lower inflammation and less insulin-like growth factor, which can contribute to tumor expansion. Both men and women participated in this trial. During the follow-up period, women who were active were less likely to develop breast cancer than those in the control group. Similarly, men in the intervention group had a lower chance of a prostate cancer diagnosis. The most exciting part of the story, however, is about their colorectal cancer treatment. Not only did patients in the physically active group have longer overall survival, they also had longer disease-free survival. Remember, these two groups have the same type of cancer and got the same kind of treatment, except for the exercise prescription. The overall 8-year survival was 90.3% in the exercise group and 83.2% in the health education control group. That means the exercisers lowered their chance of dying during those eight years by 37%. The Number Needed to Treat (NNT) was 14 exercisers to prevent one death. That is a remarkable statistic. How Did Cancer Patients Get Motivated to Move? If you’ve ever started an exercise program only to drop it a few weeks later, you are not alone. Keeping ourselves motivated to stay active isn’t always easy unless you really love what you are doing. (Joe needs no extra motivation to show up for tennis.) Consequently, it is impressive that a very high proportion of the cancer patients in the CHALLENGE trial kept exercising. Part of that perseverance might be due to the motivational coaching. No doubt another big part was the relationship with the personal trainer. Meeting with a person every two weeks for a year can help build friendships and creates a relationship in which accountability is a factor. After the first year, patients and trainers met every month for the next two years. Being able to increase physical activity was empowering for patients, giving them a sense of control that can otherwise be missing in a cancer patient’s life. What Did Cancer Patients Do? The exercise prescriptions were personalized, so people undertook a wide range of activities. Jogging and walking were popular, but some people swam, and others kayaked. There were patients who bicycled, and possibly some who rode horses. (Dr. Booth does not mention that.) The point was to find an activity you love and stick with it religiously, which they did. The most popular activity by far was also the simplest: walking. The idea was to walk at a pace so you looked like you were late for a meeting. Is It Feasible to Help Cancer Patients Survive & Thrive? One of the most exciting aspects of the CHALLENGE trial was to see that people responded to coaching. Personalized exercise prescriptions with accountability could be instituted into many cancer treatment programs. After all, if insurance pays for cardiac rehab, why shouldn’t it pay for cancer rehab? The cost of a personal trainer is about $3,000 to $5,000 over three years. That is a lot less than the next-level chemotherapy drug is likely to cost, and unlike chemo, the side effect is that the patient feels better. Not only is it feasible to help cancer patients survive through targeted exercise, it should be a part of most cancer treatment protocols, In Summary: Dr. Booth offered us this explanation of how the treatment works: “Exercise is inducing physiologic, hormonal, inflammatory, immunologic changes in the body that are helping the body eradicate a proportion of these cancer cells. ‘ Learn More: Dr. Booth is a medical oncologist. To complete this trial, he called on the expertise of a lot of colleagues, including exercise physiologists. Next week, we will speak with Claudio Battaglini, PhD, to get the exercise physiologist’s perspective on this important approach. This Week’s Guest: Christopher Booth, MD, is a medical oncologist and health services researcher at Queen’s University in Kingston, Ontario, Canada. • Director, CCE Division, Queen’s Cancer Research Institute (QCRI) • Medical Oncologist • Clinician-Scientist, Cancer Centre of Southeastern Ontario • Professor, Departments of Oncology and Medicine, Queen’s University • Canada Research Chair in Population Cancer Care https://scri.queensu.ca/faculty-staff/christopher-booth Christopher Booth, MD, Queen’s University Listen to the Podcast: The podcast of this program will be available Monday, August 18, 2025, after broadcast on August 16. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

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? How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 9, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 11, 2025. Doing an Environmental Assessment: As a rheumatologist, Dr. Cohen frequently treats patients whose immune systems have turned on them to produce conditions like lupus or rheumatoid arthritis. As an integrative medicine practitioner, she has learned to look at the patient’s environment for clues about the toxic compounds that may be causing the problem. The first environmental assessment she conducted was actually for her beloved family dog, Truxtan. When he developed autoimmune liver disease, she tried to figure out why. How Everyday Toxins Disrupt the Immune System: Dr. Cohen wasn’t able to save her dog, but the experience made her realize just how many potentially toxic chemicals we are exposed to in the course of our daily lives. If you look around your kitchen, you may discover that most of your food containers might be suspect. Plastic is incredibly convenient, since it is lightweight, break-resistant and cheap. But it often contains plasticizers such as bisphenols or phthalates that are endocrine disruptors. Some can disrupt the immune system as well. After all, immune system cells interact with the endocrine system on a regular basis. The two are tightly linked. Other food packaging can also contribute undesirable compounds such as PFAS. Exposure to these may lead to chronic inflammation. Dr. Cohen tells about a patient, Massimo, who ran a pizza shop. A young man, he had troubling fatigue. Changing his routine so that he wore nitrile gloves while handling pizza boxes helped a lot. So did bicycling to work. Everyday Toxins in Our Water: How safe is your water? One of Dr. Cohen’s patients had moved to New York from a Latin American country. Although she had filtered her water in her home country, she believed the tap water in New York was safe. It turned out the old plumbing in her building was contaminated with lead. In addition, she was relying on rice as a food staple, and it was contaminated with arsenic. Lead and arsenic are well-recognized as toxic chemicals. Filtering her water and washing her rice helped her feel much better. How do you make sure your water is free of everyday toxins? Dr. Cohen says several types of filtration devices can be useful, if they are used according to instructions. That means changing the filter medium on the recommended schedule. Any filter is better than no filter, but by far the best approach is known as reverse osmosis. This results in clean water you can trust to be free of toxins. Can You Avoid Plastic? The topic of water is almost inextricably linked to the question of plastic. Much of the water sold for consumption away from home is bottled in plastic. In addition to environmental considerations, this can expose us to plasticizers such as phthalates or even to tiny bits of plastic known as microplastics. These are accumulating in our bodies and may be harming our immune system. Bottles are not the only source of plastic in our food supply. Most cans are lined with a resin to prevent corrosion. This frequently contains BPA, bisphenol A, as a plasticizer. Some manufacturers have switched to another bisphenol instead. Thus, they can claim that the can is BPA-free, but it isn’t necessarily safer. Don’t Use Plastic Containers in the Microwave! One simple rule that can cut down on a lot of exposure to immune-disrupting plasticizers is don’t microwave food in plastic containers. Heat tends to speed leaching of plasticizers from the containers into the contents. Yes, we know a lot of frozen meals come in plastic containers that are supposedly microwave-safe. Don’t believe them. Instead, transfer the food to a glass or ceramic dish or bowl and heat it in that. That way you know you’re not getting any extra plasticizer in your snack. Prioritize! Dr. Cohen points out that to get the best results from efforts to avoid everyday toxins, we need to figure out where the exposure is greatest. That’s why she usually likes to start with cleaning up the water supply, since for most of us that is our top exposure. Analyzing your diet and focusing on foods you eat often is another way to prioritize. Those are the foods that should be free of toxins if at all possible. She recommends using the EWG (Environmental Working Group) lists of the “Dirty Dozen” foods that often contain pesticides and the “Clean Fifteen” foods that are generally safe.  For the Dirty Dozen, it makes sense to purchase USDA Organic produce whenever possible. Removing Pesticides: Dr. Cohen offers some simple, inexpensive ways to wash your produce and get the pesticide off. Add 1 part vinegar to 3 parts filtered water and let the fruit or vegetables soak in that for several minutes. Then rinse it off well with filtered water. The 21-Day Plan: To make it easier for people to implement the changes and avoid everyday toxins, Dr. Cohen offers a 21-day plan. It offers steps to avoid lots of harmful chemicals including obesogens (chemicals that make us fat). One simple way to take the first steps, after filtering the water you drink, is to carry a metal spoon and fork. That way you won’t have to resort to using plastic utensils to eat hot food, especially soup. Another step is to be cautious with skin care products. Using the online EWG guide SkinDeep can help you find sunscreen or moisturizer that is mostly free of undesirable agents. When shopping, make it a habit to seek out USDA Organic certified products for those items you eat most. Learn More: Dr. Cohen is not the only doctor concerned about toxic exposures. A summary of research into the “exposome” was published in JAMA last spring. Here’s a link. This Week’s Guest: Dr. Aly Cohen is a board-certified rheumatologist and integrative medicine physician. A member of the faculty of the Academy of Integrative Health and Medicine, Southern California University of Health Sciences, and the University of California, Irvine, she is a leading medical and legal expert in environmental health. Dr. Cohen is creator of TheSmartHuman.com social media platform, and the co-author of the bestselling consumer guidebook Non-Toxic: Guide to Living Healthy in a Chemical World. Her latest book is Detoxify: The Everyday Toxins Harming Your Immune System and How to Defend Against Them. Her website is https://alycohenmd.com/ Aly Cohen, MD, author of Detoxify The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast: The podcast of this program will be available Monday, August 11, 2025, after broadcast on August 9. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

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 You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 2, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 4, 2025. 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. Andrew Armstrong, MD, Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. Listen to the Podcast: The podcast of this program will be available Monday, August 4, 2025, after broadcast on August 2. In this week’s podcast, Dr. Armstrong describes how to find trustworthy information online. We discuss diet, exercise and natural approaches that can be helpful in preventing and recovering from prostate cancer treatment. When will medical centers recognize the value of personalized, structured exercise for cancer rehab, as they already do for cardiac rehab? You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

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. You may want to listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 26, 2025. The Basics of Lyme Disease: We begin with a quick review of the history of Lyme disease, which was first identified in Old Lyme, Connecticut, in the 1970s. Researchers eventually identified the pathogen causing the symptoms as Borrelia burgdorferi and means of transmission as bites from a black-legged tick (aka deer tick). Even though it was originally thought to be limited to New England, epidemiologists now recognize that Lyme disease is widespread across the country. Half a million people will come down with Lyme disease this year. Many others will suffer symptoms from other pathogens transmitted through tick bites. Persistent Symptoms of Lyme Disease: For much too long, doctors thought that any symptoms persisting after a course of antibiotics were psychosomatic. Patients were understandably distressed by this dismissal of their suffering. Many people report fatigue, body aches and brain fog. Some have difficulties with balance or feeling weak or faint when they stand and have been diagnosed with POTS (postural orthostatic tachycardia syndrome). Headaches, rashes, heart palpitations and joint pain may also be part of the picture. If you think some of these symptoms ring a bell, you are right. Many people with long COVID or even chronic fatigue suffer with similar problems. Avoiding Lyme or Treating It Over the Long Term: One of our expert guests, Dr. John Aucott, does research on Lyme disease and directs the Johns Hopkins Lyme Disease Clinical Research Center. His study utilizing functional MRI was very revealing. When regular imaging studies are done on people with persistent Lyme disease symptoms, the results are not particularly striking. But functional MRI results, when people are asked to do cognitive tasks while undergoing magnetic resonance imaging, show a different picture. These people’s brains are not functioning normally. No wonder they are upset about brain fog or struggling to concentrate! There are several possible explanations for why Lyme disease symptoms may persist. The spirochete responsible for these symptoms does not require oxygen and is very good at “hiding out” within tissues. When reactivated, it could cause symptoms. On the other hand, the immune system may become hyper-activated and have a hard time calming down. That too could contribute to symptoms. Non-governmental organizations have funded the Study of Lyme Immunology and Clinical Events (SLICE). In this trial, researchers have identified some risk factors associated with post-treatment Lyme disease (PTLD, aka long Lyme). They are also enrolling patients in a treatment trial. Standard of Care for Lyme Disease: Naturopathic doctor Alexis Chesney points out that there are different standards of care for Lyme disease. The CDC has published guidelines for treating “four important manifestations of Lyme disease.” Those are erythema migrans (the classic “bulls-eye” rash), neurologic Lyme disease, Lyme carditis and Lyme arthritis. The International Lyme and Associated Diseases Society (ILADS) offers its own treatment guidelines. Both experts agree that early treatment is preferable to late treatment. Dr. Chesney describes the ability of the Borrelia spirochete to protect itself by changing to a “round form” as well as by forming a biofilm that wards off antibacterial medicines. One way to combat this is by utilizing herbs that can counteract biofilm formation, such as cats’ claw or Japanese knotweed. She also pays attention to supporting patients experiencing a Herxheimer reaction, in which dying spirochetes release toxins. This can make a person feel very ill indeed. Natural ways to mitigate this response include milk thistle, burdock or Epsom salt baths. Avoiding Lyme Disease by Preventing Tick Bites: Even better than early treatment is prevention. The best prevention is to avoid tick bites. Wear shoes and socks that have been treated with permethrin. (Do not apply permethrin directly to the skin.) Using an effective insect repellent also helps, and a thorough tick check upon coming in from outdoors is indispensable. It takes ticks some time to transmit Borrelia, so prompt tick removal can help prevent illness. This Week’s Guests: Dr. John Aucott is the Barbara Townsend Cromwell Professor in Lyme Disease and Tick-borne Illness at the Johns Hopkins University School of Medicine. An infectious diseases specialist and Lyme disease expert in the Division of Rheumatology, he is the director of the Johns Hopkins Lyme Disease Clinical Research Center. https://www.hopkinslyme.org/ John Aucott, MD, Johns Hopkins University Alexis Chesney, MS, ND, Lac, is a naturopathic physician, acupuncturist, author and educator. Since 2010, Dr. Chesney has worked with people of all ages on chronic disease, general wellness, nutrition and lifestyle counseling. She has dedicated herself to working with clients who have complex chronic illness, and who often have diagnoses such as Lyme and vector-borne diseases, mold toxicity, mast cell activation syndrome, among other conditions. Dr. Chesney is the author of Preventing Lyme & Other Tick-Borne Diseases: Control Ticks in the Home Landscape; Prevent Infection Using Herbal Protocols; Treat Tick Bites with Natural Remedies. Dr. Chesney offers an online course, Preventing Lyme and Tick-Borne Disease: Ticks and Tick-Borne Diseases, Prevention, and Acute Lyme & TBD Treatment. Here is the link: https://health-transformations.teachable.com/p/preventing-lyme-and-other-tick-borne-diseases. Her website is https://www.dralexischesney.com/ Alexis Chesney, MS, ND, Lac, author of Preventing Lyme and Other Tick-Borne Diseases Listen to the Podcast: The podcast of this program will be available Monday, July 28, 2025, after broadcast on July 26. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

This week, we welcome dermatologist Dr. Chris Adigun to our studio to answer your questions about summer skin problems. You can call in your stories and questions about bites, burns and blisters between 7 and 8 am EDT on Saturday, June 21, 2025, at 888-472-3366. Or you can send us your question or story ahead of time by email: radio@peoplespharmacy.com. You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 21, 2025. 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. Call in Your Questions About Summer Skin Problems: Dr. Chris Adigun will be in our studio to answer your questions about bug bites, blisters, burns and other summer skin problems from 7 to 8 am EDT on July 19, 2025. Give us a call to ask a question or share a story: 888-472-3366 or email us ahead of time: radio@peoplespharmacy.com 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. Dr. Chris Adigun, dermatologist, with People’s Pharmacy hosts Joe & Terry Graedon Listen to the Podcast: The podcast of this program will be available Monday, July 21, 2025, after broadcast on July 19. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this 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? How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, July 12, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 14, 2025. Staying Connected Protects Our Brains: Good nutrition, adequate sleep and regular exercise are all pillars of mental as well as physical health. Our guest, integrative psychiatrist Drew Ramsey, says staying connected with others is equally important. Cultivating a variety of connections is crucial for our mental health, including friends, family and even casual acquaintances. We should keep in mind that building community is different from building friendships; we need both for mental fitness. Social isolation can be damaging both for teenagers and for older individuals. Can we use social media to bolster our support systems rather than allowing them to wither? What skills can we help our teens acquire? Dr. Ramsey described a study, the AMEND trial, that combined social connection through social media with learning to cook. The young men in the study posted their cooking experiments on Instagram and bonded with each other over the experience. Adopting a more healthful diet also reduced the youths’ risk for depression. Maybe Ultra-Processed Food Breaks Our Brains: One aspect of nutrition that is important to consider is how our food affects our microbiota. Our gut microbiome has a powerful influence on inflammation in our bodies. After all, the immune system is in part anchored in the gut, especially in the gut microbiome. When the microbiome gets disrupted and inflammation rises, our mood and mental health can suffer. What should we be eating to feed our microbes and keep them happy? Dr. Ramsey offers a little rhyme as a mnemonic: “Seafood, greens, nuts & beans…and a little dark chocolate.” We admit the last line breaks the rhyme, but it isn’t too hard to remember! When we asked what foods to focus on for healthy gut microbes, he suggested lentils. Although they are not technically beans, as in the rhyme, they are legumes and contain lots of fiber that helps gut microbes flourish. Dr. Ramsey also extolls the benefits of microgreens, another food that gut microbes love. The microbiome acts as a master dial on our immune system and inflammation levels. Beyond Diet and Activity: Dr. Ramsey provides nine tenets for reclaiming robust mental health, even when we may feel like our situation breaks our brains. In addition to thoughtful nutrition, adequate sleep and reliable physical activity, he also stresses the importance of unburdening yourself of past trauma. This need not have been anything as major as a traffic accident or losing a parent, though such experiences are certainly traumatic and deserve attention. Even minor traumas like being picked on as a child can affect our sense of well-being. Unburdening is the process of acknowledging those and trying to understand where our past is tripping us and blocking our efforts to be mentally healthy in our present. Unburdening yourself can leave you feeling freer to pursue your goals. It helps ground you so that you can pursue your purpose. Journaling, therapy or creative pursuits could all help with unburdening. How Can You Find Your Purpose? Finding your purpose might not sound like a step towards better mental fitness, but it is. How do you know when you have found your purpose? Focusing on a sense of identity and of fulfillment will help you with this. Finding a sense of purpose is important at every stage of life, but it may be especially important for older individuals. A job is not synonymous with purpose, although at times they may overlap. Sometimes, people who have relied on work to provide their sense of purpose find themselves at loose ends when they retire. This Week’s Guest: Drew Ramsey, MD, is a leading board-certified integrative psychiatrist, best-selling author and leading proponent of Nutritional Psychiatry and Mental Fitness. He served as an Assistant Clinical Professor of Psychiatry at Columbia University in the Vagelos College of Physicians and Surgeons for twenty years. Dr. Ramsey is founder of the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, WY. He is the author of several books, including his latest book, Healing the Modern Brain: Nine Tenets to Build Mental Fitness and Revitalize Your Mind. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Drew Ramsey, MD, author of Healing the Modern Brain Listen to the Podcast: The podcast of this program will be available Monday, July 14, 2025, after broadcast on July 12. In this week’s podcast, Dr. Ramsey offers further discussion of the idea of finding your purpose and how to do that even after retirement. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this week’s episode, our guest explains why treating hypothyroidism isn’t always as simple as it seems. He is a leading researcher on questions relating to thyroid hormones. What Is Hypothyroidism? Hypothyroidism, a condition in which the thyroid gland doesn’t make enough thyroid hormone, is one of the most common hormonal disorders. It was first identified near the end of the 19th century but is far more widely recognized now. More than 20 million Americans produce too little thyroid hormone for their needs, either because their thyroid glands have been removed or because they are under attack from the immune system. Inadequate thyroid hormone has an impact on every cell in the body. As a result, the symptoms are wide-ranging, from lethargy and cognitive troubles to hair loss and constipation. Why Should We Be Rethinking Hypothyroidism? Most medical students learn that this is a simple straightforward condition to diagnose and treat. For decades, doctors used a single test–the TSH, or thyroid-stimulating hormone–for diagnosis. In addition, they learn that a single medication, the hormone called levothyroxine, is the sole treatment. People may know levothyroxine by its brand names, such as Synthroid or Levoxyl. Doctors often refer to it as T4, because the molecule contains four atoms of iodine. Not everyone knows that T4 itself is not biologically active. Enzymes within the cells must remove one of those iodine atoms to create the active hormone, T3. You might recognize it by its generic name, liothyronine, or by the brand name Cytomel. What’s Wrong with Levothyroxine Only? Back in 1970, researchers discovered the enzymes that convert T4 to T3. That’s when doctors decided that patients would do well on a simple synthetic form of T4. In fact, 80 to 85 percent of patients with hypothyroidism have no great difficulties with this treatment. However, about 15 to 20 percent continue to suffer despite treatment. Some feel infuriated when the doctor tells them that their normal TSH levels mean they are fine. They don’t feel fine. They still feel exhausted, confused and miserable. Researchers, including our guest, have begun to recognize that people who do not convert T4 to T3 efficiently may suffer from residual symptoms of hypothyroidism. How Should We Be Rethinking Hypothyroidism? Lingering symptoms of hypothyroidism, such as fatigue or brain fog, are not very specific. As a result, doctors may need to utilize more sophisticated testing techniques. Moreover, rethinking hypothyroidism means considering different forms of treatment. A person who has residual symptoms despite a normal TSH level might need a trial of combination therapy. This might be in the form of desiccated thyroid extract such as Armour or Westhroid. An alternative would be a prescription for both T4 (levothyroxine) and T3 (liothyronine) as combination therapy. Doctors making such a change to their prescription need to adjust the dose carefully so that the patient does not end up with too much thyroid hormone. They also need to make sure during the diagnostic workup that the problem truly is hypothyroidism. Symptoms such as low energy don’t go away with thyroid hormone treatment unless that is the underlying problem. What Should Patients Do? For too long, patients have heard that their residual symptoms are psychological in nature. A doctor might have insisted that a normalized TSH on treatment means nothing is wrong with the thyroid gland. People who still feel bad despite such treatment may need to hunt for a clinician willing to explore ways to address those residual symptoms. This Week’s Guest: Antonio C. Bianco, MD, PhD, was professor of medicine and a member of the Committee on Molecular Metabolism and Nutrition at the University of Chicago at the time this episode first aired. He ran a laboratory funded by the National Institutes of Health to study thyroid hormones. Dr. Bianco is a former president of the American Thyroid Association and author of Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do. Twitter handle is @Bianco_Lab. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Antonio Bianco, MD, PhD, is now The Nelda C and H.J Lutcher Stark Professor in internal medicine. VP, Vice-Provost for research and Chief research officer university of Texas Medical Branch, Galveston, Texas. Antonio Bianco, MD, PhD, University of Chicago Listen to the Podcast: The podcast of this program will be available Monday, July 7, 2025, after re-broadcast on July 5. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this episode, Joe & Terry speak with two scientists studying mosquito preferences. Why are some people mosquito magnets while others barely get bitten? A range of factors influences mosquito behavior and may explain why mosquitoes bite you and leave your neighbor alone. Learn how to outsmart them. You could listen through your local public radio station or get the live stream on Saturday, June 28, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on June 30, 2025. Why We Worry About Mosquito Bites: You may think of mosquitoes as annoying insects with itchy bites. That’s certainly a reasonable summary in many places and times. But there are large swaths of the globe where mosquitoes carry deadly diseases. Malaria, for instance, kills an estimated 600,000 people a year. The majority of these victims are children under 5 years old living in sub-Saharan Africa. Even in the US, where malaria was eradicated in the mid-20th century, mosquitoes transmit some dangerous diseases, including dengue in some southern regions, West Nile virus, and in the northeast and the Gulf Coast, eastern equine encephalitis (EEE). The best prevention for these serious infections is to outsmart mosquitoes and avoid getting bitten. Depriving Mosquitoes of Breeding Grounds: One problem is that a few species of mosquito have evolved to live in close proximity to humans. They have adapted to breeding in standing water, but it doesn’t take much. An upturned bottle cap, a saucer under a potted plant or leaves lying on the ground can all offer mosquito breeding opportunities. Emptying those saucers and raking away the leaves should be a priority to reduce the risk of mosquito bites. Do You Smell Delicious? Both our guests have been studying what makes some people more appealing than others. To that end, Dr. Conor McMeniman and his team have set up the world’s largest multiple-choice smell test for mosquitoes in Zambia. They constructed a mesh greenhouse the size of two tennis courts that could be surrounded by eight single-person tents. A person sleeps in each tent and that person’s scent is wafted into the enclosure where mosquitoes are given a chance to congregate where the preferred scent appears. This scent buffet for mosquitoes demonstrated that microbial metabolites from our skin microbiome have a significant impact on insect behavior. Mosquitoes seem to home in on short chain carboxylic acids as well as acetoin. How Can We Outsmart Mosquitoes? One simple and obvious step to avoid mosquito bites is to use window screens on our homes. That helps protect us inside. Air conditioning and ceiling fans also help. We asked Dr. McMeniman how he protects himself when he is outside and what we should do. He recommends repellents. DEET is the gold standard, but some people find it unpleasant. An effective alternative repellent is derived from plants. Whether you use oil of lemon eucalyptus or DEET, it is important to read the instructions for applying the product properly. How Do Mosquitoes Change Their Behavior? In addition to smell, mosquitoes also use vision and temperature sensing to find humans to bite. (Did you know mosquitoes sing to each other? It is part of their courtship behavior.) Dr. Clément Vinauger studies how mosquito brains react during different activities. They also pay attention to people who swat them and seem to avoid those individuals who come close to killing them. Mosquitoes can also change their behavior to adapt to human behavior. For example, a species of Anopheles mosquito that was nocturnal shifted to early morning biting over a period of a few years. That happened after the human population started using effective bed nets that protected them during sleep. More on How to Outsmart Mosquitoes: Dr. Vinauger made a casual observation that some soaps seemed to attract mosquitoes while others repel them. In a study, he found that most of the soaps his team examined appealed to mosquitoes. On the other hand, coconut scented soap (Native brand tested) kept them away. We asked him about Listerine. He has not studied it, nor has he studied some remedies that our listeners like such as eating garlic. However, he suggested consulting the local gardening center or nursery in selecting plantings around the home that are not attractive to mosquitoes. This Week’s Guests: Conor McMeniman, PhD, is Associate Professor of Molecular Microbiology & Immunology at the Johns Hopkins Malaria Research Institute. Dr. McMeniman studies the molecular and cellular basis of mosquito attraction to humans. Conor McMeniman, PhD, Johns Hopkins Malaria Research Institute Clément Vinauger, PhD, is Associate Professor at Virginia Tech in the Department of Biochemistry. His research area is the molecular genetics of host-seeking behavior in insects. His website is:  https://www.vinaugerlab.com/ Clément Vinauger, PhD, Virginia Tech Listen to the Podcast: The podcast of this program will be available Monday, June 30, 2025, after broadcast on June 28. This week’s episode features bonus material, including exclusive content we couldn’t fit into the radio broadcast. In this week’s podcast bonus material, Dr. McMeniman explains why it would be really difficult to conduct a scientific study on whether taking vitamin B1 reduces your attractiveness to mosquitoes. We also discuss how climate change is likely to put Americans at greater risk for mosquito-borne diseases. Could malaria become a problem in the US once again? And we talk about “skeeter syndrome” in people who get nasty allergic reactions to mosquito bites. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.